The Current Status About Laws Of Protection From Exposure To Tobacco Smoke In China

BackgroundChina is the biggest tobacco consumer in the world and the use of tobacco is prevalent. Both smoking rate and passive smoking rate are high, and at least 1 million deaths are caused every year by tobacco related diseases. Research has shown that legislation is the key to create smoke-free environments. Smoke-free laws in public places can not only reduce exposure to second-hand smoke (SHS), but also raise the awareness of smoking and help smokers quit. Since the early nineties, many local governments have passed legislations banning smoking in public places, however, such a national law is not in place yet. Many of the existing local laws lack strong enforcement power and fail to clearly define smoke-free environment and enforcing entities. As a result, enforcement and compliance are generally not satisfactory. So far more than 100 countries in the world have passed legislation banning or restricting smoking in the public. On January 9th 2006 World Health Organization (WHO)'s The Framework Convention of Tobacco Control (FCTC) officially went into effect in China. China is also the first country to hold the Olympic Games since FCTC. Premier Wen announced that the summer Olympics in Beijing in 2008 would be a"Green Olympics"and"Smoke-free Olympics"would be part of the"Green Olympics". Therefore it is necessary to research on the local smoke-free laws to provide policy support for the design and implementation of future smoke-free laws. ObjectivesTo understand the legislation and implementation of smoke-free laws in public places in China, and to provide policy support for future smoke-free laws.Methods1. Literature researchLiterature research tools include databases such as Wanfang, Weipu, CNKI, Beijing University Law InfoNet etc) and government websites such as the National Research and Development Council (NRDC), Ministry of Health (MOH), China Center for Disease Control and Prevention (China CDC) and other tobacco control related websites such as WHO and USCDC etc.2. Questionnaire surveyThe survey was conducted in an array of locations including medical and health agencies, educational institutions, government agencies, public transportations, restaurants and internet cafes.The survey subjects include directors, doctors, nurses, patients in medical and health agencies, directors and staff in CDCs, heads, teachers, students and staff in educational institutions, directors and staff in government agencies, owners and employees in restaurants and internet cafes, and managers and drivers of public transportation.3. Quality controlQuality control was carried out throughout the course of research, literature research was conducted by multiple researchers in multiple databases. Interviewers were trained and the survey was conducted using the same questionnaire. Data collected was transferred to the Data Center using Data Fax Management System and real-time data quality control was implemented.4. Statistical analysisData was faxed and entered using the Data Fax Management System and data cleaning was carried out. Data analysis was conducted using SAS 9.1.3 Service Pack 3 together with Excel 2002.ResultsIn total 173 pieces of smoke-free laws were collected in this research, six of which were institutional regulations of MOH, the National Patriotic Health Campaign Committee, the Ministry of Railways, the Ministry of Communications and Civil Aviation Administration of China.1. 39.47% of the 337 prefectures and up level cities have passed smoke-free legislations for public places. Geographically, 50% of the prefecture and up level cities in Northern China, 36.11% in Northeastern China, 51.90% in Eastern China, 44.44% in Central-southern China, 22.22% in Southwestern China and 25.49% in Northeastern China have passed smoke-free legislations. 36.11% of the local laws were enacted through the local People's Congress while most were enacted through local governments. Smoking is prohibited in as few as two locations in some laws and up to 11 locations in others. Penalty for failing to comply ranges from 5 Yuan to 50 Yuan, with the majority of 10 Yuan.2. 99.05% of the respondents reported awareness of the health effects of smoking, but lower awareness (92.62%) was observed for harms caused by passive smoking. In Northeastern China only 85.17% of the respondents gave the right answer for health harms caused by passive smoking and 5% in Northern China didn't know passive smoking was bad for one's health.3. Among those with a smoke-free regulation, 53.23% of the locations have a no-smoking sign. The highest occurrences of"people smoking"and"smoking"in these places were observed in Southwestern China, with the percentages of 80.00% and 93.13%. Lower occurrences were observed in Northeastern China, 67.07% and 78.05%. When someone smokes in a smoke-free public place, 19.81% of these people will be notified to stop in Northern China while only 5.69% in Central-southern China.4. We observed quite different support rates for smoke-free regulations in different public places among the respondents. 85.77% of the respondents support such regulations in the hospital while only 31.96% support a smoke-free bar.5. 50.15% of the directors of public places thought smoke-free laws would do benefit to their organization, 35.75% thought no effect, and 12.81% believed such laws would affect their organizations in a negative way. In all, 79.74% were in support of a smoke-free environment in their organization.Conclusions and suggestionsSmoke-free legislation in public places is still not mature in China, more than half of the regions still do not have such legislations. The existing laws suffer from weak enforcement power, vague definitions of smoke-free environments and enforcement entities, low penalty, and poor implementation. The awareness among the public about health effects of passive smoking is also low. To tackle the problems above, existing smoke-free laws need to be revised and perfected to ensure effective implementation. Directors of public places need to be trained and the awareness level among the public toward passive smoking needs to be raised, so that smoke-free laws at national level would be on track in the near future.