The Evaluation Study of Controlling Passive Smoking in Three Counties of China

BackgroundLarge number of studies proved that passive smoking inhalation contains a variety of carcinogens and toxic substances, which have serious impacts on human health. In China, passive smoking exposure is serious, and there were 540 million people suffering from passive smoking, including 180 million children under the age of 15 in 2002. With the evidence of hazards of passive smoking increasing, and the fact of its serious pandemic all over the world, the World Health Organization and some countries have adopted some strategies and measures to reduce the hazards of passive smoking exposure. In order to decrease the hazards of passive smoking, China has carried out series of intervention activities to cut down the rate of passive smoking exposure. Specific interventions involve three parts, which is legislation, public education, creating smoke-free home and smoke-free units. Since the late 1980s, more and more health promotion projects in public health have been launched in China. Correspondingly, some evaluation studies have been developed. However, those studies have some limitations in the evaluation process studies as follows: Firstly, Tobacco control projects ever undertaken mostly adopted single strategy, and the comprehensive tobacco control projects using multi-level strategies to reduce passive smoking exposure are few. Therefore, evaluation process is usually carried out by single strategy and comprehensive tobacco control projects in the evaluation process have no reported. Secondly, the index of evaluation is not comprehensive. As evaluation process, on the one hand, it is necessary to evaluate whether or not the implementation of the project is carried out according to plan and the extent of project development. On the other hand, to evaluate the acceptance of the participants in the activities is also importance. Literature review found that most evaluation process studies had focused on one hand, and few from many angles, made comprehensively evaluated the project implementation. Some domestic literature reported the effect assessment studies in reducing the rate of passive smoking exposure. However, there are no reports on the linkage of effect evaluation and process evaluation. Therefore, it is very interesting and necessary to develop the intervention evaluation studies on reducing passive smoking exposure in China’s rural areas.ObjectiveThe aim of this study, based on Fogarty, is to probe a set of evaluation process indexes which relate to the purpose of interventions, strategies and activities. And also it aims to supply reference for other similar evaluation projects. The details are as follows:1 Summarizing the process evaluation indexes which was used in the program, and through expert advice and access to the literature, to probe on the sensitive indexes on the implementation of the interventions activities, initially forming a set of process indicators on the corresponding strategies. 2 Evaluating the implementation of projects by using the process indicators3 To evaluate the result of interventions to reduce exposure to passive smoking in three counties, and to judge the effectiveness of the implementation of interventions in the three counties.4 Through executing relevance analysis between effect evaluating results and process evaluating results, to verify the sensitivity of evaluating index on process evaluation.Methods1 process evaluation1.1 Using literature analysis methods to preliminarily screen the indicators and establish the basic framework on index system. Then, after several panel discussions, giving the initial formed framework an in-depth revision and perfection, to develop the initial index system.1.2 In the index system, the importance of different indicators is different, and needs to give the appropriate weight. In this study, we utilize the score of experts to give the various indicators corresponding weight.1.3 After identifying the indexes and their weights, we adopted a comprehensive score, which is a quantitative method, to determine the score of various kinds of strategies, evaluations and different indexes. Firstly, give each index the evaluating grade, which marked by score. According to the development of intervention activities in three counties (see Annex 3, intervention points in each strategy in three counties), select appropriate ratings to give real score. Then, according to the index weight provided by the experts, weight each index and produce the weighting score.Adopt cumulative method to add each index weighting score to obtain the weighting scores of each evaluation and strategy.2 effect evaluationAssess the effect of intervention from the county and community two different levels. In order to evaluate the effect of intervention in the county and intervention demonstration sites, we adopted questionnaire to collect information from different population, and evaluated the effect of intervention in the county and community resident demonstration sites through investigating the community residents, and evaluating the effect of intervention in demonstration hospitals and schools by investigating persons in corresponding hospitals and schools. We used different methods of evaluation, which one is itself compression, the other is horizontal comparison, based on the aims of evaluation and the availability of baseline data.3 The correlation