This paper reports a secondary data analysis intended to test the effectiveness of brief counselling by nurses to encourage mothers of sick children to advise their husbands to stop smoking. The original study was a randomised controlled trial in general paediatric wards, and it showed that a brief counselling session by nurses given to non-smoking women was effective in changing the behaviour of smoking husbands, motivating women to take action to protect their children from second-hand household smoke exposure at 3-month follow-up [1, 2]. While we demonstrated in the previous paper that it was possible for nurses to deliver the quitting message to the fathers of sick children through the non-smoking spouse, it remained unclear whether the brief intervention was effective in motivating women to help their husbands quit smoking. Furthermore, no study has examined the factors inducing women to influence their husbands in this way, although spousal support has long been discussed as a key factor in successful quitting [3–5].
Both active and passive tobacco smoke is a type–I carcinogen with immediate and direct hazards to health [6, 7]. Parental smoking is a serious health hazard to the whole family, both to the smoking parents and to non-smoking family members who are exposed to second- and third-hand smoke in the household . Quitting smoking is essential to reduce the health hazards of smokers and to remove the risk of SHS exposure to their family members. In the past 30 years, Hong Kong has made remarkable efforts in tobacco control, which have resulted in a progressive decrease in smoking prevalence from 23.3% in 1982 to 11.8% in 2008 . The government first brought in a tobacco control ordinance in 1982, and subsequent amendments have been made to restrict tobacco advertising, sponsorship in sport and other entertainment areas by tobacco companies, cigarette sales to those below 18; action has also been taken against cigarette smuggling, and no-smoking areas have been extended to all indoor workplaces and public spaces, including restaurants. Alongside this success, however, there is the unintended consequence of possible displacement of smoking to Hong Kong homes. With smoke-free legislation operating in all indoor public areas (including the whole residential area under public estates and the whole building, apart from inside apartments), many parents have simply moved their smoking to their homes, and 14% of primary school children reported an increased exposure to household SHS in 2008 . The problem could be severe in densely populated cities with crowded living quarters (in Hong Kong, the median living area per person is just 11.4 m2 in public estates), where smoking hygiene (smoke > 3 m away from non-smoking household members [8, 11]) is hardly promoted [10, 12]. This could increase the health threat to non-smoking women and children living with a smoker. As in most Asian cities, while women’s smoking prevalence is low (3% in Hong Kong ), they have little awareness about the health hazards of SHS exposure, and fewer than half non-smoking women would always advise their husbands to stop smoking [2, 13].
The hospitalisation of sick children is an important juncture where nurses can teach women to protect their children from SHS . To deal with the increasing threat of such exposure in the home, women should advise and assist their husbands to quit smoking, in order to avoid the health hazards of both active and passive smoking. Being at the frontier of patient care, nurses have a responsibility to provide smoking cessation counselling to smoking parents when they bring their children to hospital [15–17]. However, few nurses would assist smokers to quit in the clinical setting , because of heavy workload and the lack of time . Furthermore, in paediatric wards, nurses rarely have the chance to meet smoking fathers directly, as it is usually the mother who takes care of the child on admission and during hospitalisation. To address this practical situation, the present paper describes the current practice of sick children’s mothers in advising and helping their husbands to stop smoking; reports the effectiveness of a low-intensity nurse-led intervention during a child’s hospitalisation in motivating their mothers to take action to help their husbands to quit; and examines factors predicting such action.