Changing Patterns of Willingness and Cessation Behavior Among Chinese Smokers Aged 15 and Above — China, 2010–2024

Yi Nan¹; Huiyu Xie¹; Jiani Tong¹; Zi Xi¹; Lin Xiao^1,#

1. Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Lin Xiao, xiaolin@chinacdc.cn.

To evaluate the effectiveness of tobacco control efforts, we conducted a comprehensive analysis of trends in smoking cessation willingness and behavior among Chinese smokers from 2010 to 2024. Data were obtained from the 2010 Global Adult Tobacco Survey (GATS)-China Project and the National Adult Tobacco Survey (NATS) conducted in 2018, 2022, and 2024. All surveys employed multistage stratified cluster random sampling of the Chinese population aged 15 years and above. Complex sampling analysis was performed for calculations, and trend analysis was conducted using the Cochran-Armitage trend test. From 2010 to 2024, cessation behavior among Chinese smokers increased significantly. Cessation rates rose from 16.88% to 22.65%, and the proportion of smokers who attempted to quit in the past 12 months increased from 14.37% to 24.75%. The proportion of smokers planning to quit within 12 months increased from 16.10% to 21.61% from 2010 to 2022, but dropped to 16.07% in 2024. Over the 14-year period, cessation rates and quit attempts increased significantly across almost all demographic groups. However, from 2022 to 2024, cessation rates among daily smokers declined while the proportion of those willing to quit decreased. Occasional smokers consistently demonstrated higher cessation rates, quit attempts, and willingness to quit compared to daily smokers. The observed increases in cessation behavior may be attributed to expanded smoking cessation services and extensive cessation campaigns implemented over the years. Enhanced cessation interventions should be targeted toward daily smokers. Pricing policies, graphic health warnings on packaging, and community-based comprehensive smoking cessation interventions can further enhance smokers' willingness to quit and encourage more cessation attempts.

对于15岁及以上吸烟者的戒烟意愿及戒烟行为变化趋势分析 — 中国，2010–2024年

南奕¹；谢慧宇¹；童嘉妮¹；熙子¹；肖琳^1,#

1. 控烟办公室，中国疾病预防控制中心，北京，中国。

^# 通信作者：肖琳，xiaolin@chinacdc.cn。

为评估烟草控制工作的有效性，研究基于2010年全球成人烟草调查（GATS）- 中国部分以及2018年、2022年和2024年全国成人烟草流行调查数据（NATS），对2010年至2024年中国吸烟者的戒烟意愿和行为趋势进行了全面分析。所有调查均采用中国15岁及以上人口的多阶段分层整群随机抽样。采用复杂抽样分析进行计算，并使用Cochran-Armitage趋势检验进行趋势分析。2010年至2024年，中国吸烟者的戒烟行为显著增加。戒烟率从16.88%上升到22.65%，过去12个月尝试戒烟的吸烟者比例从14.37%上升到24.75%。从2010年到2022年，计划在12个月内戒烟的吸烟者比例从16.10%上升到21.61%，到2024年降至16.07%。在14年的时间里，几乎所有人口群体的戒烟率和戒烟尝试都有显著增加。然而，从2022年到2024年，每日吸烟者的戒烟率和戒烟意愿均有所下降。与每日吸烟者相比，偶尔吸烟者表现出更高的戒烟率、戒烟尝试和戒烟意愿。趋势分析得出的戒烟行为的提升可能归因于多年来扩大的戒烟干预服务及广泛的戒烟宣传倡导。研究建议，应针对每日吸烟者开展强化戒烟干预措施。价格措施、烟盒包装图形警示以及基于社区开展综合戒烟干预可以进一步增强吸烟者的戒烟意愿，鼓励更多的戒烟尝试。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.123

Smoking Prevalence in Urban and Rural Areas — China, 2024

Xinying Zeng¹; Shiwei Liu¹; Ying Liu¹; Lin Xiao^1,#

1. Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Lin Xiao, xiaolin@chinacdc.cn.

