China's smoking burden under business as usual and two replicable proven experiences from Taiwan and Hong Kong

Background Cigarettes kill more than one million Chinese each year and the number is expected to reach three million by 2030. Total smoking attributable deaths (SADs) is expected to reach 200 million in China in 21 century under business as usual scenario. Methods Taiwan and Hong Kong's historical transitions in male smoking endemic were used as references to project China smoking attributable deaths if it follows Taiwan and Hong Kong's authentic historical scenarios from 2000 to 2015 instead of its current trend. Results Male smoking was halved from 60% in early 1980's to 28.6% in 2016 in Taiwan. Hong Kong has seen a similar 50% reduction to reach below 19%. Taiwan´s moderate policy enactment and implementation resulted in correspondingly, a flat decline before 2000 and was accelerated in line with the WHO FCTC implementation after 2005. China's daunting SDA could be largely reduced by 35 to 50% If decision makers would simply follow Hong Kong or Taiwan's proven tobacco control polices that leads to favorable declining scenarios. Conclusions Price affordability appears to be the biggest distinguishing factor. Cigarettes are still readily affordable to the public in China. The front-runner Hong Kong has implemented major tobacco control policies that have led to rapid reduction in smoking in the last few decades. Hong Kong and Taiwan´s favorable transition in smoking endemic demonstrated valuable lessons as well as a culturally comparable reference for China. Taiwan hasn't implemented fully the WHO Mpower strategies and the price of cigarette remains too affordable. Further amendment of the tobacco control law is needed to continue this favorable decline trend. Had China implemented tobacco successful tobacco control polices a significant and accelerated decline in tobacco use similar to HK and Taiwan can be reasonably be expected.