Analysis Of The Current Status Of Smoking And The Influencing Factors Of Smoking Behavior In Rural Areas Of China

Objective:To describe the current smoking status of the population as a whole and the population of lower economic level in rural areas of China and to explore the factors influencing the current smoking behavior.The study will further investigate the smoking status of current smokers,their willingness to quit and the factors influencing it.To provide a reference for tobacco control efforts in rural areas and a scientific basis for precise prevention and control of the phenomenon of poverty due to disease and return to poverty due to disease caused by tobacco among people with lower economic levels.Methods:The first part utilized data from the 2018 China Chronic Disease and Risk Factor Surveillance,with a total of 184 509 permanent residents aged 18 years and older in rural areas.Their current smoking status and influencing factors were described,and then 10241 rural current smokers were screened for smoking cessation intention analysis.Theχ~2/F test was used to analyze the factors such as the prevalence of current smoking,willingness to quit smoking and demographic information,tobacco use,knowledge of tobacco-related hazards,and chronic disease prevalence.Unconditional multivariate logistic regression analysis was used in multivariate analysis.The second part of the study,was conducted from November to December 2022 with all permanent residents(≥15 years old)who were out of poverty in 10 rural areas of 5 provinces as the study subjects.Information about tobacco use,tobacco harm perception,and chronic disease prevalence was investigated by face-to-face surveys.The SAS 9.4 statistical software was used to describe the current smoking prevalence,andχ2/F test was used to analyze the factors such as current smoking prevalence with demographic information,tobacco hazard perception score,chronic disease prevalence,and other factors.Unconditional multifactor logistic regression analysis was used in multivariate analysis.Further description of the smoking status of the 191 current smokers was performed.Results:1.A total of 109,311 permanent residents in rural areas with a mean age of(54.93±13.82)years were included.The prevalence of current smoking among residents(≥18 years old)in rural areas of China was 28.23%.The prevalence of current smoking among residents aged 18 years and older in rural areas of China was 28.23%.There were differences in the prevalence of current smoking among people of different gender,age,education level,region,work status,marital status,alcohol consumption,self-rated health status,diabetes mellitus,dyslipidemia/hyperlipidemia,chronic obstructive pulmonary disease,cardiovascular and cerebrovascular disease,chronic disease prevalence,and economic level,and all differences were statistically significant(P<0.05).Using logistic regression analysis to explore the factors influencing current smoking behavior,the results showed that gender,age,education,work status,alcohol consumption,diabetes mellitus,dyslipidemia/high lipid,chronic obstructive pulmonary disease,cardiovascular disease,chronic disease prevalence,economic level,and tobacco hazard perception score were all associated with smoking behavior,and self-rated health status did not show an association.A total of 3453 smokers(37.46%)considered quitting in the next 12 months.There were differences in the willingness to quit among people with different gender,age,education,marital status,hypertension,cardiovascular and cerebrovascular diseases,smoking status,daily smoking amount,and quitting status,and all differences were statistically significant(P<0.05).The results of multi-factor logistic regression analysis showed that gender,smoking status,daily smoking amount,and cessation status were all related to the willingness to quit smoking,and the willingness to quit smoking was 1.538times higher among current smokers with college education or above than those with elementary school education or below(95%CI:1.146-2.604),and the willingness to quit smoking was higher among those with high awareness of tobacco hazards(OR=1.056,95%CI:1.028～1.086),and all differences were statistically significant(P<0.05).2.A total of 531 rural out-of-poverty residents were surveyed,290 of whom were male(54.61%),with an average age of(58.88±13.67)years.The current smoking rate was 35.97%.There were differences in the present smoking rate among people of different sex,age,ethnicity,education level,work status,alcohol consumption,self-rated health status,economic level,and chronic disease prevalence,and all differences were statistically significant(P<0.05).Using logistic regression analysis to explore the factors influencing current smoking behavior,the results showed that gender,education level,alcohol consumption,hypertension,annual per capita income,chronic disease prevalence,and tobacco hazard perception score were all associated with smoking behavior,while age,work status,and self-rated health status did not show any association.Among the 191 current smokers,the proportion of low/low-income current smokers who rated their health status as very poor/poor and had more than one chronic disease was the highest,and the proportion of smokers who had smoked for more than 40 years,the proportion who had their first cigarette in the morning within 5 minutes,and the proportion who had quit within 12 months was higher than that of higher/higher-income current smokers,and the proportion of low/lower-income current smokers who smoked more than one pack per day was lower than that of middle-income and higher/higher-income current smokers,and the proportion who had the intention to quit was higher than that of higher/higher-income current smokersConclusions:The overall prevalence of current smoking in rural areas remains high,especially among residents of lower economic levels.High prevalence of smoking among people with multiple chronic non-communicable diseases.Willingness to quit smoking is related to smoking status,amount of smoking,previous quitting experience,and perception of tobacco harms.It is recommended that health education campaigns in rural areas should be strengthened through a variety of efficient ways to provide brief cessation interventions to increase rural smokers’willingness to quit,and special attention should be paid to the disadvantaged groups in rural areas who have been lifted out of poverty,with targeted awareness of the harms of tobacco use and cessation support activities.