Emilia Zainal Abidin

Second-Hand Smoke in Public Spaces: How Effective has Partial Smoke-Free Legislation Been in Malaysia?

BACKGROUND This study was performed to gather data on second-hand smoke (SHS) concentrations in a range of public venues following the implementation of partial Smoke-Free Legislation in Malaysia in 2004. MATERIALS AND METHODS PM2.5 was measured as a marker of SHS levels in a total of 61 restaurants, entertainment centres, internet cafes and pubs in Kuala Lumpur, Malaysia. RESULTS Under the current smoke-free laws smoking was prohibited in 42 of the 61 premises. Active smoking was observed in nearly one-third (n=12) of these. For premises where smoking was prohibited and no active smoking observed, the mean (standard deviation) indoor PM2.5 concentration was 33.4 (23.8) μg/m3 compared to 187.1 (135.1) μg/m3 in premises where smoking was observed The highest mean PM2.5 was observed in pubs [361.5 (199.3) μg/m3]. CONCLUSIONS This study provides evidence of high levels of SHS across a range of hospitality venues, including about one-third of those where smoking is prohibited, despite 8 years of smoke-free legislation. Compliance with the legislation appeared to be particularly poor in entertainment centres and internet cafes. Workers and non-smoking patrons continue to be exposed to high concentrations of SHS within the hospitality industry in Malaysia and there is an urgent need for increased enforcement of existing legislation and consideration of more comprehensive laws to protect health.

A review of heavy metals in indoor dust and its human health-risk implications

Abstract Indoor dust acts as a media for heavy metal deposition. Past studies have shown that heavy metal concentration in indoor dust is affected by local human activities and atmospheric transport can have harmful effects on human health. Additionally, children are more sensitive to heavy metals due to their hand-to-mouth behaviour and rapid body development. However, limited information on health risks were found in past dust studies as these studies aimed to identify heavy metal concentrations and sources of indoor dust. The objective of this review is to discuss heavy metal concentration and sources influencing its concentration in indoor dust. Accordingly, high lead (Pb) concentration (639.10 μg/g) has been reported in heavy traffic areas. In addition, this review paper aims to estimate the health risk to children from heavy metals in indoor dust via multiple exposure pathways using the health-risk assessment (HRA). Urban areas and industrial sites have revealed high heavy metal concentration in comparison to rural areas. Hazard index (HI) values found in arsenic (As), chromium (Cr) and Pb were 21.30, 1.10 and 2.40, respectively, indicate that non-carcinogenic elements are found in children. Furthermore, most of the past studies have found that carcinogenic risks for As, cadmium (Cd), Cr and Pb were below the acceptable total lifetime cancer risk (TLCR) range (1×10−6–1×10−4). The results of health risk assessment in this review show that carcinogenic risk exists among children. Hence, this proves that future studies need to focus on children’s carcinogenic risk in indoor dust studies in order to find out the sources of heavy metals in indoor dust. This review highlights the importance of having the HRA application using bioavailable heavy metal concentration as it provides more accurate health-risk estimation. Moreover, this review is also useful as a reference for policy decision making in protecting children’s health.

Implementation of Smoke-free Legislation in Malaysia: Are Adolescents Protected from Respiratory Health Effects?

BACKGROUND This study aimed to examine the relationship between respiratory health of Malaysian adolescents with secondhand smoke (SHS) exposure and smoke-free legislation (SFL) implementation. MATERIALS AND METHODS A total of 898 students from 21 schools across comprehensive- and partial-SFL states were recruited. SHS exposures and respiratory symptoms were assessed via questionnaire. Prenatal and postnatal SHS exposure information was obtained from parental-completed questionnaire. RESULTS The prevalence of respiratory symptoms was: 11.9% ever wheeze, 5.6% current wheeze, 22.3% exercise-induced wheeze, 12.4% nocturnal cough, and 13.1% self-reported asthma. SHS exposure was most frequently reported in restaurants. Hierarchical logistic regression indicates living in a comprehensive-SFL state was not associated with a lower risk of reporting asthma symptoms. SHS exposure in public transport was linked to increased risk for wheeze (Adjusted Odds Ratio (AOR) 16.6; 95%confidence interval (CI), 2.69-101.7) and current wheezing (AOR 24.6; 95%CI, 3.53-171.8). CONCLUSIONS Adolescents continue to be exposed to SHS in a range of public venues in both comprehensive- and partial-SFL states. Respiratory symptoms are common among those reporting SHS exposure on public transportation. Non-compliance with SFL appears to be frequent in many venues across Malaysia and enforcement should be given priority in order to reduce exposure.

