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 Table of Contents 
Year : 2021  |  Volume : 10  |  Issue : 5  |  Page : 1804-1807  

Exposure of second hand smoke in women and children: A narrative review

Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India

Date of Submission09-Jul-2020
Date of Decision17-Sep-2020
Date of Acceptance21-Jan-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Twinkle Sharma
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_1397_20

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Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.

Keywords: COVID-19, pregnancy, second-hand smoke, tobacco smokeCOVID-19

How to cite this article:
Sharma T, Khapre M. Exposure of second hand smoke in women and children: A narrative review. J Family Med Prim Care 2021;10:1804-7

How to cite this URL:
Sharma T, Khapre M. Exposure of second hand smoke in women and children: A narrative review. J Family Med Prim Care [serial online] 2021 [cited 2021 Jul 23];10:1804-7. Available from: https://www.jfmpc.com/text.asp?2021/10/5/1804/317266

  Introduction Top

Smoke that remains in the environment by active smokers is called as second-hand smoke (SHS). Every year approximately 1.2 million people die due to second-hand smoke exposure.[1]

Second-hand Smoke: A neglected public health issue

The tobacco epidemic is one of the biggest threats to public health of the world and is amounting to 8 million deaths per year around the world.[1] According to WHO “Every person should be able to breathe tobacco-smoke-free air”[2] which can be difficult to attain in India as 80% of smokers are from developing countries.[1] Incomprehensive ban on smoking has taken this right to breathe in clean air from non-smokers of this world. Studies had confirmed the harmful effects of Second-hand smoke, especially in women and child population.[3],[4] However, the research on impact of SHS at a population level is limited.

This comprehensive review was planned to compile the studies on prevalence of second-hand smoke among pregnant women, assess the contributing factors and successful interventions executed in various studies and suggestion to reduce SHS exposure.

  Methodology Top

A comprehensive search of the literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications since 2004 or later on Second-hand smoke exposure among pregnant women.

Evidence on Second-hand smoke exposure among pregnant women

Number of studies had documented a varying prevalence of Second-Hand smoke exposure among pregnant women as given in [Table 1].
Table 1: Prevalence of SHS among pregnant women in India

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Factors behind SHS exposure

Studies had documented many contributing factors for exposure to passive smoke in non-smoker pregnant women [Table 2]. Study conducted in India concluded that the ignorance, low status in the family and unfavorable social environment are the barriers for creating a smoke-free environment for pregnant women who are not smokers and weakened preventive actions.[6] Another factor reported was inefficacy of women in demanding a smoke-free home from their husbands.[11] Educational programs and empowerment targeting younger and poor socio-economic status women are important to improve self-efficacy in adopting healthy behaviour to avoid second-hand smoke exposure for both husband and pregnant wife.[12]
Table 2: Contributing Factors related to Second-hand smoke exposure among Women

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Legislation that comprises a partial ban on smoking in public spaces such as COTPA (2003) was also a contributing factor leading to increased prevalence of smoking in non-prohibited areas like homes.[13],[14] Sen Zeng et al. in their study (2019) found that a partial ban on smoking may barely bring any change in overall smoking behaviours and rather it will displace smokers from governed public places to other unregulated private places. This can lead to increased exposure of SHS in non-smokers at places like their homes and places of work. It was, therefore, suggested to have a comprehensive ban policy.[15]

Women and children of developing countries are at increased risk of exposure to second-hand smoke due to factors like varying gender prevalence of smoking, more time spend by women and children at home compared to males and poorly ventilated housing condition.[16] Women from weaker socio-economic sections were more likely to experience tobacco smoke exposure as concluded in the study done in Bangladesh by Florian Fisher in the year 2011.

Effects on maternal and child health

It is a known fact that smoking has harmful effects on maternal and fetal health due to diffusion of nicotine into fetal blood, breast milk and amniotic fluid and its negative effect on neurological development.[5],[20] As maternal and Child health indicators are already adverse, SHS adds more to this by being associated with increasing the risk of miscarriage, congenital malformations and stillbirths, lower mean birth weight, heart disease, lung cancer and maternal depression. A systematic review (2019) had raised a concern over the probable association of SHS exposure with stoppage of breastfeeding before completion of 6 months.[20]

What can be done?

