The report on the baseline survey of CMB-China Medical Tobacco Initiative

School of Public Health, Sichuan University

Contents1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

Tobacco consumption is a critical public health problem in China.

Behaviors of doctors, teachers, political leaders and celebrities play a very important role in tobacco control

CMB initiated “China Medical Tobacco Initiative” in 2010, interventional means of tobacco consumption were carried out in medical college of 13 universities around China, to support further implementation of tobacco control around China

1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

Subjects ： Universities :

13 CMB-grantee universities

3 Control universities

Populations : Male students (2nd and 3rd-year students major in medicin

e)

Male teachers (work on teaching or researching)

Male doctors (physician, surgeon, gynecologist,

pediatrician)

Sampling ： Questionnaire survey : cluster sampling

Environmental observation: simple random sampling

Survey methods ： questionnaire survey

environmental observation

tobacco control material reference

group discussion on specific topics

Contentstobacco use cessationexposure to second-hand smoking awareness of tobacco harmattitude to tobacco controltobacco control regulationtobacco advertisement and sponsorship

Questionnaire survey

Environmental observation

Policy evaluation

campus environment

hospital environment

estimation on smokers

implementation of tobacco control

Population Survey number Response rate (%)

Student 7728 94.4

Teacher 2872 86.6

Doctor 2664 96.5

Table1. The response rate of each population

The response rate of questionnaire survey for each population is showed in the following table:

1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

Tobacco Use

Universities Student Teacher DoctorCMB-grantee Universities

Tibetan University 50.5 46.9 59.3Ningxia Medical University 26.0 41.1 37.7Xi'an Jiaotong University 8.3 49.5 34.5Sichuan University 14.4 35.6 36.0Jiujiang College 19.5 52.0 47.5Zhongnan University 8.4 42.1 39.2Harbin Medical University 12.8 19.3 25.8Fudan University 8.8 18.8 20.6China Medical University 8.1 32.6 24.3Peking Union Medical College 3.5 30.3 11.7Zhongshan University 3.5 33.3 28.0Peking University 4.4 23.3 —Zhejiang University 0.9 37.5 12.7

Control Universities

Chengdu Medical College 21.7 45.7 35.1Beijing TCM Medical College 10.5 31.3 34.9Hangzhou Normal University 2.1 33.3 31.8

Table 1: Smoking Prevalence of differnt Groups(%)

Smoking rates of all groups from most CMB-grantee

universities is lower than general male, while the smoking rates

from several universities are comparatively high (compared

with the result of the fourth National Health Service Survey,

the smoking rate of male population aged between 15-24 years

old is 14.9%, and that of the general male population is 48.0%).

（%）

Smoking Prevalence among all population groups in CMB-grantee universities are all lower than those in control universities

Among the CMB-grantee universities , the smoking rate in prestige schools is lower than that in non-prestige schools

(%)

In CMB-grantee universities ：

More than half students have experience of smoking, among which 30% have smoked a whole cigarette after their entry in college.

Regional Difference E.g among medical students from prestige universities: smoking rate in western region is the highest, and then the north-eastern region.

Cessation

more than 60% smokers of all groups plan to quit smoking rates of quiting from smoking or quitting for more than 2 years among smokers

of all groups is low The relapse rates of all groups are about 79%

（%）

In CMB-grantee universities:

Second-hand Smoking Exposure

The second-hand smoking exposure rate among students from CMB-grantee universities is lower than that from control universities.

（ %）

Among CMB-grantee universities: second-hand smoking exposure rate among students from prestige universities is lower than that from non-prestige universities

（ %）

In CMB-grantee universities, Teaching Building and Administration Building are the main location of students and teachers’ second-hand smoking exposure

（%）

In the affiliated hospital of CMB-grantee universities, Outpatients Department /Inpatients Building are the main location of second-hand smoking exposure

（%）

Awareness of tobacco harm

（%） （%）

In CMB-grantee universities: Only 27.6% students are aware that smoking can cause stroke,

heart attack and lung cancer; 44.2% students are aware that second-hand smoking can caus

e adult heart attack, lung cancer and children lung diseases

In CMB-grantee universities: 47.4% teachers are aware that smoking can cause stroke, hear

t attack and lung cancer; 52.9% teachers are aware that second-hand smoking can caus

e adult heart attack, lung cancer and children lung diseases

（%）（%）

In affiliated hospitals of CMB-grantee universities, about 30% doctors are not fully aware the harm of smoking and second-hand smoking exposure

（%）（%）

Attitude toward tobacco control

76.8% students, 84.5% teachers and 87.5% doctors agree that it is their own responsibility to reject smoking

83.2% students, 89.4% teachers and 91.7% doctors agree that their own group should play a main role in tobacco control campaign

80.6% students, 79.8% teachers and 88.3% doctors agree that their own group are responsible for persuading public to quit smoking

In CMB-grantee universities:

31

However More than 80% students agree that smoking can ease stress

and anxiety

More than 60% students agree that smoking can bring excitement and pleasure

About 30% students agree that smoking can express their personality

Tobacco Advertisement and Sponsorship

Within previous 30 days, 22.0% students, 13.8% teachers and 19.2% doctors of project colleges have noticed tobacco advertisements or events sponsored by tobacco companies on campus/in hospitals

