A harm reduction model for environmental tobacco smoke exposure among Bangladeshi rural household children: A modified Delphi technique approach.

This paper aimed to develop a harm reduction model to reduce exposure to environmental tobacco smoke among children of rural households in Bangladesh. A mixed-methods exploratory sequential design has been applied, and data has been collated from six randomly selected villages of Munshigonj district, Bangladesh. The research was divided into three phases. In the first phase, the problem was identified through key informant interviews and a cross-sectional study. In the second phase, the model was developed by focus group discussion, and in the third phase, the model was evaluated through the modified Delphi technique. The data was analyzed by thematic analysis and multivariate logistic regression in phase one, qualitative content analysis for phase two, and descriptive statistics in phase three. The key informant interviews showed attitude toward environmental tobacco smoke, lack of awareness, inadequate knowledge as a reason and smoke-free rules, religious beliefs, social norms, and social awareness as preclusion of environmental tobacco smoke. The cross-sectional study detected that households with no smoker (OR 0.006, 95% CI 0.002-0.021), high implantation of smoke-free household rules (OR 0.005, 95% CI 0.001-0.058), moderate (OR 0.045, 95% CI 0.004-0.461) to strong (OR 0.023, 95% CI 0.002-0.224) influence of social norm and culture along with neutral (OR 0.024, 95% CI 0.001-0.510) and positive (OR 0.029, 95% CI 0.001-0.561) peer pressure had been significantly associated with environmental tobacco smoke exposure. The final components of the harm reduction model consist of a smoke-free household, social norms and culture, peer support, social awareness and religious practice identified by the FGDs and modified Delphi technique.

Predictors of smoking initiation among Thai adolescents from low-income backgrounds: A case study of Nakhon Pathom low-cost housing estates.

INTRODUCTION: Globally, an estimated 1.3 billion people in the world smoke tobacco products, of which more than 8 million die annually. A disproportionate number of these deaths occur in low- and middle-income countries like Thailand. Over 19% (10.7 million) of the Thai population aged ≥15 years were estimated to be smokers; of these, 7.8% were aged 15-18 years. Nearly 1 in 10 Thai students is a current tobacco user; about 20% of these smokers had initiated smoking before their 10th birthday. This shows that early smoking initiation among Thai youths is indeed a public health problem. This study was conducted to examine the factors associated with smoking initiation among adolescents from low-income backgrounds. METHODS: A cross-sectional study was conducted among youth aged 15-18 years living in low-cost housing estates in Nakhon Pathom province between 1 December 2019 and 30 July 2020. A total of 290 participants were recruited by stratified random sampling. A proprietary questionnaire was used to collect the data, which were analyzed by binary logistic regression. RESULTS: Risk factors for smoking initiation were having one or both parents deceased (OR=2.28; 95% CI: 1.218-3.471, p=0.001), having divorced parents (OR=1.67; 95% CI: 1.158-2.509, p=0.013), and poor academic performance (OR=2.50; 95% CI: 0.133-3.551, p=0.032). Protective factors were having knowledge of cigarettes (OR=0.65; 95% CI: 0.179-0.895, p=0.004) and correct perception of legal public smoking places (OR=0.45; 95% CI: 0.140-0.850, p=0.025). CONCLUSIONS: To curb the risks of early smoking initiation among youths of low-income backgrounds, both education and health authorities need to collaboratively design interventions tailored to raise awareness of the negative health impacts of tobacco, improve the performance of underperforming students, and meet the social needs of students whose parents are either deceased or separated to improve their social ties.

How to Make Physical Activity Promotion Work in Thai Schools: Perspectives of Multiple Stakeholders.

BACKGROUND: This study aimed to determine current practice in physical activity (PA) promotion in Thai schools, explore barriers and facilitators to PA promotion within the school setting, and identify strategies to support schools' future practice. METHODS: A qualitative study design was applied comprising document analysis, focus groups, in-depth interviews, and onsite observations. The focus groups and in-depth interviews were conducted with 144 informants, purposively recruited through 24 schools in 4 regions across Thailand. Inductive content analysis was used. RESULTS: Most schools were promoting PA in the absence of written policies, and without an accurate understanding of PA. Nonalignment of school performance indicators and policies, concerns about children's academic performance, and lack of budget were raised as barriers to PA promotion, whereas strong partnerships with multiple local stakeholders facilitated school-based PA promotion. Mandated government PA policies and more information support were suggested as strategies to enhance schools' future practices. CONCLUSIONS: For PA promotion to be successful in the school setting, significant challenges will need to be addressed. Results from this study help the government and concerned stakeholders to better understand the situation at the school level, and further strive for achieving the target PA levels specified in the National PA Plan.

