北京市郊区农村吸烟及戒烟状况的调查及振动反应成像双肺同步性在评价吸烟相关早期肺损害中的价值
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摘要
第一部分北京市郊区农村吸烟及戒烟状况的调查
研究背景：
世界范围内,不同的国家都正在处于烟草流行的不同阶段。中国作为拥有全世界最多人口的发展中国家,农村城市化进程逐步普及。这使城市周边地区的农村人口在中国逐渐有了代表性。然而,国内关于吸烟方面的调查确很少重点关注这一人群。
研究目的：了解城市周边农村人口吸烟、被动吸烟、戒烟意愿及戒烟成功情况分布的现状；探讨吸烟到戒烟各相关个阶段的诱因及影响因素；探索尼古丁依赖在吸烟相关各个阶段转化中的作用；为促进针对城市周边农村戒烟工作的开展,和政府制定现代农村人口的控烟政策和控烟辅助医疗形式提供科学依据。
研究方法：
选定北京市郊区1个自然村,对所有≥10岁的人口用调查问卷进行入户调查,问卷内容包括吸烟和戒烟相关的个人一般情况、心理、行为、疾病以及社会家庭情况。应用统计软件对人群在吸烟、被动吸烟、戒烟意识、戒烟行动方面的分布、诱因和影响因素进行分析。
结果：
1.吸烟者的分布、始动因素和影响因素
调查整体1733人中,吸烟率为35.8%,吸烟者的平均烟龄为24.57±15.06年,每日吸烟量为16.88±10.14支。吸烟指数(SI)的中位数为17.5(23.0)包年。男性、中等收入水平和中小学及以下文化程度为吸烟率水平较高的群体。
吸烟者冬季反复咳痰和频繁活动后气短的发生率高于不吸烟者(p=0.000)。吸烟者出现反复咳痰的几率是不吸烟者的2.29(2.03-2.58)倍；出现频繁活动后气短的几率是不吸烟者的1.76(1.51-2.07)倍。
69.4%的吸烟者存在尼古丁依赖,平均Fagerstrom尼古丁依赖测试(FTND)评分为3.27±2.56分。
86.6%的吸烟者开始吸烟前有被动吸烟；73.8%的吸烟者在参加工作后开始吸烟；前三位开始吸烟的诱因所占比例从高到低排序为：好奇(33.2%)、同学或同事影响(31.0%)、社交(14.8%)。
在关于吸烟影响因素的多因素分析中,男性性别和中等级的收入水平是吸烟的危险因子。较高的文化水平则是保护因子。
2.被动吸烟
1112名不吸烟者中,有689人(62.0%)有被动吸烟的情况,平均的被动吸烟烟龄为19.55±11.61年,被动烟量(支／天)为5.35±4.81支。总体被调查人群中只有24.4%的人不受到吸烟或被动吸烟的危害。
3.戒烟意愿
621名吸烟者中,有戒烟意愿者291人,占46.9%；没有戒烟意愿者330人,占53.1%。较高年龄、有呼吸道症状(反复咳嗽咳痰或活动后气短)、有尼古丁依赖者为戒烟意愿出现率较高的群体。
在所有吸烟者接触的各种宣传中,有戒烟意愿者接触来自家人、朋友、医生或医院的宣传大于没有戒烟意愿者。没有戒烟意愿者接触媒体的宣传大于有戒烟意愿者。
在关于戒烟意愿产生影响因素的多因素分析中,男性性别、较高年龄、气短症状、存在尼古丁依赖是戒烟意愿产生的正向影响因子。
4.戒烟行动
从未戒烟者占总吸烟者64.5%,吸烟人群中的正在戒烟率为1.4%。复吸在所有曾经戒烟成功(完全戒断大于6个月)者中发生率为29.4%。
有戒烟行动者实施的绝大多数(93.9%)戒烟方法为自助式的戒烟方法,有6.1%的戒烟方法需要他人帮助,来自社会、社区和医院的戒烟方法为0%。
戒烟过程中容易产生的不适依次为吸烟渴望(47.8%)、情绪低落(12.9%)、体重增加(11.5%)。
5.成功戒烟
人群总的戒烟率水平为12.4%,戒烟成功者在女性性别、年龄较长、较低文化水平、较低收入水平、反复咳嗽咳痰、频繁活动后气短、无尼古丁依赖和FTND评分较低的吸烟者中分布较多。
在多因素分析中,年龄、中等受教育程度是戒烟成功的正向影响因子。尼古丁依赖有可能是戒烟成功的负向影响因子。
结论：
应该加强针对农村的控烟工作,减低吸烟率的途径分为预防和控制两方面。
预防农村青少年开始吸烟,学校应该是开展吸烟预防的重点场所,男性和学习较差的学生是应重点防范的人群。提高吸烟易感青少年的文化程度和营造学校禁烟环境是预防青少年吸烟的有价值手段。
