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1、 医疗卫生机构论文：医疗卫生机构无烟环境创建效果评估及影响因素研究【中文摘要】评价医疗卫生机构无烟环境创建效果；研究影响医疗卫生机构无烟环境创建效果的主要因素和创建中存在的主要问题；了解无烟医疗卫生机构评分表在实施中存在的主要问题。方法：采用定量研究数据分析和定性研究相结合的方法。定量研究数据来自于中央补助地方烟草监测和干预项目。该项目通过非随机分层抽样的方法,在每省创建20家无烟医疗卫生机构,并从2009年5月30日至11月30日开展为期半年的干预活动。在干预活动前后分别开展一次基线和终末问卷调查。利用604家医疗卫生机构干预前后的调查数据对无烟环境的创建效果进行评价。干预活动评价指标为无烟
2、政策指标、无烟支持环境指标、控烟宣传培训指标。干预效果评价指标为无烟环境执行指标、二手烟暴露指标、工作人员控烟知识、态度、行为指标。利用SAS 9.1统计软件完成定量资料的数据清理和统计分析。统计分析方法主要包括描述性分析、卡方检验、符号秩和检验和Logistic回归分析。定量数据完成后,采用个人深入访谈的方法,在北京访谈熟悉无烟医疗卫生机构创建工作的控烟人员21名。利用ATLAS TI 5.0软件完成访谈资料的整理和主题编码,并对各访谈主题进行归纳总结。结果：1.医疗卫生机构无烟环境创建效果评估1)制定禁烟规定的机构比例由干预前的53.5%上升至干预后的92.1%,销售烟草制品的机构比例由干
3、预前的16.5%降至干预后的6.3%；过去一年,工作人员接受过控烟宣传培训的比例由干预前的21.8%上升至干预后的56.7%。2)过去一周,工作人员在工作场所二手烟暴露率由干预前的61.4%下降至干预后的49.1%。工作人员对各项烟草危害知识的知晓率都有所上升。但是仍有80.9%的人错误地认为“烟中的尼古丁是引起大多数癌症的化学物质”,38.7%的人错误地认为“过滤嘴可以降低吸烟的危害”。工作人员对本单位室内全面无烟的支持率由干预前的71.9%上升至干预后80.8%。工作人员现在吸烟率由干预前的17.6%下降至干预后的15.2%,但干预后现在吸烟者中仍有82.9%的人在上班时吸过烟。2.影响医
4、疗卫生机构无烟环境创建效果的主要因素无烟环境得分总分为30分,干预后,医疗卫生机构无烟环境得分中位数由12分上升至25分。无烟环境创建效果与实施干预活动、制定禁烟规定、工作人员支持室内全面无烟、工作人员接受控烟培训成正相关,与工作人员现在吸烟情况、烟草制品销售成负相关。而是否有控烟宣传材料、是否有禁烟标志、是否设置吸烟区则对无烟环境创建效果的差异无统计学意义。通过定性研究我们也发现,设立控烟监督和巡查队伍是影响医疗卫生机构无烟环境创建效果的最重要因素,领导重视是影响无烟医疗卫生机构创建工作的关键环节。结论：1.我国医疗卫生机构无烟环境创建工作取得较大进展,但与决定要求仍存较大差距。2.设立控烟
5、监督和巡查队伍是影响医疗卫生机构无烟环境创建效果的最重要因素,领导重视是影响无烟医疗卫生机构创建工作的关键环节。3.无烟政策执行力度不足、监督人员劝阻吸烟能力欠缺、男性医生尤其是外科医生吸烟现象严重是目前我国无烟医疗卫生机构创建中存在的主要问题。4.无烟医疗卫生机构评分表在条目设置、分值设置、实施细则方面还有待改善。【英文摘要】:The aims of the study are:1) to evaluate the effects of creating smoke free health care facilities; 2) to explore the main factors tha
6、t influence the effects and to find the main barriers in creating smoke free health care facilities; 3) to find problems of the evaluation criteria for smoke free health care facilities.Method:Quantitative data analysis and in-depth individual interview were used in this study. The quantitative data
7、 were collected from “Central government subsidies to local tobacco surveillance and intervention project”. Through non-random stratified sampling,20 smoke free health care facilities were created in each province in China. From May 30th to November 30th in 2009, each selected facility carried out c
8、omprehensive interventions. Totally, there were 604 facilities which finished both the baseline and the end-point questionnaire survey. For effect assessment, we evaluated 3 aspects of intervention activities, including smoke free policy, smoke free supporting environment, tobacco control propaganda
9、 and education. We also evaluated the effects of smoke free environment implementation, the condition of second-hand smoke exposure, and the staffs knowledge, attitudes and behaviors of tobacco smoke. SAS 9.1 software was used in statistical analysis. The mainly analytic methods included: descriptiv
10、e analysis,2 test, nonparametric test and Logistic regression. In-depth individual interviews were carried out in Beijing after the data analysis.21 persons who were familiar with the work of creating smoke free health care facilities were interviewed. Atlas Ti 5.0 software was used to collate and c
11、ode the qualitative data.Results:1. Effect evaluation of creating smoke free health care facilities 1) Percentage of facilities with smoke free rules increased from 53.5% to 92.1%; Percentage of facilities that permitted cigarette sales decreased from 16.5% to 6.3%; In the last year, the percentage
12、of staff who had been training on tobacco control increased from 21.8% to 56.7%.2) In the last week, the percentage of staff that had been exposed to second-hand smoke decreased from 61.4% to 49.1%. Staffs awareness about tobacco harms was all better than before. But after the intervention,80.9% of
13、the staff believed that “the nicotine in cigarettes is the chemical that causes most of the cancer”, and 38.7% of the staff thought “the filter can decrease hazards of smoking”. The percentage of staff that supported comprehensive smoke-free policy in their indoor workplace was 80.8%, compared to 71
14、.9% before the intervention. The current smoking prevalence among the staff decreased from 17.6% to 15.2%.But 82.9% of the current smokers smoked during work time in their workplace after intervention.2. Influence factors associated with the effects of creating smoke free health care facilitiesThe t
15、otal score for smoke free environment was 30, the median score for all health care facilities increased from 12 to 25 after the intervention. From the results of logistic regression, we found factors associated with better effects included 1) tobacco control intervention (relative to that before int
16、ervention) 2) Facilities with tobacco control rule (relative to facilities without tobacco control rule) 3) Facilities with higher support rate for 100% smoke free in their indoor workplace (relative to facilities with lower support rate) 4) Facilities with higher proportion of staff who had been training on tobacco control (relative to facilities with lower proportion of staff who had been training on tobacco control). Fa
