Smoking among young rural to urban migrant women in China: a cross-sectional survey

Split household and smoking behaviour of rural migrants in China

OBJECTIVES

This study aimed to address the direct impact of split households on smoking behaviour. Three types of spilt households (sole migration, couple migration, and family migration) were incorporated to explore the concise effect of different split household forms. This study also examined factors that contributed to the narrowing gap in smoking prevalence between 2008 and 2018.

STUDY DESIGN

Retrospective observational study.

METHODS

Data were obtained from the Rural Urban Migration (RUMiC-2009) and China Household Income Project (CHIP2018). Analyses were conducted using chi-squared tests/analysis of variance tests and multiple logit regression. The order probit model with sample selection was conducted to correct for selection bias. Fairlie decomposition was used to quantify the contribution of individual variables to the observed differences in smoking prevalence.

RESULTS

Smoking prevalence for all migrants decreased by 5.79% between 2008 and 2018. The results in 2008 reveal the positive and significant contribution of couple migration (coefficient = -0.4608; 95% CI = [-0.6453, -0.2762]) and family migration (coefficient = -0.3705; 95% CI = [-0.5959, -0.1452]) on the reduction of smoking; the finding for family migration remained robust in 2018. Measurable factors partially explain the decline in smoking disparity. The migration of families, working in the construction and manufacturing industries, and educational attainment were the largest contributing factors to the declining gap in smoking prevalence.

CONCLUSIONS

The increase in family migration and education, and decrease in the number of workers in the construction and manufacturing industries, contributed to a decrease in smoking prevalence. Public policies should target sole migrants, couple migrants, individuals with lower education levels, and those working in the construction and manufacturing industries.

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants

OBJECTIVES

To identify clues for women's tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals' social integration.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15-59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month.

PRIMARY AND SECONDARY OUTCOME MEASURES

Social environmental changes were measured by differences in smoking prevalence and women's empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness.

RESULTS

Differences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women's empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women's smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women's empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified.

CONCLUSIONS

Tobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.

Local Ties, Trans-Local Ties, and Substance Use among Rural-to-Urban Migrants in China

China has witnessed unprecedented rural-to-urban migration since the early 1980s. While trying to assimilate into the city, rural-to-urban migrants still maintain close ties with their home communities. This study examines how local ties and trans-local ties of rural-to-urban migrants affect their alcohol and tobacco use. Data were obtained from the 2016 and 2018 China Labor-force Dynamics Survey, a nationally representative sample of adults aged over 15 in 29 provinces in China. Participants included 1426 rural-to-urban migrant workers and 6438 urban residents in China. We found that compared to urban natives, rural-to-urban migrants had higher tobacco use prevalence (logit = 0.19, 95% CI = [0.03, 0.35]; p < 0.05) and more frequent alcohol use (logit = 0.27, 95% CI = [0.11, 0.42]; p < 0.001) after adjusting for sociodemographic characteristics. Migrants with more local social ties engaged in more frequent drinking (having >10 local friends vs. having 0 local friends: logit = 0.58, [0.10, 1.06], p < 0.05), whereas trans-local ties were not a significant correlate. In contrast, migrants who returned to their hometown more times (an indicator of trans-local ties) were more likely to be current tobacco users (logit = 0.01, 95% CI = [0.00, 0.02], p < 0.01) after adjusting for sociodemographic variables. These findings extended the research on social networks and health behaviors by identifying how local and trans-local ties differentially affected the vulnerabilities of tobacco and alcohol use among rural-to-urban migrants in China. The findings suggested that policies and interventions on reducing migrants’ health risk behaviors should focus on the role of different types of social ties.

Health Behavior of Adolescent Smokers During Covid-19 Pandemic

AIM: This research aims to determine the health behavior of adolescent smokers during the COVID-19 pandemic. METHOD: Both quantitative and qualitative analyses were conducted simultaneously using the design of “t” and Chi-square test through the distribution of questionnaires to 135 respondents as well as descriptive design and case studies, respectively. The data were collected by 13 informants through in-depth interviews, observation, and documentation. RESULTS: The results showed that 5 out of the 6 indicators of the demographic characteristics were correlated to the economic pressure of the families of adolescent smokers which also correlates with their health behavior during the COVID-19 pandemic. CONCLUSION: The increase in the price of cigarettes and family control are measures that regulate children from buying cigarettes.

