Interagency Committee on Smoking and Health
Meeting Summary: September 18, 2007
Reducing Children's Exposure to Secondhand Smoke
Discussion on Barriers to 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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