Regional differences in smoking, drinking, and physical activities of Chinese residents

Geographical variation in dementia prevalence across China: a geospatial analysis

Background

Dementia poses great health and social challenges in China. Dementia prevalence may vary across geographic areas, while comparable estimations on provincial level is lacking. This study aims to estimate dementia prevalence by provinces across China, taking into account risk factors of individual level and potential spatial correlation of provinces.

Methods

In this study, 17,176 adults aged 50 years or older were included from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS 2018), covering 28 provinces, autonomous regions and municipalities. To improve provincial representativeness, we constructed provincial survey weights based on China 7th census (2020). The prevalence of dementia and 95% Bayesian credible intervals (BCIs) were estimated using a Bayesian conditional autoregressive (CAR) model with spatially varying coefficients of covariates.

Findings

The weighted prevalence of dementia at provincial level in China in 2018 ranged from 2.62% (95%BCI: 1.70%, 3.91%) to 13.53% (95%BCI: 8.82%, 20.93%). High dementia prevalence was concentrated in North China, with a prominent high-high cluster, while provinces of low prevalence were concentrated on East and South China, characterized by a low-low cluster. Ordered by the median estimation of prevalence, the top 10% of provinces, include Xinjiang, Jilin, and Beijing. Meanwhile, Fujian, Zhejiang, and Guangdong rank among the last. The association between dementia prevalence and drinking, smoking, social isolation, physical inactivity, hearing impairment, hypertension, and diabetes exhibits provincial variation.

Interpretation

Our study identifies a geospatial disparity in dementia prevalence and risk factor effects across China's provinces, with high-high and low-low clusters in some northern and southern provinces, respectively. The findings emphasize the need for targeted strategies, such as addressing hypertension and hearing impairment, in specific regions for more effective dementia prevention and treatment.

Funding

National Science Foundation of China/the Economic and Social Research Council, UK Research and Innovation joint call: Understanding and Addressing Health and Social Challenges for Ageing in the UK and China. UK-China Health And Social Challenges Ageing Project (UKCHASCAP): present and future burden of dementia, and policy responses (grant number 72061137003, ES/T014377/1).

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Alcohol Use Among Mental Health Professionals in China: A Nationwide Cross-sectional Survey

AIM

To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems.

METHODS

As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use.

RESULTS

13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206-4.439), being a doctor (OR = 1.259; CI = 1.052-1.506), being divorced or widowed (OR = 1.979; CI = 1.467-2.666), having an associate degree or less (OR = 1.809; CI = 1.040-3.147), working in Northeast China (OR = 1.538; CI = 1.281-1.848) and the habit of smoking (OR = 3.345; CI = 2.280-3.967) were significantly associated with alcohol misuse.

CONCLUSIONS

Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.

Cigarette Smoking, Health-Related Behaviors, and Burnout Among Mental Health Professionals in China: A Nationwide Survey

OBJECTIVES

Mental health professionals (MHPs) play an important role in treating patients with nicotine addiction. However, data on MHPs' cigarette smoking habits are scarce. This survey aimed to collect such data and to examine the correlates of smoking among MHPs working in China.

METHODS

A cross-sectional survey was conducted in all 41 provincial, tertiary psychiatric hospitals, and MHPs from these hospitals were targeted. An anonymous questionnaire was designed to collect socio-demographic and occupational factors, and the Maslach Burnout Inventory-Human Service Survey was used to assess burnout. Data about smoking and other health behaviors were also collected.

RESULTS

In total, 13,614 MHPs were included in the analysis. The overall rate of current smoking was 8.6% (31.3% in males, and 1.1% in females). A substantial proportion (28.0%) of life-time smokers had abstained for more than 3 months. Those who were male (OR=37.73), older (OR=1.02), divorced or widowed (OR=1.72), working in West (OR=1.45), and Northeast China (OR=1.65), were nurses (OR=1.44), had a high income (OR=1.31), experienced burnout (OR=1.29), frequent insomnia (OR=1.39), and used alcohol (OR=2.76) were significantly more likely to be smokers, while those who had a higher level of education (OR=0.67, 0.47, and 0.43 for college, master, and doctorate degrees, respectively), and exercised regularly (OR=0.73) were significantly less likely to be smokers.

