BACKGROUND: SHS exposure claims approximately 1.3 million lives annually through various associated diseases. While China witnessed a modest decline in SHS exposure rates from 72.4% to 68.1% between 2010 and 2018, recent trends remain unclear.
METHODS: The present study utilizes data from the 2022 National Adult Tobacco Survey (NATS), which offers both national and provincial representativeness, to analyze current SHS exposure rates across China. Spatial analyses were conducted using GeoDa (version 1.22; Dr. Luc Anselin team) to examine spatial data matrices, spatial autoregression, and ordinary least squares (OLS) spatial regression models for analyzing influencing factors and spatial heterogeneity of SHS exposure. This research aims to inform the development of targeted, region-specific tobacco control strategies and measures.
RESULTS: In 2022, the SHS exposure rate among non-smoking adults aged 15 years and above in China was 52.4%, with significant positive spatial correlation across regions (Moran's I=0.337, Z=4.626, P=0.001). Stronger tobacco control measures were associated with lower SHS exposure rates across multiple settings: homes (β=-0.571, T=4.621, P<0.001), indoor workplaces (β=-0.446, T=-3.472, P=0.002), and medical and health care institutions (β=-0.539, T=-2.502, P=0.019). Additionally, higher population coverage by comprehensive smoke-free regulations was significantly associated with reduced SHS exposure (β=-4.002, T=-4.241, P<0.001). Regarding tobacco harm awareness, regions with higher recognition of SHS-related heart disease risks (β=-0.472, T=-2.682, P=0.012) and smoking-related risks of stroke (β=-0.438, T=-2.501, P=0.018) and heart disease (β=-0.483, T=-2.977, P=0.006) demonstrated significantly lower SHS exposure rates.
CONCLUSIONS: In conclusion, while China has made notable progress in tobacco control efforts, there remains a critical need for enhanced public health interventions. Future initiatives should focus on strengthening health education programs, elevating public awareness of SHS-related health risks, establishing robust SHS exposure monitoring systems, and implementing regular regional assessments. These measures will enable the development of more targeted and regionally-specific tobacco control strategies and interventions.