BackgroundIn 2009, the China National Tobacco Company (CNTC) began their Premiumization Strategy, designed to encourage smokers to trade up to more expensive brands, mainly by promoting the concept that higher class cigarettes are better quality and less harmful. This study is the first evaluation of the strategy’s impact on: (1) prevalence of premium brand cigarettes (PBC), mid-priced brand cigarettes (MBC) and discount brand cigarettes (DBC) over 9 years, from 3 years pre-strategy (2006) to 6 years post-strategy (2015); and (2) changes in reasons for choosing PBCs, MBCs and DBCs.MethodsA representative cohort of adult Chinese smokers (n=9047) in seven cities who participated in five waves of the International Tobacco Control (ITC) China Survey: pre-implementation (Wave 1 (2006; n=3452), Wave 2 (2007–2008; n=3586)); mid-implementation (Wave 3 (2009; n=4172)); and post-implementation (Wave 4 (2011–2012; n=4070), Wave 5 (2013–2015; n=2775)). Generalised estimating equations were conducted to examine changes in prevalence of PBCs, MBCs and DBCs, and reasons for brand choice from pre-implementation to post-implementation.ResultsFrom pre-implementation to post-implementation, there was an increase in prevalence of PBCs (5.4% to 23.2%, p<0.001) and MBCs (40.0% to 50.4%, p<0.001), and a decrease in DBCs (54.6% to 26.5%, p<0.001). There was an increase in smokers who chose their current brand because they believed it to be less harmful, both for MBC smokers (+13.0%, p=0.001) and PBC smokers (+9.0%, p=0.06). There was an increase for smokers in all brand classes for choosing their current brand because they were ‘higher in quality’ and because of affordable price, but the greatest increase was among PBC smokers (+18.6%, p<0.001 and +34.9%, p<0.001, respectively).ConclusionsOur findings demonstrate that the rising trend in Chinese smokers’ choice of ‘less harmful’, ‘higher quality’ and ‘affordable’ cigarettes, particularly PBCs, is likely due to CNTC’s aggressive marketing strategies. Strong tobacco control policies that prohibit CNTC’s marketing activities are critical in order to dispel erroneous beliefs that sustain continued smoking in China, where the global tobacco epidemic is exerting its greatest toll.

China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006–2015. Cigarette affordability was measured by Relative Income Price—percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions.

ObjectivesTo examine trends in smoking prevalence in key venues (workplaces, restaurants, bars) and in public support for comprehensive smoke-free laws, with comparisons between cities and rural areas in China.DesignData are from Waves 3–5 (2009–2015) of the International Tobacco Control (ITC) China Survey, a cohort survey of smokers and non-smokers. Logistic regression analyses employing generalised estimating equations assessed changes in smoking prevalence and support for smoke-free laws over time; specific tests assessed whether partial smoking bans implemented in three cities between Waves 3 and 4 had greater impact.SettingFace-to-face surveys were conducted in seven cities (Beijing, Changsha, Guangzhou, Kunming, Shanghai, Shenyang and Yinchuan) and five rural areas (Changzhi, Huzhou, Tongren, Yichun and Xining).ParticipantsIn each survey location at each wave, a representative sample of approximately 800 smokers and 200 non-smokers (aged 18+) were selected using a multistage cluster sampling design.Main outcome measuresPrevalence of smoking (whether respondents noticed smoking inside restaurants, bars and workplaces); smoking rules inside these venues; and support for complete smoking bans in these venues.ResultsAlthough smoking prevalence decreased and support increased over time, neither trend was greater in cities that implemented partial smoke-free laws. Smoking was higher in rural than urban workplaces (62% vs 44%, p<0.01), but was equally high in all restaurants and bars. There were generally no differences in secondhand smoke (SHS) exposure between smokers and non-smokers except in rural workplaces (74% vs 58%, p<0.05). Support for comprehensive bans was equally high across locations.ConclusionsPartial laws have had no effect on reducing SHS in China. There is an urgent need for comprehensive smoke-free laws to protect the public from exposure to deadly tobacco smoke in both urban and rural areas. The high support among Chinese smokers for such a law demonstrates that public support is not a barrier for action.

