Smoking cessation among Hong Kong Chinese smokers attending hospital as outpatients: impact of doctors' advice, successful quitting and intention to quit

To identify factors affecting current smokers' intention to quit smoking and factors associated with successful quitting among ex-smokers in Hong Kong. A cross-sectional survey of Chinese patients attending medical and surgical Specialist Outpatient Clinics (SOPCs) of public hospitals in Hong Kong, using a structured questionnaire. Results of the 642 respondents, 21% were current smokers, 9% were ex-smokers and 69% were non-smokers. 74% of the smokers reportedly received quitting advice from doctors. Among the current smokers, past quitting attempts, receiving information from sources other than doctors, believing that doctor's advice was useful, believing that all smokers should quit smoking and a positive attitude towards quitting were associated with intention to quit. Among those who had attempted to quit, being older (aged 50 or above), being retired/unemployed and consuming more than 10 cigarettes per day were associated with successful quitting. We found that advice from doctors on quitting smoking did not have any impact on Chinese smokers quitting or future intention to quit and reflect the inadequacy of advice given by Hong Kong doctors. The predictors of intention to quit and successful quitting identified in the study could be used to design future smoking cessation services.     

成都市医生吸烟现状及男性医生吸烟行为影响因素研究

目的了解成都市医生的吸烟状况及男性医生吸烟的影响因素。方法采用多阶段随机抽样方法,对抽取的成都市710名医生进行吸烟现状调查,应用Logistic回归模型探讨男性医生吸烟的影响因素。结果本次调查的医生总体吸烟率为17.2%,男性医生吸烟率为37.3%;男性从不吸烟者和曾经吸现在已戒烟者的相关认知均好于吸烟者(F=3.61,P0.01;F=2.98,P0.01),从不吸烟者和曾经吸现在已戒烟者的相关态度均好于吸烟者(F=2.31,P0.01;F=2.29,P0.01);男性医生吸烟的影响因素为年龄、工龄、相关知识得分、相关态度得分和单位禁烟。结论本次调查的医生吸烟率较低,男性吸烟者吸烟相关认知差于不吸烟者,应该根据调查的相关吸烟影响因素制定医院控烟措施,进一步降低医生的吸烟率。     

Smoking among Shanghai medical students and the need for comprehensive intervention strategies

By cluster sampling, 1392 medical students of Shanghai Medical University were investigated with regard to smoking status and their knowledge and attitudes towards smoking and anti-smoking campaigns. The results showed that the smoking rate of medical students was 12.07%-21.42% for male students and 1.81% for female students. Both daily and occasional smoking rate increased as the curriculum year progressed. Of smoking students, 36.69% had made at least one serious attempt to quit smoking; 11.18% of smoking students intended to be non-smokers by the end of 5 years; and 87.07% of non-smokers and 68.35% of smokers agreed that smoking was harmful to one's health. There were widespread deficiencies in knowledge of smoking as an important causal factor in many diseases and in medical students' knowledge as to the appropriate role of doctors in anti-smoking campaigns. There existed some differences between smokers and non-smokers with respect to knowledge and attitudes towards smoking, doctors' professional responsibilities and smoking-controlling regulations. This study indicates that the current system of medical education in China has little or no effect on the attitudes and behaviours of medical students regarding smoking. It is therefore highly necessary and possible to adopt comprehensive smoking-control interventions and health education among this group.     

常州市医务人员吸烟相关行为现况调查

目的了解常州市医务人员吸烟和控烟知识、态度及行为现状,为促进医务人员开展戒烟活动,提高其控烟意识,促使其在日常工作中帮助吸烟者戒烟服务提供科学依据。方法采用分层随机抽样方法,用统一设计的《吸烟现况调查表》对常州市一、二、三级医院的620名医生进行问卷调查。用EpiData3．1录人调查数据形成数据库,用统计软件SPSS13．0进行χ^2检验、趋势检验等统计分析,P〈0．05为差异有统计学意义。结果常州市医务人员总吸烟率为27．58％。其中男性吸烟率为46．03％,女性为1．18％,差异有统计学意义（χ^2=151．2,P〈0．05）。医生在接诊时,有22．74％的医生从不或很少询问患者吸烟情况,33．71％的医生在患者疾病与吸烟相关时才询问;所调查医务人员中,如果知道患者吸烟,57．25％的医生会经常建议患者戒烟;医生吸烟率随着工作年限的增加有所上升（χ^2=18．512,P〈0．05）;不同职称医生的吸烟率差异有统计学意义（χ^2=8．764,P〈0．05）,其中高级职称的医生吸烟率最高为35．48％;不同科室的医生吸烟率间的差异有统计学意义（χ^2=60．928,P〈0．05）,其中以外科医生吸烟率最高达45．73％;在医生的不同学历中以中专及中专以下学历医生的吸烟人数最多,吸烟率分别为37．50％、32．08％。结论应加强医生的健康教育和戒烟知识培训,减少医生的吸烟行为;采取相应的对策使医生有时间也有能力向患者传送控烟知识,提高其在临床提供戒烟服务的能力,进而推进全社会的控烟工作。     

