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A Cross-Sectional Survey on Prevalence and Behaviour of Smokeless Tobacco Use Among Tobacco Users in China

Yaning Fu
Yaning Fu
, 
Huan Chen
Huan Chen
, 
Saijing Zheng
Saijing Zheng
, 
Sen Zhang
Sen Zhang
, 
Yichun Zhang
Yichun Zhang
, 
Daiwei Yan
Daiwei Yan
, 
Hongjuan Wang
Hongjuan Wang
, 
Shulei Han
Shulei Han
, 
Yushan Tian
Yushan Tian
, 
Yingyan Li
Yingyan Li
, 
Guoyu Li
Guoyu Li
, 
Tong Liu
Tong Liu
, 
Huimin Zhao
Huimin Zhao
, 
Yue Su
Yue Su
, 
Hongwei Hou
Hongwei Hou
 y 
Qingyuan Hu
Qingyuan Hu
   | 28 sept 2023
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Publicado en línea: 28 sept 2023
Páginas: 101 - 112
Recibido: 15 oct 2022
Aceptado: 14 jul 2023
DOI: https://doi.org/10.2478/cttr-2023-0011
Palabras clave
© 2023 Yaning Fu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1.

Analysis of the self-reported use occasions of ST in China based on city tiers, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201).
Analysis of the self-reported use occasions of ST in China based on city tiers, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201).

Figure 2.

Factors influencing the preference for ST producing areas. 
Factors influencing the preference for ST producing areas. 

Figure 3.

Analysis of the first opportunity to try using ST for Chinese smokers based on the city level, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201)
Analysis of the first opportunity to try using ST for Chinese smokers based on the city level, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201)

Figure 4.

Analysis of the main reason of ST use for Chinese smokers based on the city level, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201)
Analysis of the main reason of ST use for Chinese smokers based on the city level, age, and sex.(Total participants, n = 801; First-tier city, n = 400; Second-tier city, n = 401; 18–29 years, n = 176; 30–39 years, n = 427; 40–60 years, n = 198; Male, n = 600; Female, n = 201)

Prevalence of various types of tobacco products.

Category City tier Age group Sex
All (%) First-tier (%) Second-tier (%) Third-tier (%) 18–29 (%) 30–39 (%) 40–60 (%) Male (%) Female (%)
Cigarette 91.5 95.1 89.2 90.2 93.2 90.3 90.8 91.4 91.8
E-cigarette 18.5 21.7 19.6 14.1 21.8 18.1 11.4 16.3 25.0
Cigar 9.8 13.1 9.7 6.6 8.7 10.9 9.7 9.8 9.9
Heated tobacco product (HTP) 3.4 3.9 3.4 2.9 3.1 3.9 2.8 3.0 4.6
Waterpipe 2.7 2.1 3.1 3.0 2.3 3.0 3.0 2.8 2.4
Roll-your-own cigarette 2.6 1.9 3.0 3.0 2.7 2.7 2.6 2.6 2.8
Tobacco pipe 2.3 0.9 2.9 3.2 1.9 2.1 4.4 2.6 1.6
Smokeless tobacco (ST) 2.1 2.8 2.5 0.9 2.1 2.0 2.1 1.9 2.6
Number of participants 3000 1000 1000 1000 1156 1361 483 2246 754

User concerns about smokeless tobacco (ST) products.

Category All (%) City Tier Age category (years) Sex
First-tier (%) Second-tier (%) 18–29 (%) 30–39 (%) 40–60 (%) Male (%) Female (%)
Taste and feel 49.2 44.7 53.6 40.3 51.0 54.3 52.1 40.2
Convenience of carrying 38.5 42.2 35.0 46.7 37.8 32.4 38.5 41.5
Taste 38.1 34.3 42.5 35.4 38.0 40.2 39.3 35.5
Word-of-mouth 36.3 41.0 32.3 52.7 31.2 33.3 34.8 44.3
Brand 23.8 28.1 18.4 30.1 23.1 21.6 23.0 25.2
Ease of purchase 23.0 18.5 27.3 18.4 25.7 23.0 26.4 14.9
Physiological strength (nicotine content) 21.8 24.3 20.6 21.1 22.8 22.2 24.2 16.0
The smell of the product before use 20.2 18.1 23.2 18.0 18.3 27.8 20.1 21.2
Production place 19.5 24.6 14.4 30.9 20.7 10.5 17.5 26.1
Package 15.9 18.5 14.1 16.7 15.1 18.3 18.9 10.7
Pipe shape 11.1 12.3 10.0 10.6 11.2 12.1 12.3 9.6
Overall (number) 801 400 401 176 427 198 600 201

Nicotine content preference for smokeless tobacco (ST) products.

Nicotine content (mg/g) All (%) City tier Age category (years) Sex
First-tier (%) Second-tier (%) 18–29 (%) 30–39 (%) 40–60 (%) Male (%) Female (%)
41–50 3.5 1.0 4.8 1.3 3.6 2.3 2.2 6.2
31–40 0.8 0.0 1.1 0.0 1.4 1.2 0.0 2.7
21–30 9.9 7.0 13.1 9.5 7.9 13.8 11.0 6.1
11–20 27.5 24.7 30.8 32.2 27.2 26.0 31.0 16.8
1–10 58.6 67.3 50.2 57.0 60.9 55.7 55.8 69.2
Average (mg/g) 11.54 10.00 13.10 10.53 11.43 12.69 11.64 11.27
Overall (number) 801 400 401 176 427 198 600 201

Degree of nicotine dependence based on the Fagerström Test for Nicotine Dependence - Smokeless Tobacco (FTND-ST).

Degree of dependence All City tier Age category (years) Sex
First-tier (%) Second-tier (%) 18–29 (%) 30–39 (%) 40–60 (%) Male (%) Female (%)
Very low 9.4 12.7 7.4 4.0 14.1 4.0 10.8 5.0
Low 21.0 19.0 22.2 16.5 20.6 25.8 23.0 14.9
Moderate 19.9 20.3 19.6 16.5 22.5 17.2 16.8 28.9
High 43.3 43.7 43.1 55.1 36.3 48.0 41.3 49.3
Extremely high 6.5 4.3 7.8 8.0 6.6 5.1 8.1 2.0
Average score 5.29 5.14 5.38 5.90 5.03 5.30 5.20 5.56
Overall (number) 801 400 401 176 427 198 600 201

Proportion of mixed use of different tobacco products.

Category Dual use (%) Triple use (%)
Cigarette 57.60 / 63.48 60.77 39.10 53.56
E-cigarette / 42.50 36.52 / 29.10 24.62
Smokeless tobacco (ST) 42.40 57.50 / / 31.70 /
Heated tobacco product (HTP) / / / 39.03 / 21.82

Composition of smokeless tobacco (ST) users.

Characteristics of tobacco users Category Users (%) Non-users (%)
Sex Female 32.1 25.0
Male 67.9 75.0
Age 18–29 years 30.6 38.7
30–39 years 53.3 45.2
40–60 years 16.1 16.1
Household income (per month) < 10,000 RMB (< 1,533 USD) 3.2 18.2
10,000–19,999 RMB (1,533–3,065 USD) 45.1 46.6
20,000–29,999 RMB (3,065–4,598 USD) 46.8 27.2
> 30,000 RMB (> 4,598 USD) 4.8 7.9
Education College degree below 8.5 0.2
College degree 18.5 5.2
Bachelor degree 65.3 84.9
Master degree or above 7.7 9.7
Total (number) 62 2938
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