HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS.

We conducted this study to explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers in Sa Kaeo Province, Thailand. Six hundred hypertensive older adults had their blood pressure level recorded and were interviewed using questionnaires. Structural Equation Modeling (SEM) was used to determine the effect size, both direct and indirect, among factors. Almost half (48.7%) of studied subjects had inadequate health literacy, 98.3% had good medication adherence, and 80% had good blood pressure levels. The highest effect size on health literacy was literacy, followed by cognitive ability, and culture and society. Medication adherence was affected directly and indirectly by cognitive ability, literacy, and culture and society. Health literacy had not only a direct effect on medication adherence but was also the mediator. Finally, the highest effect size on blood pressure level was critical and communicative health literacy. These findings suggest that health literacy should be considered in the Health Literacy Program of the National Public Health Policy and Plan, Ministry of Public Health.

Current manufactured cigarette smoking and roll-your-own cigarette smoking in Thailand: findings from the 2009 Global Adult Tobacco Survey.

BACKGROUND: Current smoking prevalence in Thailand decreased from 1991 to 2004 and since that time the prevalence has remained flat. It has been suggested that one of the reasons that the prevalence of current smoking in Thailand has stopped decreasing is due to the use of RYO cigarettes. The aim of this study was to examine characteristics of users of manufactured and RYO cigarettes and dual users in Thailand, in order to determine whether there are differences in the characteristics of users of the different products. METHODS: The 2009 Global Adult Tobacco Survey (GATS Thailand) provides detailed information on current smoking patterns. GATS Thailand used a nationally and regionally representative probability sample of 20,566 adults (ages 15 years and above) who were chosen through stratified three-stage cluster sampling and then interviewed face-to-face. RESULTS: The prevalence of current smoking among Thai adults was 45.6% for men and 3.1% for women. In all, 18.4% of men and 1.0% of women were current users of manufactured cigarettes only, while 15.8% of men and 1.7% of women were current users of RYO cigarettes only. 11.2% of men and 0.1% of women used both RYO and manufactured cigarettes. Users of manufactured cigarettes were younger and users of RYO were older. RYO smokers were more likely to live in rural areas. Smokers of manufactured cigarettes appeared to be more knowledgeable about the health risks of tobacco use. However, the difference was confounded with age and education; when demographic variables were controlled, the knowledge differences no longer remained. Smokers of manufactured cigarettes were more likely than dual users and those who used only RYO to report that they were planning on quitting in the next month. Users of RYO only appeared to be more addicted than the other two groups as measured by time to first cigarette. CONCLUSIONS: There appears to be a need for product targeted cessation and prevention efforts that are directed toward specific population subgroups in Thailand and include information on manufactured and RYO cigarettes.

Factors associated with e-cigarette use among vocational students: A cross-sectional multistage cluster survey, Thailand.

INTRODUCTION: The use of e-cigarettes has steadily increased, and vocational students are one primary target of e-cigarette marketing. This cross-sectional survey research aimed to explore e-cigarette use and examine the factors associated with it. METHODS: Multistage cluster random sampling was employed to select 1536 students in vocational education institutions. A self-administered questionnaire was used to collect the data from September to December 2019. Multinomial logistic regression analysis was used to obtain the adjusted odds ratio (AOR) to determine the associated factors of e-cigarette use. RESULTS: Altogether, 28.7% of the subjects were currently e-cigarette users, 7.4% used e-cigarettes only, and 21.3% were dual users. Various factors were found to be significantly associated with e-cigarette use by 43.7%. Those consisted of sex (male) (AOR=2.183; 95% CI: 1.510-3.157), grade point average (GPA) of <2.5 (AOR=2.363; 95% CI: 1.502-3.717), having neutral attitudes toward e-cigarette use (AOR=2.676; 95% CI: 1.499-4.779) and positive attitudes toward e-cigarette use (AOR=4.171; 95% CI: 2.250-7.734), moderate level of perceived behavioral control on e-cigarette use (AOR=3.520; 95% CI: 2.287-5.418) and low level of perceived behavioral control on e-cigarettes use (AOR=4.959; 95% CI: 3.274-7.511), moderate price of e-cigarettes (AOR=1.436; 95% CI: 1.009-2.044), and e-cigarette use of their parents (AOR=1.827; 95% CI: 1.137-2.938), close friends (AOR=4.327; 95% CI: 2.954-6.338) and idols (AOR=4.604; 95% CI: 1.844-11.497). CONCLUSIONS: Students should be encouraged to develop negative attitudes toward e-cigarette use and increase their self-confidence to control the use of e-cigarettes. This can be achieved by regularly distributing information on the product's risks. Moreover, students can find inspiration and guidance from peers, close friends, or their idols, who will act as positive role models and inspire them not to initiate e-cigarette use.

