| BackgroudIn China there are one fourth of the world’s total smokers and tobacco consumption accounts for30%of the world’s total. China is the world’s largest tobacco producer and consumer and is also suffer most from tobacco related diseases. To curb the tobacco epidemic, the Chinese government signed the WHO Framework Convention on Tobacco Control (FCTC) in2003which came into effect since January2006. The most important part of marketing strategy of the tobacco industry, such as tobacco advertising and tobacco packaging are under the restrictions of FCTC. However, the advertising of tobacco industry has never disappeared. Point-of-purchase (POP) advertising which is regarded as the fifth largest channel in tobacco advertising ranking after newspapers, TV, magazines and broadcasting. At the same time, indirect forms of advertising as indirect advertising, promotion and sponsorship of tobacco industry still exist in daily life. In the same time, tobacco industry makes the cigarette packages as a platform to disseminate the brand image and strengthen brand loyalty among customers.There is still a long way to go in tobacco control in China.China lagged behind in implementing the FCTC with a performance score as low as37.3points. The poor performance of tobacco control in China was partly due to the interference of tobacco industry. Theme for World No Tobacco Day in2012was"Guard against tobacco industry interference with tobacco control",which focus on disclosing and countering marketing tactics from tobacco industry In recent years, tobacco industry have made efforts in seeking live space to carry out the marketing strategies. The aim of study is to explore the potential impact of tobacco advertising and tobacco packaging in China so as to provide evidence to support the comprehensive tobacco control policies which are in consistent with the principle of FCTC.ObjectiveTo understand the potential effect of tobacco advertising and packaging warnings among the public; to provide scientific evidence to establish a comprehensive ban on tobacco advertising and tobacco warning package policy in China.Method1. Direct advertising strategy-tobacco point-of-purchase (POP) advertising:Observation was conducted in seven commercial areas of Shanghai (including shopping mall、 tobacco specialty and grocery) to monitor the tobacco advertising, The number, form and distribution of tobacco advertising at the point-of-purchase were recorded. In the same time, a telephone survey was conducted to evaluate the impact among the public.2. Indirect advertising strategy-newspaper ads:13popular Shanghai newspapers were reviewed to understand the form, quantity and distribution of tobacco advertising in newspapers.3. Indirect advertising strategy-tobacco Museum:A quasi-experimental study was employed among university students before and after they visit the Chinese tobacco museum through a questionnaire survey; and in-depth qualitative analysis by focus group interviews were also conducted after the visit to explore the impact on their attitudes to tobacco industry, their knowledge about harms of tobacco use as well as their understanding to tobacco culture after the visit.4. Tobacco packaging strategy-warning packing:A cross-sectional study was applied with the combination of quantitative and qualitative methods. A questionnaire survey was conducted among community residents and different occupational groups (college students, physicians, migrant workers, parents of kindergarten). Focus group interview was conducted among college students. Both of these measures were engaged in order to compare the impact of existing tobacco warnings and graphic warnings in increasing awareness of the harms of smoking and prenventing the youth to smoke. This study also evaluated support of using graphic package warnings among the public.Results1. Zhonghua tobacco advertisements were observed in all the point-of-purchase(shopping mall、 tobacco specialty and grocery) in seven business districts including light boxes, cabinet, videos, couplets, posters. We also find Chinese pavilion model made of tobacco boxes. Zhonghua became the most well-known brand and96%of the respondents had heard of Zhonghua cigarettes. There were59.3%reporting they would choose Zhonghua tobacco as gifts to others. In all,20%of respondents knew Zhonghua tobacco advertising from tobacco point-of-purchase, ranked after television or broadcasting (36.2%) and street advertising (35.4%) in the past two years. Nearly half of smokers (47.7%) and nearly forty percent of non-smokers (37.1%) would associate "Love My China" with Zhonghua cigarettes.Tobacco industry has promulgated the tobacco brand commercially in the theme of "national spirit" and "patriotism"2. Among349mainstream newspaper pieces collected in31days, we found two kinds of tobacco advertising