As the world’s leading producer and consumer of tobacco, China has long faced significant challenges regarding secondhand smoke (SHS) exposure. Although China ratified the Framework Convention on Tobacco Control (FCTC) developed by the World Health Organization (WHO) in 2005, progress in smoke-free legislation and its implementation has been slow and uneven. In recent years, with the advancement of the “Healthy China 2030” strategy, many regions have accelerated the formulation and enforcement of smoke-free policies. However, significant legislative disparities and implementation challenges persist between regions.
Recently, Bolu Yang, a 2023 graduate of the Master of Science in Global Health program at Duke Kunshan University and currently a PhD student in the Wuhan University-Duke Kunshan University Joint PhD Supervision Program, published an article in Nicotine and Tobacco Research, a well-known journal in the field of tobacco studies. The article, titled “Analyzing the Diversity and Impacting Factors of Smoke-Free Legislation and Implementation in Mainland China: A Case Qualitative Research,” explores the diversity and influencing factors of tobacco control legislation and its implementation in mainland of China through literature analysis, policy reviews, and interviews. Using Shanghai and Chongqing as case studies, the article provides an in-depth analysis of the challenges and offers valuable recommendations for advancing the creation of a comprehensive smoke-free environment.
China has yet to establish a nationwide, unified smoke-free law, and the legislative progress in different cities varies significantly. While some cities, such as Shanghai and Shenzhen, have implemented comprehensive smoking bans that cover all indoor workplaces, public transportation, and indoor public spaces, many other regions only enforce partial smoking bans, allowing designated indoor smoking areas in certain public spaces.
The study highlights that the tobacco industry’s interference is a major barrier to advancing smoke-free legislation. For example, in Chongqing, a partial smoke-free law was introduced in 2021. While policymakers originally intended to implement a comprehensive smoking ban, the city’s legislation retained smoking areas in restaurants, entertainment venues, and hotels due to resistance from the tobacco industry. In contrast, Shanghai introduced the first provincial-level tobacco control regulation in 2010, initially implementing partial smoking bans, which were expanded to a full indoor smoking ban by 2017, though still facing interference from the tobacco industry.
During interviews, some experts and policymakers argued that temporarily allowing indoor smoking areas was a necessary transitional step toward a full smoking ban. However, the study found that no clear timeline was set for this transitional measure. Furthermore, experts pointed out that current legislation lacks provisions on how to establish and manage these designated smoking areas. A policymaker involved in the formulation of the regulations commented, “If you’re just going to allow smoking areas, it defeats the purpose of the legislation.”
In terms of enforcement, while both Shanghai and Chongqing adopted a multi-agent enforcement mode, their implementation outcomes have been markedly different. Following the full smoking ban in 2017, Shanghai strengthened its enforcement efforts, resulting in a significant increase in fines. However, enforcement in Chongqing has been weaker. Interviewees noted that limited enforcement resources and poor inter-departmental coordination were key obstacles to the effective implementation of the smoking ban.
Based on the research findings, the researchers recommend the establishment of dedicated coordinating bodies in the tobacco control field to strengthen inter-departmental collaboration and resource integration. Additionally, policymakers need to set clear timelines for the transition to full smoke-free environments, including specific deadlines for the removal of smoking areas. Furthermore, the study calls for greater public participation and advocacy to involve more people in tobacco control efforts, improving both the effectiveness of legislation and enforcement to protect the public from the harms of secondhand smoke.
The research team hopes this study will inspire greater attention from policymakers and the public to the construction of a smoke-free environment, contributing to the achievement of the “Healthy China 2030” goal. Going forward, the gradual and full implementation of smoke-free policies will be a key focus for all stakeholders. This work benefitted from an incentive grant from the World Health Organization (WHO) as part of the WHO Global Noncommunicable Disease (NCD) Platform Young Researchers Programme (Grant reg. № 2022/1249193).
By Chu Ren
Read the paper at https://doi.org/10.1093/ntr/ntae253
