Tobacco use continues to be a top threat to health and economic well-being of people in China

Efforts over the past seven years to reduce tobacco use in China have been strikingly ineffective and leave tobacco use a top threat to the health and economic well-being of the world's largest country, according to research findings by the University of Waterloo's International Tobacco Control Policy Evaluation Project (ITC Project).

China is the world's largest producer and consumer of tobacco, with more than 300 million smokers. The annual tobacco related death toll of 1.4 million, including approximately 100,000 deaths due to exposure to second-hand smoke is expected to triple by 2050.

Ten articles just published in a supplement of the journal Tobacco Control report findings from research conducted in China by the ITC Project, a 23-country partnership led by Waterloo professor Geoffrey T. Fong that examines the impact of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). China joined the FCTC in 2006.

"The new ITC studies demonstrate the urgent need for the Chinese government to accelerate progress towards ending the tobacco epidemic across several key policy fronts including a national comprehensive smoke-free law, pictorial health warnings, and strong controls on misleading marketing and harmful cigarette design practices," said Professor Fong.

In collaboration with the Tobacco Control Office of the China Center for Disease Control and Prevention, the ITC Project conducted surveys of more than 5,000 adult smokers and 1,000 non-smokers in seven cities in China in 2006, 2007-08, 2009, and 2011-12.

China's slow progress in implementing strong FCTC policies is evident across the studies. For example, in one paper, authors estimate that China's decision to implement text-only health warnings, rather than pictorial warnings resulted in an estimated 28.5 million fewer smokers noticing the warning. This estimation is based on ITC comparative surveys in Malaysia showing a 12.5 per cent increase in noticing warnings after they were changed from text to pictorial warnings, compared to an increase of only 3.1 per cent in China.

Another study reports people were smoking in more than two-thirds of restaurants visited by smokers, and more than half of indoor workplaces, indicating ongoing high levels of second-hand smoke exposure in public places.

Comparisons to other countries in the ITC Project show how far China lags in protecting their people against second-hand smoke. Smoking bans in Ireland and France, for example, led to a decrease of smoking in restaurants from over 70 per cent to less than 5 per cent. In China the largest decrease was from 93 per cent in 2007-08 to 67 per cent in 2011-12 after Beijing implemented a partial smoking ban in restaurants.

"China is unfortunately a world leader in second-hand smoke exposure: among the countries we work in, China has the highest rates of smoking in workplaces and homes, and among the highest rates in restaurants and bars. This puts the health of millions of non-smokers at risk every single day," said Professor Fong, lead author of the article.

China banned descriptors such as light, mild, or low tar on cigarette packages in January 2006 in accordance with Article 11 of the FCTC, and the maximum tar yield on cigarettes was lowered in 2011. However, two articles in the Tobacco Control Supplement found that other marketing strategies such as white or light blue package colours are still used to create misperceptions among smokers that such brands are less harmful, and that changes in cigarette design are being used to meet reduced tar limits.

In order to reduce these misperceptions, the researchers recommend removing tar and nicotine numbers from packs, in addition to banning misleading descriptors.