This study identified parents’ gender, education level, and certain occupation types as sociodemographic predictors of parents’ evaluation of the consequences of parental smoking in the presence of children. This study also shows that parents’ gender, education level, and annual family income are sociodemographic predictors of their perceptions toward parental smoking in the presence of children. Mothers with a higher education level expressed more perceptions opposed to parental smoking, and more agreement with the adverse consequences of exposing children to parental smoking. Women usually assume more responsibility for taking care of their children than do men [29
]. Therefore, women pay more attention to information related to children’s health. Parents’ education level had a trend effect on their perceptions toward parental smoking around children and their evaluations of its consequence. Specifically, the degree of the perception opposed to parental smoking and agreement with its negative consequence increased as the level of education increased. The predictors of education level, occupational field, or annual family income may reflect a group of blue-collar workers who work harder to earn money and make a living.
Parents in this group displayed a greater acceptance of parental smoking in the presence of children and were less concerned with its influence. Other than these sociodemographic factors, parents who were current smokers displayed greater acceptance with parental smoking in the presence of children and agreed less with its adverse consequences. These results indicate that parental smokers, and especially paternal smokers with lower socioeconomic status, must be considered because evidence has shown a higher level of children’s exposure to SHS when parents display more positive attitude toward it or less risk awareness of its harmful effects [17
]. In Taiwan, the percentage of male smokers is substantially higher than that of female smokers: 45%–50% of men between 30 and 50 years of age smoke, compared with only 5%–8% of women in the same age group [30
]. However, previous intervention programs emphasizing the harmful effects of SHS have targeted mothers [31
], who either smoked or did not smoke, rather than fathers. The results of this study suggest that health care providers might need to target paternal smokers in delivering health education regarding the harmful effects of SHS. Health education efforts would also be more cost-effective if they were targeted at people lacking information, because the majority of people are aware of the harmful effects of SHS [7
]. The government and health care delivery systems need to establish an effective approach to convey information to this specific group.
Parents who agreed with having home smoking restrictions perceived parental smoking more negatively and were more in agreement regarding its adverse consequences. Especially parents’ evaluation of the consequence of parental smoking in the presence of their children predicted their perceptions of this behavior. These findings indicated that promoting parents’ acceptance of establishing rules for a smoke-free home, as well as providing health education to enhance awareness of the risk of SHS, may improve parental attitudes against parental smoking. Parents present more effort to prevent children’s exposure to SHS at home if they express more attitudes against it [38
]. Therefore, we suggest that a more effective approach to promote parents’ preventive efforts would be by both improving parents’ awareness of the harm caused by parents smoking and reinforcing negative attitudes toward parental smoking rather than simply improving knowledge. A previous study found the similar results [40
The parents in this study exhibited negative perceptions and evaluations of the negative consequences of exposing children to parental smoking. However, compared with other PSPC subscales, the “rational need” subscale demonstrated a fairly neutral perspective (mean score 2.41), indicating that parents did not completely deny the rational needs of smokers. These included the need to smoke and the cultural context of smoking. Previous studies [20
] have shown that the social/cultural context often results in the failure of parents to prevent SHS at home. To prevent parental smoking in the presence of children, health educators should consider interventions aimed at increasing the awareness of nonsmokers, especially children, and their need for a smoke-free environment and reforming social customs related to smoking.
Over-fitting might have occurred during the process of model building in regression analysis, leading to a poor model. We suggest the use of assessment techniques, such as cross-validation from data of a larger sample, to detect this problem in a further study. One limitations of this study is the use of a convenience sample for parents of school-aged children in Taiwan, which limits the generalizability of the results. However, we selected study participants from four locations across the nation (north, central, south, and east). This wide range of sampling should provide a greater variety of parental characteristics, thus increasing the representativeness of the results. Nevertheless, random sampling and the inclusion of parents with younger children from more geographic locations is suggested for further study to increase the representativeness and generalizability of the results. Another limitation is the use of a cross-sectional study design, which makes it difficult to identify causal relationships. We suggest a longitudinal study design in the future to determine causality.