A Study On Tobacco Use Among Residents In Changning District, Shanghai

Research Background:Smoking has been generally recognized as one risk factor which can cause many diseases. Therefore tobacco control is always one of the most important tasks for the government. At the moment, the number of smokers all over the world has reached to1.3billion meanwhile around5million people died from the diseases related to smoking every year. Many researches have confirmed that smoking is the risk of many diseases such as heart cerebrovascular disease, cancer and chronic obstructive pulmonary disease. In conclusion, tobacco use has become the second global health killer just after hypertension. In the past decades, the smoking prevalence and tobacco consumption has shown the trend of decrease in developed countries while the tobacco consumption was still increased by3.4%per year in developing countries. China now has become the largest tobacco producer and consumer as well as the biggest victim of smoking related diseases. Currently, the smoking rate of males at the age of15and above is62.8%in China, with the total number of male smokers reaching to340millions. The smoking rate of female is3.1%with the total number of16.39million. More than1million people died from smoking related diseases every year in our country; this number can be doubled in future decades if there is no further efforts on tobacco control.Second-hand smoke (SHS) exposure is also very common in many countries. There are thousands chemicals such as carcinogens in second hand smoke. It has been proved that second-hand smoking is related to lung cancer, heart cerebrovascular disease and respiratory diseases. However, in recent years, the problem of SHS exposure in China is still serious. A survey in2010indicated that among all non-smokers who are15year old and above,72.4%were under the exposure of second-hand smoke; moreover,52.5%among them were exposure to second-hand smoke every day. It is estimated that in China,556million non-smoking adults have exposed second-hand smoke more than one day per week. In addition, there were269million people exposed to second-hand smoke every day. Public areas, home and work place were the common places where people were exposed to SHS,The negative effect of high smoking rate, which has lasted more than two decade among males in our country, has emerged in recent years. The mortality of smoking related diseases has been increase quickly. Meanwhile, the increasing medical expense and productivity loss caused by smoking related diseases has been in rapid growth. In order to stop the epidemic of tobacco use all over the world, Chinese government has signed "Framework Convention on Tobacco Control" in2003, which came into effect on January2006. However, although "FCTC" has been carried out in China for nearly5years, the reality of tobacco control is still far behind the requirements of Convention. The MPOWER strategy provided practical methods for tobacco control which are developed by WHO, including preventing people from the harm of second hand smoking; Offering quitting help; Warming the harm of smoking; Enforcement of comprehensive ban on tobacco advertisement, promotion and sponsorship; Raising tax for tobacco. However, the evaluation of the implementation of such strategy indicated that China ranked at the bottom among more than100contracting states. Therefore, there are still many difficulties, barriers and challenges on the process of tobacco control in China.Since1990s, Shanghai has paid more attention on tobacco control and has achieved some success on developing policy and creating smoke-free environment after all these years’ endeavour. At the same time, the effort put on tobacco control publicity has deepened resident’s understanding toward the hazards of tobacco and gradually raised their awareness of tobacco control. On the base of that, Changning puts lots of efforts on tobacco control and undertake the health promotion sub-project of China disease prevention project funded by World Bank Loans and the project of "Towards smoke-free China". Through smoking intervention, Changning intends to prevent people from second-hand smoke exposure and change unhealthy behaviour.Objective:To find out residents’smoking and passive smoking related behaviours, knowledge of health hazards of tobacco, attitude towards smoking control policies, tobacco Ads and the situation of media publicity in Changning District. It is expected that this study can provide the evidence for developing targeted intervention strategies in the future.Method:This study selected permanent residents aged between15to69years old among178neighbourhood committees in10streets (towns) in Changning District to conduct a one-on-one questionnaires by using stratified random sampling method. The information on the status of smoking, the exposure of second hand smoking, the knowledge, attitude and behaviours of health hazards of tobacco, the work of tobacco control publicity of regional media as well as tobacco advertisement were collected. Using chi-square test and unconditional Logistic analysis was conducted to find out the situation of tobacco usage of residents in Changning District and its impacting factors.Results:1. Smoking Status of Residents429residents living in Changning District were enrolled in this survey, including227males (52.9%) and202females (47.1%). The average age was44.47±14.12years old. The total smoking rate was26.1%%and the current smoking rate was24.5%,the standardized current smoking rate was22.0%. Specifically, the male smoking rate was44.5%,the standardized male smoking rate was39.3%and the female smoking rate was2.0%, the standardized female smoking rate was1.8%. There were significant differences between gender, age groups, education, and occupational groups. The male smoking rate is much higher than that in