促进农村人口戒烟意愿的产生的动机干预应该侧重那些较年轻、无尼古丁依赖和呼吸道症状的群体。来自家人、朋友、医院的宣传和提高农村社区的卫生服务水平有利于诱发吸烟者产生戒烟意愿,而目前来自社会、社区和医院的戒烟宣传明显不足。改善农村人口的医疗保障体系,可以使更多农村人口意识到身体健康与吸烟的关系,从而提高戒烟意识产生率。
没有尼古丁依赖的吸烟者不容易产生戒烟意愿,因此应重视该人群的动机干预；有尼古丁依赖的吸烟者容易产生戒烟意愿但不容易戒烟成功,因此应重点给予他们戒烟辅助。
在判断戒烟意愿产生、成功戒烟的分布和预后方面,选择美国心理协会定义的尼古丁依赖判定标准来判定尼古丁依赖较Fagerstorm尼古丁依赖性评分更有参考意义。
第二部分VRI双肺同步性在评价吸烟相关早期肺损害中的价值
研究背景：
呼吸内科医生而言,早期的发现和预防吸烟相关的肺损害日益受到关注。但由于缺乏简单实用的测量工具,在发现和评价吸烟对肺部造成的早期异常方面仍然面临困境。
研究目的：
使用振动反应成像(Vibration Response Imaging, VRI)设备提供的双肺同步性指标对吸烟者和不吸烟者的肺部情况进行观察和分析,初步探讨VRI在发现和评价吸烟相关早期肺损害中的价值。
研究方法：
随机选取来自于2008年12月至2009年1月被调查自然村的村民为研究对象。资料采集的具体步骤如下：(1)询问既往史及吸烟史；(2)呼出气CO检测确认受试者的吸烟状况；(3)VRI检测。VRI系统输出双肺各自呼吸能量随时间变化的曲线即呼吸能量单位曲线(Breath Energy Unit, BEU),选取12秒内4个呼吸周期受试者双肺呼吸能量曲线在吸气相峰值所存在总差异作为研究双肺同步性差距的指标；(4)肺功能检测。最终,符合纳入标准的26名村民进入研究。根据吸烟史情况将受试者分为吸烟组与不吸烟组。应用秩和检验比较两组双肺同步性差距的差异,分析两组肺同步性差距与吸烟及被动吸烟指数之间的关系。
研究结果：
不吸烟组双肺BEU同步性差距为2.0(3.0)帧,吸烟组同步性差距为2.0(3.0)帧,秩和检验提示吸烟组与不吸烟组双肺同步性差距差异不显著(z=-0.29 p=0.77)。相关性分析提示在吸烟组中,吸烟指数与肺同步性差距存在显著相关性(r=0.61,p=0.03)。不吸烟组的被动吸烟指数与肺同步性差距之间相关系数r=0.52,p=0.07。可以观察到,不吸烟组中被动吸烟指数与双肺同步性差距之间相关系数的P值接近0.05,散点图可见它们之间的存在着一定的相关趋势。
结论：
VRI所观察到的双肺呼吸能量单位(BEU)曲线同步性差距在吸烟组与不吸烟组没有显著差异。被动吸烟很可能在肺部导致与吸烟相同的损害,而VRI有可能能够体现出这种损害与吸烟水平(吸烟指数)和被动吸烟水平(被动吸烟指数)的量效关系。
Section 1 Smoking prevalence among rural population in urbanizing China:a representative survey
Background:
Different countries are at different stages in the tobacco epidemic. China, with 20% of the world's population, produces and consumes about 30% of the world's cigarettes, and already suffers about a million deaths a year from tobacco. When, rural population in China accounted for a dominant position. The progress of urbanization make the suburban rural areas become gradually representative. However, little information of smoking prevalence has been focused on the villages in urbanizing China.
