Maternal smoking and child behavior in Slovakia

Background: Numerous human epidemiologic and animal studies indicate that children's secondhand smoke exposure (SHS) is associated with increased rates of child behavior problems. Objective: To investigate the relation between children's exposure to SHS in their homes and rates of child behavior problems in Slovakia, an area where such investigation has not been previously investigated and where rates of adult smoking are substantially higher than they are in the United States. Setting and Method: Surveys were administered to parents of 1,478 children ages 6 to 15 years throughout Slovakia. Information was collected about child and family sociodemographic characteristics (child age and gender, household income and residence, and maternal and paternal educational and smoking status), and child behavior problems were assessed using the well-utilized parent-reported Child Behavior Problem Index. Bivariate and multivariate analyses were conducted. Results: The response rate was 73 percent, and girls and children from more affluent families were less likely to have behavior problems (in multivariate analyses the adjusted odds ratio for behavior problems and the 95 percent confidence interval (CI) for girls was 0.438 (95 percent CI = 0.286-0.669) and for those living in households earning more than the average income was 0.395 (95 percent CI = 0.260-0.599). In contrast, there was no evidence in bivariate or multivariate analyses of increased rates of behavior problems in children living in households with smokers. Conclusion: Children exposed to household SHS in Slovakia were not found to have increased rates of behavior problems, possibly due to the substantially higher rate of smoking in this country than in the United States and the lack of regulations limiting smoking in public settings.