A longitudinal study was conducted to determine changes in knowledge, attitudes and preventive efforts of Malaysian medical students concerning cigarette smoking and environmental exposure to tobacco smoke from their first pre-clinical year in medical school until their final clinical year. There were significant improvements in knowledge about cigarette smoking and in knowledge, attitudes and efforts concerning environmental exposure to tobacco smoke. Overall attitudes concerning cigarette smoking did not change over this period. The same pattern was found for male non-smokers. Women improved on all five scales; male smokers improved on none over the 3-year period. Male non-smokers had better scores on these scales than male smokers in both beginning and ending years. Women excelled in comparison to male non-smokers on smoking attitudes in the pre-clinical year and on all scales except preventive efforts in the final clinical year.Although medical students experienced no changes in the amount of pressures not to smoke from family and friends, there was a significant increase in the amount of prohibition on smoking from their teachers. Male non-smokers alone accounted for this increase. Women experienced more pressure than men not to smoke from their teachers in both years, but the male smokers and non-smokers did not differ in teacher pressure for either year.
This research sought to develop and validate the "Workplace Second-hand Smoke: Perception on the SHS Knowledge, Attitude, and Practice" (WSHS: PAP) instrument, which targets non-smoking employees. A cross-sectional study was conducted between April and June 2018 to validate WSHS: PAP among non-smoking employees at Universiti Malaya Medical Centre (UMMC). Experts were invited to validate the instrument. Then, for exploratory factor analysis, a cross-sectional study was conducted among 336 UMMC non-smoking employees who were recruited by convenience sampling. A total of 28 items on KAP, rated on five-point Likert scales, underwent exploratory factor analysis and were tested for internal consistency (Cronbach's alpha). Participants were approached after 2 weeks for the assessment of test-retest reliability. Cronbach's alpha was 0.828, 0.743 and 0.837, respectively, for the domains of perception of the knowledge, attitude and practice, indicating acceptable internal consistency (above 0.7). Exploratory factor analysis identified a one-factor solution for each of the KAP domains. Therefore, the Malay version of the WSHS: PAP instrument demonstrated satisfactory psychometric properties for the assessment of non-smoking employees in workplaces with a smoking ban.
Background: It is an undeniable fact that exposure to tobacco smoke from the ambiance poses harmful effects to human health. Although many countries including Malaysia have imposed smoking bans and restrictions in indoor and outdoor public places, yet, to achieve a zero exposure to tobacco smoke from one’s surroundings remains a challenge.
Objective: The objectives of this study were to determine the second-hand smoke (SHS) knowledge and percentage of exposure among adults of rural Pedas, Negeri Sembilan and assess the association between socio-demographics and knowledge of SHS among these adults.
Methods: A cross sectional study with convenient sampling was carried out on 485 adults in Pedas, Negeri Sembilan. The instrument used was a validated questionnaire which was adapted with permission to suit the sample under study. The data collected were analysed with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the non-smoking adults in rural Pedas, Negeri Sembilan was high (95.5%). More than 30% of the non-smoking respondents reported a daily exposure to SHS. The adults from this study however have good knowledge of SHS effects on health. A Mann-Whitney U test result revealed that knowledge on SHS scores was significantly higher for the non-smokers than that of smokers (U=17645, p < .001, r=.18). The top three locations identified as the most common places for SHS exposure were restaurants (38.9%), followed by workplace (26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among the non-smoking adults of rural Pedas, Negeri Sembilan is high. Although the adults in this study have good knowledge of SHS health consequences, yet they are unavoidably exposed to SHS because smoking still occurs within their home, workplaces and public places. Our findings suggest the need for more comprehensive, assertive and strongly enforced policies to ban smoking in public areas, not only in this community but all across Malaysia.
