Presentation by Dan Xiao, M.D., Ph.D., Beijing Institute of Respiratory Medicine, at the 15th World Conference on Tobacco OR Health in Singapore.

1. Progress and Challenges faced in expanding the role
of healthcare providers and delivering treatment,
China
Dan XIAO, M.D., Ph.D.
Email:danxiao@263.net
blog.sina.com.cn/cessation
WHO Collaborating Center for Tobacco or Health
Beijing Institute of Respiratory Medicine
Beijing Chao-Yang Hospital, Capital Medical University
Mar 19th, 2012, Singapore

2. In 2010, there were an estimated 301 million current
smokers (28.1% of adults: 52.9% of men and 2.4% of
women ) in China
- N Engl J Med, 2011, 364(25):2469-70
- Global Adult Tobacco Survey (GATS) in China, 2010

3. 740 million suffered from Second Hand Smoking （ SHS ）
exposure in China (2010)
The rates of SHS in
SHS exposure different districts
1984 39%
1996 54%
2002 53%
2010 74%
Smoking prevalence in Chinese aged 15 and above. Chin Med J,1987,100:886-892.
Smoking in China: findings of the 1996 National Prevalence Survey. JAMA. 1999, 282(13):1247-1253.
中国人群 2002 年吸烟和被动吸烟的现状调查 . 中华流行病学杂志 ,2005, 26(2): 77-83.
Prevalence of smoking in China in 2010. N Engl J Med, 2011, 364(25):2469-2470.

4. Lack of awareness of the health hazards of active
smoking and SHS among medical professionals
 Only 55.8% of the medical professionals know active smoking
can cause three diseases (stroke, heart attacks and lung cancer)
 Only 62.3% of the medical professionals know SHS can
cause three diseases (stroke, heart attacks and lung cancer)
- Global Adult Tobacco Survey in China, 2010

5. Misconceptions concerning smoking
 Smoking as a symbol of personal freedom
 Ability to control the health effects of
smoking through “reasonable” and
“measured” use
 The importance of tobacco in social and
cultural interactions
 The importance of tobacco to the economy
 Normal for physicians and teachers smoke
 …
Myths and attitudes that sustain smoking in China. J Health Commu, 2008, 13: 654- 666.

6. Low willingness to quit smoking in adult smokers
 The International Tobacco Control Policy
Evaluation Project (ITC)
 Prospective population-based surveys conducted
in Beijing ,Shanghai ,Guangzhou, Shenyang ,
Changsha and Yinchuan
 Stratified multi-stage sampling design
 Selected about 800 smokers from each city (total
4,815)
 Willingness to quit smoking ： 15%-31%

7. Tobacco Control in China: A Crucial Battle
 As the largest producer and consumer of tobacco
all over the world, China is suffering the most severe
consequence due to tobacco use.
Sales of cigarettes in China (1952-2007)
Unit:100 million

8. Expanding the role of healthcare
providers and delivering treatment

9. Clinical Smoking Cessation Training Programs
 Cessation training workshops (from 2000)
 Train the trainer program (from 2007)
 National CME Program - Clinical
cessation intervention (from 2008)
 Certified Stop Smoking
Specialist training program (from 2010)
 Online training program (from 2010)
 Promote cessation through series
academic conferences (from 2007) First cessation training workshop
June 27-29, 2000
 Pulmonary physicians, Cardiologist,
Oncologist, Paediatricians …

10. Nicotine Dependence Conference
 Cooperated with Mayo Clinic (1st in 2006, 2nd in 2008, 3rd in 2009)

11. China Clinical Smoking Cessation Guideline
 Trial version in 2007
 Update in 2009

12. Smoking cessation clinics
 The first Smoking Cessation
Clinic in China （ From 1996)
 There are more than 800
smoking cessation clinics in
China now, providing professional
cessation service for smokers.
Picture of a smoking cessation clinic in China

