Global exposure to second-hand smoke reached 2.71 billion people in 2023, including 767 million children, with an overall exposure prevalence of about one-third of the world population.

In India, absolute deaths from second-hand smoke rose from roughly 218,000 in 1990 to about 326,000 in 2023, while age-standardised death rates declined from 46.1 to 30.0 per 100,000.

Ischemic heart disease remains the leading cause of death linked to second-hand smoke exposure among adults.

Experts urge a coordinated national response that treats air quality as a public health emergency, engaging government, judiciary, industry, and citizens.

Strategies must reduce exposure by helping smokers quit and by protecting non-smokers in private settings and homes.

Southeast Asia, East Asia, and Oceania show the highest SHS exposure, with North Africa and the Middle East following; accelerated implementation of tobacco-control measures is essential.

Calls for stronger anti-tobacco policies to shield women and children in both public and domestic spaces, stressing that there is no safe exposure threshold for passive smoking.

Dr. Neetu Jain emphasizes that SHS exposure is avoidable through actions like smoking outdoors and tougher tobacco-control measures, including higher tobacco taxes.

Public health guidance advocates reducing exposure by smoking outside enclosed spaces, enacting stricter tobacco controls, and increasing tobacco taxes.

Pollution drivers include stubble burning, traffic, and industry, while solutions like masks and air purifiers remain out of reach for many.

The exposure trend mirrors active smoking patterns, indicating persistently high smoking rates in many low- and middle-income countries despite regional gains in reducing exposure.

Delhi-NCR exemplifies the crisis, where winter pollution creates a ‘gas chamber’ effect and policy responses have been largely reactive rather than preventive.