Estimated cost of extra work hours from co-workers' drinking in Thailand.

INTRODUCTION: Alcohol's harm to others (AHTO) in workplaces has received little attention. A few studies from high-income countries have estimated the cost of AHTO in workplaces, while data from the low- and middle-income countries are lacking. This study aimed to estimate the cost of AHTO in workplaces and to explore factors associated with the cost of AHTO in workplaces. METHODS: Data were taken from 1392 employed respondents who participated in a survey conducted in Thailand from September 2012 to March 2013. The cost of extra work hours was estimated from the hourly wage and extra hours of work. The hourly wage was computed by converting monthly income to weekly income and dividing weekly income by weekly working hours. The gamma regression with log link was used to determine factors associated with the cost of extra working hours. RESULTS: The past-year prevalence of harm from co-workers' drinking was 17.8% among the employed population. The prevalence of working extra hours was 6.1%. On average, an affected worker worked 16.0 extra hours due to co-workers' drinking. In total, 28.8 million hours of extra work was attributed to co-workers' drinking in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (57.8 million USD). Age, education and type of employment were associated with the cost of working extra hours. DISCUSSION AND CONCLUSIONS: The burden of alcohol in workplaces extends beyond drinking workers. Our findings indicate that alcohol imposes a significant cost on co-workers of drinkers.

Unrecorded alcohol consumption in Thailand: Prevalence, geographical variation, relationship with socioeconomic factors and related consequences.

INTRODUCTION: Information on unrecorded alcohol consumption in Southeast Asia and Thailand is lacking. The primary objective of this study was to estimate the prevalence of unrecorded alcohol (including illegally produced alcohol and untaxed cross-border alcohol) consumption among past-year drinkers in Thailand. The secondary objectives were to examine the geographical variation of unrecorded alcohol consumption, effects of socioeconomic factors on unrecorded alcohol consumption and the association between unrecorded alcohol consumption and alcohol-related consequences. METHODS: This study analysed data from the 2017 Smoking and Drinking Behavior Survey. The prevalence of unrecorded alcohol consumption was estimated. Associations of interest were tested using multivariate logistic regression. RESULTS: Overall, 12.3% of past-year drinkers consumed any unrecorded alcohol. The prevalence was highest in the north (24.8%) and lowest in the central region (7.4%). In multivariate analysis, living in the north was associated with consumption of any unrecorded alcohol and illegally produced alcohol, whereas living in the south was associated with untaxed cross-border alcohol consumption. The lowest education and income group had the highest likelihood of consumption of any unrecorded alcohol and illegally produced alcohol, but the lowest likelihood of untaxed cross-border alcohol consumption. Consumption of unrecorded alcohol was associated with a higher chance of alcohol-related consequences. DISCUSSION AND CONCLUSIONS: This study estimated the prevalence of unrecorded alcohol consumption among Thai drinkers and demonstrated the geographical variation in the prevalence and types of unrecorded alcohol consumed. We also found heterogenous associations between socioeconomic factors and each type of unrecorded alcohol.

Drinking abstinence during a 3-month abstinence campaign in Thailand: weighted analysis of a national representative survey.