Background China is the world´s largest tobacco producer and consumer, in recent years has become the world´s largest producer of e-cigarette. According to media reports, China-made e-cigarette is mainly exported to foreign countries, and e-cigarette are not popular in China, but such conclusions need support from surveillance data. Methods Data of 2015 China Adult Tobacco Survey (CATS) and International Tobacco Control Policy Evaluation Project China Survey (ITC China Survey) were analyzed to describe rate of awareness and prevalence on e-cigarette. 2015 CATS is a nationally representative cross-sectional survey of adults aged 15 and over. ITC China survey is a cohort study designed to measure the impact of tobacco control policies on tobacco users over time. Between 2006 and 2015, five survey waves were conducted among a cohort of adult smokers and non-smokers in China. Results The CATS found that 40.5% of adults had heard of e-cigarette and 3.1% of adults had ever tried e-cigarette, these two rates are higher among male, urban, young and educated groups. Only 0.5% of adults reported using e-cigarette currently, but most of them are occasional users. ITC China survey revealed that the percentage of smokers who had ever heard of e-cigarette went up from 29% (wave 3, 2009) to 60% (wave5, 2014). Similarly, percentage of smokers who had ever tried e-cigarette went up from 2% (wave3, 2009) to 11% (wave5, 2014). Among smokers who had tried e-cigarette at Wave 5, only 8% reported they were using currently. Conclusions Although rate of current e-cigarette use is relatively low, attention should be paid to the fact that rate of awareness and ever tried use were going up among smokers. E-cigarette prevalence indicators should be included in tobacco use monitoring system, and more researches need be conducted to understand the characteristics of the population using e-cigarette.

目的 描述我国成人吸烟人群尝试戒烟的情况,探讨影响戒烟行为的主要因素.方法 以多阶段分层整群随机抽样的方法,在全国抽取16 800个家庭户,每户随机抽取1名调查对象进行问卷调查.数据加权后,采用SAS 9.3复杂抽样设计的方法进行分析,其中尝试戒烟率的影响因素分析使用非条件Logistic回归.结果 4267名现在吸烟者纳入分析,31.51％的现在吸烟者报告在过去12个月内戒过烟,其中男性为31.28％,女性为35.93％.偶尔吸烟者的尝试戒烟率为44.97％,高于每日吸烟者的29.22％,既往得到医务人员戒烟建议的为40.32％,高于未获得者的30.87％,差异均有统计学意义(P＜0.05).居住地为农村(OR =0.55,95％ CI:0.37～0.81)、偶尔吸烟(OR=0.42,95％CI:0.25～0.70)、过去12个月内获得医务人员的戒烟建议(OR=0.65,95％CI:0.45 ～0.92)、家中室内区域一般不允许吸烟(OR=0.50,95％ CI:0.32～0.76)、完全知晓二手烟烟雾可导致成人心脏病、儿童肺部疾病和成人肺癌这3种疾病(OR =0.55,95％ CI:0.38～0.80)是尝试戒烟的保护因素.结论 中国15岁及以上成人现在吸烟者尝试戒烟率较低,采取简短戒烟干预、建立无烟家庭、大力宣传二手烟的危害,对促进吸烟者采取戒烟行动具有重要意义.

