1
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Wang X, Cao Y. Family Environment and Community Context for Longitudinal Cigarette Smoking Trajectories Among Chinese Young People. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01677-3. [PMID: 38337111 DOI: 10.1007/s10578-024-01677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Tobacco use is the leading cause of preventable death, and China accounts for about 30% of worldwide smokers and 40% of global tobacco consumption. This study examines socioeconomic and community disparities in smoking among young Chinese people from 2010 to 2016. Data were from 953 people aged 16 to 25 in four waves of the China Family Panel Studies (CFPS). Two-level logistic regressions were fitted to account for both inter-individual and intra-individual differences over time. Weight-adjusted multilevel regression results showed a decrease in cigarette smoking among rural young people (OR = 0.71, 95% CI = [0.52, 0.98]) from 2010 to 2016. Higher family income was related to higher odds of cigarette smoking among young people (OR = 1.75, 95% CI = [1.10, 2.80]). Cigarette smoking among young people in families with higher incomes increased over time. Policies and interventions targeting the young should consider the socioeconomic disparities and multilevel context.
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Affiliation(s)
- Xiafei Wang
- School of Social Work, David B. Falk College of Sport and Human Dynamic, Syracuse University, White Hall 220, 150 Crouse Dr, New York, 13244, USA.
| | - Yiwen Cao
- Sociology Department, Biquan School, Xiangtan University, Hunan, China
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2
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Ran X, Zeng H, Zheng R, Sun K, Han B, Wang S, Chen R, Li L, Wei W, He J. Geographic, sex and socioeconomic disparities in esophageal cancer incidence in China: A population-based study. Int J Cancer 2024; 154:477-487. [PMID: 37728072 DOI: 10.1002/ijc.34730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
Geographic and sex differences in esophageal cancer have been reported in China, but data are lacking at the local level. We aimed to investigate geographic and sex disparities in esophageal cancer incidence among Chinese counties and whether county-level socioeconomic status was associated with these variations. We obtained esophageal cancer data from 2015 to 2017 for 782 counties from population-based cancer registries in China. We calculated age-standardized incidence rates and male-to-female incidence rate ratios (IRRs) by county. We performed hotspot analysis to identify geographical clusters. We used negative binomial regression models to analyze the association between incidence rates and county-level socioeconomic factors. There were significant geographic disparities in esophageal cancer incidence, with 8.1 times higher rate in the 90th-percentile county than in the 10th-percentile county (23.7 vs 2.9 per 100 000 person-years). Clusters of elevated rates were prominent across north-central China. Nationally, men had 2.9 times higher incidence of esophageal cancer than women. By county, the male-to-female IRRs ranged from 1.1 to 21.1. Clusters of high male-to-female IRRs were observed in northeast China. Rurality (IRR 1.16, 95% CI 1.10-1.22), per capita gross domestic product (IRR 0.95, 0.92-0.98) and percentage of people with a high school diploma (IRR 0.86, 0.84-0.87) in a county were significantly associated with esophageal cancer incidence. The male-to-female IRRs were higher in counties with higher socioeconomic status. Substantial differences in incidence rates and sex ratios of esophageal cancer exist between Chinese counties, and county-level socioeconomic status was associated with these variations. These findings may inform interventions to reduce these disparities.
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Affiliation(s)
- Xianhui Ran
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Zeng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kexin Sun
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingfeng Han
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoming Wang
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ru Chen
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhou H, Zhang M, Yang J, Wang J, Chen Y, Ye X. Returning ryegrass to continuous cropping soil improves soil nutrients and soil microbiome, producing good-quality flue-cured tobacco. Front Microbiol 2023; 14:1257924. [PMID: 37876786 PMCID: PMC10591219 DOI: 10.3389/fmicb.2023.1257924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
The widespread and continuous cultivation of tobacco has led to soil degradation and reduced crop yields and quality. Green manure is an essential organic fertilizer that alleviates obstacles to continuous cultivation. However, the plant-soil microecological effects of green manure on flue-cured tobacco cultivation remain unclear. Thus, a positioning trail including two treatments, chemical fertilizer application only (treatment NPK) and chemical fertilizer application with turning ryegrass (treatment NPKG) was conducted, and the effect of ryegrass returning on the soil physicochemical properties, soil microbiome, crop yield, and quality of flue-cured tobacco in continuous cropping soil were investigated. Results showed that returning ryegrass to the field increased the thickness of soil humus layer from 13 cm to 15 cm, reduced the humus layer soil bulk density to 1.29 cm3/g. Ryegrass tilled and returned to the field increased soil organic matter content by 6.89-7.92%, increased rhizosphere soil available phosphorus content by 2.22-17.96%, and converted the soil non-exchangeable potassium into potassium that was available for plant absorption and utilization. Ryegrass tilling and returning to the field increased the potassium content of middle leaves of flue-cured tobacco by 7.69-10.07%, the increased potassium content in flue-cured tobacco was accompanied by increased total sugar, reducing sugar, and the ratio of reducing sugar to nicotine, which facilitated the harmonization of the chemical composition of cured tobacco leaves. Moreover, the increased number of markedly improved operational taxonomic units enhanced the complexity of the soil bacterial community and its compactness after ryegrass tillage and their return to the field. The available potassium, available phosphorus, total potassium content, pH, and sampling period of the rhizosphere soil had considerable effects on the rhizosphere microbial. Ryegrass tilling and returning to the field changed the soil microbiome, which increased the abundance of bulk soil Proteobacteria, rhizosphere soil Fibrobacterota, and microbes with anti-pathogen activity (Lysobacteria, Sphingomonas, Chaetomium, and Minimedusa); and reduced the abundance of pathogenic fungi Neocosmospore genus in the soil. In brief, ryegrass returned to the field, improved soil microecology and restored soil nutrients, and established a new dynamic balance of soil ecology, thereby improving the quality of cultivated land and the quality of flue-cured tobacco.
