{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:31:45Z","timestamp":1769002305558,"version":"3.49.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020318","name":"FrieslandCampina","doi-asserted-by":"publisher","award":["NN-2018-159"],"award-info":[{"award-number":["NN-2018-159"]}],"id":[{"id":"10.13039\/501100020318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Individuals burdened with socioeconomic disadvantages, including food insecurity, are often exposed to circumstances that may increase the likelihood of smoking, which may in turn affect the respiratory health of others in the household, particularly children. Yet, the role of these factors in perpetuating tobacco use within households remains underexplored. Therefore, this study attempts to determine the association between household food security and socioeconomic status with paternal smoking in Malaysia. This study utilised data from the South East Asian Nutrition Surveys (SEANUTS II) Malaysia, which involved 2,687 children aged 0.5\u201312.9 years, recruited through multistage cluster sampling. Although the study recruited children as participants, the present analysis draws on paternal and household information, including food security, socioeconomic status, and paternal smoking, as reported through parent\/guardian-reported questionnaires. Multivariate binary logistic regression was used to determine factors associated with paternal smoking habits. Overall, forty-three percent of fathers were reported as smokers. Younger fathers (aged &lt;30.0 years) had twice the odds of smoking [aOR: 2.032 (95%CI 1.301\u20133.173)] compared to their older counterparts (aged &gt;49.9 years). Fathers from low socioeconomic status households, particularly, those with extremely low household income [aOR: 2.606 (95%CI 1.711\u20133.968)] and without formal education\/completed primary education [aOR: 2.604 (95%CI 1.710\u20133.966)], had double the odds of smoking than their counterparts. Self-employed\/other occupation fathers [aOR: 1.343 (95%CI 1.056\u20131.709)] and families from food-insecure households [aOR: 1.251 (95%CI 1.053\u20131.487)] were found to have higher odds of smoking. In conclusion, household food insecurity and socioeconomic status, including age, occupation, household income, and education level were significantly associated with paternal smoking status. Authorities should customise interventions to mitigate socioeconomic barriers and create equitable access to quit-smoking resources. This is important for lowering smoking prevalence and safeguarding children\u2019s health.<\/jats:p>","DOI":"10.1371\/journal.pone.0338608","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:25:25Z","timestamp":1767378325000},"page":"e0338608","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between household food security and socioeconomic status with paternal smoking: Findings from SEANUTS II Malaysia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3817-0091","authenticated-orcid":true,"given":"Giin Shang","family":"Yeo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoo Thien","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1226-3341","authenticated-orcid":true,"given":"Kuan Chiet","family":"Teh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jyh Eiin","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9279-9113","authenticated-orcid":true,"given":"Wan Siti Fatimah","family":"Wan Abdul Rahman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nurul Hasanah","family":"Hasmuni Chew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caryn Mei","family":"Hsien Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Zakiah","family":"Mohd Saat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nik Shanita","family":"Safii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siti Balkis","family":"Budin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swee Fong","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Karim","family":"Norimah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8958-8880","authenticated-orcid":true,"given":"Ilse","family":"Khouw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei Hum","family":"Wee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0713-5197","authenticated-orcid":true,"given":"Bee Koon","family":"Poh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the SEANUTS II Malaysia Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"issue":"10292","key":"pone.0338608.ref001","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"GBD 2019 Tobacco Collaborators","year":"2021","journal-title":"Lancet"},{"key":"pone.0338608.ref002","doi-asserted-by":"crossref","first-page":"1606446","DOI":"10.3389\/ijph.2024.1606446","article-title":"Preventable Deaths Attributable to Second-Hand Smoke in Southeast Asia-Analysis of the Global Burden of Disease Study 2019","volume":"69","author":"J Leung","year":"2024","journal-title":"Int J Public Health"},{"key":"pone.0338608.ref003","volume-title":"National Health and Morbidity Survey (NHMS) 2023: Non-communicable Diseases and Healthcare Demand- Key Findings","author":"Institute for Public Health, National Institutes of Health Malaysia","year":"2024"},{"key":"pone.0338608.ref004","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1186\/1471-2458-11-634","article-title":"A survey of schoolchildren\u2019s exposure to secondhand smoke in Malaysia","volume":"11","author":"EZ Abidin","year":"2011","journal-title":"BMC Public Health"},{"issue":"7","key":"pone.0338608.ref005","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S2213-2600(21)00231-9","article-title":"Passive tobacco smoke in children and young people during the COVID-19 pandemic","volume":"9","author":"M Osinibi","year":"2021","journal-title":"Lancet Respir Med"},{"key":"pone.0338608.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18332\/tid\/146363","article-title":"E-cigarette prevalence among Malaysian adults and types and flavors of e-cigarette products used by cigarette smokers who vape: Findings from the 2020 ITC Malaysia Survey","volume":"20","author":"P Driezen","year":"2022","journal-title":"Tob Induc Dis"},{"key":"pone.0338608.ref007","doi-asserted-by":"crossref","first-page":"100983","DOI":"10.1016\/j.pmedr.2019.100983","article-title":"Psychological distress and cigarette smoking among U.S. households by income: Considering the role of food insecurity","volume":"16","author":"JE Kim-Mozeleski","year":"2019","journal-title":"Prev Med Rep"},{"key":"pone.0338608.ref008","volume-title":"Household income & basic amenities survey report 2019","author":"Department of Statistics Malaysia","year":"2020"},{"key":"pone.0338608.ref009","unstructured":"Bank Negara Malaysia. 