Second-hand smoke exposure as an independent determinant of quit attempts and successful tobacco cessation: A multilevel analysis of the GATS (2016–17), India

Background: Secondhand smoke (SHS) exposure remains a pervasive public health challenge in India and contributes to tobacco-related morbidity and mortality. Despite progress in tobacco control, quit rates among Indian adults remain low, and the impact of SHS exposure on cessation outcomes is not well understood. This study aimed to examine the associationsbetween SHS exposure and tobacco cessation outcomes among Indian adults using nationally representative data from the Global Adult Tobacco Survey (GATS) India 2016–17. Methods: A cross-sectional secondary analysis was conducted including adults aged 15 years and older who were current or past tobacco users. SHS exposure was assessed across three domains: home, workplace, and public places. The primary outcomes were self-reported quit attempts in the past 12 months and successful cessation. Multilevel logistic regression models accounted for the hierarchical data structure adjusting for sociodemographic and behavioral confounders. Model fit was evaluated via theAkaike information criterion and likelihood ratio tests. Subgroup and interaction analyses were performed. Results: Among 74,037 respondents, the prevalence of current tobacco use was 28.6%. SHS exposure was reported by 38.7% of the participants at home and 30.2% at the workplace. After adjustment, SHS exposure at home was independently associated with reduced odds of quit attempts (AOR = 0.72, 95% CI: 0.65–0.80) and successful cessation (AOR = 0.65, 95% CI: 0.56–0.76). Negative associations were observed for SHS exposure at workplaces and public places. Conclusion : SHS exposure significantly impedes both quittingattempts and successful tobacco cessation among Indian adults.