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Development of policy performance indicators to assess the implementation of protection from exposure to secondhand smoke in China
  1. Xia Wan1,
  2. Frances Stillman2,
  3. Huilin Liu3,
  4. Mark Spires2,
  5. Zhen Dai4,
  6. Stephen Tamplin2,
  7. Daiwei Hu1,
  8. Jonathan M Samet5,
  9. Gonghuan Yang1,3
  1. 1Department of Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences; School of Basic Medicine at Peking Union Medical College, Beijing, China
  2. 2Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, Baltimore, Maryland, USA
  3. 3Chinese Center for Disease Control and Prevention, Beijing, China
  4. 4Department of Epidemiology, Peking Union Medical College, Cancer Institute of Chinese Academy of Medical Sciences, Beijing, China
  5. 5Department of Preventive Medicine, University of Southern California, Institute for Global Health, Los Angeles, California, USA
  1. Correspondence to Professor Gonghuan Yang, Department of Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences; School of Basic Medicine at Peking Union Medical College, 5# Dongdan San Tiao, Dongcheng District, Beijing 100005, China; yangghuan{at}


Objective To develop an approach for rapid assessment of tobacco control interventions in China. We examined the correlation between components of the Strength of Tobacco Control (SOTC) index and a proposed rapid evaluation indicator, the Policy Performance Indicator (PPI), which is based on protection of non-smokers from secondhand smoke (SHS). The PPI was used to assess the implementation of policies related to SHS at the provincial/municipal level in China.

Methods Stratified random sampling was used to select five types of organisational and household respondents in two municipalities and five provinces in China (Shanghai and Tianjin, Heilongjiang, Henan, Guangdong, Zhejiang and Jiangxi, respectively). Data collection methods included key informant interviews, observation and intercept surveys (organisations), and a modified Global Adult Tobacco Survey (GATS) questionnaire (households). SOTC scores (SHS policy, capacity and efforts), PPI (no smoking in designated smoke-free places) and mid-term to long-term impact (knowledge, attitude and reduced exposure to SHS) were measured, and correlations among them were calculated.

Results The PPI varied across the seven locations. Shanghai led in the component indicators (at 56.5% for indoor workplaces and 49.1% for indoor public places, respectively), followed by Guangdong, Tianjin and Zhejiang (at 30–35% for these two indicators), and finally, Henan and Jiangxi (at 20–25%). Smoke-free policies were more effectively implemented at indoor workplaces than indoor public places. The PPI correlated well with certain components of the SOTC but not with the long-term indicators.

Conclusions The PPI is useful for evaluating implementation of smoke-free policies. As tobacco control programmes are implemented, the PPI offers an indicator to track success and change strategies, without collecting data for a full SOTC index.

  • Secondhand smoke
  • Environment
  • Low/Middle income country

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