Flor et al. (2026) used Global Burden of Disease 2023 data to estimate second-hand smoke (SHS) exposure and attributable disease burden across 204 countries and territories from 1990–2023. In 2023, an estimated 2.71 billion people, including 767 million children, were exposed to SHS, contributing to 1.66 million deaths and 44.8 million DALYs. Although age-standardised exposure prevalence declined by 22.2% since 1990, absolute exposure remained stable due to population growth, with substantial regional and sex disparities. Ischaemic heart disease was the leading contributor to disease burden, while lower respiratory infections and asthma were particularly important among children. The authors highlight the need for stronger and more comprehensive tobacco-control and smoke-free policies, including protection within domestic settings.
This paper shows that despite progress in reducing SHS prevalence, exposure remains a major and preventable global public health burden, disproportionately affecting women and children.