Prevalence of Secondhand Smoke Exposure and Thirdhand Smoke Awareness among Adults in Urban Kattankulathur, Chengalpattu, India: A Community-Based Cross-Sectional Study
DOI:
https://doi.org/10.55489/njcm.170620266521Keywords:
Second-hand Smoke (SHS) Exposure, Third-hand Smoke (THS), Tobacco Control, Community-Based Study, Urban PopulationAbstract
Background: Tobacco-related environmental exposure remains a major public health concern in India. This study assessed second-hand smoke exposure and thirdhand smoke awareness among adults in urban Kattankulathur, Tamil Nadu, India.
Methods: A community-based cross-sectional study was conducted among 230 adults using multistage random sampling. Data were collected using questionnaires adapted from the Global Adult Tobacco Survey and Beliefs About Thirdhand Smoke scale. Multivariable logistic regression identified predictors of exposure and awareness.
Results: Overall, 65.2% participants reported second-hand smoke exposure during the previous seven days, particularly in outdoor enclosed public spaces and friends’ or relatives’ homes. Among never smokers, 52.4% experienced involuntary exposure. Current smoking and cohabitation with smokers were independently associated with exposure. Although awareness regarding harmful effects of second-hand smoke was high, detailed understanding of thirdhand smoke persistence and indirect exposure pathways remained limited. Never smokers and individuals not living with smokers demonstrated significantly higher awareness.
Conclusion: Second-hand smoke exposure remains highly prevalent despite tobacco-control measures, while important knowledge gaps regarding residual tobacco hazards persist. Strengthened smoke-free policy enforcement, promotion of smoke-free homes, and targeted community education are essential to reduce environmental tobacco exposure. Focused behavioural interventions targeting smoker households may improve awareness and reduce involuntary exposure among vulnerable nonsmokers.
References
World Health Organization. Tobacco [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Apr 24]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco
Kaur J, Rinkoo AV, Richardson S. Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy. Tob Control. 2025 Jul 31;34(4):544-547. DOI: https://doi.org/10.1136/tc-2024-058599 PMid:38851291
Su Z, Xie Y, Huang Z, Cheng A, Zhou X, Wang M, et al. Second hand smoke attributable disease burden in 204 countries and territories, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021. Respir Res. 2025 May 7;26(1):174. DOI: https://doi.org/10.1186/s12931-025-03228-3 PMid:40336093 PMCid:PMC12060545
National Cancer Institute (US). Secondhand smoke and cancer [Internet]. Bethesda (MD): National Cancer Institute; 2018 [cited 2026 Apr 3]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/second-hand-smoke-fact-sheet
Centers for Disease Control and Prevention (US). Health problems caused by secondhand smoke [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2025 [cited 2026 Apr 3]. Available from: https://www.cdc.gov/tobacco/secondhand-smoke/health.html
US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: Office on Smoking and Health (US); 2006 [cited 2026 Apr 3]. (Surgeon General's Report). Available from: https://www.ncbi.nlm.nih.gov/books/NBK44324/
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal Habits and Indoor Combustions. Lyon (FR): International Agency for Research on Cancer; 2012. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 100E.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK304391/
Bhandari Y, Kishore J, Yadav A, Das A. Second hand tobacco smoke exposure among adults in an urbanized village in Delhi. Indian J Community Med. 2025 Jan-Feb;50(1):62-69. DOI: https://doi.org/10.4103/ijcm.ijcm_425_23 PMid:40124835 PMCid:PMC11927843
Nagappan N, Manigandan T. Toxic Dust: Measuring Awareness about Third-Hand Smoke Contamination in Homes Among Smokers and Non-smokers of Family Members-A Cross-sectional Study. J Pharm Bioallied Sci. 2025 Dec;17(Suppl 4):S3010-S3012. DOI: https://doi.org/10.4103/jpbs.jpbs_1434_25 PMid:41523046 PMCid:PMC12788428
Arfaeinia H, Ghaemi M, Jahantigh A, Soleimani F, Hashemi H. Secondhand and thirdhand smoke: a review on chemical contents, exposure routes, and protective strategies. Environ Sci Pollut Res Int. 2023 Jul;30(32):78017-78029. DOI: https://doi.org/10.1007/s11356-023-28128-1 PMid:37306877 PMCid:PMC10258487
James JM, George G, Cherian MR, Rasheed N. Thirdhand smoke composition and consequences: A narrative review. Public Health and Toxicology. 2022;2(3):12. DOI: https://doi.org/10.18332/pht/151102