Objective:
Focus on the prevalence of smoking among the most representative population in china.
Discuss the factors'relation with different levels:ever smoking, willingness to quit and smoke cessation.
Investigate the role of nicotine dependence in transitions of different smoking status.
Provide suggestions for tobacco control interventions and policies to rural population, the major group of population in china.
Methods:
Sample one natural village in Beijing suburb, investigate all 1901 villagers. Face-to-face survey was conducted to examine their information about smoking habit. Descriptive statistics was applied to portray all the rerated factors of different smoking status. Logistic regression was used to explore risk factors of different smoking status.
Results:
1. Prevalence, moving factors and influencing factors of smoking
Among the whole 1733 peoples, smoking rate was 35.8%. Ever smokers'average age was 24.57±15.06 years. They smoked an average of 16.88±10.14 cigarettes per day. Their smoking index (SI) was at a median of 17.5 (23.0) pack years. Male gender, secondary school or less education level, middle-income levels were higher smoking rate level groups.
The chances of repeated sputum in smokers were as 2.29 times as non-smokers, and the chances of repeated shortness in smokers were as 1.76 times as non-smokers.
Nearly 69.4% of the ever smokers had the existence of nicotine dependence, with their average Fagerstrom Test for Nicotine Dependence (FTND)score of 3.27±2.56 points.
86.6% of ever smokers had been exposure to smoking before they started smoking; 73.8% of smokers started smoking while they had already been working. The most common incentive to start smoking were:curiosity, influence from classmates or colleagues, social influence.
Male gender and the middle level of income was the risk factor of smoking. A higher educational level was a protective factor.
2. Passive smoking
The rate of passive smoking in 1112 non-smokers was 62.0%. The average age of passive smoking was 19.55±11.61 years, the average amount of passive smoke (sticks/ day) was 5.35±4.81. Only 24.4% of the overall population were neither smokers nor passive smokers.
3. Willingness to quit
In all 621 ever smokers, there were 291 (46.9%) people had the willingness to quit. Elder age, having respiratory symptoms, having the existence of nicotine dependence were the groups with higher rates of willingness to quit.
The smokers who were willing to quit had accepted more advocacy from family members, friends, doctors or hospitals and less from media publicity over quitting than smokers who did not want to quit.
Male gender, elder age, having shortness of breath and the existence of nicotine dependence were the positive impact factors of willingness to quit.
4. Action of quit
64.5% of the 621 ever smokers had never tried to quit.35.5% of the total had tried or were trying to quit. The rate of smokers who were just trying to quit was 1.4%. The rate of relapse in all those who had ever quit smoking successfully (maintain a complete abstinence greater than 6 months) was 29.4%.
The vast majority (93.9%) of smoking cessation method was self-service method, 6.1% required the help of others,0% was from the community and hospital.
Urging to smoke, depression, weight gaining were the most common consequences of quitting process.
5. Smoking cessation
The overall rate of abstinence was 12.4%, successful smoking cessation rate was higher in those groups of elder age, lower educational level, lower income level, having repeated coughing and sputum, always having breathlessness after event, no nicotine dependence and lower FTND score.
Elder age, middle level of education status was positive impact factors of successful smoking cessation. Having nicotine dependence may be the negative impact factor to reach the long term abstinence.
Conclusion:
Ways to reduce the prevalence of smoking is divided into two aspects:prevention and control.
Schools should be the most important places to carry out smoking prevention. Students who were male gender or had poor performance at school should be paid more attention to. Increase the educational level of young people and develop the smoke-refusing atmosphere will be the effective way to prevent young people from smoking initiation.
The attempt to develop the quit willingness should be focus on groups of those who were young, having no nicotine dependence and respiratory discomfort. Advocacy from family, friends, hospital, community will motivate smokers to quit. At present, the publicity and education of smoke preventing from community and hospital were clearly insufficient in rural area.
The tobacco control efforts in rural areas should be strengthened. Improving rural health care system should be the main measures of the government. For it can increase the obtaining of useful medical information, which will help improve the health awareness of rural population, raise the rate of quit willingness and abstinence. Increasing the rate of smoking cessation in rural areas will help the rural population obtaining higher living standards.
