Air Pollution inside Vehicles: Making a Bad Situation Worse.

Thailand has successfully forwarded Article 8, Protection from Exposure to Tobacco Smoke, of the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC). It achieved its 100% smoke-free goals in public places in 2010, next pursuing other bans in outdoor places to lower particulate matter air pollution (PM2.5). Our aim was to expose the secondhand smoke levels in vehicles since SHS is a danger to everyone, but especially to children and youth. This is the first experimental study of its kind in Thailand. We measured PM2.5 for 20 min under four conditions in 10 typical Thai vehicles, including commonly used sedans and small pickup trucks. We used an established protocol with two real-time air monitoring instruments to record PM2.5 increases with different vehicle air exchange and air conditioning conditions. Monitoring was recorded in the vehicle's front and back seats. The most common Thai ventilation condition is all windows closed with fan/air conditioning (AC) in operation because of Thai tropical conditions. Mean exposure levels were three and nearly five times (49 and 72 µg/m3) the 24 h WHO standard of 15 µg/m3 in the back and front seats, respectively. These high PM2.5 exposure levels warrant action to limit vehicle smoking for public health protection.

Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems.

Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.

Uncovering Philip Morris International's Fundamental Strategies for Product Placement in Thailand: Spotlighting Industry Penetration to Advance the Endgame.

BACKGROUND: Tobacco companies and their associated businesses know that placement - where one can see and purchase their products - is critical to their success. Placement is one of the four fundamental Ps of marketing along with product, price and promotion. Placement includes identifying retail locations in important places such as in shopping districts, within neighborhoods, near schools, at beaches, and in parks. In Southeast Asia, counteracting tobacco company placement strategies that result in market penetration is essential to advancing the endgame, namely ending tobacco use. However, in Southeast Asia research on the placement of tobacco products has been limited. OBJECTIVES: We undertook to analyze how Philip Morris International (PMI) through its subsidiary Philip Morris Asia Inc. (PMAI), from the time the company entered Thailand's market once it was forced open in 1990, developed its successful product placement strategies and tactics. METHODS: We examined over 4,000 PMI and PMAI internal documents using an historical, iterative and thematic approach. We analyzed the most relevant and illuminating documents, particularly those in which PMAI discussed retailer supply, retailer acceptance and retailer cooperation. RESULTS: Even before foreign tobacco brands were legally allowed to be sold in Thailand, PMAI was already doing customer research in Thailand. In 1989, PMAI conducted a study of potential Thai customers in which 24% of respondents' lack of availability (i.e., product placement) was one of the main reasons for not smoking PMI's products. Based on these findings, PMAI engaged in intensive internal efforts to address the placement barrier to gain share. PMAI placed considerable emphasis on "stimulating retail trade acceptance" by making payments to retailers who met agreed upon and contracted product sales targets. PMAI's initial successes incentivizing Thai retailers by essentially buying prime retail space for placement of their brands, to crowd out local and other foreign brands, became the foundation of what evolved into a sophisticated program to make placement highly lucrative for retailers. CONCLUSION: PMAI viewed aggressive product placement as essential to success as a new entrant in Thailand, and their product placement strategies contributed substantially to capturing a large share of the market. Therefore, endgame strategies must focus on restricting product placement through surveillance of tobacco industry legal, investment and retailer actions and through stricter tobacco retailer licensing requirements and penalties.

The Implementation Activist: How One Determined Person with a Camera Has Achieved Enforcement of Smoke-Free Laws throughout Thailand.

BACKGROUND: Smoking and exposure to secondhand smoke are leading causes of disease and premature death in low- and middle-income countries (LMICs), where over 80% of smokers live. Over 152 LMICs, including Thailand, have passed laws designating that indoor and outdoor public spaces should be smoke-free. Throughout LMICs, implementation of laws has been a persistent problem. We identified one activist in Thailand who developed his own highly effective strategy for ensuring implementation of smoke-free laws, and whose approach has potential for being a model for implementation activists in other LMICs. OBJECTIVES: We set out to describe the implementation activist's strategy and impact, and to explore his perspective and motivations. METHODS: We conducted in-depth interviews with the activist, reviewed video recordings and transcripts, and used narrative analysis to identify key themes and illuminating statements. FINDINGS: In the implementation activist's assessment, administrators and officials were not being held accountable for their responsibilities to enforce laws, resulting in low public compliance. The activist developed his strategy to first identify public places where no-smoking signs were not posted and/or where people were smoking; take photographs of violations and make notes; and file citizen's complaints at police stations, submitting his photographs as evidence. The implementation activist documented over 5,100 violations of smoke-free laws throughout Thailand and reported violations to police. Often, police officers were unsure how to deal with his complaints, but when he educated them about the law, most undertook enforcement actions. The activist's work has contributed substantially to creating smoke-free schools, sports facilities and parks. CONCLUSION: This implementation activist's approach can be a model for preventing youth from using tobacco/nicotine, and preventing exposures to secondhand smoke and e-cigarette emissions. Based on his successes, we provide a list of elements that implementation activists can use to be effective, along with recommendations for policy and practice.

