Tobacco control and the inequitable socio-economic distribution of smoking: smokers’ discourses and implications for tobacco control

Warning: this article contains strong language.

This paper focuses on the ways in which social context structures smokers’ views of, and reactions to, tobacco control. This exploratory study examined the interactions between tobacco control and smokers’ social contexts and how this may be contributing to inequalities in smoking. We found in our sample that higher socio-economic status (SES) smokers are more likely to positively respond and adapt to tobacco control messages and policies, viewing them for their future health betterment. Lower SES smokers in our study, on the other hand, are in conflict with tobacco control and feel intransigent with regard to the effects that tobacco control is having on their smoking. A better understanding of how social context structures people's perceptions of tobacco control may help us to understand why social inequalities in smoking are deepening, and potentially what can be done better in tobacco control to decrease them.     

中国居民吸烟行为的现状分析

目的分析我国居民吸烟行为,为有针对性地制定控烟措施提供基础资料.方法使用2002年中国居民营养与健康状况调查数据,对167063名（男76 556人,女90507人）15岁及以上居民的吸烟行为,包括吸烟率、现在吸烟率、常吸烟率、重型吸烟率、平均吸烟量、吸烟类别、戒烟率、戒烟成功率、复吸率及被动吸烟率等进行描述性分析.结果我国15岁及以上居民吸烟率为24.0%,男性（50.2%）明显高于女性（2.8%）,现在吸烟率为23.6%,男性（49.6%）明显高于女性（2.8%）.98.8%的男性及几乎全部女性吸烟者为现在吸烟者,95.1%的男性及92.9%的女性现在吸烟者为常吸烟者,46.0%的男性及21.4%的女性现在吸烟者为重型吸烟者.农村居民上述指标均高于城市居民.我国18岁及以上吸烟者中81.3%主要吸有过滤嘴香烟,11.9%主要吸手卷烟或旱烟,4.2%主要吸无过滤嘴香烟,2.3%主要吸烟斗或水烟袋,0.3%主要吸雪茄.结论我国居民中吸烟率仍然很高,烟草控制仍然面临着巨大的挑战,应采取有针对性的措施,有效地控制烟草的消费.     

2013年西安市居民烟草流行状况调查

目的 了解西安市居民的烟草流行状况,为进一步在全市开展控烟工作提供理论依据。 方法 采用多阶段分层随机抽样的方法,在西安城区和农村抽取2 772名15～69岁的调查对象,于2013年10-12月采用《2012年全国居民健康素养监测调查问卷》进行入户问卷调查,调查内容包括基本信息、戒烟行为及认知、戒烟史、吸烟环境及对烟草危害认知。采用SPSS 19.0软件分析居民吸烟率、二手烟暴露率人群分布差异及吸烟者戒烟想法和戒烟方式等情况。 结果 西安市居民吸烟率为28.1％,城区、农村分别为24.8%和31.4%,男、女分别为50.6％、6.3％,城乡及性别分布差异有统计学意义(P＜0.05);76.2%人群受二手烟危害,其中56.7%人几乎每天接触二手烟,不同社会特征人群除职业和年龄分类二手烟暴露率及暴露频率比较差异均有统计学意义(P＜0.05);吸烟人群中有戒烟意愿的仅占51.4%,拨打戒烟热线、咨询戒烟门诊为6.5%和10.4%。 结论 2013年西安市居民吸烟率较高,二手烟暴露严重,吸烟者有戒烟意愿者少,希望寻求专业戒烟帮助的更少,烟草流行情况不容乐观。     

Age at Smoking Initiation in Slovenia

Background

Smoking is initiated mostly by adolescents and young adults. In Slovenia, we have limited data about this. The purpose of this paper is to show data on age at smoking initiation and differences in age at smoking initiation by gender, age groups, education, social class and geographical region among inhabitants of Slovenia.

Methods

We used data from the cross-sectional survey ‘Health-related behaviour 2012’ in Slovenian population aged from 25 to 74 years.

Results

4591 ever smokers, aged 25–74, that gave information about the age at smoking initiation were included in the analysis. At the age of 25 or less, smoking was initiated by 96.7% of Slovene ever smokers, at the age of 18 or less by 71.0%. The average age at smoking initiation was 17.7 years. Male ever smokers initiated smoking at an earlier age compared to female ones. Age at smoking initiation was decreasing in both male and female ever smokers, but was more pronounced in females. In male ever smokers, there were no differences in average smoking initiation age by education, self-reported social class and geographical regions, while in female ever smokers, there were significant differences in terms of education and geographical regions.

