The Smoking Gun: How Socioeconomic Background Affects Cigarette Smoking Behavior in Beijing

Mauricio Armaza

The Smoking Gun: How Socioeconomic Background Affects Cigarette Smoking Behavior in Beijing

by Mauricio Armaza

Abstract

In many parts of the developed world, the past time of smoking cigarettes has been largely phased out by decades of increasing public awareness on the dangers of cigarettes. However, much of the world is still developing and a culture of smoking acceptance continues to permeate. Tobacco related deaths are currently at 5 million deaths annually worldwide and the number is expected to rise to 8 million by 2030. 80% of those will be in low/middle income countries such as those found in south and Southeast Asia. India and China are particularly susceptible, with the subject of this project being focused on China.

China is currently the largest country in the world by population and the largest producer and consumer of tobacco products. The relatively cheap prices of a carton of cigarettes (ranging from 5-30 Yuan, or $1-$5) makes this dangerous habit all the more accessible to the population. China has an estimated 350 million smokers and an annual count of 1 million deaths directly related to smoking and 100,000 deaths from second-hand smoking. This makes cigarette smoking the largest preventable cause of death in China. In comparison, the United States has around 450,000 thousand deaths a year from cigarette smoking and 48,000 deaths from second-hand smoking.

Research

In many parts of the developed world, the past time of smoking cigarettes has been largely phased out by decades of increasing public awareness on the dangers of cigarettes. However, much of the world is still developing and a culture of smoking acceptance continues to permeate. Tobacco related deaths are currently at 5 million deaths annually worldwide and the number is expected to rise to 8 million by 2030. 80% of those will be in low/middle income countries such as those found in south and Southeast Asia.[1] India and China are particularly susceptible, with the subject of this project being focused on China.

China is currently the largest country in the world by population and the largest producer and consumer of tobacco products. The relatively cheap prices of a carton of cigarettes (ranging from 5-30 Yuan, or $1-$5)[2] makes this dangerous habit all the more accessible to the population. China has an estimated 350 million smokers and an annual count of 1 million deaths directly related to smoking and 100,000 deaths from second-hand smoking. This makes cigarette smoking the largest preventable cause of death in China.[3] In comparison, the United States has around 450,000 thousand deaths a year from cigarette smoking and 48,000 deaths from second-hand smoking.[4]

Although the number of smokers and death from smoking is staggeringly high, the current trend in China shows a decrease in cigarette smoking. During a 10-year study conducted from 1993 to 2003, researchers showed the percentage of smokers in China dropping from 60%-49% in men and 53.2% in women. Yet, while that is amazing progress overall, the number of heavy smokers (those who smoke 20 cigarettes a day or more) had doubled. The researchers also discovered that many of those heavy smokers were had reported that they were in perfectly good health. [5]

The previous research highlights the lack of adequate cigarette smoking education in China. In one survey conducted among 8138 medical and non-medical Chinese high school level juniors and sophomores, those studying medicine and biology reported having increased levels of knowledge about tobacco and its adverse effects. However, 40% of medical students did not recognize carbon monoxide (one of the by-products of cigarette smoking) as a dangerous substance and 40% did not recognize the adverse effects of smoking cigarettes such as hypertension, strokes, and gastric ulcers. The research highlights the lack of in depth information that is available to not only to students, but to medical students who wish to become the future of Chinese healthcare.[6]

Better education regarding smoking and its effects is necessary during an individual’s formative years. In fact, 9/10 smokers start before the age of 18. In a comparison of peer education against traditional education, it was found that students begin to smoke out of either curiosity or a negative influence from their peers. In fact, the effect that peers have is substantially more effective than traditional teaching methods, such as posters or commercials. The study conducted showed that out of 354 students (253 who were being educated through peer-to-peer methods and 101 through traditional methods) the portion that were peer educated received a higher score on a test administered after they received education. The results also show that smoking and anti-smoking behavior are largely a socially learned behavior and is influenced by the desire to be socially accepted.[7]

An increase in education shows that socioeconomic factors do play a large role in cigarette smoking behavior. But do other factors such as wage play a large role as well? During a 10-year longitudinal study conducted in the United States from 1999-2009, researchers noted that a 10% increase in wages led to a 5.5% and a 4.6% decrease in men and those without a college degree. The wage increase also improved the chances of a person quitting from 17% to 20.4%.[8]

Should China be improving its smoking education? The answer is yes, but it is not that simple. Only recently have the first anti-smoking legislations seen in China been placed into effect. In June of 2015, the City of Beijing banned cigarette smoking in and around public spaces such as restaurants, schools, and office buildings. This follows a city ordinance banning smoking propaganda on public transport, films, magazines, and newspapers. While the government has issued penalties and fines, many people and law-enforcement officers take relaxed approach to this newly issued legislation.[9] (Pictures of posters and anti-smoking signs are at the end)

Although the first Chinese anti-smoking legislation has just come into effect, this is still a step in the right direction and with time might give way to a more health conscious populace. Different posters and advertisements with prominent movie stars and singers line the spaces that were filled with smoking ads. However, much still needs to be done in order to understand the underlying cultural and socioeconomic reasons of smoking cigarettes in Beijing and in China overall.

