Affiliation:
1. National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
2. Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
3. Beijing Tiantan Hospital, Capital Medical University, Beijing, China
4. Healthy China Research Center, Tus-Digital Group, Beijing, China
5. Shenzhen Sun Yat-Sen Cardiovascular Hospital, Shenzhen, China
Abstract
Abstract
Introduction
Periodic population surveys of smoking behavior can inform development of effective tobacco control strategies. We investigated smoking patterns, cessation, and knowledge about smoking hazards in China.
Methods
A nationally representative cross-sectional survey recruited 176 318 people aged ≥18 years across 31 provinces of China in 2013–2014, using multi-stage stratified cluster sampling methods. The smoking patterns, cessation, and knowledge about smoking hazards were analyzed, overall and in population subgroups, adjusting for sample selection weight and post-stratification factors.
Results
Among men, 60.7% were ever-smokers, with proportions of regular, occasional and former smokers being 46.3%, 5.5%, and 8.8% respectively. Among women, only 2.8% had ever smoked. The prevalence of ever smoking in men was higher in rural than urban areas (63.2% vs. 57.6%) and varied from 39.5% to 67.4% across 31 provinces. Among male regular smokers, the mean daily number of cigarettes smoked was 17.8, with mean age at first starting to smoke daily being 20.1 years. Among current smokers, one-third (32.6% men, 32.1% women) had tried to quit before and 36.8% (36.8% men, 35.5% women) intended to quit in the future. Of the Chinese adults, 75.9% recognized that smoking was hazardous, with the proportions believing that smoking could cause lung cancer, heart attack or stroke being 67.0%, 33.2%, and 29.5%, respectively and with 26.0% reporting that smoking could cause all these conditions.
Conclusion
Among Chinese adults, the smoking prevalence remained high in men but was low in women. In both men and women, knowledge about smoking hazards was poor.
Implications
This study showed that tobacco smoking remained highly prevalent among adult men in China in 2013–2014. Moreover, men born in recent decades were more likely to start smoking at younger ages and to smoke more cigarettes than those born in previous generations. There was a large regional variation in male smoking prevalence, with the least economically developed regions having higher prevalence. In contrast, few women in China smoked, especially among those born in recent decades. The contrasting smoking patterns in men and women is likely to result in an increasingly large gender disparity in life expectancy in the coming decades.
Funder
Central to Local Fiscal Transfer Payment Program of China
National Key R&D Program of China
Shifting the China Tobacco Control Policy Landscape
Publisher
Oxford University Press (OUP)
Subject
Public Health, Environmental and Occupational Health
Reference32 articles.
1. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015;GBD 2015 Risk Factors Collaborators;Lancet,2016
2. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015;GBD 2015 Tobacco Collaborators;Lancet.,2017
3. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies;Chen;Lancet.,2015
4. National Bureau of Statistics of China. National Data;2013. http://data.stats.gov.cn/index.htm. Accessed June 27, 2017.
5. Tobacco Control for 5 years. Beijing. The Central People’s Government of the People’s Republic of China. 2012. http://www.gov.cn/fwxx/content_1780112.htm. Accessed June 27, 2017.