Case Study of Tobacco Use among Myanmar Migrant Factory Workers in the Seafood Industry in Thailand.

Migrant workers commonly face many health disparities when they relocate to a foreign work environment. Many workers migrating to Thailand are young unskilled workers from Myanmar. In this study, we examine factors associated with Myanmar migrant workers' smoking status and characterized smoking-related knowledge, attitudes, and behavior in one seafood factory in Thailand. This descriptive study utilized person-to-person interviews among 300 Myanmar migrants in one seafood factory in Thailand, of which 94.3% were young males between 18 and 39 years of age. Results demonstrated that 90% were current daily smokers, over 90% smoked 30-60 times per month, and 95% spent less than 500 baht (US $16) per month on smoking. About 70% of current smokers had 6-10 friends who smoked, compared with 40% of non-smokers (chi-square, p-value ≤ 0.07). Among this sample of mainly male migrant workers, smoking is very common, in part driven through social contact, but levels of dependence appear relatively low. The results suggest potential intervention approaches to reduce high smoking prevalence among this population, such as targeting young males and addressing their concerns about negative attitudes by peers to tobacco use and the unhealthful exposures of women and children in their families and the larger community.

High-speed axially swept light sheet microscopy using a linear MEMS phased array for isotropic resolution.

SIGNIFICANCE: Axially swept light sheet microscopy is used for deconvolution-free, high-resolution 3D imaging, but usually the axial scan mechanism reduces the top imaging speed. Phased arrays (PAs) for axial scanning enable both high resolution and high speed. AIM: A high-speed PA with an update rate faster than the camera row read time is used to track the rolling shutter at camera-limited rates. APPROACH: The point spread function is evaluated to ensure sub-micron isotropic resolution, and the technique is demonstrated on a live Drosophila embryo. RESULTS: Isotropic resolution is shown down to 720 ± 55 nm in all three spatial dimensions. With an update rate of 2.85 µs, the PA tracks the camera sensor rolling shutter at camera-limited rates. Features in the Drosophila embryo are resolved clearly compared with the equivalent static light sheet case. The random-access nature of the PA enables a camera sensor readout in the same direction for each frame to maintain even temporal sampling in image sequences with no speed loss. CONCLUSIONS: Use of PAs is compatible with axially swept light sheet microscopy and offers significant improvements in speed.

Tunable structured illumination light sheet microscopy for background rejection and imaging depth in minimally processed tissues.

We demonstrate improved optical sectioning in light sheet fluorescence microscopy using tunable structured illumination (SI) frequencies to optimize image quality in scattering specimens. The SI patterns are generated coherently using a one-dimensional spatial light modulator for maximum pattern contrast, and the pattern spatial frequency is adjustable up to half the incoherent cutoff frequency of our detection objective. At this frequency, we demonstrate background reductions of 2 orders of magnitude.

High-speed random access optical scanning using a linear MEMS phased array.

We demonstrate a high-speed linear microelectromechanical systems (MEMS) phase modulator capable of random access scanning at 350 kHz, so that any state can be accessed in 2.9 µs from any other state. 670 scan lines with a .87 deg field of view (FOV) are demonstrated in a Fourier regime, with a projected far-field response of 660 lines with an 18 deg FOV after magnification.

Stakeholder's Assessment of the Awareness and Effectiveness of Smoke-free Law in Thailand.

