Abstract
Smoking remains the main cause of preventable early death. However, little is known about the association between parental smoking and child mortality in under-fives in developing countries. This study assesses the association between parental smoking status, smoking amount and smoking frequency with child mortality in under-fives in four Southeast Asian countries (Cambodia, Indonesia, Lao People’s Democratic Republic and Timor Leste). We used the Demographic and Health Survey dataset. The information from couples consisting of fathers and mothers (n = 19,301 couples) in the same household were collected. Under-five child mortality was significantly associated with paternal smoking only (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.14–1.38), maternal smoking only (OR = 2.40, 95% CI: 1.61–3.59) and both parents smoking (OR = 2.60, 2.08–3.26). Paternal, maternal, both parents’ smoking amount and frequency were also assessed. The estimated association decreased after adjusting for covariates but remained highly significant for smoking in both parents, mothers who smoked 1–10 cigarettes/day, when both parents smoked > 20 cigarettes/day, and in mothers who smoked every day. Future behavioural changes and smoking cessation programmes should engage parents as a catalyst for the reduction of child mortality risk in LMICs in the SEA region.
Highlights
Worldwide, smoking remains the main cause of preventable early death [1]
One-third of those who die from cigarette smoke are children under five years of age, two-thirds of which are in Sub-Saharan Africa and Southeast Asia (SEA)
The proportion of respondents living in urban areas ranged from 25.9% in Cambodia to 50.0% in Indonesia, and the lowest wealth index ranged from 18.2% in Timor Leste to 25.5% in Lao PDR
Summary
Worldwide, smoking remains the main cause of preventable early death [1]. 890,000 deaths were from second-hand smoke, and it was responsible for 150,000 deaths in children in 2017 [2]. According to Global Health Observatory data by the WHO, 40% of children globally are exposed to second-hand smoke, which is accountable for more than 600,000 deaths per year, or approximately one in 100 deaths worldwide. One-third of those who die from cigarette smoke are children under five years of age, two-thirds of which are in Sub-Saharan Africa and Southeast Asia (SEA). Second-hand smoke attributable deaths (per 1000) in children under five years is the highest in LMICs of the SEA region, where children are often exposed to cigarette smoke at home [3]. In Europe and the USA, strict cigarette policies prevents tobacco companies from developing their businesses [2,5]
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