REFRESH Project

Funded by the Big Lottery the REFRESH project was a partnership between ASH Scotland and the Universities of Aberdeen and Edinburgh which ran from to March 2010 to March 2014 with the following aims:

• to investigate the effectiveness and potential of using air quality monitors to provide tailored feedback to parents who smoke regarding levels of second-hand tobacco smoke in their own home, as a means of engaging and supporting these parents to take voluntary action to protect their families through creating smoke-free homes
• to explore the knowledge and views of policy makers at local and national level with regard to second hand smoke
• to engage with a range of health practitioners to investigate effective action on their part to support parents who smoke to reduce levels of tobacco smoke in their homes and to disseminate and encourage good practice; and
• to disseminate the findings of the research and hence to ensure that this enhanced evidence base informs and influences future action on second-hand tobacco smoke and smoke-free homes

Key findings

We:

• recruited parents who smoke at home to set up an air quality monitor in their house
• provided personalised feedback on tobacco smoke levels found
• supported parents to change their smoking behaviours to reduce risk
• interviewed decision-makers and surveyed practitioners to determine views and responses on second-hand smoke in the home
• tested alternative means of recruiting parents, partnering with family support centres
• tested new low-cost instruments to measure tobacco smoke in homes
• developed training for family support workers

Finding that

• parents who smoke were generally taking some form of action to reduce the risk but did not understand how smoke lingers and spreads through the house
• actions, such as opening windows, were not sufficient to make the home safe
• only making the home entirely smoke-free would protect families
• parents responded strongly to personalized air quality information, generally reporting “shock” and strong motivation for change
• repeat measurements one month later found significantly reduced smoke levels
• decision-makers agreed second-hand smoke is harmful but did not see it as a priority issue
• family support workers showed interest in supporting the families they work with to create smoke-free homes
• with existing relationships with the parents, family support workers have great potential as a conduit for introducing the intervention to parents

And will:

• use knowledge of the perceptions of smoking parents, and of how tobacco smoke behaves, to inform future action to address children’s exposure to tobacco smoke in the home
• communicate to decision-makers the importance of promoting smoke-free homes as the only effective means by which parents who smoke can protect their families
• further test and fine-tune the approach to develop a simple, cost-effective intervention which can be taken up by a range of agencies working with families

Conclusions

• parents who smoke at home generally take some measures to protect their families but the only effective way to do so is to make the home completely smoke-free
• parents respond well to personalized feedback on smoke levels found in their homes and are motivated to make effective changes
• programmes to reduce smoke in the home should engage parents positively and focus on entirely smoke-free homes and air quality monitoring provides an effective means to do this
• partnering with professionals with an existing support relationship can be an effective means to engage parents
• decision-makers need to be persuaded that smoke-free homes are an important goal.

Also see:

• REFRESH research report
• REFRESH How To Guide