Cigarettes, social reinforcement, and culture: a commentary on "Tobacco as a social currency: cigarette gifting and sharing in China"

Retirement transition and smoking and drinking behaviors in older Chinese adults: Analysis from the CHARLS study

Introduction

Smoking and drinking are important public problems and a substantial part of work culture in mainland China. However, little is known about the effect of retirement on these behaviors. Thus, this study examined the relationships between retirement transition, smoking and excessive drinking among older Chinese adults.

Methods

Repeated longitudinal data from a nationally representative sample of Chinese adults were collected in 2011, 2013, 2015 and 2018. Respondents completed a structured questionnaire regarding work status and health behaviors. Modified mixed-effects Poisson regression models were used to explore the associations, with additional analyses stratified by gender.

Results

Of the 10,378 participants included, 62.6% and 20.1% of men reported current smoking and excessive drinking at study entry; compared to 4.4% and 1.5% of women, respectively. There was no significant association between retirement and smoking. We found a dose-response relationship between time in retirement and excessive drinking in the adjusted model where those who retired >= 2 years ago had a 30% lower risk of excessive drinking (risk ratio (RR) = 0.70, 95% confidence interval (CI) = 0.56-0.86), and those who retired < 2 years ago had a 16% lower risk of excessive drinking (RR = 0.84, 95%CI = 0.73-0.97), compared with those who remained working. This pattern remained when analyzed separately for men and women, although not all results reached statistical significance.

Discussion

Chinese older adults are more likely to reduce drinking following retirement. Such evidence supports the positive framing of retirement in public discourse and the need for workplace interventions to address excessive drinking in China.

Real-world, anti-tobacco environmental impact upon price-induced smoking reduction among urban Chinese men: Evidence from China's 2015 cigarette tax increase

INTRODUCTION

Raising the price of cigarettes via taxation has been promoted by the World Health Organization as an important tobacco control strategy. Price elasticity of cigarettes is not uniform and is dependent upon individual and environmental determinants. Many studies have examined the determinants of price-induced smoking, taking into account sociodemographic characteristics and consumption patterns. Little research has been conducted on the association between anti-smoking environments and price-induced smoking behavior. This study addresses the deficit within the Chinese context.

METHODS

Participants were 2852 male smokers identified through a multi-stage survey sampling process encompassing 6 cities in China between July and December 2016. A standardized questionnaire tapped price-induced smoking reduction and related information. Both unadjusted and adjusted logistic regression methods were applied in the analyses.

RESULTS

In all, 25.5% (95% CI: 22.5-27.9) of smokers in this study decreased their smoking expenditures following the 2015 excise tax increase. The adjusted logistic regression analysis showed that increased exposures to an anti-smoking information environment (AOR=1.39; 95% CI: 1.10-1.79), restricted smoking in their home (AOR=1.67; 95% CI: 1.32-2.08) and workplace (AOR=1.43; 95% CI: 1.09-1.85) were more likely to report diminished cigarette smoking following the tax increases.

CONCLUSIONS

This study adds to understanding price-induced smoking behavior among urban male Chinese smokers. Strengthening of excise tax policies needs to intensify environmental smoking restrictions and public education campaigns to increase the sensitivity of cigarette price changes among smokers.

The Moderating Effect of Mental Health on the Relationship Between Cardiovascular Disease Awareness and Health Behaviors of Middle-Aged Korean Chinese Workers With Cardiovascular Risk Factors in Korea

INTRODUCTION

Cardiovascular disease (CVD) remains a leading cause of death in China and Korea, yet little is known about in Korean Chinese workers. The purpose of the study was to investigate the effects of CVD awareness and mental health on health behaviors and evaluate the moderating effect of mental health on the relationship between CVD awareness and health behaviors among Korean Chinese workers.

METHOD

We used a cross-sectional design and convenience sampling of participants from Seoul in December 2021. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, independent t tests, and hierarchical multiple regression analysis.

