Smoking a 'chronic disease'

Clinics struggle to help nation stub out habit

Smoking cessation clinics are struggling to stay in business on the Chinese mainland, as more than 300 million smokers continue to light up, health experts said.

Professor Xiao Dan, who oversees the smoking cessation clinic at Beijing Chaoyang Hospital, wants people to know that smoking is a chronic disease that needs professional medical intervention.

A community doctor explains to residents the harms of smoking by showing them nicotine dissolved in water in Weifang, Shandong province, on Thursday. ZHANG CHI / FOR CHINA DAILY

The clinic where she works is open Monday to Friday and receives nearly three to four patients a day, compared with several hundred in the hospital's other units, she said.

Established in 1996, the clinic was among the first on the mainland to provide medical treatment for smoking, offering both drug prescription and behavioral therapy.

"Due to a lack of financial support from the government, and low public awareness, nearly all clinics have been struggling to stay open for at least a decade," Xiao said.

Most of her patients are men aged 30 to 40, but in recent years she has seen an increase in patients in their 20s.

Compared with middle-aged smokers, Xiao said fewer younger patients have smoking-related illnesses, such as chronic obstructive pulmonary disease, and once they are aware of the health hazards caused by smoking they are likely to quit.

However, she conceded that it is hard to kick the habit, even with help from the clinic, which has a success rate of 30 percent during one year.

"To quit smoking requires both professional treatment and perseverance," Xiao said. "As American writer Mark Twain once said, ‘It's easy to quit smoking. I've done it hundreds of times.'"

A chain-smoking office clerk surnamed Du is a former patient of the clinic and said he found the treatment helpful but stopped going because of the cost.

His treatment included drug therapy at a cost of nearly 1,000 yuan ($163) a month and frequent consultations, which are not covered by any health insurance programs.

"The appointment fee was just 4 yuan and each consultation lasted at least a half hour," Du said.

Wu Wei, a doctor at the smoking cessation clinic at Taiyuan People's Hospital in Shanxi province, said consultations sometimes run longer for patients with smoking-related complications.

The clinic where he works treats no more than three patients a day, despite offering free consultations. Most patients are men aged 35 to 45.

According to Wu, the first month is the most difficult. About 70 percent of the clinic's patients could quit successfully after the first month, but only a small number of patients stay with the therapy and away from smoking, he said.

"We could be closing at any time," Wu said, adding that the cost of medicine is up to at least 500 yuan a month, which is expensive and not covered by medical insurance.

In fact, from 1996, when the first clinic opened in Beijing, to 2007, the number of clinics dropped from 22 to only three.

That number increased to seven in 2008 when Beijing launched a citywide anti-smoking campaign before the start of the Olympic Games, and in the following year the total reached 19 due to calls from health authorities.

However, the increase failed to attract patients, and some hospitals silently gave up services.

"It's hard for us to get financial support, and many hospitals let us go under the economic pressure," said Xiao at Beijing Chaoyang Hospital, adding that in most developed countries, the government contributes to smoking cessation clinics in their health budget.

Yang Gonghuan, deputy director of the China Association on Tobacco Control, an NGO, said cessation clinics need a support system in China, where most people do not consider smoking to be a medical condition.

She suggested setting up telephone help lines to raise public awareness.

"It's also important to integrate cessation services into routine medical care practices, particularly at community clinics where people go frequently for minor conditions," she said.

Beijing has implemented a smoking intervention plan this year. The city health authority organized an on-the-job training for community hospital medics to build a grassroots medical institution-based smoking cessation network.

Community doctors, usually general practitioners, have to ask patients whether they smoke or not and inform them of the health hazards.

"That could help refer willing smokers to professional cessation doctors at large hospitals," Yang said.

To better guide clinical practice, the National Health and Family Planning Commission issued guidelines for clinical smoking cessation last year. In May 2011, the top health authority also published an notice banning smoking indoors at all medical institutions and health administration buildings on the mainland.