Smoking, smoking cessation and tobacco control in rural China: a qualitative study in Shandong Province

BMC Public Health

Yufeng Fang³  Xiaona Yan³  Junjie Liu³  Yanxun Liu¹  Chongqi Jia¹  Chenghui Li²  Jian Wang³ 

[1] Department of Epidemiology and Health Statistics, Shandong University, Jinan, Shandong 250012, P. R. China;Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences Collage of Pharmacy, 4301 West Markham Street, Slot #522, Little Rock, AR 72205, USA;Center for Health Management and Policy, Shandong University, Jinan, Shandong 250012, P. R. China

关键词: China;    Rural residents;    Smoking cessation;   

Others  :  1128029
DOI  :  10.1186/1471-2458-14-916

 received in 2014-06-19, accepted in 2014-08-29,  发布年份 2014

【 摘 要 】

Background

Smoking prevalence is high in China and even higher among rural residents. The aims of this study were: 1) to gain insights into the motivations of tobacco use and barriers to smoking cessation among rural village residents; 2) to understand the current tobacco control measures in the rural villages and barriers encountered or perceived for implementation.

Methods

Qualitative semi-structured face-to-face interviews and focus group discussions were conducted of 59 rural villagers including 37 village residents, 10 village leaders and 12 village doctors in three counties in Shandong Province, China.

Results

Smoking initiation was most often out of curiosity when seeing others smoke, but pressure from cigarette sharing and gifting custom was the major barrier to smoking cessation. The most important reason for quitting successfully was a detrimental health problem. Although many attempted to quit at the advice of other family members, relapses were common and few were able to quit completely and for long-term unless accompanied by significant health issues. Although doctor’s advice to quit is effective, many doctors do not offer advice to all patients. There is a lack of true understanding of the harm of smoking and second-hand smoking among the villagers and a lack of access to and knowledge of effective smoking cessation tools among both smokers and village doctors. Tobacco control activities at villages were rare and infrequent.

