Discussion on Barriers
September 18, 2007: Reducing Children's Exposure to Secondhand Smoke
Corinne Husten, M.D., M.P.H., Branch Chief, Epidemiology Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
Dr. Husten presented results from CDC-sponsored focus group research conducted by two Prevention Research Centers—University of Alabama at Birmingham and Columbia University—to obtain in-depth qualitative information from low SES African American smokers and nonsmokers who are parents of children ages 11 years or younger. The purpose of these groups was to learn more about practices African American parents use to reduce their children from secondhand smoke exposure in their homes.
The criteria for selection of participants in these groups was that they be: African American; living at home with a child aged 11 or younger; themselves aged 19-45; had either a smoker or a nonsmoker living with a smoker in the home; and participated in an anti-poverty program in the past three months (e.g. WIC, Head Start, Medicaid, Food Stamp Program, National School Lunch Program). The groups took place in Harlem, New York and Birmingham, Alabama.
Dr. Husten continued by presenting some of the key results from the groups.
- The groups confirmed that African American children are exposed to secondhand smoke in the home. The main sources of exposure are husbands/fathers, guardians, grandparents and visitors. Children are exposed in every room in the house. In general parents/guardians know that secondhand smoke is bad for children and children were a key motivation to have home restrictions.
- Knowing that this exposure is bad for children, many parents stated that they only smoke when the kids are not home. They also believed that not smoking close to their child is protective, and that ventilation and covering up the smell helps. Parents also stated that they believe that outside pollutants are just as harmful and that children are exposed to smoke elsewhere anyway.
- Control over the home environment smokers was a key theme as well as a feeling that going outside was too inconvenient.
- For those living in low-income housing situations, there are unique barriers to going outside since smoking in hallways is not always an option and in some cases, there is no "outside" to go to.
- For nonsmokers, difficulty enforcing the rule, lack of control and power and respect for elders (who smoke) are issues.
- Concerns that they might harm the child if they were under stress and unable to smoke were also mentioned as barriers to smoke-free home rules.
Dr. Husten closed her remarks by offering several recommendations that participants had mentioned.
- Families could post signs outside the house/apartment stating that the house is smoke-free
- Tobacco control programs should create accessible and effective cessation programs and involve both smokers and nonsmokers
- Counseling and social work services should address secondhand smoke and how it affects the entire family
- Families living in apartments with drifting smoke and an asthmatic child could consider applying for environmental health housing assistance
Following her remarks, Dr. Husten introduced Michelle Johns to talk about OSH's Hispanic/Latino Community Outreach Initiative: Sabemos.
Michelle Johns, M.A., M.P.H., Public Health Educator, Health Communications Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Department of Health and Human Services
Ms. Johns presented information about Sabemos: Por respeto—Aquí no se fuma. The audience for this new resource is community leaders and new arrival (less than two years) Hispanic/Latino parents. One goal of the project is to provide culturally relevant messages for Latino/Hispanic community leaders to effectively reach the intended audiences. A second goal is to educate Hispanic/Latino parents about secondhand smoke and empower them to create smoke-free environments to protect their children. The ultimate goal of the project is to protect children from the damaging effects of secondhand smoke exposure.
The inspiration for Sabemos comes from another resource developed by OSH in 2001 for a broad parent audience called Got a Minute? Because of its popularity, OSH considered translating this toolkit into Spanish, but after consulting experts, conducting focus groups, literature reviews and interviews, it was determined that rather than direct translation, the kit should be culturally adapted. The benefits of cultural adaptation are that it accounts for context, is culturally relevant, provides tailored messages to specific audiences, accounts for literacy needs, and capitalizes on the protective social norms of a population.
Some of the cultural strengths of the Hispanic/Latino community are the strong family orientation; value placed on tradition and culture; strong work ethic; strong social networks; commitment to social justice issues; and "respeto"—the Spanish word for respect. Some of the cultural challenges include the presence of competing social and health priorities, language and literacy barriers, and the lack of understanding among recent immigrants about how to access health care in the United States.
Following extensive concept testing and interviews with the intended audience, several common themes surfaced. First, family proved to be an important motivator for not smoking. Second, most respondents said that they would not smoke around their children because their kids are their priority. Finally, participants felt that action-oriented and multi-generational images would have the greatest impact.
Ms. Johns shared with the Committee images from the campaign including the selected health message of "Secondhand smoke kills over 3,000 nonsmokers each year from lung cancer" as well as selected elements from the tool kit. The dissemination strategy for this kit is to work through existing partnerships with organizations such as the National Latino Council on Alcohol and Tobacco and the Border Health Association, as well as through community-based organizations.
Ms. Johns concluded her remarks with a few of the lessons learned in the development of the Sabemos campaign.
- Do not use direct translations
- Understand and respect the culture(s) represented
- Learn about the community that is being reached
- Use appropriate language(s) and literacy levels
- Target the outreach—one size doesn't fit all
- Combine media and interpersonal strategies
Dr. Husten introduced the next speaker, Debbie Montgomery.
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