Abstract
BackgroundSecond hand smoke (SHS) exposure is a severe public health problem, especially in low and middle countries, but no studies have examined both individual and city-level variables influencing exposure.MethodsA cross-sectional multistage sampling design was used to survey subjects from 21 cities in China. Using a standardized questionnaire individual level information was collected. City-level variables were retrieved from the National Bureau of Statistics database. Multilevel logistic regression analysis was used to assess SHS exposure variation at both the individual and city level.ResultsSHS exposure prevalence among non-smokers was 28.1 % (95 % CI 27.1–29.0). At the individual level lower educational attainment and income and higher exposure to tobacco advertising were associated with higher SHS exposure. On the other hand richer cities, and those with more anti-smoking media news coverage, had less SHS exposure. The presence of city smokefree regulations was unrelated to exposure.ConclusionsGiven its human and economic costs, reducing SHS exposure should receive greater priority than it does in China. The results point to the need for the enactment of national smokefree laws in order to combat unacceptably high levels of SHS exposure.
Highlights
Second hand smoke (SHS) exposure is a severe public health problem, especially in low and middle countries, but no studies have examined both individual and city-level variables influencing exposure
Secondhand smoke (SHS) is known as environmental tobacco smoke (ETS) or tobacco smoke pollution (TSP) or passive smoke, and is formed from the burning of cigarettes and other tobacco products and from smoke exhaled by the smoker [1]
At the individual level exposure to SHS was significantly associated with gender, ethnicity, education, occupation, income, and exposure to tobacco advertising (Table 1)
Summary
Second hand smoke (SHS) exposure is a severe public health problem, especially in low and middle countries, but no studies have examined both individual and city-level variables influencing exposure. Several studies have clearly linked exposure to SHS to a number of health consequences in non-smokers, including lung cancer, heart disease, and asthma in children [2, 3]. The adverse health effects of SHS have resulted in many countries banning smoking in workplaces and in. Most common are findings that SHS exposure is more common amongst non-smokers in poorer households where smoking rates are highest [10]. Harris et al [13], for example, found that workplace SHS exposure was highest amongst lower income males living in rural areas, while McClure et al [15], found that regional differences in exposure between the ‘Stroke Belt’ (states in the Deep South) and surrounding states (in the ‘Buckle of the Stroke Belt’), were most evident in the case of African Americans
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