scholarly journals COVID-19, smoking, and inequalities: a cross-sectional survey of adults in the UK

2020 ◽  
Author(s):  
Sarah E. Jackson ◽  
Jamie Brown ◽  
Lion Shahab ◽  
Andrew Steptoe ◽  
Daisy Fancourt
Keyword(s):  
Socioeconomic Disparities ◽  
List Type ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Current Smoking ◽  
Never Smokers ◽  
The Uk ◽  
Seriously Ill ◽  
Lower Adherence

AbstractObjectivesTo examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables.DesignOnline cross-sectional survey.SettingUK.Participants53,002 men and women aged ≥18y.Main outcome measuresConfirmed and suspected COVID-19, worry about catching and becoming seriously ill from COVID-19, and adherence to protective behaviours. Socioeconomic position was defined according to highest level of education (post-16 qualifications: yes/no).ResultsCompared with never smokers (0.3% [95%CI 0.2-0.3%]), prevalence of confirmed COVID-19 was higher among current (0.6% [0.4-0.8%]) but not ex-smokers (0.2% [0.2-0.3%]). The associations were similar before (current: OR 2.14 [1.49-3.08]; ex-smokers: OR 0.73 [0.47-1.14]) and after (current: OR 1.79 [1.22-2.62]; ex-smokers: OR 0.85 [0.54-1.33]) adjustment for potential confounders. For current smokers, this was moderated by socioeconomic position, with higher rates relative to never smokers only seen in those without post-16 qualifications (OR 3.53 [2.04-6.10]). After including suspected cases, prevalence was higher among current smokers (11.2% [10.6-11.9%], OR 1.11 [1.03-1.20]) and ex-smokers (10.9% [10.4-11.5%], OR 1.07 [1.01-1.15]) than never smokers (10.2% [9.9-10.6%]), but remained higher only among ex-smokers after adjustment (OR 1.21 [1.13-1.29]). Current and ex-smokers had higher odds than never smokers of reporting significant stress about catching (current: OR 1.43 [1.35-1.52]; ex-smokers: OR 1.15 [1.09-1.22]) or becoming seriously ill from COVID-19 (current: OR 1.34 [1.27-1.43]; ex-smokers: OR 1.22 [1.16-1.28]). Adherence to recommendations to prevent the spread of COVID-19 was generally high (96.3% [96.1-96.4%]), but lower among current than never smokers (OR 0.70 [0.62-0.78]).ConclusionsWhen assessed by self-report in a population sample, current smoking was independently associated with confirmed COVID-19 infection. There were socioeconomic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.RegistrationThe analysis plan was pre-registered on Open Science Framework (https://osf.io/pcs49/).What is already known on this topicFormer or current smoking can increase the risk of respiratory viral and bacterial infections and is associated with worse outcomes for those infected.However, data from several countries indicate that rates of current smoking are substantially lower among hospitalised COVID-19 patients than would be expected based on population-level smoking prevalence.What this study addsData from a large population-based sample of adults in the UK conflict with the hypothesis that smoking is protective against COVID-19 infection; rather, we found that current smoking was independently associated with increased odds of confirmed COVID-19 infection after adjusting for relevant confounders.Socioeconomic disparities were evident, with the association between smoking and confirmed COVID-19 only apparent among those without post-16 qualifications.Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.

scholarly journals COVID-19, smoking and inequalities: a study of 53 002 adults in the UK

2020 ◽  
pp. tobaccocontrol-2020-055933 ◽  
Author(s):  
Sarah E Jackson ◽  
Jamie Brown ◽  
Lion Shahab ◽  
Andrew Steptoe ◽  
Daisy Fancourt
Keyword(s):  
Population Sample ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Current Smoking ◽  
Online Study ◽  
Confounding Variables ◽  
Never Smokers ◽  
The Uk ◽  
Seriously Ill ◽  
Lower Adherence