Assessing Respiratory Inflammation among Children Living Near to Non-sanitary Landfill Using Interleukin-6 (IL-6)

Aims: To determine the respiratory inflammation among children living near to non-sanitary municipal solid waste landfill area and the concentration of Interleukin-6 cytokine. Study Design: A cross-sectional comparative study design. Place and Duration of Study: Sample: Pajam, Negeri Sembilan, Malaysia, between September 2013 and April 2014. Methodology: A total of 72 children were randomly selected based on the inclusive and exclusive criteria. A set of pre-tested questionnaires were utilized to obtain socio-demographic information and to predict health risk faced by the respondents. Saliva samples of the respondents were collected and analyzed using Human Interleukin-6 (IL-6) Platinum ELISA (Enzyme-Linked Immunosorbent Assay) kit. Results: The PM10 concentration for the exposed group was higher than the unexposed group with the mean ± standard deviation (SD) of 152.31±31.07 μg/m3 and 87.77±30.77 μg/m3 respectively. The mean ± SD of the Interleukin-6 for the exposed group was slightly higher than the unexposed group with the mean ± SD of 6.34±1.95 pg/ml and 5.77±1.08 pg/ml respectively. The most common symptoms reported was sneezing and sore throat. There was no significant correlation between PM10 concentration and IL-6 in this study. Conclusion: The findings exhibit that there was no association between Interleukin-6 and PM10 concentration of the respondent. However, there are likely potential adverse health impacts arising from particulates exposure among exposed children in this study. Respondents are advised to have a medical check-up in order to determine respiratory health status thus elimination the risks of acquiring respiratory inflammation.

Electronic cigarettes and indoor air quality: a review of studies using human volunteers

Abstract Objective: This paper is primarily aimed to review articles on electronic cigarettes (e-cigarettes) focusing on indoor air quality (IAQ) assessment that were conducted using human volunteers under natural settings that mimic actual vaping scenarios. Such studies may give a better representation of the actual potential exposure towards e-cigarettes emissions in indoor settings. Methods: A systematic literature search was conducted using PubMed search engine database. Search terms such as “electronic cigarette”, “e-cigarette”, “electronic nicotine delivery system”, and “indoor air quality” were used to identify the relevant articles to be included in this review. Articles that involved human volunteers who were asked to vape in natural settings or settings that mimic the actual vaping scenario were chosen to be reviewed. The search yielded a total of 15 published articles. Eleven articles were excluded due to 1) unavailability of its full-text (n=1), 2) did not involve human volunteers (n=5) and 3) did not involve an IAQ study (n=5). Four articles were critically reviewed in this paper. Results: From the four selected articles, two of the papers focused on the determination of nicotine level released by e-cigarettes whereas the other two covered IAQ parameters namely; particulate matters (PM), propylene glycols, formaldehyde, metals and polycyclic aromatic hydrocarbons (PAHs). Only two of the studies involved determination of biomarkers of exposure. The level of chemical contents released varied between studies. The differences in the brands of e-cigarette used, number of vapers recruited and the sensitivity of the methodologies employed in these studies may be the possible causes for such differences. However, studies using human volunteers conducted in a natural setting are more relevant to portray the actual exposure to vapors among e-cigarettes users and non-users compared to studies using a smoking machine/an exposure chamber. This is because such studies take into account the behavior of consumers and individual retention of nicotine. Such method will therefore avoid the possibility of overestimation in terms of exposures toward e-cigarettes users and non-users. Conclusion: There are limited e-cigarette studies on the impact of IAQ performed using human volunteers in natural settings. The available studies however, provided inconsistent scientific evidence on the actual exposure towards the vapor contents as unstandardized methodology were used in conducting such research. Therefore, there is a need to conduct IAQ studies in natural settings by using a standardized protocol in terms of the number of vapers recruited, the size of the indoor settings, the methods used in detecting and quantifying the contents and levels of emissions and the sensitivity of the equipment used in analyzing the contents. This will help in better utilization of the findings from such studies for the use of risk assessment of the exposures towards e-cigarette emissions. There is also a need to emphasize that it is the onus of the manufacturers in providing and proving scientifically sound safety claims for their products prior to commercializing it in the market.

