China is in the grip of a tobacco epidemic that is set to kill millions of smokers in the coming decades.

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An international study, published in the Journal of the American Medical Association, shows smoking is on the rise and people are taking up the habit at an earlier age.

It also reveals a startling level of ignorance among smokers about the associated health risks.

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The authors of the report, which confirms previous research, have called for a crackdown on tobacco sales and advertising in an effort to stem the trend.

China, the world's largest tobacco producer, is also its biggest consumer - more than 300 million men and 20 million women smoke.

Many Chinese are ignorant of the health risks

Using mortality patterns established in other countries, the research team predict there may be two million smoking-related deaths a year in 20 years's time.

"That's an extraordinary number," said one of the report's authors, Dr Jonathan Samet of Johns Hopkins School of Public Health in the United States.

"The projections made using what we know about health risks of smoking say that about 50 million of the Chinese smokers who're alive now will die prematurely," he said.

Yet many are unaware of health risks and therefore see no reason to quit smoking, or not to take it up in the first place.

The survey, a joint effort by Chinese and American scientists, found that less than half of the Chinese smokers surveyed knew of the links between cigarettes and cancer.

Dr Jonathan Samet: "They need to be persuaded that stopping is good"

Only one in 20 was aware of the connection between smoking and chronic heart disease.

"In China, unlike let's say the United Kingdom, the smokers don't say they want to stop. So they need to be persuaded that stopping is good and then they need to be helped to stop."

And with more teenagers smoking, and taking up the habit at an earlier age, the report has called for swift and vigorous action.

Tax hike

Dr Samet urged China to follow the example of Western countries, which means raising tax on cigarettes.

"Very clear warning labels, advertising bans, educational programmes in schools - these all need to be put in place.

"We know from experiences around the world that higher taxes reduce smoking. So any approach needs to be multi-faceted."

Campaigns need to be targeted at all age groups, since quitting tobacco lowers the related health risks whatever the person's age, he said.