Hu Yunfang, a newspaper reporter, began to smoke a dozen years ago. She has tried several times to quit, but with no success. In March she received four cell phone text messages from her friends telling her that the worldwide competition to give up smoking, “Quit & Win,” was to be held in May. Although they encouraged her to enter, and Hu kept seeing ads for the competition in newspapers and on the Internet, a decision was not that easy.
Quit & Win, an international effort to help people quit smoking, has been held once every other year since 1994. It offers smokers guidance on how to kick the habit and provides incentive with monetary awards. About 30 percent of past participants have stopped smoking with a year of the program. China has participated since 1996. Two Chinese participants won the international award in 1996 and a regional award in 2002. China has also decided to participate in the 2004 Quit & Win to be held in nearly a hundred countries and regions.
A Huge Industry
China is the world’s largest producer and consumer of tobacco, both of which account for more than one third of the world’s total. Its 350 million smokers make up over a quarter of the world’s total, a disproportionate figure as only one in every five humans is Chinese.
Smokers under the age of 20 are what experts most worry about. Surveys show that the number of smokers and those attempting to smoke has been increasing among young people in recent years. There are now 5 million young smokers in China. The World Health Organization (WHO) estimates that if smoking is not deterred, the number of young people smoking will continue to grow sharply.
In 1999, when working with the Institute of Child and Adolescent Health of the Peking University Health Science Center, Doctor Sun Jiangping surveyed more than 10,000 students from 186 local middle schools. The results show that 22.5 percent of the students surveyed have tried smoking. The average age of the first cigarette of those polled was 10.7 years old, which is 2.3 years earlier than the survey results from the 1960s and 1970s.
Among primary school students, aged nine-12, between 10-15 percent of those surveyed said they smoke. Of students 12-15 years old, 35 percent said they did. Among those aged 16 and above, including high schoolers and college students, a whopping 75 percent of respondents said that they at least occasionally sneak a smoke. Most alarming is that just under a third—30.5 percent—of the students surveyed began to smoke when they were under 10 years old, the youngest addict being only seven. This has severe long-term consequences: Research shows that the earlier one begins to smoke, the more difficult it will be to give it up.
Zhang Lili, a psychology teacher at Bayi Middle School in Beijing, said that there are several reasons children feel compelled to smoke, including a desire to fit in. “In general, they smoke mostly out of pressure from friends or peers, following what is ‘fashionable’ or simply imitating others,” she said. “Peer pressure is a difficult thing for children to ignore. If you refuse a cigarette offered by a friend, you could be sneered for not being a ‘man’ or ‘cool,’ which has great impact on a child’s mentality.”
The number of female smokers is also rising quickly. They seem to be lighting up for the opposite reason: To assert themselves against old social stigmas and roles. “According to the outdated traditional mentality, a girl smoker was considered a degenerate. But now, smoking symbolizes independence, freedom and fashion for women,” said Jiang Yuan, Deputy Director of the Tobacco Control Office under the Chinese Center for Disease Control and Prevention (CDC). “This change of ideas is related to an evolving cultural orientation in recent years,” he continued. “In films and on TV, female stars smoke, which undoubtedly induce young females to do the same.”
Statistics from the Ministry of Health (MOH) show that in China, about 1 million people die from smoking every year. Among these, 45 percent die of chronic pneumonic diseases, 15 percent of lung cancer, and 40 percent of esophageal cancer, stomach cancer, liver cancer, apoplexy, heart disease and phthisis. If this trend continues, estimates say that about 2 million will die from smoking-related effects by 2020.
To Quit or Not to Quit?
Hu Yunfang then forwarded the text message about Quit & Win to other friends. Three of them replied. “It’s really interesting. Their attitudes are totally different,” Hu said. One reply, “A $10,000 award! I’ll try it.” Another, “I’ll give up when I want to. Money will never tempt me.” The third expressed the paradox perhaps only known to addicts, “I know, I just don’t know.” Hu’s attitude fall somewhere between the first and second. “I’ll give it up, not now, but as soon as possible,” she said.
Hu began smoking when she was still in college. As she was just breaking away from the strict discipline of parents, she said it was a sign of her independence at the time. When she met with her classmates, lighting up a smoke would be a novel part of a newly found lifestyle. After graduation, she became a news reporter. To meet late night deadlines, cigarettes become an outlet for stress. Many of her colleagues, male and female, smoke for similar reasons.
