1. Parents’ Perceptions of Barriers and Facilitators to
Smoke-Free Homes and
Vehicles
Rosemary Herbert PhD(c)
CPHA, 2008

2. Researchers Rosemary Herbert RN, PhD(c) Anita Gagnon RN, MPH, PhD
Janet Rennick RN, MScN, PhD
Jennifer O’Loughlin PhD

3. Acknowledgments CTCRI CNRS CNF Nursing Care Partnership
PEI Lung Association
PEI Cancer Control

4. Background Children’s ETS Exposure in the Home
▪ 9.2% Canadian children <12 years
(Health Canada, 2007)
▪ 35% American children <18 years
(ALA, 2007) ▪

5. Adverse Effects ETS Respiratory problems Low birth weight SIDS
Ear infections
Cardiovascular problems
Behavioral problems, learning difficulties
(California Environmental Protection Agency, 1997; Gidding, 1999; Health Canada, 2004; Mitchell & Milerad, 1999; Strachan & Cook,1997,1998; WHO, 1999).

6. Research Objective
To describe parents’ perceptions of barriers to making homes and vehicles smoke-free, and to identify facilitators used by parents to manage these barriers.

7. Methods
RCT tested intervention designed to empower parents to make homes smoke-free
Semi-structured interview data about barriers and facilitators to smoke-free homes and vehicles collected at 6 months follow-up

8. Eligibility Criteria
At least one cigarette per day was smoked within the home
The family had one or more children aged ≤5 years who resided in the home at least 50% of the time
One parent (not necessarily a smoker) willing to participate in the intervention

9. Data Collection
What the barriers were to making homes and vehicles smoke-free, including the greatest barriers
What they did to overcome barriers and what worked best
What they would recommend to others

10. Data Analysis Inductive approach Data coded by two people
Themes assigned to codes with similar meaning
Coders reached consensus
(Thomas, 2008; Ulin, Robinson, & Tolley, 2005)

11. Results Participants 33 mothers, 3 fathers, aged 18-42
11 (31%) < high school
16 (44%) < $15,000 household income
21 (58%) >1 child
28 (78%) of the families, mothers smoked during pregnancy
29 (80%) of the families, mothers were current smokers

12. Barriers to Smoke-Free Homes
Themes congruent with ecological model of health promotion
Intrapersonal (within individual)
Interpersonal (between individuals)
Physical Environmental
(McLeroy et al.,1988; Stokols,1996)

13. Most Common Barriers to Smoke-Free Homes
Intrapersonal Barriers
Nicotine addiction
Time and effort required to make the change
“I can’t quit. It’s the addiction part of it.”
(20 year old, single mother of two)

14. Barriers to Smoke-Free Homes
Interpersonal Barriers
Supervising young children
Partners and relatives wanting to smoke in the home
“It’s hard to bundle her up and go outside. I can’t leave her unattended.”
(20 year old single mother of a one year old)

15. Barriers to Smoke-Free Homes
Physical Environmental Barriers
Inclement Weather
Lack of access to the outside
“My daughter is too young to leave alone.”
(27 year old single mother of a three year old child who lived in a third floor apartment with no balcony).

16. Barriers to Smoke-Free Vehicles
Intrapersonal Barriers
Habit of smoking while driving
“I love to smoke when I’m driving.”
(27 year old mother of two children )
Interpersonal Barriers
Habits and routines of partners and relatives

17. Facilitators to Smoke-Free Homes and Vehicles
Intrapersonal
Quitting or considering quitting, smoking less, altering smoking location, reminding self of the change, making the decision to go smoke-free
“ I tried ‘I’ statements learned in the group instead of ‘You should.’ ”
(27 year old mother of four)

18. Facilitators to Smoke-Free Homes and Vehicles
Interpersonal
Talking with household members
Ending relationship with partner
Moving to a new location
“Moving out, that worked best. I got tired of fighting with them about the smoking.”
(20 year old single mother of two who had previously lived with her parents)

19. Facilitators That Worked Best
Interpersonal Facilitators
Related to children
Informing people home was smoke-free
“Letting people know that there’s no smoking in the house…it you get annoyed enough they get the point.”
(32 year old mother of five children)

20. Recommendations to Others
Being committed to the change
Being consistent
Quickly initiating the change
Quitting smoking
Learning about the effects of ETS

21. Limitations Data were collected in follow-up interviews for RCT
Interviews that focused solely on smoke-free homes and vehicles may have provided more in-depth data

22. Implications
Multiple barriers existed for these parents, most of whom were mothers, many with low-SES
Most effective facilitators involved others yet parents most often relied on themselves
None identified health care providers as facilitators

23. Implications No single course of action will suit all families
Health care providers need to assess each parent’s context and offer individualized suggestions

24. Conclusions Most parents want to protect their children from ETS
“Do it for the kids.”
(25 year old mother of two)
Finding meaningful ways to help parents achieve smoke-free status will greatly benefit children