Source: New York Times (NY)
Contact:  http://www.nytimes.com/
Copyright: 1998 The New York Times Company
Pubdate: Sat, 21 Nov 1998
Author: ELISABETH ROSENTHAL WITH LAWRENCE K. ALTMAN

CHINA, A LAND OF HEAVY SMOKERS, LOOKS INTO ABYSS OF FATAL ILLNESS

BEIJING-For the first time, scientists have calculated the devastating toll
of cigarette smoking in China and declared the country to be on the verge of
a calamitous epidemic of smoking-related disease that could ultimately
result in the deaths of 1 in 3 Chinese men.

In a country where 70 percent of men smoke, there are now 2,000
smoking-related deaths a day, the researchers said. That will increase to
8,000 a day by the middle of the next century unless public health measures
are taken.

"There is an unprecedented epidemic of smoking deaths," Dr. Chen Zhengming,
a Chinese researcher now based at Oxford University, told a news conference
today in Beijing. "And China is still in the early stages of the epidemic."

In two papers being published Saturday in the British Medical Journal,
researchers from China, Britain and the United States draw the outlines of
China's emerging epidemic with countless statistics.

For example: In China, middle-aged smokers are three times more likely to
get lung cancer than nonsmokers. They are twice as likely to die of
tuberculosis. Today, more than 12 percent of deaths among men are related to
smoking and that proportion is increasing.

The studies, which involved interviewing more than a million people
scattered across China, represent an impressive technical achievement-the
largest epidemiologic study ever to examine the connection between
cigarettes and death, the researchers said.

In the last two years, the Chinese Government has started to combat what was
obviously a huge smoking problem. But it is a fledgling effort in a long
battle, which primarily affects men, since very few women smoke in China.

The reports' authors, mostly doctors from China's prestigious medical
academies, hope their bleak and specific picture of the devastating effect
that cigarettes are having in their homeland will energize China's
anti-smoking campaign, much as the 1964 Surgeon General's report opened
Americans' eyes to the hazards.

In China, "Most people don't understand how dangerous smoking is," said Dr.
Yang Guanghua, an associate professor at the Chinese Academy of Preventive
Medicine and one of the papers' authors. "Over 50 percent of Chinese people
think smoking does little or no harm and over 60 percent don't know it can
lead to lung cancer."

Added Dr. Chen: "Policy makers act on evidence and until now there's been no
evidence from China." Although the rate of smoking-related deaths is still
quite a bit higher in some Western countries than in China, the studies
predict that the rate will rise quickly here. That is because
smoking-related deaths usually lag several decades or more behind the start
of the habit.

In much of China cigarettes are as much a tool of social interaction as they
are an addiction. The standard greeting between men goes like this: "Smoke?"
offering a pack in outstretched hand.

The only polite response is to take one, light up, draw and only then to
start the conversation. Those who demur are viewed as slightly odd and
lacking social graces.

Selling cigarettes is a lucrative business in China, which produces more
tobacco than any other country on earth and where the Government owns an
estimated 90 percent of tobacco companies. Cigarette companies are the
sponsors of many sports events catering to young people, from the Marlboro
Soccer League to the 555 motor cross races. "It's a problem," said Dr. Chen,
with a sigh.

Niu Shiru, another of today's authors, who is Vice Secretary General of the
Chinese Association on Smoking and Health, said: "Yes we have smoke-free
days but the young people tend to ignore it; the risks seem too distant."
Within the last few years, the Government has also organized anti-smoking
campaigns, banned most cigarette advertising and forbidden smoking in public
places. But Dr. Niu's study found that once Chinese start smoking, generally
at about age 20, few ever give up.

In the first of the two papers, Dr. Liu Boqi, of China's National Cancer
Institute, directed a team of 500 workers who fanned out across the country
to interview the families of 700,000 Chinese who had died in 1990 of cancer,
lung disease, stroke and heart disease to learn about the deceased
relative's smoking habits. They also interviewed 2 million who died of other
causes for comparison.

Overall, the researchers found that about 70 percent of the men smoked, a
number that has remained fairly stable since the 1980's. But the number of
cigarettes smoked per person has climbed sharply, from 4 a day 1970's to 10
in 1992 and to 14 in 1995, they said. By contrast, the number of women who
start smoking has declined to 1 percent from 10 percent a decade ago,
although the researchers said they were uncertain why and cautioned that
this number might again rise.

The studies found that smokers in China are more likely than nonsmokers to
die of any of a list of diseases, but those illnesses are somewhat different
than those experienced by smokers in the West. While American smokers are
most likely to die from heart attacks, the Chinese are far more likely to
die from cancer, emphysema and tuberculosis.

Smoking kills people in China "by making diseases that are already fairly
common, somewhat more so," the researchers wrote.

In the second study, Professor Niu and his colleagues interviewed a quarter
of a million randomly selected men over 40 years of age-73 percent of whom
were smokers-and the researchers now plan to follow that population for
several decades. This is the first time such an ambitious project has been
undertaken in China, though such extensive studies have been done in the
United States to learn about heart disease and breast cancer. The studies in
China were paid for in part by the National Institutes of Health in
Washington.

Dr. Richard Peto of Oxford University, probably the world's foremost expert
on designing large complicated studies on human disease, is a co-author of
both papers. He said the research constituted the largest study of the
hazards of tobacco in the world and the first in a developing country.
Similar studies are planned for other developing countries.

"China now has 340 million men under 30 who smoke," said Professor Niu. "And
their risk of death due to smoking will soon approach the epidemic
proportions we have seen in the West."

It remains to be seen what effect the new information will have in a country
where the researchers estimate that 50 percent of doctors and teachers
smoke-although the medical profession is becoming increasingly vocal on the
issue. And since few smokers in China quit, there is a great concern that
the next generation not head down the same path.

"Teen-age smoking is really a big problem and more education is needed,"
said Dr. Hu Yiji, chief of the pulmonary department at the Beijing
Children's Hospital.

Today's studies do not even deal with the health fallout of second-hand
smoke, although Dr. Hu said that his young patients certainly suffered from
its effects, in a country where families live in rather cramped living
spaces.

"Parents tend to worry about air pollution, but it's passive smoking that is
the big problem," he said.

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Checked-by: Don Beck