Supporting parents living in disadvantaged areas of Edinburgh to create a smoke-free home using nicotine replacement therapy (NRT): A two-phase qualitative study.

Abstract

Background Childhood exposure to second-hand smoke in the home is largely associated with socio-economic disadvantage. Disadvantaged parents face specific challenges creating a smoke-free home, often caring for children in accommodation without access to outdoor garden space. Existing home interventions largely fail to accommodate these constraints. Innovative approaches are required to address this inequality. In this two-phase study, we engaged with parents living in disadvantaged areas of Edinburgh, Scotland, to explore tailored approaches to creating a smoke-free home and develop and pilot-test an intervention based on their views and preferences.Methods In Phase 1, qualitative interviews with 17 parents recruited from Early Years Centres explored alternative approaches to smoke-free home interventions. In Phase 2, an intervention based on parents’ views and preferences was pilot tested with parents recruited through Early Years and Family Nurse Partnership centres. 17 parents took part in an interview to share their views/experience of the intervention. Data from both study phases were thematically analysed.Results Phase 1 findings suggested that parents associated nicotine replacement therapy (NRT) with quit attempts, but supported the idea of NRT use for temporary abstinence to create a smoke-free home, viewing this as a safer option than using e-cigarettes indoors. In Phase 2, 54 parents expressed an interest in accessing NRT to create a smoke-free home, 32 discussed NRT product choice during a home visit from a smoking adviser, and 20 collected their free NRT prescription from the pharmacy. NRT was used for up to 12 weeks in the home, with ongoing advice available from pharmacy staff. During qualitative interviews (N = 17), parents self-reported successfully creating a smoke-free home; quitting smoking; and reduced cigarette consumption, often exceeding their expectations regarding changes made. The intervention was acceptable to parents, but the multi-step process used to access NRT was cumbersome. Some participants were lost to this process.Conclusions Parents living in disadvantage may benefit from access to NRT for temporary abstinence in the home to assist them to protect their children from second-hand smoke exposure. Further research using a more streamlined approach to NRT access, is required to determine the feasibility and cost-effectiveness of this approach.

Stigma and Smoking in the Home: Parents’ Accounts of Using Nicotine Replacement Therapy to Protect Their Children from Second-Hand Smoke

“…The wider implications of the feasibility study findings these participants were sampled from will be described elsewhere [31]. Returning to Goffman's [23], descriptions of discreditable and discredited stigma, our findings highlight that parents in disadvantaged communities have built up a level of secrecy to minimise public judgement of smoking practices, sometimes smoking in the home (albeit in rooms away from children), secretly during pregnancy and breastfeeding.…”

“…Participants were purposively sampled, based on context [32,33], due to their difficulty smoking outside, owing to outdoor access constraints and/or increasingly mobile young children, as shown in previous research [34][35][36]. For the purposes of this analysis, seven participants were sequentially selected for inclusion from the wider feasibility assessment of the harm-reduction strategy [31].…”

“…The research team were unaware of Amber's breastfeeding at this stage, despite careful discussion around eligibility during the study (breastfeeding being a contraindication for recruitment to the feasibility study [31]). The research team surmised that Amber likely felt unable to discuss balancing smoking or NRT use with breastfeeding once she became aware of the dangers to her baby, for fear she could be judged negatively, or NRT access might be removed.…”

“…Potential researcher power to stigmatise [24], could be perceived by participants, consciously or not, and may affect disclosure. We sought to address this by using questions designed to avoid blame or shame [31]. We viewed the eventual disclosures as a strength, indicating development of trust, rapport, and openness.…”

“…The participants we describe are from early recruitment into a feasibility study to explore NRT use for smoking abstinence to protect children from SHS in the family home, and the methods and wider findings of the feasibility study will be reported elsewhere [31].…”