BACKGROUND: Cigrarette sharing, a China-specific social norm, has not been assessed at the provincial level or analyzed the degree of its association with smoking cessation in China. Such analysis would provide critial intelligence to make evidence-based tobacco control practices more culturally sensitive and targeted.
METHODS: Using the data of 120,220 adults from the China National Adult Tobacco Survey, we estimated the prevalence of past 30-day cigarette sharing for 31 provinces of China in 2022 accounting for the complex sampling design and created choropleth maps to visualize its geographical patterning by smoking status. We fitted two-level mutivariable regression models to examine the association between cigarette sharing and quit intention,cessation and relapse, respectively.
RESULTS: In 2022, the estimated prevalence of past 30-day cigarette sharing was 21.2% among the Chinese adult population, highest among current smokers (72.0%), followed by former smokers (13.6%), and lowest among never smokers (4.3%). There were wide geographical differences in the prevalence of cigarette sharing among provinces, ranging form 7.1% (Tibet) to 32.4% (Hubei). Among current and former smokers, provinces with higher prevalence of sharing were clustered in the central, southeast and south with denser populations or more developed economies. Among never smokers, the prevalence of sharing was higher in central and north provinces, while lower in economically developed coastal provinces and underdeveloped provinces. Cigarette sharing was negatively associated with quit intention and cessation and positively associated with relapse adjusting for potential covariates.
CONCLUSIONS: In China, cigarette sharing varies geographically, with notable differences in geographic patterns between ever smokers and never smokers. Cigarette sharing is negatively associated with smoking cessation, especially among light smokers, and positively linked to relapse. Therefore, improving public health education to change social norms around cigarette sharing is urgent. Implementing targeted policies such as graphic health warnings on cigarette package to reduce sharing and thereby promote cessation.