The Importance of Research in Tobacco Control Jeffrey Koplan, MD, MPH Emory Global Health Institute- China Tobacco Control Partnership

Introduction There has been considerable success in decreasing tobacco use in western Europe, Canada, the USA, Australia and Hong Kong. Research, largely in university, government and NGO units has played a major role in driving this success.

Previous Important Research Findings - I Scientists in the US and UK established the causal link between tobacco and lung cancer in the 1950’s. Since then there have been thousands of studies linking tobacco use with dozens of diseases and bad health outcomes.

Research Findings - II The discovery and development of behavioral and pharmacologic aides to quit smoking. – Counselling – Hot lines – Medications – Nicotine replacement

Research Findings - III Determining the hazards of environmental tobacco smoke. – Has permitted strong and widespread no-smoking policies

Research Findings - IV Assessing the effects of price on cigarette smoking. – Price elasticity of -0.8 – ( 10% increase in price leads to an 8% decrease in smoking prevalence) – Biggest impact on the poor and youth

Focus and Types of Research Prevention Protection Cessation Cross-cutting – E.g. changing the social norm – Research on the industry from fields to sale of finished product.

Focus and Types of Research Surveys – e.g. KAP Cohort or population studies Intervention studies Evaluation studies Qualitative studies - e.g. focus groups Laboratory studies – smoke components, nicotine / cotinine, etc. Economic studies Public policy studies

Sites for studies Communities Industry, Businesses Schools Government offices Restaurants, hotels Etc.

Some Research Questions for China Is knowledge of and attitudes toward smoking changing – among smokers – among youth – among women? How do we best convey the dangers of smoking to poor rural populations? – What’s the most effective message? – What’s the best way to deliver it? - How do we communicate the message about the health benefits of quiting?

More Research Questions Are health warnings on packs effective? Which ones? Are there less expensive cessation aides? What is the interaction of tobacco smoke and industrial or cooking air pollution? That is price elasticity in China and can tax increases be effective? What does “smoke free” mean in practice?

Answers? Who will answer these questions? You and your colleagues and current and future students

Conclusions Research has made a major contribution to lower tobacco use in many countries. Many of the findings are undoubtedly applicable to LMIC and to China. Others may not be. To achieve successful control and do it quicker requires an active academic research agenda.

Conclusion In its absence, false paths will be taken with time, money and lives lost. As the major cause of preventable death in China, it is a topic that merits academic inquiry. This conference is meant to promote high quality academic research on tobacco use in China.