BackgroundThis study aimed to examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables.MethodsCross-sectional data were used from an online study of adults in the UK (n=53 002). Main outcome measures were confirmed and suspected COVID-19, worry about catching or becoming seriously ill from COVID-19 and adherence to protective behaviours. Covariates included age, sex, ethnicity, education (post-16 qualifications: yes/no), key worker status and comorbid health conditions.ResultsCompared with never smokers (0.26% (95% CI 0.21% to 0.33%)), prevalence of confirmed COVID-19 was higher among current (0.56% (0.41% to 0.75%)) but not ex-smokers (0.19% (0.13% to 0.28%)). Associations were similar before (current: OR=2.14 (1.49–3.08); ex-smokers: OR=0.73 (0.47–1.14)) and after (current: OR=1.79 (1.22–2.62); ex-smokers: OR=0.85 (0.54–1.33)) adjustment. For current smokers, this was moderated by socio-economic position, with higher rates only seen in those without post-16 qualifications (OR=3.53 (2.04–6.10)). After including suspected cases, prevalence was higher among current smokers (11.2% (10.6% to 11.9%), OR=1.11 (1.03–1.20)) and ex-smokers (10.9% (10.4% to 11.5%), OR=1.07 (1.01–1.15)) than never smokers (10.2% (9.9% to 10.6%)), but remained higher only among ex-smokers after adjustment (OR=1.21 (1.13–1.29)). Current and ex-smokers had higher odds than never smokers of reporting significant stress about becoming seriously ill from COVID-19 (current: OR=1.34 (1.27–1.43); ex-smokers: OR=1.22 (1.16–1.28)). Adherence to recommendations to prevent spread of COVID-19 was high (96.3% (96.1% to 96.4%)), but lower among current than never smokers (OR=0.70 (0.62–0.78)).ConclusionsIn a population sample, current smoking was independently associated with self-reported confirmed COVID-19 infection. There were socio-economic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.

scholarly journals Factors associated with adherence to self-isolation and lockdown measures in the UK; a cross-sectional survey

2020 ◽  
Author(s):  
Louise E. Smith ◽  
Richard Amlôt ◽  
Helen Lambert ◽  
Isabel Oliver ◽  
Charlotte Robin ◽  
...  
Keyword(s):  
High Temperature ◽  
Contact Tracing ◽  
List Type ◽  
Perceived Effectiveness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Perceived Severity ◽  
Factors Associated ◽  
Preventative Measures ◽  
The Uk

AbstractObjectivesTo investigate factors associated with adherence to self-isolation and lockdown measures due to COVID-19 in the UK.DesignOnline cross-sectional survey.SettingData were collected between 6th and 7th May 2020.Participants2240 participants living in the UK aged 18 years or over. Participants were recruited from YouGov’s online research panel.Main outcome measuresHaving gone out in the last 24 hours in those who reported symptoms of COVID-19 in their household. Having gone out shopping for items other than groceries, toiletries or medicines (non-essentials), and total number of outings, in the last week in those who reported no symptoms of COVID-19 in their household.Results217 people (9.7%) reported that they or someone in their household had symptoms of COVID-19 (cough or high temperature / fever) in the last seven days. Of these people, 75.1% had left the home in the last 24 hours (defined as non-adherent). Factors associated with non-adherence were being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. Adherence was associated with having received help from someone outside your household. Results should be taken with caution as there was no evidence for associations when controlling for multiple analyses. Of people reporting no symptoms in the household, 24.5% had gone out shopping for non-essentials in the last week (defined as non-adherent). Factors associated with non-adherence and with a higher total number of outings in the last week included decreased perceived effectiveness of Government “lockdown” measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules. Having received help was associated with better adherence.ConclusionsAdherence to self-isolation is poor. As we move into a new phase of contact tracing and self-isolation, it is essential that adherence is improved. Communications should aim to increase knowledge about actions to take when symptomatic or if you have been in contact with a possible COVID-19 case. They should also emphasise the risk of catching and spreading COVID-19 when out and about and the effectiveness of preventative measures. Using volunteer networks effectively to support people in isolation may promote adherence.WHAT IS ALREADY KNOWN ON THIS TOPICThe UK Government introduced “lockdown” measures, including physical or ‘social’ distancing, on 23rd March 2020 due to COVID-19.Government guidance states that people with symptoms of COVID-19 should not leave their home, also known as self-isolation.There is no research investigating adherence to self-isolation and lockdown measures, or factors associated with self-isolation or lockdown measures in the UK.WHAT THIS STUDY ADDSApproximately 10% of participants indicated that they had had symptoms of potential COVID-19 (cough and high temperature / fever) in the last week. Of these participants, 75% had left their home in the last 24 hours.Factors associated with non-adherence to self-isolation measures included being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. However, these results should be taken with caution as there was no longer evidence for associations when correcting for multiple analyses.25% of people who reported no symptoms in their household reported having gone out shopping for items other than groceries, toiletries or medicines in the last week; this was not allowed by Government guidelines in place at the time of data collection.Factors associated with non-adherence to lockdown measures, and increased number of outings in the last week, included decreased perceived effectiveness of Government “lockdown” measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules.

scholarly journals Impact of a ban on the open display of tobacco products in retail outlets on never smoking youth in the UK: findings from a repeat cross-sectional survey before, during and after implementation

