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Objective This study aimed to identify the relationship between city-level economic development and smoking behaviour. Methods Using multilevel mixed-effects logistic methods, we examined the relationship between smoking/passive smoking and respondents' lifestyles in the city. Results We found that respondents living in cities with higher per capita gross domestic product (GDP) were less likely to smoke than those living in cities with lower per capita GDP (odds ratio [OR] = 0.977, 95% confidence interval [CI]: 0.958-0.997). Further, respondents with higher levels of life satisfaction and subjective social status were less likely to smoke than those with lower levels of these variables (OR = 0.942, 95% CI: 0.893-0.994; OR = 0.955, 95% CI: 0.928-0.983, respectively). In terms of passive smoking, respondents with higher levels of subjective social status in their cities were less likely to smoke than those with lower levels (OR = 0.972, 95% CI: 0.948-0.996). Smoking and exposure to second-hand smoke were more common among those with lower socioeconomic status. Conclusions Smoking is one of the most serious public health hazards in China. People's smoking behaviour is significantly related to characteristics of their cities and their socioeconomic status. Improved smoking-prevention measures are urgently required in China.

Effect of characteristics and life in cities in China on residents’ smoking behaviour