Exploring the education effect on tobacco use: Evidences from East and Southeast Asia.

摘要

Tobacco use has been extensively documented as a predominant cause of many lethal chronic diseases. While the number of smokers is still increasing worldwide, the regional disparities of this epidemic between developed and developing countries keep enlarging in recent decades, which shifts the major burden of anti-smoking campaigns to low- and middle-income countries. Education has a lasting significant effect on reducing individuals' tobacco use. Consisting of three separate but substantially interrelated research papers, this dissertation examines the relationship between education and individuals' smoking behaviors in China and 17 other East and Southeast Asian countries, most of which are underdeveloped and plagued severely by the tobacco epidemic.;The first paper investigates the association between educational attainment and individual tobacco consumption patterns across different age-cohorts in China. By analyzing cross-sectional data from the 2010 Global Adult Tobacco Survey (GATS) in China, I employ cohort-analysis and multivariate logistic regression to examine how educational attainment is related to two crucial indicators of individuals' tobacco use: their current smoking status, and tobacco-related behavioral change. Then, structural equation modeling (SEM) technique is used to examine two underlying crucial pathways of such education-smoking relationship: individuals' knowledge about tobacco use, and their attitudes toward smoking behaviors.;The second paper analyzes the causality in the education-smoking relationship in China. By using data from China Health and Nutrition Survey (CHNS), I employ two-stage least square (2SLS) technique to draw the causal inference between educational attainment and individuals' smoking behaviors. The first Compulsory Education Law in China enacted in early 1986 is used as the instrumental variable in this study.;The third paper extends the research scope from China to 17 East and Southeast Asian countries, investigating how adolescents' smoking status is associated with the smoking-related factors in different social ecological environments they are frequently exposed to, including families, friends, schools, communities and societies. Multiple logistic regression technique is applied to analyze data from Global Youth Tobacco Survey (GYTS) in those 17 countries separately.;In sum, the results show that the negative relationship between educational attainment and tobacco use is robust and persistent in current China. Meanwhile, the strength of the education effect on individuals' tobacco-related behavioral change is weaker in middle-age cohort than in both young and old cohorts. Individuals' tobacco knowledge plays a more significant role in mediating the education effect than their attitude toward smoking, and there is no causality found in the sample in the relationship between people's years of schooling and smoking behaviors in China. Cross-national analysis on the 17 East and Southeast Asian countries shows that the strongest predictors of adolescents' smoking behaviors, including peer influence, lack of tobacco knowledge and the quality of health class, are all associated with health education in school. Therefore, improving anti-tobacco education or prevention programs in school could be an effective strategy to control the tobacco prevalence among adolescents in East and Southeast Asia. Furthermore, it is highly necessary to carry out strict anti-smoking laws and regulations to reduce the tobacco epidemic in such regions. More accurate information and knowledge about tobacco use should also be dispersed to the population, especially how harmful smoking tobacco could be to human health.