Passive Smoking in China： Contributing Factors and Areas for Future Interventions

Objective To reduce tobacco consumption and exposure to passive smoking in China. Methods Discussion consisting of 80 focus groups and 35 interviews were held in three rural intervention counties of Jiangxi, Henan, and Sichuan Provinces. Participants came from hospitals, schools, rural areas, and urban areas. Results Tobacco use and exposure to passive smoking were widely prevalent in the investigated schools, hospitals, county towns, and rural areas. Knowledge of the risks for passive smoking on health is lacking, especially in rural areas. Barriers to the control of tobacco use in public places include reluctance of administrators to implement tobacco control policies, lack of consistent policies, difficulties with regulations and enforcement, and reluctance of non-smokers to exercise their right to clean air. Conclusion To curb the current tobacco epidemic in China, tobacco control efforts must focus on reducing exposure to passive smoking. A strategy should be formulated to reduce the factors that contribute to tobacco use and exposure to passive smoking.     

Findings from 2010 Global Adult Tobacco Survey: implementation of MPOWER policy in China

Objective To assess the implementation of five key tobacco control policies in China： protection from second-hand smoke （SHS）; offering help to quit; health warnings regarding tobacco use; the enforcement of bans on tobacco advertising, promotion, and sponsorship; and increasing tobacco taxes and prices. Methods Using 2010 Global Adults Tobacco Survey in China （GATS-China）, 10 indicators are used to assess the implementation of five key tobacco control policies of MPOWER in China. Results Overall, 63.3% and 72.7% of adultsnoticed people smoking indoor workplaces and public places, respectively. Approximately 60% of smokers were not asked about their smoking habits and approximately 67% were not advised to quit on their visit to a health worker. Sixty percent of adults noticed health warning messages on cigarette packaging and in the media in the last 30 days, 63.6% stated that they would not consider quitting. Twenty percent of respondents noticed tobacco advertising, promotion, and/or sponsorship activities in the 30 days prior to the survey. Among them, 76.3% noticed the direct advertising and 50% noticed from TV programs. Although purchasing price of one pack of cigarettes ranged from 1 to 200 RMB, 50% of current smokers （about 150 million） spent 5 RMB or less on one pack of cigarette. The expenditure on 100 packets of cigarettes represents 2% of 2009 GDP per capita. Conclusion The average score for the implementation of the 5 policies of MPOWER in China is 37.3 points, indicating tobacco control policies in China is poor and there is a large gaps from the FCTC requirements.     

Awareness of tobacco-related health hazards among adults in China

Objective To determine the level of awareness of the hazards of tobacco smoking and secondhand smoke inhalation among adults in China. Methods Household surveys were conducted with a total of 13 354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. Results The findings revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively. Awareness regarding smoking-related hazards across all participants was significantly associated with several factors, including gender, smoking status, urban/rural residency, education level and exposure to tobacco control publicity in the last 30 days. Awareness regarding tobacco-related hazards in smokers was significantly associated with urban/rural residency, education level, exposure to tobacco control publicity in the last 30 days, and physician＇s advice. Awareness relating to the hazards of inhaling secondhand smoke was associated with smoking status, urban/rural residency, age, education level, and exposure to tobacco control publicity in the last 30 days. Medical professionals were found to know more about the health hazards of tobacco compared with people in other types of employment. Conclusions Overall awareness of the health hazards of tobacco has improved in the last 15 years in China, but is still relatively poor. Improved means of communicating information and more effective warning labels on cigarette packaging are necessary for increasing public awareness of tobacco hazards, particularly among rural residents and people with less education.     

An Analysis on Failure Reasons of Quit Smoking among Smokers in Beijing Communities——Based on a Cross-Sectional Study

With the implementation of tobacco control policies and increasing publicity year by year,smokers have acquired more information and knowledge through various channels about the harmful effects of smoking.As a result,more smokers have developed a desire to quit smoking and have begun to try to quit.     

