Second hand smoke exposure in public venues and mental disorder: a representative nationwide study of China
Tingzhong Yang 1  
Chengjian Cao 2
Dan Wu 1
Lingwei Yu 1
Haoxiang Lin 4
Shuhan Jiang 1
More details
Hide details
Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
Hangzhou Hospital for the Prevention and Treatment of Occupational Diseases, Hangzhou, China
Public Health Studies Program, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, USA
Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
Department of Health Sciences, California State University, Northridge, USA
Publish date: 2015-07-17
Tobacco Induced Diseases 2015;13(July):18
Many studies have clearly linked exposure to Second Hand Smoke (SHS) to various somatic diseases, however, few studies have examined the relationship between SHS and mental disorders and those that have were only conducted with specific groups. The purpose of this study was to examine the association between SHS exposure and mental disorders among Chinese residents in both worksites and public places.

A cross-sectional multistage sampling design was used to interview subjects from 21 selected cities in China. Using a standardized questionnaire including demographic characteristics, SHS exposure, and mental health information was collected. Multiple logistic regression analysis was used to assess the association between SHS exposure and mental disorders.

Sixteen-thousand-eight-hundred-sixty-six valid questionnaires were collected and utilized in this study. Of 11,206 non-smokers, SHS exposure prevalence in workplaces and public places were respectively 78.4 % (95 % C.I.:74.3–82.5 %) and 80.7 % (95 % C.I.:74.6–86.5 %). Multiple logistic regressions showed SHS exposures in these venues were positively related to mental disorder.

These findings further support the health hazards of SHS exposure. Findings underscore the importance of controlling SHS exposure, and can be used to inform future SHS control policies and reinforce the need for public education in China.