Injecting drug use via femoral vein puncture: preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment

Background

Snus is considerably less hazardous to health than cigarettes. Recent data from Scandinavia have indicated that many smokers use snus as a method for quitting smoking.

Methods

Data from five repeated cross-sectional surveys of Norwegian men and women aged 16-74 were pooled (N = 6 262). Respondents were asked about current and former smoking and snus use. Former daily smokers (N = 1219) and current daily smokers who had tried to quit at least once (N = 1118) were asked about the method they had used at their latest quit attempt and how many quit attempts they had made. Former smokers were also requested to report what year they had made their final quit attempt.

Results

Snus was the most common method used for quitting smoking among men, while NRT was most often used among women. Stratifying the data according to year of quitting smoking (1945-2007) indicated a significant increase in use of the methods for quitting asked about over time. Among men, this was largely due to an increase in the use of snus. Among male quitters under the age of 45 years, 45.8% of those who had used snus on their last attempt to quit were current non-smokers (OR = 1.61, CI 1.04-2.29), while 26,3% of those who had used NRT were current non-smokers. 59.6% of successful quitters and 19.5% of unsuccessful quitters who had used snus as a method for quitting smoking had continued to use snus on a daily basis after quitting.

Conclusion

Norwegian men frequently use snus as a method for quitting smoking whereas women are more likely to use NRT. The findings indicate that switching to snus can be an effective method for quitting smoking.     

2012年南京市地铁站台/公交车控烟公益广告宣传效果评估

目的通过调查控烟公益广告在南京市地铁站台和公交车内的宣传覆盖程度及其对受众影响,评估控烟大众媒体宣传效果。方法 2012年5-10月选取南京市15个地铁站台和12辆公交车,进行内容为"吸烟正吞噬着你的生命"和"吸烟正在吞噬着你和你孩子的生命"的控烟公益广告宣传,11月在南京市8城区随机抽取1 706名≥18岁成人进行问卷调查,评估宣传效果。结果调查人群的地铁/公交车接触率为84.7%,看到两个广告的比例分别为19.6%和16.4%。看到"吸烟正吞噬着你的生命"的人群中,58.4%的吸烟者表示广告使其戒烟可能性变大,82.9%的非吸烟者表示广告使其劝说他人戒烟可能性变大;看到"吸烟正在吞噬着你和你孩子的生命"的人群中,76.8%的吸烟者表示广告使其在他人面前吸烟可能性减少,78.3%的非吸烟者表示广告使其劝阻他人不当面吸烟可能性变大。结论控烟公益广告宣传能改变公众对吸烟相的态度,提高吸烟者戒烟和非吸烟者拒绝二手烟的意识,今后应持续开展高强度高频次的大众媒体控烟宣传,让更多公众了解吸烟和二手烟的危害,共同拒绝吸烟与被动吸烟。     

A smoking cessation intervention among tuberculosis patients in rural China

Objective: To assess the integration of a smoking cessation intervention into routine tuberculosis (TB) services.Method: Consecutive TB patients registered from 1 March to 31 August 2010 were enrolled in an intervention for self-reported smoking to promote tobacco cessation during treatment for TB. Information on the harmful health effects of tobacco smoke and smoking and TB were provided to TB patients who self-reported as current smokers. Smoking status was reassessed at every follow-up visit during anti-tuberculosis treatment with reinforced health messages and advice to quit.Results: Of 800 TB patients enrolled, 572 (71.5%) were male and 244 (30.5%) were current smokers. Females were more likely to be non-smokers (100% vs. 35.8%, P < 0.001). Of the 244 current smokers, 144 (59.0%) started smoking at <20 years, 197 (80.7%) consumed ⩾20 cigarettes per day, 211 (86.5%) had perceived smoking dependence and 199 (81.6%) had made no attempt to quit before the diagnosis of TB. Of the 244 current smokers, 234 (95.9%) were willing to quit, and 156 (66.7%) reported abstinence at month 6. Challenges to implementing smoking cessation intervention were identified.Conclusion: The majority of current smokers among TB patients were willing to quit and remained abstinent at the end of anti-tuberculosis treatment. This intervention should be scaled up nationwide.     

