The belief that secondhand smoke causes serious illness among Chinese smokers: Smoking cessation and intention to quit
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University of California, San Diego, United States
Publish date: 2018-02-05
Submission date: 2017-09-15
Final revision date: 2018-01-07
Acceptance date: 2018-01-12
Tob. Prev. Cessation 2018;4(February):5
Approximately 70% of Chinese adults are exposed to secondhand smoke (SHS) each week and 100 000 people die from SHS every year in China. This study evaluates associations between the belief that SHS causes serious illness and intention to quit, attempts to quit, and quitting smoking, among Chinese adult smokers.

A nationally representative sample of 4866 current and former adult smokers in the Global Adult Tobacco Survey was used for analysis. Multivariable weighted regression models were built to determine significant associations between smoking cessation behavior and the belief that SHS causes serious illness.

The belief that SHS causes serious illness was associated with intention to quit (AOR 1.62, 95% CI: 1.24, 2.12) and quitting smoking (AOR 1.44, 95% CI: 1.15, 1.81). Other variables associated with smoking cessation behavior included not permitting smoking at home (intending: AOR 1.59, 95% CI: 1.10, 2.31; attempting: AOR 1.73, 95% CI: 1.25, 2.40; quitting: AOR 2.71, 95% CI: 1.90, 3.89) and the belief that smoking causes serious illness (attempting: AOR 1.63, 95% CI: 1.14, 2.33; quitting: AOR 1.66, 95% CI: 1.21, 2.28).

These results indicate that believing SHS causes serious illness may play a role in quitting smoking. In China’s collectivistic culture, interventions should focus on how SHS exposure affects the health of friends and family. This message can be combined with other proven tobacco control methods such as: smoking bans in public places, warning labels on cigarette packages, high cigarette taxes, and mass media campaigns to reduce tobacco use.