In terms of dependence, the existent of nicotine dependence was more closely related with willingness to quit and cessation than the level of FTND score.
Nicotine dependent smokers were more likely to have the motivation to quit. So we should focus the motivational interviewing on those smokers who have no existence of nicotine dependence. For the nicotine dependent smokers, smoking cessation was more difficult, so we should give them more assistance and arrangement.
Section 2 Asynchrony between left and right lungs in evaluation of early smoking-related lung abnormalities
Background:
At present, pulmonary physicians confront a difficult situation when trying to reveal early lung abnormalities caused by smoking because no simple and convenient tools are available that can easily be applied in clinical practice.
Objective:
The goal of this study were to observe the asynchrony patterns between left and right lungs in smokers and non-smokers, to assess the role of vibration response imaging(VRI) in the early detection and evaluation of smoking-related lung abnormalities.
Methods:
Data collected steps are as follows:(1) asked past history and smoking history; (2) exhaled CO test confirmed that the subjects'smoking status; (3) VRI test. VRI system output the curve of Breath Energy Unit (BEU), which is an energy versus time graph of the breath energy. The asynchrony between left and right lungs was derived from this graph; (4) pulmonary function testing. In the end,26 villagers, with normal spirometry findings, were included in the study. The subjects were divided into ever-smoking group and never-smoking group.
Results:
The BEU lung asynchrony was 2.0 (3.0) frame in Never-smoking group,2.0 (3.0) frame too in ever-smoking group. Rank sum test show that there is no significant difference (z=-0.29, p= 0.77) between never-smokers and ever-smokers in the lung asynchrony. Rank correlation analysis suggests that in the ever-smoking group, smoking index and BEU asynchrony have significant correlation (r= 0.61, p= 0.03). In never-smoking group, the coefficient of passive smoking index and lung asynchrony is 0.52 (p= 0.07). The p value of the coefficient between passive smoking index and lung asynchrony is nearly 0.05, scatter between them can be seen a presence of a certain trend.
Conclusion:
Though the BEU asynchrony of left and right lungs among ever-smokers and never-smokers has no significant differences, the lung asynchrony and ever-smokers' smoking level (Smoking index) have the existence of dose-effect relationship. Thus, the lung abnormalities caused by the exposure to passive smoking is probably as same as the abnormalities caused by direct smoking.
研究背景：
世界范围内,不同的国家都正在处于烟草流行的不同阶段。中国作为拥有全世界最多人口的发展中国家,农村城市化进程逐步普及。这使城市周边地区的农村人口在中国逐渐有了代表性。然而,国内关于吸烟方面的调查确很少重点关注这一人群。
研究目的：了解城市周边农村人口吸烟、被动吸烟、戒烟意愿及戒烟成功情况分布的现状；探讨吸烟到戒烟各相关个阶段的诱因及影响因素；探索尼古丁依赖在吸烟相关各个阶段转化中的作用；为促进针对城市周边农村戒烟工作的开展,和政府制定现代农村人口的控烟政策和控烟辅助医疗形式提供科学依据。
