Chang had her first drag on a cigarette as a 21-year-old student 20 years ago. As a journalism undergraduate at Shanghai-based Fudan University, smoking was considered progressive and rebellious for women back then, at least on campus. “I thought smoking was fun and found it very relaxing. I still feel the same today,” said Chang, now a senior journalist for a Beijing-based news magazine and mother of a 10-year-old.
　　Chang smokes in front of her son, but she tells him, somewhat contradictorily, that he shouldn’t smoke until he is 18, and then only do it as long as he doesn’t become addicted. Chang herself claims she is not addicted to cigarettes, justifying this by claiming she seldom smokes more than eight a day.
　　
　　Alarming figures
　　
　　Chang surely doesn’t know, or doesn’t want to know, that every puff kills. According to statistics from the World Health Organization (WHO), there are 5 million tobacco-related deaths every year throughout the world and a quarter of those are in China. Half the people that smoke today will be eventually killed by tobacco.
　　Professor Yang Gonghuan, China’s leading medical expert on tobacco control, said 48.6 billion yuan or 12 percent of China’s total medical expenditure was spent on treating smoking-related illnesses in 2000. “Now, the upswing of medical expenses is faster than that of taxes from the tobacco industry,” Yang said.
　　According to her studies, the smoking-inflicted health disaster will peak in China in 2030. Yang explained leading killer diseases for Chinese smokers are cancers, cardio-vascular diseases and asthma.
　　It’s not only active smoking that is taking lives. Dangers of passive smoking have not been fully recognized in China. More than 50 percent of all non-smokers in China are exposed to second-hand smoke, including infants and children whose parents smoke around them, like Chang’s son.
　　While it is widely acknowledged that tobacco users are at a much higher risk of illness and premature death, the health challenge posed by smoking is particularly severe to China, where medical care is not always available for the poor and often sees rural families slide into debt and poverty.
　　It’s the only consumer product that intentionally kills and is inextricably linked with poverty. According to Dr. Henk Bekedam, WHO representative in China, households in southwestern rural areas spend an average of 11 percent of their family income on tobacco consumption, yet cannot afford daily necessities.
　　Bekedam recalls an inspection trip to Tibet in May 2004, when locals complained that iodized salt was too costly. Paradoxically he found a household where the family regularly spent 1.5 yuan on a packet of cigarettes, which would last two days, rather than use the same amount on a kilogram of iodized salt, good for about two months.
　　
　　Moving forward
　　
　　For many years, the tobacco industry has been the biggest contributor to state revenue in China. In 2004, the industry handed over 210 billion yuan in taxes, representing a massive 8 percent of China’s total fiscal revenue. Professor Yang said, “We cannot only focus on economic interest without thinking about public health. After all, the economy cannot be developed at the cost of health of the public.”
　　By signing the WHO Framework Convention on Tobacco Control (FCTC) in November 2003, China has taken an important step forward in committing itself to global tobacco control. FCTC officially took effect in China in January of this year.
　　“China’s ratification of FCTC has once again demonstrated that the country is a global public health leader. It also confirms the Chinese Government’s determination to reverse the trends in tobacco consumption and move toward a healthier society,” said Bekedam.
　　To achieve this, the National Tobacco Monopoly Administration, China’s national authority on tobacco production, released a new regulation on packaging and labeling of tobacco products that took effect on January 1, 2006. It stipulates the amount of nicotine and tar, the emission of carbon monoxide, and the warning of “Smoking is bad for health” must be clearly marked on each cigarette packet and package of tobacco products. Previous selling terms such as “safe,” “environmental protection,” “l(fā)ight,” “l(fā)ow-tar” and “mild” are now banned from appearing on tobacco packaging and labeling.
　　These provisions all conform to FCTC’s Article 11 on packaging and labeling of tobacco products.
　　Perhaps a bigger battle is changing perceptions that smoking is harmless based on the chain smoking habits of China’s most revered leaders. Mao Zedong and Deng Xiaoping were addicted smokers, but enjoyed good health and lived long lives.
　　The only way to overcome this is for today’s crop of leaders to set the tone.
