Facilitators and barriers to implementing smoke-free homes in Armenia: a qualitative study.

Abstract

Smoke-free homes (SFHs) reduce secondhand smoke exposure (SHSe), which is particularly crucial where smoking prevalence is high and public smoke-free policies are nascent, as in some low- and middle-income countries (LMICs). This study examined perspectives regarding SFHs, including barriers and facilitators, among adults in Armenia, a LMIC with high male smoking prevalence and recently-implemented smoke-free policies. In February-March 2024, focus groups were conducted with adults reporting smoking and non-smoking, separately, in two Armenian communities (n = 39; M_age = 41.00, 46.2% female, 61.5% married, 74.4% children in household). Data were examined using thematic analysis. All participants reporting smoking (n = 18) were male, non-smoking participants (n = 21) were primarily (87.5%) female, 53.8% had no SFH restrictions and 12.8% partial. Commonly, smoking was allowed for certain people (e.g. guests) or rooms/spaces (e.g. kitchen, balcony). Common SFH motives were health of children and vulnerable adults (e.g. pregnant women). Salient challenges included high male smoking rates paired with hierarchical gender roles. When asked about strategies to promote SFHs, many suggested leveraging children by involving them in a SFH intervention or emphasizing SHSe's impact on children. While some suggested empowering women as change agents, others suggested targeting men. It is crucial that SFH interventions for Armenian households address Armenia's specific characteristics, such as high male smoking rates and more hierarchical social dynamics. Effective SFH interventions for Armenia may serve as models for other countries with similar characteristics.