Epidemiology & Intervention Research for Tobacco Control in China

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DESCRIPTION (provided by applicant): China is a particularly critical country for global tobacco control. It has the world's largest number of smokers, approximately 350 million, and the immense market afforded by the 60% of men who smoke and the 95% of women who do not smoke represents a prize target for the multinational tobacco companies. China has ratified the Framework Convention for Tobacco Control (FCTC) and now needs to implement its provisions across a large and diverse population. This application builds on a 10-year collaboration with investigators in China, including Dr. Gong-Huan Yang, now Deputy Director of the China CDC. It extends formative work carried out over the last five years with support from the Fogarty International Center. In this application, we propose a program of evidence-based interventions to be implemented at the province and local levels with the overall objective of developing an approach for dissemination and implementation across China. The study aims to improve the Strength of Tobacco Control (SOTC) at the province level in China by improving capacity in program effectiveness, using resources of the China CDC and Peking Union Medical College. Capacity building activities will be undertaken using distance-based approaches and an intervention study will be conducted involving 10 provinces, five participating in a China CDC-led initiative and five continuing with the approaches generally in place. A systematic mix of approaches will be implemented based on experiences from our work in China and from the American Stop Smoking Intervention Study for Cancer Prevention (ASSIST). In the intervention provinces, the China CDC will team with the province-level CDCs to assess capacity for tobacco control and the current status of tobacco control. This systematic characterization will highlight resource, infrastructure, capacity and program needs. The intervention program will then be developed, based on the SOTC assessment and the evidence already gathered in our current Fogarty International Center funding cycle. With this evidence-based approach, the provincial CDCs should be able to identify the optimum mix of tobacco control programs and policies for its residents. The interventions will address both urban and rural locations, as the majority of Chinese population still live in rural areas. A three-year intervention phase will be followed by an evaluation. We have the overall objective of preparing the China CDC to disseminate and implement a proven approach to tobacco control across all provinces.