BMC Public Health 2006, 6:65 http://www.biomedcentral.com/1471-2458/6/65 addictive behaviors [17] and smoking cessation [13] in western societies. For example, we identified that relapse was associated with feelings of low self-control, negative stress, times of high elation, and social situations involv- ing other smokers. In addition, we found few differences between triggers or cues to smoke, and situations that caused a person to relapse fully. The relatively short peri- ods of abstinence reported by our respondents under- scores the difficulties faced by smokers who want to quit in China. While the absence of available cessation meth- ods was cited as a reason for relapse by only 17% of our sample, it was more likely related to situations where high positive feelings were associated with social situations (e.g., winning at cards). From our data, it would appear that social situations and peer influences are important barriers to smoking cessation in this Chinese population. Perhaps most central to Chinese culture is the value of family to the individual as well as to Chinese society. Fam- ily values emphasize the collective quality in the nature of the individual's life and behaviour, and a strong sense of obligation and responsibility to one's family is cherished as a virtue [18]. In this context, smoking may be perceived as a threat to the health and financial concerns of a family. Yang and Miao [19] recognized the important role of fam- ily in designing an effective smoking cessation program based on spouse support. Family and peer influences have been found to be related to smoking in China [18,20,21]. Advice about quitting and examples from others outside the family was cited as third most influential reason to attempt to quit in this study. This evidence suggests that home and family support as well as social support from others may represent important targets for effective cessa- tion program delivery. Cost was a frequently reported reason for quitting. Although the absolute price of cigarettes per pack is much cheaper in China than in western countries, the ratio of cigarette expense to a smoker's income is much higher. A study by Guindon, Tobin & Yach [22] identified that China was on the list of countries they compared in low- est affordability of cigarettes, after adjusting for purchas- ing power and exchange rates. But regional economic conditions greatly influence the affordability of cigarettes in China. For example, according to the above study [22], the minutes of labour required to purchase a packet of Marlboro in mainland Shanghai (62 minutes), is almost 3 times that for smokers in Hong Kong (27 minutes), and 6 times for smokers across the China Sea in Taiwan (11 minutes) Thus, cigarette smoking may appear to present a considerable financial burden to smokers. However, con- sidering that the national smoking rate is over 60%, and, that in China cigarettes are cheap, readily available in packs, or sold individually almost everywhere, cost may not actually represent such a significant burden for smok- ers, particularly in times of recent economic growth. Chinese culture also places high value on individual "per- sonal power" and considers this as perhaps the most important personal quality, compared to western values, which emphasize appearance, money, and/or prestige among a host of valued personal attributes [23,24]. Han- dling social interaction and personal relationships well is extremely important and is a foundation of the commer- cial enterprise and business acumen so endemic in Chi- nese society. Traditionally, offering people cigarettes has been a custom to enhance personal friendship and rela- tionships, and Chinese people have traditionally shared cigarettes with each other and treated guests with ciga- rettes. With the rapid rates of economic development in China during the last 20 years, business relationships and social contacts have considerably increased the rates of smoking [2,25,26]. One study reported the most impor- tant reasons for smoking in China are embedded in social interactions and personal relationships [27]. This places a large burden on individual self-efficacy for quitting, and refusing offers and temptations to slip within a pro-smok- ing social milieu. By regarding public smoking as socially acceptable or desirable, the social milieu in China contains considera- ble barriers to the promotion of effective smoking cessa- tion opportunities. In addition to being tobacco consumers, China is one of the world's largest producers of tobacco products so that tobacco is widely available [26]. The low desire to quit among smokers suggests a stronger public health agenda to focus more upon making smoking socially unnecessary and/or unacceptable [27]. While at the outset this may appear a forlorn utopian dream, evaluations from western style intervention pro- grams with Chinese youth have shown promise and potential [28]. In addition, cessation efforts targeted at parents and adult smokers could help to reduce the adop- tion of smoking among future generations [29]. Conclusion The results of this study help to fill a void in the literature with regard to identifying important psychosocial issues related to cessation and smoking relapse among male Chinese smokers in a large city. Notwithstanding the rela- tively encouraging finding that a modest proportion of smokers have a desire to quit, the high rate of recidivism is cause for concern. By highlighting the salient challenges facing attempted quitters in China both from a situa- tional/cultural perspective as well as on a personal level, our data may provide important information for the design of smoking cessation programs and/or the settings in which they might be delivered. Our respondents iden- tified a lack of cessation resources available for well-inten- Page 5 of 7 (page number not for citation purposes)