Introduction

A serious health threat, particularly for newborns and children, is secondhand smoking (SHS). Smoking causes six million deaths globally each year, according to the Centers for Disease Control and Prevention (CDC, 2019). As a result of the rise in cigarette use, more people are being exposed to SHS, which contains over 50 carcinogens and 4,000 harmful toxins and chemicals. Nonsmokers are also at risk for developing heart disease, lung cancer, and other ailments due to exposure to these substances according to the World health organization (WHO 2018).

Unwanted inhalation of tobacco smoke from other people’s cigarettes or burning tobacco items is known as second-hand smoke exposure (SHS). Between 1964 and 2014, 2,500,000 non-smokers died or experienced health-related consequences as a result of exposure to SHS, which comprises 70 kinds of carcinogens (WHO, 2021). Annually, second-hand smoking causes $267 million in medical costs because of the illnesses and deaths it causes in both children and adults. Children are more likely to have respiratory symptoms and infections as a result of the adverse impacts, and their lung development is also slowed (Hock et al., 2019). SHS is especially dangerous to children because of their rapidly developing bodies and quicker breathing rates. Children across the globe are exposed to Second hand smoking at a rate of around 40% (CDC, 2020).

According to two Lancet publications in 1974, babies whose parents smoked had higher medical admission rates, as well as higher rates of bronchitis and pneumonia among their medical problems (Colley et al., 1974; and Harlap and Davies, 1974). Several studies since then have shown an increase in the number of baby deaths due to sudden infant death syndrome (SIDS), asthma, respiratory tract infections (RTIs), and prematurity (Hock et al., 2019). Using the prevalence of exposure in the area and disease-specific estimates for lower respiratory infections, otitis media, lung cancer, asthma, and ischaemic heart disease, Daly et al. (2016) conservatively attributed 603 000 deaths (1% of all deaths) and 10.9 million disability-adjusted life years (DALYs) (0.7 percent of all DALYs) to second hand smoking. No safe amount of SHS exists, and children’s underdeveloped immune systems and lungs make them especially susceptible.

It is the parents’ responsibility to ensure that their children are not exposed to SHS via their own smoking habits at home or in the automobile. Therefore, adult interventions are needed to promote the health of children, and to prevent them from starting to smoke or to assist them in quitting (Martínez et al., 2014). Changing parents’ views and educating them via individual counseling, education, or smoking cessation programs is one way to individual prevention. A structural strategy, on the other hand, relies on tactics like as economic incentives, lowering the supply of cigarettes, tobacco-free advertising, or smoke-free public areas to change the environment and organizational structures (Fernández et al., 2020).

Ethnicity, children’s age, and parental smoking behavior are all connected with parental risk knowledge and perception of the exposure to SHS in children (Cairney and Mamudu, 2014). More protective parents prefer to avoid smoking in the house if they believe their children are at greater danger of exposure from secondhand smoke. Tobacco smokers with children under the age of three are more concerned about exposing them to SHS than those with older kids (Elton-Marshall et al., 2015). Having a smoker in the household increases the chances of a child being exposed to SHS by 3.5 times (Laverty et al., 2020). To create effective treatments for particular groups of parents with low risk knowledge, it is necessary to establish the variables that impact the risk perception of SHS exposure amongst parents.

Children are exposed to SHS because their parents smoke, and programs focused at stopping their parents from smoking are unsuccessful (Kuehni and Barben, 2015). Parents and carers should not be allowed to smoke in the proximity of their children. It may be possible to determine the viability of these initiatives by assessing the opinions of parents of young children on such restrictions. Therefore, this study sought to assess the knowledge and health risk perceptions of parents/carers when it comes to children’s exposure to second hand smoking, as well as their existing actions for preventing children from being exposed to SHS in Middlesbrough, UK.

Literature review

As infants are typically unable to leave smoky situations, they are exposed to the greatest levels of second-hand smoke in the house. Compared to adults, children and babies have smaller airways, higher breathing rates, and underdeveloped immune systems, making them more sensitive to health problems (Wagijo et al., 2017). In rural regions, where smoking rates are higher than normal and quitting rates are lower, exposure to SHS is a particular problem for children. According to research by Protano et al. (2017), socioeconomic status is connected with higher rates of smoking, with high rates of smoking linked to unemployment and overcrowding in public housing, lone motherhood and low income. Infants and children breathe in two times as much home dust as adults do, which means they are exposed to more secondhand smoke particles as a result (Protano et al., 2017).

Recent research conducted in the UK reveals that parents may be unaware of the dangers of secondhand smoke exposure on their children’s health (Norbäck et al., 2019). The researchers documented that people in 318 homes with at least one child under the age of 10 who took part in a cross-sectional study knew of the dangers of secondhand smoke exposure, the results revealed. However, when questioned about the negative effects on children’s health that second-hand smoke exposure may have, the majority mentioned non-specific concerns such as “breathing issues” and “passive smoking”. There have been similar studies worldwide that show a lack of knowledge of particular ailments, despite a basic understanding of the dangers of secondhand smoking exposure (Drehmer et al., 2017; Hill et al., 2017; and Flexeder et al., 2019).

Toxic exposure to second-hand smoke toxins is five to ten times greater for newborns in households with smokers who attempt to shield their children from exposure (e.g., not smoking in front of the kid or doing so outdoors) than in homes where no smokers reside. It is nonetheless true that the exposure of these children is reduced by half compared to those who do not take any precautions. Secondhand smoke contaminates dust, surfaces, and the air in the homes of smokers, putting newborns at danger of exposure to secondhand smoke. Tobacco smoking in a smoker’s house and away from a child may lessen, but not eliminate, the danger of secondhand smoke exposure in a smoker’s home and to an infant (Kassem et al., 2018).

According to the UK Confidential Inquiry into Stillbirths and Infant Death, the risk of Sudden Infant Death Syndrome (SIDS) is 2.5 times higher in households where only the father smokes. Nearly four times as many children die from SIDS if both parents smoke (UK Confidential Inquiry into Stillbirths, 2017). Parents who smoke while pregnant or while breastfeeding have a greater risk of their child dying from Sudden Infant Death Syndrome (SIDS). Thirty-nine research were examined, and all but one found a link between prenatal exposure to chemicals and the infant death syndrome (SIDS). Since most women that smoke during pregnancy keep smoking thereafter, it is impossible to tell if prenatal smoking has any influence on the risk of SIDS or not (Tsai et al., 2018). Exposure to second-hand smoking during infancy may raise the risk of significant infection-related morbidity. The effects of second-hand smoking on preterm and low-birth-weight newborns are more pronounced than on healthy babies.