Core Viewpoint - The article discusses the slow progress of comprehensive smoke-free legislation in China, highlighting that only 24 cities, covering approximately 16% of the population, are under full smoke-free legal protection nearly 20 years after the WHO Framework Convention on Tobacco Control came into effect in China [3][4]. Group 1: Legislative Impact - Smoke-free legislation effectively reduces smoking behavior, with Beijing's adult smoking rate decreasing from 23.4% in 2015 to 19.2% in 2025, a decline of 4.2 percentage points [4]. - The implementation of the Beijing Smoking Control Regulation has led to significant health benefits, avoiding nearly 500,000 hospitalizations due to acute myocardial infarction, chronic obstructive pulmonary disease, and childhood asthma [4]. Group 2: Economic Benefits - From 2015 to 2025, the comprehensive economic benefits of the Beijing Smoking Control Regulation amounted to 125.7 billion RMB, representing 0.23% of Beijing's GDP during the same period [5]. - In 2024, the economic benefits from the regulation were approximately 11.6 billion RMB, accounting for 0.22% of Beijing's GDP for that year [5]. - The reduction in smoking-related healthcare costs is notable, with an estimated savings of 2.64 billion RMB in 2024, which is 2.5% of the total healthcare expenditure in Beijing [5]. Group 3: Enforcement Challenges - Despite stricter enforcement trends in cities with smoke-free legislation, challenges remain, including inter-departmental responsibility issues and low compliance from businesses [6]. - Public participation in smoking regulation has increased, with citizens actively reporting violations in various public spaces, contributing to heightened enforcement pressure [6]. Group 4: Long-term Mechanisms - Beijing has established a multi-departmental mechanism for handling smoking complaints, enhancing the enforcement of smoke-free regulations [7]. - In Shanghai, the Public Places Smoking Control Regulation has undergone two revisions over 15 years, achieving comprehensive indoor smoking bans and incorporating e-cigarettes into the regulations [7].

Core Points - Only 24 cities in China, covering approximately 16% of the population, are under 100% smoke-free legislative protection nearly 20 years after the WHO Framework Convention on Tobacco Control came into effect [1] - The progress of comprehensive smoke-free legislation in China has slowed down in recent years, with societal attitudes towards smoking changing faster than the legislative process [1] - Key issues such as social consensus on smoke-free legislation, economic benefits versus costs, and the potential for nationwide legislation are causing local governments to be cautious in implementing smoke-free laws [1] Legislative Impact - Beijing has implemented comprehensive local smoking regulations that align with WHO standards, showing significant social and economic benefits [1] - The smoking rate among adults aged 15 and above in Beijing decreased to 19.2% in 2025, down 4.2 percentage points since the implementation of the Beijing Smoking Control Regulation in 2015 [2] - The regulation has led to a significant reduction in secondhand smoke exposure in various indoor public places, with the largest decreases observed in bars and restaurants [2] Economic Benefits - From 2015 to 2025, the Beijing Smoking Control Regulation generated a total economic benefit of 125.7 billion RMB, accounting for 0.23% of Beijing's GDP during the same period [3] - In 2024, the regulation is estimated to contribute approximately 11.6 billion RMB to the economy, representing about 0.22% of Beijing's GDP for that year [3] - The reduction in smoking-related healthcare costs is projected to save 2.64 billion RMB in 2024, which is 2.5% of the total healthcare expenditure in Beijing [3] Enforcement Challenges - Cities with smoke-free legislation are experiencing stricter enforcement, but challenges remain, including inter-departmental coordination issues and low compliance from businesses [4] - Public participation in smoking regulation enforcement has increased, with citizens actively reporting violations in various public spaces [4] - The complexity of enforcement is heightened by the lack of awareness of local smoking regulations among transient populations in major cities like Beijing and Shanghai [5] Shanghai's Experience - Shanghai has implemented its own smoking control regulations, which have undergone multiple revisions over 15 years, now including a complete indoor smoking ban and regulations on electronic cigarettes [5] - Since the indoor smoking ban was enacted in 2017, Shanghai has seen an annual average of 2.2 million RMB in fines for violations, with a significant drop in smoking rates in designated non-smoking areas [5]

Group 1: Tobacco Control and Legislation - The WHO emphasizes the importance of comprehensive smoke-free legislation to reduce smoking rates and related socio-economic harms, advocating for 100% smoke-free environments in indoor public spaces [3][8][10] - As of now, 24 cities in China have implemented comprehensive smoke-free policies, covering approximately 16% of the population, but the target of 20% coverage by 2022 has not been met [2][8][9] - Public support for smoke-free legislation is high, with support rates reaching 96% in Beijing and around 90% in other cities, indicating a societal shift towards anti-smoking norms [9][12] Group 2: Economic Impact of Tobacco Consumption - The tobacco industry in China reported a total tax and profit of 16,008 billion yuan in 2024, a 5.0% increase year-on-year, while other sectors, such as dining, have seen growth following smoke-free legislation [12][14] - Reducing tobacco consumption can lead to increased spending in other sectors, such as education and dining, which can stimulate economic growth [12][13] - The economic burden of tobacco-related diseases in China was estimated at 15,214 billion yuan in 2018, equivalent to 1.7% of GDP, highlighting the financial impact of smoking on healthcare costs [6][12] Group 3: Challenges and Future Directions - Despite progress, achieving 100% smoke-free environments remains challenging due to resistance from the tobacco industry and the need for consistent national legislation [10][11] - The last increase in tobacco tax occurred in 2015, and there is potential for further tax increases to align with WHO recommendations, as current tax levels are below optimal [14][15] - The rise of e-cigarettes poses additional challenges, as they may increase the likelihood of tobacco use among youth, necessitating targeted public health campaigns [16]