Many Young Urban Girls Today Smoke

Many Young Urban Girls Today Smoke

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PLoS One

PMC3150421

Published online 2011 Aug 4. doi: 10.1371/journal.pone.0023028

1
Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences, School of Basic Medicine of Peking Union Medical College, Beijing, China

2
Joint Doctoral Program in Public Health, San Diego State University/University of California San Diego, San Diego, California, United States of America

3
San Francisco Department of Public Health, San Francisco, California, United States of America

4
Chinese Center for Disease Control and Prevention, Beijing, China

5
Graduate School of Public Health, San Diego State University, San Diego, California, United States of America

Institute for Clinical Effectiveness and Health Policy (IECS), Argentina
Received 2011 Mar 17; Accepted 2011 Jul 8.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
Participant characteristics, restaurant/hotel workers (RHWs) and commercial sex workers (CSWs), China 2010.
Prevalence of current smoking among those rural-to-urban migrant women have ever tried smoking, China 2010.
Characteristics of current smokers, restaurant/hotel workers (RHWs) and commercial sex workers (CSWs), China 2010.
Correlates of having first tried smoking after coming to the city and current smoking a .
a Based on multiple logistic regression analysis.
b Among 1802 participants who had never tried smoking prior to migrating to the city.
c Among 594 participants who had ever tried smoking.
1. Gu D, Kelly TN, Wu X, Chen J, Samet JM, et al. Mortality attributable to smoking in China. N Eng J Med. 2009; 360 :150–159. [ PubMed ] [ Google Scholar ]
2. World Health Organization. WHO report on the global tobacco epidemic, 2009: implementing smoke-free environments. Geneva, Switzerland: WHO; 2009; 2009. [ Google Scholar ]
3. Global Adult Tobacco Survey. 2010. GATS Fact Sheet: China: 2010. [ http://www.cdc.gov/tobacco/global/gats/countries/wpr/fact_sheets/china/2010/pdfs/china_2010.pdf ]. Accessed April 15, 2011.
4. Chinese Academy of Preventive Medicine; Dept. of Disease Control Ministry of Health; Chinese Association of Smoking of Health; Office of Committee of the National Patriotic Health Campaign. Smoking and health in China -1996 National Prevalence Survey of Smoking Pattern. Beijing (China): China Science and Technology Press; 1997. [ Google Scholar ]
5. Yang GH. Deaths and their risk factors among Chinese population. Beijing (China): Union Medical University Press of China; 2005. [ Google Scholar ]
6. Department of Gender, Women and Health, Tobacco Free Initiative, World Health Organization. Sifting the evidence: gender and tobacco control. Geneva, Switzerland: WHO; 2007. [ Google Scholar ]
7. National Population and Family Planning Commission of P.R.China: [ http://www.chinapop.gov.cn/xwzx/rkxw/201006/t20100628_208418.html ]. Accessed April 15, 2011.
8. Blumenthal D, Hsiao W. Privatization and its discontents – the evolving Chinese health care system. N Engl J Med. 2005; 353 :1165–1170. [ PubMed ] [ Google Scholar ]
9. Ho MG, Shi Y, Ma S, Novotny TE. Perceptions of tobacco advertising and marketing that might lead to smoking initiation among Chinese high school girls. Tob Control. 2007; 16 :359–60. [ PMC free article ] [ PubMed ] [ Google Scholar ]
10. Taylor A, Chaloupka F, Guindon E, Corbett M. The impact of trade liberalization on tobacco consumption. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford, England: Oxford University Press; 2000. pp. 343–364. [ Google Scholar ]
11. World Health Organization. Women and health: today's evidence, tomorrow's agenda. Geneva, Switzerland: WHO; 2009. [ Google Scholar ]
12. Novotny TE, Levintova M, Lee K. An analysis of multinational tobacco industry efforts to stimulate the female smoker market in China. 2006. Paper presented at: World Conference on Tobacco or Health; July 12–15, 2006; Washington, DC.
