Module 1: The Big Picture The Big Picture. Module 1: The Big Picture 2 Introductions NameName Reason for being involved with tobacco controlReason for.

Module 1: The Big Picture The Big Picture

Module 1: The Big Picture 2 Introductions NameName Reason for being involved with tobacco controlReason for being involved with tobacco control What you hope to get out of this trainingWhat you hope to get out of this training Module 1: The Big Picture

3 About This Module Defines the scope of the tobacco epidemic worldwide and in China Describes the reach and influence of the tobacco industry Describes the harms caused by tobacco Introduces the Framework Convention on Tobacco Control (FCTC) and describes its role in international tobacco control Describes the current strengths and challenges of tobacco control in China Provides guidance on how the articles from the FCTC can be implemented for local and city-wide tobacco control in China Module 1: The Big Picture

4 Learning Objectives At the end of this module, you will be able to: Describe the current and projected impact of tobacco use in China Describe the harms caused by tobacco to active smokers, people exposed to secondhand smoke, and the economy List the 3 goals of tobacco control Explain the role of the Framework Convention on Tobacco Control (FCTC) in international tobacco control Describe the guidelines put forth by the FCTC Explain the current strengths and weaknesses of tobacco control in China Define social norm change and its implications for tobacco control in China Describe ways to operationalize FCTC guidelines in cities in China Module 1: The Big Picture

5 Module Sections Section 1: The Tobacco Epidemic: Worldwide and China Section 2: International Tobacco Control and Best Practices Section 3: Tobacco Control in China Module 1: The Big Picture

6 Agenda Welcome & Introductions Section 1: The Tobacco Use Epidemic – China and Worldwide 8:30-9:15 9:15-10:00 Break10:00-10:15 Section 1 (continued)10:15-11:30 Lunch11:30-12:30 Section 2: International Tobacco Control Best Practices12:30-1:45 Break1:45-2:00 Section 3: Tobacco Control in China2:00-3:30 Wrap up and Evaluation3:30-4:00 Module 1: The Big Picture

7 Logistics and Housekeeping Parking, bathrooms, scheduleParking, bathrooms, schedule ParticipationParticipation Group rulesGroup rules Participant GuideParticipant Guide Module 1: The Big Picture

8 Section 1: The Tobacco Use Epidemic – Worldwide and China Module 1: The Big Picture

1960s: Major health hazards of smoking were reported 9 Section 1: The Tobacco Use Epidemic Tobacco History: Worldwide 1 BC 15 th Century 19 th Century 20 th Century 1 BC: Use in the Americas, including smoking, chewing, and tobacco enemas 1492: “Discovered” by Columbus in the Americas 16th Century: Tobacco imported from the Americas and introduced to East Asia and China by European traders 1881: Invention of the cigarette rolling machine 16 th Century Source: Tobacco Atlas 4 th edition, tobaccoatlas.org

Module 1: The Big Picture Tobacco widely cultivated and consumed in Ming China and Qing Manchuria Tobacco becomes an important commercial crop; provides a livelihood for millions, becomes a revenue source for the government Fully appropriated by Chinese local cultures of production and consumption, enjoyed by both men and women Tobacco History: China Tobacco introduced to China via Japan and the Philippines Tobacco becomes a commercial crop along South China seaboard 16 th Century 17 th Century Section 1: The Tobacco Use Epidemic 10

Module 1: The Big Picture British-American Tobacco (BAT) Company marketing and factories in China Aggressive countrywide marketing Peasant farmers taught to grow tobacco from American seeds 1950s: China-State Tobacco Monopoly Administration founded and foreign companies had to leave Nationalized cigarette industry became major part of Chinese economy Aggressive advertisement, promotion, and sponsorship campaigns have continued Photo Credit: AP Photo in 18 Aug 2010 Telegraph The 20 th Century Tobacco Epidemic Section 1: The Tobacco Use Epidemic 11

Module 1: The Big Picture 12 Current Cigarette Consumption: Worldwide Source: Tobacco Atlas 4 th edition, tobaccoatlas.org Section 1: The Tobacco Use Epidemic 18801900192019401960198020002009 1000b 3000b 2000b 4000b 5000b Number of cigarettes consumed, counted in billions Global Cigarette Consumption in one century increased over 100 times.

