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Int J Epidemiol. 2019 Feb 1;48(1):199-206. doi: 10.1093/ije/dyy209.

Parental tobacco use and child death: analysis of data from demographic and health surveys from South and South East Asian countries.

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Center for Tobacco Control Research and Education.
Helen Diller Family Comprehensive Cancer Center.
Department of Medicine, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.



Child mortality is a public health challenge in developing countries, and exposure to second-hand smoke and prenatal exposure to smokeless tobacco are risk factors for child death. We determined the associations between parental tobacco use and child death under the age of five in eight South and South East Asian countries.


We analysed cross-sectional demographic and health survey data collected between 2005 and 2016, using multiple logistic regressions to estimate the unadjusted and adjusted associations between parental tobacco use and child death, accounting for demographic and economic covariates.


Overall prevalence of tobacco smoking was 46.8% for fathers and 2.7% for mothers, smokeless tobacco use was 32.6% for fathers and 7.8% for mothers and any tobacco use was 67.1% for fathers and 10.1% for mothers. Adjusted for demographic and economic covariates, child death was significantly associated with fathers' [odds ratio: 1.10; 95% confidence interval (CI): 1.03, 1.17] and mothers' (1.44; 1.23, 1.70) smoking tobacco, fathers' (1.25; 1.17, 1.34) and mothers' (1.11; 1.00, 1.23) use of smokeless tobacco and fathers' (1.21; 1.13, 1.29) and mothers' (1.24; 1.12, 1.36) use of any tobacco.


Both smoked tobacco and smokeless tobacco policies should be aggressively implemented in public places and workplaces in developing countries, because they stimulate voluntary smoke and smokeless tobacco-free policies in homes.


Tobacco; chid mortality; low- and middle-income countries; second-hand smoke; smokeless tobacco


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