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Background and aims More than 20 cities in China have enacted local smoke-free laws that prohibit smoking in public places. Only two of these cities have examined the health impact of the law. Enacted in 2013, Qingdao's smoke free-law was stricter than most other municipal smoke-free laws because it did not allow designated smoking rooms. This study aimed to estimate the impact of Qingdao's smoke-free legislation on acute myocardial infarction (AMI) and stroke. Design, setting and participants We used an interrupted time-series design adjusting for underlying secular trends, seasonal patterns and meteorological factors to estimate the impact of the smoke-free law on AMI and stroke events among permanent residents aged 35 years or older in Qingdao, China. The study period was from 1 January 2010 to 31 December 2015, with a post-ban follow-up of approximately 2.5 years. Measurement Outcome measures were weekly numbers of hospitalizations and deaths due to AMI/stroke. Findings A total of 10 371 and 56 101 patients were hospitalized, with a principal discharge diagnosis of AMI and stroke, respectively; 32 196 AMI and 49 711 stroke deaths occurred during the study period. Following the smoke-free legislation, an incremental 20% [95% confidence interval (CI) = 14-26%] and 8% (95% CI = 3-13%) decrease per year was observed in AMI and stroke hospitalization rates, respectively. Neither the immediate nor gradual change in AMI nor stroke mortality rates associated with the law was statistically significant (P > 0.05). Post-hoc subgroup analyses indicated that statistically significant reductions in AMI hospitalizations were evident among both the 35-64 (18% per year, 95% CI = 12-27%) and 65-84 (20% per year, 95% CI = 12-27%) age groups. Statistically significant reductions in stroke hospitalization were only in the older subgroup (13% per year, 95% CI = 8-18%). Conclusions The 2013 smoke-free legislation in Qingdao, China was associated with reduction in hospitalization from acute myocardial infarction and stroke among permanent residents aged 35 years or older. There was no statistically significant reduction in mortality from acute myocardial infarctions or stroke.

The COVID-19 pandemic has caused staggering human and economic costs. We outline four key lessons learned from efforts to address the pandemic in China and the US. First, effective surveillance, reporting, and contact tracing are needed to contain an epidemic at its emergence and to mitigate its impact at a later stage. Second, multi-sectoral efforts to offer incentives for those with no or minor symptoms to seek care and to quarantine themselves are critical, which would need concerted efforts from payers, providers, and public health. Third, sustained and routine prevention efforts involving both the public and the health systems will prove to be useful in times of a pandemic. Fourth, a strong public health system is essential and will be appreciated at times of urgency. Concerted multi-sectoral efforts are required to address COVID-19 pandemic with strong leadership from the public health sector.

Background Previous studies have reported that the development of pancreatic cancer (PC) may be associated with environment pollution. But the relationship between ambient air pollution and PC remains unclear. Objectives This study aimed to examine the association between PC mortality and exposure of fine particular matter. Methods We used PC mortality data from 103 continuous points in national Disease Surveillance Point system from 1991 to 2009 in China. The annual concentrations of PM2.5 at 0.1° × 0.1° spatial resolution for each points were estimated based on the context of the Global Burden of Disease Study 2015. A spatial age-period-cohort model was used to examine the relative risks of PC mortality associated with PM exposure, after adjusting gender, urban/rural status, spatial variation as well as age, period and cohort effect. Results The relative risks of PC mortality related to 10 μg/m3 increase of PM2.5 were 1.16 (95% confidence interval (CI): 1.13, 1.20) for all the population, 1.08 (1.05,1.13) for those aged 40–64 years, 1.21 (1.17,1.25) for those aged 65–84 years, 1.14 (1.10,1.18) for the male, 1.19 (1.14,1.24) for the female, 1.23 (1.16,1.30) for the urban population and 1.29 (1.22, 1.37) for the rural population. Conclusions Ambient PM2.5 may raise the risk of mortality from PC, especially in older population. Pollution control policy should be further strengthened to reduce the health damages.

Background In China, the spatiotemporal variations in cardiovascular disease (CVD) mortality are seldom characterized to understand their epidemiological features. It would be helpful to evaluate the performance of CVD-related interventions for subsequent adjustments. Methods The 2010 Census data as well as the coronary heart disease (CHD) and stroke mortality data from the Disease Surveillance Points (DSPs) were used to calculate the age standardized death rates (ASDRs) of CVD in the DSP counties during 1991–1995, 1996–2000, 2004–2005, and 2006–2009. The ordinary kriging (OK) method was used to estimate the county-level death rates of CHD and stroke and achieved satisfactory results. Results The goodness-of-fit between measured and estimated values of CVD mortality was significant at the 0.01 level (0.34 75 per 105) were located in the Northwest, North, and Northeast in 1991–2000 and then extended toward the North, Central, and South, yielding an inverted-triangle-shaped area in 2004–2009. The counties with a CHD death rate increase greater than 100% were concentrated in the Northeast and South. The Northeast-Southwest regions with a high stroke death rate gradient (> 150 per 105) narrowed in1991–2000, was followed by a slight expansion during 2004–2005, finally reducing in 2006–2009. The counties with a stroke mortality increase greater than 100% were scattered across the Northeast, Northwest, Central, and South. Conclusion The epidemiological characteristics of both CHD and stroke mortality in China was spatiotemporally featured on the county level during 1991–2009.

Summary Background Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. Methods We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). Findings Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). Interpretation China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. Funding China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Summary Background China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Methods Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. Findings All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4·0 years in Hebei province to 14·2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0–14, 15–49, and 50–74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Interpretation Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. Funding China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.