An Evaluation on Smoking—induced Health Costs in China（1988—1989）

A study on smoking-attributable health economic costs in China was conducted from 1988-1992,in which three major categories of chronic diseases,diseases of cancer,diseases of circulatory system,and diseases of respiratory system were included.A prevalence-based method which estimated the cumuative effect of cigarette smoking during the past 20-30 years was used.The results show that in 1989,the totoal smoking-attributable economic costs to health sectors in China were about 27.1 billion of Chiense Yuan,including about 7 billion Yuan in direct medical costs and 20 billion Yuan in indirect costs,which include indirect morbidity costs and indirect mortality costs.The relatively low direct costs reflected the low medical costs at hospitals in China at that time.And the high proportion of indirect costs relative to the total costs shows the high potential years of life lost due to cigarette smokin.The results also show the heavier health burden in urban areas than in rural areas,reflecting the worse situation in urban China at nowadays.But if considering that almost 80% of the Chinese are rural farmers with the higher smoking prevalence and relatively shorter history of manufactured cigarette smoking than their urban counterparts,the very frightful situation due to cigarette smoking would be for China in the next century.     

Mutagenicity of Urine From Individuals Exposed to LPG Combustion Products

The mutagenicity of urine from individuals exposed to the combustion products of liquefied petroleum gas(LPG)was detected with Salmonella typhimurium TA98 and its newly developed derivatives YG1021(nitroreductase overproducing)and YG1024(O-acetyltransferase overproducing).The detection showed significantly increased mutagenicity for two YG strains and increased positive rates for all three strains in the presence of both rat liver S9 and β－glucuronidase.Further analysis demonstrated that urine samples taken from smoking and non-smoking exposed individuals exhibited significatly higher mutagenic potency(revertants/10μl urine concentrate)than their corresponding controls.These results indicate that the increased urine mutagenicity is caused by the exposure to LPG combustion products or smoking.The mutagenic potency of urine samples of all exposed individuals tested with YG 1024 was found to be about 7 times higher than with TA98.The difference in mutagenic potency was smaller for the same samples when comparison was made betweenTG1021 and TA98.This suggests that the mutagenic compounds present in the urine samples contain mainly armatic compounds as glucuronide conjugates.Our results demonstrate that YG1024 is more sensitive than TA98 in detecting the mutagenicity of these samples.In addition ,no significant difference in the mutagenic potency between the‘pure’ exposed(non-smokers‘) and the ‘pure’ smokers’(unexposed) samples was found in all three tester strains.This might mean that the exposure extent of mutagens/carcinogens in LPG combustion products for exposed individuals roughly corresponds to the smoking level of smokers who smoke 20-40 cigarettes per day.Furthermore,the results also suggest that synergism might exist in the mutagenic effects of exposure to LPG combustion products and cigarette smoking.     

Smoking is associated with the incidence of AMS: A large-sample cohort study

Background: In recent years, the number of people visiting high altitudes has increased. After rapidly ascending to a high altitude, some of these individuals, who reside on plains or other areas of low altitude, have suffered from acute mountain sickness(AMS). Smoking interferes with the body’s oxygen metabolism, but research about the relationship between smoking and AMS has yielded controversial results.Methods: We collected demographic data, conducted a smoking history and performed physical examinations on 2,000 potential study participants, at sea level. Blood pressure(BP) and pulse oxygen saturation(SpO2) were measured for only some of the patients due to time and manpower limitations. We ultimately recruited 520 smokers and 450 nonsmokers according to the inclusion and exclusion criteria of our study. Following acute high-altitude exposure, we examined their Lake Louise Symptom(LLS) scores, BP, HR and SpO2; however, cerebral blood flow(CBF) was measured for only some of the subjects due to limited time, manpower and equipment.Results: Both the incidence of AMS and Lake Louise Symptom(LLS) scores were lower in smokers than in nonsmokers. Comparing AMS-related symptoms between nonsmokers and smokers, the incidence and severity of headaches and the incidence of sleep difficulties were lower in smokers than in nonsmokers. The incidences of both cough and mental status change were higher in smokers than in nonsmokers; blood pressure, HR and cerebral blood flow velocity were lower in smokers than in nonsmokers.Conclusions: Our findings suggest that the incidence of AMS is lower in the smoking group, possibly related to a retardation of cerebral blood flow and a relief of AMS-related symptoms, such as headache.     