研究方法：
选定北京市郊区1个自然村,对所有≥10岁的人口用调查问卷进行入户调查,问卷内容包括吸烟和戒烟相关的个人一般情况、心理、行为、疾病以及社会家庭情况。应用统计软件对人群在吸烟、被动吸烟、戒烟意识、戒烟行动方面的分布、诱因和影响因素进行分析。
结果：
1.吸烟者的分布、始动因素和影响因素
调查整体1733人中,吸烟率为35.8%,吸烟者的平均烟龄为24.57±15.06年,每日吸烟量为16.88±10.14支。吸烟指数(SI)的中位数为17.5(23.0)包年。男性、中等收入水平和中小学及以下文化程度为吸烟率水平较高的群体。
吸烟者冬季反复咳痰和频繁活动后气短的发生率高于不吸烟者(p=0.000)。吸烟者出现反复咳痰的几率是不吸烟者的2.29(2.03-2.58)倍；出现频繁活动后气短的几率是不吸烟者的1.76(1.51-2.07)倍。
69.4%的吸烟者存在尼古丁依赖,平均Fagerstrom尼古丁依赖测试(FTND)评分为3.27±2.56分。
86.6%的吸烟者开始吸烟前有被动吸烟；73.8%的吸烟者在参加工作后开始吸烟；前三位开始吸烟的诱因所占比例从高到低排序为：好奇(33.2%)、同学或同事影响(31.0%)、社交(14.8%)。
在关于吸烟影响因素的多因素分析中,男性性别和中等级的收入水平是吸烟的危险因子。较高的文化水平则是保护因子。
2.被动吸烟
1112名不吸烟者中,有689人(62.0%)有被动吸烟的情况,平均的被动吸烟烟龄为19.55±11.61年,被动烟量(支／天)为5.35±4.81支。总体被调查人群中只有24.4%的人不受到吸烟或被动吸烟的危害。
3.戒烟意愿
621名吸烟者中,有戒烟意愿者291人,占46.9%；没有戒烟意愿者330人,占53.1%。较高年龄、有呼吸道症状(反复咳嗽咳痰或活动后气短)、有尼古丁依赖者为戒烟意愿出现率较高的群体。
在所有吸烟者接触的各种宣传中,有戒烟意愿者接触来自家人、朋友、医生或医院的宣传大于没有戒烟意愿者。没有戒烟意愿者接触媒体的宣传大于有戒烟意愿者。
在关于戒烟意愿产生影响因素的多因素分析中,男性性别、较高年龄、气短症状、存在尼古丁依赖是戒烟意愿产生的正向影响因子。
4.戒烟行动
从未戒烟者占总吸烟者64.5%,吸烟人群中的正在戒烟率为1.4%。复吸在所有曾经戒烟成功(完全戒断大于6个月)者中发生率为29.4%。
有戒烟行动者实施的绝大多数(93.9%)戒烟方法为自助式的戒烟方法,有6.1%的戒烟方法需要他人帮助,来自社会、社区和医院的戒烟方法为0%。
戒烟过程中容易产生的不适依次为吸烟渴望(47.8%)、情绪低落(12.9%)、体重增加(11.5%)。
5.成功戒烟
人群总的戒烟率水平为12.4%,戒烟成功者在女性性别、年龄较长、较低文化水平、较低收入水平、反复咳嗽咳痰、频繁活动后气短、无尼古丁依赖和FTND评分较低的吸烟者中分布较多。
在多因素分析中,年龄、中等受教育程度是戒烟成功的正向影响因子。尼古丁依赖有可能是戒烟成功的负向影响因子。
结论：
应该加强针对农村的控烟工作,减低吸烟率的途径分为预防和控制两方面。
预防农村青少年开始吸烟,学校应该是开展吸烟预防的重点场所,男性和学习较差的学生是应重点防范的人群。提高吸烟易感青少年的文化程度和营造学校禁烟环境是预防青少年吸烟的有价值手段。
促进农村人口戒烟意愿的产生的动机干预应该侧重那些较年轻、无尼古丁依赖和呼吸道症状的群体。来自家人、朋友、医院的宣传和提高农村社区的卫生服务水平有利于诱发吸烟者产生戒烟意愿,而目前来自社会、社区和医院的戒烟宣传明显不足。改善农村人口的医疗保障体系,可以使更多农村人口意识到身体健康与吸烟的关系,从而提高戒烟意识产生率。
没有尼古丁依赖的吸烟者不容易产生戒烟意愿,因此应重视该人群的动机干预；有尼古丁依赖的吸烟者容易产生戒烟意愿但不容易戒烟成功,因此应重点给予他们戒烟辅助。
在判断戒烟意愿产生、成功戒烟的分布和预后方面,选择美国心理协会定义的尼古丁依赖判定标准来判定尼古丁依赖较Fagerstorm尼古丁依赖性评分更有参考意义。
第二部分VRI双肺同步性在评价吸烟相关早期肺损害中的价值
研究背景：
呼吸内科医生而言,早期的发现和预防吸烟相关的肺损害日益受到关注。但由于缺乏简单实用的测量工具,在发现和评价吸烟对肺部造成的早期异常方面仍然面临困境。
研究目的：
使用振动反应成像(Vibration Response Imaging, VRI)设备提供的双肺同步性指标对吸烟者和不吸烟者的肺部情况进行观察和分析,初步探讨VRI在发现和评价吸烟相关早期肺损害中的价值。
研究方法：
随机选取来自于2008年12月至2009年1月被调查自然村的村民为研究对象。资料采集的具体步骤如下：(1)询问既往史及吸烟史；(2)呼出气CO检测确认受试者的吸烟状况；(3)VRI检测。VRI系统输出双肺各自呼吸能量随时间变化的曲线即呼吸能量单位曲线(Breath Energy Unit, BEU),选取12秒内4个呼吸周期受试者双肺呼吸能量曲线在吸气相峰值所存在总差异作为研究双肺同步性差距的指标；(4)肺功能检测。最终,符合纳入标准的26名村民进入研究。根据吸烟史情况将受试者分为吸烟组与不吸烟组。应用秩和检验比较两组双肺同步性差距的差异,分析两组肺同步性差距与吸烟及被动吸烟指数之间的关系。
研究结果：
不吸烟组双肺BEU同步性差距为2.0(3.0)帧,吸烟组同步性差距为2.0(3.0)帧,秩和检验提示吸烟组与不吸烟组双肺同步性差距差异不显著(z=-0.29 p=0.77)。相关性分析提示在吸烟组中,吸烟指数与肺同步性差距存在显著相关性(r=0.61,p=0.03)。不吸烟组的被动吸烟指数与肺同步性差距之间相关系数r=0.52,p=0.07。可以观察到,不吸烟组中被动吸烟指数与双肺同步性差距之间相关系数的P值接近0.05,散点图可见它们之间的存在着一定的相关趋势。
结论：
VRI所观察到的双肺呼吸能量单位(BEU)曲线同步性差距在吸烟组与不吸烟组没有显著差异。被动吸烟很可能在肺部导致与吸烟相同的损害,而VRI有可能能够体现出这种损害与吸烟水平(吸烟指数)和被动吸烟水平(被动吸烟指数)的量效关系。
Section 1 Smoking prevalence among rural population in urbanizing China:a representative survey
Background:
