Evaluation Indicator System Establishment And Validation Study On The Strength Of Tobacco Control On Provincial Level

BackgroundIn recent years, as WHO "Framework Convention on Tobacco Control" took effect in more and more countries, MPOWER series policies were widely adopted in tobacco control practice activities all over the world. Lots of researches showed that comprehensive intervention model which oriented in policy promotion and supplemented by population-based intervention was the main trend in tobacco control field, and it was necessary to develop suitable evaluation strategies. The theory of ecology assessment was widely used in the evaluation of public health field, which focued on the changes of comprehensive investments such as resource,policy capacity, and associated with the directed results and long-term effects to evaluate the comprehensive effects of tobacco control.So far, the comprehensive investment in tobacco control were less considered in the evaluation of public health fields in China, and the methods that were most adopted were Delphi method and simple assignment method, which may have certain subjectivity and one-sidedness, eventually lead to uncertainty of the evaluation result. This study evaluated the strength of tobacco control on provincial level which was based on the international advanced evaluation experience and the present situation of tobacco control activities in China, tried to establish association with effect indicators of different terms to verify the applicability and feasibility of the evaluation indicators.Objective1. To explore and develop a set of reasonable comprehensive evaluation indicators, methodologies and tools, which could properly measure the strength of tobacco control on provincial level.2. To verify the applicability and feasibility of the evaluation index system, furthermore, to improve the index system and provide the basis for evaluating the change of tobacco control strength on provincial level.Method1. Through literature review and panel discussion proposing the evaluation logic model and the frame of possible index according to the evaluation strategies of domestic and international tobacco control interventions, and present situation of China’s tobacco control activities.2. Formulating evaluation indicators and developing the questionnaire and survey methodology by literature review, expert consultation, and panel discussion.3. Collecting tobacco control strength information in Shanghai, Heilongjiang, Tianjin, Zhejiang, Guangdong, Henan and Jiangxi Province, by conducting informant interview and questionnaire survey, then calculating the score of the strength of tobacco control by using the percentage assignment method.4. Verfying the correlation between the score of tobacco control strength and effect index by using the correlation analysis and multiple linear regression analysis, thus verfying the rationality of the evaluation indexes.Results1. This study developed and proposed the evaluation indicators to evaluate the strength of tobacco control from five aspects such as resource, political will, policy, capacity, and tobacco control efforts.2. The scores of tobacco control strength of project provinces showed that Shanghai got a maximum score of64.73points, followed by Zhejiang and Henan provinces,50.52and48.84respectively.3. The results of correlation analysis showed that the total score of tobacco control strength had significant association with the score of smoke-free environment creation and secondhand smoke exposure rate (p<0.05), Which policy made the greatest contribution to the effect of smoke-free environment creation(standard regression coefficient was0.713), capacity and policy contributed larger to second-hand smoke exposure rate (standard regression coefficient were0.825and0.579respectively).Conclusion1. The research evaluated the strength of tobacco control on provincal level from resource, political will, policy, capacity, and tobacco control efforts aspects, which could properly evaluate the strength of tobacco control on provincal level.2. This study tested the rationality of the tobacco control strength index system, and the results showed that the score of smoke-free environment creation and second-hand smoke exposure rate were more sensitive to changes in investment on tobacco control (correlation coefficient were0.481and-0.383, respectively).3. The order of seven provinces of the tobacco control strength from strong to weak was:Shanghai, Zhejiang, Henan, Tianjin, Heilongjiang, Guangdong and Jiangxi. Except the policy, Shanghai was stronger in political will, capacity and tobacco control efforts, and Tianjin got a maximum score in policy(51.11), most of the other provinces showed a similar level.