# Health Needs and Challenges in Preventing Secondhand Smoke Exposure Among Rural Adolescents: Implications for Innovative Health Education

## TL;DR

This study explores how rural adolescents in Taiwan are exposed to secondhand smoke and examines a health education program to help them advise family smokers, highlighting cultural and practical challenges.

## Contribution

The study introduces and evaluates innovative strategies for adolescents to advise family smokers in a rural setting, with implications for health education and policy.

## Key findings

- 46.9% of participants attempted to advise family members to quit smoking or smoke outdoors after the program.
- Factors associated with advising included being female, avoidance behaviors, and witnessing smoking on campus.
- Cultural values like filial piety and parental resistance posed significant challenges to successful advice.

## Abstract

Adolescents exposed to secondhand smoke (SHS) and those living with parents who smoke are at higher risk for tobacco use and adverse health outcomes. School nurses are expected to support smoke-free policies on campuses and play a prominent role in health promotion. However, few nursing studies on SHS exposure prevention have included recommended strategies for advising family smokers (AFS).

This study was developed to examine the prevalence of SHS exposure among adolescents in rural areas and assess the impact of implementing a pilot program that incorporates innovative strategies for AFS.

A school-based, educational intervention study was conducted in four middle schools in western coastal Yunlin County between March and September 2023. Innovative strategies for AFS were integrated into the school’s health education curricula using a 6-hour secondhand smoke prevention program. Data were collected using self-administered, anonymous questionnaires. Descriptive and inferential statistical analyses were employed to examine the factors and barriers associated with AFS.

Of the 1,202 adolescents who participated at baseline, 806 (51.4% boys; mean age=13.5 years) reported living with a smoker at home (67%). Among these 806, 91.4% reported family members smoked indoors, and, after completing the AFS program, 46.9% reported having attempted to advise their family members to quit smoking or smoke outdoors. The factors identified as significantly associated with AFS included being female, practicing avoidance behaviors, and witnessing smoking on campus. Only 8.1% felt their advice was successful, with common challenges including parental refusal, being scolded, and feelings of hopelessness. Also, many of the participants reported experiencing moral dilemmas, particularly with regard to cultural values such as filial piety, when advising parents.

Exposure to secondhand smoke among adolescents living in rural areas is a serious issue. Teaching them strategies on how to advise family smokers may help reduce home exposure, particularly among boys. However, in Eastern cultures, advising parents about smoking presents moral challenges due to cultural values. Regulatory changes are needed to protect youths from secondhand smoke at home.