Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Methods
2.2. Data Collection
3. Results
3.1. Knowledge of the Health Effects of Smoking Cigarettes
Wang: I know smoking causes lung cancer and makes teeth yellow. Smoking during pregnancy can have a bad effect on babies. But this information does not stop me from smoking. I just gain some knowledge. That’s it (22-year-old, male, undergraduate, occasional smoker).
Wu: I already knew smoking is bad for health when I was young. There is a health warning statement on the pack, saying smoking is bad for health. But it does not have any impact on me. Otherwise, I wouldn’t be a smoker now (18-year-old, male, high school student, occasional smoker).
Shi: Sometimes I think that those kinds of education campaigns are exaggerated to frighten smokers (22-year-old, male, undergraduate, occasional smoker).
Yue: I know smoking is bad for your health. But I don’t care much about it. As far as symptoms go, sometimes I smoke heavily then have a sore throat (24-year-old, male, employee, daily smoker).
Ying: Smoking is of course bad for health, and I obviously feel that my throat is always flawed. I only stop smoking when I am not feeling well, but I will start smoking again after I am in good health (23-year-old, female, employee, occasional smoker).
Shi San: Smoking certainly has an impact on health, such as heart and lungs. I care about my health, so I do some aerobic exercise to strengthen my heart and lungs (20-year-old, female, unemployed, daily smoker).
Wang Wei: I am not worried about health too much. That is the thing for the future. Sometimes I am thinking I have already smoked for several years, my lung has already become black, and it is meaningless to stop smoking now (24-year-old, male, employee, daily smoker).
Shen: Now I am young, I never think about the bad effect on my health. The health outcomes will appear when I am around 40 years old when I have smoked for a long time. When I am that age, I will think about stop smoking (18-year-old, male, migrant worker, daily smoker).
No matter how popular education is, whatever health warnings or ugly pictures on the packs, it is hard to change behaviour There are many education campaigns on TV or the Internet about smoking leading to lung cancer. Most smokers definitely know smoking is bad for their health. But when they are addicted, it is hard for them to stop smoking (22-year-old, male, undergraduate, daily smoker).
Jinze: I don’t think there should be more education campaigns on the dangers of smoking among teenagers. Teenagers are rebellious. The more control government or teachers attempt, the more rebellious young people are (24-year-old, male, employee, daily smoker).
Jiang: It is hard to control smoking among young people. They are in adolescence and rebellious. They don’t even listen to their parents, let alone the public health campaigns (18-year-old, male, migrant worker, daily smoker).
Jiao: The education campaigns on the dangers of smoking should start from primary school. If it starts from junior or high school, the young people are in transition to adulthood and rebellious. The more you tell them not to smoke, the more like they will (22-year-old, male, teacher in college, daily smoker).
Liu: I suggest the tobacco industry should decrease the tar content in order to reduce the harm to smokers’ health (23-year-old, male, employee, daily smoker).
Jinze: Tar in cigarettes is the most harmful ingredient. The higher purity of tar cigarettes contain, the more harm it causes to smokers (24-year-old, male, employee, daily smoker).
3.2. E-Cigarettes: A Healthier Alternative to Cigarette Smoking?
Ge: Some people cannot stop smoking cigarettes; they use e-cigarettes for cessation (22-year-old, male, undergraduate, occasional smoker).
Hao Wang: I used an e-cigarette for a period of time. In the beginning, I was curious about how e-cigarette helped stop smoking. I saw the advertisement on TV then bought one (24-year-old, make, employee, daily smoker).
Zheng: I tried an e-cigarette once out of curiosity (18-year-old, male, high school student, daily smoker).
Jiao: In 2014, e-cigarettes are very popular. My flatmate bought one and gave it to me to have a try. I tried it and I found it interesting and then I bought one for myself (22-year-old, male, administrator in college, daily smoker).
Jinze: Some people may use e-cigarettes to be special. For example, in the pub, people vape and there is lots of smoke. Vaping might make young people who never smoke want to try e-cigarettes. Young people are curious. They may try e-cigarettes if their peers smoke (24-year-old, male, employee, daily smoker).
Qiu: I have an e-cigarette. I heard about this product from my friend. I tried his e-cigarette once and it seemed interesting, then I bought one online for around RMB 400 (22-year-old, male, undergraduate, daily smoker).
Hao Wang: I used my e-cigarette for a month, but it did not help me stop smoking at all…. There is no nicotine in it and I still have a craving for cigarettes. Moreover, it was inconvenient to carry my e-cigarette, as it was heavy and needed to be recharged often. Compared to e-cigarettes, conventional cigarettes can be bought in the store easily (24-year-old, male, employee, daily smoker).