13. Wright AA, Katz IT. Tobacco tightrope–balancing disease prevention and economic development in China. N Engl J Med. 2007; 356 :1493–1496. [ PubMed ] [ Google Scholar ]
14. Ho MG, Ma S, Chai W, Xia W, Yang G, et al. Smoking among rural and urban young women in China. Tob Control. 2010; 19 :13–18. [ PMC free article ] [ PubMed ] [ Google Scholar ]
15. Li X, Stanton B, Fang X, Lin D. Social stigma and mental health among rural-to-urban migrants in China: a conceptual framework and future research needs. World Health Popul. 2006; 8 :14–31. [ PMC free article ] [ PubMed ] [ Google Scholar ]
16. Finch K, Novotny TE, Ma S, Qin D, Xia W, et al. Smoking knowledge, attitudes, and behaviors among rural-to-urban migrant women in Beijing, China. Asia Pac J Public Health. 2010; 22 :342–353. [ PMC free article ] [ PubMed ] [ Google Scholar ]
17. Pierce JP, Choi WS, Gilpin EA, Farkas A, et al. Validation of susceptibility as a predictor of which adolescents take up smoking in the US. Health Psychol. 1996; 15 :355–361. [ PubMed ] [ Google Scholar ]
18. Yang T, Wu J, Rockett I, Abdullah A, Beard J, et al. Smoking patterns among Chinese rural-urban migrant workers. Public Health. 2009; 123 :743–749. [ PubMed ] [ Google Scholar ]
19. Chen X, Li X, Stanton B, Fang X, Lin D, et al. Cigarette smoking among rural-to-urban migrants in Beijing, China. Prev Med. 2004; 39 :666–673. [ PubMed ] [ Google Scholar ]
20. Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ. 2002; 325 :188. [ PMC free article ] [ PubMed ] [ Google Scholar ]
21. The Regulations on Cigarette Packaging and Labeling in the Territories of the People's Republic of China. [ http://www.tobacco.gov.cn/newspic2002/20080410-xw-ql2.doc ]. Accessed April 15, 2011.
22. Jiang Y, Fong GT, Li Q, Hammond D, Quah ACK, et al. Efectiveness evaluation of health warnings on cigarette packs in China, 2008. Chinese Journal of Health Education. 2009; 25 :411–413. (Article in Chinese) [ Google Scholar ]
23. Increasing tobacco taxes doesn't lead to increase the price of a pack of cigarettes. [ http://news.xhby.net/system/2009/06/22/010530027.shtml ]. Accessed April 15, 2011.
24. Chaloupka FJ, Hu TW, Warner KE, Jacobs R, Yurekli A. The taxation of tobacco products. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford, England: Oxford University Press; 2000. pp. 237–272. [ Google Scholar ]
25. Lynne EWagenknecht. Misclassification of smoking status in the CARDJA Study: a comparison of self-report with serum cotinine levels. Am J Public Health. 1992; 82 :33–36. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Articles from PLoS ONE are provided here courtesy of Public Library of Science
1. Gu D, Kelly TN, Wu X, Chen J, Samet JM, et al. Mortality attributable to smoking in China. N Eng J Med. 2009; 360 :150–159. [ PubMed ] [ Google Scholar ] [ Ref list ]
2. World Health Organization. WHO report on the global tobacco epidemic, 2009: implementing smoke-free environments. Geneva, Switzerland: WHO; 2009; 2009. [ Google Scholar ] [ Ref list ]
3. Global Adult Tobacco Survey. 2010. GATS Fact Sheet: China: 2010. [ http://www.cdc.gov/tobacco/global/gats/countries/wpr/fact_sheets/china/2010/pdfs/china_2010.pdf ]. Accessed April 15, 2011. [ Ref list ]
4. Chinese Academy of Preventive Medicine; Dept. of Disease Control Ministry of Health; Chinese Association of Smoking of Health; Office of Committee of the National Patriotic Health Campaign. Smoking and health in China -1996 National Prevalence Survey of Smoking Pattern. Beijing (China): China Science and Technology Press; 1997. [ Google Scholar ] [ Ref list ]
5. Yang GH. Deaths and their risk factors among Chinese population. Beijing (China): Union Medical University Press of China; 2005. [ Google Scholar ] [ Ref list ]
