China is becoming a smoker’s paradise—and a doctor’s nightmare.

Cigarettes are an increasingly gendered health risk in China, according to a new study that reports 68% of Chinese men smoke, compared to just 3.2% of women.

The study of male and female smoking trends, published in medical journal The Lancet on Oct. 8, doesn’t mince words when it comes to health risks. The authors conclude that smoking will cause roughly one in five adult male deaths in China during the current decade. And the fatality rate will rise steadily without preventative action.

“About two-thirds of young Chinese men become cigarette smokers, and most start before they are 20. Unless they stop, about half of them will eventually be killed by their habit,” study co-author Zhengming Chen from the University of Oxford wrote in a statement.

The report, which studied a total of 730,000 people in China, warned that tobacco caused about one million deaths in 2010. Unless smokers give up the habit en masse, the death toll will rise to two million in 2030 and three million in 2050.

A separate Lancet article on how to reduce smoking in China warned that although men are most obviously at risk, they are not the only ones affected. Young women are an attractive target to the tobacco industry, and hold “the allure of increasing sales by crafting appeals based on themes of independence, glamour, sophistication, sexuality, and social acceptance.”

The authors of that study, Jeffrey Koplan and Michael Eriksen of the Emory Global Health Institute in Atlanta, noted that while still only a relatively small percentage of total smokers, young women have increased their tobacco usage “substantially” since the 1980s.

The report also notes several political issues that make it difficult to reduce China’s fondness for tobacco:

Complicating any efforts to reduce the public health burden of tobacco is the fact that China is the world’s largest grower, manufacturer, and consumer of tobacco and has the largest workforce devoted to tobacco farming, manufacturing, and sales. Being a government monopoly, China Tobacco (the Chinese National Tobacco Corporation) provides over 7% of the Central Government’s annual revenue through both taxes and net income.

Widespread misinformation about tobacco in China is not helping public information efforts. Popular myths claim that smoking is less hazardous to Asian people and that tobacco is an “intrinsic and ancient part of Chinese culture,” according to Koplan and Eriksen.

To combat the health risk, earlier this year Beijing introduced a smoking ban in all offices, shopping malls, restaurants, bars and airports. Some four million smokers live in Beijing, smoking an average of 14.6 cigarettes per day, according to Global Times. But an earlier attempt to ban the practice in 2008 was widely ignored and it remains to be seen whether the latest ban will have an effect.