Prevalence and predictors of indoor second-hand smoke among the non-smoker household population in India: Evidence from the Demographic and Health Survey (DHS) 2021 data

Despite high risk, exposure to indoor second-hand smoke (SHS) among the non-smokers is scarcely studied in India. To address this gap, we assessed the prevalence and predictors of indoor SHS among the non-smoker household population of India. Bivariate and multivariate analysis of Demographic and Health Survey 2021 data of 1,529,486 household members was carried out. For India, the prevalence of indoor SHS exposure was 40.6 percent. Adults (aOR 0.88; 95% CI 0.87-0.89), educated individuals (aOR 0.87; 95% CI 0.86-0.88), married couples (aOR 0.72; 95% CI 0.71-0.73), and occupants of pucca houses (aOR 0.77; 95% CI 0.75-0.78) had lower odds of indoor SHS exposure than their respective reference categories. Females (aOR 1.54; 95% CI 1.53-1.56), higher household size (aOR 1.07; 95% CI 1.07-1.08), joint family (aOR 1.11; 95% CI 1.10-1.12), Muslims (aOR 1.18; 95% CI 1.17-1.20), Scheduled Tribes (aOR 1.15; 95% CI 1.14-1.17), rural residents (aOR 1.26; 95% CI 1.25-1.27), and the northeastern zone (aOR 1.12; 95% CI 1.10-1.14) were positively associated with indoor SHS exposure. Every four out of ten Indians experienced indoor SHS exposure. Half of them were daily exposed to indoor SHS. Particularly children, women, and occupants of Kachha houses were at higher risk. The susceptibility among these high-risk groups to cancers, respiratory diseases, and cardiovascular diseases can be averted by improving housing, increasing access to tobacco cessation services and additional pharmacotherapies, and strict enforcement of tobacco control regulations in India.