In China, tobacco companies sponsor schools. Almost half of all male doctors smoke. And one wedding dinner ritual involves the bride lighting cigarettes for each of her male guests.

China has committed to banning smoking at public indoor venues by Jan. 9 next year, in accordance with a global anti-tobacco treaty backed by the World Health Organization. But smoking is such a way of life that China is unlikely to meet the deadline, and even the government seems resigned to failure.

"There are only some months left," said Jiang Yuan, deputy director of the National Office of Tobacco Control. "And I feel that it is extremely difficult to reach that goal...China is facing a tremendous challenge in tobacco control."

Smoking is linked to the deaths of at least 1 million people in China every year. The WHO cites a projection by Oxford University professor Sir Richard Peto that of the young Chinese men alive today, one in three will die from tobacco.

"You're talking about one in three of the Tsinghua University male graduates, one in three of the male CEOs of high-tech businesses, one in three engineers, one in three scientists, one in three policymakers and military leaders," said Dr. Sarah England, who runs the WHO's Tobacco Free Initiative in China. "It becomes a question of national interest."

Over the past several years, China has banned tobacco advertising on radio, television and newspapers and outlawed smoking in some places, such as on airplanes. During the 2008 Olympics, Beijing and other host cities in China went smoke-free.

In recent months, China banned smoking at pavilions and restaurants in the Shanghai Expo, as well as the Health Ministry's own 19-story office building in Beijing - the first central government agency to prohibit puffing indoors. Weeks ago, authorities also instructed kindergartens and elementary, secondary and vocational schools to ban smoking on campus and bar teachers from lighting up in front of students.

But health authorities are still losing the fight against a habit that has wafted into nearly every corner of society, backed by a powerful state-owned tobacco monopoly. The rate of smoking has not changed significantly, and tobacco production has actually gone up.

Earlier this year, the Chinese media buzzed with reports of a 3-year-old girl hooked on smoking. Photos posted on the Internet showed round-cheeked Xing Yawen sitting on a chair taking a drag from a cigarette.

The child's mother said Yawen started smoking possibly due to trauma after being hit by a truck in February last year. "In the past, we worked too hard and maybe we neglected her," 33-year-old Gao Shuli said by phone. "The child is too small and knows nothing, but smoking will affect her entire future."

The WHO agreement requires countries to fight smoking through measures that include raising cigarette prices and taxes, mandating health warnings on cigarette packs and banning tobacco advertising. Parties are also expected to ensure that all indoor public places, workplaces and public transport are smoke-free within five years of the treaty coming into force - which in China's case was on Jan. 9, 2006.

Parties must periodically report to one another on their efforts, and China is due to do so in January. Nearly 170 countries are signatories to the treaty, including the United States, although it has not yet ratified it.

Making public spaces smoke-free is a challenge for many countries - only 17 have policies that provide effective protection from secondhand smoke, the WHO says, including New Zealand, Colombia, the United Kingdom and Iran. In China, cigarettes are handed out as gifts to family and bribes to officials. Even in large cities like Beijing, people light up in bars and restaurants, elevators, hotel lobbies and government buildings.

Forty percent of civil servants recently surveyed in eastern Jiangsu province smoke, lighting an average of 12.4 cigarettes a day. And all but 5 percent do so at work, according to the provincial center for disease control and prevention. Meanwhile, nearly half of male doctors in China smoke, according to Jiang, who conducted a recent study in 31 provinces and cities.

"The biggest obstacle is the lack of awareness," Jiang said. "If people realize passive smoking will also cause lung cancer, will they still allow people around them to smoke?"

There is also an apparent conflict of interest: China's State Tobacco Monopoly Administration, which sets tobacco policy and enforces rules, is the same federal agency that controls the China National Tobacco Corp. - the world's largest cigarette maker.

One result of this paradox is that control efforts are piecemeal. Warnings on Chinese cigarette packages are in tiny characters and take up only a third of the design - which critics say falls short of the WHO agreement's requirements. Tobacco tax increases are absorbed by companies and never passed down to smokers.

"The tobacco industry has traditionally been central within government and really very important," said Judith Mackay, a World Lung Foundation senior policy adviser. "It's a really serious problem."

The State Tobacco Monopoly Administration did not respond to a request for comment. Mackay says its position has always focused on the possible economic impact of raising cigarette taxes, arguing that it would reduce revenue to the government and put tobacco farmers out of work.

Many experts say otherwise. Raising the tax on a pack of cigarettes by 1 yuan ($0.15) would increase the Chinese government's revenue by $17 billion and reduce the number of smokers by 3.4 million, according to a study led by Teh-wei Hu, professor emeritus in health economics at the University of California, Berkeley.

China National Tobacco Corp.'s general manager Jiang Chengkang said in January that the company made 513 billion yuan ($76 billion) in profit and taxes last year, a 12 percent increase over the previous year. Tobacco companies say school sponsorship is their way of giving back to society.

In celebration of Children's Day in June, students from an elementary school sponsored by the famous Hongta cigarette company were taken on a tour of a cigarette-rolling factory in northeastern Shenyang, according to a report on TobaccoChina Online, a website catering to the tobacco industry. Prominently displayed on the grounds of another such school is the slogan: "Talent stems from hard work, tobacco helps you become accomplished."

(Washington Post, 07/08/2010)