Prevalence, knowledge and education level associated with secondhand smoke exposure among never-smoking women in Inner Mongolia, Northern China

INTRODUCTION

Currently, 40.7% of women in China are exposed daily to secondhand smoke (SHS); however, research on SHS exposure among women in Inner Mongolia is limited. We aimed to investigate the prevalence of SHS exposure, knowledge about the harms of smoking and SHS, and the association between sociodemographic factors and SHS exposure among never-smoking women in Inner Mongolia, Northern China.

METHODS

This study was based on a survey of chronic disease and nutrition conducted among Chinese adults in Inner Mongolia during 2015, a cross-sectional study with multi-stage stratified cluster sampling. A total 2293 never-smoking women aged ≥18 years were included in the study. Face-to-face interviews were used to collect data of sociodemographic characteristics, SHS exposure, and related knowledge. Questionnaires were administered by trained investigators, and the reliability and validity of the questionnaires were high. We performed descriptive analysis and logistic regression. All analyses were performed by IBM SPSS Statistics version 19.0.

RESULTS

Of the total, 69% of young women in Inner Mongolia in 2015 reported that they were exposed to SHS, the highest rate in comparison with older and middle-aged women. A total 49.90% of young women reported being exposed to SHS every day. Respondents had insufficient knowledge regarding smoking and SHS exposure. Compared with older never-smoking women, their young counterparts had a higher risk of SHS exposure, with an odds ratio of 2.143 (95% CI: 1.647–2.787). Education level and ethnicity were also significantly associated with SHS exposure.

CONCLUSIONS

This study showed that the highest rates of SHS exposure were among young never-smoking women in Inner Mongolia, and women with high education levels were less likely to be exposed to SHS. Improved public health information is needed that prioritizes SHS exposure among young women in Inner Mongolia. Health education regarding SHS exposure should be widely implemented throughout communities in this region.

Tobacco and the lung cancer epidemic in China

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).

Patterns of smoking initiation during adolescence and young adulthood in South-West China: findings of the National Nutrition and Health Survey (2010-2012)

OBJECTIVE

This study aims to understand the age patterns of smoking initiation during adolescence and young adulthood in South-West China, where the prevalence of tobacco use is reported as the highest in the country.

DESIGN

A cross-sectional study.

SETTING

The data were derived from the China National Nutrition and Health Survey in Yunnan Province, South-West China (2010-2012).

PARTICIPANTS

A total of 4801 participants aged 15-65 years were included.

PRIMARY OUTCOME MEASURES

A survival model was used to estimate the hazard of smoking initiation by age and log-rank test was used to compare the hazard curves across subgroups (men/women, urban/rural, Han Chinese/ethnic minority).

RESULTS

The prevalence of current smoking among men and women were 60.4% (95% CI 58.2% to 62.6%) and 5.1% (95% CI 4.3% to 5.9%), respectively. Smoking was more prevalent among men and women of lower education and less income, as well as rural and ethnic minority women. Among the current smokers, cigarette (80.7%) was the most commonly used tobacco product, followed by waterpipe (10.8%) and pipe tobacco (8.5%). The hazards of smoking initiation were low for both men and women before the age of 15 years (1% for men and 0.05% for women); and the hazards increased quickly from age 15 years and peaked at 19years (21.5% for men and 1.0% for women). Rural and ethnic minority women were at higher risk of smoking initiation than their counterparts between 15 years and 19 years of age (χ²=44.8, p<0.01; χ²=165.2, p<0.01) and no such difference was found in men.

CONCLUSIONS

Findings of this study underscore the importance to implement tobacco prevention interventions among older teens and young adults in South-West China, especially for rural and ethnic minority women.

The prevalence of smoking, second-hand smoke exposure, and knowledge of the health hazards of smoking among internal migrants in 12 provinces in China: a cross-sectional analysis

BACKGROUND

Previous studies have provided inconsistent findings on smoking among migrants, and very limited data exist on their second-hand smoke exposure. This study aims to investigate internal migrants' smoking prevalence, second-hand smoke exposure among non-smokers, and knowledge of the health hazards of smoking in 12 major migrant provinces in China in 2013.

