Abstract
China has the largest population of male smokers globally. Men who have sex with men (MSM) are at greater risk of cigarette smoking compared to the general population. Limited data are available regarding cigarette smoking and its associations with other health issues among Chinese MSM. Eligible MSM (n = 1100) were recruited from mainland China using an online national cross-sectional survey conducted in 2014–2015. Socio-demographic characteristics, smoking behavior, substance use, homosexual stigma and outness, HIV-related risk behavior, and HIV status were obtained. Logistic regression analyses were performed to evaluate predictors of current cigarette smoking frequency and the co-occurrence of smoking and drug use. Nearly 41% (n = 446) of participants had ever smoked cigarettes; 25% (n = 278) were current frequent smokers; and 13% (n = 138) were current infrequent smokers. Factors associated with a history of smoking included age, employment status, and monthly salary. Risk factors associated with current frequent smoking included self-identification as gay, having female sexual partners, binge drinking, drug use, higher levels of homosexual stigma, and being partially or fully “out” as gay. Adjusted multinomial analysis showed that human immunodeficiency virus (HIV) related risks, including risky sexual behaviors, lack of condom use, and a reported history of sexually transmitted infections (STIs), were associated with co-occurrence of current smoking and drug use. Cigarette smoking rates remain high among MSM in China. Cigarette smoking is associated with binge drinking, drug use, and HIV-related risks in this community. There is a clear opportunity for smoking cessation interventions to be linked with HIV and substance use prevention interventions, thereby addressing multiple health issues simultaneously for the MSM community in China.
Highlights
Cigarette smoking has been the second leading risk factor globally for early death and disability in recent years [1,2]
Among the 1100 completed surveys that were eligible for analyses, the mean participant age was 24.79 years; 70.6% were educated at the college level or higher, 31.8%
Minority stress has been found to be associated with tobacco use, binge drinking, drug use, stigma, and outness [11]. We found both binge drinking and drug use were associated with current smoking among Chinese Men who have sex with men (MSM), which is consistent with studies conducted in Western countries such as the U.S [21,25] and one other study conducted in China [34]
Summary
Cigarette smoking has been the second leading risk factor globally for early death and disability in recent years [1,2]. Smoking is the leading factor attributed to cardiovascular diseases, cancers, and chronic respiratory diseases, for both sexes [2]. These issues are highly relevant to the Chinese context. Since official ratifications on the Framework Convention on Tobacco Control in 2005 and proceeding governmental programs and policies, the prevalence of cigarette smokers in China decreased substantially in the past 15 years, dropping by 22.4% and 48.4%, respectively, for males and females [2]. Given the substantial public health threats of smoking and the huge number of smokers, reducing tobacco use remains a major health challenge in
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