Zachary Joseph Madewell   
University of California, San Diego, 9500 Gilman Dr, 92093 La Jolla, CA, United States
1. Koplan J, Eriksen M. Smoking cessation for Chinese men and prevention for women. Lancet. 2015;386(10002):1422-3. doi:10.1016/s0140-6736(15)00416-x
2. Yang GH. Global Adult Tobacco Survey (GATS) China 2010 Country Report. China Three Gorges Publishing House. 2011.
3. Chen Z, Peto R, Zhou M, Iona A, Smith M, Yang L, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. 2015;386(10002):1447-56. doi: 10.1016/s0140-6736(15)00340-2
4. Liang X. Report of China City Adult Tobacco Survey 2013–14. 2015. CDC Foundation, Atlanta, Georgia, USA.
5. Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139-46. doi: 10.1016/s0140-6736(10)61388-8
6. Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: detailed findings. AIHW cat. no. PHE 107 (Drug Statistics Series no. 22) Canberra: AIHW. 2008: Accessed 15 October 2016.
7. Kruger J, Patel R, Kegler M, Babb SD, King BA. Perceptions of harm from secondhand smoke exposure among US adults, 2009–2010. Tob Induc Dis. 2016;14(1):3. doi: 10.1186/s12971-016-0069-8
8. World Health Organization. Tobacco in China. 2016. Accessed 16 October 2016.
9. Campaign for Tobacco Free Kids. Tobacco Burden Facts: China. 2016. Accessed 11 October 2016.
10. Yang T, Jiang S, Barnett R, Peng S, Yu L. Individual and city-level determinants of secondhand smoke exposure in China. Int J Health Geogr. 2015;14(1):36. doi: 10.1186/s12942-015-0029-1
11. Jiang Y, Elton-Marshall T, Fong GT, Li Q. Quitting smoking in China: findings from the ITC China Survey. Tob Control. 2010;19(Suppl 2):i12-7. doi: 10.1136/tc.2009.031179
12. Feng G, Jiang Y, Li Q, Yong HH, Elton-Marshall T, Yang J, et al. Individual-level factors associated with intentions to quit smoking among adult smokers in six cities of China: findings from the ITC China Survey. Tob Control. 2010;19(Suppl 2):i6-11. doi: 10.1136/tc.2010.037093
13. Yang T, Fisher KJ, Li F, Danaher BG. Attitudes to smoking cessation and triggers to relapse among Chinese male smokers. BMC Public Health. 2006;6(1):65. doi: 10.1186/1471-2458-6-65
14. World Health Organization. Global Adult Tobacco Survey (GATS); 2016. Accessed 3 October 2016.
15. Palipudi KM, Morton J, Hsia J, Andes L, Asma S, Talley B, et al. Methodology of the Global Adult Tobacco Survey—2008–2010. Glob Health Promot. 2016;23(Suppl 2):3-23. doi: 10.1177/1757975913499800
16. Winickoff JP, Friebely J, Tanski SE, Sherrod C, Matt GE, Hovell MF, et al. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics. 2009;123(1):e74-9. doi: 10.1542/peds.2008-2184
17. Ma GX, Tan Y, Fang CY, Toubbeh JI, Shive SE. Knowledge, attitudes and behavior regarding secondhand smoke among Asian Americans. Prev Med. 2005;41(2):446-53. doi: 10.1016/j.ypmed.2004.11.022
18. Dormann CF, Elith J, Bacher S, Buchmann C, Carl G, Carré G, et al. Collinearity: a review of methods to deal with it and a simulation study evaluating their performance. Ecography. 2013 Jan 1;36(1):27-46. doi: 10.1111/j.1600-0587.2012.07348.x
19. Song AV, Glantz SA, Halpern-Felsher BL. Perceptions of second-hand smoke risks predict future adolescent smoking initiation. J Adolescent Health. 2009;45(6):618-25. doi: 10.1016/j.jadohealth.2009.04.022
20. Tong EK, Ong MK, Vittinghoff E, Pérez-Stable EJ. Nondaily smokers should be asked and advised to quit. Am J Prev Med. 2006;30(1):23-30. doi: 10.1016/j.amepre.2005.08.048
21. Mao A, Bottorff JL, Oliffe JL, Sarbit G, Kelly MT. A Qualitative Study on Chinese Canadian Male Immigrants’ Perspectives on Stopping Smoking: Implications for Tobacco Control in China. Am J Men's Health. 2016; 19:1557988316644050. doi: 10.1177/1557988316644050
22. Im PK, McNeill A, Thompson ME, Fong GT, Xu S, Quah AC, et al. Individual and interpersonal triggers to quit smoking in China: a cross-sectional analysis. Tob Control. 2015;24(Suppl 4):iv40-7. doi: 10.1136/tobaccocontrol-2014-052198
23. Sansone N, Fong GT, Lee WB, Laux FL, Sirirassamee B, Seo HG, et al. Comparing the experience of regret and its predictors among smokers in four Asian countries: findings from the ITC surveys in Thailand, South Korea, Malaysia, and China. Nicotine Tob Res. 2013;15(10):1663-72. doi: 10.1093/ntr/ntt032
24. Shakib S, Zheng H, Johnson CA, Chen X, Sun P, Palmer PH, et al. Family characteristics and smoking among urban and rural adolescents living in China. Prev Med. 2005;40(1):83-91. doi: 10.1016/j.ypmed.2004.05.029
25. Gallus S, Muttarak R, Franchi M, Pacifici R, Colombo P, Boffetta P, et al. Why do smokers quit? Eur J Cancer Prev. 2013;22(1):96-101. doi:10.1097/cej.0b013e3283552da8
26. McCaul KD, Hockemeyer JR, Johnson RJ, Zetocha K, Quinlan K, Glasgow RE. Motivation to quit using cigarettes: a review. Addict Behav. 2006;31(1):42-56. doi: 10.1016/j.addbeh.2005.04.004
27. Gong X, Luo X, Ling L. Prevalence and Associated Factors of Secondhand Smoke Exposure among Internal Chinese Migrant Women of Reproductive Age: Evidence from China’s Labor-Force Dynamic Survey. International J Environ Res Pub He. 2016 Apr 1;13(4):371. doi: 10.3390/ijerph13040371
28. Gan Q, Smith KR, Hammond SK, Hu TW. Disease burden of adult lung cancer and ischaemic heart disease from passive tobacco smoking in China. Tob Control. 2007 Dec 1;16(6):417-22. doi: 10.1136/tc.2007.021477
29. He QQ, Wong TW, Du L, Jiang ZQ, Yu TS, Qiu H, et al. Environmental tobacco smoke exposure and Chinese schoolchildren's respiratory health: a prospective cohort study. Am J Prev Med. 2011 Nov 30;41(5):487-93. doi:10.1016/j.amepre.2011.07.019
30. World Health Organization. Smoke-free policies in China: evidence of effectiveness and implications for action. 2015 Oct 1.
31. Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: a review. Nicotine Tob Res. 2009;ntp122. doi: 10.1093/ntr/ntp122
32. Zheng P, Kegler MC, Berg CJ, Fu W, Wang J, Zhou X, et al. Correlates of smoke-free home policies in Shanghai, China. BioMed Res Int. 2014. doi: 10.1155/2014/249534
33. Liu H, Tan W. The effect of anti-smoking media campaign on smoking behavior: The California experience. Ann Econ Financ. 2009;10(1):29-47.
34. Durkin SJ, Biener L, Wakefield MA. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health. 2009;99(12):2217-23. doi: 10.2105/ajph.2009.161638
35. Abdullah AS, Lam TH, Chan SS, Hedley AJ. Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline?. Tob Control. 2004 Dec 1;13(4):415-21. doi: 10.1136/tc.2003.006460
36. Liu S, Zhang M, Yang L, Li Y, Wang L, Huang Z, et al. Prevalence and patterns of tobacco smoking among Chinese adult men and women: findings of the 2010 national smoking survey. J Epidemiol Commun Health. 2017 Feb 1;71(2):154-61. doi: 10.1136/jech-2016-207805
37. Yang T, Rockett IR, Li M, Xu X, Gu Y. Tobacco advertising, environmental smoking bans, and smoking in Chinese urban areas. Drug Alcohol Depen. 2012;124(1):121-7. doi: 10.1016/j.drugalcdep.2011.12.021
38. Li L, Yong HH, Borland R, Fong GT, Thompson ME, Jiang Y, et al. Reported awareness of tobacco advertising and promotion in China compared to Thailand, Australia and the USA. Tob Control. 2009;18(3):222-7. doi: 10.1136/tc.2008.027037
39. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008;2(2). doi: 10.1002/14651858.cd000165.pub2
40. Kim SS, Chen W, Kolodziej M, Wang X, Wang VJ, Ziedonis D. A systematic review of smoking cessation intervention studies in China. Nicotine Tob Res. 2012 Jan 16;14(8):891-9. doi: 10.1093/ntr/ntr289
41. Smith DR, Zhao I, Wang L. Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature. Tob Induc Dis. 2012;10(1):14. doi: 10.1186/1617-9625-10-14