METHODS

Data from the 2013 Migrant Dynamics Monitoring Survey in China published by the National Commission of Health and Family Planning was used in this study. Descriptive analysis, Chi-square analysis, and sex-stratified multivariate logistic regression analysis were used to explore the determinants of current smoking and second-hand smoke exposure.

RESULTS

Among 7200 migrants, 34.1% (55% male, 4% female) were current smokers. For males, factors associated with current smoking were education year (aOR = 0.95, 95% CI: 0.93-0.98), duration of stay (aOR = 1.01, 95% CI: 1.00-1.03) and occupation (aOR = 1.25, 95% CI: 1.03-1.53). For females, household registration status (aOR = 1.70, 95% CI: 1.04-2.80) was the most important factor associated with current smoking. Sixty five percent of non-smokers were exposed to second-hand smoke. Factors associated with exposure to second-hand smoke were duration of stay (aOR = 1.01, 95% CI: 1.00-1.02), divorced/widowed marital status (aOR = 0.48, 95% CI: 0.25-0.91), occupation (aOR = 1.29, 95% CI: 1.05-1.58) and the nature of employer (aOR = 0.77, 95% CI: 0.60-0.97). About 95% of participants were aware that lung cancer is one of the hazards of smoking. Non-current smokers had a better knowledge of fertility reduction and accelerated aging as hazards of smoking than current smokers (p < 0.01). Knowledge of the impact of smoking on cardiovascular diseases was relatively low compared with knowledge of other smoking-related hazards (26.1-44.3%).

CONCLUSIONS

Current smoking and exposure to second-hand smoke among internal migrants in China is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors, such as focusing on divorced/widowed women.

Prevalence of Tobacco Smoking and Determinants of Success in Quitting Smoking among Patients with Chronic Diseases: A Cross-Sectional Study in Rural Western China

Tobacco use is one of the behavioral risk factors for chronic diseases. The aim of the study was to investigate smoking prevalence in chronically ill residents and their smoking behavior in western rural China, to identify factors associated with success in quitting smoking, and to provide appropriate intervention strategies for tobacco control. Cross-sectional survey data from patients with chronic diseases from rural western China were analyzed. Among the 906 chronically ill patients, the current smoking prevalence was 26.2%. About 64.3% of smokers with chronic diseases attempted to quit smoking, 21.0% of which successfully quitted. The odds ratio (OR) of smokers with only one chronic disease to quit smoking successfully was higher than that of those who have other diseases (OR = 2.037, 95% confidence interval (CI) = 1.060-3.912; p < 0.05). The smokers who were always restricted to smoking in public places were more likely to quit smoking successfully than those who were free to smoke (OR = 2.188, 95% CI = 1.116-4.291; p < 0.05). This study suggests that health literacy, comorbidity of diseases, and psychological counseling should be considered when developing targeted tobacco prevention strategies. Strengthening tobacco control measures in public places such as rural medical institutions will be effective.

