Jaber S Alqahtani, Albandari Alzahrani, Manar Alqarni, Razan Mubarak, Shouq Khalid, Abdulelah M Aldhahir, Rayan A Siraj, Abdullah A Alqarni, Saeed M Alghamdi, Ibrahim A AlDraiwiesh, Hussam M Almarkhan, Abdullah A Ghazwani, Abdallah Y Naser, Hassan Alwafi, Nowaf Y Alobaidi, Ahmed M Hjazi, Duaa AlSubait, Zechariah Arulanantham, Mushabbab A Alahmari, Mohammed M Alyami, Turki M Alanazi, Salma AlBahrani, Tope Oyelade
SHS exposure is prevalent among the Saudi public, particularly in households, among males, e-cigarette smokers and the unemployed. Overall, there is low knowledge and awareness regarding the overall health risks of SHS exposure among the public.
OBJECTIVE: This study aimed to assess the burden of secondhand tobacco smoke (SHS) exposure in the Kingdom of Saudi Arabia by examining its prevalence, awareness levels and associated factors.
DESIGN: Cross-sectional study.
SETTING: A large population-based survey was conducted across Saudi Arabia from March 2023 to January 2024 using non-probability sampling.
PARTICIPANTS: Adults (≥18 years of age) with Saudi nationality and presently residing within the borders of Saudi Arabia.
PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of SHS and public knowledge and awareness. The factors linked to exposure and lack of awareness of SHS health risks were assessed.
RESULTS: A total of 10 082 participants were analysed, of whom 53% were female and 62% were aged 18-30. The sample included 36% married, 56% living with their children and 49% living with 3-4 people in their household. Around 14% of the sample had comorbid conditions, including heart disease, diabetes mellitus and chronic respiratory disease. The prevalence of SHS in our sample was 50% (95% CI 48.9% to 50.9%), with a considerable prevalence at home (57.1% (95% CI 55.8% to 58.5%)) and (16.2% (95% CI 15.2% to 17.2%)) in cafes, coffee stores and tea houses. Most people were exposed to a combination of cigarettes and water pipes (42% (95% CI 40.5% to 43.2%)) and to regular cigarettes (27.4% (95% CI 26.1% to 28.6%)). Nearly 74% of individuals exposed to SHS were unhappy with their exposure. SHS health risks were known by 56% (95% CI 55.5% to 57.4%) of respondents, while 86.5% (95% CI 85.9% to 87.2%) advocated for stronger laws to stop public smoking. Social media (75% (95% CI 74.2% to 76.4%)) and friends and family (57.9% (95% CI 56.6% to 59.3%)) were respondents' top sources of SHS risk information. An increased risk of SHS exposure was associated with males OR (95% CI): 1.56 (1.16 to 2.11), e-cigarette use OR (95% CI): 1.95 (1.33 to 2.92), unemployment OR (95% CI): 2.30 (1.52 to 3.48) and diploma and secondary school education OR (95% CI): 4.94 (3.21 to 7.59); 2.10 (1.52 to 2.90), respectively. Lack of awareness of SHS health risks is linked to males OR (95% CI): 0.41 (0.31 to 0.54), cigarette smokers OR (95% CI): 0.55 (0.40 to 0.77) and big households (7+ persons) compared with 1-2 households OR (95% CI): 1.70 (1.06 to 2.74).
CONCLUSION: SHS exposure is prevalent among the Saudi public, particularly in households, among males, e-cigarette smokers and the unemployed. Overall, there is low knowledge and awareness regarding the overall health risks of SHS exposure among the public.