Odo Daniel Bogale, Ayo-Yusuf Olalekan, Dinku Yonatan, Mekonnen Alemayehu Gonie, Maddox Raglan
National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health (SHSPH), University of Pretoria, Prinshof, Pretoria, South Africa.
BMJ Glob Health. 2025 Feb 12;10(2):e017110. doi: 10.1136/bmjgh-2024-017110.
The health consequences of secondhand smoke (SHS) are a long-standing concern. The WHO Framework Convention on Tobacco Control (FCTC) is an evidence-based treaty that aims to protect people from health and environmental harms of commercial tobacco use and exposure to SHS. This study quantified the prevalence of daily smoking inside the house (indoor smoking) and change over time and examined the determinants of indoor smoking in 24 WHO FCTC Parties.
We used data from the 2 most recent Demographic and Health Surveys (DHS) from 24 countries. Counties were selected if they submitted at least one FCTC implementation report and had two DHS surveys conducted after 2010. The weighted prevalence and percentage changes in daily indoor smoking in the two consecutive surveys were calculated, including rate of change, and a two-sample test of proportions was used to assess changes. Multinomial logistic regression model was employed to examine the association between socioeconomic characteristics and indoor smoking. All results were presented by country.
A significant decline in the prevalence of daily indoor smoking was detected in 16/24 countries, with the rate of decline ranging from -45.8% in Liberia to -15.2% in India. Jordan reported a significant increase in daily indoor smoking from 57% to 60%; p=0.002. The meta-analytical estimate showed that overall, the relative risk ratio (RRR) of daily indoor smoking was significantly lower for households in the 5th wealth quintile compared with counterparts in the 1st quintile (RRR=0.40; 95% CI: 0.30 to 0.52), and in households where head of the household attended higher education compared with no formal education (RRR=0.60; 95% CI: 0.53 to 0.69).
This study demonstrated that prevalence of daily indoor smoking was associated with low socioeconomic status. Reducing SHS exposure is critical, including addressing inequities to help improve health outcomes. Currently, over 2.8 billion people in low-income countries are not protected by smoke-free environment laws, and only 18% of the world's population is covered by strong restrictions on tobacco marketing.
二手烟（SHS）对健康的影响一直备受关注。世界卫生组织《烟草控制框架公约》（FCTC）是一项基于证据的条约，旨在保护人们免受商业烟草使用及接触二手烟对健康和环境造成的危害。本研究对24个《世界卫生组织烟草控制框架公约》缔约方室内每日吸烟的流行情况及其随时间的变化进行了量化，并考察了室内吸烟的决定因素。
我们使用了来自24个国家的2份最新的人口与健康调查（DHS）数据。若这些国家提交了至少一份《烟草控制框架公约》实施报告，且在2010年后进行了两次人口与健康调查，则被纳入研究。计算了连续两次调查中室内每日吸烟的加权流行率和百分比变化，包括变化率，并使用两样本比例检验来评估变化情况。采用多项逻辑回归模型来考察社会经济特征与室内吸烟之间的关联。所有结果均按国家呈现。
在24个国家中的16个国家，室内每日吸烟的流行率显著下降，下降幅度从利比里亚的-45.8%到印度的-15.2%不等。约旦报告称室内每日吸烟率从57%显著上升至60%；p = 0.002。荟萃分析估计显示，总体而言，与最贫困五分位家庭相比，最富裕五分位家庭室内每日吸烟的相对风险比（RRR）显著更低（RRR = 0.40；95%置信区间：0.30至0.52），与户主未接受正规教育的家庭相比，户主接受高等教育的家庭室内每日吸烟的相对风险比（RRR = 0.60；95%置信区间：0.53至0.69）。
本研究表明，室内每日吸烟的流行率与社会经济地位低下有关。减少二手烟暴露至关重要，包括解决不平等问题以改善健康状况。目前，低收入国家超过28亿人未受到无烟环境法律的保护，全球仅有18%的人口受到对烟草营销的严格限制。
