Smoke Free World Expo ： Decision- making, Advocating and Evaluation Zheng Pinpin School of Public Health, Fudan University

Background It is an effective strategy to advocate smoke free concept through developing f large-scale smoke free activities WHO declared that it is a feasible way to enforce smoke free policy and create smoke free environment in the large- scale events through media campaign.

Background 2010 Shanghai World Expo is marked as the first World Expo since the enforcement of FCTC.

Shanghai Healthy City Action Plan （ ） issued in 2009, smoking-control in all public places was advocated which was combined with smoke free World Expo. in 2009, Shanghai World Exposition Coordination Bureau sent back 200 Million RMB donation from the Shanghai Tobacco industry Shanghai People’s Congress passed the “Smoking Control Regulation in Public Places of Shanghai” in Dec, This regulation lays a foundation for “Smoke-Free Expo” enforcement. Opportunity

Challenge （ 1 ） What is smoke free World Expo ？ （ 2 ） Will it work? （ 3 ） How to put it into practice?

Implementation standards Referenced to “Implementation proposal on the large-scale of tobacco-free and smoke-free events” proposed by World Health Organization, Shanghai Health Promotion Committee brought forward the standards of smoke-free Expo and tobacco-free pavilions, which translated the concept of smoke free Expo into manipulable and specific criteria.

Smoke free World Expo standards % smoke free environment: Smoking is prohibited in any indoor places (including any space where has ceiling or wall in one side or more of the room) 2. Prohibiting all kinds of tobacco advertising, promotion and sponsorship 3.Tobacco products or tobacco substitutes, lighters cannot be sold within the Expo area. 4. Prohibiting the use of Expo logo in any tobacco related products. 5. Having no relationship with tobacco industry (including but not limited to sponsorship, donations)

Smoke free pavilion standards 1. Smoking free within pavilions 2. Selling tobacco products is prohibited 3. Any form of tobacco advertising, promotion and sponsorship is prohibited 4. Lighters, matches and fire are prohibited in all areas except special needs

Collecting local evidences and making evidence-based public health decision 1. Is it practical to hold a smoke free Expo? 1) How supportive towards Smoke-Free Expo among Shanghai residents? 2) How supportive towards Smoke-Free Expo among foreign visitors? 2. How can the smoke free Expo be achieved? 1) Should all restaurants in Expo-park be smoke-free? 2). How to set up smoking areas in Expo-park? Are indoor smoking zones effective to control smoking in Expo-park?.

Study 1 Opinion poll towards Smoke Free Expo among the Shanghai residents Study 2 Opinion poll among the hotel guests Study 3 The survey about the current status of SHS among the working populations Study 4 Secondhand smoke exposure among restaurant customers and their attitude to smoke free restaurant during Expo in Shanghai

Major research results Recognition of the harms of secondhand smoke amongst Shanghai residents is high, same as the support for smoke-free Expo. Smoke-free Expo can help improve Shanghai’s image and earn reputation from foreign tourists. In the workforce, restaurant and bar workers are the most exposed to secondhand smoke. Cutomers widely support the idea of smoke-free restaurants. Smoke-free policies should not affect a restaurant’s income based on the analysis of consume intention and actual expense. Neither ventilation nor separating zones can eliminate the impact of SHS and 100% smoke-free environments is the only effective method. All indoor places must be smoke free in the Expo.

Advocate from multi- angel to increase public support In total there were 30 original reports which reproduced for hundreds of times. Before the World Expo, the media focused on reporting the support to the smoke free Expo among residents and popularized the concept of smoke free Expo. After the World Expo opened, the media reported on the phase evaluation of smoking control status in the Expo area.

Series of activities

Observation results Observation was done within a total of 155 pavilions and it was found that no one smoking indoor. Moreover, there was no tobacco display, introduction or tobacco advertising of any form inside all the pavilions except for Cuba, Zimbabwe and Nicaragua Pavilion due to their special needs for exhibition. Smoking customers account for 1/1000 of the total customers in the restaurants. No cigarette butts, cigarette smoke, smokers, tobacco advertising or sale in any of the shops. During the total 810 minutes of observing time in out door areas, smokers accounted for 4.5% of total visitors, which is lower than that of other outdoor public areas outside Expo area.

Result of questionnaire for tourists 3022 questionnaires from tourists were gathered which included 42.8% females. The average age was 30.3 years old. 17.6% of them were current smokers. Tourists’ awareness of smoke free Expo in different months

Tourists' attitude towards smoke free Expo JulyAugustSeptemberOctoberTotal Smoke free Expo improves the tobacco control consciousness of people Smoke free Expo promotes the civilization process Every visitor should obey the smoking control regulation in the Expo Every visitor should dissuade smoking behavior Smoking freely in the Expo damages the image of Chinese people

Tourists support smoke free Expo 92.5% of the tourists support smoke free Expo policy; 53.4% of them think it greatly-controlled ， 43.7% think it well-controlled People generally agreed that Expo raised the smoke free concept of the public (91%), Smoke-free World Expo promoted the process of civilization in Shanghai(90.3%); Complying with smoking regulation in the Expo is the obligation of each visitor (96.6%), everyone has the responsibility to discourage smokers (76.6%)

In Oct ， WHO carried out on spot survey in Shanghai and declared that it achieved smoke free goal. Shanghai Expo became first smoke free World Expo in history. Smoke free Expo witnessed the theme of Shanghai Expo as "Better City, Better Life”,enhanced confidence of international society to China in implementation of FCTC, and showed the public support to smoke-free concept.