Association Between Secondhand Smoke Exposure Among Women and the Implementation of Tobacco Control Measures on Campus: A Cross-Sectional Study in 50 Universities Across China.

INTRODUCTION: Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China. AIMS AND METHODS: 7469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policies reported the implementation of smoke-free policies on campus measured by: (1) no evidence of smoking and (2) the display of smoke-free signs in public places. Multivariate logistic regression models were applied using weighted survey data. RESULTS: SHS exposure among participants was 50.5% (95% CI = 44.2% to 56.9%). The adoption of a smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI = .71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI = .47 to 0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI = 1.42, 3.82; OR: 1.52; 95% CI = 1.15, 2.02, respectively). CONCLUSIONS: Exposure to SHS is prevalent among female college students in China. Successful implementation of a smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China. IMPLICATIONS: Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.

The toxic gift: reciprocity and social capital in cigarette exchange in China.

The widespread exchange of tobacco cigarettes as a gift in some societies normalises the symbolic desirability of tobacco products and promotes smoking. Little is known about how and why people exchange toxic substances as gifts. This study argues two key factors involved in social exchange processes - reciprocity and social capital - can explain gift cigarette circulation. We conducted a multistage survey among household heads from China and measured the quantity and monetary values of outgoing and incoming gift cigarettes circulated by each household and measured social capital in three dimensions: collective participation, social ties, and trust. Ordinary Least Square regressions showed that reciprocity is strongly and significantly associated with both the value and quantity of gift cigarettes. All three dimensions of social capital are varyingly associated with gifting cigarettes. Income and higher classes are also associated with greater quantity and value of received cigarettes. This study broadens the phenomenon of gifting cigarettes to the more universal patterns of reciprocity and social capital, wherein better social capital and socioeconomic position ironically lead to a higher risk of tobacco use and endanger health. We suggest policymakers target the endemic social need for gift exchange in China's informal economy.

Association of Excessive WeChat Use with Mental Disorders: A Representative Nationwide Study in China.

OBJECTIVES: We examined associations between excessive WeChat use and mental disorders at the individual and contextual level. METHODS: We conducted a representative nationwide survey sampling process of 11,283 medical students from 30 universities in China. Mental health status was measured by the Chinese Health Questionnaire. Both unadjusted and adjusted methods were considered in the analyses. RESULTS: High frequency and long-time use prevalence was 19.1% and 31.2% respectively among WeChat users. The multilevel logistic regression model found that individual-level high frequency (OR = 1.26) and long-time use (OR = 1.24) were significantly associated with mental health disorders. University-level excessive WeChat use also was associated with the mental disorders (OR = 1.33 [high frequency use]; OR = 1.17 [long-time use]). Structural equation analysis showed that individual- and university-level high frequency and individual-level and university-level long-time WeChat use have a direct influence on poor mental health. The above variables, except individual-level long-time use, have an indirect influence on poor mental health through mental stress. CONCLUSIONS: This study provides new evidence that excessive WeChat use is associated with mental disorders. These findings underscore the importance of alerting people to the possible health risks of excessive social media use.

Social deprivation and secondhand smoke exposure among urban male residents: A nationwide study in China.

INTRODUCTION: Social deprivation is a known determinant of health and related behaviors. Many studies have linked socioeconomic factors to secondhand smoke (SHS) exposure. However, no studies have examined the relationship between social deprivation and SHS exposure. This study examined whether contextual social deprivation - variously based on living in a house without a car, that was overcrowded, or had an unemployed member (s) - had an independent association with SHS exposure at both individual and regional levels among Chinese residents. METHODS: A cross-sectional multistage sampling design was utilized to interview subjects from 6 selected cities in China. A standardized questionnaire selected sociodemographic characteristics, contextual social deprivation and SHS exposure. Multilevel logistic regression models were used to assess the association between social deprivation and SHS exposure. RESULTS: A total of 5782 valid questionnaires were collected in this study. Among 2930 non-smokers, the SHS exposure prevalence was 21.9% (95% CI: 19.5- 24.30). Multilevel logistic regression showed a negative association between household income, regional GDP, and SHS exposure, respectively, and positive associations between contextual social deprivation and SHS exposure. CONCLUSIONS: Findings support the central proposition that contextual social deprivation must be factored into SHS exposure messages. Our research underscores the importance of reducing health inequality in controlling SHS exposure.

