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BACKGROUND It is well-known that secondhand smoke exposure in childhood or adolescence is positively associated with morbidity and mortality. However, less is known about the current status of and most recent trends in secondhand smoke exposure among adolescents in China. OBJECTIVE We aimed to assess recent changes in the prevalence of secondhand smoke exposure among adolescents in China using nationally representative data. METHODS We used data from 2 repeated national cross-sectional surveys conducted in 2013-2014 and 2019. A total of 155,117 students (median age 13.5 years) in 2013-2014 and 147,270 students (median age 13.1 years) in 2019 were included in this study. Sociodemographic factors and secondhand smoke exposure information were collected via a standardized questionnaire. Exposure was defined as secondhand smoke exposure ≥1 day during the past 7 days at home or in public places. Other frequencies of secondhand smoke exposure (ie, ≥3 days, ≥5 days, and every day) during the past 7 days were also assessed. The weighted prevalence of secondhand smoke exposure was calculated according to the complex sample design for surveys. RESULTS The prevalence of secondhand smoke exposure in any place (home or public places ≥1 day during the past 7 days) decreased from 2013-2014 (72.9%, 95% CI 71.5%-74.3%) to 2019 (63.2%, 95% CI 62%-64.5%), as did exposure at home (2013-2014: 44.4%, 95% CI 43.1%-45.7%; 2019: 34.1%, 95% CI 33.1%-35.2%) and in public places (2013-2014: 68.3%, 95% CI 66.9%-69.6%; 2019: 57.3%, 95% CI 56%-58.6%). The prevalence of secondhand smoke exposure decreased with increased gross domestic product per capita in each of the 2 survey years irrespective of exposure frequency or location. The prevalence of exposure at other frequencies (ie, ≥3 days, ≥5 days, or every day during the past 7 days) also decreased in any place, at home, and in public places. Secondhand smoke exposure was associated with higher school grade level (ninth vs seventh grade: odds ratio [OR] 1.76, 95% CI 1.68-1.84), gender (boys vs girls: OR 1.18, 95% CI 1.15-1.22), urban status (urban vs rural: OR 1.10, 95% CI 1.01-1.19), and cigarette smoking (yes vs no: OR 6.67, 95% CI 5.83-7.62). CONCLUSIONS Although the prevalence of secondhand smoke exposure among Chinese adolescents declined from 2013-2014 to 2019, it remains unacceptably high. More effective strategies and stronger action are needed in China to further, and dramatically, curb secondhand smoke exposure among adolescents.

BACKGROUND Noncommunicable diseases (NCDs) have become the main public health concern worldwide. With rapid economic development and changes in lifestyles, the burden of NCDs in China is increasing dramatically every year. Monitoring is a critical measure for NCDs control and prevention. However, because of the lack of regional representativeness, unsatisfactory data quality, and inefficient data sharing and utilization, the existing surveillance systems and surveys in China cannot track the status and transition of NCDs epidemic. OBJECTIVE To efficaciously track NCDs epidemic in China, this pilot program conducted in Ningbo city by the Chinese Center for Disease Control and Prevention (CDC) aimed to develop an innovative model for NCDs surveillance and management: the integrated noncommunicable disease collaborative management system (NCDCMS). METHODS This Ningbo model was designed and developed through a 3-level (county/district, municipal, and provincial levels) direct reporting system based on the regional health information platform. The uniform data standards and interface specifications were established to connect different platforms and conduct data exchanges. The performance of the system was evaluated based on the 9 attributes of surveillance system evaluation framework recommended by the US CDC. RESULTS NCDCMS allows automatic NCDs data exchanging and sharing via a 3-level public health data exchange platform in China. It currently covers 201 medical institutions throughout the city. Compared with previous systems, automatic popping up of the report card, automatic patient information extraction, and real-time data exchange process have highly improved the simplicity and timeliness of the system. The data quality meets the requirements to monitor the incidence trend of NCDs accurately, and the comprehensive data types obtained from the database (ie, directly from the 3-level platform on the data warehouse) also provide a useful information to conduct scientific studies. So far, 98.1% (201/205) of medical institutions across Ningbo having been involved in data exchanges with the model. Evaluations of the system performance showed that NCDCMS has high levels of simplicity, data quality, acceptability, representativeness, and timeliness. CONCLUSIONS NCDCMS completely reshaped the process of NCD surveillance reporting and had unique advantages, which include reducing the work burden of different stakeholders by data sharing and exchange, eliminating unnecessary redundancies, reducing the amount of underreporting, and structuring population-based cohorts. The Ningbo model will be gradually promoted elsewhere following this success of the pilot project, and is expected to be a milestone in NCDs surveillance, control, and prevention in China.