Tobacco and Public Health - TCSC Indonesia

(57%) was higher than in males (45%). The highest prevalence of exposure to ETS was
in women in the reproductive age range, up to 60%, with higher exposure in younger
groups than in older age groups. The majority of passive smokers were exposed to ETS
every day, with 71.2% reporting exposure at home, 25.0% reporting ETS exposure in
their work environments, and 32.5% in public places (multiple choices offered)
(Chinese Academy of Preventive Medicine 1996). The level was higher compared with
that in other countries, such as the United States (37% in men and women over 18 years
in 1993, and 31% in 1997) (Yang et al. 1999).
ETS exposure in children is strongly associated with a number of adverse effects, particularly
involving the respiratory tract. The vast majority of children exposed to
tobacco smoke do not choose to be exposed. Children’s exposure is involuntary, arising
from smoking, mainly by adults, in places where children live, work, and play.
Unfortunately there were a few reports on ETS exposure in Chinese children. A survey
on distribution, frequency, and intensity of asthma was carried out among 71 867 subjects
in six areas of Guangdong province. The overall prevalence rate was 0.94%. The
group with high prevalence of asthma focused on children less than 7 years old. Among
patients with asthma frequent exposure to side-stream smoke was reported by 54.7%
(Tang et al. 2000). A cross-sectional survey on 1449 never-smoking pregnant women
who made their first prenatal visit to the Women and Children’s Hospital of
Guangzhou, China during 1996–97, found that 60.2% (95% Confidence Interval
57.7–62.7%) of the never-smoking pregnant women had a husband who currently
smoked. Women with smoking husbands (n = 872) were more exposed to ETS than
those with non-smoking husbands (n = 577) at home (71% vs. 33%), in public places
(77% vs. 66%), and at work (60% vs. 50% of working women), and they took less action
against passive smoking in public places (Loke et al. 2000). In general passive smoking
is an important public health problem in China, especially in women and children.
Summary
The present situation of tobacco use in China is alarming from a public health perspective.
On the one hand, tobacco use is on the increase in China while it is decreasing
steadily in most of the developed countries. On the other hand, smoking rates among
women may be relatively low at present, but it is most likely to go up when big international
tobacco companies swarm into China when China enters the World Trade
Organization. The big international tobacco companies will undoubtedly target
Chinese women and adolescents. This situation requires strategic efforts to reduce
tobacco use among men and control the possible increase among women and youth.
The hazards of tobacco use
YANG HONGHUAN 223
The most useful epidemiological studies for assessing the health risks of tobacco were
cohort studies initiated in the 1950s, 1960s, and 1970s, with follow-up mortality analyses
pertaining to this period as well (Peto et al. 1994). In the USA, UK, and Canada,