Abstract
Objectives
This study compared urban/rural differences in smoking initiation during the transition from adolescence to young adulthood among Chinese males.
Methods
Data were derived from the China Health and Nutrition Survey (N = 2395). Logistic and cox models were computed to assess smoking initiation between the ages of 15 and 20 across urban/rural administrative districts (i.e. urban neighborhood, suburban village, county town neighborhood, and rural village).
Results
Findings revealed that rates of smoking initiation decreased from the 1970 to 1996 cohorts in all four administrative districts. After adjusting for household and community characteristics, the inverse association between smoking initiation and birth year remained statistically significant (p < 0.05) in all administrative districts with the exception of urban neighborhoods. County town neighborhoods and suburban villages witnessed accelerated reductions in smoking initiation.
Conclusions
Decreased smoking initiation appears to be associated with birth year, which may be correlated with social and economic development of China in conjunction with an unprecedented rate of urbanization. Results suggest that the rate of smoking initiation for male youths may experience further decreases, particularly in areas with a heightened potential of urbanization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bekedam H (2007) Foreword. In: Hu TW (ed) Tobacco control policy analysis in china: economics and health. World Scientific Publishing, Hackensack, pp V–VII
Breslau N, Fenn N, Peterson EL (1993) Early smoking initiation and nicotine dependence in a cohort of young adults. Drug Alcohol Depend 33:129–137. doi:10.1016/0376-8716(93)90054-T
Edwards R, Carter K, Peace J, Blakely T (2013) An examination of smoking initiation rates by age: results from a large longitudinal study in New Zealand. Aust N Z J Public Health 37:515–519. doi:10.1111/1753-6405.12105
Freedman KS, Nelson NM, Feldman LL (2012) Smoking initiation among young adults in the United States and Canada, 1998–2010: a systematic review. Prev Chronic Dis 9:E05
Gan Q, Smith KR, Hammond SK, Hu T (2007) Disease burden from smoking and passive smoking in China. In: Hu TW (ed) Tobacco control policy analysis in China: economics and health. World Scientific Publishing, Hackensack, pp 83–104
Gilman SE, Rende R, Boergen J et al (2009) Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control. Pediatrics 123:e274–e281. doi:10.1542/peds.2008-2251
Griffin E, Moon G, Barnet R (2015) Examining the significance of urban-rural context in tobacco quitline use: does rurality matter? Int J Public Health 60:327–333. doi:10.1007/s00038-014-0634-y
Gu D, Wu X, Reynolds K, Duan X et al (2004) Cigarette smoking and exposure to environmental tobacco smoke in China: the international collaborative study of cardiovascular disease in Asia. Am J Public Health 94:1972–1976. doi:10.2105/AJPH.94.11.1972
Hesketh T, Ding QJ, Tomkins A (2001) Smoking among youths in China. Am J Public Health 91:1653–1655. doi:10.2105/AJPH.91.10.1653
Hu TW (2007) Introduction. In: Hu TW (ed) Tobacco control policy analysis in china: economics and health. World Scientific Publishing, Hackensack, pp 1–11
Hu T, Tsai Y (2000) Cigarette consumption in rural China: survey results from 3 provinces. Am J Public Health 90:1785–1787
Jones-Smith J, Popkin BM (2010) Understanding community context and adult health changes in China: development of an urbanicity scale. Soc Sci Med 71:1436–1446. doi:10.1016/j.socscimed.2010.07.027
Kenkel D, Lillard DR, Liu F (2009) An analysis of life-course smoking behavior in China. Health Econ 18:S147–S156. doi:10.1002/hec.1507
Lantz PM (2003) Smoking on the rise among young adults: implications for research and policy. Tob Control 12:i60–i70. doi:10.1136/tc.12.suppl_1.i60
Li Q, Hsia J, Yang G (2011) Prevalence of smoking in China in 2010. N Engl J Med 364:2469–2470. doi:10.1056/NEJMc1102459
Liu BQ, Peto R, Chen ZM, Boreham J, Wu YP, Li JY (1998) Emerging tobacco hazards in China: retrospective proportional mortality study of one million deaths. BMJ 317:1411–1422. doi:10.1136/bmj.317.7170.1411
