Susceptibility to smoking and determinants among medical students: A representative nationwide study in China

Culturally specific health-related features on cigarette packs sold in China

BACKGROUND

China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy.

METHODS

We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time.

RESULTS

Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint).

CONCLUSION

Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.

Susceptibility to smoking and determinants among never-smoking high school students in Thailand

INTRODUCTION

To prevent youth from becoming smokers, it is essential to understand factors contributing to them becoming susceptible to smoking. The aim of this study was thus to estimate the prevalence of smoking susceptibility among neversmoking youth in Thailand and to identify determinants associated with such behavior.

METHODS

Cross-sectional data for 4572 eighth-grade students (aged 13-15 years) from 120 secondary schools were obtained from a classroom-based survey using a self-administered questionnaire. Using data from never-smoking students (n=3180), simple and multiple logistic regression analyses were performed to identify factors associated with smoking susceptibility. Frequencies and proportions for descriptive statistics are reported along with adjusted odds ratios and 95% confidence intervals for logistic regression models.

RESULTS

A total of 16.4% of Thai never-smoking youth were susceptible to smoking. Several variables of interest were identified in multivariable analysis as significantly associated with increased susceptibility to smoking: being male (AOR=3.16; 95% CI: 25.4-3.92), having a positive attitude toward smoking - agreeing that smoking displays maturity (AOR=1.49; 95% CI: 1.07-2.09), the perception that smoking helps relieve stress (AOR=1.57; 95% CI: 1.14-2.15), the presence of current smoking peers (AOR=2.04; 95% CI: 1.57-2.66), exposure to secondhand smoking in public (AOR=1.51; 95% CI: 1.17-1.94), exposure to online cigarette and smoking-related advertising occasionally (AOR=1.98; 95% CI: 1.49-2.65), attendance at schools where there are sometimes anti-smoking education activities (AOR=1.57; 95% CI: 1.18-2.07); as well as exposure to anti-tobacco messages rarely (AOR=1.40; 95% CI: 1.05-1.87), occasionally (AOR=1.48; 95% CI: 1.12-1.96) and infrequently (AOR=1.41; 95% CI : 1.07-1.87).

CONCLUSIONS

Approximately one in six Thai never-smoking youth was found to be susceptible to smoking. Findings suggest it should be useful to supplement relevant tobacco prevention and control efforts by considering such interpersonal and socio-environmental determinants, among vulnerable people to smoke.

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.

Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study

Background

Medical students play an indispensable role in providing smoking cessation counseling. Despite the rapid increase in tobacco use, there is little data on what Chinese medical students know or are taught about it. This study aims to investigate the relationship between medical students' tobacco education level, clinical experience, and tobacco cessation counseling (TCC) provided by medical students.

Methods

This cross-sectional study was carried out among clinical medical students of Chongqing medical university. An anonymous, self-administered questionnaire included items on demographic information, perceptions, and perceived preparedness, clinical medical students' self-reported level of education about alternative tobacco products, and traditional cigarettes. We assessed their perspectives toward TCC using a 5-point Likert scale. Descriptive and binary logistic regression analyses were carried out.

Results

A total of 1,263 medical students completed the questionnaire. The majority of students (85%) expressed a willingness to provide TCC to patients in need. However, only half of the students stated unequivocally that they knew some ways and methods of tobacco cessation, while 18% stated that they did not know methods of tobacco cessation. Tobacco education and clinical experience were significantly associated with the ability to provide TCC. Our findings revealed that students with more clinical experience (undergraduates: B = 0.326, P < 0.001; postgraduates: B = 0.518, P < 0.001) were significantly more likely to have a greater self-reported comprehensive ability to provide TCC.

Conclusion

Tobacco education and clinical experience can enhance the ability of medical students to provide smoking cessation counseling. There is a need to focus on alternative tobacco products with changing times, and curriculum planners should collaborate to incorporate comprehensive tobacco prevention and cessation training into the medical school curriculum.