Knowledge, attitude, and practices of pregnant women regarding environmental tobacco smoke in Yerevan and Nor-Hachn, Armenia 2007: a Qualitative study

Abstract

According to the World Health Organization (WHO), Armenia is the sixth in the world for and number one smoking country in Europe: 63.7% of men (the heaviest puffers in Europe) and 3.1% of women in Armenia are smokers. The Armenian population is highly exposed to environmental tobacco smoke (ETS) everywhere. The Global Youth Survey, conducted in 2004 in Armenia, reported 90.1% of never smokers and 96.4% of current smokers are exposed to ETS at their households. A nationwide survey, in 2006, states that 90 % of interviewees report smoking in their households during the last month. In regards to smoking rules at home, 53% reported no restriction in households for family members and guests, and 16% - smoking is allowed in some rooms. Unfortunately, no official data exists in terms of pregnant women ETS exposure. A pilot survey done for this study showed 95 % of women interviewed were exposed to ETS during their pregnancies. The problem of pregnant women’s exposure to ETS is particularly alarming, because this population is the most vulnerable group of the Armenian population, as both mother and fetus health is jeopardized. To protect future generations of Armenia a policy limiting exposure to ETS should be developed. Thus, there is a need to understand the problem deeply and from a behavioral perspective for which qualitative research is the most appropriate methodology. The aim of this study was to explore the knowledge, attitude and practices of pregnant women regarding ETS. An exploratory qualitative study was conducted in Yerevan and NorHachn, Kotayk marz, health facilities. A semi-structured interview guide was employed. The sampling was done by convenience. Inclusion criteria were pregnant women above 18 years of age and registered for prenatal care. Twenty-five pregnant women were interviewed: fifteen in Nor-Hachn policlinic and ten in Yerevan. Interviews were tape-recorded. Data were analysed manually. The study revealed a lack of information which results in poor knowledge about active/passive smoking health effects, particularly on pregnant woman and fetus. As the study shows this in turn forms tolerate behavior of pregnant women towards passive smoking in the households. Almost all interviewees mentioned no actions to avoid or minimize tobacco smoke. Women who realize the danger of smoke and try to avoid it by asking smokers not to smoke got no results and conflicts in the family. This study yields also the absence of information given by health care providers, specifically by gynecologists and nurses about ETS health effects on pregnant woman and fetus. The determinants of this problem do not work separately; they are interrelated with each other, as well as with social and cultural issues. Based on the study findings the following recommendations are suggested: to conduct a quantitatve study in order to posess generalizable results; to develop and implement health education programs about passive smoking health effects on pregnant woman and fetus; to train and instruct gynecologists and nurses to give advice to pregnant women about passive smoking health effects on pregnant woman and her fetus during prenatal care.