6. Department of Gender, Women and Health, Tobacco Free Initiative, World Health Organization. Sifting the evidence: gender and tobacco control. Geneva, Switzerland: WHO; 2007. [ Google Scholar ] [ Ref list ]
7. National Population and Family Planning Commission of P.R.China: [ http://www.chinapop.gov.cn/xwzx/rkxw/201006/t20100628_208418.html ]. Accessed April 15, 2011. [ Ref list ]
8. Blumenthal D, Hsiao W. Privatization and its discontents – the evolving Chinese health care system. N Engl J Med. 2005; 353 :1165–1170. [ PubMed ] [ Google Scholar ] [ Ref list ]
9. Ho MG, Shi Y, Ma S, Novotny TE. Perceptions of tobacco advertising and marketing that might lead to smoking initiation among Chinese high school girls. Tob Control. 2007; 16 :359–60. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
10. Taylor A, Chaloupka F, Guindon E, Corbett M. The impact of trade liberalization on tobacco consumption. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford, England: Oxford University Press; 2000. pp. 343–364. [ Google Scholar ] [ Ref list ]
11. World Health Organization. Women and health: today's evidence, tomorrow's agenda. Geneva, Switzerland: WHO; 2009. [ Google Scholar ] [ Ref list ]
13. Wright AA, Katz IT. Tobacco tightrope–balancing disease prevention and economic development in China. N Engl J Med. 2007; 356 :1493–1496. [ PubMed ] [ Google Scholar ] [ Ref list ]
14. Ho MG, Ma S, Chai W, Xia W, Yang G, et al. Smoking among rural and urban young women in China. Tob Control. 2010; 19 :13–18. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
15. Li X, Stanton B, Fang X, Lin D. Social stigma and mental health among rural-to-urban migrants in China: a conceptual framework and future research needs. World Health Popul. 2006; 8 :14–31. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
16. Finch K, Novotny TE, Ma S, Qin D, Xia W, et al. Smoking knowledge, attitudes, and behaviors among rural-to-urban migrant women in Beijing, China. Asia Pac J Public Health. 2010; 22 :342–353. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
17. Pierce JP, Choi WS, Gilpin EA, Farkas A, et al. Validation of susceptibility as a predictor of which adolescents take up smoking in the US. Health Psychol. 1996; 15 :355–361. [ PubMed ] [ Google Scholar ] [ Ref list ]
18. Yang T, Wu J, Rockett I, Abdullah A, Beard J, et al. Smoking patterns among Chinese rural-urban migrant workers. Public Health. 2009; 123 :743–749. [ PubMed ] [ Google Scholar ] [ Ref list ]
19. Chen X, Li X, Stanton B, Fang X, Lin D, et al. Cigarette smoking among rural-to-urban migrants in Beijing, China. Prev Med. 2004; 39 :666–673. [ PubMed ] [ Google Scholar ] [ Ref list ]
20. Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ. 2002; 325 :188. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
21. The Regulations on Cigarette Packaging and Labeling in the Territories of the People's Republic of China. [ http://www.tobacco.gov.cn/newspic2002/20080410-xw-ql2.doc ]. Accessed April 15, 2011. [ Ref list ]
22. Jiang Y, Fong GT, Li Q, Hammond D, Quah ACK, et al. Efectiveness evaluation of health warnings on cigarette packs in China, 2008. Chinese Journal of Health Education. 2009; 25 :411–413. (Article in Chinese) [ Google Scholar ] [ Ref list ]
23. Increasing tobacco taxes doesn't lead to increase the price of a pack of cigarettes. [ http://news.xhby.net/system/2009/06/22/010530027.shtml ]. Accessed April 15, 2011. [ Ref list ]
24. Chaloupka FJ, Hu TW, Warner KE, Jacobs R, Yurekli A. The taxation of tobacco products. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford, England: Oxford University Press; 2000. pp. 237–272. [ Google Scholar ] [ Ref list ]
25. Lynne EWagenknecht. Misclassification of smoking status in the CARDJA Study: a comparison of self-report with serum cotinine levels. Am J Public Health. 1992; 82 :33–36. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]