Social measures for reducing exposure to secondhand smoke in migrant workers of sugarcane harvest in the lower northern region of Thailand.

INTRODUCTION: The sugarcane harvest migrant workers are an underprivileged group in Thailand and have a high risk of exposure to secondhand smoke but are potentially neglected in health promotion interventions. METHODS: This three-phase study applied a mixed-method research approach. The data were collected from February to December 2019 from the Sukhothai province of Thailand. In Phase 1, the level of secondhand smoke exposure of the sugarcane harvest migrant workers at the worker camp was explored. The data were collected from 462 workers by questionnaires and from 24 sample participants in the group discussions about the factors leading to the exposure to secondhand smoke. Phase 2 was the provision and implementation of social measures for the health protection of migrant workers and families from exposure to secondhand smoke. In Phase 3, an evaluation of the health protection model for the migrant workers and families from secondhand smoke exposure was explored. RESULTS: Workers aged ≤40 years had 1.9 times higher exposure to secondhand smoke than workers aged ≥41 years (OR=1.93; 95% CI: 1.24-3.01). Those who worked overtime had 1.7 times higher exposure to secondhand smoke than those who did not work overtime (OR=1.71; 95% CI: 1.10-2.66). Social measures to prevent secondhand smoke were: given a warning, no rewards for cigarettes, designated smoking area, not asking the children to buy cigarettes, stop displaying cigarettes at grocery shops, and empowering woman to go against the smoking husband in the camp and the sugarcane field when the women, children, and nonsmokers are present. After implementing the measures, there was no exposure to secondhand smoke inside the room, cooking area, and at the quad in the camp center. CONCLUSIONS: Appropriate social measures for health protection can help to reduce exposure to secondhand smoke.

Prevalence and Correlates of Alcohol Consumption among Hill-Tribe Adolescents below the Legal Drinking Age-A Community-based Cross-Sectional Study in Northern Thailand.

Alcohol drinking has been prevalent among various hill tribes of northern Thailand due to their distinctively different lifestyles, traditions, cultures and beliefs than the general Thai population; the majority of these traditions involve annual rounds of customary rituals that make alcohol abundantly accessible to all age groups. To study the prevalence and predictors of alcohol use, a community-based analytical cross-sectional study was conducted between October 2017-September 2018 among 480 sampled adolescents aged 12 through 18 years drawn by stratified random sampling. A proprietary questionnaire developed by the researchers was used to collect the data which were analyzed using binary logistic regression. The prevalence of alcohol use in the previous 30 days was 46.7%. Drinking predictors were: having at least a drinking parent, drinking peers, ever been sent to buy alcohol, smoking, cordial relationship with peers, gambling, family violence experience, stress and leisure time company. Therefore, our results suggest that prevention interventions should be designed with a focus on discouraging parents from sending children to buy alcohol and drinking or smoking in their presence; to reduce both social and commercial access to alcohol, age limits should be imposed on alcohol intake at all ceremonious events, while strictly reinforcing the law that prohibits selling alcohol to minors.

Secondhand Smoking Among Children in Rural Households: A Community Based Cross-Sectional Study in Bangladesh.

OBJECTIVES: This study aimed to determine the factors associated with reducing exposure to secondhand smoke among children in households of rural Bangladesh. METHODS: A cross-sectional study of 410 smokers and non-smokers, in 6 villages of Munshigonj district was conducted. Data were collected randomly using a self-administrative questionnaire. Differences between variables were assessed using Chi-square or Fisher's exact test (as appropriate). Univariate and multivariate logistic regression models were used to investigate associations. All results were presented as unadjusted and adjusted odds ratios with a 95% confidence interval. The level of statistical significance was reached when p < 0.05. RESULTS: A smoker in the household was determined to be a risk factor associated with exposure of other household members to secondhand smoke (p < 0.001). Higher education, strict implementation of household smoke-free rules, a higher influence of social norms and culture, as well as moderate knowledge on exposure to secondhand smoke were considered as preventive factors associated with exposure of others in the home to secondhand smoke. CONCLUSION: Exposure to secondhand smoke is an extensive and preventable risk factor for children, and reducing exposure to secondhand smoke will have a largely positive effect in the community. An effective public health intervention model may reduce secondhand smoking.