Smoking is the second leading risk factor for disease burden in China. This study aims to analyze smoking behaviors among urban and rural areas in China to evaluate the effectiveness of current tobacco control measures and formulate strategic adjustments for achieving the Healthy China 2030 tobacco control targets.This study analyzed smoking prevalence [with 95% confidence intervals (CIs)] using the 2024 China National Adult Tobacco Survey (NATS) data. Rao-Scott χ² tests compared prevalence differences across subgroups. Linear, nonlinear and logistic regression models tested age-related trends in smoking behaviors (smoking initiation age, mean cigarettes daily smoked, and slim cigarette use).In 2024, the current and daily smoking prevalence among Chinese adults aged ≥15 years were 23.2% and 20.3%, respectively, with males exceeding females, peaking in 30-59 years. Rural areas had higher rates (24.9%, 22.1%) than urban areas (20.9%, 17.9%), particularly among high-income rural households. Agricultural workers, government/public institution employees, and business/service workers showed higher rates than teaching staff and medical/health workers. Daily smokers initiated daily smoking at a mean age of 22.4 years, with younger smokers starting earlier. Current smokers consumed an average of 15.8 cigarettes/day, with higher consumption in rural than in urban areas. Slim cigarette use was reported by 32.9% of current smokers, with higher proportions in females, urban residents and adults aged <50 years. Targeted strategies are required to sustain tobacco use reduction: addressing inadequate enforcement of control policies, focusing on smoking initiation, and implementing enhanced regulation of industry-promoted misleading "harm reduction" products (e.g., slim cigarettes).

城市和农村地区吸烟率 — 中国，2024年

曾新颖¹；刘世炜¹；刘影¹；肖琳^1,#

1. 控烟办公室，中国疾病预防控制中心，北京，中国。

^# 通信作者: 肖琳，xiaolin@chinacdc.cn。

吸烟是中国疾病负担的第二大危险因素。本研究旨在分析中国城乡居民的吸烟行为，以评估现行控烟措施的成效，并为实现"健康中国2030"控烟目标制定战略调整方案提供数据支撑。本研究采用2024年中国成人烟草调查（NATS）数据，计算了吸烟率及其95% CI。采用Rao-Scott χ²检验比较亚组间吸烟率的差异。运用线性、非线性及logistic回归模型检验了吸烟行为（开始吸烟年龄，平均每日吸卷烟量和细支卷烟使用）随年龄变化趋势。研究结果显示，2024年中国15岁及以上人群现在吸烟率和每日吸烟率分别为23.2%和20.3%，男性显著高于女性，30-59岁人群达峰值。农村地区吸烟率（现在吸烟率：24.9%，每日吸烟率：22.1%）均高于城市地区（20.9%，17.9%），高收入农村家庭尤为显著。农林牧渔水利业从业人员、政府/事业单位人员及商业/服务业工作人员的吸烟率显著高于教师和医务人员。每日吸烟者开始每日吸烟的平均年龄为22.4岁，越年轻的群体其开始每日吸烟的年龄越早。现在吸烟者日均吸烟量为15.8支卷烟，农村地区高于城市地区。32.9%的现在吸烟者使用细支卷烟，女性、城市居民和50岁以下人群使用比例更高。本研究提示，应采取针对性策略以持续减少烟草使用，包括强化控烟政策执行力度，重点关注吸烟起始行为，加强对烟草行业推广的"减害"误导性产品（如细支卷烟）的监管。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.124

E-Cigarette Use Behavior and Influencing Factors Among People Aged 15 Years and Above — Beijing Municipality, China, 2016–2023

Luting Xu¹; Jianhui Shi¹; Yuan Cao¹; Yaohan Meng¹; Lin Xiao²; Xiurong Liu^1，#

1. Beijing Center for Disease Prevention and Control, Beijing, China;

2. Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Xiurong Liu, liuxr@bjcdc.org.

Substantial evidence indicates that e-cigarettes pose considerable health risks to the human body. There is a lack of surveillance data regarding adult e-cigarette use behavior in Beijing. This study utilizes the 2016–2023 Beijing Adult Tobacco Survey data to assess the current status, changing trends and influencing factors of e-cigarette use among urban and rural residents aged ≥15 years across 16 districts of Beijing Municipality. All statistical analyses incorporated complex sampling weights. The prevalence of e-cigarette ever use among Beijing residents aged ≥15 years was 5.7%, 8.1%, 8.6%, and 6.9% in 2016, 2019, 2021, and 2023, respectively, while current use prevalence was 1.6%, 2.1%, 2.7%, and 1.8%, respectively. Males, younger individuals, those with higher educational attainment, and those living alone demonstrated greater odds of e-cigarette use. Current smokers who had attempted to quit within the past 12 months showed the highest odds of use, followed by current smokers without quit attempts and former smokers who had quit for less than 12 months. The public are not fully aware of the academic and clinical controversies regarding e-cigarettes’ effectiveness for smoking cessation, and may underestimate their health risks. There is an urgent need for targeted knowledge campaigns addressing these misconceptions and for the provision of more accessible smoking cessation services.

