Abstract
There are more than 300 million smokers in China. This study aimed to evaluate the rate of smoking cessation, smoking relapse and related factors in middle-aged and older smokers in China. We performed a secondary analysis of data from China Health and Retirement Longitudinal Study (CHARLS) that recruited a nationally representative sample of adults aged 45 and older. Participants were 3708 smokers in 2011 who completed two waves of follow-up interviews in 2013 and 2015. Self-reported quit and relapse rates at follow-ups were estimated. Multiple logistic regressions were conducted to identify factors associated with smoking cessation and relapse. The overall quit rate was 8.5% (95% CI 7.7% - 9.5%) at the 2-year follow-up in 2013, and 16.6% (95% CI 15.5% - 17.9%) at the 4-year follow up. Smoking cessation in 2013 was associated with not living in the northeast region (p = 0.003), fewer cigarettes smoked daily (p <0.001), and longer time to the first cigarette in the morning (p<0.001). Smoking cessation in 2015 was associated with older age (p = 0.049), smoking initiation at age ≥20 years (p<0.001), longer time to the first cigarette in the morning (p<0.001), and self-perceived poor health (p<0.001). Of the 317 participants who stopped smoking in 2013, 13.3% (95% CI 9.9% - 17.5%) relapsed by 2015. Smoking relapse was associated with younger age (p = 0.025), shorter time to the first cigarette in the morning (p = 0.003), and self-perception of not poor health (p = 0.018). The overall quit rate was 8.5% at the 2-year follow up, and 16.6% at the 4-year follow up in the middle-aged and older smokers, but 13% of quitters returned to smoking in two years. Successful smoking cessation was associated with older age, lower nicotine dependence, and self-perceived poor health.
Highlights
There are more than 300 million smokers, and the death toll from smoking-related diseases is estimated to exceed one million annually in China [1,2,3]
The overall quit rate was 8.5% at the 2-year follow up, and 16.6% at the 4-year follow up in the middle-aged and older smokers, but 13% of quitters returned to smoking in two years
It is important to have an appropriate understanding of smoking cessation and its related factors
Summary
There are more than 300 million smokers, and the death toll from smoking-related diseases is estimated to exceed one million annually in China [1,2,3]. Tobacco control and smoking cessation are important actions to achieve the "Healthy China" official target [4]. Previous studies reported that possible predictors of, or factors associated with, smoking cessation included age, socioeconomic status, health conditions, and the severity of nicotine dependence [7]. Evidence on smoking cessation and related factors is rare in China, from longitudinal studies. A one-year follow-up study of participants of ‘Quit and Win’ in 2002 in China found that smoking cessation was associated with motivation to quit, age, and marital status [8]. Findings from International Tobacco Control (ITC) China Survey identified older age, quitting intentions, nicotine dependence, and geographical location as important predictors of quit attempts or successful quitting [10]
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