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Impact of cigarette package warnings on attitudes towards sharing and gifting cigarettes in China: a nationwide study of smokers and non-smokers
  1. Yanhui Liao1,2,
  2. Jinsong Tang1,2,
  3. Ann McNeill3,
  4. Brian C Kelly4,
  5. Joanna E Cohen5
  1. 1 Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
  2. 2 Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, Zhejiang, China
  3. 3 Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  4. 4 Department of Sociology, Purdue University, West Lafayette, Indiana, USA
  5. 5 Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Yanhui Liao, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China; liaoyanhui{at}; Dr Jinsong Tang, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China; tangjinsong{at}


Background Sharing and gifting cigarettes are common in China. These social practices promote cigarette consumption, and consequently may reduce quit rates in China. This study investigated sharing and gifting cigarettes, and the relationship of observing pictorial health warnings to attitudes towards sharing and gifting cigarettes in China.

Methods We conducted an online nationwide cross-sectional study of 9818 adults in China. Experiences of sharing and gifting cigarettes, and attitudes towards sharing and gifting cigarettes before and after viewing text and pictorial health warnings on the packages were assessed, and compared between smokers and non-smokers.

Results Most current smokers reported experiences of sharing (97%) and gifting (around 90%) cigarettes. Less than half of non-smokers reported sharing cigarettes and receiving gifted cigarettes, but over half (61.4%) gave cigarettes as a gift to others. More than half of non-smokers but less than 10% of smokers disagreed with sharing and gifting cigarettes. After observing both text and pictorial health warnings on the packages, disagreement with sharing and gifting cigarettes increased by more than 10 percentage points among both smokers and non-smokers.

Conclusion Having pictorial health warnings on cigarette packages may reduce sharing and gifting cigarettes in China.

  • packaging and labelling
  • surveillance and monitoring
  • public opinion
  • low/middle income country
  • cessation

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  • Contributors YL conceived the idea for the research with the supervision of JEC. YL and JT conducted the survey. YL conducted the analyses and all interpreted the results. YL wrote the manuscript. JEC, AM and BCK provided edits and feedback to manuscript drafts. All authors contributed to and approved the final version of the manuscript.

  • Funding The research is supported by the KC Wong Postdoctoral Fellowship for YL to study at King’s College London, the China Medical Board (CMB) Open Competition Program (grant number 15-226) and CMB Faculty Development Award for YL to study at the Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to write the report or to submit the paper for publication. The content is solely the responsibility of the authors.

  • Competing interests AM is a National Institute for Health Research (NIHR) senior investigator.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.