, 2006), who are in early stages of the tobacco epidemic and thus likely to experience an increase in smoking-related deaths (Ezzati & Lopez, 2003a, 2003b; Ku 0059436 B. Q. Liu et al., 1998). China is the world��s leading producer and consumer of tobacco (Milenkovich, 2004; United States Department of Agriculture, 2004). Smoking rates in China are high, with higher smoking rates among men and women (Yang, 2008). For example, smoking prevalence in Beijing is 56% among men and 6% among women (S. Lee et al., 2009). Smoking is related to mortality among the Chinese (Chen, Xu, Collins, Li, & Peto, 1997; Lam, He, Li, He, & Liang, 1997; Niu et al., 1998; Yuan et al., 1996), with 673,000 smoking-attributable deaths annually (Gu et al., 2009). One subpopulation at high risk for smoking is gay men or men who have sex with men (MSM).

High smoking rates have been documented among MSM in North America (Austin et al., 2004; D��Augelli, 2004; Greenwood et al., 2005; Lampinen, Bonner, Rusch, & Hogg, 2006; McKirnan, Tolou-Shams, Turner, Dyslin, & Hope, 2006; Tang et al., 2004), but extremely limited research has examined smoking among MSM in developing countries. Given that different cultural factors may influence smoking, research must examine prevalence and correlates of smoking among MSM more globally. The Chinese culture may be particularly important in understanding smoking among MSM. First, like other socially marginalized communities, MSM may face higher stress or depression related to discrimination, resolving sexual identity, and challenges in eliciting social support, particularly among Chinese MSM.

Same-sex sexual relationships are regulated by social factors (Choi et al., 2003; J. X. Liu & Choi, 2006; Pilcher, 2003). Within East Asian societies, concern about ��shaming�� the family (P. Liu & Chan, 1996) Batimastat may impede developing a ��gay�� or ��bisexual�� identity, thus hindering the coming out process (P. Liu & Chan, 1996) as well as disclosure to oneself (T. Lee, 2000). Because smoking is related to increased stress (Sheahan & Garrity, 1992), these factors are critical. In addition, behaviors associated with smoking, such as alcohol and drug use (Shiffman & Wills, 1985), may be higher among MSM, both in Western societies (Greenwood et al., 2001; Stall, Greenwood, Acree, Paul, & Coates, 1999) and in China (Wong et al., 2008). Finally, since the 1980s, the tobacco industry has targeted the gay market (Elliot, 1997; Goebel, 1994; Lipman, 1992). Thus, many factors may play a role in increased smoking among Chinese MSM. These high smoking rates are alarming because MSM are affected disproportionately by smoking-related health problems. For example, smoking is associated with development of anal cancer (Chin-Hong & Palefsky, 2002; Daling et al., 2004).