Subnational smoke-free laws in China

INTRODUCTION: Implementing comprehensive smoke-free laws is an important part of tobacco control and has been promoted since China ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005. This study shows the predictors of adopting subnational smoke-free laws and their alignment with Article 8 of WHO FCTC. METHODS: The legislations of 125 cities from China’s top three city grades were assessed, covering the cities that have smoke-free laws. Logistic regression is applied to evaluate the characteristics of cities that adopted a smoke-free law. We also compare each smoke-free law with the WHO FCTC Article 8 requirements. RESULTS: Provincial capital cities were more likely to adopt smoke-free laws compared with other cities. Smoke-free laws vary from comprehensive to partial bans with major exemptions. Among the 21 cities that have enacted smoke-free laws, 9 cities prohibited smoking in all indoor workplaces, indoor public places (restaurants, bars, health facilities, government buildings and schools) and public transportation. More than half of the smoke-free laws still allow designated indoor smoking rooms. Smoke-free laws that clearly ban e-cigarettes in smoke-free areas have been implemented in only two cities (Nanning and Hangzhou). CONCLUSIONS: This study shows that a number of Chinese cities have taken legislative measures to protect people from exposure to tobacco smoke. It identifies signs of progress but also areas for improvement, such as the scope of smoke-free laws, imperfect implementation of such laws, and the potential omission of e-cigarettes from the legislation.