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He J, Han D, Qian K, Guan W, Zhang G, Lu W, Li H, Zhi X. Smoking cessation in Chinese patients undergoing thoracic surgery: A multicenter prospective observational study. Tob Induc Dis 2024; 22:TID-22-06. [PMID: 38204733 PMCID: PMC10777477 DOI: 10.18332/tid/175639] [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: 09/07/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The multicenter CHAMPION study aimed to assess the impact of smoking cessation on post-operative complications (PCs) and smoking cessation patterns in Chinese patients undergoing lung surgery. METHODS Patients undergoing elective lung surgery were prospectively enrolled from three major tertiary centers in China. Patients were categorized as smokers or quitters before surgery. Baseline characteristics and smoking status were analyzed. The incidence of PCs and pulmonary PCs (PPCs), smoking relapse rate, and causes within six months post-operatively were investigated. The questionnaire was conducted in all patients and 30 healthcare professionals (HCPs), regarding the awareness and effectiveness of smoking cessation methods. RESULTS Of the 276 enrolled patients, 213 (77.2%) were smokers and 63 (22.8%) were quitters; 76.4% were diagnosed with primary lung cancer. PCs occurred in 13.8% of patients, with similar proportions in smokers (14.1%) and quitters (12.7%). PPCs occurred in 9.8% of patients with no significant differences between smokers and quitters (9.4% vs 11.1%, p=0.70). At six months, 9.2% of patients relapsed, with a lower rate in quitters compared to smokers (3.3% vs 11.0%, p=0.01). HCPs exhibited higher awareness of smoking cessation methods than patients. Perceived effectiveness of smoking cessation methods from the patients were low. CONCLUSIONS In patients undergoing lung surgery with a low risk of PCs, active smoking does not significantly increase the risk of PCs or PPCs relative to quitters, suggesting that there is likely no need to postpone lung surgery for those who have not yet quit smoking. However, further large-scale studies are necessary to confirm these findings.
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Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Qian
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weijie Guan
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ge Zhang
- Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, Shanghai, China
| | - Weiqing Lu
- Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Xie X, Nan Y, Lin B, Chen T, Zhang L, Xiao L. A COM-B analysis of facilitators of and barriers to smoking cessation among Chinese smokers: A qualitative study. Tob Induc Dis 2023; 21:152. [PMID: 38026498 PMCID: PMC10652708 DOI: 10.18332/tid/174128] [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: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Smoking prevalence remains high in China with a low cessation motivation level, despite the government's tobacco control efforts. There is a lack of research specifically examining perceptions, attitudes, and behaviors related to smoking cessation in this region, particularly from a theory-based deductive perspective. Utilizing the COM-B (Capability, Opportunity, Motivation-Behavior) model as a theoretical framework, this study aimed to identify facilitators and barriers to smoking cessation among Chinese smokers. METHODS The study employed semi-structured individual interviews with 40 participants. Each interview spanned approximately 30 minutes. The participants, constituting both current and former smokers, were all aged ≥18 years (n=40). Interview data were then examined using a directed content analysis approach. RESULTS Analysis revealed three interrelated themes. Capability: Smokers face challenges when resisting peer pressure and dealing with life after quitting. They also lack knowledge about smoking, quitting techniques, and withdrawal symptoms. Opportunity: Changing societal attitudes towards smoking create opportunities for quitting, but these are hindered by inadequate cessation services and a lack of family support. Motivation: Smokers' motivation to quit is mainly driven by health concerns. Resistance to quitting often stems from the belief that smoking is a personal choice or just a habit. Excessive emphasis on willpower may hinder motivation to quit. CONCLUSIONS To enhance smoking cessation efforts in China, three key aspects should be considered: capability, opportunity, and motivation. Publicity and educational campaigns should target common misconceptions about smoking as a personal freedom, correct the overemphasis on willpower, and widely promote available cessation services. A crucial aspect is shifting societal norms to foster anti-smoking sentiments. Effective strategies may involve using real-life stories to illustrate smoking's health consequences, disseminating information about cessation services in maternity centers, enhancing services through mobile health initiatives, and empowering families to support smokers in their quit attempts.
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Affiliation(s)
- Xiaoyun Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yi Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Bingliang Lin
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Tianqi Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Luge Zhang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
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Liu Z, Qin R, Hu XJ, Liu LJ, Xu SQ, Shi GC, Zhou H, Bai J, Zhang CM, Qi Y, Zhou W, Lan SH, Tong J, Su TS, Wang Q, Yang XY, Sun DJ, Zhu LM, Chen XY, Chen H, Xie YP, Xiao ZH, Chen YB, Zhao B, Wu QG, Chen WL, Li DY, Liu H, Cheng AQ, Cui ZY, Zhao L, Li JX, Wei XW, Zhou XM, Su Z, Chung KF, Chen ZM, Xiao D, Wang C. Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100826. [PMID: 37927997 PMCID: PMC10624982 DOI: 10.1016/j.lanwpc.2023.100826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 11/07/2023]
Abstract
Background Tobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation. Methods This a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18-85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers. Findings A representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome. Interpretation The CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China. Funding Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Heilongjiang Provincial Science and Technology Key Program (2022ZXJ03C02), and National Key R&D Program of China (grant no. 2017YFC1309400).
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Affiliation(s)
- Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Qin
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Xue-Jun Hu
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Jun Liu
- Department of Respiratory and Critical Care Medicine, Baiyin First People's Hospital of Gansu Province, Baiyin, Gansu Province, China
| | - Su-Qin Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Guo-Chao Shi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jing Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - Chun-Mei Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yong Qi
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Wei Zhou
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - Shu-Hua Lan
- Department of Pulmonary and Critical Care Medicine, Nanping People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Nanping, Fujian Province, China
| | - Jin Tong
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tong-Sheng Su
- 3rd Department of Acupuncture and Moxibustion, Shaanxi Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi Province, China
| | - Qiang Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xin-Yan Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - De-Jun Sun
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China
| | - Li-Ming Zhu
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Xiao-Yang Chen
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Peng Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhi-Hua Xiao
- Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Datong City, Datong, Shanxi Province, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Bo Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qiu-Ge Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wen-Li Chen
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Dong-Yan Li
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hongbo Liu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - An-Qi Cheng
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zi-Yang Cui
- Department of Geriatric Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Liang Zhao
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Xuan Li
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xiao-Wen Wei
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xin-Mei Zhou
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK
| | - Zheng-Ming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dan Xiao
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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WANG WYY, YE XF, MIAO CY, ZHANG W, SHENG CS, HUANG QF, WANG JG. Current and recent cigarette smoking in relation to cardiovascular and non-cardiovascular mortality in an elderly male Chinese population. J Geriatr Cardiol 2023; 20:567-576. [PMID: 37675264 PMCID: PMC10477588 DOI: 10.26599/1671-5411.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men. METHODS Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-to-moderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest. RESULTS The 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min vs. < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min. CONCLUSIONS Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.
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Affiliation(s)
- Wen-Yuan-Yue WANG
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Fei YE
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao-Ying MIAO
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei ZHANG
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Sheng SHENG
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang HUANG
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang WANG
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Nian Q, Hardesty JJ, Cohen JE, Kennedy RD. The association between viewing cigarette health warning labels and intention to quit smoking among Chinese adult smokers: support for including health outcome content and culturally specific messages. BMC Public Health 2023; 23:866. [PMID: 37170086 PMCID: PMC10176816 DOI: 10.1186/s12889-023-15718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Tailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants' intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices. METHODS A cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data. RESULTS After viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01-1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14-1.69) and 1.29 (95% CI 1.04-1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample. CONCLUSIONS Findings of this study provide evidence of an association between all four pictorial HWL themes and smokers' intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA.
