Our children cannot be killed by smoke.

May 31, 2024 is the 37th World No Tobacco Day. The theme of this year's event is: Protect young people from the harm of tobacco. At present, young people are increasingly affected by e-cigarettes and nicotine-related products. According to statistics, as of 2024, 12.5% ​​of young people in Europe use e-cigarettes, while only 2% of adults do.

In China (2021) , the youth smoking rate is 4.7%, the youth smoking attempt rate is 16.7%, and there are more than 15 million youth smokers . The tobacco control situation is very serious. Therefore, World No Tobacco Day 2024 calls on the government and the public to protect the present and future generations from the harm of tobacco, and urges the tobacco industry to bear the corresponding responsibility for the harm it has caused.

1. Tobacco is associated with a variety of diseases

In 1950, British scientists first discovered that smoking is associated with lung cancer. After the research results were published, they attracted widespread attention and continued in-depth research from many scientists. In the following 70 years, tens of thousands of scientific research papers on the health hazards of tobacco have been published around the world, proving from different angles that smoking is an important risk factor for many diseases. Scientific research results from many countries show that smoking and secondhand smoke can cause many diseases.

Studies have shown that smoking can double the risk of chronic diseases, advance the onset of coronary heart disease by 10 years, and increase the risk of acute myocardial infarction by up to 7 times, with a linear relationship with the amount of smoking. In addition, smoking can increase the risk of ischemic stroke by 90% and the risk of subarachnoid hemorrhage by 190%.

It is worth noting that smoking is the number one risk factor for lung cancer death in China. The number of cancer deaths attributed to smoking is the highest for lung cancer, followed by liver cancer and stomach cancer. The population attributable risk for lung cancer is 42.7%, while that for liver cancer and stomach cancer is 13%. 26% of male cancer deaths can be attributed to smoking, and the number of lung cancer deaths caused by passive smoking in women significantly exceeds the number of deaths caused by direct smoking. The risk of lung cancer in smokers is 8.96 times that of non-smokers. The risk of lung cancer in women due to their husbands' smoking is 1.27 times that of women with non-smoking husbands.

Smoking is a recognized cause of severe illness in COVID-19. In 2020, a review published in the British Journal of Respiratory Medicine pointed out that smoking is associated with the susceptibility of the heart and lungs to the COVID-19 virus, and that smoking is a potential risk factor for COVID-19 infection and critical illness. Smokers are at a higher risk of developing severe illness and death.

2. my country has a heavy disease burden caused by smoking

China is one of the countries most seriously affected by tobacco smoke. There are more than 300 million smokers, more than 15 million adolescent smokers, and more than 1 million deaths each year due to tobacco. If it is not controlled, it is estimated that this number will reach 2 million per year by 2030. At the same time, more than 540 million non-smokers are harmed by secondhand smoke, including 180 million children under the age of 15. More than 100,000 people die from passive smoking each year, but the awareness rate of the harm of passive smoking is only 35%.

Tobacco consumption has caused huge medical insurance expenditures and economic losses, and has placed a heavy burden on families. Studies have shown that in 2018, the economic burden of diseases caused by tobacco use in the country was about 1.5 trillion yuan, of which treatment costs were 207.5 billion to 541.5 billion yuan, and productivity loss costs were 1.2 trillion to 3.2 trillion yuan. The economic losses caused by the harm of secondhand smoke exceeded 1.7 trillion yuan, and the funding sources included 24 billion to 62.6 billion yuan in government fiscal funds, 100 billion to 260.9 billion yuan in social medical insurance funds, and 45.4 billion to 118.4 billion yuan in household expenditures. Treatment costs and self-medical expenses accounted for 7.0% of the total health costs during the same period, and the ratio of direct economic burden to indirect economic burden was about 3:7.

The direct and indirect losses caused by tobacco-related diseases are equivalent to 1.6% to 4.1% of GDP. If the goal of reducing the smoking rate to 20% is achieved by 2030, a quarter of medical expenses can be saved.