BACKGROUND: This study reports stakeholders' ratings, and perceived gaps in World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) Article 8 implementation in Thailand viewed against WHO's Guidelines for Article 8 and to inform action in preparing the 2017 Tobacco Product Control Act. METHODS: Stakeholder ratings of Guideline provisions of Article 8 on a three-tiered scale of implementation from understanding to effectiveness and efficiency were used to identify gaps in enforcement and compliance important to success in meeting Article 8 goals. This stakeholder assessment occurred through a stakeholder meeting of 55 stakeholders in Bangkok, Thailand in June 2016. RESULTS: The average of all assessment ratings by stakeholders on an ascending 0-3 scale had a mean score of 1.67, which means the level of implementation for Article 8 in Thailand was rated less than effective for enforcement. The assessment shows that the public understanding of smoke-free principles is also poor at a mean of 1.28, that there is incomplete effectiveness of smoke-free measures with a mean of 1.75, and only a general effectiveness that smoke-free protections are adequately covering most places with a mean of 1.98. More needs to be done to make all places compliant through enforcement efforts rated with a mean of only 1, and that more is necessary for protection from tobacco-smoke exposure in other public places and in private vehicles with mean ratings of 1.71 and 1.14. CONCLUSION: This stakeholder approach using a three-tiered rating scale found that the implementation of Article 8 in Thailand is still lacking. With this approach, stakeholders identified critical issues needing improvement and informed changes in the then-proposed Tobacco Product Control Act which later was adopted in 2017.

Using an Assessment Tool to Further Tobacco Control Accomplishment in Thailand.

BACKGROUND: Because implementation of the Framework Convention on Tobacco Control (FCTC), a World Health Organization (WHO) treaty to reduce tobacco use, is an important goal of the 2015 United Nations Sustainable Development Goals (SDGs) and Thailand has sought to fully comply with all its articles, a multiperspective assessment was developed to ensure that any gaps in compliance with FCTC provisions were identified and addressed. METHOD: One assessment mechanism of this multicomponent assessment was the development by experts and use by stakeholders of a 3-tiered rating of all major provisions of the main articles of the FCTC. The results of the performance ratings on FCTC articles by a diverse group of stakeholders were used to spotlight areas of local and regional implementation and compliance with FCTC provisions. RESULTS: Implementation ratings by stakeholders generally followed the chronology of WHO priorities as reflected in the development by WHO of guidelines for the various FCTC articles with highest ratings for articles 6, 8, 11, 12, 14, 15, and 16. However, only 5 articles (Articles 6, 11, 12, 15, and 16) reached level 2 (effectiveness) of the 3-level rating; articles 6, 8, 11, 13, and 14 are discussed because they are the WHO priority articles of the MPOWER tobacco control policy. Importantly, stakeholders cited problems with lack of completeness of present Thai law and processes for enforcement, as well as lack of public understanding regarding tobacco control strategies and provisions. CONCLUSIONS: Overall, the breadth and inclusiveness of the stakeholder approach devised for improving implementation by the Tobacco Control Research and Knowledge Management Center provided greater understanding about shortcomings of present policy and resource management which informed the Tobacco Products Control Act passed in 2017 and plans for advancing stronger Thai regulation by local and national government.

Cigarette Waste in Popular Beaches in Thailand: High Densities that Demand Environmental Action.

Thailand, like all nations, has a responsibility to initiate environmental actions to preserve marine environments. Low- and middle-income countries face difficulties implementing feasible strategies to fulfill this ambitious goal. To contribute to the revitalization of Thailand's marine ecosystems, we investigated the level of tobacco product waste (TPW) on Thailand's public beaches. We conducted a cross-sectional observational survey at two popular public beaches. Research staff collected cigarette butts over two eight-hour days walking over a one-kilometer stretch of beach. We also compiled and analyzed data on butts collected from sieved sand at 11 popular beaches throughout Thailand's coast, with 10 samples of sieved sand collected per beach. Our survey at two beaches yielded 3067 butts in lounge areas, resulting in a mean butt density of 0.44/m². At the 11 beaches, sieved sand samples yielded butt densities ranging from 0.25 to 13.3/m², with a mean butt density of 2.26/m² (SD = 3.78). These densities show that TPW has become a serious problem along Thailand's coastline. Our findings are comparable with those in other countries. We report on government and civil society initiatives in Thailand that are beginning to address marine TPW. The solution will only happen when responsible parties, especially and primarily tobacco companies, undertake actions to eliminate TPW.

Time-multiplexed light field synthesis via factored Wigner distribution function.

An optimization algorithm for preparing display-ready holographic elements (hogels) to synthesize a light field is outlined, and proof of concept is experimentally demonstrated. This method allows for higher-rank factorization, which can be used for time-multiplexing multiple frames for improved image quality, using phase-only and fully complex modulation with a single spatial light modulator.

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

Background: Throughout 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. Methods: We 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. Results: At 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. Conclusions: Action 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.

Light sheet fluorescence microscopy using high-speed structured and pivoting illumination.

We show that light sheet fluorescence microscopy with structured and pivoting illumination enables fast image acquisition and improved image quality. A one-dimensional spatial light phase modulator is used to control the illumination profile at high speed. To demonstrate the features of the system, we image fluorescent beads and biological samples, successfully obtaining optically sectioned images with higher contrast using structured illumination and with reduced shadowing effects using pivoting illumination.