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
| | - Ryan D Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
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Lyu JC, Sung HY, Yao T, Jiang N, Quah ACK, Meng G, Jiang Y, Fong GT, Max W. Cigarette Gifting Among Nonsmokers in China: Findings From the International Tobacco Control China Survey. Nicotine Tob Res 2023; 25:928-936. [PMID: 36574502 PMCID: PMC10077925 DOI: 10.1093/ntr/ntac294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/23/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cigarette gifting is commonly practiced in China and has contributed to the social acceptability and high prevalence of cigarette smoking in the country. As a result, nonsmokers in China are particularly susceptible to smoking. While previous studies have examined cigarette gifting behaviors among smokers, little is known about cigarette gifting among nonsmokers. AIMS AND METHODS This study aimed to examine the percentage and correlates of giving and receiving cigarettes as gifts among adult nonsmokers in China. We analyzed nonsmokers (N = 1813) aged ≥18 years using data from the International Tobacco Control China Wave 5 Survey. Descriptive statistics summarized the characteristics of those who gave and received cigarettes as gifts. Multivariable logistic regression models were used to identify factors associated with the two behaviors. RESULTS Among nonsmokers, 9.9% reported giving cigarettes as gifts to family or friends in the last 6 months. A higher level of knowledge about smoking harms was associated with lower adjusted odds of gifting cigarettes. Nonsmokers aged 25-39 years, with middle income, positive attitude toward cigarette gifts, exposure to anti-smoking information, and exposure to smoking promotion, and those who reported receiving cigarettes as gifts from family or friends were more likely to give cigarettes as gifts. A total of 6.6% of nonsmokers reported receiving cigarettes as gifts in the last 6 months. High education, neutral or positive attitude toward cigarette gifts, exposure to anti-smoking information, exposure to smoking promotion, and having smoking friends were associated with receiving cigarettes as gifts. CONCLUSIONS It is concerning that Chinese cultural norms that support cigarette gifting have extended to giving nonsmokers cigarettes as gifts. Effective anti-smoking messages are needed. Changing the norms around cigarette gifting and increasing knowledge about smoking harms should help reduce cigarette gifting among nonsmokers. IMPLICATIONS Easy access to cigarettes received as gifts, along with the wide acceptance of smoking in China, places Chinese nonsmokers in a risky position. More educational campaigns targeting nonsmokers to proactively prevent them from smoking are called for. The ineffectiveness of existing anti-smoking information highlights the need for more effective anti-smoking messages. That attitude toward cigarette gifts is the strongest predictor of giving cigarettes as gifts suggests the need for interventions to reverse the positive attitude about cigarette gifting to decrease the popularity of this activity.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Hai-Yen Sung
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Tingting Yao
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Nan Jiang
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Yuan Jiang
- National Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Wendy Max
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
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Nian Q, Hardesty JJ, Cohen JE, Xie X, Kennedy RD. Perceived effectiveness of four different cigarette health warning label themes among a sample of urban smokers and non-smokers in China. Tob Control 2023; 32:205-210. [PMID: 34400570 PMCID: PMC9985749 DOI: 10.1136/tobaccocontrol-2021-056703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study, conducted in China, evaluated the effectiveness of four different themes of health warning labels (HWLs) that used both text and pictures: (1) self-harm from using cigarettes, (2) harming family or children with secondhand smoke, (3) reinforcing compliance with existing smoke-free policies and (4) anticigarette gift giving practices. METHODS A cross-sectional randomised experimental survey was conducted among 3247 adult (aged 18+ years) participants in Beijing, Shanghai and Shenzhen in 2017, using quotas for age group, gender and smoking status. Participants were randomly assigned to one of the four HWL themes. Each participant viewed eight HWLs and rated how effective these themed-labels were in terms of credibility, raising awareness of health harms of smoking on family and children, improving compliance with public smoking bans, stopping the practice of gifting cigarettes, thinking about quitting and preventing smoking using a 10-point scale, with 10 being most effective. Analysis of variance and independent t-tests were used to analyse these data. FINDINGS All four HWL themes performed well for each outcome with average ratings >6.5. Harming family or children with secondhand smoke was the theme that received the highest ratings for each outcome, with credibility (8.0, 95% CI 7.86 to 8.09) and prevention of smoking (8.8, 95% CI 8.63 to 8.91) outcomes being significantly higher (p<0.05). Overall, analysis of ratings by gender, income and education did not impact outcomes. CONCLUSION All four HWL themes tested could be effective in China; the theme of secondhand smoke harming family or children may be a particularly credible/effective theme.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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8
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Li WHC, Xia W, Wang MP, Cheung DYT, Cheung KY, Wong CKH, Lam TH. Effect of quitting immediately vs progressively on smoking cessation for smokers at emergency department in Hong Kong: A posteriori analysis of a randomized controlled trial. PLoS One 2023; 18:e0280925. [PMID: 36701401 PMCID: PMC9879435 DOI: 10.1371/journal.pone.0280925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/22/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A progressive approach to quitting smoking has been a popular strategy for motivating smokers who are reluctant to quit. However, whether this strategy can effectively achieve complete cessation or is as successful as quitting immediately remains unresolved. This study aimed to determine whether quitting immediately or progressively was more effective in achieving complete cessation among smokers in Hong Kong who presented at emergency departments. METHODS AND FINDINGS A posteriori analysis of a single-blinded, multicenter, randomized controlled trial was performed. The original trials was conducted at emergency departments of four major acute hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major emergency departments between July 4, 2015 and March 17, 2017 were randomized into an intervention group (n = 787) and a control group (n = 784). The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive, labeled QI and QP, respectively). The control group received a smoking cessation leaflet. Follow-ups were conducted at 1, 3, 6 and 12 months. The primary outcomes, by intention-to-treat, were biochemically validated abstinence between the QI subgroup and control group; between the QP subgroup and control group, and between the QI subgroup and QP subgroup at 6 months. After the propensity sore matching, the biochemically validated abstinence was statistically significantly higher in the QI subgroup than the control group at 6 months (12.1% vs 3.4%, P = 0.003; adjusted odds ratio [aOR] 4.34, 95% CI 1.63-11.52) and higher in the QP subgroup than the control group at 6 months (9.8% vs 3.4%, P = 0.02; aORs 2.95, 95% CI: 1.04-8.39). No statistically significant differences of biochemically validated abstinence at both 6 month (12.1% vs 9.8%, P = 0.49; aORs 1.50, 95% CI: 0.71-3.19) were found in the comparison between QI and QP subgroups. CONCLUSIONS This study demonstrates that the strategy of quitting progressively is effective, especially for smokers who lack motivation or find it difficult to quit. If adopted routinely, such an approach can help achieve a greater level of smoking abstinence in the community. TRIAL REGISTRATION ClinicalTrials.gov: NCT02660957.
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Affiliation(s)
- William Ho Cheung Li
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- * E-mail:
| | - Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Kai Yeung Cheung
- United Christian Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Carlos King Ho Wong
- Department of Pharmacology and Pharmacy & Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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9
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Wang* R, Qiang* Y, Gao* X, Yang Q, Li B. Prevalence of non-communicable diseases and its association
with tobacco smoking cessation intention among current
smokers in Shanghai, China. Tob Induc Dis 2022; 20:106. [DOI: 10.18332/tid/155828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
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10
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Gao X, Shen F, Li S, Zhang R, Jiang W, Li B, Wang R. The estimated influence of assumed physicians' advice for tobacco smoking cessation among current smokers in Shanghai, China: A cross-sectional study. Tob Induc Dis 2022; 20:86. [PMID: 36317058 PMCID: PMC9574849 DOI: 10.18332/tid/153508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Evidence indicates that physicians' smoking cessation advice is significant for tobacco control, which is an impetus to encourage smoking cessation among smokers, but the estimated influence of physicians' smoking cessation advice on smokers' intention to quit is limited in Shanghai, China. METHODS We enrolled 1104 participants who were current smokers in the SJ (Songjiang) and FX (Fengxian) districts in Shanghai in 2021. An electronic questionnaire was used to collect data and SAS 9.4 was used for data analysis. Univariate and multivariate logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to estimate the influence of the assumed physicians' advice for smoking cessation on current smokers' smoking cessation plan. RESULTS A total of 1104 participants provided information of which 914 were male smokers (82.8%) and 190 (17.2%) were female smokers. Multivariate logistic regression demonstrated that female smokers (OR=2.47; 95% CI: 1.66-3.68), smokers with at least 1 type of non-communicable disease (OR=2.09; 95% CI: 1.42-3.07), smoking intensity <20 cigarettes/day (OR=1.64; 95% CI: 1.22-2.17), with personal tobacco burden less than 20% (OR=1.52; 95% CI: 1.10-2.13), exposed to secondhand smoke (OR=1.99; 95% CI:1.44-2.76), and previous smoking cessation attempt (OR=4.43; 95% CI: 3.23-6.08), were more likely to report an intent to quit smoking. Moreover, approximately 50% of participants without a plan to quit in a year had also reported their intention to quit smoking with the presumption that the physicians would advise them to quit, irrespective of their sex, age, NCD status and secondhand tobacco smoke exposure. CONCLUSIONS Physicians' cessation advice could promote smokers to consider stopping smoking. The reported cessation intention was higher among female smokers, and smokers with NCD, lower smoking intensity and burden, with smoking cessation attempts, all of which could be incorporated into the implementation of tobacco control measures in the future in Shanghai.
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Affiliation(s)
- Xiangjin Gao
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fanlingzi Shen
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Siyuan Li
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Zhang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Wencheng Jiang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Bin Li
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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The estimated effect of graphic warning labels on smoker's intention to quit in Shanghai, China: a cross-sectional study. BMC Public Health 2021; 21:2170. [PMID: 34836519 PMCID: PMC8626992 DOI: 10.1186/s12889-021-12257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco consumption is the leading cause of death worldwide. Overwhelming studies demonstrate graphic warning labels (GWLs) on cigarette packs are effective in eliciting negative response to tobacco smoking, modifying beliefs about tobacco dangers, and increasing reported intention to quit, but the estimated effect of GWLs on smoking cessation intention among smokers is still limited in China. In this study, we aim to understand the smoking intensity, smoking duration and smoking cessation intention among current smokers, and to explore how their smoking cessation intention would be influenced by the GWLs in Shanghai. METHODS From January to June 2021, we totally recruited 1104 current smokers in Songjiang district and Fengxian district of Shanghai by multistage sampling design. We used Android pad assisted electronic questionnaire for data collection, and then implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore how smoking cessation intention would be influenced by the GWLs among current smokers. RESULTS One thousand one hundred four current smokers included 914 males (82.79%), with an average age of 43.61 years. 58.06% of current smokers reported smoking cessation intention due to GWLs. Logistic regression indicated a higher percentage of smoking cessation intention due to GWLs was among female smokers [OR = 2.41, 95% CI (1.61-3.59)], smokers with smoking intensity < 20 cigarette/day [OR = 1.92, 95% CI (1.44-2.55)], smokers with tobacco burden < 20% [OR = 1.94, 95% CI (1.35-2.79)], and among smokers had plan to quit in a year [OR = 6.58, 95% CI (4.71-9.18). Smokers with higher individual monthly income had lower percentage of smoking cessation intention (OR were 0.35, 0.46 and 0.41). Meanwhile, among 642 current smokers without plan to quit in a year, approximately 40% of them reported smoking cessation intention due to GWLs. CONCLUSIONS Smoking cessation intention due to the assumed GWLs on cigarette packs is high among current smokers in Shanghai, especially in female smokers, smokers with light tobacco burden and mild nicotine dependence. Incorporating smoking intensity as well as smoking burden into the implementation of GWLs as tobacco control measures would discourage smoking in China.
