Elsevier

Health & Place

Volume 13, Issue 4, December 2007, Pages 894-903
Health & Place

Disadvantaged mothers, young children and smoking in the home: Mothers’ use of space within their homes

https://doi.org/10.1016/j.healthplace.2007.03.001Get rights and content

Abstract

Breathing tobacco smoke is linked to poor health in young children, with their homes identified as the primary place of exposure. This UK study uses focus group discussions to explore how mothers living in disadvantaged areas use space within their homes to smoke while looking after children aged 0–4 years, and critically examines how they define non-smoking or smoking homes. Many women imposed temporary and ad hoc restrictions, and this research highlights how the mothers’ desire to create a smoke-free environment for their children competes with their caring responsibilities, and how their efforts are restricted by the limitations of the physical environment of 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.

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