Susan V. Lawrence is Head of China Programs at the Campaign for Tobacco-free Kids, a Washington, DC-based non-governmental organization that works to reduce tobacco use and its devastating health and economic consequences in the United States and around the world. She divides her time between Washington, DC and China.

The Campaign is a partner organization in the Bloomberg Initiative to Reduce Tobacco Use, launched in 2005 with funding from New York Mayor and philanthropist Michael Bloomberg. The initiative’s work is focused on low- and medium-income countries that together account for two thirds of the world’s smokers. Other partners in the initiative are the Centers for Disease Control Foundation, the Johns Hopkins University Bloomberg School of Public Health, the International Union Against Tuberculosis and Lung Disease, the World Health Organization, and the World Lung Foundation.

Before joining the Campaign for Tobacco-free Kids, Ms. Lawrence worked for 16 years as a journalist, including a cumulative 11 years between 1990 and 2003 as a staff correspondent in China. She served as China bureau chief and later Washington correspondent for the Hong Kong-based newsweekly Far Eastern Economic Review, as a Beijing-based staff correspondent for The Wall Street Journal, and as China bureau chief for the newsmagazine US News & World Report. A fluent Mandarin Chinese speaker, she holds Bachelor’s and Master’s degrees in East Asian Studies from Harvard University and was a Harvard-Yenching Institute Scholar in the History Department at Peking University from 1985-87. 

Her talk is the third in the colloquium series on tobacco control in East Asia, sponsored by the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, in coordination with FSI’s Global Tobacco Prevention Research Initiative.

The stated purpose of the Trade Act of 1974 was to promote free trade. Section 301 authorized the U.S. President to impose retaliatory trade sanctions if negotiations were unsuccessful in reducing unreasonable limits on trade. The Act was reinforced in 1984, became known as “Super 301”, and made annual assessment and retaliatory measures mandatory.

Because of trade imbalances, four emerging Asian countries gave the US firms access to cigarette markets: Japan (1987), Taiwan (1987), South Korea (1989) and Thailand (1990). These forced market opennings were called the “Second Opium War” by local protestors in these countries, challenging U.S. export of unwelcome and unhealthy products.

A sea change occurred in the decades that followed the cigarette market opening in Taiwan. Of particular interest are changes in areas marketing skills and market share; lower cigarette prices; paradoxical increased smuggling; increased youth consumption; evolution of the powerful tobacco industry lobby; and a sharp increase in tobacco-related cancer deaths. Accompanying the increased cigarette consumption, a special, unusual habit of chewing betel quid started and grew into a mainstream practice among adult males (nearly one out of four). Oral and esophageal cancer increased sharply soon after the market opened. At the same time, the patriotic protectionists, NGOs, and government galvanized an anti-smoking movement, which gradually transformed Taiwan's culture so that smoking in public is no longer socially acceptable. A new term, “de-normalization,” was coined about the favorable effect of market opening.

 The ironic outcome of Super 301 is that while the market was forced open solely by the US, in only ten years, US market share, once leading, shrunk to a distant fifth, after Japan, UK, Germany and domestic producers. The trade imbalance was little affected by the opening of the cigarette market.

Dr. Wen's colloquium continues the colloquium series on tobacco control in East Asia, sponsored by the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, in coordination with FSI’s Global Tobacco Prevention Research Initiative.

Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral?

This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions. We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology.

What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability.

A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings, which defined program success or failure, were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom.

In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.