RESULTS

CVD awareness, mental health, and health behaviors were relatively low and mental health showed a moderating effect on the relationship between the two variables.

DISCUSSION

Understanding relationships between CVD awareness, socioculturally mediated health behaviors, and mental health issues is critical to CVD prevention among participants; moreover, mental health should be specifically assessed and targeted for improvement.

Needs and views on healthy lifestyles for the prevention of dementia and the potential role for mobile health (mHealth) interventions in China: a qualitative study

OBJECTIVES

Over the coming decades, China is expected to face the largest worldwide increase in dementia incidence. Mobile health (mHealth) may improve the accessibility of dementia prevention strategies, targeting lifestyle-related risk factors. Our aim is to explore the needs and views of Chinese older adults regarding healthy lifestyles to prevent cardiovascular disease (CVD) and dementia through mHealth, supporting the Prevention of Dementia using Mobile Phone Applications (PRODEMOS) study.

DESIGN

Qualitative semi-structured interview study, using thematic analysis.

SETTING

Primary and secondary care in Beijing and Tai'an, China.

PARTICIPANTS

Older adults aged 55 and over without dementia with an increased dementia risk, possessing a smartphone. Participants were recruited through seven hospitals participating in the PRODEMOS study, purposively sampled on age, sex, living area and history of CVD and diabetes.

RESULTS

We performed 26 interviews with participants aged 55-86 years. Three main themes were identified: valuing a healthy lifestyle, sociocultural expectations and need for guidance. First, following a healthy lifestyle was generally deemed important. In addition to generic healthy behaviours, participants regarded certain specific Chinese lifestyle practices as important to prevent disease. Second, the sociocultural context played a crucial role, as an important motive to avoid disease was to limit the care burden put on family members. However, time-consuming family obligations and other social values could also impede healthy behaviours such as regular physical activity. Finally, there seemed to be a need for reliable and personalised lifestyle advice and for guidance from a health professional.

CONCLUSIONS

The Chinese older adults included in this study highly value a healthy lifestyle. They express a need for personalised lifestyle support in order to adopt healthy behaviours. Potentially, the PRODEMOS mHealth intervention can meet these needs through blended lifestyle support to improve risk factors for dementia and CVD.

TRIAL REGISTRATION NUMBER

ISRCTN15986016; Pre-results.

Are E-Cigarette and Tea Cigarette Gifting Behaviors Associated with Tobacco Use and Failed Quit Attempts in China?

This study aims to investigate e-cigarette and tea cigarette gifting in China and their influencing factors, as well as to explore whether they were associated with tobacco use and cessation. Using a multistage sampling design, 1512 household heads from Guangdong and Shaanxi provinces were recruited for the study and filled out an online questionnaire about smoking status, social participation, e-cigarette, and tea cigarette gifting. Results showed that more than 30% and nearly 3% of participants had been gifted tea cigarettes and e-cigarettes, respectively. Marital status, province of residence, smoking status, and social participation were associated with gifting behaviors. Logistic regressions showed that receiving e-cigarettes (OR = 3.43, p < 0.05) and tea cigarettes (OR = 1.70, p < 0.01) were related to tobacco use. Smokers who have received e-cigarettes (OR = 9.85, p < 0.01) and tea cigarettes (OR = 1.92, p < 0.05) were also less likely to quit smoking.