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Affiliation(s)
- Hanjun Zhou
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
- College of Natural Resources and Environment, Northwest A&F University, Yangling, China
| | - Mingjie Zhang
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
| | - Jiahao Yang
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
| | - Jing Wang
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
| | - Yulu Chen
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
| | - Xiefeng Ye
- Key Laboratory of Tobacco Cultivation of Tobacco Industry, National Tobacco Cultivation & Physiology & Biochemistry Research Centre, Tobacco Science College of Henan Agricultural University, Zhengzhou, China
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Zheng C, Pearce J, Feng Z. Potential impacts of spatial restrictions on tobacco retail availability in China: a simulation study in Shanghai. Tob Control 2023:tc-2022-057704. [PMID: 36889913 DOI: 10.1136/tc-2022-057704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Regulating tobacco retail availability provides promising new opportunities for effective tobacco control. This study simulates the potential impacts of introducing spatial restrictions on the availability of tobacco in Shanghai, the largest city in China. METHODS Twelve stakeholder-informed simulation scenarios under four types of spatial restrictions were considered: (1) capping, (2) ban of sales, (3) minimum spacing and (4) school-buffer exclusion zone. Tobacco retailer data for Shanghai (n=19 413) were used. The main outcome was per cent reduction in retail availability measured by population-weighted kernel density estimation across neighbourhoods, and impacts on social inequality in availability were estimated using the Kruskal-Wallis test and effect size estimation. All analyses were further stratified by three levels of urbanity to examine geographical disparities in overall effectiveness and equity of the simulation scenarios. RESULTS All simulation scenarios have the potential to reduce availability, with overall reductions ranging from 8.60% to 85.45%. Compared with the baseline, the effect size regarding the association between availability and neighbourhood deprivation quintiles suggests that the most effective scenario, '500 m minimum spacing' between retailers, increased the social inequality in availability (p<0.001). Conversely, school-buffer scenarios were both effective and equitable. Additionally, the effectiveness and the equity impact of scenarios varied by urbanity level. CONCLUSION Spatial restrictions offer potential new policy opportunities to reduce retail availability, but some may increase social inequality in accessing tobacco. For effective tobacco control, policymakers should consider the overall and equity impacts of spatial restrictions when developing comprehensive tobacco retail regulations.
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Affiliation(s)
- Chunyu Zheng
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Zhiqiang Feng
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
- Scottish Centre for Administrative Data Research, The University of Edinburgh, Edinburgh, UK
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Li N, Wu P, Wang Z, Shen Y, Zhang L, Xue F, Han W, Chen Y, Du J, Zhao Y, Yang C, Hu Y, Gu W, Chen W, Guo X, Liu B, Jiang J, Xu N. Smoking-related cancer death among men and women in an ageing society (China 2020-2040): a population-based modelling study. Tob Control 2023; 32:163-169. [PMID: 34725269 DOI: 10.1136/tobaccocontrol-2020-056444] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND China is experiencing a postpeak smoking epidemic with accelerating population ageing. Understanding the impacts of these factors on the future cancer burden has widespread implications. METHODS We developed predictive models to estimate smoking-related cancer deaths among men and women aged ≥35 years in China during 2020-2040. Data sources for model parameters included the United Nations World Population Prospects, China Death Surveillance Database, national adult tobacco surveys and the largest national survey of smoking and all causes of death to date. The main assumptions included stable sex-specific and age-specific cancer mortality rates and carcinogenic risks of smoking over time. RESULTS In a base-case scenario of continuing trends in current smoking prevalence (men: 57.4%-50.5%; women: 2.6%-2.1% during 2002-2018), the smoking-related cancer mortality rate with population ageing during 2020-2040 would rise by 44.0% (from 337.2/100 000 to 485.6/100 000) among men and 52.8% (from 157.3/100 000 to 240.4/100 000) among women; over 20 years, there would be 8.6 million excess deaths (0.5 million more considering former smoking), and a total of 117.3 million smoking-attributable years of life lost (110.3 million (94.0%) in men; 54.1 million (46.1%) in working-age (35-64 years) adults). An inflection point may occur in 2030 if smoking prevalence were reduced to 20% (Healthy China 2030 goal), and 1.4 million deaths would be averted relative to the base-case scenario if the trend were maintained through 2040. CONCLUSIONS Coordinated efforts are urgently needed to curtail a rising tide of cancer deaths in China, with intensified tobacco control being key.