Slowing the Titanic: China's Epic Struggle with Tobacco

China is home to a third of the world's smokers and, correspondingly, to a third of the world's cases of lung cancer. Beginning in the mid-1990s, a generation or so later than in many Western countries, the Chinese government commenced measures to control tobacco, limiting advertising, banning smoking in many public venues, and increasing taxation. At the time of this review, there are signs that these policies are having some effect, but hundreds of millions of Chinese continue to smoke and rates of diagnosis of lung cancer continue to rise. There is much work to be done and much premature death to be suffered before the epidemic is slowed to the levels reached in Australia or the United States. This article aims to provide, particularly for practicing lung cancer clinicians, a description of patterns of smoking in China, the lung cancer epidemic there, and the stimuli for and barriers to tobacco control imposed by the highly complex and unique regulatory setting of the Chinese tobacco industry. A particular challenge in developing this description has come from the variability of studies published about a huge nation that has enormous diversity in wealth, education, urbanization, and tradition. The studies vary because the data vary. Much information on lung cancer and smoking rates in China comes, for example, from studies of cohorts that may number in the millions yet represent only a small percentage of the population and sometimes only a tiny geographic area of such a vast nation. National registry data on lung cancer in China do not yet cover even a fifth of the national population. Even so, we argue that several major trends can be identified: (1) more than 50% of men smoke regularly; (2) there are more than 300 million smokers in China; (3) almost half a million new cases of lung cancer are diagnosed in China each year; (4) secondhand smoking is a significant problem in China (as elsewhere), accounting for a high proportion of lung cancer cases among women, most of whom do not smoke; (5) corrected for age and sex, lung cancer rates in the Chinese population are as least as high as in Western countries and arguably higher; and (6) a shift over time from squamous cell carcinoma (SCC) to adenocarcinoma is occurring in parallel with that noted in Western populations. Looking to the future, measures to control tobacco in China are strengthening but remain relatively weak. The reinforcement of control is hampered by the circumstance that the tobacco industry remains a powerful state-owned monopoly that participates, through its membership of key government bodies, in the processes that oversee the implementation of tobacco control. The conflict between the government's dual responsibilities for both the production and distribution of tobacco and for the implementation of tobacco control carries inherent contradictions and bias. How long the Chinese government chooses to live with these contradictions will determine how quickly the smoking of tobacco will be reduced and how soon the burden of disease that tobacco inflicts on individuals and society as a whole will be eased.

Determinants of tobacco smoking among rural-to-urban migrant workers: a cross-sectional survey in Shanghai

Background

Although there are several studies to investigate the smoking behaviors among rural-to-urban Chinese migrants, no study has focused individually on this population in Shanghai. This study was performed to estimate the prevalence and identify the determinants of tobacco smoking among rural-to-urban migrants in Shanghai.

Methods

In this cross-sectional study, multi-stage quota sampling was used to select 5,856 rural-to-urban migrants aged 18 years or older from seven districts in Shanghai between July and October 2012. A structured questionnaire was administered to assess smoking knowledge, attitude, behavior and demographic characteristics. Mental health was assessed by the self-reported SCL-90. Multiple logistic regression analysis was used to determine the risk factors of smoking behavior.

Results

A total of 5,380 of the 5,856 migrants enrolled completed the questionnaire, among whom 45.0% of male and 2.0% of female participants reported current smoking. Multivariate analysis revealed current smoking in female migrants to be significantly associated with working at construction (OR, 8.08; 95% CI, 1.80-36.28), hotels/restaurants (OR, 5.06; 95% CI, 1.68-15.27), entertainment sector (OR, 6.79; 95% CI, 2.51-18.42), with monthly income > 3500 yuan (OR, 2.69; 95% CI, 1.21-5.98), number of migratory cities of 2 (OR, 2.39; 95% CI, 1.23-4.65), and SCL-90 total score > 160 (OR, 2.03; 95% CI, 1.03-3.98), while the male migrants working at construction (OR, 1.30; 95% CI, 1.04-1.62), entertainment sector (OR, 1.86; 95% CI, 1.36-2.56), being divorced/widowed (OR, 2.20; 95% CI, 1.02-4.74), with duration of migration of 4 or more than 4 years (OR, 1.42; 95% CI, 1.06-1.91), number of migratory cities of 3 or more than 3 (OR, 1.42; 95% CI, 1.13-1.80), and SCL-90 total score > 160 (OR,1.39; 95% CI, 1.07-1.79) showed an excess smoking prevalence.

Conclusion

Migration lifestyle and mental status were associated with current smoking behaviors. The identifications of risk factors for current smoking may help to target health promotion interventions.

An early-stage epidemic: a systematic review of correlates of smoking among Chinese women

BACKGROUND

Despite the historically low smoking prevalence among Chinese women, there is a trend of future increase.

PURPOSE

We systematically reviewed the correlates of smoking among Chinese girls and women.

METHOD

We conducted a systematic review of literature on correlates of smoking among Chinese women using Medline and China Academic Journals databases. Following the PRISMA statement, two investigators independently searched for literature, identified and reviewed papers, assessed the quality of the papers, and extracted information. The characteristics of studies and correlates of smoking were synthesized separately for youth and adults.

