Different tobacco control policies in China’s regions

The tobacco epidemic represents a significant public health challenge globally. In response, the World Health Organization (WHO) introduced the Framework Convention on Tobacco Control (FCTC) and MPOWER measures to assist countries in implementing effective tobacco control strategies^1-4. In 2005, China endorsed the WHO FCTC, marking a significant development in its tobacco control policies. Despite some progress, China’s tobacco control legislation remains less advanced compared to international standards. As of 2019, WHO evaluated China’s smoke-free regulations at Level IV, indicating the lowest compliance².

Macau SAR, recognized as a healthy city by WHO, has progressively enhanced its legal framework for tobacco control through revisions of the ‘Regime of Tobacco Prevention and Control’ in 2012, 2018, and 2022³. The implementation has been effective, as evidenced by the decreasing trend in tobacco usage from 16.9% in 2011 to 10.6% in 2022⁴.

Research on Chinese news media reporting

Research on tobacco control media coverage in China primarily employs content and text analysis methods. Previous studies have analyzed media discourse, opinion leaders, and tobacco control culture^5,6. Zheng et al.⁷ evaluated newspaper articles using the WHO MPOWER framework. Studies have also examined the relationship between media and policy agendas in tobacco control^8,9.

Agenda-setting theory

Agenda-setting theory, introduced by McCombs¹⁰, posits that mass media play a crucial role in setting the public agenda^10-14. The theory explores interactions between media, public, and policy agendas through a three-part linear process. Media significantly affect the content and value orientation of public opinion on various issues. Research has established a positive correlation between media agenda and public policy agenda¹⁵.

This study examines the variance in tobacco control reporting within mainstream newspapers across different regulatory environments in various regions of China, through the lens of agenda-setting theory. It offers evidence and recommendations for enhancing tobacco control advocacy based on this theory.

Data sources and collection

Based on previous research approaches, this study utilized WisersOne (http://www.wisers.com), the largest and most authoritative database of Chinese newspapers, to source pertinent news articles. Specifically, articles were retrieved using ‘tobacco control’ (控烟) as the search keyword from three strategically selected newspapers: People’s Daily, Nanfang Daily, and Macao Daily News. We included all news articles, editorials, opinion pieces, and feature stories that substantially addressed tobacco control topics. Two researchers independently reviewed all articles to ensure they substantially addressed tobacco control policies, implementation, or related public health issues. Any disagreements were resolved through discussion with a third researcher.

The selection of these three newspapers was based on their distinct administrative levels and significant influence (Table 1). The People’s Daily, as the organ of the Central Committee of the Communist Party of China, boasts a daily circulation of 3.46 million copies¹⁶. The Nanfang Daily, representing the Guangdong Provincial Committee of the Communist Party of China, daily circulates 850000 copies¹⁷. The Macao Daily News holds the status of the most widely circulated and representative daily in Macao SAR¹⁸. These newspapers serve as official chronicles and previous research demonstrates significant correlation between newspaper reporting and coverage in other media platforms.

The study period was strategically divided into two phases:

This temporal division was based on: 1) the COVID-19 pandemic’s significant impact on media priorities, and 2) the implementation of key tobacco control policies during these periods. In 2019, the national Healthy China Action and provincial Healthy Guangdong Action were launched². Macao enacted its New Tobacco Control Law in 2018, followed by significant e-cigarette regulations in 2022⁵.

Data processing

The analytical framework integrated co-word analysis and topic modeling to examine thematic patterns and their evolution. Following established methodological protocols^19-22, we employed qualitative axial coding to transform textual data into systematic themes. The coding process utilized both deductive and inductive reasoning, with repeated data review and integration of similar codes. Eigenvector centrality (EC) was calculated to measure keywords’ significance within the policy framework, where higher EC values indicate greater centrality and influence in the semantic network.

To complement the co-word analysis and address potential limitations of keyword-based approaches, we implemented topic modeling using Python. The process involved text preprocessing using Peking University’s pkuseg toolkit for word segmentation, followed by stop words removal to enhance analysis accuracy. Initial topic identification was conducted through WordCloud visualization, with subsequent topic extraction and clustering using Latent Dirichlet Allocation (LDA) modeling²³. This integrated analytical framework enabled systematic examination of both manifest and latent content patterns across different policy contexts and time periods, combining quantitative measures with qualitative thematic analysis.

