SETTING: 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.
PARTICIPANTS: Community audits and surveys of adults (35-70 years, n=12 953).
PRIMARY AND SECONDARY OUTCOME MEASURES: Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models.
RESULTS: Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1).
CONCLUSIONS: This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.
BACKGROUND: Work-life balance practices are associated with employee perceptions of the need for achievement and well-being which subsequently influence their intention to leave the organization. This study contributes new knowledge to nursing studies on work-life balance in an Asian and Islamic society where the expectations for women are to focus on family rather than career.
DESIGN: A cross-sectional, explanatory mixed methodology.
METHODS: This is a two-phase study conducted between 2015-2017 with 401 nurses in East Malaysia. In Phase 1, researchers surveyed 379 nurses to test eight hypotheses and in Phase 2 researchers interviewed 22 nurses to explore the results of Phase 1.
RESULTS: Phase 1 revealed job satisfaction mediates the relationship between work-life balance practices (e.g. flexibility and choice in working hours, supportive supervision), financial success, and intention to leave. However, life satisfaction and money as a motivator did not mediate such relationships. Phase 2 identified four important factors that cast light on survey results: working conditions of Malaysian nurses; inadequate compensation in the public healthcare sector; team-based practices; and pressure on senior nurses in both administrative and clinical roles.
CONCLUSION: This is one of the first studies to investigate work-life balance issues among nurses in Malaysia. Outcomes of this study extend the debates on work-life balance and employee well-being in an Asian Islamic social context.
IMPACT: The use of flexible working arrangements and collectivist teamwork approaches, improving compensation and employment benefits and eliminating the 'time-based job promotion' policy may help to mitigate work-life balance issues and intention to leave among nurses in Malaysia.