Jiao: I think most of the people who have smoked for a long time want to use e-cigarettes for stopping smoking. However, the refill liquids contain nicotine and can be added to e-cigarettes as much as you like. So vaping does not decrease the dose of nicotine compared to conventional cigarettes. Moreover, an e-cigarette is heavy to carry and not easy to use. This product especially does not work for elderly people, who have smoked cigarettes for ages and do not want to try a new product (22-year-old, male, administrator in college, daily smoker).
Yue: I bought an e-cigarette for smoking cessation and used it for a period of time, but it was not helpful at all. I felt I like I was inhaling air rather than smoke (24-year-old, male, employee, daily-smoker).
Shi San: I used an e-cigarette to stop smoking. But the fruit flavour was so disgusting that I did not use it anymore (20-year-old, female, unemployed, daily smoker).
Yang Wang: I used an e-cigarette for smoking cessation but it was not helpful. As an addicted smoker, I smoked cigarettes to wake myself up. But the e-cigarette did not give the same exact sensation as a cigarette, as there was no nicotine in it (24-year-old, male, employee, daily smoker).
Wang: I used an e-cigarette which was chocolate flavour and peach flavour…… A bad feature of e-cigarettes is that they have a plastic smell which disgusts me (22-year-old, male, undergraduate, occasional smoker).
I use an e-cigarette when I cannot smoke cigarettes, not for stopping smoking. …. My parents do not allow me to smoke when I am at home, so I smoke an e-cigarette to reduce my craving for cigarettes. …. A year ago, I saw e-cigarettes online. I spent over 500 RMB to buy an e-cigarette. I smoked it in front of friends to show I was vaping. I also introduced flavours to them for fun. Actually, I never think of stopping smoking. I was lying to my parents when I told them I smoked an e-cigarette to stop smoking because they did not want me to smoke cigarettes. But I was addicted to nicotine, especially when playing video games. The withdrawal feeling was really horrible. So I found e-cigarettes online, which I used at home (24-year-old, male, employee, daily smoker).
Jinze: Using e-cigarettes is a healthy hobby. E-cigarettes are not purely harmless, but vaping is much much less harmful than smoking…. Cigarettes have nicotine, which is addictive. Cigarettes also have tar and carbon monoxide, which are the unhealthy ingredients. But e-cigarettes do not have these unhealthy ingredients. Look at these liquid bottles, one says 6 mg/mL nicotine content and one is 3 mg/mL. At the beginning of using e-cigarettes, I used 12 and 6 mg/mL. After half a year, I decreased the nicotine content, from 12, 6 to 3 mg/mL. I did feel a big change in my body. After the first week of using it, I did not have phlegm anymore…. I checked online, which said that e-cigarettes are not good for the body but are not harmful either (24-year-old, male, employee, daily smoker).
Ge: E-cigarettes are less harmful than conventional cigarettes. However, generally speaking, both of them are bad for your health (22-year-old, male, undergraduate, occasional smoker).
Wang: I think e-cigarettes are harmful…. Users do not know what the liquid is (22-year-old, male, undergraduate, occasional smoker).
Jiao: I feel e-cigarettes are unsafe. The device has a battery. The liquid contains addictive ingredients, which maybe are less harmful than conventional cigarettes (22-year-old, male, administrator in college, daily smoker).
Wang Wei: I think an e-cigarette is much unhealthier than a conventional cigarette because the liquid is chemical rather than nicotine (24-year-old, male, employee, daily smoker).
3.3. How Do Tobacco Control Policies Influence Young People’s Smoking Behaviour?
3.3.1. Smoke-Free Laws
Zhao: Many places have banned smoking, like taxis, the metro, hospitals, and shopping malls… But enforcement is bad. No fines, no monitors. Smokers still smoke in public places (17-year-old, female, high school student, never-smoker).
Man Ling: I heard there is a smoking ban in public places in Tianjin. You are not allowed to smoke in any public place with a ceiling. But the implementation does not work at all. There are no smoking signs on the wall but nobody pays any attention to them. There is no monitoring at all (20-year-old, female, undergraduate, never-smoker).
Ling Ge: No smoking signs are everywhere. But if customers smoke in restaurants, the business staff will not try to dissuade them from smoking (18-year-old, female, high school student, never-smoker).
Zheng: I feel the smoke-free ban is implemented well in Beijing. No smokers smoke in Beijing restaurants. But in Tianjin, smokers smoke in restaurants… I think if the fines are high enough, nobody would dare to smoke in public places (22-year-old, male, undergraduate, daily smoker).