The qualitative and quantitative components of our analysis were integrated through an iterative process. Initially, qualitative axial coding provided a preliminary understanding of thematic patterns, which informed keyword selection for co-word analysis. The semantic networks generated through co-word analysis then revealed underlying relationships between concepts, highlighting potential thematic clusters that might not have been immediately apparent in the qualitative coding. These insights were subsequently used to refine our topic modeling approach, particularly in interpreting the LDA results. Conversely, the topic modeling results helped validate and expand upon the manually coded themes, identifying additional linguistic patterns and thematic associations. This methodological triangulation enhanced the robustness of our findings by allowing each method to inform and validate the others, providing a more comprehensive understanding of media coverage patterns across different policy contexts.

Overview of coverage

The analysis of 749 tobacco control news articles revealed significant disparities in coverage intensity and thematic focus across regions. Macao Daily News published substantially more articles (596) than People’s Daily (46) and Nanfang Daily (107). During the pre-pandemic period (2017–2019), a total of 450 articles from Macao Daily News, 65 articles from the Nanfang Daily, and 33 articles from People’s Daily were collected. Coverage decreased during the pandemic period (2020–2022) to 146, 42, and 13 articles, respectively, as shown in Table 2.

Keyword centrality analysis

Analysis of eigenvector centrality (Table 3) revealed distinct patterns in thematic emphasis across regions and time periods. At the national level, People’s Daily maintained high centrality for ‘tobacco control’ (EC=0.529 to 0.546), while ‘health’ gained prominence during the pandemic (EC=0.341 to 0.546). Nanfang Daily showed a significant shift from tobacco control-specific discourse (EC=0.501 to 0.299) to broader health initiatives (EC=0.251 to 0.553). Macao Daily News demonstrated the most balanced thematic distribution, with consistently lower but more diverse EC values (0.381 to 0.134), reflecting comprehensive coverage. The emergence of ‘e-cigarettes’ (EC=0.406) and sustained focus on ‘youth’ (EC=0.252) during the pandemic indicated responsive policy adaptation.

Thematic evolution

The pre-pandemic semantic networks (Supplementary file Figures 1.1–1.3) illustrated regional variations in coverage focus. The People’s Daily network centered on national guidance and youth prevention, while Nanfang Daily emphasized provincial implementation and smart supervision. Macao Daily News exhibited more distributed networks encompassing enforcement, legislation, and public health initiatives (Table 4).

During the pandemic (Supplementary file Figures 2.1 and 2.2), network structures evolved significantly. Mainland media networks showed increased health-centric clustering and emerging emphasis on policy promotion. The Macao Daily News network maintained comprehensive coverage while adapting to new challenges, particularly e-cigarette regulation and youth protection (Table 5).

Topic modeling complemented these network patterns, revealing distinct thematic clusters. National coverage evolved from six pre-pandemic clusters (including national guidance and harm standards) to emphasis on policy integration. Provincial coverage shifted from five clusters centered on supervision to enhanced focus on legislative protection. Macao’s coverage maintained three comprehensive clusters throughout, adapting content while preserving structural balance.

Implications

This analysis suggests several implications for tobacco control advocacy. First, comprehensive smoke-free legislation appears crucial for sustaining media attention. Second, multi-stakeholder engagement, as demonstrated in Macao, can enhance both policy implementation and media coverage²⁸. Finally, maintaining diverse thematic coverage may better serve public education and policy advancement than focusing on isolated events or campaigns²⁹.

Limitations

While this study provides valuable insights into newspaper coverage, it does not address emerging digital media platforms. Future research could explore the role of social media in tobacco control advocacy, particularly regarding youth engagement. Additionally, investigating the bidirectional relationship between media coverage and policy implementation could further illuminate effective advocacy strategies. Lastly, our focus on three newspapers – one from each administrative level – may not capture the full diversity of media coverage within each region. Each selected newspaper has its distinct editorial focus and audience, which may influence its coverage patterns. This limitation is partially mitigated by the fact that the selected newspapers are official Party publications that often set the agenda for other media outlets in their respective regions.