2019 ◽  
pp. tobaccocontrol-2018-054831 ◽  
Author(s):  
Allison Ford ◽  
Anne Marie MacKintosh ◽  
Crawford Moodie ◽  
Mirte A G Kuipers ◽  
Gerard B Hastings ◽  
...  
Keyword(s):  
Brand Awareness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Tobacco Products ◽  
Point Of Sale ◽  
Cigarette Brand ◽  
The Mean ◽  
Never Smokers ◽  
The Uk ◽  
Smoking Susceptibility

BackgroundIn the UK, a ban on the open display of tobacco products at the point of sale (POS) was phased in between 2012 and 2015. We explored any impact of the ban on youth before, during and after implementation.MethodsA repeat cross-sectional in-home survey with young people aged 11–16 years old in the UK was conducted preban (2011, n=1373), mid-ban (2014, n=1205) and postban (2016, n=1213). The analysis focuses on the never-smokers in the sample (n=2953 in total). Preban, we quantified the associations of noticing cigarettes displayed at POS and cigarette brand awareness with smoking susceptibility. We measured any change in noticing cigarettes displayed at POS, cigarette brand awareness and smoking susceptibility between preban, mid-ban and postban. Postban, we assessed support for a display ban, perceived appeal of cigarettes and perceived acceptability of smoking as a result of closed displays.ResultsPreban, noticing cigarettes displayed at POS (adjusted OR [AOR]=1.97, 95% CI 1.30 to 2.98) and higher brand awareness (AOR=1.15, 95% CI 1.03 to 1.29) were positively associated with smoking susceptibility. The mean number of brands recalled declined from 0.97 preban to 0.69 postban (p<0.001). Smoking susceptibility decreased from 28% preban to 23% mid-ban and 18% postban (p for trend <0.001). Postban, 90% of never-smokers supported the display ban and indicated that it made cigarettes seem unappealing (77%) and made smoking seem unacceptable (87%).ConclusionsBoth partial and full implementation of a display ban were followed by a reduction in smoking susceptibility among adolescents, which may be driven by decreases in brand awareness.

scholarly journals Prevalence and characteristics of ever regular use of non-combustible nicotine for 1 year or more: a population survey in England

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sharon Cox ◽  
Jamie Brown ◽  
Loren Kock ◽  
Lion Shahab
Keyword(s):  
Smoking Status ◽  
Cross Sectional Survey ◽  
Hazardous Alcohol Use ◽  
Cross Sectional ◽  
Current Smoking Status ◽  
Current Smoking ◽  
Hazardous Alcohol ◽  
Multiple Product ◽  
Never Smokers ◽  
Weighted Prevalence

Abstract Introduction Up-to-date monitoring of non-combustible nicotine products (e.g. e-cigarettes, nicotine replacement therapies (NRT), heated tobacco products (HTP); NNP) is important to assess their impact. To date, there is little evidence on the association between ever regular use (defined here as 1 year or more) of NNP and current smoking status. Aims/methods The purpose of this study was to examine the prevalence, and sociodemographic, alcohol and smoking status correlates, of ever regular use of NNP in England in 2020. A cross-sectional survey of adults in England was conducted between February and June 2020. Results A total of 8486 adults were surveyed; 94.9% (8055) were complete cases. The weighted prevalence of ever regular NNP use was 5.4% (n = 436; 95% CI 5.0–6.0), of which 82% (n = 360; 95% CI 78.7–85.8) was single and 18% (n = 79; 95% CI 14.8–22) multiple product use. Amongst ever regular NNP users, the prevalence of ever regular NRT, e-cigarette and HTP use was 64.7% (95% CI 60.1–69), 43.4% (95% CI 38.8–48) and 2.5% (95% CI 1.4–4.5), respectively. In adjusted analysis, ever regular NNP use was associated with smoking status, being significantly higher among current (22.3%; adjusted OR (aOR) 34.9, 95% CI 24.0–50.8) and ex-smokers (12.7%, aOR 19.8, 95% CI 11.1–14.4) than among never-smokers (0.6%). More advantaged occupational grade (aOR, 1.27 95% CI 1.02–1.57) and at least hazardous alcohol use (aOR, 1.38 95% CI 1.06–1.78) were associated with greater prevalence of ever regular NNP use. Conclusions Ever regularly using NNP was highest among smokers and ex-smokers and rare among never-smokers. Among people who have ever regularly used NNP, NRT is the most popular.

scholarly journals The impact of believing you have had COVID-19 on behaviour: Cross-sectional survey