Effects of a Youth-Engaging Intervention on Illegal Sales by Tobacco Retailers Near Schools in Thailand.

This study assessed the effects of youth-engaging interventions on illegal sales by tobacco retailers near schools in Thailand. The youth were educated and engaged in the planning and implementation of a program to reduce tobacco retailers' illegal sales in the Uttaradit Municipality, Thailand. Intervention components included community education, retailer education, and direct approaches to tobacco retailers. A study included a pretest-posttest control group. The 6-month intervention focused on 114 tobacco retailers. The posttest showed that the percentage of tobacco retailers violating the retail law decreased: tobacco product displays at points of sales decreased from 67.5% to 23.7%, single cigarette sales declined from 71.1% to 36.0%, and tobacco sales to minors decreased from 74.6% to 5.3%. Asking for identification or the buyer's age before selling tobacco increased from 33.3% to 78.1%. The intervention led to a significant reduction in the violation of tobacco retail laws near schools.

Prevalence of secondhand smoke exposure at home and associated factors among middle school students in Northern Thailand.

INTRODUCTION: One-third of youths in Thailand will be exposed to secondhand smoke (SHS) from family members who are smokers. This research aims to study the prevalence of and factors associated with SHS exposure at home among middle school students in Northern Thailand. METHODS: This study used a cross-sectional survey. The sample was 780 middle school students in Northern Thailand. A self-administered questionnaire was used for data collection and analyses were performed using a chi-squared test and multiple logistic regression. RESULTS: Of the respondents, 46.8% reported that they had been exposed to SHS at home. The main SHS sources were from fathers (45.4%), relatives (24.1%), siblings (12.4%), mothers (3.3%), and neighbours and guests (14.8%). The factors associated with SHS exposure at home included: household members who were smokers (OR=7.43; 95% CI: 5.17-10.68; p<0.001), home without a smoke-free rule (OR=3.40; 95% CI: 1.85-6.24; p<0.001), household members who were alcohol drinkers (OR=2.29; 95% CI: 1.59-3.30; p<0.001), and living in homes with ≤3 rooms (OR=1.79; 95% CI: 1.21-2.63; p=0.003). CONCLUSIONS: Thai student's exposure to SHS at home is high, especially when household members smoke and they live in a home without a smoke-free rule. Our findings highlight the need for policies and interventions to establish smoke-free homes.

Reducing Children's Exposure to Passive Smoking in Rural Communities of Bangladesh: An Application of the Theory of Planned Behavior.

BACKGROUND: Passive smoking prevalence is high in Bangladesh. We aimed to explore the association of the theory of planned behavior constructs to reduce the exposure of passive smoking among children in the rural area of Bangladesh. STUDY DESIGN: Cross-sectional study. METHODS: Overall, 410 adults had been taken at random following a self-administrative questionnaire. Data had been collected from six villages of Munshiganj district of Bangladesh from Jul to Oct 2018. Descriptive statistics were applied to describe socio-demographic characteristics. Inter correlations coefficient was done to observe the correlation, differences between demographic and dependent variables were assessed for significance using the Chi-square or Fisher's exact test as appropriate. Univariate and multivariate logistic regression models were used to investigate the association between the theory of planned behavior constructs and exposure of passive smoking among both smoker and nonsmoker groups. All results were presented as unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CIs). A P-value ≤0.05 was considered as statistically significant. RESULTS: Attitude (OR 0.681, 95% CI: 0.498, 0.931) among smoker and intention (OR 0.226, 95% CI: 0.081, 0.633) was found statistically significant constructs (P<0.001) among non-smoker to reduce the exposure. Additionally, the prevalence of passive smoking exposure was found 36.6% (95% CI: 0.32%, 0.41%) on average 40% among males and 28.33% among females. CONCLUSION: The theory of planned behavior constructs is useful to reduce the exposure of passive smoking among children, which may be useful in the future to design interventions of controlling passives smoking exposure.

