This report presents the ITC China Survey findings on the attitudes and behaviours of smokers and non-smokers and the impact of tobacco control policies in China to assist policymakers in implementing effective tobacco control policies in Mainland China.

This report has also been translated in Chinese.

ITC China Survey Confirms Alarming Lack of Progress on Tobacco Control but Growing Public Support for Stronger Policies

*City-level partial bans on indoor smoking in public places have been ineffective

*Despite tax increases, prices have not increased, and affordability of cigarettes continues to increase

*Text-only warnings introduced in 2008 were generally not any more effective than the previous warnings

*Chinese smokers have low awareness of the harms of smoking and secondhand smoke

*The majority of smokers (84%) and non-smokers (91%) ‘agree’ or ‘strongly agree’ that the Chinese government should do more to control smoking

Beijing, China (Saturday, Dec 15, 2012).
The International Tobacco Control Policy Evaluation Project (the ITC Project) and the Chinese Center for Disease Control and Prevention (China CDC) launched the findings of a three-year evaluation of tobacco control policies in China – the world’s largest producer and consumer of tobacco. The ITC Project Report was presented in Beijing on Friday, December 14 and Saturday, December 15 by Professor Geoffrey T. Fong, Chief Principal Investigator and Founder of the ITC Project at the China Forum on Chronic Disease Prevention and Control. The ITC China Report confirms that China has fallen well short of its commitments to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) the world’s first public health treaty. The findings of the ITC China Survey, conducted between 2006 and 2009 among 5,600 adult smokers and 1,400 non-smokers in 7 cities in Mainland China, show clearly the China’s policies are very weak across several key areas of tobacco control:

Smoke-free Policies: Partial smoke-free laws have not decreased smoking in public places. In 2009, more than 90% of smokers in 5 cities reported that they observed smoking in restaurants. ITC surveys conducted in other countries show that strongly enforced smoke-free policies are effective – in France, Ireland, and Scotland, where smoking rates in restaurants were once about as high as China prior to comprehensive smoke-free laws were implemented in those countries, fewer than 5% of smokers noticed indoor smoking in restaurants after smoke-free laws were implemented.

Warning Labels: The majority of Chinese smokers lack the knowledge that smoking causes non-communicable diseases such as stroke among smokers and heart attacks among non-smokers due to secondhand smoke and overall, knowledge of the harms of smoking and secondhand smoke are at the lowest levels of the 19 ITC countries where data have been collected to date. Thus, warning labels represent a critically important policy in China for raising knowledge and awareness. In October 2008, new text warning labels were introduced in China on 30% of the front and 30% of the back of the pack.  The ITC China Survey results showed that these new labels had little effect. The newer warnings were generally unnoticed by smokers, did not stop smokers from having a cigarette, and did not motivate smokers to quit. In 2009, only 8% of smokers reported that the current health warnings made them think about the health risks of smoking ‘a lot’. In an experimental study conducted by the ITC China Project team, Chinese smokers rated pictorial warnings as much more effective that the same warnings without graphic images.

Taxation and Price: China implemented a tax increase on June 1, 2009, but retail prices have still not increased. The ITC China Survey found that 50% of Chinese urban smokers spent 6 Yuan or less on a pack of cigarettes and smokers spent less than 1.4% of their annual income on cigarettes. Few smokers think about the cost of smoking in China—lowest of all ITC countries—and affordability of cigarettes has increased from 2007 to 2010.  China has the lowest percentage of smokers across all ITC countries who mention price of cigarettes as a reason to quit. 

The ITC China Report calls on the Chinese government to take swift action to implement stronger policies to protect China’s more than 300 million smokers, and 740 million non-smokers and provides evidence that that the majority of smokers and non-smokers are in favour of stronger policies.  Support for comprehensive smoking bans in workplaces increased among smokers in all six cities between 2007 and 2009.  In Yinchuan, smokers’ support for 100% smoke-free workplaces increased from 56% in 2006 to 80% in 2009.

The Report’s recommendations include increasing cigarette taxes and prices, implement graphic warning labels on packs that cover 50% of both sides of the pack, and implementing and enforcing a national comprehensive ban on smoking in public places, with no exceptions. Other recommended steps forward include implementing well-funded public education programs to increase knowledge of the harms of smoking and secondhand smoke, as well as a strong system of cessation services to help smokers who want to quit.

While the Chinese government has recently taken steps to implement stronger smoke-free and warning label policies, evidence to date suggests that these new policies are not effective. The Wave 4 ITC China Survey currently in progress will determine whether these and other policies have led to improvements in protecting Chinese smokers and non-smokers from the harms of tobacco.