Perceived benefits of smoke-free homes, the process of establishing them, and enforcement challenges in Shanghai, China: a qualitative study

Sociodemographics

Gender/smoking status

 Male current smoker

13 (43.3)

 Female nonsmoker

17 (56.7)

Ethnic

 Han

29 (96.7)

 Other

1 (3.3)

Age

 20-29

2 (6.7)

 30-39

16 (53.3)

 40-49

11 (36.7)

 50-59

1 (3.3)

Education

 Less than high school

5 (16.7)

 High school graduated

9 (30.0)

 College or higher

16 (53.3)

Monthly household income

 Less than 3000 Yuan

7 (23.3)

 3001-5999 Yuan

12 (40.0)

 6000-7999 Yuan

7 (23.3)

 More than 8000 Yuan

4 (13.3)

Marital status

 Married

30 (100.0)

 Other

0 (0.0)

Residence

 Apartment

26 (86.7)

 Single house

4 (13.3)

Number of people in the home

3.8 (0.9)

Number of children in the home

1.1 (0.3)

Smoking characteristics*

 Days smoked, past 30 days

26.9 (6.2)

 CPD on smoking days

11.1 (6.2)

Smoking practices and rules in the home

Locations where smoking is allowed

“Smoking is only allowed in the living room and balcony. In fact, smoking occurs most frequently in the living room, because we watch television and have guests come to visit sit there. It is also a place to rest. It has larger space, so the air circulates faster than other places.” (FA01)

“It is because there is a range hood in the kitchen that can take the smoke out. If smoking is allowed in the bedroom or the living room, there will be much smoke smell and residue remains.” (FA03)

“We stay in the bedroom longer. In addition, it is comparatively closed off with less air circulation. If someone smokes there, the smell will remain for a long time and I cannot stand it. My children are still young.” (FA08)

“Generally, he does not smoke in son’s presence. Therefore, his smoking won’t affect the child.” (FA05)

Triggers for smoking

“It’s hard to stop him smoking after having meals, because smokers are used to smoking after meals.” (FA04)

“He may smoke one or two cigarettes in the computer room while play computer.” (FF03)

“When he is playing mahjong or watching TV, he husband smokes frequently.” (FA02)

“When he is working at home, sometimes writing a report on the computer, typing, or making calls to his clients, at these times, he will smoke without stopping. This may be a shortcoming for all males. The more busy or annoyed they are, the more they will smoke.” (FA08)

Perceived benefits of or motivators for smoke-free homes

Family’s health

“First it is good for our health. Health is the most important point. Nothing else matters.” (FF04)

“There will be less secondhand smoke and thirdhand smoke, and it can ensure family’s health.” (FA04)

Children’s health

“When I was pregnant and when child was still very little, I often discussed with my husband about whether to let people smoke in our home or not. Because we were afraid smoking is bad to his growth, I told my husband not to smoke at home….” (FA01)

Role model for children

“My children rarely see me smoking because I don’t want them to see the bad habit. In this way, there will be positive influence on children’s development. Especially to young boys, I don't want him to smoke when he grows up.” (MF01)

Clean environment, no smell

“Our home would be clean, without pollution. If someone smokes inside, cigarette ash will be everywhere. It is bad for children.” (FF03)

“At least there will not be smoke smell, and the air will be fresh. That would be good for the health of the family.” (FA03)

“First, the house will be cleaner, and smoke smell will not be so strong…. Rooms where people smoke, like our office, the walls have turned yellow.” (MF02)

Avoiding embarrassment

“For example, guests want to smoke. If you ask them not to smoke on the spot, it must be embarrassing. If you tell them clearly at the beginning that your home is smoke-free, then these embarrassments could be avoided. In addition, it ensures the health of older adults and children.” (MA02)

Potential impact on smoking behavior

“Because it only asks the person to smoke outside of the house, but not force the person to quit smoking. [They] will still continue to smoke. Outside of the door, in the hallway, or going outside, smoking still continues.” (MA03)

“I don’t think it is helpful. He smokes in the office and I can’t control him when he is not at home. We do not work in the same place.” (FF04)

“Despite the fact that smokers still smoke outside, the amount of their smoking will definitely decrease. For example, when I go to a friend’ home where smoking is only allowed on the balcony, I will feel embarrassed if I go outside for smoking frequently. Therefore I can control the amount I smoke.” (MA01)

“When you keep watching them and pushing them, they will have some impression in their brain. It is sort of helpful.” (FF06)

Initiation of discussions about whether to allow smoking in the home

Establish the rule early in the relationship

“Of course, I brought it up first. This should be settled when you are getting married. We reached an agreement when we got married. I was against smoking, but I still tolerate it.” (FF02)

“My wife often talks of this issue with me. We made the rule at the beginning that I am not allowed to smoke anywhere in our home.” (MA03)

“I established them at the beginning. My wife keeps an eye on it. We work with each other pretty well.” (MA01)

No discussion

“We cannot discuss it. Discussing this is like gunpowder exploding. I can only hope that these reports become more frequent to influence him subconsciously. He is a stubborn person, and we cannot communicate about this problem. It is impossible to have a smoke-free home, so I no longer mention it.” (FA08)

