BACKGROUND: Secondhand smoke (SHS) exposure negatively impacts children's health, often leading to school absenteeism. School absenteeism may affect academic performance and lead to funding losses for schools relying on attendance-based funding. However, limited research has quantified missed school days due to the SHS exposure. This study aims to estimate the annual school absenteeism attributable to SHS exposure at home among children aged 6 to 11.
METHODS: We analyzed the 2016–2022 National Survey of Children's Health (NSCH) data. SHS exposure was defined as living with someone smoking cigarettes, cigars, or pipes at home. The outcome was the number of school days missed due to illness or injury. Using propensity score weights to adjust for observed differences in covariates, including child age, sex, race/ethnicity, parental education, child health, family federal poverty level, and year and state fixed effects, we estimated a two-part model to assess missed school days as a function of secondhand smoke (SHS) exposure and these covariates. To calculate the excess missed school days attributable to SHS exposure, we used an 'excess utilization' approach by multiplying the SHS-attributable fraction derived from the model by the total number of missed school days among children aged 6–11 in 2022.
RESULTS: Between 2016 and 2022, among 79.641 children aged 6-11 years old who enrolled in school in the US, 1.9% were exposed to SHS at home. This exposure was associated with an increased likelihood of missing school and more missed school days than unexposed children. The estimated annual excess missed school days attributable to SHS exposure was 371.159 days among students aged 6-11, equivalent to 2 days per 100 students in 2022.
CONCLUSIONS: These findings highlight the need for targeted public health interventions and policies to reduce SHS exposure at home, which could mitigate its impact on children's health, academic performance, and school funding.