RESULTS

A total of 15 articles (11 on adults, 4 on youth) met the inclusion criteria. Based on these studies, peer smoking was the most consistent correlate of smoking among Chinese girls. Among Chinese women, partner smoking, job-related stress, and exposure to cigarettes made for women were consistent correlates of smoking. Knowledge of harms and negative attitudes towards smoking were found to be negatively associated with smoking.

CONCLUSION

Overall, the evidence base for smoking among Chinese women is limited. Although smoking among Chinese women is still at an early stage, it is becoming more prevalent among specific population subgroups, such as rural-to-urban migrant workers. Although further research is needed, findings from the current study provide a roadmap for research and policy on prevention of smoking among Chinese girls and women.

Perceived discrimination and smoking among rural-to-urban migrant women in China

Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31-2.23) and current smoking (PR, 2.52; 95% CI, 1.32-4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16-1.61) and current smoking (PR, 1.63; 95% CI, 1.28-2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.

Acceptability and adoption of handheld computer data collection for public health research in China: a case study

Background

Handheld computers for data collection (HCDC) and management have become increasingly common in health research. However, current knowledge about the use of HCDC in health research in China is very limited. In this study, we administered a survey to a hard-to-reach population in China using HCDC and assessed the acceptability and adoption of HCDC in China.

Methods

Handheld computers operating Windows Mobile and Questionnaire Development Studio (QDS) software (Nova Research Company) were used for this survey. Questions on tobacco use and susceptibility were drawn from the Global Adult Tobacco Survey (GATS) and other validated instruments, and these were programmed in Chinese characters by local staff. We conducted a half-day training session for survey supervisors and a three-day training session for 20 interviewers and 9 supervisors. After the training, all trainees completed a self-assessment of their skill level using HCDC. The main study was implemented in fall 2010 in 10 sites, with data managed centrally in Beijing. Study interviewers completed a post-survey evaluation questionnaire on the acceptability and utility of HCDC in survey research.

Results

Twenty-nine trainees completed post-training surveys, and 20 interviewers completed post-data collection questionnaires. After training, more than 90% felt confident about their ability to collect survey data using HCDC, to transfer study data from a handheld computer to a laptop, and to encrypt the survey data file. After data collection, 80% of the interviewers thought data collection and management were easy and 60% of staff felt confident they could solve problems they might encounter. Overall, after data collection, nearly 70% of interviewers reported that they would prefer to use handheld computers for future surveys. More than half (55%) felt the HCDC was a particularly useful data collection tool for studies conducted in China.

Conclusions

We successfully conducted a health-related survey using HCDC. Using handheld computers for data collection was a feasible, acceptable, and preferred method by Chinese interviewers. Despite minor technical issues that occurred during data collection, HCDC is a promising methodology to be used in survey-based research in China.

Work stress, life stress, and smoking among rural-urban migrant workers in China

Background

Stimulated by rapid modernization and industrialization, there is massive rural–urban migration in China. The migrants are highly susceptible to smoking and mental health problems. This study examined the association between both perceived work stress and perceived life stress with smoking behavior among this group during the period of migration.

Methods

Participants (n = 1,595) were identified through stratified, multi-stage, systematic sampling. Smoking status separated non-smokers from daily and occasional smokers, and migration history, work stress, and life stress were also measured. Analyses were conducted using the Chi-square test and multiple logistic regression. Two models were utilized. The first was the full model that comprised sociodemographic and migration-related characteristics, as well as the two stress variables. In addressing potential overlap between life and work stress, the second model eliminated one of the two stress variables as appropriate.

Results

Overall smoking prevalence was 64.9% (95% CI: 62.4-67.2%). In the regression analysis, under the full model, migrants with high perceived life stress showed a 45% excess likelihood to be current smokers relative to low-stress counterparts (OR: 1.45; 95% CI: 1.05 – 2.06). Applying the second model, which excluded the life stress variable, migrants with high perceived work stress had a 75% excess likelihood to be current smokers relative to opposites (OR: 1.75; 95% CI: 1.26–2.45).

Conclusions

Rural–urban migrant workers manifested a high prevalence of both life stress and work stress. While both forms of stress showed associations with current smoking, life stress appeared to outweigh the impact of work stress. Our findings could inform the design of tobacco control programs that would target Chinese rural–urban migrant workers as a special population.