Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.
BMC Public Health. 2018 Feb 27;18(1):296. doi: 10.1186/s12889-018-5182-6.
As a vulnerable population in China, migrant workers have a higher smoking rate than the general population. This study aims to assess the effectiveness of a WHO-5A based comprehensive tobacco control program in workplaces aggregated with migrants.
Using a controlled before and after design, four purposely selected manufacturing factories were assigned to either intervention or control groups. Participants in the intervention arm received adapted 5A group counseling regularly supported by social-media and traditional health education approaches. The primary outcome was the change of smoking rate based on salivary cotinine concentration at three-month follow-up as compared to the control arm. Secondary outcomes were changes in smoking-related knowledge and attitudes assessed using questionnaires. Difference-in-differences approach (DID) and generalized estimating equations (GEE) models were used to conduct the effectiveness analysis.
149 and 166 workers were enrolled in the intervention and control arm respectively. The multiple imputed and adjusted GEE models demonstrated that, compared to those in the control arm, participants in the intervention arm had nearly 2.4 times odds of improving smoking-related knowledge (OR = 2.40, 95% CI = 1.32-4.36, P = 0.02) and three times the odds of improving smoking-related attitude (OR = 3.07, 95% CI = 1.28-7.41, P = 0.03). However, no significant difference was found regarding the change of smoking rate between the two arms (P > 0.05). The regression analysis showed that attendance at the 5A group counseling sections was an important determinant of stopping smoking or improving smoking-related knowledge and attitudes in the intervention group.
This WHO-5A comprehensive intervention was effective in improving migrant workers' knowledge of smoking and anti-smoking attitudes. A large-scale, long-term trial is recommended to determine the effectiveness of this intervention.
ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.
在中国，农民工属于弱势群体，其吸烟率高于一般人群。本研究旨在评估一项基于世卫组织五因素（5A）的综合性控烟方案在聚集了农民工的工作场所中的效果。
采用对照前后设计，将四个有针对性选择的制造工厂分配到干预组或对照组。干预组的参与者定期接受经过调整的 5A 小组咨询，同时辅以社交媒体和传统健康教育方法。主要结局是与对照组相比，在三个月随访时基于唾液可替宁浓度评估的吸烟率变化。使用问卷评估吸烟相关知识和态度的变化作为次要结局。采用差值-差异（DID）和广义估计方程（GEE）模型进行效果分析。
分别有 149 名和 166 名工人入组干预组和对照组。多重插补和调整后的 GEE 模型表明，与对照组相比，干预组参与者改善吸烟相关知识的几率高出近 2.4 倍（OR=2.40，95%CI=1.32-4.36，P=0.02），改善吸烟相关态度的几率高出 3 倍（OR=3.07，95%CI=1.28-7.41，P=0.03）。然而，两组间吸烟率的变化无显著差异（P＞0.05）。回归分析显示，参加 5A 小组咨询部分是干预组停止吸烟或改善吸烟相关知识和态度的一个重要决定因素。
这项基于世卫组织 5A 的综合干预措施有效地提高了农民工对吸烟和反吸烟态度的认识。建议进行大规模、长期试验以确定该干预措施的效果。
ChiCTR-OPC-17011637 于中国临床试验注册中心。2017 年 6 月 12 日进行了回顾性注册。
