《 Promotion of Capability and Effectiveness for Tobacco Control Program among Rural Residents* 》 --Report On The Baseline Survey (Tobacco use status among rural residents in Shandong, China) School of Public Health Shandong University Department of Epidemiology and Health Statistics Chongqi Jia, MD.,PhD. * POE from Emory Global Health Institute

1. Background China is the biggest country for tobacco production and consumption worldwide. It currently has more than 300 million smokers and 540 million subjects suffering from passive smoking. Rural residents take the main percentage among Chinese population. Since the backgrounds of social culture and customs in rural areas is different from that in urban areas, especially, the rural residents have low educational level, and lack of awareness of harmfulness resulted from smoking, thus it is imperative to conduct tobacco control among rural residents. In 2009, Shandong University, Jinan Center for Disease Control and Prevention (CDC), Linyi CDC, and Jining CDC jointly signed a 10-year agreement on the establishment of a cohort for the Community-based Health Research of Shandong University. This cohort consists of three counties i.e. Pingyin, Junan, and Liangshan counties. This survey was conduced in the above cohort.

2. Objectives 2.1 To describe and analyze the present smoking status and characteristics among rural residents. 2.2 To provide scientific basis for the future tobacco control interventions in rural areas.

3. Subjects and Methods 3.1 Subjects According to the plan of Shandong University, the above- mentioned cohort is evenly divided into two groups, i.e. the intervention and reference groups. This survey, including 9 natural villages, was conducted in the intervention group of the cohort aged 15 years or more.

3.2 Methods The cross-sectional study was performed by face-to-face interviews with Global Adult Tobacco Survey (GATS) Core Questionnaire with Optional Questions.

3.3 Definitions of smoking Smokers: person who smoked continuously or cumulatively for at least 6 months in life, including ever smokers Current smokers: person who achieve the standard of smokers and smoked in the past 30 days before investigation, excluding ever smokers Smoking cessation: person who reach the criteria for smokers but has quitted for more than 30 days before investigation Successful smoking cessation: person who quitted smoking for more than 2 years Successful smoking cessation rate: the proportion of subjects quitting smoking successfully among the smokers tried to quit smoking.

4. Results 4.1 General characteristics 6,806 questionnaires in total and 6,760 valid questionnaires are obtained. The distributions of the 6,760 subjects by age and sex are shown in Table 1.

4.2 The smoking status The smoking prevalence is 35.55% among all the participants, and 67.15% and 0.87% for the males and females, respectively Smoking prevalence by age group: In general, the smoking prevalence increases with the increase of age (Table 2).

4.2.2 Smoking prevalence by education level: Generally, smoking prevalence increases with decrease of education level (Table 3).

4.2.3 Smoking prevalence by different occupations: Overall, the smoking prevalence is higher among the retired people, the elderly, drivers and village officers than the others (Table 4).

4.2.4 Smoking prevalence by marital status: subjects who live alone have the highest smoking prevalence (remarried is seldom) (Table 5).

4.3 The current smoking The current smoking prevalence is 27.88% among all the participants, and 52.67% and 0.68% for the males and females, respectively. Distributions of current smoking are similar as those of smoking among age group, sex, education level, occupation and marital status.

4.4 The age starting smoking, duration and amount of smoking Above 70% of the smokers started smoking after 18 years old, and about 70% of the smokers experience a smoking duration of 15 years or more. Those who smoked more than 10 cigarettes per day account for more than 70%. Details are shown in Table 6-8.

4.5 Smoking cessation 30.40% of the smokers had tried to quit smoking. The successful cessation rate is 40.43% among individuals tried to quit smoking. The main reasons for quitting smoking were illness or fear of being ill (Table 9-10).

4.6 Passive smoking 37.74% of the non-smokers suffered from passive smoking, and the passive smoking prevalence is slightly higher among the females (39.30%) than that of the males (34.77%). Men usually tend to be affected in workplace (54.30%) and family is the main location for women’s passive smoking (88.31%) (Table 11).

4.7 Knowledge and attitude on health hazard of tobacco 95.62% of the respondents know that smoking is harmful to health, but the percentage of subjects who are aware of the specific hazards caused by smoking is relatively low % of respondents realize that smoking is a bad habit, but there are still a considerable proportion of people with the notions that “smoking is a need for social contacting” and “smoking is a personal choice, others have no right to interfere”. More than 95.00% of the respondents disapprove of their offspring to have smoking (Table 12).

4.8 To persuade smoker to stop smoking 26.55% of the non-smokers did not have a try to persuade smoker to stop smoking in front of them. The main reasons are as follows: “It has nothing to do with me” (41.23%), “Fear of hurting them feelings or being ashamed” (25.70%), and “No effect to persuade” (18.77%) % of the persons who persuaded smoker to stop smoking before, currently do not to do it. “No effect to persuade” is the main reason (66.25%).

5 Conclusions and Suggestions 5.1 It is imperative to conduct tobacco control among rural residents The epidemic of smoking including tobacco-use in male and second-hand smoke in female is a very big problem of public health among rural residents, thus it is very important to conduct tobacco control among rural residents. 5.2 To strengthen the education and improve the knowledge of smoking harmfulness among rural residents Although almost all rural residents believe that smoking is harmful to health, but few persons know the specific hazards caused by smoking. Thus, strengthening and improvement of tobacco control education are necessary, to let the rural residents fully understand what the specific hazards caused by smoking, which is helpful for them to quit smoking.

5.3 To change traditional bad habits and normalize society Although almost all rural residents think that smoking is a bad habit, but a considerable number of people think that “smoking is a need for social contacting”. Thus in the rural, it is very common for persons to offer cigarettes with each other. Moreover, there are a considerable number of people think that “smoking is a personal choice, others have no right to interfere”. Therefore, we must strengthen the health education to make rural peoples realize that offering cigarette is a bad habit, and someone having smoke will also have detriment of your health.

5.4 To improve the education methods and enhance educational effect In general, the rural residents have relative low educational level, so it is relatively difficult for them to accept the tobacco control education. According to the survey, the main reasons for smoking cessation are illness or fear of being ill, this indicated that peoples often pay much more attention to their health conditions. Therefore, during tobacco control education in rural areas, more pictures such as lung cancer should be used for increasing people’s awareness of the harmfulness resulted from smoking, with aim to increase the educational effect.

5.5 To increase the women’s role for establishing smoke-free family For most women, the passive smoking occurred in their own homes. Thus, health education for women should be strengthened, in order to raise women's awareness of tobacco control, to know the method for avoiding exposure to second-hand smoke, to increase the women’s role on promoting smoking cessation in their own homes.

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