BACKGROUND: Temporary drinking abstinence campaigns have emerged globally in recent years. In Western countries, campaigns usually challenge drinkers to abstain for one month. In Thailand, the campaign called the Buddhist Lent Abstinence Campaign has been organized annually since 2003. The campaign encourages Thai people to abstain from drinking for three months during the Buddhist Lent period, which coincides with the monsoon season in Southeast Asia (around July-October). This study aimed to estimate the proportion and number of drinkers changing their drinking behaviours during the 3-month Thai abstinence campaign and to examine the determinants of abstinence. METHODS: The 2016 Buddhist Lent Abstinence Evaluation Survey was analysed. The survey was a national representative survey of Thai populations aged ≥15 years. Weighted data were employed throughout the analysis. The number and proportion of drinkers changing their drinking behaviours were estimated. The determinants of alcohol abstinence during the campaign were explored using weighted logistic regression. RESULTS: The prevalence of drinking in the Thai population was 34.3% (95% CI: 32.2-36.4%). A third of the current drinkers, equal to almost six million drinkers, abstained completely during the 3-month period. Another six million drinkers partially changed their drinking behaviours (16.3% abstained for a certain period, and 18.7% decreased the quantity of alcohol they consumed). The factors associated with abstinence included religion, occupation, drinking frequency prior to the campaign, type of beverages consumed, perceived harm from alcohol, exposure to campaign media, and making a public commitment. CONCLUSION: This study demonstrated the effectiveness of a temporary abstinence campaign in Thailand. The work is part of the growing global evidence on the effectiveness of this type of intervention. Temporary abstinence campaigns could be a potential approach to controlling alcohol consumption and related harms. Further research should focus on the long-term effects of such campaigns.

Results from the Medical School Physical Activity Report Card (MSPARC) for a Thai Medical School: a mixed methods study.

BACKGROUND: Data systems for surveillance and monitoring are essential to develop understanding of the levels of physical activity (PA) occurring at the population levels. To comprehensively understand PA in medical schools, a suitable surveillance tool might be useful to present and monitor key PA-related metrics. This study investigated PA-related metrics in a Thai medical school and summarised the findings using a newly developed tool-the Medical School Physical Activity Report Card (MSPARC). METHODS: A mixed methods study was carried out at three campuses of a medical school in Southern Thailand. Data analysis included descriptive statistics and qualitative reviews. All 285 medical students from a medical school were the target population. The prevalence of PA (≥ 150 min/week of moderate- to vigorous-intensity PA) and sedentary behaviours (SB) (≥ 8 h/day of sedentary time) among medical students were analysed using data from a self-administered questionnaire. Usage patterns, quality, and accessibility of walkable neighbourhoods; bicycle facilities; and recreational areas were assessed. PA promotion programmes, education, and investment related to PA promotion were reviewed from the school documents. RESULTS: Of 279 participants, 138 (49.5%) met PA recommendation, but 71.7% met criteria for SB. Male students were more active (61.8 vs. 42.4%) and less sedentary (65.7 vs. 75.1%) than female students. Bicycle facilities were rated as having the lowest quality and accessibility among PA-related facilities. Most PA promotion programmes were sports clubs and sport competitions. A total of 25 h of PA education was taught throughout the entire curriculum, which provided minimal PA counselling training. The school invested 2136.14 Baht/student/year (US $64.34) in PA promotion, or 2.4% of the annual tuition. The MSPARC presented the summary of the findings by using simple symbols, infographics, and short texts. CONCLUSIONS: To increase PA and decrease SB among medical students, there is a need to improve the quality and accessibility of the built environment as well as the natural environment, so as to establish health promoting policies. PA counselling training is required to develop the medical students' essential skills and awareness for future practices. Monitoring and subsequent surveillance of PA in medical school are needed.

Patients' perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study.

BACKGROUND: A universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients' perspectives on hospital visits under universal health coverage. METHODS: A qualitative study was carried out in four public hospitals in rural Thailand. We collected data through focus group discussions (FGDs) and in-depth interviews (IDIs). The semi-structured interview guide was designed to elicit perspectives on hospital visits among participants covered by the Universal Coverage Scheme, Social Security Scheme or Civil Servant Medical Benefit Scheme. Data were transcribed and analysed using a thematic approach. RESULTS: Twenty-nine participants (mean age, 56.76 ± 16.65 years) participated in five FGDs and one IDI. The emerging themes and sub-themes were identified. Factors influencing decisions to visit hospitals were free healthcare services, perception of serious illness, the need for special tests, and continuity of care. Long waiting times were barriers to hospital visits. Employees, who could not leave their work during office hours, could not access some services such as health check-ups. From the viewpoint of participants, public hospitals provided quality and equitable healthcare services. Nevertheless, shared decision making for treatment plans was not common. CONCLUSIONS: The factors and barriers to utilisation of healthcare services provide exploratory data to understand the healthcare-seeking behaviours of patients. Perceptions towards free services under universal health coverage are positive, but participation in decision making is rare. Future studies should focus on finding ways to balance the needs and barriers to hospital visits and to introduce the concept of shared decision making to both doctors and patients.

