Background Second-hand tobacco smoke (SHS) exposure is a cause of serious disease for children. The home is now the main environment where SHS exposure occurs. This may have been exacerbated during the pandemic because of ‘stay at home’ restrictions. The novel use of nicotine replacement therapy (NRT) for temporary abstinence indoors may help to overcome challenges associated with creating a smoke-free home in more disadvantaged households, including lack of access to garden space and sole caring for children/grandchildren. NRT is widely used as an aid to quitting smoking, however current NHS practice does not extend to prescribing NRT for temporary abstinence to create a smoke-free home. This study explored the feasibility of providing free NRT to smokers through local community pharmacies for this purpose.

Methods Twenty-five adult smokers who smoked in the home and cared for children at least weekly were recruited via Facebook. They discussed NRT product choice with a local participating pharmacy and used NRT for up to 12 weeks in the home, with ongoing advice available from pharmacy staff. Participants could switch NRT product if their first choice product didn’t suit them. As a quantitative outcome measure, participants undertook seven days of air quality monitoring in their home using a PurpleAir PA-II-SD monitor (PurpleAir Inc., Draper, USA) before receiving NRT (week 1) and 12 weeks later (week 13). Mean fine particle (PM_2.5­) concentrations were compared between each pair of measurements and results were fed back during qualitative interviews which explored experiences of using NRT in this way.

Results Most participants reported positive experiences of discussing and accessing NRT through local pharmacies, using NRT with little to no ongoing support. A few participants reported creating a smoke-free home, several reported reduced cigarette consumption (indoors and overall), and one participant quit smoking. Some reported no change to indoor smoking behaviours whilst SHS levels decreased in some homes, overall paired air quality measurements show little change in SHS concentrations indoors. Some follow up air quality readings may have been affected by reduced ventilation in homes where measurements were obtained during winter months and by others’ smoking in the home.

Conclusion Access to free NRT through local community pharmacies may assist some smokers in disadvantaged homes to move towards creating a smoke-free home for the children they care for. Future studies should include use of quantitative outcome measures which are less likely to introduce seasonal effects.