ArticleBMJ open2026
Prevalence, predictors and burden of secondhand tobacco smoke (SHS) exposure in Saudi Arabia: a large-scale cross-sectional survey.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis 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.
designCross-sectional study.
settingA large population-based survey was conducted across Saudi Arabia from March 2023 to January 2024 using non-probability sampling.
participantsAdults (≥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.
resultsA 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).
conclusionSHS 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.
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