Decreased smoking initiation among male youths in China: an urban–rural comparison

Objectives: This study compared urban/rural differences in smoking initiation during the transition from adolescence to young adulthood among Chinese males. Methods: Data were derived from the China Health and Nutrition Survey (N = 2395). Logistic and cox models were computed to assess smoking initiation between the ages of 15 and 20 across urban/rural administrative districts (i.e. urban neighborhood, suburban village, county town neighborhood, and rural village). Results: Findings revealed that rates of smoking initiation decreased from the 1970 to 1996 cohorts in all four administrative districts. After adjusting for household and community characteristics, the inverse association between smoking initiation and birth year remained statistically significant (p < 0.05) in all administrative districts with the exception of urban neighborhoods. County town neighborhoods and suburban villages witnessed accelerated reductions in smoking initiation. Conclusions: Decreased smoking initiation appears to be associated with birth year, which may be correlated with social and economic development of China in conjunction with an unprecedented rate of urbanization. Results suggest that the rate of smoking initiation for male youths may experience further decreases, particularly in areas with a heightened potential of urbanization.