15岁及以上人群电子烟使用行为及影响因素研究 — 北京市，中国，2016–2023年

徐露婷¹；石建辉¹；曹远¹；孟耀涵¹；肖琳²；刘秀荣^1,#

1. 北京市疾病预防控制中心，北京，中国；

2. 中国疾病预防控制中心，北京，中国。

^# 通信作者：刘秀荣，liuxr@bjcdc.org。

有充分证据表明吸电子烟会对人体健康产生危害。迄今为止，北京市仍缺少电子烟使用情况的人群监测数据。本研究旨在利用2016–2023年北京市成人烟草调查数据，评估北京市15岁及以上城乡居民电子烟使用现况与变化趋势，探索其影响因素。所有统计学分析过程均经过复杂抽样加权。结果显示，在2016、2019、2021和2023年，北京市16岁及以上人群电子烟曾经使用率分别为5.7%、8.1%、8.6%和6.9%，电子烟现在使用率分别为1.6%、2.1%、2.7%和1.8%。多因素分析显示，男性、年轻人、文化程度较高、独居的个体电子烟使用率更高。按吸烟状况分类，过去12个月中尝试过戒烟的现在吸烟者电子烟使用率最高，其次是没有过戒烟尝试的现在吸烟者和戒烟不足12个月的曾经吸烟者。这说明相当一部分吸烟者仍使用电子烟辅助戒烟。电子烟作为戒烟手段的有效性，在学术和临床上仍存在争议，而社会公众对此并不完全了解，且有可能低估电子烟的健康危害。因此有必要开展更有针对性的科普教育，以及提供可及性更强的戒烟服务。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.125

Impact of Smoking Cessation Duration on Exacerbation Readmission Frequency and Hospitalization Costs in COPD — Beijing Municipality, China, 2013–2021

Jiachen Li¹; Jian Su²; Zhaohui Tong³; Lirong Liang^1,#

1. Evidence-Based Medicine Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China;

2. School of Economics, Peking University, Beijing, China;

3. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

^# Corresponding author: Lirong Liang, llr@bjirm.cn.

The relationship between smoking cessation duration and subsequent healthcare utilization, particularly exacerbation readmissions and costs, remains unclear in patients with chronic obstructive pulmonary disease (COPD). This retrospective cohort study included 7 868 COPD patients from Beijing Chao-Yang Hospital. Patients were classified by smoking status (never smokers, current smokers, and former smokers categorized by cessation duration: ≤10 years, 11–20 years, >20 years). We analyzed the association between smoking status and 3-year frequency of exacerbation readmissions and hospitalization costs. Over the three-year follow-up, 3 546 AECOPD readmissions were documented, with an overall incidence rate of 0.15 per person-year. Compared with never smokers, the adjusted incidence rate ratios (IRRs) were 1.48 (1.05–2.07) for >20 years cessation, 2.17 (1.57–3.00) for 11–20 years, 1.77 (1.46–2.14) for ≤10 years, and 1.75 (1.44–2.13) for current smokers. Corresponding hospitalization costs were 1.35, 1.80, 1.37, and 1.28 (in 10 000 CNY), respectively, versus 0.80 in never smokers. Among patients aged <60 years, those who had quit for over 10 years had risks similar to never smokers. Restricted cubic spline analyses among former smokers indicated a nonlinear association between smoking cessation duration and AECOPD readmission risk, with risk peaking within 10 years after cessation and declining thereafter. These findings reinforce the importance of early, sustained smoking cessation in COPD management. Smoking cessation may represent a cost-effective strategy to reduce healthcare expenditures.

