Smoke-free environments are crucial for protecting the public from the harms of secondhand smoke, and there is very strong public support for making public places smoke-free in China. Strong laws are needed - and where they exist and are rigorously enforced, they work. These are the key findings from the results of the China City Adult Tobacco Survey, released in Beijing.

"Secondhand smoke is toxic, and deadly. Yet this report shows that far too many people across cities in China - more than 4 in every 10 people in workplaces, for instance - are still being exposed. There is no safe level of secondhand smoke, and the only way to protect against its harms is to make all indoor places 100% smoke-free," said Dr Bernhard Schwartländer, World Health Organization (WHO) Representative in China.

"For years, many cities around China have been leading the charge on tobacco control in an effort to reduce the terrible impact of tobacco use on the health of their communities. We have seen this most recently in Beijing - where the country's strongest tobacco control law to date came into effect on 1 June this year," said Dr Schwartländer.

The survey asked people a range of questions about tobacco use and their awareness of, and attitudes toward, tobacco control policies.

"The survey results demonstrate very strong public support for smoke-free environments. These results are very encouraging. The data shows that smoke-free public places are not only good for people's health, they are also very popular with the public. Smoke-free policies are win-win," said Dr Liang Xiaofeng, Deputy Director of the Chinese Center for Disease Control and Prevention.

However, the results from the survey across cities highlight that the effectiveness of smoke-free policies depends on the strength of the laws themselves, and the rigour with which they are enforced. Stronger laws, when well enforced, deliver greater benefits. For example, rates of exposure to secondhand smoke were lower in cities with smoke-free regulations when compared to those without regulations, or in situations with weak and/or poorly implemented regulations.

"The U.S. data are crystal clear: smoke-free policies, raising the price of tobacco, and educating the public about the harmful use of tobacco and exposure to secondhand smoke saves lives," said U.S. Centers for Disease Control and Prevention Director Tom Frieden, M.D., M.P.H. "However to be most effective, policies must be implemented across the board and laws must be enforced."

"Political commitment is key to the success of smoke-free policies, both in passing a strong policy and in making sure it is well implemented," said Dr Ehsan Latif, Director of Tobacco Control at the International Union Against Tuberculosis and Lung Disease (The Union).

Other key findings from the survey include:

  • Strong public support for smoke-free policies: in all 14 cities, over 90% of adults support smoking bans inside health care facilities and indoor areas of universities and schools;
  • Among all public places included in the survey, public transportation and health care facilities have the lowest rates of exposure to secondhand smoke.

However, the survey results point to a range of areas where more progress is needed. For example:

  • Where local smoke-free policies are in effect, awareness of the policy is often poor. For example, awareness of smoking bans in health care facilities and schools is as low as 34% in some places; and less than half of all people surveyed knew about complete smoking bans inside restaurants in Anshan, Kelamayi, Qingdao, and Shenzhen;
  • Tobacco is still extremely cheap - and very affordable - in China: among current smokers in most of the 14 cities, the median cost of 20 manufactured cigarettes was less than ¥10;
  • Knowledge of the harms of smoking and secondhand smoke among adults is improving, but still far from adequate. For instance, about half of adults did not know that smoking can cause stroke or heart disease;
  • Tobacco marketing is still very visible in the cities surveyed - in particular at retail points of sale. In cities such as Harbin, 1 in 7 adults surveyed noticed cigarette marketing in retail settings.

The survey results make clear that full implementation of the policy measures contained in the WHO Framework Convention on Tobacco Control (WHO FCTC) is needed to protect China's people from the deadly harms of tobacco use and secondhand smoke.

"The results of this survey contain important lessons for future tobacco control efforts in China, both for other cities, and for national lawmakers considering the draft national tobacco control regulation currently before China's State Council. In particular - the results highlight the importance of having tough, comprehensive laws, and ensuring they are implemented well," Dr Schwartländer concluded.