Conclusion

The initiation of smoking predominantly occurs in adolescents and young adults. Age at smoking initiation has decreased in recent decades. Our study confirms the importance of early and sustained smoking prevention programmes in youth and the importance of national comprehensive tobacco control programme with effective tobacco control measures to ban tobacco products marketing.     

Peer Reviewed: Exploring the Use of Little Cigars by Students at a Historically Black University

Introduction

Considerable evidence exists that little cigars are popular among African American adolescents and young adults who smoke. However, few studies have been published on the use of this tobacco product by young blacks in the United States. This research investigated little-cigar use among students at a historically black university in the southeastern United States.

Methods

As a follow-up to a survey on tobacco use among freshmen that revealed unexpectedly high rates of little-cigar use, 3 focus groups were conducted with current or former smokers of little cigars. Topics included preferred brands of little cigars, preference for little cigars over cigarettes, social contexts for smoking little cigars, perceived health risks of smoking little cigars relative to smoking cigarettes, and thoughts about quitting.

Results

Focus group participants preferred little cigars to cigarettes for various reasons, among them taste, smell, a better "buzz," social purposes, status, and perceptions that smoking little cigars is less addictive and less harmful than smoking cigarettes. Opinions on health risks varied; some participants believed that health risks can be reduced by removing the inner liner of little cigars.

Conclusion

Use of little cigars should be addressed in tobacco research, use prevention, and use cessation efforts, targeting students at historically black colleges and perhaps other young African Americans. Results also suggest that clear distinctions should be made among cigarettes, little cigars, and cigars, and that tobacco use prevention and cessation programs should debunk myths that little cigars are a safe alternative to cigarettes. Study findings should be confirmed and elucidated through additional research.     

Characterizing and identifying "hard-core" smokers: implications for further reducing smoking prevalence

OBJECTIVES: Some smokers may never quit. Depending on how many of these "hard-core" smokers exist, tobacco control efforts could reach the limits of a minimum achievable smoking prevalence. We defined the hard core as heavy smokers with weak quitting histories who expect never to quit smoking. We compared them with other smokers and analyzed whether they represent a meaningful barrier to further reducing smoking prevalence. METHODS: We used data from the 1996 California Tobacco Surveys (18616 adults; response rate = 72.9%). RESULTS: In 1996, 5.2% of California smokers 26 years and older (1.3% of the California population) were hard-core smokers. Compared with other smokers, hard-core smokers were more likely to be retired non-Hispanic White males, with 12 years or less of education and incomes below $30,000 a year, who live alone. They began smoking at younger ages and attributed fewer negative health consequences to smoking than other smokers. CONCLUSIONS: Current tobacco control efforts have a long way to go before they "hit the wall." Nonetheless, the group of hard-core smokers represents a challenge because they appear to be largely unaffected by the messages of tobacco control.     

常熟市居民吸烟与被动吸烟现状分析

目的了解常熟市居民吸烟与被动吸烟现状,为开展健康宣教和控烟工作提供依据。方法按照＂2002年中国居民营养与健康状况调查抽样方案＂进行样本的选择,抽取的8个村/居委会720户家庭中年满3周岁及以上成员作为调查对象,使用个人健康情况调查表进行问卷调查。结果共调查2 150人,其中吸烟者688人,吸烟率为32.0%。男性吸烟率为66.1%,女性为0.8%。城镇和农村中51～60岁年龄组吸烟率均最高,分别为41.9%和38.2%。居民现在吸烟率、常吸烟率、重度吸烟率分别为31.6%（男65.3%,女0.8%）、30.0%（男62.0%,女0.8%）和28.7%（男59.0%,女0.8%）。有94.7%的吸烟者每天至少吸1支烟。吸烟者的平均开始吸烟年龄为22.4岁,基本都吸带有过滤嘴的香烟,平均每天吸烟14.9支,曾经戒烟超过2年的占吸烟者的8.1%。常熟市居民吸烟百分率为47.1%,被动吸烟率为35.3%;农村女性周围人员吸烟率和农村女性被动吸烟率均最高。结论常熟市居民吸烟和被动吸烟状况严重。这些居民都应该作为今后健康宣教和控烟工作的主要对象,社会各相关部门应积极参与到这项工作进来。     

