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Why are male Chinese smokers unwilling to quit? A multicentre cross-sectional study on smoking rationalisation and intention to quit
  1. Xinyuan Huang1,2,3,
  2. Wenjie Fu1,2,3,
  3. Haiying Zhang4,
  4. Hong Li4,
  5. Xiaoxia Li5,
  6. Yong Yang5,
  7. Fan Wang1,2,
  8. Junling Gao1,2,
  9. Pinpin Zheng1,2,
  10. Hua Fu1,2,
  11. Simon Chapman6,
  12. Ding Ding6,7
  1. 1 Department of Preventive Medicine and Health Education, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
  2. 2 Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
  3. 3 Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
  4. 4 School of Public Health, Guangxi Medical University, Nanning, China
  5. 5 School of Public Health, Mudanjiang Medical University, Mudanjiang, China
  6. 6 Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
  7. 7 Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
  1. Correspondence to Dr Pinpin Zheng; zpinpin{at}


Objective We aimed to describe the rationalisation beliefs endorsed by Chinese male smokers and to examine the association between rationalisation and the intention to quit.

Setting Questionnaires were conducted among male smokers in three cities (Shanghai, Nanning and Mudanjiang) which represent different geographical locations, economic development levels and legislative status of tobacco control in China.

Design and participants It was a multicentre cross-sectional survey involved a total of 3710 male smokers over 18 years.

Outcome measures Primary outcomes were intention to quit, smoking rationalisation scores and sub scores in six dimensions. Smoking rationalisation was assessed using a newly developed Chinese rationalisation scale. Multivariable logistic regression was performed to examine the relationship between rationalisation and intention to quit.

Results On average, smokers scored 3.3 out of 5 on the smoking rationalisation scale. With a one point increase in total rationalisation scale, the odds for intention to quit in the next 6 months decreased by 48% (OR=0.52, 95% CI: 0.44 to 0.61; p<0.001). Separate logistic regressions for six subscales of rationalisation shown consistent inverse associations with intention to quit (all p values <0.001). Believing that smoking was socially acceptable was the strongest predictor (OR=0.62, 95% CI: 0.55 to 0.71; p<0.001).

Conclusions Rationalisation beliefs could be important barriers to smoking cessation. Some beliefs have stronger association with quit intention than others. Eroding rationalisation beliefs endorsed by smokers is a potential strategy for smoking cessation intervention.

  • epidemiology
  • public health

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  • Contributors XH, WF, PZ: conceived the study. XH: performed the data analysis and drafted the manuscript. XH, WF: collected the data of Shanghai. HZ, HL: collected the data of Nanning. XL, YY: collected the data of Mudanjiang. FW, JG, HF, SC: participated in study design. SC, DD: contributed to the intellectual content and revised the manuscript. PZ: was the principal investigator, she conceived and led the overall study, critically reviewed the manuscript and coordinated input from other authors. All authors read and approved the final version of the manuscript.

  • Funding This study was funded by National Nature Science Foundation of China (#71573047), National Institute of Health (R01TW010666) and Shanghai Municipal Commission of Health and Family Planning (15GWZK1001). DD is funded by a Future Leader Fellowship from Heart Foundation of Australia (#101234).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ethics Committee of the School of Public Health, Fudan University (no. IRB00002408 and FWA00002399).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data were shared among the institutions as part of a data-sharing agreement. These data are not available for public sharing.

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