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12
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Wang R, Gao X, Qiang Y, Yang Q, Li X, Li B. The Estimated Effect of Physicians' Advice for Smoking Cessation and Assumed Tobacco Retail Price Increase on Smoker's Intention to Quit in Shanghai, China: A Cross-Sectional Study. Front Public Health 2021; 9:740476. [PMID: 34646806 PMCID: PMC8502931 DOI: 10.3389/fpubh.2021.740476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Tobacco consumption produces a heavy disease burden worldwide, and tobacco price increase, an advertisement for tobacco-induced harm, graphic warning labels on cigarette packages and advice of physicians for quitting are policies that have been proved as effective smoking cessation measures. But evidence on the estimated effect of advice of physicians for quitting and assumed tobacco retail price increase on smoking cessation intention among smokers is still limited in China. Methods: From January to April of 2021, we recruited 664 current smokers in Songjiang district of Shanghai by a multistage sampling design. We implemented a logistic regression analysis to calculate the odds ratio (OR) and 95% confidence interval (CI) to explore how smoking cessation intention would be influenced by the assumed tobacco retail price increase as well as advice of physicians for quitting, and used the paired tabulation method to identify the salient tobacco control measures among smokers as well. Results: A total of 664 current smokers included 548 males (82.53%), with an average smoking duration of 22.50 years (SD: 11.52 years). About 68.79 and 43.67% of current smokers reported smoking cessation intention due to advice of physicians for quitting and the assumed tobacco retail price increase, respectively. Logistic regression analysis indicated that female smokers (OR = 2.85 and 4.55), smokers with previous smoking cessation attempt (OR = 3.71 and 3.07), longer smoking duration (OR = 2.26 and 2.68), lower smoking intensity (OR = 1.82 and 1.69), and heavier tobacco burdens (OR = 1.67 and 2.22) had the higher intention of smoking cessation both due to advice of physicians for quitting and due to assumed tobacco price increase, respectively. Meanwhile, the advice of physicians for quitting was more effective and acceptable (over 80%) than the assumed tobacco price increase for inducing smokers to consider quitting in Shanghai. Conclusions: Smokers have a high intention of smoking cessation in Shanghai, and the advice of physicians for quitting is a potentially more salient tobacco control measure than the assumed tobacco retail price increase. Incorporating smoking duration, intensity, personal burden as well as noncommunicable disease (NCD) status of smokers into the implementation of tobacco control measures is beneficial for descending smoking prevalence.
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Affiliation(s)
- Ruiping Wang
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
- College of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangjin Gao
- College of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Qiang
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Qiong Yang
- Songjiang Fang Song Community Health Service Center, Shanghai, China
| | - Xiaopan Li
- Shanghai Pudong Disease Prevention and Control Center, Shanghai, China
| | - Bin Li
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
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13
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Ye L, Yang J, Li J, Cheng N, Zhang Y, Lu X, Zhou Z, Wang Z, Liu L, Huang X, Song Y, Xing S, Wang D, Li J, Wang B, Tang G, Qin X, Zalloua P, Zhang H, Yan F, Xu X. Cigarette smoking and all-cause mortality in rural Chinese male adults: 15-year follow-up of the Anqing cohort study. BMC Public Health 2021; 21:696. [PMID: 33836720 PMCID: PMC8034075 DOI: 10.1186/s12889-021-10691-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background According to the Global Burden of Disease Study 2017, smoking is one of the leading four risk factors contributing to deaths in China. We aimed to evaluate the associations of smoking with all-cause mortality in a Chinese rural population. Methods Male participants over age 45 (n = 5367) from a large familial aggregation study in rural China, were included in the current analyses. A total of 528 former smokers and 3849 current smokers accounted for 10 and 71.7% of the cohort, respectively. Generalized Estimating Equations were used to evaluate the association between baseline smoking status and mortality, adjusting for pertinent covariates. Results There were 579 recorded deaths during the 15-year follow-up. Current smokers (odds ratio [OR],1.60; 95% CI,1.23–2.08) had higher all-cause mortality risks than nonsmokers. Relative to nonsmokers, current smokers of more than 40 pack-years ([OR],1.85; 95% CI,1.33–2.56) had a higher all-cause mortality risk. Compared to nonsmokers, current smokers who started smoking before age 20 ([OR],1.91; 95% CI,1.43–2.54) had a higher all-cause mortality risk, and former smokers in the lower pack-year group who quit after age 41 (median) ([OR],3.19; 95% CI,1.83–5.56) also had a higher risk of death after adjustment. Furthermore, former smokers who were also former drinkers had the highest significant risk of mortality than never smokers or drinkers. (P for interaction = 0.034). Conclusions This study provides evidence that current smokers and former smokers have a higher mortality risk than nonsmokers and would benefit from cessation at a younger age. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10691-2.
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Affiliation(s)
- Lijing Ye
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Jie Yang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Jingyi Li
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Nannan Cheng
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Yue Zhang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Xiaofan Lu
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Ziyi Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Zhuo Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Shibo Xing
- Health Center of Dongguo Center, Tengzhou, Shandong, China
| | | | - Junnong Li
- Weinan Central Hospital, Weinan, Shanxi, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Genfu Tang
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- National Clinical Research Study Center for Kidney Disease; The State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pierre Zalloua
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Huisheng Zhang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Fangrong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,National Clinical Research Study Center for Kidney Disease; The State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Lee YH, Ang TFA, Lin HC, Chang YC. Rural-urban disparities in smoking patterns among Chinese adults: a social-ecological approach. J Ethn Subst Abuse 2021; 20:241-256. [PMID: 31271342 DOI: 10.1080/15332640.2019.1633980] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
China has a long history of smoking behavior. Currently, nearly 26% of Chinese citizens smoke daily. This research used a nationally representative database to study the urban and rural disparities on smoking patterns applying the social-ecological model. Using the 2011 China Health and Nutrition Survey, the study sample included adult participants who were at least 18 years of age (n = 12,688). A subanalysis was carried out to investigate smoking cessation duration among smoking quitters (n = 519). Multinomial logistic regression was used to examine participants' smoking status. Zero-inflated negative binomial regression was applied to investigate participants' number of cigarettes smoked per day, and multivariable logistic regression was used to examine nondaily smoking behavior. Negative binomial regression was carried out to assess the duration of smoking cessation for individuals who quit smoking. Urban residents had lower odds of reporting current smoking status (AOR [adjusted odds ratio] = 0.83, 95% CI [0.74, 0.95]) as compared to rural residents. Urban residents also had higher odds of reporting nondaily smoking status (AOR = 1.17, 95% CI [1.04, 1.32]) and smoked fewer cigarettes per day (IRR [incidence rate ratio] = 0.93, 95% CI [0.89, 0.98]) as compared to rural participants. The disparity between urban and rural areas was not observed for smoking cessation duration. Further efforts should target the disparity between urban and rural regions regarding smoking prevention.
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Hu Y, Xie J, Chang X, Chen J, Wang W, Zhang L, Zhong R, Chen O, Yu X, Zou Y. Characteristics and Predictors of Abstinence Among Smokers of a Smoking Cessation Clinic in Hunan China. Front Public Health 2021; 9:615817. [PMID: 33816416 PMCID: PMC8017299 DOI: 10.3389/fpubh.2021.615817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background: More than 300 million smokers make China the largest cigarette consumer globally, which is a huge economic burden. Smoking cessation (SC) clinics can offer counseling and follow-up services. The operational experience of SC clinics in China needs to be summarized and improved based on research evidence. Purpose: The objectives of this study were to describe quit rates among attendees of SC clinics in Hunan and assess predictors of successful SC. Methods: The participants in this study were smokers who visited the SC clinic of Hunan Cancer Hospital from February 1, 2015 to September 30, 2018. Individuals who received individual counseling and assessment from the SC clinic staff and were willing to quit smoking were eligible for inclusion. Those with critical illness or cancer were excluded. Application of smoking cessation clinic registration form (unified by Chinese Center for Disease Control and Prevention) was used to assess participants at the consultation. Follow-ups and counseling were performed over telephone at 1 week, 1 month, and 3 months after the initial cessation consultation or in times of need. Successful SC was checked for at 3 months after the start of SC. Results: A total of 328 smokers (mean age 45.67 ± 12.38 years) had participated. The abstinence rate at 3 months was 28.4%. Binary regression analysis revealed significant independent predictors to be the total numbers of SC follow up sessions, previous SC attempts, and participants' decision on when to quit smoking (The relative to quit immediately group, quit within 30 days, quit after 30 days, and undecided quit were less likely to succeed in quitting. while quit within seven days had no statistical significance. Conclusion: SC clinics can achieve a desirably high quit rate. Participant's previous attempts at quitting, three or more follow-ups, and the decision to quit immediately or within seven days were factors helpful in predicting the success of SC.