Results of Environmental Observation

Campus environment

In CMB-grantee universities: rare to find smokers at tobacco control foc

us locations

The proportion of finding cigarette butts in the following locations are

higher than that of other locations: corridors/stairs of teaching building outside the teaching building gates corridors/stairs of the teachers' office building outside the male students' dorm building

In CMB-grantee universities: corridors/stairs and male bathrooms in te

aching buildings are main locations for tobacco control signal displayin

g, less are found in other locations

Teachers' office and meeting rooms of teaching building in some CMB-

grantee universities are placed with ash tray

Hospital Environment

In the affiliated hospitals of CMB-grantee universities, it is rare to find smo

kers at tobacco control focus locations, except for the hospital yards

In the affiliated hospitals of CMB-grantee universities, the proportion of

finding tobacco control signals are higher at the corridors/stairs of the out

patients department and in-patients department

In the affiliated hospitals of CMB-grantee universities, the proportion of finding cigarette butts are higher at corridors/stairs of the outpatient department and in-patients department and the hospital yards

In the CMB-grantee universities: ash trays are placed in a few offices and meeting rooms within the outpatient department and in-patients department buildings

37

Estimation of different groups’ smoking status and policy evaluation

Estimation of different groups' smoking status

In most CMB-grantee universities, the smoking rates of students are low, except for some overseas students from few universities

The smoking rate of older teachers is higher than that of

the younger ones. The smoking rate of the administrative staff is higher than that of teachers in lecturing and researching positions

Within hospitals, doctors with more pressure smoke mo

re, for example, surgeons smoke more than internal medicine physicians

Situation of tobacco control

Most CMB-grantee universities and their affiliated hospitals have

held tobacco control campaign before this project

Works after the initiation of this projects include: Established and improved the organizing committee for tob

acco control Established certain tobacco control policies, evaluation, re

wards and punishment system Established policies to encourage and help smokers to quit

smoking Rejected inquiries from tobacco companies on campus and

in hospitals Other special tobacco control activities

Analysis of factors related with smoking behavior

Factors which influenced students' smoking behavior include:

Nationality

prestige universities or not Smoking behavior of parents Smoking behavior of best friends attitude toward smoking of people around

Factors which influenced teachers' smoking behavior include:

institutions (departments)

prestige universities or not own attitude toward tobacco control co-workers' attitude toward smoking

Factors which influenced doctors' smoking behavior include:

Whether the affiliated hospitals is of prestige universities or not

own attitude toward tobacco control co-workers' attitude toward smoking

1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

General smoking rates of different groups from CMB-grantee universities are lower than that of general public, but some subject groups in CMB-grantee universities have serious smoking problem

There are regional and prestige or non-prestige difference among CMB-grantee universities

Non-smokers are seriously exposed to second-hand smoking, teaching building, office building and hospital outpatient/inpatient department buildings are the main locations of second-hand smoking exposure

The situation of relapse is serious among subjects who have quitted smoking

Our survey subjects have certain awareness of the harm of smoking and second-hand smoking exposure, but their knowledge is not comprehensive

The attitude towards tobacco control of our survey subjects is inconsistent

The awareness and attitude toward harm of smoking are inconsistent with their behaviors

Some non-smoking students may become smokers

Some of the CMB-grantee universities and their affiliated hospitals need to improve their policy on tobacco control, and strength policy promotion and implementation

Some CMB-grantee universities and their affiliated hospitals’ environment need to reinforce tobacco control

Problems during the tobacco control campaign in universities Focus on advocating and persuading, lack in constrain by pol

icy and policy implementation Campus tobacco control focus on students, but neglect teac

hers Smoking rate among administrative staff is comparatively hi

gh Tobacco control activities are scattered, without consistenc

e

1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

Put tobacco control campaigns in western and non-prestige medical universities as priority

Further Planning and integration on tobacco control strategy and policies

University leaders should be good examples on tobacco control, administrative staff should be the focus of the campaign

Tobacco control activities targeting teachers and doctors should be prior to those to students

Use evidence-based and vivid health education to improve teachers, doctors and students' awareness of the harm of smoking

Open tobacco control courses and lectures and adapt them into teaching plan of the universities

Use effective measures to prevent people who have quitted smoking from relapse

Motivate and support non-smokers to defend their rights of not being harmed by smoking

To decrease second-hand smoking exposure, adapt some Transitional measures: for example, set up smoking area within hospitals

Strengthening the anti-tobacco environment construction

Improve tobacco control policy, reinforce their implementation

1 Background1 Background

2 Methods 2 Methods

3 Results3 Results

4 Conclusions4 Conclusions

5 Suggestions5 Suggestions

6 Challenges6 Challenges

Without official legislation of tobacco control in China, it is difficult to implement the tobacco control policies effectively in universities and hospitals

There is no national legislation to forbid smoking in any public area or working area indoors

There is no law to prevent second-hand smoking exposure There are legal constrains to prevent tobacco advertisements, but laws c

annot prevent some "invisible" advertisements from tobacco companies

Patients and their family members are the main problem in tobacco control within hospitals

Principles and policies from the hospitals mainly target medical workers

The hospital principles are not legally binding which cann

ot constrain the behaviors of the patients and their family members

It is hard to manage due to the patients' large number an

d mobility