Following the rollout of a booster campaign to promote immunity against COVID-19 in China, this study aimed to assess booster hesitancy among adults who were fully vaccinated with primary doses across Zhejiang Province. Firstly, the modified 5C scale developed by a German research team was assessed for reliability and validity via a pre-survey in Zhejiang Province. Then, a 30-item questionnaire was established to conduct online and offline surveys during 10 November to 15 December 2021. Demographic characteristics and information on previous vaccination experience, vaccine type of primary doses, attitudes towards booster doses and awareness of SARS-CoV-2 infection were collected. Chi-square tests, pairwise comparison and multivariate logistic regression were performed in data analysis. In total, 4039 valid questionnaires were analyzed, with booster hesitancy of 14.81%. Dissatisfaction with previous vaccination experience of primary doses (ORs = 1.771~8.025), less confidence in COVID-19 vaccines (OR = 3.511, 95%CI: 2.874~4.310), younger age compared to the elderly aged 51–60 years old (2.382, 1.274~4.545), lower education level (ORs = 1.707~2.100), weaker awareness of social responsibility of prevention and control of COVID-19 (1.587, 1.353~1.859), inconvenience of booster vaccination (1.539, 1.302~1.821), complacency regarding vaccine efficacy as well as self-health status (1.224, 1.056~1.415) and excessive trade-offs before vaccination (1.184, 1.005~1.398) were positively associated with booster hesitancy. Therefore, intelligent means should be strengthened to optimize vaccination services. More influential experts and other significant figures should be supported to promote timely evidence-based information via various media platforms to reduce public hesitancy and increase booster uptake.

Introduction: Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess...

Objective In 2018, the Chinese tobacco industry initiated the nationwide ‘civilised smoking environment’ campaign via a 5-year action plan. The goal of this study was to analyse content of reports regarding this topic as evidence to policy-makers to prevent interference from the tobacco industry. Methods A search of WiseNews, a Chinese media information service provider, for reports regarding the ‘civilised smoking environment’ between January 2018 and December 2022. Reports were coded separately by two trained researchers using a codebook developed by the team, including four sections with 19 items. Results A total of 1062 reports were included, of which 66.5% were from general media. Key themes include mention of approaches to promote the civilised smoking environment (59.8%), primarily by establishing civilised smoking areas (86.1%). A majority of reports (72.9%) disclosed key promoters of these initiatives, including the Tobacco Monopoly Administration (69.5%), Tobacco Corporation (52.3%) and other government agencies (20.4%). Funders were mentioned in 252 reports (23.7%), primarily the Tobacco Monopoly Administration (60.3%) and Tobacco Corporation (50.8%). Most reports (92.8%) supported these initiatives, while only 45 (4.2%) opposed it. Conclusions ‘Civilised smoking environment’ in China was promoted and financed primarily by tobacco industry and widely supported by media. This undermines smoke-free environments and violates the WHO Framework Convention on Tobacco Control. China’s government should cease its involvement in these initiatives, and government agencies should refrain from agreeing, supporting, cooperating or participating in these activities.

Objective: During 2009–2018, the Emory Global Health Institute conducted the Tobacco-Free Cities (TFC) programme in 22 cities in mainland China. This study aims to assess the sustained impact of the TFC programme. Design: A qualitative study using semi-structured interviews was adopted, which focused on the leadership and capacity building, city-level smoke-free policies, tobacco control activities, outcomes of tobacco control, sustainability post TFC programme and the accomplishments of tobacco control. The thematic analysis was employed for qualitative data analysis. Setting: Online in-depth personal interviews. Participants: This qualitative study recruited 17 participants from 10 cities which participated in the TFC programme (five with comprehensive and five with partial smoke-free policies). Interview participants included TFC programme leaders, TFC staff and current tobacco control staff. Results: First, TFC members reported enhanced competencies in smoke-free policy effort and leadership. Five cities with comprehensive smoke-free policies had a high degree of public support, while cities with partial bans faced barriers such as lack of leadership support and experiencing tobacco industry influence. Tobacco control activities, including media campaigns, policy enforcement, cessation programmes and monitoring activities, were sustained in almost all cities. Enhancement in smoke-free social norms, decrease in smoking rate and second-hand smoking exposure were perceived. Challenges to sustainability included reduced financial and personnel resources and weakened policy enforcement. Conclusions: The TFC programme was regarded by participants as an effective model that provided the necessary training and technical support to develop and enforce effective and sustainable tobacco control policies and initiatives at the city level in China. Future tobacco control training should focus more on developing concrete solutions for sustainability challenges.

Background: Alcohol consumption in China poses significant public health challenges. Alcohol marketing has been shown to increase public alcohol consumption, with social media platforms such as Douyin (TikTok in Mainland China) being among the main channels for alcohol marketing. Objective: This study aimed to analyze the thematic content of alcohol advertising on the Douyin platform and to explore the factors influencing the popularity of these types of advertising. Methods: Using data from the JINGDONG platform and alcohol industry reports, we identified 40 popular alcohol brands. For each brand, we located their official Douyin accounts and selected the top 20 most-liked videos posted between November 1, 2020, and November 1, 2021. In total, 659 videos from 37 brands were collected for analysis. Two trained researchers independently coded each video using a predefined codebook, which consisted of 7 sections and 20 items. Binary logistic regression was conducted with the grouping of the number of likes as the dependent variable, and the marketing strategies and warning elements of each video as independent variables. Results: Among the 659 videos analyzed, 320 (48.6%) garnered more than 1000 likes. A significant portion of the videos was direct advertisements (281/659, 42.6%) and short skits (255/659, 38.7%), with 56.0% (369/659) featuring characters engaging in drinking-related behaviors or directly consuming alcohol. Additionally, many videos highlighted brand elements (510/659, 77.4%) and extended features (161/659, 24.4%). Cultural themes were also common, with 23.2% (153/659) of the videos promoting the enjoyment of life and 6.8% (45/659) emphasizing balance in life. However, age restrictions were missing for 26.9% (177/659) of the videos, and only 1.2% (8/659) included a health warning stating that “Drinking is harmful to health.” Certain marketing strategies were significantly associated with greater video popularity, including the use of short skits (odds ratio [OR] 2.77, 95% CI 1.42‐5.41), highlighting brand elements (OR 2.96, 95% CI 1.59‐5.51), and emphasizing life balance (OR 3.44, 95% CI 1.11‐10.66). In contrast, the presence of age restrictions (OR 0.32, 95% CI 0.15‐0.67) and explicit health warnings (OR 0.06, 95% CI 0.01‐0.84) were associated with lower popularity. The period from July to September and November was the peak release period for alcohol advertisements on Douyin. Conclusions: Alcohol marketing strategies on Douyin leverage experiential, brand-driven, collaborative, and cultural marketing techniques to enhance video attractiveness and create alcogenic environments. Moreover, effective age restrictions and health warnings are largely absent. It is essential to legislate and enforce stricter alcohol marketing regulations to reduce the health risks associated with alcohol marketing.