Exposure to household tobacco smoke and risk of cancer morbidity and mortality: Analysis of data from the Afghanistan Demographic and Health Survey 2015

Active and secondhand tobacco exposures are major causes of cancer. Cancer prevention efforts are particularly relevant in resource-constrained settings in which significant barriers to early detection and cancer treatments contribute to poor outcomes. We assess the associations between exposure to household tobacco smoke and cancer morbidity and mortality. We used household data from Afghanistan Demographic and Health Survey, which was a national cross-sectional survey that applied a two-stage stratified random sampling technique in 2015 and 2016. We performed regression analysis to estimate associations between exposure to household tobacco smoke and cancer morbidity and mortality at the household level. Exposure to household tobacco smoke was significantly associated with household reports of a history of any cancer (Adjusted Odds Ratio (AOR): 1.90; 95% Confidence Interval (CI): 1.44, 2.51), breast cancer (1.59; 1.00, 2.55), lung cancer (2.88; 1.58, 5.27), and liver cancer (2.56; 1.10, 5.96), compared to households with no tobacco smoke exposure. These associations persisted after controlling for household location, wealth index, type of cooking fuel used in house, and location of food preparation. Households in a rural location experienced significantly higher mortality of any cancer (4.40; 95% CI: 1.57, 12.38), breast cancer (2.91; 1.02, 8.25), and liver cancer (3.91; 1.29, 11.89) vs. those in an urban location. Exposure to household tobacco smoke is a risk factor for cancer morbidity in Afghanistan. Strategies to implement comprehensive smoking cessation and smoke free housing policies are urgently needed as primary cancer prevention strategy in Afghanistan and comparable resource-constrained settings.