The Two Faces of Diversity: The Relationships between Religious Polarization, Religious Fractionalization, and Self-rated Health.

A dominant discourse in the social sciences theorizes that religious diversity puts individuals' health at risk via interreligious hostility. However, this discourse overlooks the different subtypes of religious diversity and the moderation of political institutions. To better understand the issue of diversity and health, in this study, we distinguish between two subtypes of religious diversity-polarization and fractionalization-and argue that their impacts on health are heterogeneous. Using a sample of 67,399 individuals from 51 societies drawn from the 2010-2014 wave of the World Values Survey, our multilevel analyses show that religious polarization is negatively associated with individual health, whereas the health effects of religious fractionalization are positive. Moreover, the associations between religious polarization/fractionalization and individual health are found to depend on the democratic level of the state. In more democratic countries, the negative effects of polarization on health are mitigated, and the positive effects of fractionalization are stronger.

Individual and regional association between socioeconomic status and uncertainty stress, and life stress: a representative nationwide study of China.

BACKGROUND: Many studies have examined the association between socioeconomic status (SES) and mental stress. Uncertainty stress is a prominent aspect of mental stress. Yet no research has ever empirically analyzed the impact of SES on uncertainty stress. METHODS: Students were identified through a multistage survey sampling process including 50 universities. Each student participant completed the Global Health Professions Student Survey (GHPSS) on Tobacco Control in China. Regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were considered in the analyses. RESULTS: Among the 11,942 participants, severe uncertainty stress prevalence was 19.6%, while severe life stress prevalence was 8.6%. Multilevel logistic regression showed that most SES variables were associated with uncertainty stress. Students with "operation and commercial work" as mother's occupation and "rural or township" as family location exhibited a higher prevalence of severe uncertainty stress. Lower family income and original region gross domestic products (GDP) were also associated with higher severe uncertainty stress prevalence. However, only father's occupation was correlated with life stress. CONCLUSIONS: Based on the literature review, this is the first empirical study examining the impact of SES on uncertainty stress in China and elsewhere in the world. Our research underscores the importance of decreasing socioeconomic inequalities in controlling excessive uncertainty stress.

How community-level social and economic developments have changed the patterns of substance use in a transition economy?

Most social changes take place at the community level before indirectly affecting individuals. Although the contextual effect is far-reaching, few studies have investigated the important questions of: how do community-level developments affect drinking and smoking, and how do they change the existing gender and income patterns of drinking and smoking, particularly in transition economies? In this study, I used a Chinese panel dataset between 1991 and 2011 to reveal the moderating effects of community developments. Through multilevel growth curve modeling that controls for age, period, and cohort effects, as well as individual- and community-level covariates, I found that community-level economic development and social development are negatively associated with drinking and smoking. Moreover, economic and social developments also moderate the important influences of income and gender: women start to drink more in communities with higher economic development; the traditionally positive association between income and smoking/drinking is also reversed, i.e. the rich start to smoke and drink less in communities with higher social development. This study concludes that the rapid changes in communal social and economic structures have created new health disparities based on the gender and socioeconomic hierarchy.

Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study.

OBJECTIVE: This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates. METHOD: A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates. RESULTS: Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders. CONCLUSIONS: Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

Violent injuries and regional correlates among women in China: results from 21 cities study in China.

BACKGROUND: Ecological models depict violent injuries against women being influenced by both individual and environmental characteristics. However, only few studies examined the association between regional variables and the likelihood of violent injuries. Our study is a preliminary assessment of the impact of regional variables on the likelihood that a woman has experienced violent injuries. METHODS: Participants were 16 866 urban residents, who were identified through a multi-stage sampling process conducted in 21 Chinese cities. Out of the sampled population, 8071 respondents were female. Subsequent analyses focused solely on the female sample. Multilevel logistic regression analyses were performed to examine regional variation in violent injuries. RESULTS: Prevalence of violent injuries against women is 10.7% (95% CI: 7.8%, 15.5%). After controlling for individual-level characteristics, higher regional male-female ratio (OR: 1.97, P < 0.05), population growth rate (OR: 4.12, P < 0.01) and unemployment rate (OR: 2.45, P < 0.01) were all associated with an elevated risk of violent injuries among Chinese women caused by physical attack. CONCLUSIONS: The results suggest violent injuries among Chinese women caused by physical attack have become an important social and public health problem. The findings point to the importance of developing effective health policies, laws and interventions that focuses on the unequal economic development between different regions.

