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Lancet. 1987 Aug 15; 2(8555):394.I have questioned 1000 people in 4 sample populations in China about their attitude to and knowledge of health information on smoking and about smoking habits. I then interviewed 50 people from this sample in greater detail. I also studied past smoking control efforts in China. Greater attention must be given to health education in schools and to young people. Smoking is common among schoolchildren and, and at least in Guangzhou, Canton, health education about smoking appeared limited. Of 250 schoolchildren only 40% reported exposure to health education. Smoking is banned in schools and the attitude seemed to be that there was therefore no need for education about the dangers. On the other hand, 70-80% of the whole sample seemed aware that smoking is harmful to health. Thus there is a need to increase not only the level of health education but also its sophistication, so that the gap between health knowledge and behavior can be closed. Attention must be given to women's attitudes to smoking. Generally I found a small proportion of female smokers (a study in Tianjin excepted), and the impression at interview is that smoking among women is considered impolite or "not done." Add this to the fact that women were more aware of the dangers of smoking (77% of 286 females vs 63% of 701 males, with 62% of women saying smoking was "very" harmful compared with 37% of men) and the potential for using women as health educators becomes apparent. The increasing understanding of passive smoking and the fact that women are usually the casualties might also be useful ammunition in this context. However, there may be competition for the attention of women--'Slim Kings' aimed specifically at the female market, have already been introduced into Hong Kong. 1 of the most important elements in any approach to smoking control must be an attempt to influence public policy. The history of government China is 1 of sporadic initiatives originally formulated by a joint committee involving several departments (public health, finance, agriculture, and light industry), but more recently only involving the Department of Public Health. Some action has been taken but a question mark remains over the strength of political will. Many factors operate against a reduction in cigarette production, which earned the state $6 million in 1984. Remarks by a representative of the State Tobacco Company suggest enthusiasm for increased production and more joint ventures with the multinational tobacco companies. Both British American Tobacco and Reynolds are now working in China, and the Canton Biannual Trade Fair and Grand Prix Tennis Tournament were sponsored by tobacco companies. I recently revisited China after 2 years and was struck by the volume and increasing sophistication of advertising and by the continuing cheapness of cigarettes which are now sold by increasing numbers of private entrepreneurs. Deregulation of the market and farmland may encourage increased tobacco production. These are all worrying developments for the "antismokers", who will need all the determination Sir John Crofton talks of to help them push forward a multipronged attack on the smoking pandemic and the vested interests that support it. (full text)
INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION. 1987; 7(3):201-10.Bangladesh is an example of a developing country where tobacco use and its subsequent social costs are increasing. The production of cigarettes in Bangladesh increased by 300% in the 1972-84 period. To assess attitudes toward the use of tobacco and reactions to various alternative governmental policies aimed at discouraging smoking, a cross-section of 772 adult residents of the capital city of Dhaka were interviewed. Respondents were selected from 5 distinct groups: university students, the informal working class, skilled blue collar workers, housewives, and the entrepreneurial-white collar management class. The results indicate that smokers and nonsmokers in Bangladesh differ in their awareness regarding the dangers of smoking. Both smokers and nonsmokers agreed that the governments should warn people of the dangers associated with tobacco use and that high schools should educate young people about such health hazards, although nonsmokers felt more strongly about these issues than smokers. Nonsmokers were also significantly more likely than smokers to support the idea of a ban on cigarette production. Both groups expressed agreement with the notion that women should not smoke during pregnancy. In general, however, smokers were less likely than nonsmokers to be aware of the health hazards associated with tobacco use. Limitations on public places where smoking would be allowed were accepted as a viable government policy by most respondents. Neither group advocated an increase in cigarette production as a means of increasing government revenues. It is hoped that market pressures in the form of a reduced demand for tobacco products, social pressure resulting from nonacceptance of smoking in public places, and government intervention in the form of a ban on the advertising of tobacco products will force the tobacco companies to reallocate their resources.