【目的】

烟草流行状况存在明显性别差异，虽然相较于男性，女性吸烟率处于较低水平，但是由于女性特殊的生理结构，吸烟使女性存在包括生育在内的更多健康风险。本研究旨在描述中国女性的烟草使用情况，如吸烟率、烟草依赖患病率、吸烟包年数等，探索吸烟相关的影响因素，以更加全面地了解女性吸烟者群体，控制女性吸烟的流行。

【方法】

本研究是一项具有全国代表性的横断面研究，数据来源于2018年中国居民健康素养监测烟草专项调查，该调查采用多阶段分层抽样法，共调查全国31个省336个区（县）的15-69岁城乡常住居民。通过问卷形式收集了一般人口学信息、吸烟情况、每日吸烟支数、吸烟持续时间、开始吸烟年龄、FTND尼古丁依赖评分（Fagerström Test of Nicotine Dependence）、烟草依赖相关信息。本次分析共计纳入数据完整有效的20-69岁女性44 319名（43 074名从不吸烟者和1 245名有烟草使用史者）。评估2018年中国女性的吸烟流行现状和现在吸烟者的烟草依赖流行现状。采用logistics回归模型探索与女性吸烟情况有关的一般人口学特征和与烟草依赖有关的吸烟特征，计算调整后比值比（Odds ratios，ORs）。通过2010年全国第六次人口普查数据，使用SUDAAN11.0软件计算权重并对数据进行加权，根据2018年全国人口数估算我国女性的吸烟人数和烟草依赖人数。使用SPSS25.0软件进行统计分析，双侧P<0.05为差异有统计学意义。

【结果】

2018年中国女性的现在吸烟率为1.85%，其中半数以上现在吸烟者存在烟草依赖（约734万人），烟草依赖患病率为52.53%。单身（OR=1.54，95%CI：1.07-2.21，P=0.021）、受教育程度低（OR=1.93，95%CI：1.47-2.52，P<0.001）和家庭年收入低（OR=1.74，95%CI:1.48-2.03，P<0.001）的女性吸烟风险更高。女性开始吸烟年龄出现代际性提前，即20世纪90年代出生的女性平均开始吸烟年龄显著早于20世纪50年代出生的女性（19.36岁比25.69岁，P<0.001），这在城乡中表现出相同的趋势。在所有年代出生的女性中，有烟草依赖者开始吸烟年龄始终早于无烟草依赖者。

各省份间吸烟率和烟草依赖患病率差异显著，吉林省女性吸烟率和烟草依赖患病率均较高（10.59%和68.16%）；浙江省女性吸烟率和烟草依赖患病率均较低（0.87%和31.22%）；北京女性吸烟率较高，烟草依赖患病率较低（3.38%和25.27%）；云南省女性吸烟率较低，但烟草依赖患病率较高（0.94%和69.32%）。

【结论】

2018年中国女性现在吸烟率为1.85%，半数以上现在吸烟者为烟草依赖患者，存在明显地域差异。女性开始吸烟年龄越来越早，这一现象在烟草依赖者中更为突出。

Background： There are obvious gender differences in the prevalence of tobacco use, and smoking puts women at greater health risks due to their special physiology. This study aims to describe tobacco use among Chinese women, such as smoking prevalence, tobacco dependence rate, and pack-years of smoking, and to explore smoking-related influencing factors. In order to have a more comprehensive understanding of the female smoking population and control the prevalence of smoking among women. Methods： This study is a nationally representative cross-sectional study. It is based on the 2018 Chinese Health Literacy Survey. The survey covered urban and rural permanent residents aged 15-69 years from 336 districts (counties) in 31 provinces across the country. A multi-stage stratified sampling method was used. General demographic information, smoking status, number of cigarettes smoked per day, smoking duration, age of smoking initiation, FTND (Fagerström Test of Nicotine Dependence), and tobacco dependence-related information were collected by questionnaire. A total of 44319 women aged 20-69 years with complete and valid data (43 074 never smokers and 1 245 with a history of tobacco use) were included in this analysis. The current status of smoking prevalence among Chinese women and the current status of tobacco dependence prevalence among current smokers were assessed in 2018. Logistic regression models were used to explore general demographic characteristics related to women's smoking status and smoking characteristics related to tobacco dependence, and adjusted odds ratios (ORs) were calculated. The number of smokers and tobacco dependence among women in China were estimated from the data of the sixth national census in 2010 using SUDAAN 11.0 software to calculate the weights and weight the data according to the national population number in 2018. Statistical analysis was performed using SPSS25.0 software, and two-sided P<0.05 was considered statistically significant difference. Results： The current smoking prevalence among Chinese women in 2018 was 1.85 percent, with more than half of smokers having tobacco dependence (about 7.34 million people) and a tobacco dependence rate of 52.53 percent. Women with low levels of education, single, and with low annual household incomes were at higher risk of smoking. There is an intergenerational advancement in the age of female smoking initiation, that is, the average age of smoking initiation for women born in the 1990s (19.36 years) is significantly earlier than that for women born in the 1950s (25.69 years), and it shows the same trend in both urban and rural areas. Among women born in all generations, the age of smoking initiation was consistently earlier among those with tobacco dependence than among those without tobacco dependence. There were significant differences in smoking prevalence and prevalence of tobacco dependence among provinces, with Jilin Province having a higher prevalence of both female smoking and tobacco dependence (10.59% and 68.16%); Zhejiang Province having a lower prevalence of both female smoking and tobacco dependence (0.87% and 31.22%); Beijing having a higher prevalence of female smoking and lower prevalence of tobacco dependence (3.38% and 25.27%); and Yunnan Province having a lower prevalence of female smoking but a higher prevalence of tobacco dependence (0.94% and 69.32%). Conclusion： The prevalence of smoking among women in China was 1.85 percent in 2018, and more than half of the smokers were tobacco dependent, with significant geographical differences. Women start smoking at an earlier age, and this phenomenon is more pronounced among tobacco-dependent individuals.