title: Protecting children from secondhand smoke: a mixed-methods feasibility study of a novel smoke-free home intervention.
abstract: BACKGROUND
  Globally, 40 % of children under 14 years are regularly exposed to secondhand smoke (SHS), typically in their homes. There is limited evidence of the effectiveness of interventions to reduce children's SHS exposure, and so the aim of this study was to test the feasibility and acceptability of a novel intervention to help parents and carers (caregivers) to reduce their children's exposure to SHS at home.
  
  
  METHODS
  A novel multi-component intervention to support caregivers to reduce their children's SHS exposure at home was tested in a two-phase feasibility study. The 12-week intensive intervention delivered in the home consisted of three components: behavioural support, nicotine replacement therapy (NRT) for temporary abstinence and feedback on levels of SHS exposure in the form of children's salivary cotinine (phase 1) or home air quality (PM2.5) (phase 2). Participants were caregivers who smoked inside their homes and had at least one child under the age of 5 years living with them the majority of the time. Mixed-methods were used to explore the acceptability and feasibility of the intervention as well as processes, particularly around recruitment and retention, for an exploratory efficacy trial.
  
  
  RESULTS
  Twelve caregivers completed the study, all received personalised feedback on SHS exposure and behavioural support to help them to make their homes smoke-free and the majority at least tried NRT. Saliva cotinine results were variable in phase 1, and therefore, measures of PM2.5were used for feedback in phase 2. Behavioural support was well received with personalised feedback reported as being the key motivator for initiating and maintaining behaviour change.
  
  
  CONCLUSIONS
  Recruiting disadvantaged caregivers was labour intensive, but once recruited, this novel intervention was both feasible and acceptable in supporting caregivers to reduce their children's exposure to SHS at home. It is appropriate to test the efficacy of this novel intervention in an exploratory randomised controlled trial.
  
  
  BACKGROUND
  This is not applicable for the current study; however, a registered exploratory randomised controlled trial linked to this manuscript is currently ongoing (ISRCTN81701383).
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB UK.
authors.forename: John
authors.initials: J
authors.lastname: Marsh
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK.
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewis
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB UK.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Bains
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Larwood
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Purdy
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Institute of Applied Health Research, University of Birmingham, Public Health Building, Edgbaston, Birmingham, B15 2TT UK.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Jones
keywords: Acceptability; Complex intervention; Feasibility study; Mixed-methods; PM2.5; Recruitment; Secondhand smoke; Smoke-free homes