Nipapun Kungskulniti

Patterns of Smoking Among Adolescents in Malaysia and Thailand: Findings From the International Tobacco Control Southeast Asia Survey

At present, 70% of the worlds 1.1 billion smokers are in developing countries, with over 50% in Asia alone. The current study examined patterns of youth smoking in Thailand and Malaysia. Respondents were 2002 youths between the ages of 13 and 17 from Thailand (n = 1000) and Malaysia (n = 1002). Respondents were selected using a multistage cluster sampling design and surveyed between January 2005 and March 2005. Approximately 3% of youth between the ages of 13 and 17 were current smokers, with an additional 10% to 12% reporting experimental smoking. Males were between 7 and 15 times more likely to report smoking behavior than females. Less than 1% of females respondents in either country met the criteria for current smoking, and less than 5% met the criteria for experimental smoking. In contrast, more than 50% Thai males and approximately one-third of Malaysian males aged 17 met the criteria for either experimental or current smoking.

Indoor/outdoor PM10 and PM2.5 in Bangkok, Thailand

Twenty-four-hour averaged PM10 and PM2.5 concentrations were obtained by using 4-liter-per-minute-pumps and impactors in microenvironments of a busy shopping district and a university hospital campus. In both areas, most people live directly adjacent to their worksites — minimizing the need to measure commuting exposure as part of total daily exposure. Co-located samplers were set in indoor microenvironments, the near-ambient zone of the households, and at nearby streetside central ambient monitoring stations. Smoking and use of other indoor PM sources were recorded daily via questionnaires. Consistent with previous studies, smoking and the use of charcoal stoves increased indoor particulate matter levels. The sampled air-conditioned hospital area had substantially lower particle concentrations than outdoors. A simple total exposure model was used to estimate the human exposure. The averaged ratios of co-located PM2.5/PM10 concentrations in various microenvironments are reported for each location. A single daily indoor average PM10 concentration for all households measured in a given sampling day is calculated for correlation analysis. Results showed that day-to-day fluctuations of these calculated indoor PM10 levels correlated well with near-ambient data and moderately well with ambient data collected at the nearby central monitoring site. This implies that ambient monitors are able to capture the daily variations of indoor PM levels or even personal exposure and may help explain the robust association of ambient PM levels and health effects found in many epidemiological studies. Absolute PM exposures, however, were substantially underestimated by ambient monitors in the shopping district, probably because of strong local sources.

Solid Waste Scavenger Community: An Investigation in Bangkok, Thailand

A solid waste scavenger community at On-Nooch dump site in Bangkok was investigated. The purpose was to identify the dimensions of the public health risk to this group of people and their community due to exposure to hazardous conditions from waste materials. A cross-sectional descriptive study utilizing field surveys and measurements was performed. The demographic, socioeconomic, health related and environmental characteristics of this community were examined. Health complaints and injuries were inventoried among scavengers. Prevalence of childhood respiratory illness was high especially in those households where smoking was present. Intestinal helminthic and protozoan infection in children were detected. Six individuals with possible HIV infection and a number of Hepatitis B antigenemia were found among male respondents. An appreciable proportion of respondents fell below normal when tested for lung function. Air pollution measurements showed acceptable ambient air levels except for particulate matters. Water quality was low for both potable and nonpotable water.

Success Counteracting Tobacco Company Interference in Thailand: An Example of FCTC Implementation for Low- and Middle-income Countries

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face ‘how to’ challenges of implementation. For more than two decades, Thailand’s public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with ‘two faces’, (2) seeking to influence people in high places, (3) ‘buying’ advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

Determining the burden of secondhand smoke exposure on the respiratory health of Thai children

BackgroundThe impact of secondhand smoke (SHS) on Southeast Asian children’s health has been assessed by a limited number of studies. The purpose of this study was to determine whether in Thailand, pre- and postnatal exposure to SHS is associated with acute lower respiratory conditions in young children.MethodsWe conducted a case control study of 462 children under age five admitted with acute lower respiratory illnesses, including asthma and pneumonia, at a major hospital in Bangkok. We selected 462 comparison controls from the well-child clinic at the hospital and matched them by sex and age. We used a structured questionnaire to collect information about exposure to SHS and other factors. We conducted bivariate and multivariate analyses to identify risk factors for acute lower respiratory conditions.ResultsThe number of cigarettes smoked at home per day by household members was significantly greater among cases. A greater number of household caregivers of cases held and carried children while smoking as compared to controls (26% versus 7%, p <0.05). Cases were more likely to have been exposed to SHS in the household (adjusted ORu2009=u20093.82, 95% CIu2009=u20092.47-5.9), and outside (adjusted ORu2009=u20092.99, 95% CIu2009=u20091.45-6.15). Parental lower educational level and low household income were also associated with respiratory illnesses in Thai children under five.ConclusionsThai children who are exposed to SHS are at nearly 4 times greater risk of developing acute lower respiratory conditions. Continued effort is needed in Thailand to eliminate children’s exposure to SHS, especially at home.