Module 1: The Big Picture Country Consumption (billions) China2,264.9 Russian Federation 390.0 USA315.7 Indonesia260.8 Japan233.9 These five countries consume more than half of the world’s cigarettes Current Cigarette Consumption: Top 5 Countries 13 Section 1: The Tobacco Use Epidemic Source: Tobacco Atlas 4 th edition, tobaccoatlas.org

Module 1: The Big Picture 14 Historically, high-income countries had highest rates Low and mid-income countries increasing rates –Increased marketing –Increased social acceptability –Economic development –Population growth Smoking Patterns: Worldwide Source: Tobacco Atlas 4 th edition, tobaccoatlas.org Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 15 Four Stages of the Tobacco Epidemic Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 16 Tobacco’s Grip on China: Today 301 million smokers in China 53% of adult males smoke ½ of all smokers are killed by smoking and many more disabled by the disease 3.5 million people will die by 2030 if trends continue China is the world’s largest producer and consumer of tobacco Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 17 Current Smoking Rates: China. 301 Million Current Smokers Source: GATS China 2010 Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 18 375 million “ever” smokers 25 million have quit smoking (7%) 350 million continue to smoke (93%) Smokers who attempted to quit Previously: 36% In the past 12 months: 36% Smokers advised to quit by a health care provider in the past 12 months 34% Smoking Cessation: China Section 1: The Tobacco Use Epidemic Tobacco Control Office, Department of Health, The Government of the Hong Kong Special Administrative Region

Module 1: The Big Picture 19 Source: Tobacco Atlas 4 th edition, tobaccoatlas.org Section 1: The Tobacco Use Epidemic Trend in Tobacco Production (1965-2009): Worldwide

Module 1: The Big Picture 20 Tobacco Company Cigarette Production (% of total) 1. China National Tobacco Corporation37.1 2. Philip Morris - International 17.4 3. BAT – British-American Tobacco12.0 4. Japan Tobacco International9.6 5. Imperial Tobacco4.9 Five Largest Tobacco Companies: Worldwide （ 2008 ） Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture Tobacco industry is large part of economy 33 province companies 57 enterprises of cigarette industry More than 1000 commerce agencies 510,000 staff 16,530 retail shops Output and sale of cigarettes Estimated 2 trillion cigarettes sold per year Over 400 brands available Tobacco Industry in China Section 1: The Tobacco Use Epidemic Tobacco industry represents an estimated 8% of yearly national income 21

Module 1: The Big Picture Break Section 1: The Tobacco Use Epidemic 22

Module 1: The Big Picture 23 Active smokers Secondhand smoke (SHS) The economy Harm Caused by Tobacco Use Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 24 Activity: What are the harms that tobacco can cause to: Active smokers? People exposed to secondhand smoke? The economy? Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 25 Tobacco smoke contains a mix of more than 7,000 chemicals Toxic metals Includes chromium, arsenic, lead, and cadmium Cancer-causing chemicals Includes formaldehyde, benzene, polonium, and vinyl chloride Poison gases Carbon monoxide, hydrogen cyanide, ammonia, butane Source: Surgeon General’s Report, 2004 Chemicals in Tobacco Smoke: Active Smokers Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 26 Cancer Cardiovascular diseases Heart attack Stroke Respiratory diseases Lung cancer COPD Diabetes Tuberculosis Cancer and Diseases in Active Smokers Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 27 Lung Trachea Bronchus Esophagus Oral Cavity Lip Nasopharynx Nasal Cavity Larynx Paranasal Sinuses Stomach Bladder Kidney Pancreas Uterine Cervix Acute Myeloid Leukemia Most Common Cancers in Active Smokers Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture What is secondhand smoke? Secondhand smoke is mixture of smoke released by the cigarette, cigar, or pipe AND exhaled smoke by the smoker Secondhand smoke contains over 2,000 chemicals produced when tobacco products burn Section 1: The Tobacco Use Epidemic 2 hours of secondhand smoke = approximately 4 cigarettes 28

Module 1: The Big Picture 29 Toxins in SHS include: Ammonia Arsenic Benzene Carbon monoxide DDT Formaldehyde Hydrogen cyanide Lead Chromium VI Chemicals in Secondhand Smoke Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 30 Secondhand smoke causes: Lung cancer Heart disease Asthma Pneumonia Bronchitis Low birth weight babies SHS increases risk of: Sudden Infant Death Syndrome (SIDS) Respiratory infections Ear problems Scientific evidence shows that there is no safe level of exposure to secondhand smoke. Section 1: The Tobacco Use Epidemic Dangers of Secondhand Smoke

