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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 41-46

A study to assess the magnitude of exposure to secondhand smoke among antenatal mothers in an urban slum of central Karnataka


Department of Community Medicine, Karwar Institute of Medical Sciences, Karwar, Karnataka, India

Date of Submission19-Jul-2019
Date of Decision20-Dec-2019
Date of Acceptance02-Apr-2020
Date of Web Publication5-Jun-2020

Correspondence Address:
Malatesh Undi
Department of Community Medicine, Karwar Institute of Medical Sciences, Uttara Kannada, Karwar - 581 301, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_57_19

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  Abstract 


Introduction: Secondhand smoke (SHS) exposure in reproductive-age women can cause adverse reproductive health outcomes similar to active tobacco smoking such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death. Nearly 56% of the reproductive-age women in the World Health Organization South-East Asian region are exposed to SHS. However, no data is available on exposure to SHS among pregnant mothers, especially in urban slums.
Objectives: The objective was to assess the magnitude of exposure to SHS among antenatal mothers in an urban slum and their knowledge regarding hazards of exposure to SHS on them and fetus.
Material and Methods: After obtaining ethical clearance, 418 antenatal mothers who visited the antenatal clinic in an urban slum were included. Data regarding exposure to SHS were collected. Their knowledge on hazards of exposure to SHS on both mother and fetus was also collected.
Results: Majority were in the age group of 21–25 years (55.5%), studied up to high school (40.7%), and were homemakers (72.1%). Among the 418 antenatal mothers, 277 (66.27%) were exposed to secondhand smoke; 199 (47.61%) at public places, 53 (12.68%) at their homes, and 25 (5.98%) at their workplaces. Only half of the study participants were aware that SHS is injurious to health of the individual, and only 24.4% of the study participants were aware that SHS is also injurious to fetal health.
Conclusion: Exposure to SHS among the study participants was high (66.27%), and the awareness regarding the harmful effects of SHS on the health of the mother and fetus among the participants was poor.

Keywords: Antenatal mothers, fetus, magnitude, secondhand smoke, urban slum


How to cite this article:
Annadani RR, Bhat SK, Undi M. A study to assess the magnitude of exposure to secondhand smoke among antenatal mothers in an urban slum of central Karnataka. Indian J Community Fam Med 2020;6:41-6

How to cite this URL:
Annadani RR, Bhat SK, Undi M. A study to assess the magnitude of exposure to secondhand smoke among antenatal mothers in an urban slum of central Karnataka. Indian J Community Fam Med [serial online] 2020 [cited 2020 Oct 30];6:41-6. Available from: https://www.ijcfm.org/text.asp?2020/6/1/41/286030




  Introduction Top


Tobacco use is a leading cause of preventable deaths all over the world.[1] Tobacco is also one of the major causes of deaths and diseases in India, accounting for almost a million deaths every year.[2] Global Adult Tobacco Survey (GATS) India (2010) data revealed that more than one out of three adults in India (35%) used tobacco in some form or the other. Among them, 21% of the adults used only smokeless tobacco, 9% only smoked, and 5% used smoked as well as smokeless tobacco.[3]

Women in South-East Asian Region, who neither smoke nor work for the beedi industry, are still exposed to the effects of tobacco by living in smoking environments and inhaling the tobacco smoke emitted by the smokers. According to the World Health Organization (WHO) 2007 report, in our region, children, women, pregnant mothers, and other nonsmokers are exposed to considerable amount of secondhand smoke (SHS) because most adult male smokers smoke inside homes and in public places. The high levels of nicotine and tar in smoked tobacco, coupled with the poor implementation of smoking bans and high incidence of indoor smoking, put nonsmokers as well as women and children at conspicuous risk of tobacco-related consequences.[4]

According to the WHO, 56% of the women in the South-east Asian region are exposed to secondhand smoke (SHS).[5] Secondhand smoke has twice as much nicotine and tar and five times the carbon monoxide than the smoke that smokers inhale.[6]

Evidence suggests that SHS exposure in women of reproductive age can cause adverse reproductive health outcomes similar to active tobacco smoking such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death.[7] Pregnant women who are exposed to secondhand smoke are estimated to be 23% more likely to experience stillbirth and 13% more likely give birth to a child with a congenital malformation.[8]

Evidence also suggests that infants born to women who use smokeless tobacco in pregnancy have a higher risk of several adverse outcomes such as stillbirth, preterm birth, and low birth weight.[9],[10],[11]

However, extensive review of literature showed that there is scarcity of information about the magnitude of exposure to secondhand smoke (SHS) and knowledge regarding the hazards of exposure to SHS and other tobacco products to both mother and baby among antenatal mothers attending urban health centers in urban slums. Hence, the present study was undertaken to assess the magnitude of exposure to secondhand smoke (SHS) and knowledge regarding hazards of exposure to SHS and other tobacco products to both mother and baby among antenatal mothers attending urban health centers in urban slum of Central Karnataka.