13. National Quit-line


14. Integrate with health system
 Aim: screen and treat every smoker admitted to the
outpatient department
 Physicians should ask patients the following 3 questions
– Have you smoked in the past 30 days?
– How many cigarettes do you smoke per day on average?
– Are you willing to get quit help?
 Current smoker will have a treatment referral printed
automatically

15. Textbooks of medical education
 10 textbooks at least (Chapters)

16. Promoting smoking cessation among medical professionals
Chantix: No data now
HOPE Study:
 6 hospitals in Beijing, Shanghai and Guangzhou
 Targets physicians and hospital staff of smoking-free hospitals
 300 smokers with motivation to quit, 293 finished the 24-week study
 Self-determine quit with gum or patch
 12 weeks NRT treatment, followed by 12 weeks
off-treatment follow up
 Continuous Abstinence Rate:
 17% of subjects (n=51) were continuously, CO-verified smoking
abstinent from Week 2 until and including the 24-week visit

17. Facilitating smoke free hospitals in China
 41 hospitals from 20 provinces
- 6 hospital presidents or vice presidents quit successfully
- 329 smoking doctors in 41 hospitals quit smoking (self-report)
Supported by The Union: CHINA-OC-400

18. www.smokefreehealthcare.org

19. Media Promotion

20. B
l
o
g
.
s
i
n
a
.
c

21. Network of WHO Collaborating Center for Tobacco or Health for
Medical Professionals against Smoking

22. Tobacco Control Policies
 Ministry of Health:
 Smoke-free hospital standard (2008)
 All healthcare facilities should be smoke free at the end of 2011(2009)
 Tobacco control mass media promotion activities (08-09, 09-10,10-11)
 Indoor smoking bans in public places (Health Implementation) (2011)
 Ministry of Education:
 2010 Decision on smoke-free schools (2010)
 State Administration of Radio, Film and Television (Feb
2011)
 Strict control of smoking scenes
 Central Committee of civilization :
All indoor public places and workplaces should be smoke-free and have clear
No Smoking Signs. Only achieve this goal, to be able to get the "National
Civilized City" title
——Comprehensively implementation of smoking bans in
public places (National Economic and Social Development Twelfth Five-
Year Plan, Mar 2011)

23. C
h Government
a  The Chinese National Tobacco Corporation (CNTC) : state monopoly
Culture
l  Offering cigarettes as gifts and handing out cigarettes in social settings
as a gesture of politeness or friendship is a strong social habit
 Hospitals
l  Male doctors commonly smoke
 Some top hospital administrators are smokers themselves
e Social environment outside the hospitals
n  Cigarette brand names constantly appear on TV programs shown as
company names, and this regulation is not enforced
 The ban on smoking in public places in many cities has not been
g effectively enforced
Individuals
e  Most people are unaware of full range of health risks from tobacco use
and second-hand smoke exposure
s 

Most smokers have not the willing to quit
No reimbursement of cessation attempts

24. National smoking prevalence surveys:
Trend in past 26 years
Year 1984 1996 2002 2010
Total smoking rate 33.9% 37.6% 35.8% 28.1%
(Aged>15)
Male 66.9% 66.0% 52.9%
Female 4.2% 3.08% 2.4%
Smoking rate in 60.0% 56.8% 40.4%
male medical doctors
Smoking prevalence in Chinese aged 15 and above. Chin Med J,1987,100:886-92.
Smoking in China: findings of the 1996 National Prevalence Survey. JAMA. 1999, 282(13):1247-53.
中国人群 2002 年吸烟和被动吸烟的现状调查 . 中华流行病学杂志 ,2005, 26(2): 77-83.
Prevalence of smoking in China in 2010. N Engl J Med, 2011, 364(25):2469-70.

26. T
h
e
 Capacity building
w
 Research
a
 Sustained promotion
y
—— Combine the current work conducted
f
o
( MOH White Paper, et al)
r
w
a

27. THANK YOU VERY MUCH FOR
YOUR ATTENTION!