It is universally known that cigarette smoking is harmful to health, and much evidence shows that exposure to Secondhand Smoke (SHS) also poses great harm to the health [1, 2]. Research has shown that SHS poses a greater health risk to children than to adults . Children who are exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lower respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth [4, 5].
Children are more heavily exposed to secondhand smoke at home than adults. Since the Taiwanese smoking population was recently estimated at 3.61 million, 35.4% of the male and 4.2% of the female population smoked , much of the general public is quite vulnerable to SHS exposure. According to the survey on smoking behavior conducted by the Taiwanese Bureau of Health Promotion, 46.8% of junior high school students self-reported having SHS exposure at home over the past 7 days . The aforementioned findings indicate that younger non-smokers are more vulnerable to SHS exposure at home. Another recent study in Taiwan [8, 9] found that 67.5% of the children have family members smoking at home and that 53.9% of them smoked in front of these elementary students.
The Tobacco Hazards Prevention Act, first enacted in Taiwan in 1997, aims to prevent tobacco hazards such as child exposure to SHS, to prohibit children and adolescents from smoking and has established regulations with respect to where tobacco use is restricted. The amendments to the Act in 2009 stipulated that tobacco use is strictly prohibited in indoor public spaces and workplaces. These amendments, also further aimed to reduce SHS in children by expanding the prohibition of tobacco use in any indoor area with the presence of pregnant women and/or children under the age of three. While this act protects children and other non-smokers from SHS exposure in public spaces, and pregnant women and children under the age of 3 from SHS exposure in-doors it does not protect all children from SHS exposure within the home environment.
One's confidence in regard to avoidance behavior of SHS plays a critical role in its exposure to SHS. Self-confidence and SHS avoidance behavior in the youth were found inversely associated with the number of family members who smoke at home after Taiwan's regulatory partial smoking bans in some public and private places . These results indicate that the youth was extremely confident of their SHS avoidance behavior in the school setting, whereas was not at all confident of their avoidance of SHS in the home setting. Most studies have focused on the status quo of SHS exposure or avoidance behaviors on adolescents and adults [10–12]. As a result, there is a research need to better understand elementary children's SHS exposure at home and their avoidance behavior of SHS exposure. Hence, this study aimed to assess the degree of household SHS exposure and factors associated with confidence level in avoiding SHS exposure in elementary school children in southern Taiwan, both before and after the implementation of the newly amended Act.