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Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS)
  1. Lazarous Mbulo1,
  2. Krishna Mohan Palipudi1,
  3. Linda Andes1,
  4. Jeremy Morton1,
  5. Rizwan Bashir1,
  6. Heba Fouad2,
  7. Nivo Ramanandraibe3,
  8. Roberta Caixeta4,
  9. Rula Cavaco Dias5,
  10. Trudy M A Wijnhoven5,
  11. Mina Kashiwabara6,
  12. Dhirendra N Sinha7,
  13. Edouard Tursan d'Espaignet8
  14. on behalf of the GATS Collaborative Group
  1. 1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
  2. 2Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
  3. 3Regional Office for Africa, World Health Organization, Brazzaville, Congo
  4. 4Pan American Health Organization, World Health Organization, Washington DC, USA
  5. 5Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
  6. 6Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
  7. 7Regional Office for South-East Asia, World Health Organization, New Delhi, India
  8. 8Tobacco Free Initiative, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Lazarous Mbulo, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-79, Atlanta, GA 30341, USA; vyp7{at}


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.

  • Secondhand smoke
  • Surveillance and monitoring
  • Global health

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