a1 The Johns Hopkins Medical Institutions, Baltimore, MD, USA
a2 Helen Keller International Asia Pacific, Singapore
a3 Helen Keller International, Jakarta, Indonesia
a4 Nutrition Service, Policy, Strategy and Programme Support Division, World Food Program, Rome, Italy
Objective Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures.
Design Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < − 2), underweight (weight-for-age Z-score < − 2) and stunting (height-for-age Z-score < − 2), and severe wasting, underweight and stunting (defined by respective Z-scores < − 3).
Setting In total, 175 583 households from urban slum areas in Indonesia.
Subjects Children 0–59 months of age.
Results The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08–1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03–1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04–1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker.
Conclusions Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.
(Received January 25 2006)
(Accepted August 03 2006)
c2 † Correspondence address: Johns Hopkins School of Medicine, 550 N. Broadway, Suite 700, Baltimore, MD 21205, USA.