Development of Tobacco Control Trial among Migrant Workers in Guangzhou, China

Lead Research Organisation: Sun Yat-Sen University
Department Name: School of Public Health

Abstract

It has been widely accepted that cigarette has tremendous impact on human health. Effective tobacco control effects can help prevent kinds of diseases and social-economic disasters which may happen on smokers of non-smokers exposed to secondhand smoke. In China, internal rural-to-urban migrant (mostly migrant workers) makes a large proportion of the whole population, accounting for about 0.24 billion in 2012. This migrant workers population has a serious situation of tobacco exposure.

We first propose to design a package tailoring the WHO 5A's model into 5A's group consulting intervention package through literature review, in-depth interview and focus group discussion.

The 5A's group consulting package intervention would include:
1. Factsheets detailing key information on smoking, SHS.
2. Guidelines for group guiders on how to deliver the 5A's group consulting (activities for different audiences: smokers, non-smokers exposed to SHS).
3. A leaflet that contains the key facts about smoking and SHS that can be disseminated to migrant workers after consulting.

Based on the package desigend, we aim to recruit 8 factories (clusters) and all the migrant workers working in these factories from industrial zone of Guangzhou, China. The clusters will be randomized to the intervention and control group in a 1:1 ratio. Clusters allocated to the intervention arm will be offered the 5A's group consulting package. The clusters in the control arm will not be offered the package until the completion of the study. All the migrant workers who work in each factory and provides informed consent will be recruited. Factories will complete a factory survey of basic factory information, all participants will complete a questionnaire (about the status of tobacco exposure, knowledge and attitude of tobacco, and demographic information), and a non-smoking individual will provide a salvia sample which will be tested for cotinine. All these participant outcomes (questionnaire and salvia cotinine) will be measured before and after the 3-month intervention in both arms of the trial. In addition, a purposive sample of participants will be invited for interviews to investigate the facilitators and barriers for integrating 5A's group consulting package into workplace settings and how these can be enhanced or addressed at the end of this trial.

Technical Summary

First, the package would be designed by tailoring the WHO 5A's model into 5A's group consulting intervention package through literature review, in-depth interview and focus group discussion.
The 5A's group consulting package intervention includes:
1. Factsheets detailing key information on smoking, SHS.
2. Guidelines for group guiders on how to deliver the 5A's group consulting (activities for different audiences: smokers, non-smokers exposed to SHS).
3. A leaflet that contains the key facts about smoking and SHS that can be disseminated to migrant workers after consulting.
Second, we aim to recruit 8 factories (clusters) and all the migrant workers working in these factories from industrial zone of Guangzhou, China. The clusters will be randomized to the intervention and control group in a 1:1 ratio. Clusters allocated to the intervention arm will be offered the 5A's group consulting package. Factories will complete a factory survey of basic factory information, all participants will complete a questionnaire (about the status of tobacco exposure, knowledge and attitude of tobacco, and demographic information), and a non-smoking individual will provide a salvia sample which will be tested for cotinine. All these participant outcomes (questionnaire and salvia cotinine) will be measured before and after the 3-month intervention in both arms of the trial. In addition, a purposive sample of participants will be invited for interviews to investigate the facilitators and barriers for integrating 5A's group consulting package into workplace settings and how these can be enhanced or addressed at the end of this trial.

Planned Impact

Using the development grant, we will involve 8 factories and approximately 800 individuals, of which about 400 migrant workers will get intensive tobacco-related education.
At individual level, participants will get a better knowledge of tobacco hazards, benefits of quitting, and methods about quitting. They may benefit from quitting, reducing of SHS contact, and encouraging people around them to quit.
At factory level, improvement of workers' tobacco control concept will facilitate the development and implementation of tobacco-free factory regulation. Evidence shows that the tobacco-free regulation has long lasting effects to reduce the smoking rate among workers and smoking intensity of those smokers.
If the effect and cost-effective could be approved by the larger study, the government would have approved tools to help reduce the tobacco exposure of migrant workers in industrial settings.
The economic benefit from tobacco manufacturing and taxing, and the monopoly position of tobacco industry tended to be the most crucial obstacle to the effective implementation of the FCTC in China. Therefore, efforts in health sector should provide useful supplement to the general tobacco control policy, because health and tobacco sectors are relatively independent with each other.
 