Tingzhong Yang   
Center for Tobacco Control Research, Zhejiang University School of Medicine, Yuhangtang Road, Hangzhou 310058, China
1. Bandiera FC, Arheart KL, Caban-Martinez AJ, Fleming LE, McCollister K, Dietz NA, et al. Secondhand smoke exposure and depressive symptoms. Psychosom Med. 2010;72(1):68–72.
2. Bandiera FC, Richardson AK, Lee DJ, He JP, Merikangas KR. Secondhand smoke exposure and mental health among children and adolescents. Arch Pediatr Adolesc Med. 2011;165(4):332.
3. Carle AC. Fitting multilevel models in complex survey data with design weights: Recommendations. BMC Med Res Methodol. 2009;9:49.
4. Cheng KW, Glantz SA, Lightwood JM. Association between smokefree laws and voluntary smokefree-home rules. Am J Prev Med. 2001;41(6):566–72.
5. Chinese Center for Disease Control and Prevention. Global Adult Tobacco Survey (GATS) China 2010 country report. Beijing: China Sanxia Press; 2011. p. 8–95.
6. Eisner MD, Iribarren C, Yelin EH, Sidney S, Katz PP, Sanchez G, et al. The impact of SHS exposure on health status and exacerbations among patients with COPD. Int J Chron Obstruct Pulmon Dis. 2009;4:169.
7. Glantz SA, Parmley WW. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation. 1991;83:1–12.
8. Goldberg D, Williams P. A user’s guide to the general health questionnaire. Windsor, UK: NFER-Nelson; 1991.
9. Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L. Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. Am J Respir Crit Care Med. 2007;175:840–5.
10. Grilli L, Pratesi M. Weighted estimation in multilevel ordinal and binary models in the presence of informative sampling designs. Surv Meth. 2004;30:93–103.
11. Hamer M, Stamatakis E, Batty GD. Objectively assessed secondhand smoke exposure and mental health in adults: cross-sectional and prospective evidence from the Scottish Health Survey. Arch Gen Psychiatry. 2010;67:850–5.
12. He R, Qin X, An L, et al. Prevalence of anxiety disorders of outpatients in internal medicine departments of general hospitals at different level. Chinese Public Health. 2008;24:702–4.
13. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71:171–86.
14. Jedrychowski W, Perera F, Mroz E, Edwards S, Flak E, Bernert JT, et al. Fetal exposure to secondhand tobacco smoke assessed by maternal self-reports and cord blood cotinine: prospective cohort study in Krakow[J]. Matern Child Health J. 2009;13(3):415–23.
15. Kabir Z, Manning PJ, Holohan J, Keogan S, Goodman PG, Clancy L. Second-hand smoke exposure in cars and respiratory health effects in children. Eur Respir J. 2009;34(3):629–33.
16. Larsson M, Boethius G, Axelsson S, Montgomery SM. Exposure to environmental tobacco smoke and health effects among hospitality workers in Sweden–before and after the implementation of a smoke-free law. Scand J Work Environ Health. 2008;34:267–77.
17. Li J, Tu Y, Huang Y. Review about tobacco control law in world and China. Journal of Public Health and Preventive Medicine. 2010;21:71–5.
18. Ma H, Zhang N, Sun Y. Mental health status and personality characteristic among Najing residents. China Journal of Health Psychology. 2007;15:536–7.
19. Ministry of Health of the People’s Republic of China. A report on Chinese tobacco control. Beijing. 2007.
20. Ministry of Health of the People’s Republic of China. Regulations on the sanitary administration of public place. 2011.
21. Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull. 1991;110:406–25.
22. Nakata A, Takahashi M, Ikeda T, Hojou M, Nigam JA, Swanson NG. Active and passive smoking and depression among Japanese workers. Prev Med. 2008;46:451–6.
23. NAMI. Mental health conditions. Available at Accessed on May 9, 2015.
24. National Bureau of Statistics of the People’s Republic of China. China statistical yearbook, 2011. Available at Accessed on Sep 16, 2013.
25. Pearlin LI. Stress and mental health: a conceptual overview. In: Horwitz AV, Scheid TL, editors. A handbook for the study of mental health: social contexts, theories, and systems. New York, NY: Cambridge University Press; 1999. p. 161–74.
26. Petty F. GABA and mood disorders: a brief review and hypothesis. J Affect Disord. 1995;34:275–81.
27. Qiu J, Wang Z, Xie B. A survey on the mental status of community residents in Shanghai. Shanghai Arch Psychiatry. 2006;18:65–8.
28. Rao U, Hammen CL, London ED, Poland RE. Contribution of hypothalamic-pituitary-adrenal activity and environmental stress to vulnerability for smoking in adolescents. Neuropsychopharmacology. 2009;34:2721–32.
29. Rebagliato M. Editorial: validation of self-reported smoking. J Epidemiol Community Health. 2002;55:163–4.
30. Rohrbach LA, Howard-Pitney B, Unger JB, Dent CW, Howard KA, Cruz TB, et al. Independent evaluation of the California Tobacco Control Program: relationships between program exposure and outcomes, 1996–1998. Am J Public Health. 2002;92(6):975–83.
31. Sargent RP, Shepard RM, Glantz SA. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ. 2004;328:977–80.
32. SAS Institute Inc. SAS/STAT 9.3 user’s guide survey data analysis (Book Excerpt). Cary NC: SAS Institute Inc; 2011.
33. Stillman F, Navas-Acien A, Ma J, Ma S, Avila-Tang E, Breysse P, et al. Second-hand tobacco smoke in public places in urban and rural China. Tob Control. 2007;16:229–34.
34. Stranges S, Bonner MR, Fucci F, Cummings KM, Freudenheim JL, Dorn JM, et al. Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western New York health study, 1995–2001. Arch Intern Med. 2006;166(18):1961.
35. Takala J. Introductory report: decent work–safe work. XVIth World Congress on Safety and Health at Work. May 27, 2002.
36. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke. A report of the surgeon general: 2006. Washington DC: US Government Printing Office; 2006. p. 29–66.
37. Wells AJ, English PB, Posner SF, Wagenknecht L, Perez-Stable EJ. Misclassification rates for current smokers misclassified as non-smokers. Am J Public Health. 1998;88:1503–9.
38. World Health Organization. Second-hand smoke: assessing the burden of disease at national and local levels. Geneva: WHO Environmental Burden of Disease Series, No. 18. Geneva: World Health Organization; 2008. Accessed May 16, 2013 (accessed 16 Dec 2013).
39. World Health Organization. Making cities smoke-free. Geneva: WHO Press; 2012.
40. World Health Organization. WHO report on the global tobacco epidemic 2013. Geneva: World Health Organization; 2014.
41. Xiao L, Yang Y, Li Q, Wang C, Yang G. Population based survey of secondhand smoke exposure in China. Biomed Environ Sci. 2010;23:430–6.
42. Yang T. Tobacco control theory and implementation. Beijing: People’s Health House; 2010. p. 77–105.
43. Yang T, Abdullah AS, Li L, Rockett IRH, Lin Y, Ying J, et al. Public place smoke-free regulations, secondhand smoke exposure and related beliefs, awareness, attitudes, and practices among Chinese urban residents. Int J Environ Res Public Health. 2013;10:2370–83.
44. Yang XY, Anderson JG, Yang T. Impact of role models and policy exposure on support for tobacco control policies in Hangzhou, China. Am J Health Behav. 2014;38(2):275–83.
45. Yang TZ, Huang L, Wu ZY. The application of Chinese health questionnaire for mental disorder screening in community settings in mainland China. Zhonghua liu xing bing xue za zhi. 2003;24:769–73.
46. Yang T, Rockett IRH, Li M, Xu X, Gu Y. Tobacco advertising, environmental smoking bans, and smoking in Chinese urban areas. Drug Alcohol Depend. 2012;124:121–7.
47. Yang T, Yu L, Jiang S, Feng X, Xian H, Cottrell RR, et al. Household smoking restrictions among urban residents in China: individual and regional influences. Int J Publ Health. 2015;60(4):479–86.
1. Secondhand Smoke and Women’s Cognitive Function in China
Xi Pan, Ye Luo, Amy Restorick Roberts
American Journal of Epidemiology
2. Secondhand smoke exposure and mental health in adults: a meta-analysis of cross-sectional studies
Yan-Ni Zeng, Ya-Min Li
Social Psychiatry and Psychiatric Epidemiology
3. Are older adults' home exposures to secondhand smoking during earlier life stages associated with current health status and life satisfaction in China? A multilevel approach
Yen-Han Lee, Yen-Chang Chang, Yi-Ting Hana Lee, Ching-Ti Liu, Mack Shelley
Journal of Ethnicity in Substance Abuse
4. Spillover effects of children’s political status on elderly parents’ health in China
Xin Zhao, Yi Zhou, Huaqing Tan, Haoxiang Lin
Journal of Epidemiology and Community Health