Tob Control: first published as 10.1136/tobaccocontrol-2018-054646 on 13 July 2019. Downloaded from Original research ‘Pro- tobacco propaganda’: a case study of tobacco industry- sponsored elementary schools in China Jennifer Fang ,1 Gonghuan Yang,2 Xia Wan2 3 ► Additional material is ABSTRACT to central government revenue and as high as 4 published online only. To Background China is the largest producer and 77.8% in Yunnan province. Although China rati- view, please visit the journal online (http:// dx. doi. org/ 10. consumer of tobacco products worldwide. While direct fied WHO’s Framework Convention on Tobacco 1136tobaccocontrol- 2018- marketing and advertisement of tobacco products is Control (WHO FCTC) in 2005, national tobacco 054646). restricted, indirect marketing still exists under the guise control legislation remains to be enacted. of sponsorship and corporate social responsibility (CSR). Direct marketing of tobacco has been restricted 1Faculty of Health Sciences, This case study is focused on tobacco industry- sponsored via amendments to the national Advertisement Simon Fraser University, 5 Burnaby, British Columbia, elementary schools in Chinese rural areas. Law in 2015, but indirect marketing still exists Canada Methods Field visits were conducted in Yunnan under the guise of sponsorship and corporate social 2Institute of Basic Medical province to interview students, teachers, school responsibility (CSR), exposing adults and children Sciences, Chinese Academy of principals and parents to understand their perceptions alike to ‘pro- tobacco propaganda’.2 The Chinese Medical Sciences and School of of the tobacco industry and its sponsorship of schools. tobacco industry enjoys a certain level of respect- Basic Medicine, Peking Union 4 Medical College, Beijing, China Interviews with tobacco control activists were conducted ability by being a state-owned enterprise, lending in Beijing to discuss national tobacco control efforts its charitable activities a degree of legitimacy. This Correspondence to targeting tobacco industry sponsorship. Interview data also enables the CNTC to directly engage with other Gonghuan Yang, Epidemiology were transcribed and coded, with key themes developed government sectors or government initiatives,4 such and Statistics, Insitute of Basic using thematic analysis. as Project Hope or All Women’s Alliance. Medical Sciences Chinese Academy of Medical Sciences, Results While health consequences of smoking are Although indirect marketing has received some Beijing 100005, China; generally known, attitudes towards the tobacco industry attention in recent years, and tobacco promotion yangghuan@ vip. sina. com and its CSR activities remain positive among the through charitable donations has been restricted with Professor Xia Wan; general public. Educators and parents do not perceive the enactment of Charity Law in 2016,6 China does xiawan@ ibms. pumc. edu. cn any impacts on schoolchildren from exposure to ’pro- not have a complete ban on tobacco advertisement, Received 24 July 2018 tobacco propaganda’ created by the industry’s CSR promotion and sponsorship (TAPS). It is estimated Revised 14 May 2019 activities. Attitudes among tobacco control activists were that comprehensive bans of all forms TAPS could Accepted 17 May 2019 drastically different, with consensus that CSR activities decrease smoking rates by 4%–7%,6 7 preventing Published Online First constitute indirect marketing attempts that should be 2.15 million deaths by 2050.8 Despite several cases 13 July 2019 banned. of successful removal of tobacco-related branding 9 Conclusion National tobacco control legislation in recent years, tobacco CSR in China remains a http://tobaccocontrol.bmj.com/ banning all forms of indirect marketing including poorly understood phenomenon. Existing research CSR is needed in order to protect the health of future on tobacco CSR is focused on transnational tobacco generations. companies (TTCs) and shows that it can undermine tobacco control efforts through perceived improve- ments to its public image, promote brand aware- ness for smoking uptake,10–12 and provide access to INTRODUCTION policy makers.13 14 China is the largest producer and consumer of CNTC engages in a range of CSR activities, tobacco products, accounting for a third of smokers including education, disaster relief, event sponsor- and 40% of cigarette outputs worldwide.1 The ship and various social causes.9 We focus on Project country’s 350 million smokers expose nearly 740 Hope elementary schools sponsored by the tobacco on October 1, 2021 by guest. Protected copyright. million non- smokers to secondhand smoke.2 Such industry due to its prominence in the media. Project high smoking prevalence, coupled with a lack of Hope is a