　　“It is very important that senior leaders get involved in the fight against smoking,” said Bekedam. He was personally encouraged by Chinese Premier Wen Jiabao’s promise in a talk with WHO Director General, Dr. Lee Jong Wook, in April 2004 that the Beijing 2008 Olympics would be smoke-free. This, believes Bekedam, sends a clear message to the country that sport and health cannot be associated with tobacco.
　　
　　Changing attitudes
　　
　　Bekedam said in line with FCTC, the Chinese Government has four areas in which to battle the big smoke. First, China has to raise taxation on tobacco products, which has been proven one of the most effective ways to reduce tobacco consumption without losing revenue in most industrialized countries. Second, implementation of strict rules on banning of tobacco advertisements is a must. Third, the government should enforce stricter rules on packaging and labeling of cigarettes, and finally intensify efforts to address the issue of passive smoking.
　　There are no disillusionments about how difficult this task will be in a country where one third of the world’s smokers are lighting up. When a diner lights up a cigarette in a restaurant in China, no one bats an eyelid. In some restaurants in smaller cities, patrons are not surprised to find packets of cigarettes served along with the dishes. Across the country cigarettes are considered a common gift to friends and relatives during festivals and it is considered impolite not to offer a male guest a cigarette at formal functions.
　　Bekedam said change of cultural behavior would take some time and needs investment and effective campaigns.
　　For those who are keen to quit, practical medical help is available. For example, two hospitals in Beijing, Anzhen Hospital and Chaoyang Hospital, have set up half-day-a-week medical consultation sessions, prescribing internationally-advanced nicotine replacement therapy and providing supporting psychological treatment for smokers who seek help.
　　China has been a national participant in the biennial smoking cessation contest, International Quit&Win, ever since 1996, where smokers across the world try to give up. In the last contest of 2004, nearly 60,000 Chinese smokers registered for participation. The regional winner for the contest’s West Pacific region is Chain Chien-Kuo, a 33-year-old truck driver from China.
　　Xu Guihua, Vice President of Chinese Association on Tobacco Control, a Beijing-based national nongovernmental organization promoting smoking-free initiatives, shares similar concerns. She said the reason behind the current trend of rising smoking rate among teenagers and young women, particular white collar workers with college-education, is the lack of an anti-smoking culture in society. To make things worse, she said, smoking scenes from movies and soap operas and the fact that pop stars smoke give young people the false idea that smoking is fashionable.
　　Five years ago, Xu’s association successfully launched a national campaign urging primary and middle school students to “refuse the first cigarette and become the new generation of non-smokers.” By April 2005, at least 1 million students had signed a pledge committing them to being non-smokers for life.
　　Medical personnel in China present a big problem to the anti-tobacco lobby, seeing as 58 percent of male doctors smoke. Smokers looking for ways to justify their addiction are often quick to point to this fact. Seeing this as an urgent area to address, the Chinese Association on Tobacco Control has launched a campaign to create smoking-free hospitals, with Chaoyang Hospital and Beijing Hospital carrying out pilot projects. Less than 2 percent of doctors in developed countries smoke.
　　Xu said besides honoring its commitments under FCTC, the Chinese Government also brings these commitments down to the masses. This means enhanced domestic legislation and, more importantly, to strictly enforce laws on tobacco control. Xu said China’s efforts in this regard have been insufficient. She said a dozen laws and regulations forbidding smoking in public places had been released by the government since the 1980s, but the implementation has fallen way short of resources and supervision.
　　
　　Li Qing, 29, male, engineer--smoker of eight years
　　
　　I started to smoke in the second year of senior high school, quitted during college and restarted right after graduation. I can clearly feel that smoking has devastated my health. Smoking relaxes me but I don’t smoke in public places. In selecting cigarettes brands, I choose low-tar ones to help me quit in the future.
　　
　　 Xie Hanshuang, 23, female, company secretary--non-smoker
　　
　　I hate people smoking in public places because I think the smell is bad and the image of a smoker is vulgar. My boyfriend smokes occasionally; one or two cigarettes whenever he feels moody. I think it is OK as long as he is not addicted.