Background Xuanwei is one of the towns with highest lung cancer mortality in China. Residents there frequently use smoky coal for domestic cooking and heating. The smoking prevalence there is also high. Methods We conducted a population-based case-control study. 388 lung cancer cases and 388 gender-age-area-matched controls were surveyed. The exposure levels to potential lung cancer risk factors of multi-aspects 10 years ago were collected. After checking Spearman correlations between variables and referring to previous studies, we built conditional logistic regression model adjusting education, family history of malignancy, diet, alcohol consumption, occupational history, housing type and exposure to second hand smoke. We then introduced household annual consumption of smoky coal and total consumption of cigarettes from born to 10 years ago to the model in the form of ordered categorical variable (coal level 1-3: never use, less than 3 tons per year, 3 tons or more per year; tobacco level 1-3: never use, less than 130 thousands cigarettes, 130 thousands or more cigarettes). Results There were 27% and 31.2% ever-smokers in case and control group, respectively. Without interactive item, the effect of tobacco use on lung cancer was (all comparing with level 1, with 95% confidence intervals) level 2: OR=0.90(0.22, 3.67), level 3: OR=1.59(0.45, 5.70). After adding interactive item of coal and tobacco in the model, the effect of tobacco use among people never used smoky coal was level2: OR=1.09(0.09, 13.78), level3: OR=2.20(0.16, 29.44); among people using relatively small amount of coal was level2: OR=0.59(0.03, 11.37), level3: OR=0.18(0.01, 4.82); among people using large amount of coal was level2: OR=0.93(0.32, 2.72), level3: OR=1.78(0.30, 10.67). Household annual amount of smoky coal used, 10 years ago Total consumption of cigarettes from born to 10 years ago (reference group: never smoker) β SE OR(95%CI) Never

The prevalence of tobacco in Chinese men has peaked since the 1980s. The past 30 years, the smokers start to smoking more and more early, and a half of smokers did before 20 years old in 2010 survey; the prevalence of male smoking only fallen about 10% from 1984 to 2015, did not drop and still over 50% from 2002 to 2015. For female, its prevalence of smoking has been kept very low level. By 2015, after 10 years the entry into force of the Convention, the prevalence of SHS exposure at homes and in the public places were dropped to 46.7 and 54.3%, separately. However, there are still about half of the non smokers at home or in public places suffer from SHS exposure. Reviewing eight case-control or prospective cohort studies in different urban and rural of China from 1980s to 2005. The overall mortality of smokers was significantly greater than that of nonsmokers, relative risk (RRs) are from 1.1 in 1990s rural to 1.65 in 2010 urban. The urban male smokers who had started before age 20 years had twice the never-smoker mortality rate (RR 1.98, 1.79–2.19) and who daily smoked more than 25 cigarettes was closed twice (RR 1.93, 1.75–2.12). Based on these estimation, smoking caused about one million (840,000 male, 130,000 female) deaths in China in 2010. The female tobacco attributable mortality fraction may be over-estimated from GBD2010 study and WHO 2008 study, which is different with the results of all epidemiological studies. GBD study estimated that exposure SHS causes around 159,000 deaths in China in 2010. Although it is need to further approach and deepen for the scientific evidence on secondhand smoke, the current global and Chinese evidences were sufficient for public health intervention.

Article 11 has formed the basis for international action to communicate the health risks of tobacco use, and requires each Party to implement within 3 years after ratifying the treaty. The Regulations on Cigarette Packaging and Labeling in the Territories of the People’s Republic of China (the Labeling Regulation) jointly issued and updated by STMA and GAQSIQ in 2008, 2011 and 2016, are the reproduction of STMA’ Research on Counterproposals and Countermeasures against WHO FCTC. This is a typical case of national public power servicing for the interests of tobacco industry. The cigarette package display and assessment study strongly suggested that the Chinese text-only health warnings on cigarette packages are very low effective. By 2016, 105 Parties adopted the graphic warnings on cigarette packaging, covering 58% of the world’s population. China is obviously behind.

Marketing and promotion increase tobacco sales by encouraging current smokers to smoke more and decreasing their motivation to quit. Marketing also encourages potential users, young people specifically to try cigarettes and become long-term customers. The key point of Article 13 of WHO FCTC is to undertake a comprehensive ban all tobacco advertising, promotion and sponsorship (TAPS) within 5 years after ratifying the treaty. The Chinese Advertising Law promulgated in 1994 were obvious deficiencies compared with WHO FCTC. However, tobacco industry has been impeding the revision of national laws to reserve room for TAPS. Eight types of prevalent tobacco advertising in China are summarized: disguised forms of tobacco advertising or promotion in media, outdoor cigarette advertising, the displays at the Point Of Sale, grand scale gathering for brand recommendation and product presentations, tobacco advertising at internet and new media, cigarette packaging as advertising and production and distribution of items that resemble cigarettes such as sweets and toys. The tobacco industry often participates in sponsorship such as education, scientific research, sports, music, cultural, social events and public education campaigns in the name of social responsibility. Over 100 Tobacco Hope primary schools is a typical case. Surveys in 2009–2015 showed extremely high exposure to TAPS among urban population, especially among teenagers. To promote comprehensive ban all forms of TAPS, a lot of public health advocacy campaigns have been carried out over past 10 years. The amended Advertising Law and the other regulations have come into force successively, most form of TAPS have been banned up to 2015.

