Analysis On Smoking Rationalization Belief And Its Influencing Factors Among Male Smokers In Shanghai

Objectives To study the current status and its influencing factors of smoking rationalization belief among male smokers in Shanghai, and to provide evidence for developing innovative and effective tobacco control strategies.Methods This study was conducted through a cross-sectional survey. Focus group interviews and individual interviews were conducted in three cities to collect the smoking rationalization beliefs. A scale of rationalizing beliefs was developed on the base of qualitative interview. The questionnaire was applied among adult male smokers from three districts through occupational population proportion sampling. The questionnaire covered information on demographics, smoking status, smoking rationalization belief scale, smoking related knowledge as well as social norms. Statistical analysis methods included factor analysis, structural equation model (exploratory factor analysis), variance analysis, multiple linear regression and logistic regression analysis.Results(1) The smoking rationalization belief scale was composed of 33 items, which was separated into 6 dimensions:Smoking benefits belief, Skeptic&Bulletproof belief, Social environment belief, harm reduction belief, Cessation harms belief, Jungle belief. The Cronbach’ s a coefficient of the whole scale was 0.939, while the Cronbach’s a coefficients of the 6 dimensions were between 0.762-0.858. The test-retest Pearson coefficient was 0.739 (P<0.01).The result of confirmatory factor analysis showed:RMSEA was 0.058; x 2/df=3.22;NFI, IFI and CFI were more than 0.9.(2) Multiple linear regression analysis showed that age was the main affecting factor in the six dimensions of the scale. Elder age was significantly associated with higher smoking rationalization belief scores in six dimensions (P<0.001).Besides, marital status, average personal monthly household income and education degree were positively associated with smoking rationalization belief scores. Compared to married smokers, Unmarried smokers had higher score in Skeptic&Bulletproof belief and Cessation harms belief. Smokers with lower average household income had higher Skeptic & Bulletproof belief and Harm reduction belief.(3) The logistic regression analysis between smoking rationalization belief scores and smoking status/social support factors/social environmental factors found that:smoking rationalization belief scores were significantly higher among those smokers who were heavily addicted to nicotine and had low intention to quit(P<0.001). Smokers with higher proportion of smoking cessation around, the more frequently criticized for smoking behavior and been persuaded to quit by people around, the more likely to have lower smoking rationalization score. Smoking rationalization belief scores were significantly higher among those who were allowed to smoke in home and workplace (P<0.001).Conclusion (1) The smoking rationalization belief scale developed in this study had high reliability and consistency and could be applied to evaluate the smoking rationalization belief of smokers; (2) Smoking rationalization belief were related to age.marital status, income and education. (3) Social support around smokers and smoke-free home & workplace would have an positive impact in reducing smoking rationalization belief.