Secondhand smoke exposure and support for smoke-free policies in cities and rural areas of China from 2009 to 2015: a population-based cohort study (the ITC China Survey)

Abstract

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.

Secondhand Smoke Exposure in Public Places and Support for Smoke-Free Laws in Japan: Findings from the 2018 ITC Japan Survey

“…ITC cross-country comparisons using identical survey measures of smoke-free policy evaluation suggest that smoking prevalence in public places in Japan in the current study may be as high or higher than in other Asian countries before the implementation of smoke-free laws [27]. For example, the overall prevalence of smoking in restaurants was 55% in Japan in 2018, compared to 59% in China in 2013-2015 (as reported by both smokers and non-smokers in five cities)-where no national smoke-free laws were in place [26]. Smoking was even more prevalent in workplaces and in bars in Japan (49% and 83% overall, respectively) than in China (44% and 79% overall in cities).…”

“…The present study was designed: (1) to measure current prevalence of smoking in public places (workplaces, restaurants, and bars) as reported by large, representative samples of adult cigarette smokers, HTP users, and non-smokers at their last visit, and (2) to assess the level of support among Japanese smokers and non-smokers for comprehensive smoke-free laws. These findings aim to complement recent data comparing the rates of HTP use and cigarette smoking in public places in Japan in 2018 [25], and follows the same design as previous studies evaluating the impact of smoke-free policies in other countries such as China [26]. This study was conducted in 2018, prior to the implementation of the amended Health Promotion Act.…”

“…For example, the percentage of Japanese cigarette-only smokers who support smoke-free bars (21%) is higher than the percentage of smokers in Ireland (12%) and France (14%) before those countries implemented their national smoke-free laws [27]. The overall level of public support in Japan is also much higher than the overall level found among smokers and non-smokers in China on the same measures (e.g., 65% of all respondents in Japan vs. 41% of all respondents in Chinese cities support smoke-free bars) [26]. Support for smoke-free laws in 2018 is also greater than the level of support found in earlier studies in Japan.…”

“…While previously published data has also reported on rates of cigarette smoking in indoor public places by smokers themselves [25], this study includes data from both tobacco users and non-users to measure overall national estimates for the prevalence of observed smoking and SHS exposure. This same method for estimating overall prevalence has also been used in other ITC studies where non-users were sampled [26]. However, as this is a baseline cross-sectional study, causal inferences about the impact of smoke-free laws (or the lack thereof) cannot be made.…”

“…However, as this is a baseline cross-sectional study, causal inferences about the impact of smoke-free laws (or the lack thereof) cannot be made. An additional limitation in this study is the use of self-report measures which were not validated and may be subject to recall bias; however, these same measures have been used in many other published studies to evaluate smoke-free policies, including over 50 studies published from ITC Project data across over 20 countries [3,26,29,34,35]. Further research with additional waves of the ITC Japan Survey will be conducted to evaluate the more extensive smoke-free laws that will be implemented in April 2020, including any differences in the impact of laws on cigarette smoking compared to HTP use in public places.…”