According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS).
Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking.
After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05).
Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Averina M, Nilssen O, Brenn T, Brox J, Arkhipovsky VL, Kalinin AG (2005) Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia—a population-based study in Arkhangelsk. Soc Psychiatry Psychiatry Epidemiol 40:511–518
Boudreaux ED, Francis JL, Carmack Taylor CL, Scarinci IC, Brantley PJ (2003) Changing multiple health behaviors: smoking and exercise. Prev Med 36:471–478
Boyle RG, O’Connor P, Pronk N, Tan A (2000) Health behaviors of smokers, ex-smokers, and never smokers in an HMO. Prev Med 31:177–182. doi:10.1006/pmed.2000.0699
Centers of Disease Control and Prevention (1998) Behavioral risk factor surveillance system user’s guide. http://www.cdc.gov/brfss/about/about_brfss.html
Gauthier AP, Snelling SJ, King M (2012) “Thinking outside the pack”: examining physically active smokers and implications for practice among Ontario residents. Health Promot Prac 13:395–403
Global Adult Tobacco Survey (GATS)(2010) Fact sheet china. http://www.who.int/tobacco/surveillance/en_tfi_china_gats_factsheet_2010.pdf
Gu D, Kelly TN, Wu X, Chen J, Samet JM, Huang JF, He J (2009) Mortality attributable to smoking in China. N Engl J Med 360:150–159
Ho MG, Ma S, Chai W, Xia W, Yang G, Novotny TE (2010) Smoking among rural and urban young women in China. Tob Control 19:13–18
Johnson CA, Xie B, Liu C, Reynolds KD, Chou CP, Koprowski C, Gallaher P, Spruitj-Metz D, Guo Q et al (2006) Socio-demographic and cultural comparison of overweight and obesity risk and prevalence in adolescents in southern California and Wuhan, China. J Adolesc Health 39(925):e1–e8
Koh WP, Yuan JM, Sun CL, Lee HP, Mimi CY (2005) Middle-aged and older Chinese men and women in Singapore who smoke have less healthy diets and lifestyles than nonsmokers. J Nutr 135:2473–2477
Komiyama M, Wada H, Ura S, Yamakage H, Satoh-Asahara N, Shimatsu A, Koyama H, Kono K, Takahashi Y et al (2013) Analysis of factors that determine weight gain during smoking cessation therapy. PLoS One 8:e72010
Liu JT, Lee IH, Wang CH, Chen KC, Lee CI, Yang YK (2013) Cigarette smoking might impair memory and sleep quality. J Formos Med Assoc 112:287–290
Ma S, Hoang MA, Samet JM, Wang J, Mei C, Xu X, Stillman FA (2008) Myths and attitudes that sustain smoking in China. J Health Commun 13:654–666
Mak KK, Ho SY, Thomas GN, Lo WS, Cheuk DK, Lai YK, Lam TH (2010) Smoking and sleep disorders in Chinese adolescents. Sleep Med 11:268–273
Mukamal KJ (2006) The effects of smoking and drinking on cardiovascular disease and risk factors. Alcohol Res Health 29:199–202
Naimi TS, Brewer RD, Mokdad A, Denny C, Serdula MK, Marks JS (2003) Binge drinking among US adults. JAMA 289:70–75
National Sleep Foundation (2013) How much sleep do we really need? http://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need
Paavola M, Vartiainen E, Haukkala A (2004) Smoking, alcohol use, and physical activity: a 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health 35:238–244
Palmer CD, Harrison GA, Hiorns RW (1980) Association between smoking and drinking and sleep duration. Ann Hum Biol 7:103–107
Peto R, Chen ZM, Boreham J (2009) Tobacco: the growing epidemic in China. CVD Prev Control 4:61–70
Pomerleau CS, Marks JL, Pomerleau OF (2000) Who gets what symptom? Effects of psychiatric cofactors and nicotine dependence on patterns of smoking withdrawal symptomatology. Nicotine Tob Res 2:275–280
Riedel BW, Durrence HH, Lichstein KL, Taylor DJ, Bush AJ (2004) The relation between smoking and sleep: the influence of smoking level, health, and psychological variables. Behav Sleep Med 2:63–78
Rose JE, Brauer LH, Behm FM, Cramblett M, Calkins K, Lawhon D (2004) Psychopharmacological interactions between nicotine and ethanol. Nicotine Tob Res 6:133–144
Shi J, Liu M, Zhang Q, Lu M, Quan H (2008) Male and female adult population health status in China: a cross-sectional national survey. BMC Public Health 8:277