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Affiliation(s)
- Ning Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Peng Wu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yubing Shen
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Luwen Zhang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yali Chen
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jin Du
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yujie Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Cuihong Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wentao Gu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wangyue Chen
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiaobo Guo
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Boqi Liu
- Department of Cancer Epidemiology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ningzhi Xu
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Hoe C, Cohen JE, Yang T, Peng S, Zhang W. Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China. Tob Control 2022; 31:e118-e125. [PMID: 34230057 PMCID: PMC9726971 DOI: 10.1136/tobaccocontrol-2021-056655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022]
Abstract
The primary aims of this study are to examine the associations between two key environmental factors-regional cigarette tobacco production and tobacco retail outlet density-and secondhand smoke (SHS) exposure in urban China and to explore the possible mechanisms that explain this association. METHODS A cross-sectional multistage sampling design was used to collect individual information in 21 cities in China. Environmental variables were retrieved from national databases. Multilevel logistic regression analysis was conducted to examine the associations between regional cigarette tobacco production, tobacco retail outlet density and SHS exposure. Structural equation modelling was employed to determine possible mechanisms. RESULTS SHS exposure prevalence defined as daily exposure to SHS for at least 15 min/day at the time of the survey was found to be 28.1% among non-smokers (95% CI 27.1 to 29.0) across the 21 cities. The multilevel logistic regressions showed that province-level per capital cigarette production (OR: 2.72 (95% CI 1.56 to 4.76)and per GDP cigarette production(OR:1.69(95% CI 1,42,2.01), and city-level tobacco retail outlet density (OR: 2.66 (95% CI 1.63 to 4.38)) were significantly associated with SHS exposure. Moreover, results showed that these associations may be explained by the level of tobacco advertisement, which influences social norms, including attitudes and behaviours toward SHS exposure. CONCLUSIONS Findings shed light on the role of cigarette manufacturers and retailers in producing environmental SHS pollution. To address the health and economic burden associated with SHS in China, it will be critical for the Chinese government to enact tobacco control measures consistent with the Framework Convention for Tobacco Control. Efforts should also focus on restricting the permitted density of tobacco retail outlets, and tobacco production in China.
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Affiliation(s)
- Connie Hoe
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tingzhong Yang
- Women's Hospital/Center for Tobacco Control Rsearch, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sihui Peng
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Weifang Zhang
- Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Zhao Y, Di X, Li S, Zeng X, Wang X, Nan Y, Xiao L, Koplan J, Chen Z, Liu S. Prevalence, frequency, intensity, and location of cigarette use among adolescents in China from 2013-14 to 2019: Findings from two repeated cross-sectional studies. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 27:100549. [PMID: 35923777 PMCID: PMC9340429 DOI: 10.1016/j.lanwpc.2022.100549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The burden of disease caused by tobacco use is a grave public health concern in China. Preventing smoking initiation among adolescents will lower the prevalence of adult tobacco use later. Surveillance of tobacco use among adolescents helps set priorities in developing tobacco control policies. We aim to ascertain the prevalence and differences of cigarette use across sex, grade, and region among middle and high school students in 2019 and associated changes from 2013-14 to 2019 among middle school students. METHODS Using a multistage stratified cluster-randomized sampling design with national and provincial representativeness, we conducted two school-based cross-sectional surveys in 2013-14 and in 2019. A total of 155 117 middle school students in grades 7-9 in 2013-14 and 288 192 middle and high school students in grades 7-12 in 2019 were interviewed. Self-reported experimental and current (past 30-day) cigarette use among middle school and high school students; frequent use (≥20 days in the past 30 days) and intensity (>20 cigarettes per day) of smoking among current cigarette users; and location of smoking among current cigarette users were investigated. All estimates were weighted based on the complex sampling design. FINDINGS The 2013-14 survey (overall response rate: 98.1%) included 155 117 middle school