Willingness to Pay for Colorectal Cancer Screening and Effect of Copayment in Southern Thailand

Background: The incidence rate of colorectal cancer in Thailand is increasing. Hence, the nationwide screening programme with copayment is being considered. There are two proposed screening alternatives: annual fecal immunochemical test (FIT) and once-in-10-year colonoscopy. A copayment for FIT is 60 Thai baht (THB) per test (≈ 1.7 USD); a copayment for colonoscopy is 2,300 THB per test (≈ 65.5 USD). Methods: The willingness to pay (WTP) technique, which is theoretically founded on a cost-benefit analysis, was used to assess an effect of copayment on the uptake. Subjects were patients aged 50-69 years without cancer or screening experience. WTP for the proposed tests was elicited. Results: Nearly two thirds of subjects were willing to pay for FIT. Less than half of subjects were willing to pay for colonoscopy. Among them, median WTP for both tests was greater than the proposed copayments. In a probit model, knowing CRC patient and presence of companion were associated with non-zero WTP for FIT. Presence of companion, female, and family history of cancer were associated with non-zero WTP for colonoscopy. After adjustment for starting price in the linear model, marital status, drinking behavior, and risk attitude were associated with WTP. None of factors was significant for colonoscopy. Uptake decreased as levels of copayment increased. At proposed copayments, the uptake rates of 59.8% and 21.6% were estimated for colonoscopy and FIT respectively. The demand for FIT was price inelastic; the demand for colonoscopy was price elastic. Estimates of optimal copayment were 62.1 THB for FIT and 460.2 THB for colonoscopy. At the optimal copayment, uptake rates would be 59.8% for FIT and 42.3% for colonoscopy.Conclusion(s): More subjects were willing to pay for FIT than for colonoscopy (59.0% versus 46.5%). The estimated uptake rates were 59.8% and 21.6% for colonoscopy and FIT at the proposed copayments.

Development of a physical activity monitoring tool for Thai medical schools: a protocol for a mixed methods study.

INTRODUCTION: Physical activity (PA) is important in promoting health, as well as in the treatment and prevention of diseases. However, insufficient PA is still a global health problem and it is also a problem in medical schools. PA training in medical curricula is still sparse or non-existent. There is a need for a comprehensive understanding of the extent of PA in medical schools through several indicators, including people, places and policies. This study includes a survey of the PA prevalence in a medical school and development of a tool, the Medical School Physical Activity Report Card (MSPARC), which will contain concise and understandable infographics and information for exploring, monitoring and reporting information relating to PA prevalence. METHODS AND ANALYSIS: This mixed methods study will run from January to September 2017. We will involve the School of Medicine, Walailak University, Thailand, and its medical students (n=285). Data collection will consist of both primary and secondary data, divided into four parts: general information, people, places and policies. We will investigate the PA metrics about (1) people: the prevalence of PA and sedentary behaviours; (2) place: the quality and accessibility of walkable neighbourhoods, bicycle facilities and recreational areas; and (3) policy: PA promotion programmes for medical students, education metrics and investments related to PA. The MSPARC will be developed using simple symbols, infographics and short texts to evaluate the PA metrics of the medical school. ETHICS AND DISSEMINATION: This study has been approved by the Human Research Ethics Committee of Walailak University (protocol number: WUEC-16-005-01). Findings will be published in peer-reviewed journals and presented at national or international conferences. The MSPARC and full report will be disseminated to relevant stakeholders, policymakers, staff and clients.