Tobacco use among youth and adults in Mainland China: The China Seven Cities Study

doi:10.1016/j.puhe.2006.07.023

Public Health

Volume 120, Issue 12, December 2006, Pages 1156-1169

https://doi.org/10.1016/j.puhe.2006.07.023 Get rights and content

Summary

Objective

The China Seven Cities Study (CSCS) monitors geographic and temporal trends in tobacco use among adolescents and adults in seven cities throughout Mainland China: Harbin, Shenyang, Wuhan, Chengdu, Kunming, Hangzhou, and Qingdao. This article presents the methodology and prevalence data from the baseline survey of the CSCS, conducted in 2002.

Methods

Stratified random samples of middle schools, high schools, and colleges were selected within each city. Students and their parents completed self-report surveys of their tobacco use. Data were obtained from 6138 middle school students, 5848 academic high school students, 2448 vocational high school students, 2556 college students, and 25 697 parents.

Results

Smoking prevalence varied across age groups, school types, genders, and cities. Past-month smoking prevalence was 9% among middle school students, 8% among academic high school students, 26% among vocational high school students, 21% among college students, and 40% among parents. Smoking prevalence was higher among males than among females, with larger gender disparities among adults than among youth. Smoking also varied across cities, with higher smoking prevalence in southwestern cities and lower prevalence in coastal cities. Intraclass correlations of students within schools are presented to inform statistical power estimates for further research in China.

Conclusions

These results provide a baseline for future longitudinal studies of smoking in these cities and identify demographic groups at risk for tobacco-related disease. Effective smoking prevention programmes for youth and smoking cessation programmes for adults are needed in China, especially in the lower-income southwestern cities and in vocational high schools throughout the country.

Introduction

The public health problem of tobacco use in China continues to increase. Per capita cigarette consumption increased nearly three-fold between 1970 and 2000.¹ There are currently nearly one million tobacco-related deaths per year in China,² and if current trends in smoking behaviour continue, this number will increase to 2 to 3 million tobacco-related deaths per year by 2025.³ specially alarming are the sharp increases in tobacco use recently documented among Chinese women and adolescents.4, 5 Although the prevalence of smoking has decreased slightly among the entire Chinese population from 1996 to 2002, it has increased among people 15–24 years of age and among women in specific geographic areas.⁵ The prevalence of quit attempts has increased from 1996 to 2002, but 74% of current smokers still report no intention to quit.⁵

Numerous cross-sectional surveys in various regions of China have documented the smoking prevalence among specific age groups living in specific regions at specific points in time.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 However, it is difficult to compare smoking prevalence estimates across studies, because the sampling strategies and measures vary. To prevent tobacco-related morbidity and mortality in China, it is important to monitor the variation in tobacco-related behaviours across geographic regions, across age groups, and across time.

The China Seven Cities Study (CSCS) was initiated by a consortium of researchers in the USA and China in 2001. The purpose of the CSCS is to gain a more complete understanding of the role of rapid social, economic, and cultural change on tobacco use and related health practices and outcomes in China, with the ultimate goal of developing and implementing effective community-based approaches to tobacco use prevention and control. The choice of cities for this study, from the far northeast to the far southwest of China's population centres, permits us to assess the co-variation of socio-economic factors with tobacco use and health outcomes. The seven participating cities are located in four regions in China: northeast (Harbin, Shenyang), centre (Wuhan), southwest (Chengdu, Kunming), and coastal (Hangzhou, Qingdao).

The baseline survey of the CSCS was conducted in 2002. Within each of the seven cities, the CSCS selected stratified random samples of middle schools, academic high schools, vocational high schools, and colleges. Students within the selected schools, and the parents of the middle and high school students, completed self-report surveys about their tobacco use and related health topics. This article reports the demographic characteristics of the participants in the baseline survey, along with their smoking prevalence data. Smoking prevalence is compared across cities, age groups, school types, and genders.