  Material and Methods Top


This was a cross-sectional, observational study conducted at an urban health center located in an urban slum of Davanagere district in Central Karnataka, India, among the antenatal mothers who visited the antenatal clinic in the urban health center for the first time during the study period (June 01, 2016–July 31, 2016) and who gave consent to participate in the study. Antenatal mothers who were willing to participate and visiting the center for the first time during the study period were included in the study.

Sample size

The sample size was calculated considering the prevalence of exposure to SHS among reproductive-age women to be 50.4%.[12] Taking 10% relative precision and confidence interval of 95%, the minimum sample size was calculated to be 400. The participants were selected consecutively as per the outpatient attendance at the antenatal clinic in the urban health center.

Ethical committee approval

This study was conducted after obtaining permission from the Institutional Ethics Review Board (IERB Ref. No. IERB/ICMR-STS/21-2016).

Study procedure

The urban health center situated in the slum was visited with prior permission from the medical officer in charge of the urban health center. At the center, every Monday and Thursday are dedicated as antenatal clinics, and visits for data collection were made during antenatal clinic days. The antenatal women attending antenatal clinic for the first time during the study period were briefed on the purpose of the study and assured confidentiality of the information obtained. Following this, antenatal women who were willing to participate in the study were included; their written informed consent was obtained; and the data regarding sociodemographic profile, exposure to secondhand smoke at home, workplace, and public places such as government buildings, health-care facilities, restaurants, and public transportation in the past 1 month, and exposure to other forms of tobacco were collected using a pretested, semi-structured questionnaire by interview technique. Their knowledge on the hazards of exposure to secondhand smoke and other forms of tobacco on both mother and baby was also assessed by a predesigned, pretested, semi-structured questionnaire by interview technique. Totally, 418 women were included in the study.

Secondhand smoke (SHS) in the study refers to the combination of smoke from the burning end of a cigarette and the smoke breathed out by smokers either indoor or outdoor. SHS is also known as passive smoking or environmental tobacco smoke.

Statistical analysis

The data obtained were coded, entered in Microsoft Excel 2010, validated, and analyzed using statistical software: SPSS Statistics for Windows, version 16.0 (SPSS Inc., Chicago, Ill., USA). The data were presented in mean, standard deviation, and proportions. Multiple logistic regression was applied to find out the factors associated with Secondhand smoke among the study participants. Variable with P < 0.05 was taken as statistically significant.


  Results Top


The data obtained from the total of 418 antenatal women were analyzed, and the results were as follows:

Among the study participants [Table 1], majority were in the age group of 21–25 years (55.5%), studied up to high school (40.7%), and were homemakers (72.1%). Majority of the husbands of the study participants were in the age group of 26–30 years (52.6%), studied up to high school (35.6%), and were semi-skilled workers (42.6%). Majority of the study participants belonged to upper lower class (46.41%), Hindu religion (63.64%), and nuclear (39.71%) and joint family (39.71%) [Table 2].
Table 1: Sociodemographic profile of the study participants

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Table 2: Socioeconomic status and other family details of the study participants

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None of the study participants had a habit of smoking. However, 63 (15.07%) antenatal women agreed that they consume other forms of tobacco. Majority, i.e., 41 (65.07%), said that they consume tobacco leaves along with beetle leaf, followed by gutkha (25.39%) and snuff (9.5%). Among the 418 study participants, 277 (66.26%) of them reported exposure to secondhand smoking (SHS); among the 277 study participants, 199 (47.61%) were exposed to Secondhand smoke at public places, 53 (12.68%) at their homes, and 25 (5.98%) at their workplace (26.92%) [Table 3].
Table 3: Details of exposure to secondhand smoke (n =418) among the study participants

