Effect Evaluation Of Shanghai Public Place Smoke Control Legislation In Internet Cafes

BackgroundEnvironmental tobacco smoke exposure (ETS) is also called passive smoking. Scientific evidence has unequivocally established that ETS causes death, disease and disability, which is the main contributor to indoor air pollution as well as the common health hazards at workplace. There is no safe level of exposure to tobacco smoke, and only100%smoke free environment can protect non smokers from such exposure. The Article8of WHO Framework Convention on Tobacco Control (FCTC) indicates that Parties should adopt legislation to provide universal protection from tobacco smoke in all indoor public places, indoor workplaces, and public transport. Many countries and regions have implementd smoke free policy to protect people from exposure to tobacco smoke. In the same time, the effects of such measures have been monitored and evaluated in accordance with Article8. FCTC went into effect in China on Jan9th2006formally. However, no comprehensive smoke-free policy at national level has been enforced in China till now. Shanghai Public Place Smoke Control Legislation is the first smoke free policy passed by provincial people’s congress. According to this legislation, internet cafe is the only one entertainment place in all13types of smoke free public places, which is viewed as "severely polluted area by secondhand smoke". Currently, evaluation of smoke free policy has become a common strategy in many countries and regions, and most results confirmed the positive impacts and supported extension of smoke free policy. However, effect evaluation on smoke free policy was seldom conducted in China till now. Therefore it is urgent to evaluate the effectiveness of the implementation, as well as explore influencing factors of Shanghai Smoke Control Legislation.ObjectiveThe study was aimed to evaluate the implementation effects of Shanghai Public Place Smoke Control Legislation. In addition, this study can provide some evidence on how to implement and adjust the future smoke control policy.MethodA repeated cross-sectional survey was employed through stratified sample among30internet cafes in Shanghai. One cross-sectional survey was conducted at3months before smoke control policy, and the other three were conducted after the enforcement of such policy (2months,5months and15months, respectively). Mixed evaluation methods were employed which included field observation, PM2.5monitoring, questionnaire survey among the workers and customers. The qualitative interview was also conducted before and after the implementation among the staff, to explore further information of such policy.Content1、Exposure to secondhand smoke in internet cafes before the ban. Acquire the internet cafes overall situation, especially the smoking situation through field observation. Acquire the level of ETS in internet cafes through PM2.5monitoring. Acquire the status of passive smoking among workers, and the smoking behavior among customers through questionnaire survey.2、Change of tobacco control measures and ETS level in internet cafes after the ban. Acquire the change of non smoking sign, tobacco product sale and workers’dissuasion from smoking through field observation. Acquire the change of ETS level in internet cafes through indoor and outdoor PM2.5monitoring, space measurement and smoking customers recording.3、Change of workers’ passive smoking status, knowledge and attitude towards smoke free policy. Acquire the change of workers’ exposure to secondhand smoke, knowledge about health hazards of passive smoking, attitude towards smoke free policy through questionnaire survey.4、Change of customers’ knowledge and attitude towards smoke free policy. Acquire the change of customers’ active smoking status, knowledge about health hazards of passive smoking, attitude towards smoke free policy through questionnaire survey.5、Implementation status, influencing factors and suggestions of smoke free policy in internet cafes. Acquire the implementation status of the policy, as well as the obstacles and challenges during the implementation, also the interviewees’attitude towards this policy through pre and post ban in-depth interviews.Results1、The average PM2.5difference level between indoor and outdoor air was199.61ug/m3before the ban, which was much higher than the EPA\WHO health standard (PM2.5≤65.5ug/m3). The average number of customer smokers was4.3in each setting. The percentage of exposing to passive smoking among the workers was63.9%, and the average time of exposing to passive smoking at workplaces per day was6.08. The percentage of smokers among the customers was41.5%, and the percentage of who reported "always" or "sometimes" smoked in the internet cafes among the smokers was as high as84.0%. 2、The average of PM2.5difference level between indoor and outdoor air were199.61ug/m3(3months pre-ban),78.91ug/m3(2months post-ban),147.87ug/m3(5months post-ban), and109.51ug/m3(15months post-ban). There were significant difference among PM2.5difference level in the4times measurement (P<0.01). Specially, such difference was showed in the central and suburban area (P<0.05), but not in the rural-urban area.3、The percentage of exposing to secondhand smoke among the workers were63.9%(3months pre-ban),36.1%(5months post-ban) and57.2%(15months post-ban), and the difference was statistically significant according to chi-square test(P<0.01). The self-reported average time of exposing to passive smoking at workplaces per day were6.08(±3.92)(3months pre-ban),4.23(±4.44)(5months post-ban) and6.03(±4.56)(15months post-ban), and the difference was statistically significant according to variance analysis (P<0.05). The rates of supporting to the smoke free internet cafe among workers were49.5%(3months pre-ban),75.2%(5months post-ban) and75.7%(15months post-ban), and the difference was statistically significant according to chi-square test (P<0.01). The percentage of who reported willing to dissuading customers from smoking were24.9%(3months pre-ban),79.1%(5months post-ban) and70.5%(15months post-ban), and the difference was statistically significant according to chi-square test (P<0.01).4、The percentage of who reported "always" or "sometimes" smoked in the internet cafes among the smokers were49.6%(3months pre-ban),26.4%(5months post-ban) and33.8%(15months post-ban) respectively, and the difference was statistically significant according to chi-square test(P<0.01). The rates of supporting to the smoke free internet cafe among customers were44.2%(3months pre-ban),67.1%(5months post-ban) and63.8%(15months post-ban), and the difference was statistically significant according to chi-square test (P<0.01).5、Most interviewees agreeed that the exposure to secondhand smoke in internet cafes was serious before the ban. In general, the interview showed support to smoke free internet cafes because of the health hazards of active and passive smoking. However, there were still some interviewees expressing doubts about the feasibility of smoke free policy, and concerning about the influence on income before the ban. However, at the15months post-ban, most interviewees said that the smoke free policy was feasible and effective in internet cafes, which was also helpful to improve the environment and staff’s related health symptoms to a certain degree. Therefore, almost each interviewee showed great support for this policy after the ban. Customers’ poor obedience to the policy, some conflicts between workers and customers during dissuading process, and the addiction to smoking among some customers’ were the obstacles met in practice. Some suggestions for the smoke free policy were put forward, including increase punishment of smokers, strengthen the law enforcement and enhance social propaganda, et al.Conclusion1、Exposure to secondhand smoke was serious in internet cafes before the ban. The implementation of smoke free policy had reduced the ETS level in internet cafes to some degree, although showing a fluctuation after the implementation. The effectiveness of smoke free internet cafe policy in central and suburban areas was better than that in rural-urban area. After the enforcement of smoking control policy, the passive smoke status of internet cafe staff was reduced, and the staff’s knowledge and attitudes towards smoke free policy were improved. In general, the implementation of smoke free policy in internet cafes was feasible and achieved some effectiveness, but not greatly.2、The internet cafe staff showed high support both pre and post-ban. More and more staff showed their acceptance and identification to smoke free policy with the implementation of such policy. As for the influencing factors of smoke free policy in internet cafes, three main aspects can be divided:internet cafes, law enforcement units and internet cafe customers. It is necessary to increase the staff’s responsibility, strengthen tobacco control measures and law enforcement, and enhance social propaganda. Only through combined and sustained efforts, can the smoke free internet cafe come ture.