Association between secondhand smoke exposure at home and cognitive performance among rural primary school children in Malaysia

Abstract

INTRODUCTION Secondhand smoke (SHS) exposure is linked to a series of serious health problems. Children may be particularly vulnerable to the effects of SHS exposure at home. This study aimed to determine the association between SHS exposure at home and cognitive performance in school children. METHODS A multistage sampling was performed across rural primary schools in Kuala Krai, Kelantan, Malaysia. Data were collected using self-administered questionnaires and the children aged 10–11 years (n=312) were subjected to cognitive tests including digit span, letter-number sequencing, coding, and symbol search. Cognitive performance was tested using subscales derived from the Wechsler Intelligence Scale for Children. RESULTS The prevalence of SHS exposure at home was 55.8%, where 11.9% of children lived with one smoker, while 43.9% of children lived with ≥2 smokers. There was a significant difference in the mean score of the combined cognitive tests between SHS-exposed and non-exposed children after adjustment for sex, parental educational level, family income and academic performance [Pillai’s Trace=0.084, F statistic (df)=6.803 (4302), p<0.001]. CONCLUSIONS More than half of the primary school children in rural Kuala Krai were exposed to SHS from at least one smoker at home. There was a significant association between SHS exposure at home and cognitive performance.

High Urinary Cotinine Levels and Low Academic Performance of Elementary School Students in Families with Careless Smoking Habits

“…13,14 The ability to read and count was shown to decline in children aged 6-16 years who were exposed to SHS. 17 This study showed that almost 90% of students stated that they had a family member who smoked at home. Smoking habits were also very likely to expose children with SHS and THS, such as smoking inside the house while meals and watching television with children and other family members, as evidenced by urinary cotinine levels on average of 121.64 ng/mL.…”

Knowledge, Beliefs, and Behaviors Related to Secondhand Smoke and Smoking in the Home: A Qualitative Study With Men in Malaysia

“…Malaysia has a relatively high adult smoking prevalence compared with other South Asian countries, almost one-quarter (21%) of Malaysian adults are smokers. 1 Smoking is almost exclusively a male behavior, with 43% of men aged 15 years and over reported to smoke compared with 1.4% of women. 2 The Malaysian Government has adopted a number of measures to reduce the risks of secondhand smoke (SHS) exposure, prohibiting smoking in several types of public places and workplaces,(for example 3 , 4 ) in line with the Framework Convention on Tobacco Control (FCTC), ratified by the Malaysian government in December 2005.…”

“…The prevalence of children’s SHS exposure at home was 55.8%, with nearly half of children (44%) living in a home with two or more adults who smoked. 1 Only 22% of Malaysian adult smokers and 47% of Malaysian adult nonsmokers report having a completely smoke-free home, according to 2015 Global Adult Tobacco Survey (GATS) data. 13 …”

“…Several published papers have included calls for the development of policies, campaigns, and interventions to reduce nonsmokers' and children’s exposure to SHS in homes in Malaysia. 1 , 9 , 11 , 14–16 It has been suggested that in some Asian cultures traditional gender-based norms may cause some women to refrain from challenging men in their households when they are smoking in the home, even when women perceive the risks of SHS to be high for their children. 17 , 18 An enhanced understanding of adult male smokers’ knowledge, beliefs, and associated home-smoking behaviors could inform the development of behavioral change and educational interventions targeted at men.…”

Development and validation of the Self-efficacy, Knowledge, Attitude and Practice towards Environmental Tobacco Smoke (SE-KAP-ETSQ) in the Malay language for mothers with children below 6 years old.

“…4 A recent local study in Malaysia showed higher ETS exposure among rural primary school children with a prevalence of 55.8%. 5 Several studies identified that the major contributor for child ETS exposure due to parental smoking habit, especially if the ETS comes from the mother. [4][5][6] As younger children tend to spend more time at home, thus increasing the risk of being exposed and exposure time to ETS by parents who…”