One in three young men in China could eventually be killed by smoking, researchers said Friday, warning of a “growing epidemic of premature death” caused by tobacco use here.
Conversely, it is very rare for Chinese women to smoke, and the risk of premature deaths in women due to tobacco use is low and falling, according to a study published in The Lancet medical journal.
But even that positive finding is under threat as more young women are enticed to smoke by a tobacco industry trying to portray cigarettes as “elegant” and “fashionable.”
Researchers, from Oxford University, the Chinese Academy of Medical Sciences and the Chinese Center for Disease Control estimated the number of tobacco deaths in China would rise to 2 million by 2030 and 3 million by 2050, from around 1 million in 2010.
“About two-thirds of young Chinese men become cigarette smokers in early adult life,” the study found. “Unless they stop, the present study suggests that at least half of them will eventually be killed by their habit.”
China is the world’s largest producer and consumer of tobacco products, with around 300 million smokers typically paying around $1.50 for a packet of 20. It consumes more than a third of the world’s cigarettes, and has a sixth of the global smoking death toll.
That compares to 20 percent of men in the United States and 15 percent of women, where smoking causes about one in every five deaths, according to the U.S. Centers for Disease Control and Prevention.
Business deals in China are often conducted by men in a haze of cigarette smoke, and sometimes with copious amounts of alcohol consumed. Cigarettes are commonly given as gifts to men in social or business settings. But drinking and smoking is much less socially acceptable for women.
While tobacco use has been rising among younger Chinese men, smoking rates have plummeted among women.
Whereas 10 percent of women born in the 1930s smoked, only 1 percent of women born since the 1960s did so, the study found.
"This is a cultural thing: from movies to TV shows, women who smoke are either prostitutes or hooligans, or landlords' wives," said Xu Guihua, vice president of the Chinese Association on Tobacco Control. "Chinese people look down on a woman who smokes as a bad woman. On the other hand, a man who does not smoke or drink is not a man. Smoking is a reflection of manhood."
But attitudes may be changing as increasing numbers of young , urban women perceive smoking as “cool.”
“Tobacco use by adolescent females has recently begun to increase in some parts of China,” the study said. “This underlines the danger that, as in many Western countries, social changes may well lead young Chinese women to start smoking.”
A separate study published in the International Journal of Environmental Research and Public Health this year showed the prevalence of smoking among women rose from 0.3 percent in the early 1980s to 3.3 percent in the 2000s.
That study blamed economic globalization and urbanization, as well as a deliberate effort by the tobacco industry to portray female smokers as “fashionable,” “elegant,” and “cool,” and tobacco products as useful for “cognitive work, mood regulation and weight control.”
Research shows “many Chinese females now agree that ‘smoking looks cool,’ ‘smoking is good for social networking,’ and ‘smoking makes people feel comfortable,’’ Juan Han and Xinguang Chen of the University of Florida and Huazhong University wrote. “If no specific measures are taken, the gender difference in tobacco use among Chinese adolescents could soon disappear.”
Even so, it will take decades for that to show up in mortality rates: while mortality rates among men continue to rise, the study published in the Lancet said, they will likely fall among women from around 3 percent of all deaths now to less than 1 percent by 2030.
The proportion of deaths attributed to smoking among men aged 40-79 in China has doubled from around 10 percent in the early 1990s to 20 percent today, the study found.
Of the 2010 death toll, some 840,000 were men and 130,000 women.
But smoking is not the only risk to Chinese lungs and hearts.
In a study published in August, scientists from the University of California, Berkeley estimated that about 1.6 million people in China die each year from heart, lung and stroke problems because of incredibly polluted air, especially small particles of haze. That would mean many more women currently die of smog-related illness than due to smoking.
Facing an aging population and an already overburdened healthcare system, the Chinese government has begun to wake up to the health risks and economic costs associated with smoking -- even though tobacco remains an important source of revenue.
In December 2013, the Chinese government banned officials from smoking in public or while performing official duties, while also banning the use of public funds to buy cigarettes. "That was clearly a signal that the top leadership actually expects a change," said Bernard Schwartlander, the WHO representative in China.
In June of this year , Beijing outlawed smoking in all indoor public places, including bars, restaurants and hotels. While enforcement is not absolute, the new rules have had an effect in reducing the choking clouds of smoke that used to envelop many restaurants, and a similar national law has been drafted.
The WHO estimates that PM2.5 readings of particulate matter in the air can reach 600 in a restaurant with three people smoking and 1,200 when five people are smoking. That compares to Beijing’s citywide average reading outdoors of 85.9 in 2014.
Secondhand smoke kills around 100,000 people in China every year, the WHO estimates.
Liu Liu contributed to this report.