females. Smoking rates increase with age. Residents of35to65year-old had higher smoking rates. However, the smoking rate began to decline after65years old. With higher education level, smoking rate decreased gradually.Daily smoking rate was89.52%for smokers. The heavy smokers accounted for46.81%. All smokers were smoking cigarettes. The average age of smoking initiation was24.49±6.94years while average daily cigarette consumption was15.6±8.0. There were39.36%of daily smokers smoked the first cigarette in morning within one hour after waking up. The time of first cigarette smoking in early morning was significant different between light and heavy smokers.Successful smoking cessation rate was6.3%in current smokers, however, only18.1%investigators tried to quit smoking. When smokers seek medical treatment, most of the doctors asked about smoking and advised to quit, but doctor’s advice and opinion does not cause smokers’ attention to quit smoking. The proportion of current smokers who do not want to quit smoking was64.8%, and20%of smokers did not consider this issue.From the point of view of smoking behaviour,81.9%of smokers bought cigarettes themselves, and89.1%of smokers believed that the price of cigarettes did not change the past six months.73.9%of smokers believed that their own smoking behaviour would not be influenced by cigarette price.76.1%of smokers believed that cigarette price is reasonable.2. Second-hand smoke exposure of residentsExposure rate to second-hand smoke was40.43%among the participants and passive smoking rate was22.2%in324non-smokers at home. Second-hand smoke exposure rate was22.5%in workplace. For other public places, second-hand smoke exposure was highest in restaurants as66.0%. Second-hand exposure rate was49.2%and35.4%in male and female non-smokers respectively with significant difference.33.3%of those surveyed residents said they did not permit smoking in indoor area at home. And in the workplace,"smoking allowed in some indoor rooms only " was the most common situation which accounts for40.6%.3. Knowledge, behaviour and attitudes of the dangers of tobaccoThe hazards of passive smoking knowledge awareness result found that the prevalence of understanding of passive smoke can cause lung cancer was the highest as97.9%. However, the hazards of passive tobacco smoke can cause adult heart disease awareness rate is relatively low. There are significant differences in smokers and non-smokers in the behaviours as "guest with cigarettes in the past year" and "presenting cigarettes as a gift". Logistic regression results showed that male, higher monthly income were risk factors of exposure to second-hand smoke and strict home smoking ban was protective factors.There were84.4%of respondents know that smoking causes serious diseases, and the difference was significant between smokers and non-smokers; the awareness rate of " smoking causes lung cancer,"was high as85.5%. The correct rate of the question that cigarettes indicated as low tar content of are less harmful than ordinary cigarettes was the lowest as52.9%.Non-smokers showed higher support to comprehensive ban in all public places than smokers, with highest supportive rate in hospitals and relatively low supportive rate in restaurant and bar. Female respondents were more supportive than the male toward smoking ban in public places. Significant differences were found between smokers and non-smokers towards following opinions such as whether smoking room should be preserved and whether smoking should be banned in private offices.4. Media publicityThe survey on media publicity involved498interviewees showed that81.1%of the interviewees got the knowledge of tobacco control from newspaper and magazines. Other important communication channels included%TV (79.5%) and outdoor advertisement (64.1%).84.6%interviewees has seen or heard information about "no smoking in public areas" on TV or other media in the past year. However, the behaviours in favour of tobacco control such as "do not smoke in front of others" and "do not offer cigarette in social occasions" were relatively as low as50.8%and46.6%, respectively.There were20.0%smokers who used to see cigarette promotion advertisements at cigarette outlets and15.2%used to watch tobacco advertisements on TV. The sports games or competitions sponsored by tobacco industry are seldom to be found. Most common activities are delivering free cigarette samples and offering cigarette discount.Conclusion:1. Smoking rate of residents in Changning District is below average level, however, the percentage of both daily smokers and heavy smokers are high. The major smoking group are the males aged between35to65years old.2. The percentage of the smokers who attempt quitting or achieved successful cessation is low. Most smokers never consider quitting. Persuasions from medical practitioners don’t work effectively on smokers.3. Most smokers think the current price of cigarette is reasonable and rising up price will not affect their smoking behaviours.4. Currently, in Changning District, most exposure to SHS happens in public areas. Work place exposure to SHS ranks the second while family second hand smoke exposure rate is relatively lower than national average level. Among all the public areas, restaurants have the highest second hand smoke exposure rate while that in medical institutions, junior and primary school is in a low level.5. Although the knowledge rate of "smoking or passive smoking can cause lung cancer" is high, the knowledge rate of smoking hazards of other diseases is relatively low. Around half interviewees still hold the wrong idea that low-tar cigarette is less harmful than normal cigarette.6. Most resident support a total ban of smoking in school, hospital, and office. However, there are relatively less supports for total ban smoking in entertainment venues such as restaurants and bars.