As the world's largest producer and consumer of tobacco products, China bears a large proportion of the world's burden of tobacco-related disease and may be experiencing a tobacco epidemic. At least 50 million Chinese smokers alive today are expected to die prematurely.

To address this global concern, researchers from the Chinese Academy of Preventive Medicine and the Chinese Association of Smoking and Health, in collaboration with the School of Public Health, conducted and analyzed a representative survey on smoking patterns and attitudes among more than 120,000 people throughout China. The study appeared in the Oct. 6 issue of The Journal of the American Medical Association.

During a three-month period in 1996, smokers and nonsmokers ages 15 to 69 were asked about smoking history, smoking-related knowledge and attitudes, cessation, passive smoke exposure, health status and demographics. Information from the 52-item survey was completed by respondents in 30 provinces at 145 disease surveillance points in China. Of those surveyed, 41,187 (34.1 percent) said that they smoked, with far more men (63 percent) than women (3.8 percent) identifying themselves as smokers.

Only 36 percent of the smokers surveyed said they knew smoking causes lung cancer. Of the nonsmokers, 53.5 percent reported that they were exposed to passive smoke at least 15 minutes per day on more than one day a week.

Study findings indicate that a national research agenda on tobacco control is needed. Co-author Jonathan M. Samet, professor and chair of the Department of Epidemiology in the School of Public Health, said, "First, the smoking problem in China is multifaceted, and no single variable or control measure will resolve the problem throughout the country. Second, a high priority should be placed on preventing women and adolescents from starting to smoke."

A strong public consensus in China supports national policies that would keep young people from starting to smoke, and that would place bans on tobacco sales, advertising and use. Parents, regardless of whether they smoke, do not want their children to become future smokers. An estimated 300 million men and 20 million women in China already smoke, out of a population of 1.2 billion. They provide an enormous potential market for sales of Western brands. The researchers stressed that by setting national goals and targets but encouraging those in local authority to find their own culturally acceptable approaches, China has a unique opportunity to show the rest of the world that tobacco control is possible, and that it can be accomplished by the country with the world's largest problem.