Introduction

From the time of the progress report, my thesis has gone substantial revision. Before it was focused on certain socioeconomic factors, and how they might individually influence smoking behavior in Beijing. However, after conducting field work and getting a greater knowledge of the topic, I realize that these factors are not only interconnected among themselves, but also to Chinese culture.

One of the biggest criticisms with my earlier proposal was that my research design focused solely on quantitative data. While quantitative data is good at gathering information, it is not good for gathering information pertaining to a location’s culture and the underlying values. This is why the project now has an ethnographical viewpoint, and is now more focused on the cultural aspect and analysis while also taking into account the quantitative data. Therefore, my thesis statement is: higher socioeconomic statuses affect cigarette smoking behavior by allowing greater education and access to peers who do not smoke.

Research Design

Originally, the experimental design was an undertaking comprising of 50-100 research participants and a large gathering of quantitative data collected. However, after changing perspectives I decided to scale the research down and decreased the research cap to 25 people, all male, and all at Wudaokou station. The experimental design would also allow for a number of interviews (cap at 5) that were informal and with the objective of obtaining qualitative data on Chinese culture and how that relates to smoking cigarettes.

The survey still consists of a binary data system in order to make it easier for me to gather information, and the 1-4 scale of acceptance on cigarette smoking.

Data and Analysis

The data collected was split evenly among the lines of smokers and non-smokers. Going along the different questions asked on the survey:

– Most of the people surveyed were over the age of 20

– 56% are currently students in either high school or a college

– Almost all but 2 received a high school education

– 2/3 received a college education

– 80% were employed

– Of those with jobs, 60% had a salary with over 56,000 Yuan

– 48% were smokers

– Of those, 1/3 was found to be a heavy smoker (over 20 cigarettes a day)

– And 83% of smokers started before the age of 18 (supports 9/10 statistic)

 

The trends found in the data were not abnormal as there were correlations between smoking cigarettes and three different factors: education level, employment and income, and age.

It was found that those with a college education and no job were less likely to smoke than any other demographic, while there was no correlation between high school students or with those that just received a high school education. In fact, 100% of those with no education were smokers.

Data collected also found that 60% of those unemployed were smokers and those with a salary of over 56,000 were significantly less likely to smoke cigarettes.

The final trend shows that almost all smokers started to smoke before the age of 18 and all of the heavy smokers started to smoke before the age of 18.

The trends derived from the data show that an increase in education level, an increase in salary, and waiting to start smoking (reducing peer-pressure effect) after 18 all contribute to a lower rate of smoking when compared to their counterparts.

Furthermore, the trends support some of the outside literature and research as income was already seen to be a factor that affected cigarette smoking, and the data supports the idea that cigarette smoking is habit forming.

The qualitative data gathered was less formally obtained, but it also contained invaluable data that describes how the quantitative data might fit in to Chinese culture. The questions asked were simple: “are you a smoker? Why do you smoke? If you smoke, do you have good health?” The responses that I received were hard to understand at times but two trends became apparent. Chinese people do know about the dangers of smoking cigarettes, and most of them smoke because it is something that other people around them do.

It appears that from the qualitative data, education in Beijing surrounding smoking is better than the average. Out of those who did not smoke, they said it was because of health reasons. Smoking was “补身体” or unhealthy. Out of the people that did smoke, smoking was seen as a fun activity to do with friends, or with co-workers. One participant even answered that because his dad did it, he himself does it too.

Conclusion

The qualitative and quantitative data both support my thesis. Quantitatively, the trends showed that education, higher salary, and starting age all affect a person’s attitude towards cigarette smoking. Interestingly enough, more than half of the people surveyed also marked that they viewed cigarette smoking in a negative aspect. While this shows a dislike for smoking, many people also marked down that they sometimes approved of smoking. The data gathered here show’s that although a slight majority disapproves of cigarette smoking, overall people lacked hard opinions as most of them put that smoking was either somewhat acceptable or unacceptable. Although this doesn’t support my thesis, it is necessary to discuss because this shows that Beijing citizens are still ambivalent towards smoking cigarettes, and that more effective campaigns are needed if the government wants to lessen smoking.