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Majority of the study participants, i.e., 376 (89.95%), were aware that tobacco smoking is injurious to the health of individuals and 259 (61.96%) were aware that tobacco smoking is injurious to the health of the fetus. Half of the study participants were aware that passive smoking is injurious to the health of individuals, but only 102 (24.4%) study participants were aware that passive smoking is also injurious to fetal health. A total of 297 (71%) study participants were aware that other forms of tobacco is injurious to the health of the individual, but only 114 (27.27%) study participants were aware that other forms of tobacco is also injurious to fetal health [Table 4].
Table 4: Awareness regarding the harmful effects of smoking, secondhand smoke, and other forms of tobacco on individual health and health of the fetus (n =418)

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The following were the measures taken by the study participants to avoid Secondhand smoke: majority, i.e., 91 (21.77%), told that they requested the smokers to stop smoking followed by they left that area because of the smell (21.53%), some of the study participants told that they leave that area because passive smoking is injurious to health (5.26%), some opined that they have to stay in the same area because they cannot avoid (4.55%), and few told they that don't do anything (1.91%) [Table 5]. None of these antenatal mothers were enquired for exposure to SHS by the healthcare workers during any of the antenatal visits.
Table 5: Measures taken by the study participants to avoid Secondhand smoke (n =418)

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Multiple logistic regression was applied to find out the factors associated with Secondhand smoke among the study participants. Factors such as women's education (<secondary level), employment of the women, lower socioeconomic status, and active smoking at home were found to be statistically significant associated with the exposure to Secondhand smoke [Table 6].
Table 6: Factors associated with secondhand smoking among the study participants

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  Discussion Top


In the present study, 66.26% of the study participants reported exposure to Secondhand smoke (SHS), of which 47.61% were exposed to SHS at public places followed by 12.68% at home and 5.98% at work environment. According to GATS, India 2009–2010, exposure to Secondhand smoke at any public place was 37% in Karnataka, which is less when compared our study finding; this might be attributed to factors such as study setting (urban slum), wherein the residents are less educated and unaware of the hazards of active as well as passive smoking, because of not exhibiting the public place as designated nonsmoking area, and improper implementation of tobacco control legislations in urban slums. The GATS in Karnataka also showed that exposure to SHS at home and workplaces was 40.7% and 36.5%, respectively, which is high compared to that of our study finding, which may be because of underreporting from the participants and the study participants might be hesitant to reveal the smoking behavior of their husbands and colleagues.[12]

The systematic review of the studies in China published from 1995 through 2012 conducted by Zhang et al. reported that the exposure to SHS among pregnant women was in the range of 60%–70%, which is similar to our study findings.[13] It is also similar to a study done by Lin et al. that reported SHS exposure among mothers of preschoolchildren as 70%.[14]

In the present study, none of the study participants had the habit of smoking, whereas GATS survey reported that 2.4% of females in India had the habit of occasional smoking and only 0.5% had the habit of daily smoking. Our study finding might be attributed to reporting bias because of hesitancy and they might have quit the habit because of pregnancy. Our study also found that 15.07% of the study participants consume other forms of tobacco, which is slightly higher than that in GATS survey, which reported the prevalence of other forms of tobacco usage as 18.4%.

In our study, majority of the study participants were aware that tobacco smoking and other forms of tobacco were injurious to health of the individual, which is similar to the findings of GATS survey and also to a study done by Goel et al., during the year 2004, among the nonsmoking women delivering a singleton pregnancy at a tertiary hospital in Chandigarh.[15]

In the present study, 42% of the study participants were aware that smoking leads to cancer of various organs, but it was less in comparison to the GATS survey, in which they reported that 83.6% of women in Karnataka were aware that smoking causes lung cancer. About 26.79% of women were aware that smoking leads to coronary heart disease, which was again less when compared to the GATS survey report. The present study also found out that less than one-third of the study participants were aware of other consequences of smoking such as asthma (34.21%), pneumonia and other respiratory infections (31.58%), coronary heart diseases (26.79%), cerebrovascular accidents (18.18%), pregnancy complications (12.92%), and peptic ulcer (8.13%).[12]

The overall awareness regarding the adverse effects of tobacco smoke on health of the individuals among the study participants was less when compared with that of the GATS survey report and also to the study done by Goel et al. This was attributed to the background characteristics such as level of education, which is lesser among the residents of urban slums as compared to the others, which leads of lack of knowledge/awareness.[15]

The present study found that more than half of the study participants were aware of the harmful effects of tobacco smoking on the fetus. Around 22.49% were aware that smoking leads to low birth weight followed by fetal death (18.66%), fetal growth restriction (18.42%), still birth (11.48%), reduced respiratory function in fetus (7.42%), and preterm delivery (6.22%), which is less compared to the study done by Goel et al. because of the lower educational status of their participants.[15]

In our study, half of the study participants were aware that passive smoking is injurious to the health of the individual and only 24.4% knew that passive smoking is hazardous to the fetus, which is less when compared to the GATS survey reports and to that of the study done by Goel et al.[15] This is again attributed to the educational status of the study participants residing in the urban slums.

