Parental tobacco use is associated with increased risk of child malnutrition in Bangladesh

ObjectivesWe investigated the relation between parental tobacco use and malnutrition in children <5 y of age and compared expenditures on foods in households with and without tobacco use.MethodsTobacco use, child anthropometry, and other factors were examined in a stratified, multistage cluster sample of 77 678 households from the Bangladesh Nutrition Surveillance Project (2005–2006). Main outcome measurements were stunting, underweight, and wasting, and severe stunting, severe underweight, and severe wasting. Secondary outcomes included the proportion of household expenditures spent on food.ResultsThe prevalence of parental tobacco use was 69.9%. Using the new World Health Organization child growth standards, prevalences of stunting, underweight, and wasting were 46.0%, 37.6%, and 12.3%, respectively. After adjusting for potential confounders, parental tobacco use was associated with an increased risk of stunting (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.12–1.21, P < 0.0001), underweight (OR 1.17, 95% CI 1.12–1.22, P < 0.0001), and wasting (OR 1.10, 95% CI 1.03–1.17, P = 0.004), and severe stunting (OR 1.16, 95% CI 1.10–1.23, P < 0.0001), severe underweight (OR 1.21, 95% CI 1.13–1.30, P < 0.0001), and severe wasting (OR 1.14, 95% CI 0.98–1.32, P = 0.09). Households with tobacco use spent proportionately less per capita on food items and other necessities.ConclusionsIn Bangladesh parental tobacco use may exacerbate child malnutrition and divert household funds away from food and other necessities. Further studies with a stronger analytic approach are needed. These results suggest that tobacco control should be part of public health strategies aimed at decreasing child malnutrition in developing countries.