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1
Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences, School of Basic Medicine of Peking Union Medical College, Beijing, China

2
Joint Doctoral Program in Public Health, San Diego State University/University of California San Diego, San Diego, California, United States of America

1
Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences, School of Basic Medicine of Peking Union Medical College, Beijing, China

3
San Francisco Department of Public Health, San Francisco, California, United States of America

4
Chinese Center for Disease Control and Prevention, Beijing, China

2
Joint Doctoral Program in Public Health, San Diego State University/University of California San Diego, San Diego, California, United States of America

1
Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences, School of Basic Medicine of Peking Union Medical College, Beijing, China

4
Chinese Center for Disease Control and Prevention, Beijing, China

5
Graduate School of Public Health, San Diego State University, San Diego, California, United States of America

Conceived and designed the experiments: TEN XW SSS HFR DD GY. Performed the experiments: XW QW HL. Analyzed the data: XW QW SSS. Wrote the paper: XW SSS TEN. Funding and research supervision: TEN. Arranged for training by consultants: TEN. Designed and edited questionnaires: DD. Trained interviewers in hand-held data collection: HFR QW HL. Supervised and accessed research sites: GY.
Rural-to-urban migrant women may be vulnerable to smoking initiation as they are newly exposed to risk factors in the urban environment. We sought to identify correlates of smoking among rural-to-urban migrant women in China.
A cross-sectional survey of rural-to-urban migrant women working in restaurants and hotels (RHW) and those working as commercial sex workers (CSW) was conducted in ten provincial capital cities in China. Multiple logistic regression was conducted to identify correlates of smoking. We enrolled 2229 rural-to-urban migrant women (1697 RHWs aged 18–24 years and 532 CSWs aged 18–30 years). Of these, 18.4% RHWs and 58.3% CSWs reported ever tried smoking and 3.2% RHWs and 41.9% CSWs reported current smoking. Participants who first tried smoking after moving to the city were more likely to be current smokers compared to participants who first tried smoking before moving to the city (25.3% vs. 13.8% among RHWs, p = 0.02; 83.6% vs. 58.6% among CSWs, p = <0.01). Adjusting for other factors, “tried female cigarette brands” had the strongest association with current smoking (OR 5.69, 95%CI 3.44 to 9.41) among participants who had ever tried smoking.
Exposure to female cigarette brands may increase the susceptibility to smoking among rural-to-urban migrant women. Smoke-free policies and increased taxes may be effective in preventing rural-to-urban migrant women from smoking initiation.
The tobacco epidemic in China is responsible for an enormous burden of disease and poses a significant challenge to the country's public health system [1] . China ratified the Framework Convention on Tobacco Control (FCTC) in 2005 and has begun to implement a number of tobacco control measures [2] . However, due to low prevalence of smoking among women; little attention has been given to tobacco prevention in this population. According to the nationally representative Global Adult Tobacco Survey conducted in China in 2010, the estimated prevalence of current smoking was 2.4% among women, which corresponds to about 15 million female smokers in China [3] . However, the national tobacco survey results in 1996 and 2002 show the proportion of young females smoking increasing, especially among women aged 15–19 [4] , [5] . While male smoking rates have peaked and are in slow decline, female smoking rates are still rising [6] . There is a need for ongoing monitoring and research on tobacco use among women in China, particularly among vulnerable segments of the population, such as rural women who migrate to urban centers for employment.
In 2009, there were approximately 211 million rural-to-urban migrants in China and 49.6% were women [7] . These women may be vulnerable to risky health behavior as they are newly exposed to risk factors in the urban environment. In recent years, the social and economic environment in Chinese cities has been rapidly changing, and potentially associated with increased susceptibility to smoking among young women [8] . For example, changing gender norms may have significantly weakened the previously widespread social stigma against smokers among women. A recent qualitative study of female high school students suggests that smoking among women has become increasingly socially acceptable [9] . A typical response among participants was “smoking is quite normal—if men can smoke, then why can't women?” Historically, trans-national tobacco companies have exploited social change and increasing affinity to Western culture in low and middle income countries to expand the market for cigarette products among youth and women [10] . In fact, a study of multi-national tobacco company documents revealed plans to target Chinese women as a major, previously-untapped market for expansion of tobacco products [11] – [13] . Tobacco industry marketing efforts targeting young women include the introduction of candy-flavored cigarettes and women-specific brands [11] – [13] . A recent study has shown that exposure to women-specific cigarette brands is associated with a higher prevalence of smoking among young Chinese women [14] .
For rural-to-urban migrants, navigating life in the urban environment is often a source of psychosocial stress which,
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