Different countries are at different stages in the tobacco epidemic. China, with 20% of the world's population, produces and consumes about 30% of the world's cigarettes, and already suffers about a million deaths a year from tobacco. When, rural population in China accounted for a dominant position. The progress of urbanization make the suburban rural areas become gradually representative. However, little information of smoking prevalence has been focused on the villages in urbanizing China.
Objective:
Focus on the prevalence of smoking among the most representative population in china.
Discuss the factors'relation with different levels:ever smoking, willingness to quit and smoke cessation.
Investigate the role of nicotine dependence in transitions of different smoking status.
Provide suggestions for tobacco control interventions and policies to rural population, the major group of population in china.
Methods:
Sample one natural village in Beijing suburb, investigate all 1901 villagers. Face-to-face survey was conducted to examine their information about smoking habit. Descriptive statistics was applied to portray all the rerated factors of different smoking status. Logistic regression was used to explore risk factors of different smoking status.
Results:
1. Prevalence, moving factors and influencing factors of smoking
Among the whole 1733 peoples, smoking rate was 35.8%. Ever smokers'average age was 24.57±15.06 years. They smoked an average of 16.88±10.14 cigarettes per day. Their smoking index (SI) was at a median of 17.5 (23.0) pack years. Male gender, secondary school or less education level, middle-income levels were higher smoking rate level groups.
The chances of repeated sputum in smokers were as 2.29 times as non-smokers, and the chances of repeated shortness in smokers were as 1.76 times as non-smokers.
Nearly 69.4% of the ever smokers had the existence of nicotine dependence, with their average Fagerstrom Test for Nicotine Dependence (FTND)score of 3.27±2.56 points.
86.6% of ever smokers had been exposure to smoking before they started smoking; 73.8% of smokers started smoking while they had already been working. The most common incentive to start smoking were:curiosity, influence from classmates or colleagues, social influence.
Male gender and the middle level of income was the risk factor of smoking. A higher educational level was a protective factor.
2. Passive smoking
The rate of passive smoking in 1112 non-smokers was 62.0%. The average age of passive smoking was 19.55±11.61 years, the average amount of passive smoke (sticks/ day) was 5.35±4.81. Only 24.4% of the overall population were neither smokers nor passive smokers.
3. Willingness to quit
In all 621 ever smokers, there were 291 (46.9%) people had the willingness to quit. Elder age, having respiratory symptoms, having the existence of nicotine dependence were the groups with higher rates of willingness to quit.
The smokers who were willing to quit had accepted more advocacy from family members, friends, doctors or hospitals and less from media publicity over quitting than smokers who did not want to quit.