Qualitatively, the data shows that peers are influential in decision-based habits such as smoking cigarettes. Because many people answered that they smoked because they wanted to either socialize or because someone close to them smoked, smoking cigarettes can be seen as a binding or a glue that joins people together. Chinese society is a collective society and one where people pride themselves on not standing out from the crowd. Even if one were to realize that smoking is unhealthy, they might not want to say anything because it is going against their group mentality and ideal. Furthermore, cigarettes and tobacco related products are ingrained into society. They are given as gifts and are common among business deals and dinners. It is a social phenomenon that is learned and maintained through one’s peers and is used to also maintain relationships among people (关系). It is more important to Chinese society because it is more useful here, as a tool to maintain relationships and to keep social acceptance.

 

 


[1] Ayaz, Sultan and Acil, Dilay, “Comparison of Peer Education and the Classic Training Method for School Aged Children Regarding Smoking and its Dangers.” Journal of Pediatric Nursing-Nursing Care of Children and Family 30, no. 3 (5-6, 2015): E3-E12.

[2] Field journal entry

[3] “Comparison of Peer Education” E3-E12

[4] CDC, “Smoking and Tobacco Use.” CDC, April 15, 2015.

[5] Qian, Juncheng, Min Cai, Jun Gao, Shenglan Tang, Ling Xu, and Julia Alison Critchle.

“Trends in Smoking and Quitting in China from 1993 to 2003: National Health Service Survey Data.” Bulletin of the World Health Organization 88, no. 10 (10, 2010): 769-782

[6] medical students

[7] Comparison of peer educa

[8] Du, Juan and Leigh, J. Paul, “Effects of Wages on Smoking Decisions on Current and

Past Smokers.” Annals of Epidemiology 25, no. 8 (8, 2015): 575-582.

[9] “Chinese Smokers Face Cigarette Ban in Beijing.” BBC, November 28 2014.

 

Bibliography

 

Ayaz, Sultan and Acil, Dilay, “Comparison of Peer Education and the Classic Training

Method for School Aged Children Regarding Smoking and its Dangers.” Journal of Pediatric Nursing-Nursing Care of Children and Family 30, no. 3 (5-6, 2015): E3-E12.

http://apps.webofknowledge.com.proxy.wm.edu/full_record.do?product=WOS&search_mode=GeneralSearch&qid=1&SID=3EmmKDDRUNCN5L1x4f1&page=1&doc=1

 

CDC, “Smoking and Tobacco Use.” CDC, April 15, 2015.

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/

 

“Chinese Smokers Face Cigarette Ban in Beijing.” BBC, November 28 2014. http://www.bbc.com/news/world-asia-china-30253162

 

Du, Juan and Leigh, J. Paul, “Effects of Wages on Smoking Decisions on Current and

Past Smokers.” Annals of Epidemiology 25, no. 8 (8, 2015): 575-582.

http://apps.webofknowledge.com.proxy.wm.edu/full_record.do?product=UA&search _mode=GeneralSearch&qid=1&SID=3AlT4HT7as3aSIlyEtv&page=1&doc=1

 

Qian, Juncheng, Min Cai, Jun Gao, Shenglan Tang, Ling Xu, and Julia Alison Critchle.

“Trends in Smoking and Quitting in China from 1993 to 2003: National Health Service Survey Data.” Bulletin of the World Health Organization 88, no. 10 (10, 2010): 769-782. doi:http://dx.doi.org/10.2471/BLT.09.064709. http://search.proquest.com/docview/837451118?accountid=15053.

qufu_2qufu_1

Both of these were found inside Qufu, outside of Beijing. It appears that other places have enacted anti-smoking policies as well

outside_dorm outside_dorm_building

These were found outside of my dorm building, one being anti-smoking propaganda and the other a simple warning

mount_tai

On way to the top of Mount Tai. A national monument and a holy place, it makes sense why people don’t want cigarette butts on the ground

kfc

SMOKERS BEWARE, KFC is not a smoker friendly establishment. The anti-smoking imagery is one of the stronger ones I’ve encountered.

inside_subway_car inside_subway_car_2 bathroom_bullet_1

All of these were found on public transportation such as inside a metro car, or inside a train station. One was even found inside the bathroom of a bullet train! However, I did smell the faint stink of cigarette ash when I walked in, demonstrating the lack of respect for the newly enacted laws.