In this chapter we review how to implement Article14 of WHO FCTC assisting smokers to quit tobacco use in China. In 2015, the currently smokers run up to 315 million, only 18% ever smokers gave up smoking, but proportion of taking action to quit (quitter and relapse maker) was increasing over 50%, which revealed the tremendous and increasing demand for smoking cessation in China. Chinese government has supported the popularization and establishment of cessation clinics and hotlines, introduced simple smoking cessation intervention techniques, updated guidance in cessation clinics and developed guidance cessation hotline although these strategies and measures are need to be further improved. However, why a few people visit the smoking cessation clinic in China with great demand for smoking cessation? The fundamental reasons are related to that Chinese government have not integrated tobacco dependence diagnosis, treatment and counseling into their health-care systems, especially into the primary medical service. Also the costs of quitting services and treatment are totally not covered with the medical insurance plan or by public funding or reimbursement schemes. Chinese government should adjust the current cessation strategy and take effective measures on the WHO recommendations approach of offering quit help, to promote cessation of smokers and adequate treatment for tobacco dependence.

Since 1980s, the tobacco control campaign has been supported by financial assistance of international community. Tobacco control donation from major American foundations has increased considerably after China ratified the WHO FCTC in 2006. The research grants are to support the study of health risk of tobacco use, prevalence pattern of smoking and secondhand smoke exposure (SHS), as well as policy assessment of tobacco control. Next, tobacco control as a significant public health measure was introduced project activities in an early health loan of the World Bank. For the past century, such distinguished philanthropies as the Rockefeller foundation (China Medical Board), Ford Foundations have pioneered many fields in China, especially in medicine. The Bloomberg Initiative (BI) Grants and the Bill & Melinda Gates Foundations provided the biggest support for tobacco control in China. During 2007–2016, BI grant has provided 21.4 million US$ fund to China for tobacco control with 96 projects for national professional organization, local agency of tobacco control, university and non-government organization (NGO). The Grant supported to promote national and local tobacco control legislation, including 100% smoke free environments in project cities, and so on. The Bill and Melinda Gates Foundation continues to provide more than $34 million (US) to support policy interventions, social marketing and building the evidence base in tobacco control in China. Meanwhile, it is important for tobacco control community should consider how to promote domestic charitable donations to tobacco control.

The development and sustainment of a comprehensive tobacco-use surveillance system is critical to support its national plans, priorities, and programs, as well as an obligation for the WHO FCTC’s Parties. We discussed methodology used in China’ tobacco surveillance, including sample design, module and questionnaire, along with the indicators and analysis methodology for policy performance assessment. China updated the surveillance data almost every 5 years with the similar indicators; results from the five national adult surveys and 2014 youth survey provided the trend and distribution of tobacco use at national level. Prevalence of tobacco use in China did not change a lot more than 10 years after WHO FCTC came in force in 2005, decreasing 1% and hovering around 27%. The tobacco control policies implementation was very poor in China during this period: the average score for the implementation of the five key policies of MPOWER assessment was 37.3 points based on 2010 GATS-China. The current system can’t effectively monitor the tobacco industry and has trouble with data sharing and data use, therefore, the surveillance system on tobacco is need to further improvement in China. In addition, the regular funding is shortage and capacity for surveillance is still limited, especially in local level.

This chapter, as the introduction of the book “Tobacco Control in China”, described the response to the tobacco use pandemic from international public health community so as to understand the tobacco control in China by the international perspective. Tobacco use pandemic is a global problem and must be solved at the global level. It cannot be solved by traditional public health strategy, but should be solved based on the international law at the legal level! WHO Framework Convention on Tobacco Control (WHO FCTC) is the important weapon responding the tobacco pandemic under the Globalization. However, the attitudes and actions of the Chinese government during the negotiations on the WHO FCTC have shown that China’s more pursuit of international recognition beyond pursuit of public health and safety, has presaged the setback of the implementation of WHO FCTC in China. Thirdly, the brief review of the tremendous progress made by the most Parties of WHO FCTC over the last 10 years reflects the status of China’s tobacco control described in the following chapters as a mirror.

Background We conducted a meta-analysis to evaluate the association between traffic-related air pollution and lung cancer in order to provide evidence for control of traffic-related air pollution. Methods Several databases were searched for relevant studies up to December 2013. The quality of articles obtained was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Statistical analysis, including pooling effective sizes and confidential intervals, was performed. Results A total of 1106 records were obtained through the database and 36 studies were included in our analysis. Among the studies included, 14 evaluated the association between ambient exposure to traffic-related air pollution and lung cancer and 22 studies involved occupational exposure to air pollution among professional drivers. Twenty-two studies were marked A level regarding quality, 13 were B level, and one was C level. Exposure to nitrogen dioxide (meta-odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.99–1.13), nitrogen oxide (meta-OR: 1.04, 95% CI: 1.01–1.07), sulfur dioxide (meta-OR: 1.03, 95% CI: 1.02–1.05), and fine particulate matter (meta-OR: 1.11, 95% CI: 1.00–1.22) were positively associated with a risk of lung cancer. Occupational exposure to air pollution among professional drivers significantly increased the incidence (meta-OR: 1.27, 95% CI: 1.19–1.36) and mortality of lung cancer (meta-OR: 1.14, 95% CI: 1.04–1.26). Conclusion Exposure to traffic-related air pollution significantly increased the risk of lung cancer.