Impact of Ambient Air Pollution on Public Health under Various Traffic Policies in Shanghai,China

Objective To investigate the potential impact of ambient air pollution on public health under various traffic policies in Shanghai. Methods The exposure level of Shanghai residents to air pollution under various planned traffic scenarios was estimated, and the public health impact was assessed using concentration-response functions derived from available epidemiological studies. Results Our results showed that ambient air pollution in relation to traffic scenarios had a significant impact on the future health status of Shanghai residents. Compared with the base case scenario, implementation of various traffic scenarios could prevent 759-1574, 1885-2420, and 2277-2650 PM10-related avoidable deaths （mean-value） in 2010, 2015, and 2020, respectively. It could also decrease the incidence of several relevant diseases. Conclusion Our findings emphasize the need to consider air pollution-related health effects as an important impact of traffic policy in Shanghai.     

CD8+ Tc-lymphocytes immunodeviation in peripheral blood and airway from patients of chronic obstructive pulmonary disease and changes after short-term smoking cessation

Background Cigarette smoke induces an acute but persisting inflammation in peripheral blood and airway in chronic obstructive pulmonary disease （COPD）,and CD8＋ Tc-lymphocytes are considered as a key role in this process.We aimed to investigate the Tc-lymphocytes immunodeviation in system and local airway of COPD patients and changes of the immunodeviation after short-term smoking cessation.Methods Peripheral blood （PB） and bronchoalveolar lavage fluid （BALF） were collected from 42 patients （14 COPD patients,16 smokers with normal lung function and 12 nonsmokers）,while PB and induced sputum （IS） were obtained from other 19 patients （10 quitting smokers and 9 continuing smokers） at baseline and follow-up respectively of 4-week smoking cessation.Percentages of CD8＋ Tc-lymphocytes （%CD3＋） and Tc1/Tc2 ratios were measured by flow cytometry.Results Percentages of CD8＋ Tc-lymphocytes were higher in COPD patients than those in smokers and nonsmokers in both PB and BALF.Tc1/Tc2 ratio in PB and in BALF from COPD patients was greater than that from smokers and nonsmokers and negatively correlated with FEV1%pre.When comparing the ratios between PB and BALF,significantly positive correlation was found in COPD patients.Furthermore,after 4-week smoking cessation,percentages of CD8＋ Tc-lymphocytes in PB and IS in quitting smokers were decreased compared to that in baseline and continuing smokers,whereas Tc1/Tc2 ratios were not influenced.Conclusions CD8＋ Tc1-trend immunodeviation profiles occurred in both system and local airway of COPD patients.This exceptional immunodeviation could not be relieved by short-term smoking cessation.     

成都市医务人员吸烟状况及控烟干预研究

目的 了解成都市医务人员的吸烟状况及其控烟态度和行为,并对其进行干预及其效果评价。方法 采用问卷形式对成都市3家医院的932名医务人员的吸烟危害知识、控烟态度和行为进行调查,并对一家医院进行干预,同时对干预结果进行评价。结果 男性吸烟率为49．7％,女性为0．2％,男性吸烟者主要集中在外科医生和医技人员中;知识方面,对吸烟与肺癌、缺血性心脏病的关系掌握较好,但对被动吸烟与儿童中耳炎和猝死综合症关系回答正确的仅41．5％和48．2％;86．2％的不吸烟者中反对“被动吸烟无害”,但吸烟者中仅为70．4％,两者的差异有统计学意义;态度方面,对于以经济手段来处罚违反吸烟规定者,不吸烟者和吸烟者赞成的比例分别是87．5％和68．1％,差异有统计学意义（P＜0．001）;行为方面,不吸烟者询问病人吸烟状况的比例高于吸烟者,同时不吸烟者鼓励家人或朋友戒烟的比例明显高于吸烟者,二者差异有统计学意义。通过综合干预,医务人员的吸烟率差异虽无统计学意义,但有好转趋势;控烟态度明显好于干预前,差异有统计学意义（P＜0．05）。结论 目前医务人员的吸烟率较高,控烟意识淡漠,吸烟者和不吸烟者在控烟态度和行为方面存在差异。在医院环境中采取综合干预的方法可以改变医务人员的吸烟行为,提高其控烟意识。     

