Smoking, smoking cessation and tobacco control in rural China: a qualitative study in Shandong Province.

Jian Wang,Chongqi Jia,Xiaona Yan,Chenghui Li,Yanxun Liu,Junjie Liu,Yufeng Fang

doi:10.1186/1471-2458-14-916

Abstract

BackgroundSmoking prevalence is high in China and even higher among rural residents. The aims of this study were: 1) to gain insights into the motivations of tobacco use and barriers to smoking cessation among rural village residents; 2) to understand the current tobacco control measures in the rural villages and barriers encountered or perceived for implementation.MethodsQualitative semi-structured face-to-face interviews and focus group discussions were conducted of 59 rural villagers including 37 village residents, 10 village leaders and 12 village doctors in three counties in Shandong Province, China.ResultsSmoking initiation was most often out of curiosity when seeing others smoke, but pressure from cigarette sharing and gifting custom was the major barrier to smoking cessation. The most important reason for quitting successfully was a detrimental health problem. Although many attempted to quit at the advice of other family members, relapses were common and few were able to quit completely and for long-term unless accompanied by significant health issues. Although doctor’s advice to quit is effective, many doctors do not offer advice to all patients. There is a lack of true understanding of the harm of smoking and second-hand smoking among the villagers and a lack of access to and knowledge of effective smoking cessation tools among both smokers and village doctors. Tobacco control activities at villages were rare and infrequent.ConclusionsThis study highlighted the need to develop tobacco control measures that reflect the unique culture in rural China. Smoking cessation measures are not likely to achieve large scale effect unless the prevailing cigarette sharing and gifting custom is drastically changed. More educations of the hazards of smoking and second-hand smoking to village residents and educations of effective smoking cessation treatment to both village residents and healthcare providers are needed.

Highlights

Smoking prevalence is high in China and even higher among rural residents
These findings reflected the unique cigarette sharing and gifting practice in China, in which, as a gesture of friendship and respect, an individual cigarette is offered to others for immediate consumption during social and business functions or cartons of cigarettes are given as gifts during holidays [13]
This study found that both smokers and doctors in Chinese rural villages are lacking knowledge of effective smoking cessation medications

Summary

Introduction

Smoking prevalence is high in China and even higher among rural residents. The aims of this study were: 1) to gain insights into the motivations of tobacco use and barriers to smoking cessation among rural village residents; 2) to understand the current tobacco control measures in the rural villages and barriers encountered or perceived for implementation. Smoking prevalence is higher among rural residents (29.8% vs 26.1% among urban residents) [3], and among adult males (56.1% vs 49.2% among urban residents) [4]. Agriculture workers had higher smoking prevalence than males working in other occupations with over 60% of them smoke [3]. While quantitative studies using questionnaires have the advantage of being able to assess factors associated with smoking behaviors in a large sample, the factors that can be explored are limited to what have been included in the questionnaires. Qualitative studies, with their own limitations, can offer far more in-depth insights into the attitudes, perceptions, and beliefs of the respondents

Objectives

Methods

Results

Discussion

Conclusion