Child exposure to second-hand smoke within "private spaces"- Comparing survey data with photographic evidence

Abstract

ABSTRACT

There is a restricted range of non-survey research on child exposure to second-hand smoke (SHS) within ‘private’ spaces - i.e. homes (inside and outside) and personal vehicles. The available evidence has typically resulted from survey and observation-based investigations. Both methods are limited in their capacity to adequately document contextual information, necessary to enrich the understanding of these exposures. This thesis appears to be the first study to investigate child SHS exposure within ‘private’ spaces using photographs captured by automated wearable cameras. The photographic evidence was collected as part of the Kids’Cam study: one of the first studies in New Zealand and internationally to use automated wearable cameras to collect data of what can be seen by children. Raw survey data from the 2014 ASH (Action on Smoking and Health) Year 10 Snapshot survey (n= 31,020) and the 2014 HPA (Health Promotion Agency) Youth Insights Survey (YIS) (n= 2,919) were analysed alongside the Kids’Cam photographs. This allowed the utility of the photo data to be assessed. The Kids’Cam sample used was 140,818 photos which were captured during 669 hours in 102 days by 34 children (Māori, Pacific and New Zealand European) living in households with smokers. When screened, 99 tobacco-related incidents were identified, 62 of which were of tobacco-related paraphernalia only; tobacco pouches, loose tobacco, cigarette packets, cigarettes, rolling papers, filter tips, and cigarette butts. Only two incidents of in-vehicle smoking were photographed by single New Zealand European and Pacific participants. Māori participants photographed indoor (0.26 incidents/day) and outdoor (0.24 incidents/day) home-based smoking at the highest rates (incident/day). In both surveys, Māori were significantly (p < 0.05) more likely than all other ethnic groups to report at least one day of home-based SHS exposure during the previous week (54% HPA, 52% ASH). In the 2014 HPA YIS, females were statistically (p < 0.05) more likely to have been reported smoking around children inside of their homes during the previous week. In the Kids’Cam data, females were most likely to be photographed smoking by the Kids’Cam participants in each type of the ‘private spaces’. A total of 18 adults were photographed smoking, of which 13 (72.2%) were female and five (27.8%) were male. The Kids’Cam photos revealed that participants encountered tobacco paraphernalia more frequently than smoking. The photographs suggest that parents were either unaware of the harm posed by tobacco-marketing and paraphernalia, or discounted paraphernalia as being an influential driver toward smoking. The photo data is advantageous in that it adds to the existing body of knowledge by offering insights as to the insidious nature of tobacco, supplementary to the data derived from surveys or field-based observations. The main disadvantage of this study is the small sample size. Time restrictions allowed for the photo data from only 34 participants to be screened. Within this, there was a high level of inter-participant variability with respect to the quality and quantity of the captured photographs. This limited the extent to which meaningful comparisons could be made within the Kids’Cam sample, and with the two sets of survey data. The findings from this thesis strongly support the need to implement plain packaging and in-vehicle smoking bans within New Zealand. This is imperative for reducing the tobacco-related harm of children. The need to allocate additional funding for mass media campaigns is also discussed.