The Suitable Evaluation Of A Comprehensive Model For Controlling Passive Smoking In Chinese Rural Areas

IntroductionUntil recently,causal conclusions have been reached that passive smoking can cause lung cancer,CHD(Coronary heart disease) and COPD(Chronic Obstructive Pulmonary Disease) in adult non-smokers and low birth weight infants,SIDS(Sudden Infant Death Syndrome),reduction in lung function,additional episodes and increased severity of symptoms in children with asthma.China produces and consumes one third of the total number of tobacco products in the world,making it the largest producer and consumer. And then some,this makes involuntary inhalation of tobacco smoke almost unavoidable throughout the county.In 2002,the national survey found 52.9%of current non-smokers reported exposure to secondhand smoke.The level of exposure in 2002 was not significantly lower compared with that in 1996(53.6%).Secondhand smoking has become a major public health public health issue in China,there is,however,insufficient information regarding the range of exposure,the location where passive smoking is taking place,the determinants of exposure and the community intervention model,especially for Chinese rural areas.ObjectivesTo identify the current situation of passive smoking behavior and its risk factors on Chinese rural residents as well as to provide a basis for formulation of passive smoking intervention model in Chinese rural areas,a behavior epidemiological study was conducted in county town and the rural areas.Methods1.Community diagnosis11985 subjects(18-69 years old) were recruited by three-stage sampling method from six counties of three provinces to investigate the range of exposure,the location where passive smoking is taking place,the determinants of exposure.We select 3 counties(one county as the control,the other county as the intervention in each province) into our intervention study.Before conducting the intervention,we interviewed KAP(knowledge, attitude and practice) to passive smoking control from different target population and policy,organization and resources related to tobacco control.Subsequently,we implemented the intervention in the intervention counties,and have done nothing on the control counties.2.Establishment of a community based intervention model1) StrategiesThe influencing factors identified by community diagnosis were categorized at the individual,community and local government level.At the individual level,IEC (information education and communication) strategies are needed to disseminate the health consequences of secondhand smoke exposure to the public along the skills to create and maintain tobacco free areas,including the home.At the community level,a smoke free environment is created to make smoking at home and in enclosed public places unacceptable,and at the same time,drawing on government and nongovern- -mental resources,including the mass media develops local tobacco control coalitions.At the local level,government can enact laws to ban smoking in public places,particularly in hospitals and schools.2) Action planBased on the baseline level,the three counties set attainable goals,feasible activities and timetable for every activity in one year.3) Suitable Evaluation of intervention modelBase on community diagnosis,health promotion theory and activity surveillance,we use SMART to evaluate the suitability of intervention models of three counties.Results1.Results of the community diagnosis59.1%of 8142 nonsmokers reported exposure to secondhand smoke.Among passive smokers,82.2%,79.2%,40.0%,72.1%and 43.5%reported exposure at home,at work,in school,in the waiting room and in hospital,respectively.As to the knowledge,the quantitative survey found only a small portion of the respondents were aware of the health of passive smoking(19.6%).Likewise,in the qualitative research,there was an underlying uncertainty and skepticism about the real level of danger for individuals from smoking or passive smoking.As to the attitude,the quantitative study showed 96.5%respondents were in favor of banning smoking in public places,the qualitative study further explored participants' attitudes towards tobacco control.As was the case in the surveys,respondents were generally mentioned the benefits of tobacco control.However,when it come to how to carry out smoking control,smokers and nonsmokers pointed out that,as smoking was legal,addictive and influenced by social norms,currently it was almost unrealistic to expect all smokers to give up or not to smoke in the enclosed place.Furthermore,they were concerned about the potentially detrimental effects of providing counseling advice to all smokers on the interpersonal relationship among colleagues or between doctors and patients or between husband and wife.In Anyi and Xin'an,county government did not enact laws to ban smoking in public places,in Mianzhu,a law was issued in 1998 but not implemented effectively.2.Intervention model and suitability evaluationThe three counties established a comprehensive model,including developing and implementing smoking policies in public places at the local government level,IEC (information education and communication) strategies at the individual level,creating a smoke free environment and building tobacco control networks at the community level. Suitability evaluation showed there existed shortcomings in the three county intervention models.1) Developing and implementing smoking policiesIt is unattainable to advocate government to issue a smoking policy containing a penalty clause in Anyi.The three counties did not arrange or have unspecific community mobilization activities.The policy clauses not closely related to program goals was that public places referred to a narrow spectrum of enclosed areas(not including offices, meeting room and restaurants) and that setting up smoking rooms were permitted in the same space.2) IEC(information education and communication)From Smoke free Day to Festival Day,IEC activities of the three counties went through a gradual improvement process.Compared to the Smoke free Day activities,there was key information more closely related to program goals,more specific activity plan and more effective community involvement in the Festival Day activities.3) Creating a smoke free environmenta) Creating a smoke-free hospitalIn the three hospitals,only doctors were involved in developing and implementing smoking policies and policy implementation plan was not specific.The policy clauses not closely related to program goals was that in Mianzhu hospital,public places referred to a narrow spectrum of enclosed areas(not including offices,meeting room),and that in Xin'an hospital,only doctors who did comply with the smoking policy were fined.In the IEC activities,there existed inadequate information and not formed a route map of implementation of smoking policy for the patient in the three hospitals.b) Creating a smoke-free schoolIn developing and implementing smoking policies,Mianzhu and xin'an did not develop policy implementation plan,while Anyi's plans were not specific.In the IEC activities,there are obvious differences between the three schools.Since it had not only adequate information,but also made full use of media-mix strategy to enlarge the coverage of publicity,Mianzhu School became the best.c) Creating a smoke-free home and a smoke-free communityAll these county and rural community had not formed a comprehensive action plan and had some unspecific activities.4) Building local tobacco control networksThe three counties planed to build their own tobacco control networks,including county CDC,the mass media,hospitals,schools,government and non-governmental organization.Only the county TV media and the four pilot areas planed relatively more activities,the other network members were involved in 1 -2 activities on Smoke free Day or on Festival Day.ConclusionsSince exposure to secondhand smoke takes place in multiple types indoor locations in which people smoke(e.g.,homes,workplaces,schools,waiting rooms) and the personal exposure were influenced by many factors at the individual,community,and local government level,it was necessary and applicable to build a comprehensive intervention models such as developing and implementing smoking policies in public places at the local government,IEC(information education and communication) strategies at the individual level,creating a smoke free environment and building tobacco control networks at the community level.The three models should be further tested and verified,for the suitability evaluation indicated there existed many shortcomings in the three models.