gms | German Medical Science

Background and objectives: Second-hand smoke (SHS) is a harmful risk factor which may cause acute and chronic diseases [1], [2]. Currently, Bangladesh faces the challenges of both demographic and epidemiological transition. Bangladesh is a highly susceptible country for SHS due to high smoking rates and low awareness about the harmful effects of SHS [3]. This study aims to identify the SHS exposure and its determinants which are essential to implement successful strategies to prevent adverse health effects in Bangladesh.

Methods: The analysis is based on the Bangladesh Demographic and Health Survey (BDHS) 2011, in which 17,749 women in the reproductive age group (12-49 years) were included. The information regarding SHS exposure was derived from the question: “How often does anyone smoke inside your house?” The variable was recoded into three groups: high (daily exposed), low (weekly, monthly or less than monthly exposed) and no SHS exposure. Independent variables on sociodemographic and socioeconomic characteristics, place of residence (urban vs. rural, divisions of Bangladesh) and household structure were selected. Concerns regarding water safety were used as a proxy for health behaviour in general, decisions on health care as a sign of empowerment and frequency of watching TV as a proxy for access to health information. We performed descriptive and bivariable analyses and multinomial logistic regression.

Results: A total of 46.7% of the women reported high exposure to SHS at home. Almost all bivariable analyses revealed significant results (p<0.05). According to the multinomial logistic regression model, women with no education had 3.93 (95%-CI: 3.34-4.61) times higher odds of being highly exposed to SHS at home than women with higher education (p<0.001). The likelihood of being highly exposed doubled in the sample of poor women (OR: 2.08; 95%-CI: 1.88-2.30) compared to women of the rich population (p<0.001). Large household sizes, and lower practices to make water safe (as a proxy for health behaviour) were significantly associated with high SHS exposure at home. Children at home and the Islamic religion were protective factors. The exposure differed significantly between the divisions of Bangladesh.

Conclusion: The study clearly indicates that socioeconomically disadvantaged households in terms of education and wealth index are more exposed to SHS at home. Therefore, more public attention is needed particularly for these vulnerable groups, in addition to aspects of legislation, to reduce tobacco consumption. Greater efforts to educate smokers about the health risks associated with SHS for themselves as well as for their family members are necessary. Measures to reduce SHS exposure particularly at home are scarce. Therefore, future research should investigate how this exposure can be lowered, smoking initiation be prevented and smoking cessation be facilitated.