Effect Evaluation And Influence Factors Study For The Creation Of Smoke Free Health Care Facilities

Objective:The aims of the study are:1) to evaluate the effects of creating smoke free health care facilities; 2) to explore the main factors that influence the effects and to find the main barriers in creating smoke free health care facilities; 3) to find problems of the evaluation criteria for smoke free health care facilities.Method:Quantitative data analysis and in-depth individual interview were used in this study. The quantitative data were collected from "Central government subsidies to local tobacco surveillance and intervention project". Through non-random stratified sampling,20 smoke free health care facilities were created in each province in China. From May 30th to November 30th in 2009, each selected facility carried out comprehensive interventions. Totally, there were 604 facilities which finished both the baseline and the end-point questionnaire survey. For effect assessment, we evaluated 3 aspects of intervention activities, including smoke free policy, smoke free supporting environment, tobacco control propaganda and education. We also evaluated the effects of smoke free environment implementation, the condition of second-hand smoke exposure, and the staff's knowledge, attitudes and behaviors of tobacco smoke. SAS 9.1 software was used in statistical analysis. The mainly analytic methods included: descriptive analysis,χ2 test, nonparametric test and Logistic regression. In-depth individual interviews were carried out in Beijing after the data analysis.21 persons who were familiar with the work of creating smoke free health care facilities were interviewed. Atlas Ti 5.0 software was used to collate and code the qualitative data.Results:1. Effect evaluation of creating smoke free health care facilities 1) Percentage of facilities with smoke free rules increased from 53.5% to 92.1%; Percentage of facilities that permitted cigarette sales decreased from 16.5% to 6.3%; In the last year, the percentage of staff who had been training on tobacco control increased from 21.8% to 56.7%.2) In the last week, the percentage of staff that had been exposed to second-hand smoke decreased from 61.4% to 49.1%. Staff's awareness about tobacco harms was all better than before. But after the intervention,80.9% of the staff believed that "the nicotine in cigarettes is the chemical that causes most of the cancer", and 38.7% of the staff thought "the filter can decrease hazards of smoking". The percentage of staff that supported comprehensive smoke-free policy in their indoor workplace was 80.8%, compared to 71.9% before the intervention. The current smoking prevalence among the staff decreased from 17.6% to 15.2%.But 82.9% of the current smokers smoked during work time in their workplace after intervention.2. Influence factors associated with the effects of creating smoke free health care facilitiesThe total score for smoke free environment was 30, the median score for all health care facilities increased from 12 to 25 after the intervention. From the results of logistic regression, we found factors associated with better effects included 1) tobacco control intervention (relative to that before intervention) 2) Facilities with tobacco control rule (relative to facilities without tobacco control rule) 3) Facilities with higher support rate for 100% smoke free in their indoor workplace (relative to facilities with lower support rate) 4) Facilities with higher proportion of staff who had been training on tobacco control (relative to facilities with lower proportion of staff who had been training on tobacco control). Factors associated with worse effects included 1) facilities with higher smoking prevalence among staff (relative to facilities with lower smoking prevalence among staff) 2) facilities which sold cigarette (relative to facilities without cigarette sale). Factors with no statistical significance include 1) whether or not the facility had tobacco control propaganda materials 2) whether or not the facility had anti-smoking signs 3) whether or not the facility had smoking areas. From in-depth individual interview study, we also found that setting tobacco control supervision and inspection team was the most important factor associated with the effects. And getting leadership attention was the key point for creating smoke free environment.Conclusion:1. Big progress has been made in creating smoke free health care facilities, but there is still much work to do to fulfill the "2011 Decision".2. Setting tobacco control supervision and inspection team is the most important factor and getting leadership attention is the key point for creating smoke free environment.3. Barriers for creating smoke free health care facilities include 1) inadequate enforcement of smoke-free policy 2)lack of capacity of supervision team to discourage smoking 3)the serious problem of male physician smokers (especially the surgeon)smoking during work time.4. The evaluation criteria for smoke free health care facility need to be improved in variables and weights, and a detailed scoring method is still needed.