Background The prevalence and psychosocial determinants of smoking and passive smoking in older people in China are not well documented.

Methods Using a standard interview method, we examined random samples of 6071 participants aged ≥60 years in Anhui, Guangdong, Heilongjiang, Shanghai and Shanxi provinces, China during 2007–2009. The smoking and passive smoking questionnaire was derived partly from the Scottish MONICA survey.

Results World age-standardised prevalence for current and former smoking in men was 45.6% (95% CI 42.6% to 48.6%) and 20.5% (18.6% to 22.4%), and in women 11.1% (9.87% to 12.3%) and 4.49% (3.73% to 5.26%). Age-gender adjusted OR for current and former smoking was significantly with younger age (for current-smoking), male gender, low levels of education, occupational class and annual income, living in rural area, less satisfaction for life, alcohol drinking, widow status, having no religion, pessimism (for current-smoking), worrying and depressive syndrome. Among 3774 never-smokers, 1160 had passive smoking (prevalence of 31.5%, 29.5% to 33.5%), 53% of which was from exposure at home only. Its risk was significantly related to female gender, low levels of education, occupational class and annual income, living in rural area, less satisfaction for life, being married, alcohol drinking, and having a religion.

Conclusions There is a high level of smoking in Chinese older men and of passive smoking in women. Differences between active and passive smoking in association with marital status and having a religion may reflect less success in controlling smoking and passive smoking in China. The associations of smoking and passive smoking with psychosocial factors suggest priority preventive strategies.