Background: China currently does not have comprehensive laws or regulations on tobacco advertising and promotion, although it ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in October 2005 and promised to ban all tobacco advertising by January 2011. Much effort is needed to monitor the current situation of tobacco advertising and promotion in China.
Objective: This study aims to examine levels of awareness of tobacco advertising and promotion among smokers in China as compared to other countries with different levels of restrictions.
Methods: One developing country (Thailand) and two developed countries (Australia and the USA) were selected for comparison. All four countries are part of the International Tobacco Control (ITC) Policy Evaluation Survey project. Between 2005 and 2006, parallel ITC surveys were conducted among adult smokers (at least smoked weekly) in China (n = 4763), Thailand (n = 2000), Australia (n = 1767) and the USA (n = 1780). Unprompted and prompted recall of noticing tobacco advertising and promotion were measured.
Results: Chinese respondents reported noticing tobacco advertisements in a range of channels and venues, with highest exposure levels on television (34.5%), billboards (33.4%) and in stores (29.2%). A quarter of respondents noticed tobacco sponsorships, and a high level of awareness of promotion was reported. Cross-country comparison reveals that overall reported awareness was significantly higher in China than in Thailand (particularly) and Australia, but lower than in the USA.
Conclusions: There is a big gap between China and the better-performing countries such as Thailand and Australia regarding tobacco promotion restrictions. China needs to do more, including enhanced policy and more robust enforcement.
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LL conducted the literature review, performed the data analysis, wrote most of the initial draft and coordinated input from other authors. H-HY helped to design the analytic strategy, provided input into the initial draft and edited subsequent drafts. RB conceived of the paper and articulated the broad framework for analysis. RB reviewed the data analysis strategy and provided comment on all drafts. GTF helped to design the study, was involved in instigating the study in all jurisdictions and provided detailed edits. MT helped to design the study, provided analytical suggestions and edited the manuscript. YJ and YY helped to design the ITC China survey, supervised the collection and management of the Chinese data and provided comments on drafts as well as ensuring the accuracy of the descriptions of the situation in China. BS supervised collection and management of the Thai data and provided input into the description of the Thai context. GH and FH provided overviews and detail on the arguments about the role of advertising and its measurement and comments on drafts.
Funding: The research reported in this paper was supported by grants P50 CA111236 and R01 CA100362 (Roswell Park Transdisciplinary Tobacco Use Research Center) from the US National Cancer Institute, Robert Wood Johnson Foundation (045734), Canadian Institutes for Health Research (57897 and 79551), National Health and Medical Research Council of Australia (265903 and 450110), Cancer Research UK (C312/A3726), Canadian Tobacco Control Research Initiative (014578), Center for Behavioural Research and Program Evaluation, National Cancer Institute of Canada/Canadian Cancer Society and Thai Health Promotion Foundation.
Competing interests: None.
Ethics approval: Ethical clearance for ITC study has been obtained for all ITC countries. In particular, there was clearance from the institutional review or research ethics boards from the University of Waterloo (Canada), Roswell Park Cancer Institute (USA), University of Strathclyde (UK), the Cancer Council Victoria (Australia), Mahidol University (Thailand) and the Chinese Center for Disease Control and Prevention.
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