Ge: I think the implementation of smoke-free law does not work at all. Non-smokers do not stop smokers who smoke in public places. Smokers just ignore no smoking signs in public places (22-year-old, male, undergraduate, occasional smoker).
3.3.2. Smoking Cessation Aids
I do not trust any telephone quitline, clinics, whatever. I have never heard of it. I do not think the aid can really help me stop smoking. Stopping smoking is really a matter of using willpower (22-year-old, male, undergraduate, occasional smoker).
Pan: I started smoking when I was in high school. I was addicted to nicotine and cough often. When I was in college, I always wanted to quit but I could not. Until graduating from college, I really decided to stop smoking as I knew smoking is not good for me. Then I did it by willpower (21-year-old, male, undergraduate, ex-smoker).
3.3.3. Cigarette Packaging
Shen: I knew there was a health warning on the pack of cigarettes, saying ‘smoking is bad for health’, ‘stopping smoking is good for health’… I never buy the foreign brands that have ugly pictures on the packs. But most of the Chinese brands have delicate packages. Sometimes I would like to buy brands that have beautiful packages (18-year-old, male, migrant worker, daily smoker).
Ying: I know on the pack of Chinese brands of cigarettes there is a warning sentence saying ‘smoking is bad for health’. I know Thai brands of cigarettes have ugly pictures, which make me feel disgusted (23-year-old, female, employee, occasional smoker).
Shi San: The ugly picture on the pack of cigarettes definitely has an impact on me. I feel disgusted and I do not buy those brands of cigarettes (20-year-old, female, unemployed, daily smoker).
3.3.4. The Price of Cigarettes
Liu: Compared to some other countries, like Japan, the price of cigarettes in China is very cheap. Some brands of packs of cigarettes just cost RMB 2, which is too cheap (23-year-old, male, master graduate, daily smoker).
Shen: Last year, there was RMB 1–2 increase per pack. It has little effect. If the price increased by double, I would consider stopping smoking because it is too expensive… I think increasing the price may have more influence on young people as they do not work and have no income (18-year-old, male, migrant worker, daily smoker).
Gao Shou: Even though the price increased, I buy cheaper brands instead of stopping smoking (17-year-old, male, high school student, daily smoker).
Shi San: The price increased by like RMB 1 per pack. [Does it affect you?] More or less. I bought cheaper brands of cigarettes but did not decrease my consumption (20-year-old, female, unemployed, daily smoker).
Zhou: Although the price increased, let’s say from RMB 10 to RMB 20, there are still cheaper brands of cigarettes. Now, most people can afford the price of cigarettes and they do not care about the RMB 10 increase (18-year-old, male, high school student, daily smoker).
Jinze: I know the price increased by like 10%. I can afford it. Living expenses increased as well. I think this slight increase may influence young people much more because they have limited pocket money (24-year-old, male, employee, daily smoker).
4. Discussion
5. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Topic 1: General information on smoking behaviours | ||
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Topic 2: Knowledge of the effects of tobacco smoke on health | ||
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Topic 3: Understanding of tobacco control policies | ||
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Demographic Categories | Number |
---|---|
Gender | |
Male | 30 |
Female | 15 |
Age | |
≤18 | 15 |
>18 | 30 |
State of current employment | |
Unemployed | 2 |
Employed | 15 |
Student | 28 |
Education | |
Current education for students | |
Academic high school | 9 |
Vocational college school | 3 |
Undergraduate | 15 |
Postgraduate | 1 |
The highest level of education for those who work | |
Junior school | 3 |
Vocational college | 4 |
High school | 3 |
Bachelor | 6 |
Masters | 1 |
Current smokers in the family excluding themselves | |
Only father smoker | 25 |
Only mother smoker | 2 |
Both father and mother smokers | 1 |
Sibling smokers | 2 |
None | 16 |
Smoking Status 1 | Total | Smoking History by Years | |
---|---|---|---|
Non-smokers | Never-smokers | 16 | / |
Ex-occasional smokers | 0 | / | |
Ex-smokers | 1 | 6 | |
Smokers | Daily smokers | 19 | 3–11 |
Occasional smokers | 9 | 2–9 | |
Total | 45 | / |
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Pei, T.; Yang, T. Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study. Children 2022, 9, 1412. https://doi.org/10.3390/children9091412
Pei T, Yang T. Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study. Children. 2022; 9(9):1412. https://doi.org/10.3390/children9091412
Chicago/Turabian StylePei, Tong, and Tingzhong Yang. 2022. "Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study" Children 9, no. 9: 1412. https://doi.org/10.3390/children9091412