The toxic gift: reciprocity and social capital in cigarette exchange in China

The widespread exchange of tobacco cigarettes as a gift in some societies normalises the symbolic desirability of tobacco products and promotes smoking. Little is known about how and why people exchange toxic substances as gifts. This study argues two key factors involved in social exchange processes - reciprocity and social capital - can explain gift cigarette circulation. We conducted a multistage survey among household heads from China and measured the quantity and monetary values of outgoing and incoming gift cigarettes circulated by each household and measured social capital in three dimensions: collective participation, social ties, and trust. Ordinary Least Square regressions showed that reciprocity is strongly and significantly associated with both the value and quantity of gift cigarettes. All three dimensions of social capital are varyingly associated with gifting cigarettes. Income and higher classes are also associated with greater quantity and value of received cigarettes. This study broadens the phenomenon of gifting cigarettes to the more universal patterns of reciprocity and social capital, wherein better social capital and socioeconomic position ironically lead to a higher risk of tobacco use and endanger health. We suggest policymakers target the endemic social need for gift exchange in China's informal economy.

Prevalence, correlates, and behavioral outcomes of alcohol gifting in China

Introduction

Alcohol gifting is a very common practice in China. However, little is known about the potentially adverse consequences of alcohol gifting. This study aimed to investigate the prevalence of, and factors associated with, alcohol gifting, and explore whether drinking and tobacco use were associated with alcohol gifting.

Methods

Using a cross-sectional multi-stage survey, a sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi Province was collected online from 30 April to 30 July 2020 in China. Participants completed questionnaires regarding socio-demographic characteristics, social capital, drinking status, and gifting alcohol behavior. Chi-square analysis and multiple logistic regression analysis were used to identify the factors associated with alcohol gifting, and to identify its relationship with alcohol and cigarette use status.

Results

Multiple logistic regression analysis showed that age, gender, household annual income, province, drinking status, and social participation were prominent correlates of both offering and receiving alcohol. Participants who were married, had an education level of junior high school, or had a large social network had higher odds of receiving alcohol. When both alcohol gifting behaviors were included in the models, participants who offered alcohol had 2.15 (95% CI: 1.63–2.85) times higher odds of current drinking than those who didn’t offer alcohol and participants who received alcohol had 1.87 (95% CI: 1.45–2.41) times higher odds of current drinking than those who did not receive alcohol. Those who received alcohol had significantly higher odds of current smoking (AOR = 1.64; 95% CI: 1.25–2.14), while those who offered alcohol had significantly lower odds of current smoking (AOR = 0.71;95% CI:0.53–0.95).

Conclusions

Social participation is an important correlate of alcohol gifting. Alcohol receiving behaviors were significantly associated with both current alcohol and tobacco use. These associations can be used to inform alcohol gifting interventions in China.

Cigarette sharing and gifting in China: Patterns, associated factors, and behavioral outcomes

INTRODUCTION

The purpose of this study was to investigate the patterns and factors associated with cigarette sharing and gifting, and to explore whether smoking can be predicted by these social practices.

METHODS

A cross-sectional survey using a multi-stage sampling design was conducted online from 30 April to 30 July 2020 in China. A sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi province were involved in the data analysis. Demographic characteristics, social participation, beliefs and behaviors related to cigarette sharing and gifting were assessed. Chi-squared analysis and multiple logistic regression analysis were used to explore the key factors associated with cigarette sharing and gifting, and to identify their relationship with smoking.

RESULTS

The shared and gift cigarettes were both mainly offered to friends, and receiving gift cigarettes mostly occurred during the holidays. Gender and province were associated with cigarette sharing, and marital status and social participation were associated with cigarette gifting. Cigarette gifting beliefs and smoking status were prominent predictors for both sharing and gifting cigarettes. Cigarette gifting beliefs were significantly higher among smokers than non-smokers, and people with high cigarette gifting beliefs were 1.68 (adjusted odds ratio, AOR=19.17; 95% CI: 13.31-27.61) times more likely to be a smoker. Offering shared cigarettes has been found to significantly predict tobacco use (AOR=19.17; 95% CI: 13.31-27.61), while people who received shared and gift cigarettes were 1.50 (95% CI: 1.08-2.09) and 2.58 (95% CI: 1.66-4.00) times more likely to be a current smoker than those who did not receive cigarettes, respectively.

