Running head: EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

Effects of Second Hand Smoke on the Urban Family

Family Nurse Practitioner Students
Coppin State University
Urban Family Theory and Research
NURS 512
Dr. Robin Warren-Dorsey, DNP, CRNP, FNP-BC
July 31, 2014

Effects of Second Hand Smoke on the Urban Family

Introduction
Numerous health conditions stem from smoking. And although society is aware of the
health risks of smoking, many continue to partake in this behavior. The problem is that smoking
not only affects the health of the smoker, but exposure to secondhand smoke (SHS) also
jeopardizes other family members health. It is estimated that 40% of children around the world

are exposed to SHS. (Jones et al., 2011). Over 30% of children living in the US are exposed to
SHS in their homes and approximately 46% of these children are living in poverty. (Butz et al.,
2011). Childhood morbidities such as respiratory infections, asthma, otitis media, and sudden
infant death syndrome (SIDS) are linked to caregivers smoking in the home (Jones et al., 2011).
It is significant for health care professionals to gain knowledge and skill in reducing SHS
in urban homes by attempting to modify the caregivers behavior. SHS is a public health and
financial burden on the U.S. health care system. It costs approximately $10 million in medical
care costs (Healthy People, 2020). Health care professionals can help reduce these medical costs
by helping urban families create smoke-free homes. Caregivers in urban homes, especially those
living in poverty may face obstacles in maintaining a smoke-free home environment for their
families because of having to undergo behavioral changes.
The population focus for the study will be inner city urban families that are living below
the middle-socioeconomic class status and at least one caregiver who smokes daily. Focused
variables that will be measured in the smoking caregiver will derive from the health belief model
(HBM). These components consist of perceived seriousness of health risk, perceived
susceptibility to being affected by disease, perceived barriers to changing unhealthy behaviors,
and perceived of changing unhealthy behaviors. It is hypothesized that if a health care
professional can change the caregivers (smokers) attitudes and beliefs about SHS exposure and
the risks it poses to other family members, then the smoker will modify his/her behavior in order
to create a smoke-free home. In creating a smoke-free home, consequently, there will be a
decrease in childhood morbidities seen in the urban communities and a decrease medical costs.
Review of Literature

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

The Centers for Disease Control and Prevention (CDC) reiterates that no amount of SHS
exposure is considered safe due to the long-term effects that nicotine has on health. Overall, SHS
can be attributed to recurrent and acute asthma attacks, respiratory infections, ear infections, and
sudden infant death syndrome (SIDS) among infants and children (CDC, 2014). According to the
CDC (2014), exposure to SHS among adults causes lung cancer, coronary heart disease and
stroke. The CDC estimates that SHS increases the chances of developing heart disease by 25
30%, stroke by 2030%, and lung cancer by 2030%; 8,000 deaths due to stroke and 7,300
deaths due to lung cancer annually. Therefore, healthcare costs related to SHS exposure place an
enormous burden on the urban family due to money spent on sickness and lost income from
missing work and decreased productivity.
A randomized controlled study done among inner city children in Baltimore revealed that
exposure to second hand smoke (SHS) exacerbates asthma, hinders management of asthma, and
creates chronic airway inflammation (Butz et al, 2011). Despite this awareness, Butz et al, note
that many parents continue to expose their children to SHS which results in moderate to severe
persistent asthma. The article by Butz (2011) recommends that similar to the ban on smoking in
public areas, stronger policies are needed to restrict smoking in private residences with an aim to
eliminate SHS exposure among children. In addition, pediatricians and primary care providers
are urged to continue advocating for children exposed to SHS during well-child clinic visits by
encouraging the parents or caregivers to quit smoking but if unable to quit then make the home
smoke-free educating them on the benefits of smoking cessation (Butz et al., 2011; Jones et al.,
2011).
A cross-sectional study conducted in Jordan, Middle East in urban hospitals demonstrated
that exposure of women to SHS during pregnancy was associated with low birth weight and

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

preterm birth (Khader, Al-Akour, AlZubi, Lataifeh, 2011). In the study, 12.5% of women
exposed to SHS gave birth to low birth weight babies compared to 7.7% among the non-exposed
women. The percentage of preterm births in women exposed to SHS as determined by Khader
was 17.2% compared to 10.6% in the non-exposed women. Low birth weight and preterm birth
puts financial strain on the family due to increased health care needs of the infant. Since this
study centered on effects of SHS on preterm birth and birth weight, Khader et al. (2011),
recommend future studies that focus on spontaneous abortion, SIDS, perinatal mortality, and
morbidity.
Studies have demonstrated that exposure to SHS has been associated with poorer
cognitive functions in all age groups (Heffernan & ONeill, 2012). An exploratory study
conducted in the UK among urban college students showed that there was impairment of
prospective memory and cognitive function because cigarette smoke interferes with oxygen
supply to the brain (Heffernan & ONeill, 2012). Impairment of prospective memory renders an
individual incapable of carrying out an activity at a future time Heffernan & ONeill (2012).
Therefore, this can disrupt family harmony and compromise important family events for example
forgetting to keep important family dates. Heffernan and ONeill (2012) recommend that future

longitudinal studies need to be conducted to determine the long-term effects of SHS on daily
functioning and performance.
Family/Nursing Theory Conceptual Framework
As previously stated, second hand smoking (SHS) poses significant health and
financial burdens on society and the various individuals it affects. It is not only an issue for
smokers and their families, but it is also problematic for those that care for these individuals and

