To investigate the status of secondhand smoke (SHS) exposure and hazard cognition among current non-smokers aged ≥15 years in Ningxia, analyze its main influencing factors, and provide scientific evidence for developing effective tobacco control intervention strategies and measures.

This study selected current non-smokers from the 2024 National Adult Tobacco Surveillance data for Ningxia as the study population. The National Adult Tobacco Surveillance employed a stratified, multistage sampling method with probability proportional to size (PPS). Between March and October 2024, the survey covered 5 districts (urban sites) and 5 counties/cities (rural sites), comprising 30 townships/subdistricts and 60 neighborhood committees/villages (sub-districts). Within each sub-district, 120 households were randomly selected, and one permanent resident aged 15 years or older was randomly selected from each household to participate in a face-to-face questionnaire survey. SPSS 27.0 software was used to perform descriptive analysis and statistical inference on the weighted data derived from the complex sampling design.

A total of 7 200 questionnaires were completed during this survey. After data cleaning, 6 259 valid questionnaires remained, resulting in a valid response rate of 86.93%. This study included 4 821 current nonsmokers as study subjects. In 2024, the overall prevalence of secondhand smoke exposure among current nonsmokers aged ≥15 years in Ningxia was 47.1% (95% CI: 41.8-52.5). Among indoor venues, restaurants had the highest rate of secondhand smoke exposure at 53.2% (95% CI: 40.1-65.8). The overall level of comprehensive awareness regarding the hazards of secondhand smoke was 54.8% (95% CI: 43.1-66.0). Multivariable logistic regression analysis showed that regarding population exposure to secondhand smoke, urban residents (OR=0.733, P<0.05) had lower exposure rates than rural residents.Compared to the ≥65 age group, the 25~<45 age group (OR=1.905, P<0.01) and the 45~<64 age group (OR=1.864, P<0.001)had higher risks of exposure to secondhand smoke. Regarding the overall level of awareness of the hazards of secondhand smoke, men (OR=0.788, P<0.05) had lower awareness than women, and individuals with an education level of primary school or below (OR=0.338, P<0.001) had lower awareness than the reference group with a college degree or higher. Compared with those in other occupational groups, workers in agriculture, forestry, animal husbandry, fisheries, and water conservancy (OR=0.556, P<0.01), employees in enterprises, commerce, and services (OR=0.672, P<0.05), and the unemployed (OR=0.715, P<0.01) had lower levels of comprehensive awareness of the hazards of secondhand smoke.

The SHS exposure rate among non-smokers in Ningxia is relatively high. Males, individuals with low education level, and specific occupational groups have insufficient cognition of SHS hazards. Tobacco control interventions should be strengthened in rural areas and among different occupational groups to reduce SHS exposure.