CONCLUSIONS

Cigarette sharing and gifting were especially pervasive among male smokers and married people in Shaanxi Province. Offering shared cigarettes and receiving shared/gift cigarettes might facilitate cigarette use. This study provides evidence-based data to support the design and implementation of tobacco control programs for the denormalization of gifting and sharing cigarettes.

Achieving the Goals of Healthy China 2030 Depends on Increasing Smoking Cessation in China: Comparative Findings from the ITC Project in China, Japan, and the Republic of Korea

Tobacco smoking is the number one preventable cause of disease and death in China as it is globally. Indeed, the toll of smoking in China is much greater than its status as the world's most populous country. There is a persistent and continuing need for China to implement the measures specified in the global tobacco control treaty, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), which China ratified in 2005. The theme for the 2021 WHO World No Tobacco Day focuses on the need to support smoking cessation. This article presents findings from the International Tobacco Control (ITC) Policy Evaluation Project cohort surveys in China, in comparison to ITC cohort surveys in two neighboring countries: Japan and the Republic of Korea. These findings demonstrate that smokers in China very much want to quit, but these intentions are not being translated into quit attempts, relative to smokers in Japan and the Republic of Korea. Additionally, about 80% of Chinese smokers want the Chinese government to do more to control smoking. These findings reaffirm the need for China to implement strong, evidence-based measures to reduce smoking. The objective of Healthy China 2030 to reduce deaths from non-communicable diseases by 30% can be achieved by reducing smoking prevalence from its current 26.6% to 20%, and this reduction can be achieved through strong implementation of FCTC measures.

Trends in Disease Burden Attributable to Tobacco in China, 1990-2017: Findings From the Global Burden of Disease Study 2017

In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, SHS, and chewing tobacco. In this study, we aimed to evaluate the trends in deaths and disability-adjusted life years (DALYs) attributable to tobacco, smoking, SHS, and chewing tobacco by sex in China from 1990 to 2017 and to explore the leading causes of tobacco-attributable deaths and DALYs using data from the GBD 2017. From 1990 to 2017, the tobacco-attributable death rates per 100,000 people decreased from 75.65 [95% uncertainty interval (95% UI) = 56.23-97.74] to 70.90 (95% UI = 59.67-83.72) in females and increased from 198.83 (95% UI = 181.39-217.47) to 292.39 (95% UI = 271.28-313.76) in males. From 1990 to 2017, the tobacco-attributable DALY rates decreased from 2209.11 (95% UI = 1678.63-2791.91) to 1489.05 (95% UI = 1237.65-1752.57) in females and increased from 5650.42 (95% UI = 5070.06-6264.39) to 6994.02 (95% UI = 6489.84-7558.41) in males. In 2017, the tobacco-attributable deaths in China were concentrated on chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke. The focus of tobacco control for females was SHS in 1990, whereas smoking and SHS were equally important for tobacco control in females in 2017. Increasing tobacco taxes and prices may be the most effective and feasible measure to reduce tobacco-attributable disease burdens.

Social engagement pattern, health behaviors and subjective well-being of older adults: an international perspective using WHO-SAGE survey data

BACKGROUND

Social engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Previous research demonstrates that social engagement was associated with positive health behaviors among older adults. However, the results have been different across health-related behaviors, and mostly based on data from high-income countries. For example, studies from the US and UK showed that social engagement was protective against smoking, while others found social engagement encouraged more smoking in many Asian cultures. In this study, we aim to examine the association between social engagement and a range of health-related behaviors and subjective well-being among older adults in six low- to middle-income countries.

METHODS

Data from the WHO Study on Global Ageing and Adult Health (SAGE Wave 1) were used. A total of 33,338 individuals aged 50 and older in China, Russia, India, Ghana, South Africa, and Mexico were included. Social engagement, tobacco use, alcohol consumption, fruit and vegetable intake, physical activity, sedentary behavior, sleep duration, depression symptoms, self-rated health status, and quality of life were assessed using established self-reported measures. Multiple logistic regression models were used to examine the relationship between social engagement and nine outcome variables, adjusting for socio-demographic characteristics.

