Study Of Tobacco Control Model In Hospital Environment

Objective: Tobacco use has become one of the most serious threats to the global public health. In the world, one-third adults use tobacco, half of them will die earlier than the nonsmoker. Tobacco control has become the most urgent task for all the countries. Because of the character of the cigarette harm and prevalence, there are three professionals who have more responsibility to the tobacco control, that are doctors, teachers and public servants. In order to learn the opinion and attitude of the hospital leaders about tobacco control and medical staff's smoking status and their KAP (Knowledge, Attitude and Practices) of tobacco control, we interview the leaders of the hospitals and carry on a survey in medical staff. Based on the results, we establish the comprehensive intervention model, through using it in the hospital environments we hope that we can prevent the medical staff from smoking and encourage them participating in the work of tobacco control, and set an example for the public. Methods: We interviewed 25 presidents of 25 hospitals in Chengdu City. Based on the results of the interviews, we selected 3 hospitals (2 hospitals as control group, 1 hospital as intervention group) into our study, which have the similar tobacco control status. Before conducting the intervention, we survey the medical staff' smoking status and their attitude and behavior to smoking control in the three hospitals. Subsequently, we implemented the intervention in the intervention hospital, and have done nothing on the control hospitals. In the intervention group, we intervene hospital directors and medical staff respectively. After the intervention, the smoking behavior and KAP of tobacco control in medical staff were surveyed b y q uestionnaire. T he c oncentration o f N icotine in air w as measured before and after the intervention in intervention group. And then we use these subjective and objective indexes to evaluate the effect of the intervention model. Results: 1. Results of the interview:The total conditions of tobacco control in these 25 hospitals are poor. 20 hospitals have the regulations about tobacco control, 3 of them constitute special tobacco control rules initiatively, and other 17 hospitals constitute the rules by the requirement of the superior, and these rules only mention tobacco control in it. As to the implementation, only 2 hospitals which have special rules carry out firmly, and the directors of them are nonsmokers, think much more of tobacco control than others. This result indicate that the smoking behavior of the directors is correlated with the tobacco control condition of the hospitals. 22 hospital directors agree that the medical workers should not smoke and set an example for the public, and think that smoking behavior can damage the medical professionals' image in the patients. 76% leaders show that they would support tobacco control in their hospitals, but there are also some directors refusing to do that. As for the national or local government' tobacco control regulations, only 68% leaders know about it. All the directors give some advices to the government for tobacco control, first is that the government should strengthen legislation to prevent the public from smoking and protect the right of the non-smokers (76%); The second is that government should give more health care education to the public, making them aware of tobacco harm to the health and then give up smoking initiatively; The third is that country should cut down the dependence on the tax of tobacco, the government should indicate its attitude to restrict development of tobacco factory and to encourage them tumning into other industry. 2 Baseline survey: the current smoking rate is 49.7% in male, while that of the female was 0.2%. Surgeons and medical technicians have higher smoking rate than other professionals. As to the knowledge, most of the medical staff know that smoking is harmful to respiratory system and circulating system, but as to the relationship of smoking and cervical cancer, passive smoking and children tympanitis, only 1 ess than 5 0% gave the right answer. The difference of score between smokers and non-smokers had no statistics significance(P> 0.05), which indicated that there was no relationship between smoking status and score. Attitude: As to the term "passive smoking isn't harmful", smokers and non-smokers have different opinions, the difference between them has statistics significance, while to the item "low tar cigarette is less harmful" , more than 40% of smokers and non-smokers agree with it, there is nosignificant difference between them(P > 0.05). 87.5% non-smokers agreed using economic measures to punish smokers if they broke the tobacco control regulations, but only 68.1% of smokers agree with it, the difference between them has statistic significance. When meeting a patient smoking, more than 60% of medical staff show that they will choose "asking patients to quit smoking", but when there is a colleague smoking, only 22.5% will choose "asking him or her to quit smoking". Medical staff have a negative attitude toward their quitting smoking suggestion to the patients, less than 30% of them believed that the patients or most of patients would accept their suggestion. Tobacco control behavior: nearly 50% of them rarely inquired or even didn't inquire smoking status of patients. The first reason is that they do not think patients would follow their advices (36%), the second was that they didn't believe patients' illness was associated with smoking (33.7%). As to Nicotine Replacement Therapy (NRT), 41.2% of them even didn't hear about it and 52.7% of them never or rarely suggested patients to use it. 3 Intervention model and effects evaluation An intervention model was established, this model include two levels intervention, leader level and staff level. Through the leader level intervention, the directors' attitude to tobacco control has been changed from against to support, this change is the key factor to establish tobacco control system and enact a regulation. Through intervention, the smoking rate declined from 48.6% of pre-intervention to 42.7% of post-intervention, but the difference has no statistic significance. Analysis trend of behavior change using 5 stages theory, the result show that the smokers' position of intervention group in the stages moved to the tail obviously, while the change in the control group was not significant (p>0.05). Knowledge: The rate of right answer about smoking with impotency and gingivitis, passive smoking with tympanitis in post-intervention is higher than pre-intervention, the difference o f s core b etween p re-intervention and post-intervention i s statistic significant, while difference of the score in control group has no statistic significance. In attitudes, the difference of rate in supporting "Ask them not to smoke" when seeing patients or colleagues smoking in intervention group was statistic significant between pre-intervention and post-intervention. But there was no statistic significance in control group. As to suggestion of quitting smoking, there was no statistic significance between pre-interventionand post-intervention in intervention group. Most of them think their patients wouldn't follow their suggestion. When smokers face a no-smoking sign, 30.3% in case group show that they would not smoke again, the ratio increased to 64.6% after intervention, the difference was statistic significance between pre-intervention and post-intervention. In behavior, 51% of them in case group never or rarely inquired patients' smoking status before intervention, but the rate decreased to 35.8% after intervention (p<0.01). But in control group no statistically significant differences was observed between pre-intervention and post-intervention. 13% smokers before the intervention show that they smoked before the patients, this rate decreased to 0% after the intervention, and the rate of smokers who never smoked before patients increased to 53.1%, the difference is statistic significance (P<0.05). As to the methods of smoking cessation, 43.8% medical professionals had never heard of NRT, this figure decreased to 18.9% after intervention, the difference is statistical significant. In the control group, most of the people still do not hear of NRT before and after our study. Nicotine concentration in the air decreased obviously after the intervention (P<0.05). Conclusion: The comprehensive s tratified i ntervention m odel i n h ospital c an d ecrease the smoking rate in the medical staff, and will strengthen medical staffs tobacco control consciousness, this will accelerate the tobacco control work of the whole society.