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Impact of China National Tobacco Company’s ‘Premiumization’ Strategy: longitudinal findings from the ITC China Project (2006–2015)
  1. Steve Shaowei Xu1,
  2. Shannon Gravely1,
  3. Gang Meng1,
  4. Tara Elton-Marshall2,3,4,5,6,
  5. Richard J O’Connor7,
  6. Anne C K Quah1,
  7. Guoze Feng8,
  8. Yuan Jiang8,
  9. Grace J Hu1,
  10. Geoffrey T Fong1,5,9
  1. 1Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  2. 2Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
  3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  5. 5School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  6. 6Ontario Tobacco Research Unit, Toronto, Ontario, Canada
  7. 7Roswell Park Cancer Institute, Buffalo, New York, USA
  8. 8Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
  9. 9Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Shannon Gravely, Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; shannon.gravely{at}


Background In 2009, the China National Tobacco Company (CNTC) began their Premiumization Strategy, designed to encourage smokers to trade up to more expensive brands, mainly by promoting the concept that higher class cigarettes are better quality and less harmful. This study is the first evaluation of the strategy’s impact on: (1) prevalence of premium brand cigarettes (PBC), mid-priced brand cigarettes (MBC) and discount brand cigarettes (DBC) over 9 years, from 3 years pre-strategy (2006) to 6 years post-strategy (2015); and (2) changes in reasons for choosing PBCs, MBCs and DBCs.

Methods A representative cohort of adult Chinese smokers (n=9047) in seven cities who participated in five waves of the International Tobacco Control (ITC) China Survey: pre-implementation (Wave 1 (2006; n=3452), Wave 2 (2007–2008; n=3586)); mid-implementation (Wave 3 (2009; n=4172)); and post-implementation (Wave 4 (2011–2012; n=4070), Wave 5 (2013–2015; n=2775)). Generalised estimating equations were conducted to examine changes in prevalence of PBCs, MBCs and DBCs, and reasons for brand choice from pre-implementation to post-implementation.

Results From pre-implementation to post-implementation, there was an increase in prevalence of PBCs (5.4% to 23.2%, p<0.001) and MBCs (40.0% to 50.4%, p<0.001), and a decrease in DBCs (54.6% to 26.5%, p<0.001). There was an increase in smokers who chose their current brand because they believed it to be less harmful, both for MBC smokers (+13.0%, p=0.001) and PBC smokers (+9.0%, p=0.06). There was an increase for smokers in all brand classes for choosing their current brand because they were ‘higher in quality’ and because of affordable price, but the greatest increase was among PBC smokers (+18.6%, p<0.001 and +34.9%, p<0.001, respectively).

Conclusions Our findings demonstrate that the rising trend in Chinese smokers’ choice of ‘less harmful’, ‘higher quality’ and ‘affordable’ cigarettes, particularly PBCs, is likely due to CNTC’s aggressive marketing strategies. Strong tobacco control policies that prohibit CNTC’s marketing activities are critical in order to dispel erroneous beliefs that sustain continued smoking in China, where the global tobacco epidemic is exerting its greatest toll.

  • economics
  • price
  • social marketing
  • taxation
  • tobacco industry

Statistics from


  • Contributors SSX and SG contributed equally to this paper and are considered joint first authors. GM conducted the data analyses, created the tables and helped draft the methods section of the manuscript. GTF, TEM, RJOC, ACKQ, GF, YJ and GJH helped interpret the analytical results and revise all drafts. The final version of this paper has been reviewed and approved by all coauthors.

  • Funding ITC China Project was supported by multiple grants from the US National Cancer Institute (R01 CA125116), the Roswell Park Transdisciplinary Tobacco Use Research Center (P50 CA111236), the Canadian Institutes of Health Research (MOP 79551 and MOP 115016), and the Chinese Center for Disease Control and Prevention. GTF was supported by a Senior Investigator Award from the Ontario Institute for Cancer Research and by a Prevention Scientist Award from the Canadian Cancer Society Research Institute. SG was supported by a Canadian Cancer Society Career Development Award in Prevention (No 703858). Additional support in preparing this paper was provided to University of Waterloo by the Canadian Institutes of Health Research (FDN-148477).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The ITC China Survey was cleared by the Office of Research Ethics, University of Waterloo, Canada (Waterloo, Canada) and internal review boards at Roswell Park Cancer Institute (Buffalo, USA), the Cancer Council Victoria (Melbourne, Australia) and Chinese Center for Disease Control and Prevention (Beijing, China).

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

  • Correction notice This article has been corrected since it was published Online First. Additional details of funding have been added.

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