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Proposals for Change in the World's Largest Epidemic Region

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Proposals for Change in the World's Largest Epidemic Region Special communication Tob Control: first published as 10.1136/tobaccocontrol-2012-050852 on 17 April 2013. Downloaded from Tobacco control challenges in East Asia: proposals for change in the world’s largest epidemic region Kota Katanoda,1 Yuan Jiang,2 Sohee Park,3 Min Kyung Lim,4 You-Lin Qiao,5 Manami Inoue6 ▸ Additional material is ABSTRACT Despite the large health burden of tobacco use in published online only. To view East Asia is one of the world’s largest tobacco epidemic East Asia, comprehensive and comparative informa- please visit the journal online (http://dx.doi.org/10.1136/ regions. Although several international studies have tion on the present status of tobacco control in this tobaccocontrol-2012-050852). evaluated the status of tobacco control in this region, region is scarce. Although several international 1 the findings have not been integrated with knowledge studies have provided valuable data related to Surveillance Division, Center 7–11 for Cancer Control and on domestic activities at the national and municipal tobacco control in individual countries, no Information Services, National levels. We analysed the current tobacco control situation study has integrated the data with domestic activ- Cancer Center, Tokyo, Japan in three East Asian countries, Japan, China and the ities at the national and municipal levels to build 2 fi Tobacco Control Of ce, Republic of Korea, using both international and domestic region-specific strategies. The present study aimed Chinese Center for Disease Control and Prevention, data sources. We collected data between 2008 to analyse the current status of tobacco control in Beijing, China and 2011 in each country according to the framework of three countries in East Asia ( Japan, China and the 3Department of Epidemiology WHO’s MPOWER (Monitoring, Protect, Offer, Warn, Republic of Korea) to develop policy strategies for and Health Promotion, Enforcement and Raise) approach for guiding changing the world’s largest tobacco epidemic Graduate School of Public implementation of the WHO Framework Convention on region. Health, Yonsei University, – Seoul, Korea Tobacco Control. Analysis revealed that 37 53% of 4National Cancer Information adult men were current smokers and that smoking METHODS Center, National Cancer prevalence among middle-aged men reached 63%. Less We d e fined East Asia as a geographical area includ- Control Institute, National than 20% of male smokers plan to quit and the use of ing Japan, mainland China, Taiwan, the Republic Cancer Center, Goyang, Korea ’ 5Cancer Institute/Hospital, nicotine replacement drugs was 14% at maximum. of Korea, and the Democratic People s Republic of Chinese Academy of Medical Forty-six percent or more of men and 20% or more of Korea. The present study analysed data from three Sciences, Peking Union women were exposed to passive smoking at workplaces countries ( Japan, mainland China and the Republic copyright. Medical College, Beijing, China 6 and at home, respectively. Many tobacco industry of Korea). We have discussed the status in Taiwan Epidemiology and Prevention activities remain unrestricted and prevalent. Our findings based on the available literature. In the following Division, Research Center for fi Cancer Prevention and indicate an urgent need for the following set of policies: sections (including tables and gures), we refer to Screening, National Cancer raise cigarette prices to increase the quit attempt rate, mainland China as China and the Republic of Center, Tokyo, Japan particularly among adult men; develop a multi- Korea as South Korea, for simplicity. component quitting assistance system to provide We set six themes (Monitoring, Protect, Correspondence to http://tobaccocontrol.bmj.com/ Dr Kota Katanoda, Surveillance adequate assistance for smoking cessation; implement Offer, Warn, Enforcement and Raise) in accordance Division, Center for Cancer effective smoke-free policies in workplaces and public with the MPOWER package for implementation of Control and Information places to reduce exposure to passive smoking; and the Framework Convention on Tobacco Control Services, National Cancer rebuild the administrative structure to denormalise (FCTC).78FCTC ratification occurred in 2004 for Center, 5-1-1 Tsukiji Chuo-ku tobacco industry activities. The importance of these Japan and 2005 for China and South Korea. One or Tokyo 104-0045, Japan; fi [email protected] standard approaches should be reaf rmed by all tobacco two researchers collected data for the six themes control policymakers in East Asia. between 2008 and 2011 for each of the three coun- Received 30 October 2012 tries examined ( Japan: KK; China: JY; South Korea: Accepted 20 