Abstract
Introduction: Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. Methods: WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher’s exact test, ANOVA test, linear regression, and logistic regression were used for analysis. Results: Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (β = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. Discussion: Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.
Highlights
Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally
Significant differences were found between participants who lived in urban, suburban, and rural areas according to age groups, household income, household registration, education level, and occupation
No significant differences were found between participants who lived in urban, suburban, and rural areas for baseline 24-h point prevalence abstinence (PPA) rates, 7-day PPA rates, attempt to quit, daily cigarette use, and nicotine dependence score at baseline
Summary
Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Within China, the smoking prevalence is consistently higher in rural areas than in urban areas [5,6,7]. The overall smoking prevalence in rural and urban areas was 29.8% and 26.1%, respectively, with a significant difference among males in particular living in rural versus urban areas: 56.1% and 49.2%, respectively [8]. These differences in smoking prevalence by living area indicate a health disparity between rural and urban areas. This disparity in smoking prevalence heavily influences long-term health outcomes: male smokers living in rural areas were more likely to develop cancers than smokers in urban areas [9]
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