【作者】 张之幸；

【导师】 傅华； 郑频频；

【作者基本信息】 复旦大学 ， 公共卫生， 2009， 硕士

【摘要】 研究背景烟草危害是当今世界乃至我国最严重公共卫生问题之一,是人类健康所面临的最大的可以预防的危险因素。目前全球共有11亿吸烟者,每年导致近500万例本应可以预防的死亡。世界控烟运动已取得了巨大进展,2005年2月27日《烟草控制框架公约》（以下简称《公约》）正式生效,这是第一个具有法律效应的公共卫生条约。随着2006年1月9日《公约》在我国生效,中国政府一直高度重视开展控制吸烟工作并积极推进。目前公共场所被动吸烟状况依然严峻,对被动吸烟者造成的危害日益引发关注。大量的科学证据说明被动吸烟不存在安全暴露水平,无论是单独还是同时使用通风和过滤措施,都不能将室内二手烟雾暴露水平降低到可接受的程度,只有完全无烟环境才能真正有效地保护不吸烟者的健康。全国各地愈来愈多的研究报道证实这一点,公共场所禁止吸烟已成为大势所趋。上海作为国际化大都市,从1994年起执行《上海市公共场所禁止吸烟暂行规定》,但在上海公共场所室内被动吸烟的现况调查研究报道甚少,并且在国内对于公共场所室内环境烟雾测定尚处于探索性热点研究阶段。研究目的开展长宁区公共场所被动吸烟监测,评估目前公共场所室内被动吸烟情况,为制定适合上海市相关公共场所控烟政策提供依据。探索有效公共卫生监管的可能性,在今后工作中全面开展控烟和卫生监管提供科学正确的指导和借鉴。研究方法1、通过方便抽样,在长宁区二大区域（东西）内星级宾馆、证券交易所和餐厅中各分别选取4家场所,共抽取了24家非法定禁烟公共场所,采用AM510个人智能防爆粉尘测试仪对颗粒物(PM_2.5)浓度进行检测,并测定空间大小。同时利用观察法观察与控烟相关的包括通风情况、大厅空间、人数等在内的软硬件设施情况。评估目前非法定禁烟公共场所的环境烟雾污染情况。2、采取目的性抽样,抽取长宁区21家非法定禁烟公共场所的服务业（宾馆和餐厅）工作人员作为调查对象,采用自填问卷的方式了解他们被动吸烟状况、相关健康效应以及对无烟政策的态度。共有600名员工参加。3、采用目的性抽样,抽取长宁区13家四星级以上涉外宾馆,对调查期间（2008年4月中旬-下旬）入住的中外客人作为调查对象。自填问卷调查内容包括人口学资料、对上海公共场所控烟状况的评价、对于创建无烟环境的意愿以及个人的吸烟状况。共有811名中外客人参加。研究结果1、24家非法定禁烟公共场所室内细颗粒物平均浓度达到334.62μg/m³,高于室外细颗粒物平均浓度116.71%;其中宾馆、证券交易所和餐厅的室内细颗粒物平均浓度分别是125.14μg/m³、353.84μg/m³、518.38μg/m³;被调查的不同场所（宾馆和餐厅）室内细颗粒物浓度与单位体积吸烟人数呈显著正相关。2、75.2%的宾馆和餐厅员工遭受被动吸烟,其中宾馆组被动吸烟率69.8%,餐厅组被动吸烟率93.2%。服务业员工平均每天在工作中有2.91+2.42小时遭受被动吸烟,其中宾馆组被动吸烟时间为2.43+2.22小时,餐厅组被动吸烟时间为3.94+2.53小时。76.8%受调查者报告有呼吸系统症状和刺激症状的发生。3、62.1%星级宾馆的中外客人认为上海公共场所吸烟的情况严重。酒吧、火车站,餐厅成为宾馆客人评价被动吸烟最为严重的公共场所。有72.9%的宾馆客人赞成上海应该在公共场所完全禁烟。《上海市公共场所禁止吸烟暂行条例》在中国大陆与非中国大陆客人的知晓率均不足半数。多因素分析结果表明:不吸烟者和所在地区执行无烟政策者更赞成公共场所完全禁烟政策,其OR值分别达4.42（95%CI:2.58-7.58）和3.92（95%CI:2.03-7.56）,与小于30岁年龄组相比,中年组（30-49岁）更赞成上海公共场所完全禁烟政策,其OR值为1.81（95%CI:1.01-3.26）。75.8%的调查对象同意“公共场所无烟会提升城市的形象”,54.8%的调查对象表示在上海实施公共场所完全禁烟会更愿意来上海,28%表示不受影响。结论1、目前上海部分公共场所被动吸烟状况仍然存在,尤以旅游餐饮服务窗口相关的公共场所较为严重,并对服务业员工健康产生危害;在上海现有的控烟规定不足以保护员工和公众健康,有效的控烟立法有利于提升国际性大都市的形象。2、公众对于公共场所无烟具有较高的支持程度,室内公共场所完全无烟具有一定的可行性。更多还原

