1. GATS CHINA ------ LAUNCH OF RESULTS Lin Xiao China CDC Tabacco Control Office Lin Xiao China CDC Tabacco Control Office

2. Background  This is the responsibility clearly given by the WHO Framework Convention on Tobacco Control (FCTC) to all parties, as well as an important component of the six most effective strategies for tobacco control (the MPOWER package) vigorously advocated by WHO.  It is essential to establish an effective monitoring, supervising and evaluation system to monitor tobacco use and obtain nationally representative periodic data on the key indicators of tobacco use among adolescents and adults. 2015-9-22

3. The Global Adult Tobacco Survey (GATS)  GATS is a household survey to provide strong evidence for developing, monitoring, and implementing effective tobacco control measures.  Sponsors:  The Bloomberg Initiative to Reduce Tobacco Use  The Bill and Melinda Gates Foundation  The U.S. Centers for Disease Control and Prevention  World Health Organization  So far, 14 countries have implemented the survey 2015-9-23

4. GATS CHINA  The 2010 Global Adult Tobacco Survey in China (GATS China) was a nationally representative household survey of non-institutionalized men and women aged 15 and older, which was organized by China CDC authorized by MOH.  The study design and pilot surveys was conducted by China CDC in 8 months, and the training in 4 months;  The field work was completed by more than 500 stuff from provincial and county CDCs from December 2009 to March 2010;  Data cleaning, analysis and report writing were completed during May to July, 2010. 2015-9-24

5. Methods of Survey  A multi-stage stratified cluster sampling method was used in the survey in order to obtain the nationally representative sample;  Internationally standard questionnaire was used in the survey; iPAQ handheld was used to collect data;  The survey was completed with high qualities by mobilization in community and strict quality control measures;  A total of 13,354 people completed the individual questionnaire, and the total response rate was 96.0%. 2015-9-25

6. Field Work 2015-9-26

7. The sampled counties and districts

8. Survey Contents  Participants’ general information,  Tobacco use (smoking and smokeless),  Cessation,  Secondhand smoke (SHS),  Tobacco economic  Media  Knowledge, attitudes, and perceptions on tobacco use and SHS 2015-9-28

9. Results of GATS CHINA  Tobacco Use  Nicotine Dependence and Cessation  Secondhand smoke  Knowledge and Perceptions of Tobacco Harm  Implementation of a series of policies on tobacco control  Protecting people from the harms of SHS  Protecting people from tobacco smoke  Offering help to quit tobacco use  Warning about the dangers of tobacco  Enforcing bans on tobacco advertising, promotion and sponsorship  Raising taxes on tobacco 2015-9-29

10. Tobacco Use  Male smoking rate in China remains at a high level. 2015-9-210 Sources: Data come from the 1996 National Prevalence Survey of Smoking Pattern, the 2002 Behavior Risk Factor Survey, and GATS China, 2010.

11. Tobacco Use  Smoking rate was higher among those with lower education  Male smoking rates were higher in rural and western areas 11  Smoking rates for men was the highest in machine operators and agriculture workers  Among ever daily smokers 20-34 years old, 52.7% started daily smoking before the age of 20.

12. Nicotine Dependence and Cessation  Half of smokers were heavily dependent on nicotine, 50.3% of current daily smokers smoked within 30 minutes after waking. 2015-9-212 Among ever smokers: 57.5 million (16.9%) quitted smoking, 112.8 million (33.1%) relapsed, 17.3 million planned to quit, 152.8 million (44.9%) had no intention to quit smoking.

13. The quit ratio for daily smoker in China was 12.8%, second to no other GATS countries except for India. 2015-9-213 Quit ratio for daily smokers ： the proportion of quitters among ever daily smokers

14. Secondhand smoke  Prevalence of exposure to secondhand smoke was high; 72.4% of nonsmokers were exposed to secondhand smoke.  72.7% of participants noticed smoking in indoor public places  88.5% of people noticed smoking in restaurants,  58.4% in government buildings,  Around 35% in each of the following places: health care facilities, schools, and public transportation.  Smoking occurred in 67.3% of homes. 2015-9-214

15. Secondhand smoke exposure 2015-9-215 Note: among those who had visited those public places in the past 30 days prior to the survey

16. ≥75% adults were not aware that smoking could cause stroke, heart disease and lung cancer 2015-9-216

17. 75% adults were not aware that SHS causes HD & lung cancer in adults, and lung diseases in children. 2015-9-217

18. low-tar cigarettes are no less harmful than regular cigarettes  35.8% of adults thought low-tar cigarettes were less harmful than regular cigarettes and 50.2% did not know.  The highest proportion of adults with this misconception was among those with a college or above education, or medical staff and teacher. 2015-9-2 18