Knowledge and attitudes regarding smoking: a health education experiment with Malay college students

This study investigated whether knowledge and attitudes of Malay college students regarding smoking can be positively influenced by educational intervention. The experiment included a pretest to assess the students knowledge and attitudes regarding smoking, a lecture on the health risks associated with smoking, and a posttest given six weeks later to assess whether any changes had occurred. A profile of the typical Malay student smoker was also elicited. Twenty-seven percent of the study population were smokers. Of the men in the sample, 44% were smokers, while less than 4% of the women were smokers. T-tests indicated that knowledge of the health risks associated with smoking was significantly improved for most groups, while attitudes towards smoking were essentially unchanged.     

北京市新型农村合作医疗制度住院报销模式研究

目的总结北京市现行的新型农村合作医疗(新农合)住院报销政策,分析其中存在的问题,并提出相应的建议。方法对北京市各级新农合管理者进行深入访谈,了解各样本区新农合的住院报销政策,获取各区新农合住院报销的数据;问卷调查6区县1080户农民的人口学特征、就诊模式、对各级医疗机构的评价、对新农合政策的态度、理想的报销比例、支付意愿等。结果北京市2006年农民新农合参合率为89.7%,全市区县级以上医院住院补偿比例为31.46%,区县级医院为30.49%,乡镇卫生院为39.76%。有67.9%的农民认为报销比例低,理想的报销比例平均为65.7%。农民生大病首选去区县级医疗机构的最多,占55.0%。仅有8.6%的农民认为卫生院医疗设备较好,5.5%的农民认为卫生院医生技术较好。结论北京市新农合乡参合率较高,但镇卫生院利用率低,大医院医疗费用过高,新农合资金面临透支风险。建议在筹资水平不断提高的情况下将新农合提高到市级统筹,调整各级医院的住院报销比例,适当扩大报销范围。     

中医类别全科医生特设岗位计划实施现状及对策研究

背景　自2013年起,国家通过实施全科医生特设岗位计划,引导和鼓励优秀医疗卫生人才到基层医疗卫生机构从事全科医疗工作,逐步解决基层全科医生紧缺和无执业医师问题。目前对中医类别全科医生特设岗位计划实施现状的调研相对较少。目的　了解中医类别全科医生特设岗位计划的实施现状,推进基层中医药人才队伍建设。方法　2019年7月1-20日,在实施全科医生特设岗位计划工作的14个省中采用整群随机抽样的方法,随机抽取970个乡镇卫生院的行政负责人和258例中医类别特岗全科医生进行问卷调查;抽取4名县级中医药主管部门领导、4名县中医院领导、8名乡镇卫生院院长、16名中医类别特岗全科医生进行小组访谈。结果　参与网络调查的970家乡镇卫生院中,793家（81.8%）认为中医技术人员短缺,915家（94.3%）认为特设岗位计划在本院具备适应性,851家（87.7%）认为特设岗位计划有必要扩大规模。参与网络调查的258例中医类别特岗全科医生中,173例（67.0%）学历为专科及以下;112例（43.4%）年薪酬5万元以下;主要困难及诉求分别为接受继续医学教育培训（94.2%,243/258）、解决编制（91.1%,235/358）、提高工资待遇（73.6%,190/258）、工作中有上级医师指导（64.3%,166/258）等;255例（98.8%）认为在乡镇卫生院设置特设岗位计划有必要,249例（96.5%）认为有扩大规模必要。参与访谈的4名县级中医药主管部门领导、4名县中医院领导、8名乡镇卫生院院长、16名中医类别特岗全科医生代表都主张扩大特岗计划实施规模。结论　中医类别全科医生特设岗位计划充实了乡镇卫生院,受到了基层卫生部门和患者好评,但受聘中医类别全科医生学历偏低、待遇不高、职业发展受限、培训机会少等问题突出。应加快推进全科医生特设岗位计划试点工作,扩大覆盖面;强化继续教育,加大投入力度,解决医生切身利益,保障基层对中医全科人才的需求。     

