Supporting parents living in disadvantaged areas of Edinburgh to create a smoke-free home using nicotine replacement therapy (NRT): A two-phase qualitative study.

Abstract Background Childhood exposure to second-hand smoke in the home is largely associated with socio-economic disadvantage. Disadvantaged parents face specific challenges creating a smoke-free home, often caring for children in accommodation without access to outdoor garden space. Existing home interventions largely fail to accommodate these constraints. Innovative approaches are required to address this inequality. In this two-phase study, we engaged with parents living in disadvantaged areas of Edinburgh, Scotland, to explore tailored approaches to creating a smoke-free home and develop and pilot-test an intervention based on their views and preferences.Methods In Phase 1, qualitative interviews with 17 parents recruited from Early Years Centres explored alternative approaches to smoke-free home interventions. In Phase 2, an intervention based on parents’ views and preferences was pilot tested with parents recruited through Early Years and Family Nurse Partnership centres. 17 parents took part in an interview to share their views/experience of the intervention. Data from both study phases were thematically analysed.Results Phase 1 findings suggested that parents associated nicotine replacement therapy (NRT) with quit attempts, but supported the idea of NRT use for temporary abstinence to create a smoke-free home, viewing this as a safer option than using e-cigarettes indoors. In Phase 2, 54 parents expressed an interest in accessing NRT to create a smoke-free home, 32 discussed NRT product choice during a home visit from a smoking adviser, and 20 collected their free NRT prescription from the pharmacy. NRT was used for up to 12 weeks in the home, with ongoing advice available from pharmacy staff. During qualitative interviews (N = 17), parents self-reported successfully creating a smoke-free home; quitting smoking; and reduced cigarette consumption, often exceeding their expectations regarding changes made. The intervention was acceptable to parents, but the multi-step process used to access NRT was cumbersome. Some participants were lost to this process.Conclusions Parents living in disadvantage may benefit from access to NRT for temporary abstinence in the home to assist them to protect their children from second-hand smoke exposure. Further research using a more streamlined approach to NRT access, is required to determine the feasibility and cost-effectiveness of this approach.