• Zachary C Rich and Shuiyuan Xiao.
• Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China. zachary.rich@fulbrightmail.org
• Nicotine Tob. Res. 2012 Mar 1; 14 (3): 258-63.

IntroductionChina produces and consumes more tobacco than any other country in the world and as such is at the forefront of the world tobacco epidemic. Many studies have recently emerged that directly or indirectly reference the acts of giving and sharing cigarettes as a major contributor to China's high tobacco usage. The goal of this report is to review relevant literature relating to sharing and gifting cigarettes as well as provide useful historic and cultural contexts. Important differences between the act of giving individual cigarettes and the gifting of packaged cigarettes are explored as well as explanations for how both these practices have influenced current tobacco control efforts.MethodsAvailable Chinese and English sources on gifting and sharing cigarettes in China published between 1991 and 2011 were reviewed and discussed with a cultural and historical background.ResultsThe practices of gifting and sharing cigarettes strongly contribute to smoking initiation as well as failure to quit smoking among Chinese males. Historical and cultural roots have reinforced these practices and hampered efforts to reduce tobacco use in China.ConclusionsTraditional tobacco control efforts should be combined with culture-specific approaches to reduce tobacco usage in China. The regular exchange of cigarettes normalizes smoking across society and promotes tobacco's acceptability. Great efforts should be taken not only to minimize these practices among males but also to discourage their adoption by females.

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