The social context of smoking: A qualitative study comparing smokers of high versus low socioeconomic position

Background  

The reductions in smoking prevalence in a number of industrialised countries are accompanied by a strong social gap and associated health inequality. Groups such as the World Health Organisation emphasise the importance of exploring potential causal factors for smoking such as socio-economic context & position. There has been little effort to compare the social context of smoking for smokers of high versus lower socio-economic position (SEP) to consider how tobacco control efforts might reduce smoking-related health inequality.     

贵州省成人烟草流行状况研究

目的了解贵州省成人烟草流行状况,为控烟政策、干预措施的制定提供科学依据。方法采用多阶段整群随机抽样的方法,选取贵州省9市（州）12个县（区）18岁及以上居民进行问卷调查,并对调查数据进行统计分析。结果全省共调查9 280人,吸烟率为31.6%,现在吸烟率为29.0%;男性吸烟率和现在吸烟率分别为63.7%和58.7%,明显高于女性（分别为2.1%和1.7%）,差异均有统计学意义（P〈0.01）;城市居民吸烟率为34.4%,明显高于农村居民（30.6%）,差异有统计学意义（P〈0.05）,城市居民现在吸烟率为30.5%,与农村居民（28.5%）相比,差异无统计学意义（P〉0.05）。现在吸烟者中每日吸烟者所占比例为88.5%。男性平均开始每日吸烟年龄为（20.2±6.3）岁。男性每日吸烟者日均吸烟量为（16.8±8.2）支。男性吸烟者戒烟率及成功戒烟率分别为7.9%、5.3%。结论贵州省烟草流行严重,应积极采取多项措施加强控烟。     

2018年中国15岁及以上人群吸烟现况及变化趋势研究

目的描述中国≥15岁人群的吸烟现况, 并与既往调查比较, 分析其发展变化趋势。方法本次调查采用全球成人烟草调查的多阶段分层整群随机抽样, 覆盖全国31个省(自治区/直辖市)的200个区/县。于2018年7-12月收集个人问卷19 376份, 应答率为91.50%。数据采用SAS 9.4软件进行复杂抽样加权分析。结果 2018年我国≥15岁人群吸烟率为26.59%, 男性(50.47%)高于女性(2.07%), 农村(28.87%)高于城市(25.05%)。吸烟者戒烟率为20.10%, 女性(30.22%)高于男性(19.64%), 城乡差异无统计学意义(P=0.864)。与既往调查结果相比, 吸烟率呈现下降趋势, 其中, 25～44岁和45～64岁人群吸烟率下降明显, 大专及以上文化程度人群的吸烟率下降幅度最大。此外, 2018年我国≥15岁吸烟者平均每日吸烟量为16.00支, 现在每日吸烟者开始每日吸烟的平均年龄为20.95岁。结论我国≥15岁人群吸烟率下降速度不足以保证《健康中国行动(2019-2030年)》既定控烟目标的顺利实现, 需加大控烟工作力度。     

A randomized intervention of smoking for adolescents in urban Wuhan, China

BACKGROUND: Tobacco use is a significant public health problem in China. Culturally specific smoking prevention programs are needed for Chinese adolescents. This study evaluated a school-based smoking prevention curriculum with a social normative approach developed in the United States for adolescents in urban Wuhan, China. METHODS: As a randomized trial, the intervention was implemented in 1998 with 7th grade students in seven schools with seven matched control schools. Multilevel logistic regression models were used to compare ever and recent (past-month) smoking behaviors for the control and program conditions. RESULTS: At the 1-year follow-up, smoking had increased more rapidly in the control schools than in the program schools. The odds of baseline nonsmokers initiating smoking did not differ between the program and control groups (OR=1.08 with 95% CI=0.71, 1.64). The program prevented progression to recent smoking among boys who were baseline ever smokers. Among boys who were recent smokers at baseline, the prevention program significantly reduced risk of remaining recent smokers at follow-up (OR=0.45 with 95% CI=0.23, 0.88). CONCLUSIONS: This social normative smoking prevention curriculum did not demonstrate a significant primary prevention effect but showed potential for secondary prevention. Culturally specific smoking prevention programs are needed for Chinese adolescents.     

Smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness for smoke-free air in the workplace: a study from the Balkans

Objective

Identify the psychosocial variables that predict smokers’ compliance with smoke-free policies at work, and non-smokers’ assertiveness for smoke-free rights in Greek and Bulgarian workplaces.

Methods

Data were collected from employees in Greece and Bulgaria. The main outcome measures were smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness intentions. Demographic variables, tobacco use and dependence, as well as beliefs about second-hand smoke (SHS) exposure and smoking at work were also assessed.

Results

Regression analyses showed that smokers’ compliance with smoke-free policies was predicted by age, perceived health risks of smoking, and beliefs related to the benefits of smoking at work. Non-smokers’ assertiveness was predicted by annoyance from exposure to SHS at work, and assertiveness-related social cognitions (e.g., attitudes, social norms, and self-efficacy).

Conclusions

Interventions to promote support for tobacco control policies at work in Greece and Bulgaria may benefit from targeting smokers’ beliefs about the actual effects of tobacco use on health and job performance. Accordingly, efforts to promote non-smokers assertiveness should build stronger assertiveness-related attitudes, convey anti-smoking normative messages, and strengthen self-efficacy skills.     

Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

Cigarette consumption in rural China: survey results from 3 provinces

OBJECTIVES: This study assessed cigarette consumption and its main determinants in rural China. METHODS: A logistic regression model was used to analyze status of smoking, daily amount of smoking, and expense of cigarettes in rural China. RESULTS: Approximately 57.1% of the males and 3.1% of the females were current smokers. The daily amount of smoking among smokers was 15.23 cigarettes, and their annual expenses were 227 yuan. CONCLUSIONS: People in rural China consume fewer cigarettes and are less likely to smoke than those in urban areas. Education and occupation are 2 major factors that determine the likelihood of smoking in rural China.     

‘Every space is claimed’: smokers’ experiences of tobacco denormalisation

Over the past decade, the strategy of ‘denormalising’ tobacco use has become one of the cornerstones of the global tobacco control movement. Although tobacco denormalisation policies primarily affect people on the lowest rungs of the social ladder, few qualitative studies have explicitly set out to explore how smokers have experienced and responded to these legislative and social changes in attitudes towards tobacco use. Drawing on a qualitative study of interviews with 25 current and ex‐smokers living in Vancouver, Canada, this paper examines the ways they interpret and respond to the new socio‐political environment in which they must manage the increasingly problematised practice of tobacco smoking. Overall, while not opposed to smoking restrictions per se, study participants felt that recent legislation, particularly efforts to prohibit smoking in a variety of outdoor settings, was overly restrictive and that all public space had increasingly been ‘claimed’ by non‐smokers. Also apparent from participants’ accounts was the high degree of stigma attached to smoking. However, although the ‘denormalisation’ environment had encouraged several participants to quit smoking, the majority continued to smoke, raising ethical and practical questions about the value of denormalisation strategies as a way of reducing smoking‐related mortality and morbidity.     

我国40岁及以上吸烟人群烟草依赖严重程度及其影响因素分析

目的 了解我国≥40岁吸烟人群烟草依赖情况及其影响因素,为我国广泛开展戒烟干预提供科学数据。方法 本研究数据来源于2014-2015年中国居民慢性阻塞性肺疾病监测,覆盖31个省（自治区、直辖市）的125个监测点,以面对面询问调查的方式收集≥40岁居民吸烟和烟草依赖的相关变量。应用复杂抽样加权估计我国≥40岁现在吸烟和现在每日吸烟人群烟草依赖率及其95%CI并分析其影响因素。结果 纳入分析现在吸烟者22 380人,现在每日吸烟者19 999人。≥40岁现在吸烟人群的重度烟草依赖率为31.1%（29.3%~32.9%）,其中男性为32.0%（30.2%~33.9%）,高于女性17.6%（13.4%~21.7%）;乡村为32.7%（30.2%~35.2%）,高于城镇;40~59岁年龄组重度烟草依赖率较高,为33.3%（31.3%~35.2%）。≥40岁现在每日吸烟人群的重度烟草依赖率为35.0%（33.0%~37.0%）,男性为35.8%（33.8%~37.8%）,女性为22.0%（16.8%~27.2%）。在现在吸烟人群和每日吸烟人群中,文化程度越低,重度烟草依赖率越高;18岁以前开始吸烟者重度烟草依赖率明显高于18岁及以后开始吸烟者;有慢性呼吸道症状者的重度烟草依赖率明显高于无症状吸烟者;慢性呼吸系统疾病患者和非患者的重度烟草依赖率差异无统计学意义（P>0.05）;患有糖尿病、心脑血管疾病和高血压的吸烟者的重度烟草依赖率略低于非患者（P<0.05）。多因素logistic回归分析结果显示,男性、中部和东部地区、40~59岁年龄组、从事农林牧渔水利、生产运输和商业服务职业、文化程度低、18岁以前开始吸烟者患重度烟草依赖的风险高。结论 我国≥40岁吸烟人群的重度烟草依赖水平较高,戒烟干预服务客观需求巨大,应采取有效措施推动我国戒烟干预工作的开展。     

