To our knowledge, this is the first study reporting smokers’ views on the value of trying to achieve temporary abstinence from smoking when in the home and the potential role of NRT in this context. We found a generally negative attitude both to the concept of optional temporary abstinence and the use of NRT to achieve it, for a number of reasons. First, many smokers felt that the strength of their addiction and their deeply ingrained smoking routines would be too difficult to overcome for them to stop smoking temporarily whilst inside their home. A number of caregivers also stated a preference for trying to stop smoking altogether, rather than “just” stopping in the house. Despite the fact that most of our participants had previously made failed quit attempts, many would still consider using NRT to help them to quit, either abruptly or after cutting down.
In our previous analysis, we showed that interviewees had an incomplete knowledge and confusion about, and a lack of engagement with the effects of ETS on children’s health [15
] and this may have influenced their lack of enthusiasm for optional temporary abstinence. A UK study from 2003 found that 86% of parents who smoked were aware that ETS was harmful to their children’s health [6
]. Nevertheless, many parents from the same study were using measures to protect their children from ETS which have been shown to be ineffective, suggesting that many parents underestimate the risks of ETS. Mothers’ perceptions of children’s health risks from ETS has been explored in more detail in other studies, which found that they tended to rely on alternative explanations for ill health unrelated to smoking and falsely viewed older children as more resilient to the effects of ETS [12
]. In our study, few caregivers who smoked in the home appeared to link our discourse about temporary abstinence to their children’s health. Instead, the emphasis amongst our participants seemed to be around personal goals, such as cutting down or the desire to stop smoking completely, rather than temporarily abstaining from smoking in their homes to benefit their children. Conversely, however, interviewees who did not smoke in their homes believed that knowledge about the harmful effect of ETS on children’s health and prioritization of children’s health were the key issues to making a transition to smoke-free homes. This supports the findings from a Swedish study [20
] which showed that parental level of evidence based knowledge regarding the potential risks of ETS to young children might have significantly affected their willingness to protect their children from ETS. We did not attempt to educate parents about the health risks of ETS and it is possible that our results would have been different if we had done so. However, collectively, our findings suggest that providing better knowledge and understanding of these risks would be an essential part of any future intervention to promote smoke-free homes.
It is also possible that the failure to engage with the concept of temporary abstinence in our study group could be partly explained by the relative lack of exposure to situations where the smokers have to abstain from smoking. Many of our participants were unemployed or homemakers, and it is likely that they spend less time in situations of enforced temporary abstinence from smoking than more advantaged households with higher employment rates where smokers are potentially more used to the concept of enforced temporary abstinence and could then transfer this approach to their homes. A major strength of our study is that we explored the views of socio-economically disadvantaged smokers whose children would, potentially, have the most to gain from reduced exposure to ETS. However, it is not clear how closely the findings from this sample would relate to more affluent households where children have less exposure to ETS in the home [11
Most of our participants had previously tried unsuccessfully to stop smoking, and therefore may have had more negatively biased views about the use of NRT, which were described in other studies [21
]. We found that some resistance to optional temporary abstinence and NRT came from the complex role of smoking in the lives of these disadvantaged families. Nicotine addiction per se
appeared to play a small part compared to the much-valued need to have a break and “me” time, which smoking afforded, a finding that is in agreement with previous studies [13
]. It was almost seen as “cheating” or cutting corners to use NRT if the smokers were not determined to radically change their lifestyle. This belief emphasizes the major effort required of these families to change their smoking behaviour in the home, as reported elsewhere [24
Despite the negative views, there was still some support for using NRT to achieve optional temporary abstinence, as demonstrated by a father who used NRT successfully to stop smoking in the home and another participant who could see a role for NRT and optional temporary abstinence as a first step towards quitting. Of note, most of our failed quitters could still see themselves using NRT in more traditional ways, in particular, for smoking reduction – either through cutting down, or cutting down to quit. With appropriate support to ensure smokers cut out the cigarettes smoked in the home, such smoking reduction could lead to benefits to children, as well as the smokers’ personal health. A possible implication for healthcare professionals who are involved with smoking families is that it is important to take a person-centred approach, exploring smoker’s previous experiences and knowledge about temporary abstinence and NRT and use them as positive levers to make a permanent change in their household smoking habits.
The findings of our study provide insight into the relatively unexplored ways of protecting children from ETS, which could inform any future interventions around smoke-free homes and ETS exposure. Future research around clinical interventions could explore the possible effectiveness of education on the risks of ETS and lack of effect of partial restrictions of smoking in the homes.