Description The WHO 5A's model is a cost-effective way of protecting non-smokers from hazards of exposure to SHS. We designed and adpated a 5A's group consulting package, which has potentials to be implemented in the workplaces settings in China. This study aims to test the feasibility and acceptability of conducting a workplace-based migrant-workers intervention program of the 5A's and aims to provide information to inform the future design of RCT. The adapted 5A's model was designed into an operational guideline and a training module was developed. In each intervention factory, several team leaders were selected from the migrant workers and were trained to conduct the 5A smoking cessation intervention and follow-up within their teams. Other supportive interventions include public health education lectures, posters/leaflets and social medias.
Exploitation Route Provided research infrastructure for further study.
Gave evidence to a government review.
Sectors Communities and Social Services/Policy,Healthcare

 
Description At individual level, participants(i.e., migrant workers) have improved their knowledge of tobacco hazards, benefits and methods of smoking cessation. They have also reduced second hand smoking contact, and encouraged their workmates around them to quit. Our initial analysis shows that, a total of 51 workers in the intervention group have taken action to quit smoking, accounting for 71.8% of smoking participants, and 20(39%) of them have successfully stopped smoking. The smoking rate has been reduced from 51.2% to 46.6% in intervention group. At the factory level, improvement of workers' tobacco control awareness has facilitated the development and implementation of tobacco-free factory regulations. Evidence shows that the tobacco-free regulations have long lasting effects to reduce the smoking rate among workers and smoking intensity of those smokers. At the policy level, the piloting processes have improved the awareness of local health system to implement the smoking cessation activities among the factories.
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal,Policy & public services

 
Description Provide evidence in promoting tobacco control in the workplace. The research team held an consulting seminar in May, 2016, and invited policy makers, healh education researchers and tobacco control practitioners to attend the seminar and discuss strategy of working place tobacco control. Our study team presented the research findings of our study, which drew great attentions of Deputy Director of the Guangdong Provincial Institute of Public Health, who has been implementing the Guangdong Provincial Tobacco Control Legislation. He pointed out that our study has provided evidence for making smoking smoking ban in work place.
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Gave evidence to a government review
 
Description The research team members participated in the 11th Asia-Pacific Conference on Tobacco or Health in Beijing. The conference addressed the importance of tobacco control for health promotion and disease control. The representatives of the APACT nations or regions shared their experiences and knowledge in the field of tobacco control during the event in order to further set forth the implementation of the WHO FCTC, and to contribute to preventing chronic diseases, controlling tobacco use, and protecting people's health in the Asian-Pacific regions. The research team gave a poster presentation at the conference.
Geographic Reach Asia 
Policy Influence Type Participation in a national consultation
 
Description The research team members participated in the National Health Statistics Academic Annual Meeting, 2017, Wuhan. The conference aims to create a platform for communication about statistical methods on medical researches. The representatives shared their experiences and knowledge in the field of their researches. And our research team gave a poster presentation about tobacco control efforts and statistical analysis methods in the evaluation of the effectiveness at the conference.
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description The team members, Prof. Li Ling and Miss Wenxin Chai, participated in the 8th Cross-Strait Conference on Tobacco Control, which was held in Macau. The conference provided a platform to share experiences and facilitate development on tobacco control issues in mainland China, Taiwan, Hong Kong and MacauAn oral presentation was given by team members to introduce the results and processes of the pilot study.
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description The team members, Prof. Li Ling, and Miss Jingrong Shi, participated in "The 29th World No Tobacco Day Media Expert Forum" which was held by Health Education Center of Guangdong Province and the Guangdong Provincial Association of Tobacco Control". The piloting study have improved the awareness of local health system to implement the smoking cessation activities among the factories. Prof. Li Ling was interviewed by the provincial satellite TV station.
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Title Qualitative interviews 
Description In-depth interviews were conducted with health professionals, factory managers, migrant workers before and after the pilot intervention, to understand the context and processes/experiences of the pilot intervention. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Understand the feasibility, barriers and facilitators of the pilot intervention 
 
Title Questionaire survey 
Description Questionnaire surveys were conducted before and after the pilot intervention to understand the change of the knowledge, attitudes and behaviours of the smoking participants and exposure of second-hand smoking of the non-smoking participants. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Understand the feasibility and effectiveness of the pilot intervention. 
 
