【作者】 李恂；

【导师】 周宝森；

【作者基本信息】 中国医科大学 ， 肿瘤学， 2009， 博士

【摘要】 前言科学研究已从不同角度证明了吸烟是肺癌、慢性呼吸系统疾病、冠心病、脑卒中等多种疾病发生和死亡的重要危险因素。目前全球有11亿吸烟者,每年近500万人死于烟草相关疾病。我国烟草生产和消费各占全球的1/3以上;15-69岁的吸烟人数达3.5亿;每年死于烟草相关疾病的人数近100万,占全部死亡人数的12%。英国著名流行病学家理查德皮托教授预测:若中国当前的吸烟形势得不到有效控制,到2025年中国每年死于烟草相关疾病的人数将达200万;现在的儿童中,届时将有2亿人跻身烟民的行列,其中5000万人将死于吸烟引起的疾病。吸烟者戒烟是21世纪中叶以前减少吸烟相关死亡的最有效途径。但根据1984年全国50万15岁以上人群随机抽样调查结果表明:我国男性吸烟者戒烟率仅为4.17%,女性为9.73%,男女平均戒烟率为4.78%;戒烟原因68.37%是由于本人患病。1996年全国吸烟行为流行病学调查结果显示:仅有16.8%吸烟者打算戒烟,但实际戒烟者仅占吸烟者的9.4%,且成功率仅占吸烟者的3.6%。吸烟者戒烟的主要原因是已患吸烟有关疾病而被迫戒烟。因此,制定行之有效的控烟戒烟措施刻不容缓。然而目前,国内外对戒烟过程的行为学特征及其影响因素研究甚少,从而制约了有效戒烟措施的制定。国内外的流行病学调查显示:吸烟习惯的养成主要是在青少年时期,可见青少年吸烟问题是中国吸烟问题的关键所在。因为青少年正处在生长发育时期,吸烟对正常生长发育会造成损害。因此,让青少年远离烟草是每个国家义不容辞的责任和义务。被动吸烟的受害人群也不容忽视,2007年《中国烟草控制报告》指出,中国有5.4亿非吸烟者(其中包括1.8亿名15岁以下的儿童)正在遭受二手烟所带来的危害,而且这种现象在娱乐场所更为严重。中国烟草消费及烟草相关疾病所导致的沉重负担,使烟草控制成为一个亟需解决的公共卫生问题。目的通过对“中国《烟草控制框架公约》监测”沈阳市基线调查数据的分析,来了解沈阳市吸烟人群中有戒烟意愿者的人口学特征及其影响因素,为有关部门制定有效的戒烟控烟措施提供科学依据;通过对沈阳市大中学生吸烟行为及相关影响因素的调查分析,来掌握沈阳市大中学生的吸烟状况,探讨影响其吸烟行为的相关因素,为开展学生控烟提供依据;以出入娱乐场所的吸烟者为研究对象,来探索娱乐场所吸烟行为的相关因素,为制定适合我国娱乐场所具体情况的综合性控烟政策提供依据。研究方法沈阳市成年吸烟者戒烟意愿调查及影响因素分析:2006年4月-10月,在沈阳市内五个区(和平区、皇姑区、沈河区、铁西区和大东区),采用多阶段分层随机整群抽样的方法,按照“街道→社区→家庭→调查对象”四个阶段进行抽样。其中,第一阶段使用按容量比例概率抽样法(PPS)抽取10个街道;第二阶段使用按容量比例概率抽样法(PPS)在每个街道抽取2个社区;第三阶段使用简单随机抽样法在每个社区抽取300户家庭并进行家庭成员信息登记;第四阶段使用简单随机抽样法在300户家庭中抽取60个家庭(先调查40个家庭,剩余20个家庭备用)。抽中的家庭如果只有1名成年吸烟者则为调查对象;如果有1名以上成年吸烟者,则选择1个生日距离调查日期最近的为调查对象;若没有成年吸烟者,采用简单随机抽样方法从备用户中抽取1户置换;每个居委会至少调查40名吸烟者(每户家庭调查吸烟者数不超过1个);最终在沈阳市抽取调查了801名成年吸烟者。调查对象纳入标准为:年龄≥18周岁;沈阳市常住居民(户口和日常生活均在沈阳市内五区);至抽样之日时,已经吸烟≥100支,并且现在仍然吸烟的人。吸烟定义:至抽样之日,已经吸烟≥100支,并且现在仍然吸烟者;有戒烟意愿者定义:吸烟人群中现在仍吸烟,但在未来一年内有戒烟打算者。沈阳市大中学生吸烟行为现状调查及影响因素分析:于2005年11月-2006年5月,采取分层随机整群抽样的方法,分别确定了1855名中学生和1117名大学生作为调查对象;由经过统一培训的调查员,采用自制封闭式问卷为调查表,以班级为单位进行调查;调查表以不记名的方式由调查员在教室发给学生,由调查员讲解调查目的和问卷的填写方式后,学生在教室当场填写,统一答卷,并当场收回。吸烟定义:指包括尝试吸烟(曾经尝试过吸烟,即使只吸过一两口的行为)和现在吸烟(在过去30天,吸过完整一支烟的行为)在内的所有情况。吸烟者在室内娱乐场所吸烟行为调查及影响因素分析:该研究的数据来自中国《烟草控制框架公约》监测调查的基线数据。我国ITC基线调查现场工作于2006年4月到10月在沈阳开展。北京、上海、长沙、广州、银川等城市也同时开展。每个城市采用多阶段抽样法,按照“街道→社区→家庭→调查对象”四个阶段进行抽样。其中,第一阶段使用按容量比例概率抽样法(PPS)在每个城市抽取10个街道;第二阶段再次使用按容量比例概率抽样法(PPS)在每个街道抽取2个社区;第三阶段使用简单随机抽样法在每个社区抽取300户家庭并进行家庭成员信息登记;第四阶段使用简单随机抽样法在300户家庭中抽取约40名吸烟者(每户家庭调查吸烟者数不超过1个)。最终在每个城市抽取至少800名成年吸烟者。调查对象纳入标准为:年龄≥18岁,本市常住居民(户口和日常生活均在本市的居民);至抽样之日,已经吸烟≥100支烟,并且现在仍然吸烟者。主要研究结果沈阳市吸烟者中有戒烟意愿者的比例为30.7%;男性有戒烟意愿者的比例(29.8%)远低于女性(46.7%);职业分布中,以国家机关党群组织负责人中有戒烟意愿的比例最高达47.5%,其次为离退休人员36.7%,以专业技术人员有戒烟意愿的比例最低为21.4%。影响因素分析发现:亲人反对、社会舆论、对健康的影响、控烟宣传的力度、健康警示信息的普及、对烟草相关疾病的知晓程度以及对戒烟产品和戒烟服务的接触均会影响吸烟者戒烟意愿的产生。沈阳市大中学生的尝试吸烟率为34.6%,男女生分别为46.9%和21.2%,男生显著高于女生;现在吸烟率为11.3%,男女生分别为18.5%和3.4%。影响因素分析发现:处身于吸烟的环境(同吸烟者在一起)、不知道如何拒绝别人递烟的礼节、伤心压抑的心情均是促进学生吸烟习惯形成的重要因素;而帮助学生提高学习成绩、正确认识烟草的危害可以很好地预防学生吸烟习惯的形成。全国六城市吸烟人群的调查结果显示:高达83.6%的吸烟者在光顾室内娱乐场所时都曾有过吸烟行为(男性:84.0%,女性:70.1%);地区分布以沈阳和上海最高分别为87.7%和87.1%,以北京最低仅75.4%。影响因素分析发现:室内娱乐场所禁烟规定实施不力或者无禁烟法规、吸烟者对室内娱乐场所控烟的态度、对烟草相关疾病的知晓程度、周围人群的影响、对吸烟行为的态度是影响吸烟者在室内娱乐场所吸烟行为的主要因素。结论沈阳市吸烟人群中有戒烟意愿者的比例低于国内同级城市,烟草相关疾病的知晓程度偏低。通过普及烟草危害的健康教育、提倡亲人积极参与吸烟者的戒烟活动、丰富烟草包装健康警示信息内容、提高控烟宣传的力度以及推广戒烟产品和戒烟服务等措施可以很好地提高沈阳市吸烟者戒烟意愿的产生。沈阳市大中学生的尝试吸烟率,无论男生还是女生,均高于全国平均水平;现在吸烟率与全国平均水平相一致。通过营造大学生和中学生生活的无烟环境、提高其拒绝别人递烟的技巧、缓解其伤心压抑的心情、帮助学生提高学习成绩、正确认识吸烟对健康的危害,可以很好地预防青少年学生吸烟习惯的形成。加强室内娱乐场所控烟法规的实施力度是控制室内娱乐场所吸烟行为和二手烟暴露的关键环节;提高吸烟者烟草相关疾病的知晓程度是控烟工作取得成效的有效措施和根本保证。更多还原

