ArticleBMJ open2026
Maintaining smoke-free homes in Germany: a hypothesis-generating qualitative study of women's experiences across social and household contexts.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo explore how women perceive, negotiate and maintain smoke-free home rules in Germany, and how age (life stage) and educational experiences shape these processes, using a hypothesis-generating qualitative approach.
designHypothesis-generating qualitative study using semi-structured interviews analysed with thematic content analysis and an interpretive critical discourse layer, informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model.
settingThe German arm of the Qualitative Component of the European Code Against Cancer, 4th Edition study conducted in Bremen, Germany, and coordinated by the International Agency for Research on Cancer.
participantsNine women purposively sampled for maximum variation in age (18-30, 31-45, 46-65 years) and educational level (low, secondary, high); all resided in Germany and had no previous cancer diagnosis.
resultsWomen expressed strong motivation to protect family members, particularly children, from secondhand smoke. However, their ability to enforce smoke-free rules varied. Difficulties were greater when household authority was constrained, when a cohabiting person who smokes shaped daily routines or when smoking was socially normalised. In these situations, women often adopted partial restrictions or harm-reduction strategies. Life stage and educational experiences intersected with household roles and relationship dynamics, shaping women's perceived legitimacy and negotiation strategies.
conclusionsEstablishing and sustaining smoke-free homes is not solely an individual decision but is embedded in social relations, gender roles and structural constraints. These insights suggest that strengthening smoke-free homes in Germany requires approaches that address relational and contextual barriers alongside individual intentions.
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