Cigarette Smoking in China On May 1, 2011, the Chinese Government issued a call for no-smoking in 28 public indoor spaces such as offices, restaurants, museums, waiting rooms of train stations, bus stations, and parks.

To provide some insights into the current cigarette smoking trend in China, we have collected five research papers in this special issue. The authors have drawn samples from northern, central and southern China. Three of the five papers study cigarette smoking habits of health professionals, physicians and nurses, or future health professionals, medical students. The importance of research on health professionals can not be over emphasized since past research indicates that non-smoking health professionals are more likely to counsel their patients about cigarette smoking. We argue that the anti-smoking campaigns cannot be effective if health professionals keep smoking. Their behavior could mislead the general population into thinking that perhaps smoking is not harmful to the human body.

In the first paper, Gong et al. report on a random sample of 677 physicians in Wuhan, a large city in central China. Among the 677 physicians, 31.6 percent of the men and 0.9 percent of the women were current smokers, which are lower rates than the 48 percent and 2.6 percent smoking rates in the general population for males and females respectively (Yang et al., 1999, 2005), but higher than rates of western physicians (e.g. Josseran et al., 2000, 2005; Kotz et al., 2007).

The surprising finding is that 79.2 percent of the smokers reported smoking on duty; 15 percent of the smokers smoked in front of patients; 40 percent smoked in a location within the hospital buildings (e.g. aisles, offices, and restrooms), and 37.7 percent smoked outside the hospital buildings.

In the second paper, Li et al. examine cigarette smoking prevalence and smoking cessation counseling frequencies in a sample of 200 Chinese nurses from Baoding, a large city near Beijing. In the third paper, Zhou et al. surveyed 269 patients from 13 hospitals in several cities of Hubei Province, to assess whether a nationwide campaign promoting smoking-free hospitals and smoking-free doctors was effective. Majority of the patients had seen "no-smoking" signs in the hospital but half of them reported no awareness of any tobacco control rules and regulations. In the fourth paper, Chen et al. report on a survey of 758 medical students in Hainan Medical College of southern China. Although 66.9 percent of males and 26 percent of the females had started cigarette smoking, only 26.5 percent of males and 1.6 percent of females had smoked in the previous 30 days. These rates are lower than those found in physicians (e.g. Li et al., 2008), the message being there is hope of preventing medical students from developing an ingrained smoking habit.

In the fourth paper, Chen et al. report on a survey of 758 medical students in Hainan Medical College of southern China. Although 66.9 percent of males and 26 percent of the females had started cigarette smoking, only 26.5 percent of males and 1.6 percent of females had smoked in the previous 30 days. These rates are lower than those found in physicians (e.g. Li et al., 2008), the message being there is hope of preventing medical students from developing an ingrained smoking habit.

In the final paper, Yanping Cui, et al sampled 150 university students who were current smokers, in Baoding, a large city in northern China. Among the significant findings are: 55.9 percent of the students reported having offered cigarettes as gifts; female students were more likely than male 3 students to receive cigarettes as gifts; 62 percent of the students perceive smoking as a social status symbol, and 11 percent thought smoking would not harm the human body. Students smoked more if they had more friends who were smokers and if they often offered others cigarettes as gifts. The authors argue that teaching students to resist peer pressure and discourage them to pass cigarettes around in dorms are potentially effective strategies to decrease smoking among university students.

Cigarette smoking among Chinese women is rare and viewed negatively in society. Therefore discouraging smoking in young, educated women should not pose a huge difficulty as long as the media does not portray female smoking as fashionably western (e.g. Li et al., 2007). On the contrary, the Chinese media should report the changing norm regarding cigarette smoking, as well as the wide acceptance of smoking bans in indoor spaces in western countries. These reports may discourage the fashion-conscious young Chinese women from developing the habit of cigarette smoking.

Based on: Han Zao Li (2012) "Cigarette smoking in China'. Health Journal, vol 112(4), p. 312-318.

Please answer the following questions based on the case study as described above.

1. Describe the main and subsidiary research. (20 marks)

2. Describe the unit of analysis used in the first paper (Gong et al). (5 marks)

3. The above studies used sampling method. In your opinion, is this sampling method appropriate or should it be a census study? Give FOUR (4) reasons to support your answer. (20 marks)

4. The research papers in the case study above have mainly applied random sampling method. If you were to carry out the same research, what would be your choice of sampling method? Explain your choice. (15 marks)

5. From five research studies cited in the case above, explain TWO (2) significant conclusion related to smoking. (20 marks)

6. If a smoking research study is to be carried out in Malaysia, how would you expand the scope of the study? (20 marks