الفهرس 
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Abstract
Tobacco smoke is one of the most important behavior related risk factors, Although it is declining worldwide and in many countries, the prevalence of tobacco smoking appears to be increasing in the Eastern Mediterranean Region and the African Region ,tobacco smoking, is considered a custom and addiction primarily of men, leaving mothers and children involuntary or passive smokers. The most common sites for exposure of women and children to SHS are the houses, and the primary sources are fathers and other household members.
Because of high smoking prevalence among males, limited options of children for avoiding SHS the role of mothers to take actions towards SHS to protect themselves and their children should be encouraged, the major factors influencing mothers’ perception and attitude to their husbands’ smoke behavior were their knowledge, therefore, educational interventions targeting the mothers parents could significantly reduce the exposure of their children to second hand smoke at home.
The aim of our work was to determine percent of smoking among parents of target children, assessment of knowledge, attitude, practice of mothers towards passive smoking in a rural area in Asyut governorate and comparison between children exposed and not exposed to SHS.
The study was a cross-sectional study one that was carried out in the primary health unit at Bani Adi Al-Bahariyah Village (a Village is about 8 km west to Manfalout district which is about 35 km north to Asyut city) from October 2017 to October 2018, by systematic random sampling technique.
The study included collection of data from 400 eligible mothers coming to our family medicine center for immunization of their children via Structured face to face interview, the interview covered data about, socio-demographic characteristics, smoking status, knowledge, attitude, practice of participants towards SHS. also the collection of data included weight, length of babies at birth, at12month, at18 month of age and hemoglobin level at 12 month, 18 month of age taken from our health unit records, in addition to that serum cotinine level was carried out on 90 of eligible mothers after taken their consent consecutively.
Based on report history of mothers (72.5%) of mothers was exposed to SHS in the past week compared to (27.5%) was not exposed, (81.7%) of them exposed at home, (68.8%) of mothers lived with at least one smoker at their homes and the main source of smoke at home was by husband (75.65 % of smokers ), and there were no active smokers among them.
Based on serum cotinine level of mothers by choosing the appropriate suggested serum cotinine cutoff point ((0,05 − 40.35 ng/ml) we found that the percentage of active smokers was (1.1%), the percentage of non-smokers exposed to SHS was (88.9%) and the percentage of non-smokers not exposed was (10%).
In general a large percentage of mothers knew that SHS was harmful to adults and children. while fewer mothers knew specific related health effects, the overall knowledge among the participants of the present study was as the following: The percentage of mothers who had good knowledge was (61.5%), while the percentage of mothers who had good attitude was (43.8.%) which may explain low level of good practice (23.5%) among mothers.
When we assessed the relationship between some factors and knowledge of mothers towards SHS we noticed that the mothers belonging to low SES trended to had less education and hence were less informed about the harmful effects of smoking on their health and others.
As regards the relationship between participants characteristics with attitude we noticed that increasing in age of mothers, presence of smoker, high SES, high education level were associated with increased level of good attitude.
concerning practice of mothers towards SHS it was noticed that increasing age , educational level, SES, good knowledge, good attitude, and presence of smoker were associated with increased percentage of good practice among mothers of target study.
As regards the relationship between some factors and serum cotinine level of mothers our study showed that presence of smoker, increasing in age, and educational level, were associated with reduced serum cotinine of mothers but failed to document the difference in relation to SES.
Based on report history of mothers the comparison between babies exposed to SHS (presence of at least one smoker at home) and babies not exposed to SHS was carried out and the findings as follow: exposure of pregnant women to SHS was associated with reduced birth weight, birth length, and exposure of babies to SHS was associated with reduced weight, length at 12 month, and reduced weight only at 18 month, also exposure of babies to SHS was associated with reduced hemoglobin level at 12 month, 18 month.
Mothers’ avoidance action of SHS plays a critical role in the exposure of mothers and their children to SHS, if mothers do not take adequate precautions to avoid exposure to such SHS hazards, they and their children may be more susceptible to a series of negative health effects, and on the lights of our results we recommend the followings
1) Intensified community based programs should be done on Smoking cessation particularly for husband and members of family, and also Public health implication-behavioral change communication is needed toward smoking in public places.
2) strategies to successfully reduce exposure to home SHS are needed the best things in this concern are educational and clinical initiatives direct approaches.
3) Surveillance of passive smoking on target groups (young aged Mothers, less educated mothers, mothers of rural areas and low Socio-economic backgrounds) should be initiated, continues and not interrupted.
4) Physicians and mass media campaigns to implement and Maintain smoke-free households
5) Additionally follow-up studies are needed to further explore harm perceptions associated with SHS especially in relation to Children and pregnancy, as well as the actions that mothers and family members may be taking to protect themselves and others.