RESULTS

Lower levels of social engagement were positively related to physical inactivity, prolonged sitting time, unhealthy sleep duration, perceived depression, poor self-rated health, and low quality of life. However, the associations between social engagement and tobacco use, excessive drinking, and insufficient fruit and vegetable intake were mixed across countries.

CONCLUSION

This international study found high social engagement as a potential health-promoting factor in some low- to middle-income countries. Although the impacts of social engagement on tobacco and alcohol use and diet were complicated and culture-specific, interventions at both individual and community levels should encourage healthy lifestyles through positive social engagement.

Impact of China National Tobacco Company's 'Premiumization' Strategy: longitudinal findings from the ITC China Surveys (2006-2015)

BACKGROUND

In 2009, the China National Tobacco Company (CNTC) began their Premiumization Strategy, designed to encourage smokers to trade up to more expensive brands, mainly by promoting the concept that higher class cigarettes are better quality and less harmful. This study is the first evaluation of the strategy's impact on: (1) prevalence of premium brand cigarettes (PBC), mid-priced brand cigarettes (MBC) and discount brand cigarettes (DBC) over 9 years, from 3 years pre-strategy (2006) to 6 years post-strategy (2015); and (2) changes in reasons for choosing PBCs, MBCs and DBCs.

METHODS

A representative cohort of adult Chinese smokers (n=9047) in seven cities who participated in five waves of the International Tobacco Control (ITC) China Survey: pre-implementation (Wave 1 (2006; n=3452), Wave 2 (2007-2008; n=3586)); mid-implementation (Wave 3 (2009; n=4172)); and post-implementation (Wave 4 (2011-2012; n=4070), Wave 5 (2013-2015; n=2775)). Generalised estimating equations were conducted to examine changes in prevalence of PBCs, MBCs and DBCs, and reasons for brand choice from pre-implementation to post-implementation.

RESULTS

From pre-implementation to post-implementation, there was an increase in prevalence of PBCs (5.4% to 23.2%, p<0.001) and MBCs (40.0% to 50.4%, p<0.001), and a decrease in DBCs (54.6% to 26.5%, p<0.001). There was an increase in smokers who chose their current brand because they believed it to be less harmful, both for MBC smokers (+13.0%, p=0.001) and PBC smokers (+9.0%, p=0.06). There was an increase for smokers in all brand classes for choosing their current brand because they were 'higher in quality' and because of affordable price, but the greatest increase was among PBC smokers (+18.6%, p<0.001 and +34.9%, p<0.001, respectively).

CONCLUSIONS

Our findings demonstrate that the rising trend in Chinese smokers' choice of 'less harmful', 'higher quality' and 'affordable' cigarettes, particularly PBCs, is likely due to CNTC's aggressive marketing strategies. Strong tobacco control policies that prohibit CNTC's marketing activities are critical in order to dispel erroneous beliefs that sustain continued smoking in China, where the global tobacco epidemic is exerting its greatest toll.

A Qualitative Study on Chinese Canadian Male Immigrants' Perspectives on Stopping Smoking: Implications for Tobacco Control in China

China has the largest number of smokers in the world; more than half of adult men smoke. Chinese immigrants smoke at lower rates than the mainstream population and other immigrant groups do. This qualitative study was to explore the influence of denormalization in Canada on male Chinese immigrant smoking after migration. Semistructured interviews were conducted with 22 male Chinese Canadian immigrants who were currently smoking or had quit smoking in the past 5 years. The study identified that, while becoming a prospective/father prompted the Chinese smokers to quit or reduce their smoking due to concern of the impacts of their smoking on the health of their young children, changes in smoking were also associated with the smoking environment. Four facilitators were identified which were related to the denomormalized smoking environment in Canada: (a) the stigma related to being a smoker in Canada, (b) conformity with Canadian smoking bans in public places, (c) the reduced social function of smoking in Canadian culture, and (d) the impact of graphic health messages on cigarette packs. Denormalization of tobacco in Canada in combination with collectivist values among Chinese smokers appeared to contribute to participants' reducing and quitting smoking. Although findings of the study cannot be claimed as generalizable to the wider population of Chinese Canadian immigrants due to the small number of the participants, this study provides lessons for the development of tobacco control measures in China to reverse the current prosmoking social environment.