Health Risk Assessment of Heavy Metal Exposure to Classroom Dust in Primary School, Serdang (Malaysia)

Investigation of indoor dust is one of the major pathways in children exposure to heavy metal. High concentration of heavy metal in dust will have significant unequivocal ecological impacts and pose a potential health hazard. Dust samples were collected from seven randomly selected classrooms using a clean plastic brush and shovel. The dust samples were digested using aqua regia method and analyzed for Cd, Pb and Cu using Flame Atomic Absorption Spectrophotometer. Non-cancer effects due to heavy metal exposure from the classroom dust were also assessed. The heavy metal concentrates found on the floor, fan and windows were 0.17–6.14 μg/g for Cd, 0.34–454.86 μg/g for Pb and 12.63–185.82 μg/g for Cu, respectively. In comparison to other reported studies in the literature, the maximum levels of Cd, Pb and Cu were comparable or lower to those reported elsewhere. According to the calculation on Hazard Quotient (HQ) in the case of non-cancer effects, primary school children are experiencing no adverse effects since.

A systematic review of micro correlates of maternal mortality

Abstract In the year 2000, the World Health Organization launched the Millennium Development Goals (MDGs) which were to be achieved in 2015. Though most of the goals were not achieved, a follow-up post 2015 development agenda, the Sustainable Development Goals (SDGs) was launched in 2015, which are to be achieved by 2030. Maternal mortality reduction is a focal goal in both the MDGs and SDGs. Achieving the maternal mortality target in the SDGs requires multiple approaches, particularly in developing countries with high maternal mortality. Low-income developing countries rely to a great extent on macro determinants such as public health expenditure, which are spent mostly on curative health and health facilities, to improve population health. To complement the macro determinants, this study employs the systematic review technique to reveal significant micro correlates of maternal mortality. The study searched MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and Global Index Medicus of the World Health Organization. Our search was time framed from the 1st January, 2000 to the 30th September, 2016. In the overall search result, 6758 articles were identified, out of which 33 were found to be eligible for the review. The outcome of the systematic search for relevant literature revealed a concentration of literature on the micro factors and maternal mortality in developing countries. This shows that maternal mortality and micro factors are a major issue in developing countries. The studies reviewed support the significant relationship between the micro factors and maternal mortality. This study therefore suggests that more effort should be channelled to improving the micro factors in developing countries to pave the way for the timely achievement of the SDGs’ maternal mortality ratio (MMR) target.

Pesticide management approach towards protecting the safety and health of farmers in Southeast Asia