Soldatos CR, Kales JD, Scharf MB, Bixler EO, Kales A (1980) Cigarette smoking associated with sleep difficulty. Science 207:551–553
Subar AF, Harlan LC, Mattson ME (1990) Food and nutrient intake differences between smokers and non-smokers in the US. Am J Public Health 80:1323–1329
Unger JB (1996) Stages of change of smoking cessation: relationships with other health behaviors. Am J Prev Med 12:134–138
United States Department of Agriculture (1998) The 1994–1996 continuing survey of food intakes by individuals and the 1994–1996 diet and health knowledge survey [report on CDROM]. http://www.ars.usda.gov/Services/docs.htm?docid=14531
World Health Organization (2009) WHO report on the Global Tobacco Epidemic: implementing smoke-free environments. http://www.who.int/tobacco/mpower/2009/en/
World Health Organization, Western Pacific (2014) WHO Representative Office, China: Tobacco in China. http://www.wpro.who.int/china/mediacentre/factsheets/tobacco/en/
Xie B, Chou CP, Spruijt-Metz D, Reynolds K, Clark F, Palmer PH, Gallaher P, Sun P, Guo Q et al (2006a) Weight perception, academic performance, and psychological factors in Chinese adolescents. Am J Health Behav 30:115–124
Xie B, Chou C, Spruijt-Metz D, Reynolds K, Palmer PH, Gallaher P, Sun P, Qian G, Johnson CA (2006b) Weight perceptions and weight-related socio-cultural and behavioral factors in Chinese adolescents. Prev Med 42:229–234
Xie B, Palmer PH, Pang Z, Sun P, Duan H, Johnson CA (2010) Environmental tobacco use and indicators of metabolic syndrome in Chinese adults. Nicotine Tob Res 12:198–206
Yang GH, Fan L, Tan J, Qi G, Zhang Y, Samet JM, Taylor CE, Becker K, Xu J (1999) Smoking in China: findings of the 1996 National Prevalence Survey. JAMA 282:1247–1253
Yang GH, Ma JM, Liu N, Zhou LN (2005) Smoking and passive smoking in Chinese, 2002. Zhonghua Liu Xing Bing Xue Za Zhi 26:77–83
Yang GH, Li Q, Wang CX, Hsia J, Yang Y, Xiao L, Yang J, Zhao LH, Zhang J et al (2010a) Findings from 2010 Global Adult Tobacco Survey: implementation of MPOWER policy in China. Biomed Environ Sci 23:422–429
Yang GH, Li Q, Wang CX, Hsia J, Yang Y, Xiao L, Yang J, Zhao LH, Zhang J et al (2010b) Findings from 2010 Global Adult Tobacco Survey: implementation of MPOWER policy in China. Biomed Environ Sci 23:422–429
Zhang L, Samet J, Caffo B, Punjabi NM (2006) Cigarette smoking and nocturnal sleep architecture. Am J Epidemiol 164:529–537
This research was supported by the University of Southern California Transdisciplinary Tobacco Use Research Center (TTURC), funded by the National Institutes of Health (Grant #1 P50 CA84735-01), and the Sidney R. Garfield Endowment. Manuscript preparation was partially supported by the Grant (1 R03 CA172985-01). The authors thank the China Seven Cities Study (CSCS) directors and project staff at the Centers for Disease Control and Prevention in the cities of Chengdu, Hangzhou, Harbin, Qingdao, Shenyang, and Wuhan and the Institute for Health Education in Kunming, People’s Republic of China, for assistance with project coordination and data collection. We also thank the principals, physicians, and teachers in the participating schools for their cooperation. Finally, we express our gratitude to the national Chinese Center for Disease Control and Prevention, Peking University School of Public Health, and the municipal government, Health Bureau, and Education Committee in each participating city for their support. The study protocol was approved by the IRB at University of Southern California/Claremont Graduate University, and informed consent was obtained from participants.
Conflict of interest
The authors declare that they have no conflicts of interest.
The authors declare that the experiments comply with the current laws of the country in which they were performed.
S. Masood and B. Xie contributed equally to this manuscript.
About this article
Cite this article
Masood, S., Cappelli, C., Li, Y. et al. 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 60, 891–899 (2015). https://doi.org/10.1007/s00038-015-0730-7