Secondhand smoke exposure in children: It is time to move forward

Global burden of lower respiratory infections attributable to secondhand smoke among children under 5 years of age, 2010-2019: a systematic analysis of the global burden of disease study 2019

BACKGROUND

Epidemiological trends of lower respiratory infections (LRIs) attributable to secondhand smoke (SHS) among children under 5 years since smoking bans have been increasingly applied globally remain unclear. Here, we aimed to estimate the spatiotemporal trends of the global, regional, and national burden of LRIs attributable to SHS among children under 5 years old between 2010 and 2019.

METHODS

Data on the deaths, and disability adjusted life years (DALYs) of the disease burden was retrieved from the Global Burden of Disease (GBD) 2019 for 204 countries and territories between 2010 and 2019. The rates per 100,000 population, along with 95% uncertainty intervals, as well as population-attributable fraction (PAF) was presented for each estimate.

RESULTS

In 2019, an estimated 6.94% (3.80-10.12%) of under-5 LRIs deaths were attributable to SHS globally, with an under-5 mortality rate of 7.02 per 100,000, a decrease of 5.77% since 2010. Similarly, 6.95% (3.81-10.13%) of LRIs DALYs were due to SHS among children under 5 years, with a rate in under-5s of 619.36 DALYs per 100,000, and also a 5.77% decrease since 2010. Azerbaijan, Turkmenistan, and Papua New Guinea showed the highest under-5 mortality and DALYs burden rates of LRIs attributable to SHS in 2019. In contrast, the PAF was stagnant over the past ten years and there is even a year-on-year upward trend in South Asia. Nationally, in 2019, Bosnia and Herzegovina, Armenia, and Montenegro showed the highest PAFSHS of LRIs burden among children under 5 years of age. In addition, the burden was heavier in children under 1 year of age and was significantly negatively associated with sociodemographic index.

CONCLUSIONS

SHS remains a risk factor that cannot be ignored for LRIs burden worldwide. Hence, governments and health systems should continue to take steps to reduce SHS pollution among young children to mitigate this burden.

Social inequalities in secondhand smoke exposure in children in Spain

INTRODUCTION

Children are particularly vulnerable to the health effects of secondhand smoke (SHS). The objectives of this study are to describe SHS exposure of children younger than 12 years in Spain and to identify potential social inequalities associated with SHS exposure.

METHODS

A cross-sectional study was conducted in a representative sample of the population younger than 12 years in Spain. A computer-assisted telephone interview was conducted with parents or legal guardians in 2016, to assess the children’s SHS exposure at home, in the car, at school and at the nursery gates, in public transport, and during leisure time. The socio-demographic variables included were the child’s age and sex, the highest educational attainment at home, and occupational social class. Prevalence and 95% confidence intervals were calculated for SHS exposure in each setting and for overall exposure.

RESULTS

In all, 71.8% of the children were exposed to SHS: 25.8% were exposed at home, 4.6% in the car, 8.2% in public transport, 31.9% at outdoor nursery or school gates, and 48% during leisure time. The higher the educational attainment at home, the lower the exposure (38.8% for primary school or lower, 28.7% for secondary school and 20.8% university level). The more deprived the social class, the higher the exposure (21.7% class I-II, 23.4% class III-IV and 31.1% class V-VII). SHS exposure in cars and overall exposure also decreased with higher educational achievement.

CONCLUSIONS

In Spain, a large proportion of children are still exposed to SHS. Furthermore, there are clear social inequalities. To reduce SHS exposure, there is an urgent need for evidence-based interventions with an equity perspective.