This article presents the results of spatial analysis of gastric cancer and its relation to environmental conditions in Shenqiu County, China. Retrospective data on gastric cancer mortality (GCM) were analysed at various spatial scales, with its relation to environmental factors explored at an appropriate scale. The results considered 2 × 2 km(2) grid as the optimal level for characterising GCM due to the highest Moran's I (I = 0.68, p 0.01). Then, three clustering regions were clearly identified. Meanwhile, GCM was obviously associated with topography (r = -0.11, p 0.10), farmland (r = 0.11, p 0.10), population density (r = 0.10, p 0.10) and river density (r = 0.11, p 0.10) in the buffered zones. It indicates that spatial grid technique is suitable for characterising GCM in Shenqiu County, and that GCM was geographically associated with environmental conditions. We suggest that preventive measures for controlling the environment-related malignant neoplasm should not be limited in the regions suffering from this disease but be reasonably extended to surrounding areas.

Previous studies have reported that the development of pancreatic cancer (PC) may be associated with environment pollution. But the relationship between ambient air pollution and PC remains unclear.This study aimed to examine the association between PC mortality and exposure of fine particular matter.We used PC mortality data from 103 continuous points in national Disease Surveillance Point system from 1991 to 2009 in China. The annual concentrations of PMThe relative risks of PC mortality related to 10 μg/mAmbient PM

Esophageal and gastric cancers share some risk factors. This study aimed to compare the long-term trends in mortality rates of esophageal and gastric cancers in China to provide evidence for cancer prevention and control. Mortality data were derived from 103 continuous points of the Disease Surveillance Points system during 1991–2009, stratified by gender and urban-rural locations. Age-period-cohort models were used to disentangle the time trends of esophageal and gastric cancer mortality. The downward slope of the period effect for esophageal cancer was steeper than that for gastric cancer in rural areas. Cohort effect patterns were similar between esophageal and gastric cancers, with an inverse U-shape peaking around the late 1920s and early 1930s. A second peak, appearing around the 1950s, was weaker than the first but apparent in males, especially for esophageal cancer. The more marked changes in period effect for esophageal cancer in rural areas suggest esophageal cancer screening practices are effective in reducing mortality, and similar programs targeting gastric cancer should be implemented. The similarities of the cohort effects in these two cancers support the implication of nutrition deficiency in early childhood in the development of upper gastrointestinal cancer.

In a recent publication in the journal Science of the Total Environment, Die Fang et al. (2016) reported health effects of current ambient PM

The Characteristics of 102 DSP Points. There were four variables in this table, including the DSPs name, regions where each DSP belongs to, population for each DSP in 1991 and 2009 respectively. (DOCX 49 kb)

Using a very rich set of health indicators that include both self-reported measures and biomarkers from the CHARLS national baseline data, we document health conditions of the Chinese mid-aged and elderly, examine correlations between these health outcomes and socio-economic status and compare these associations by gender, hukou status and region. As expected, we find that Chinese mid-aged and elderly are facing challenges from chronic diseases including hypertension. Overnutrition has become a bigger problem than undernutrition, particularly for women, reflected in a higher rate of overweight compared to underweight. Disability rates are also high, especially for female, rural and inland respondents, who also report suffering from more pain than male, urban and coastal ones. In general, education and PCE tend to be positively correlated with better health outcomes, as it is in other countries. For PCE the relationship is very nonlinear. At low levels of PCE, there exists a positive correlation with better health outcomes, while for higher levels of PCE the relationship flattens out. Unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. We also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged, although less large than in some other developing countries. This implies that the current health system is still not well prepared to address the rapid aging of the Chinese population.

In a recent publication in the journal Science of the Total Environment, Die Fang et al. (2016) reported health effects of current ambient PM2.5 (particulate matters with aerodynamic diameters

Objective To develop an approach for rapid assessment of tobacco control interventions in China. We examined the correlation between components of the Strength of Tobacco Control (SOTC) index and a proposed rapid evaluation indicator, the Policy Performance Indicator (PPI), which is based on protection of non-smokers from secondhand smoke (SHS). The PPI was used to assess the implementation of policies related to SHS at the provincial/municipal level in China. Methods Stratified random sampling was used to select five types of organisational and household respondents in two municipalities and five provinces in China (Shanghai and Tianjin, Heilongjiang, Henan, Guangdong, Zhejiang and Jiangxi, respectively). Data collection methods included key informant interviews, observation and intercept surveys (organisations), and a modified Global Adult Tobacco Survey (GATS) questionnaire (households). SOTC scores (SHS policy, capacity and efforts), PPI (no smoking in designated smoke-free places) and mid-term to long-term impact (knowledge, attitude and reduced exposure to SHS) were measured, and correlations among them were calculated. Results The PPI varied across the seven locations. Shanghai led in the component indicators (at 56.5% for indoor workplaces and 49.1% for indoor public places, respectively), followed by Guangdong, Tianjin and Zhejiang (at 30–35% for these two indicators), and finally, Henan and Jiangxi (at 20–25%). Smoke-free policies were more effectively implemented at indoor workplaces than indoor public places. The PPI correlated well with certain components of the SOTC but not with the long-term indicators. Conclusions The PPI is useful for evaluating implementation of smoke-free policies. As tobacco control programmes are implemented, the PPI offers an indicator to track success and change strategies, without collecting data for a full SOTC index.

Summary Background China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. Findings The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. Interpretation The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Funding Bill & Melinda Gates Foundation.