CONCLUSION

Although lower than that of the general population in China, smoking is still relatively high among MPHs. Efforts to lower smoking rates among MHPs in China should continue and should incorporate strategies that target burnout, sleep, alcohol use, exercise and other factors associated with smoking.

A Multilevel Analysis of Regional and Gender Differences in the Drinking Behavior of 23 Countries

Introduction: Drinking behavior differs not only among countries, but also among regions within a country. However, the extent of such variation and the interplay between gender and regional differences in drinking have not been explored and are addressed in this study. Methods: Data stem from 105,061 individuals from 23 countries of the GENACIS data set. The outcomes were heavy drinking (10/20 g or more of pure ethanol per day for women/men), and risky single occasion drinking (RSOD) (5+ drinks per occasion) at least monthly. Analyses used binary logistic mixed models. Variance at specific levels was measured by the intra-class correlation coefficient (ICC). Gender differences in outcomes were measured using gender ratios. Results: Country-level ICC was 0.13 (95% CI: 0.09-0.18) for heavy drinking and 0.16 (95% CI: 0.10-0.26) for RSOD. Within-country regional-level ICC for heavy drinking and RSOD was 0.02 (95% CI: 0.009-0.05; 0.01-0.04, respectively), implying that 2% of variation in heavy drinking and RSOD was explained by regional variation. Variance in drinking indicators was larger for women compared to men across countries. Gender ratios were higher in low- and middle-income countries. Conclusions: Regional variations in risky drinking were more often present in low- to middle-income countries as well as in a few higher-income countries, and could be due to cultural and demographic differences. Variations in gender differences were larger on the country level than on the regional level, with lower-income countries showing larger differences. These results can help to better identify specific high-risk groups for prevention strategies.

A healthy diet and physical activity are important to promote healthy ageing among older Chinese people

Objective

To examine the associations between multiple health behaviours and health outcomes among older Chinese adults.

Methods

Data from the World Health Organization’s Study on global AGEing and adult health Wave 1 (2007–2010), collected among the older Chinese population, were included in this study. Smoking, diet, and physical activity were analysed by linear regression for any associations with depressive symptoms, quality of life (QoL), cognitive function, and physical function.

Results

A total of 13 367 participants aged >49 years were included in the analyses. After controlling for key socioeconomic factors, healthy diet was significantly associated with higher QoL (β = 0.099) and better cognitive function (β = 0.023). Physical activity was significantly associated with fewer depressive symptoms (β = –0.020), higher QoL (β = 0.086), better cognitive function (β = 0.072), and better physical function (β = –0.155 [higher scores = poorer physical function]). No relationship was found between smoking and any health-related outcome included in this study.

Conclusion

This study demonstrates the importance of healthy diet and physical activity for health outcomes in the older Chinese population.

Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach

Tobacco smoking and alcohol consumption are among the most important public health concerns not only in South Korea but also globally. This study identified the factors associated with single-use and co-use of tobacco and alcohol in Korean adults and provided more accurate estimates using a multinomial modeling approach. This study used the Korea Community Health Survey Data 2017, of which 205,336 respondents were selected as the sample for a multinomial logistic regression analysis. For the group that identified as only drinking monthly compared to the reference group, we found that the direction of the following factors was opposite to that of the results of the only currently smoking group: Age, marital status, educational level, monthly household income, occupation, obesity, self-rated health, hypertension, and hyperlipidemia. For the currently smoking and drinking monthly group relative to the reference group, the overall direction was a mix of the results of only currently smoking and only drinking monthly. These findings support the development of policies that consider the risk of smoking tobacco and consuming alcohol simultaneously.

Patterns and trends of alcohol consumption in rural and urban areas of China: findings from the China Kadoorie Biobank

BACKGROUND

In China, alcohol consumption has increased significantly in recent decades. Little evidence exists, however, about temporal trends in levels and patterns of alcohol consumption and associated factors in adult populations.

