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2022, 39(1):47-52.doi:10.11836/JEOM21233

Investigation and analysis of smoking behaviour of civil servants in Minhang District, Shanghai


1. Health Education Department, Shanghai Minhang District Center for Disease Control and Prevention, Shanghai 201101, China
2. Department of Health Promotion, Office of Shanghai Minhang District Patriotic Health Campaign Committee, Shanghai 201199, China

Received: 2021-05-23;  Accepted:2021-11-10;  Published: 2022-01-25

Corresponding Author: YANG Qinwen, Email: 329370057@qq.com  

[Background] The tobacco epidemic as one of the most serious public health problems in the world contributes great harm to human health. It is urgent to develop tobacco control strategy. Civil servants' behaviors as a role model for society have a great influence on the rest of society. Thus, it is important to promote tobacco control program on helping civil servants to quit smoking.

[Objective] To understand the smoking and second-hand smoking exposures status, the awareness of knowledge of tobacco hazards, and the attitudes to tobacco control policies of civil servants in Minhang District, Shanghai. Furthermore, to explore the related strategies and measures for tobacco control, to provide a basis for the development and revision of relevant intervention measures and policies.

[Methods] A total of 20 government agencies with newly installed smoking-free programs from 10 subdistricts and towns in Minhang District, including Xinzhuang, Wujing, Maqiao, Qibao, Meilong, Hongqiao, Zhuanqiao, Jiangchuan, Gumei, and Xinhong were selected as study sites.A questionnaire survey was conducted to investigate all civil servants (n=801) of selected agencies. The questionnaire included general characteristics, smoking and second-hand smoking exposure status, knowledge of tobacco hazard, and attitudes to tobacco control policies.

[Results] A total of 794 civil servants returned valid questionnaires. The awareness rate of tobacco hazards in the smoking group was lower than that in the non-smoking group (P<0.05). Relatively high smoking rates were reported in those being male (17.08%), age ≥51 years old (25.61%), divorced or widowed (12.50%), technical secondary school or below education level (22.81%), having more than 10 years of working years (11.57%), being willing to dissuade indoor smoking (24.54%), having no punishment or warning measures for violation of smoking regulations in workplaces (18.37%), and having no dedicated smoking spot at home (15.38%). The results of multiple logistic regression analysis showed that age 31-40 years old (OR=3.446, 95%CI: 1.236-9.609) and to avoid confronting indoor smoking (OR=3.686, 95%CI: 1.041-13.049) were risk factors for smoking in civil servants.

[Conclusion] Civil servants aged 31-40 years old who deliberately avoid confronting indoor smoking behaviors are the key intervention population of smoking control in Minhang District, Shanghai.

Key Words: civil servant;  smoking behaviour;  influencing factor 

表 1

上海市闵行区不同特征公务员吸烟率分布

Table 1

Distribution of smoking rate among civil servants of different characteristics in Minhang District, Shanghai

表 2

上海市闵行区公务员烟草危害知晓率比较

Table 2

Comparison of the tobacco hazard awareness rates among civil servants in Minhang District, Shanghai

表 3

上海市闵行区公务员吸烟影响因素的多因素logistic回归分析

Table 3

Logistic regression analysis of influencing factors of smoking civil servants in Minhang District, Shanghai

Reference

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NIMA Q C, XIONG H, RENQING Y Z, et al. Analysis of the smoking status among the civil servants in Tibet and the influencing factors[J]. Health Educ Health Promot, 2012, 7(2): 99-101,123.

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Shanghai Municipal Health Commission. newest! The city has achieved remarkable results in tobacco control in public places, and the adult smoking rate has decreased for “six consecutive years”[EB/OL]. (2020-05-29)[2020-05-29]. http://wsjkw.sh.gov.cn/gzdt1/20200529/1109da0b21874e6290623e55feac860b.html.

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LYU Q H, XU S Y, WU Q Q, et al. An investigation on smoke-free environment and smoking status at or below county-level governments[J]. Prev Med, 2017, 29(4): 342-346.

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我国各级医疗机构对儿童用基本药物剂型和规格的需求调查

烟草流行是全球面临的重大公共卫生威胁之一。我国是世界上最大的烟草生产国和消费国,吸烟对人民群众健康的影响尤为严重[1]。我国大约有3亿主动吸烟人群,另外约有7.4亿的人群正遭受二手烟的危害,每年有超过100万的民众由于吸烟导致的相关疾病而死亡。但大众对吸烟和二手烟危害的重视程度不足,对暴露在烟草环境中的危害缺少认知,如不加以控制,到2050年我国将突破每年300万的死亡人数,社会的经济发展将遭受重击[2]。我国于2003年11月10日签署了《烟草控制框架公约》(以下简称《公约》),自2005年10月11日正式加入《公约》缔约国行列后,一直积极履行《公约》[3]。《公约》生效后,中国政府加快推出多项有效的控烟政策。公务员的行为对整个社会而言是很重要的风向标,因而公务员从自身做起,拒绝烟草显得格外重要。目前,已有多篇关于公务员吸烟行为及其影响因素方面的研究[4-7],但对上海市公务员吸烟行为的现况及其影响因素的调查还处于空白状态。因此本研究拟了解上海市闵行区公务员目前吸烟情况,探讨其影响因素以及对政策的接受程度,为控烟政策的制定提供依据。