2020 ◽  
Author(s):  
Louise E. Smith ◽  
Abigail L. Mottershaw ◽  
Mark Egan ◽  
Jo Waller ◽  
Theresa M. Marteau ◽  
...  
Keyword(s):  
Public Health ◽  
List Type ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Protective Measures ◽  
Social Distancing ◽  
Behavioural Insights ◽  
Prevalence Estimates ◽  
Competing Interest ◽  
The Uk

ABSTRACTObjectivesTo investigate whether people who think they have had COVID-19 are less likely to engage in social distancing measures compared with those who think they have not had COVID-19.DesignOn-line cross-sectional survey.SettingData were collected between 20th and 22nd April.Participants6149 participants living in the UK aged 18 years or over.Main outcome measuresPerceived immunity to COVID-19, self-reported adherence to social distancing measures (going out for essential shopping, nonessential shopping, and meeting up with friends/family; total out-of-home activity), worry about COVID-19 and perceived risk of COVID-19 to oneself and people in the UK. Knowledge that cough and high temperature / fever are the main symptoms of COVID-19.ResultsIn this sample, 1493 people (24.3%) thought they had had COVID-19. Only 245 (4.0%) reported receiving a test result saying they had COVID-19. Reported test results were often incongruent with participants’ belief that they had had COVID-19. People who believed that they had had COVID-19 were: more likely to agree that they had some immunity to COVID-19; less likely to report adhering to social distancing measures; less worried about COVID-19; and less likely to know that cough and high temperature / fever are two of the most common symptoms of COVID-19.ConclusionsThe number of people in the UK who think they have already had COVID-19 is about twice the rate of current prevalence estimates. People who think that they have had COVID-19 may contribute to transmission of the virus through non-adherence to social distancing measures. Clear communications to this growing group are needed to explain why protective measures continue to be important and to encourage sustained adherence.COPYRIGHTThe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence.FUNDING SOURCESJW is funded by a career development fellowship from Cancer Research UK (ref C7492/A17219). LS and GJR are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King’s College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, Public Health England. Data collection was funded via a block Government grant to the Behavioural Insights Team.COMPETING INTEREST STATEMENTAll authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: ALM and ME report grants from government partners to the Behavioural Insights Team, during the conduct of the study, JW reports grants from Cancer Research UK, during the conduct of the study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.TRANSPARENCY DECLARATIONThe authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained.AUTHOR CONTRIBUTION STATEMENTThe study was conceptualised by LS, GJR, JW and TMM. AM and ME completed data collection. LS analysed the data. All authors contributed to, and approved, the final manuscript.WHAT IS ALREADY KNOWN ON THIS TOPICDuring the COVID-19 pandemic, multiple countries, including the UK, have introduced “lockdown” measures.The World Health Organization has warned against using the results of antibody tests to issue “immunity passports” due to fears that those who test positive for antibodies may stop adhering to protective measures.There is no research investigating adherence to protective measures among those who think they have had COVID-19.WHAT THIS STUDY ADDSThis is the first study investigating behavioural differences between those who think they have had COVID-19 and those who do not.About twice as many people think they have had COVID-19 than prevalence estimates suggest.Results suggest that there may be a high degree of self-misdiagnosis within those who think they have had COVID-19.Those who think they have had COVID-19 were more likely to think they were immune to COVID-19, and less likely to adhere to social distancing measures.

Social Influences, Social Norms, Social Support, and Smoking Behavior among Adolescent Workers

2001 ◽  
Vol 15 (6) ◽  
pp. 414-421 ◽  
Author(s):  
Pebbles Fagan ◽  
Marla Eisenberg ◽  
Anne M. Stoddard ◽  
Lindsay Frazier ◽  
Glorian Sorensen
Keyword(s):  
Social Support ◽  
Social Norms ◽  
Social Influences ◽  
Self Report ◽  
Grocery Stores ◽  
Retail Sector ◽  
Friendship Networks ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Never Smokers

Purpose. To examine the relationships between worksite interpersonal influences and smoking and quitting behavior among adolescent workers. Design. The cross-sectional survey assessed factors influencing tobacco use behavior. Setting. During the fall of 1998, data were collected from 10 grocery stores in Massachusetts that were owned and managed by the same company. Subjects. Eligible participants included 474 working adolescents ages 15 to 18. Eighty-three percent of workers (n = 379) completed the survey. Measures. The self-report questionnaire assessed social influences, social norms, social support, friendship networks, stage of smoking and quitting behavior, employment patterns, and demographic factors. Results. Thirty-five percent of respondents were never smokers, 21% experimental, 5% occasional, 18% regular, and 23% former smokers. Using analysis of variance (ANOVA), results indicate that regular smokers were 30% more likely than experimental or occasional smokers to report coworker encouragement to quit (p = .0002). Compared with regular smokers, never smokers were 15% more likely to report greater nonacceptability of smoking (p = .01). χ2 tests of association revealed no differences in friendship networks by stage of smoking. Conclusions. These data provide evidence for the need to further explore social factors inside and outside the work environment that influence smoking and quitting behavior among working teens. Interpretations of the data are limited because of cross-sectional and self-report data collection methods used in one segment of the retail sector.

