Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China

Abstract

The primary aims of this study are to examine the associations between two key environmental factors—regional cigarette tobacco production and tobacco retail outlet density—and secondhand smoke (SHS) exposure in urban China and to explore the possible mechanisms that explain this association.MethodsA cross-sectional multistage sampling design was used to collect individual information in 21 cities in China. Environmental variables were retrieved from national databases. Multilevel logistic regression analysis was conducted to examine the associations between regional cigarette tobacco production, tobacco retail outlet density and SHS exposure. Structural equation modelling was employed to determine possible mechanisms.ResultsSHS exposure prevalence defined as daily exposure to SHS for at least 15 min/day at the time of the survey was found to be 28.1% among non-smokers (95% CI 27.1 to 29.0) across the 21 cities. The multilevel logistic regressions showed that province-level per capital cigarette production (OR: 2.72 (95% CI 1.56 to 4.76)and per GDP cigarette production(OR:1.69(95% CI 1,42,2.01), and city-level tobacco retail outlet density (OR: 2.66 (95% CI 1.63 to 4.38)) were significantly associated with SHS exposure. Moreover, results showed that these associations may be explained by the level of tobacco advertisement, which influences social norms, including attitudes and behaviours toward SHS exposure.ConclusionsFindings shed light on the role of cigarette manufacturers and retailers in producing environmental SHS pollution. To address the health and economic burden associated with SHS in China, it will be critical for the Chinese government to enact tobacco control measures consistent with the Framework Convention for Tobacco Control. Efforts should also focus on restricting the permitted density of tobacco retail outlets, and tobacco production in China.

Secondhand smoke exposure among never-smoking adolescents in Wuhan, China

“…The universe of the survey was adolescents, who were vulnerable groups and had limited ability to avoid smoking environment, which meant that knowledge about the harm of SHS has a limited impact on behaviour 16 . We also found that exposure to SHS in school and public places were significantly higher for adolescents exposed to tobacco advertising and promotion, consistent with earlier studies 43 , 44 . Exposure to tobacco advertising and promotion may shift adolescents' attitudes toward smoking favourably by shaping adolescents' curiosity about smoking, perceived norms, and perceptions about the benefits of smoking, thus making adolescents accept and tolerate smoking and SHS 45 , 46 .…”

Association of smoking with poor health-related quality of life among health-profession students in China: A 31-university multilevel, multivariable analysis

“…The source was the National Bureau of Statistics 28 . The preceding categorizations were based on prior practice 42 . Moreover, our sensitivity analyses using different categorizations of these variables produced similar results.…”

Retail-focused tobacco control: equity and endgame implications

“…Nearly half of the 17 studies in this e-issue characterise the marketing environment,16 17 the built environment18–21 or both 6 7…”

“…It calls for further research regarding retailer density/proximity and ENDS use among adults and adolescents. Adding to a growing list of reasons for retailer reduction, a study from China considers the role of tobacco retailer density in increasing exposure to secondhand smoke 21. Across 21 cities, 28% of non-smokers report at least 15 minutesof daily exposure to secondhand smoke, with higher odds of exposure among those living in cities with greater tobacco retail density.…”