Socioeconomic disparities in smoking prevalence among adults in China

Background. Although socioeconomic disparities in smoking have been well documented in Western countries, this issue remains under-investigated in China. This dissertation aims to provide insights into this key tobacco control issue for China by 1) describing the pattern of socioeconomic disparities in smoking prevalence in China; and 2) examining if communication inequality accounted for educational disparities in smoking cessation in China.;Method. Data from the Chinese 2002 National Behavior Risk Factor Surveillance survey were used to describe socioeconomic disparities in smoking and data from a smoking survey in 1998 were used to examine communication inequality and educational disparities in smoking cessation. Multivariate log binomial and logistics regression models using the generalized estimating equations (GEE) method were employed in the data analysis.;Results. The current smoking prevalence for males at the lowest end of the educational hierarchy was 26 percent (Relative Index of Inequality [RII]=1.26; 95% confidence interval (CI) =1.07, 1.49) or 8.66 percentage points (Slope Index of Inequality [SII1= 8.66; 95%CI=1.47, 15.85) higher than the prevalence for those at the very top of the educational hierarchy. Compared with those smokers with less than primary school education, those with college or high education were 1.58 times [Rate Ratio (RR)=1.58, 95% CI=1.17, 2.15] more likely to have a quit desire and were 2.29 times [Odds Ratio (OR)=2.29, 95%CI=1.55, 3.37] more likely to be former smokers. Highly educated smokers were more likely to be exposed to anti-smoking mass media campaigns and had more smoking related knowledge. Among less-educated smokers, the adjusted OR of being former smokers was1.51 (95%CI=1.18, 1.93), comparing those who reported having seen/heard anti-smoking messages on three or four types of media with those who had never been exposed to media campaigns. Among more-educated smokers, the adjusted OR of being former smokers was 3.01 (95%CI=1.51, 6.01).;Conclusions. Educational disparities but no income disparities were found in smoking prevalence in Chinese men. Communication inequality may partially explain these disparities. Along with other targeted smoking cessation services, tailored media campaigns designed to meet the literacy and motivational needs of various populations, especially of those with lower educational levels, are recommended to reduce smoking disparities and smoking prevalence as a whole.