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Visualizing tobacco’s impact on children in China

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

January 2014 marks the 50th anniversary of the US Surgeon General’s Report on Smoking and Health, hailed as the first report to establish a definitive link between smoking and cancer and heart disease. Many academic journals, advocacy groups, and government officials around the United States are seizing the opportunity of the anniversary to assess progress made in curbing tobacco use globally and determine how much more work must be done.

This week, researchers at the University of Washington’s Institute for Health Metrics and Evaluation published a study tracking smokers and cigarettes consumed from 1980 to 2012. They also launched an interactive data visualization tool, shown below, and a 5-minute video tutorial that allows you to explore the study’s findings at the global, regional, and country level.

China Tobacco

This week, we’ll focus on a major political and economic powerhouse who is also a key driver of global smoking rates – China. In 2012, the Chinese accounted for 29% of the world’s smokers. Watch the short video below to see how China stacks up in comparison to other countries in the world.

The words “tobacco” and “global health” typically conjure up images of adult men lighting up. Indeed, in many countries, smoking is typically more common in men than in women. In China in 2012, smoking prevalence was 45% in males, but was only 2% in females. The screen grab below illustrates how smoking prevalence in Chinese males (dark blue line) compares to males from other countries in the world (light blue lines).


With all this focus on adult smoking and the lung cancer, heart disease, and chronic respiratory disease that smoking can lead to, it’s easy to forget about vulnerable bystanders, especially children.

“With the high prevalence of smoking in men, you can imagine how women and children are exposed to a considerable amount of secondhand smoke, which also is harmful to health,” said Dr. Marie Ng, the lead author of the study and an IHME faculty member.

Among children under 5 in China, secondhand smoke was the fifth-leading risk factor for early death and disability in 2010. When children are exposed to secondhand smoke, it can lead to lower respiratory infections. GBD researchers estimated that secondhand smoke was to blame for 26% of premature death and disability from lower respiratory infections in Chinese kids under 5 in 2010. The following screen grab shows how secondhand smoke contributed to more loss of healthy life than underweight, zinc deficiency, and sanitation in this age group.

ChinaTobacco3As these children grow older, they start smoking in greater numbers, especially boys. The screen grab below highlights the dramatic jumps in the proportion of male smokers from age 15, 20, and beyond.


CHinese adThe Tobacco Atlas sheds light on some of the factors that encourage Chinese children to start smoking. Courtesy of the Tobacco Atlas, shown at right is an advertisement at a Chinese school that reads “Genius comes from hard work/Tobacco helps you to be successful.” The Atlas notes that the Chinese National Tobacco Corporation sponsors numerous elementary schools in China and advertises to thousands of students around the country. A 2011 article by CNN Beijing Bureau Chief Jaime FlorCruz discussed how smoking in China is associated with respect, wealth, and sophistication, noting that national leaders Mao Zedong and Deng Xiaoping were chain smokers and many Chinese celebrities smoke in public.

Quoted about the new study’s findings on China in the New York Times, Judith Mackay, senior adviser to the World Lung Foundation, said “The study shows that the tobacco epidemic is going to be a whole lot worse before it gets better, particularly in lower income countries. If they do nothing at all there are going to be massive costs for China in terms of premature deaths, health care costs, environmental costs, economic costs, family costs — there are all manners of costs.”

Is China likely to break the vicious cycle of smoking passed on from generation to generation?

China ratified the World Health Organization’s Framework Convention on Tobacco Control in 2005, but the proportion of males who smoke increased starting in 2010 (purple line on figure below). Recent moves by the government to ban officials from smoking in public and plans to ban smoking in public places are encouraging.  The New York Times article noted that these measures are seldom enforced, however. Regular assessments of smoking trends in the country will be crucial for monitoring the impact of these reforms.



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