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Open Access Research article

Second-hand smoke exposure and the factors associated with avoidance behavior among the mothers of pre-school children: a school-based cross-sectional study

Pi-Li Lin12, Hsiao-Ling Huang3, Kuei-Yun Lu4, Ted Chen5, Wei-Ting Lin6, Chien-Hung Lee6 and Hsiang-Ming Hsu7*

Author Affiliations

1 Graduate Institute of Medical Science, Tzu Chi University, 701, Zhongyang Road, Sec. 3, Hualien, 97004, Taiwan

2 Department of Nursing, Meiho University, 23, Pingguang Rd., Neipu, Pingtung, 91202, Taiwan

3 Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan

4 School of Nursing, Fooyin University, 151, Chinhsueh Rd., Ta-liao, Kaohsiung, 831, Taiwan

5 Department of Community Health Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA

6 Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan

7 Department of Public Health, Tzu Chi University, 701, Zhongyang Road, Sec.3, Hualien, 97004, Taiwan

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BMC Public Health 2010, 10:606  doi:10.1186/1471-2458-10-606

Published: 14 October 2010



Second-hand Smoke (SHS) exposure is a significant public health problem that may be responsible for serious health hazards for child. This study aimed to examine the exposure status of SHS and the factors associated with SHS avoidance behavior among the mothers of pre-school children.


A cross-sectional study was used to obtain a sample of the mothers of pre-school children (n = 1,020) in 30 registered kindergartens in eastern Taiwan. Overall, 919 (a response rate of 90%) completed the questionnaires. Regression models were used to identify factors with respect to the avoidance behavior of SHS.


The prevalence of exposure to SHS was 70% and 50% for the mothers and their children, respectively. After adjusting for other variables, mothers who were current smokers (β = -0.260, p < 0.001), had spouses who smoked (β = -0.060, p < 0.05), SHS exposure (β = -0.138, p < 0.001), and/or children with exposure to SHS (β = -0.084, p < 0.05) were found to be less likely to avoid SHS, whereas mothers with a high knowledge score about SHS (β = 0.082, p < 0.01), positive attitudes (β = 0.274, p < 0.001) and a high self-efficacy level in regard to the avoidance of SHS (β = 0.397, p < 0.001) were observed to be more likely to avoid SHS. Regression analyses confirmed that the significantly factors associated with the avoidance behavior of SHS were self-efficacy, being a current smoker, and the attitude toward the avoidance of SHS to be that of 55.5% of the total variance explained (p < 0.001).


The high prevalence rate of exposure to SHS for mothers and their children suggests that a well-designed future intervention program should be implemented in regard to pre-school children's mothers in order to prevent these mothers and their children from SHS exposure hazards, more particularly, to strengthen the knowledge base, to enhance self-efficacy and to foster a more positive attitude toward the avoidance of SHS in the mothers.