Introduction: Understanding the prevalence of secondhand smoke (SHS) exposure and the associated factors is beneficial for the formulation of effective measures to reduce exposure to SHS. The purpose of this study was to determine SHS exposure at home and workplace, and its associated factors among non-smoker Malaysian adults. Methods: Data were extracted from the Global Adult Tobacco Survey-Malaysia (GATS-M) that involved a representative sample of 5112 Malaysian adults. Logistic regression analyses were performed to examine the association between SHS exposure, sociodemographic factors, knowledge on the danger of SHS, and smoking restrictions at home and at work among non-smokers. Results: Among non-smoker Malaysians, age ≥15 years, 27.9% (equivalent to approximately 4.21 million non-smokers) and 33.9% (equivalent to approximately 1.37 million non-smokers) reported that they were exposed to SHS at home and the workplace, at least once a month, respectively. Women (AOR=2.12, 95% CI: 1.61.2.78), young individuals (AOR=3.06, 95% CI: 1.48.6.33), Malays (AOR=2.39, 95% CI: 1.56.3.64) or other Bumiputra ethnic groups (AOR=2.40, 95% CI: 1.39.4.19) and those who worked as other than government employees were more likely to report SHS exposure at home (non-government employee: AOR=1.88, 95% CI: 1.06.3.36). Respondents with a total smoking restriction at home did not report any SHS exposure at home. Similarly, those whose workplace had smoking restrictions were less likely to report SHS exposure at the work compared to their counterparts whose workplace had partial (AOR=3.08, 95% CI: 1.84.5.15) or no smoking restrictions (AOR=15.33, 95% CI: 6.75.34.86). Conclusions: A substantial proportion of Malaysian adults were exposed to SHS at home and at work. The findings emphasize the need for policies on smoking restrictions at work and the need to promote the adoption of a completely smoke-free home, among the Malaysian population.
Study name: Global Adults Tobacco Survey (GATS-2011)
This study aimed to examine the association between second-hand smoke (SHS) exposure and psychological distress amongst non-smoking pregnant women. A cross-sectional study was used to obtain a representative sample of non-smoking pregnant women attending health clinics (n = 661) across six states in Malaysia. The duration of SHS exposure inside and outside the house was recorded from the participants. Psychological distress was assessed via General Health Questionnaire (GHQ12). The analyses were conducted using a logistic regression adjusted for demographic variables and other variables. Amongst non-smoking pregnant women, the prevalence of global SHS exposure and psychological distress was 80.4% and 64.2%, respectively. In the multivariate adjusted odds ratio (OR) models for psychological distress and the duration of SHS exposures, there was an OR of 1.04 (95% CI: 0.61-1.77) for individuals with SHS exposure of 1-4 hours/week, 0.44 (95% CI: 0.23-0.81) for SHS exposure of 5-14 hours/week and 0.84 (95% CI: 0.32-2.22) for exposures of >15 hours/week compared to those with no SHS exposure outside the home. Meanwhile, SHS exposure outside the house with the duration of 5-14 hours might have temporary calming effects against psychological distress. Nonetheless, more research is needed to ascertain this.
Tobacco use is one of the largest causes of preventable diseases across the world. It is interesting to note that second-hand smoke exposure is a major public health problem in Malaysia. The objectives of this study are first, to explore the perspectives of pregnant mothers whose partners are smokers, and second, to explore barriers and facilitators to creating a smoke-free environment in their home. This study uses a qualitative method in analysing the experiences of 15 pregnant mothers taken from a specialist healthcare centre in Sungai Buloh, Malaysia. It discusses the perspectives of these pregnant mothers towards their partners’ smoking habits, as well as the barriers and facilitators in creating a smoke-free home. From the interviews, it became apparent that pregnant mothers despised their partners’ smoking habits due to smoke odour, lack of money, and poor health. The barriers in creating a smoke-free home include the attitude of the smoking spouse, difficulty in weaning off the habit, excessive encouragement by a spouse, difficultly in advising a smoking spouse, influences from friends, and wrong perceptions. Meanwhile, the facilitators towards creating a smoke-free home are illnesses developed through smoking, multiple reminders from family members, and nicotine replacement therapy (NRT) were perceived to work on certain smokers and habitual cues in quitting smoking. The transition process towards making homes smoke-free is complex and individualistic; healthcare professionals may need to tailor strategies to take into account the specific contexts of each individual. More education programmes on the impacts of smoking and second-hand smoke exposures to family members and smoking cessation are needed for both pregnant mothers and their smoking partners.