While the ‘low-tar’ scheme has been widely recognised as a misleading tactic used by the tobacco industry to deceive the public about the true risks of cigarette smoking, a similar campaign using the slogan of ‘less harmful, low tar’ was launched by the Chinese tobacco industry, that is, State Tobacco Monopoly Administration/China National Tobacco Corporation and began to gain traction during the last decade. Despite the fact that no sufficient research evidence supports the claims made by the industry that these cigarettes are safer, the Chinese tobacco industry has continued to promote them using various health claims. As a result, the production and sales of ‘less harmful, low-tar’ cigarettes have increased dramatically since 2000. Recently, a tobacco industry senior researcher, whose main research area is ‘less harmful, low-tar’ cigarettes, was elected as an Academician to the prestigious Chinese Academy of Engineering for his contribution to developing ‘less harmful, low-tar’ cigarettes. The tobacco researcher's election caused an outcry from the tobacco control community and the general public in China. This paper discusses the Chinese tobacco industry's ‘less harmful, low-tar’ initiatives and calls for the Chinese government to stop the execution of this deceptive strategy for tobacco marketing.

The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative longitudinal survey of persons in China 45 years of age or older and their spouses, including assessments of social, economic, and health circumstances of community-residents. CHARLS examines health and economic adjustments to rapid ageing of the population in China. The national baseline survey for the study was conducted between June 2011 and March 2012 and involved 17 708 respondents. CHARLS respondents are followed every 2 years, using a face-to-face computer-assisted personal interview (CAPI). Physical measurements are made at every 2-year follow-up, and blood sample collection is done once in every two follow-up periods. A pilot survey for CHARLS was conducted in two provinces of China in 2008, on 2685 individuals, who were resurveyed in 2012. To ensure the adoption of best practices and international comparability of results, CHARLS was harmonized with leading international research studies in the Health and Retirement Study (HRS) model. Requests for collaborations should be directed to Dr Yaohui Zhao (yhzhao@nsd.edu.cn). All data in CHARLS are maintained at the National School of Development of Peking University and will be accessible to researchers around the world at the study website. The 2008 pilot data for CHARLS are available at: http://charls.ccer.edu.cn/charls/. National baseline data for the study are expected to be released in January 2013.

Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31–2.23) and current smoking (PR, 2.52; 95% CI, 1.32–4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16–1.61) and current smoking (PR, 1.63; 95% CI, 1.28–2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.

BACKGROUND: In China, there have been few large prospective studies of the associations of body mass index (BMI) with overall and cause-specific mortality that have simultaneously controlled for biases that can be caused by pre-existing disease and smoking. METHODS: Prospective cohort study of 224 064 men, of whom 40 700 died during follow-up between 1990-91 and 2006. Analyses restricted to 142 214 men aged 40-79 years at baseline with no disease history and, to further reduce bias from pre-existing disease, at least 5 years of subsequent follow-up, leaving 17 800 deaths [including 4165 stroke, 1297 coronary heart disease (CHD), 3121 chronic obstructive pulmonary disease (COPD)]. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) per 5 kg/m(2) calculated within either a lower (15 to

Summary China has experienced an epidemiological transition shifting from the infectious to the chronic diseases in much shorter time than many other countries. The pace and spread of behavioural changes, including changing diets, decreased physical activity, high rates of male smoking, and other high risk behaviours, has accelerated to an unprecedented degree. As a result, the burden of chronic diseases, preventable morbidity and mortality, and associated health-care costs could now increase substantially. China already has 177 million adults with hypertension; furthermore, 303 million adults smoke, which is a third of the world's total number of smokers, and 530 million people in China are passively exposed to second-hand smoke. The prevalence of overweight people and obesity is increasing in Chinese adults and children, because of dietary changes and reduced physical activity. Emergence of chronic diseases presents special challenges for China's ongoing reform of health care, given the large numbers who require curative treatment and the narrow window of opportunity for timely prevention of disease.

Several epidemiological studies have reported on the association between body mass index (BMI) and risk of esophageal cancer, but these were mostly in Western populations where many are overweight or obese. There is little direct evidence about the relationship in China where the mean BMI is relatively low and the disease rate is high. We examined the data from a populationbased prospective study of 220,000 Chinese men aged 40–79 without a previous history of cancer (mean BMI 21.7 kg/m 2 ), which included 1,082 esophageal cancer deaths during 10 years of follow-up. Adjusted hazard ratios for death from esophageal cancer by baseline BMI category were calculated using Cox proportional hazards models. Even among men with good self-assessed health and BMI 18.5 kg/m 2 , there was a strong inverse association between BMI and death from esophageal cancer, with each 5 kg/ m 2 higher BMI associated with 25% (95%CI: 11–36%) lower esophageal cancer mortality. This inverse association persisted when analysis was restricted to men who had never smoked or when the first 5 years of follow-up were excluded. The strength of the relationship was consistent with the pooled estimate for squamous cell carcinoma of the esophagus in a meta-analysis of prospective studies (31% lower relative risk per 5 kg/m 2 higher BMI; 95% CI: 25–37%), but contrasted with that for adenocarcinoma which showed a positive association with BMI. Together, these data provide reliable evidence that in many populations low BMI is associated with an increased risk of squamous cell carcinoma of the esophagus. ' 2007 Wiley-Liss, Inc.