analysisThe correlation analysis of the results of process evaluation and effect evaluation, and verification the sensitivity of process evaluation indicatorsThe process evaluation and the effect evaluation are closely interrelated, both of them reflecting the quality of intervention strategy and activity. Therefore, this study discusses the sensitivity of process evaluation index system by analyzing the results of process evaluation and effect evaluation. Results1. According to the intervention activities points in three counties and communities, we obtained the weighted score of each strategy, various strategies and each index(前后顺序). The results showed that the score of intervention activities is different in each county and community.In the process of policy formulation and implementation, the score of process evaluation of XINAN County is higher than other counties. The main reason lies in the implementation of the policy stage: better completion of the intervention activities and broader coverage of the crowd.In mass media and health education, ANYI County got higher score than other counties, mainly due to the higher frequency and intensity of the propaganda activities than the two other counties, and covering a wide range of people.In the activities of creating smoke-free hospitals, the County of XINAN demonstration hospitals obtained higher scores, mainly due to staff training in place and better implementation of oversight.In the activities of creating free-smoke schools, the teachers and students in ANYI County demonstration school got higher scores than other counties, mainly due to better implementation of school rules and feedback in place, and emphasizing the propaganda and education on the teachers and students. The results of process evaluation in the other schools showed that few activities were carried out among the teachers.In the activities of creating smoke-free family, the results of process evaluation in ANYI city intervention demonstration site is superior to all other intervention demonstration site, either from publicity and education activities, or creating an atmosphere of community tobacco control.2. The effect evaluation on intervention activities and intervention spots in the county levels in the three counties. The results are as follows:The evaluation results on the intervention activities in the county level: except Mianzhu city, other two counties both demonstrated some positive results. People there showed more information about the hazards of passive smoking and high attitude to control tobacco smoking, There some changes about behaviors and atmosphere related to passive smoking hazards.The results on all related intervention spots:The results about establishing non-smoking hospitals: there are no significant changes about knowledge, attitude and behavior in faculty of intervention spot hospitals in Mianzhu city. However, there are positive changes including attitude and behaviors related to passive smoking in intervention hospitals in Anyi county, while the exposure to passive smoking has no significant changes in faculties in some organizations. The attitude and behavior about tobacco control improved in the faculty of intervention spot hospitals in Xian’an county. The passive smoking exposure rate also decreased.The results about establishing non-smoking schools: there are no significant changes about knowledge, attitude and behaviors related passive smoking exposure in teachers and students in intervention spot schools in Mianzhu city. Similarly, there are no evident changes including knowledge, attitude and behaviors related to passive smoking in teachers in intervention schools in Anyi county, while there are improvements about knowledge, attitude and behaviors related passive smoking exposure in students. There are no significant changes about knowledge, attitude and behaviors related passive smoking exposure in teachers and students in intervention spot schools in Xian’an county. The results about establishing non-smoking communities: there are no significant changes about knowledge, attitude and behaviors related passive smoking exposure in intervention suburban regions in Mianzhu city. While there are improvements about information related passive smoking exposure in urban regions. There are no significant changes on behaviors. Similarly, there are some changes including knowledge, attitude and behaviors related to passive smoking in intervention suburban regions in Anyi county, while there are significant improvements about knowledge, attitude and behaviors related passive smoking exposure in urban regions. There are some changes about knowledge, attitude and behaviors related passive smoking exposure in intervention spot schools of urban and suburban regions in Xian’an county.3. The relevance analysis results on process evaluation and effect evaluation: process evaluationresults and effect evaluation results basically showed identical tendency. The county and communityshowed better process evaluation results also showed better.ConclusionsProcess evaluation and effect evaluation should depend on the strategies, measures and implement levels of intervention activities. The studies evaluated the effects of intervention including process evaluation index and effect evaluation index, according to the strategies, measures and implement levels of intervention activities, and provided reference and thoughts for other similar projects.