Lian Yang et al. (2015) in China during their randomized control trial suggested interventions such as group educational sessions, standardised advice from primary health-care physicians or brief follow-ups every month to reduce second-hand smoke exposure.[21] Another community-based research in India claims that initiative for a home free from passive smoke relies on the collective efficacy.[14] To design interventions, which can reduce the exposure of second-hand smoke an in-depth understanding and knowledge of various factors like social and cultural, is required.

Suggestions, as offered in [Table 3], can help primary care physicians to intervene according to associated factors and reduce passive smoke exposure in their patients. Some interventions like counselling and health education about harms of SHS can be introduced as a part of routine advice during antenatal visits to physicians.
Table 3: Suggestions by various studies conducted according to associated factors for Second-hand smoke

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Second-hand smoke and COVID-19

According to the “Global Adult Tobacco Survey”, (2016–2017) India, the percentage of pregnant women exposed to Second-hand smoke is 37.7% at home, 21% at work and 25.9% at any public place. However, these numbers will be increasing due to nationwide corona virus-induced lockdown which started from 24th March and is extended till date as a preventive measure for COVID-19. It's important to protect those who do not smoke, especially women who are pregnant and children from exposure to SHS during this time when everyone is in close quarters with family and others.

  Conclusion Top

There are various factors like lack of self-efficacy, lack of awareness, cultural and social barriers behind a smoke-free home for a pregnant woman. A comprehensive ban on smoking should be enforced. There is need for behavioural interventions, community awareness and women empowerment. Recognising the high prevalence of SHS among pregnant women in pandemic era, primary health-care physicians must assess the women for SHS exposure and provide focussed counselings to couples during every antenatal visit. Husbands who are active smokers should be counselled for harms to people surrounding them due to SHS exposure, and motivate them to quit smoking.[23]