METHODS

In 2004-08, the China Kadoorie Biobank recruited ~ 512,000 adults (41% men, mean age 52 years [SD 10.7]) from 10 (5 urban, 5 rural) geographically diverse regions across China, with ~ 25,000 randomly selected participants resurveyed in 2013-14. The self-reported prevalence and patterns (e.g., amount, beverage type, heavy drinking episodes) of alcohol drinking at baseline and resurvey were compared and related to socio-demographic, health and other factors.

RESULTS

At baseline, 33% of men drank alcohol at least weekly (i.e., current regular), compared to only 2% of women. In men, current regular drinking was more common in urban (38%) than in rural (29%) areas at baseline. Among men, the proportion of current regular drinkers slightly decreased at resurvey (33% baseline vs. 29% resurvey), while the proportion of ex-regular drinkers slightly increased (4% vs. 6%), particularly among older men, with more than half of ex-regular drinkers stopping for health reasons. Among current regular drinkers, the proportion engaging in heavy episodic drinking (i.e., > 60 g/session) increased (30% baseline vs. 35% resurvey) in both rural (29% vs. 33%) and urban (31% vs. 36%) areas, particularly among younger men born in the 1970s (41% vs. 47%). Alcohol intake involved primarily spirits, at both baseline and resurvey. Those engaging in heavy drinking episodes tended to have multiple other health-related risk factors (e.g., regular smoking, low fruit intake, low physical activity and hypertension).

CONCLUSIONS

Among Chinese men, the proportion of drinkers engaging in harmful drinking behaviours increased in the past decade, particularly among younger men. Harmful drinking patterns tended to cluster with other unhealthy lifestyles and health-related risk factors.

Contextual influences affecting patterns of overweight and obesity among university students: a 50 universities population-based study in China

Background

Many studies have examined childhood and adolescent obesity, but few have examined young adults and the effect of their home and current living environments on prevalence rates. The present study explores contextual factors affecting overweight and obesity among university students in China and, in particular, focuses on how the SES–obesity relationship varies across different geographical contexts.

Methods

Participants were 11,673 students, who were identified through a multistage survey sampling process conducted in 50 universities. Individual data was obtained through a self-administered questionnaire, and contextual variables were retrieved from a national database. Multilevel logistic regression models were used to examine urban and regional variations in overweight and obesity.

Results

Overall the prevalence of overweight and obesity in the study sample was 9.5% (95% CI 7.7, 11.3%). After controlling for individual factors, both attributes of the home location (regional GDP <gross domestic product> per capita and rurality) and the current university location (city population) were found to be important, thus suggesting that the different origins of students affect current levels of obesity. At the individual level, while students with more financial resources were more likely to be obese, the extent of this relationship was highly dependent upon area income and city size.

Conclusion

The results of this study add important insights about the role of contextual factors affecting overweight and obesity among young adults and indicate a need to take into account both past as well as present environmental influences when considering the role of contextual factors in models of the nutrition transition.

Smoking intensity among male factory workers in Kunming, China

INTRODUCTION

This study investigated the intensity of cigarette consumption and its correlates in China among urban male factory workers, a cohort especially vulnerable to tobacco exposure, one that appears to have benefitted little from recent public health efforts to reduce smoking rates.

METHODS

Data were collected from men working in factories of Kunming city, Yunnan, China, who are current daily smokers (N = 490). A multinomial logistic regression was conducted to examine the factors in association with smoking intensity in light, moderate, and heavy levels.

RESULTS

Light smoking correlated with social smoking, smoking the first cigarette later in the day, self-reported health condition, and quit intention. Heavy smoking was associated with purchase of lower priced cigarettes, difficulty refraining from smoking, and prehypertensive blood pressure.

CONCLUSION

Even in regions where smoking is highly prevalent, even among cohorts who smoke heavily, variation exists in how cigarettes are consumed. Analyses of this consumption, with special consideration given to smoking intensity and its correlates, can help guide tobacco-control strategists in developing more effective interventions.