Ministry of Health and Family Welfare, Government of India; Tata Institute of Social Sciences (TISS), Mumbai. Global Adult Tobacco Survey: India 2016-2017 (GATS 2) [Internet]. New Delhi: Ministry of Health and Family Welfare, Government of India; 2017 [cited 2026 Feb 28]. Available from: https://ntcp.mohfw.gov.in/assets/document/surveys-reports-publications/Global-Adult-Tobacco-Survey-Second-Round-India-2016-2017.pdf?utm_
Verma M, Kathirvel S, Das M, Aggarwal R, Goel S. Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II. PLoS One. 2020 Jun 10;15(6): e0233861. DOI: https://doi.org/10.1371/journal.pone.0233861 PMid:32520979 PMCid:PMC7286505
World Health Organization. Global Adult Tobacco Survey (GATS) core questionnaire with optional questions [Internet]. Geneva: World Health Organization; [cited 2026 Feb 28]. Available from: https://cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/gats/06_gats_corequestionnairewithoptionalquestions.pdf?sfvrsn=3b5ca226_15
Haardörfer R, Berg CJ, Escoffery C, Bundy ŁT, Hovell M, Kegler MC. Development of a scale assessing Beliefs About ThirdHand Smoke (BATHS). Tob Induc Dis. 2017 Jan 17;15:4. DOI: https://doi.org/10.1186/s12971-017-0112-4 PMid:28104999 PMCid:PMC5240270
Shah PP, Bhaskar S, Singh MM. Updated BG Prasad's socio-economic status classification for the year 2025. Int J Community Med Public Health. 2025;12(5):2345-2347. DOI: https://doi.org/10.18203/2394-6040.ijcmph20251399
Chopra M, Gupta A, Sharma B, Kakade N, Arora M. Assessing second-hand smoke exposure among non-smoking youth in India: Insights from GATS I & II. The Indian Journal of Medical Research. 2024 Dec;160(6):578-591. DOI: https://doi.org/10.25259/IJMR_388_2024 PMid:39913523 PMCid:PMC11801776
Ahmed F, Gawde N, Parasuraman S. Prevalence, sources, and correlates of second-hand smoke exposure among non-smoking pregnant women in India. J Prev Med Public Health. 2025 Mar;58(2):136-145. DOI: https://doi.org/10.3961/jpmph.24.278 PMid:39901756 PMCid:PMC11986596
Sharma T, Aggarwal P, Singh M. Second hand smoke exposure in pregnant women in Dehradun, Uttrakhand: A cross sectional study. J Family Med Prim Care 2022 Feb;11(2):667-671. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1607_21 PMid:35360800 PMCid:PMC8963620
Tripathi S, Chinnakali P, Naik BN, Kar SS. COTPA implementation status: an observational study in a South Indian city. Indian J Med Res 2022 Sep;156(3):508-515. DOI: https://doi.org/10.4103/ijmr.IJMR_2376_20 PMid:36751746 PMCid:PMC10101349
Gupta R, Bhatt G, Singh R, Chahar P, Goel S, Singh RJ. Enforcement of COTPA in India- current status, challenges and solutions. Indian J Tuberc. 2025 Jan;72(1):94-97. DOI: https://doi.org/10.1016/j.ijtb.2024.06.007 PMid:39890380
Pradhan A, Oswal K, Padhan A, Seth S, Sarin A, Sethuraman L, et al. Cigarettes and Other Tobacco Products Act (COTPA) implementation in education institutions in India: A crosssectional study. Tob Prev Cessat. 2020 Sep 10;6:51. DOI: https://doi.org/10.18332/tpc/125722 PMid:33083679 PMCid:PMC7552856
Sharma D, Goel NK. Prevalence And Predictors of Exposure to Second-Hand Smoke Among Never-Tobacco Smokers. Natl J Community Med. 2022;13(10):738-741. DOI: https://doi.org/10.55489/njcm.131020222366
Aras A, Bayraktar M. Third-hand smoke perception and awareness among medical students: a survey study. Sci Rep. 2024 Jun 10;14(1):13355. DOI: https://doi.org/10.1038/s41598-024-61636-9 PMid:38858408 PMCid:PMC11164951
Yoshany N, Karimiankakolaki Z, Khodayarian M, Jambarsang S, Ghaderi A, Afkhami Z. Invisible smoke, real threat: can education protect pregnant women from thirdhand smoke exposure? (a protocol study). BMC Pregnancy Childbirth. 2025 Oct 21;25(1):1117. DOI: https://doi.org/10.1186/s12884-025-08215-6 PMid:41120919 PMCid:PMC12539110
Wang Y, Gu J. The Physical Processes and Chemical Transformations of Third-Hand Smoke in Indoor Environments and Its Health Effects: A Review. Atmosphere. 2025 Mar 24;16(4):370. DOI: https://doi.org/10.3390/atmos16040370
Marya CM, Jha N, Taneja P, Nagpal R, Kataria S, Josh J. Exploring the Knowledge, Attitude, and Practices of Second and Thirdhand Smoke Among Smokers and Nonsmokers: A Web Based Survey. Journal of Indian Association of Public Health Dentistry [Internet]. 2025 Jan [cited 2026 Feb 28];23(1):52-57. DOI: https://doi.org/10.4103/jiaphd.jiaphd_202_24
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kaarunya A, Abinaya P, Sathya Priya T, Anantharaman VV
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.
