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Smoking cessation strategies in tobacco control in China
Date:2012-09-19 09:59 

Nation tobacco control capacity building workshop was hold August 1-3 in 2012, national tobacco control exports and professors from 35 universities discussed some key issues related to the curriculum implement in at medical universities in workshop. Tobacco control policy advocacy, community action and smoking cessation strategies were included. Recently smoking cessation strategies are being attention and dept in China.
Health professionals play critical roles in advocating for policies, providing tobacco control or smoking cessation services, and serving as role models for social change. Tobacco control advanced experiences in many countries indicated that successful tobacco control dependent on health professionals involving.
The several national tobacco control investigation in China showed that smoking prevalence is still high, which about one-third of residents smoke as male smoking rate reached 60%. Population survey smoking quitting and relapse rates were higher, they respectively are 9.5% and 10.5% in 1996, 12.0% and 32.5% in 2002, 16.9% and 32.5% in 2010, which relapse rate is high than smoking quitting rate. However, a few of those people who quitted smoking used specialized smoking cessation services. The results in 2002 survey showed that the proportion of people who used pharmacotherapy and counseling to quit smoking are very low, 3.1% and 3.0%, respectively.
Since the 1990s, the nicotine drug therapy and smoking cessation hotline had become popular western world. In China, a lot of smoking cessation clinics has been built, but only few smokers went to visit. Beijing’s smoking cessation clinic began in 1996, and there are 22 cessation clinics in hospitals of whole city. Due to the rare patients, most of them have been shut down. Up to 2007, only Chaoyang Hospital, Anzhen Hospital, and the China-Japan Friendship Hospital these three hospitals have the cessation clinic. Since the smoke-free policy in public places was implemented in Beijing in 2008, the number of smoking cessation clinics in Beijing city increased to 7. In 2009, the number reached 19 and then Beijing planned to set up smoking cessation clinics in all 50 tertiary hospitals and some second-class hospitals within two years. But in 2012, the smoking cessation clinic in Beijing is still in the loss and embarrassing situation. Smoking cessation clinics in other cities like Shanghai also meet the similar situation. Since Hangzhou tobacco control work began, Second Affiliated Hospital of Zhejiang University School of Medicne , Sir Run Run Shaw Hospital , Zhejiang Provincial People's Hospital , Hangzhou First People's Hospital and dozen of provincial and municipal hospitals had built a smoking cessation clinic. However, as times goes by, smoking cessation clinic seems to be using the word "deplorable" to describe.
Smoking cessation clinic in Tongde Hospital of Zhejiang Province opened two years ago. Xu Xianrong, director of Department of Respiratory Medicine, said, just one out, patients who came to treatment specifically are not many, sometimes they came because of other respiratory diseases such as cough, bronchitis , and usually patients who wanted to quit but addictive would asked for quit smoking " prescription" by the way. Due to the few patients, smoking cessation outpatient and Respiratory Medicine were merged later. The number of people who take the initiative to seek treatment to quit smoking is very little , it is estimated that only one or two a month .
This situation is the same in Zhejiang Provincial People's Hospital. In the beginning, a separate outpatient service was also opened and canceled later." Because patient is too few, hospital could not put so much medical resources into it. Yan Jianping, director of respiratory medicine, Zhejiang Provincial People's Hospital, said, the reasons for this situation is smoking in China still enjoyed a relatively relaxed atmosphere, unlike some countries as the environment to force you to quit; Secondly, people who really want to quit smoking always are able to quit alone, while who are not firm to quit may not come to the doctor.
On outpatients of Second Affiliated Hospital of Zhejiang University School of Medicne is about 10,000 people a day, but the doctor of smoking cessation treatment answer : very few patients .
Smoking cessation clinic in Sir Run Run Shaw Hospital is "old brand" , because in the beginning of the establishment of the hospital foreigners involved in the management, the smoking cessation treatment programs has been put forward more than 10 years, and smoking cessation clinic officially opened in 2008. While now it is very few hospitals that opened a separate smoking cessation clinic, the hospital is still quietly persisted.
Why smokers refused to look for assist from smoking cessation clinic?
Dr Yang think that different from the Western culture, Chinese emphases on spirit and perseverance they are used rational and instrumental thinking to deal with the problem. So, Chinese smokers are hard to accept the smoking cessation services supplied by specialized medical institutes. Nicotine dependence as a chronic disease has been included in the International Classification of Diseases by World Health Organization. However, Chinese smokers don’t regard themselves as patients and they have never thought of tobacco addiction as a disease. Smokers think they do not need special 'treatment' to quit smoking though smoking cessation institutions. This indicates that it is no smart to implement smoking cessation service by means of the specialized medical institutes. Is it same important our country have the large population of smokes, we have not so much resources to provide so much services using this way.  Prof. Yang suggested that the establishment of smoking cessation specialist agencies should be seriously considered in China.