19. Implementation of policy package on tobacco control PolicyIndicators used in GATS China surveyResult Protect people from SHS % of respondents who noticed smoking at their indoor work places in the previous 30 days 63.3% % of respondents noticing smoking in indoor public places in previous 30 days. 72.7% Offer help for cessation % of smokers reporting that they were advised to quit when seen by a doctor or other health professional during the previous 12 months. 33.9% % of smokers who attempted to quit without any cessation aids during the previous 12 months. 91.8% Warn about the dangers of tobacco % of respondents who noticed information on the dangers of smoking during the previous 30 days 59.8% % of respondents who thought about quitting after seeing the health warnings on the cigarette packages 36.4% Enforce bans on tobacco advertising, promotion & sponsorship % of respondents who noticed tobacco promotion during the previous 30 days. 19.6% % of respondents who noticed tobacco promotion on TV among those who noticed tobacco marketing during the previous 30 days. 49.8% Increase tobacco taxes & prices Maximum expenditure to buy a pack of cigarettes paid by 50% of smokers 5 RBM & LESS Expenditure of 100 packs of cigarettes as a percentage of 2009 GDP per capita. 2.0% 2015-9-219

20. Protecting people from the harms of SHS  Among those who worked indoors, 37.7% reported that there was no policy on smoking indoors at the workplace, while 31.0% reported a complete ban on indoor smoking.  During the past 30 days  Among workplaces without a smoking ban, 89.2% reported smoking had occurred at the workplace.  Among workplaces with partially banning smoking, 69.3% reported smoking had occurred at the workplace.  In places with a complete smoking ban, 25.5% of people reported seeing people smoking.  Overall, 63.3% reported smoking occurred at indoor workplaces in past 30 days. 2015-9-220

21. Offering cessation services  During the previous 12 months, only 33.9% of smokers who had visited a healthcare provider received cessation advice.  During the previous 12 months ， smokers who had attempted to quit ：  91.8% did not use any special cessation methods.  3.1% used smoking cessation medications  3.0% did consult  Among GATS countries, the percentage of those using smoking cessation medications and counseling in China was one of the lowest. 2015-9-221

22. Warning of the harms of tobacco  In the previous 30 days, 59.8% of adults had seen a message about the dangers of tobacco use or encouraging smokers to quit, via the media or in public places.  Television (seen by 45.4%),  newspapers and magazines (21.8%),  billboards (20.5%),  public transportation (20.3%),  public walls (18.8%).  In the previous 30 days, despite 86.7% of current smokers having seen a warning label on a cigarette pack (“Smoking is harmful for your health” “ Quitting is benefit for your health”), 63.6% of those did not consider quitting smoking after seeing the warning label. 2015-9-222

23. Enforcing bans on tobacco advertisement, promotion and sponsorship  During the previous 30 days, 19.6% of adults surveyed had noticed tobacco advertisements and promotions in media or in public places.  During the previous 30 days, among adults who had noticed tobacco advertisements in media, 49.8% saw such advertisements on TV. 2015-9-223

24. Raising taxes on tobacco products  The distribution of cigarette prices in China was skewed. Although some cigarettes prices were high, 50% of current smokers spent RMB 5.0 Yuan (~US$0.74) or less on 20 manufactured cigarettes (one pack).  Only 10.0% spent 13.7 Yuan or more on a pack of cigarettes.  The median price in urban areas was 7.0 Yuan, and 4.9 Yuan in the rural areas.  The median amount was 3.9 Yuan for agriculture workers, 5.5 Yuan for machine operator and 9.9 Yuan for leaders of organizations. 2015-9-224

25. Increasing tobacco taxes and prices  The percentage of expenditure of 100 packs of manufactured cigarette in 2009 GDP per capita is only 2%  This indicator was lower in China than several other GATS countries (e.g., Thailand 3.4%, Uruguay 3.0% and Bangladesh 5.0%).  The relative cost of cigarettes in China was very low, even compared to other developing countries. 2015-9-225

26. Summary  Male smoking rate in China remains at a high level  Only 16.9% of ever smokers quitted smoking, and the relapsing rate is high.  SHS exposure rate in nonsmokers is still very high ;  Low awareness of the harms of smoking and SHS;  The proportion of medical professionals with misconceptions about low-tar cigarettes was 54.7%, higher than farmers; further research is needed to explore the reason for this abnormal result.  Weak implementation of strategies and measures on tobacco control 2015-9-226

27. 2015-9-227