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Council. NSW. The reciprocal relationship between social disadvantage, financial stress and smoking: what does the research tell us? What can community service organisations do? Smoking and Disadvantage Seminar July 23; 2008."},{"issue":"1","key":"pone.0338608.ref031","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1017\/S136898000722292X","article-title":"Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia","volume":"10","author":"RD Semba","year":"2007","journal-title":"Public Health Nutr"},{"issue":"1","key":"pone.0338608.ref032","article-title":"Influence of family socioeconomic status on IQ, language, memory and executive functions of Brazilian children","volume":"29","author":"R Piccolo L da","year":"2016","journal-title":"Psicol Refl Cr\u00edt"},{"issue":"6","key":"pone.0338608.ref033","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1111\/1467-8624.t01-1-00382","article-title":"The home environments of children in the United States part I: variations by age, ethnicity, and poverty status","volume":"72","author":"RH Bradley","year":"2001","journal-title":"Child Dev"},{"key":"pone.0338608.ref034","doi-asserted-by":"crossref","first-page":"274056","DOI":"10.1155\/2015\/274056","article-title":"Smoking Cessation and Socioeconomic Status: An Update of Existing Evidence from a National Evaluation of English Stop Smoking Services","volume":"2015","author":"R Hiscock","year":"2015","journal-title":"Biomed Res Int"},{"issue":"5","key":"pone.0338608.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0020331","article-title":"Social determinants of smoking in low- and middle-income countries: results from the World Health Survey","volume":"6","author":"AR Hosseinpoor","year":"2011","journal-title":"PLoS One"},{"issue":"1","key":"pone.0338608.ref036","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pec.2021.05.024","article-title":"Health beliefs associated with preventive behaviors against noncommunicable diseases","volume":"105","author":"T Wang","year":"2022","journal-title":"Patient Educ Couns"},{"key":"pone.0338608.ref037","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.18713","article-title":"A comparative perception and impact of pictorial warnings on cigarette packaging among Malaysian smokers and non-smokers","volume":"12","author":"NA Yahya","year":"2024","journal-title":"PeerJ"},{"issue":"1","key":"pone.0338608.ref038","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-020-01648-y","article-title":"Socioeconomic status, health-related behaviours, and death among older people: the Concord health and aging in men project prospective cohort study","volume":"20","author":"S Khalatbari-Soltani","year":"2020","journal-title":"BMC Geriatr"},{"issue":"3","key":"pone.0338608.ref039","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2188\/jea.JE20180195","article-title":"The Association Between Education and Smoking Prevalence, Independent of Occupation: A Nationally Representative Survey in Japan","volume":"30","author":"K Tomioka","year":"2020","journal-title":"J Epidemiol"},{"key":"pone.0338608.ref040","first-page":"1","article-title":"Malaysia\u2019s self-employment explosion: why so many own-account workers?","volume":"20","author":"MT Schaper","year":"2020","journal-title":"ISEAS Perspective"},{"key":"pone.0338608.ref041","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1186\/s12889-019-6857-3","article-title":"Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study","volume":"19","author":"AH Nur Atikah","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0338608.ref042","first-page":"29","article-title":"A Review of Smoking Research In Malaysia","volume":"71","author":"LH Wee","year":"2016","journal-title":"Med J Malaysia"},{"issue":"1","key":"pone.0338608.ref043","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1080\/14034940410028361","article-title":"Association between age, gender and reasons for smoking cessation","volume":"33","author":"L Gr\u00f8tvedt","year":"2005","journal-title":"Scand J Public Health"},{"issue":"4","key":"pone.0338608.ref044","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/1010539509345862","article-title":"Factors contributing to utilization of health care services in Malaysia: a population-based study","volume":"21","author":"S Krishnaswamy","year":"2009","journal-title":"Asia Pac J Public Health"},{"issue":"3","key":"pone.0338608.ref045","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.33736\/ijbs.5199.2022","article-title":"Impact of Tobacco Control Policies on Cigarette Consumption in Malaysia","volume":"23","author":"N Norashidah Mohamed","year":"2022","journal-title":"IJBS"},{"key":"pone.0338608.ref046","article-title":"Challenges and prospects in implementing the Generational Endgame policy: Malaysia and global perspectives","author":"PKA Phoa","year":"2025","journal-title":"Tob Control"},{"key":"pone.0338608.ref047","unstructured":"World Health Organization. Tobacco. 2025. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco#:~:text=More%20on%20tobacco%20health%20warnings,products%20consumed%20globally%20is%20illicit"},{"key":"pone.0338608.ref048","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1186\/s12889-015-1797-z","article-title":"Parental smoking and child poverty in the UK: an analysis of national survey data","volume":"15","author":"C Belvin","year":"2015","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0338608.ref049","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.amepre.2016.04.003","article-title":"Predictors of the Onset of Cigarette Smoking: A Systematic Review of Longitudinal Population-Based Studies in Youth","volume":"51","author":"RJ Wellman","year":"2016","journal-title":"Am J Prev Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T23:07:34Z","timestamp":1768950454000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338608"}},"subtitle":[],"editor":[{"given":"Seo Ah","family":"Hong","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338608","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}