Socioeconomic variations in nicotine dependence in rural southwest China Health behavior, health promotion and society

Background: This study examines how nicotine dependence is distributed across socioeconomic gradients in rural Yunnan province, which has the most ethnic minorities in one province in southwest China. Methods: A cross-sectional survey was conducted in four rural areas of Yunnan province among 17,158 consenting individuals aged ≥18 years in 2011. Information on demographic characteristics and smoking habits was obtained using a standard questionnaire. The Fagerstrom Test for Nicotine Dependence (FTND) was applied to assess nicotine dependence. Multilevel logistic regression was used to model the variation in prevalence of nicotine dependence. Results: In the study population, the overall prevalence of current smokers and nicotine dependence was 32.4 % and 31.6 %, respectively. Females were much less likely to have nicotine addiction than males: odds ratio (OR) of 0.01 (95 % CI: 0.008 - 0.012). Higher annual household income was associated with a greater risk of nicotine dependence (OR 1.09, 95 % CI: 1.01 - 1.17). Adults who grew tobacco were more likely to have nicotine addiction (OR 1.22, 95 % CI 1.07 - 1.41). Individual educational level was inversely associated with the probability of nicotine dependence (OR 0.63, 95 % CI 0.55 - 0.72), lower community educational level was also associated with an increased risk of nicotine dependence (OR 0.94, 95 % CI 0.92 - 0.98). Conclusions: Nicotine dependence showed significant variations across different indicators of both contextual and individual socioeconomic status in rural southwest China. Future interventions on tobacco cessation should give increased attention to men, tobacco farmers, less educated or poorer persons, and lower educational level communities.