Disadvantaged mothers, young children and smoking in the home: Mothers’ use of space within their homes
Introduction
The research evidence linking exposure to environmental tobacco smoke (ETS) and the development of chronic health conditions, including heart disease and some forms of cancers is well established (Glantz and Parmley, 2001; Hackshaw et al., 1997; Law et al., 1997). Although recent health education campaigns have centred on the risks to adults of being exposed to ETS in public places and at their place of work, there is a growing recognition that the real health risks may be experienced by children who are exposed to cigarette smoke in their homes (Ferrence and Ashley, 2000; Mannino et al., 2001). Children are at greater risk than adults to the effects of inhaling ETS as they breathe more quickly and have smaller, less developed airways. Specific health risks for children include a range of conditions, including lower respiratory tract infections, asthma, and glue ear, as well as increasing their chance of developing in the longer term health conditions such as heart disease and cancer (Cook and Strachan, 1999; Hofhuis et al., 2003). Longer term exposure to ETS in childhood has been linked to poor school performance (Batstra et al., 2003; Eskenazi and Castorina, 1999; Yolton et al., 2005), and children whose parents smoke are more likely to go on to smoke themselves (Chassin et al., 1998).
People living in areas of high economic, health and social disadvantage are more likely to smoke, and to smoke more cigarettes than people living in more affluent areas (Goddard and Green, 2005; Graham, 2003; Marsh and McKay, 1994). Research has suggested that smoking in disadvantaged communities, specifically white communities, may represent a normative social behaviour (Jarvis, 2004; Wiltshire et al., 2003). Findings from UK studies suggest that children living in the most disadvantaged communities are routinely exposed to smoke in their home, and in the homes of friends and family (Wallace-Bell, 2003), and there is evidence that parents and family members living in poverty more likely to smoke in the presence of a child than smokers living in more affluent areas (Jaakkola et al., 1994; Jarvis et al., 1992; Johansson et al., 2003). In a recent study of parents of infants in the UK, Blackburn found that although 86% of parents who smoked believed that exposure to ETS was harmful for their children, less than 20% of these parents had imposed a smoking ban in their home (Blackburn et al., 2003). Even children living with non-smoking parents may have low levels of exposure to tobacco smoke from visitors smoking within their own home (Cook et al., 1994; Jarvis et al., 2000; SCOTH, 2004).
Unlike the highly regulated places protected by current smoking restrictions, the state plays little role in the regulation of the home environment, which constitutes the most important source of children's exposure to tobacco smoke (Ashley and Ferrence, 1998; Graham, 1993). The first few years of a child's life are seen as a key intervention point for parents to change their smoking behaviours (Spencer et al., 2005), and there is a clear directive for healthcare professionals to support parents to protect their children from harm (DoH, 2004). Research has established why mothers smoke, but we know much less about why they continue to smoke in their homes knowing the risks of ETS to their children. Recent work around ETS exposure in the home has identified a range of behaviours that parents may adopt to try to reduce levels of ETS exposure, including restricting smoking in certain rooms, or not smoking in the home (Blackburn et al., 2005, Blackburn et al., 2003), but these studies have not been able to take account of any temporal fluctuations in home smoking, influenced by factors such as the time of day, or changing social situations, or smoking as an emotional responses to day to day events. This study uses qualitative research methods to explore the smoking practices of smoking mothers with young children in their homes, and explores the complex relationship between smoking and place.
Section snippets
The study
This research was conducted as part of a wider study, sponsored by SmokeFree Merseyside, to explore parents’ knowledge and understanding of the effects of passive smoking on the health of their children. In this paper, we present the findings from focus group discussions with 54 smoking mothers of young children living in areas of high social and economic disadvantage and explore how their knowledge of the risks of passive smoking to their children may have affected their smoking behaviour
Understanding of the risks of exposing children to ETS in the home
To understand how a mother's knowledge of ETS exposure might influence their reported smoking behaviour, women were asked at the start of the focus group discussion what they understood by the terms ‘passive smoking’ and ‘second-hand smoke’. In each of the seven groups, one or more women were able to define passive smoking (and second-hand smoke), and by both verbal agreement and observed non-verbal communication such as nodding and leaning forward, the other group participants appeared to
Discussion
One of the strengths of the design of this study is that it has enabled women to openly discuss a topic that they admitted they usually avoided talking about with people outside their immediate social circle. Focus groups appear to provide an appropriate means of enabling women to discuss their smoking with other smoking women, although there is the possibility that some of the participants may have held views that they were not willing to express within the groups, and so any consensus within
Acknowledgements
The authors would like to thank Gina McDaid, Central Liverpool PCT, Tina Williams, Birkenhead and Wallasey PCT, Brenda Fullard, North West Regional Tobacco Policy Manager, and also Richard Glendinning at NOPWorld, for their help and support.
References (42)
- et al.
Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort
Early Human Development
(2003) - et al.
Smoking behaviour change among fathers of new infants
Social Science & Medicine
(2005) - et al.
Intervention and policy issues related to children's exposure to environmental tobacco smoke
Preventive Medicine
(2001) Gender and class as dimensions of smoking behaviour in Britain: insights from a survey of mothers
Social Science & Medicine
(1994)- et al.
Restrictions on smoking at home and urinary cotinine levels among children with asthma
American Journal of Preventive Medicine
(2000) Focus groups in feminist research: power, interaction, and the co-construction of meaning
Womens Studies International Forum
(1998)- et al.
How to prevent exposure to tobacco smoke among small children: a literature review
Acta Paediatrics Supplement
(2000) - et al.
Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies
Tobacco Control
(1998) - Aspinwall, S., McDaid, G., Williams, T., 2004. Passive smoking and children: campaign report: SmokeFree Merseyside...
- et al.
Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey
British Medical Journal
(2003)
Maternal socialization of adolescent smoking: the intergenerational transmission of parenting and smoking
Developmental Psychology
Passive exposure to tobacco smoke in children aged 5–7 years: individual, family, and community factors
British Medical Journal
Summary of effects of parental smoking on the respiratory health of children and implications for research
Thorax
Groups: A Guide to Small Group Work in Healthcare, Management, Education and Research
Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children
Environmental Health Perspectives
Protecting children from passive smoking
British Medical Journal
Local Knowledge: Futher Essays in Interpretative Anthropology
Even a little secondhand smoke is dangerous
Journal of American Medical Association
Smoking and Drinking Among Adults, 2004, General Household Survey 2004
When Life's a Drag
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