P3.E093: The Impact of Household Smoking on Children’s Emotional and Mental Health: Evidence from 2022 National Survey of Children’s Health

Background: Over a third (34.4%) of children live with more than one adult smoker, this number goes high to 49.4% in poor children population. Secondhand smoke exposure causes asthma, hospitalization in children and is considered child abuse. However, there is a lack of solid evidence about the impact of household smoking on children’s emotional and mental health. We investigated the impact of living with household smokers on mental, emotional, developmental, or behavioral (MEDB) problems for children at the 3-17 years.

Methods: By using a cross-sectional, nationally representative sample from the 2022 National Survey of Children's Health, we analyzed 5,330 children aged 3-17 years living with household smokers and 39,086 children in the same age group living with nontobacco users. Household smokers are defined as someone in the household who smokes and/or uses e-cigarettes or vaping products. First, a chi-square test was conducted to assess the difference in MEDB between the two groups. Then, logistic regression was used to estimate the association between living with household smokers and children’s MEDB problems.

Results: The rate of children with MEDB problems in the child group living with household smokers is significantly higher than the child group living with nontobacco users (37.5% vs. 26.7%, p < 0.001). After controlling for premature birth, low birth weight, fair or poor mental health status of mother (each is significantly associated with increased likelihood of MEDB problems), living with household smokers is positively associated with children’s MEDB problems (odds ratio = 1.325, 95% CI = [1.236, 1.421], p < 0.001). Further, we distinguished smoking inside house vs. smoking not inside house and found that the two conditions are both positively related to children’s MEDB problems (odds ratio = 1.858 and 1.273 for smoking inside house and smoking not inside house respectively, p < 0.001). However, we found that smoking inside house has a significantly higher association with children’s MEDB problems than smoking not inside house (z = 3.68, p < 0.001). Interestingly, we found that children living with vaping users have a higher probability of having MEDB problems, compared to children living with tobacco users in the house (z = 3.39, p < 0.01).

Conclusion: Living with household smokers is significantly associated with children’s MEDB problems. This positive association remains significant no matter whether the household member smokes inside the house or not, though smoking inside house has a greater impact on children’s emotional and mental health than smoking not inside house. Compared to using tobacco, vaping has an even higher negative impact on children’s emotional and mental health. This study not only contributes to the literature on the relationship between household smoking and children’s MEDB problems, but also offers insights into policies aimed at improving children’s emotional and mental health.