The tobacco epidemic is one of the most crucial public health issues in the world, killing more than 7 million people per year(1). More than 6 millions of deaths as a result of direct tobacco use while roughly 890000 are as a result of being exposed to second-hand smoke(1). The mortality rate of lung cancer is about 23 times higher among male smokers and 13 times higher among female smokers than nonsmokers(2). On the basis of current trend it is projected that, 10 million people annually will die earlier as a result of tobacco use by 2030, two-thirds of these deaths will happen in low- and middle-income countries(3). And because lack of effective global tobacco control, one billion people will die since tobacco use in this century(3). In China, tobacco is also a major threat to public health. China has the largest tobacco consumption in the world(4). The latest available data reveals that the cumulative prevalence of smoking is 27.7% across China. The specific prevalence rates among Chines men is 52.1% while that of women stands at 2.7% among Chinese women(5). The high smoking prevalence improves a high risk of death among smokers. The cigarette smoking is reason for 7.9 percent of the total premature mortality in China(4). In many developed countries, most smoker started using tobacco products before 18 years old(6). The prevalence of tobacco use of 13–15 years old teenagers is 8.6%-14.6% in four major provinces in China, while the overall median percent is 18.7 in the world(6). Meanwhile, some study provided evidence that second-hand smoke exposure is very common in public places in China(7).
Smoking harms almost every organ of the body: causing many diseases especially lung cancer, cardiovascular disease, respiratory disease and reducing the health of smokers in general(8). The hazard of tobacco use endangers not only smokers but also non-smokers who are exposed to second-hand smoke in indoor environments(7). Second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer among adults(1). Second-hand smoke exposure can also cause sudden death among infants. For pregnant women, it causes low birth weight(1).
Treatment for tobacco use and addiction is a decisive part of reducing tobacco use, and WHO recommends offering cessation services as part of primary health care(5). However, accessing cessation support is a challenge because it needs sustained commitment from governments that often find it difficult to identify sufficient resources for such programs(5). In China, there are three main challenges for tobacco control:
1. Education level.
Education level always influence people’s smoking behavior. Individuals with less educated, poorer, and employed in stressful jobs are more likely to using tobacco and less likely to quit smoking than those with higher income and better education(2).
2. Barriers to implementation of tobacco control policies and accession of smoking cessation resources.
Although there are some regulations on the control of smoking in large cities like Beijing and Shanghai, tobacco control activities at villages were rare and infrequent. There are only smoking cessation-related posters and blackboard bulletins at village gathering places or in village clinics. And participant are always feel negative regarding the effectiveness of these activities(9).
3. Cigarette Sharing culture
The practice of giving and sharing cigarettes are acceptable and widespread throughout China.
People usually share cigarettes to each other in their daily life and special occasions or during holidays to express courtesy or blessing(10).
4. The interference of tobacco industry
The tobacco industry is increasingly using domestic and especially international trade litigation as an attempt to block progress on many tobacco control measures, such as smoke-free public places, pictorial health warnings, plain packaging and product regulation(5).
Most tobacco users want to quit smoking, especially if they are aware of the full range of harms caused by tobacco use(5). However, the extremely addictive nature of nicotine makes it difficult for most people to quit without some form of assistance(5). Three tobacco cessation interventions are highly recommended by WHO: Cessation advice in primary health care systems, Quitlines, Pharmacological therapy.
To address the problem of smoking we hereby discuss the efforts that have been put in place in three Chinese regions and America based in universally agreed indicators by the WHO and the United Nations member states. The two interventions are presented hereunder:
1.Text to Quit China: An mHealth Smoking Cessation Trial
The major intervention in this study is 6-week text message–based smoking cessation intervention. Participants were randomly divided into the intervention or control group. Intervention group is the high-frequency text contact (HFTC) group which received one to three messages daily. Control group is the low-frequency text contact (LFTC) group received one weekly message. All the text messages came from a professional American text message library. After translation and adapting to the Chinese context, this library was reviewed by Chinese health communication and tobacco cessation experts. The study assessed smoking status of each group for four times which at 0, 1, 3, and 6 months after intervention.
By considering all nonresponders to be smokers, this study observed high reported quit rates (between 26.7% and 30.5%) at all of the follow-up time points for both HFTC and LFTC groups. However, there is no any difference in quit rates between HFTC and LFTC groups. Excluding those who did not report their smoking status, this study observed significantly greater 7-day point prevalence abstinence in the HFTC group compared with the LFTC group immediately after the intervention (66% vs. 58% for the HFTC and LFTC, respectively p