Elsevier

Public Health

Volume 134, May 2016, Pages 46-53
Public Health

Original Research
Problems with cigarette smoking and attitudes towards the ban of smoking in Shantou, China

https://doi.org/10.1016/j.puhe.2016.01.019Get rights and content

Highlights

  • Contains novel information which promotes improvement of public health research, policy, practice and education.

  • Identified the more serious cigarette smoking problem in China than previously indicated.

  • Revealed the contradictory and non-effective cigarette smoking control policy.

  • Presented a potentially useful citizen-based bottom-up effort to solve the problem.

Abstract

Objectives

To investigate the extent of cigarette smoking, knowledge of health hazards and attitudes towards the ban of smoking in Shantou, China, as causes for failure to control smoking.

Study design

Environmental monitoring and population survey.

Methods

Particulate matter (PM2.5) measurements were conducted in randomly selected public places (restaurants, non-alcoholic drink shops and internet bars) and exposure-related health hazards were evaluated. University students and adult citizens were randomly selected to determine their extent of cigarette smoking, knowledge of health hazards and attitude towards the ban of smoking in public places. The collected data were used to evaluate possible causes and solutions to the smoking problem.

Results

From PM2.5 measurements, the average indoor to outdoor concentrations in non-smoking restaurants were 33.4 vs. 30.6 μg/m3, P > 0.05; average indoor of smoking restaurants was 350.0% higher, P < 0.05; internet bars was 395.7% higher, P < 0.05; and non-alcoholic drink shops was 650.2% higher, P > 0.001. From our survey of 1100 university students: 1) 17.5% and 7.5% were active male and female smokers, respectively; and 2) 57.5% of students would accept a smoke-ban policy. From 502 adult citizens: 1) 27.5% were active male smokers; 2) Approximately 40 and 60% had inadequate knowledge of health hazards from smoking and second-hand smoke exposure; and 3) >90% of them would accept a smoke-ban policy.

Conclusions

Our data indicate that failure to ban smoking was not caused by resistance from smokers but inadequate (national and local) government effort to educate the public and to enforce existing policy. The data suggest that development of a citizen-based approach, in collaboration with willing officials, may be highly successful in the control of cigarette smoking in China.

Introduction

With 300 million cigarette smokers in China, smoking-related health effects are among the largest public health problems in the world.1, 2, 3 Indeed, the World Health Organization (WHO) predicted in 2003 that the smoking problem in China would be a ‘time-bomb of the 21st century’.4 Such enormous increase of cigarette smoking in China may have contributed to the slower increase in life expectancy compared to that of some less affluent countries.5

Recognizing the severity of its smoking problem, China signed an agreement with WHO in 2003 to reduce smoking.1 Since then, tobacco control policies after policies have been issued to achieve the goal. The latest one for 2012–2015 also appointed participations from the Ministries of Education, Health, Commerce, Foreign Affairs, Treasury, etc.6 However, due to the lack of concerted effort for many years, the result has been greatly disappointing.2, 3 This failure may be influenced by the government-owned cigarette manufacturing companies.7

Cigarette smoking problem in smaller cities in China is even more serious. For example, Shantou is a mid-sized city of 5.4 million people. It is a designated economic free zone therefore the citizens have medium to above medium level income and it always had a higher rate of smoking than the national average.3 This may have contributed to the lower life expectancy in Shantou for both males and females compared to that of China and Hong Kong (71.4 years vs. 72.7 years and 81.6 years, respectively).8

Most publications have blamed the Central Government of China for failure to control the smoking problem and suggested stronger enforcement as the solution.9, 10, 11 However, we believe that specific local factors can be both the source of and the solution to the problem. Therefore, we have conducted environmental sampling studies to determine the extent of cigarette smoking problems in public places in Shantou. In addition, we surveyed both university students and adult citizens to identify their knowledge about health hazards from smoking and from second-hand exposure to cigarette smoke. Finally, we documented their attitudes towards a ban of smoking in public places.

Section snippets

A. PM2.5 measurements

  • 1)

    Location selection and selection criteria

Restaurants, non-alcoholic drink shops and internet bars were screened for suitability to conduct particulate matter (PM) measurements. [PM2.5 represents particulate matter of aerodynamic diameter <2.5 m and indoor PM2.5 mainly comes from combustion products such as cigarette smoke.] These businesses were selected within a 5 km radius of Shantou University Medical College. The sites with a lot of customers were identified and then randomly selected for

A. PM2.5 investigation

  • 1)

    Characteristics of the sites for PM2.5 measurements

A total of 40 sites were selected: 20 restaurants (12 Chinese and 8 Western restaurants), 10 drink shops and 10 internet bars. All were mid-to-large sized businesses (Table 2). The restaurants were frequented by families. The drink shops and internet bars were favorite locations for adolescents, who typically spent long hours at a time on site.

A total of 55 visits to the 40 sites were conducted and these visits were performed in two phases:

Discussion

Despite signing an agreement with WHO in 2003 to reduce smoking, the effort to control smoking in China has not been successful. Cigarette smoking in Shantou, China, is even worse. When we contacted local government agencies, we were informed that the departments responsible for smoking control either had no operating budget or had no priority assignments. Despite this setback, several officials provided us with valuable information for our investigation.

From our measurement of indoor PM2.5

Acknowledgements

The authors deeply appreciate the strong support from Ms. Daisy Su (Shantou University Medical College) and Dr. Li Qiang (China Center for Disease Control and Prevention) during the course of this investigation.

Ethical approval

In our study, all human subjects have provided informed consent before they volunteered to the investigation. Our investigation has complied with ethical practice of public health, e.g. non-disclosure, anonymous and confidentiality.

Funding

Funding for the investigation was provided by the

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