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Affiliation(s)
- Yina Hu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianghua Xie
- Hunan University of Chinese Medicine, Changsha, China
| | - Xiaochang Chang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianhua Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lemeng Zhang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Rui Zhong
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ouying Chen
- Hunan University of Chinese Medicine, Changsha, China
| | - Xinhua Yu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yanhui Zou
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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16
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Qiu D, Chen T, Liu T, Song F. Smoking cessation and related factors in middle-aged and older Chinese adults: Evidence from a longitudinal study. PLoS One 2020; 15:e0240806. [PMID: 33057395 PMCID: PMC7561122 DOI: 10.1371/journal.pone.0240806] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES There are more than 300 million smokers in China. This study aimed to evaluate the rate of smoking cessation, smoking relapse and related factors in middle-aged and older smokers in China. METHODS We performed a secondary analysis of data from China Health and Retirement Longitudinal Study (CHARLS) that recruited a nationally representative sample of adults aged 45 and older. Participants were 3708 smokers in 2011 who completed two waves of follow-up interviews in 2013 and 2015. Self-reported quit and relapse rates at follow-ups were estimated. Multiple logistic regressions were conducted to identify factors associated with smoking cessation and relapse. RESULTS The overall quit rate was 8.5% (95% CI 7.7% - 9.5%) at the 2-year follow-up in 2013, and 16.6% (95% CI 15.5% - 17.9%) at the 4-year follow up. Smoking cessation in 2013 was associated with not living in the northeast region (p = 0.003), fewer cigarettes smoked daily (p <0.001), and longer time to the first cigarette in the morning (p<0.001). Smoking cessation in 2015 was associated with older age (p = 0.049), smoking initiation at age ≥20 years (p<0.001), longer time to the first cigarette in the morning (p<0.001), and self-perceived poor health (p<0.001). Of the 317 participants who stopped smoking in 2013, 13.3% (95% CI 9.9% - 17.5%) relapsed by 2015. Smoking relapse was associated with younger age (p = 0.025), shorter time to the first cigarette in the morning (p = 0.003), and self-perception of not poor health (p = 0.018). CONCLUSION The overall quit rate was 8.5% at the 2-year follow up, and 16.6% at the 4-year follow up in the middle-aged and older smokers, but 13% of quitters returned to smoking in two years. Successful smoking cessation was associated with older age, lower nicotine dependence, and self-perceived poor health.
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Affiliation(s)
- Dechao Qiu
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Ting Chen
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Taiyi Liu
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
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The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients. Respir Med 2020; 172:106155. [PMID: 32949957 DOI: 10.1016/j.rmed.2020.106155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/11/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the long-term efficacy of tobacco control strategies based on cognitive intervention for smoking cessation in chronic obstructive pulmonary disease (COPD) patients, and to provide basis for clinical practice. MATERIALS AND METHODS 102 COPD patients with a long-term history of smoking from the outpatient clinic were recruited in the study. These smokers were randomly divided into intervention group and control group. The intervention group received a cognitive intervention containing individual consultation, telephone follow-ups and self-help materials, etc. The prevalence of quitting smoking, acute exacerbation (AE), lung function and survival were compared in the groups in 10 years. RESULTS There were significant differences between the intervention group and the control group in the rate of persistent quitting smoking in half a year (17.6% vs 3.9%) (P < 0.05), the rate of quitting smoking at the 6th month (58.8% vs 33.3%) (P < 0.05). After 3 months (P < 0.01) and 6 months (P < 0.01), the difference in body weight between the intervention group and the control group was statistically significant. Intervention-group patients had fewer AE per year (P < 0.01) and higher FEV1/FVC ratio (P < 0.01) after 5-year and 10-year follow-up. Besides, the FEV1% predicted in the intervention patients was higher than that in control group after 10-year follow-up. The ages of patients in the death group were greater than those in the survival group. Death-group patients had longer smoking times, higher smoking index, and later onset of COPD symptoms. Death-group patients had lower FEV1% predicted (P < 0.05) and FEV1/FVC ratio (P < 0.01). During 10-year follow-up, 30 patient deaths were recorded (the control group: n = 48; 19 deaths, and intervention group: n = 46; 11 deaths), and patients in the control group had lower survival than those in the intervention group. (P < 0.05). CONCLUSION The method of quitting smoking based on cognitive intervention is an effective way for COPD patients to quit smoking successfully. Quitting smoking can slower deterioration in lung function and improve the survival of COPD patients. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR2000031239 (Chinese clinical trial registry).
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Yang T, Zhu Z, Barnett R, Zhang W, Jiang S. Tobacco Advertising, Anti-Tobacco Information Exposure, Environmental Smoking Restrictions, and Unassisted Smoking Cessation Among Chinese Male Smokers: A Population-Based Study. Am J Mens Health 2020; 13:1557988319856152. [PMID: 31185783 PMCID: PMC6563409 DOI: 10.1177/1557988319856152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study examined the prevalence of unassisted smoking cessation among Chinese urban male smokers and factors important in the decision to quit. A cross-sectional survey employing multistage sampling involving 5,782 participants in six cities in China was conducted. Survey respondents reported their smoking cessation status and related individual and environmental variables. Among current smokers 1,112 or 35.0% (95% CI [31.0%, 40.8%]) had attempted to quit and of those who had made such an attempt 87.6% reported that they had done so without assistance. Of all former smokers (3,389), most (97.6%; 95% CI [96.7%, 98.5%]) quit without assistance. Logistic regression analysis showed those who engaged in physical exercise and who had more belief in their ability to quit were more than twice as likely to make a quit attempt and be successful than those in comparable reference groups. Exposure to tobacco advertising was negatively associated with both unassisted quit attempts and success. By contrast, exposure to anti-tobacco information was positively associated with unassisted quit attempts while household and workplace smoking restrictions were negatively associated with unassisted attempts to quit. Most attempts to quit smoking among Chinese males are unassisted. Unassisted attempts to quit smoking and success rates are highly influenced by the presence of environmental smoking restrictions, tobacco advertising, and exposure to anti-tobacco information. Smoking cessation programs and policies in China need to pay greater attention to the social and cultural norms, which perpetuate high levels of smoking.
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Affiliation(s)
- Tingzhong Yang
- 1 Children's Hospital/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Zan Zhu
- 2 Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Ross Barnett
- 3 Department of Geography, University of Canterbury, Christchurch, New Zealand
| | - Weifang Zhang
- 4 Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuhan Jiang
- 5 School of Humanities and Management, Zhejiang Chinese Medical University. Hangzhou, China
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Wen H, Xie C, Wang F, Wu Y, Yu C. Trends in Disease Burden Attributable to Tobacco in China, 1990-2017: Findings From the Global Burden of Disease Study 2017. Front Public Health 2020; 8:237. [PMID: 32766191 PMCID: PMC7381278 DOI: 10.3389/fpubh.2020.00237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Haoyu Wen
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, China
| | - Cong Xie
- Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Fang Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yini Wu
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, China
- China Global Health Institute, Wuhan University, Wuhan, China
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He H, Pan L, Cui Z, Sun J, Yu C, Cao Y, Wang Y, Shan G. Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS). Front Public Health 2020; 8:177. [PMID: 32596196 PMCID: PMC7300263 DOI: 10.3389/fpubh.2020.00177] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022] Open
Abstract
As part of the China National Health Survey, the objective of this study was to explore the prevalence, patterns, and influencing factors of smoking, and understand reasons for smoking cessation among adults in Hebei Province, central China. Using a multi-stage stratified cluster sampling method, 6,552 adults (2,594 males) aged 20–80 were selected in 2017. Demographic, socioeconomic, and tobacco use information were collected by questionnaire interview. The prevalence of ever-smoking, current smoking, and ex-smoking was 28.94, 21.08, and 7.86%, respectively. Male participants had a much higher prevalence of ever-smoking and current smoking (67.39 and 48.77%) than females (3.74 and 2.93%). In male participants, the daily cigarette consumption was 16.61, and the mean age of smoking initiation was 20.95, decreasing with birth year (27.50 in people born before 1946 vs. 17.9 for those born after 1985, p for trend < 0.001). Over 40% of male ever-smokers initiated regular smoking before 20. Compared with never drinking, the ORs (95% CI) of ever-smoking for low, moderate, and high alcohol consumption in male participants were 1.44 (1.11–1.86), 2.80 (1.91–4.11), and 2.40 (1.72–3.33), respectively. Among 479 male ex-smokers, 50.94% stopped smoking because of illness and 49.06% by choice. Among male ex-smokers, hypertensive men were more likely to quit smoking than the normotensive individuals (OR: 1.48, 95% CI: 1.13–1.96). For CVD patients, this effect was estimated as 2.27 (95% CI: 1.56–3.30). This study revealed a high prevalence of ever-smoking, especially in men, in a representative population in central China. Health education focus on tobacco control could be integrated with alcohol consumption reduction to achieve additional benefit.
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Affiliation(s)
- Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Ze Cui
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Jixin Sun
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Yajing Cao
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Ye Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
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Abstract
Background Continued smoking after receiving a diagnosis of cancer seriously affects disease prognosis and survival. The prevalence and risk factors of continued smoking among patients with newly diagnosed lung cancer are unknown in Taiwan. Purpose The aims of this study were to assess the smoking status of patients with newly diagnosed lung cancer and to identify the characteristics that are associated with different smoking statuses. Methods Baseline data of a longitudinal study on smoking behaviors after lung cancer diagnosis were analyzed in this study. Patients were consecutively recruited from three medical centers in northern Taiwan. A structured questionnaire and medical chart reviews were used to collect data. Multinomial logistic regression analysis was used to examine the factors associated with continuing to smoke after being diagnosed with lung cancer. Results Among the 406 patients with newly diagnosed lung cancer who were recruited, 47.0% were never-smokers and 53.0% were ever-smokers. Among the second group, 38% were former smokers, 18% were recent quitters, and 44% were current smokers. Compared with former smokers, current smokers were more likely to be younger (OR = 1.05), to not exercise regularly (OR = 2.74), to currently live with smokers (OR = 2.48), and to have lower self-efficacy for refusing to smoke (OR = 0.95). Compared with recent quitters, current smokers were more likely to have lower self-efficacy for refusing to smoke. Conclusions/Implications for Practice A significant proportion of ever-smoker lung cancer patients in Taiwan will continue to smoke after receiving their diagnosis. Variables known to modify the risk factors associated with continued smoking such as regular exercise and better refusal self-efficacy should be considered and incorporated into future smoking cessation programs for patients with lung cancer.
