Tobacco Smoking, Quitting, and Relapsing Among Adult Males in Mainland China: The China Seven Cities Study

Abstract

Introduction: Despite an estimated 1 million tobacco-related deaths annually in China, public health offi cials face overwhelming barriers to implementing effective tobacco control policies and programs. Models of effective tobacco control can be adapted for Chinese tobacco use and culture based on reliable and valid data regarding predictors of smoking and abstaining. Methods:As part of the China Seven Cities Study to assess the role of rapid social, economic, and cultural change on tobacco use and related health practices and outcomes, 4,072 adult male smokers provided data in 3 annual waves. Measures included current smoking, nicotine dependence, readiness for quitting, perceived stress, hostility, depressive symptoms, as well as covariates (e.g., age, marital status, educational attainment, and family income).Results: Odds of being abstinent at Wave 3 were increased by: lower nicotine dependence at Wave 1 and becoming less dependent between Waves 1 and 3; progressing beyond the contemplation stage between Waves 1 and 3; perceiving less stress, whether initially at Wave 1 or over time from Wave 1 to Wave 3; and lower hostility scores at Wave 1 and decreased hostility from Wave 1 to Wave 3. Among those who quit, odds of remaining abstinent rather than relapsing by Wave 3 were higher among those who were less dependent at Wave 1 and who became less dependent from Wave 1 to Wave 3; and those who showed decreases in hostility from Wave 1 to Wave 3. Conclusions:The public health challenge posed by very high prevalence of male smoking in China can be met by policies and programs that lead to successful long-term cessation. This can only be done successfully by designing interventions based on knowledge of the country ' s smokers and the current study suggests several elements.

Hostility and Cigarette Use: A Comparison Between Smokers and Nonsmokers in a Matched Sample of Adolescents

“…This association was verified using the C-M scale, which has better test-retest and internal consistency reliability than the Buss-Durkee Hostility Inventory (Bishop & Quah, 1998;Vassar & Hale, 2009), as used elsewhere (Gruder et al, 2013;Weiss et al, 2005Weiss et al, , 2008Weiss et al, , 2011. Furthermore, our results did not indicate that hostility is related to smoking quantity, but hostile smokers did begin using cigarettes at an earlier age than their less hostile peers who also smoke.…”

“…A longitudinal approach would allow us to directly test the hypothesized directionality of the relationship, specifically, that hostility is an antecedent of smoking. While this hypothesis is consistent with laboratory research inducing negative affect (McKee et al, 2010), prospective studies (Gruder et al, 2013;Weiss et al, 2005), and the negative reinforcement model of smoking (Baker et al, 2004;Brandon et al, 2004), directionality of effects cannot be established using the present data. Finally, since the C-M and morphing tasks were not completed at the same time, participants may have been in different affective states, reducing the precision of this relation.…”

“…Prospectively, higher baseline hostility predicts smoking several years later (Gruder et al, 2013;Hampson, Tildesley, Andrews, Luyckx, & Mroczek, 2010;Weiss et al, 2005;Weiss, Mouttapa, Cen, Johnson, & Unger, 2011) while increases in hostility over time are positively related to an increase in cigarette use (Hampson et al, 2010;Weiss et al, 2005) and reduced likelihood of abstaining (Gruder et al, 2013). While these studies are informative, they rely exclusively on survey measures of hostility.…”

The impact of regional economic reliance on the tobacco industry on current smoking in China

“…Our analyses were adjusted for such potential individual-level demographic confounders as age, gender, ethnicity, educational level, and occupation, all of which have been shown to be related to smoking and smoking cessation in China (e.g., Gruder et al, 2013;Li et al, 2011;Yang et al, 2014;Yong et al, 2013).…”

Relationships Between Stress, Negative Emotions, Resilience, and Smoking: Testing a Moderated Mediation Model

“…Despite the growing need to curb the tobacco epidemic (Zhang, Liu, Wang, & Jia, 2014), evidence-based programs for smoking cessation and intervention are limited in China (Kim et al, 2012), except some interventions among adolescents (Chou et al, 2006; Shek & Yu, 2011; Unger, Yan, et al, 2001; Wu, Detels, Zhang, Li, & Li, 2002). Effective and cost-efficient tobacco cessation programs in China will benefit from more in-depth etiological research (Gruder et al, 2013), especially research that focuses on how multiple psychosocial risk/protective factors interact with each other to affect tobacco use (Koplan, Eriksen, Chen, & Yang, 2013). …”