Higher exposure to secondhand smoking among adolescents living in Zambia in 2021

BackgroundSecondhand smoke (SHS) exposure remains a major public health concern among adolescents, particularly in low- and middle-income countries. Evidence from Zambia is limited, despite increasing tobacco use and existing tobacco control policies. This study examined the prevalence and correlates of SHS exposure among adolescents in Zambia. MethodsWe analyzed data from the 2021 Zambia Global Youth Tobacco Survey (GYTS), a nationally representative, school-based survey. The sample included 6,499 adolescents aged 11-17 years enrolled in grades 7-9. The primary outcome was any SHS exposure, defined as exposure to tobacco smoke at home, school, enclosed public places, or outdoor public places. Weighted prevalence estimates were calculated, and multivariable logistic regression was used to identify factors associated with SHS exposure, adjusting for demographic, social, environmental, and socioeconomic variables. ResultsOverall, 66.0% of adolescents reported exposure to SHS. Adolescents living with a parent or guardian who smoked had nearly three times higher odds of SHS exposure (adjusted odds ratio [AOR] = 2.76; 95% CI: 2.12-3.62; p < 0.001). Having friends who smoked tobacco (AOR = 1.86; 95% CI: 1.52-2.30; p < 0.001) and seeing teachers smoking at school (AOR = 1.88; 95% CI: 1.40-2.56; p < 0.001) were also significant predictors. Media exposure was important: seeing people use tobacco on television (AOR = 1.88; 95% CI: 1.63-2.17; p < 0.001) and exposure to tobacco advertisements (AOR = 1.38; 95% CI: 1.14-1.67; p = 0.001) increased odds of SHS exposure. Adolescents who had smoked cigarettes had higher odds of exposure (AOR = 2.80; 95% CI: 1.70-4.67; p < 0.001), as did those intending to use tobacco in the next five years (AOR = 1.64; 95% CI: 1.21-2.24; p = 0.002). Age, sex, and grade level were not independently associated with SHS exposure. ConclusionsSHS exposure among adolescents in Zambia is widespread and is largely driven by household smoking, peer influence, school environments, and media exposure. Strengthening enforcement of smoke-free policies, promoting smoke-free homes, and addressing social and media influences are critical to reducing adolescent SHS exposure.