students (47.1% girl). The 2019 survey (overall response rate: 98.7%) included 147 270 middle school students (46.5% girl), 106 432 academic high school students (50.8% girl) and 34 490 vocational high school students (43.8% girl). In 2019, the prevalence rate of experimental and current cigarette use was 12.9% and 3.9% for middle school students, 21.6% and 5.6% for academic high school students, and 30.3% and 14.7% for vocational high school students, respectively, with large sex and regional differences. The prevalences of smoking on 20 or more days and daily cigarette use in the past 30 days were higher in vocational high school (5.9%, 4.1%) than in academic high school (1.8%, 1.2%) and middle school (0.7%, 0.5%), and higher among boys than girls. The proportions of current cigarette users smoking more than 20 cigarettes per day in the past 30 days for girls were higher than for boys in academic high school. Students usually smoke at school and at home. Boys were more likely to use cigarettes in an internet cafe, while girls often smoked at social venues. From 2013-14 to 2019, the prevalences of experimental and current cigarette use declined by 5.0% and 2.0% (percentage points), respectively, among middle school students but increased by 1.4% and 0.5% (percentage points) among rural girls. Among current cigarette users in middle school students, the proportions of heavy cigarette use (>20 cigarettes per day) have increased by 1.8 percentage points, mainly among boys, by 2.2% (percentage points). INTERPRETATION From 2013-14 to 2019, the prevalences of experimental and current cigarette use among middle school students decreased overall but increased among rural girls, while the intensity of cigarette use rose among boys. Cigarette use among Chinese adolescents differs across sex and regions, with higher rates among boys, in rural areas, and in the Western region (low socioeconomic status). Smoking is much more prevalent in vocational high schools than the other settings. Effective targeted tobacco control interventions among adolescents are urgently needed in China. FUNDING Dr. Zhuo Chen is supported by National Natural Science Foundation (Grant#: 72174098) through the University of Nottingham Ningbo China.
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Affiliation(s)
- Yan Zhao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
- Department of Public Health, School of Public Health, Inner Mongolia Medical University, Huhehot, Inner Mongolia 010110, China
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Sixuan Li
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
- Ningbo Municipal Center for Disease Control and Prevention, 237# Yongfeng Road, Haishu District, Ningbo, Zhejiang Province 315010, China
| | - Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Xiaofeng Wang
- Information Center, Chinese Center for Disease Control and Prevention, 155# Changbei Road, Changping District, Beijing 102206, China
| | - Yi Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
| | - Jeffrey Koplan
- Emory Global Health Institute, Emory University, Atlanta 30322 Georgia, USA
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens 30602 Georgia, USA
- School of Economics, University of Nottingham Ningbo China 315100 Ningbo, Zhejiang Province, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27# Nanwei Road, Xicheng District, Beijing 100050, China
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Hao P, Xu SS, Sung H, Yao T, Jiang Y, Quah AC, Fong GT. Local Brand Smoking Among Adult Smokers: Findings from the Wave 5 International Tobacco Control China Survey — China, 2015. China CDC Wkly 2022; 4:452-459. [PMID: 35686048 PMCID: PMC9167607 DOI: 10.46234/ccdcw2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 11/15/2022] Open
Abstract
What is already known about this topic? Branding of cigarettes may play a role in shaping the smoking behaviors of Chinese smokers, and local brand (LB) cigarettes may reflect this influence because of greater tax and non-tax incentives compared to non-LB. Some of these brands are regional flagships that market to smokers using local landmarks or icons. What is added by this report? LB brands were significantly more likely to be the usual brand of smokers residing in provincial-level administrative divisions (PLADs) that produced their own LB cigarettes [adjusted odds ratio (AOR): 30.95; 95% confidence interval (CI): 26.36–36.49] compared to those residing in PLADs that had non-local ventures with non-LB cigarettes. Further, smokers residing in urban areas were found to be less likely to smoke LB cigarettes (AOR: 0.79; 95% CI: 0.67–0.93) compared to those in rural areas. What are the implications for public health practice? These findings suggest that LB smoking may be a result of industry-driven incentives to boost LB sales, fueled by such as supply-side strategies to boost LB sales or targeted cultural/social marketing that appeals to certain demographic groups. Although addressing these incentives to support LBs would be challenging given the nature of China’s tobacco industry, doing so would have potential to reduce cigarette smoking and ultimately the health burden of smoking in China.
