A comparative analysis of smoke-free regulations in 23 Chinese cities, 2015-2022

China ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005 but lacks a national comprehensive smoke-free law. By 2024, 23 cities had achieved FCTC Article 8 compliance through three distinct legislative vehicles: Dedicated Tobacco Control regulations (DTC), Patriotic Health regulations (PH), and Civilization Promotion regulations (CP). This study compared their legal authority, textual scale, and FCTC-related content coverage.

Full legislative texts of all 23 FCTC-compliant city regulations, identified via the Healthy China Smoke-Free Legislation platform, were analyzed. Two coders independently extracted 16 variables (5 legislative-feature variables; 11 FCTC-related content dimensions, of which 9 were eligible for cross-vehicle comparison). Legislative scale was compared using Kruskal-Wallis H tests with exact permutation p-values and epsilon-squared effect sizes; content coverage was compared using exact chi-squared tests.

The 23 cities protect approximately 178 million residents (12.64% of China's 2023 population), below the Healthy China 2030 target of 80%. Regulations were enacted as local statutes or government rules of differing legal rank. Legislative scale differed markedly: median clause count 27.5 (DTC) versus 3.0 (PH) and 2.0 (CP); median character count 4158 (DTC) versus 319 (PH) and 88 (CP) (both p<0.001, ε²>0.76). Seven of 9 FCTC-related dimensions differed significantly across vehicles - individual violator penalty, venue-operator penalty, complaint hotline, youth cigarette sales ban, tobacco advertising ban, cessation services, and health education - with DTC showing near-complete coverage and CP concentrating on Article 8 core prohibitions.

Chinese cities implement FCTC Article 8 through legislative vehicles of differing legal rank and markedly divergent textual scope. To progress toward the 80% coverage target of Healthy China 2030, these findings support the case for comprehensive national smoke-free legislation extending protections beyond municipal-level legislative authority, ideally with graduated penalties, designated enforcement authorities, and public complaint mechanisms.