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Prenatal Exposure to Environmental Tobacco Smoke and Early Development of Children in Rural Guizhou Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122866. [PMID: 30558202 PMCID: PMC6313710 DOI: 10.3390/ijerph15122866] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a substantial body of evidence supporting the association between maternal active smoking during pregnancy and child development, but the association between prenatal exposure to environmental tobacco smoke (ETS) and early child development has not been well documented. This cross-sectional study examines the association between prenatal exposure to ETS and the development of children in their first two years of life. METHODS We interviewed the primary caregivers of 446 children under two years old in rural Guizhou Province, China. Based on self-reported assessments about whether the mother was exposed to ETS during pregnancy, we divided the children into the ETS-exposed group or the non-exposed group. Sociodemographic information was collected through a questionnaire. The cognitive, language, motor, and socioemotional abilities of children were assessed using the Bayley Scales of Infant Development III (BSID-III). A multivariate linear regression model adjusting for confounding variables was used to estimate the association of interest. RESULTS About 60% of mothers experienced ETS exposure during pregnancy. Cognitive and language scores were lower among children in the ETS-exposed group. When adjusting for characteristics of the child, the mother, the household, and village fixed effects, prenatal exposure to ETS was associated with lower cognition scores (-3.41; 95% confidence interval (CI): -6.39 to -0.42; p = 0.03) and language scores (-3.01; 95% CI: -5.39 to -0.09; p = 0.04). Frequency of prenatal exposure to ETS was also negatively associated with language development (-0.48; 95% CI: -0.87 to -0.09; p = 0.02) before children reached two years old. CONCLUSIONS Prenatal exposure to ETS is negatively associated with the cognitive and language development of rural young children within their first two years of life. The government should take action to raise public awareness about the negative effects of tobacco use, with an emphasis on the protection of pregnant women and their children, in order to carry through comprehensive smoke-free laws in rural areas, while also increasing tobacco taxation.
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Liao Y, Wu Q, Kelly BC, Zhang F, Tang YY, Wang Q, Ren H, Hao Y, Yang M, Cohen J, Tang J. Effectiveness of a text-messaging-based smoking cessation intervention ("Happy Quit") for smoking cessation in China: A randomized controlled trial. PLoS Med 2018; 15:e1002713. [PMID: 30562352 PMCID: PMC6298640 DOI: 10.1371/journal.pmed.1002713] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND China has the highest global prevalence of cigarette smokers, accounting for more than 40% of the total cigarette consumption in the world. Considering the shortage of smoking cessation services in China, and the acceptability, feasibility, and efficacy of mobile-phone-based text messaging interventions for quitting smoking in other countries, we conducted a mobile-phone-based smoking cessation study in China. METHODS AND FINDINGS We conducted a randomized controlled trial in China across 30 cities and provinces from August 17, 2016, to May 27, 2017. Adult smokers aged 18 years and older with the intention to quit smoking were recruited and randomized to a 12-week high-frequency messaging (HFM) or low-frequency messaging (LFM) intervention ("Happy Quit") or to a control group in a 5:2:3 ratio. The control group received only text messages unrelated to quitting. The primary outcome was biochemically verified continuous smoking abstinence at 24 weeks. Secondary outcomes included (1) self-reported 7-day point prevalence of abstinence (i.e., not even a puff of smoke, for the last 7 days) at 1, 4, 8, 12, 16, 20, and 24 weeks; (2) self-reported continuous abstinence at 4, 12, and 24 weeks; and (3) self-reported average number of cigarettes smoked per day. A total of 1,369 participants received 12 weeks of intervention or control text messages with continued follow-up for 12 weeks. The baseline characteristics of participants among the HFM (n = 674), LFM (n = 284), and control (n = 411) groups were similar. The study sample included 1,295 (94.6%) men; participants had a mean age of 38.1 (SD 9.79) years and smoked an average of 20.1 (SD 9.19) cigarettes per day. We included the participants in an intention-to-treat analysis. Biochemically verified continuous smoking abstinence at 24 weeks occurred in 44/674 participants in the HFM group (6.5%), 17/284 participants in the LFM group (6.0%), and 8/411 participants (1.9%) in the control group; participants in both the HFM (odds ratio [OR] = 3.51, 95% CI 1.64-7.55, p < 0.001) and the LFM (OR = 3.21, 95% CI 1.36-7.54], p = 0.002) intervention groups were more likely to quit smoking than those in the control group. However, there was no difference in quit rate between the HFM and LFM interventions. We also found that the 7-day point quit rate from week 1 to week 24 ranged from approximately 10% to more than 26% with the intervention and from less than 4% to nearly 12% without the intervention. Those who continued as smokers in the HFM group smoked 1 to 3 fewer cigarettes per day than those in the LFM group over the 24 weeks of trial. Among study limitations, the participants were able to use other smoking cessation services (although very few participants reported using them), cotinine tests can only detect smoking status for a few days, and the proportion of quitters was small. CONCLUSIONS Our findings demonstrate that a mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messaging, led to smoking cessation in the present study, albeit in a low proportion of smokers, and can therefore be considered for use in large-scale intervention efforts in China. Mobile-phone-based interventions could be paired with other smoking cessation services for treatment-seeking smokers in China. TRIAL REGISTRATION ClinicalTrials.gov NCT02693626.
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Affiliation(s)
- Yanhui Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Qiuxia Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Brian C. Kelly
- Department of Sociology, Purdue University, West Lafayette, Indiana, United States of America
- Center for Research on Young People’s Health, Purdue University, West Lafayette, Indiana, United States of America
| | - Fengyu Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Global Clinical and Translational Research Institute, Bethesda, Maryland, United States of America
| | - Yi-Yuan Tang
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, United States of America
- Center for Advanced Study in the Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Qianjin Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Honghong Ren
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mei Yang
- Department of Drug Dependence, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Joanna Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jinsong Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
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Zhang T, Wang L, Xu Z, Zhang Q, Ye Y. Predictors of smoking relapse after percutaneous coronary intervention in Chinese patients. J Clin Nurs 2018; 27:e951-e958. [PMID: 28833665 DOI: 10.1111/jocn.14050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the prevalence and predictors of smoking relapse after percutaneous coronary intervention in Chinese patients. BACKGROUND Smoking is considered a vital risk factor for coronary heart disease. Although smoking cessation could decrease the risks of adverse cardiac outcomes, many patients resume smoking following a short period of abstinence. However, little is known about smoking resumption in patients who have undergone percutaneous coronary intervention. DESIGN AND METHODS A longitudinal study was conducted among Chinese patients who underwent percutaneous coronary intervention. Predictive variables were assessed at baseline through medical records and interviews with questionnaires including the Fagerström Test for Nicotine Dependence, Center for Epidemiologic Studies-Depression scale and Smoking Self-Efficacy Questionnaire. Smoking relapses were recorded at three, six, nine and 12 months by the self-reporting through telephone or at routine visits to the cardiology outpatient clinics. RESULTS A total of 221 patients who quit smoking immediately after percutaneous coronary intervention completed the whole study. Overall, 51.1%(n = 113) of the patients relapsed within 12 months after percutaneous coronary intervention. The prevalence showed a particular rise (49.6%, n = 56) in the first 3 months and a more gradual increase in the following months. The patients who were employed and had higher nicotine dependence, worse depressive symptoms and lower level of smoking self-efficacy were more vulnerable to relapse to cigarettes. CONCLUSION The prevalence of smoking relapse is high in the patients who stop smoking in the hospital due to percutaneous coronary intervention. The predictors of smoking relapse are employment, nicotine dependence, depression and smoking self-efficacy in the post- percutaneous coronary intervention patients. RELEVANCE TO CLINICAL PRACTICE This study may prompt the healthcare providers to focus on the issue of smoking relapse and provide some instructions for identification of the patients with a high-risk of relapse after percutaneous coronary intervention.
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Affiliation(s)
- Tingyu Zhang
- Department of cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lizi Wang
- Department of cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenzhen Xu
- Department of cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiongxiao Zhang
- Department of cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yawen Ye
- Department of cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Mao A, Bottorff JL, Oliffe JL, Sarbit G, Kelly MT. A Qualitative Study on Chinese Canadian Male Immigrants' Perspectives on Stopping Smoking: Implications for Tobacco Control in China. Am J Mens Health 2018; 12:812-818. [PMID: 27099344 PMCID: PMC6131442 DOI: 10.1177/1557988316644050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Aimei Mao
- Kiang Wu Nursing College of Macau, Macau,
China
| | - Joan L. Bottorff
- University of British Columbia, Kelowna,
British Columbia, Canada
- Australian Catholic University, Melbourne,
Australia
| | - John L. Oliffe
- University of British Columbia, Vancouver,
British Columbia, Canada
| | - Gayl Sarbit
- University of British Columbia, Kelowna,
British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Kelowna,
British Columbia, Canada
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Madewell ZJ. The belief that secondhand smoke causes serious illness among Chinese smokers: Smoking cessation and intention to quit. Tob Prev Cessat 2018; 4:5. [PMID: 32411836 PMCID: PMC7205068 DOI: 10.18332/tpc/82813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/07/2018] [Accepted: 01/12/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Approximately 70% of Chinese adults are exposed to secondhand smoke (SHS) each week and 100 000 people die from SHS every year in China. This study evaluates associations between the belief that SHS causes serious illness and intention to quit, attempts to quit, and quitting smoking, among Chinese adult smokers. METHODS A nationally representative sample of 4866 current and former adult smokers in the Global Adult Tobacco Survey was used for analysis. Multivariable weighted regression models were built to determine significant associations between smoking cessation behavior and the belief that SHS causes serious illness. RESULTS The belief that SHS causes serious illness was associated with intention to quit (AOR 1.62, 95% CI: 1.24, 2.12) and quitting smoking (AOR 1.44, 95% CI: 1.15, 1.81). Other variables associated with smoking cessation behavior included not permitting smoking at home (intending: AOR 1.59, 95% CI: 1.10, 2.31; attempting: AOR 1.73, 95% CI: 1.25, 2.40; quitting: AOR 2.71, 95% CI: 1.90, 3.89) and the belief that smoking causes serious illness (attempting: AOR 1.63, 95% CI: 1.14, 2.33; quitting: AOR 1.66, 95% CI: 1.21, 2.28). CONCLUSIONS These results indicate that believing SHS causes serious illness may play a role in quitting smoking. In China’s collectivistic culture, interventions should focus on how SHS exposure affects the health of friends and family. This message can be combined with other proven tobacco control methods such as: smoking bans in public places, warning labels on cigarette packages, high cigarette taxes, and mass media campaigns to reduce tobacco use.