Module 1: The Big Picture 31 SHS endangers everyone Certain groups are at special risk Children Pregnant women People with asthma or cardiovascular disease Dangers of Secondhand Smoke Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 32 Smoking is the leading preventable cause of death in the world In 2011, almost 6 million people died from smoking 1.2 million deaths in China 80% of deaths occurred in low- and middle-income countries By 2030, 8 million annual tobacco-related deaths expected 3.5 in China It is estimated that one billion people worldwide will die from smoking during the 21 st century Deaths from Smoking and Secondhand Smoke: Worldwide and China Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 33 Projected Tobacco-Related Deaths: China Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 34 Tobacco causes more than 15% of deaths among men worldwide In China, between 10 and 14.9% of men die from tobacco-related causes Male Deaths from Tobacco: Worldwide and China Source: Tobacco Atlas 4 th edition, tobaccoatlas.org Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 35 Tobacco causes 7% of deaths among women worldwide In China, 10-15% of women die from tobacco-related causes Smoking rates are increasing among women in many countries Source: Tobacco Atlas 4 th edition, tobaccoatlas.org Section 1: The Tobacco Use Epidemic Female Deaths from Tobacco: Worldwide and China

Module 1: The Big Picture 36 In 2011 approximately 600,000 nonsmokers died from secondhand smoke exposure 75% of secondhand smoke deaths occur among women and children In China it is estimated that more women die from exposure to passive smoking than from active smoking Deaths Caused by Secondhand Smoke in Nonsmokers: Worldwide Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 37 Smoking harms the economy through: Health care costs for smokers and nonsmokers Productivity lost among workers who smoke Premature death and disability among smokers Increasing or deepening poverty Harm to the Economy Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 388 According to a 2008 survey, the total smoking costs were 200.7 billion RMB (0.7% of GDP) –Direct medical costs of smoking: 43.1 billion RMB (3% of total health expenditures) –Indirect costs of smoking: 157.6 billion RMB The economic burden of cigarette smoking has increased substantially during the past decade Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008. Harm to the Economy: China Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 39 Smoking rates often higher within lower socioeconomic groups Resources spent on tobacco instead of food and other essential needs. One half of tobacco-related deaths in the developing world occur in middle age, depriving many households of years of potential income. Medical care costs for treating chronic diseases further impoverish poor families. Tobacco Use and Poverty In China, an average of 17% of household income is spent on tobacco Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture Knowledge Competition! 40 Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 41 Knowledge Competition! Question 1: In China, of the 375 million “ever” smokers, what percentage have quit? a.3% b.7% c.15% d.53% Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 42 Knowledge Competition! Question 2: Chinese men currently smoke what portion of the world’s cigarettes? a.One-tenth b.One-fifth c.One-third d.One-half Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 43 Knowledge Competition! Question 3: TRUE or FALSE: China National Tobacco Corporation produces more cigarettes than any other company in the world. Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 44 Knowledge Competition! Question 4: Which of the following is NOT a stage of the tobacco epidemic? a.Stage 1: The onset of cigarette smoking in men b.Stage 2: A dramatic increase in smoking in men and onset of smoking in women c.Stage 3: A dramatic decrease in smoking in men and women d.Stage 4: An increase in smoking-related illnesses and death Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 45 Knowledge Competition! Question 5: By 2030 if current patterns continue, smoking is predicted to cause approximately what percentage of all deaths among middle-aged Chinese individuals? a.13% b.33% c.46% d.73% Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 46 Congratulations!!! The winner is… Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture 47 Smoking became a solidified part of Chinese culture beginning in the early 1900s China is in Stage 2 of the tobacco epidemic – meaning that it is experiencing a sharp increase in men smoking and the onset of smoking in women Smoking can cause dire consequences for smokers, non-smokers who are exposed to secondhand smoke, and to the economy Summary Section 1: The Tobacco Use Epidemic

Module 1: The Big Picture Lunch 48

Module 1: The Big Picture 49 Section 2: International Tobacco Control and Best Practices Module 1: The Big Picture

