Urban chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: Results from the international tobacco control-china survey

Introduction: Research findings on social disparities in barriers to quitting faced by smokers from mainly Western Englishlanguage countries may or may not generalize to smokers in China. This paper sought to determine whether nicotine dependence, quitting self-efficacy, quitting interest differ by socio-economic status (SES), and whether they mediate the relationship between SES and quitting behavior of urban Chinese smokers. Methods: Data come from 7,309 adult smokers who participated in the first 3 waves of the International Tobacco Control-China survey conducted in 7 cities across China. The association of socio-economic indicators with nicotine dependence, quitting self-efficacy, quitting interest, and behavior was evaluated using generalized estimating equations models along with a formal test of mediational effects. Results: The SES index indicated that those from lower SES were significantly more addicted (p <.001), less confident (p <.001), and less interested in quitting (p <.05). This finding was replicated by education and employment status, but it was not clearly related to income. Mediational analyses revealed that the effects of SES on making quit attempts and quit success among those who tried were indirect. For quit attempts, self-efficacy, interest to quit, and heaviness of smoking index (HSI) were all significant mediators of the SES effect (p <.001), but for maintenance, only HSI was a significant mediator (p <.001). Conclusions: Urban Chinese smokers from lower socio-economic backgrounds experience greater levels of psychological and behavioral barriers to quitting than their counterparts from higher socio-economic backgrounds and as such, they need more help to quit and do so successfully.