in13newspapers from20to29September which are around the National Day and Mid-Autumn festival. It was worth noting that a special statement from Shanghai Tobacco Group to remind consumers to be mindful when purchasing cigarettes because there were some counterfeit forms of Zhonghua and Panda brands in the market was gradually into the perspective of the media and the public. These statements were a total of11(six of them in the cover of the newspaper), accounting for1/12to1/6of the layout."Statement" repeatedly mentioned’Zhonghua’and’Panda’brand, and also announced the Shanghai Tobacco Group phone. In addition, the title, content, font color were very eye-catching, and the adjacent content were advertising, Expo news, national or international news which could easily cause the reader’s attention. We also found another report about how the tobacco companies protect workers’rights by democracy building. Although it was not an explicit advertisement and published only once, it may have improved the social image of the tobacco industry.3. The prevalence of agreement of "tobacco industry revitalizing the national economy and reflecting the spirit of self-reliance of the China" was greatly increased after visiting (P<0.05); Overall impression of the tobacco industry shift from poor to good (P<0.05). In the same time, after the visit, the proportion of supporting that "smoking is very harmful" decreased from83.1%to49.2%(P<0.05). The visitors had a obvious trend toward tobacco use after the visit, and the proportion of "not smoking in future" decreased from82.1%to75%(P<0.05).The ratio that the visitors were in favor of tar harm reduction increased from23.7%to40.7%(P<0.05). Compared to medical students, non-meidical students improved the willingness to smoke in the future significantly after visiting (P<0.05). The relationship between tobacco and culture had been strengthened, and the support ratio increased from42.4%to59.4%(P<0.05), and compared to non-medical students, meidical students improved significantly (P<0.05).4. The results of community residents and special groups were similar.67.6%community residents knew the package warnings, and smokers had higher awareness than non-smokers (P<0.05); Awareness rates of college students and medical staff were higher than those of migrant workers (P<0.05). However, even among the migrant workers, the awareness rate was as high as75.2%. The respondents had supportive attitude to graphic warnings, and the support rates of residents and special populations were76.7%and86.7%, respectively.98.2%of special populations were able to obtain tobacco hazard information from graphic warnings. Multivariate analysis indicated that smokers, medical workers and people who knew warnings were easier obtain to all hazard information from the package warnings. Both community population and special populations had highly supported that graphic warnings could contribute to the establishment of health behavior of individuals and non-smoking social norms. Graphic warnings could contribute to reduce youth smoking (78.7%), reduce people hand cigarettes to each other (72.9%) and reduce cigarettes as gifts (67.1%) among community groups. Conclusion1. Point-of-purchase advertising has been an important direct channel of tobacco advertising which includes various forms, such as cabinet, posters, videos, light boxes, couplets, cruises and artworks.The public support for legislation to prohibit all forms of tobacco advertising.2. New indirect adverting communication-"fake" statement was gradually into the perspective of the media and the public. The size of the layout, font size, font color, and adjacent content of the statement were extremely eye-catching.3. China Tobacco Museum is rather a tobacco marketing setting than the patriotism education base. The introduction of the dangers of tobacco was not enough and the data was old and misleading. A significant improvement of image of tobacco industry and decreased awareness of dangers of tobacco were detected among the visitors. The design of China Tobacco Museum made public had misunderstanding of the danger of tobacco use and stimulate youth and female smoking.4. The public generally believed that tobacco warnings of Hong Kong and Taiwan were much better than that of the existing packaging of the mainland. Graphic warnings were effective among different education levels of the public. Graphic warnings would help to establish healthy behaviors and change social norms which are essential in creating smoke-free culture. The public supported the use of graphic warnings on cigarette packets. Even among the current smokers, the support rate was more than half. People with different education background also widely support the application of graphic warnings on the package. |
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