Smoking cessation clinics not helping China kick the habit

 

Smoking cessation clinic.   Photo by Peng Zhaozhi 

 

By Lv Qiuping and Mou Xu

Fewer and fewer smokers are walking through the doors of the smoking cessation clinics in Chinese hospitals.

In the past, smoking cessation had seemed to be a promising business in the country of 300 million smokers, but the operating realities of smoking cessation clinics show how far off the mark such assessments were.

 

“TOO MUCH TEMPTATION”

The smoking cessation clinic at the Chongqing Fifth People’s Hospital (CFPH) in southwest China’s Chongqing Municipality received no more than 10 patients last year, down from 100 in 2008, when the clinic was established.

Meanwhile, in Beijing, where 29 percent of the city’s 20 million residents are smokers, most of the city’s 20-plus hospitals have shut down their smoking cessation clinics.

According to Lai Fuhua, the head of the smoking cessation clinic of the CFPH, one course of treatment costs about 2,000 yuan (322 U.S. dollars). That may seem like a lot, but it is actually less than what a heavy smoker might spend on cigarettes each year.

Smokers have been reluctant to turn to the clinic, as they found that even after successfully kicking the habit while receiving treatment, they would eventually start smoking again, he said.

“Most patients who quit smoking will relapse sooner or later, because there is too much temptation and too few restrictions out there,” said Lai.

In China, colleagues, friends and relatives often offer cigarettes to others as a show of hospitality, and smoking indoors is common.

“Seeing smoking in offices, restaurants and bars, and then others offer you a cigarette, someone who has quit smoking will be very likely to resume smoking,” said Lai.

To promote tobacco control and help smokers quit, Beijing’s municipal health bureau announced earlier this month that the costs of smoking cessation treatments and therapies will be covered in the public health insurance program.

Yang Gonghuan, a professor on tobacco control with Peking Union Medical College, warned that if such treatments are covered, smoking cessation costs will become a huge burden for the public insurance scheme, considering the large number of smokers.

Yang advises smokers to first call the smoking cessation hotline and try to quit smoking on their own. Only heavy smokers who are told to seek professional help should go to a smoking cessation clinic, she said.

Lai agrees with Yang, but is not optimistic that offering insurance coverage for cessation programs will encourage more people to quit smoking. “As long as smoking can be seen everywhere, quitting is difficult. A national law is urgently needed for tobacco control.”

 

TOBACCO CONTROL LEGISLATION, OR LACK THEREOF

With nearly 2 trillion cigarettes produced here in 2011, China is the world’s top producer and consumer of tobacco. The country is also home to over 300 million smokers, and about 740 million people are subject to passive smoking through the inhalation of second-hand smoke or environmental tobacco smoke.

However, there is no national legislation on tobacco control in China, which experts say allows tobacco consumption to continue unrestrained.

Although a government regulation issued in 2011 bans smoking in enclosed public spaces, enforcement of the regulation has been considered very poor because it does not stipulate any penalties for offenders.

Beijing, Shanghai and several other Chinese cities have passed local legislation to ban smoking in public spaces. But with enforcement posing a persistent challenge, the legislation has yielded limited progress.

Meanwhile, in many parts of China, local legislation on tobacco control has mostly hit an impasse.

An official with the tobacco control office of the Health Department of Chongqing said that the office has proposed including tobacco control regulations on the local legislation agenda for the past two years, but both proposals were rejected.

The official, who spoke on condition of anonymity, said the proposal was rejected due to the tobacco industry’s huge contributions to local government tax revenues.

Experts warn that although the tobacco industry makes significant contributions to government revenues, the costs associated with smoking-related diseases are also significant.

Last year, Liang Xiaofeng, vice director of the Chinese Center for Disease Control and Prevention, warned that the medical cost of tobacco-related diseases was rising annually and would put heavy pressure on China’s health insurance system in 20 years.

 

“WHY IS QUITTING SO DIFFICULT?”

Lai, also director of the respiratory department of the hospital in Chongqing, said most lung cancer inpatients at the CFPH are smokers, but many either do not believe that smoking could cause cancer or simply choose to ignore these facts.

According to the latest figures, 600,000 people develop lung cancer every year in China, accounting for one-third of the world’s total, and smoking is considered the major cause of the disease.

Yang, the tobacco control professor, said the fact that many people in China offer cigarettes to others shows that the public is not fully aware of the health hazards related to smoking.

A 2012 report from the former Ministry of Health said the Chinese public’s underestimation of the dangers of tobacco use is a major impediment to tobacco control progress in China. Most prominently, many think smoking is a habit of personal choice, failing to understand that tobacco is highly addictive and smoking eventually becomes an addiction.

“Starting to smoke is a choice, but continuing to smoke is an addiction. Many of my patients seem to think they choose to smoke,” Lai said. “If so, why is quitting so difficult?”

The report also points to interference from the tobacco industry as an element misleading the public. For instance, the industry has been promoting low-tar cigarettes, which it claims pose fewer health risks.

“Low-tar cigarettes are as harmful as any other cigarettes. The concept of ‘low tar’ equaling ‘lower risk’ misleads smokers to consume more,” said Lai.

Yang said tobacco control requires systematic efforts.

While it is necessary to create legislation and decrease consumption, international experience has shown that the awareness and support of the public are crucial to success in this regard, she said. 

 

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