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Affiliation(s)
- Peter Hao
- Chinese Center for Disease Control and Prevention, Beijing, China
- Peter Hao,
| | | | - Haiyen Sung
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California at San Francisco, San Francisco, California, USA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California at San Francisco, San Francisco, California, USA
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Geoffrey T. Fong
- University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Chen N, Kim CG. The Moderating Effect of Community-Level Deprivation on the Association between Individual Characteristics and Smoking Behavior among Chinese Adults: A Cross-Level Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115785. [PMID: 34072249 PMCID: PMC8199057 DOI: 10.3390/ijerph18115785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
China joined the World Health Organization (WHO) Framework Convention on Tobacco Control in 2006; however, the overall Chinese smoking rate is still high. The aim of this study is to provide new evidence for the direct effects of community-level deprivation, and the effects of interactions between community-level deprivation and individual characteristics, on smoking intensity, by using cross-sectional data from the 2015 China Health and Nutrition Survey (CHNS). The results show that there is a strong association between community-level deprivation and individual smoking intensity, and that community deprivation moderates the relationship between individual perceived stress and smoking intensity. The findings imply that adequate interventions should be conducted in the context of deprived neighborhoods, and should consider differences between levels of individual perceived stress and between sexes, especially focusing on highly stressed women who live in deprived communities.
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Affiliation(s)
- Nan Chen
- Major in Chinese Studies, Department of Global Business, Kosin University, Busan 49104, Korea;
| | - Chang-Gyeong Kim
- Department of Chinese Studies, Pukyong National University, Busan 48513, Korea
- Correspondence: ; Tel.: +82-51-629-5342
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10
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Davey G, Zhao X. Smoking and the City: A Travelogue in Yuxi. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2021. [DOI: 10.1080/14442213.2021.1889652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Yang Y, Zhou M, Zeng X, Wang C. The burden of oral cancer in China, 1990-2017: an analysis for the Global Burden of Disease, Injuries, and Risk Factors Study 2017. BMC Oral Health 2021; 21:44. [PMID: 33509185 PMCID: PMC7842005 DOI: 10.1186/s12903-020-01386-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Oral cancer is among the most common malignant tumors worldwide, and it has become an increasingly important public health problem in China. This study systematically assesses the current state of oral cancer in China from 1990 to 2017, providing new information and perspectives for oral health researchers and public health policy makers. METHODS Based on the Global Burden of Disease, Injuries, and Risk Factors Study 2017 (GBD 2017), we evaluated the incidence rates, mortality and disability-adjusted life year (DALY) rates for oral cancer in China and their changing trends between 1990 and 2017, making comparisons by gender and age. We also assessed the DALY rates associated with oral cancer at the provincial level for 33 provinces and their trends over time. RESULTS From 1990 to 2017, the number of new cases and the age-standardized incidence rate for oral cancer in China increased by 280.0% and 79.7%, respectively; the number of deaths and the age-standardized mortality rose by 196.8% and 29.0%, respectively; and the number of DALYs and the age-standardized DALY rate increased by 149.1% and 21.0%, respectively. The incidence rates for oral cancer rose after 30 years of age and peaked at 65-69 years; the mortality for oral cancer rose after 50 years of age and peaked at 65-69 years; and the DALY rates for oral cancer rose after 45 years of age and peaked at 65-69 years. The incidence rates, mortality and DALY rates for oral cancer in males were significantly higher than those in females and showed an upward trend, while there was a decrease or no significant change in females. The DALY rates increased in 21 provinces and decreased in 12 provinces, with the largest growth in Henan Province and the largest decline in Hong Kong Province. CONCLUSIONS The burden of oral cancer in China continues to increase continuously. More prevention, control and intervention measures should be taken and increased attention paid to common risk factors is essential for the prevention of oral cancer.