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Spence W, Zhu L. Perceptions of smoking cessation among Glasgow's Chinese community. Tob Prev Cessat 2017; 3:127. [PMID: 32432201 PMCID: PMC7232811 DOI: 10.18332/tpc/77942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/28/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health related needs and services are stratified by ethnicity in UK. The Chinese community is Scotland’s second-largest minority ethnic group but a relatively under-researched one. This study aimed to explore the views and experiences of smoking cessation and related services among Chinese community members in Glasgow and to inform them about smoking cessation interventions. METHODS This cross-sectional study was conducted in 2016 using a qualitative research method. Purposive sampling methods were used to recruit 15 Chinese community members in Glasgow. Semi-structured interviews were audio-recorded and data transcribed, translated, and thematically analysed. RESULTS Many factors influenced participants’ smoking: concern for personal health, advice from medical professionals, expenditure, family pressure, tobacco-control policies, nicotine dependence, self-efficacy, and acculturation. Smoking initiation and relapse were influenced by interpersonal relations, emotional factors, Chinese social norms, and acculturation. Barriers reported to accessing and participating in cessation services included: excessive or inflexible working hours, low confidence in cessation services, language barriers, cultural barriers and unsuitability of cessation services for Chinese smokers. Employing community resources, improving language support, working with cultural values, and accommodating degrees of acculturation may improve services and their uptake. CONCLUSIONS Smoking-cessation services should consider the culture of this ethnic minority population to improve cessation uptake. Further investigation of this community’s needs and expectations is needed to tailor smoking-cessation interventions for Chinese immigrants in Glasgow.
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Affiliation(s)
| | - Lanyu Zhu
- University of Glasgow, Glasgow, Scotland
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Zheng QD, Lin JG, Pei W, Guo MX, Wang Z, Wang DG. Estimating nicotine consumption in eight cities using sewage epidemiology based on ammonia nitrogen equivalent population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 590-591:226-232. [PMID: 28259433 DOI: 10.1016/j.scitotenv.2017.02.214] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 05/23/2023]
Abstract
Sewage epidemiology is a real-time tool used to monitor tobacco consumption. In this study, we investigated the tobacco consumption in eight cities in Jilin province using sewage epidemiology. We collected influent wastewater samples from ten wastewater treatment plants (WWTPs) that serve nearly four million people. Mean nicotine (NIC) loads ranged from 1.42 to 14.2mg/d/capita, whereas mean cotinine (COT) loads showed lower levels with 0.33 to 2.15mg/d/capita. Population size was estimated to provide an accurate and real-time population based on ammonia nitrogen (NH4-N) concentration in influent. To verify the NH4-N equivalent population, we compared these results with the corresponding population estimated based on the expert knowledge of the local WWTPs operators. Daily consumption of NIC was estimated to be approximately 2.39±1.47mg/d/capita. Monte Carlo simulation was used to analyze uncertainty and variability in the number of cigarettes consumed by smokers in the range of 9.8 to 31.4 per day with a median of 16.9. The data of tobacco consumption in this study coordinated strongly with a traditional survey on the consumption of tobacco in China, indicating sewage epidemiology with NH4-N equivalent population estimation may provide a suitable and useful tool for tobacco use monitoring.
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Affiliation(s)
- Qiu-Da Zheng
- College of Environmental Science and Engineering, Dalian Maritime University, 1 Linghai Road, Dalian, Liaoning 116023, China
| | - Jian-Guo Lin
- College of Environmental Science and Engineering, Dalian Maritime University, 1 Linghai Road, Dalian, Liaoning 116023, China
| | - Wei Pei
- College of Environmental Science and Engineering, Dalian Maritime University, 1 Linghai Road, Dalian, Liaoning 116023, China
| | - Ming-Xing Guo
- College of Environmental Science and Engineering, Dalian Maritime University, 1 Linghai Road, Dalian, Liaoning 116023, China
| | - Zhuang Wang
- Collaborative Innovation Center of Atmospheric Environment and Equipment Technology (AEET), School of Environmental Science and Engineering, Nanjing University of Information Science and Technology, Nanjing, China
| | - De-Gao Wang
- College of Environmental Science and Engineering, Dalian Maritime University, 1 Linghai Road, Dalian, Liaoning 116023, China.
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Yin H, Chen X, Zheng P, Kegler M, Shen Q, Xu B. A neglected opportunity for China's tobacco control? Shift in smoking behavior during and after wives' pregnancy. Tob Induc Dis 2016; 14:39. [PMID: 27990102 PMCID: PMC5148914 DOI: 10.1186/s12971-016-0105-8] [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: 07/24/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022] Open
Abstract
Background Although observational data suggest that men’s attempts and behavior at quitting smoking are often stimulated during their spouses’ pregnancy, few studies have systematically examined this phenomenon. Methods This was a cross-sectional study which examined Chinese men’s smoking behaviors during and after their wives’ pregnancy. Women who visited community health centers for routine immunization of their children were approached. Information was mainly collected on men’s tobacco use before, during and after pregnancy in July to August 2011. Individual and socio-environmental factors were examined by non-conditional logistical regression analysis to find potential reasons behind men’s quitting during pregnancy and maintained this change till the post-partum period. Results Totally 765 of 811 eligible women (94.3%) completed the interview. Prior to pregnancy, 42.9% of husbands smoked; this decreased to 36.34% during pregnancy, a reduction of 6.53%. Although the rate increased to a higher level (43.79%) after delivery, positive changes in men’s smoking behavior were detected. One-third (29.88%) reduced the daily number of cigarettes smoked, and nearly half (45.12%) relocated themselves to smoke when their pregnant wives were nearby. Noticeably, those who quit were most likely occasional smokers (Odds Ratio(OR) = 4.83, 95%CI [2.22, 10.48]), smoking less than ten years (OR = 2.80, 95%CI [1.19, 6.58]), not smoking at home (OR = 4.48, 95%CI [1.94, 10.39]), not smoking for social use (OR = 4.05, 95%CI [1.74, 9.41]), under lower financial pressure after the birth of child (OR = 5.28, 95%CI [2.14, 13.02]) and influenced by family members (OR = 2.82, 95%CI [1.25, 6.38]). However, only 22% of spontaneous cessation was maintained postpartum. Most relapses occurred within 6 months after delivery. Conclusions Pregnancy offers an opportunity to decrease smoking amongst Chinese males. Intervention programs involving expectant fathers may be effective to further reduce prevalence of smoking among men in China.
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Affiliation(s)
- Hao Yin
- School of Public Health, Fudan University, Shanghai, China ; Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Xiao Chen
- University of Missouri, Kansas City, Kansas City, MO USA
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai, China ; Health Communication Institute, Fudan University, Shanghai, China
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Qinfeng Shen
- School of Public Health, Fudan University, Shanghai, China ; Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, China ; Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China ; Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
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Mao A, Bottorff JL. A Qualitative Study on Unassisted Smoking Cessation Among Chinese Canadian Immigrants. Am J Mens Health 2016; 11:1703-1712. [PMID: 26819181 DOI: 10.1177/1557988315627140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Aimei Mao
- 1 Kiang Wu Nursing College of Macau, Macau, China
| | - Joan L Bottorff
- 2 University of British Columbia, Kelowna, British Columbia, Canada.,3 Australian Catholic University, Melbourne, Australia
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Wu L, Sun S, He Y, Zeng J. Effect of Smoking Reduction Therapy on Smoking Cessation for Smokers without an Intention to Quit: An Updated Systematic Review and Meta-Analysis of Randomized Controlled. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10235-53. [PMID: 26308034 PMCID: PMC4586609 DOI: 10.3390/ijerph120910235] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Effective strategies are needed to encourage smoking cessation for smokers without an intention to quit. We systematically reviewed the literature to investigate whether smoking reduction therapy can increase the long-term cessation rates of smokers without an intention to quit. METHODS PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) on the effect of smoking reduction therapy on long-term smoking cessation in smokers without an intention to quit. The primary outcome was the cessation rate at the longest follow-up period. A random effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Fourteen trials with a total of 7981 smokers were included. The pooled analysis suggested that reduction support plus medication significantly increased the long-term cessation of smokers without an intention to quit compared to reduction support plus placebo (RR, 1.97; 95% CI, 1.44-2.7; I(2), 52%) or no intervention (RR, 1.93; 95% CI, 1.41-2.64; I(2), 46%). In a subgroup of smokers who received varenicline or nicotine replacement therapy (NRT), the differences were also statistically significant. This suggests the safety of using NRT. The percentage of smokers with serious adverse events who discontinued because of these events in the non-NRT group was slightly significantly different than in the control group. Insufficient evidence is available to test the efficacy of reduction behavioural support in promoting long-term cessation among this population. CONCLUSIONS The present meta-analysis indicated the efficacy of NRT- and varenicline-assisted reduction to achieve complete cessation among smokers without an intention to quit. Further evidence is needed to assess the efficacy and safety of reduction behavioural support and bupropion.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Samio Sun
- Department of Bioengineering, The University of Tokyo, 1138656, Japan.
