Perceived benefits of smoke-free homes, the process of establishing them, and enforcement challenges in Shanghai, China: a qualitative study

BACKGROUND: We examined reasons for establishing smoke-free home policies, interpersonal processes by which they are established, and challenges in enforcing them in Shanghai, China. METHODS: In 2013, we conducted 30 in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from urban and a suburban communities in Shanghai. RESULTS: Reasons for adopting a smoke-free home included family’s health, being a role model for children, cleaner environment, and potential impact on smoking behavior. Wives were credited with initiating discussion regarding the implementation of a smoke-free home most often and were reported to have decision-making authority. Some households had not discussed such a rule. Common responses to asking to establish a smoke-free home among husbands were agreeing not to smoke at home or in front of family members, ignoring the request, temporarily acquiescing, insisting on smoking in the home anyway, and devaluing the benefits of smoke-free homes. Challenges to enforcement included weather, social situations, the smoker being home alone, ineffective harm reduction behaviors such as smoking near windows, and addiction were challenges in enforcement. CONCLUSIONS: Specific factors (e.g. family’s health) could be highlighted to assist women, men, and children in adopting and enforcing smoke-free home policies.