99% children across the country subjected to second-hand smoking, study reveals

A study co-authored by researchers from the Department of Community Health Sciences and Medicine at the Aga Khan University has discovered the presence of second-hand smoking (SHS) in an alarming 95% of children in Pakistan and Bangladesh.

SHS occurs when people around an active smoker inhale the exhaled tobacco fumes coming from the smoker. This highlights the deeply disturbing ripple effect of smoking, which can penetrate through different social spaces, especially in places where poor smoking restrictions are in place.

The level of SHS exposure in Dhaka and Karachi, the two study sites indicate widespread and unrestricted smoking, according to the researchers. The findings, published in the Nicotine and Tobacco Research Journal, provide evidence for extremely high level of SHS exposure in Karachi, Pakistan where nearly all (99.4%) of the children were found exposed to SHS, the majority of which is perpetuated through male-dominated smoking cultures.

The research team conducted a survey on 2769 children aged 9-14 from 74 primary schools in Dhaka and Karachi to assess their exposure to SHS. To measure the exposure, they tested their saliva to see if it contained cotinine. They examined the association between the adult smoking behaviours of residents and visitors at homes and salivary cotinine levels in children in both cities. Compared to children living with non-smokers, those living with adult smokers had higher levels of SHS exposure. Similarly, children living in houses permitting indoor smoking had slightly higher levels of SHS exposure than those houses where smoking was not permitted.

Dr Romaina Iqbal, and Prof Javaid Khan from the Aga Khan University, Pakistan pointed out that, “The high exposure of children to SHS is in contrast to figures from many developed countries where only a minority of children are now exposed to such risks.”

The effects of second-hand smoking have been long observed and analysed by scientists around the world, and are nothing short of horrendous. It has been proven to add to a variety of respiratory tract infections in newborns, infants, and children right up to the age of adolescence. Moreover, research suggests that children born with hereditary disorders are less likely to survive when exposed to second-hand smoke and may lead to an increased frequency of Sudden Infant Death Syndrome (SIDS).

“This research findings are really alarming. If we cannot protect the children from SHS exposure, they will develop increased risk of respiratory infections and associated deaths and will be at risk of lower academic performance and a high rate of smoking uptake in later life”, said Professor Rumana Huque, from ARK Foundation, Bangladesh and a co-author of the paper.

“It is important to advocate for smoke-free homes and cars to protect children from SHS exposure. However, in addition to these initiatives, it is also important to enforce smoking bans in public places and transportation, especially those public spaces that children frequently visit, such as playgrounds, parks and fairgrounds. It is essential to complement smoking restrictions with tobacco cessation advice and support in these settings,” said Professor Kamran Siddiqi, from University of York, UK, and the Chief Investigator of the study.

The research team called for a comprehensive approach to protect the children from this harm, smoking restrictions in households and enforcement of smoking bans in public places.