Tobacco control challenges in East Asia: proposals for change in the world's largest epidemic region

Abstract

East Asia is one of the world's largest tobacco epidemic regions. Although several international studies have evaluated the status of tobacco control in this region, the findings have not been integrated with knowledge on domestic activities at the national and municipal levels. We analysed the current tobacco control situation in three East Asian countries, Japan, China and the Republic of Korea, using both international and domestic data sources. We collected data between 2008 and 2011 in each country according to the framework of WHO's MPOWER (Monitoring, Protect, Offer, Warn, Enforcement and Raise) approach for guiding implementation of the WHO Framework Convention on Tobacco Control. Analysis revealed that 37–53% of adult men were current smokers and that smoking prevalence among middle-aged men reached 63%. Less than 20% of male smokers plan to quit and the use of nicotine replacement drugs was 14% at maximum. Forty-six percent or more of men and 20% or more of women were exposed to passive smoking at workplaces and at home, respectively. Many tobacco industry activities remain unrestricted and prevalent. Our findings indicate an urgent need for the following set of policies: raise cigarette prices to increase the quit attempt rate, particularly among adult men; develop a multi-component quitting assistance system to provide adequate assistance for smoking cessation; implement effective smoke-free policies in workplaces and public places to reduce exposure to passive smoking; and rebuild the administrative structure to denormalise tobacco industry activities. The importance of these standard approaches should be reaffirmed by all tobacco control policymakers in East Asia.

Are secondhand smoke-related diseases of children associated with parental smoking cessation? Determinants of parental smoking cessation in a population-based cohort study

“…Fourth, we could not include the effect of any tobacco control measures such as workplace smoking restrictions. However, this effect may be small and not specific because we found no significant tobacco control measures between 2001 and 2005 in Japan, except for small a price increase in 2003 (Katanoda et al, 2014).…”

The impact of regional economic reliance on the tobacco industry on current smoking in China

“…For example, since the 1990s provincial smokefree policies, most notably the introduction of stronger smokefree policies at the Beijing Olympic Games and the 2010 World Expo in Shanghai , have reflected central, rather than provincial, government initiatives and have been designed to improve the image of China to the world and evidence of its global health commitment as a signatory of the FCTC. Third, given the above two trends, as Cheng et al (2013) have suggested, there is an urgency to develop tobacco control efforts at the provincial level in the cigarette producing regions, particularly as national smoking rates have increased, rather than decreased, since China signed the FCTC in 2001 (Katanoda et al, 2013;Lv et al, 2011). Others have similarly stressed the need for population-level interventions that modify the policy and social environments which encourage smoking (Ding and Hovell, 2012).…”

The costs of smoking and secondhand smoke exposure in Taiwan: a prevalence-based annual cost approach

“…Although all East Asian countries ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2004 or 2005, a recent assessment study2 revealed that the majority of countries in East Asia lagged behind in implementing the FCTC recommended tobacco control programmes according to WHO's MPOWER (Monitoring, Protect, Offer, Warn, Enforcement and Raise) criteria 3. As of 2010, 37−53% of adult men in East Asia were current smokers and more than 46% of men were exposed to passive smoking at workplaces 2. To enhance the incentives to implement the promises of the ratified FCTC to reduce the tobacco epidemic in East Asia, updating of evidence on the economic costs due to active and passive smoking-caused illness, disability and premature mortality in this region is imperative.…”

“…Taiwan is regarded as a model in East Asia in tobacco control 2. During the 1960s and 1970s, smoking prevalence among Taiwanese aged 35 and above exceeded 75% for men and 8–12% for women 4.…”