'You think that I'm smoking and they're not': why mothers still smoke in the home

Past research into smoking and motherhood has explained how smoking enables mothers to care in conditions of hardship and poverty. However, much of this research was conducted before the risks to the health of non-smokers of inhaling tobacco smoke were widely known, and so mothers' attitudes towards passive smoking and caring remain under explored. Children living with smokers are at risk of developing serious acute and chronic conditions during childhood and later life. Despite increased awareness of health messages among parents, young children are still exposed to environmental tobacco smoke (ETS) in the home, with maternal smoking identified as the primary source of exposure. In this paper, we present the findings from a project set up to explore the changing social and environmental context of smoking and motherhood. Using focus groups, 54 mothers of children aged under five years from the Merseyside area of England, who smoked, discussed their beliefs about smoking, passive smoking and the health of their children. Although mothers were aware of the messages linking ETS exposure to childhood illnesses they appeared to rely more on their own explanations for any ill health experienced by their children, discounting smoking as a primary cause and preferring alternative explanations including 'genetics' and 'pollution'. These alternative explanations were common both within and between groups, suggesting that they form part of a wider resistant dialogue constructed within families and communities, where information about smoking and child health is received, challenged, and reconciled with existing knowledge, before being either accepted or rejected. Crucially, this alternative dialogue supports the mothers' continued smoking, and is inevitably linked to their personal need to smoke while caring. These findings have implications for the development of future strategies for promoting the health of children with mothers who are reluctant, or feel unable, to accept that smoking can affect the health of their children.