Three intervention levels for improving smoking behavior among Royal Thai Army conscripts.

We evaluated a smoking cessation program based on an ecological model among Royal Thai Army conscripts with three levels of behavioral change intervention: intrapersonal level, interpersonal level and organizational level. The program applied processes of change in the Transtheoretical Model for intervention at the intrapersonal level; social support from the family at the interpersonal level; strengthening policies and activities to support quitting, including providing a smoke-free workplace at the organizational level. Eighty-nine participants were purposively selected from the first regiment of conscripts at the King's Royal Guard, recruited into the Army in 2009. The behavioral change intervention was conducted during their first six months of duty. A self-administered questionnaire was used to collect data between May and November 2009. Individual interviews and checklist observations were employed to collect data. Data was analyzed using inferential statistics, comparing means by paired t-test and the chi-square test was used to analyze correlations. Qualitative data were analyzed thematically. Sixty-three percent of participants significantly (p<0.001) reduced the number of cigarettes smoked, and 4.5% quit smoking. There was significant improvement in self-efficacy for improving smoking behavior (p=0.002) and making an effort to quit (p<0.001).

Policy measures on strengthening and developing capabilities for national tobacco control in Thailand.

OBJECTIVE: To assess the situation and report on a national capacity plan for tobacco control under the National Strategic Plan for Tobacco Control (NSPTC) 2010-2014. MATERIAL AND METHOD: Systematic documentary review and analysis were managed by the working group. The results were discussed and provided recommendations by the sub-committee on developing the NSPTC 2010-2014. Seven meetings were organized from March 2009-January 2010. Eventually, the NSPCT 2010-2014 was approved by the National Committee for Tobacco Control, chaired by the Minister of Public Health on 22 April 2010. RESULTS: The major result of the present study was brought to the National Capacity in Tobacco Control Plan under the NSPTC 2010-2014. The purpose of the plan is to strengthen and develop national tobacco control capacity before 2011. Seven strategic areas for National Tobacco Control Capacity have been proposed. They are, 1) tobacco control policy and leadership development, 2) developing an organizational structure and management systems, 3) developing surveillance, monitoring and evaluation systems, 4)formulate measures to support research and knowledge management, 5) capacity building and network expansion for tobacco control in various sectors, 6) capacity building and expansion of a collaborative network for tobacco control at regional levels and 7) improving and strengthening tobacco control laws. In addition, the indicators, key players and support partners were addressed. CONCLUSION: Although the strength of the strategic plan on National Capacity in Tobacco Control is participatory planning process and result in the integrated and comprehensive capacity in tobacco control plan, but some concerns should be considers. They are infrastructure, evidence and networking and leadership.

Cigarette consumption among foreign tourists in Thailand.

OBJECTIVE: To explore the cigarette consumption among foreign tourists in Thailand. MATERIAL AND METHOD: The data in this cross-sectional survey is collected by interviewing 655 foreign tourist smokers with questionnaires in congested areas including Suvarnabhum International Airport, Khao San Road, shopping centers and tourist attraction sites. The data was collected in October, 2010, analyzed by descriptive statistic and the crude magnitude of cigarette consumption was calculated. RESULTS: The findings indicated that 62.9% of tourists were male and 58.9% were from European countries and 22.7% were from Asian countries. 59.2% smoked cigarettes sold in Thailand and were taxed legally. In that amount, 55.7% smoked imported cigarettes and only 3.5% smoked Thai cigarettes. 40.8% had brought cigarettes from their countries or bought cigarettes from Duty Free shops with the amount allowed by Thai law. The top 2 popular brands were Marlboro and L&M. The main reason why they bought imported cigarettes in Thailand was that the price was cheaper or the same when compared with that in their countries. The cigarette consumption share crudely calculated was around 8.90 million packs. CONCLUSION: Foreign tourists smoked imported cigarettes distributed in Thailand and cigarettes brought from abroad. So, Free Trade Agreement in bilateral level or multilateral level need to be reviewed and should separate cigarettes from other goods. The tax barrier excise tax measure and permission law of carrying in 200 sticks should be reviewed in order to control cigarette consumption effectively.