Abstract Background: It is estimated that pesticide production and use have increased continuously in the countries of Southeast Asia in recent years. Within the context of protecting the safety and health of workers in the agricultural sector, there is an existing gap in the implementation of the pesticide management framework because safety and health effects arising from occupational exposures continue to be reported. Objective: This study aims to provide narrative similarities, differences and weaknesses of the existing pesticide management system in Southeast Asian countries (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam) within the context of occupational safety and health. Methods: This is preliminary traditional review study. Pesticide regulation and management at the country level were identified using web-based search engines such as Scopus, ScienceDirect, PubMed and Google. Book, reports, legislation document and other documents retrieved were also gathered from international organizations and specific websites of governmental agency in Southeast Asian countries. The scope of this review is only limited to literature written in English. In total, 44 review articles, reports and documents were gathered for this study. The approach of pesticide management in protecting safety and health in the agricultural setting were benchmarked according to the elements introduced by the United States Environmental Protection Agency, namely, (1) the protection of workers and (2) the practice of safety. Results: All countries have assigned a local authority and government organization to manage and control pesticide use in the agricultural sector. The countries with the highest usage of pesticide are Thailand, Philippines and Malaysia. Most Southeast Asian countries have emphasized safety practice in the management of pesticide usage, but there were less emphasis on the element of protection of workers within the framework in Indonesia, Myanmar, Thailand and Vietnam. Conclusion: The governing bodies in the countries of Southeast Asia have placed significant effort to develop framework related to pesticide management at the country level. The implementation of pesticide management based on the existing framework is evident in most of the countries but needs to be improved. It is suggested that emphasis be given to the implementation of diagnosis, health surveillance and reporting system as well as following or adopting standard guidelines for the protection of workers in terms of safety and health in the agricultural sector.

Potential safety risks in schools: Ensuring the safety of our precious ones

The school has become an inextricable part of the modern society throughout the world and especially in Malaysia. During the weekdays, schools are typically a hive of activities where the adults (teachers and other workers) and children (students) interact with each other daily. Schools often maintain a low-risk level of safety and health. Schools have potential variety of risk and hazards (physical and social) that can negatively affect the wellbeing and health of the people. The Malaysian Department of Safety and Health (DOSH) have issued the Hazard Identification, Risk Assessment and Risk Control (HIRARC) for identifying the risk elements during usual and special operations and to predict the likelihood and severity in workplaces. This study was carried out to identify all the factors and hazards that may cause harm to occupant of a selected school in the state of Selangor, Malaysia. An assessment was carried out to consider the chances of that harm befalling anyone in the circumstances of a particular case and the possible severity of the outcome to enable school administrators to plan, introduce, and monitor preventive measures to ensure that the risks are adequately controlled at all times. The HIRARC assessment on the selected school identified that physical hazard has the highest frequency, followed by ergonomic, biological, chemical, and psychosocial hazards. The kitchen, science laboratory, and toilet are the areas that have higher potential for accident to happen. Although in terms of risk, most of the hazards are categorized under medium followed by low risk, but none of hazards are categorized under the high-risk group. There is a critical need to ensure that the school environment is constantly kept safe and healthy to ensure that the process of lifelong building of knowledge and practices can be sustained for the future of the nation.

Knowledge, attitude and perception of second-hand smoke and factors promoting smoking in Malaysian adolescents

OBJECTIVE To identify the relationship between knowledge, attitude and perception regarding environmental tobacco smoke (ETS) and smoking among Malaysian adolescents living in states with complete or partial smoke-free legislation (SFL). METHODS A total of 898 respondents aged 13-14 years were randomly selected from 21 secondary schools. The Malay version of the modified Global Youth Tobacco Survey questionnaire was used. Hierarchical logistic regression was performed in examining predictors of smoking attempt among adolescents. RESULTS Participants exposed to ETS >5 h/day were more likely to have smoked compared to those exposed to ETS <1 h/day (OR 4.1, 95%CI 1.03-16.0). Living in a state with partial SFL was associated with a two-fold increase in self-reported smoking attempts (OR 1.95, 95%CI 1.10-3.43) compared to living in a state with complete SFL. Negative attitudes and perceptions towards smoking and ETS exposure were linked to lower smoking attempts in states with complete SFL. CONCLUSIONS Adolescents with limited ETS exposure who lived in a state with complete SFL were less likely to attempt smoking compared to those exposed more regularly to ETS and living in a state with partial SFL. Preventing adolescents from becoming smokers is the key to reducing national prevalence rates in smoking. There is a need to implement comprehensive smoke-free legislation nationally across Malaysia.