Development of policy performance indicators to assess the implementation of protection from exposure to secondhand smoke in China

Objective To develop an approach for rapid assessment of tobacco control interventions in China. We examined the correlation between components of the Strength of Tobacco Control (SOTC) index and a proposed rapid evaluation indicator, the Policy Performance Indicator (PPI), which is based on protection of non-smokers from secondhand smoke (SHS). The PPI was used to assess the implementation of policies related to SHS at the provincial/municipal level in China. Methods Stratified random sampling was used to select five types of organisational and household respondents in two municipalities and five provinces in China (Shanghai and Tianjin, Heilongjiang, Henan, Guangdong, Zhejiang and Jiangxi, respectively). Data collection methods included key informant interviews, observation and intercept surveys (organisations), and a modified Global Adult Tobacco Survey (GATS) questionnaire (households). SOTC scores (SHS policy, capacity and efforts), PPI (no smoking in designated smoke-free places) and mid-term to long-term impact (knowledge, attitude and reduced exposure to SHS) were measured, and correlations among them were calculated. Results The PPI varied across the seven locations. Shanghai led in the component indicators (at 56.5% for indoor workplaces and 49.1% for indoor public places, respectively), followed by Guangdong, Tianjin and Zhejiang (at 30–35% for these two indicators), and finally, Henan and Jiangxi (at 20–25%). Smoke-free policies were more effectively implemented at indoor workplaces than indoor public places. The PPI correlated well with certain components of the SOTC but not with the long-term indicators. Conclusions The PPI is useful for evaluating implementation of smoke-free policies. As tobacco control programmes are implemented, the PPI offers an indicator to track success and change strategies, without collecting data for a full SOTC index.

[1]  P. Cairney,et al.  The global tobacco control ‘endgame’: Change the policy environment to implement the FCTC , 2014, Journal of public health policy.

[2]  Alistair Woodward,et al.  Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries , 2011, The Lancet.

[3]  J. Lv,et al.  [Evidence of effectiveness on tobacco control programs: a systematic review of intervention studies in China]. , 2011, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[4]  Yan Yang,et al.  Findings from 2010 Global Adult Tobacco Survey: implementation of MPOWER policy in China. , 2010, Biomedical and environmental sciences : BES.

[5]  Yan Yang,et al.  Methodology of the Global Adult Tobacco Survey in China, 2010. , 2010, Biomedical and environmental sciences : BES.

[6]  Patrick N Breysse,et al.  Reduction of secondhand tobacco smoke in public places following national smoke-free legislation in Uruguay , 2010, Tobacco Control.

[7]  S. Haw,et al.  Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey , 2007, BMJ : British Medical Journal.

[8]  K. Cummings,et al.  Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey , 2006, Tobacco Control.

[9]  L. Joossens,et al.  The Tobacco Control Scale: a new scale to measure country activity , 2006, Tobacco Control.

[10]  James L. Repace,et al.  Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars , 2005, Tobacco Control.

[11]  Office on Smoking.  The Health Consequences of Smoking , 2004 .

[12]  Office on Smoking.  The Health Consequences of Smoking: A Report of the Surgeon General , 2004 .

[13]  E. Gilpin,et al.  Evaluation of the American Stop Smoking Intervention Study (ASSIST): a report of outcomes. , 2003, Journal of the National Cancer Institute.

[14]  Christopher J L Murray,et al.  WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty , 2003, BMJ : British Medical Journal.

[15]  R. Brownson,et al.  Application of a rating system to state clean indoor air laws (USA) , 2002, Tobacco control.

[16]  E. Gilpin,et al.  The American Stop Smoking Intervention Study , 1999, Evaluation review.

[17]  T. Cooper.  Department of Health, Education, and Welfare. , 1976, Military medicine.

[18]  J. Steinfeld.  The Health consequences of smoking : a report of the Surgeon General 1972 , 1972 .