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Affiliation(s)
- Yang Yang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Xinying Zeng
- Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Chunxiao Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
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12
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Zhao X, White KM, Young RM, Obst PL. Smoking Beliefs Among Chinese Secondary School Students: A Theory-Based Qualitative Study. Nicotine Tob Res 2019; 20:321-331. [PMID: 28187221 DOI: 10.1093/ntr/ntx012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/12/2017] [Indexed: 11/12/2022]
Abstract
Introduction China has the world's greatest number of smokers but theory-based smoking interventions are rare. To develop an effective intervention, understanding the determinants of Chinese adolescent smoking is crucial. The Theory of Planned Behavior (TPB) is empirically supported to predict and assist in informing intervention strategies to change health-related behaviors. Based on the TPB, the elicitation of shared smoking beliefs among adolescents can inform future intervention designs among this at-risk population. Methods We investigated the beliefs from six focus groups (N = 30) of one senior secondary school in Kunming, Yunnan Province, China. We used semi-structured questions based on the TPB framework, including prompts about behavioral (advantages and disadvantages), normative (important referents), and control (barriers and facilitators) beliefs. Following the Consensual Qualitative Research (CQR) methodology, data were discussed until consensus was reached. Auditing was undertaken by an external researcher. Results Seven domains (advantages, disadvantages, approvers, disapprovers, facilitators, barriers, and smoker images) were examined. Smoking as a gendered behavior, smoking as influenced by cultural and environmental contexts, smoking as a strategy to cope with stress, and awareness of the harm of smoking, are highlighted themes across domains. Data suggested an extended-TPB framework as an appropriate approach to adopt when addressing smoking beliefs among the target population. Conclusions These beliefs can be utilized to inform future school-based interventions and public health campaigns targeting smoking among Chinese adolescents. Implications A modified TPB approach has potential for future smoking interventions among Chinese adolescents. Beliefs elicited in this study form a strong basis for designing a location- and population-specific antismoking programme.
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Affiliation(s)
- Xiang Zhao
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Ross McD Young
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Patricia L Obst
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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13
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Abstract
China is in the midst of a lung cancer epidemic on an unprecedented scale. In 2015, there were an estimated 733,000 new lung cancer cases (17% of total cancer incidence) and 610,000 deaths (21.7% of total cancer mortality) in China. Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in China. Tobacco smoke exposure is the primary factor driving current lung cancer trends. In 2015, smoking prevalence was 27.7% (52.1% among men and 2.7% among women). China has taken substantial steps to control tobacco use in recent years, including 19 cities implementing comprehensive smoke free laws and expansion of cessation services. However, significant challenges remain in order to meet the 2030 Healthy China goal of reducing smoking prevalence to 20%. In particular, ongoing attention is needed to continuing to control secondhand smoke exposure, to further enhance smoking cessation services, and to address novel alternative nicotine delivery devices (ANDS).
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Affiliation(s)
- Mark Parascandola
- Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD, USA
| | - Lin Xiao
- Center for Disease Control and Prevention, Beijing 102206, China
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14
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Chen W, Xia C, Zheng R, Zhou M, Lin C, Zeng H, Zhang S, Wang L, Yang Z, Sun K, Li H, Brown MD, Islami F, Bray F, Jemal A, He J. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment. Lancet Glob Health 2019; 7:e257-e269. [PMID: 30683243 DOI: 10.1016/s2214-109x(18)30488-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/24/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China. METHODS In this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 county-level surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors. FINDINGS About 1 036 004 cancer deaths (45·2% of all cancer deaths [95% CI 44·0-46·4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51·2% [95% CI 50·0-52·4]) than in women (34·9% [33·6-36·2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35·2% in Shanghai to 52·9% in Heilongjiang, while the PAF varied from 40·9% in Shanghai to 56·4% in Guangdong among men and from 26·9% in Shanghai to 48·0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province). INTERPRETATION The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden. FUNDING National Science and Technology Basic Research Special Foundation of China.
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Affiliation(s)
- Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Changfa Xia
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunqing Lin
- International Agency for Research on Cancer, Lyon, France
| | - Hongmei Zeng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siwei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhixun Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kexin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Matthew D Brown
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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15
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The Association between Socioeconomic Status, Smoking, and Chronic Disease in Inner Mongolia in Northern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020169. [PMID: 30634452 PMCID: PMC6352126 DOI: 10.3390/ijerph16020169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/23/2018] [Accepted: 12/29/2018] [Indexed: 11/16/2022]
Abstract
The interactive associations of socioeconomic status (SES) and smoking with chronic disease were investigated with a view to expanding the evidence to inform tobacco policies and interventions in Northern China. The fifth NHSS (National Health Service Survey) 2013 in Inner Mongolia was a population-based survey of national residents, aged 15 years and older, in which multi-stage stratified cluster sampling methods were used to survey 13,554 residents. The SES was measured by scores derived from levels of education level and household annual income. Multivariate logistic regression models were performed to determine the association between SES, smoking, and chronic disease adjusted by confounders. Three thousand nine hundred and thirty-seven residents (32.29%) were identified as current smokers and 3520 residents (26.01%) had been diagnosed with chronic diseases. In the males, former smoking with low SES had the highest risk of one chronic disease, with an odds ratio (OR) of 2.505 (95% confidence interval [95% CI] (OR = 2.505, 95% CI: 1.635–3.837) or multiple chronic diseases (OR = 2.631, 95% CI: 1.321–5.243). In the females, current smoking with low SES had the highest risk of one chronic disease (OR = 3.044, 95% CI: 2.158–4.292). The conclusion of this study was that residents with combined ever-smoking and low SES deserved more attention in the prevention and control of chronic disease.
