Smoking cessation for Chinese men and prevention for women

1422 www.thelancet.com Vol 386 October 10, 2015 Tobacco use is the largest preventable cause of death worldwide. It is estimated that more than 6 million people die every year from tobacco use, and that this growing toll will lead to more than a billion deaths in the 21st Century. China is at the epicentre of the global tobacco epidemic and accounts for 1 million of these deaths annually. If current rates of smoking in China continue unabated, 2 million people in China will die per year in 2030, contributing greatly to the global burden of disease. Complicating any eff orts to reduce the public health burden of tobacco is the fact that China is the world’s largest grower, manufacturer, and consumer of tobacco and has the largest workforce devoted to tobacco farming, manufacturing, and sales. Being a government monopoly, China Tobacco (the Chinese National Tobacco Corporation) provides over 7% of the Central Government’s annual revenue through both taxes and net income. In The Lancet, the study by Zhengming Chen and colleagues reveals the extent of the tobacco challenge in China, its peculiar characteristics, and most importantly future implications unless aggressive public health actions are taken to promote smoking cessation in men. The study examines national trends in prevalence in two large cohorts during a period of about 14 years. Given the multi-year latency period from tobacco exposure to onset of various smoking-associated diseases, careful data-based projections of future burden are crucial for the planning, implementation, and assessment of policies aimed at smoking prevention and control. A striking characteristic of the tobacco epidemic in China is its gender distribution: 68% of men and 3·2% of women were smokers in Chen and colleagues’ study (defi ned as ever regular users from the 2004–08 second cohort study). This distribution produces a correspondingly large eff ect on tobacco-attributed mortality, which is rising in men and falling in women. This eff ect has several implications. While men are at substantial risk of death and disease from active smoking, women are at risk from passive exposure at home and in the workplace. Although female smoking rates are associated with older ages, young Chinese women remain an attractive target for the tobacco industry, with the allure of increasing sales by crafting appeals based on themes of independence, glamour, sophistication, sexuality, and social acceptance. Such a focus on attracting female smokers has been Smoking cessation for Chinese men and prevention for women resilience by upgrading the training of emergency responders in handling specifi c disaster hazards, and educating the public about environmental health risks of chemical incidents. If the Chinese Government shows zero tolerance of illegal industrial practices and holds the relevant stakeholders accountable for such practices, the Tianjin incident could become a historical milestone for improvement of disaster risk reduction in China.