Motivations, challenges and coping strategies for smoking cessation: Based on multi-ethnic pregnant couples in far western China

The present study aimed to clarify the smoking cessation motivations, challenges and coping strategies among pregnant couples. A qualitative design using a grounded theory approach was applied. Data were collected by individual semi-structured interviews with 39 married individuals (21 non-smoking pregnant women and 18 smoking or ever-smoking men with a pregnant wife) and 3 imams in an ethnically diverse region of far western China. The most common theme for smoking cessation motivation was "embryo quality" (i.e., a healthier baby), followed by family's health. Most interviewees reported that husband's withdrawal symptoms were the greatest challenge to smoking cessation, followed by the Chinese tobacco culture. Coping strategies given by the pregnant women typically involved combining emotional, behavioral and social interventions. Social interventions showed advantages in helping to quit smoking. Pregnancy appears to be a positive stimulus for pregnant couples' smoking cessation. Our results suggest that pregnancy, a highly important life event, may help to reduce barriers to smoking cessation at the social level (e.g., limiting access to cigarettes, avoiding temptation to smoke), but does little to help with the withdrawal symptoms. Professional guidance for smoking cessation is still necessary.

Smoking environments in transition: the experiences of recent Chinese migrants to Canada

International migrants experience first-hand differences between countries in terms of the social meanings, spatial regulation and prevalence of smoking. This research centred on the smoking-related perceptions, experiences and behaviours of recent migrants from China to Canada. Eight focus groups were held in Edmonton, Alberta, in July-October 2013 to explore migrants' understandings of the practices and meanings of smoking in both countries. There were 58 participants (37 non-smokers and 21 smokers), most of whom were international students. Qualitative content analysis of focus group transcripts was undertaken to identify key themes. Participants observed that smoking remains almost ubiquitous in China due to ineffective spatial restrictions and the social importance of smoking among men. By contrast, smoking bans in Canada were perceived as effective due to widespread compliance and expectations of enforcement. They were conscious that male smoking was both less prevalent and less socially valued in Canada; conversely, female smoking was perceived as more accepted in Canada than in China. There was broad agreement that smoking was tolerated in Canada, provided it occurred in appropriate places. Complying with widespread spatial restrictions brought about changes in smokers' behaviours: they smoked less often, and consumed fewer cigarettes. Because smoking was more difficult to perform, participants thought the Canadian context supported quitting. Non-smokers were enthusiastic about smoke-free environments in Canada, and had become acculturated to air that did not smell of smoke. These findings affirm the importance of comprehensive smoking bans, backed by enforcement, in contributing to the denormalisation of smoking and the protection of non-smokers.

Association between secondhand smoke exposure at home and cigarette gifting and sharing in Zhejiang, China: a repeat cross-sectional study

OBJECTIVES

The aims of the current study were to assess the prevalence of household cigarette gifting and sharing, and to evaluate the relationship between secondhand smoke (SHS) exposure, and cigarette gifting and sharing, in Zhejiang, China.

DESIGN

A repeat cross-sectional design.

SETTING

10 sites in 5 cities in Zhejiang, China.

PARTICIPANTS

Two surveys were conducted with adults in Zhejiang, China, in 2010 (N=2112) and 2012 (N=2279), respectively. At both waves, the same questionnaire was used; respondents were asked questions on residence, number of family smokers, indoor smoking rules, household income and cigarette gifting and sharing.

