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Household secondhand smoke exposure of elementary schoolchildren in Southern Taiwan and factors associated with their confidence in avoiding exposure: a cross-sectional study

Hsiao-Ling Huang1, Yea-Yin Yen1, Pi-Li Lin2, Chin-Hsuan Chiu1, Chih-Cheng Hsu3, Ted Chen4, Chih-Yang Hu5, Ya-Ying Lin6, Chien-Hung Lee7 and Fu-Li Chen8*

Author Affiliations

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

2 Department of Nursing, Meiho University. 23, Pingguang Rd., Neipu Town, Pintung County 91202, Taiwan

3 Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes. No. 35, Keyan Road, Zhunan Town, Miaoli County 350, Taiwan

4 Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA

5 School of Public Health, Health Sciences Center, Louisiana State University, New Orleans, LA 70112, USA

6 Department of Physical Therapy, Shu Zen College of Medicine and Management. No. 452, Huanqiu Rd., Luzhu District, Kaohsiung City 82144, Taiwan

7 Department of Public Health, College of Health Science, Kaohsiung Medical University. 100 Shih-Chuan 1st Road, Kaohsiung City 80708, Taiwan

8 Department of Public Health, Fu-Jen Catholic University. 510 Jhongjheng Rd., Sinjhuang District, New Taipei City 24205, Taiwan

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BMC Public Health 2012, 12:40  doi:10.1186/1471-2458-12-40

Published: 17 January 2012



Exposure to household Secondhand Smoke (SHS) poses a major health threat to children after an indoor smoking ban was imposed in Taiwan. This study aimed to assess the household SHS exposure in elementary school children in southern Taiwan and the factors associated with their avoidance of SHS exposure before and after the implementation of Taiwan's new Tobacco Hazards Prevention Act in 2009.


In this cross-sectional school-based study, data on household SHS exposure, avoidance of SHS and related variables was obtained from the 2008 and 2009 Control of School-aged Children Smoking Study Survey. A random sample of 52 elementary schools was included. A total of 4450 3-6 graders (aged 8-13) completed the questionnaire. Regression models analyzed factors of children's self-confidence to avoid household SHS exposure.


Over 50% of children were found to have lived with a family member who smoked in front of them after the new law enacted, and 35% of them were exposed to household SHS more than 4 days a week. Having a positive attitude toward smoking (β = -0.05 to -0.06) and high household SHS exposure (β = -0.34 to -0.47) were significantly associated with a lower avoidance of SHS exposure. Comparing to girls, boys had lower scores in their knowledge of tobacco hazards; and this factor was significantly related to their SHS avoidance (β = 0.13-0.14).


The intervention program should enhance school children do actively avoid exposure to SHS in home settings, and more importantly, provide tobacco hazard knowledge to male students to avoid exposure to household SHS for themselves. The results also provide further evidence that Tobacco Hazards Prevention Act should perhaps be extended to the family environment in order to protect children from the hazards of household SHS exposure.

Children; Secondhand smoke