Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS)
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OBJECTIVE: Children are vulnerable to secondhand smoke (SHS) exposure because of limited control over their indoor environment. Homes remain the major place where children may be exposed to SHS. Our study examines the magnitude, patterns and determinants of SHS exposure in the home among children in 21 countries (19 low-income and middle-income countries and 2 high-income countries). METHODS: Global Adult Tobacco Survey (GATS) data, a household survey of people 15 years of age or older. Data collected during 2009-2013 were analysed to estimate the proportion of children exposed to SHS in the home. GATS estimates and 2012 United Nations population projections for 2015 were also used to estimate the number of children exposed to SHS in the home. RESULTS: The proportion of children younger than 15 years of age exposed to SHS in the home ranged from 4.5% (Panama) to 79.0% (Indonesia). Of the approximately one billion children younger than 15 years of age living in the 21 countries under study, an estimated 507.74 million were exposed to SHS in the home. China, India, Bangladesh, Indonesia and the Philippines accounted for almost 84.6% of the children exposed to SHS. The prevalence of SHS exposure was higher in countries with higher adult smoking rates and was also higher in rural areas than in urban areas, in most countries. CONCLUSIONS: A large number of children were exposed to SHS in the home. Encouraging of voluntary smoke-free rules in homes and cessation in adults has the potential to reduce SHS exposure among children and prevent SHS-related diseases and deaths.
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In many countries, there is still a 40% level of SHS exposure among children.
“Studies from Malaysia and Bangladesh20 have demonstrated that, in many countries, there is still a 40% level of exposure among children.”
From Estimated Worldwide Mortality Attributed to Secondhand Tobacco Smoke Exposure, 1990-2016 (2020) · cites this paper as [20]
The Results report that 48.7% of children under 15 across the 21 countries studied were exposed to SHS at home, supporting the claim that exposure remains widespread but not its stated 40% figure. The Introduction cites a separate estimate of 40% worldwide exposure in any environment; this paper does not present itself as a study from Malaysia and Bangladesh. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPrivate homes remain a major source of SHS exposure, particularly for women and children.
“Moreover, private homes remain a major source of SHS exposure, particularly for women and children3,460”
From Health effects associated with exposure to secondhand smoke: a Burden of Proof study (2024) · cites this paper as [3]
The Objective states that homes remain the major place where children may be exposed to secondhand smoke, and the Results document substantial exposure at home among children in 21 countries. The paper does not establish the corresponding claim for women. Section labels are available in our copy, but page numbers are not. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSmoking in homes results in sustained high levels of particulate and gaseous pollution and is an increasingly important source of secondhand smoke exposure, particularly for children, with an estimated 430 million people exposed in China, India, Bangladesh, Indonesia, and the Philippines alone.
“Smoking in homes results in sustained high levels of particulate and gaseous pollution and is an increasingly important source of SHS exposure, particularly for children (147-149), with a point of times estimate, based on the latest available survey in each country, of 430 million people estimated to be exposed in China, India, Bangladesh, Indonesia, and the Philippines alone (101).”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [101]
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- Authors
- Mbulo, L., Palipudi, K. M., Andes, L., Morton, J., Bashir, R., Fouad, H., Ramanandraibe, N., Caixeta, R., Dias, R. C., Wijnhoven, T. M. A., Kashiwabara, M., Sinha, D. N., Tursan d'Espaignet, E., & on behalf of the GATS Collaborative Group
- Affiliations
- Centers for Disease Control and Prevention (US)
- World Health Organization Regional Office for the Eastern Mediterranean (EG)
- World Health Organization Regional Office for Africa (CG)
- World Health Organization Regional Office for the Americas (US)
- World Health Organization Regional Office for Europe (DK)
- World Health Organization Regional Office for the Western Pacific (PH)
- World Health Organization Regional Office for South-East Asia (IN)
- Corresponding author
- Mbulo, Lazarous
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2016-02-11
- Volume
- 25
- Issue
- e2
- Pages
- e95-e100
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- PMC
- PMC5488799
- OpenAlex
- W2318208204
- Cited by
- 141
- References
- 31
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 10 · 2023: 11 · 2022: 21 · 2021: 15 · 2020: 13 · 2019: 11 · 2018: 11 · 2017: 4 · 2016: 11
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Tobacco Control (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- World Health Organization
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- passive smoking, children, family environment, indoor air pollution, prevalence estimates, urban-rural differences, low- and middle-income countries
- MeSH terms
- Adolescent, Child, Child, Preschool, Developing Countries, Environmental Exposure, Health Surveys, Humans, Infant, Infant, Newborn, Smoking, Tobacco Smoke Pollution, Global Health, Prevalence, Air Pollution, Indoor, Developed Countries
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