Background Secondhand smoke (SHS) poses a major public health threat in China, causing over 100,000 deaths/year. China, however, has not yet implemented a national comprehensive smoke-free law, and the few subnational laws are only partial. This study presents trends in selected cities from 2007 to 2015 in: (1) exposure to SHS in key public places (workplaces, restaurants, bars), and (2) smokers' support for comprehensive smoke-free laws, comparing cities and rural areas in 2013-15. Methods Data are from Waves 2 to 5 of the International Tobacco Control (ITC) China Survey (2007-15), a face-to-face cohort survey of 800 smokers in each of five cities (Beijing, Guangzhou, Kunming, Shanghai, Shenyang), plus five rural areas at Wave 5 (2013-15) (total N=8000). GEE logistic regression models tested changes over time. Results At the latest wave (2013-15), the majority of respondents reported being exposed to SHS in public places. Smoking was most prevalent in bars, with little reduction over time across cities (from 93% overall in 2007 to 86% in 2013-15). Smoking in other venues decreased over time, but remained very high in 2013-15 (from 94% to 67% for restaurants; and 75% to 51% for workplaces). In rural areas, smoking prevalence was higher in workplaces (73% vs 56%, p < .001) and lower in bars (73% vs 88%, p < .05) compared to cities; there was no difference in restaurants. Support for complete smoking bans among smokers in cities increased over time for each venue and is higher than nearly all other 20+ ITC countries. Support did not differ between cities and rural locations. Conclusions Partial smoke-free laws in China are failing to protect both urban and rural residents from SHS, demonstrating the urgent need for a comprehensive national smoke-free law, as called for by the FCTC. Such a law would be supported by the majority of the Chinese public.

为推进健康中国建设, 提高人民健康水平, 2016年中共中央政治局审议通过了《"健康中国2030"规划纲要》 (以下简称《纲要》) [1], 这是全面提升中华民族健康素质、实现人民健康与经济社会协调发展的国家战略.《纲要》中对控烟工作提出了具体目标要求, 到2030年实现人群吸烟率降低到20％[1], 这一指标是基于国内外控烟经验提出的可实现的目标.本文从我国目前烟草使用和控烟履约现状、国际先进控烟经验来分析实现2030控烟目标的可行性及为实现目标所需要采取的措施.

Background China's health warnings do not meet the FCTC Article 11 guidelines. They are small (< 35% of the pack) and do not include pictorial images, which research has shown to have greater impact. Four rounds of warnings have been implemented between 1992-2016. This study examines warning impact over 9 years (2006-15), including the third round (April 2012), which increased font size while maintaining overall warning size and replaced the English text with Chinese on the back. Methods Data are from Waves 1-5 (2006-15) of the International Tobacco Control (ITC) China Survey, a cohort survey of 800 adult smokers in each of five cities, adding five rural areas at Wave 5 (2013-15) (total N=8000). GEE logistic regression models tested changes in key indicators of warning impact over time. Results Over 9 years, there has been little change in impact of the Chinese warnings. Indeed, the percentage of smokers who noticed warnings 'often' actually DECREASED from 51% (2006) to 38% (2013-15) ( p < .001), and fewer than one-third of smokers reported cognitions or behaviours related to quitting because of the warnings. The April 2012 revision did not improve any of the warning impact indicators. Warning noticing/salience did not differ between cities and rural areas, but rural smokers were more likely to think 'a lot' about harms of smoking (17% vs 11%, p < .001) and about quitting (14% vs 6%, p < .001) because of the warnings. Conclusions China's text-only warnings continue to be extremely weak. The minor changes in 2012 did not increase warning impact. Global evidence is clear that large pictorial warnings depicting specific harms of cigarettes would greatly enhance warning impact in China, including increasing knowledge and motivation to quit among the 300M Chinese smokers. These benefits would be especially important for the large rural population, where there are fewer other sources of health information.

Health warnings labels (HWLs) have the potential to effectively communicate the health risks of smoking to smokers and non-smokers, and encourage smokers to quit. This study sought to examine whether non-smokers in China notice the current text-only HWLs and whether they support adding more health information and including pictures on HWLs.

目的 通过实验性研究,评估原卫生部设计的健康警示图形与中外现行烟包健康警示的有效性.方法在北京、绍兴共调查600人.12种模拟烟盒以中华烟为背景制作,包含原卫生部设计的10种健康警示图形、1种澳大利亚现行图形警示以及中国现行文字警示.调查对象针对健康警示是否能够有效促使吸烟者戒烟和阻止青少年开始吸烟两方面对12种健康警示分别进行评价.结果 澳大利亚全警示烟盒包装在促进戒烟[(4.09±1.17)分,F=157.10,P＜0.01]和阻止尝试吸烟[(4.13±1.13)分,F=166.53,P＜0.01]2个方面都被评价为最有效,其次是原卫生部的10种图形警示,中国现行文字警示有效性评价得分最低.结论 图形警示有效性远远强于文字警示,可以有效地向公众宣传吸烟、二手烟危害.