1   对象与方法

1.1   对象

选取2020年上海市闵行区10个街道镇(莘庄镇、吴泾镇、马桥镇、七宝镇、梅陇镇、虹桥镇、颛桥镇、江川街道、古美街道、新虹街道)的所有新创无烟机关(共20家机关单位)的公务员801人作为调查对象。

1.2   问卷调查和质控

在职工大会上发放“职工吸烟与二手烟暴露情况调查问卷”,调查对象在知情同意的情况下匿名自填问卷。问卷内容包括一般情况、吸烟及二手烟暴露情况、烟草危害知识以及控烟政策态度4个方面。一般情况包括年龄、性别、婚姻状况、文化程度、工作年限等;吸烟及二手烟暴露情况包括吸烟情况、戒烟情况、二手烟暴露情况以及对待烟草及二手烟的态度;烟草危害知识包括烟草危害相关知识以及二手烟危害相关知识;控烟环境及政策知晓包括对单位无烟环境创建知晓以及对单位控烟政策知晓。本研究经上海市闵行区疾病预防控制中心伦理委员会审批通过(编号:EC-2021-001),所有调查对象均签署知情同意书。

问卷完成后由调查员统一核查后回收,剔除漏答错答等无效问卷,所有问卷均在质控后进行计算机双机录入,录入错误率控制在1.0%以内,在核查校正以后,进行数据库的合并以及统计分析。本研究中吸烟率=(吸烟人数/调查人数)×100%。

1.3   统计学分析

使用EpiData 3.1 软件进行数据录入,采用SPSS 17.0软件进行描述性统计分析,组间比较用χ2检验,公务员吸烟影响因素用多因素logistic回归分析,将是否吸烟作为应变量(0=不吸烟,1=吸烟),将性别、年龄、婚姻状态、文化程度、工作年限、对于室内吸烟的态度、对违反单位禁烟规定的行为是否有惩罚或警告措施及家里是否允许吸烟作为自变量进行回归分析。检验水准α=0.05。

2   结果

2.1   基本情况

本次调查闵行区20家机关单位801名公务员,回收问卷794份,回收率99.13%。被调查公务员中男性363人(占45.72%),女性431人(占54.28%);年龄为22~60岁,平均年龄(37.37±8.71)岁;已婚599人(占75.44%),未婚147人(占18.51%),离婚或丧偶48人(占6.05%);中专及以下学历57人(占7.18%),大专学历74人(占9.32%),本科学历507人(占63.85%),硕士及以上学历156人(占19.65%);参加工作<5年132人(占16.62%),5~10年178人(占22.42%),11年及以上484人(占60.96%);吸烟者为67人(占8.44%),不吸烟者为727人(占91.56%)。见表1

表1

上海市闵行区不同特征公务员吸烟率分布

Table1.

Distribution of smoking rate among civil servants of different characteristics in Minhang District, Shanghai

2.2   不同特征公务员的吸烟率分布

不同性别、年龄、婚姻状况、文化程度、工作年限、看见有人在室内吸烟的做法、单位禁烟政策、家庭禁烟措施的公务员吸烟率存在差异。男性吸烟率(17.08%)高于女性(1.16%);年龄在51岁及以上的公务员吸烟率比较高(25.61%);婚姻状态为离异或者丧偶状态的公务员吸烟率比较高(12.50%);随着学历增高,吸烟率呈下降的趋势;而工作年限越长,其吸烟率呈增高的趋势;在吸烟的公务员中,看见有人吸烟时进行劝阻的百分比(24.54%)高于采取躲避和无所谓的公务员(15.37%);对违反单位禁烟规定的行为,没有惩罚或警告措施机关的公务员的吸烟率(18.37%)是有惩罚或警告措施机关公务员(9.44%)的近两倍;家里任何地方都可以吸烟的公务员吸烟率(15.38%)远高于只能在家里某些地方吸烟(8.30%)以及不能在家里任何地方吸烟(4.59%)的公务员(见表1)。

2.3   公务员烟草危害相关认知情况

吸烟组对于烟草危害相关知识知晓率均低于不吸烟组,差异有统计学意义(均P<0.05)(见表2)。

表2

上海市闵行区公务员烟草危害知晓率比较

Table2.

Comparison of the tobacco hazard awareness rates among civil servants in Minhang District, Shanghai

2.4   公务员吸烟影响因素的多因素logistic回归分析

结果显示,男性吸烟的风险是女性的17.55倍;年龄31~40岁、对室内有人吸烟持躲避态度为公务员吸烟的危险因素(均P<0.05)(见表3)。

表3

上海市闵行区公务员吸烟影响因素的多因素logistic回归分析

Table3.

