National survey of smoking cessation provision in China
Haoxiang Lin 1, 2, 3, 4
Dan Xiao 1, 2, 3, 4  
Zhao Liu 1, 2, 3, 4
Qiang Shi 1, 2, 3, 4
Peter Hajek 5
Chen Wang 1, 2, 4, 6
More details
Hide details
Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital, Beijing, China
Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
National Clinical Research Center for Respiratory Diseases, Beijing, China
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Dan Xiao   

China–Japan Friendship Hospital, Chaoyang District, Beijing, China
Publish date: 2019-04-02
Tob. Induc. Dis. 2019;17(April):25
Treatment for smoking cessation is an important part of tobacco control and has been promoted within the Chinese health service for many years. The aim of this study was to assess the current status of smoking cessation treatment provision within the Chinese health service.

A nationwide survey, sponsored by the National Health and Family Planning Commission, assessed smoking cessation activities in all 31 Provincial Health and Family Planning Commissions (PHFPCs) in China. Within the 31 provinces, 366 hospitals and primary care centers running smoking cessation clinics provided details of their activities.

Findings show that all PHFPCs took steps to promote smoking cessation, such as by conducting inspections and supervising local cessation clinics. Specifically, among the 366 health institutions,73% were based in general hospitals, with smoking cessation clinics predominantly located in respiratory departments. Furthermore, only 43% provided smoking cessation medications.

This was the first nationwide survey of smoking cessation support available to smokers in China. It provides the most comprehensive picture of the treatment arm of smoking cessation activities so far. The Chinese government has taken measures to support smoking cessation, however, further efforts are needed to address the imbalanced distribution of resources and the limited availability of medications. On-going monitoring of barriers and facilitators affecting treatment provision is needed, as well as an understanding of the importance of each hospital focusing on working priorities specific to their needs. This survey could be a reference for other countries starting to promote smoking cessation.

We are grateful to K Pittaccio, from Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK who helped us with the English and SL Song, W Jiang, BC Yao and other members of NHFPC who supported this study. We would also like to thank all the Provincial-level governments, hospitals,, primary care institutions for their participation, as well as the coordinators in each of the 31 provinces.
Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This study was supported by National Key Research and Development Program of China (Project Number: 2017YFC1309400) and by Communication Department of NHFPC (Project Number: 2016-QTL-060).
This study was supervised by DX and CW. HXL managed the survey and QS and ZL monitored quality of the data. HXL collaborated with PH on analyzing and interpreting the data and drafting the report. All authors contributed to the final version of this paper.
Not commissioned; externally peer reviewed.
National Bureau of Statistics of China. China Statistical yearbook. Beijing, China: China Statistics Press; 2010.
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China. CA Cancer J Clin. 2016;66(2):115-132. doi:10.3322/caac.21338
Austoker J, Sanders D, Fowler G. Cancer Prevention in Primary Care: Smoking and cancer: smoking cessation. BMJ. 1994;308(6942):1478-1482. doi:10.1136/bmj.308.6942.1478
Arnold EM. The cessation of cancer treatment as a crisis. Social Work in Health Care. 1999;29(2):21-38. doi:10.1300/j010v29n02_02
Chen Z, Richard P, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. 2015;386(10002):1447-1456. doi:10.1016/S0140-6736(15)00340-2
Liang X. Report of China City Adult Tobacco Survey 2013–14. Atlanta, Georgia, USA: CDC Foundation; 2015.
Cooper J, Borland R, Yong H, et al. To what extent do smokers make spontaneous quit attempts and what are the implications for smoking cessation maintenance? Findings from the International Tobacco Control Four country survey. Nicotine Tob Res. 2010;12(Suppl 1):S51-S57. doi:10.1093/ntr/ntq052
Xiao D, Wang C, Chen H, Peter H. Making hospitals in China smoke-free: a prospective study of implementing the new standard. Nicotine Tob Res. 2013;15(12):2076-2080. doi:10.1093/ntr/ntt098
World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2003.
The China National Health and Family Planning Commission. 2015 Guideline on China Clinical Smoking Cessation .Chinese Journal of Public Health Management. 2016;10(2):88-95.
Wang LL, Shen Y, Jiang Y, Yang Y. Investigation and analysis on current status of smoking cessation clinics in China. Chinese Journal of Epidemiology. 2015;36(9):917-920.
Peng JL, Yang GW, Li WF, Li JK. The investigation and analysis of the status of the smoking cessation clinics. Chronic Pathematology Journal. 2013;14(3):197-201.
Piné-Abata H, McNeill A, Murray R, Bitton A, Rigotti N, Raw M. A survey of tobacco dependence treatment services in 121 countries. Addiction. 2013;108(8):1476-1484. doi:10.1111/add.12172
West R, Raw M, McNeill A, et al. Health‐care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction. 2015;110(9):1388-1403. doi:10.1111/add.12998
McEwen A, Hajek P, McRobbie H, West R. Manual of Smoking Cessation: A Guide for Counsellors and Practitioners. Oxford, United Kingdom: Wiley-Blackwell; 2006.
Zhang CM, Xiao D, West R, Michie S, Troughton R, Hajek P. Evaluation of 3-day smoking cessation training course for doctors from 38 cities in China. Chinese Medical Journal. 2012;125(7):1338-1340. doi:10.3760/cma.j.issn.0366-6999.2012.07.026
National Bereau of Statistics. Main Results of the Sixth National Census 2010. China Statistics Press; 2011. Accessed October 24, 2018.
World Health Organization. Strengthening Health Systems for Treatment Tobacco Dependence in Primary Care: Training for policy-makers. Geneva, Switzerland: WHO; 2013.
Walker N, Howe C, Bullen C, et al. Study protocol for a non-inferiority trial of cytisine versus nicotine replacement therapy in people motivated to stop smoking. BMC Public Health. 2011;11:880. doi:10.1186/1471-2458-11-880
Sala M, Braida D, Pucci L, et al. CC4, a dimer of cytisine, is a selective partial agonist at α4β2/α6β2 nAChR with improved selectivity for tobacco smoking cessation. British Br J Pharmacol. 2013;168(4):835-849. doi:10.1111/j.1476-5381.2012.02204.x
Mooney ME, Reus VI, Gorecki J, et al. Therapeutic Drug Monitoring of Nortriptyline in Smoking Cessation: A Multistudy Analysis. Clin Pharmacol Ther. 2008;83(3):436-442. doi:10.1038/sj.clpt.6100307
Davies H. Nortriptyline may help in smoking cessation. Thorax. 2005;60(3):253. doi:10.1136/thx.2004.la0140
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2017. Geneva, Switzerland: World Health organization; 2017.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009. Geneva, Switzerland: World Health Organization; 2009.
Eriksen M, Mackay J, Schluger N, Gomeshtapeth FI, Drope, J. The Tobacco Atlas. American Cancer Society, World Lung Foundation; 2015. Accesed October 24, 2018.
World Health Organization. The Bill China Cannot Afford: Health, Economic and Social Costs of China’s Tobacco Epidemic. Manila, Philippines: World Health Organization; 2017.