Background In 2009, China changed its health warnings on cigarette packs from side-only text warnings to two text-only warnings on 30% of the bottom of the front and back of the pack. Also in 2009, Malaysia changed from similar text warnings to pictorial health warnings consistent with Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines.Objective To measure the impact of the change in health warnings in China and to compare the text-only health warnings to the impact of the pictorial health warnings introduced in Malaysia.Methods We measured changes in key indicators of warning effectiveness among a longitudinal cohort sample of smokers from Waves 1 to 3 (2006-2009) of the International Tobacco Control (ITC) China Survey and from Waves 3 to 4 (2008-2009) of the ITC Malaysia Survey. Each cohort consisted of representative samples of adult (18years) smokers from six cities in China (n=6575) and from a national sample in Malaysia (n=2883). Generalised Estimating Equations (GEE) were used to examine the impact of the health warnings on subsequent changes in salience of warnings, cognitive and behavioural outcomes.Findings Compared to Malaysia, the weak text-only warning labels in China led to a significant change in only two of six key indicators of health warning effectiveness: forgoing cigarettes and reading the warning labels. The change to pictorial health warnings in Malaysia led to significant and substantial increases in five of six indicators (noticing, reading, forgoing, avoiding, thinking about quitting).Conclusions The delay in implementing pictorial health warnings in China constitutes a lost opportunity for increasing knowledge and awareness of the harms of cigarettes, and for motivating smokers to quit.

This paper describes the design features, data collection methods and analytical strategies of the ITC China Survey, a prospective cohort study of 800 adult smokers and 200 adult non-smokers in each of six cities in China .In addition to features and methods which are common to ITC surveys in other countries, the ITC China Survey possesses unique features in frame construction, a large first phase data enumeration and sampling selection; and it uses special techniques and measures in training, field work organisation and quality control.It also faces technical challenges in sample selection and weight calculation when some selected upper level clusters need to be replaced by new ones owing to massive relocation exercises within the cities.

Background The sensory belief that light/low tar' cigarettes are smoother can also influence the belief that light/low tar' cigarettes are less harmful. However, the light' concept is one of several factors influencing beliefs. No studies have examined the impact of the sensory belief about one's own brand of cigarettes on perceptions of harm.Objective The current study examines whether a smoker's sensory belief that their brand is smoother is associated with the belief that their brand is less harmful and whether sensory beliefs mediate the relation between smoking a light/low tar' cigarette and relative perceptions of harm among smokers in China.Methods Data are from 5209 smokers who were recruited using a stratified multistage sampling design and participated in Wave 3 of the International Tobacco Control (ITC) China Survey, a face-to-face survey of adult smokers and non-smokers in seven cities.Results Smokers who agreed that their brand of cigarettes was smoother were significantly more likely to say that their brand of cigarettes was less harmful (p<0.001, OR=6.86, 95% CI 5.64 to 8.33). Mediational analyses using the bootstrapping procedure indicated that both the direct effect of light/low tar' cigarette smokers on the belief that their cigarettes are less harmful (b=0.24, bootstrapped bias corrected 95% CI 0.13 to 0.34, p<0.001) and the indirect effect via their belief that their cigarettes are smoother were significant (b=0.32, bootstrapped bias-corrected 95% CI 0.28 to 0.37, p<0.001), suggesting that the mediation was partial.Conclusions These results demonstrate the importance of implementing tobacco control policies that address the impact that cigarette design and marketing can have in capitalising on the smoker's natural associations between smoother sensations and lowered perceptions of harm.

