BACKGROUND: China is the epicenter for tobacco production and consumption in the world, making it a priority target for tobacco control interventions. The Emory Global Health Institute, Georgia State University and China's Think Tank Research Center for Health, with funding from the Bill & Melinda Gates Foundation, launched the China Tobacco Free Cities (TFC) (2008-2018) to establish effective and sustainable tobacco control programs. Funding, targeted MPOWER-based trainings and technical assistance was provided to 22 selected large and influential cities. In 2023, the program was evaluated to assess the status of smoke-free policies, social norm change, program sustainability and leadership development.
METHODS: In 2023, ten cities were selected based on cohort, type of smoke-free policy, location, economics and population. Seventeen in-depth online interviews were conducted with TFC program staff and current government staff. A semi-structured interview guide was used, and topics included: city smokefree policies, sustainability post implementation, and leadership and capacity building among TFC program staff.
RESULTS: The evaluation indicated cities with comprehensive smoke-free policies had a high degree of public support, while cities with partial bans faced barriers such as lack of leadership support and tobacco industry influence. Interventions including media campaigns, policy enforcement, cessation programs and monitoring activities were sustained in almost all cities. Challenges to sustainability included reduced financial and personnel resources and weakened policy enforcement. Positive changes in smoke-free social norms were detected. Finally, TFC staff reported their skills in developing and implementing smoke-free policies and leadership increased.
CONCLUSIONS: The collaborative TFC initiative between US and China provides an effective model to develop and enforce effective and sustainable tobacco control policies and initiatives at the city level. Cities can effectively implement and sustain tobacco control programs and media campaigns, adopt and enforce smoke-free policies and monitor and evaluate tobacco measures when there is sufficient funding, training, technical support and leadership.