Sociocultural Barriers to Reduce Children’s Exposure to SHS in Georgia: A Technical Report

Background Despite the success of Georgia’s 2017 comprehensive tobacco control legislation in public spaces, the home remains the primary setting for children’s exposure to secondhand smoke (SHS), driven by deeply rooted cultural norms and misconceptions regarding protective smoking practices. This study explores parental smoking behaviors and their underlying determinants, with a focus on how clinical cues to action during routine pediatric visits may influence the adoption of strict indoor smoking bans. Methods An exploratory qualitative study was conducted in Tbilisi, Georgia, using stratified purposive sampling to recruit 16 smoking parents of children under 18. Two semi-structured focus group discussions were held, supported by a brief demographic questionnaire adapted from the Global Adult Tobacco Survey. Data were transcribed verbatim and analyzed using qualitative content analysis with inductive coding, while descriptive severity ratings were used to contextualize perceived risk. The Health Belief Model (HBM) guided the interpretation of behavioral determinants. Findings Phase I findings (2020) reveal a widespread reliance on pseudo-protective behaviors, such as smoking near open windows, under kitchen exhaust fans, or on balconies, based on the belief that these measures eliminate risk. This sensory-based logic overlooks the persistence of thirdhand smoke (THS), a toxic residue that remains on surfaces and contributes to continued exposure. This study identifies pediatric health consultations as a critical cue to action, with parents expressing a high willingness to adopt smoke-free home rules when provided with clear, child-specific clinical guidance. Conclusion These findings suggest that interventions focusing on clinical communication strategies, including frameworks such as the 5 A’s and CEASE, may support the reduction of SHS exposure in domestic settings. Phase II (2026) is currently underway to assess the stability of these behavioral patterns over time.