Background
Methods
Study design and recruitment strategy
Questionnaire development
Risk perceptions
Dimension | Description of dimension by Brewer | Tobacco smoke exposure question |
---|---|---|
Perceived likelihood | The probability that one will be harmed by the hazard | In your opinion, is it reasonable that a child exposed to secondhand smoke will get a respiratory tract infection? (1 = completely unreasonable, 7 = absolutely) |
Perceived susceptibility | An individual's constitutional vulnerability to a hazard | In your opinion, is a child exposed to secondhand smoke more likely to get a respiratory tract infection than other children? (1 = Not at all susceptible, 7- Most susceptible) |
Perceived severity | The extent of harm a hazard would cause | In your opinion, how much will tobacco smoke in the child’s environment affect your child’s health? (1 = No influence, 7 = Very strong influence) |
Knowledge questions
Smoking behavior
Additional variables
Validation of instrument
Statistical analyses
Ethical approval
Results
Participants
Variable | Entry | Others (N = 66) | Regular smoker (N = 66) | p-value for difference between groups |
---|---|---|---|---|
Age (in years) | Mean (STD) | 30.0 (5.1) | 29.3 (5.6) | .4367 |
Years of education | Mean (STD) | 14.4 (2.1) | 12.7 (1.9) | <.0001 |
Number children | Mean (STD) | 2.1 (1.2) | 1.7 (1.2) | .0887 |
Religiosity | Secular/Traditional | 43.8% | 56.2% | .0050 |
Religious/Ultra-Orthodox | 74.1% | 25.9% | ||
Parent | Mother | 58.5% | 41.5% | <.0001 |
Father | 15.4% | 84.6% | ||
Family financial status (New Israeli Shekels, per month) | <5000 | 31.6% | 68.4% | .2262 |
5000-12000 | 51.8% | 48.2% | ||
12,000+ | 54.8% | 45.2% | ||
Origin | Israel | 44.0% | 56.0% | .3078 |
Russia | 50.0% | 50.0% | ||
Other | 63.6% | 36.4% | ||
Marital status | Single | 16.7% | 83.3% | .0092 |
Married | 54.7% | 45.3% | ||
Divorced | 0.0% | 100.0% | ||
Work | Full-Time | 45.0% | 55.0% | .2751 |
Part-Time | 64.0% | 36.0% | ||
None | 48.9% | 51.1% | ||
Number of cigarettes per day | Mean (STD) | 1.1 (0.35) | 5.2 (0.90) | <.0001 |
Family members smoke at home (% yes) | 16.7% | 78.8% | <.0001 | |
Family members smoke in car (% yes) | 15.2% | 50.0% | <.0001 | |
Lactate | 0-3 months | 47.1% | 52.9% | .0014 |
4+ months | 79.0% | 21.0% |
Risk perceptions and knowledge
Mean (STD) | Others (N=66) | Regular smokers (N=66) | p-valuet-test | Family does not smoke in home (N=69) | Family smokes in home (N=63) | OR [CI] p-value (logistic regression) |
---|---|---|---|---|---|---|
Q19. Likelihood. Is it reasonable that a child exposed to passive smoking will be sick with respiratory illnesses? (1=Completely unreasonable 7- Absolutely) | 5.14 (1.41) | 4.53 (1.96) | .0440 | 5.19 (1.53) | 4.44 (1.86) | .81 [.62,1.06] .1228 |
Q20. Susceptbilty. Will an infant who is exposed to passive smoking be more susceptible to respiratory illness than other children? (1=Not at all susceptible 7- the most susceptible) | 5.67 (1.22) | 4.68 (1.72) | .0002 | 5.68 (1.29) | 4.62 (1.66) | .71 [.52,.97] .0319 |
Q21. Severity. How much can exposure to smoke around your child influence his health? (1=No influence 7- Very strong influence) | 5.85 (1.19) | 4.82 (1.73) | .0001 | 5.83 (1.12) | 4.79 (1.80) | .75 [.55,1.01] .0595 |
Combined risk perception
| 16.65 (3.39) | 14.03 (4.67) | .0003 | 16.7 (3.33) | 13.86 (4.71) | .89 [.79,.88] .0350 |