Objective: To assess airborne nicotine concentrations as an indicator of second-hand smoke (SHS) exposure in public places in both urban and rural areas of China. Design: Measurement of vapour-phase nicotine concentration using a common protocol in all locations. A total of 273 samplers were placed for 7 days in urban and rural areas of China, including Beijing and the capital city, and a county (rural) area of the following provinces: Sichuan (Chengdu/Mianzhu), Jiangxi (Nanchang/Anyi) and Henan (Zhengzhou/Xin’an). Setting: Samplers were placed in hospitals, secondary schools, city government buildings, train stations, restaurants and entertainment establishments (internet cafes, mahjong parlours and karaoke bars) in each location. Main outcome measure: The time-weighted average airborne concentration of nicotine (μg/m 3 ) was measured by gas chromatography. Results: Airborne nicotine was detected in 91% of the locations sampled. Beijing had the highest nicotine concentrations in most indoor environments (median 3.01 μg/m 3 ) and Chengdu had the lowest concentrations (median 0.11 μg/m 3 ). Overall, restaurants and entertainment establishments had the highest nicotine concentrations (median 2.17 and 7.48 μg/m 3 , respectively). High nicotine concentrations were also found in government buildings and in train stations. Conclusions: The data collected in this study provide evidence that SHS exposure is frequent in public places in China. Environmental nicotine concentrations in China provide evidence for implementation and enforcement of smoke-free initiatives in public places in China and indicate the need for protecting the public from exposure to SHS.

Background: Death registration systems in rural China are in a developmental stage. The Disease Surveillance Points (DSP) system provides the only nationally representative information on causes of death. In this system, there are no standard procedures or instruments for ascertaining causes of death; hence available statistics require careful evaluation before use. Aim: To assess the reliability of data from the DSP. Methods: 14 DSP sites were selected through stratified sampling, enrolling 2482 deaths registered during June–November 2002. Defined verbal autopsy (VA) procedures were used to derive underlying causes of death. κ Measures of agreement between VA and registered diagnoses were computed. VA diagnoses were used as references to compute sensitivity and positive predictive values. Finally, patterns of cause-specific discordance between the two data sources were studied. Results: κ Scores indicate only moderate agreement for chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). The results also suggest that COPD is undercounted in registration data. A significant degree of cross attribution of cause was found between the two data sources. Overall, the VA was successful in limiting deaths with ill-defined causes to Conclusions: Diagnoses based on structured symptom questionnaires in the VA approach seem plausible and reliable as compared with lay-reported diagnoses in registration data. Concerns with attribution of cause of death due to COPD, IHD and tuberculosis in registration data suggest caution in their use for research and health programme purposes. The VA methods tested in this study offer promise for implementation in the routine registration system.

The potential insensitivity to depression of translated diagnostic instruments makes it difficult to assess the relationship of depressive symptoms to suicide in non-Western cultures.Addition of culturally sensitive probes and other modifications were made to the depression section of the Chinese version of the SCID; the standard SCID probes and the expanded-probes are separately used to assess each symptom of depression, the resultant diagnoses and the overall severity of depression. This modified SCID was included in the psychological autopsy interviews with family members and, separately, close associates of 887 suicides and 721 non-suicidal decedents from 23 regions of mainland China.Compared to the standard interview, the expanded-probe method increased reported prevalence of major depressive episode among suicide decedents from 26.4% (234/887) to 40.2% (357/887) and for other deaths from 1.0% (7/721) to 2.1% (15/701). The additional 131 cases identified using the expanded-probe method had substantial social impairment and a greatly elevated risk of suicide compared to those with no depressive symptoms (OR=37.0, 95% CI=17.6-77.6). Inter-observer reliability for major depressive episode between the two independent interviews was greater for the expanded probe method (ICC=0.77 vs. 0.67, P0.001). For both interview methods there was a strong dose-response relationship between suicide risk and the number and severity of depressive symptoms.This study uses proxy informants to obtain information about the psychological status of deceased subjects; the value of this expanded-probe method for the diagnosis of depression in non-Western cultures needs to be confirmed with living subjects.Adding culture-appropriate probes about depressive symptoms to standardized diagnostic instruments identifies many Chinese subjects with unrecognized depression. Dimensional measures of depressive symptoms are more powerful predictors of suicide risk than categorical diagnoses.

The paper summarized briefly the evidences for tobacco use as a cause of cancer based on hundreds of epidemiologic and biomedical studies carried out over the past 50-60 years, as well as overviewed the carcinogens in tobacco products and mechanisms of neoplasm induction by tobacco products. So, tobacco control is the important measure for cancer prevention.

The Fogarty International Center (FIC) initiative, “International Tobacco and Health Research Capacity Building Program” represents an important step in US government funding for global tobacco control. Low‐ and middle‐income countries of the world face a rising threat to public health from the rapidly escalating epidemic of tobacco use. Many are now parties to the Framework Convention on Tobacco Control (FCTC) and capacity development to meet FCTC provisions. One initial grant provided through the FIC was to the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to support capacity building and research programmes in China, Brazil, and Mexico. The initiative's capacity building effort focused on: (1) building the evidence base for tobacco control, (2) expanding the infrastructure of each country to deliver tobacco control, and (3) developing the next generation of leaders as well as encouraging networking throughout the country and with neighbouring countries. This paper describes the approach taken and the research foci, as well some of the main outcomes and some identified challenges posed by the effort. Individual research papers are in progress to provide more in‐depth reporting of study results.