Conclusions

This study highlighted the need to develop tobacco control measures that reflect the unique culture in rural China. Smoking cessation measures are not likely to achieve large scale effect unless the prevailing cigarette sharing and gifting custom is drastically changed. More educations of the hazards of smoking and second-hand smoking to village residents and educations of effective smoking cessation treatment to both village residents and healthcare providers are needed.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO MPOWER Report [http://whqlibdoc.who.int/publications/2008/9789241596282_eng.pdf webcite]
• [2]Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, Peto R, Zatonski W, Hsia J, Morton J, Palipudi KM, Asma S, GATS Collaborative Group: Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 2012, 380:668-679.
• [3]Global Adult Tobacco Survey (GATS) China Fact Sheet 2010 [http://www.who.int/tobacco/surveillance/en_tfi_china_gats_factsheet_2010.pdf webcite]
• [4]Li Q, Hsia J, Yang G: Prevalence of Smoking in China in 2010. N Engl J Med 2011, 364:2469-2470.
• [5]Yang GH, Ma JM, Liu N, Zhou LN: Smoking and passive smoking in Chinese, 2002. Zhonghua Liu Xing Bing Xue Za Zhi 2005, 26:77-83. pmid: 15921604
• [6]Ho MG, Ma S, Chai W, Xia W, Yang G, Novotny TE: Smoking among rural and urban young women in China. Tob Control 2010, 19:13-18.
• [7]China Statistical Yearbook 2009 [http://www.stats.gov.cn/tjsj/ndsj/2009/indexeh.htm webcite.]
• [8]Yang G, Fan L, Tan J, Qi G, Zhang Y, Samet JM, Taylor CE, Becker K, Xu J: Smoking in China: Findings of the 1996 National Prevalence Survey. JAMA 1999, 282:1247-1253.
• [9]Yang T, Li F, Yang X, Wu Z, Feng X, Wang Y, Wang X, Abdullah AS: Smoking patterns and sociodemographic factors associated with tobacco use among Chinese rural male residents: a descriptive analysis. BMC Public Health 2008, 8:248. BioMed Central Full Text
• [10]Yang T, Abdullah ASM, Mustafa J, Chen B, Yang X, Feng X: Factors Associated With Smoking cessation among Chinese adults in rural china. Am J Health Behav 2009, 33(2):125-134.
• [11]Yang L, Tong E, Mao Z, Hu TW: Exposure to secondhand smoke and associated factors among non-smoking pregnant women with smoking husbands in Sichuan Province, China. Acta Obstet Gynecol Scand 2010, 89:549-557.
• [12]Rich ZC, Hu M, Xiao S: Gifting and sharing cigarettes in a rural Chinese village: a cross-sectional study. Tob Control 2013. [Epub ahead of print]
• [13]Hu M, Rich ZC, Lou D, Xiao S: Cigarette sharing and gifting in rural china: A focus group study. Nicotine Tob Res 2012, 14(3):361-367.
• [14]World Health Organization: MPOWER programme. 2013. [http://www.who.int/tobacco/mpower/en/ webcite]
• [15]Best practices for comprehensive tobacco control programs—2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2007. Reprinted with corrections; [http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm webcite]
• [16]Zhang CM, Xiao D, West R, Michie S, Troughton R, Hajek P, Wang C: Evaluation of 3-day smoking cessation training course for doctors from 38 cities in China. Chin Med J (Engl) 2012, 125(7):1338-1340.
• [17]Zheng P, Guo F, Chen Y, Fu Y, Ye T, Fu H: A randomized controlled trial of group intervention based on social cognitive theory for smoking cessation in China. J Epidemiol 2007, 17(5):147-155.
• [18]Dahlgren L, Emmelin M, Winkvist A: Qualitative Methodology for International Public Health. Umea: Epidemiology and Public Health Sciences, Umea University; 2007.
• [19]Ritchie J, Lewis J: Qualitative research practice. London: SAGE Publications Ltd; 2003.
• [20]Pope C, Ziebland S, Mays N: Qualitative research in health care: Analysing qualitative data. BMJ 2000, 320:114-116.
• [21]Branu V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3(2):77-101.
• [22]Patton MQ: Qualitative evaluation and research methods. 2nd edition. Newbury Park: Sage Publications Inc.; 1990.
• [23]Rich ZC, Xiao S: Tobacco as a social currency: cigarette gifting and sharing in China. Nicotine Tob Res 2012, 14(3):258-263.
• [24]Abdullab AS, Qiming F, Pun V, Stillman FA, Samet JM: A review of tobacco smoking and smoking cessation practices among physicians in China: 1987–2010. Tob Control 2013, 22:9-14.
• [25]Abdullab AS, Stillman FA, Yang L, Lou H, Zhang Z, Samet JM: Tobacco use and smoking cessation practices among physicians in developing countries: A literature review (1987–2010). Int J Environ Res Public Health 2014, 11:429-455.
• [26]Zhou J, Abdullab AS, Pun V, Huang D, Lu S, Lou S: Smoking status and cessation counseling practices among physicians, Guangxi, China, 2007. Prev Chronic Dis 2010., 7(1) [http://www.cdc.gov/pcd/issues/2010/jan/09_0006.htm webcite]
• [27]Xu H, Zhang W, Gu L, Qu Z, Sa Z, Zhang X, Tian D: Aging village doctors in five counties in rural China: situation and implications. Hum Res Health 2014, 12:36. BioMed Central Full Text
• [28]Spigner C, Yip MP, Huang B, Tu SP: Chinese and Vietnamese adult male smokers’ perspectives regarding facilitators of tobacco cessation behavior. Asian Pac J Cancer Prev 2007, 8(3):429-435.
• [29]Mao A, Bristow K, Robinson J: Caught in a dilemma: why do non-smoking women in China support the smoking behaviors of men in their families? Health Educ Res 2013, 28(1):153-164.
• [30]Fu C, Chen Y, Wang T, Edwards N, Xu B: Exposure to environmental tobacco smoke in Chinese new mothers decreased during pregnancy. J Clin Epidemiol 2008, 61:1182-1186.
• [31]Lee AH: A pilot intervention for pregnant women in Sichuan, China on passive smoking. Patient Educ Couns 2008, 71:396-401.
• [32]Rosen LJ, Noach MB, Winickoff JP, Hovell MF: Parental smoking cessation to protect young children: A systematic review and meta-analysis. Pediatrics 2012, 129:141-152.
• [33]Friebely J, Rigotti NA, Chang Y, Hall N, Weiley V, Dempsey J, Hipple B, Nabi-Burza E, Murphy S, Woo H, Winickoff JP: Parental smoker role conflict and planning to quit smoking: a cross-sectional study. BMC Public Health 2013, 13:164. BioMed Central Full Text
• [34]Kostova D, Chaloupka FJ, Yurekli A, Ross H, Cherukupalli R, Andes L, Asma S, on behalf of the GATS Collaborative Group: A cross-country study of cigarette prices and affordability: evidence from the Global Adult Tobacco Survey. Tobacco Control 2012. doi:10.1136/tobaccocontrol-2011-050413
• [35]Treating Tobacco Use and Dependence: 2008 Update - Overview: Slide Presentation. Rockville, MD: Agency for Healthcare Research and Quality; 2009. [http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-overview/index.html webcite]
• [36]Yang J, Hammond D, Direzen P, O’Connor RJ, Li Q, Yong H, Fong GT, Jiang Y: The use of cessation assistance among smokers from China: Findings from the ITC China Survey. BMC Public Health 2011, 11(75):1-8. Available at: http://www.biomedcentral.com/1471-2458/11/75 webcite
• [37]Wang C, Xiao D, Chan KP, Pothirat C, Garza D, Davies S: Varenicline for smoking cessation: a placebo-controlled, randomized study. Respirology 2009, 14(3):384-392. doi:10.1111/j.1440-1843.2008.01476.x
• [38]Sheng LX, Tang YL, Jiang ZN, Yao CH, Gao JY, Xu GZ, Tong XY: Sustained-release bupropion for smoking cessation in a Chinese sample: a double-blind, placebo-controlled, randomized trial. Nicotine Tob Res 2013, 15(2):320-325. doi:10.1093/ntr/nts124
• [39]WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2003.
• [40]Wan X, Ma S, Hoek J, Yang J, Wu L, Zhou J, Yang G: Conflict of interest and FCTC implementation in China. Tob Control 2011, 21:412-415.
• [41]Lv J, Su M, Hong Z, Zhang T, Huang X, Wang B, Li L: Implementation of the WHO Framework Convention on Tobacco Control in mainland China. Tob Control 2011, 29:309-314.
• [42]Hu TW: WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations. Glob Health Promot 2013, 20(4):13-22. doi:10.1177/1757975913501910