Logistic regression analysis of influencing factors of smoking civil servants in Minhang District, Shanghai

3   讨论

本次调查显示上海市闵行区公务员吸烟率为8.44%,低于2019年上海市成人烟草流行监测结果显示的全市15岁及以上人群吸烟率(19.7%)[8],其原因可能是由于本次调查主要针对上海市闵行区部分在岗在编的公务员,各单位均需严格执行《“健康中国2030”规划纲要》中把机关单位建成无烟机关的要求[9]。吕筠等[10]认为健康教育很重要,通过各种形式的控烟健康教育,能够有效预防吸烟行为的发生,降低场所内人群吸烟率,但是政策更具效力。通过强有力的政策支持以及对控烟做出的政治承诺,能够有效降低公务员吸烟率。

本次调查提示公务员中吸烟者对烟草危害的知晓率均低于不吸烟者。根据2015年中国成人烟草调查报告,中国居民对吸烟和二手烟能导致的后果仍缺乏足够认识,超过一半的人不了解吸烟或二手烟会带来什么疾病[11]。相关研究表明,提高民众对烟草危害的知晓率能够降低成年人的吸烟率,并提高吸烟者尝试戒烟及打算戒烟的比例[12]。因此,应进一步加强对政府机关及公务员烟草危害相关知识的宣传力度和深度,在帮助公务员吸烟者改变“知、信、行”的过程中,加强了解吸烟公务员的家庭结构及个人经历,框定个性化的信息框架,即对不同对象根据其不同情况对吸烟危害及戒烟益处进行选择性宣教。由于信息框架效应对个体行为改变决策具有普遍影响[13],在特定的信息框架下实施的控烟健康教育会具有更高的认知效用,进而提高无烟机关控烟健康教育的效果。本调查中离异或者丧偶者、年龄在51岁及以上、工作年限较长、学历较低、家中任何地方都可以吸烟的公务员吸烟率比较高,与吕巧红等[14]的研究结果一致,该部分人群为重点需要实施个性化教育的群体。另发现机关单位中有明确惩罚制度并且坚定实施的,其公务员吸烟率明显降低,这与一项在浙江省4个县(市、区)的12家机关单位控烟措施的研究结果一致[15]。在看见有人在室内吸烟后进行劝阻的公务员吸烟率高于躲避及无所谓态度的公务员,可能是由于闵行区每年3月《控烟条例》实施周年,针对机关事业单位、居(村)委、医院、学校、企业五大场所中的吸烟重点人群开展《控烟条例》宣贯,吸烟公务员群体对于室内禁止吸烟的规定知晓程度较高,反而忽视了不吸烟的非重点公务员群体宣贯。因此,本研究结果提示,闵行区除了继续针对吸烟重点人群开展控烟政策普及,还需进一步加强不吸烟非重点人群的政策宣贯。另外吸烟率随学历上升而下降,文化水平越高,公务员对相关法律规则更加重视,能够自觉去遵守。

多因素logistic回归分析显示年龄31~40岁的公务员吸烟的风险较高,这可能与该年龄段公务员社交场景较多,接触烟草的机会增加有关,另外该年龄段的公务员家庭结构也发生了变化,根据第六次人口普查数据显示,20~29岁年龄段妇女生育率占全部生育人数的66.63%[16],随着孩子的出生,家庭支出增加,故而社会压力和生活压力剧增。但随着年龄的增加,身体逐渐出现各种慢性疾病,对自身的健康状况开始注重,并开始践行健康生活方式,因而≥50岁的公务员吸烟危险度反而降低,这与江苇等[17]的研究结果类似。因此处于31~40岁的公务员应成为控烟干预的重点人群。在对室内吸烟的态度上,看到有人在室内吸烟采取躲避是公务员吸烟的危险因素,很大可能是由于人的社会属性,无法当面指出,也可能觉得和自己无关,不想指出,进而导致吸烟者弱化吸烟对他人与自身的危害,从而无所顾忌地吸烟。有研究表明公共场合其他人吸烟作为宏观系统会影响单位中其他人的吸烟态度[18],因此下阶段闵行区需要进一步加强二手烟及三手烟危害、室内禁烟的宣教,鼓励公务员积极对违规吸烟行为进行劝阻,提倡不吸游烟,不做行走的污染源。

本次调查存在一些局限性, 本研究以上海市闵行区无烟党政机关创建工作为依托,所选取的20家机关单位均为主动申报创建无烟机关的单位,并非随机抽样产生,容易产生偏倚。

吸烟不仅是个人行为,也是社会行为及群体行为[4]。吸烟公务员的态度、行为改变不是一蹴而就,需要加强对吸烟公务员烟草危害的知识宣教以及对不吸烟公务员的政策教育,采取多样化以及有针对性的健康教育,使其建立起吸烟危害健康的正确观念。只有公务员建立起吸烟危害健康的正确观念,整体具有了制定和执行无烟法规的强烈意愿和意志才能持续有效地推动控烟工作,为单位职工和公众做好榜样,持续推进无烟上海建设。

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