The effects of community education on tobacco use among older adults in China.

INTRODUCTION

Smoking among older adults is increasingly linked to chronic diseases and higher mortality rates. However, the influence of community education on smoking behavior in older adults remains understudied. This research examines the causal effect of community education on smoking habits of older adults in China.

METHODS

We use four waves of longitudinal secondary data (2011, 2013, 2015, and 2018) from the China Health and Retirement Longitudinal Study (CHARLS), covering adult children aged 22-58 years and their parents aged ≥60 years. A two-stage least squares (2SLS) model is applied to estimate the causal impact of community education on smoking behaviors among older adults, using exposure to the 1986 Compulsory Schooling Law as an instrumental variable. Mechanism and subgroup analyses are further conducted to validate and interpret the estimated effects.

RESULTS

This study includes 26489 adults aged ≥60 years. Community education significantly reduces the likelihood of ever smoking (β= -0.030; 95% CI: -0.048 - -0.012), current smoking (β= -0.020; 95% CI: -0.038 - -0.003), and the number of cigarettes (β= -0.038; 95% CI: -0.075 - -0.001). Mediation analysis indicates that these effects are partially explained by intergenerational support, well-being, and mental health. Among ever smokers, the Center for Epidemiologic Studies Depression Scale (CES-D) score shows the largest indirect effect (β=0.0004; 95% CI: 0.0000-0.0010), accounting for 3.5% of the total effect, followed by contact with children (β= -0.0003; 95% CI: -0.0010 - -0.0000; 1.8%) and optimism (β= -0.0001; 95% CI: -0.0002 - -0.0000; 0.7%). For smoking intensity, CES-D remains the only significant mediator (β=0.0008; 95% CI: -0.0003-0.0010), explaining 4% of the total effect.

CONCLUSIONS

Community education plays a crucial role in lowering smoking rates among older adults. Policymakers should prioritize educational programs and enhance healthcare services to reduce smoking and improve public health outcomes for aging populations.