Experience and Perceptions of Perinatal Smoke Exposure Among Ultra-Orthodox Women in Israel

Secondhand smoke exposure remains a public health concern, particularly for vulnerable populations such as pregnant women. In the ultra-Orthodox community in Israel, cultural norms and religious practices shape health behaviors, including cigarette smoking and exposure. This study explores the perceptions of perinatal secondhand smoke exposure among ultra-Orthodox women in Israel and the influence of cultural and religious factors.

A qualitative phenomenological study was conducted with 17 ultra-Orthodox pregnant and postpartum women exposed to smoking at home. Using a semi-structured interview guide, interviews were conducted by a culturally aligned nurse researcher.

Two primary themes emerged from the narratives: "He smokes but not at such amounts that it bothers me" and smoking is "antithetical to religion". Sixteen women had rules against cigarette smoking at home, although most permitted e-cigarettes in the house, perceiving them as "not as bad". Some of the women identified the risks of secondhand smoke exposure, although none were assessed for or received information about secondhand smoke from health care providers.

Secondhand smoke exposure among ultra-Orthodox pregnant and postpartum women is influenced by socio-cultural and religious factors. Women understood that smoking was unhealthful and often tried to minimize their secondhand smoke exposure although some of the women accepted their husbands' smoking behavior as a norm in their community context. The women perceived smoking as contrary to religious values, despite its prevalence in the community. Health care providers must consider these factors, emphasizing culturally sensitive education and engagement with community leaders when developing and implementing interventions.

Health care providers should assess ultra-Orthodox pregnant and postpartum women about smoke exposure at home. It is critical to educate the women about the risks of secondhand smoke from combustible cigarettes and e-cigarettes, explaining that exposure occurs even in the absence of odor. To reduce exposure, advise families to implement rules against smoking in the home and in the proximity of pregnant women and children. Considering religious and cultural needs, coordinate discussions with rabbinic authorities and health care providers in their communities to develop culturally respectful recommendations and programs for mitigating secondhand smoke exposure, educating about the risks of smoke exposure framed in a religious context.