50 Question: What are the goals of tobacco control? Section 2: International Tobacco Control

Module 1: The Big Picture 51 Prevent initiation among youth and young adults Promote cessation Eliminate exposure to secondhand smoke What are the Goals of Tobacco Control? Section 2: International Tobacco Control

Module 1: The Big Picture 52 Framework Convention on Tobacco Control (FCTC) Section 2: International Tobacco Control

Module 1: The Big Picture 53 Developed in response to global tobacco epidemic Evidence-based treaty First international health treaty Signed by 174 countries Became effective in China in January 2006 Framework Convention on Tobacco Control (FCTC) Section 2: International Tobacco Control

Module 1: The Big Picture 54 Section 2: International Tobacco Control Framework Convention on Tobacco Control (FCTC)

Module 1: The Big Picture 55 Indicates a country’s commitment to implementing tobacco control Provides the foundation and structure for countries to implement tobacco control Establishes best practices for reducing supply/demand for tobacco Contains articles for use at both national and/or local levels FCTC: What it Does Section 2: International Tobacco Control

Module 1: The Big Picture Decrease affordability of tobacco products (Article 6) Establish smoke-free policies (Article 8) Increase knowledge of risks of smoking and exposure to SHS (Article 12) Minimize tobacco advertising and promotion (Article 13) Promote and assist tobacco users to quit (Article 14) Control access to tobacco products (Article 16) Conduct research, surveillance, and exchange information (Article 20) 56 FCTC: International Best Practices Section 2: International Tobacco Control

Module 1: The Big Picture Increase the price of tobacco products by raising taxes Taxation of tobacco most effective at reducing use Higher tobacco taxes help the young and the poor 57 Decrease Affordability of Tobacco Products – FCTC Article 6 Section 2: International Tobacco Control

Module 1: The Big Picture 58 Why protection from secondhand smoke is critical: Exposure to secondhand smoke is widespread Most nonsmokers do not choose to be exposed Secondhand smoke exposure is completely preventable Establish Smoke-Free Policies – FCTC Article 8 Section 2: International Tobacco Control

Module 1: The Big Picture Smoke-free laws should be created, implemented, and enforced Smoking should be banned in all: Public venues Workplaces Schools and educational settings Health care facilities Public transportation There is no safe level of exposure to SHS Environments must be made smoke-free Ventilation and air filtration systems do not reduce harm of tobacco smoke 59 Establish Smoke-Free Policies – FCTC Article 8 Section 2: International Tobacco Control

Module 1: The Big Picture Smoke-free environments help create smoke-free norm Smoke-free environments common throughout much of the developed world Smoke-free restaurants can maintain (or even increase) revenues 60 Establish Smoke-Free Policies – FCTC Article 8 Section 2: International Tobacco Control

Module 1: The Big Picture 61 Educate the public about the health risks of smoking and exposure to secondhand smoke Educate the public about the benefits of quitting smoking and adopting smoke-free lifestyles Increase Knowledge of Risks of Smoking and Exposure– FCTC Article 12 Section 2: International Tobacco Control

Module 1: The Big Picture 62 Ban any advertising, promotion, and/or sponsorship promoting tobacco products Enforce bans on marketing tobacco Enforce bans on tobacco companies’ sponsoring events Prohibit distribution of free tobacco samples Minimize Tobacco Advertising and Promotion – FCTC Article 13 Section 2: International Tobacco Control

Module 1: The Big Picture 63 Science shows likelihood of successful quitting with counseling and medication Design and implement programs aimed at helping smokers quit Offer programs in locations such as educational institutions, health care facilities, workplaces, and sporting environments Promote and Assist Tobacco Smokers to Quit – FCTC Article 14 Section 2: International Tobacco Control

Module 1: The Big Picture 64 Enforce laws prohibiting the sale of tobacco products to minors Control Access to Tobacco Products – FCTC Article 16 Section 2: International Tobacco Control

Module 1: The Big Picture 65 Monitor prevalence of tobacco use and related outcomes Evaluate tobacco control activities Identify evidence-based best practices Research, Surveillance, and Exchange of Information – FCTC Article 20 Section 2: International Tobacco Control

Module 1: The Big Picture 66 Established by WHO for use with FCTC guidelines MPOWER measures intended to assist in the country-level implementation of tobacco control interventions 6 evidence-based measures to reduce tobacco use and foster social change Represent comprehensive program for tobacco control MPOWER Section 2: International Tobacco Control