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16
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Xia C, Zheng R, Zeng H, Zhou M, Wang L, Zhang S, Zou X, Sun K, Yang Z, Li H, Parascandola M, Islami F, Chen W. Provincial-level cancer burden attributable to active and second-hand smoking in China. Tob Control 2018; 28:669-675. [DOI: 10.1136/tobaccocontrol-2018-054583] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
BackgroundUnderstanding disparities in the burden of cancer attributable to smoking is crucial to inform and improve tobacco control measures. In this report, we estimate the population attributable fraction (PAF) of cancers deaths attributable to smoking at the national and provincial levels in China.MethodsUsing cancer mortality data from 978 counties, smoking data from a nationwide survey and relative risks from a prospective study of 0.5 million adults in China, we calculated the absolute (non-standardised) and standardised numbers and proportions of cancer deaths among adults 30 years and older attributable to active and second-hand smoking in 2014 across all 31 provinces in Mainland China.ResultsThe estimated number of cancer deaths attributable to smoking in China in 2014 was 342 854 among men and 40 313 among women, of which second-hand smoking accounted for 1.8% and 50.0%, respectively. Among men, the absolute PAF in China was 23.8%, ranging from 14.6% in Xinjiang to 26.8% in Tianjin; the overall standardised PAF was 22.2%, ranging from 15.7% in Xinjiang to 26.0% in Guizhou. Among women, the overall absolute and standardised PAFs were 4.8% and 4.0%, ranging from 1.8% and 1.6% in Jiangxi to 14.9% and 9.6% in Heilongjiang, respectively. Overall, provinces with the highest standardised PAFs among men were located in Southwest China and among women in the Northeast.ConclusionsComprehensive smoke-free policies in China should expand to all provinces, notably those with a higher burden of cancer attributable to smoking, instead of being mostly limited to Beijing and some other metropolitan areas.
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17
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Moon G, Barnett R, Pearce J, Thompson L, Twigg L. The tobacco endgame: The neglected role of place and environment. Health Place 2018; 53:271-278. [PMID: 30238907 DOI: 10.1016/j.healthplace.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
An increasing number of countries across the world are planning for the eradication of the tobacco epidemic. The actions necessary to realise this ambition have been termed the tobacco endgame. The focus of this paper is on the intersection between the tobacco endgame with place, a neglected theme in recent academic and policy debates. We begin with an overview of the key themes in the literature on endgame strategies before detailing the international landscape of engame initiatives, paying particular attention to the opportunities and challenges of endgame strategies in low and middle income countries. Finally, we critically assess the current endgame debates and suggest a novel agenda for integrating geographical perspectives into research on the endgame that provides enhanced understanding of the challenges associated with this important global health vision.
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Affiliation(s)
- Graham Moon
- School of Geography and Environmental Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, England, United Kingdom.
| | - Ross Barnett
- Department of Geography, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
| | - Jamie Pearce
- School of GeoSciences, Drummond Street, University of Edinburgh, Edinburgh EH8 9XP, Scotland, United Kingdom.
| | - Lee Thompson
- Department of Population Health, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Buckingham Building, Lion Terrace, PO1 3HE England, United Kingdom.
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18
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Zhao X, Young RMCD, White KM. 'I'm not a smoker…yet': a qualitative study on perceptions of tobacco control in Chinese high schools. BMJ Open 2018; 8:e019483. [PMID: 29678968 PMCID: PMC5914720 DOI: 10.1136/bmjopen-2017-019483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Chinese adolescents' perceptions about tobacco control at schools are rarely researched. We explored how current antismoking strategies work in middle school environments, as well as the attitudes towards these strategies held by students and teaching staff members. METHODS Four focus groups (24 eleventh graders; Mage=16 years) and five indepth interviews (teaching staff members with tobacco control experience in schools) were conducted in Kunming, Yunnan Province, China. We used thematic analysis combining inductive and deductive processes, along with field observations and research group discussions, for data analysis. RESULTS With educational approaches and practical strategies, antismoking education reported in the middle schools had limited effectiveness. Although smoking is banned in schools, students can circumvent schools' controls easily. Notably salient is the pessimistic attitude towards school-based antismoking strategies at school. Detrimental influences within (teachers' smoking) and beyond schools (high societal smoking prevalence) largely challenged the efforts to manage students' smoking. CONCLUSIONS Current antismoking approaches in schools fail to curb smoking among Chinese high school students. Their effectiveness is undermined by both within-campus and off-campus influences. Students' perceptions of smoking should be valued as their knowledge of smoking is actively constructed. Future antismoking education at school should incorporate interactive sessions rather than merely didactic approaches about the harms of smoking. Although stricter rules for teachers' smoking are needed, complementary strategies such as population-level interventions and policy measures in wider society will assist in efforts within schools.