Section snippets

Method

The data reported in this article are from the baseline health behaviour survey of the CSCS, which was conducted between October 2002 and December 2002. In each of the seven participating cities, the research team from the USA partnered with a municipal health agency to conduct the research. In Harbin, Shenyang, Wuhan, Chengdu, Hangzhou, and Qingdao, this municipal health agency was the local Center for Disease Control and Prevention (CDCP). In Kunming the local partner agency was the Institute

Participants

A total of 6522 middle school students, 8994 high school students, 3729 college students, and 31 032 parents were invited to participate. Data were collected from 6138 middle school students, 8296 high school students, 2556 college students, and 25 697 parents. The participation rates were 94.1% for middle school, 92.2% for high school, 68.5% for college students, and 82.8% for parents. Of these participants, 14 (0.2%) of the middle school students, 31 (0.5%) of the academic high school

Discussion

In this study of 42 687 adolescents and adults in China, there was variation in smoking prevalence across age groups, school types, genders, and cities. There were distinct demographic patterns in smoking behaviour, described in detail below.

Acknowledgements

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. 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

References (32)

X. Chen et al.
Hazard of smoking initiation by age among adolescents in Wuhan, China
Prev Med
(2001)
X. Li et al.
Cigarette smoking among schoolboys in Beijing, China
J Adolesc
(1999)
J.B. Unger et al.
Adolescent smoking in Wuhan, China: baseline data from the Wuhan smoking prevention trial
Am J Prev Med
(2001)
H. Xiang et al.
Cigarette smoking among medical college students in Wuhan, People's Republic of China
Prev Med
(1999)
C.A. Johnson et al.
Smoking prevention for ethnically diverse adolescents: two-year outcomes of a multicultural, school-based smoking prevention curriculum in Southern California
Prev Med
(2005)
J.B. Unger et al.
Peer influences and access to cigarettes as correlates of adolescent smoking: a cross-cultural comparison of Wuhan, China and California
Prev Med
(2002)
J.B. Janega et al.
Assessing the most powerful analysis method for school-based intervention studies with alcohol, tobacco, and other drug outcomes
Addict Behav
(2004)
Shafey O, Dolwick S, Guindon GE. Tobacco control country profiles 2003. Atlanta, GA, USA: American Cancer Society;...
R. Peto et al.
Tobacco—The growing epidemic
Nat Med
(1999)
J. Mackay
Smoking in China: ‘the limits of space’
Tob Control
(1997)

G. Yang et al.

Smoking in China: findings of the 1996 national prevalence study

JAMA

(1999)

G.H. Yang et al.

Smoking and passive smoking in Chinese, 2002

Zhonghue Liu Xing Bing Xue Za Zhi

(2005)

Y.L. Gong et al.

Cigarette smoking in China: prevalence, characteristics and attitudes in Minhang district

JAMA

(1995)

D. Gu et al.

Cigarette smoking and exposure to environmental tobacco smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia

Am J Public Health

(2004)

W. Hao et al.

An epidemiological survey on smoking in the Changsha, Harbin, and Zhenjian areas

Chinese J Clin Psychol

(1995)

T. Hesketh et al.

Smoking among youths in China

Am J Public Health

(2001)

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Original ResearchTobacco use among youth and adults in Mainland China: The China Seven Cities Study

Summary

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Method

Participants

Discussion

Acknowledgements

Prev Med

J Adolesc

Am J Prev Med

Prev Med

Prev Med

Prev Med

Addict Behav

Tobacco—The growing epidemic

Nat Med

Smoking in China: ‘the limits of space’

Tob Control

Smoking in China: findings of the 1996 national prevalence study

JAMA

Smoking and passive smoking in Chinese, 2002

Zhonghue Liu Xing Bing Xue Za Zhi

Cigarette smoking in China: prevalence, characteristics and attitudes in Minhang district

JAMA

Cigarette smoking and exposure to environmental tobacco smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia

Am J Public Health

An epidemiological survey on smoking in the Changsha, Harbin, and Zhenjian areas

Chinese J Clin Psychol

Smoking among youths in China

Am J Public Health

Original Research
Tobacco use among youth and adults in Mainland China: The China Seven Cities Study