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首页> 外文期刊>Military Medicine: Official Journal of AMSUS, The Society of the Federal Health Agencies >A Tobacco-Free Medical Campus Policy Is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation
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A Tobacco-Free Medical Campus Policy Is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation

机译：无烟草医疗校园政策与二手烟雾暴露的减少和军事医疗员工的满意度增加相关：混合方法评估的结果

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Introduction: Tobacco control is an ongoing concern for the U.S. Army. Although tobacco use is currently prohibited within all military hospitals and clinics, known as military treatment facilities (MTFs), no such facility had implemented a tobacco-free medical campus (TFMC) policy before 2012. This evaluation examined the effects of one Army installation's TFMC policy implementation at its medical facilities. Materials and Methods: Online questionnaires were distributed to medical campus employees, including Active Duty Soldiers, civilians, and contractors, before policy implementation (N = 1,210) and 12 months following policy implementation (N = 1,147). Chi-square analyses, independent t tests, and logistic regression models were utilized to examine pretest/post-test changes in employees' secondhand smoke (SHS) exposure; tobacco use, motivation to quit, and cessation; and health outcomes. Twenty-three focus groups, interviews, and informal discussions with 65 employees and patients were conducted 13 months after initial policy implementation to capture both the intended and unintended policy effects. Results: After controlling for demographic characteristics, the study found that employees had more than twice the odds of exposure to SHS in the workplace at baseline than at 12-month follow-up (odds ratio: 2.06, 95% confidence interval: 1.73-2.46, p < 0.001). Employees also reported a lower prevalence of diagnosis with chronic bronchitis (p < 0.05) at follow up compared to baseline. Although the mean number of sick days taken for respiratory illness decreased over time, results were not significant after controlling for demographic factors. No significant differences existed in tobacco-use prevalence or quit rates among tobacco users over time. Employees reported significantly higher levels of satisfaction with a TFMC policy than the original policy (p < 0.001) though this finding was moderated by smoker status such that smokers reported lower levels of satisfaction with the policy over time. Qualitative findings revealed that the most common policy effect was that the policy caused smokers to change the location of where they used tobacco to off campus. Findings further revealed several unintended policy effects, including safety concerns and greater visibility of smokers in front of the MTF. Conclusion: The first Army MTF TFMC policy was associated with reported reductions in SHS exposure and improvements in some short-term health outcomes. The policy had no observed association with tobacco-use prevalence, motivation to quit, or cessation at 12-month follow-up. Focus group participants discussed several positive and negative policy effects. These policies should be expanded and studied in more depth across military installations, and policy makers should plan mitigation strategies to reduce unintended effects. This is an important step in military tobacco control, but additional efforts will be necessary to curb tobacco use within this population.
机译：简介：烟草控制是美国军队的持续担忧。虽然目前在所有军事医院和诊所禁止烟草使用，被称为军事处理设施（MTFS），但在2012年之前没有这样的设施在2012年之前实施了烟草免医疗校园（TFMC）政策。该评估审查了一支军队安装TFMC的影响其医疗设施的政策实施。材料和方法：在政策实施前（N = 1,210）和12个月之前，在医疗校园雇员，包括现役士兵，平民和承包商，在政策实施前12个月（n = 1,147）。 Chi-Square分析，独立的T测试和逻辑回归模型用于检查员工二手烟（SHS）曝光的预测试/后测试变化;烟草使用，戒烟的动机和停止;和健康结果。在初始政策实施后，与65名员工和患者进行二十三个焦点小组，访谈和非正式讨论，以占据预期和意外的政策效应。结果：在控制人口特征后，研究发现，在基线时，员工员工在工作场所暴露于SHS的两倍以上，而不是12个月的随访时间（赔率比：2.06,95％置信区间：1.73-2.46 ，p <0.001）。员工亦报告慢性支气管炎诊断较低（P <0.05）与基线相比随访。虽然随着时间的推移，呼吸道疾病所需的病天的平均数量降低，但在控制人口因子后，结果并不重要。在烟草用途中没有显着差异，随着时间的推移，在烟草用户中戒烟或退出速率。员工报告的员工与TFMC政策的满意度明显更高，而不是原始政策（P <0.001），尽管这一发现受到吸烟者的主持，但吸烟者报告了随着时间的推移对政策的较低满意度。定性调查结果显示，最常见的政策效果是，该政策导致吸烟者改变他们使用烟草到校外的位置。调查结果进一步揭示了几种意外的政策效应，包括安全问题，并且在MTF前面的吸烟者的可见性更高。结论：第一款军队MTF TFMC政策与报告的额外减少了SHS暴露和一些短期卫生成果的改进有关。该政策没有观察到与烟草使用的关联，在12个月的随访中戒烟，戒烟的动机或停止。焦点集团参与者讨论了几个积极和消极的政策效果。这些政策应更深入地扩展和研究，跨军事设施更深入，政策制定者应该计划缓解策略，以减少意外的影响。这是军事烟草控制的重要一步，但额外的努力将在这个人口中遏制烟草。

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