Patterns of smoking, quit attempts and services for a cohort of 15- to 19-year-olds

Objectives To establish patterns of smoking among 15‐to 19‐year‐olds within mixed urban and suburban area and explore preference for the nature of services to assist quitting. Design Postal survey and depth interviews with focus group validation. Setting People registered with health services in the Borough of Solihull, UK. The borough has a diverse population with areas of high deprivation to the north and a range of prosperity elsewhere. Participants Questionnaires were sent to 50% of those registered and 20 people interviewed aged from 15 to 19 years. Main outcome measures The survey contained demographic questions relating to educational attainment and family, smoking status, history and quit attempts, use of facilities for quit attempts. Qualitative themes explored attitudes and experience of quitting, utilization of cessation services, barriers to access and nicotine replacement therapy. Results Total survey response rate was 32.6%. Three in five reported smoking a cigarette sometime, 17.2% current regular smokers, 7.2% current occasional smokers. Median age of starting smoking was significantly lower (P = 0.004) for current regular smokers, distinguishable in two groups; weekend smokers and all week smokers. More quit attempts had been made or planned by current regular smokers but were often short lived. Weekend smokers had a slightly longer duration of quitting (P = 0.03). Eight‐two per cent were optimistic about quitting in the future although the majority (80%) had already made one quit attempt. Knowledge and use of existing services was poor, with concerns about privacy and confidentiality. Models based on autonomy were identified as potentially useful. Conclusion Teenage smoking is characterized by optimism about quitting despite the failure of many quit attempts, lack of regard for existing services and barriers to uptake.     

Attitudes of Students and Employees Towards the Implementation of a Totally Smoke Free University Campus Policy at King Saud University in Saudi Arabia: A Cross Sectional Baseline Study on Smoking Behavior Following the Implementation of Policy

Tobacco smoking is the preventable health issue worldwide. The harmful consequences of tobacco smoking and exposure to second-hand tobacco smoke are well documented. The aim of this study is to compares the prevalence of smoking among students, faculty and staff and examines their interest to quit. Study also determines the difference on perceptions of smoking and non-smoking students, faculty and staff with regard to implementation of a smoke-free policy. A cross-sectional survey was administered to one of the largest universities in Riyadh, Saudi Arabia during the academic year of 2013. A Likert scale was used on questionnaires towards attitude to smoking and smoking free policy. The Chi squared test was used to determine the difference of support on completely smoke free campus for smokers and non-smokers. Smoking rates were highest among staff members (36.8 %) followed by students (11.2 %) and faculty (6.4 %). About half of the smokers (53.7 %) within the university attempted to quit smoking. Students (OR 3.10, 95 % CI 1.00–9.60) and faculty (OR 4.06, 95 % CI 1.16–14.18) were more likely to make quit smoking than staff members. Majority of the respondents (89.6 %) were supportive of a smoking—free policy and indicated that should be strictly enforced especially into public places. Results also showed that smokers were more likely to support a smoke-free policy if there are no fines or penalties. These baseline findings will provide information among administrators in formulating and carrying out a total smoke free policy. Although the majority of people within the King Saud University demonstrate a high support for a smoke–free policy, administrators should consider difference between smokers and non-smokers attitudes when implementing such a policy.     

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.     

Young adult former ever smokers: The role of type of smoker,quit attempts,quit aids,attitudes/beliefs,and demographics

Objective

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.

Method

Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.

Results

Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.

Conclusion

Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.     

