Prevalence of smoking and knowledge about the smoking hazards among 170,000 Chinese adults: a nationally representative survey in 2013-2014.

Introduction: Periodic population surveys of smoking behaviour can inform development of effective tobacco control strategies. We investigated smoking patterns, cessation and knowledge about smoking hazards in China. Methods: A nationally representative cross-sectional survey recruited 176,318 people aged ≥18 years across 31 provinces of China in 2013-14, using multi-stage stratified cluster sampling methods. The smoking patterns, cessation and knowledge about smoking hazards were analysed, overall and in population subgroups, adjusting for sample selection weight and post-stratification factors. Results: Among men, 60.7% were ever smokers, with proportions of regular, occasional and former smokers being 46.3%, 5.5%, and 8.8% respectively. Among women, only 2.8% has ever smoked. The prevalence of ever smoking in men was higher in rural than urban areas (63.2% vs 57.6%) and varied from 39.5% to 67.4% across 31 provinces. Among male regular smokers, the mean daily number of cigarettes smoked was 17.8, with mean age at first starting to smoke daily being 20.1 years. Among current smokers, one third (32.6% men, 32.1% women) had tried to quit before and 36.8% (36.8% men, 35.5% women) intended to quit in the future. Of the Chinese adults, 75.9% recognized that smoking was hazardous, with the proportions believing that smoking could cause lung cancer, heart attack or stroke being 67.0%, 33.2% and 29.5%, respectively and with 26.0% reporting that smoking could cause all these conditions. Conclusion: Among Chinese adults, the smoking prevalence remained high in men but was low in women. In both men and women knowledge about smoking hazards was poor. Implications:This study showed that tobacco smoking remained highly prevalent among adult men in China in 2013-14. Moreover, men born in recent decades were more likely to start smoking at younger ages and to smoke more cigarettes than those born in previous generations. There was a large regional variation in male smoking prevalence, with the least economically developed regions having higher prevalence. In contrast, few women in China smoked, especially among those born in recent decades. The contrasting smoking patterns in men and women is likely to result in an increasingly large gender disparity in life expectancy in the coming decades.