戒烟时长与慢性阻塞性肺疾病患者急性加重再入院频率和住院费用的关联 — 北京市，中国，2013–2021年

李嘉琛¹；苏剑²；童朝晖³；梁立荣^1,#

1. 循证医学中心，首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所，北京，中国；

2. 北京大学经济学院，北京，中国；

3. 呼吸与危重症医学科，首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所，北京，中国。

^# 通讯作者: 梁立荣，llr@bjirm.cn。

戒烟时长与慢性阻塞性肺疾病（慢阻肺）患者急性加重再入院频率以及住院费用之间的关系尚不明确。本研究采用回顾性队列研究设计，纳入来自北京朝阳医院的7,868名慢阻肺患者，根据吸烟状态（从未吸烟、当前吸烟、戒烟≤10年、戒烟11-20年、戒烟>20年）进行分组，分析吸烟状态与3年内急性加重再入院频率和住院费用之间的关联。在3年随访中，共有3,546例急性加重再入院事件，发生率为0.15次/人年。与从未吸烟者相比，多因素调整的发病率比（IRR）分别为：戒烟>20年组1.48（1.05-2.07）、戒烟11-20年组2.17（1.57-3.00）、戒烟≤10年组1.77（1.46-2.14）、当前吸烟组1.75（1.44-2.13），相应的累计住院费用分别为1.35、1.80、1.37和1.28万元，而从未吸烟者为0.80万元。在年龄<60岁的患者中，戒烟超过10年的患者与从未吸烟者的急性加重风险相似。限制性立方样条分析发现，戒烟时长与急性加重再入院风险之间存在非线性关系，风险在戒烟后10年内达到峰值，之后逐渐下降。研究结果表明早期戒烟并维持对于慢阻肺管理具有重要意义，戒烟干预可能是降低慢阻肺患者急性加重风险和住院费用的具有成本效益的策略。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.126

Spatial Distribution and Its Influencing Factors of Secondhand Smoke Exposure Among Adults — 31 PLADs, China, 2022

Ying Liu¹; Xinying Zeng¹; Shiwei Liu¹; Lin Xiao^1,#

1. Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Lin Xiao, xiaolin@chinacdc.cn.

Secondhand smoke (SHS) exposure remains a significant public health threat to human health. Understanding the spatial distribution characteristics of SHS exposure is essential for developing targeted, region-specific tobacco control strategies and interventions. This study analyzed the spatial clustering of SHS exposure and its influencing factors in China in 2022. This study utilized data from the 2022 China National Adult Tobacco Survey (NATS). Descriptive statistical analyses were performed using Stata (version 15.0; StataCorp). Spatial analyses were conducted using GeoDa (version 1.22; Dr. Luc Anselin team) to examine global spatial autocorrelation, local spatial autocorrelation and ordinary least squares (OLS) spatial regression. Provincial-level figures of SHS exposure rates were visualized using Graphpad Prism9.5. In 2022, the SHS exposure rate among non-smoking adults aged 15 years and above in China was 52.4%. The distribution of SHS exposure in China exhibited significant provincial clustering (Moran's I=0.337, Z=4.626, P=0.001). LISA analysis identified High-High clusters of SHS exposure in Yunnan, Guizhou, Sichuan, Chongqing, Guangdong, and Hainan, while Henan emerged as a Low-Low cluster. Key factors influencing regional SHS exposure included smoking rates, tobacco control measures in homes, indoor workplaces, and healthcare institutions, population coverage of comprehensive smoke-free regulations, and public awareness of SHS and smoking-related health risks. Although SHS exposure rates in China have decreased, they remain a significant concern. Targeted interventions should be implemented in southwestern and central southern China, with strengthened smoke-free management in key settings including homes, indoor workplaces, and medical institutions. Additionally, expanding the coverage of comprehensive smoke-free laws and regulations is recommended.

