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From the long-stemmed pipe to snuff, the water pipe, hand-rolled cigarettes, and finally, manufactured cigarettes, the history of tobacco in China is the fascinating story of a commodity that became a hallmark of modern mass consumerism. Carol Benedict follows the spread of Chinese tobacco use from the sixteenth century, when it was introduced to China from the New World, through the development of commercialized tobacco cultivation, and to the present day. Along the way, she analyzes the factors that have shaped China’s highly gendered tobacco cultures, and shows how they have evolved within a broad, comparative world-historical framework. Drawing from a wealth of historical sources—gazetteers, literati jottings (biji), Chinese materia medica, Qing poetry, modern short stories, late Qing and early Republican newspapers, travel memoirs, social surveys, advertisements, and more—Golden-Silk Smoke not only uncovers the long and dynamic history of tobacco in China but also sheds new light on global histories of fashion and consumption.

Background Tobacco advertisements or promotions (TAPs) can increase smoking susceptibility, especially among adolescents.China has made great progress in reducing TAPs, but has not yet achieved a total ban.This study estimated exposure to TAPs and smoking susceptibility and their changes from 2013–14 to 2021 among Chinese adolescents and examined their association. Methods Samples of middle school (MS) students in 2013 and MS and high school (HS) students in 2021 were examined, with national and provincial representativeness. Exposure to different TAPs and non-smokers’ smoking susceptibility were determined. Multilevel logistic regression was used to assess the association between exposure to TAPs and smoking susceptibility in different age groups, and whether this exposure moderated the association between anti-tobacco messages and smoking susceptibility. Results In 2021, MS and HS students had high exposure to TAPs on TV/movies (63.8% and 68.8%) and at points-of-sale (POS; 41.3% and 38.3%), but MS students had slightly lower percentages than in 2013–14. In 2021, 9.2% of MS students and 12.9% of HS students who were non-smokers were susceptible to smoking, a 5.6% decrease compared to 2013–14 among MS students. Exposure to TAPs had positive associations with susceptibility after adjusting for covariates in all age groups. Anti-tobacco messages decreased smoking susceptibility, but TAPs moderated this association. Conclusion Students had decreasing exposure to TAPs, but exposure remained high, especially at POS and TV/movies. Non-smokers had low smoking susceptibility, and this decreased over time. Exposure to TAPs was positively associated with smoking susceptibility, especially in younger students. Exposure to TAPs also reduced the benefits of anti-tobacco messages.

Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

Background Tobacco dependence remains a critical public health challenge in China. However, population-level data on its prevalence and determinants, particularly at the local level, remain scarce. This study aimed to estimate the prevalence of tobacco dependence and analyze its sociodemographic and behavioral correlates among current smokers in Wuxi City. Methods A population-based cross-sectional survey was conducted from June to October 2024 among residents aged ≥ 15 years in Wuxi, using a four-stage complex sampling design. Data were collected via face-to-face interviews. Tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence, with a score of ≥ 4 indicating dependence. Complex sampling weighting was applied. Rao-Scott χ² tests and survey-weighted multivariable logistic regression were used to identify factors associated with tobacco dependence. Results A total of 6,646 participants were included in the survey. Among adults aged ≥ 15 years, the prevalence of current smoking was 19.62% (male: 37.73%, female: 0.44%). Among individuals who currently smoke ( n  = 1,309), 30.66% exhibited tobacco dependence (male: 30.78%, female: 19.50%). Dependence prevalence increased significantly with age and was higher among those with lower education level (both P <  0.001). In multivariable analyses, older age and lower education level remained significant factors. Compared with smokers aged 15–34 years, those aged 55–64 (aOR = 2.69, 95% CI: 1.35–5.37) and ≥ 65 years (aOR = 3.43, 95% CI: 1.66–7.09) had significantly higher odds of dependence. Smokers with middle/high school (aOR = 2.16) or primary education level or less (aOR = 2.61) were more likely to be dependent than those with college or higher education level. Compared with those reporting “Good” health, smokers reporting “Average” self- reported health had significantly higher odds of tobacco dependence (aOR = 1.54, 95% CI: 1.11–2.14). Conclusion Tobacco dependence among current smokers in Wuxi is significantly associated with older age, lower education level, and self-reported average health status. These findings highlight the need for targeted tobacco control interventions focused on older individuals with lower education level to reduce tobacco dependence and promote public health. Clinical trial number Not applicable.