Tobacco Retailers Near Schools and the Violations of Tobacco Retailing Laws in Thailand.

CONTEXT: A growing body of evidence indicates that the location of tobacco retailers may influence tobacco access among youths. OBJECTIVE: The aim of this research was to examine the relationship between the proximity of tobacco retailers to schools and the violations of tobacco retailing laws. DESIGN: A cross-sectional survey research. MAIN OUTCOME MEASURES: We applied geographical information system to measure the proximity between tobacco retailers and schools and linked them with self-report surveys concerning the violations of tobacco retailing laws. We then tested the relationship between the proximity of tobacco retailers within 500 m of schools and the violations of tobacco retailing laws by the χ test. PARTICIPANTS: All tobacco retailers (121 shops) and schools (14 schools) (covering 5 levels: 2 primary schools, 6 primary-middle schools, 3 secondary schools, 2 vocational schools, and 1 university) in a town municipality in Thailand. RESULTS: Most tobacco retailers were most densely located around primary schools and located less than 500 m away from schools (47.1%), and most of them had violated the tobacco retailing laws. In addition, it was found that the tobacco retailers that were located less than 500 m away from schools allowed customers to do a self-service (P = .04). Nonetheless, the tobacco shops that were far away from schools, more than 500 m, were likely to sell the cigarettes in sticks (P = .04). CONCLUSION: Our results suggest that Thai young people may be at a particularly high risk of tobacco-related problems due to high exposure to tobacco retailers and sales near their educational institutions. We support the possibility of zoning restrictions that can be used to prohibit the operation of tobacco retailers close to schools.

Predicting Factors for Retailers' Sale of Cigarettes to Adolescents in the Lower Part of Northern Region of Thailand.

BACKGROUND: Thailand is one of the members of WHO FCTC and has paid so much attention to preventing adolescents' access to tobacco. However, Thai adolescents still have access to tobacco with ease. The aim of this research was to investigate the predicting factors for the cigarettes sale to adolescents by the retailers in Thailand. STUDY DESIGN: A cross-sectional study. METHODS: This cross sectional survey was conducted after a careful desk review of the relevant literature. Multistage random sampling technique was used to sample the survey participants (n = 675) who were retailers of tobacco in the lower northern region of Thailand. Data were collected by validated questionnaires and analyzed by descriptive analytic, chi-square test and binary logistic regression. RESULTS: More than half (58.7%) of the participants sell cigarettes to adolescents. Factors such as open display of cigarette at the point of sale, selling cigarettes in sticks, selling cigarettes by self-service, and reluctant disregard of buyers' age by the seller significantly correlated with and predicted, at 95% level of confidence, the behavior of retailers selling cigarettes to adolescents. CONCLUSIONS: Thai adolescent's access to tobacco continues to be a serious public health problem. Therefore, the Ministry of Public Health and other relevant stakeholders saddled with the responsibility of interventions to scale up measures that would reinforce the law of Tobacco Control Act.

Participatory management of waste disposal.

The general objective of this study was to develop a sustainable waste disposal management model in Yom riverside communities by creating a sense of ownership in the project among the villagers and encourage the community to identify problems based on their socio-cultural background. The participatory approach was applied in developing a continual learning process between the researcher and stakeholders. The Tub Phueng community of Si Samrong, Sukhothai Province was selected as the location for this study. From the population of 240 households in the area, 40 stakeholders were selected to be on the research team. The team found that the waste in this community was comprised of 4 categories: 1. Occupation: discarded insecticide containers used for farming activities; 2. Consumption: plastic bags and wrappers form pre-packed foods; 3. Traditional activities: after holding ceremonies and festivities, the waste was dumped in the river; and 4. Environmental hygiene: waste water from washing, bathing, toileting, cooking and cleaning was directly drained into the Yom River. The sustainable waste disposal model developed to manage these problems included building simple waste-water treatment wells, digging garbage holes, prosecuting people who throw garbage into the river, withdrawing privileges from people who throw garbage into the river, and establishing a garbage center. Most of the villagers were satisfied with the proposed model, looked forward to the expected positive changes, and thought this kind of solution would be easy to put into practice.