Elsevier

The Journal of Pediatrics

Volume 157, Issue 6, December 2010, Pages 1012-1017.e1
The Journal of Pediatrics

Original Article
Exposure to Secondhand Smoke and Academic Performance in Non-Smoking Adolescents

https://doi.org/10.1016/j.jpeds.2010.06.013Get rights and content

Objective

To study the association between exposure to secondhand smoke (SHS) and academic performance in non-smoking adolescents.

Study design

A questionnaire survey of 23 052 non-smoking students aged 11 to 20 years was conducted. Information on academic performance, number of days of SHS exposure per week at home and outside the home, number of smokers at home and their relationship with the student, and sociodemographic characteristics was recorded.

Results

Students exposed to SHS at home 1 to 4 and 5 to 7 days per week were 14% (95% confidence interval, 5%-25%) and 28% (15%-41%) more likely, respectively, to report poor academic performance compared with students who were not exposed to SHS. Living with one, two, and ≥3 smokers, compared with no smoker, was also associated with 10% (0.1%-20%), 43% (23%-65%) and 87% (54%-127%), respectively, higher odds of poor academic performance (P for trend <.001). The greatest excess risks were observed with SHS exposure from co-residing non-relatives, followed by siblings, visitors, co-residing grandparents and relatives, and parents.

Conclusion

SHS exposure is associated linearly with poor academic performance in non-smoking adolescents, and the effect of SHS exposure at home is stronger from smokers other than the parents.

Section snippets

Methods

From February 2003 to April 2004, a youth smoking survey with a self-administered questionnaire was conducted in Hong Kong with a high response rate (98%) from students in 85 mainstream secondary schools (non-international schools), which were randomly selected with a probability proportional to school enrollment size pursuant to the requirement of the Global Youth Tobacco Survey.7 Classes from Form 1 to 5 (grades 7-12 in the United States) of the participating schools (total = 1012 classes)

Results

Of all non-smoking students, 19% reported poor academic performance, 68% aspired to achieve a bachelor degree or higher, and 95% realized the harmful effects of SHS. Exposure to SHS at home (36%) and outside the home (66%) was common. One in 3 students lived with one or more smoker (33%), most commonly parents (24%), followed by non-parent family members (9%) and visitors (3%). Table I shows that poor academic performance was associated with male sex, older age, lower parental education,

Discussion

Our positive findings of strong dose-response relations suggest that adolescents are vulnerable to poor academic performance from SHS exposure. We have controlled for the potential confounding effects of socioeconomic status10 by both adjustment and stratification of two locally relevant indicators that adolescents should be able to report, namely parental education and housing type. The coherent findings for SHS exposure outside home, which mainly occurred in indoor environments such as

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    Supported by Hong Kong Council on Smoking and Health and the Department of Health (The Government of Hong Kong S.A.R.). The authors declare no conflicts of interest.

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