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National Survey of Smoking Cessation Provision in China

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Tobacco Induced Diseases Research Paper National survey of smoking cessation provision in China Haoxiang Lin1,2,3,4, Dan Xiao1,2,3,4, Zhao Liu1,2,3,4, Qiang Shi1,2,3,4, Peter Hajek5, Chen Wang1,2,4,6 ABSTRACT INTRODUCTION Treatment for smoking cessation is an important part of tobacco control and has been promoted within the Chinese health service for many years. The AFFILIATION aim of this study was to assess the current status of smoking cessation treatment 1 Center for Respiratory Diseases, China-Japan Friendship provision within the Chinese health service. Hospital, Beijing, China METHODS A nationwide survey, sponsored by the National Health and Family 2 WHO Collaborating Centre for Tobacco Cessation and Planning Commission, assessed smoking cessation activities in all 31 Provincial Respiratory Diseases Prevention, Health and Family Planning Commissions (PHFPCs) in China. Within the 31 China-Japan Friendship Hospital, Beijing, China provinces, 366 hospitals and primary care centers running smoking cessation 3 Tobacco Medicine and clinics provided details of their activities. Tobacco Cessation Center, RESULTS Findings show that all PHFPCs took steps to promote smoking cessation, China-Japan Friendship Hospital, Beijing, China such as by conducting inspections and supervising local cessation clinics. 4 National Clinical Research Specifically, among the 366 health institutions,73% were based in general Center for Respiratory Diseases, Beijing, China hospitals, with smoking cessation clinics predominantly located in respiratory 5 Wolfson Institute of departments. Furthermore, only 43% provided smoking cessation medications. Preventive Medicine, Queen Mary University of London, CONCLUSIONS This was the first nationwide survey of smoking cessation support London, United Kingdom available to smokers in China. It provides the most comprehensive picture of the 6 Chinese Academy of treatment arm of smoking cessation activities so far. The Chinese government has Medical Sciences & Peking Union Medical College, taken measures to support smoking cessation, however, further efforts are needed Beijing, China to address the imbalanced distribution of resources and the limited availability of CORRESPONDENCE TO medications. On-going monitoring of barriers and facilitators affecting treatment Dan Xiao. China–Japan Friendship provision is needed, as well as an understanding of the importance of each hospital Hospital, Chaoyang District, Beijing, China. E-mail: focusing on working priorities specific to their needs. This survey could be a [email protected] reference for other countries starting to promote smoking cessation. KEYWORDS smoking cessation, China, cessation clinic Received: 24 October 2018 Revised: 3 January 2019 Accepted: 27 February 2019 Tob. Induc. Dis. 2019;17(April):25 https://doi.org/10.18332/tid/104726 INTRODUCTION cessation efforts do not become widespread, smoking In China, cancer has been the leading cause of death related deaths will continue to rise; estimated from 1 since 2010 and a major public health concern1. In million in 2010 to 2 million by 20305. 2015, 4.29 million new cancer cases and 2.81 million In 2015, the China Adult Tobacco Survey found cancer deaths were recorded, with lung cancer being that there were 316 million smokers (52.1% of adult the most common2. Of these deaths, 23% to 25% were males and 2.7% of adult females), of which 18% were attributable to smoking2. Smoking cessation treatment planning to quit smoking within 12 months6. As most has been shown to be effective in cancer prevention3 self-help quit attempts fail7, this suggests that there and cancer patient survival4. However, if smoking are tens of millions of smokers in China who could Published by European Publishing on behalf of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID). © 2019 Lin H. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/) 1 Tobacco Induced Diseases Research Paper benefit from stop-smoking treatment. previous survey frameworks, proven to be effective The Chinese government ratified the WHO internationally13,14. One assessed activities at local Framework Convention on Tobacco Control (WHO government level (Government Survey, GS) and FCTC) in 2005, coming into force in China in January the other assessed smoking cessation provision at 20068. A key component of this program was offering individual institutions (Institution Survey, IS). The help to smokers (Article 14)9, but, at that time most questionnaires comprised mostly multiple-choice medical and health institutions lacked the capacity to questions. The GS consisted of 18 questions. These offer smoking cessation services. included support for smoking cessation at government Nevertheless, The Chinese Government’s Tobacco level, policy development, capacity building, and Control Plan (2012–2015) recognized this problem and technical and financial support from Provincial Health adopted measures to improve treatment access. Chinese and Family Planning Commissions (PHFPCs) and Smoking Cessation Guidelines were issued in 2007 and relevant provincial governments. The IS consisted of 201510, and provincial governments received funding 26 questions concerning settings of the clinics, staff to establish smoking cessation clinics in 2014. From training, medical resources, and treatment details. 