Module 1: The Big Picture 67 Section 2: International Tobacco Control MPOWER

Module 1: The Big Picture Knowledge Competition! Section 2: International Tobacco Control 68

Module 1: The Big Picture 69 Knowledge Competition! Question 1: TRUE or FALSE: Ventilation and air purification systems are acceptable alternatives to smoke-free environments. Section 2: International Tobacco Control

Module 1: The Big Picture 70 Knowledge Competition! Question 2: Evidence has shown that the MOST effective means of decreasing cigarette smoking is: a.Increasing prices b.Banning marketing, promotion, and sponsorship of tobacco c.State ownership of tobacco assets d.Raising public awareness of the dangers of tobacco Section 2: International Tobacco Control

Module 1: The Big Picture 71 Knowledge Competition! Question 3: In what year did China sign the Framework Convention on Tobacco Control (FCTC)? a.1996 b.2000 c.2002 d.2006 Section 2: International Tobacco Control

Module 1: The Big Picture 72 Knowledge Competition! Question 4: Which of the following was NOT discussed as an international best practice of the FCTC: a.Establish smoke-free policies b.Promote alternative nicotine-delivery systems c.Minimize tobacco advertising and promotion d.Control access to tobacco products Section 2: International Tobacco Control

Module 1: The Big Picture 73 Knowledge Competition! Question 5: TRUE or FALSE: In order to meet the FCTC guidelines, China must pass laws that prohibit the sale of tobacco products to minors. Section 2: International Tobacco Control

Module 1: The Big Picture 74 Congratulations!!! The winner is… Section 2: International Tobacco Control

Module 1: The Big Picture 75 The Framework Convention on Tobacco Control (FCTC) provides the foundation and guidelines for country-level tobacco control. The FCTC international best practices include: Decrease affordability of tobacco products (Article 6) Establish smoke-free policies (Article 8) Increase knowledge of risks of smoking and exposure to secondhand smoke (Article 12) Minimize tobacco advertising and promotion (Article 13) Promote and assist tobacco users to quit (Article 14) Control access to tobacco products (Article 16) Research, surveillance, and exchange of information (Article 20) MPOWER measures assist in the country-level implementation of interventions Summary Section 2: International Tobacco Control

Module 1: The Big Picture Break 76

Module 1: The Big Picture 77 Section 3: Tobacco Control in China Module 1: The Big Picture

78 Section 3: Tobacco Control in China Small Group Discussion: What are the strengths of tobacco control in China?

Module 1: The Big Picture 79 China’s Progress FCTC in effect in China: January, 2006 Active organizations/people Existing laws since 1987: advertising bans, smoke-free areas, health warnings, health education Data: prevalence, mortality, economic Prevalence trends: Now some ex- smokers National Tobacco Control Plan (NTCP), 2011 Section 3: Tobacco Control in China

Module 1: The Big Picture 80 In 2010, found that 60% of adults had seen messages about the dangers of tobacco use or the benefits of quitting smoking in the past 30 days Television: 45% Newspapers/magazines: 22% Billboards: 21% Public transportation: 20% Public walls: 19% Anti-Smoking Campaigns Section 3: Tobacco Control in China GATS China 2010

Module 1: The Big Picture 81 Smoke-free public places Includes public transportation Guidelines for smoke-free schools Policy for hospitals Tobacco packaging and labeling Warning labels Advertising, promotion, and sponsorship National law bans tobacco advertising on movie, television, radio, and in newspapers and magazines Current National Policy Section 3: Tobacco Control in China

Module 1: The Big Picture 82 Policy: Smoke-free public places Reality: Not widespread, rarely enforced 72% of non-smokers exposed to SHS Smoking in public places remains commonplace In recent study, smoking was reported in: 89% of restaurants 67% of homes 63% of workplaces 58% of government buildings 38% of health care facilities 34% of public transportation Policy Vs. Reality GATS China 2010 Section 3: Tobacco Control in China

Module 1: The Big Picture 83 Policy: Tobacco package warning labels Reality: Weak labeling Small font, written in English Cover only 30% of pack Same background color Do not specify harms Self-regulation, not law Policy Vs. Reality Section 3: Tobacco Control in China

