A CASE STUDY OF BARRIERS TO IMPLEMENTING A SMOKE-FREE POLICY IN COMMUNITY HEATH SERVICE CENTERS IN WUXI, CHINA Pubblico

Abstract

Abstract A Case Study of Barriers to Implementing a Smoke-Free Policy in Community Heath Service Centers in Wuxi, China By Changwei Li Background: As the world's largest tobacco producer and consumer, China faces the most serious and urgent public health problem in the world--tobacco use. Health workers are believed to play an exemplary role in tobacco control, but a sampling survey in 2009 in Wuxi showed that 38.7% of the male physicians smoked, and some even smoke in the clinics. Thus, from May 2010, Wuxi developed and implemented a smoke-free policy in 47 pilot healthcare institutions through its Tobacco Free Cities-Starting with the Health Care System (TFC-SFHCS) project. Objective: This research examines the objective barriers existing in community health service centers (CHSC) and subjective barriers perceived by staff members, patients, and visitors. Methods: Data fromabaseline survey and intercept survey collected by Wuxi's TFC-SFHCS project were analyzed using SAS and Excel. Results: High prevalence of smoking among male staff members and second-hand smoke were found in CHSCs. Inpatient clinic physicians and security staff had the highest smoking prevalence. Smoking prevalence declined as education level increased. Staff members usually smoked in rest rooms, toilets, outside the building, in their offices, and in hallways. Physicians and nurses received very little training on cessation and were unprepared to provide cessation service to patients. The will of high-level leaders in the CHSCs and binding force were important factors to implement smoke-free policy successfully. Patients and visitors preferred vivid tobacco control publicity, such as cartoons, and eschewed text format publicity. Discussion: Thetepid willingness of political leaders, especially high-level leaders, with regard to tobacco control, health professionals' poor knowledge of the harms of smoking and second-hand smoke, health professionals' lack of cessation training, the weakness of the current policy and tobacco control publicity constitute the barriers to controlling tobacco use in CHSCs. The findings from this research can be used to improve the quality of the new smoke-free policy and its implementation in Wuxi's CHSCs, and will result in the reduction of smoking and exposure to second-hand smoke in these areas.

Table of Contents

Table of Contents
Introduction

........................................................................................................................1
Problem ............................................................................................................................2
Figure 1: Maps of China with Jiangsu province highlighted .......................................2
Figure 2: Maps of Jiangsu province with Wuxi highlighted ........................................3
Purpose .............................................................................................................................4
Research Questions ..........................................................................................................4
Significance ......................................................................................................................4
Literature Review ..............................................................................................................6
Figure 2: Trends of smoking prevalence in China from 1994 to 2010 ........................6
Methods .............................................................................................................................13
Study design ...................................................................................................................13
Methods of analysis ........................................................................................................16
Results ...............................................................................................................................19
Discussion..........................................................................................................................24
Future direction ...............................................................................................................28
Reference ..........................................................................................................................29
Appendix ...........................................................................................................................32
Appendix A: List of tables .............................................................................................32
Appendix B: Questionnaire ............................................................................................42

List of Tables and Figures

FIGURE 1: MAP OF CHINA WITH JIANGSU PROVINCE HIGHLIGHTED ...............2
FIGURE 1: MAP OF JIANGSU PROVINCE WITH WUXI HIGHLIGHTED .................3
FIGURE 2: TREND OF SMOKING PREVALENCE IN CHINA FROM 1994 TO 2010..6
TABLE 1: SELECTED CHARACTERISTICS OF PARTICIPANTS IN THE
BASELINE SURVEY .......................................................................................33
TABLE 2: THE ASSOCIATION BETWEEN SMOKING STATUS AND GENDER,
OCCUPATION AND EDUCATION ...............................................................37
TABLE 3: KNOWLEDGE ON SMOKING AND SECOND HAND SMOKING ...........38
TABLE 4: THE RELATIONSHIP BETWEEN ATTITUDE TO SMOKING AND
SMOKING STATUS, AND GENDER ............................................................38
TABLE 5: THE RELATIONSHIP BETWEEN ATTITUDE TO SMOKE-FREE
POLICY AND SMOKING STATUS, AND GENDER ...................................39
TABLE 6: THE ASSOCIATION BETWEEN PHYSICIANS' PREPARATION IN
PROVIDING CESSATION SERVICE TO PATIENTS AND CESSATION
TRAINING .......................................................................................................39
TABLE 7: DIFFERENCE OF PERCEPTION INDEX ON PHYSICIANS' ROLE IN
TOBACCO CONTROL WORKS AMONG GROUPS WITH DIFFERENT
GENDER, SMOKING STATUS, QUIT BEHAVIOR, AND KNOWLEDGE,
ATTITUDE, PRACTICE OF TOBACCO USE ………..…………………..40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	China Barriers smoke-free policy Community Health Service Centers
Committee Chair / Thesis Advisor	Huang, Cheng, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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