中国成人二手烟暴露空间分布及其影响因素 — 31省份，中国，2022年

刘影¹；曾新颖¹；刘世炜¹；肖琳^1,#

1. 控烟办公室，中国疾病预防控制中心，北京，中国。

^# 通信作者：肖琳，xiaolin@chinacdc.cn。

二手烟暴露仍然是一个威胁人类健康的重要公共卫生问题。了解二手烟暴露率的空间分布特征对于制定有针对性的、区域化的控烟策略和干预措施至关重要。本研究分析了2022年中国二手烟暴露的空间聚集性及其影响因素。数据来自2022年全国成人烟草调查。研究使用STATA 15.0进行描述性流行病学分析，使用GeoDa 1.22软件进行全局空间自相关、局部空间自相关和普通最小二乘法（OLS）空间回归分析，使用Graphpad Prism9.5对省（区、市）二手烟暴露率进行可视化。2022年，中国15岁及以上非吸烟成年人的二手烟暴露率为52.4%，中国二手烟暴露分布中存在全局空间聚集性（Moran's I=0.337, Z=4.626, P=0.001），LISA分析识别出云南、贵州、四川、重庆、广东和海南为二手烟暴露高-高聚集区，河南处于低-低聚集区。影响二手烟暴露空间聚集的关键因素包括吸烟率、家庭、室内工作场所和医疗机构中的控烟措施、全面禁烟法规的覆盖范围以及公众对二手烟和吸烟危害认知。中国的二手烟暴露率虽然有所下降，但仍不可忽视，应对西南和中南地区采取有针对性的干预措施，对重点场所家庭、室内工作场所和医疗机构加强无烟管理，同时提高全面无烟法规覆盖范围。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.127

The Current Situation of Subnational Legislation on Smoking Ban in Indoor Public Places, Indoor Workplaces, and Public Transport — China, 2024

Mengmeng Bi¹; Li Xie¹; Zi Xi¹; Jie Yang^1,#

1. Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Jie Yang, yangjie@chinacdc.cn.

Smoke-free regulations play a crucial role in protecting people from the harmful effects of tobacco smoke. The "Healthy China Initiative (2019-2030)" designates tobacco control as a special action area and establishes a target that by 2030, comprehensive smoke-free environment regulations will protect 80% or more of the population. This study analyzes smoke-free regulation texts to provide an evidence base for enhancing the quality of smoke-free legislation. This study examined smoke-free regulation texts issued by provincial and municipal governments in China through December 31, 2024. The analysis included specialized smoke-free regulations, patriotic health regulations, and regulations promoting civilized behavior. The screening process excluded repealed regulations, rules, normative documents, and city regulations lacking provincial-level legislation or explicit smoke-free provisions. Through comprehensive textual analysis, the study identified deficiencies in China’s smoke-free legislation and developed recommendations for future improvements. Comprehensive analysis integrating provincial and municipal smoke-free regulations revealed that 46 cities are protected by comprehensive smoke-free regulations, covering over 200 million people. Regarding smoke-free environment establishment, healthcare facilities, two categories of educational facilities, and government facilities demonstrated optimal performance, all achieving 100% comprehensive smoke-free standards. However, progress in establishing smoke-free environments in other locations varies significantly. National-level regulations are expected to effectively address these disparities. Despite significant achievements in smoke-free legislation by some cities, national legislative progress remains inadequate and falls short of the "Healthy China Initiative (2019-2030)" requirements. We recommend formulating legislation at the national level and gradually shifting tobacco control management from a place-centered to a people-centered approach.

地方室内公共场所、室内工作场所及公共交通工具无烟立法现状 — 中国，2024年

毕盟盟¹；谢莉¹；熙子¹；杨杰^1,#

1. 控烟办公室，中国疾病预防控制中心，北京，中国。

^# 通信作者：杨杰，yangjie@chinacdc.cn。

无烟法规在保护人们免受烟草烟雾危害方面发挥着关键作用。《健康中国行动（2019 - 2030 年）》将控烟列为专项行动之一，并设定了到 2030 年，全面无烟环境法规将保护 80% 或以上人口的目标。本研究对无烟法规文本进行分析，为完善无烟立法提供证据基础。本研究对截至 2024 年 12 月 31 日中国省级和市级政府发布的无烟法规文本进行分析。分析涵盖了专门的无烟法规、爱国卫生法规以及文明行为促进的法规。筛选过程排除了已废止的法规、规章、规范性文件以及缺乏省级立法或未明确无烟规定的市级法规。通过全面的文本分析，该研究发现了中国无烟立法的不足之处，并提出了未来改进的建议。综合分析省级和市级的无烟法规后发现，有 46 个城市受到全面无烟法规的保护，覆盖人口超过 2 亿。在无烟环境的建立方面，医疗保健机构、两类教育机构和政府机构表现最佳，均达到了 100% 的全面无烟标准。然而，其他场所无烟环境的建设进展差异显著。预计国家级法规将有效解决这些差异。尽管一些城市在无烟立法方面取得了显著成就，但全国性的立法进展仍显不足，未能达到《健康中国行动（2019-2030 年）》的要求。我们建议在国家层面制定相关立法，并逐步将控烟管理从以场所为中心转向以人群为中心。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.128