《上海市公共场所控制吸烟条例》修正案在上海市浦东新区实施半年的控烟效果
Implementaton evaluaton of The Revised Shanghai Regulaton on Smoking Control in Public Places over six months in Pudong New Area of Shanghai
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摘要:
背景 2010年3月1日《上海市公共场所控制吸烟条例》（简称《条例》）在上海实施。2017年3月1日，经上海市人民代表大会常务委员会重新修订过的《条例》，即《条例》修正案正式实施。与原《条例》相比，《条例》修正案将原来部分室内公共场所禁烟扩大为所有室内公共场所、室内工作场所和公共交通工具全面禁烟，向创建无烟环境迈出重要一步。
目的 评估《条例》修正案实施后上海市浦东新区各类室内公共场所、室内工作场所和公共交通工具的控烟效果。
方法 以上海市浦东新区为研究现场，抽取237个室内公共场所、室内工作场所和公共交通工具，分别于《条例》修正案实施前（2016年12月）、《条例》修正案实施后一个月（2017年4月）和《条例》修正案实施后半年（2017年9月）进行了3次监测，包括环境观察和拦截人员问卷调查。环境观察内容包括场所内控烟宣传资料、禁烟标识、举报电话、烟具、吸烟区的设置和观察到烟蒂和吸烟行为的情况。拦截人员问卷调查包括调查对象对《条例》/《条例》修正案和无烟立法的态度、吸烟危害知识的知晓情况。共完成230家场所的环境监测（失访7家），3次监测分别完成2 327份、2300份和2277份拦截人员问卷调查。
结果 《条例》修正案实施后，提供控烟宣传资料、张贴举报电话的场所比例均提高（P < 0.001），观察到烟具、烟蒂和吸烟现象的场所比例均下降（P < 0.001）。不同类型场所的无烟环境变化有所不同。未成年人活动场所（3/28，10.7%）、医疗卫生机构（1/18，5.6%）、餐饮场所（8/37，21.6%）、休闲娱乐场所（6/38，15.8%）、酒店旅馆（1/20，5.0%）、办公楼宇和居民楼（4/14，28.6%）、生产型企业（2/6，33.3%）和公共交通工具（1/7，14.3%）出现吸烟行为。公众对于《条例》/《条例》修正案的知晓率和支持率，对于"每个人都享有无烟环境的权利"的认同率，对相关吸烟危害的知晓率均有不同程度的提高（P < 0.05）。logistc回归分析表明，年龄与调查对象对《条例》修正案的知晓有关，30~49岁组和50~岁组对《条例》修正案知晓率分别是15~29岁组的2.585（95% CI：1.928~3.466）倍和1.778（95% CI：1.294~2.444）倍（P < 0.001）；而年龄、性别与调查对象对《条例》修正案的支持无关联；吸烟状态与调查对象对《条例》修正案的支持有关，支持《条例》修正案的吸烟者是非吸烟者的0.220（95% CI：0.061~0.790）倍（P=0.020），但戒烟者与非吸烟者对《条例》修正案的支持率差异无统计学意义。
结论 《条例》修正案实施半年已经获得一定成效，公众对于全面室内公共场所无烟立法的支持和对吸烟危害的正确认知提高，但部分场所的无烟环境管理和执法应继续加强。
Abstract:Background The Shanghai Regulation on Smoking Control in Public Places was implemented on March 1, 2010. The revision of the regulaton, which was revised by the Standing Commitee of the People's Congress of Shanghai, was implemented on March 1, 2017. The revision is a more comprehensive smoke-free law than the old version, which expands non-smoking places from partcular indoor public places to all indoor public places, indoor workplaces, and on public transport, indicatng an important step forward.
Objectve This paper evaluates the impact of the revision of the regulaton in indoor public places, indoor workplaces, and on public transport in Pudong New Area of Shanghai.
Methods Three investigations were conducted at the pre-implementation stage (December 2016) and the post-implementation stage (1 month, April 2017; and 6 months, September 2017) in 237 indoor public places, indoor workplaces, and on public transport in Pudong New Area of Shanghai, and included observatons and questonnaire survey. The observatons included smoking control publicity materials, no-smoking signs, hotline numbers, ashtrays, smoking areas, cigarete buts, and smoking behavior. The intercept questonnaire survey was about the public attudes and support towards the regulaton/the revision of the regulaton and the awareness of smoking harms. A total of 230 places were included in the study (7 were withdrawn), and 2 327, 2 300, and 2 277 partcipants completed the questonnaires in the three waves of intercept surveys, respectvely.
Results Afer the implementaton, more places provided tobacco control publicity materials and posted hotline numbers to report illegal smoking (P < 0.001), while less were observed with ashtrays, cigarete buts, and smoking behavior (P < 0.001). The changes of smoke-free environment differed among different types of places. Smoking behavior was found in places for kids (3/28, 10.7%), medical and health insttutons (1/18, 5.6%), restaurants (8/37, 21.6%), entertainment places (6/38, 15.8%), hotels (1/20, 5.0%), ofce buildings and residual buildings (4/14, 28.6%), manufacturing enterprises (2/6, 33.3%), and public transport (1/7, 14.3%). Increased proportons of partcipants were aware of and supported the regulaton/the revision of the regulaton, agreed with the noton that "every person deserves the right to breathe tobacco-smoke-free air", and were aware the hazards of smoking (P < 0.05). The logistc regression analysis results showed that age was associated with the awareness of the regulaton revision, and the odds ratos of the 30-49 years age group and the 50-years age group versus the 15-29 years age group were 2.585 (95%CI:1.928-3.466) and 1.778 (95%CI:1.294-2.444) respectvely (P < 0.001); gender and age had no associatons with the support of the regulaton revision; smoking status was signifcantly associated with the support of the regulaton revision, and the odds rato of current smokers versus never-smokers was 0.220 (95%CI:0.061-0.790) (P=0.020), but there was no difference between former smokers and never-smokers.
Conclusion The half-year implementation of the revised regulation has produced some positive effects that more citizens support banning smoking in all indoor public places and are aware of the hazards of smoking, but strengthened supervision and management is needed in some types of the places.
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