Q23. Childhood illnesses are not associated at all with smoking around the child (1=Completely disagree, 7=Agree a lot) | 3.64 (1.89) | 4.79 (1.92) | .0007 | 4.01 (1.95) | 4.43 (2.01) | 1.15 [0.91,1.47] .2440 |
Q24. In my opinion, there is a link between the health of children and between smoking by their parents (1=Completely disagree, 7=Agree a lot) | 6.11 (1.44) | 4.52 (1.94) | <.0001 | 5.86 (1.63) | 4.71 (1.96) | 1.09 [0.84,1.40] .5215 |
Q25. In my opinion, passive smoking harms child development (1=Completely disagree, 7=Agree a lot) | 5.27 (1.79) | 4.03 (2.17) | .0005 | 5.30 (1.83) | 3.94 (2.11) | 1.28 [1.02,1.59] .0322 |
Q29. Breathing tobacco smoke is a risk factor for many diseases in infants (1=Completely disagree, 7=Agree a lot) | 6.06 (1.18) | 5.33 (1.69) | .0048 | 6.06 (1.27) | 5.30 (1.62) | 1.28 [0.93,1.75] .1326 |
Q30. Breathing tobacco smoke is a risk factor for child mortality (1=Completely disagree, 7=Agree a lot) | 4.05 (1.84) | 3.48 (2.09) | .1048. | 4.13 (1.93) | 3.37 (1.98) | 1.20 [0.95,1.50] .1250 |
Combined knowledge scale (Q23 reversed, Q24, Q25, Q29, Q30) (Scale: 5–35) | 25.85 (5.35) | 20.58 (6.83) | <.0001 | 23.62 (3.3) | 20.3 (5.14) | 1.16 [1.03,1.31] .0124 |
Smoking behavior in home and car
Statistical models
Model 1: outcome: risk perception | Model 3: outcome: family smoking in home | Model 4: outcome: family smoking in home | |
---|---|---|---|
(N=131) | (N=131) | (N=131) | |
Least squared means | Odds ratio | Odds ratio | |
Type III p-values | [Confidence Interval], | [Confidence Interval], | |
p-value | p-value | ||
Status (regular smoker vs. other) | Regular smokers: 14.01 | Regular smoker vs. other: | Regular smoker vs. other: |
Others: 16.04 | OR:45.00 [9.98,202.94] | OR:24.25 [6.90,85.20] | |
p-value: .0158 | p-value: <.0001 | p-value: <.0001 | |
Risk perception | OR: 0.93 [0.81,1.07] | OR: 0.88 [0.78,1.003] | |
p-value: .3224 | p-value: .0560 | ||
Parent (father vs. mother) | Father: 14.37 | OR: 1.36 [0.30,6.15] | OR: 1.37 [0.34,5.59] |
Mother: 15.68 | p-value:.6865 | p-value:.6624 | |
p-value: .1974 | |||
Work status | Full: 15.23 | No vs.full-time: OR: 4.45 | No vs.full-time: OR: 5.87 |
No vs. full-time | No: 14.93 | [1.16,17.02] | [1.60,21.63] |
Part vs. full-time | Part: 14.91 | Part vs. full-time: OR: 0.44 | Part vs. full-time: OR: 0.46 |
p-value: .9214 | [0.95,2.00] | [0.11,1.94] | |
p-value:.0181 | p-value:.0042 | ||
Origin | Israel: 16.29 | Russia vs. Israel: OR: | Not in model |
Russia vs. Israel | Other: 15.54 | 4.03[0.93,17.37] | |
Other vs. Israel | Russia: 13.26 | Other vs. Israel: 0.41 | |
p-value: .0019 | [0.09,1.96] | ||
p-value: .0433 | |||
Age (30 years + vs. <30 years) | 30+: 14.42 | 30+ vs. <30: OR:1.09 | 30+ vs. <30: OR:0.75 |
<30: 15.63 | [0.34,3.52] | [0.26,2.20] | |
p-value: .1192 | p-value:.8885 | p-value:.6056 | |
Education (<=12 years vs.12+ years) | 0-12:14.39 | <=12 vs. 12+: 0.996 [0.32,3.07] | <=12 vs. 12+: 1.12 [0.39,3.25] |
>12:15.66 | p-value:.9941 | p-value:.8367 | |
p-value: .1145 | |||
Religiosity (Ultra Orthodox and religious vs. secular or traditional) | Religious, Haredi:15.29 | Haredi/religious vs. | Haredi/religious vs. |
Secular, traditional: 14.76 | secular/traditional: 2.60 | secular/traditional: 0.98 | |
p-value: .5977 | [0.50,13.46] | [0.26,3.75] | |
p-value:.2562 | p-value:.9750 | ||
Marital | Divorced:12.83 | Divorced vs. Married: 0.21 | Divorced vs. Married: 0.12 |
(Divorced vs. Married | Married: 15.37 | [0.01,7.57] | [0.004,3.08] |
Single vs. Married) | Single: 16.87 | Single vs. Married: 0.87 | Single vs. Married: 1.47 |