3. my country faces many challenges in tobacco control

Since the end of the 20th century, the tobacco epidemic has become one of the most serious public health problems facing countries around the world. In 2003, the World Health Assembly approved the WHO Framework Convention on Tobacco Control (hereinafter referred to as the "Convention"), which is the world's first international public health law aimed at reducing the devastating impact of tobacco on health and the economy. China ratified the Convention in 2005 and it came into force in January 2006. At present, more than 180 countries and regions have joined the Convention.

The World Health Organization launched the "MPOWER" package of tobacco control policy measures in 2007. "MPOWER" consists of six tobacco control and tobacco demand reduction measures, corresponding to one or more articles in the Convention, to better help countries implement the Convention and its implementation guidelines.

“MPOWER” tobacco control policy measures:

M - Monitor tobacco use and ensure that tobacco consumption continues to decline

P——Protect people from the harm of tobacco smoke (strengthen tobacco harm publicity and legislation)

O - Provide help to quit smoking

W——Cigarette packages warn of the dangers of tobacco

E – Comprehensive ban on tobacco advertising and promotion

R – Increase tobacco taxes and prices

The latest World Health Organization Global Tobacco Epidemic Report released in July 2023 shows that more than 70% of the world's population (5.6 billion people) are now protected by best practice policies with at least one "MPOWER" measure, five times the number in 2007. Since the introduction of the MPOWER series of tobacco control measures, the global average smoking rate has dropped from 22.8% in 2007 to 17% in 2021; if this decline had not been achieved, it is estimated that there would be 300 million more smokers in the world today.

Corresponding to the "MPOWER" tobacco control policy measures, my country faces many challenges in tobacco control:

1. Smoking rates are declining slowly

The national smoking rate was 35.2% when the agreement was implemented in 2005, and is currently 24.1%, a decrease of only 11.1% in 14 years.

The reasons for the slow decline include the low willingness of smokers to quit smoking, which is only 5.1%. According to a survey conducted by the University of Waterloo in Canada on the desire of smokers to quit smoking in 12 developing countries, Chinese smokers have the second lowest desire to quit smoking. In addition, the low success rate of smokers quitting smoking and the high relapse rate also lead to the slow decline in the smoking rate.

2. National tobacco control regulations have not yet been issued

In early 2014, the National Health and Family Planning Commission drafted the "Regulations on Controlling Smoking in Public Places" after extensive consultation and submitted it to the State Council Legislative Affairs Bureau. On November 24, 2014, the State Council Legislative Affairs Bureau published the "Regulations on Controlling Smoking in Public Places" on its website and solicited public opinions, but no results have been reached so far.

3. Cigarettes are too cheap

Tobacco tax in my country only accounts for 56% of the retail price, which is still a big gap from the Convention's target of 75%.

4. The cigarette box includes no warning pictures

my country’s cigarette packaging has not yet used warning pictures, and most of them are still beautifully designed pictures.

5. E-cigarettes are on the rise

Tobacco control faces a new problem, namely the strong rise of e-cigarettes. As a new product, e-cigarettes have been widely used in recent years, including by high-income people and teenagers. Currently, there are about 16,000 unique e-cigarette flavors available on the market, many of which are attractive to children.

According to a survey in my country, among college students, 90.3% had heard of e-cigarettes, 10.1% had used e-cigarettes, and 2.5% were currently using e-cigarettes in 2021, all of which were higher than the results of the adult survey in 2018 (48.5%, 5.0%, and 0.9%). Among middle school students, 86.6% had heard of e-cigarettes, 16.1% had used e-cigarettes, and 3.6% were currently using e-cigarettes in 2021, up 9.2%, 3.5%, and 0.8% respectively from 2019. The most commonly used e-cigarette flavor is fruit flavor (63.8%).

At present, the progress of tobacco control legislation is slow, the effect of tobacco control publicity is not obvious, the emergence of new tobacco products such as invisible variant electronic cigarettes, and interference from the tobacco industry have all affected the progress of tobacco control. Tobacco control is urgent. I hope that for ourselves and our next generation, we can form a consensus in the whole society to eliminate tobacco!