Progress and Challenges in Expanding the Role of Health Care Providers and Delivering Treatment in China -- Dan Xiao, M.D., Ph.D.
Progress and Challenges faced in expanding the roleof healthcare providers and delivering treatment,China Dan XIAO, M.D., Ph.D. Email:email@example.com blog.sina.com.cn/cessation WHO Collaborating Center for Tobacco or Health Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital, Capital Medical University Mar 19th, 2012, Singapore
In 2010, there were an estimated 301 million currentsmokers (28.1% of adults: 52.9% of men and 2.4% ofwomen ) in China - N Engl J Med, 2011, 364(25):2469-70 - Global Adult Tobacco Survey (GATS) in China, 2010
740 million suffered from Second Hand Smoking （ SHS ） exposure in China (2010) The rates of SHS in SHS exposure different districts 1984 39% 1996 54% 2002 53% 2010 74%Smoking prevalence in Chinese aged 15 and above. Chin Med J,1987,100:886-892.Smoking in China: findings of the 1996 National Prevalence Survey. JAMA. 1999, 282(13):1247-1253.中国人群 2002 年吸烟和被动吸烟的现状调查 . 中华流行病学杂志 ,2005, 26(2): 77-83.Prevalence of smoking in China in 2010. N Engl J Med, 2011, 364(25):2469-2470.
Lack of awareness of the health hazards of activesmoking and SHS among medical professionals Only 55.8% of the medical professionals know active smoking can cause three diseases (stroke, heart attacks and lung cancer) Only 62.3% of the medical professionals know SHS can cause three diseases (stroke, heart attacks and lung cancer) - Global Adult Tobacco Survey in China, 2010
Misconceptions concerning smoking Smoking as a symbol of personal freedom Ability to control the health effects of smoking through “reasonable” and “measured” use The importance of tobacco in social and cultural interactions The importance of tobacco to the economy Normal for physicians and teachers smoke … Myths and attitudes that sustain smoking in China. J Health Commu, 2008, 13: 654- 666.
Low willingness to quit smoking in adult smokers The International Tobacco Control Policy Evaluation Project (ITC) Prospective population-based surveys conducted in Beijing ,Shanghai ,Guangzhou, Shenyang , Changsha and Yinchuan Stratified multi-stage sampling design Selected about 800 smokers from each city (total 4,815) Willingness to quit smoking ： 15%-31%
Tobacco Control in China: A Crucial Battle As the largest producer and consumer of tobaccoall over the world, China is suffering the most severeconsequence due to tobacco use. Sales of cigarettes in China (1952-2007) Unit:100 million
Expanding the role of healthcareproviders and delivering treatment
Clinical Smoking Cessation Training Programs Cessation training workshops (from 2000) Train the trainer program (from 2007) National CME Program - Clinical cessation intervention (from 2008) Certified Stop Smoking Specialist training program (from 2010) Online training program (from 2010) Promote cessation through series academic conferences (from 2007) First cessation training workshop June 27-29, 2000 Pulmonary physicians, Cardiologist, Oncologist, Paediatricians …
Nicotine Dependence Conference Cooperated with Mayo Clinic (1st in 2006, 2nd in 2008, 3rd in 2009)
China Clinical Smoking Cessation Guideline Trial version in 2007 Update in 2009
Smoking cessation clinics The first Smoking CessationClinic in China （ From 1996) There are more than 800smoking cessation clinics inChina now, providing professionalcessation service for smokers. Picture of a smoking cessation clinic in China
Integrate with health system Aim: screen and treat every smoker admitted to the outpatient department Physicians should ask patients the following 3 questions – Have you smoked in the past 30 days? – How many cigarettes do you smoke per day on average? – Are you willing to get quit help? Current smoker will have a treatment referral printed automatically
Textbooks of medical education 10 textbooks at least (Chapters)
Promoting smoking cessation among medical professionals Chantix: No data now HOPE Study: 6 hospitals in Beijing, Shanghai and Guangzhou Targets physicians and hospital staff of smoking-free hospitals 300 smokers with motivation to quit, 293 finished the 24-week study Self-determine quit with gum or patch 12 weeks NRT treatment, followed by 12 weeks off-treatment follow up Continuous Abstinence Rate: 17% of subjects (n=51) were continuously, CO-verified smoking abstinent from Week 2 until and including the 24-week visit
Facilitating smoke free hospitals in China 41 hospitals from 20 provinces - 6 hospital presidents or vice presidents quit successfully - 329 smoking doctors in 41 hospitals quit smoking (self-report) Supported by The Union: CHINA-OC-400
Network of WHO Collaborating Center for Tobacco or Health for Medical Professionals against Smoking
Tobacco Control Policies Ministry of Health: Smoke-free hospital standard (2008) All healthcare facilities should be smoke free at the end of 2011(2009) Tobacco control mass media promotion activities (08-09, 09-10,10-11) Indoor smoking bans in public places (Health Implementation) (2011) Ministry of Education: 2010 Decision on smoke-free schools (2010) State Administration of Radio, Film and Television (Feb2011) Strict control of smoking scenes Central Committee of civilization : All indoor public places and workplaces should be smoke-free and have clear No Smoking Signs. Only achieve this goal, to be able to get the "National Civilized City" title——Comprehensively implementation of smoking bans inpublic places (National Economic and Social Development Twelfth Five-Year Plan, Mar 2011)
Ch Governmenta The Chinese National Tobacco Corporation (CNTC) : state monopoly Culturel Offering cigarettes as gifts and handing out cigarettes in social settings as a gesture of politeness or friendship is a strong social habit Hospitalsl Male doctors commonly smoke Some top hospital administrators are smokers themselvese Social environment outside the hospitalsn Cigarette brand names constantly appear on TV programs shown as company names, and this regulation is not enforced The ban on smoking in public places in many cities has not beeng effectively enforced Individualse Most people are unaware of full range of health risks from tobacco use and second-hand smoke exposures Most smokers have not the willing to quit No reimbursement of cessation attempts
National smoking prevalence surveys:Trend in past 26 yearsYear 1984 1996 2002 2010Total smoking rate 33.9% 37.6% 35.8% 28.1% (Aged>15) Male 66.9% 66.0% 52.9% Female 4.2% 3.08% 2.4%Smoking rate in 60.0% 56.8% 40.4%male medical doctors Smoking prevalence in Chinese aged 15 and above. Chin Med J,1987,100:886-92. Smoking in China: findings of the 1996 National Prevalence Survey. JAMA. 1999, 282(13):1247-53. 中国人群 2002 年吸烟和被动吸烟的现状调查 . 中华流行病学杂志 ,2005, 26(2): 77-83. Prevalence of smoking in China in 2010. N Engl J Med, 2011, 364(25):2469-70.
T h e Capacity building w Research a Sustained promotion y—— Combine the current work conducted f o ( MOH White Paper, et al) r w a