Trends of smoking prevalence and implications for chronic diseases in China: an analysis of data from serial national cross-sectional surveys

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BackgroundTobacco control in China is far from satisfactory and the demographic trends ofsmokers in China are poorly described. This study aimed to investigate the latest trends in smoking and its implication for chronic diseases. MethodsWe analysed data from serial cross-sectional national health service surveys from 2003 to 2013 in mainland China. Risk factors of ever-smoking were identified by multiple logistic regression. We compared the differences between ever-smokers and non-smokers in the prevalence of chronic diseases. FindingsThe overall prevalence of smoking remained high from 2003 (27·7%, 95% CI 27·5–27·9) to 2013 (27·9%, 27·7–28·1). Strikingly, the smoking prevalence in adolescents aged 15–24 years increased from 8·3% (8·0–8·7) in 2003 to 12·5% (12·1–13·0) in 2013. Among male smokers, the biggest difference between age groups was in 2013, when smoking prevalence in individuals aged 20–24 years (36·2%) was 3·9 times that in individuals aged 15–19 years (9·2%). 78% of male smokers reported starting smoking before age 25 years, whereas only 36·72% of female smokers reported smoking before this age. The prevalence of smoking in young people was positively related with the number of older smokers in their families, especially older female family members (p<0·0001; correlation coefficient 0·1). Young people aged 15–24 years with low education levels (junior high school or less) had an increased risk of tobacco use (OR 1·3, 95% CI 1·2–1·4) compared with those with senior high school or above. Smokers were more likely than non-smokers to have chronic diseases (OR 1·06, 95% CI 1·03–1·08), and even higher risks were related to early smoking initiation (smoking in adolescence) and long-term smoking (OR 1·2 every 10 years, 95% CI 1·2–1·3). InterpretationThe high plateau of tobacco use has not been curbed in China, particularly in young people and women. Programmes should target crucial years for smoking adoption (age 15–24 years), and thorough implementation of the 9-year compulsory education in China might help to reduce the initiation of smoking in young people. Involving older family members in tobacco control programme and addressing family influences on young people's tobacco use might also contribute to this goal. FundingNone