【作者】 李伟霞；

【导师】 傅华； 郑频频；

【作者基本信息】 复旦大学 ， 社区卫生与健康促进， 2010， 硕士

【摘要】 研究背景烟草使用已成为引起早死和疾病的重要原因,是人类健康所面临的最大的可预防的危险因素之一。世界控烟运动已取得巨大进展,2005年2月27日《烟草控制框架公约》正式生效,这是第一个具有法律效力的国际公共卫生条约。我国于2003年11月10日签署了《烟草控制框架公约》,并于2006年1月9日在我国正式生效。《烟草控制框架公约》的签署为中国的控烟工作带来了新的机遇和挑战。目前我国公共场所被动吸烟状况严重,对被动吸烟者造成的危害日益引起人们的关注。大量科学证据表明被动吸烟不存在所谓的“安全暴露”水平。无论是单独或同时使用通风和过滤措施,都不能将室内烟草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。越来越多的国内外研究报道证实了这一点,公共场所禁止吸烟已成为大势所趋。作为国际化大都市,上海于1994年12月1日开始实施《上海市公共场所禁止吸烟暂行规定》,但有关上海市公共场所室内被动吸烟现况的研究报道尚很少见。如今,上海市政府正在为创办2010年“无烟世博”而努力,为本研究提供了契机。研究目标开展上海市公共场所室内被动吸烟现状的调查与监测,全面评价上海市公共场所被动吸烟现状,为上海市公共场所的进一步控烟研究提供依据。探索实施公共场所完全无烟的可能性,为今后的控烟研究提供借鉴与参考。研究方法1.采用多阶段分层整群抽样方法,对上海市7大类别公共场所的4388名员工进行一对一问卷调查,了解其工作期间的被动吸烟状况、相应的健康效应以及对无烟政策的态度。2.采用目的抽样,在人口密集的徐汇、静安、黄浦、卢湾和长宁5个中心城区,抽取一定数量、市民经常出入的餐厅、星级宾馆、娱乐场所、大型购物商场及医院等作为本研究的监测点,共抽取110家公共场所.采用AM510个人型气溶胶监测仪对细颗粒物(PM2.5)浓度进行监测,并测定空间大小。同时利用观察法观察与控烟相关的包括禁烟标志、通风情况、大厅空间、人数等在内的软、硬件设施情况。评估上海市公共场所的环境烟草烟雾污染情况。3.采用目的抽样,在人口密集的徐汇、静安、黄浦、卢湾和长宁5个中心城区,抽取一定数量、市民经常出入的餐厅、星级宾馆、娱乐场所及大型购物商场的公共场所的管理人员作为访谈对象。了解其对上海市公共场所实施完全无烟的态度及意愿。共访谈30位公共场所管理人员。研究结果1.有55.1%的公共场所员工在工作期间遭受被动吸烟。娱乐、餐饮等非法定禁烟公共场所员工的工作场所被动吸烟率较高(分别为81.9%,77.7%)。公共场所员工平均每天在工作中被动吸烟时间为1.51±2.39小时,其中餐饮业员工被动吸烟时间为2.98±3.09小时,娱乐业员工被动吸烟时间为2.02±2.30小时。支持所在单位实施完全禁烟的不吸烟员工和吸烟员工比例分别为81.8%和45.3%。工作场所被动吸烟时间是6种呼吸道及粘膜刺激症状的危险因素(P<0.05)。2.110家公共场所的室内PM2.5平均浓度达到61.05μg／m3,比室外PM2.5平均浓度的高68.6%；其中娱乐、餐厅的室内PM2.5平均浓度分别为83.16μg／m3、94.68μg／m3,均显著高于三类公共场所(P<0.05)；实施完全禁烟、吸烟分区和无吸烟限制规定三种不同禁烟措施的公共场所室内PM2.5浓度分别为27.86μg／m3、52.73μg／m3和103.07μg／m3,两两间存在差异,且均有统计学意义(P<0.05)；公共场所室内PM2.5浓度与室外PM2.5浓度、室内吸烟者密度均呈显著的正相关关系。3.有73.3%(22／30)的公共场所管理人员赞同公共场所完全无烟；72.7%(8／11)的吸烟者管理人员赞成公共场所完全无烟。63.3%(19／30)的公共场所管理人员认为公共场所完全无烟不会对其单位运营造成影响。公共场所管理人员(30／30)均认为实施公共场所完全无烟长远来说是可行的。结论1.目前上海市公共场所被动吸烟状况依然严峻,尤以餐厅、娱乐等服务窗口行业的公共场所被动吸烟较为严重,并对员工健康产生危害；2.公共场所员工及管理人员对实施公共场所完全无烟具有较高的支持程度,实施公共场所室内完全无烟具有一定的可行性。更多还原

