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:
"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."
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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