　　
　　 Lu Xiaoyuan, 57, male, civil servant--smoker of 38 years
　　
　　I usually smoke two packets in three days. I know smoking is bad for my health, but it’s a habit. I will not quit abruptly as it could have a disastrous impact on my health. A friend of mine died of lung cancer within one year after quitting smoking. For me, smoking is nothing more than a way to kill time.
　　 Wei Lianshan, 40, male, Beijing taxi driver--smoker of 20 years
　　
　　I smoke a pack a day on average. I have thought about quitting but my addiction is too strong. Besides, life as a taxi driver is boring and smoking gives me something to do on night shift. I don’t smoke while I am driving because of safety concerns and female passengers don’t like the smell. If a passenger wants to smoke, it’s OK. I might even break my rule and light up.
　　
　　 Wang Zhiwei, 21, male, student--smoker of two years
　　
　　I am the last in my dorm to start smoking. Besides my curiosity about smoking, another reason is I felt embarrassed when I was the only boy in a talk who refused a cigarette. I know that smoking is bad for health and I don’t want my parents to know that I smoke.
　　
　　A Family’s Battle
　　
　　Daughter of an anti-smoking crusader, Beijing Review reporter Li Li feels embarrassed for not exposing her younger sister’s potential tobacco addiction to her mother. She tells her story.
　　When I noticed the cellophane packet the size of a business card slip out of my 18-year-old sister’s textbook, something about it seemed strange. Inside the packet was shredded tobacco she had taken from a cigarette. I was shocked and demanded to know why she would use such a bookmark. “It smells good” was her simple answer.
　　Behind my seeming overreaction and anger is the story of a family haunted by smoking addiction and a three-generation battle that cigarettes are winning.
　　“Do you think you will become a smoker,” I asked my sister, now in her first year of college at seaside city of Qingdao, Shandong Province.
　　“Yes, I think so,” she said.
　　Despite being privy to this information, I decided not to say anything to my mother, who had always done her best to protect her two daughters from the dangers of smoking.
　　Since lung cancer killed my paternal grandmother, my mother’s hatred for cigarettes has been a constant part of our lives. Grandmother was diagnosed with advanced lung cancer in 1996 at the age of 73. She was a smoker for over 30 years. As a farmer, she mostly rolled her own cigarettes from self-grown tobacco leaves. She refused factory-made brands, saying the flavor was too mild for her taste. Nine months after being diagnosed, grandmother passed away. On her deathbed, her last wish was to smoke a cigarette.
　　One of my paternal aunts picked up the habit of smoking in her early 30s. At the age of 50, she was diagnosed with diabetes, which her doctor attributed partly to smoking and suggested she quit. She did for six months then lit up again. Now as the full-time nanny for her two-year-old grandson, she smokes away from the child three or four times a day, holding the smoke in her lungs as long as she can.
　　My mother often discusses the health hazards of smoking with my sister, using our family’s painful experiences as an example. Despite my sister’s nonchalant attitude toward smoking, mother is relieved none of her friends smoke to influence her and is happy the family smoking cycle won’t continue into the next generation. She still hasn’t seen the cellophane bookmark.
　　
　　Facts and Figures of Smoking in China
　　
　　-- 1 of every 3 cigarettes consumed worldwide is smoked in China.
　　-- There are more than 300 million Chinese smokers--more than the entire U.S. population.
　　-- About 3,000 people die every day in China due to smoking.
　　-- Smoking contributes to 4 of the 5 leading causes of death in China today.
　　-- Smoking will kill about 33% of all young Chinese men alive (under 30 years).
　　-- About 67% of men smoke, and 4% of women.
　　-- Chinese smokers consume an estimated 1.7 trillion cigarettes per year--or 3 million cigarettes every minute.
　　-- China is the world’s largest tobacco producer, accounting for about 25% of the global tobacco leaf
　　
　　production.
　　-- In 1993, WHO estimated that while China gained $5 billion in tobacco taxes, the country lost $7.8 billion
　　in productivity and additional health care costs.
　　-- A study in Shanghai’s Minhang District finds smokers spend an average of 60% of their personal income
　　and 17% of household income on cigarettes. (Source: WHO/2002)

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