Objective To understand the smoking status and associated factors in permanent residents in Hainan province, and provide evidence for the development of smoking control policies.

Methods Two-stage unequal proportion cluster sampling method was used in this study, and a total of 32 857 permanent residents aged >18 years from different areas in Hainan were randomly selected for on-site investigation from January to June 2023. The main factors affecting smoking behavior of adults were analyzed by using logistic regression and decision tree models.

Results The current smoking rate in permanent residents in Hainan was 27.39% (weighted rate 33.31%) in 2023, and the average daily smoking amount of smokers was 17.88 cigarettes. The multivariate logistic regression analysis showed that being man (OR=99.33, 95%CI:85.57-115.29), being employed (OR=1.16, 95%CI: 1.05-1.29), living in rural area (OR=1.19, 95%CI: 1.09-1.29), alcohol consumption (OR=3.10, 95%CI: 2.88-3.34) were positively associated with the current smoking status. The results of the decision tree model showed that being man, alcohol consumption, lower education level and age <60 years were the main factors affecting current smoking status.

Conclusion The current smoking rate was high in permanent residents in Hainan. Future tobacco control efforts should target youngand middle-aged men, drinkers, and more stringent tobacco control measures need to be taken.