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中国七省份对WHO《烟草控制框架公约》执行情况的评价研究
作者:张晓畅 万霞 杨功焕

摘要:

目的  从机构开展工作的角度评价中国7个省份对WHO《烟草控制框架公约》(简称《公约》)的执行情况。方法  2010年和2012年采用多阶段抽样方法,选取中国7个省份的医院、学校、政府、卫生行政部门和公共交通场所作为调查对象,共901个。采用知情人问卷调查和现场观察法了解其对《公约》的执行情况,对无烟环境创建、控烟知识传播和培训,以及戒烟相关措施实施等工作的开展情况进行比较。结果  在无烟环境创建方面,各类机构差异明显,其中医院、卫生行政部门和学校有全面无烟政策的比例较高,在2012年分别为83.3%(111/192)、81.6%(146/179)和66.5%(121/182),与政府机构(32.4%,33/102)和公共交通场所(25.0%,27/108)相比,差异有统计学意义(χ2=174.93,P<0.01)。控烟知识传播和培训方面,开展控烟宣传工作的卫生行政部门比例由2010年的78.1%(150/192)上升至2012年的100.0%(192/192)(χ2=42.00,P<0.01)。针对媒体进行控烟培训的卫生行政部门所占比例较低,仅为11.8%(22/187),低于针对卫生行政部门单位内部进行培训的比例(67.7%,128/189)(χ2=413.99,P<0.01);戒烟相关工作上,为员工提供戒烟帮助、开展戒烟技巧培训或开设戒烟门诊的被调查机构所占比例分别为41.1%(312/760)、55.6%(104/187)和45.9% (89/194)。上海市在多项指标上工作开展情况均较好,28所学校中的27所均实施了全面无烟政策,而江西26所学校中仅3所有此政策,差异有统计学意义(χ2=47.63,P<0.01)。控烟健康教育课程指标,上海24所学校全部达标,浙江29所中有23所达标,最低为江西,26所中仅12所达标,差异有统计学意义(χ2=17.95,P<0.01)。结论  中国7省份的5类机构对《公约》的执行有不同程度进展,但还需进一步推进公共交通场所等机构的无烟环境创建,加强卫生行政部门对媒体的控烟培训,以及提高医疗机构提供戒烟服务的能力。

关键词:烟草;流行病学;评价研究

Abstract:

Objective  To assess the implementation of World Health Organization Framework Convention on Tobacco Control (WHO FCTC) by organizations in seven provinces/municipalities in China.Methods  A total of 901 organizations, including hospitals, schools, government departments, health administrative departments and public transportation facilities, were selected by multistage sampling method in five provinces and two municipalities in China, 2010 and 2012. Key informant interview and observation survey were conducted to collect data on implementation of WHO FCTC. Analysis was performed among three clusters of indexes, which were establishment of smoke-free environment, education and training on tobacco control, and tobacco cessation measures.Results  The five types of organizations performed differently in creating smoke-free environment. The ratios of conducting complete smoke-free policy in hospitals, health administrative departments and schools were separately 83.3% (111/192), 81.6% (146/179) and 66.5% (121/182) in 2012, which were comparatively higher than those in governments (32.4%, 33/102) and public transport facilities (25.0%, 27/108) (χ2=174.93, P<0.01). As for promotion and training programs of tobacco control information, the ratio of health administrative departments raised from 78.1% (150/192) to 100.0% (192/192), and the difference showed statistical significance (χ2=42.00, P<0.01). But those departments who provide training to social media only accounted for 11.8% (22/187), which was substantially lower than the percentage of those providing training to themselves (67.7%, 128/189) (χ2=413.99, P<0.01). Three indexes of tobacco cessation related work--offering help in tobacco use quitting, providing health workers with training on tobacco cessation skills and establishing tobacco cessation clinics, only reached as low as 41.1% (312/760), 55.6% (104/187) and 45.9% (89/194), respectively. Among the seven provinces/municipalities, Shanghai did better than the others on most of the indexes. 27 out of 28 schools in Shanghai implemented complete smoke-free policy, which was the best among the seven, while only 3 out of 26 in Jiangxi, as the poorest (χ2=47.63, P<0.01). Meanwhile, all of the 24 schools in Shanghai had health education classes on tobacco control, followed by Zhejiang (23 out of 29), while Jiangxi was also the poorest, only 12 out of 26 (χ2=17.95, P<0.01).Conclusion  The implementation of WHO FCTC by the five types of organizations in the seven provinces/municipalities has improved to various degrees. Nevertheless, further actions should be taken to promote smoke-free environment especially in certain circumstances such as public transport facilities, to strengthen training programs of tobacco control for social media, and to enhance hospitals′ abilities in providing tobacco cessation services.

Key words: Tobacco;Epidemiology;Evaluation studies

发表日期:2014/6

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T001:表1 各地区所选调查机构分布情况(个)

    10.3760/cma.j.issn.0253-9624.2014.06.014.T001:表1 各地区所选调查机构分布情况(个)

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T002:表2 调查地区各类机构2012年室内场所无烟政策实施情况

    10.3760/cma.j.issn.0253-9624.2014.06.014.T002:表2 调查地区各类机构2012年室内场所无烟政策实施情况

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T003:表3 各类机构2010年和2012年无烟环境创建质量得分情况比较

    10.3760/cma.j.issn.0253-9624.2014.06.014.T003:表3 各类机构2010年和2012年无烟环境创建质量得分情况比较

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T004

    10.3760/cma.j.issn.0253-9624.2014.06.014.T004

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T005

    10.3760/cma.j.issn.0253-9624.2014.06.014.T005

  • 10.3760/cma.j.issn.0253-9624.2014.06.014.T006:表6 各地区戒烟工作在2010年和2012年的开展情况(%)

    10.3760/cma.j.issn.0253-9624.2014.06.014.T006:表6 各地区戒烟工作在2010年和2012年的开展情况(%)

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