OBJECTIVE:To identify the levels of exposure to second-hand smoking (SHS) among Chinese adults living in the urban areas and their knowledge on the risks of SHS, to support for the Smoke-free policy.METHODS:Data from the Global Adult Tobacco Survey (GATS) and the International Tobacco Control Policy Evaluation China Survey (ITC China Survey) was analyzed and SAS was used to calculate the rates and 95%CI.RESULTS:In the two surveys, less than 40% of the respondents reported that their workplaces had completely stopped smoking. Participants who reported that they had seen people smoking at various public places with different rates, also they could reflect the levels to SHS exposure. Restaurants were the venue with the heaviest overall exposure (83.4%-95.6%), followed by the workplace (53.3%-84.0%). Exposure was low in health facilities, schools and public transport venues. In the GATS survey, 60.6% smokers and 68.5% non-smokers believed that SHS could cause lung cancer, but only one-third of the participants believed that SHS could cause heart diseases in adults. Participants in the ITC China survey reported a comparatively higher level of awareness on the harm of SHS, but only 58.2% smokers believed that SHS could cause heart diseases in adults. Overall, data from the ITC China survey showed that participants' support for a comprehensive smoke-free policy in schools, health-related facilities, government buildings and in taxi were high (over 70% ). However, the proportion of participants supporting comprehensive smoking-free policy at workplaces (50.9%-60.9%) was relatively low.CONCLUSION:The proportion of indoor workplaces with complete smoking ban was low in urban areas but levels to SHS exposure were high. People's awareness of harms related to SHS and their attitude on setting up a comprehensive smoke-free workplace need to be improved.

目的 描述医疗卫生机构二手烟暴露现况调查中的现场观察、拦截调查结果,评价不同方法结果的一致性,探讨现场观察法的应用条件.方法 在天津、重庆、沈阳、哈尔滨、南昌、兰州和深圳7个城市分别通过简单随机抽样的方法,抽取各级医院(三级医院、二级医院、社区卫生服务中心)、疾病预防控制中心和健康教育所,进行现场观察和针对场所内来访者及工作人员的拦截调查.使用场所内有吸烟现象的观察点率(P1)、调查当天来访者看到有人在机构内的吸烟率(P2)、调查当天机构工作人员看到有人在机构内的吸烟率(P3)、工作人员暴露于二手烟的率(P4)指标来讨论不同调查方法的一致性.结果 7个城市共观察169家医院,86家疾病预防控制中心.在上述机构内完成来访者拦截调查2 368人,工作人员拦截调查2 515人.使用非参数检验比较P1与P2、P3、P4的分布一致性,结果发现,绝大多数城市内P1与P2、P3的分布一致,多数城市的P1、P4的分布不一致.结论 现场观察法可以用于了解对外开放的公共场所吸烟现象的严重程度,但难以客观反映场所内工作人员真实的二手烟暴露程度.

<正>包装是消费品市场营销中关键的环节之一。良好的包装设计有助于在市场竞争中树立品牌形象,是消费者购买产品与使用产品时有效的促销形式。对于吸烟者而言,卷烟包装具有很高的暴露频率,如果烟草制品的包装上能够有健康警示,每天吸1包烟的人每年看到这些健康警示高达

Objective To understand the smoking status and related factors in middle school students from Hangzhou,Taiyuan and Guiyang cites.Methods A cross-sectional survey was adopted with 11 171 students randomly selected through a stratified cluster sampling method.A selfadministrated questionnaire survey was employed,which including the information of respondents' background characteristics,cigarette smoking,exposure to tobacco advertisement,recognition on indirect tobacco advertisement,exposure to second-hand smoke,related knowledge,attitude and perceptions towards tobacco use etc.Data was weighted by the amount of male and female students in junior high,senior high and vocational middle schools in the above said three cities and was analyzed by complex sampling analysis methods of SPSS 15.0.Confidence Intervals of each indicator were used to evaluate for difference between groups.Logistic regression was used to explore the potential factors associated with smoking in youths.Results The overall attempted smoking rate of the three cities was 26.2％ (95％ CI:23.6-29.1 ),with male as 39.9％ and female 12.5％ respectively.The current smoking rate was 12.5％ (95％CI:11.1-14.2 ) with boys as 21.9％ and girls as 3.2％.The smoking rate were different among three kinds of schools,with vocational school was the highest (25.8％),followed by senior high (7.9％) and junior high (6.3％).The rate of smoking was different among cities,lower with better economic situation.The average age of debut was 11.9 years old.Nearly half of the students who smoked had no intention to quit.Factors that associated with smoking would include:having or wishing to have tobacco promotion products,having friends or families who smoke,their friends' attitude towards smoking behavior,and misconceptions about smoking such as underestimate the harm of smoking and the difficulty of quitting,realizing that smoking was an important way for social contact,and to be seen as being matured etc.Conclusion Boys are much more likely than girls to smoke cigarette.Smoking prevalence is much higher in low-income cities.Additianally,it should be concerned that girls has higher smoking rate than female adults.It is urgent for tobacco control among adolescents,especially in low-income area in China.