As part of the PLoS Medicine series on Global Health Diplomacy, Kelley Lee and colleagues provide a case study of Brazil's growing influence in international relations and global health, using as an example that country's role and use of “soft power” in the negotiation of the Framework Convention on Tobacco Control.

Introduction Cigarette smoking is usually more prevalent among those with a lower socioeconomic status (SES), which can be driven by inequalities in the initiation and cessation of smoking, giving rise to SES disparities in health. This study aimed to gauge the SES inequalities in smoking related behaviours and their evolving trends based on a nationally representative database. Method Data were extracted from repeated cross-sectional China Family Panel Studies (CFPS) of adults aged ≥18 and <60 years in 2012, 2014, 2016 and 2018. SES was constructed by principal component analysis based on income, education and occupation. Regression-based odds ratios and coefficients as the relative effect index of inequality were applied to quantify the degree of socioeconomic inequality in smoking related behaviours and to adjust for possible confounding factors. Multivariable regressions were utilized to explore the temporal trends in smoking inequalities. Results The smoking prevalence among men decreased from 61.16% to 2012 to 57.88% in 2018, cigarette consumption among current smokers declined from 16.71 to 15.49 cigs/per day, and the cessation rate increased from 17.55% to 24.08%. Cigarette consumption for women decreased from 13.39 in 2012 to 11.01 cigs/per day in 2018. Smoking prevalence showed significant SES inequalities among men and women from 2012 to 2018 (men: OR 20 12  (95%CI)= 0.72 (0.63, 0.83), OR 20 14  = 0.60 (0.52, 0.69), OR 2016  = 0.58 (0.50, 0.67), OR 2018  = 0.56 (0.48, 0.66); women: OR 2012  = 0.63 (0.41, 0.97), OR 2014  = 0.50 (0.32, 0.79), OR 2016  = 0.44 (0.26,  0.73), OR 2018  = 0.50 (0.30,  0.85)). Cigarette consumption showed significant SES inequalities among men from 2012 to 2018 ( β 2012 = -1.39 (-2.22, -0.57), β 2014 = -2.37 (-3.23, -1.50), β 2016 = -2.35 (-3.25, -1.44), β 2018 = -2.91 (-3.86, -1.97)). In 2018, inequality emerged in smoking cessation rates among men and smoking intensity among women. However, all tests for trends in changes over time were not statistically significant ( P varied from 0.072 to 0.602). Conclusion The smoking prevalence declined between 2012 and 2018 in China. However, SES inequalities in smoking persist, while socioeconomic inequalities in smoking were not alleviated among adults aged 18 ~ 59 in China. Tobacco control measures should be implemented by giving more attention to people with lower SES who are more vulnerable to tobacco use.

E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction-related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes.

Background Cardiovascular disease (CVD) caused by air pollution poses a considerable burden on public health. We aim to examine whether lifestyle factors mediate the associations of air pollutant exposure with the risk of CVD and the extent of the interaction between lifestyles and air pollutant exposure regarding CVD outcomes. Methods We included 7000 participants in 2011–2012 and followed up until 2018. The lifestyle evaluation consists of six factors as proxies, including blood pressure, blood glucose, blood lipids, body mass index, tobacco exposure, and physical activity, and the participants were categorized into three lifestyle groups according to the number of ideal factors (unfavorable, 0–1; intermediate, 2–4; and favorable, 5–6). Satellite-based spatiotemporal models were used to estimate exposure to ambient air pollutants (including particles with diameters ≤ 1.0 μm [PM 1 ], ≤ 2.5 μm [PM 2.5 ], ≤ 10 μm [PM 10 ], nitrogen dioxide [NO 2 ], and ozone [O 3 ]). Cox regression models were used to examine the associations between air pollutant exposure, lifestyles and the risk of CVD. The mediation and modification effects of lifestyle categories on the association between air pollutant exposure and CVD were analyzed. Results After adjusting for covariates, per 10 μg/m 3 increase in exposure to PM 1 (HR: 1.09, 95% CI: 1.05–1.14), PM 2.5 (HR: 1.04, 95% CI: 1.00–1.08), PM 10 (HR: 1.05, 95% CI: 1.03–1.08), and NO 2 (HR: 1.11, 95% CI: 1.05–1.18) was associated with an increased risk of CVD. Adherence to a healthy lifestyle was associated with a reduced risk of CVD compared to an unfavorable lifestyle (HR: 0.65, 95% CI: 0.56–0.76 for intermediate lifestyle and HR: 0.41, 95% CI: 0.32–0.53 for favorable lifestyle). Lifestyle played a significant partial mediating role in the contribution of air pollutant exposure to CVD, with the mediation proportion ranging from 7.4% for PM 10 to 14.3% for PM 2.5 . Compared to an unfavorable lifestyle, the relative excess risk due to interaction for a healthier lifestyle to reduce the effect on CVD risk was − 0.98 (− 1.52 to − 0.44) for PM 1 , − 0.60 (− 1.05 to − 0.14) for PM 2.5 , − 1.84 (− 2.59 to − 1.09) for PM 10 , − 1.44 (− 2.10 to − 0.79) for NO 2, and − 0.60 (− 1.08, − 0.12) for O 3 . Conclusions Lifestyle partially mediated the association of air pollution with CVD, and adherence to a healthy lifestyle could protect middle-aged and elderly people from the adverse effects of air pollution regarding CVD.