Key Message

Second-Hand smoke exposure is already prevalent in pregnant women and due to movement restrictions imposed by pandemic COVID-19, SHS exposure might had increased tremendously. Therefore it's important for health-care professionals to include the education and counseling regarding harm and preventive measures during antenatal visits.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Tobacco [Internet]. [cited 2020 Feb 7]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco.  Back to cited text no. 1
Tong VT, Morello P, Alemán A, Johnson C, Dietz PM, Farr SL, et al. Pregnant women's secondhand smoke exposure and receipt of screening and brief advice by prenatal care providers in argentina and uruguay. Matern Child Health J 2015;19:1376-83.  Back to cited text no. 2
Abraham M, Alramadhan S, Iniguez C, Duijts L, Jaddoe VW, Dekker HT, et al. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS One 2017;12:e0170946. doi: 10.1371/journal.pone. 0170946.  Back to cited text no. 3
Simons E, To T, Moineddin R, Stieb D, Dell SD. Maternal second-hand smoke exposure in pregnancy is associated with childhood asthma development. J Allergy Clin Immunol Pract 2014;2:201-7.e3.  Back to cited text no. 4
Quy Ngo C, Thu Phan P, Van Vu G, Thi Chu H, Thi Nguyen T, Hong Nguyen M, et al. Prevalence and sources of second-hand smoking exposure among non-smoking pregnant women in an urban setting of Vietnam. Int J Environ Res Public Heal 2019;16:5022.  Back to cited text no. 5
Khapre MP, Meshram RD, Mudey AB, Wagh V. KAP study on second hand smoke among pregnant mothers attending tertiary care rural hospital. Indian J Public Heal Res Dev 2014;5:204-7.  Back to cited text no. 6
Ministry of Health & Family Welfare Government of India. Global Adult Tobacco Survey 2016-2017[Internet]. International Institute for Population Sciences; 2017. Available from: https://mohfw.gov.in/sites/default/files/GlobaltobacoJune2018.pdf.  Back to cited text no. 7
Mistry R, Dasika A. Antenatal Tobacco use and secondhand smoke exposure in the home in India. Nicotine Tob Res 2018;20:258-61.  Back to cited text no. 8
Agrawal D, Aggarwal A, Goel S. Women exposed to second-hand smoke more at home than at workplace: An analysis of GATS Report, India, 2009-10. J Fam Med Prim Care 2015;4:293-7.  Back to cited text no. 9
Hikita N, Haruna M, Matsuzaki M, Sasagawa E, Murata M, Oidovsuren O, et al. Prevalence and risk factors of secondhand smoke (SHS) exposure among pregnant women in Mongolia. Sci Rep 2017;7:1-8. doi: 10.1038/s41598-017-16643-4.  Back to cited text no. 10
Mahmoodabad SS, Karimiankakolaki Z, Kazemi A, Mohammadi NK, Fallahzadeh H. Exposure to secondhand smoke in Iranian pregnant women at home and the related factors. Tob Prev Cessat 2019;5:7.  Back to cited text no. 11
Mohebi S, Parham M, Sharifirad G, Gharlipour Z. Social Support and Self-Care Behavior Study 2018:1-6.  Back to cited text no. 12
Singh RJ, Lal PG. Second-hand smoke: A neglected public health challenge. Indian J Public Health 2011;55:192-8.  Back to cited text no. 13
[PUBMED]  [Full text]  
Ministry of Law and Justice. COTPA 2003 [Internet]. 2003 [cited 2020 Sep 30]. Available from: https://www. Tobaccocontrollaws.org/files/live/India/India-COTPA—national.pdf.  Back to cited text no. 14
Sen zeng, Haruko naguch sitoru shimokawa. 2019 Partial smoking ban and second hand smoke exposure in japan. Int. J. Environ. Res. Public Health 2019, 16(15), 2804; https://doi.org/10.3390/ijerph16152804.  Back to cited text no. 15
Kadir MM, McClure EM, Goudar SS, Garces AL, Moore J, Onyamboko M, et al. Exposure of pregnant women to indoor air pollution: A study from nine low and middle-income countries. Acta Obstet Gynecol Scand 2010;89:540-8.  Back to cited text no. 16
Jackson C, Huque R, Satyanarayana V, Nasreen S, Kaur M, Barua D, et al. “He doesn't listen to my words at all, so i don't tell him anything”—A qualitative investigation on exposure to second-hand smoke among pregnant women, their husbands and family members from rural Bangladesh and urban India. Int J Environ Res Public Health 2016;13:1098.  Back to cited text no. 17
Van Vu G, Quy Ngo C, Thu Phan P, Phuong Thi Doan L, Thi Nguyen T, Hong Nguyen M, et al. Inadequate knowledge, attitude and practices about second-hand smoke among non-smoking pregnant women in urban Vietnam: The need for health literacy reinforcement. Int J Environ Res Public Health 2020;17:3744.  Back to cited text no. 18
Al-Shaikh G, Alzeidan R, Fayed A, Mandil AA, Marwa B, Wahabi H. Awareness of an obstetric population about environmental tobacco smoking. J Fam Community Med 2014;21:17-22.  Back to cited text no. 19
[PUBMED]  [Full text]  
Suzuki D, Wariki WM, Suto M, Yamaji N, Takemoto Y, Rahman M, et al. Secondhand smoke exposure during pregnancy and mothers' subsequent breastfeeding outcomes: A systematic review and meta-analysis. Sci Rep 2019;9:8535.  Back to cited text no. 20
Yang L, Tong EK, Mao Z, Hu TW, Lee AH. A clustered randomized controlled trial to reduce secondhand smoke exposure among nonsmoking pregnant women in Sichuan Province, China. Nicotine Tob Res 2016;18:1163-70.  Back to cited text no. 21
Zeng S, Noguchi H, Shimokawa S. Partial smoking ban and secondhand smoke exposure in Japan. Int J Environ Res Public Health 2019;16:2804.  Back to cited text no. 22
Wahabi HA, Massis A, Fayed AA, Esmaeil SA. Effectiveness of health education in reducing secondhand smoke exposure among pregnant women visiting the antenatal clinic in Saudi Arabia: A randomized controlled trial. Indian J Public Health 2020;64:102-8.  Back to cited text no. 23
[PUBMED]  [Full text]  


  [Table 1], [Table 2], [Table 3]


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