Decision-making authority regarding home smoking rules

Wives

“Yes. I have more power to say in regard to this point.” (FF04)

“Of course, my wife does [have the authority].” (MA05)

Children

“My daughter. She comes back from school in the evening and often asks me not to smoke. She said smoking is harmful to health and even wanted to stick a non-smoking sign on my face.” (MA06)

Shared authority

“We all talk about that. My daughter also opposes smoking at home. [When she smells the smoke on his father, she will ask her father not to smoke.] There is not much difference regarding who has the most saying.” (FF06)

Extended family

“Yes, my mother and I have the power to make decisions. Non-smoking people have the right to speak.” (FF01)

Husband’s response to conversations about smoke-free home policy

Ignoring the request

“He can't help smoking. I think it makes no difference whether I talk with him about this or not because he is a heavy smoker. Generally he would not smoke in son’s presence.” (FA05)

Not smoking at home for a few days but then starting again

“There were some quarrels when I oppose him smoking. After that, he might not smoke at home for a period of time, but a few days later he would smoke again. So that's why there are often some conflicts and fights.” (FA04)

Insist on smoking anyway

“Anyway at home, I will smoke when I want. The rule depends on self-awareness. If my son is doing homework at home or something else, I will smoke less. But even with the concern of children, I will not make my home smoke-free unless I am sick and have to lie in the bed and can’t smoke cigarette anymore.” (MA07)

Devaluing the benefit of smoke-free homes

“Unless someone has health problems or suffers from some diseases, it is impossible to establish the rule.” (FA05)

“But frankly speaking, it means little to China, because the toxicity of the cigarettes must be smaller than the toxicity of powder dust. It is less harmful than the PM2.5 particles.” (MA02)

Challenges and exceptions in enforcing smoke-free policies or rules

Weather

“You can’t ask him to smoke downstairs and outside every time when he wants to smoke. It is so cold and he has to change the clothes to go outside.” (FA07)

“In the winter and at night, I think it is sort of cruel to ask them to go outside.” (FF09)

“Like in a raining day or during the winter. People don’t want to go outside to smoke when the weather is bad.” (MA06)

“But he may feel a bit wronged and sometimes he complains. For example, when the weather is cold, and he does not want to smoke on the balcony.” (FF01)

Social gatherings, guests visiting

“It depends on the person. It varies from person to person. Some people you ask him to go outside, and they are pretty self-aware [to comply]. Some people no matter what you say, they are still uncaring. Also, generally, when a group of people are gathering together, if you ask someone to go outside to smoke, it will make the person feel shamed or embarrassed.” (MF05)

“When some guests who have close relationship with us come to visit. Because they didn't often come to my home, I felt embarrassed to ask them not to smoke. I would just let them smoke, and open the window to keep the room ventilated.” (FF05)

“In traditional Chinese culture, guests are always respected. I will give them cigarettes. During those time the smoke smell is the strongest in our home.” (MF05)

Family relationships

“I am afraid that this regulation will trigger many family arguments and conflicts. I think this regulation doesn’t respect human rights.” (MA08)

“I don’t know about other families, but I think that banning smoking inside the home will increase family tensions or stress.” (FA03)

“My daddy is a smoker. When he comes I will open the windows and prepare a big astray with some water inside. After he smokes one cigarette, I will wash the astray so he can’t smoke any more unless he goes to outside stairs to smoke.” (FF03)

Smoker at home alone

“My husband could smoke secretly in the restroom. But basically I don’t allow him to smoke at home. When I go to sleep at night, I don’t know whether he smokes or not.” (FF05)

Closing the door or opening the window to reduce the impact

“For example, when it's very cold and raining heavily, smokers may smoke secretly when they go to restroom, or smoke in the kitchen. Although he shuts the door, the smell still spread out to the living room and bedrooms, which sometimes makes us argue again.” (FF02)

“I smoke not necessarily because I want to ponder over things. It is very casual. I smoke toward the window just because the smoke can disperse quickly.” (MA08)

“He will ask our daughter to leave the study room if he wants to smoke, and he would open the window even it’s cold outside. I think this is good enough.” (FA07)

Less motivated with older children

“And after our baby was born, as a father, he realized that smoking was bad for our baby even if I didn't emphasize it. Especially when the kid was young, he is more likely to make it. He would not smoke around the child as possible as he can. He would try to only smoke when taking the garbage out. Thus, from the time we got married and had our child, as a farther, he was gradually aware of his responsibility. However, as the child grows up, sometimes he is being lazy on this thing and secretly smokes a little bit.” (FF02)

Addiction

“I have thought about that but it seems not practical. My husband is so addicted to smoking. I have talked to him for many times but there is no solution.” (FA05)

“My smoking addiction is quite strong, about two packs a day. Sometimes at home, even in the bedroom I will smoke. For example, if in the winter, the door and windows are open. I smoke in the bedroom, and other people will think that the smell is really bad, and got stung by the smoke badly. They keep complaining to me. But once my smoking addiction comes, I will still smoke.” (MA07)