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Frequency–risk relationships between second-hand smoke exposure and respiratory symptoms among adolescents: a cross-sectional study in South China
  1. Zhiyao Chen1,
  2. Guocong Liu2,
  3. Jianying Chen3,
  4. Shunming Li1,
  5. Ting Jiang2,
  6. Bin Xu2,
  7. Xiaohua Ye1
  1. 1 School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
  2. 2 Health Education Section, Guangzhou Yuexiu Center for Disease Control and Prevention, Guangzhou, China
  3. 3 General Department, Guangzhou Yuexiu Baiyun Community Health Service Center, Guangzhou, China
  1. Correspondence to Dr Xiaohua Ye; smalltomato{at}


Objectives Although previous studies have suggested an association between second-hand smoke (SHS) exposure and respiratory symptoms, current evidence is inconsistent. Additionally, it remains unclear whether there are frequency–risk relationships between SHS exposure and respiratory symptoms among adolescents.

Methods A cross-sectional survey was conducted using a stratified cluster sampling method to obtain a representative sample of high school students in Guangzhou, China. The respiratory symptoms were defined as persistent cough or sputum for three consecutive months during the past 12 months. Self-reported SHS exposure was defined as non-smokers' inhalation of the smoke exhaled from smokers on ≥1 day a week in the past 7 days. The univariable and multivariable logistic regression models were fitted to explore the potential frequency–risk relationships between SHS exposure and respiratory symptoms.

Results Among 3575 students, the overall prevalence of SHS exposure was 69.2%, including 49.5% for SHS in public places, 34.5% in homes, 22.7% in indoor campuses and 29.2% in outdoor campuses. There were significantly increased risks of having respiratory symptoms corresponding to SHS exposure in public places (OR=1.60, 95% CI 1.30 to 1.95), in homes (OR=1.53, 95% CI 1.25 to 1.87), in indoor campuses (OR=1.43, 95% CI 1.14 to 1.79) and in outdoor campuses (OR=1.37, 95% CI 1.10 to 1.69) using no exposure as reference. Notably, we observed monotonic frequency–risk relationships between setting-specific(eg, homes, public places and campuses) SHS exposure and respiratory symptoms.

Conclusion Our findings suggest that setting-specific SHS exposure is associated with a significant, dose-dependent increase in risk of respiratory symptoms.

  • second-hand smoke exposure
  • respiratory symptoms
  • adolescents

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  • ZC, GL and JC contributed equally.

  • Contributors ZC, GL, SL, TJ, BX, JC and XY were involved in the design of the study, data analysis and writing of the draft of the manuscript. All the authors read and approved the final version of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval The Ethics Committee of Guangdong Pharmaceutical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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