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Affiliation(s)
- Xiang Zhao
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ross M cD Young
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katherine M White
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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19
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Astell-Burt T, Zhang M, Feng X, Wang L, Li Y, Page A, Zhou M, Wang L. Geographical Inequality in Tobacco Control in China: Multilevel Evidence From 98 058 Participants. Nicotine Tob Res 2017; 20:755-765. [DOI: 10.1093/ntr/ntx100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 05/14/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Early Start Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Menzies Centre for Health Policy, University of Sydney Sydney Australia
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention Beijing P.R. China
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Early Start Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Menzies Centre for Health Policy, University of Sydney Sydney Australia
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention Beijing P.R. China
| | - Yichong Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention Beijing P.R. China
| | - Andrew Page
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention Beijing P.R. China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention Beijing P.R. China
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20
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Yang XY. How community-level social and economic developments have changed the patterns of substance use in a transition economy? Health Place 2017; 46:91-100. [PMID: 28521177 DOI: 10.1016/j.healthplace.2017.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/07/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
Most social changes take place at the community level before indirectly affecting individuals. Although the contextual effect is far-reaching, few studies have investigated the important questions of: how do community-level developments affect drinking and smoking, and how do they change the existing gender and income patterns of drinking and smoking, particularly in transition economies? In this study, I used a Chinese panel dataset between 1991 and 2011 to reveal the moderating effects of community developments. Through multilevel growth curve modeling that controls for age, period, and cohort effects, as well as individual- and community-level covariates, I found that community-level economic development and social development are negatively associated with drinking and smoking. Moreover, economic and social developments also moderate the important influences of income and gender: women start to drink more in communities with higher economic development; the traditionally positive association between income and smoking/drinking is also reversed, i.e. the rich start to smoke and drink less in communities with higher social development. This study concludes that the rapid changes in communal social and economic structures have created new health disparities based on the gender and socioeconomic hierarchy.
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Affiliation(s)
- Xiaozhao Y Yang
- Department of Political Science and Sociology, Murray State University Murray, KY 42071, USA.
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21
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Chinese smokers' behavioral response toward cigarette price: individual and regional correlates. Tob Induc Dis 2016; 14:13. [PMID: 27051357 PMCID: PMC4820870 DOI: 10.1186/s12971-016-0078-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background Many studies have explored smokers’ behavioral response to cigarette prices at the individual level, but none have factored in regional variation and determinants. This study addresses these research gaps in the Chinese context. Methods A cross-sectional multistage sampling process was used to recruit participants in 21 cities in China. Individual-level information was collected using standardized questionnaires. City-level variables were retrieved from a nationall database. Multilevel logistic regression analysis was used to assess price sensitivity variation at both individual and city levels. Results Among 5660 current smokers, 5.9 % used non-self-paying cigarettes, 32.8 % purchased cigarettes in cartons, and 5.2 % decreased their smoking expenditure due to price. Multilevel analysis showed that individual demographic and smoking expenditure characteristics and regional smoking restrictions in work places, cigarette production, and media news coverage are associated with price sensitivity. Conclusions This study adds substantially to the understanding of Chinese smokers’ behavioral responses to cigarette prices. Increasing smoker sensitivity to cigarette prices will require stronger tobacco control and public education campaigns.
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22
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Yang T, Barnett R, Jiang S, Yu L, Xian H, Ying J, Zheng W. Gender balance and its impact on male and female smoking rates in Chinese cities. Soc Sci Med 2016; 154:9-17. [PMID: 26943009 DOI: 10.1016/j.socscimed.2016.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/27/2016] [Accepted: 02/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although gender differences in smoking have received much attention, few studies have explored the importance of contextual effects on male and female smoking rates. The aim of this study is to examine the association between variations in city-level sex ratios and gender differences in smoking in China. METHODS Participants included 16,866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. RESULTS The study found that, independent of personal characteristics, cities with more males had higher male smoking rates and lower female rates. CONCLUSIONS Our research underscores the importance of city-level contextual effects in understanding gender differences in smoking in China.
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Affiliation(s)
- Tingzhong Yang
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China.
| | - Ross Barnett
- Department of Geography, University of Canterbury, Christchurch 8140, New Zealand
| | - Shuhan Jiang
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Lingwei Yu
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Hong Xian
- Department of Biostatistics, Saint Louis University, St. Louis, MO 63104-1314, USA
| | - Jun Ying
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Weijun Zheng
- Department of Preventive Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
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