Doctors are the authority of health problems in people's minds, patients have smoking cessation motivation due to having smoking-related disease clues. This may make clinic intervention have better effect for smoking quitting during general clinical diagnosis and treatment, International studies have shown that during general clinical diagnosis and treatment, doctors provide 5A’s strategy (ask, advise, assess, assist, and arrange follow-up) for brief advice and help can make certain effects of smoking cessation. In some countries the implementation of all clinical divisions providing smoking cessation services do a good job, especially in New Zealand. Hospitals in New Zealand have electronic medical records. One option in electronic medical record is to ask the patient smoking history. If smoking history is not asked, the other projects in electronic medical records can not carry on. However, in China, only Beijing Chang'an Hospital use of electronic medical records containing smoking history. However, National 2010 survey results indicated that only 40.8% patients were asked whether they smoked by doctors, and 33.9% got smoking quitting advice during the past 12 months. Moreover, these medical staffs have not related knowledge and skill for no experiencing smoking cessation training.
With lacking smoking quitting motivation and higher smoking quitting relapse rate. National survey show that percent of smoker want to smoking quit only is 5.1%. Dr Yang suggests that many work should be strengthen. (1) Carry out FCTC measures (2) implement smoke free public place (3) conduct community tobacco control action and public education (4) provide clinic intervention.
Doctors are the authority of health problems in people's minds and a lot of people who go to the hospital for treatment have smoking-related disease clues. These two factors lead to a better effect on clinical cessation advice. Many studies have shown that during general clinical diagnosis and treatment, doctors provide 5A’s brief cessation advice (ask, advise, assess, assist, and arrange follow-up) have better effects for smoking quitting. However, only few doctors do cessation advice in clinic. The key issue they lack this capacity due to not experiencing this training. If tobacco control and smoking cessation become the required course for medical students in University Medical Education, as they graduate, they will become doctors who are responsibility for tobacco control, which may greatly enhance the level of the country’s tobacco control.
The clinical brief advice for smoking cessation involved all the clinical departments to participant. Prof. Yang think that for the clinical smoking cessation service the brief advice should be the most common way, the pharmacotherapy or other special treatment second-line strategy for those who are a severe nicotine dependence and have medical problems with smoking quitting. 
Fourth National Health Services Survey indicated that resident two-week morbidity was 18.9% in 2008. According to the total population of 1.33 billion in the same year, it is calculated that the country's incidence of cumulative total number was 6.54 billion. Meanwhile, the resident two-week visiting rate was 14.5% in 2008 and that means the number of outpatients in our country reached 5.01 billion. Furthermore, the resident annual hospitalization rate was 6.8% in 2008 and there were nearly 100 million inpatients and 25 million surgical cases nationwide. Confronted so many people, if all doctors could provide brief intervention in clinic situation, it must contribute to control the number of smokers. Due to there are the large number of patients "5A" methods implement may bring heavy workload for doctors, Center for Tobacco Control Research Zhejiang University School of Medicine has developed an "ask- advice-behavioral technical help" program which may be suitable in Chinese context. 
Prof. Yang recommended that (1) the content of tobacco control and smoking cessation should be incorporated into compulsory curriculum of college medical education. Currently, there is an urgent need for training university teachers, embedding the tobacco control course into universities’ teaching plans and then implementing it;(2) National Medical Licensing Examination should contain the content of tobacco control and smoking cessation. It is said that the National Examination Center is engaged in this work; (3) Clinical Diagnosis and Treatment Operation Guideline should include the content of smoking cessation services and doctors should provide smoking cessation services and help for patients;(4) Centers for Disease Control and Prevention and other preventive medicine institutions should take the tobacco control as their compulsory content of the disease prevention and management, and require all doctors to master the method and content of tobacco control advocacy. 
Prof. Yang think tobacco control in China is complicated by two potent competing perspectives. One perspective advocates rejection of basic Framework Convention on Tobacco Control (FCTC) principles and measures on the basis of a "special national situation,” and the other advocates wholesale adoption of foreign approaches. Although the Chinese National People’s Congress ratified the FCTC in 2005, implementation of its recommendations is progressing very slowly. Resistance to tobacco countermeasures buttressed by the slogan of a "special national situation" is commonplace, whether these countermeasures pertain to “warnings about the dangers of tobacco,” “enforcement of bans on tobacco advertising, promotion, and sponsorship,” “raising of taxes on tobacco products,” or “protection of the public from passive tobacco smoking.” While foreign methods of tobacco control likely can be adapted for use to some degree in China, there is currently a lack of national, provincial, and local specialist agencies to oversee the implemenation and evaluation of such methods.
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