Smoking, cessation and expenditure in low income Chinese: cross sectional survey

Background: This study was carried-out to explore smoking behaviour and smoking expenditure among low income workers in Eastern China to inform tobacco control policy. Methods: A self-completion questionnaire was administered to 1958 urban workers, 1909 rural workers and 3248 migrant workers in Zhejiang Province, Eastern China in 2004. Results: Overall 54% of the men and 1.8% of all women were current smokers ( at least 1 cigarette per day). Smoking was least common in migrant men ( 51%), compared with 58% of urban workers and 64% rural inhabitants ( P < 0.0001). Forty-nine percent of rural males smoke more than 10 cigarettes/day, and 22% over 20/day. The prevalence of smoking increased with age. Overall 9% of the males had successfully quit smoking. Reasons for quitting were to prevent future illness ( 58%), current illness ( 31%), family pressures ( 20%) and financial considerations ( 20%). Thirteen percent of current smokers had ever tried to quit ( cessation for at least one week) while 22% intended to quit, with migrants most likely to intend to quit. Almost all ( 96%) were aware that smoking was harmful to health, though only 25% were aware of the dangers of passive smoking. A mean of 11% of personal monthly income is spent on smoking rising to a mean of 15.4% in rural smokers. This expenditure was found to have major opportunity costs, including in terms of healthcare access. Conclusion: The prevalence of smoking and successful quitting suggest that smoking prevalence in low income groups in Eastern China may have peaked. Tobacco control should focus on support for quitters, on workplace/public place smoking restrictions and should develop specific programmes in rural areas. Health education messages should emphasise the opportunity costs of smoking and the dangers of passive smoking.