Study site: Gynaecology Clinic, public teaching hospital, Malaysia
Exposure to secondhand smoke (SHS) in the workplace has led many workplaces to set up smoke-free policies to protect non-smoking employees. Although smoke-free workplaces are pervasive, the intensity of the practice is questionable. The purpose of this review is to identify the pooled prevalence estimate of secondhand smoke at smoke-free workplaces and the factors associated with SHS exposure at the workplace despite existing smoke-free policies. Fourteen studies (total 7458 employees) were identified from Pubmed, ScienceDirect, Cinahl, Scopus, and Web of Science from inception to December 2017. Results indicate that despite the existence of smoke-free policies at the workplace, 14 studies reported exposure to secondhand smoke. The pooled prevalence of the SHS exposure was 0.29 (95% CI = 0.23 to 0.36) (P smoke at the smoke-free workplace. While most of the selected studies show the exposure of SHS within the smoking ban workplace, only two studies reported no exposure to secondhand smoke after implementation of smoke-free policies. Although the smoking ban policy at the workplace has been introduced, there are still a number of employees being affected by secondhand smoke. This indicates that there is still a gap of knowledge, attitude, and practice of non-smokers in strengthening the smoke-free policy at the workplace.
Background The possibility of a person who had undergone surgery to be exposed to the ill effects of cigarette smoke is high, more so if the person lives with a smoker. With increasing popularity of reverse sural fasciocutaneous flaps, a surgeon may have to manage a person who lives with a smoker or is exposed to cigarette smoke. A clear understanding of the effects of exposure to cigarette smoke on reverse sural fasciocutaneous flaps is necessary. This study was performed to establish a clearer understanding of the effects of smoking on reverse sural fasciocutaneous flaps and evidence for preoperative patient counseling about smoking and smoke exposure. Objective The study investigated effects of exposure to cigarette smoke on the survival of the reverse sural fasciocutaneous flap. Methods This was an experimental observational study conducted at the Laboratory for Animal Research Unit in the Health Campus of Universiti Sains Malaysia. Twelve adult White New Zealand rabbits ( Oryctolagus cuniculus ) were divided into two groups of six. All 12 rabbits had a 2.5- × 2.5-cm reverse sural fasciocutaneous flap raised on both its hind limbs. The group exposed to cigarette smoke underwent 4 weeks of smoke exposure for 2 hours daily prior to surgery. This was then continued until analysis of the results. The control group had no intervention. All flaps were analyzed on the seventh postoperative day, after tracing on transparent plastic sheets with the necrotic area marked followed by 2D planimetry done on a grid paper. The flaps were assessed on the total flap area and survival area percentage. It was recorded as mean ± SD. The presence or absence of infection and hematoma was also noted. Results Twelve flaps were analyzed in each group. Total mean flap area and survival area percentage of the control group were 120.33 ± 31.03 mm 2 and 80.12 ± 15.75%, respectively, whereas in the cigarette smoke-exposed group, it was 121.83 ± 17.93 mm 2 and 62.04 ± 34.01%, respectively. The control group had two infections and one hematoma, and the smoking-exposed group had six infections and nine hematomas. The comparison between the groups was made in terms of total flap area, survival percentage, presence of infection, and hematoma for which the p values were 0.886, 0.115, 0.083, and 0.003, respectively. The differences between right and left hind limbs were also analyzed ( p = 0.414). Conclusion There was no statistical difference in the results from the right and left hind limbs. There was no statistical difference in the survival of reverse sural fasciocutaneous flap between the control and smoking-exposed groups.