Lung Diseases Clinical Trial
Official title:
Research on China Tobacco Control Epidemiology and Intervention
To characterize the development of tobacco control capacity with staff from the Chinese Center's for Disease control (CDCs) at the provincial level and to have them develop and implement population-level interventions to build awareness and knowledge concerning the harms of smoking that could help lead to policy action being taken to protect the population from the harms caused by smoking. Compare capacity, policy and, second-hand smoke exposure and smoking rates in selected provinces to national levels.
China is a particularly critical country for global tobacco control. It has the world's
largest number of smokers, approximately 350 million, and the immense market afforded by the
60 percent of men who smoke and the 95 percent of women who do not smoke represents a prize
target for the multinational tobacco companies. China has ratified the Framework Convention
for Tobacco Control (FCTC) and now needs to implement its provisions across a large and
diverse population. In this application, we propose a program of evidence-based community
interventions to be implemented at the province and local levels with the overall objective
of developing an approach for implementation nationally.
This application builds on a long-standing partnership between the Chinese Center for
Disease Control and Prevention (China CDC), the Peking Union Medical College (PUMC) and the
Johns Hopkins Bloomberg School of Public Health. That partnership began in 1995 with an
agreement to collaborate on the conduct of China's 1996 national smoking survey. Our
principal collaborator over those years, Dr. Gong-Huan Yang, is now Deputy Director of the
China CDC and responsible for tobacco control at the national level. In the four years of
funding to date from the Fogarty International Center (FIC), we have carried out a project
in selected communities in three provinces, including urban and rural areas that provide a
foundation for the intervention approach in this proposal. Specifically, we have carried out
quantitative and qualitative studies to assess barriers to tobacco control and readiness for
interventions, measured levels of airborne nicotine in key public environments, and
developed capacity-building approaches. Our original FIC supported study involved three
countries, China, Mexico and Brazil. However, this application will focus solely on China,
as the latter two countries developed the necessary infrastructure and capacity to conduct
research, publish their research findings, and seek further grants and government funding to
sustain progress.
This application proposes a tobacco control study that will involve 7 provinces in a CDC-led
initiative to develop a systematic mix of approaches. The plan uses strategies based on
experiences from our work in China and from the American Stop Smoking Intervention Study for
Cancer Prevention (ASSIST) and anticipates barriers that have been identified in the data
collected to date. In the intervention provinces, the China CDC will team with the
provincial-level CDCs to assess capacity for tobacco control and the current status of
tobacco control, using an adapted version of the Strength of Tobacco Control (SOTC) index
developed for evaluating ASSIST. This systematic characterization will highlight capacity
needs. An extensive capacity development program, based in distance-based methods, will be
used. We have the overall objective of preparing the China CDC to implement a proven
approach to tobacco control at the national level. A household survey will be conducted and
compared to the national survey results. Second-hand smoking will be assessed in selected
locations in the 7 provinces.
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Observational Model: Ecologic or Community, Time Perspective: Cross-Sectional
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