Module 1: The Big Picture 84 Policy: Ban on tobacco advertisements and sponsorships Reality: Tobacco products widely marketed and promoted Advertising permitted through: Point of sale Sponsored events Branded schools Billboards Online Advertising by affiliated companies Brand images and colors well known Policy Vs. Reality Section 3: Tobacco Control in China

Module 1: The Big Picture 85 Chinese tobacco industry large, state- owned, and important to economy Cigarette taxes low Cigarettes widely available easy to purchase Prevalence of smoking high Tobacco Control Challenges Section 3: Tobacco Control in China China’s tobacco output was increased by 32% from 2004 to 2011

Module 1: The Big Picture 86 Smoking common and widely accepted During and after meals In public places Part of social and financial interaction Cigarettes Commonly given as presents Some brands linked to charitable causes of special occasions Smoking and Culture Section 3: Tobacco Control in China

Module 1: The Big Picture 87 Knowledge of risk of smoking and exposure to secondhand smoke is low Similar awareness of risks of smoking and SHS found in both smokers and non-smokers Awareness increased among more educated Low Awareness of Health Risks Section 3: Tobacco Control in China Photo credit: Amanda Mills, CDC, 2011

Module 1: The Big Picture 88 Social norms: perceived standards of acceptable attitudes and behaviors prevalent among the members of a community Social norms can be positive or negative Tobacco Control and Social Norm Change Section 3: Tobacco Control in China

Module 1: The Big Picture 89 Small Group Discussion: What are some historic social norm changes that have occurred in China? What were the forces behind the change? How long did it take for the norm to change? What norm changes would you like to see occur? Section 3: Tobacco Control in China

Module 1: The Big Picture 90 Tobacco is harmful not only to the smoker but also those exposed to SHS Goal: to create a social and legal climate in which tobacco becomes: Less acceptable Less attractive Less accessible Less affordable Tobacco Control and Social Norm Change Section 3: Tobacco Control in China

Module 1: The Big Picture 91 Harmful effects of tobacco documented by scientific evidence and personal experience Citizen action Institutional change led by laws and policies Litigation to address failure in public policy Decreasing social acceptability of smoking How has Social Norm Change Been Accomplished with Tobacco? Section 3: Tobacco Control in China

Module 1: The Big Picture 92 Combine policy, health education, and programs/interventions to change social norms: Establish smoke-free policies and norms (FCTC Article 8) Educate the public about health risks of tobacco (FCTC Article 12) Minimize tobacco advertising and promotion (FCTC Article 13) Promote and assist tobacco users to quit (FCTC Article 14) Prohibit the sales of tobacco to minors (FCTC Article 16) Policy, Health Education, Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 93 Activity: What strategies could be used in your city to: Group 1: Establish smoke-free policies and norms Group 2: Educate the public about the health risks of tobacco Group 3: Minimize tobacco advertising and promotion Group 4: Promote and assist tobacco users to quit Group 5: Conduct research, surveillance, and the exchange of information Section 3: Tobacco Control in China

Module 1: The Big Picture 94 Develop smoke-free city-wide policy for: Public places, including restaurants and bars Hospitals/clinics Schools Public transportation Worksites and government buildings Strengthen existing policies Implement Enforce Evaluate Smoke-Free Laws (Article 8): Policy Section 3: Tobacco Control in China

Module 1: The Big Picture 95 Provide press releases about benefits of smoke-free policy Provide press releases about smoke-free policy launch Host launch event at site of smoke-free policy Develop and implement media campaign to encourage parents to make their homes and cars smoke-free Smoke-Free Laws (Article 8): Health Education Section 3: Tobacco Control in China

Module 1: The Big Picture 96 Educate decision-makers (city leaders or site leaders) on the benefits of smoke-free policy to adopt strong city wide policy(s) to fully enforce smoke-free policies in their city Develop and provide instruction on benefits of smoke-free sites and implementation guidelines for employees Smoke-Free Laws (Article 8): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 97 Develop and implement media campaign to educate on dangers of smoking and secondhand smoke Media may include: TV, radio, newspapers, billboards, pamphlets, etc. Consider harm messages to target populations including: Non-smokers Pregnant women Infants and children Increase Public Awareness (Article 12): Health Communication Section 3: Tobacco Control in China

