title: The challenge of mothers learning about secondhand smoke (MLASS): a quasi-experimental, mixed methods feasibility study.
abstract: BACKGROUND
  Exposure to secondhand smoke (SHS) in the antenatal and postnatal period is associated with a detrimental health impact to the foetus and newborn baby and is recognised as a preventable public health challenge. The aim of the mother's learning about secondhand smoke (MLASS) study was to test the feasibility of delivering and evaluating the effectiveness of a smoke-free homes (SFH) health education intervention in the antenatal and postnatal period to reduce foetal and newborn exposure to SHS.
  
  
  METHODS
  Pregnant women aged 17-40 years old who attended their first community-based antenatal appointment in Leeds, UK, were eligible to participate if they currently smoked, or if they were non-smokers but lived in a household where someone else smoked, or had regular visitors to the home who smoked. A SFH health education intervention was delivered at four time points by community midwives and health visitors. Outcome measures included self-reported level of household smoking restrictions and SHS exposure in pregnant women who did not smoke during pregnancy and in the newborn baby, measured by salivary and urine cotinine levels, respectively. We planned to conduct focus group discussions with participants and health professionals. A post hoc survey of pregnant women was conducted at the recruitment site.
  
  
  RESULTS
  Eight pregnant women were recruited over a 6-month recruitment period. Of the 65 eligible pregnant women approached, 57 (88 %) declined to participate in the study. The majority declined to participate due to lack of interest in the study. In the post hoc survey, the majority of pregnant women reported that they were already implementing household smoking restrictions to reduce SHS; only a small number had no household smoking restrictions.
  
  
  CONCLUSIONS
  The post hoc survey identified women who could benefit from a SFH intervention; therefore, future studies should consider what SFH means to pregnant women and may wish to target those not currently implementing household smoking restrictions. Future recruitment strategies in studies of an SFH intervention in the context of maternity service pressures needs careful consideration; this includes the capacity to undertake the research, the recruitment setting, the criteria for individuals requiring the intervention, and individuals' willingness to engage with such research.
authors.affiliation: Social Policy Research Unit, Alcuin College, University of York, Heslington, York, YO10 5DD UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Mann
authors.affiliation: The Office of the Director of Public Health, Technorth, 9 Harrogate Road, Chapel Allerton, Leeds, LS7 3NB UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Thomson
authors.affiliation: Public Heath Team, Bath & North East Somerset Council, St Martin's Hospital, Clara Cross Lane, Bath, BA2 5RP UK.
authors.forename: Becky
authors.initials: B
authors.lastname: Reynolds
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Amos
authors.affiliation: Department of Health Sciences, University of York, ARRC Building, 1st Floor, Heslington, York, YO10 5DD UK.
authors.forename: Kamran
authors.initials: K
authors.lastname: Siddiqi