RESULTS

The findings revealed that more than half of respondents' families (54.50% in 2010, 52.79% in 2012) reported exposure to SHS. Many families (54.73% in 2010, 47.04% in 2012) shared cigarettes with others, and a minority (14.91% in 2010, 14.17% in 2012) reported their family giving cigarettes as a gift. There was a significant decrease in cigarette sharing from 2010 to 2012, irrespective of household with SHS exposure status; and the cigarette gifting was significantly decreased in household without SHS exposure.

CONCLUSIONS

Compared to households without SHS exposure, the prevalence of cigarette gifting and sharing in households with SHS exposure was more obvious. Encouraging and promoting a smoke-free household environment is necessary to change public smoking customs in Zhejiang, China.

A Qualitative Study on Unassisted Smoking Cessation Among Chinese Canadian Immigrants

It is well-known that majority of smokers worldwide quit smoking without any assistance. This is even more evident among Chinese smokers. The aim of this qualitative study was to explore how Chinese Canadian immigrant men who smoked cigarettes perceived smoking cessation aids and services and how they used any form of the smoking cessation assistance to help them quit smoking. The study was conducted in British Columbia, Canada. Twenty-two Chinese immigrants were recruited by internet advertisement and through connections with local Chinese communities. Ten of the 22 participants were current smokers and the other 12 had quit smoking in the past 5 years. Data were collected using semistructured interviews. Although all participants, including both the ex-smokers and current smokers, had made more than one quit attempt, they rarely used cessation aids or services even after they had immigrated to Canada. The barriers to seeking the cessation assistance were grouped into two categories: practical barriers and cultural barriers. The practical barriers included "Lack of available information on smoking cessation assistance" and "Difficulty in accessing smoking cessation assistance," while cultural barriers included "Denial of physiological addiction to nicotine," "Mistrust in the effectiveness of smoking cessation assistance," "Tendency of self-reliance in solving problems," and "Concern of privacy revelation related to utilization of smoking cessation assistance." The findings revealed Chinese immigrants' unwillingness to use smoking cessation assistance as the result of vulnerability as immigrants and culturally cultivated masculinities of self-control and self-reliance.

A qualitative study of Chinese Canadian fathers' smoking behaviors: intersecting cultures and masculinities

BACKGROUND

China is home to the largest number of smokers in the world; more than half of the male population smoke. Given the high rates of Chinese immigration to Canada and the USA, researchers have explored the effect of immigration on Chinese smokers. Reduced tobacco use among Chinese immigrants has been reported in the United States; however, little is known about the social factors underlying men's smoking practices in settings where tobacco control measures have denormalized smoking, and in the context of fatherhood. The purpose of this Canada-based study was to explore the smoking-related experiences of immigrant Chinese fathers.

METHODS

In this qualitative study, semi-structured telephone interviews were conducted with 22 Chinese Canadian fathers who smoked or had recently quit smoking, and had at least one child under the age of five years old.

RESULTS

The Chinese fathers had dramatically changed their smoking patterns due to concern for their children's health and social norms and restrictions related to smoking in Canada. The facilitators and barriers for men's smoking were intertwined with idealized masculine provider and protector roles, and diverse Canadian Chinese cultural norms related to tobacco use.

CONCLUSIONS

The findings have implications for the development of future smoking cessation interventions targeting Chinese Canadian immigrant smokers as well as smokers in China.

An exploratory study of the socio-cultural risk influences for cigarette smoking among Southern Nigerian youth

Background

The increase in smoking prevalence in developing countries including Nigeria has been mainly blamed on the aggressive marketing strategies of big tobacco companies. There is a paucity of research on other socio-cultural risk factors for smoking among the youth. The main objective of this study is to explore and describe socio-cultural risk factors influencing cigarette smoking among the youth in Southern Nigeria.