Smoking status moderates the contribution of social-cognitive and environmental determinants to adolescents' smoking intentions

In this study, it was tested whether attitudes, self-efficacy, social influences and the perception of the school and home environments had different associations with intentions for adolescent non-smokers, occasional smokers and daily smokers. A regression model allowing for separate slopes of social-cognitive and environment variables accounted for 72% of the variation in intentions. For non-smokers, ease of refusing to smoke (beta = -0.06) and social influences favouring smoking (beta = 0.05) were linked to intentions. Occasional and daily smokers' intentions were associated with health consequences (beta = -0.05 and beta = -0.06, respectively) and ease of smoking/buying cigarettes (beta = 0.05 and beta = 0.24, respectively). Social influences favouring smoking (beta = 0.10) were also associated with intentions in daily smokers. In an extended model for current smokers (adjusted R(2) = 0.45), context-cued nicotine cravings (beta = 0.27) were linked to daily smokers', but not occasional smokers' intentions. The results suggest that motivating adolescents to abstain from or to quit smoking implies working on different combinations of determinants in non-smokers, occasional smokers and daily smokers. Interventions for daily smokers should supplement motivational techniques with stratagems that allow smokers to reduce the number of cravings they experience in specific contexts.     

甘肃省15～69岁现在吸烟者戒烟意愿及影响因素

  目的  了解甘肃省现在吸烟者的戒烟意愿以及影响因素,为烟草防控工作提供科学依据。  方法  采用多阶段抽样方法,随机抽取15~69岁现在吸烟者作为调查对象。采用《全国居民吸烟情况调查问卷》开展面对面调查,分析不同特征现在吸烟者的戒烟意愿,采用Logistic回归分析模型分析现在吸烟者戒烟意愿的影响因素。  结果  甘肃省现在吸烟者的戒烟意愿为16.4%（95%CI:15.5%~17.3%）,农村地区（OR=1.199,95%CI:1.022~1.408,P=0.026）、家中禁止吸烟（OR=1.767,95%CI:1.273~2.454,P=0.001）、12个月内就医时医务人员劝阻吸烟（OR=1.599,95%CI:1.359~1.842,P < 0.001）、去过戒烟门诊（OR=3.089,95%CI:2.031~4.698,P < 0.001）、初中、高中、大专及以上文化程度（OR=1.383,95%CI:1.101~1.736;OR=1.627,95%CI:1.252~2.116;OR=1.374,95%CI:1.009~1.873,均有P < 0.05）、高烟草危害知识得分为1~,3~,5~6（OR=1.248,95%CI:1.030~1.514;OR=1.574,95%CI:1.289~1.922;OR=2.288,95%CI:1.879~2.786,均有P < 0.05）是现在吸烟者戒烟意愿的促进因素;年龄20~、30~岁组以及烟龄20~、30~年是现在吸烟者戒烟意愿的阻碍因素。  结论  甘肃省现在吸烟者戒烟意愿总体不高,今后应进一步在全社会普及烟草危害知识,加强医务人员戒烟服务能力培训,在诊疗过程中开展戒烟服务,同时应鼓励和支持医疗机构加快戒烟门诊建设。     

Factors associated with successful smoking cessation among adolescent smokers undergoing a smoking cessation program involving nicotine replacement therapy

OBJECTIVE: To identify factors associated with successful smoking cessation among adolescent smokers in a smoking cessation program involving nicotine replacement therapy. METHODS: We recruited adolescent smokers who were prepared to quit smoking and participated in the smoking cessation program in Kanagawa prefecture. All participants fulfilled a questionnaire beforehand, covering gender, age at the beginning of the study, age at onset of smoking, the number of quit attempts, the number of cigarettes per day and the smoking status of their families and friends. Seven nicotine patches (nicotine 52.5 mg/day) were given to them free of charge for daily use. Their smoking status and the use of nicotine patches were confirmed by telephone or postcard at the 1 and 6 month follow-ups. The relationships between successful smoking cessation and different factors among eligible participants were analyzed using the Fisher's exact test and the Mann-Whitney U test. RESULTS: The subjects included 39 adolescent smokers (mean 16.4 years). The mean age at onset of smoking and the mean duration of smoking were 13.3 years and 2.3 years, respectively. The average daily number of cigarettes smoked was 12.8. Of 39 eligible participants at the one month follow up, 14 (35.9%) were found to be abstaining from smoking. The subjects treated with nicotine patches were significantly more likely to be abstinent than those without them (P<0.05). However, no significant associations with other factors were found. Of 39 participants at the six months follow up, 10 (25.6%) were still abstinent but there were no significant associations with any of the factors, including use of nicotine patches. Subjects living with smokers were significantly less likely to be successful in their efforts to quit than those living with non-smokers (P< 0.05). There were no significant associations with other factors, including using nicotine patches. No adverse events relating to the use of the nicotine patches were encountered during the study period. CONCLUSION: The smoking cessation program involving NRT provided for adolescent smokers appeared effective at the one month follow up. Those adolescents living with smokers had more difficulties in quitting smoking than those with non-smokers at the 6 month follow up. In order to increase the number of adolescent smokers in the smoking cessation study, the need to obtain parental consent might be considered as a barrier to be overcome. Additionally, more effective follow-up procedures should be considered for the purpose of avoiding dropouts during the study.     

Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.

STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour.     

Young adult social smokers: Their co-use of tobacco and alcohol,tobacco-related attitudes,and quitting efforts

ObjectiveYoung adults frequently report social smoking. This study examined the relationship between different social smoking definitions and the co-use of cigarettes and alcohol, tobacco-related attitudes, and quitting efforts.MethodCross-sectional data were collected at bars using randomized time location sampling among young adults aged 21–26 in San Diego, California from 2010 to 2011 (73% response rate). Multivariable logistic regression examined if current smoking and quit attempts were associated with tobacco-related attitudes, and whether social smoking self-identification or behavior was associated with cigarette-and-alcohol co-use, tobacco-related attitudes, quit attempts, or quitline use.ResultsAmong 537 current smokers, 80% self-identified and 49% behaved as social smokers. Social smoking self-identification was positively associated with cigarette-and-alcohol co-use, and quit attempts. Social smoking behavior was negatively associated with tobacco marketing receptivity, quit attempts, and quitline use. Tobacco-related attitudes were associated with smoking but did not generally differ by social smoking status.ConclusionIdentification and behavior as a social smoker have opposing associations with co-use of cigarettes and alcohol and quit attempts. Tobacco cessation programs for self-identified social smokers should address co-use. Interventions denormalizing the tobacco industry or emphasizing the health effects of temporary smoking and secondhand smoke may address smoking among young adult bar patrons regardless of social smoking status.     

简短戒烟干预在北京市各级综合医院门诊应用的效果

目的评价简短戒烟干预技术在北京市各级综合医院门诊应用的效果。方法方便抽取北京市一级、二级、三级综合医院各1家,在一级医院全科及中医科门诊、二级和三级医院呼吸内科门诊开展为期4周的研究,期间所有门诊患者为调查对象。在门诊后1周内,对现在吸烟患者采用电话调查形式进行随访,了解简短戒烟干预技术的应用效果。结果研究共调查门诊患者2460人,其中278人现在吸烟,占11．3％。门诊后1周内成功随访了122名现在吸烟患者,成功随访率43．9％。成功随访者中14．8％的现在吸烟患者因1次简短戒烟干预发生戒烟意愿的正向改变,且具有统计学意义（z=3．551,P〈0．01）。其中,三级医院的此种改变有统计学意义（Z=3．035,P〈0．01）。有戒烟服务需求的门诊患者简短戒烟干预前后戒烟意愿的改变有统计学意义（Z=3．420,P〈0．01）。结论综合医院门诊应用简短戒烟干预技术有效果,三级医院干预效果更好。对有戒烟服务需求的门诊患者实施简短戒烟干预,效果更好。     

黄浦区医务人员吸烟状况与戒烟服务情况的调查

目的了解黄浦区医疗卫生单位医务人员的吸烟现况及向病人提供戒烟服务的情况。方法对本区申报参加上海市无烟医疗卫生的单位,以问卷的方式进行调查。结果黄浦区医务人员的吸烟率为13.7%;96.0%的医务人员知晓本单位开展无烟医疗机构,95.5%的医务人员赞同创建无烟医疗机构;10.7%的病人主动寻求医务人员提供戒烟帮助,35.4%的医务人员主动向病人提供戒烟服务;14.1%的医务人员曾经得到过戒烟方法与技巧的培训,43.7%的医务人员打算学习戒烟的方法与技巧。吸烟者与非吸烟者在支持创建无烟医疗机构、提供戒烟服务的态度上存在差别。结论创建无烟医疗卫生机构应做好吸烟医务人员的戒烟工作;医务人员对病人提供戒烟服务的意识和能力均有待提高。