Abstract
BackgroundThere is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). The aim of this study is to identify factors influencing schoolchildren's exposures to SHS in Malaysia.MethodThis cross-sectional study was carried out to measure salivary cotinine concentrations among 1064 schoolchildren (10-11 years) attending 24 schools in Malaysia following recent partial smoke-free restrictions. Parents completed questionnaires and schoolchildren provided saliva samples for cotinine assay.ResultsThe geometric mean (GM) salivary cotinine concentrations for 947 non-smoking schoolchildren stratified by household residents' smoking behaviour were: for children living with non-smoking parents 0.32 ng/ml (95% CI 0.28-0.37) (n = 446); for children living with a smoker father 0.65 ng/ml (95% CI 0.57-0.72) (n = 432); for children living with two smoking parents 1.12 ng/ml (95% CI 0.29-4.40) (n = 3); for children who live with an extended family member who smokes 0.62 ng/ml (95% CI 0.42-0.89) (n = 33) and for children living with two smokers (father and extended family member) 0.71 ng/ml (95% CI 0.40-0.97) (n = 44). Parental-reported SHS exposures showed poor agreement with children's self-reported SHS exposures. Multiple linear regression demonstrated that cotinine levels were positively associated with living with one or more smokers, urban residence, occupation of father (Armed forces), parental-reported exposure to SHS and education of the father (Diploma/Technical certificate).ConclusionsThis is the first study to characterise exposures to SHS using salivary cotinine concentrations among schoolchildren in Malaysia and also the first study documenting SHS exposure using salivary cotinine as a biomarker in a South-East Asian population of schoolchildren. Compared to other populations of similarly aged schoolchildren, Malaysian children have higher salivary cotinine concentrations. The partial nature of smoke-free restrictions in Malaysia is likely to contribute to these findings. Enforcement of existing legislation to reduce exposure in public place settings and interventions to reduce exposure at home, especially to implement effective home smoking restriction practices are required.
Highlights
There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS)
The geometric mean (GM) salivary cotinine concentrations for 947 non-smoking schoolchildren stratified by household residents’ smoking behaviour were: for children living with non-smoking parents 0.32 ng/ml (n = 446); for children living with a smoker father 0.65 ng/ml (n = 432); for children living with two smoking parents 1.12 ng/ml (n = 3); for children who live with an extended family member who smokes 0.62 ng/ml (n = 33) and for children living with two smokers 0.71 ng/ml (n = 44)
There were no differences between the children who opted out of the study/or did not provide a sample/or have insufficient saliva samples for laboratory analysis (n = 721) and the children for whom we had a Number opted out of study (n = 721)I, a Number consented to salivary cotinine study (n=1064)II
Summary
There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). There is established evidence linking Secondhand Smoke (SHS) exposures to poor health outcomes [1,2,3,4]. SHS exposures among children have been linked with outcomes such as asthma [5], exacerbations of respiratory ill-health [6], otitis media [7], sudden infant death syndrome [8] and poor cognitive development [9]. In Malaysia, the prevalence of smoking in adults has been estimated at 25% [10] This figure was derived from a cross-sectional study of more than 17,000 Malaysian respondents in 2004 (matching the ethnic distribution of approximately 56% of Malays, 21% Chinese and 11% Indians) and is similar to that obtained for other countries including Scotland [11].
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