Male gender, elder age, having shortness of breath and the existence of nicotine dependence were the positive impact factors of willingness to quit.
4. Action of quit
64.5% of the 621 ever smokers had never tried to quit.35.5% of the total had tried or were trying to quit. The rate of smokers who were just trying to quit was 1.4%. The rate of relapse in all those who had ever quit smoking successfully (maintain a complete abstinence greater than 6 months) was 29.4%.
The vast majority (93.9%) of smoking cessation method was self-service method, 6.1% required the help of others,0% was from the community and hospital.
Urging to smoke, depression, weight gaining were the most common consequences of quitting process.
5. Smoking cessation
The overall rate of abstinence was 12.4%, successful smoking cessation rate was higher in those groups of elder age, lower educational level, lower income level, having repeated coughing and sputum, always having breathlessness after event, no nicotine dependence and lower FTND score.
Elder age, middle level of education status was positive impact factors of successful smoking cessation. Having nicotine dependence may be the negative impact factor to reach the long term abstinence.
Conclusion:
Ways to reduce the prevalence of smoking is divided into two aspects:prevention and control.
Schools should be the most important places to carry out smoking prevention. Students who were male gender or had poor performance at school should be paid more attention to. Increase the educational level of young people and develop the smoke-refusing atmosphere will be the effective way to prevent young people from smoking initiation.
The attempt to develop the quit willingness should be focus on groups of those who were young, having no nicotine dependence and respiratory discomfort. Advocacy from family, friends, hospital, community will motivate smokers to quit. At present, the publicity and education of smoke preventing from community and hospital were clearly insufficient in rural area.
The tobacco control efforts in rural areas should be strengthened. Improving rural health care system should be the main measures of the government. For it can increase the obtaining of useful medical information, which will help improve the health awareness of rural population, raise the rate of quit willingness and abstinence. Increasing the rate of smoking cessation in rural areas will help the rural population obtaining higher living standards.
In terms of dependence, the existent of nicotine dependence was more closely related with willingness to quit and cessation than the level of FTND score.
Nicotine dependent smokers were more likely to have the motivation to quit. So we should focus the motivational interviewing on those smokers who have no existence of nicotine dependence. For the nicotine dependent smokers, smoking cessation was more difficult, so we should give them more assistance and arrangement.
Section 2 Asynchrony between left and right lungs in evaluation of early smoking-related lung abnormalities
Background:
At present, pulmonary physicians confront a difficult situation when trying to reveal early lung abnormalities caused by smoking because no simple and convenient tools are available that can easily be applied in clinical practice.
Objective:
The goal of this study were to observe the asynchrony patterns between left and right lungs in smokers and non-smokers, to assess the role of vibration response imaging(VRI) in the early detection and evaluation of smoking-related lung abnormalities.
Methods:
Data collected steps are as follows:(1) asked past history and smoking history; (2) exhaled CO test confirmed that the subjects'smoking status; (3) VRI test. VRI system output the curve of Breath Energy Unit (BEU), which is an energy versus time graph of the breath energy. The asynchrony between left and right lungs was derived from this graph; (4) pulmonary function testing. In the end,26 villagers, with normal spirometry findings, were included in the study. The subjects were divided into ever-smoking group and never-smoking group.
Results:
The BEU lung asynchrony was 2.0 (3.0) frame in Never-smoking group,2.0 (3.0) frame too in ever-smoking group. Rank sum test show that there is no significant difference (z=-0.29, p= 0.77) between never-smokers and ever-smokers in the lung asynchrony. Rank correlation analysis suggests that in the ever-smoking group, smoking index and BEU asynchrony have significant correlation (r= 0.61, p= 0.03). In never-smoking group, the coefficient of passive smoking index and lung asynchrony is 0.52 (p= 0.07). The p value of the coefficient between passive smoking index and lung asynchrony is nearly 0.05, scatter between them can be seen a presence of a certain trend.
Conclusion:
Though the BEU asynchrony of left and right lungs among ever-smokers and never-smokers has no significant differences, the lung asynchrony and ever-smokers' smoking level (Smoking index) have the existence of dose-effect relationship. Thus, the lung abnormalities caused by the exposure to passive smoking is probably as same as the abnormalities caused by direct smoking.
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