【Abstract】 IntroductionTobacco has been identified as the important risk factor of lung cancer,respiratory disease,cardiovascular disease,stroke,etc.There are 1.1 billion smokers all over the world.One such country,the world’s largest producer,consumer and victim of tobacco, is China.Currently,China is home to 350 million smokers(30%of the world’s smokers) and loses approximately 1 million persons per year directly or indirectly due to tobacco-related deaths(TRD).If the smoking situation cannot be controlled effectively, it is estimated that about 2 million smoking-related deaths will occur among Chinese men by the year 2025,and 200 million children currently living in China will become smokers,50 million of whom will die from smoking-attributable diseases.Thus,we must strengthen our late start tobacco control campaigns,but smoking cessation among adults is the best way to prevent the death rates before mid-21st century.However,the survey results show that:smoking cessation rate was only 4.78% (4.17%for male,9.73%for female),and 68.37%by the reasons of illness,in China. Too low success rate of quitting smoking and too late by the main reasons for suffering from smoking-related diseases,are prompting us to develop effective smoking cessation programs.However,the efficacious design of smoking cessation strategies for smokers is hampered by the relative absence of information.Much of our current knowledge on smoking cessation has come from Western countries.Various studies have noted that adolescence is a major risk period in the process of becoming tobacco dependent.The younger the age at which young people start to smoke,the more likely they are to become regular smokers in adulthood.However,a huge proportion of smoking experimentation occurs during this period.In China, research has shown that the prevalence of smoking is alarming high in the adult population,but little is known about adolescents smoking because few studies have focused specifically on this population. According to the Report on Tobacco Control in China for 2007,540 million non-smokers are suffering from secondhand smoke,including 180 million children aged below 15.China’s high prevalence of smoking and tremendous burden from tobacco-induced diseases make tobacco prevention an essential health priority. However,China doesn’t have a smoke free law with Chinese characteristics at the national level,let alone one aimed at the population within recreational venues,which are all common venues for smoking and passive smoking exposure. cObjectiveTo explore the determinants of the willingness to quit smoking among regular smokers,and to provide a scientific basis for establishing smoking cessation strategies for adult smokers.To provide information on the determinants and prevalence of cigarette smoking among school students in Shenyang,and develop a practical and effective intervention strategy.To provide information on the determinants of smoking behavior in recreational venues,and to develop a practical and effective smoking intervention strategy for recreational venuesMethodsThe study was the baseline survey for the International Tobacco Control(ITC) China Survey of Shenyang,conducted between April to October 2006.The Survey used a stratified multistage cluster sampling design.Within Shenyang,10 Jie Dao were randomly selected,with probability of selection proportional to the population size of the Jie Dao.Within each of these Jie Dao,two Ju Wei Hui were selected,again with probability of selection proportional to the population size of the Ju Wei Hui,from which a city-identified list of family households was used to sample 300 households from every Ju Wei Hui using a simple random sampling method without replacement. Information on age,gender and smoking status for all adults living in these 300 households was collected.The enumerated 300 households were then randomly ordered, and individuals 18 years or older who had smoked at least 100 cigarettes in their lifetime were then approached following the randomized order until 40 adult smokers were surveyed.To increase the sample size for women