Objectives To explore the variations in the mortality trends, especially death due to lung cancer, from 1990 to 2013 in Xuanwei City. Materials and methods Mortality data were collected in Xuanwei during the 2nd and 3rd National Retrospective Sampling Survey on Mortality and Routine Death Registration System (DRS) during 2011–2013. According to the result of the survey on under-reported deaths, mortality data from DRS during 2011–2013 were adjusted. Disease specific mortality rate, age-standardized mortality rate (ASMR) and 45Q15 were calculated in Xuanwei and compared with those in rural areas of China. Results During three periods, 1990–1992, 2004–2005 and 2011–2013, lung cancer contributed to 56.86%, 58.45% and 63.03% of deaths from all cancers respectively with a much higher proportion than rural areas nationally. The ASMR of lung cancer for males surged from 41.43/10 5 to 88.17/10 5 during 1990–2005 and it surged from 37.70/10 5 to 74.45/10 5 for females. Although they declined slightly during 2011–2013 (82.53/10 5 and 62.62/10 5 for males and females respectively), the ASMR of lung cancer among males in Xuanwei was three times of that in rural areas in China, and it was six times higher among females. The 45Q15 of lung cancer for males in Xuanwei was 3–5 times of that in rural areas of China and for females it was 7–9 times. The high-mortality areas of lung cancer were still located in Laibin, Longchang, Wanshui and Shuanglong Communities. High-mortality areas of lung cancer expanded to their surrounding areas and those in southeast. Conclusions Although indoor air pollution caused by smoky coal has been fairly well controlled, patterns of death due to lung cancer have not obviously changed. The mortality rate of lung cancer among females was similar to that among males. Therefore, further studies should be conducted to comprehensively explore the risk factors of lung cancer in Xuanwei.

Background: Vital registration of causes of death in China is incomplete with poor coverage of medical certification. Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) methods. A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics. Methods: Detailed medical records and clinical evidence for 3290 deaths (mostly adults) among residents of six cities representative of the urban Chinese population were reviewed by a panel of physicians and coded by experts to establish a reference underlying cause of death. Independently, families of the deceased were interviewed using a structured symptomatic questionnaire and a separate death certificate was prepared for each matching case (2102). Validity of the VA procedure was assessed using standard measurement criteria of sensitivity, specificity, and positive predictive value. Results: VA methods perform reasonably well in identifying deaths from several leading causes of adult deaths including stroke, several major cancer sites (lung, liver, stomach, oesophagus, and colorectal), and transport accidents. Sensitivity was less satisfactory in detecting deaths from several causes of major public health concern in China including ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and tuberculosis, and was particularly poor in diagnosing deaths from viral hepatitis, hypertension, and kidney diseases. Conclusions: VA is an imprecise tool for detecting leading causes of death among adults. However, much of the misclassification generally occurs within broad cause groups (e.g. CVD, respiratory diseases, and liver diseases). Moreover, compensating patterns of misclassification would appear to suggest that, in urban China at least, the method yields population-level cause-specific estimates that are reasonably reliable. These results suggest the possible utility of these methods in rural China, to back up the low coverage of medical certification of cause of death owing to poor access to health facilities there.

Research has been shown to be a critical component of successful national tobacco control programmes. China currently has a small number of dedicated researchers addressing tobacco use and control. We encourage the growth of tobacco research as an academic and governmental field of inquiry. Such research would include multiple foci: biologic and toxicologic, epidemiologic, economic, health promotion, evaluation, policy and regulatory, and legal. Developing a community of tobacco researchers would elevate the tobacco issue on the public policy agenda, encourage transparency among key stakeholders and better identify strategies of tobacco control that could be effective in the Chinese context.

Summary Background Unlike almost every other country in the world, the prevalence of both schizophrenia and suicide in China is higher in women than in men. Schizophrenia and suicide are important public-health problems for China that might be related to each other. We present prevalence data for schizophrenia and estimate relative and attributable risk of suicide in people with schizophrenia in mainland China. Methods We used data from the national psychiatric epidemiology study, the Ministry of Health's mortality registry, the census, and the national psychological autopsy study to estimate frequencies and rates of schizophrenia, suicide, and suicide in people with schizophrenia aged 15 years and older in mainland China during 1995–99. Findings We estimated 4·25 million people with schizophrenia in China, and 284 614 suicides and 28 737 suicides in people with schizophrenia yearly. Prevalence of schizophrenia was higher in women than men (relative risk 1·77 [95% CI 1·15–2·72]), and greater in urban than rural areas (1·62 [1·10–2·40]). Risk of suicide was greater in women than men (1·22 [1·20–1·23]) and in rural than urban areas (3·61 [3·56–3·66]). Relative risk of suicide in individuals with schizophrenia compared with those without was 23·8 (18·8–30·2); the proportion of all suicides attributable to schizophrenia was 9·7% (7·7–12·1). Relative risk of suicide in rural residents with schizophrenia versus those without was higher in men than in women (ratio of two relative risks 2·02 [1·13–3·63]), but in urban residents with schizophrenia the ratio was lower in men than women (0·56 [0·21–1·49]). Interpretation Risk factors for suicide vary in people with different mental disorders, so identification of illness-specific risk profiles would improve prediction of suicide and help tailor prevention efforts. The difference in suicide rates by sex and residential location in individuals with schizophrenia might be one of several contributing factors to the unique epidemiological pattern of schizophrenia in China.

Background Identifying factors that affect cotinine levels in smokers may be useful for smoking cessation programs. Our aims were to characterize the distribution of salivary cotinine levels in Chinese smokers and to investigate factors that influence cotinine concentrations. Methods In a cross-sectional study, 600 Chinese adult smokers answered a questionnaire on smoking habits and provided a saliva sample for cotinine analysis. Modification of the relation between number of cigarettes smoked and cotinine concentration by individual characteristics, smoking behavior, and type of tobacco was evaluated. Results Quadratic model provided the best fit for the relation between number of cigarettes smoked in the previous 24 hours and salivary cotinine concentration. Among those smoking up to 20 cigarettes, the median cotinine concentration was higher among younger subjects, those smoking cigarettes without filter and regular rather than light cigarettes, and those inhaling frequently and deeply. Such trends were not observed among heavier smokers. The increase in cotinine per cigarette tended to be larger in those with lower median cotinine level. Conclusions Our findings show that smoking behavior-related factors modify the relation between number of cigarettes smoked and salivary cotinine concentration. This suggests that smokers may regulate their smoking behavior to achieve a certain optimum nicotine level.

