The Epidemic of Cigarette Gifting: A Social Barrier to Tobacco Control in China

Context One of the challenges China faces in implementing tobacco control policies is to change the social norm, especially the culture and behaviors surrounding cigarette gift giving.Objectives To develop evidence for the tobacco control policy initiative issued in China at the end of 2013.Methods Analysis of data from a national survey on tobacco utilization that contains information on cigarette gift exchanges, conducted by the China Bureau of Statistics in 31 provinces of China from October to November 2005.Participants A national representative random sample of 171,924 persons aged 15 years or older from 23,000 urban and 37,000 rural households. The sample was based on the 2005 Census. Of the sample, 171,876 people had valid data, and 43,457 smokers reported information on cigarette gift exchanges.Results 19.11% of Chinese smokers reported receiving cigarettes as gifts, 9.02% of smokers gave cigarettes to others, and over 23% of the smokers had either received or given cigarettes as gifts. Given that the survey was not conducted during the country's highest gift-giving occasion, the Chinese New Year, the rate of cigarette gift exchange could actually be much higher than these figures suggest. The highest smoking prevalence (39.08%) and the highest rate of cigarette gifting (36.05%) were reported by smokers working for government agencies. The multivariate results show urban smokers were more likely to receive cigarette gifts (Odds=1.13). Male smokers were less likely to receive cigarette gifts than female smokers (Odds = 0.88). Smokers between the ages of 15 to 19 were more likely to receive or give cigarette gifts. Higher educated and high-income smokers were more likely to receive cigarette gifts, and smokers with a high school education level were more likely to send cigarettes to others.Conclusions Tobacco control measures should be aimed at changing the cigarette gifting culture and behavior in China. Targeting government officials, higher educated and high-income people will help remove the social barriers to implementing tobacco control in China. In November, 2013, China's State Council released regulation against giving cigarette as gift to government officials. This was a major step for the Chinese government to change the social norm from using cigarette as a means of gift giving. It should help to remove one of the social barriers of tobacco control.