Urban Indians' smoking patterns and interest in quitting.

Little is known about smoking patterns of urban American Indians and their interest in quitting. Most published research has focused upon American Indians who live on rural reservations. In this study, personal interviews were conducted with a convenience sample of patients at Urban Indian Health Clinics in four geographically diverse sites: Milwaukee, WI, Minneapolis, MN, and Seattle and Spokane, WA. A total of 419 current smokers and 173 ex-smokers completed interviews. Current smokers reported a median cigarette consumption of 11 per day. Smokers indicated both a moderate desire to quit (mean 5.97, on a scale 0-10) and moderate confidence in their ability to do so (mean 5.56, on a scale 0-10). More than 70 percent of current smokers indicated having previously tried to quit. The most common reasons cited for relapse included craving, social situations, stress, and nervousness. The most common reasons for quitting given by ex-smokers included being "sick" of smoking, health concerns, respiratory problems, and pregnancy. The estimated quit-ratio (former smokers divided by current+former smokers) was 29.7 percent. This quit-ratio, although substantial, is lower than the 45 percent quit-ratio reported for the general U.S. population. Perhaps the most striking findings are the similarities between American Indians and the overall population in both interest in quitting and reasons for doing so. Smoking cessation previously has been viewed as a low priority for this population. The current results suggest the viability of systematic efforts to encourage urban American Indians to quit smoking.     

Patterns of cigarette and smokeless tobacco use among children and adolescents

Although cigarette and smokeless tobacco use are recognized as major problems among school-age youth, few nationwide or statewide data exist on the prevalence and patterns of use. To determine the patterns of tobacco use among children and adolescents in Missouri, self-report information was obtained from a representative sample of 5,431 students in grades 5, 8, and 12. Both cigarette smoking and smokeless tobacco use were more common among males than females for each grade level except the 12th, where 30% of females and 28% of males had smoked during the previous week. Smoking prevalence was considerably lower among blacks than whites. Smokeless tobacco use was rare among both blacks and females. Smokeless tobacco use was more common than cigarette smoking in rural areas, where 17% of 8th-grade males and 31% of 12th-grade males had used smokeless tobacco during the previous week. The mean age at first use of cigarettes was slightly lower in the rural than the urban area, whereas the mean age of initial smokeless tobacco use was more than a year earlier in the rural area. Data regarding the perceived difficulty of quitting smoking and quit rates suggested that adolescent females have more difficulty quitting smoking than males. Male smokeless tobacco users appeared to be more addicted than male cigarette smokers. Smokeless tobacco brand preference indicated that users may switch to progressively stronger types of smokeless tobacco as they get older and a nicotine tolerance is developed. The current study emphasizes the urgent need for carefully targeted tobacco prevention and cessation efforts among school-age youth.     

How place matters for smoking cessation: Barriers to smoking cessation among low-income Black women

African Americans start smoking later in life, yet they are less likely to quit smoking than other racial/ethnic groups. Drawing upon 40 in-depth interviews with former and current Black women smokers in the South Side of Chicago, this study examines external barriers to successful smoking cessation among socioeconomically disadvantaged Black women smokers. Beyond individual factors (e.g., stressors), this study finds interpersonal and structural factors that influence Black women's cessation efforts, including the high prevalence and normality of smoking and access to cheaper, loose cigarettes in their communities. Findings highlight the importance of considering local contexts for future tobacco research and policies.