Use of e-cigarettes among public health students in Thailand: Embedded mixed-methods design.

INTRODUCTION: E-cigarettes are new tobacco products widely used among adolescents. Public health students are not only susceptible to e-cigarette use, but they should also serve as non-smoking role models. The study aimed to investigate the current situation of e-cigarette use and the factors associated with its use among public health students. METHODS: In this embedded mixed-methods design, the primary approach was a cross-sectional online survey. The samples were 2302 third-year public health students from 37 public health education institutes across Thailand. Stratified two-stage cluster random sampling was employed to select the subjects. Data were collected using self-administered questionnaires from January to March 2021. A checklist form was employed to collect qualitative data about teaching and learning activities related to tobacco control in June 2021. Descriptive statistics were used for data analysis, including inferential statistics regarding logistic regression. RESULTS: Overall, 3.9% (95% CI: 3.1-4.6) of the students currently used e-cigarettes in the past 30 days. The significant factors that could explain 43.4% of e-cigarette use were predisposing factors: being male (adjusted odds ratio, AOR=1.8; 95% CI: 1.0-3.3), having a neutral attitude toward e-cigarette use (AOR=2.2; 95% CI: 1.1-4.5), and not believing that public health professionals should serve as non-smoking role models for clients and the general public (AOR=2.3; 95% CI: 1.2-4.0). The enabling factor was having tried tobacco products (AOR=40.7; 95% CI: 19.1-87.1), and the reinforcing factor was having three or more close friends who smoke cigarettes (AOR=3.2; 95% CI: 1.8-5.8). CONCLUSIONS: Students' behaviors should be modified through curriculum-based teaching and learning activities to develop negative attitudes toward e-cigarette smoking, increase students' awareness as non-smoking role models, and establish smoke-free environments.

Factors related to tobacco use among middle school students in China.

The objectives of this study were to determine the status of tobacco use among middle school students in China, and to identify factors related to tobacco use. The study was conducted in December 2009. An ecological model was used to formulate the conceptual framework of the study. Three thousand two hundred twenty-one middle school students aged 12-17 years were selected by three stage stratified cluster sampling. Data were collected by self-completed questionnaires and interviews. The prevalence of current smoking was 10.6%; 16.2% among males and 4.3% among females. The prevalence of ever having smoked was 19.7%, 25.3% among males and 13.4% among females. Zero point seven percent of middle school students used other forms of smoked tobacco products other than cigarettes. Multinomial logistical regression analysis found gender, age, knowledge, attitude, life skills, self-concept, parental smoking, friends smoking, friends attitudes toward smoking, peer pressure, family rules, availability of cigarettes, tobacco-free school environment, smoking intervention program, community tobacco control activities, and tobacco control policies had significant associations with smoking behavior. Structural equation modeling (SEM) analysis found intrapersonal factors had direct relationships with smoking behavior among smoking middle school students. Interpersonal factors, organizational factors and policies had indirect relationships with smoking behavior, and through intrapersonal factors affected smoker behavior among middle school smoking students.

The impact of cigarette tax increase on smoking behavior of daily smokers.

OBJECTIVE: To assess the impact of excise tax increase on smoking behavior of daily smokers aged 15 years and over and to explore the association between smokers' characteristics and smoking behavior prior and after excise tax increase. MATERIAL AND METHOD: This cross-sectional survey was performed in 504 daily smokers, who were selected from data records of Global Adult Tobacco Survey (GATS) between February and April, 2009. The data were collected by telephone interview in the first and second weeks of July, 2009. Data were analyzed by frequency distribution and binary logistic regression. RESULTS: After the cigarette tax increase, 9.7% of daily smokers quitted smoking and 48.0% reduced the amount of cigarettes and/or changed the brands and types of tobacco, from manufactured cigarettes to hand-rolled cigarettes. After other covariance being adjusted, the analysis revealed that the amount of cigarettes per day, the types of cigarettes (manufactured and hand-rolled cigarettes), and the smokers' reaction towards the increased price after the excise tax increase were respectively associated with the fact that the smokers quitted smoking or reduced the amount of cigarettes (p < 0.05). CONCLUSION: Cigarette tax increase is beneficial for government revenue and it also affects smoking behavior change of daily smokers. However Ministry of Public Health should co-operate with Ministry of Finance to raise the tax rate on both cigarettes and hand-rolled cigarettes continuously and provide sufficient cessation service to respond to the need to quit smoking.