| Background and objectiveThe harm of tobacco use is one of the most serious public health problems in the world. China is the world’s largest consumer of tobacco products, with an estimated301million smokers, and740million non-smokers who were exposed to secondhand smoke. The annual number of deaths caused by tobacco use now exceeds1million, if the current trends are maintained, that number will rise to over2million by2030and to3million by2050. Though tobacco use is steadily declining in developed countries, smoking prevalence and cigarette consumption are increasing in China. Extensive use of tobacco makes secondhand smoke (SHS) exposure at public places and workplaces a serious public health problem. Public venues are common sources of SHS exposure, and restricting smoking at these venues through smoke-free policies is an effective way to reduce SHS exposure and to protect health. Scientific research shows that Secondhand smoke can cause various diseases to multiple systems and organs in humans, such as lung cancer, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Smoking is not only harmful to human themselves, but also result in large economic losses. In other words, the rapidly growing medical expenditures and loss of productivity from tobacco-related illnesses outweigh the economic benefits of the industry. The society and government authorities should pay more attention to secondhand smoke exposure.MethodsThe5regions (Jiaxing, Zhoushan, Taizhou, Quzhou, and Jinhua) were selected based on their geographic locations. Within each region, a complete list of venues of interest (hospitals, health administrative organizations) was compiled. All venues from the5regions were similar to each other in terms of size. Simple random sampling without replacement was used to draw the venues. The field work of survey consists of3components:(a) a tobacco control capacity survey of each venue,(b) an observational survey of smoking phenomenon, and (c) an intercept survey of people at the venue. The tobacco control capacity survey was a survey of a staff member of each venue. Information about the internal smoke-free policies and tobacco control capacity was collected. The observational survey was conducted within each venue for30minutes. Observational spots include halls, men’s lavatories, hallways, stairwells, and so on. The investigators stayed in each spot for3minutes to record the number of smoke-free signs, ashtrays, smokers, and cigarette butts. The intercept survey investigated about10staff and10visitors at each venue. Questions about whether the respondents smoked within indoor areas of the venue on the day of survey were asked. The survey was conducted by-trained professional investigators. A total of62settings (30hospitals,32health administrative organizations) were surveyed. An intercept survey was conducted to examine SHS exposure at these venues, a total of1275adults (613in hospitals,662in health administrative organizations) were investigated.ResultsSmoking rate of hospitals and the health administrative organizations were11.59%and23.26%, respectively. In the62settings,98.39%of the venue’s leaders supported tobacco control, and87.10%of venues had health promotion activities about tobacco control. About70.97%of venues had completely indoor smoking ban, and69.35%of venues had created smoking-free units.46.77%of venues had staff training about tobacco control, only32.26%of venues provided employees with smoking cessation assistance. No tobacco advertisement was found at any of the venues, and95.16%of venues didn’t sell tobacco. In all,96.77%of venues put up smoke-free signs within indoor areas, and45.16%of venues put up mark of smoking-free unit, and48.39%of venues had tobacco control propaganda with bulletin boards.24.19%of venues designated outdoor smoking areas. In29.03%of venues, the staff stop customer from smoking. We found that ashtrays were noticed in41.0%of venues, and a total of35.48%and38.71%of venues had smell of cigarette and cigarette butts, respectively. In all, there were43.55%of venues with SHS exposure. Compared with hospitals, the health administrative organizations had significantly less SHS exposure (OR=7.24), Venues that had put tobacco control contents in the bulletin boards had significantly less SHS exposure (OR=0.19), and venues that provided employees with smoking cessation assistance had significantly less SHS exposure (OR=0.09).In the intercept survey,69.50%of respondents know smoking-free indoor in venues,25.30%of respondents found smoking in the venues, and43.93%of respondents who was smoking in the venues that day were stop by staff. The proportion of health administrative organizations where smokers were smoking were more than hospitals (x2=6.23, P<0.05), but the proportion of health administrative organizations where staff stop customer from smoking were less than hospitals (x2=15.13, P<0.01). There were47.41%of smokers smoking in the venues that day, only31.09%were stoped by staff. The proportion of smokers who were smoking in the venues that day were as follows:hospitals (38.14%), health administrative organizations (55.64%), and the proportion of smokers who were stopped by staff in the venues that day were as follows:hospitals (33.33%), health administrative organizations (29.73%). Moreover, the proportion of smokers who was worker in the venues was as follows:hospitals (40.00%), health administrative organizations (70.27%).ConclusionsEnvironmental SHS exposure in the health venues was still serious, and tobacco control measures were relatively weak. It indicated that implementation of indoor smoking ban can reduce indoor secondhand smoke exposure. Health administrative organizations should strengthen health promotion about tobacco control, especially to increase the public’s tobacco knowledge. Hospitals should strengthen personnel training to improve the capability and quality of services to help people kick smoking. |
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