Five more Chinese cities have joined a project by Georgia State University's School of Public Health to curb smoking in a country where there are more than 300 million smokers or one-third of the world's total smokers.

Chongqing, Chengdu, Wuhan, Xian, and Xiamen have joined the school's China Tobacco Control Partnership-Tobacco Free Cities project, a continuation of an ongoing project that began with funding from the Bill and Melinda Gates Foundation. Seventeen other Chinese cities already are part of the project.

"We're working with local organizations in these cities, including the local Center for Disease Control, city health departments and other partners to train their employees to establish and enforce clean indoor air policies," Michael Eriksen, dean of the public health school, told China Daily.

"They'll be making available smoking cessation programs to help the smokers in the cities who would like to quit because smoking has become more of a hassle, less acceptable, and they're getting pressure from their spouses, etcetera," he said.

These five cities have leaders who have "shown willingness to support tobacco control efforts and where public health organizations are in a position to lead the efforts," the school said at the end of April.

The five cities were added with an $850,000 grant from drug company Pfizer, Eriksen said. Pfizer sells a smoking cessation product, but the program doesn't promote that product and isn't offered to smoking cessation clinics, Eriksen said.

"China has over 300 million smokers, and there's very little quitting that currently occurs because it's the norm for men. This is based on the experience we've had in other cities, but when you start to change the norm through local efforts, there's an increased effort and interest in quitting and that's what we're doing with these cities with the support of Pfizer," he added.

The World Health Organization (WHO) has estimated that death and health complications related to smoking will have cost China about $500 billion in the past decade.

The School of Public Health, in conjunction with China's National Health and Family Planning commission (formerly the Ministry of Health), the Chinese Center for Disease Control and Prevention, and ThinkTank Research Center for Health Development, will work with local health departments to train them on how to create smoke-free environments in restaurants, hotels, and other establishments. They will also help them educate the public on the harmful aspects of smoking, Eriksen said.

"These policies and changes in social norms will never really grab hold unless they come from the people. The government in Beijing can pass laws and make recommendations and provide guidelines, but this is the type of change that has to be embraced by individuals and communities and there really needs to be a demand for it, and that starts at the city level," he said.

"We've been working over there for six years, and people used to kind of laugh, 'You can't do anything here because it's a monopoly,'" Eriksen said. "But despite that though, there's been some really good progress both in Beijing as a city and nationally.

"Things happen quickly in China, and can happen more quickly in China than in anywhere else because it's a very dynamic country. If you set it as a priority to reduce smoking, more change can happen there than anywhere else."

China announced earlier this month that it was raising its cigarette tax to 11 percent from 5 percent to curb smoking. About two-thirds of Chinese males smoke and more than 740 million people in China are exposed to second-hand smoke, according to the Xinhua News Agency. In response to the tax hike, the WHO praised the Chinese government for its efforts, though it said that it's also important for the tax increase to be passed onto retail prices.

In June, smoking will be forbidden in indoor public spaces and on public transportation in Beijing. Fines for violating that regulation will be anywhere from 200 yuan (about $30) for individuals to 100,000 yuan for businesses. At the end of April, the government banned tobacco-related advertising in mass media and in public places.

Tobacco control efforts have led to a fall in the proportion of Beijing's population who smoke over the past six years, according to a survey released on Wednesday as the city prepares to put its toughest smoking restrictions into force.

The smoking rate among people ages 15 and above was 23.4 percent last year, 4 percentage points lower than in 2008. This means there were 4.19 million smokers in Beijing in 2014, according to the study.

amyhe@chinadailyusa.com