Methods

A total of 27 respondents (5 community leaders, 4 political analysts and 18 young cigarette smokers) were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyse the data.

Results

Social-cultural practices fuelling early usage and exposure of children to cigarettes and the promotional activities of tobacco companies were identified as possible factors influencing youth’s smoking behaviour in Southern Nigeria.

Conclusion

Tobacco control policies should include cultural interventions to modify current traditional practices and social norms which fuel the use of tobacco in the society. Such interventions must target specific groups, subpopulations and subcultures more exposed to the cultural risk influences for smoking.

Why FCTC policies have not been implemented in China: domestic dynamics and tobacco governance

The international community, under the auspices of the World Health Organization, developed the landmark Framework Convention on Tobacco Control (FCTC) to curb the global tobacco epidemic. As an internationally binding convention about global best practices on tobacco control, the FCTC has become an overriding source of policy transfer for developing countries in the fight against smoking. However, since its ratification of the first global norm over tobacco governance and against the grim background of the widespread tobacco-induced public health devastation within its borders, China has failed to genuinely pursue FCTC policies because of domestic political and social factors. The empirical findings of this article point to the dominance of political-social dynamics for China's nontransfer of FCTC policies, arguing that the government's GDPism, its sovereignty-first mentality, and hostility to NGOs as well as widespread social acceptability of tobacco consumption and high smoking prevalence are fundamental causes of China's nontransfer of FCTC policies. The article explicates how these variables correspond to FCTC policies in an analytic framework of policy transfer.

The development of a Chinese-language instrument to measure social smoking motives among male Taiwanese smokers

PURPOSE

The purpose of this study was to develop a scale to measure the social smoking motives of adult male smokers using a Chinese social context.

DESIGN

Three phases were conducted between February 2006 and May 2009. First, the initial instrument development was guided by a literature review, interviews with smokers, and item analysis. Second, the validity and reliability of the refined scale were tested. The factor structures of the Social Smoking Measures (SSM-12) scale were validated.

RESULTS

The final scale consists of 12 items. Two factors that account for 49.2% of the variance emerged from the exploratory factor analysis. Cronbach's alpha was .88, and test-retest reliability was .82. The results of the confirmatory factor analysis indicated that the SSM model was a two-correlated factor.

CONCLUSION

Field testing revealed the SSM-12 to be a reliable and valid Chinese-language instrument to measure social smoking motives, which can be used to guide nursing interventions that support culturally and socially appropriate smoking cessation programs.

Gifting and sharing cigarettes in a rural Chinese village: a cross-sectional study

OBJECTIVES

Quantitative measurement of the prevalence of cigarette sharing and gifting in a town in rural China and evaluation of the impact of these practices on individual smoking habits and family expenditures.

METHODS

An interview-based cross-sectional study of 105 households in rural Hunan, China tabulated household cigarette gifting and expenditures. Individual smoking and cigarette sharing activities were also recorded among 198 household members aged >15 years who were resident for at least 6 months.

RESULTS

With regard to sharing cigarettes, 92% of men and 19% of women reported being offered a cigarette within the past week. Among previous and current smokers who had attempted to quit smoking, 90% reported that their friends had tried to dissuade them from quitting by tempting them with cigarettes. Concerning gifting cigarettes, 74% of households reported sending packaged cigarettes as gifts during the Chinese New Year Festival at an average expense of 2.8% of household annual income. Although households received an average of 12.4% of their annual cigarette consumption in the form of gifts during the Chinese New Year Festival, no association was found between the amount of cigarettes received by a household and the annual cigarette consumption for that household.

CONCLUSIONS

Both gifting and sharing cigarettes are common in rural China. Gifting of cigarettes during the New Year Festival is a significant expenditure affecting both smoking and non-smoking households and may be an opportunity for additional mass media marketing. Among current and former smokers, sharing cigarettes in China is a major impediment to smoking cessation.