Exposure To Secondhand Smoke And Discouragement Of Smoking Among People In Some Public Venues In Qingdao,China

Objective:Non-smokers exposed to secondhand smoke(SHS)also have an increased risk of developing multiple smoking related diseases.Legislation to achieve a completely smoke-free environment is the most effective measure to protect non-smokers from the hazards of SHS,and give the public the right and obligation to discourage from smoking.Studies have found that the implementation of smoke-free policies are strongly associated with discouraging smoking behavior,that higher knowledge of tobacco hazards can have a positive impact on dissuasive behaviors,and that effective smoke-free policies are more conducive to knowledge of tobacco hazards.Accordingly,the study collected the information of SHS exposure and dissuasion from smoking of people in public venues,evaluated the SHS exposure of people since the implementation of Regulations on Tobacco Control in Qingdao in public venues,analyzed the behaviors and influencing factors of discouraging smoking,and explored the relationship between the awareness of tobacco control regulations,knowledge of tobacco hazards and discouraging smoking behavior and its potential mechanisms.To provide a scientific basis for promoting the establishment of a comprehensive smoke-free environment in public venues.Methods:According to the smoke-free places stipulated in Article 6 of the Regulations on Tobacco Control of Qingdao City,the study adopted the typical sampling method,selected some typical public venues within the jurisdiction of Qingdao according to the background data for on-site observation,and the employers,employees and visitors were intercepted by questionnaires,which included general information,non-smoking conditions,tobacco control training,and tobacco control management regulations,awareness of tobacco control regulations,tobacco hazard knowledge level,anti-smoking attitude,tobacco control effect perception,dissuade smoking behavior.Airborne nicotine concentration was monitored selected from the observation venues,and saliva cotinine concentration was detected in non-smoking employees in restaurants,office buildings and leisure service establishments.SPSS 25.0 and Stata 14.0 was used for statistical analysis,the airborne nicotine concentration,saliva cotinine concentration and the dissuasive smoking behaviors were statistically described.Univariate analysis was conducted on discouraging smoking behavior,and BP neural networks were used to rank the importance of each influencing factor.Baron and Kenny’s causal steps method was used to examine the relationships between awareness of tobacco control regulations(independent variable),tobacco hazard knowledge level(mediator variable)as well as discouragingsmokingbehavior(dependentvariable).Furthermore,Karlson/Holm/Breen(KHB)method was used to evaluate the mediating effects.All models were adjusted for the potential confounders:gender,age,occupation,education level,type of venue personnel,current smoking status,anti-smoking attitude,and perceived effectiveness of tobacco control.Results:A total of 287 public venues in 8 categories were observed on-site,110 of which were monitored for airborne nicotine concentration,and 250 non-smoking employees were tested for salivary cotinine concentration.A total of 222 workers’salivary cotinine effective data were obtained.The results of airborne nicotine concentration monitoring showed that the median nicotine concentrations were,in descending order,restaurants(0.792ug/m~3),hotels(0.285ug/m~3),leisure service establishments(0.215ug/m~3),government agencies(0.150ug/m~3),office buildings(0.048ug/m~3),schools(0.005ug/m~3),and hospitals(0.005ug/m~3),with statistically significant differences(P<0.001).Among them,the airborne nicotine concentrations in public venues with total indoor and outdoor smoking bans were significantly lower than those without smoking bans(P=0.025,P=0.002).The results of saliva cotinine concentrations showed that employees in venues with indoor smoking bans were significantly lower than those without smoking bans(P<0.001).Saliva cotinine concentration of employees in venues with tobacco control management system and tobacco control training were significantly lower than those without them(P=0.012,P=0.011).A total of 1108 people in public venues were intercepted and investigated,including employees and visitors,and the rate of discouraging smoking was 44.86%.The results of univariate analysis showed that the occupation,education level,type of people in venues,current smoking status,anti-smoking attitude,perception of tobacco control effect,awareness of tobacco control regulations,and tobacco hazard knowledge level on discouraging smoking behaviors were statistically different.The results of the BP neural network model showed that tobacco hazard knowledge level ranked first in terms of the importance of the factors influencing the discouraging smoking behaviors.The results of the Baron and Kenny’s causal steps method and the KHB model showed that knowledge of tobacco hazards mediated the relationship between awareness of tobacco control regulations and discouraging smoking behavior,with a mediating effect of 1.090(95%CI:1.038～1.145,P=0.001),accounting for 25.96%of the total effect.Conclusions:(1)SHS exposure still exists in public venues in Qingdao,especially in restaurants.(2)Comprehensive smoking bans play an important role in reducing SHS exposure in public venues.(3)Measures such as tobacco control system and tobacco control training can reduce exposure to SHS among people in public venues.(4)Tobacco hazard knowledge level plays an important role in the factors influencing discouraging smoking behaviors among people in public venues.(5)Tobacco hazard knowledge level mediates the relationship between awareness of tobacco control regulations and discouraging smoking behaviors.