smokers,one male smoker and one female smoker from every selected household were surveyed whenever possible. The Next Birthday Method was used to select a respondent in households with more than one eligible male smoker.A self-administered anonymous questionnaire survey was conducted among 1855 high and middle school students,and 1117 university students selected from 9 middle schools,9 high schools,3 vocational schools,and 2 universities located in different districts of Shenyang from Nov.2005 to May.2006.2935 questionnaires were collected with a response rate of 98.8%.The ITC China Survey used a stratified multistage cluster sampling design in which six cities were first selected based on geographical representations and levels of economic development.These six cities were:Shenyang,Beijing,Shanghai, Guangzhou,Changsha,and Yinchuan.Within each city,the more detailed description can be found in 1.ResultsThe voluntary quitting smoking rate among smokers in Shenyang,was only 30.7%, with 29.8%in male far less than in female(46.7%).Among different occupations, "Leaders of government,Chinese Com.party org.,companies & institute" with the highest of 47.5%,then was "Retired"(36.7%),"Operators of prod.or transportation. equipment & related personnel" with the lowest of 21.4%.The following factors were significant predictors of voluntary quitting smoking among smokers:family members’ objects,public opinion,the health effects of smoking,advocacy efforts of tobacco control,low number of health effects reported,and The popularity of health warning information.Among the surveyed students,34.6%had experienced smoking.The prevalence of smoking was 46.9%in male,21.2%in female,with a significant difference between sexes;the prevalence of current smoking was 11.3%(18.5%in male,3.4%in female). The smoking-related knowledge and attitude were found out through Logistic analysis. "Exposed to smoking environment","don’t know how to refuse other’s free cigarettes", and "sad depressed mood" were the significant factors affecting the cigarette smoking behavior.Of all adult smokers,60%attended recreational venues at least once in the last six months.Of them,84%reported smoking in these settings.Analyses showed that the smoke-free laws had been exempted in various kinds of recreational venues,with only 32.0%of the patrons reporting bans on smoking in these locations.The following factors were significant predictors of smoking in recreational venues:absence of bans on smoking,support for non-bans,to be aged 18-24 years,positive smoking-related attitudes,low number of health effects reported,and living in cities other than Beijing.ConclusionsThe percentage of smokers contemplating quitting was low in Shenyang.The study shows that smokers in Shenyang must be mobilized to contemplate quitting and then to take action.It was a serious problem that the current smoking rate of adolescent was high in Shenyang.The students in polytechnics were the priority objects in prevention of smoking.The cognize about the harm of smoking was not widely understood or misunderstood.So it is essential to take action in educating and giving help to the quitting in adolescent smoking.The findings point to the importance of informing the Chinese public about the harmfulness of smoking and of second-hand smoke in both building support for smoke-free laws in recreational venues and in reducing smokers’ desire to smoke in such venues.They also point to the importance of good enforcement(without exemptions) of smoke-free laws when they are implemented.Such strategies could serve to de-normalize smoking in China,a key strategy for reducing smoking in general.更多还原