scholarly journals Survey of young people in one region of the UK on accessing COVID-19 information (SOCIAL)

2021 ◽  
Vol 5 (1) ◽  
pp. e000942
Author(s):  
Oliver G P Lawton ◽  
Sarah A Lawton ◽  
Lisa Dikomitis ◽  
Joanne Protheroe ◽  
Joanne Smith ◽  
...  
Keyword(s):  
Social Media ◽  
Young People ◽  
Significant Role ◽  
Online Survey ◽  
Descriptive Statistics ◽  
Sources Of Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Education Gaps ◽  
The Uk

COVID-19 has significantly impacted young people’s lives yet little is known about the COVID-19 related sources of information they access. We performed a cross-sectional survey of pupils (11–16 years) in North Staffordshire, UK. 408 (23%) pupils responded to an online survey emailed to them by their school. Descriptive statistics were used to summarise the data. Social media, accessed by 68%, played a significant role in the provision of information, despite it not being considered trustworthy. 89% felt that COVID-19 had negatively affected their education. Gaps in the provision of information on COVID-19 have been identified.

scholarly journals Cross-Sectional Associations of Smoking and E-cigarette Use with Self-Reported Diagnosed Hypertension: Findings from Wave 3 of the Population Assessment of Tobacco and Health Study

Toxics ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 52
Author(s):  
Connor R. Miller ◽  
Hangchuan Shi ◽  
Dongmei Li ◽  
Maciej L. Goniewicz
Keyword(s):  
Electronic Cigarettes ◽  
Epidemiologic Studies ◽  
Health Condition ◽  
Health Study ◽  
Cigarette Use ◽  
Health Consequences ◽  
Cross Sectional ◽  
Population Assessment ◽  
Current Smoking ◽  
Never Smokers

Following their introduction a decade ago, electronic cigarettes (e-cigarettes) have grown in popularity. Given their novelty, knowledge of the health consequences of e-cigarette use remains limited. Epidemiologic studies have not comprehensively explored associations between e-cigarette use and hypertension, a highly prevalent health condition and major contributor to cardiovascular disease burden. In this study, cross-sectional associations of cigarette smoking and e-cigarette use (vaping) with self-reported diagnosed hypertension were evaluated among 19,147 18–55 year old respondents in Wave 3 (2015–2016) of the Population Assessment of Tobacco and Health Study. Multivariable analyses first modeled smoking and vaping as separate 2-category variables, then as a 6-category composite variable accounting for former smoking. After adjusting for potential confounders, current vaping (aOR = 1.31; 95%CI: 1.05–1.63) and current smoking (aOR = 1.27; 95%CI: 1.10–1.47) were both associated with higher odds of hypertension. In analyses modeling smoking and vaping compositely, respondents who were concurrently smoking and vaping had the highest odds of hypertension (aOR = 1.77; 95%CI: 1.32–2.39 [referent: never smokers]). These results differ somewhat from prior epidemiologic studies of vaping and respiratory outcomes, which consistently report smaller point estimates for current vaping than for current smoking. Our findings reinforce the uncertainty surrounding long-term health consequences of vaping, as well as highlight important distinctions between respiratory and cardiovascular outcomes when considering the harm reduction potential of e-cigarettes.

scholarly journals Determinants of successful guideline implementation: a national cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-hui Jin ◽  
Li-Ming Tan ◽  
Khalid S. Khan ◽  
Tong Deng ◽  
Chao Huang ◽  
...  
Keyword(s):  
Guideline Development ◽  
Guideline Implementation ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
The West ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Multi Stage ◽  
Geographical Regions ◽  
Tertiary Hospitals

Abstract Background CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China. Methods This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2–5 provinces were selected from each region. 2–3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P < 0.001; the west P = 0.02; the middle P < 0.001 compared with the east), hospital grades (P = 0.028), length of practitioners’ practice (P = 0.006), education background (Ph.D., P = 0.027; Master, P = 0.002), evidence-based medicine skills acquired in work unit (P = 0.012), and medical specialty of practitioner (General Practice, P = 0.006; Surgery, P = 0.043). Conclusion Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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