Design and fabrication of silicon-tessellated structures for monocentric imagers.

Compared with conventional planar optical image sensors, a curved focal plane array can simplify the lens design and improve the field of view. In this paper, we introduce the design and implementation of a segmented, hemispherical, CMOS-compatible silicon image plane for a 10-mm diameter spherical monocentric lens. To conform to the hemispherical focal plane of the lens, we use flexible gores that consist of arrays of spring-connected silicon hexagons. Mechanical functionality is demonstrated by assembling the 20-µm-thick silicon gores into a hemispherical test fixture. We have also fabricated and tested a photodiode array on a silicon-on-insulator substrate for use with the curved imager. Optical testing shows that the fabricated photodiodes achieve good performance; the hemispherical imager enables a compact 160 ° field of view camera with >80% fill factor using a single spherical lens.

How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization.

BACKGROUND: Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. OBJECTIVE: In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. DESIGN: We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority - road accidents - to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. RESULTS: In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. CONCLUSIONS: Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.

Impact of Point-of-Sale Tobacco Display Bans in Thailand: Findings from the International Tobacco Control (ITC) Southeast Asia Survey.

In September 2005 Thailand became the first Asian country to implement a complete ban on the display of cigarettes and other tobacco products at point-of-sale (POS). This paper examined the impact of the POS tobacco display ban in Thailand, with Malaysia (which did not impose bans) serving as a comparison. The data came from the International Tobacco Control Southeast Asia Survey (2005-2011), a prospective cohort survey designed to evaluate the psychosocial and behavioral impacts of tobacco control policies. Main measures included smokers' reported awareness of tobacco displays and advertising at POS. At the first post-ban survey wave over 90% of smokers in Thailand were aware of the display ban policy and supported it, and about three quarters thought the ban was effective. Noticing tobacco displays in stores was lowest (16.9%) at the first post-ban survey wave, but increased at later survey waves; however, the levels were consistently lower than those in Malaysia. Similarly, exposure to POS tobacco advertising was lower in Thailand. The display ban has reduced exposure to tobacco marketing at POS. The trend toward increased noticing is likely at least in part due to some increase in violations of the display bans and/or strategies to circumvent them.

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 ≤2.5 µm (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 188.7 µg/m(3)), higher outside DSRs than in the US airports (overall mean=50.1 vs 43.7 µg/m(3)), and at comparable levels with the US airports in the terminals away from DSRs (overall mean=13.8 vs 11.5 µg/m(3). 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.

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

BACKGROUND: The 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. METHODS: We 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. RESULTS: The 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 OR = 3.82, 95% CI = 2.47-5.9), and outside (adjusted OR = 2.99, 95% CI = 1.45-6.15). Parental lower educational level and low household income were also associated with respiratory illnesses in Thai children under five. CONCLUSIONS: Thai 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.

Adult smokers' reactions to pictorial health warning labels on cigarette packs in Thailand and moderating effects of type of cigarette smoked: findings from the international tobacco control southeast Asia survey.

INTRODUCTION: In this study, we aimed to examine, in Thailand, the impact on smokers' reported awareness of and their cognitive and behavioral reactions following the change from text-only to pictorial warnings printed on cigarette packs. We also sought to explore differences by type of cigarette smoked (roll-your-own [RYO] vs. factory-made [FM] cigarettes). METHODS: Data came from the International Tobacco Control Southeast Asia Survey, conducted in Thailand and Malaysia, where a representative sample of 2,000 adult smokers from each country were recruited and followed up. We analyzed data from one wave before (Wave 1) and two waves after the implementation of the new pictorial warnings (two sets introduced at Waves 2 and 3, respectively) in Thailand, with Malaysia, having text-only warnings, serving as a control. RESULTS: Following the warning label change in Thailand, smokers' reported awareness and their cognitive and behavioral reactions increased markedly, with the cognitive and behavioral effects sustained at the next follow-up. By contrast, no significant change was observed in Malaysia over the same period. Compared to smokers who smoke any FM cigarettes, smokers of only RYO cigarettes reported a lower salience but greater cognitive reactions to the new pictorial warnings. CONCLUSIONS: The new Thai pictorial health warning labels have led to a greater impact than the text-only warning labels, and refreshing the pictorial images may have helped sustain effects. This finding provides strong support for introducing pictorial warning labels in low- and middle-income countries, where the benefits may be even greater, given the lower literacy rates and generally lower levels of readily available health information on the risks of smoking.