Most smokers in China, the world's largest tobacco consumer, have no intention of kicking the habit and remain unaware of some of its most damaging health effects, Chinese health officials and outside researchers said Wednesday.
An estimated 316 million people smoke in China, almost a quarter of the population, and concerns are growing about the long-term effects on public health and the economy.
The vast majority of smokers are men, of whom 59 percent told surveyors that they have no plans to quit, according to a decade-long study by the Chinese Center for Disease Control and Prevention and Canadian researchers with the International Tobacco Control project.
Such numbers have prompted efforts to restrict the formerly ubiquitous practice. Major cities including Beijing and Shanghai having recently moved to ban public smoking, with Shanghai's prohibition going into effect in March. In 2015, the central government approved a modest nationwide cigarette tax increase.
But Chinese and international health officials argue that more is needed, including a nationwide public smoking ban, higher cigarette taxes and more aggressive health warnings. Such actions are "critically important," Yuan Jiang, director of tobacco control for the Chinese Center for Disease Control, said in a statement released with Wednesday's study.
A public smoking ban appeared imminent last year. The government health ministry said in December that it would happen by the end of 2016, but that has yet to materialize.
"They have to figure out what's important as a health policy," said Geoffrey Fong of Canada's University of Waterloo, one of the authors of Wednesday's study. "Every third man that you pass on the street in China will die of cigarettes. ...When you have cheap cigarettes, people will smoke them."
In line with global trends, smoking rates among Chinese have fallen slowly over the past 25 years, by about 1 percent annually among men and 2.6 percent among women, according to a separate study published in April in the medical journal The Lancet.
Yet because of China's population growth — 1.37 billion people at last count — the actual number of smokers has continued to increase. Rising prosperity means cigarettes have become more affordable, while low taxes keep the cost of some brands at less than $1 a pack.
Sixty percent of Chinese smokers were unaware that cigarettes can lead to strokes and almost 40 percent weren't aware that smoking causes heart disease, according to the study, which was released on World No Tobacco Day, when the World Health Organization and others highlight health risks associated with tobacco use.
Judith Mackay, an anti-tobacco advocate based in Hong Kong, said China has made strides with the public smoking bans in some cities and a similar ban covering schools and universities, but that's not enough.
"This is the first time there has been a report looking at the overall picture of where China stands," said Mackay, senior adviser at Vital Strategies, a global health organization. "The reality is, it's falling behind."
Mackay blamed behind the scenes lobbying by China's state-owned tobacco monopoly for impeding efforts to toughen tobacco policies. The State Tobacco Monopoly Administration did not immediately respond to a request for comment.
Government agencies and research institutes in China, Canada and the United States funded the study.