Original researchHousehold smoking practices of parents with young children, and predictors of poor household smoking practices
Introduction
Environmental tobacco smoke or second-hand smoke (SHS) causes ill health and mortality in children, especially those under 5 years of age.1 Pre-school aged children are particularly vulnerable because of more prolonged exposure to their parents' smoking at home.
A population-based cohort study has reported that parental smoking patterns at home have the highest predictive accuracy of urinary cotinine levels among children from birth to 2 years of age.2 A survey of children aged 3–6 years also revealed that the mean level of urinary cotinine was higher in children whose parents smoked at home, indicating a higher level of passive smoking exposure.3
The health effects of SHS exposure among children are well documented in the US Surgeon General's report (2006),4 which notes that parental smoking is causally related to sudden infant death syndrome, respiratory problems and middle ear disease in children generally, and cough, phlegm, wheezing, breathlessness and prevalent asthma among children of school age. It reports further on cardiovascular disease and neurobehavioural impairment in adulthood as the long-term effects of SHS exposure among young children.4
In Hong Kong, it was found that SHS exposure was a cause of lower respiratory problems, chronic respiratory symptoms, middle ear disease and impaired lung function.5 Infants of smoking parents use medical health services significantly more often than infants of non-smoking parents.6 Although many studies have described the prevalence of SHS exposure,7, 8, 9 data from Asia, including China, on parental household smoking behaviour are scanty.
In Hong Kong, men have a higher smoking rate (26.1%) than women (3.6%).10 Women and children are often the victims of passive smoking, and are less capable of taking self-protective action. Traditional Chinese culture does not encourage women to take more pro-active action targeted at another person, particularly if that person is their husband. The authors' study in Guangzhou, China revealed that most women would not take preventive action to protect themselves and their children by asking smokers to move away or to stop smoking in their presence.11
The World Health Organization has called for strong public policies to protect children from exposure to tobacco smoke.12 Such exposure of young children in Hong Kong may be more serious than in Western countries, since Hong Kong is among the world's most densely populated cities and most families live in small apartments with a household area of less than 50 m2. Therefore, it is particularly important to examine parental household smoking behaviour in Hong Kong for the protection and betterment of the health of both parents and young children.
The aims of this study were: (1) to describe the household smoking practices of parents in Hong Kong with children aged 4–5 years; (2) to examine the associated characteristics of smoking parents and their practices with regard to household smoking; and (3) to identify the predictive factors of parents who smoked at home.
Information on household smoking practices of parents with young children can provide an indicator of the effectiveness of existing education on tobacco control among families with smoking parents. Results related to the predictive factors of parental household smoking practices, according to three levels of restriction (complete, partial or none), will help clinicians to develop strategies to help parents refrain from smoking at home.
Section snippets
Methods and participants
The present study was a follow-up to a 1997 birth cohort study,6 where parental smoking status was identified among 8327 families. Of the families in the cohort, 2733 smoking fathers and 230 smoking mothers were identified. All families with smoking parents were contacted when the babies were born and at 3, 9 and 18 months. At the end of the 18-month follow-up period, 2311 smoking parents remained in the sample pool.
The families with smoking parents remaining in the cohort were re-contacted and
Data analysis
The characteristics of parents practising different levels of household smoking were described and compared. Potential covariates that might be related to parental household smoking at the bivariate level were examined using Chi-squared tests. Fisher's exact test was used for expected frequencies less than five. Linear association trends were used to assess the relationship between the outcome variable (e.g. the proportion of the three levels of household smoking practices) and ordered
Results
Of the 2311 reportedly smoking parents re-contacted from the 1997 birth cohort, only 1420 were eligible for inclusion in the present study. In total, 891 parents were excluded for various reasons: 510 could not be contacted because their telephone numbers were no longer valid; 23 denied ever having smoked; 159 reported that they had stopped smoking more than 6 months previously; 141 no longer resided in Hong Kong; 50 were separated or divorced and not living with the index child; and eight were
Discussion
Children should be protected from exposure to SHS in their homes. However, previous studies have reported that one-third to nearly one-half of young children are exposed at home: approximately 35% in Canada21; 43% in the USA22; and half in the UK.23 These are comparable with the prevalence rate of approximately 43% in Hong Kong.24
This study fills the gaps in the literature regarding young children in Asia with smoking parents, and the predictive factors of parental household smoking practices.
Limitations
The main limitation of this study was that the information on parental household smoking behaviour was self-reported. The validation of self-reported smoking behaviour by biochemical measures, such as urinary cotinine, is costly and not feasible in the case of a telephone-based survey. Validation of household smoking practices is even more difficult. However, parental self-reports have been found to be reliable in reflecting smoking status among Chinese populations29 and their household smoking
Conclusions
A high proportion of smoking parents with young children displayed poor smoking practices at home. Mothers who consumed more cigarettes daily, had a higher level of nicotine dependence, and were married to smoking husbands were more likely to demonstrate poor household smoking practices. Such mothers may find it difficult to restrict their smoking at home. Smoking cessation counselling and with nicotine replacement therapy, are urgently needed for these smoking parents. Children in families
Implications
Identifying parental household smoking practices is the first step in smoking control interventions.21 Nurses and other health professionals have many opportunities to meet parents in clinical settings when caring for children, but parental household smoking behaviour has not previously been included in routine health assessments. The authors recommend that identification of the smoking behaviour and practices of parents and other family members should be made routine in children's health
Acknowledgements
The authors wish to thank the parents who took part in this research.
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