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
- State Key Laboratory of Kidney Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Jing Zeng
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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Wu L, He Y, Jiang B, Zhang D, Tian H, Zuo F, Lam TH, Cheung YTD. The effect of a very brief smoking-reduction intervention in smokers who have no intention to quit: study protocol for a randomized controlled trial. BMC Public Health 2015; 15:418. [PMID: 25944023 PMCID: PMC4443634 DOI: 10.1186/s12889-015-1749-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background Tobacco use is one of the most common preventable causes of death, but more than half of the Chinese men still use tobacco products. Moreover, 63.6% of Chinese smokers have stated that they would not consider quitting. Specialized and intensive smoking-cessation services are too expensive and passive to have major clinical and public health impacts in developing countries like China. Smoking cessation medications are not covered by medical insurance, and their high price prevents Chinese smokers from using them. Brief interventions are needed to provide cost-effective and timesaving tobacco dependence treatments in China mainland. Methods/design We describe a two-arm randomized controlled trial for smokers who have no intention to quit. The project will be conducted in outpatient clinics at a large hospital in Beijing, China. Both arms include one face-to-face interview plus five follow-up interventions. Each intervention will last approximately one minute. Subjects allocated to the smoking-reduction intervention arm (SRI) will be advised to reduce smoking consumption to at least half of their current consumption level within the next month. All subjects in the SRI will be warned to bear in mind that an attempt to reduce smoking is an intermediate step before complete cessation. Smokers who have successfully reduced their smoking consumption will be encouraged to completely cease smoking. Controls are subjects allocated to the exercise- and diet-advice arm (EDA) and will be given advice about healthy diet and physical activity, but the advice will not include smoking cessation or reduction. Data collection will be done at baseline and at each follow-up interview using standardized questionnaires. The primary outcomes include self-reported and biochemically verified 7-day point prevalence and prolonged abstinence rates at 12-month follow-up. Discussion We expect that an intention to quit in smoking outpatients can be motivated by physicians in the clinic setting. If this very brief smoking-reduction intervention can be demonstrated to have a positive impact on long-term smoking cessation, this strategy has the potential to be a viable and acceptable approach and may be used widely in China and elsewhere. Clinical trial registration ClinicalTrials.gov: NCT02370147 (date of registration: 23th February, 2015).
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Affiliation(s)
- Lei Wu
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yao He
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Bin Jiang
- Department of Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Di Zhang
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Hui Tian
- Department of Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Fang Zuo
- Department of Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Yee Tak Derek Cheung
- School of Public Health, Li Ka Shang Faculty of Medicine, The University of Hong Kong, 5/F William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pok Fu Lam, Hong Kong.
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Mao A, Bottorff JL, Oliffe JL, Sarbit G, Kelly MT. A qualitative study of Chinese Canadian fathers' smoking behaviors: intersecting cultures and masculinities. BMC Public Health 2015; 15:286. [PMID: 25879194 PMCID: PMC4379716 DOI: 10.1186/s12889-015-1646-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/16/2015] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Aimei Mao
- Kiang Wu Nursing College of Macau, Est. Repouso No.35, R/C, Macau, China.
| | - Joan L Bottorff
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, 3333 University Way, Kelowna, BC, Canada.
- Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
| | - John L Oliffe
- School of Nursing, University of British Columbia, 302 6190 Agronomy Rd, Vancouver, BC, Canada.
| | - Gayl Sarbit
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, 3333 University Way, Kelowna, BC, Canada.
| | - Mary T Kelly
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, 3333 University Way, Kelowna, BC, Canada.
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Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. Int J Infect Dis 2015; 32:138-46. [DOI: 10.1016/j.ijid.2014.12.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022] Open
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Tam CL, Bonn G, Yeoh SH, Wong CP. Investigating diet and physical activity in Malaysia: education and family history of diabetes relate to lower levels of physical activity. Front Psychol 2014; 5:1328. [PMID: 25520676 PMCID: PMC4253661 DOI: 10.3389/fpsyg.2014.01328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/02/2014] [Indexed: 11/21/2022] Open
Abstract
The National Health and Morbidity Survey (NHMS, 2011), estimates that the number of Malaysian adults suffering from type 2 diabetes has increased from 8.3 to 31.2% since 1996. This study is a preliminary investigation of possible factors contributing to this epidemic. Knowledge of diabetes, health locus of control, diet and exercise habits, as well as family history, education level and other demographic factors to better understand the correlates of risky and healthy behaviors. This was done as part of a larger initiative to improve prevention efforts. Questionnaires were completed by 770 individuals from three Malaysian states: Selangor, Penang, and Terengganu. Findings showed that people with better health knowledge and those who have a family history of type 2 diabetes were more likely to have healthy diets. Also, health knowledge related to lower alcohol consumption. Participants with diabetic family members, however, also reported higher levels of stress. Counterintuitively, higher educational levels, higher internal locus of control, better health knowledge, as well as a family history of diabetes all correlated with lower levels of physical activity. Thus, it is suggested that, while increasing health knowledge will be important in addressing the type 2 diabetes epidemic in Malaysia, especially in relation to diet, other cultural factors, specifically norms related to exercise and physical activity, also need to be addressed if the spread of type 2 diabetes is to be addressed over the long term.
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Affiliation(s)
- Cai Lian Tam
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Bandar Sunway, Malaysia
| | - Gregory Bonn
- Takai Lab, Graduate School of Education and Human Development, Nagoya University Nagoya, Japan ; Foreign Research Fellow, Japan Society for the Promotion of Science Tokyo, Japan
| | - Si Han Yeoh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Bandar Sunway, Malaysia
| | - Chee Piau Wong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Bandar Sunway, Malaysia
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Zhang Y, Liu Y, Wang J, Jia C. Mediation of smoking consumption on the association of perception of smoking risks with successful spontaneous smoking cessation. Int J Behav Med 2014; 21:677-81. [PMID: 24347251 DOI: 10.1007/s12529-013-9378-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The perception of smoking risks has positive and smoking consumption has negative effects on successful smoking cessation, but no information is now available for what is the role of smoking consumption on the relationship between perception of smoking risks and successful smoking cessation. PURPOSE To assess the mediation of smoking amount on the association of perception of smoking risks with successful spontaneous smoking cessation. METHOD A community-based case-control study was conducted with 294 adult spontaneous successful smoking quitters who have been quitting smoking consecutively for more than 2 years as the cases, and 347 adult failed spontaneous smoking quitters who quitted but relapsed or have been quitting smoking continuously equal to or less than 2 years as the controls. The smoking amount was evaluated by pack-year that was categorized into tertiles and scored inversely. The score of perception of smoking risks was also categorized into tertiles. Propensity score as the covariate in the regression model was used to adjust the potential confounding. The total effect was decomposed into direct effect and indirect (mediating) effect by using logistic regression based on the KHB method proposed by Karlson, Holm, and Breen. The proportion of mediating effect among the total effect is calculated as the indirect effect divided by the total effect. RESULTS After adjusting age, profession, education, marital status, and reasons for quitting smoking by using propensity score, the small mediating effect of smoking amount on the association of perception of smoking risks with successful spontaneous smoking cessation was observed, and the mediating effect of smoking amount was 23.75% among the total effect. The dose-response analysis showed that the mediating effect of smoking amount in the groups with middle and high score of perception of smoking risks were 10.15 and 37.84% among their total effect, respectively. CONCLUSION This study reveals that smoking amount has only small mediating effect among the total effect of perception of smoking risks on the successful spontaneous smoking cessation; enhancing the smokers' perception of smoking risks could promote their attempt to reduce smoking, so as to increase the probability of successful smoking cessation.
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Affiliation(s)
- Yan Zhang
- Department of Epidemiology and Biostatistics, Shandong University, Jinan, 250012, Shandong, People's Republic of China
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Berg CJ, Nehl EJ, Wang X, Ding Y, He N, Wong FY. Utilization of cessation resources among HIV-positive and HIV-negative men who smoke and who have sex with men in Chengdu, China. Nicotine Tob Res 2014; 16:1283-8. [PMID: 24827789 DOI: 10.1093/ntr/ntu064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Given the implications for smoking among individuals living with HIV and the high rates of smoking and HIV among men who have sex with men (MSM) in China, we examined differences in prior use of and future interest in various cessation resources among MSM smokers with or without HIV. METHODS We conducted a cross-sectional survey of 381 MSM; HIV status was provided by 350 MSM, and complete data was provided by a total of 344 (188 HIV-positive and 156 HIV-negative) current smokers (past 30 days) recruited by a nongovernmental organization in Chengdu in 2012-2013. Participants reported tobacco and alcohol use; psychosocial factors; past-year quit attempts; health care provider interactions on smoking; and prior use of and interest in cessation resources. RESULTS Smokers living with HIV were more likely to have used behavioral interventions (p < .001) and pharmacotherapy (p = .033). Those who were HIV-positive were also more interested in behavioral interventions (p = .002) and pharmacotherapy (p = .008). Correlates of interest in behavioral interventions in the regression model included lower cigarette consumption (p = .011), higher confidence in quitting (p = .035), greater likelihood of attempting to quit in the past year (p = .026), and being HIV-positive (p = .008). Correlates of interest in pharmacotherapy included greater depressive symptoms (p = .047) and being HIV-positive (p = .015). CONCLUSIONS Smokers living with HIV were more likely to have ever attempted to quit smoking, to have used cessation resources, and to be interested in using cessation aids. These findings indicate the promise of greater dissemination of cessation resources, particularly if Chinese clinical practices are strengthened to offer cessation support.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Xiaodong Wang
- Chengdu Tongle Health Service and Counseling Center, Chengdu City, Cichuan Province, China
| | - Yingying Ding
- Department of Epidemiology, Fudan University School of Public Health, Shanghai, China
| | - Na He
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Fudan University School of Public Health, Shanghai, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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Berg CJ, Nehl EJ, Wang X, Ding Y, He N, Johnson BA, Wong FY. Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China. AIDS Care 2014; 26:1201-7. [PMID: 24601710 DOI: 10.1080/09540121.2014.892565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012-2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers.
