2. Secondhand smoke (SHS) is environmental tobacco smoke (ETS) that is inhaled involuntarily and passively. SHS is a combination of “sidestream” smoke, which is given off by the burning tobacco product and “mainstream” smoke, which is exhaled by a nearby smoker (American Cancer Society, 2014).

3.  Secondhand smoke (SHS) Is a cancer causing agent that jeopardizes the health of non- smokers (Jones et al., 2011).  Childhood morbidities that have a high prevalence in urban dwellings, such as respiratory infections, asthma, otitis media, and sudden infant death syndrome (SIDS) have been linked to secondhand smoke from caregivers (Jones et al., 2011).  In the U.S., SHS is considered a public health burden that costs approximately $10 million in medical care costs (Healthy People 2020).

4.  Focus population for the evaluation of the effects of secondhand smoke includes low income, inner city urban families that have close contact with an everyday smoker (caregiver).  Variables include the caregiver’s perceptions of: * seriousness of secondhand smoke * susceptibility to secondhand smoke * barriers inhibiting a smoke free environment * benefits of a smoke free environment  Variables are measured using The Health Belief Model.

5.  The overall focus of literature that discusses secondhand smoke effects on the urban family supports the idea that promotion of a smoke free environment greatly decreases childhood morbidities, thus decreasing medical costs (Jones et al., 2011).  The caregiver’s perception of factors associated with secondhand smoke exposure has a direct influence on cessation of smoke in the home (Jones et al., 2011).  Smoke cessation in the home promotes a healthy environment and also decreases loss of income related to sickness.

6.  SHS poses significant mortality and morbidity risks to adults and children.  SHS contributes to over 7,000 deaths annually, related to lung cancer (CDC,2014).  Randomized studies among inner city children revealed SHS as a major contributor to asthma exacerbations (Butz et al, 2011).  Cross- sectional studies in Middle- Eastern urban hospitals identified a correlation between an increase in low birth weight babies born to mothers exposed to secondhand smoke (Khader, 2011).  Exploratory studies conducted among urban college students identified a decrease in cognitive functions and an impairment of memory in students exposed to secondhand smoke (Heffernan & O’Neill, 2012).

7.  Kurt Lewin’s, “Health Belief Model” (HBM), serves as the theoretical framework to examine the effects of secondhand smoke on the urban family.  Lewin’s theory proposes that the caregiver’s perceptions and behaviors surrounding secondhand smoke directly impact a smoke- free home environment (Jones et al., 2011).  Lewin’s, “HBM”, proves effective in assisting nurse practitioners in understanding and formulating effective plans to bring about positive outcomes for the urban family affected by secondhand smoking caregivers.

8. American Cancer Society. (2014, March 1). Cancer Facts & Figures 2014. Atlanta, GA. Center for Disease Control and Prevention. (2014, March5). CDC- Fact sheet- Health effects of secondhand smoke- smoking & tobacco use. Retrieved July 25, 2014, from http://www.cdc.gov/tobacco/data statistics/ fact sheets/ secondhand smoke/health effects/index.htmhttp://www.cdc.gov/tobacco/data statistics/ fact sheets/ secondhand smoke/health effects/index.htm Healthy People 2020. (2014). Tobacco. Retrieved from Healthy People. gov Hefferman, T. M., & O’Neil, T.S. (2012). Exposure to secondhand smoke damages everyday prospective memory. Addiction, 108, 420- 426. doi: 10.1111/j.1360-0443.2012.04056.x Jones, L.L., Atkinson, O., Longman, J., Coleman, T., McNeil, A., & Lewis, S.A. (2011, June). The Motivators and Barriers to a Smoke- Free Home Among Disadvantaged Caregivers: Identifying the Positive Levers for Change [Journal]. Nicotine & Tobacco Research, 13(6), 479-486. http://dx.doi.org/10.1093/ntr/ntr030 http://dx.doi.org/10.1093/ntr/ntr030 Khader, Y.S., AlAkour,N., AlZubi, I.M., & Lataifeh, I. (2011). The association between secondhand smoke and low birth weight and preterm delivery. Maternal Child health Journal, 15, 453- 459. doi: 10.1007/s10995-010-0599-2