【Abstract】 BackgroundTobacco use is one of the most serious and preventable public health issues in the world and in the China as well currently.There are approximately 1.1 billion smokers in the world among whom 5 million smokers died yearly attributable to tobacco use. However,those dead cases should be totally avoided.Now tobacco control actions have been spreaded globally.WHO Framework Convention on Tobacco Control （FCTC）was implemented on Feb 27th 2005 in the world as the first worldwide legal convention regarding public health.Then,FCTC went into effect in China on Jan 9th 2006.Chinese Government really respects campaigns of tobacco control and makes effort in pushing those campaigns.Tobacco use in China is still serious.Now more emphasis has been focused on the risk of secondhand smoke.Most of the scientific researches confirmed that there are no safe exposure levels for secondhand smoking,even if using filter or ventilation individually or combining both of them.Smoke-free environment is the only effective way to protect non-smokers’health.More and more researches from different fields of China have reached a common sense that implementing smoke free policy in public places is a necessary trend in China.As a mega-city,Shanghai has issued and enforced’Interim smoking restrictions in public places in Shanghai’since 1994.A few researches,however,have been conducted about exposure to Secondhand smoke in public places in Shanghai.Furthermore,air monitoring indoor smoke exposure level in public places is still in the research stage to explore in China.ObjectiveThe objective of this study is to evaluate the exposure to secondhand smoke in public places in Changning District.It is hoped that this study could provide strong evidence to advocate for a smoke-free legislation in Shanghai.In addition,the present study could make contribution to exploring effective inspection methods on exposure to secondhand smoke in Changning District.Method1.Exposure information of 24 smoke-free public places was collected through applying convenient sampling from star hotel,stock exchange and restaurant in east and west of Changning District.Monitoring exposure level of smoking particles and size of space of those public places were monitored with AM510 air monitoring. Meanwhile,Air flowing,size of hall,number of lients and staff were observed and recorded.In this means,the status of exposure to secondhand smoke could be evaluated in public places without legal smoking restrictions.2.Related information of 600 workers in hotels and restaurants was collected through self-completed questionnaires from twenty-one from hotels and restaurants in Changning District.The questions included the status of secondhand smoke,effect of exposure to secondhand smoke on health and attitude for smoke-free policy.3.Related information of 811 clients was collected through self-completed questionnaires from thirteen four-star and five-star hotels in Changning District with purposive sampling from mid Apr to late Apr in 2008.The contents of questionnaire included demography,smoking behavior,exposure to secondhand smoke indifferent public places in Shanghai,attitudes about establishing smoking-free legisltation.Results1.The average PM_2.5concentration indoor in the 24 public places without smoking ban was 334.62μg/m³ and was 116.71%higher than the PM_2.5concentration outdoors. Fine particle concentrations hotels,stock exchange and restaurants were 125.14μg/m³, 353.84μg/m³ and 518.38μg/m³.The PM_2.5concentration in hotels and restaurants was significantly correlated with the density of the litten cigarettes.2.75.2%of the workers surveyed were found to be exposed to SHS while working, 69.8%of the hotels workers surveyed were found to be exposed to SHS,93.2%of the restaurants workers surveyed were found to be exposed to SHS.The average hours of exposure to secondhand smoke per day were 2.91±2.42, 2.43±2.22,3.94±2.53 hours correspondently.Respiratory and irritative symptoms were significantly related to smoking and SHS were found in most workers（76.8%）. 3.62.1%of respondents considered the environmental smoke exposure in the public places in Shanghai as serious.Bars,railway stations and restaurants were the most frequently mentioned public places by the respondents where they were substantially exposed to secondhand smoke.There were 72.9%of respondents supporting smoking ban in the public places.Less than half of clients did not know the current tobacco control regulations in Shanghai.The result of logistic regress analysis indicated that the non-smokers and clients who came from nations（areas）with smoke-free policies in the public places showed more supportive attitude to smoking bans.The correspondent OR value were 4.42（95%CI:2.58-7.58）and 3.92（95%CI:2.03-7.56） respectively.The middle aged respondents（30-49 year）showed more supportive attitude to smoking ban in the public places in Shanghai.The correspondent OR were 1.81（95%CI:1.01-3.26）.There were 75.8%of respondents agreeing that“smoke free public place can promote the image of the city”.54.8%of respondents expressed that they were more likely to come to Shanghai if there was a total smoking ban in the public places.28%of respondents reported that such a measure would not have any impact on their willingness to visit Shanghai.Conclusions1.Exposure to environmental smoking in the public places was serious in Shanghai, especially in restaurants,hotels,and public transportation stations.It also caused harm for workers health.The current tobacco control polices in Shanghai could not protect public from secondhand smoke.There is urgent need to establish smoke-free policies in Shanghai.2.Public in Shanghai highly supported the smoking ban in the public places.A smoke-free policy is a feasible and practical measure for control secondhand smoking in Shanghai.更多还原