Open Access Research article

Smoking, smoking cessation and tobacco control in rural China: a qualitative study in Shandong Province

Jian Wang12, Chenghui Li3*, Chongqi Jia4, Yanxun Liu4, Junjie Liu12, Xiaona Yan12 and Yufeng Fang12

Author Affiliations

1 Key Lab for Health Economics and Policy Research, Ministry of Health, Shandong University, Jinan, Shandong 250012, P. R. China

2 Center for Health Management and Policy, Shandong University, Jinan, Shandong 250012, P. R. China

3 Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences Collage of Pharmacy, 4301 West Markham Street, Slot #522, Little Rock, AR 72205, USA

4 Department of Epidemiology and Health Statistics, Shandong University, Jinan, Shandong 250012, P. R. China

For all author emails, please log on.

BMC Public Health 2014, 14:916  doi:10.1186/1471-2458-14-916

Published: 4 September 2014



Smoking prevalence is high in China and even higher among rural residents. The aims of this study were: 1) to gain insights into the motivations of tobacco use and barriers to smoking cessation among rural village residents; 2) to understand the current tobacco control measures in the rural villages and barriers encountered or perceived for implementation.


Qualitative semi-structured face-to-face interviews and focus group discussions were conducted of 59 rural villagers including 37 village residents, 10 village leaders and 12 village doctors in three counties in Shandong Province, China.


Smoking initiation was most often out of curiosity when seeing others smoke, but pressure from cigarette sharing and gifting custom was the major barrier to smoking cessation. The most important reason for quitting successfully was a detrimental health problem. Although many attempted to quit at the advice of other family members, relapses were common and few were able to quit completely and for long-term unless accompanied by significant health issues. Although doctor’s advice to quit is effective, many doctors do not offer advice to all patients. There is a lack of true understanding of the harm of smoking and second-hand smoking among the villagers and a lack of access to and knowledge of effective smoking cessation tools among both smokers and village doctors. Tobacco control activities at villages were rare and infrequent.


This study highlighted the need to develop tobacco control measures that reflect the unique culture in rural China. Smoking cessation measures are not likely to achieve large scale effect unless the prevailing cigarette sharing and gifting custom is drastically changed. More educations of the hazards of smoking and second-hand smoking to village residents and educations of effective smoking cessation treatment to both village residents and healthcare providers are needed.

Smoking cessation; Rural residents; China