Barriers to Tobacco Control in China: A Narrative Review

Abstract

This research chooses the method of narrative literature review to analyze the barriers in implementing tobacco regulatory policies in China and explore the strategies that can overcome these challenges. China is the world’s largest producer and consumer of tobacco products. Although the prevalence of cigarette smoking declined from 34.5% to 27.7% between 1984 and 2015, the reduction over the 30 years has been slow. Therefore, effective tobacco regulatory policies are necessary. However, as the tobacco industry is one of the major sources of government revenue and an indispensable part of the national economy, the implementation of tobacco regulatory policies faces many challenges. In terms of the institutional dimension, the ambiguous attitude of national institutions and tobacco companies’ development strategies impede the enforcement of tobacco policies. In addition, the primary economic barrier to tobacco control is the unwillingness of the government to raise value-added tax on tobacco. Finally, the social customs of exchanging individual cigarettes and gifting packaged cigarettes among adults and juveniles in China hinder the implementation of tobacco regulatory policies. In this case, a combined strategy of top-down and bottom-up approaches can remove these barriers, such as using the authoritative power to control tobacco use and raising non-smokers’ awareness of smoking risks and public education.

Untitled

“…The Literature-Based Method Three considerations led to the selection of a literature-based technique for my research. First, as Leng & Mu (2020) noted, the literature-based method can help get a comprehensive and correct grasp of the study subject's status quo and make the most use of available data, experience, and scientific research achievements. Secondly, this method can be used to clarify some notions and make some fresh arguments based on the previous literature.…”

“…Considering the above, based on the model of direct and indirect media effects on adolescent smoking (Gunther et al, 2006, p. 53), a new and advanced model displaying the progress of health communication of smoking cessation in China is proposed (see Diagram 1). Furthermore, previous research indicates that warning messages against smoking may incite existing smokers to smoke more and non-smokers to try (Grandpre et al 2003); also, in the cultural context of China, sharing cigarettes is an important social custom and etiquette (Leng & Mu, 2020;Kohrman, 2007). Hence, the "unexpected" media effects and interpersonal communication will be considered in my model.…”

“…On the other hand, the great deal of POS and the unregulated POS display greatly increases the cigarette pack's media effects in persuading the consumer to shop for tobacco products since the pack is well designed and the effect of the PSA is weak. Moreover, smoking, sharing cigarettes, and giving cigarettes as gifts have been viewed as a crucial socialising culture in Chinese people's social lives, which increases the re-exposure rate of cigarette cartons in public and private during interpersonal communication acts (Leng & Mu, 2020;Qin, 2011;Kohrman, 2007;Dong et al, 2007). Thus, in the following subsection, I will focus on Chinese smokers and their impact on non-smokers.…”

“…Second, as part of a commercial campaign, the pack is too attractive (Qin et al, 2011). Third, China has a strong cigarette sharing and gifting culture (Leng & Mu, 2020;Qin, 2011;Kohrman, 2007). Fourth, cigarette consumption/usage serves as a metaphor for one's status (Li et al, 2015).…”

“…Keywords: China, health communication, media effects, media power, tobacco packaging design China is the largest tobacco producer and has the most smokers in the world (Parascandola & Xiao, 2019;Leng & Mu, 2020). Although the Chinese government has taken many measures and introduced policies to control the tobacco industry and discourage tobacco use, smoking prevalence has been decreasing at a very slow rate.…”