title: Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  In total, 175,583 households from urban slum areas in Indonesia.
  
  
  METHODS
  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.
authors.affiliation: The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. rdsemba@jhmi.edu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Leah M
authors.initials: LM
authors.lastname: Kalm
authors.forename: Saskia
authors.initials: S
authors.lastname: de Pee
authors.forename: Michelle O
authors.initials: MO
authors.lastname: Ricks
authors.forename: Mayang
authors.initials: M
authors.lastname: Sari
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bloem
mesh_terms: D000328:Adult; D001827:Body Height / Q000502:physiology; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D016000:Cluster Analysis; D016001:Confidence Intervals; D005260:Female; D005502:Food / Q000191:economics*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D016017:Odds Ratio; D011203:Poverty; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000191:economics*; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014505:Urban Population
chemical_list: D014028:Tobacco Smoke Pollution