Background Smoking rationalisation beliefs are a huge barrier to quitting smoking. What types of rationalisations should be emphasised in smoking cessation interventions? Although past literature has confirmed the negative relationship between those beliefs and motivation to stop smoking, little is known regarding the importance and performance of those beliefs on motivation with varying cigarette dependence. The study aimed to ascertain rationalisations that are highly important for motivation yet perform poorly in different cigarette dependence groups. Methods The cross-sectional study was conducted from November 19 to December 9, 2023 in Guiyang City, China. Adult male current smokers were enrolled. Partial least squares structural equation modelling was used to test the hypothesis. The multi-group analysis was used to determine the moderating effect of cigarette dependence, and the importance-performance map analysis was utilised to assess the importance and performance of rationalisations. Results A total of 616 adult male current smokers were analysed, and they were divided into the low cigarette dependence group ( n  = 297) and the high cigarette dependence group ( n  = 319). Except for risk generalisation beliefs, smoking functional beliefs (H1: -β = 0.131, P  < 0.01), social acceptability beliefs (H3: β = -0.258, P  < 0.001), safe smoking beliefs (H4: β = -0.078, P  < 0.05), self-exempting beliefs (H5: β = -0.244, P  < 0.001), and quitting is harmful beliefs (H6: β = -0.148, P  < 0.01) all had a significant positive influence on motivation. Cigarette dependence moderated the correlation between rationalisations and motivation. In the high-dependence group, the social acceptability beliefs and smoking functional beliefs were located in the “Concentrate Here” area. In the low-dependence group, the social acceptability beliefs were also situated in there. Conclusions Social acceptability beliefs and smoking functional beliefs showed great potential and value for improvement among high-dependence smokers, while only social acceptability beliefs had great potential and value for improvement among low-dependence smokers. Addressing these beliefs will be helpful for smoking cessation. The multi-group analysis and the importance-performance map analysis technique have practical implications and can be expanded to other domains of health education and intervention practice.

Background While people are exposed to various air pollutants, limited research exists on the combined effects of multiple pollutants on mental health, and no studies have explored the social and behavioral mechanisms of mental health issues in real-world settings. This study aimed to evaluate the association between mixed air pollutants and deliberate self-harm (DSH), as well as the potential social and behavioral mechanisms underlying these associations. Methods The study involved 5,025 university students, selected through a multistage survey sampling process from 22 universities in 20 cities. Participants provided information on socioeconomic characteristics and DSH via a standardized questionnaire. Regional socioeconomic status and air pollution data were obtained from a national database. Multilevel logistic regression models were used to assess the association between mixed air pollution and DSH, and a structural equation model was used to explore underlying social mechanisms. Results The multilevel logistic regression model revealed that the mixed air pollution index, exposure to secondhand smoke (SHS), and the number of air pollution days were significantly associated with the likelihood of DSH, with odds ratios (OR) of 2.78 (95% CI: 1.22, 6.31) and 3.30 (95% CI: 1.67, 6.52), respectively. Significant quantitative correlations were found between the number of air pollution days and the likelihood of DSH (r = 0.5553, p < 0.0001). Structural equation modeling revealed that SHS exposure had a significant direct effect on DSH (β’ = 0.7458, p  < 0 0.001). In contrast, air pollution days demonstrated both a direct effect (β’ = 0.3323, p  < 0.001) and an indirect effect on DSH through a mediating pathway (β’ = 0.054, p  < 0.001). Conclusion Using nationally representative data from 20 cities in China, this study provides compelling evidence of the detrimental impact of environmental air pollution on DSH. It underscores the urgent need for stronger environmental protection policies and the development of effective mental health strategies to reduce DSH and alleviate environmental strain on mental health.