Prevalence and associated factors of cigars in China: Findings from nationwide China Health Literacy Survey during 2018-19

Abstract Background Cigar prevalence is increasing year by year and is more and more harmful, but little is known about the prevalence of cigars in Chinese groups. Methods The data were divided from the 2018–2019 National Health Literacy Survey, which employed a rigorous multi-stage stratified sampling method. Finally, 86,701 individuals were included in the final analysis. Logistic regression was employed to analyze the odds ratio (OR) and calculate the corresponding 95% confidence intervals (CI) to assess the association between demographic characteristics and cigar use. To estimate the nationwide proportion of cigar users, appropriate data weighting was applied. Results The proportion of cigar users in China was currently 4.47% among smokers. Cigar prevalence varied greatly between provinces, it was related to the economic development and customs of cities. Cigar users had distinct demographic characteristics, mainly concentrated in urban (P = 0.009) and high education level (P < 0.001) population. Males (OR = 1.427, 95% CI 1.036–1.965, P = 0.030), education level more than middle and high school (OR = 1.654 95%, CI 1.306–2.095, P < 0.001), self-report health status was poor (OR = 1.416, 95% CI 1.124–1.784, P = 0.003) adults had the high risk to use cigars. It was estimated that about 10.464 million (10.401–10.527 million) cigar users were currently in China, mainly men (10.218 million [10.173–10.263 million]). Interpretation Higher education levels, living in rural areas, and belonging to ethnic minority groups are at a higher risk of cigar use in China. Cigar use by teenagers should not be underestimated.