Ma H, Unger JB, Chou CP, Sun P, Palmer PH, Zhou Y, Wei Y (2008) Risk factors for adolescent smoking in urban and rural China: findings from the China seven cities study. Addict Behav 33:1081–1085. doi:10.1016/j.addbeh.2008.04.004
Masood S, Cappelli C, Li Y, Tanenbaum H, Chou CP, Spruijt-Metz D, Xie B (2015) Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults. Int J Public Health Online First. doi:10.1007/s00038-015-0730-7
O’Loughlin JL, Dugas EN, O’Loughlin ER, Karp I, Sylvestre M (2014) Incidence and determinants of cigarette smoking initiation in young adults. J Adolesc Health 54:26–32. doi:10.1016/j.jadohealth.2013.07.009
Pan Z, Hu D (2008) Multilevel analysis of individual and community predictors of smoking prevalence and frequency in China: 1991–2004. J Public Health Pol 29:72–85. doi:10.1057/palgrave.jphp.3200163
Sung HY, Wang L, Jin S, Hu T, Jian Y (2007) Economic burden of smoking in China, 2000. In: Hu TW (ed) Tobacco control policy analysis in china: economics and health. World Scientific Publishing, Hackensack, pp 105–126
Wang SQ, Yu JJ, Zhu BP, Liu M, He GQ (1994) Cigarette smoking and its risk factors among senior high school students in Beijing, China, 1988. Tob Control 3:107–114
Wang J, Li C, Jia C, Liu Y, Liu J, Yan X, Fan Y (2014) Smoking, smoking cessation and tobacco control in rural China: a qualitative study in Shandong Province. BMC Public Health 14:916. doi:10.1186/1471-2458-14-916
Weiss JW, Spruijt-Metz D, Palmer PH, Chou C, Johnson A, China Seven Cities Study Research Team (2006) Smoking among adolescents in China: an analysis based upon the meanings of smoking theory. Am J Health Promot 20:171–178. doi:10.4278/0890-1171-20.3.171
Wen X, Chen W, Muscat JE, Qian Z, Lu C et al (2007) Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China. Prev Med 45:189–197. doi:10.1016/j.ypmed.2007.02.009
Weng XZ, Hong ZG, Cheng DY (1987) Smoking prevalence in Chinese aged and above. Chin Med J 100:886–892
World Health Organization (2014) China’s youth tobacco survey highlights the need to protect youth from tobacco harms (news release). http://www.wpro.who.int/mediacentre/releases/2014/20140618/en/. Accessed 9 Oct 2015
Yang DT (2002) What has caused regional inequality in China. China Econ Rev 13:331–334. doi:10.1016/S1043-951X(02)00088-3
Yang GH (2007) Prevalence of smoking in China. In: Hu TW (ed) Tobacco control policy analysis in China: economics and health. World Scientific Publishing, Hackensack, pp 13–32
Yang GH, Fan LX, Samet J et al (1999) Smoking in China: findings of the 1996 national prevalence survey. JAMA 282:1247–1253. doi:10.1001/jama.282.13.1247
Yang M, Abughosh S, Sansgiry SS, Wu I, Peters R, Essien EJ (2012) Predictors of cigarette smoking among Chinese adults. J Behav Health 1:157–166. doi:10.5455/jbh.20120702020328
Yang T, Yu L, Jiang S, Feng X, Xian H, Cottrell RR, Rockett IR (2015) Household smoking restrictions among urban residents in China: individual and regional influences. Int J Public Health 60:479–486. doi:10.1007/s00038-015-0672-0
Yao T, Sung H, Mao Z, Hu T, Max W (2014) The healthcare costs of secondhand smoke exposure in rural China. Tob Control Online First. doi:10.1136/tobaccocontrol-2014-051621
Zhang J, Ratcliffe JM (1993) Paternal smoking and birthweight in Shanghai. Am J Public Health 83:207–210
Acknowledgments
This research uses data from China Health and Nutrition Survey (CHNS). We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, Carolina Population Center (5 R24 HD050924), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the Fogarty International Center, NIH for financial support for the CHNS data collection and analysis files from 1989 to 2011 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009. Ms. Zhi is grateful for the support provided by School of Social Work, Saint Louis University during her visit and the support from the National Social Science Foundation Research Program (12BRK001).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhi, K., Huang, J., Deng, S. et al. Decreased smoking initiation among male youths in China: an urban–rural comparison. Int J Public Health 61, 417–425 (2016). https://doi.org/10.1007/s00038-016-0795-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-016-0795-y