Assessment of secondhand smoke in international airports in Thailand, 2013

Objective To assess secondhand smoke (SHS) exposure in Thai international airports using a fine particulate indicator, particulate matter ≤2.5u2005μm (PM2.5), and to compare with 2012 exposure findings in international airports in the USA. Methods Smoking rooms in the four largest international airports that serve the most travellers and with the most operating designated smoking rooms (DSRs) were monitored using PM2.5 monitoring equipment following an approved research protocol for assessing fine particle pollution from tobacco smoke. Monitoring was conducted inside and just outside DSRs and throughout the airport terminals in all four airports. Altogether 104 samples were taken to assess SHS exposure in four airports. Simultaneous samples were taken multiple times in a total of 11 DSRs available for sampling in the research period. Results Levels of PM2.5 in DSRs were extremely high in all four airports and were more dangerous inside DSRs than in the US airports (overall mean=532.5 vs 188.7u2005µg/m3), higher outside DSRs than in the US airports (overall mean=50.1 vs 43.7u2005µg/m3), and at comparable levels with the US airports in the terminals away from DSRs (overall mean=13.8 vs 11.5u2005µg/m3. Findings show that travellers and employees in or near DSRs in the airports assessed in Thailand are being exposed to even higher levels of SHS than in US airports that still have DSRs. Conclusions Extremely high levels of SHS in and adjacent to DSR show that these rooms are not providing safe air quality for employees and travellers. These high levels of exposure are above those levels reported in US airports and show the need for remedial action to ensure safe air quality in international airports in Thailand.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia

IntroductionIn low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailands comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures.MethodWe used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailands tobacco control community, and an analysis of research productivity.FindingsIn Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support.ConclusionThe evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Three-month effects of Project EX: A smoking intervention pilot program with Thai adolescents

Adolescent smoking is a major public health problem around the world, including Thailand. The current study provides a three-month follow-up evaluation of the Project EX tobacco use cessation program among Thai adolescents. The intervention was tested involving a quasi-experimental trial with 185 smokers, with two program and two control condition schools (within each condition, one school in Bangkok Province and one school in Nakhon Pathom Province). At 3-month follow-up, the intent-to-treat (ITT) quit rate was 23% in the program group and 11% in the standard care control group (p<0.02). The intervention also lowered the level of last 30-day smoking at follow-up among persons who did not quit in the program condition, while no change in level of smoking was reported in the control condition. These results are promising for teen tobacco use cessation programming in Thailand.

Secondhand smoke point-source exposures assessed by particulate matter at two popular public beaches in Thailand

BackgroundnThroughout Asia, smoking is commonplace at crowded public beaches. Evidence has clearly shown the dangers of secondhand smoke (SHS) indoors, but no naturalistic studies have determined levels of SHS in outdoor air.nnnMethodsnWe measured SHS exposure at two public beaches in Thailand where families lounge in beach chairs under beach umbrellas. Researchers unobtrusively collected PM2.5 in close proximity to smokers by placing instruments downwind from smokers. We collected 88 samples of second-by-second measurements over 10-min periods. The density of people, smokers and children in each sampling area was also recorded.nnnResultsnAt the two beaches, mean levels were 260 and 504 µg/m3; peak levels reaching up to 716 and 1335 µg/m3. Five of the 88 samples were below the outdoor standard for Thailand of 50 µg/m3. Density counts in sampled zones were up to 4 smokers and 15 children under 12 years of age. Findings show high beach exposures suggesting regulatory protections, especially for children whose exposures can produce multiple health consequences.nnnConclusionsnAction should be taken to prohibit smoking on Thai beaches as in other outdoor settings because peak levels of PM2.5 almost always exceeded the outdoor standard in Thailand and pose a danger to health.

Smoking Prevalence Among Monks in Thailand

Previous studies among Buddhist monks in Thailand have reported smoking rates to be as high as 55%. Because 95% of Thais are Buddhist, monks are highly influential in establishing normative behavioral patterns. As the first population-based study on smoking among Buddhist monks in Thailand, this study aims to determine the smoking prevalence in six regions of the country, and to examine smoking knowledge, risk perceptions, behaviors, and associated demographics among full-fledged and novice monks (n = 6,213). Results demonstrated that the overall prevalence for current smoking monks is 24.4% (95% confidence interval [24.453, 24.464]), with regional differences ranging from 14.6% (North) to 40.5% (East). Findings suggest that integrating prevention and cessation programming into religious courses may be one avenue for reaching many incoming monks. Further, involving monks in tobacco control education and setting a nonsmoking standard among them is vital to the success of reducing smoking rates among the general population in Thailand.