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

their families in urban community settings. Nursing, other health professionals and sociological
theorists have attempted for many years to introduce and implement smoking cessation programs
that would benefit smokers and their families and help to reduce the risk of many of the
associated morbidities (asthma, otitis media, SIDS) that occur especially in children that live in
smoking homes. However, many smoking cessation initiatives are unsuccessful in our
communities despite the known risks of smoking and SHS. As the hypothesis states, the success
of these smoking cessation programs and the health of affected inner city urban children and
their families depends on health care providers changing the attitudes and beliefs of smokers.
Health care providers especially nurses and nurse practitioners are in a unique
position to help influence the health behaviors of the communities they serve. They are usually
he most trusted source of information and role models for their patients. Knowledge of the
family and nursing theoretical framework, Health Belief Model, can assist providers in
understanding how to reach patients and consequently affect positive change. The Health Belief
Model (HBM) as introduced by Kurt Lewin in the 1950s is a theory that is frequently used in
health care and health promotion because it describes patient motivators for change from the
perspective of the patient. The HBM is comprised of four main components. They are: how
serious the person perceives a disease to be, how susceptible or prone they believe themselves to
be to a particular disease, their perception of the advantage(s) of changing said health behavior
and the barriers they perceive to changing behaviors.
For instance, in the research article The Motivators and Barriers to a Smoke-Free
Home among Disadvantaged Caregivers: Identifying the Positive Levers for Change, the issue of
second hand smoking (SHS) is studied. The article uses portions of the HBM to examine and
identify urban smokers perceived incentives for and obstacles to providing a smoke-free home

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

environment especially for their children. By attempting to identify specific motivations that
influence positive behavioral changes, as well as identifying potential barriers to change, health
providers are able to more successfully understand and support their clients in initiating and
sustaining long-term positive health changes such as smoke-free homes and smoking cessation.
Lewins Health Belief Model surmises that it isnt merely enough for an individual to
know about a particular health issue or disease process and how it may negatively impact society
or individuals in general. The person must innately perceive the disease to be a personal threat to
their life or livelihood and also perceive the benefit of changing a negative health behavior to
outweigh the risks of continuing with a negative health behavior. In light of the study individuals
who smoked in the home, there must be an added benefit to foregoing smoking, such as,
providing a healthier home environment for their children, saving more money and being a
positive role model. Merely knowing about the dangers of smoking and smoke related illnesses
such as lung cancer and emphysema that are most commonly talked about did not always
provide enough impetus for changing a smokers attitude or behavior. However, upon
understanding how smokers think and what motivates them and deters them from quitting or
providing a smoke-free home environment, health care professionals are more successful on
positively affecting health behavior changes or modifications. Thus, information and initiatives
should be tailored to meet the specific needs of the community.
Study Definitions
Theoretical definitions exist for all the variables used in this study, based on the current
literature. Secondhand smoking (SHS) occurs when nonsmokers are exposed to air that is
polluted by smoke. In this research study, children are mostly affected by SHS who live with
both or either parents that smoke and are considered the caregivers of the children ( Jones et al.,

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

2011). Operational definitions: The variables were measured through interviews developed from
previous studies and information from health care professionals (HCP) working with smokers
that are caregivers, a qualitative study conducted through one-on-one interview to encourage
open discussion between caregivers, and the researchers ( Jones et al., 2011).
Data were collected from the translated recorded interviews with the smoking caregivers
that consented to the research study and the data analysis was continuous throughout the period
of study. The reliability and validity of this research is based on the participants that consented to
the study and were recruited from four children centers (CCs) who had children less than 5 years
of age and are children of smokers. Twenty-two face to face interviews were conducted of
individuals that participated in this stud:16 mothers, 1 grandmother and five fathers. The
interviews were audio recorded and transcribed using NVivo software version 8(OSR
International Pty Ltd) (Jones et al., 2011). The data was then coded and grouped according to
responses.
The literature suggests that second hand smoke is still a significant health care concern
for health care providers and members of smokers families. It costs millions of dollars annually
for diseases that may be otherwise preventable. The health belief model suggests that if smokers
are motivated to change their behaviors, they must clearly see the benefit in doing so. Health care
professionals may not be able to completely convince smokers to quit but through suitable
programs, we may be able to get smokers to buy into the necessity of a smoke-free home
environment for themselves and their families especially for the sake of our children.

EFFECTS OF SECOND HAND SMOKE ON THE URBAN FAMILY

References
Butz, A. M., Breysse, P., Rand, C., Curtin-Brosnan, J., Eggleston, P., Diette, G. B., & Matsui, E.
C. (2011). Household smoking behavior: Effects on indoor air quality and health of urban
children with asthma. Maternal Child Health Journal, 15, 460-468. doi: 10.1007/s10995010-0606-7
Centers for Disease Control and Prevention. (2014, March 5). CDC - Fact sheet - Health effects
of secondhand smoke - smoking & tobacco use. Retrieved July 25, 2014, from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects
/index.html
Healthy People 2020. (2014). Tobacco. Retrieved from HealthyPeople.gov
Heffernan , T. M., & O'Neill, T. S. (2012). Exposure to second-hand smoke damages everyday
prospective memory. Addiction, 108, 420-426. doi:10.1111/j.1360-0443.2012.04056.x
Khader, Y. S., AlAkour , N., AlZubi, I. M., & Lataifeh, I. (2011). The association between second
hand smoke and low birth weight and preterm delivery. Maternal Child Health Journal,
15, 453-459. doi:10.1007/s10995-010-0599-2
Jones, L. L., Atkinson, O., Longman, J., Coleman, T., McNeill, A., & Lewis, S. A. (2011, June).
The Motivators and Barriers to a Smoke-Free Home Among Disadvantaged Caregivers:
Identifying the Positive Levers for Change [Journal]. Nicotine & Tobacco Research,
13(6), 479-486. http://dx.doi.org/10.1093/ntr/ntr030