Title saliva sample collection 
Description We use saliva instead of blood or urine as biological sample to test participants' cotinine content to reflect workers tobacco exposure . Because cotinine is a metabolite of nicotine and has longer half-life than nicotine in human body and mentain comparative stable conentration in saliva,which is much easier to collect by non-invasive method . Sliva was split into a clean sample cup and saved in cntrifuge tube for subsequent test. 
Type Of Material Biological samples 
Provided To Others? No  
Impact Participants' compliance was increased from this new method of sample collection. All partipants who finished the questionair survey were collected with saliva sample and have cotinine concentration records. 
 
Title SPSS/NVIVO database 
Description An Epidata database was constructed to record data from questionnaire survey and saliva test , then exported to SPSS for future analysis. A merged database for baseline and endpoint results was built. Nivio was used to collect particiants' quanlitative data collected by in-depth interview. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Analysis of the baseline database has helped us to develope and revise the intrvention package. Analysis of the meged database helps us to understand the feasibility and effect of pilot intervention through difference-in- difference analysis. 
 
Description saliva Cotinine test 
Organisation iPhase Pharma Services
Country China 
Sector Public 
PI Contribution The reseach team collected all salver sample of workers slected in this study.
Collaborator Contribution This company helped test the contents of collected workers'salver Cotinine,which is a direct prefiction of workers' tobacco exposure. Throug before-after difference comparison,we can know the short-term effect of our intervention.
Impact Two formal report of workers' salver cotinine content for basline and endpoint of the intervention respectively were resulted. Thisis not a muti-discplinary collbration.
Start Year 2015
 
Title public health intervention-5A's smoking cessation model 
Description The WHO 5A's model is a cost-effective way of protecting non-smokers from hazards of exposure to SHS. We designed and adpated a 5A's group consulting package, which has potentials to be implemented in the workplaces settings in China. This study aims to test the feasibility and acceptability of conducting a workplace-based migrant-workers intervention program of the 5A's and aims to provide information to inform the future design of RCT. The adapted 5A's model was designed into an operational guideline and a training module was developed. In each intervention factory, several team leaders were selected from the migrant workers and were trained to conduct the 5A smoking cessation intervention and follow-up within their teams. Other supportive interventions include public health education lectures, posters/leaflets and social medias. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2016
Development Status Under active development/distribution
Impact At individual level, participants(i.e., migrant workers) have improved their knowledge of tobacco hazards, benefits and methods of smoking cessation. They have also reduced second hand smoking contact, and encouraged their workmates around them to quit. Our initial analysis shows that, a total of 51 workers in the intervention group have taken action to quit smoking, accounting for 71.8% of smoking participants, and 20(39%) of them have successfully stopped smoking. The smoking rate has been reduced from 51.2% to 46.6% in intervention group. At the factory level, improvement of workers' tobacco control awareness has facilitated the development and implementation of tobacco-free factory regulations. Evidence shows that the tobacco-free regulations have long lasting effects to reduce the smoking rate among workers and smoking intensity of those smokers. At the policy level, the piloting processes have improved the awareness of local health system to implement the smoking cessation activities among the factories. At the academic level, this project has improved the capacity of conducting intervention research , and enriched our portfolio of migrant health research. 
 
Description public lecture on tobacco control 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Industry/Business
Results and Impact Two rounds of open lectures were held in the two selected intervention factories, which provided information on the harms of smoking, mechnism of tobacco addiction, benefit and barries to quit smoking, how to successfully quit smoking. 78 and 65 currently smoking workers, most of whom were migrants, attended the lectures, which sparked questions and disccusion afterwards. A printed manual/ leaflet on tobacco control were distributed during the lecture. The lectures increased smoking workers' knowledge about tobacco control and helped them to make decision and take action to quit smoking.
Year(s) Of Engagement Activity 2015
 
Description social media intervention 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact In order to support the 5 A smoking cessation intervention, and reinforce the influence of the intervention, a multi-channel social media method were employed in this study. The research team collected contact information of study participants, which included telephone No., Tencent QQ and weichat account. A QQ chat group and two real-time weichat groups were set up for smoking workers to share with their experiences of smoking and smoking cessation, and seek assistance of quiting smoking . 45 smoking workers participated in our two weichat groups(one group for each intervention factory),and 13 members were added in the QQ group. We also used public subscription to promote smoking cessation knowledge. 26 audience subscribed to our wechat's public subscription"Smoking-free working place". These social media intervention measures helped to increase workers' enthusiasm on tobacco control in intervention factories.
Year(s) Of Engagement Activity 2015