Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Luke Davis

Abstract

ABSTRACT

Introduction: Tuberculosis (TB) remains one of the leading causes of death globally, with children and young adolescents having a significant burden of the disease. Smoking is a well-established risk factor for TB, but the association between secondhand smoke (SHS) exposure and TB remains inconclusive. Pediatric populations are commonly exposed to SHS due to living with smokers in their households. Inconsistencies in the findings of previous systematic reviews on the associations between SHS exposure and TB status (infection and disease) highlight the need for an updated systematic review to better establish these associations and provide evidence-based guidance for reducing the TB burden in children. Our systematic review aimed to investigate the associations of SHS exposure with TB infection and with TB disease in children, focusing on studies published after 2015.

Methods: We conducted a systematic review by searching PubMed, Embase, and Scopus for studies published between January 1, 2015 and December 31, 2024. We used predefined inclusion and exclusion criteria to identify original studies. We conducted a meta-analysis to estimate the summary effect size for the association between SHS and TB infection, and a summary analysis to examine the association between SHS and TB disease.

Results: We identified a total of 72 non-duplicate studies, seven of which met all inclusion criteria and no exclusion criteria and were thus included in the study. We discovered that SHS exposure was associated with a higher odds of TB infection in children (OR 3.93, 95% CI 1.91–8.09, p-value = 0.0002). We observed a dose-response relationship between the number of household smokers and the odds of TB infection in children. We found a non-significant association between SHS exposure and TB disease (OR 1.93, 95% CI 0.72–5.10, p-value = 0.1932).

Conclusions: Our study confirmed a positive association between SHS exposure and TB infection in children, suggesting the importance of addressing SHS exposure as a risk factor for TB infection in pediatric populations, and highlighting the need for public health policies and interventions targeting household smoking behaviors, particularly in countries with high TB incidence. However, due to the limited number of studies included, the high risk of bias in some studies, and the substantial heterogeneity among the studies, the evidence remains weak. Additionally, our study found no statistically significant association between SHS exposure and TB disease, potentially due to the limited number of studies available for analysis and the limited statistical power of the included studies. Additional longitudinal studies with a longer duration of follow-up (e.g., ≥ 2 years) and with standardized measurements of SHS exposure and TB status are needed to better assess the associations of SHS exposure with TB infection and with TB disease.

Key words: Tuberculosis, Secondhand smoke, Passive smoking, Children

Comments

This is an Open Access Thesis.

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