Cigarette sharing has not been assessed at the provincial level or analysed the degree of its association with smoking cessation in China. Such analysis would provide critical intelligence to make evidence-based tobacco control practices more culturally sensitive and targeted.
This study analysed the cross-sectional data from the China National Adult Tobacco Survey to assess past 30-day cigarette sharing prevalence for 30 provinces of China in 2022, visualised through choropleth maps stratified by smoking status. Cochran-Armitage trend tests compared sharing prevalence across smoking status. Multilevel multivariable regression models evaluated associations between cigarette sharing and smoking cessation (intention, quit and relapse).
This study found a 21.2% prevalence of past 30-day cigarette sharing among Chinese adults in 2022, with the highest in people who currently smoke (72.0%), followed by those who formerly smoked (13.6%) and never smoked (4.3%). Occupational disparities emerged: business/service workers who currently (80.6%) or formerly (20.4%) smoked showed the highest sharing prevalence, while agricultural workers who never smoked had the highest rate (6.1%). Among adults who currently smoke, those exposed to anti-tobacco media messages (76.2% vs 69.7%) or tobacco advertising (77.7% vs 71.2%) exhibited higher sharing prevalence than non-exposed. Provincial prevalence ranged from 1.1% (Tibet) to 32.4% (Hubei), clustering regionally: higher among adults who currently or formerly smoked in densely populated or developed central, southeastern and southern regions, while those who never smoked showed higher prevalence in central and northern provinces. Cigarette sharing was negatively linked to quit intention (ref: No, Yes: adjusted OR (AOR)=0.64, 95% CI 0.57 to 0.73) and smoking quit (ref: Q1 <1.49%; Q2 1.49%–12.40%: AOR=0.66, 95% CI 0.58 to 0.76; Q3 12.41%–33.29%: AOR=0.52, 95% CI 0.43 to 0.62; Q4 >33.29%: AOR=0.38, 95% CI 0.31 to 0.47) but positively associated with relapse (ref: Q1 <1.49%; Q2 1.49%–12.40%: AOR=0.96, 95% CI 0.85 to 1.08; Q3 12.41%–33.29%: AOR=1.17, 95% CI 1.01 to 1.35; Q4 >33.29%: AOR=1.29, 95% CI 1.12 to 1.51) after covariate adjustment.
Cigarette sharing persists in China with occupational/geographic disparities and impedes cessation while promoting relapse, necessitating region-specific interventions—intensifying smoke-free policies in developed areas while promoting alternatives like tea sharing in areas with a strong Confucian “reciprocity” culture, embedding refusal tactics and cessation incentives into public health campaigns, and expediting adoption of standardised cigarette packaging aligned with WHO Framework Convention on Tobacco Control guidelines.