Study highlights increased passive smoking risk at home

Most non-smoking mothers recognise the need to protect sick children from smoking husbands, but persuading their spouse to quit isn't always an option, according to research published in the latest Journal of Advanced Nursing.

Researchers at The University of Hong Kong surveyed the mothers of 1,483 children admitted to four major hospitals to see if a health educational initiative would help them to protect their children from passive smoking. None of the mothers smoked, but all of the children's fathers did.

The study, by the Department of Nursing Studies and the School of Public Health, found that although most of the mothers realised the importance of protecting their child's health, family tensions and the need to maintain marital harmony often got in the way.

The mothers reported that 86 per cent of their husbands smoked at home, with 54 per cent of the total smoking when their child was around and 32 per cent smoking away from the child. The remaining 14 per cent didn't smoke while they were at home.

This was despite the fact that half of the children suffered from respiratory problems - putting them at high-risk from passive smoking - and 60 per cent of the total sample had been admitted to hospital more than once.

The majority of the children involved in the research were under 10 and the average age was just under five years-old.

"We divided the mothers into two groups" explains lead author Dr Sophia Chan, Head of the Department of Nursing Studies. "The education group of 752 mothers received health advice from nurses, purpose-designed booklets, a no-smoking sticker and a telephone reminder a week later. The control group of 731 mothers did not.

"Although we found this initiative had some short-term benefits, many of the mothers found it difficult to persuade their husbands to quit smoking and the education group were more likely to take evasive action, such as moving the child out of the room.

"With an increasing number of countries worldwide introducing smoking bans in public areas such as bars and restaurants, there are fears that more parents will smoke at home and that this will have an even greater effect on children."

Key findings include:

• The average age of the mothers was 34 and two-thirds were housewives. Most of the husbands worked in factories, crafts, services and shops.
• 95 per cent of the mothers were already aware of the dangers of passive smoking to children's health. 90 per cent agreed that it could cause lung cancer in smokers, but only 77 per cent felt it posed a lung cancer risk to passive smokers. Awareness of coronary heart disease was 12 per cent lower on both counts.
• Three-quarters believed that a smoker could quit successfully if they were determined to do so.
• In the week before the study started, the most common actions taken by mothers when their husband smoked were to open the windows (44 per cent), ask the father not to smoke near the child (42 per cent) and move the child away from the smoke (33 per cent).
• Only 29 per cent said they had asked their husband to quit smoking in the previous week, 31 per cent had asked him to stop smoking at home and 32 per cent had asked him to smoke fewer cigarettes.
• Both groups were interviewed at three, six and 12 months. At three months, 78 per cent of the education group said they always took action when their husband smoked, but this fell to 64 per cent at six months and 11 per cent at 12 months.
• The control group were less likely to intervene, but the difference between the two groups reduced as time went on. 71 per cent of the control group took action at three months (seven per cent lower), 59 per cent at six months (five per cent lower) and 10 per cent at 12 months (one per cent lower).
• The greatest difference was that more mothers in the education group moved their child away from the smoke at three months. However, this was not sustained and there was no difference between the two groups at 12 months.
• 12 months after the study started 58 per cent of the education group and 51 of the control group said they always or sometimes intervened when their husband smoked, but less than a fifth said they always took action.
• 42 per cent of the education group and 50 per cent of the control group seldom or never intervened. The control group (14 per cent) were twice as likely as the education group (seven per cent) to take no action at all.

"When we spoke to the mothers during our 12-month follow-up, some of them expressed concerns about the conflicts that had arisen when they had asked their husbands to quit smoking and they said that they preferred to take evasive action instead" adds Dr Chan, who is currently a Visiting Scientist at Harvard School of Public Health in the USA.

"While it is the responsibility of the mother to protect the health of their child and husband, keeping harmony is sometimes considered more important in Chinese culture.

"Although the mothers openly acknowledged the health risks their husband's passive smoking posed to their child, they were also very keen to maintain a harmonious relationship with their spouse.

"Recent research suggests that infants are exposed to passive smoking in more than 41 per cent of Hong Kong households and up to 60 per cent of American children under the age of five are regularly exposed to tobacco smoke in their own homes."

The authors argue that there is a clear need to tackle smoking in the home and that this will be given added momentum by public smoking bans.

"A number of countries have, or are planning to introduce, legislation to ban smoking in public places" says Dr Chan "This includes Hong Kong, which will introduce new legislation covering indoor workplaces, bars and restaurants next year.

"We welcome this move, as evidence shows that public bans can encourage some people to quit smoking and this will reduce the health risks from smoking and passive smoking.

"However, we also need to monitor the effect that public bans have on smoking in the home, especially in densely populated places like Hong Kong, where lots of families live in high-rise buildings with little outside space."