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Title: Using household air quality feedback to encourage smokers towards a smoke-free home : a workplace-based intervention in Malaysia
Author: Binti Abd Latif, Norul Hernani
ISNI:       0000 0004 8498 4536
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2019
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Background: Over 80% of second-hand smoke (SHS) is invisible and smokers are often unaware of how much SHS is produced when they smoke at home. The fine particulate matter (PM2.5) from the tobacco smoke can drift and linger around the home. This study aims to develop an educational intervention in encouraging smokers to move towards a smoke-free home (SFH) in Malaysia. The study measured the SHS-PM2.5 levels in homes where smoking occurred and used personalised household air-quality feedback intervention to help the implementation of SFH rules. This study also examined the feasibility and acceptability of providing a new, low-cost, personalised air quality measuring system to smokers through participant's workplaces. Methods: Research invitations were made directly to the management team at selected Malaysian workplaces that have Occupational Safety and Health (OSH) Management Systems in place. Upon organisational agreement, workers were invited to take part using letters of invitation, flyers and emails. Smoking and non-smoking workers were recruited as long as they lived in a home where smoking occurs and where at least one other family member resided. Initial laboratory work developed a method for identifying PM2.5 readings which distinguish tobacco smoke from non-SHS sources in typical household's air by examining common particle emission sources including candles, air freshener, fragrance oil burner, incense, and various cooking activities. This was used to ensure that feedback could be targeted at smoking activity. This study also developed a set of useful educational intervention information. Recruited participants received standard SHS advice plus personalised air quality feedback. Measurement of SHS-PM2.5 was made using a Dylos DC1700 particle counter at baseline and then again (post-intervention) at 1-month follow-up. The main outcome measures were the difference in SHS-PM2.5 concentrations between the baseline and follow-up, participant's attitudes towards SHS exposure, and commitment towards a SFH. Qualitative data was also collected to determine the feasibility and acceptability of providing an indoor air quality measuring system delivered through the workplaces together with an optional individual interview. Qualitative data were analysed thematically using MS Excel with differences between smoking status and types of behavioural changes also examined. Results: A total of 212 participants were invited to take part in the study and 119 consented to participate. Of these, 102 participants from four different workplaces completed both baseline and follow-up measurements. A total of 1,218,547 minutes of PM2.5 concentrations (range between 1,896 - 9,056 minutes from each home) were gathered, making it the largest dataset of PM2.5 measurements collected from smoking homes in a developing country. After eliminating the SHS exposure measurements from a group of participants with < 24 hours of recorded data (at both baseline and follow-up), the PM2.5 readings from a total of 97 smoking households were analysed. The primary outcome for this study was the change in household air quality measured by PM2.5 concentrations within the smoker's homes and it was found that the mean difference of the SHS-derived PM2.5 exposure concentrations increased by 12.9 μg/m3 (p < 0.001) after the intervention with the average value of SHS-derived PM2.5 concentrations at follow-up (39.2 μg/m3 ± 51.7 μg/m3 ) is higher than the average value measured during the baseline (26.3 μg/m3 ± 42.9 μg/m3 ). Despite the average increase of PM2.5 concentrations, the study found that 31% (n=30) of the participants reduced their household PM2.5 levels inside their homes after the intervention, compared to 69% (n=67) who had higher exposures than their baseline readings. These findings indicate that this kind of intervention method is effective in helping about one-third of the targeted population in reducing their SHS exposure at home in Malaysia. Thus, future work is required to identify suitable populations to be involved in this type of intervention. Furthermore, the secondary outcomes of this study were mainly gathered from a selfreported data analysed from two sets (pre and post intervention) of questionnaires (n=97) and thematic quotes cited from categorised individual interviews (n=10) which were conducted at the end of the study. The self-reported results suggested that the participants already had good knowledge and strong opinions about the dangers of SHS exposure at home. Most participants also valued the additional information that they received during the intervention programme as it helped them realise the fact that SHS can remain suspended and lingers around the house for many hours. In terms of research and practice perspective, the qualitative results indicate that providing an indoor air quality monitoring system to the participants through their workplaces was feasible for both smoking and non-smoking workers in Malaysia. This is because both management and employees agreed that the delivery of this intervention study at their place of work as part of work-based health programme was acceptable. In addition, most participants also stated that this study was easy and simple to be involved in and it has a high potential to evolve as it brings various benefits to the society and the workplace community. Besides, some participants also suggested for this kind of intervention work could be continued via social media. Most participants also expressed their eagerness to recommend this study to others and considered that it could be a useful tool in helping smokers to make the move towards a SFH. From the qualitative findings, participants indicated a range of emotions and feelings about the IAQ feedback that they received during the intervention. Most of them expressed feelings of shock, surprise and disappointed that smoking led to such substantial impacts on their household air quality. Conclusion: The educational intervention was inadequate in changing smoking behaviour in most households in this target population. Future studies should consider how best to identifying and targeting smoking households where behaviour change is more likely. This may include identifying households where the smoker has both the interest and the capability to smoke outdoors.
Supervisor: Turner, Stephen ; Semple, Sean Sponsor: Ministry of Higher Education Malaysia ; International Islamic University Malaysia
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Smoking ; Smoking cessation