p-value: .2597 | [0.08,8.99] | [0.18,11.90] | |
p-value:.6875 | p-value:.3205 | ||
Income (in thousands of New Israeli Shekels) | 12+: 15.16 | 5-12 vs. 12+: 1.25 [0.36,4.42] | 5-12 vs. 12+: 1.11[0.34,3.62] |
5-12: 14.57 | 5 vs. 12+: 1.04 [0.10,10.60] | 5 vs. 12+: 0.76 [0.08,7.14] | |
5-12 vs. 12+ | <5:15.35 | p-value:.9278 | p-value: .9221 |
<5 vs. 12+ | p-value:.6644 |
Discussion
Measuring parental risk perceptions
Study ID | Question + scale for answer | Author definition | Inferred dimension |
---|---|---|---|
Bock | How much do you think other people’s smoking affects your baby’s health Scale: 1-5 | Risk perception | Severity |
Chen 2013 | Smoking has bad impact on children’s health | Perception, consequence | Harm |
Children’s health is affected | |||
Scale: 1–5, strongly agree to strongly disagree | |||
Drehmer, Winickoff | Breathing air in a room where people smoked yesterday can harm children today (third hand smoke) | Health risks (thirdhand smoke) | Harm |
Scale: 1–4 agreement, strongly agreed – strongly disagreed | |||
Evans and Gilmore | 'Do you think that living with someone who smokes does, or does not, increase a child's risk of: asthma/ear infection/cot death/chest infections/other infections?' | Knowledge | Susceptibility |
Scale: Binary (yes/no) | |||
Farber | How much effect do you think exposure to tobacco smoke has on your child’s asthma? | Beliefs | Severity |
Scale: 4 categories: No/small/moderate/large negative effect. | |||
Helgason | Children exposed to ETS more likely to have inner ear/respiratory diseases/asthma attacks | Health risk awareness | Susceptibility |
Scale: 1-4 | |||
Lonergan | A nonsmoker who regularly breathes in someone else’s smoke increases the risk of a nonsmoker getting… ear infections in children (Increases risk/does not increase risk) | Risk perceptions | Susceptibility |
Lund & Helgason | Children exposed to ETS are more likely to have inner ear/respiratory diseases/ | Health risk awareness | Susceptibility |
Scale: 1-4 | |||
McMillan | Inhaled smoke from a parent’s cigarette harms health of infants and children | Knowledge of harm | Harm |
Scale: 1–4 agreement/ disagreement | |||
Wagener | From Perceived vulnerability scale: | Risk perception, Perceived vulnerability, optimism bias | Susceptibility |
How much do you believe that | |||
a. your smoking is related to your child’s asthma symptoms | Severity | ||
b. your smoking increases the frequency of your child’s asthma attacks | Severity | ||
c. your smoking affects how bad your child’s asthma is | Severity | ||
d. your smoking increases the chance that your child will have to go to the emergency room or be hospitalized for an asthma attack? | Susceptibility/Severity | ||
From Optimistic Bias scale: | Susceptibility/Severity | ||
Compared to other children with asthma whose parents don’t smoke, what are the chances that | Susceptibility/Severity | ||
a. your child will have an asthma attack | Susceptibility/Severity | ||
b. your child’s asthma symptoms getting worse, | |||
c. your child will have to visit the emergency room for an asthma attack | |||
d. your child will have to visit a doctor because of worsening asthma | |||
Scale: 1–5, low – high risk | |||
Winickoff 2009 | Inhaled smoke from a parent’s cigarette harms health of infants and children | Health beliefs | Harm |
Harm | |||
Breathing air in a room today where people smoked yesterday can harm | |||
Health of infants and children | |||
Scale: 1–4 agreement |