Summary Background Suicide is the fifth most important cause of death in China, but the reasons for the high rate and unique pattern of characteristics of those who kill themselves are unknown. Methods We pretested, and then administered a comprehensive interview to family members and close associates of 519 people who committed suicide and of 536 people who died from other injuries (controls) randomly selected from 23 geographically representative sites in China. Findings After adjustment for sex, age, location of residence, and research site, eight significant predictors of suicide remained in the final unconditional logistic regression model. In order of importance they were: high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behaviour, and a friend or associate with previous suicidal behaviour. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide. Interpretation Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programmes what concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors.

To assess the implementation of World Health Organization Framework Convention on Tobacco Control (WHO FCTC) by organizations in seven provinces/municipalities in China.A total of 901 organizations, including hospitals, schools, government departments, health administrative departments and public transportation facilities, were selected by multistage sampling method in five provinces and two municipalities in China, 2010 and 2012. Key informant interview and observation survey were conducted to collect data on implementation of WHO FCTC. Analysis was performed among three clusters of indexes, which were establishment of smoke-free environment, education and training on tobacco control, and tobacco cessation measures.The five types of organizations performed differently in creating smoke-free environment. The ratios of conducting complete smoke-free policy in hospitals, health administrative departments and schools were separately 83.3% (111/192), 81.6% (146/179) and 66.5% (121/182) in 2012, which were comparatively higher than those in governments (32.4%, 33/102) and public transport facilities (25.0%, 27/108) (χ(2) = 174.93, P0.01) . As for promotion and training programs of tobacco control information, the ratio of health administrative departments raised from 78.1% (150/192) to 100.0% (192/192), and the difference showed statistical significance (χ(2) = 42.00, P0.01). But those departments who provide training to social media only accounted for 11.8% (22/187), which was substantially lower than the percentage of those providing training to themselves (67.7%, 128/189) (χ(2) = 413.99, P0.01). Three indexes of tobacco cessation related work--offering help in tobacco use quitting, providing health workers with training on tobacco cessation skills and establishing tobacco cessation clinics, only reached as low as 41.1% (312/760) , 55.6% (104/187) and 45.9% (89/194), respectively. Among the seven provinces/municipalities, Shanghai did better than the others on most of the indexes. 27 out of 28 schools in Shanghai implemented complete smoke-free policy, which was the best among the seven, while only 3 out of 26 in Jiangxi, as the poorest (χ(2) = 47.63, P0.01). Meanwhile, all of the 24 schools in Shanghai had health education classes on tobacco control, followed by Zhejiang (23 out of 29), while Jiangxi was also the poorest, only 12 out of 26 (χ(2) = 17.95, P0.01).The implementation of WHO FCTC by the five types of organizations in the seven provinces/municipalities has improved to various degrees. Nevertheless, further actions should be taken to promote smoke-free environment especially in certain circumstances such as public transport facilities, to strengthen training programs of tobacco control for social media, and to enhance hospitals' abilities in providing tobacco cessation services.

Background We conducted a meta-analysis to evaluate the association between traffic-related air pollution and lung cancer in order to provide evidence for control of traffic-related air pollution. Methods Several databases were searched for relevant studies up to December 2013. The quality of articles obtained was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Statistical analysis, including pooling effective sizes and confidential intervals, was performed. Results A total of 1106 records were obtained through the database and 36 studies were included in our analysis. Among the studies included, 14 evaluated the association between ambient exposure to traffic-related air pollution and lung cancer and 22 studies involved occupational exposure to air pollution among professional drivers. Twenty-two studies were marked A level regarding quality, 13 were B level, and one was C level. Exposure to nitrogen dioxide (meta-odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.99–1.13), nitrogen oxide (meta-OR: 1.04, 95% CI: 1.01–1.07), sulfur dioxide (meta-OR: 1.03, 95% CI: 1.02–1.05), and fine particulate matter (meta-OR: 1.11, 95% CI: 1.00–1.22) were positively associated with a risk of lung cancer. Occupational exposure to air pollution among professional drivers significantly increased the incidence (meta-OR: 1.27, 95% CI: 1.19–1.36) and mortality of lung cancer (meta-OR: 1.14, 95% CI: 1.04–1.26). Conclusion Exposure to traffic-related air pollution significantly increased the risk of lung cancer.

To apply Computer Assisted Telephone Interview (CATI) in evaluation on effectiveness of non-communicable diseases control and prevention among general population.Totally 2450 permanent residents aged 15 to 69 years old were interviewed by telephone in Xicheng District and Changping District, Beijing. Telephone numbers were selected by simple random sampling. CATI was used to collect data. Focus group interview was used to interview telephone interviewers in order to analyze the reason of the midway refusal.93,524 telephone numbers were dialed. Survey efficiency, response rate and successful completion rate were 3.8%, 26.2% and 75.1%, respectively. The main cause resulting in low survey efficiency and response rate were no answer, busy, and refusal to answer at the beginning. The main cause which influenced successful completion rate was midway refusal to answer.Successful completion rate in this survey was high, so CATI is suitable for this survey. However, survey efficiency and response rate were too low. The emphasis was to reduce the proportion of no answer, busy and refusal in the beginning in order to improve the efficiency of this survey.