Second-hand smoke exposure among school children during COVID-19 in Jeddah.

Background: Second-hand smoke (SHS) exposure among children leads to significant health risks and increases the likelihood of smoking initiation. Global research into SHS is extensive but very few studies have been conducted in KSA, especially during pandemic lockdowns. Objectives: This study explored the patterns of SHS exposure among school-age children during the COVID-19 pandemic in Jeddah, KSA. The relationships of SHS with smoking behaviors were also examined, including attempts, active smoking, willingness to smoke, and peer influence. Methods: A cross-sectional school-based survey was conducted from September to December during 2020 among 6,717 children in Jeddah, aged 8-22 years. The survey, adapted from the Global Youth Tobacco Survey, assessed self-reported SHS exposure across various locations and sources, and its correlations with smoking behaviors and peer influence. Results: Among the participants, 48.8 % reported exposure to SHS at varying levels (95 % confidence interval: 47.6-50.0 %), where the most common exposure sites were public places (33.8 %) and homes (23.8 %). Daily exposure was highest at home (13.4 %). Independent factors associated with SHS exposure included older age, maternal employment, and receipt of weekly pocket money. Furthermore, SHS exposure was positively correlated with a higher risk of ever smoking, current smoking, and future willingness to smoke, as well as peer influence in an independent relationship, with stronger effects at higher exposure levels. Conclusion: Despite the pandemic lockdown, exposure to SHS remained high among children in Jeddah, and it was consistent with pre-pandemic levels. These findings highlight the need for targeted strategies to reduce SHS exposure and prevent smoking initiation, contributing to better health outcomes for children.