2006, smoking cessation training was incorporated Additional reference materials were used to develop into the medical education system as a chapter in the questions regarding treatment details and medical book of Respiratory Medicine and Internal Medicine, as resources. These included a tobacco dependence well as tobacco control content added into the national survey conducted in 121 countries by The University qualification examination for medical practitioners. of Nottingham13, and a related paper published by Previous studies have only covered a few areas or West et al.14. Further questions were created in collected insufficient information11,12. As a result, to collaboration with the NHFPC of China by taking into monitor progress The National Health and Family consideration China’s specific status. The contents of Planning Commission (NHFPC, formerly Ministry the questionnaires are outlined in Figure 1. of Health) authorised a nationwide survey to assess Institutions responding to IS were divided into the state of smoking cessation provision across China two groups: those that included staff that had from 2016 to 2017. undergone specialist training in smoking cessation This study reports the first nationwide survey offered nationally by the WHO Collaborating Center of smoking cessation support available in China. It at China–Japan Friendship Hospital in Beijing provides baseline data and a comprehensive picture (Participating Institutions, PI) and those that did of the treatment arm of tobacco control activities not (Non-participating Institutions, NPI). The available so far. Importantly, it identifies issues and training comprised a 3-day course using the model of remedies not only useful to China but also to other Withdrawal Oriented Treatment practiced by the UK countries that are embarking on providing smokers Specialist Stop Smoking Service15. This was adapted with treatment options. to accommodate the healthcare environment in China and on-going support from the Beijing team16. METHODS Study design This was a national survey covering all 31 provinces Figure 1. Questionnaire contents of mainland China. It was conducted by WHO Topics covered in Local Government Survey Collaborating Center for Tobacco Cessation and Information on local hospitals and primary care institutions Initiatives to promote smoking cessation Respiratory Diseases Prevention at the China–Japan Training of health professionals in cessation treatment Friendship Hospital in Beijing. The questionnaire and Financial and technical support to cessation clinics Reporting requirements and supervision of the clinics online platform were developed in July–September 2016, and the survey was carried out between October Topics covered in Institutions Survey 2016 and March 2017. Information on institution staffing and patient throughput Details of cessation clinic set-up and when established Briefing advice of physicians and nurses on smoking Measures Smoking cessation clinic procedures Two questionnaires were developed using Availability of smoking cessation medications Tob. Induc. Dis. 2019;17(April):25 https://doi.org/10.18332/tid/104726 2 Tobacco Induced Diseases Research Paper Procedures All PHFPCs took steps to promote smoking NHFPC issued a formal request to all Chinese cessation using mass media to encourage smokers to PHFPCs to complete the Local Government Survey quit, such as smoking cessation related PSA, micro (GS), and appoint a coordinator to liaise with the film and TV shows. Of the PHFPCs, 77% published research team to ensure all eligible local healthcare locally relevant government recommendations or institutions complete the Institution Survey (IS). The documents targeting health institutions to promote GS questionnaire was completed by the 31 PHFPCs cessation treatment and patient referrals. Additionally, responsible for tobacco control. The IS questionnaire 77% commissioned local cities to promote smoking was completed by smoking cessation doctors or cessation, and 97% funded or supported cessation counselors in hospitals in mainland China.
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