The role of cities in reducing smoking in China

China is the epicenter of the global tobacco epidemic. China grows more tobacco, produces more cigarettes, makes more profits from tobacco and has more smokers than any other nation in the world. Approximately one million smokers in China die annually from diseases caused by smoking, and this estimate is expected to reach over two million by 2020. China cities have a unique opportunity and role to play in leading the tobacco control charge from the “bottom up”. The Emory Global Health Institute—China Tobacco Control Partnership supported 17 cities to establish tobacco control programs aimed at changing social norms for tobacco use. Program assessments showed the Tobacco Free Cities grantees’ progress in establishing tobacco control policies and raising public awareness through policies, programs and education activities have varied from modest to substantial. Lessons learned included the need for training and tailored technical support to build staff capacity and the importance of government and organizational support for tobacco control. Tobacco control, particularly in China, is complex, but the potential for significant public health impact is unparalleled. Cities have a critical role to play in changing social norms of tobacco use, and may be the driving force for social norm change related to tobacco use in China

mHealth Intervention is Effective in Creating Smoke-Free Homes for Newborns: A Randomized Controlled Trial Study in China.

Mobile-phone-based smoking cessation intervention has been shown to increase quitting among smokers. However, such intervention has not yet been applied to secondhand smoke (SHS) reduction programs that target smoking parents of newborns. This randomized controlled trial, undertaken in Changchun, China, assessed whether interventions that incorporate traditional and mobile-phone-based education will help create smoke-free homes for infants and increase quitting among fathers. The results showed that the abstinence rates of the fathers at 6 months (adjusted OR: 3.60, 95% CI: 1.41-9.25; p = 0.008) and 12 months (adjusted OR: 2.93, 95% CI: 1.24-6.94; p = 0.014) were both significantly increased in the intervention group compared to the control. Mothers of the newborns in the intervention group also reported reduced exposure to SHS at 12 months (adjusted OR: 0.53, 95% CI: 0.29-0.99; p = 0.046). The findings suggest that adding mHealth interventions to traditional face-to-face health counseling may be an effective way to increase male smoking cessation and reduce mother and newborn SHS exposure in the home

Smoking Experimentation among Elementary School Students in China: Influences from Peers, Families, and the School Environment

The aim of this study was to investigate experimentation with smoking among primary school students in China. Data were acquired from a recent survey of 4,073 students in grades 4 to 6 (ages 9–12) in 11 primary schools of Ningbo City. The questions were adapted from the Global Youth Tobacco Survey (GYTS). Results suggest that although the Chinese Ministry of Education (MOE) encourages smoke-free schools, experimentation with cigarettes remains a serious problem among primary school students in China. Peers, family members, and the school environment play important roles in influencing smoking experimentation among students. Having a friend who smoked, seeing a family member smoke, and observing a teacher smoking on campus predicted a higher risk of experimentation with smoking; the exposure to anti-tobacco materials at school predicted a lower risk of experimentation with smoking. The evidence suggests that public health practitioners and policymakers should seek to ensure the implementation of smoke-free policies and that intervention should target young people, families, and communities to curb the commencement of smoking among children and adolescents in China

Violent Sport and Children’s Audience Participation

Many children are naturally drawn to sporting events either through family activity participation or personal interest. Hockey, long known as a physical, aggressive and potentially violent sport, often has young fans in attendance at live sporting events. The intention of this study was to observe the reactions of children who attend professional hockey games. Both the nature and level of children’s participation were examined through observational methods. Violent occurrences, defined as moments of violence such as hard hits and fights displayed both within and outside of regulation rules of play constituted the study’s primary focus. Results include an identification of levels of reaction and participation, and implications are drawn regarding children’s spectator status during violent sporting events

Use of Electronic Nicotine Delivery Systems (ENDS) in China: Evidence from Citywide Representative Surveys from Five Chinese Cities in 2018

China is the largest cigarette consuming country in the world. The emergence of electronic nicotine delivery systems (ENDS) in China may have important implications for the Chinese tobacco market. Unfortunately, research on ENDS in China, while growing, is still limited. This study was designed to examine the awareness and use of ENDS among adult urban residents in China. Data from five citywide representative surveys conducted in 2017–2018 were used. Percentages of residents who had ever heard of, ever used, or used ENDS in the past 30 days among all residents and smokers were estimated, in total and by demographic characteristics. Multiple logistic regression models were used to estimate the adjusted associations between awareness and use of ENDS and individual-level demographic characteristics and socioeconomic status (SES). Overall, 51.3% had ever heard, 4.8% ever used, and 0.9% used ENDS in the past 30 days. Men, young adults, those with high levels of education, and current smokers were more likely to be aware of and use ENDS. Among smokers, 67.8% had ever heard, 17.1% ever used, and 3.9% used ENDS in the past 30 days, respectively. Young adult smokers and smokers with high levels of education were more likely to be aware of and use ENDS. Our study results on ENDS awareness and use patterns and associated factors in China provide important evidence to inform research and policies related to ENDS manufacture, marketing, and sales in China

Use of electronic nicotine delivery systems (ENDS) among Chinese adults: evidence from citywide representative surveys from 12 cities in China (2014 to 2016)

Background Tobacco is the leading cause of preventable death in China. Any comprehensive strategies to reduce tobacco use in China need to increase smoking cessation among current smokers. While the evidence is limited, ENDS may reduce the health risks for current smokers if they switch completely to ENDS. ENDS have the potential of reducing harms of tobacco smoking if Chinese smokers who do not intent to quit can switch completely to ENDS. To systematically assess the awareness and use of ENDS among Chinese adults, Tobacco Questions for Surveys (TQS) was conducted in twelve Chinese cities from 2014 to 2016. Methods Citywide representative surveys were conducted in 12 Chinese cities between 2014 and 2016. The target population was non­institutionalized urban adults age 15 and above. Multi­stage cluster sampling was applied to select 2,500 individuals from each city. SAS and R were used to obtain point estimates and adjusted associations accounting for the complex sample design features. Results Awareness of ENDS was above 40% in all 12 cities, the percent of respondents who have heard about ENDS ranging from 41.3% (Qingdao) to 63.2% (Xi'an). The overall rate of ever use ENDS was 2.9%, and the overall rate of current use was 0.9%. In addition, across most cities, awareness of ENDS were statistically significantly associated with current smoking, being male, aging 25-34, and having higher education. Conclusions Significant variations existed in awareness and use of ENDS among urban Chinese adults. Tailored interventions, as part of a comprehensive tobacco control and cessation strategy, which may include ENDS in assisting smokers in achieving complete cessation, may have a positive public health impact in China. In addition, nation-wide surveillance is needed to monitor the use of ENDS among both adult smokers and among adolescents and young adults, with an emphasis on the complete abstinence from any nicotine product among adolescents