March 2013 MKL and SHP). Survey data were selected according Published Online First 17 April 2013 to the following criteria: publicly available in a quot- INTRODUCTION able form (mandatory); variables clearly defined to on September 28, 2021 by guest. Protected East Asia is one of the world’s largest tobacco epi- allow for comparative analyses (mandatory); and demic regions. Nearly half of men in this region are highly representative of the population (national cigarette smokers (38.2% in Japan, 52.9% in China representative data preferable). For information and 47.7% in the Republic of Korea).1 China and other than survey data, official information, such as Japan are the largest and fifth largest tobacco- governmental publications, was consulted. Data for – consuming countries, respectively, with China alone the prevalence of adult smoking,12 18 youth – – Open Access accounting for approximately 38% of total global smoking,19 21 passive smoking,13 14 18 21 25 and ces- Scan to access more 1 13 14 26 free content tobacco consumption. Due to these factors, the sation behaviours were obtained from repre- estimated number of smoking-attributable deaths in sentative surveys conducted at the national level in China and Japan is 670 000 and 130 000 per year, each country. Data for cigarette prices, taxes and – respectively.2 4 In China, the number of cancer sales were collected from governmental or official – deaths attributable to smoking was recently esti- publications.27 31 Information on the availability of mated to be 495 000 annually.5 If tobacco smoking pharmacotherapy was obtained from clinical guide- – in China continues at the current rate, the annual lines for each country,32 35 and information on the To cite: Katanoda K, number of smoking-attributable deaths is estimated health warning labels was obtained from laws or – Jiang Y, Park S, et al. Tob to reach 3 million by the middle of the twenty-first official reports of each country.36 38 For collected – Control 2014;23:359 368. century.6 survey data, those related to active smoking Katanoda K, et al. Tob Control 2014;23:359–368. doi:10.1136/tobaccocontrol-2012-050852 359 Special communication Tob Control: first published as 10.1136/tobaccocontrol-2012-050852 on 17 April 2013. Downloaded from prevalence, passive smoking prevalence and smoking cessation The prevalence of ever smokers, that is, current or former were classified as Monitoring, Protect, and Offer, respectively. smokers, among men in the three countries reached 70–80% Collected data were descriptively analysed and priority issues for among middle-aged men (50–59 years). Average age at smoking tobacco control were extracted through discussion between initiation among this age group was around 20 years. authors. Specifically, men younger than 40 years started smoking at even younger ages, as low as 17.5 years in Japan. RESULTS Smoking prevalence among women was highest in Japan Collected data items and their information sources are sum- (10%). Average age at smoking initiation among women in the marised in the supplementary appendix. three countries was lower among younger women; for example, the average initiation age was 32.7 years among women in Monitoring (active smoking) Japan in their 60s and 18.7 years among women in their 20s. Nearly half of adult men in China and South Korea were active In Japan, teenage smoking prevalence was substantially lower smokers in 2010 (52.9% and 48.3%, respectively, table 1). than among adults; only 13% of men and 5% of women aged Smoking prevalence among men in Japan was as high as 37%, 18 years said they had smoked 1 day or more during the past even after the price increase in 2010 (from 300 to 410 JPY/ month. The smoking prevalence among Japanese male teenagers pack). When divided into age groups, smoking prevalence in was approximately half of the corresponding rates in China and men was over 60% in those aged 50–59 years in China and South Korea (26% and 27%, respectively), even though the aged 30–39 years in South Korea. Chinese data excluded those who reported trying to smoke or Table 1 Comparisons between Japan, China and South Korea in the status of active smoking Japan China South Korea Men Women Men Women Men Women Definitions and notes Adult prevalence, %* (current smoking) 20–29 years 34.2 12.8 33.6 0.7 47.3 7.4 J: Having smoked 100 cigarettes or more in their lifetime and currently daily or sometimes 30–39 years 42.1 14.2 59.3 1.6 60.9 7.6 smoking (2010) C: Currently smoking (daily or less than daily) (2010) 40–49 years 42.4 13.6 53.6 6.6 K: Having smoked 100 cigarettes or more in their lifetime and currently smoking (2010) copyright. 50–59 years 40.3 10.4 63.0 3.2 45.0 5.2 60–69 years 27.4 4.5 40.2 6.7 30.8 2.9 Total (20–69 years) 36.7 10.4 52.9 2.4 48.3 6.3 Adult prevalence, %* (former smoking) 20–29 years 5.2 5.4 2.6 0.2 10.2 8.5 J: Having
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