Ethical Issues in COVID-19 Communication to Mitigate the Pandemic: Dilemmas and Practical Implications.

Communication plays a critical role in all stages of a pandemic. From the moment it is officially declared governments and public health organizations aim to inform the public about the risk from the disease and to encourage people to adopt mitigation practices. The purpose of this article is to call attention to the multiple types and the complexity of ethical challenges in COVID-19 communication. Different types of ethical issues in COVID-19 communication are presented in four main sections. The first deals with ethical issues in informing the public about the risk of the pandemic and dilemmas regarding communicating uncertainty, using threats and scare tactics, and framing the pandemic as a war. The second concerns unintended consequences that relate to increasing inequities, stigmatization, ageism, and delaying medical care. The third raises ethical issues in communicating about specific mitigation practices: contact tracing, wearing face masks, spatial (also referred to as social) distancing, and handwashing or sanitizing. The fourth concerns appealing to positive social values associated with solidarity and personal responsibility, and ethical challenges when using these appeals. The article concludes with a list of practical implications and the importance of identifying ethical concerns, which necessitate interdisciplinary knowledge, cross-disciplinary collaborations, public discourse and advocacy.

"I can't stand it but I do it sometimes" parental smoking around children: practices, beliefs, and conflicts - a qualitative study.

BACKGROUND: Many parents continue to smoke around their children despite the widely known risks of children's exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents' perspective. METHODS: Semi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents' perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic. RESULTS: Many parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered 'safe'. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change. CONCLUSION: Findings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking 'rules' and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.

Parental Perceptions and Misconceptions of Child Tobacco Smoke Exposure.

Introduction: Forty percent of young children worldwide are exposed to the harmful effects of tobacco smoke, predominantly by parental smoking. Little is known about why parents regularly expose their children to these risks; perhaps parents underestimate the degree of exposure. Qualitative methods were used to investigate parental perceptions of tobacco smoke exposure. Methods: Sixty-five in-depth interviews were conducted with parents of young children in smoking families in central Israel. Parents were asked to explain what "exposure to smoking" meant. Thematic analysis was performed, a conceptual model of perceptions was built, and misconceptions were identified. Results: Parents reported that exposure occurs when smoke or smokers are visible, when smoke can be smelled, felt, or inhaled, or when it "reaches" an individual. Conversely, some believed that exposure does not occur in the absence of odor, visible smoke, or smokers or if smoking occurs outdoors or in indoor ventilated environments. Proximity in space and time affected perceptions of exposure; some parents believed that smoke does not spread far but dissipates rapidly. There was some uncertainty regarding whether or not exposure was occurring. Conclusions: Awareness of child exposure to tobacco smoke among parents in this study was based on sensory perceptions in the context of the physical environment. The limited capacity of humans to perceive tobacco smoke can lead to misconceptions about exposure. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. Implications: Parents use sensory perceptions (sight, smell, and feel) in the context of the physical environment to assess whether or not their children are exposed to tobacco smoke. Because 85% of smoke is invisible and the sense of smell is unreliable, assessments based on sensory perceptions cannot provide accurate information about the presence of tobacco smoke. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. The scientific information summarized here about exposure in common situations should be useful in persuading parents to protect their children. Clinical Trial Registration: This study is registered as a Phase I study which is part of a larger research endeavor entitled: A program to protect young children from tobacco smoke exposure. Registration number: NCT01335178.

Spreading the handwashing message: an alternative to traditional media campaigns.

Schools are a natural place from which to disseminate health messages to the community. Sending an entertaining handwashing video home with preschoolers as a component of a school-based program yielded impressive degrees of penetration and reach among families; consequently, this strategy offers a promising alternative to traditional media campaigns.