“Actually, I have deep feelings about the harms of smoking,” she said. When smoking a lot, especially at night, she would get a sore throat or irritated skin. She would feel physically and mentally drained. “The pressure from work is huge, sometimes I can’t work without cigarettes.”
Hu has tried to quit smoking several times but failed. “Giving it up is really difficult. Strong self-control is necessary,” Hu continued. She admires a friend of hers, an officer in the army who has not smoked for eight years. His doctor told him he had some health problems after a physical exam. The doctor advised he give up smoking. He told his wife that night that he would give up smoking. He has not smoked a cigarette since. Hu does not believe she could quit cold turkey like her friend, saying, “I don’t have such a strong will.”
Besides sheer nicotine—the addictive chemical found in tobacco, some people are hooked into a sort of “tobacco culture,” according to Hu. For instance, cigarette packaging can be a factor that allures girl smokers, especially beginners, Hu noted. Tobacco companies use slim, colorful cigarettes to target trendy women, and some are flavored with orange or lemon.
China has a variety of cigarette brands. Apart from big national brands, there are also popular regional favorites. Prices of cigarettes in China differ widely. A box of cigarettes can range from less than 10 yuan ($1.21) to dozens of yuan (about $5). Some people consider the cigarettes they smoke as a symbol of their identity. Offering cigarettes in public is often regarded as social etiquette, especially among men. Another chronic Chinese social vice, drinking alcohol, is often accompanied with chain smoking and chatting. When friends gather, cigarettes become sort of a collective property, one could say.
Whether a smoker is willing or able to quit depends on the individual, said Hu. But Hu also concedes that environment is also a factor, saying she is definitely “influenced by the outside.”
In addition to cell phone messages from friends, Hu has learned from the media that smoking is extremely harmful to one’s health. One of her friends who works at the Shanghai Center for Disease Control and Prevention has also sent her anti-smoking emails. “I’ve known the harm of smoking and I am a little frightened. So, I have decided to quit as soon as possible and test my will.”
Tobacco Control
On May 21, 2003, the 56th World Health Assembly passed the Framework Convention on Tobacco Control (FCTC). Through the end of 2003, some 85 countries signed the FCTC, including China, which signed it on November 10, 2003. Experts predict the FCTC, the first multilateral treaty on public health that has legal sanction, is likely to take effect this year and urge the governments of all the signatories to take strong measures on tobacco control.
Tobacco control in China did not get off the ground until the 1990s, later than many other countries, according to Yang Gonghuan, Vice President of the Chinese Association on Smoking and Health as well as negotiator for China to the FCTC signing. Compared with countries performing well in tobacco control, China’s ability to regulate tobacco is only comparable to their level in the 1970s and 1980s. In those countries, 30 percent of men smoke, as compared to 65-70 percent in China.
In light of the large population of smoking addicts and the money to be lost, tobacco control in China faces opposition and has a long way to go, Yang said.
In China, tobacco planting, production and sale are all monopolized by the government. Nearly 100 million people are making their well-being on the tobacco industry. One-10th of government tax revenue comes from tobacco sales. So, pulling the rug on developing the tobacco industry will have substantial social ramifications in a negative way. Diverging and conflicting views with the government often exist when publicizing and making policies.
While China has no state law forbidding smoking in public, legislative clauses are included in the Law on Tobacco Monopoly, the Advertising Law and the Law on Protection of Minors, according to Weng Xinzhi, a professor from the WHO. Countries that have deterred smoking have drafted laws controlling tobacco consumption. China would do well to bite the bullet and formulate such a law. Long-term health advantages will outweigh immediate drops in tax revenue and unemployment.
Currently, 14 provinces and municipalities and 86 cities have regulations forbidding smoking in public, said Weng. But an epidemiological investigation showed that 90 percent of smokers still smoke in public, which indicates that ordinances are not being implemented or observed properly.
A framework for the 2003-05 plan on tobacco control in China, administered by the Tobacco Control Office of the Chinese CDC entrusted by the MOH, has been passed. Experts feel that implementation of the plan will directly determine how well China can control tobacco-related harms. The framework contains six main parts: publicity and policy research of the FCTC, monitoring tobacco-related harms, building a control network, recreational activities and anti-tobacco advertisements, controlling adolescent smokers, improving guidance and service to smokers to help them quit.
Enforcement will come, however, with not only a good policy and a competent police force, but also a populace that actually understands the harms of smoking. Voluntary abstinence from smoking should gradually lighten the burden of those who are responsible for enforcement.
(Beijing Review May 25, 2004)