Module 1: The Big Picture 98 Use special events (Expo, festivals) and holidays To educate decision- makers that tourists expect “Tobacco-Free Cities” To educate sites or general public on harms of tobacco use and secondhand smoke Increase Public Awareness (Article 12): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 99 Educate on the dangers of smoking and SHS and teach skills in avoiding SHS: Parents and families Women (pregnant, mothers, employees) Children and youth Make parents aware of the importance of discussing the harms of tobacco with their children In schools: Involve students, parents, and families in school policy efforts Train educators to deliver anti-tobacco education Increase Public Awareness (Article 12): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 100 Target Youth: Make children and youth aware of tobacco industry tactics –Empower youth to organize and speak out against tobacco Anti-tobacco programs in schools, including: –Physiologic and social consequences of tobacco use –Social influences of tobacco use –Peer norms –Life skills Develop partnerships with community groups, schools, hospitals, youth associations Increase Public Awareness (Article 12): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 101 Encourage enforcement of laws related to tobacco advertisement Example laws: Tobacco Monopoly Law Advertising Law of People’s Republic of China Ban on Advertising, Promotion, and Sponsorship (Article 13): Policy Section 3: Tobacco Control in China

Module 1: The Big Picture 102 Organize youth to attend (with anti-tobacco product posters) tobacco industry sponsored youth events (for example, Parkour Tour) Document examples of tobacco sponsorship of school activities Document current examples of direct and indirect tobacco advertisement, sponsorship, and promotion activities in your city Educate government leaders to fully enforce laws related to tobacco advertisement Ban on Advertising, Promotion, and Sponsorship (Article 13): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 103 Use media messaging to promote quitting –Make cessation seem achievable, desirable, doable –Use direct, concrete messaging for the individual smoker Use media messaging to support programs in your city –Quit-lines –Cessation clinics Media may include: TV, radio, newspapers, billboards, pamphlets, etc. Cessation (Article 14): Health Communication Section 3: Tobacco Control in China Tobacco Control Office, Department of Health, The Government of the Hong Kong Special Administrative Region

Module 1: The Big Picture Develop and promote training(s) to educate medical professionals to counsel smokers to quit Incorporate stop-smoking programs into primary care Provide medication that assists with quitting smoking Cessation (Article 14): Programs/Interventions Section 3: Tobacco Control in China “The superior doctor prevents sickness; the mediocre doctor attends to impending sickness; the inferior doctor treats actual sickness” 104

Module 1: The Big Picture 105 Educate government leaders and business owners who sell tobacco products to fully enforce laws Example laws: Protection of Minors Law of People’s Republic of China Prevention of Juvenile Delinquency Law of People’s Republic of China Prohibit Sales to Minors (Article 16): Programs/Interventions Section 3: Tobacco Control in China

Module 1: The Big Picture 106 Engage with editorial boards to discuss local stories supporting tobacco control Organize press coverage of national tobacco control leaders making public presentations that support local tobacco control agenda Distribute summary of national and international stories related to local tobacco control agenda to local media outlets, including how the stories relate to the locals Other Health Communication Strategies Section 3: Tobacco Control in China

Module 1: The Big Picture 107 Measure tobacco use and SHS exposure Monitor and evaluate policies, compliance, and impact of tobacco control policies Use findings to promote effective allocation of tobacco control resources Identify, strengthen, and expand effective policies Maintain system of surveillance and enforcement Show economic savings of smoke-free policies Research, Surveillance, and Exchange of Information (Article 20) Section 3: Tobacco Control in China

Module 1: The Big Picture 108 Activity: Scavenger Hunt! Section 3: Tobacco Control in China

Module 1: The Big Picture 109 China’s tobacco control strengths include participation in the FCTC, active organizations, laws, availability of current data, and national tobacco control planning Challenges include making many policies a reality, including: smoke- free laws, banning advertisements, prohibiting sales to minors marketing, and promoting cessation Social norm change must drive tobacco control efforts in China Policy, health communication, and programs/interventions can be used to operationalize FCTC tobacco control articles in China Summary Section 3: Tobacco Control in China

Module 1: The Big Picture 110 Final questions? Module 1: The Big Picture

111 Evaluation Module 1: The Big Picture

Module 1: The Big Picture The Big Picture. Module 1: The Big Picture 2 Introductions NameName Reason for being involved with tobacco controlReason for.

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Module 1: The Big Picture The Big Picture. Module 1: The Big Picture 2 Introductions NameName Reason for being involved with tobacco controlReason for.

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