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Association of environmental tobacco smoking exposure with an increased risk of hospital admissions for pneumonia in children under 5 years of age in Vietnam
  1. M Suzuki1,2,
  2. V D Thiem3,
  3. H Yanai1,2,
  4. T Matsubayashi1,2,
  5. L-M Yoshida1,2,
  6. L H Tho4,
  7. T T Minh4,
  8. D D Anh3,
  9. P E Kilgore5,
  10. K Ariyoshi2
  1. 1
    Center for International Collaborative Research, Nagasaki University, Nagasaki, Japan
  2. 2
    Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
  3. 3
    National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
  4. 4
    Khanh Hoa Health Service, Nha Trang, Vietnam
  5. 5
    International Vaccine Institute, Seoul, South Korea
  1. Dr H Yanai, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; hyanai{at}; hidekiyana{at}


Background: The association between environmental tobacco smoking (ETS) and childhood pneumonia has not been established in developed or developing countries. A study was conducted to assess the effect and impact of ETS exposure on pneumonia among children in central Vietnam.

Methods: A population-based large-scale cross-sectional survey was conducted covering all residents of 33 communes in Khanh Hoa Province, the central part of Vietnam. Information on demographics, socioeconomic status and house environment, including smoking status of each household member, was collected from householders. Hospital admissions for pneumonia among children aged <5 years in each household in the previous 12 months were recorded based on caregiver’s report.

Results: A total of 353 525 individuals living in 75 828 households were identified in the study areas. Of these, 24 781 (7.0%) were aged <5 years. The prevalence of ETS was 70.5% and the period prevalence of hospital admissions for pneumonia was 2.6%. Multiple logistic regression analysis showed that exposure to ETS was independently associated with hospital admissions for pneumonia (adjusted odds ratio 1.55, 95% CI 1.25 to 1.92). The prevalence of tobacco smoking was higher among men than women (51.5% vs 1.5%). It is estimated that 28.7% of childhood pneumonia in this community is attributable to ETS.

Conclusions: Children in Vietnam are exposed to substantial levels of ETS which results in 44 000 excess hospital admissions due to pneumonia each year among children aged <5 years.

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  • Competing interests: None.

  • Funding: This study was funded by the Program of Founding Research Centers for Emerging and Reemerging Infectious Diseases, Ministry of Education, Culture, Sports, Science and Technology, Japan. The funding source did not have any role in the study design, execution, analysis, writing of the manuscript or conclusions.

  • Ethics approval: The study was approved by the Institutional Review Board (IRB) at the National Institute of Hygiene and Epidemiology, Hanoi, Vietnam and the IRB of the Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.

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