上海市某区孕妇被动吸烟干预研究

发布时间：2018-03-09 16:46

本文选题：被动吸烟　切入点：孕妇　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的了解上海市某区孕妇二手烟暴露情况及主要影响因素、关于二手烟与健康关系的知识、对被动吸烟的态度,评价基于技能培养的被动吸烟干预活动对降低孕妇被动吸烟暴露水平的效果。研究方法横断面调查法分析孕妇被动吸烟现况,随机对照试验评价干预效果,采用问卷调查方法。具体包括：1.采用整群抽样的方法,选择上海市某区人口构成基本接近、社区卫生服务提供较均衡的6个社区,对从2011年3月至2012年2月建册的孕妇在基线与终末调查时分别进行一对一问卷调查,内容包括孕妇人口学特征,孕妇及丈夫吸烟状况,二手烟吸入情况,吸二手烟与健康关系的知识等。2.将其中4个社区分配到干预组,2个社区分配到对照组。在干预社区进行两次面对面指导、两次孕妇学校视频课程(孕妇及丈夫一同参加)、一次入户访视、一次电话随访,提供二手烟危害知识和主动拒绝被动吸烟的技能；对对照社区不另外施加特殊干预措施。研究结果共3700名孕妇完成基线调查,剔除自报吸烟者25名,最后共3675人纳入分析,其中干预组2301人,对照组1374人。3240名产妇完成终末调查,其中干预组2151人,对照组1089人。1.二手烟暴露情况本次调查在基线调查的3675名非吸烟孕妇中,发现1486名孕妇在近30天内遭受到被动吸烟,总被动吸烟率为40.4%。孕妇在家中的近30天内被动吸烟率分别为18.4%,在室内工作场所为12.4%,公共场所为26.1%。2.二手烟暴露率的影响因素调查发现,在控制其他因素前提下,孕妇二手烟暴露率与其年龄、家庭人均月收入、教育程度、职业和生育史有关。与年龄较低者相比,年龄高一岁者被动吸烟率是降低7%(OR=0.93,95%CI=0.9～0.96)；与人均月收入为10000元以上者相比,人均月收入为3000元以下的被动吸烟率是其1.32倍(OR=1.32,95%CI=1.02～1.72)；与教育程度为大学及以上者相比,教育程度为高中/中专的是其0.78倍(OR=0.78,95%CI=0.65～0.94)；与职业为无业/失业的相比,职业为工人或服务人员、专业技术人员或管理人员、个体户或临时工、其他的被动吸烟率分别是前者的1.16倍、1.29倍、1.34倍与2.02倍(OR=1.16,95%CI=0.89～1.53;OR=1.29,95%CI=1.04～1.62：OR=1.34,95%CI=0.97～1.86与OR=2.02,95%CI=1.55～2.62)；与初产妇相比,经产妇被动吸烟率是其0.73倍(OR=0.73,95%CI=0.59～0.92)。3.对二手烟与健康关系认识的知识得分及对被动吸烟的态度本次调查发现,被调查的孕妇对二手烟与健康关系认识的知识得分为58.4分。99%的被调查孕妇表示不希望被动吸烟。4.干预效果基线时干预组知识得分58.6分,终末调查知识得分增加至86.1分,差异有统计学意义(p0.001)：基线时对照组知识得分为57.6分,终末调查知识得分增加至87.0分,差异也具有统计学意义(p0.001)。基线时干预组在家中被动吸烟率为21.9%,终末调查时干预组在家中被动吸烟率为3.2%,差异有统计学意义(p0.001)；基线时对照组在家中被动吸烟率为12.0%,终末调查时对照组在家中被动吸烟率为2.8%,差异也具有统计学意义(p0.001)。终末调查时干预组与对照组在家中近30天内被动吸烟时间均减少,差异均有统计学意义。基线时干预组在室内工作场所被动吸烟率为12.6%,终末调查时干预组在室内工作场所被动吸烟率为1.2%,差异有统计学意义(p0.001)；基线时对照组在家中被动吸烟率为13.1%,终末调查时对照组在家中被动吸烟率为1.1%,差异也具有统计学意义。终末调查时干预组与对照组在室内工作场所近30天内被动吸烟时间均减少,差异均有统计学意义。基线时干预组在公共场所被动吸烟率为29.1%,终末调查时干预组在家中被动吸烟率为5.0%,差异有统计学意义(p0.001)；干预前对照组在家中被动吸烟率为18.0%,终末调查时对照组在家中被动吸烟率为2.3%,差异具有统计学意义。终末调查时干预组与对照组在公共场所近30天内被动吸烟时间均减少,差异均有统计学意义。结果显示,终末调查时干预组对二手烟与健康关系认识的知识得分增值与对照组差异无统计学意义(F=1.67,p=0.196)。排除了基线的差异后,终末调查时,干预组在家中的被动吸烟率是对照组的0.50倍(t=-2.75,p=0.006),在家中被动吸烟时间低于对照组,差异有统计学意义(F=11.41,p=0.0007)；排除了基线的差异后,终末调查时干预组在室内工作场所的被动吸烟率、被动吸烟时间与对照组差异无统计学意义(t=0.12,p=0.907与F=0.45,p=0.5022);排除了基线的差异后,终末调查时,干预组在公共场所的被动吸烟率、被动吸烟时间与对照组差异无统计学意义(t=-1.23,p=0.218与F=0.02,p=0.8866)。选择年龄低于30岁,职业为专业技术人员或行政管理人员的孕妇进行分析。结果显示,终末调查时干预组在家中的被动吸烟率与对照组差异无统计学意义(χ2=2.089,p=0.148),但被动吸烟时间减少值的总体中位数大于对照组,差异有统计学意义(z=2.122,p=0.034)；终末调查时,干预组在室内工作场所的被动吸烟率、被动吸烟时间减少值的总体中位数与对照组差异无统计学意义(χ2=1.745,p=0.186与z=1.45,p=0.147)；干预组在公共场所被动吸烟时间减少值的总体中位数大于对照组,差异有统计学意义(z=-2.521,p=0.012)。研究结论干预对降低孕妇在家庭内被动吸烟暴露水平有效,对降低在工作场所和公共场所的被动吸烟暴露水平无效。技能与知识综合干预有一定效果。应改变传统干预模式,注重培养研究对象的技能。应加大工作场所和公共场所禁烟,加大控烟执法监督力度,营造无烟环境。
[Abstract]:Objective: To study in a district of Shanghai City maternal exposure to secondhand smoke and its influencing factors, on the relationship between passive smoking and passive smoking on health knowledge, attitude, evaluation of passive smoking intervention activities based on skill training to reduce passive smoking exposure level of pregnant women. The effect of analysis of the status of passive smoking pregnant women cross-sectional survey method, effect test evaluation of randomized controlled intervention, using the method of questionnaire investigation. Including: 1. by cluster sampling method, choose a district population of Shanghai close to the community health service, providing 6 community more balanced, from March 2011 to 2012 of 2 volumes of pregnant women were built one to one survey in the baseline survey and final at the end, including the demographic characteristics of pregnant women, pregnant women and her husband smoking, secondhand smoke, smoking between passive smoking and health knowledge of the.2. In 4 communities assigned to the intervention group, 2 communities were assigned to the control group. Two face to face