Socioeconomic inequalities and mental stress in individual and regional level: a twenty one cities study in China.

OBJECTIVES: This study will examine explanatory variables including socioeconomic inequalities related to mental stress at both the individual and regional level. METHODOLOGY: A cross-sectional multistage sampling process was used to obtain participants. Data on mental stress and individual socioeconomic status were gathered via face to face interview. Regional variables were retrieved from a national database. Multilevel logistic regression analysis was used to assess socioeconomic variances in mental stress. RESULTS: Among the 16,866 participants, 27.2% reported severe levels of mental stress (95% CI: 19.4%-35.1%). Multilevel regression analysis indicated that lower individual educational attainment and income, and lower regional Per Capita GDP was associated with mental stress. The results also indicated that managers, clerks, and professional workers manifested higher stress levels than those in other occupations. CONCLUSIONS: Based on the results of this study individual and regional socioeconomic inequalities in China are associated with mental stress.

The impact of regional economic reliance on the tobacco industry on current smoking in China.

The purpose of this study was to conduct a preliminary assessment of province of residence and other contextual factors on the likelihood of being a current smoker in China. A cross-sectional, multistage sampling process was used to recruit participants, and their smoking status and sociodemographic characteristics were obtained through face-to-face interviews. The contextual variables were retrieved from a national database. Multilevel logistic regression analysis was performed to assess the impact of provincial economic reliance on the tobacco industry, as well as individual-level characteristics, on the likelihood of being a current smoker. Participants totaled 20,601 from 27 cities located in 26 of the 31 municipalities/provinces in China. Overall smoking prevalence was 31.3% (95% CI: 19.3-33.2%), with rates being highest in Yinchuan City in Ningxia Province (49.8%) and lowest in Shanghai (21.6%). The multilevel analysis showed an excess likelihood of being a current smoker for individuals living in provinces with the highest rate of cigarette production relative to those with the smallest (p<0.001). Findings underscore the importance of restricting cigarette production and regulating the marketing of tobacco products in China.

The influence of self-exempting beliefs and social networks on daily smoking: a mediation relationship explored.

The decision to initiate, maintain, or quit cigarette smoking is structured by both social networks and health beliefs. Self-exempting beliefs affect people's decisions in favor of a behavior even when they recognize the harm associated with it. This study incorporated the literatures on social networks and self-exempting beliefs to study the problem of daily smoking by exploring their mediatory relationships and the mechanisms of how smoking behavior is developed and maintained. Specifically, this article hypothesizes that social networks affect daily smoking directly as well as indirectly by facilitating the formation of self-exempting beliefs. The sample comes from urban male residents in Hangzhou, China randomly selected and interviewed through multistage sampling in 2011. Using binary mediation analysis with logistic regression to test the hypotheses, the authors found that (a) daily smoking is associated with having smokers in several social network arenas and (b) self-exempting beliefs about smoking mediate the association between coworker network and daily smoking, but not for family network and friend network. The role of social network at work place in the creation and maintenance of self-exempting beliefs should be considered by policymakers, prevention experts, and interventionists.

Impact of role models and policy exposure on support for tobacco control policies in Hangzhou, China.

OBJECTIVES: To examine how expectations of role models concerning smoking and exposure to tobacco control policies are associated with people's support for smoking bans. METHODS: Face-to-face interviews were conducted using multistage sampling. Employed structural equation modeling to examine the relationships and multi-group analysis to compare cross-group difference between smokers and non-smokers. RESULTS: Expectations of role models were found to be significantly associated with support for FCTC policies related to smoking. Policy exposure indirectly relates to policy support. Cross-group differences between smokers and non-smokers were not significant. CONCLUSION: Expectations of role models are strong predictors of support for FCTC tobacco control policy among Chinese urban residents; policy exposure is associated with policy support indirectly through the influence of expectations of role models. Policymakers should utilize social roles to promote tobacco control measures.