Air quality feedback: a tool to encourage smoke-free homes

Exposure to second-hand tobacco smoke (SHS) is associated with a wide-range of ill-health outcomes that are entirely preventable. More than 85% of SHS is invisible and many smokers are unaware of the impact of their smoking on air-quality in their home. Inhaling SHS can lead to effects on the respiratory system, and is likely to be especially harmful during early life. Children's exposure to SHS in the UK is estimated to cause approximately 830 healthcare consultations per day, with over 20 children per day suffering illness leading to admission to hospital. Non-smokers who live with smokers can have high SHS exposures, particularly young children who spend much of their day at home with a smoker. The UK government has stated that they wish to see two-thirds of smokers' homes being smoke-free by 2020 and the Scottish government tobacco control strategy has a target of reducing the number of children exposed to SHS at home by 50% by 2020. Recent work has also shown that SHS remains in household air for many hours after a cigarette is extinguished while previous work has demonstrated that personalized measurements of household air quality can lead to changes in smokers' smoking behavior and that visual, graphical and numerical data can be effectively explained to a wide-variety of users. This study aims to provide health workers with a simple, low-cost procedure to help change smoking behavior of parents in their house and car, and create a safer and healthier environment for children. The work will seek to help parents exchange ineffective strategies to create a smoke-free environment (e.g., opening the window when smoking in the car, smoking in another room in the house) for effective strategies (e.g. smoking outside, delaying smoking, quit smoking).

The health effects of exposure to second-hand smoke (SHS) are substantial. Smoke-free legislation demonstrated the significant health benefits achievable by reducing SHS exposure. While this eliminated SHS exposure in work and many social settings, for those who live with a smoker SHS exposure has remained high. Most smokers try to protect their children from SHS, but apply strategies that are insufficiently effective. The Reducing Families' Exposure to Second-hand Smoke and Health (REFRESH) study demonstrated that providing smoking parents with objective information about the effect of their behaviours on their home's air-quality changed their behaviour and reduced children's SHS exposure. Barriers to this approach were instrumentation cost and the labour-intensive method of intervention delivery, which involved home-visits to install and retrieve air quality monitoring devices. Recent work has identified an air-quality monitor that is cheap and can be self-installed at home by the user.
This study seeks to determine how best to incorporate this new device in a simple package that can be used by NHS and non-NHS smoking intervention workers to encourage parents who smoke to make their home and car smoke-free. The project will involve three work-packages: (1) development of a theoretical framework for an intervention to promote parental self-management of home air quality using the air quality monitor, and identify the optimal way of intervention delivery; (2) work with the manufacturers of the device to refine the instrument to present the data in plots that can be easily interpreted by parents; (3) a feasibility study to evaluate intervention acceptability, likely rates of recruitment and effect size to examine the potential of a future large-scale trial. Throughout the project we will expand our partnership with key stakeholders responsible for the future adoption, delivery and sustainability of the program.