Despite the great progress made towards smoke-free environments, only 9% of countries worldwide mandate smoke-free restaurants and bars. Smoking was generally not regulated in restaurants and bars in China before 2008. This study was designed to examine the public attitudes towards banning smoking in these places in China. A convenience sample of 814 restaurants and bars was selected in five Chinese cities and all owners of these venues were interviewed in person by questionnaire in 2007. Eighty six percent of current nonsmoking subjects had at least one-day exposure to secondhand smoke (SHS) at work in the past week. Only 51% of subjects knew SHS could cause heart disease. Only 17% and 11% of subjects supported prohibiting smoking completely in restaurants and in bars, respectively, while their support for restricting smoking to designated areas was much higher. Fifty three percent of subjects were willing to prohibit or restrict smoking in their own venues. Of those unwilling to do so, 82% thought smoking bans would reduce revenue, and 63% thought indoor air quality depended on ventilation rather than smoking bans. These results showed that there was support for smoking bans among restaurant or bar owners in China despite some knowledge gaps. To facilitate smoking bans in restaurants and bars, it is important to promote health education on specific hazards of SHS, provide country-specific evidence on smoking bans and hospitality revenues, and disseminate information that restricting smoking and ventilation alone cannot eliminate SHS hazards.

烟草使用是当今世界最大的可预防死因,烟草使用者中近一半将死于烟草使用.目前全世界吸烟者总人数超过10亿,约占世界人口的1/4.每年烟草使用导致全球500多万人死亡.在发展中国家,随着人口的稳步增长以及烟草企业的大力市场营销措施,烟草使用人数持续增长[1].如果当前的趋势继续下去,到2030年,由于烟草使用导致的年死亡人数将超过800万;到21世纪末,烟草使用将夺去10亿人生命,而且据估计,其中3/4以上集中在发展中国家[1]. 关键词：烟草流行;烟草控制

AIMS:To examine predictors of quitting behaviours among adult smokers in China, in light of existing knowledge from previous research in four western countries and two southeast Asian countries. DESIGN:Face-to-face interviews were carried out with smokers in 2006 using the International Tobacco Control (ITC) China Survey, with follow-up about 16 months later. A stratified multi-stage cluster sampling design was employed. SETTING:Beijing and five other cities in China. PARTICIPANTS:A total of 4732 smokers were first surveyed in 2006. Of these, 3863 were re-contacted in 2007, with a retention rate of 81.6%. MEASUREMENTS:Baseline measures of socio-demographics, dependence and interest in quitting were used prospectively to predict both making quit attempts and staying quit among those who attempted. FINDINGS:Overall, 25.3% Chinese smokers reported having made at least one quit attempt between waves 1 and 2; of these, 21.7% were still stopped at wave 2. Independent predictors of making quit attempts included having higher quitting self-efficacy, previous quit attempts, more immediate intentions to quit, longer time to first cigarette upon waking, negative opinion of smoking and having smoking restrictions at home. Independent predictors of staying quit were being older, having longer previous abstinence from smoking and having more immediate quitting intentions. CONCLUSIONS:Predictors of Chinese smokers' quitting behaviours are somewhat different to those found in previous research from other countries. Nicotine dependence and self-efficacy seem to be more important for attempts than for staying quit in China, and quitting intentions are related to both attempts and staying quit.