guidance and intervention in the community, two pregnant women (pregnant women school video course and her husband to join in a home visit), and a telephone follow-up, to provide second-hand smoke knowledge and active denial of passive smoking in addition to the control community skills; not to impose special intervention measures. The results of a total of 3700 women completed the baseline survey, excluding self-reported smokers 25, finally a total of 3675 people were included in the analysis, including 2301 in the intervention group and control group of 1374.3240 women completed at the end of the investigation, including 2151 in the intervention group and the control group of 1089.1. exposure to second-hand smoke in this survey in 3675 non pregnant women who smoke baseline survey, found that 1486 of pregnant women exposed to passive smoking in the past 30 days, the total rate of passive smoking for 40.4%. pregnant women at home in the past 30 days passive smoking rate was 18. 4%, in indoor workplaces, public places for 12.4%, 26.1%.2. survey found that secondhand smoke exposure factors affected the rate, in the premise of controlling other factors, maternal exposure to secondhand smoke in their age, income, family education, the occupation and reproductive history. Compared with the younger age, higher age passive smoking rate is reduced by 7% (OR=0.93,95%CI=0.9 ~ 0.96); compared with the per capita monthly income of 10000 yuan, per capita monthly income of 3000 yuan for the passive smoking rate was 1.32 times (OR=1.32,95%CI=1.02 ~ 1.72); and the level of education for college and above compared to the level of education for high school / secondary school is the 0.78 times (OR=0.78,95%CI=0.65 ~ 0.94); for the unemployed / unemployed compared with the occupation, occupation for workers and service personnel, professional and technical personnel and management personnel, the self-employed or other temporary, passive smoking rates were 1.1 of the former 6 times, 1.29 times, 1.34 times and 2.02 times (OR=1.16,95%CI=0.89 ~ 1.53; OR=1.29,95%CI=1.04 ~ 1.62:OR=1.34,95%CI=0.97 ~ 1.86 and OR=2.02,95%CI=1.55 ~ 2.62); compared with the primipara, the maternal passive smoking rate was 0.73 times (OR=0.73,95%CI=0.59 ~ 0.92).3. understanding of the relationship between passive smoking and health knowledge and attitude of passive smoking was found the investigation, investigation of pregnant women's understanding of the relationship between passive smoking and health knowledge score of 58.4.99% pregnant women surveyed said they did not want the baseline effect of passive smoking.4. intervention intervention group knowledge score of 58.6 points, the final investigation of knowledge score increased to 86.1 points, the difference was statistically significant (p0.001): baseline control group knowledge score of 57.6 points, the final investigation of knowledge score increased to 87 points, the difference was statistically significant (p0.001). Baseline intervention group at home in the passive smoking rate was 21.9%, At the end of the investigation in the intervention group home passive smoking rate was 3.2%, the difference was statistically significant (p0.001); the control group at baseline in the passive smoking rate was 12%, the final investigation, the control group in the passive smoking rate was 2.8%, the difference was statistically significant (p0.001). At the end of the investigation the intervention group and the control group of passive smoking at home time nearly 30 days were reduced, there were statistically significant differences in baseline. The intervention group in indoor workplaces, passive smoking rate was 12.6%, the final investigation, the intervention group in