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Smoking Attributable Mortality Analysis And Tobacco Control Strategy Evaluation Research

Posted on:2009-06-15Degree:DoctorType:Dissertation
Country:ChinaCandidate:L ZhouFull Text:PDF
GTID:1119360272959829Subject:Occupational and Environmental Health
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BackgroundSmoking is considered as the leading preventable cause of premature death and illness in China and worldwide.Smoking causes the adverse health effects,disease burdens and social economic lost which have arisen the great attentions of governments and international health organizations worldwide.It has inspired the global tobacco control strategies and prompt actions to count the epidemic,to reduce the disease burdens and promote the health of populations.It is crucial and necessary that assessment research of smoking attributable disease impacts and health effects among the different regions and populations be taken.With the Framework Conventions of Tobacco Control adopted by WHO which is an historic international treaty to deal with one health issue,ratified and passed by Chinese government,it is necessary to assess the regional smoking attributable disease impacts and health effects,to explore the decision-making situation and framework system of "research to actions",to promote the implementation and enforcement of evidence-based tobacco control policies and interventions.The Political Policy Circle Analysis is a scientific and systemic analysis tool to guide the problem definition,causes diagnosis, policy development and political decision.The research program was funded by the IDRC.The quantity and quality investigations were conducted at Xuhui District, Shanghai,in 2006.ObjectivesThis research study is to analyze the characteristics and trends of health status and diseases patterns in the district,to monitor the smoking behaviors among different age and gender,to assess the population smoking attributable fraction and the disease impact from smoking.The research is to investigate and assess the general public's opinions and perceptions toward smoking and tobacco control strategy,to analyze the national tobacco control situation,and conduct policy diagnosis and analysis to map out barriers and obstacles for policy development in order to provide the evidence and stimulate decision-making around implementation and enforcement of tobacco control.Research MethodsQuantity and quality research methods were applied based on the smoking attributable disease impact and political policy circle analysis.The main research methods are as follows:(1) Disease surveillance and analysis:monitor and analyze five-year mortality of population,master the epidemiological characteristics and trends,evaluate the health status of the target population.(2) Population attributable risk assessment:considering the risk relatives and smoking prevalence,the population smoking attributable fraction was estimated to analyze the smoking attributable mortality and potential years of life lost,to assess the population smoking attributable impact.(3) Qualitative research:focus group interviews and key informants interviews were conducted.The two focus groups consist of 9 students and 7 health professionals. 6 key informants were selected as a health administrator,an education supervisor,a representative of tobacco business,a local government official,NGO representative and a journalist and Editor in chief of Magazine.(4) Quantitative research:a multistage-sampling questionnaire survey with PPS method and sample investigation were undertaken respectively.A total of 721 residents and 480 students from grade one of primary school,high school and professional school were surveyed.Main Findings1.Smoking attributable disease impacts and health effectsThe smoking attributable disease impacts and health effects to local people are severe and evident.During year 2006,the smoking attributable mortality is 931, accounting for 24.5%of total deaths of population over 35 years old,15.2%of total deaths of whole population.Among the total deaths of whole population,26.1%of male deaths and 2.6%of female deaths were caused by smoking.The actual cause of death from 52.9%respiratory diseases,20.8%malignant neoplasms and 8.8% cardiovascular diseases is smoking.Malignant neoplasm is the most popular smoking attributable disease,accounting for 44.0%of total smoking attributable mortality.The three leading SAM are lung cancer,COPD and bronchitis & emphysema.The three leading smoking attributable PYLL are lung cancer,COPD and cerebrovascular disease. 2.Main health issues that affect the health status of local populationDue to the impacts of demography,relative and absolute epidemiology disease effects,the mortality of local population remains the lower lever during recent five years.The cardiovascular diseases,malignant neoplasms and respiratory diseases become three main causes of deaths,accounting for 78.74%of total deaths.The leading three causes of deaths from potential years of life lost are malignant neoplasms,Cardiovascular Diseases and injuries,accounting for 78.02%The NCDs and injury become the main issues that affect the health of population.3.The smoking of the adolescents and influencing factors of their cognition and behaviorThe smoking prevalence of the adolescents is 2.91%,16.01%for experimental smoking.The smoking prevalence has significant difference among gender,age and grade.The smoking and experimental smoking