Analyzing the Diversity and Impacting Factors of Smoke-Free Legislation and Implementation in Mainland China: A Case Qualitative Research.

Introduction: Since the ratification of the Framework Convention on Tobacco Control in 2005, mainland China has experienced notable delays in implementing the Framework Convention on Tobacco Control. This study aims to examine the legislation and implementation of smoke-free laws in different cities in mainland China, with a particular focus on identifying factors that contribute to these differences.

Aims and methods: Through a literature review and policy mapping, we gathered information on the variations in smoke-free laws' legislation and implementation across mainland China. To delve deeper into the local specifics of implementation and the factors contributing to these variations, qualitative interviews were conducted with 16 key stakeholders in two selected cities. This group included former policy makers, policy experts, enforcement officers, and public venue owners.

Results: Although the revision of Healthy Cities standards advocates for the enactment of smoking bans post-2021, less than half of these cities have implemented comprehensive smoke-free laws. This phenomenon can be partly attributed to the tobacco industry's significant influence in the legislative process and to policy makers' limited understanding of smoking rooms/areas being temporary measures without setting clear end dates for transition periods. We also identified inconsistent implementation across selected cities, attributed to inadequate coordination and workforce shortages.

Conclusions: Our study reveals significant variations and delays in the adoption of smoke-free laws across different cities in mainland China. We identify key factors contributing to this disparity, underscoring the urgent need for targeted measures to address these challenges, such as setting up a coordinated department and promoting policy advocacy.

Implications: This study reveals geographical disparities in the legislative progress and enforcement effectiveness of smoke-free laws in mainland China. Persistent interference from the tobacco industry has obstructed the establishment of comprehensive smoke-free laws. Additionally, policy makers' limited awareness of the harm caused by designated smoking areas, regional economic disparities, and inadequate interdepartmental coordination have impeded effective policy implementation. These findings underscore the urgent need to set enforcement goals aligned with local economic contexts and strengthen policy dialogue to empower policy makers and stakeholders to mitigate tobacco industry influence and achieve successful implementation.