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• Cultural considerations for tobacco control strategies in rural China
  Diana M. Sheehan
  Published on: 13 May 2016

• Published on: 13 May 2016

  Cultural considerations for tobacco control strategies in rural China

  • Diana M. Sheehan, Research Fellow

  NOT PEER REVIEWED Dear Editor,

  The recent article by Cai et al, reported that male gender, young age, low educational attainment, and tobacco cultivation are predictors of tobacco use and second-hand smoke (SHS) exposure in rural China [1]. Neighborhood-level income was the only contextual predictor of tobacco use and SHS exposure identified. Hence, the authors suggested that "future interventions to reduce smo...

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  NOT PEER REVIEWED Dear Editor,

  The recent article by Cai et al, reported that male gender, young age, low educational attainment, and tobacco cultivation are predictors of tobacco use and second-hand smoke (SHS) exposure in rural China [1]. Neighborhood-level income was the only contextual predictor of tobacco use and SHS exposure identified. Hence, the authors suggested that "future interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities." (pg. ii19)

  Nevertheless, Cai and colleagues also found that the Han majority had higher prevalence of smoking and SHS exposure when compared to ethnic minorities (p<0.05). Differences in health outcomes and risk factors have been reported among the Han population when compared to other Chinese ethnic minorities [2,3]. Stratified analysis might elucidate unique risk factors to smoking and SHS exposure between ethnic groups important for the design of tobacco control strategies.

  In addition, Cai et al. showed that townships varied widely in the proportion of the population who were ethnic minorities (3.1% to 97.1%). In the study of contextual determinants of health, results and implications should not ignore such vast differences in ethnic composition between areas. Important information might be conveyed if results were stratified by the proportion of ethnic minorities in the area (e.g. high, medium, low). Ethnic minorities living in areas with a high proportion of the population of the same ethnic minority may experience better health [4]. Therefore, it might also be important to compare the risk of smoking and SHS exposure among individuals living in areas highly populated by their ethnic group versus those residing in areas where they are the minority group.

  Cultural differences and ethnic composition of a geographic area should be considered in the design and implementation of tobacco control programs and in the allocation of resources. Resources may be better spent in areas with a high proportion of the Han population; while areas with a high minority population may be at decreased risk. Interventions should be culturally appropriate to minimize the expenditure of resources on ineffective strategies.

  Diana M. Sheehan, MPH

  References

  1. Cai L, Wu X, Goyal A, et al. Multilevel analysis of the determinants of smoking and second-hand smoke exposure in a tobacco- cultivating rural area of southwest China. Tob Control 2013;22(suppl2):ii16-20.

  2. Ruixing Y, Hui L, Jinzhen W, et al. Association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations. Public Health Nutr 2009;12(4):553-561.

  3. Sun H, Zhang Q, Luo X, et al. Changes of adult population health status in China from 2003 to 2008. PLoS One 2011;6(12):e28411.

  4. Inagami S, Borell LN, Wong MD, et al. Residential segregation and Latino, black and white mortality in New York City. J Urban Health 2006;83(3):406-20.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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