【Abstract】 BackgroundTobacco use has been one of leading causes of death and dieases, as well as one of the most serious and preventable public health issues. 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, which greatly promotes tobacco control actions spreaded globally. After China sighed FCTC on Nov 10th 2003, FCTC went into effect in China on Jan 9th 2006. FCTC brings in many opportunities and challenges for Chinese campaigns of tobacco control.As a mega-city, Shanghai has issued and enforced ’Interim smoking restrictions in public places in Shanghai’since 1994. Few researches, however, have been conducted about passive smoking in public places in Shanghai. Furthermore, the goverment of Shanghai has been tried hard to create a smoke-free environment for expo 2010 in Shanghai.ObjectiveThe objective of the present study was to overally evaluate the passive smoking in public places in Shanghai by investigation and monitoring. In addition, potential of creating a smoke-free environment in public places in Shanghai would be explored.Method1. A cross-sectional survey was employed through multistage stratified cluster sample among 4388 employees from 7 kinds of workplaces in public places in Shanghai. The questions included the status of passive smoking, effect of passive smoking on health and attitude for smoke-free policy.2. Five thickly populated districts were selected among the 19 districts in Shanghai. In each district, a certain number of public places where citizens heavily traveled were selected through applying purposive sampling from restaurants, star hotels, places of entertainment, shopping malls and hospitals. Altogether,110 public places were involved in the study. Exposure level of smoking particles of those public places was monitored with AM510 Personal Aerosol Monitor. Meanwhile, no smoking signs, air flowing, size of hall, number of clients and staff were observed and recorded. Through these means, the status of passive smoking could be evaluated in public places. 3. Five thickly populated districts were selected among the 19 districts in Shanghai. In each district, a certain number of managers of public places where citizens heavily traveled were selected as interviewees through applying purposive sampling from restaurants, star hotels, places of entertainment and shopping malls.30 managers’ anttitude and willingness to smoke-free policy in public place came to find out through in-depth interview.Results1.55.1% of the employees surveyed were found to be exposed to passive smoking while working. Employees who worked in public places without any legal regulation on smoking exposed to passive smoking seriously, for example, the proportion of exposing to passive smoking of entertainment and resturant employees were 81.9% and 77.7% respectively.The average hours of exposure to passive smoking while working per day were 1.51±2.39,2.02±2.30,2.98±3.09 hours correspondently. The supporting rate of total smoking ban among the employees who are non-smokers and the employees who are smokers were 81.8% and 45.3% respectively. Exposure to passive smoking was a risk factor for 6 kinds of symptoms of disease (P<0.05).2. The average PM2.5 concentration indoors in the 110 public places was 61.05μg/m3 and was 68.6% higher than the PM2.5 concentration outdoors. The average PM2.5 concentration indoors in places of entertainment and resturants were 83.16μg/m3 and 94.68μg/m3 respectively, both higher than the PM2.5 concentration indoors of other 3 kinds of public places (P<0.05).Public places with 3 different kinds of smoking ban had different PM2.5 concentration indoors (P<0.05). The average PM2.5 concentration indoors in the public places with total smoking ban, a partial smoking ban and none smoking ban respectively were 27.86μg/m,52.73μg/m and 103.07μg/m respectively. The PM2.5 concentration indoors in public places was significantly correlated with the density of the litten cigarettes as well as the PM2.5 concentration outdoors.3. Among 30 managers in public places who were interviewed,73.3% supported the smoke-free policy in public places, with 8 out of 11 smokers supported the smoke-free policy in public places.63.3% managers expressed that the implementation of smoke-free policy wouldn’t impact the operating revenue of public places. All managers considered that implementing the smoke-free policy in public places was feasible in the long run. Conclusions1. Exposure to passive smoking in the public places was serious in Shanghai, especially in restraurants, and places of entertainmen. It also caused harm for employees’ health.2. Employees and managers in public places in Shanghai highly supported the total 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