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China

Updated: July 18, 2011

Overview
Prevalence of Tobacco Use
Cost of Tobacco Use
Tobacco-Related Health Information
Tobacco Use in the Workplace
Tobacco Cessation Treatment Options
Resources
Citations

Overview

More people in China use tobacco than in any other nation in the world. 1 China is also the world's leading tobacco producer, accounting for about a quarter of global tobacco leaf production.2 The tobacco industry has considerable political power in China given its financial resources and economic contributions. In 2005, cigarette sales generated $32.5 billion in taxes and profits in China (7.6% of total government revenue).3

Lack of national tobacco policies, cultural norms about tobacco use and government support of the industry handicap national cessation efforts. Although tobacco use is a significant public health challenge in China, there are few tobacco cessation programs available to the public and even fewer offered in the workplace. China is slowly taking steps toward promoting national tobacco cessation. New legislation effective May 1, 2011 made all indoor public spaces smoke free, although there are no penalties for violations. 4


Prevalence of Tobacco Use

China has 300 million smokers, 5 more people than the total populations of Russia, Germany, and Japan combined. 6 Smokers in China consume one-third of the world's cigarettes, numbering 1.7 trillion cigarettes per year. 1
  • Tobacco use is much more common among men than women.
    • 53% of men use tobacco.5
    • 2% of women use tobacco.5
  • This gender gap is due to a strong negative cultural stigma associated with Chinese women who smoke. Women who smoke are thought to have bad morals.
  • Children in China begin smoking at younger ages. A Peking University survey of over 100,000 students revealed that middle school smokers (on average) took their first puff before age 11.7 Among 13- to 15-year-olds, 7.1% of boys and 4.1% of girls use tobacco.2

Smoking is a dominant and important social activity in daily Chinese life. Many believe that "a cigarette after a meal makes you happier than gods in heaven."7 Boxes of cigarettes are common gifts for friends, family, professors and people in government jobs.7 To decline a cigarette in such circumstances is seen as socially inappropriate.7

Smokeless tobacco is commonly used in China, particularly among youth. Common types of smokeless tobacco in China include: 7

  • Gutkha
  • Nass
  • Pan masala


Cost of Tobacco Use

In 2010, smoking cost China U.S.$22.7 billion.5 This is equivalent to 1.9% of China's gross domestic product (GDP). 5 About U.S.$1.7 billion was spent on direct health care costs, 3.1% of the total health care expenditure. 5 The remaining U.S.$21 billion were for indirect costs like lost productivity. 5

Tobacco-Related Health Information

About 3,000 people die every day in China from smoking-related illnesses, translating into over 1 million deaths per year. 5 The death toll will double to 2 million per year by 2020 if current trends continue. 5 By the year 2030, one-third of all male deaths will be from smoking-related diseases. 5

Over two-thirds of all deaths related to smoking in China are attributed to lung cancer, pulmonary tuberculosis and chronic obstructive pulmonary disease (COPD). 8 It is estimated that 25 million people die each year from COPD in China, of which 72% are smokers. 8 By the year 2030, years of productive life lost to cardiovascular disease (CVD) will increase by 57%. 9


Tobacco Use in the Workplace

The largest cigarette manufacturer monopoly in the world is in China.10 As a result, the tobacco industry influences China's health policies. Even so, the Chinese government did ban smoking in all indoor public spaces in 2011.4 The legislation does not include specific penalties for smoking in these areas and excludes offices and government workplaces.4

Although tobacco use is a public health challenge in China, few tobacco cessation programs are available for the public or in the workplace. The Chinese government is beginning to implement laws and policies to reduce tobacco use. These include the World Health Organization Framework Convention on Tobacco Control, smoking bans and cigarette warning labels:

  • In 2011, China banned smoking in indoor public places, although there are no penalties for violating the ban.4
  • China declared the 2008 Olympic Games in Beijing as "non-smoking." 11
  • The city of Hong Kong banned smoking in restaurants, workplaces, schools and public parks in 2007. People who violate the law could pay up to a U.S.$644 fine.12
  • At the end of 2007, all cigarette manufacturers were required to put mandatory new images on their packages, illustrating the impact of smoking (e.g., cancerous lung and diseased gums).13
  • In 2005, China ratified the World Health Organization Framework Convention on Tobacco Control Treaty .4


Tobacco Cessation Treatment Options

Although smoking cessation programs are not widely available nor promoted, 2 there are various treatment options available to smokers. Medications are available to those who want to quit. Bupropion SR (trade name Wellbutrin® and Zyban®) is available with a prescription, and nicotine patches and replacement drugs are available and growing in popularity..2 However, cost may be a deterent to use. Many customers with tight budgets look online for cheaper alternatives. As counterfeit drugs are a major problem in China, .14 consumers should be wary. Counterfeit drugs ineffectively treat symptoms and may be hazardous for the user.14

In Hong Kong, the Hospital Authority Smoking Counseling and Cessation Centres (16 total) provide smoking cessation programs, including counseling by health care professionals, nicotine replacement therapy and cessation services.15 In addition, these centers provide information and support for smoker's family and friends. 15


Resources



Citations

1 Campaign for Tobacco-free Kids. Tobacco taxes in China. August 2010. Accessed May 20, 2011.
2 World Health Organization. Report on the global tobacco epidemic, 2009.Accessed May 20, 2011.
3 Wright A, Katz I. Tobacco tightrope-balancing disease prevention and economic development in China. NEJM. 2007;356:1493-1496.
4 Andrews, J. China issues nationwide restrictions on smoking. The New York Times. March 24, 2011. Accessed May 20, 2011.
5 Campaign for Tobacco-free Kids. China: tobacco burden facts. August 2010. Accessed May 20, 2011.
6 Lawrence D. Ban smoking in China? A state-run industry has objections. The New York Times. March 14, 2007. Accessed May 20, 2011.
7 Lost in the haze. People's Daily Online. October 10, 2007. Accessed May 20, 2011.
8 Zhang H, Cai B. The impact of tobacco on lung health in China. Respirology. 2003;8(1):17-21.
9 American Heart Association. (2004). International cardiovascular disease statistics. Accessed May 20, 2011.
10 World Health Organization. The Tobacco Atlas. Accessed May 20, 2011.
11 World Health Organization: Western Pacific Region. Tobacco: 8 facts on smoke-free Olympics. Accessed May 20, 2011.
12 Hong Kong wakes up to new smoking ban. MSNBC: Asia. January 2, 2007. Accessed May 20, 2011.
13 Fong G, Hammond D, Hitchman S. The impact of graphic pictures on the effectivness of tobacco health warnings. Bulletin of the World Health Organization 2009; 87:640-653. Accessed May 20, 2011.
14 Combating counterfeit pharmaceuticals from China. Science Daily. July 17, 2007. Accessed May 20, 2011.
15 Tobacco Control Office Department of Health. Smoking cessation clinics. Accessed May 20, 2011.
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