Tobacco use in local authority children's homes: a socioecological exploration of influences

Abstract

BackgroundResearch on tobacco use among looked-after children (LAC) has primarily focused on the individual characteristics of young people in care. We aimed to conceptualise additional factors influencing tobacco use by young people living in English local authority children's homes from a policy and provider perspective. MethodsWe did a socioecological analysis of existing data, which included an evaluation of LAC health assessment documentation (n=31 cases), a survey of residential carers in six local authorities in the East Midlands (n=42 respondents), and semi-structured interviews with residential carers (n=14) working in three children's homes operated by one local authority in the East Midlands. We thematically coded and mapped these data to the social ecological model for health promotion to identify and understand the interplay of influences on tobacco use. Collaborative consensus was reached on coding and interpretation. We chose the social ecological model for its potential to answer questions about how to address tobacco use and highlight potential leverage points. Findings32 factors influencing tobacco use were identified: intrapersonal level (n=10), interpersonal level (n=9), institutional level (n=6), community level (n=3), and macro-organisational (policy) level (n=4). The challenge of balancing child protection responsibilities and safeguarding, with expected parenting practices were highlighted. Institutional, organisational, and community strategies were found to facilitate tobacco use. For example, provision of designated smoking areas in the grounds of the homes and the ease at which young people can purchase tobacco in the local area were compounded by the scarcity of policy monitoring and information sharing at the macro-organisational level. Some data fell outside of individual chose the social ecological model levels, requiring a degree of researcher interpretation. InterpretationVarious influences across and within multiple levels of the care system might complicate and compound typical youth smoking influences and measures to address them. We recommend that, in the development of smoke-free children's home policies, local authorities should be guided by the experiences and knowledge of carers and be cognisant of previous implementation challenges or successes to enable informed and contextually relevant strategies to be developed and implemented. This study offers a much-needed direction for developing and testing tobacco-related interventions targeting this vulnerable population. FundingUniversity of Nottingham PhD studentship and the UK Centre for Tobacco and Alcohol Studies.