| Objective: As a risk factor for six major death worldwide, usage of tobacco kills600million people every year, among whom more than60million killed by exposure tosecondhand smoke, and lead to hundreds of billion dollars losses. As to such awell-known harmful major public health problem that can be taken into preventionand control, global experience from tobacco control has shown that theimplementation of tobacco control legislation is the most effective measure to reducedanger of tobacco usage, and comprehensive smoke-free laws proved to be the onlysufficient way to control secondhand smoke exposure hazard. Guangzhou SmokingControl Legislation (referred to "the Legislation" for short) was carried out inGuangzhou, September1,2010. Just as other legislations about smoking control inChina, it’s a partial smoke-free ban, defining public places into full smoke-free andpartial smoke-free, while few literatures about effectiveness of smoking control inboth places have been seen at present. So the studies were carried out in order tounderstand the compliance of " the legislation" in three years (2011-2013) after itsimplementation, compare that of full smoke-free places with smoke-free places to seewhether there were differences and how were the trends in both places, to provideempirical evidence to further work on smoking control in public places in Guangzhou.Methods: Multi-stage stratified sampling method was used to obtain sites of publicplaces in23categories supervised by15competent authorities in July of2011,2012and2013.Observation was carried out to get basic venues information, enforcement ofthe legislation, and data on smoking phenomenon, taken down on observation sheets. Questionnaire interview was carried out on one or two objects who is18years andabove intercepted in the site, to obtain demographic data, knowledge and attitudesrelated to smoking control, and smoking status. Chisq χ2test was used to examinewhether there were differences between levels or indexes about smoking and smokingcontrol, and to learn the trends.Results:1360public places(including full smoke-free and partial smoke-free) wereobserved,471from survey of2011,454from2012, and435from2013, covering sixdistricts of Guangzhou, i.e Yuexiu district, Liwan district, Huangpu district, Tianhedistrict, Baiyun district, and public transportation systems, including smoking-freeplaces (379from2011’s survey,339from2012,317from2013), partial smke-freeplaces(92from2011’s survey,115from2012,118from2013).There were fluctuations on implementation of the legislation among three years,reflected by ranges of indexes. Posting rate of No-smoking signs and complaintshotlines were increasing every year(85.77%,90.31%,91.49%,P<0.05;2.55%,15.20%,33.56%,P<0.05), so as in full smoke-free places(85.75%,89.38%,91.80%,P<0.01;2.37%,12.39%,35.33%,P<0.01). Posting proportions of No-smoking signs turned outto be on the top level, with proportions above85%, and achieved highest in2012withproportion of91.80%. And the other indexes`posting proportions were below50%.The existence of cigarette smoke, butts, and smoking phenomenon were rising overtime, while with lower prevalence in smoke-free places compared to particalsmoke-free places in three years. Smoking phenomenona were more serious at halls,lobbies, and water closets other locations. Prevalence of discourage smoking were atlow levels, under10%.There was a sample including547investigators fron2011’s survey,547fron2011’s and509fron2011’s. The mean age(SD) was31.31±10.88of2011、32.16±10.12of2012and32.00±10.72. Female, people at20～30,with highschool/technical secondary school education, married or living together, composedlarger parts. Current smoking prevalence was21.57%in2011,20.11%in2012,and22.59%in2013, the difference was statistically significant. Male smokingprevalences (46.03%,40.71%,47.41%, separately) were higher than females(0.68%,2.38%,1.81%,separately) in each year. Staffs`attitudes to the regulation inboth places were positive, with support above86%. Awareness of the implementation of the regulation was above62%, with no significant difference between places of twotypes (P>0.05). Willingness to discourage smoking was stronger in full smoke-freeplaces than partial smoke-free places (P>0.05) in three years. than willingness toreport complaints, with81.96%in no-smoking places in2012. Staffs’ self-reportedrates of implementation of the legislation were not so good in three years, withestablishment of leadership, management systems and inspectors teams, and publicityand training related to smoking control were under60%.Conclusions: The effectiveness of Tobacco Control in public places of Guangzhouseems not so good as expected during2011to2013. While the effectiveness in fullsmoke-free public places is better than partial smoke-free public places. Posted rate ofNo-smoking signs is at high level, while at low level of other indexes. Smokingphenomena is more serious in halls and lobbies, corridors and toilets. Most staffssupport the ban, with strong willingness to discourage smoke in their places, howeverseldom discouragement in practice can be witnessed. Here we suggest that morepowerful execution of the legislation is needed to advace to run full smok-freelegislation instead of the partial one timely. Publicity and education is not enough onsmoking control, comprehensive measures are necessary, including improvement oftobacco control management systems, establishment of special enforcement, staffstraining related to tobacco control and turnning willingness of discourange ofsmoking into practice. More powerful enforcement is needed, especially in halls andlobbies, corridors and toilets, to improve the effectiveness. |
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