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Affiliation(s)
- Carla J Berg
- a Department of Behavioral Sciences & Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Chen J, Chen Y, Chen P, Liu Z, Luo H, Cai S. Effectiveness of individual counseling for smoking cessation in smokers with chronic obstructive pulmonary disease and asymptomatic smokers. Exp Ther Med 2013; 7:716-720. [PMID: 24520273 PMCID: PMC3919914 DOI: 10.3892/etm.2013.1463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/06/2013] [Indexed: 11/18/2022] Open
Abstract
Few studies have examined the effect of individual counseling for smoking cessation in China. The present study evaluated the efficacy of individual counseling in patients with chronic obstructive pulmonary disease (COPD) and asymptomatic smokers. This prospective randomized study evaluated 85 smokers with COPD and 105 asymptomatic smokers with normal lung function. The individuals were randomly allocated to intervention and control groups. Subjects in the intervention group were provided with individual cognitive counseling based on face-to-face individual consultation, self-help materials and nine telephone follow-ups. Subjects in the control group were provided with simple smoking cessation advice. The smoking status for all subjects and the St. George’s Respiratory Questionnaire (SGRQ) for COPD patients were assessed at baseline, week 4 and month 6. The COPD patient exacerbations during the 6 months were recorded. In the total study population, individual counseling resulted in higher abstinence rates compared with those in the control: Intervention vs. control, 23.4 vs. 10.4% (P=0.007), respectively. Similar results were observed in the smokers with COPD: Intervention vs. control, 40.5 vs. 18.6% (P=0.027), respectively. However, for asymptomatic smokers, the effect of individual counseling was identified to be statistically insignificant: Intervention vs. control, 9.6 vs. 3.8% (P=0.230), respectively. SGRQ scores and COPD exacerbations were significantly improved in patients who abstained from smoking compared with those in the patients who failed to stop smoking. Airway obstruction, quitting motivation and individual counseling were predictors associated with smoking cessation. Airway obstruction was the most significant predictor of smoking cessation (odds ratio, 4.215; 95% confidence interval, 2.215–7.865). The results of the present study show that individual counseling is an effective method for smoking cessation, particularly in COPD patients. However, its efficacy in asymptomatic smokers requires confirmation in further studies.
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Affiliation(s)
- Juan Chen
- Department of Radiology, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Yan Chen
- Department of Internal Medicine, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Ping Chen
- Department of Internal Medicine, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zhijun Liu
- Department of Internal Medicine, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Hong Luo
- Department of Internal Medicine, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Shan Cai
- Department of Internal Medicine, Division of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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40
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Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease? Public Health 2013; 127:435-41. [DOI: 10.1016/j.puhe.2012.12.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/02/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022]
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41
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Lin PR, Zhao ZW, Cheng KK, Lam TH. The effect of physician's 30 s smoking cessation intervention for male medical outpatients: a pilot randomized controlled trial. J Public Health (Oxf) 2013; 35:375-83. [PMID: 23487178 DOI: 10.1093/pubmed/fdt018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To study the effectiveness of a very brief advice (<30 s) on smoking cessation. DESIGN A 'proof-of-principle' single-blind, randomized controlled trial (RCT). SETTING Medical outpatient clinics of a general hospital in Guangzhou, China. PARTICIPANTS One hundred and twenty-six male current smokers randomly allocated into an intervention (n = 74) and a control group (n = 52). Intervention A health warning by physicians that half of all smokers would be killed by smoking, an advice to quit immediately and referral to a cessation clinic. The control group received none. OUTCOMES Primary: seven-day quitting point prevalence at 6 months. Secondary: 7-day point prevalence at 1, 3 and 12 months, sustained abstinence at 3, 6 and 12 months, smoking reduction by half and cessation clinic attendance. RESULTS By intention-to-treat analysis, 7-day quitting point prevalence rates at four follow-ups were 27.0, 23.0, 21.6 and 18.9% in the intervention group, compared with 5.8, 3.8, 5.8 and 5.8% in the control group (first three P < 0.05). At 3, 6 and 12 months, sustained abstinence prevalence rates were 18.9, 17.6 and 14.9% versus 3.8, 3.8 and 3.8% (P = 0.035, 0.046, 0.074). More smokers in the intervention group had reduced smoking. Almost no participants attended the cessation clinic. CONCLUSION Our findings support the need for large RCTs on minimal interventions with the 'one in two' warning.
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Affiliation(s)
- Pei Ru Lin
- Guangzhou First Municipal Peoples Hospital, Guangzhou Medical University, Guangzhou, China
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42
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Xu Y, Wu Q, Xu S, Xu J, Wan X, Guo Y. Environmental secondhand smoke exposure and policy assessment at five venues in Zhejiang Province, China. Asia Pac J Public Health 2013; 26:622-30. [PMID: 23355055 DOI: 10.1177/1010539512472360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to assess environmental secondhand smoke exposure and tobacco control policy at 5 venues. A cross-sectional study was conducted involving 134 settings and 2727 adults in Zhejiang, China. The results show that the proportions of venues that had complete smoking ban were as follows: health administrative organizations (71.9%), hospitals (70.0%), schools (66.7%), public transportation vehicles (24.0%), and government agencies (11.8%). The proportions of venues where smoking was noticed were as follows: public transportation vehicles (88.0%), government agencies (47.1%), hospitals (46.7%), health administrative organizations (40.6%), and schools (30.0%). Venues with completely indoor smoking ban were 5 times more likely to be smoke-free at the time of survey than other venues without smoking ban (odds ratio = 5.39, 95% confidence interval = 1.92-15.14). It indicated that implementation of indoor smoking ban can reduce indoor secondhand smoke exposure.
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Affiliation(s)
- Yue Xu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - QingQing Wu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - ShuiYang Xu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - JinHang Xu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xia Wan
- School of Basic Medicine of Peking Union Medical College, Beijing, China
| | - YuJie Guo
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Gruder CL, Trinidad DR, Palmer PH, Xie B, Li L, Johnson CA. Tobacco smoking, quitting, and relapsing among adult males in Mainland China: the China Seven Cities Study. Nicotine Tob Res 2013; 15:223-30. [PMID: 22581939 PMCID: PMC3611989 DOI: 10.1093/ntr/nts116] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/24/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite an estimated 1 million tobacco-related deaths annually in China, public health officials face overwhelming barriers to implementing effective tobacco control policies and programs. Models of effective tobacco control can be adapted for Chinese tobacco use and culture based on reliable and valid data regarding predictors of smoking and abstaining. METHODS As part of the China Seven Cities Study to assess the role of rapid social, economic, and cultural change on tobacco use and related health practices and outcomes, 4,072 adult male smokers provided data in 3 annual waves. Measures included current smoking, nicotine dependence, readiness for quitting, perceived stress, hostility, depressive symptoms, as well as covariates (e.g., age, marital status, educational attainment, and family income). RESULTS Odds of being abstinent at Wave 3 were increased by: lower nicotine dependence at Wave 1 and becoming less dependent between Waves 1 and 3; progressing beyond the contemplation stage between Waves 1 and 3; perceiving less stress, whether initially at Wave 1 or over time from Wave 1 to Wave 3; and lower hostility scores at Wave 1 and decreased hostility from Wave 1 to Wave 3. Among those who quit, odds of remaining abstinent rather than relapsing by Wave 3 were higher among those who were less dependent at Wave 1 and who became less dependent from Wave 1 to Wave 3; and those who showed decreases in hostility from Wave 1 to Wave 3. CONCLUSIONS The public health challenge posed by very high prevalence of male smoking in China can be met by policies and programs that lead to successful long-term cessation. This can only be done successfully by designing interventions based on knowledge of the country's smokers and the current study suggests several elements.
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Affiliation(s)
- Charles L Gruder
- School of Community and Global Health, Claremont Graduate University, Claremont, CA 91711, USA.
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Li R, Wang D, Chen J, Chai J, Tang M. Regional differences in smoking, drinking, and physical activities of Chinese residents. Asia Pac J Public Health 2012; 27:NP230-9. [PMID: 22357550 DOI: 10.1177/1010539512437604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This article aims at analyzing regional differences in smoking, drinking, and physical activities in China and informing cross-regional initiatives addressing these behaviors. METHODS Data were extracted from available large-scale surveys. Index of dissimilarity (ID), linear correlation, and geographical mapping were used to analyze regional differences in the prevalence of smoking (PS), smoking cessation (PSC), regular drinking (PRD), and physical activities (PPA). RESULTS Significant differences existed across regions in all the behaviors (P < .01). IDs ranged from 0.04 to 0.42. IDs of PRD and PPA were much higher than IDs of PS and PSC. Linear correlation coefficients of the 4 indicators by regions varied substantially ranging (in absolute value) from 0.031 to 0.982. Characteristic formats of geographical distribution were found with PS, PSC, and PRD and PPA being in "high plateau," "low plateau," and "shifting" patterns, respectively. CONCLUSIONS Distinct regional disparities in health behavior exist, and socioculturally and contextually competitive policies and interventions are needed.
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Affiliation(s)
| | | | - Jing Chen
- Anhui Medical University, Hefei, China
| | - Jing Chai
- Anhui Medical University, Hefei, China
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