indoor workplaces, passive smoking rate was 1.2%, the difference was statistically significant (p0.001); baseline control group at home passive smoking rate was 13.1%, the final investigation, the control group in the passive smoking rate was 1.1%, the difference was statistically significant. The final investigation, the intervention group and the control group in indoor workplaces, nearly 30 days of passive smoking is reduced, There were statistically significant differences in baseline. The intervention group in passive smoking in public places was 29.1%, the final investigation of the intervention group at home in the passive smoking rate was 5%, the difference was statistically significant (p0.001); the control group before intervention in passive smoking rate was 18%, the terminal survey of control group at home the passive smoking rate was 2.3%, the difference was statistically significant. The final investigation, the intervention group and the control group in public places in the last 30 days of passive smoking time are reduced, the differences were statistically significant. The results showed that the final investigation, the intervention group on the relationship between passive smoking and health knowledge score of knowledge increment and control group the significance of (F=1.67, p=0.196). The baseline differences excluded after the final investigation, the intervention group of passive smoking at home rate is 0.50 times higher than that of control group (t=-2.75, p=0.006), passive smoking at home time is lower than that of control group, the difference was statistically Statistically significant (F=11.41, p=0.0007); exclude baseline differences, passive smoking at the end of the intervention group in the investigation of indoor work places, passive smoking time and the control group had no significant difference (t=0.12, p=0.907 and F=0.45, p=0.5022); the difference between the baseline were excluded after the final investigation. The intervention group of passive smoking in public places, passive smoking time and the control group had no significant difference (t=-1.23, p=0.218 and F=0.02, p=0.8866). Under the age of 30, for the occupation of professional and technical personnel or administrative personnel of pregnant women were analyzed. The results show that the terminal survey intervention in passive smoking group at home the rate of the control group had no significant difference (2=2.089, p=0.148), but the time of passive smoking reduction in median overall value greater than that of the control group, the difference was statistically significant (z=2.122, p=0.034); at the end of the investigation, the intervention group in the room Passive smoking in the workplace smoking rate, reduce the time value of the median overall and the control group had no significant difference (x 2=1.745, p=0.186 and z=1.45, p=0.147); the intervention group reduced the median overall value is greater than that of the control group in passive smoking in public places, the difference was statistically significant (z=-2.521, p=0.012). The conclusion of the study of intervention to reduce maternal exposure to passive smoking in family level effectively, to reduce passive smoking in workplaces and public places, the exposure level is invalid. Skills have certain effect and knowledge of comprehensive intervention. We should change the traditional intervention mode, pay attention to the cultivation of study skills. Should increase the workplace and smoking in public places, increase tobacco control supervision of law enforcement to create a smoke-free environment.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R715.3

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