In the present study, less than one-third of the study participants made an attempt to avoid secondhand smoke because of the lack of knowledge regarding the harmful effects of SHS on fetus and mother. Even among those who were aware, efforts by pregnant women to avoid SHS exposure were ineffective or suboptimal, particularly at workplace and in public places. In addition, the study participants might be anxious about disrupting family harmony if they asked their husbands or other family members to stop smoking.


  Conclusion Top


In the present study, 66.26% of the study participants reported exposure to Secondhand smoke (SHS), of which 47.61% were exposed to SHS at public places followed by 12.68% at home and 5.98% at work environment. None of the study participants had a habit of smoking, but 15.07% of antenatal women agreed that they consume other forms of tobacco.

Majority (89.95%) of the study participants were aware that tobacco smoking is injurious to the health of individuals and 61.96% were aware that smoking is injurious to the health of fetus. Half of the study participants were aware that SHS is injurious to the health of the individual, but only 24.4% of the study participants were aware that SHS is also injurious to fetal health. Nearly 71% of the study participants were aware that other forms of tobacco is injurious to the health of individuals, but only 27.27% of the study participants were aware that other forms of tobacco are also injurious to fetal health.

Recommendations

The present study showed that more than two-third of the antenatal mothers attending the antenatal clinic at the urban health center are exposed to secondhand smoke. However, no inquiry regarding the SHS exposure among these mothers is made by the health-care workers during the first visit or subsequent visits at the center. Hence, health-care providers should inquire all antenatal mothers attending the antenatal clinic about their tobacco use (past and present) and exposure to SHS as early as possible in the pregnancy and at every antenatal care visit.

The study also revealed that majority (72.7%) of the antenatal mothers were not aware that SHS exposure during pregnancy is harmful to the fetus. Hence, health-care providers should inform the antenatal mothers, their partners, and other household members about the adverse effects of SHS exposure on fetus and mother and advice strategies to reduce SHS in the home.

Nearly half of the antenatal mothers in the present study were exposed to SHS at public places, which showed that laws on ban of smoking in public places are not effectively enforced. Hence, there is a need for strong enforcement of laws on the ban of smoking in public places and also to provide information to the public regarding whom to contact immediately when they find anyone smoking in public.

Acknowledgement

We would like to acknowledge ICMR, New Delhi for approving this project under ICMR-STS (short term studentship) project with Ref. No. ICMR/STS/2016-01875; however ICMR had no role in designing the study, data collection or analyzing the data obtained by investigators. The final project report has been submitted to ICMR, accepted by it and it has no objection in publishing the final results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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WHO Report on the Global Tobacco Epidemic. Geneva: World Health Organization; 2008.  Back to cited text no. 1
    
2.
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Global Adult Tobacco Survey 2009-10 Document. New Delhi, India: National Tobacco Control Programme, Ministry of Health and Family Welfare, Government of India; 2010.  Back to cited text no. 3
    
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National Cancer Institute. Secondhand Smoke: Questions and Answers. Available from: http://www.cancer.gov/images/Documents/3770da1d-1c3a-4a1c-905f-44140049158/Fs10_18.pdf. [Last accessed on 2016 Aug 20].  Back to cited text no. 6
    
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Wikström AK, Cnattingius S, Galanti MR, Kieler H, Stephansson O. Effect of Swedish snuff (snus) on preterm birth. BJOG 2010;117:1005-10.  Back to cited text no. 10
    
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Zhang L, Hsia J, Tu X, Xia Y, Zhang L, Bi Z, et al. Exposure to secondhand tobacco smoke and interventions among pregnant women in China: A systematic review. Prev Chronic Dis 2015;12:E35.  Back to cited text no. 13
    
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Lin PL, Huang HL, Lu KY, Chen T, Lin WT, Lee CH, Hsu HM. Second-hand smoke exposure and the factors associated with avoidance behavior among the mothers of pre-school children: A school-based cross-sectional study. BMC Publ Health 2010;10:606-10.  Back to cited text no. 14
    
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Goel R, Radotra A, Singh I, Aggarwal A, Dua D. Effect of passive smoking on outcome in pregnancy. J Postgrad Med 2004;50:12-6.  Back to cited text no. 15
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