prevalence rise with the development of the grade.For male students from high school and technical school,their smoking and experimental smoking prevalence are much higher.The main reasons for their initial smoking are curious and influenced by the others.The primary way for getting their initial cigarettes is from their peers.The cognition and behavior of the adolescent smoking are more easily influenced by the environmental factors and others behaviors. Although their smoking prevalence is not so high,the smoking behaviours for the adolescents and the health effects should not be ignored.It should arise the great emphasis from the school,parents,health departments and the whole society.4.The smoking status and perception of the adultsThe smoking is still epidemic among the public.The proportion of heavy smoking is much higher and quit rate is still low.The perception of adverse effects of smoking has been accepted by most adults.But the severity of the harmful effects of smoking is not clearly understood.Especially,the knowledge for smoking attributable disease,such as stroke and coronary heart diseases is low.Non-smokers are lack of responsibility of self-protection for their health and environment.The smoking status and perception of the adults are not optimistic.5.Quitting status and confidence of the smokersThe proportions of quitting smoking and contemplation to quit are still low.Most of the smokers have no much confidence and confirmation to quit.Nearly half of them are unwilling to quit and thinking about quitting.38.5%of smokers are not sure their ability for quitting.24.6%of smokers have no confidence to quit.About 75%of respondents consider it government responsibility for providing the smoking-quitting service. 6.Three primary areas for baring the tobacco control strategiesThe primary reasons that cause the situation of smoking and tobacco control strategies not optimistic were diagnosed and classified as three areas:1) the deficiency of tobacco controlling in supply area-tobacco planting and production;2) the deficiency of tobacco control in circulation area-tobacco marketing circulation, distribution and trade;3) the deficiency of tobacco control in consumption area—tobacco consumers' demand.Recommendations1.Accurate identification,systemic surveillance and comprehensive assessment of the actual causes of deathsAccurate identification,systemic surveillance and comprehensive analysis about the patterns and trends of diseases and risk factors that affect the population health and quality of life in the district should be strengthened in order to evaluate the health status of target population.Meanwhile,it is crucial to fully recognize the significance, severity and prevention of the important risk factors,to determine the priority of disease prevention and controlling according to health effects of the risk factors,to strengthen the preventive strategies to NCDs and risk factors,such as smoking.2.Reinforce the enacting and implementation of tobacco control policy based on the assessment of smoking attributable disease impacts.The identification and assessment of population smoking attributable mortality and health effects in the district should be enhanced.It should be recognized that severity of smoking to the health and need of prevention.Based on the smoking attributable disease impacts,the tobacco control strategies and interventions should be enacted and implemented.It provides the evidence to the FCTC,support tobacco control strategies,actions and decisions,to promote the process of tobacco control.3.Social action acquiring more political policy to tobacco controlThe tobacco epidemic of disease impacts and social effects is devastating,but preventable.The powerful,cooperative and supportive union should be built.It is imperative to put enacting and implementation of tobacco control policy and regulations priority from the government among comprehensive national tobacco control strategies. 4.Strengthen smoking prevention and interventions among the adolescents to create the supportive,tobacco-free environmentSmoking prevention and interventions among the adolescents should be integrated to important priority program that requires the whole society to promote their health. According to the physical and psychological characteristics of different age,the theme education and peer activities should be conducted in order to acquire the health related knowledge and skills of life-lasting,which emphasize the positive participation to the formal health education.Meanwhile the supportive environment and positive cultural surrounding should be created for the adolescents to promote their healthy behaviors and habits.It is vital to build the tobacco-free environment for everyone participation and actions.5.The responsibility and obligation of the government to adopt the comprehensive tobacco control strategiesThe comprehensive tobacco control strategy should focus on the three areas: tobacco supply,circulation and consumption areas.Depending on the cooperation of multi-departments,government organization and the whole society support and participation,the effective implementation and enforcement of tobacco control policy lie on organization,regulation,financing,behaviour,capacity and international cooperation to counter the epidemic.
Keywords/Search Tags:Smoking, Tobacco Control, Population Attributable Risk, Smoking Attributable Mortality, Political Policy Circle Analysis
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