吸烟者与非吸烟者对吸烟和禁烟知识态度的比较分析

在武汉市采取街道拦截法调查了１５００名市民。内容包括一般情况、吸烟情况、对吸烟和禁烟的知识、态度等。结果表明吸烟者多为中青年男性，文化程度较非吸烟者低，吸烟者对吸烟危害知识、对禁烟规定的了解及对禁烟的支持率均较非吸烟者低。ＬＯＧＩＳＴＩＣ回归分析表明，性别、文化程度、对吸烟危害的知识均能影响吸烟行为。针对影响吸烟的各因素，作者提出并探讨了若干控烟的措施及对策。     

The status of tobacco use and knowledge, and attitudes relating to smoking among female students in a Bengbu medical school

Objective: To learn the status of tobacco use, and the knowledge, attitudes, and behaviors among female students in Bengbu Medical College. Methods: In a cross-sectional survey, questionnaires were completed by 634 female students in the medical college in 2007,including the prevalence of current smoking, their knowledge of the effects of tobacco use on health, and attitudes towards the smoking behaviors of young women. Results: Only 6.9% of female medical students were former smokers, and 4.9% of them were current smokers. There was no significant difference in the current smoking rate among the students from each department surveyed. Female students from urban areas were more likely to be current or attempted smokers than those from rural areas. The proportion of the students who were aware of the health risks of smoking was less than 45%. The students from the Department of Nursing had more knowledge regarding the harmful health effects of smoking than those from the other departments. There was no significant difference in attitudes towards the smoking behaviors of young women among the students from each department. Compared with female students from rural areas, the female students from urban areas were significantly more likely to think that a young woman who smoked was cool, mature and charming. Conclusion: The smoking prevalence of the female students in Bengbu Medical College is high. They are not aware of the smoking related risks and have erroneous beliefs and perceptions about female smoking behaviors.     

Health Education and Cigarette Smoking: A Report on a Three-Year Program in the Winnipeg School Division, 1960-1963

The smoking habits of Winnipeg school students were surveyed before and after a three-year program of health education on the hazards of smoking, directed to 8300 out of 48,000 students. The program consisted of informal approaches to students in elementary schools and a formal program of talks, lectures, films, and student participation for older students.

There were fewer students at all ages who had never smoked a cigarette at the time of the second survey. There was a slight decrease in the number of regular smokers in high school, most marked in the school where the program was enthusiastically received and student participation was most active. A direct relationship between parental smoking and that of the student, and an inverse relationship between academic achievement and student smoking, were shown on both surveys. The majority of students believed that smoking caused lung cancer and other hazards to health, although this was less marked among smokers.

The results indicated that an intensive program of health education directed to the teenagers in school was a potentially useful approach to the problem of cigarette smoking.

     

Information and Communications Technologies Health Projects in Panama: A Systematic Review and their Relation with Public Policies

This paper presents a review about Information and Communications Technologies (ICTs) health projects in Panama. The main contribution is to provide a vision of the situation in Panama, allowing an understanding of the dynamics of health policies and how they have affected the implementation of ICT’s Projects to improve the health of Panamanians. We analyze the projects found with ICT’s in health of Panama, which allow us to see a perspective of projects information is obtained from 2000 to 2016, however it is important to highlight that there may be other projects that we do not know because we did not find enough information or evidence of the same. That is why this review has interviews with key personnel, who have guided us with the search for information. 56% of technology projects are concentrated in the capital city and only 16% in the province of Chiriquí. 64% of these projects are focused on the development of information systems, mainly focused on electronic patient registration. And 60% refers to projects related to primary health care. The MINSA and CSS both with a 20% participation in ICT project, in addition we can notice the dispersion of projects for hospitals, where each one is developing programs per their needs or priorities. The national information about ICT projects of Health, it has been notorious the state of dispersion and segmented of public health information. We consider that it is a natural consequence of Policy in Panamanian Health System. This situation limits the information retrieval and knowledge of ICT in Health of Panama. To stakeholders, this information is directed so that health policies are designed towards a more effective and integral management, administering the ICT’s as tools for the well-being of most the Panamanian population, including indigenous group.