Association between secondhand smoke exposure among women and the implementation of tobacco control measures on campus: A cross-sectional study in 50 universities across China

Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China.7,469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policy reported the implementation of smoke-free policy on campus measured by (1) no evidence of smoking and (2) display of smoke-free signs at public places. Multivariate logistic regression models were applied using weighted survey data.SHS exposure among participants was 50.5% (95% CI: 44.2%-56.9%). The adoption of smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI: 0.71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI:0.47-0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI: 1.42, 3.82; OR: 1.52; 95% CI: 1.15, 2.02, respectively).Exposure to SHS is prevalent among female college students in China. Successful implementation of smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China.Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with a higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.