training workshop sponsored by the China CDC for 12 cities that are participating in the Smoke-Free Cities project. Michael Eriksen, ScD

1. Tobacco Control Research in China and The Tobacco Atlas

2. • Harm
• Products and Their Use
• Costs
• Tobacco Industry
• Solutions
Research Areas Corresponding to The Tobacco Atlas

3. • Biologic and toxicologic research
• Epidemiologic research
• Economic research
• Health promotion research
• Evaluation research
• Policy and regulatory research
• Legal research
Koplan, Eriksen, Chen, Yang. The value of research as a component of successful tobacco control in
China. Tob Control doi:10.1136/tobaccocontrol-2013-051054
Framework for Tobacco Control Research in China

4. Stages of the Tobacco Epidemic
Harm and Use Over Time
Thun M et al. Tob Control 2012;21:96-101

5. Harm from Tobacco Use
One billion tobacco-related deaths are expected in the 21st century
and smoking harms every organ of the body.

6. Harm from “Forced smoking”
• 600,000 deaths annually from secondhand smoke
exposure (mostly women and children)
• More women die in China from exposure to second
hand smoke than die from smoking themselves

7. – Calculate the exposure to and impact of secondhand smoke
• at home,
• at work, and
• combined at work and home?
– What are the synergistic effects of smoking, combined with
air pollution, on Chinese public health?
– Are the relative risks of diseases caused by smoking
different in China? If so, why?
Possible research questions related to harm caused by
smoking

8. The Western Pacific Region of the world consumes almost half of all
cigarettes and China consumes 38% of the world’s cigarettes.
Tobacco Products and Their Use

9. Tobacco Products and Their Use

10. Tobacco Products and Their Use

11. Benefits of Cessation
Tobacco Products and Their Use
Cumulative risk at
UK male 1990 rates
BMJ 2000; 321:323−9

12. – Why are Chinese women’s smoking rates so low and how can these
low rates be maintained?
– Why do Chinese teenage boys have low smoking rates while Chinese
adult men have high rates? What is responsible for this delayed
initiation?
– What is the likelihood that electronic cigarettes will become a
common source of nicotine, and what should be the appropriate
public policy regarding e-cigarettes?
– Why is there such a large cost differential in the price of a pack of
cigarettes in China, and what impact does this have on tobacco
control policies, especially tax increases?
Possible research questions related to tobacco products and
their use

13. Tobacco-related costs in China are growing.
Costs Related to Tobacco Use
2000
$7.2 billion
2008
$28.9 billion
Between 2000 and
2008, total costs
attributable to
tobacco use in China
more than
quadrupled
Direct costs of
smoking (size of
figures proportional
to total in USD)

14. – What are the economic costs of smoking in rural
households, and how does that impact food availability?
– What is a realistic estimate of the direct (healthcare costs)
and indirect (loss of productivity) costs of smoking for
China?
– What is the appropriate level for government investment
in tobacco control, and what needs to occur in order for
that investment to be made?
Research questions related to costs of tobacco use

15. The Western Pacific Region leads the world in cigarette manufacturing.
The Tobacco Industry and Cigarette Production
In 2010, 41% of the
world’s cigarettes
were produced in
China.

16. CNTC leads all tobacco companies in total revenue and profits.
The Tobacco Industry and Company Profits

17. China grows 43% of all the tobacco in the world, more than the next
9 leading tobacco growing countries combined.
The Tobacco Industry and Tobacco Growing

18. Country 2000 Production (MT)
2009 Production
(MT)
2000 vs. 2009
Percent Change
China 2,563,850 3,067,928 20%
Brazil 578,451 863,079 49%
India 520,000 620,000 19%
United States of America 477,753 373,440 -22%
Malawi 98,675 208,155 111%
Indonesia 146,100 181,319 24%
Argentina 114,509 159,495 39%
Italy 129,937 119,119 -8%
Pakistan 107,700 104,996 -3%
Zimbabwe 227,726 96,367 -58%
4,964,701 5,793,898 16.70%
The world’s leading tobacco producers and change over time in tobacco leaf
production.
The Tobacco Industry and Tobacco Growing

19. Tobacco industry sponsorships in China are an everyday occurrence.
The Tobacco Industry and Sponsorships

20. – What impact does having a state monopoly have on
implementing effective tobacco control measures? Is
there a way the monopoly can advance tobacco control?
– If the Chinese tobacco industry was privatized, what
would the optimal tax rate be to discourage smoking
while also providing sufficient government revenue?
– How can tobacco control progress in a way to minimize a
negative impact on tobacco farming?
– How can a government-owned tobacco industry be
criticized in a patriotic country like China?
Research questions related to the tobacco industry

21. Innovative plain packaging introduced in Australia.
Tobacco Control Solutions

22. Shanghai Tobacco Company’s “I Love China” brand circumvents advertising
bans.
Tobacco Control Solutions

23. Clean indoor air laws make a difference.
Tobacco Control Solutions
Bill Gates and Baidu CEO Robin Li wear shirts reading
“Say no to forced smoking”

24. Hong Kong implements successful smoking ban without negatively
impacting restaurant sales.
Tobacco Control Solutions

25. Support for smoke free hospitality in China
Tobacco Control Solutions
Sample of 814 restaurants and bars in five Chinese cities (Beijing, Xi’an,
Wuhan, Kunming and Guiyang) found (Liu, 2011b):
• 86% of nonsmoking subjects were exposed to at least a day of SHS at work
each week
• 51% knew SHS could cause heart disease
• 17% supported prohibiting smoking in restaurants ; 11% supported
prohibiting smoking in bars
• 53% of subjects were willing to prohibit/restrict smoking in their venues
– 82% of those unwilling to restrict smoking thought smoking bans would
reduce revenue
– 63% unwilling to restrict smoking thought indoor air quality depended
on ventilation rather than bans
Study indicates support for smoking bans among Chinese restaurant and
bar owners and highlights knowledge gaps

26. – In China, what are the most effective tobacco control interventions, and
are they different from those elsewhere in the world?
– What is the most effective way to increase the currently low quit rates
among Chinese men?
– How can tobacco control progress be accelerated so that public health
benefits can be achieved in years rather than decades?
– How can smoking be made socially unacceptable in a culture where
most men smoke and cigarettes are still given as gifts?
– What laws and regulations need to be established to support tobacco
control efforts in a relatively new and changing legal system where the
government owns the tobacco industry?
Research questions related to tobacco control solutions

27. Michael Eriksen
Dean, School of Public Health
Georgia State University
meriksen@gsu.edu
Additional information available at:
TobaccoAtlas.org
TobaccoPortal.org