The Intervention Study On Advocacy Capacity About Tobacco Control Among Public Health Students

BackgroundIn 1964, the United States integrated more than 6000 researches and confirmed that: tobacco was harmful to health. Nowadays, Tobacco is still the single greatest preventable cause of death in the world. China is the biggest tobacco production and consumption country. Figures from the Ministry of Health show that China has an estimated 350 million smokers. Every year, about one million people die from the lung, heart, or other diseases caused by smoking. Smokers are not the only ones sickened and killed by tobacco. Second-hand smoke also has serious and often fatal health consequences. Now there are 540 million people suffered from second-hand smoking in China. Tobacco use has become one of the most serious public health problems in the world, yet plausibly preventable.How to reduce the harm of smoking to protect and promote public health has become an important high-profile issue. Several strategies have been shown to reduce tobacco use all over the world . The WHO Framework Convention on Tobacco Control (FCTC) was the first treaty negotiated under the auspices of the World Health Organization. It was entered into force on 27 February 2005. It aims to reduce the burden of disease and death caused by smoking. It prescribed for price and tax, tobacco advertisement, packaging and labeling of tobacco products, protection from exposure to smoking and so on . In August 2005, the government of China ratified the FCTC, but the move had not gone downwell.With the widely increase of tobacco's harm, one of the successful experiences to control smoking is that medical students' function as exemplars and educators for public health , and consequently should set an example by abstaining from smoking. Now most tobacco control workers are members of CDC in China. They must possess better theory and skills on advocacy capacity for tobacco control and do the job well. Public health students are future workers of CDC , also are the mothball strength of tobacco control team. Their knowledge, attitude and behavior toward tobacco control impact on the community directly. But almost all the medical schools in China are lack of professional training about tobacco control. Therefore, it is necessary to make a special anti-smoking program among public health students to enhance their sense of responsibility and mission and to build advocacy capacity for tobacco control.ObjectivesThis research based on the program of "Building advocacy capacity for tobacco control among the public health workforce in China". The objective is to find out smoking status, attitude and behavior of tobacco control among public health students, in order to evaluate effect of smoking control intervention and to lay a good foundation for other smoking control programs in China.Methods1 The questionnaire surveys were conducted to public health students.2 The method of random cluster sampling was adopted and the questionnaires were administered to public health students in 7 intervention schools and 7 control schools.3 The students' questionnaire included series variables shown in our framework, which included demographic characteristics, basic smoking situation, attitude and behavior towards tobacco control, etc.4 The advocacy behavior capacity changes toward tobacco control among students in intervention schools had been assessed by using a questionnaire between Oct 2007 and Feb 2009, respectively at the beginning, middle, and the end of the project. We also used the same questionnaire to do the survey for public health students in control universities at the beginning and the twelfth month of the project.5 Appropriate statistic methods were used according to the research objectives and data characteristics. Cronbach's alpha parameter and factor analysis were used to test the reliability and validity of the questionnaire; Simple descriptive statistical method was used to analyze the demographic data, smoking rates and so on; One-factor analysis of variance was used to explore the relationship between the tobacco control attitude and demographic characteristics; Multiple factor logistic regression model was conducted to analyze the factors influencing tobacco control behavior; Repeated measures analysis of variance was used to evaluate intervention effect of the program.Results:A total of 819 public health students were approached to participate in the study . Of those, 463 individuals were chosen from intervention schools and 356 were in control schools respectively. The number of effective questionnaire returns at the end of the program were 426 and 338 respectively.1 Of the respondents (N=764 ), 426 were from intervention schools , accounted for 55.8% and 338 were from control schools, accounted for 44.2%. Male students reached 339, accounted for 44.4% and female students reached 425, accounted for 55.6%.2 Through analyzing 764 questionnaires of public health students, we can learn the total smoking rate was 8.0% (intervention school students was 4.1%, control school students was 3.9%).The rates of smoking in male and female students were 6.5% and 1.5% respectively. Male students' rate evidently higher than female students (x~2=37.96, P＜0.01).3 By single-factor analysis, it was suggested that gender, cost, father's occupation, school and students' smoking behavior were related to students' advocacy attitude towards tobacco control.4 With analysis of Logistic Regression, it is indicated that advocacy attitude towards tobacco control, gender and mothers' educational level were the most significant factors for smoking behavior.5 With analysis of Logistic Regression, it is indicated that advocacy attitude towards tobacco control, gender, area distribution and fathers' occupation significantly affect students' advocacy behavior for tobacco control.6 After the preventing work during 1.5 year, public health students' advocacy attitude towards tobacco control has significantly improved.7 After intervention the number of students who tried to advocacy their family or friends away from smoking increased, with statistical significance. But the prevalence of smoking decreased slightly in intervention group, which did not reach the level of statistical significance.Conclusion:Compare with previous studies and base on our research we drew several conclusions:1 This is the first study assessing the advocacy attitude and behavior of public health students toward tobacco control2 By single-factor analysis ,it is indicated that gender, cost, father's occupation and students' smoking behavior significantly affect students' advocacy attitude towards tobacco control.3 With analysis of Logistic Regression, it is indicated that advocacy attitude towards tobacco control, gender, mothers' educational level and fathers' occupation these four factors significantly affect students' advocacy behavior for tobacco control.4 After intervention, public health students' attitude towards tobacco control improved obviously and the number of students who tried to advocacy their family or friends away from smoking increased. The comprehensiveness measures of the education and training of tobacco control carried out in medical schools were effective.5 This results suggests that our capacity building program is both feasible and effective. To our knowledge, this is the first study assessing the advocacy attitude and behavior of public health students toward tobacco control and providing sufficient evidence for supporting implemented tobacco control advocacy training in China public health schools.Tobacco continues to be the most significant preventable cause of death and disability in China If we are to reach the health China objectives for the year 2020, government and other agencies must support academic and research-related tobacco control training opportunities in schools of public health.6 In order to take the advantage of medical personnel to promote smoking control in China, the suggestions were offered:①Taking the advantage of school to develop health education and health promotion.②The medical students should be the promoters and transmitters of health education. So they should increase social responsibility and to be the example of smoking control for the whole society.③Combining health education and administrative intervention. Call for the leaders' attention, rules, regulations, and the public opinions to build a good environment for smoking control.④Different strategies for smoking control should be constituted by focusing on smokers and non-smokers, especially female non-smokers.