government initiative supporting rural tobacco control legislation, has led tobacco use to development, and Project Hope elementary schools quickly become the leading risk factor for national are largely built in remote rural regions, with more mortality and disability, accounting for 16.5% of than 100 sponsored by the tobacco industry. Photos deaths in China in 2010.2 of new school buildings bearing CNTC logos and The Chinese tobacco industry is a state- owned pro- tobacco slogans, such as ‘Genius is from hard monopoly, organised as a vertical tiered system. work, tobacco helps you excel’, have been published The industry is comprised of two organizations: in various Chinese and international news outlets © Author(s) (or their 15–17 employer(s)) 2020. Re-use the State Tobacco Monopoly Adminsitration over the years. Despite this wide publicity, no permitted under CC BY-NC . No (STMA), the governmental beaurocracy arm, and studies have been conducted in this area, and public commercial re-use . See rights the China National Tobacco Corporation (CNTC), perception of tobacco CSR and its impacts remain and permissions. Published the commercial arm. CNTC manages provin- poorly understood. by BMJ. cial daughter companies, which oversee their This case study focuses on the X Hongta Hope To cite: Fang J, Yang G, own branches and subsidiaries at the local level. Elementary School in Yi Autonomous Prefecture Wan X. Tob Control The tobacco industry is a major revenue gener- of C, Yunnan province. Formerly called D Central 2020;29:447–451. ator, contributing as much as 11% in some years Elementary School X Primary School, it received Fang J, et al. Tob Control 2020;29:447–451. doi:10.1136/tobaccocontrol-2018-054646 447 Tob Control: first published as 10.1136/tobaccocontrol-2018-054646 on 13 July 2019. Downloaded from Original research Table 1 School demographics Table 2 List of interviewees School Basic demographics Administrators Teachers Parents Students X Hongta Hope ► Student body: 400 students X Hongta Hope One principal and 3 10 Grade 4: 5 Elementary School ► Kindergarten and grades 1–5 Elementary school one vice principal Grade 5: 5 15 teachers ► D Central One principal and 0 10 Grade 5: 4 Recipient of Hongta Group’s sponsorship ► Elementary School one vice principal ► New school building in 2008 Grade 6: 4 ► Equipment, school supplies and computers H Elementary Two principals 10 10 Grade 5: 4 D County Central ► Student body: 515 students school Grade 6: 5 Elementary ► Grades 1–6 One local education bureau official ► Grade six students from schools within a radius of 11 tobacco control advocates 3 km merged here, including those from X Hongta Hope Elementary ► 34 teachers H Elementary ► Student body: 1800 students involvement in tobacco control and tobacco industry research. A ► Grades 1–6 list of tobacco control advocates was developed after reviewing ► Tobacco- free school journal articles and media reports and were invited to partici- pate in the study. Snowball sampling was expected to be used to recruit additional participants; however, this proved unneces- 700 000 RMB from Hongta Group in 2008, a sponsorship that sary due to the small size of the tobacco control community in entailed a name change. Hongta Group is one of the largest China (see online supplementary file 1 for the interview guides.) production facilities of China Tobacco Yunnan Tobacco Indus- Informed consent from eligible adult participants was trial Co, CNTC’s subsidiary in Yunnan province. Hongta Group obtained prior to conducting fieldwork, and interviews were has been sponsoring elementary schools since the 1990s,16 each 18 recorded where permitted. Informed consent for students was with the words ‘Hongta Hope Elementary School’ in its name. obtained from their parents. Audio recordings were transcribed and coded, with key themes developed using thematic analysis. METHODS We began by conducting a literature review of Chinese and RESULTS English sources by searching Google Scholar and Baidu Scholar A total of 82 participants were included: 1 education bureau to review scholarly literature on the Chinese tobacco industry’s official, 11 tobacco control advocates, 6 principals and vice prin- CSR activities targeting children. As this literature proved to be cipals, 13 teachers, 30 parents and 27 students from grades 4–6 very limited, we also reviewed official industry sources, such as (table 2). the State Tobacco Monopoly Administration/CNTC website ( Results are grouped based on themes by topic. www. tobacco. gov. cn), Tobacco China ( www. tobaccochina.com), China Tobacco ( www. echinatobacco. com) and China Tobacco Yearbook. Perceptions of school sponsorship http://tobaccocontrol.bmj.com/ Two field visits were conducted: first, to tobacco industry-