The Influences Of Social Capital On Smoking Behavior Among Health Professional Students In China

BackgroundSmoking epidemic is acknowledged as one of the most serious public health issues around the world.Currently,there are approximately 300 million smokers and one million Chinese people die from smoking in China,which leads to substantial economic losses and disease burden.“Tobacco Control”is a critical part of“Healthy China”which is a national strategy of China.It was reported that the overall smoking prevalence was 22.3%among health professionals,that of male doctors was 38.9%.Health professionals are the health model of the public and their smoking behavior may mislead the public that smoking is harmless,resulting in serious negative external effects in health.The smoking prevalence of health professional students was as much as 30%.In other words,many health professionals began to smoke in schools.health professional students are health professionals in the future.It is cost-effective to carry out research and action on tobacco control among them,which may significantly reduce the smoking prevalence among future health professionals.Social capital was defined as relationships between individuals or organizations,which has been widely used in the field of health research.In western society,smoking was used to relive negative emotion;social capital can improve mental health,and thus reduce smoking.However,cigarettes are considered as critical social currency in China.Many studies on social capital and smoking behavior were conducted in western societies.But the western results and conclusions may not be applicable in Chinese society due to the huge differences between Chinese and Western cultures.In addition,there are rare studies on the influencing mechanism of social capital on smoking behavior in China.Therefore,the research on the mechanism of social capital and smoking behavior may reach important social demand,theoretical value and practical significance.ObjectivesBased on the theory of social capital,this study aims to establish a research framework of social capital and smoking behavior among health professional students.This paper discusses the influencing mechanism of social capital on smoking behavior including social participation,social interaction,social network and trust and reciprocity from the perspective of gender differences.The final purpose of this paper is to provide theoretical basis and empirical evidence for the formulation of effective intervention policies on tobacco control among health professional students.MethodsA population based multi-stage cluster sampling method was employed to collect data.The participants of this study are medical college students with a sample size of7595.In this study,Social Capital Scale,Chinese General Health Questionnaire and Smoking Behavior Questionnaire were used to assess social capital,mental disorder and smoking status of the respondents.SPSS 24.0 and Amos 23.0 were used to analyze the data.Cronbach?coefficient,exploratory and confirmatory factor analysis were used to evaluate the reliability and validity of the scales.Chi square test,Pearson correlation analysis,Spearman correlation analysis,linear regression and logistic regression were used to assess the relationship between social capital and smoking behavior.Structural equation models were constructed to verify the theoretical hypothesis.Results(1)The overall smoking prevalence was 6.9%among health professional students,and the smoking prevalence of male students(16.4%)was significantly higher than that of female students(2.4%)(?~2=509.931,P<0.001).The smoking prevalence in eastern area(4.9%),middle(6.7%)and western(9.4%)areas were significantly different.(?~2=40.724,P<0.001).However,the significant differences on smoking prevalence in various areas only exist in males.(2)Univariate analysis showed that the smoking prevalence among minority males(33.2%)was significantly higher than that of Han males(14.9%)(?~2=52.397,P<0.001).The smoking prevalence of males(20.8%)with mental disorder was significantly higher than those(15.3%)without mental disorder.(?~2=8.711,P<0.01).However,the correlation was not significant in females(?~2=3.465,P>0.05).The differences of smoking prevalence among male students majoring in nursing(31.2%),public health(20.2%)and clinical(13.1%)was statistically significant(?~2=36.443,P<0.001).Drinking and smoking were significantly co-occurred among both boys(?~2=304.425,P<0.001)and females(?~2=565.186,P<0.001).(3)Logistic regression model showed that students with lower social capital suffered a higher risk of smoking among both males among both males(OR=1.571,95%CI:1.226-2.014)and females(OR=1.803,95%CI:1.253-2.595).For males,social participation was not significantly correlated with smoking.However,students with smaller social network(OR=1.402,95%CI:1.102-1.784)and lower trust and reciprocity(OR=1.478,95%CI:1.146-1.907)had significant higher possibility of smoking.For females,social participation and social network had no significant influence on smoking.Female students with lower sense of trust and reciprocity(OR=1.269,95%CI:1.222-1.582)had significant higher possibility of smoking.Lower social interaction significantly protect male students from smoking(OR=0.762,95%CI:0.566-0.931),but it is not associated with smoking statistically among females(:0.532-1.159).There was no significant relationship between interactions in general public places interaction and smoking behaviors among both male students(OR=1.095,95%CI:0.855-1.403)and female students(OR=0.960,95%CI:0.642-1.436).For both males and females,lower religious places interaction(males:OR=0.694,95%CI:0.500-0.964;males:OR=0.474,95%CI:0.288-0.779)and lower entertaining places interaction(males:OR=0.471,95%CI:0.369-0.601;Females:OR=0.568,95%CI:0.382-0.844)significantly reduced the risk of smoking.(4)Structural equation model showed that social participation(male:?=0.001,p>0.05;female:?=-0.011,p>0.05)and social network(male:?=-0.042,p>0.05;female:?=-0.010,p>0.05)have no significant direct influences on smoking,but social participation(male:?=-0.026;female:?=-0.023)and social network(male:?=-0.106;?=-0.056)both reduce smoking indirectly through trust and reciprocity.No matter males or females,interaction in general public places could reduce the possibility of smoking(males:?=-0.270,P<0.001;females:?=-0.140,P<0.001).There is a significant positive correlation between social interaction in adult entertaining places and smoking(males:?=0.423,P<0.001);female:?=0.232,P<0.001).However,interaction in religious places have no significantly direct relationship with smoking in both males(?=0.070,P>0.05)and females(?=0.081,P>0.05).Gender differences exist on the relationship between social capital and smoking.For males,social interaction can significantly increase the probability of smoking behavior(males:?=0.193,P<0.05),while females'social interaction had no significant influences on smoking(females:?=0.160,P>0.05).Social capital appeared to regulate the relationship between mental disorder and smoking behavior among males,while this relationship was not statistically significant among females.ConclusionsSocial capital plays an important role in reducing the possibility of smoking among health professional students in China.However,there are a few differences on the mechanism between different dimensions of social capital and smoking behavior between genders.This study yields crucial insights on the role of social capital in smoking,providing basis for future research.Different measurements of social participation or social interaction may lead to different results and conclusions.Therefore,when researchers use the concept of social capital,they should pay attention to its measurement issues,avoiding over extension of meaning,improper use of the concept and wrong application of conclusions.In the context of Chinese culture,social interaction has both positive and negative influence on smoking behavior.During social interaction,especially for men,it is necessary to escape from smoking susceptibility environment exposure,to reduce the possibility of smoking behavior adoption.Trust and reciprocity are the core contents of social capital,which can effectively reduce the smoking rate,should be fully valued and applied in future tobacco control policy formulations and actions...