We assessed the combined effect of household air pollution from solid fuel use and from environmental tobacco smoke and child health outcomes in Indonesia.
Survey subjects self-reported solid fuel use, frequency of indoor smoking, and health outcomes in children. We then evaluated the effect of a combined exposure using multivariate logistic regression.
Children exposed to high levels of pollution from solid fuel use had an increased risk of low birth weight, neonatal death, infant death, and acute lower respiratory infection. Exposure to environmental tobacco smoke increased the risk of acute lower respiratory infection. The combined effect of both pollution sources outweighed the independent risk of each exposure alone.
Solid fuel use and environmental tobacco smoke independently increased the risk and child health outcomes and the combined exposure showed the additive effect.
Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jalan P.B. Sudirman, Denpasar, Bali, Indonesia (Ms Suryadhi); Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, Kita-ku, Okayama, Japan (Ms Suryadhi, Mr Abudureyimu, and Dr Yorifuji); Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan (Dr Kashima).
Address correspondence to: Made Ayu Hitapretiwi Suryadhi, MHSc, Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8558, Japan (firstname.lastname@example.org).
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Clinical significance: In the present study we found that solid-fuel use and environmental tobacco smoke independently increased the risk of child health outcomes, and the combined effect of both pollution sources outweighed the independent risk of each exposure alone, showing the presence of additive effect.
The authors report no conflicts of interest.
Supplemental digital contents are available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.joem.org).