Knowledge, Attitude and Behavior in Avoiding Secondhand Smoke (SHS) Exposure among Non-smoking People
Nur Zainie Abd Hamid
Secondhand smoke (SHS) contributes to air pollutant in public and cause health problem to children and adolescents. Many people hold less knowledge and assumed that, SHS is harmless to health. This study is about knowledge, attitude and behavior in avoiding SHS exposure among non-smoking women. The aim of the study is to determine the extent of people’s avoidance behavior towards SHS exposure in Klang Valley, Malaysia. This cross-sectional study involves 200 respondents who have been conveniently selected around public places in Klang Valley. The descriptive findings suggested that, 173 respondents agreed tobacco smoke is dangerous for non-smoker’s health. Surprisingly, the respondents did not have accepted level of knowledge and attitude to avoid SHS with mean = 3.99, 4.10 accordingly. Besides, multiple regression test statistically proved that, among the variables, knowledge added statistically significant to the prediction of avoiding SHS with p = 0.00. This study may be a corner stone and an initial effort for responsible authorities such as Ministry of Health to begin formulating plan to increase the awareness of non-smokers about the rationales of preventing SHS, as an alternative plan for creating awareness among smokers.
Keywords: attitude, behavior, knowledge, secondhand smoke (SHS).
Author: Faculty of Business and Management, Universiti Teknologi MARA Kedah, Malaysia.
SMOKING is one of the main causes of death in the world. Around 6 million of death is due to tobacco smoking . In fact, the number of death is predicted to be eight million in 2030 . This is an actual fact experienced by Malaysia where smoking bring about 20 percent of all death due to tobacco smoking diseases such as cardiovascular disease, diabetes, pulmonary disease, and many more .
Considering the impacts of smoking towards smokers, smoking may also affect non-smokers. Non-smokers here are also known as secondary smokers. The group consists of people who breathe in secondhand smoke (SHS) and take in nicotine and toxic chemicals by the same route smokers do. Therefore, the higher the amount of SHS they breathe in, the higher level of harmful chemical in their body. Children for example, are among the most risk group and usually the effect is related to respiratory disease such as bronchial disease. Besides that, the smokers also could harm their infant in which may bring a wide range of problems including lower weight during birth .
More worrying, the SHS that is exhaled has affected non-smokers to continue smoke. One of the reasons lying behind is because of insufficient knowledge and attitude . Statistic indicates that, one third of adult and about 40% of children worldwide are exposed to SHS  where such exposure has caused 1.0% of global death and 0.7% of global disease. This is because, SHS is more danger than to non-smoker since the exhaled smoke contains more than 7000 chemicals . However, only few studies done to investigate the influence of level of knowledge, attitude and avoidance behavior towards SHS exposure. Therefore, the main objective of this article is to access the level of knowledge and attitude of non-smokers in avoiding SHS. As well, the author wanted to explore the main contributor of the avoidance behavior of SHS exposure.
3.1 Knowledge about Secondhand Smoke (SHS)
SHS or known as environmental tobacco smoke or tobacco smoke pollution  is a risk of a number of health problems including cardiovascular disease, lung cancer, respiratory problem, asthma as well as infant death syndrome. Therefore, knowledge about SHS exposure is very important because the environment today is extremely exposed to smoking. The environment includes home, public area and workplace. According to Labib, Abeer & Ahmed , the community have sufficient knowledge about the danger caused by smoking and it effects to the health. Most of the respondents in their study showed high awareness towards SHS.
Prior research also has investigated the knowledge gaps between smoker and non-smoker groups . It is proven that those who are not smoking have better tobacco smoking related knowledge than those who are smoking . This may be due to several reasons and one of them is education, where the more people have education, the more they will tend to avoid SHS. Redhwan, et. al. have identified a few knowledge gap issues between smoker and non-smoker . The first issue is related to the ingredients of the smoke. The knowledge about the harmful substances in the cigarettes or any tobacco products has caused non-smoker to prevent him or herself from it. The non-smoker realized about the effects that they might acquire when contacted with the products. The second issue is the extent of restriction towards non-smoker. People, regardless of smokers or non-smokers are not aware of the public smoking policy being enforced in the country . The third issue is lack of knowledge among smokers about the effect of SHS expose to non-smokers. Evidence suggested that cigarette smoking is a major cause of many chronic diseases, including stroke, peripheral vascular disease, pneumonia, lung and oral cancer . Therefore, low awareness among smokers may be enhanced if they are given direct exposure about the dangers of smoking to them.
3.2 Attitude towards Avoidance Behavior of SHS exposure
The attitude of people played important role to avoid from SHS exposure. According to Hayfaa, Rasmeieh and Amel, there were many effects on maternal smoking nd expose to SHS exposure . People in the smoking area simply assumed that the SHS will not affect them since they are in the open air area . Consistent findings found in Bangladesh by Bhanji, Andrades, Taj & Khuwaja where housewife women held a false conception towards SHS exposre in which they believed that SHS will not affect their health since they live in rural area and only spent most of their time at home, eventhough their husband is a smoker . This false attitude also practiced by parents, because study indicated that, parents do not aware the harmfulness of SHS toward their children and their spouse. They will only change when the effects appear and this will bring major changes in motivation and attitude to avoid SHS later .
3.3 Public Perception on SHS Exposure
Perception can be referred to senses, feelings, ideas, thought, theories and the ability to understand the difference. It is very crucial in every aspect of one’s life. Any perception or senses about something will contribute to the attitude of individual. Previous study revealed that public perceived SHS as a harmful substance to their health . Statistic released by National Youth Tobacco Survey in 2013 shows that 37.0 to 40.5 percent of female youths and 33.2-36.3 male youths held negative perception towards SHS exposure. It needs an effort to avoid SHS especially in public area however, not everybody aware of the dangerous awaits them from being exposed to SHS.
4.1 Setting and Population
This cross-sectional study involved target population of Klang Valley. 25% or 10 districts are randomly selected from the total number of 40 districts. Data are collected using convenience sampling method among both male and female, those aged between 18 to 60 years old and non-smokers at public places in the identified districts. Theorist suggested that, an appropriate number of respondents should be not less than 30 and not more than 500 , therefore the researcher has decided to have 200 sample for the present study in which 10 samples are taken from each identified public places.
Self-administered questionnaire is used as the instrument of data collection. All items are prepared in bi-language to aids the respondents’ understanding. The questionnaire covered four sections: (1) demographic characteristics, (2) public perceptions of SHS, (3) knowledge and attitude towards SHS and (4) avoidance efforts undertaken when exposed to SHS in the environment. Section 2 is adapted from Kurtz, Kurtz, Contreras and Booth, consists of 6 items on knowledge to access the respondents’ knowledge related to SHS and 6 items on their attitude towards SHS exposure . Section 3 is adapted from Wang, Herting and Tung, consists of 18 items on the respondents’ efforts to avoid SHS in their contacted environment . The subscale is in the form of 5-point Likert-type response scale ranging from (1) strongly agree to (5) strongly disagree. Respondents are given a minimum of 15 minutes to complete the questionnaire.
4.3 Data Analysis
Data obtained is analyzed using the Statistical Package for the Social Science (SPSS) version 21. Descriptive analysis is conducted to report the demographic characteristic of the respondents. It is also used to characterize respondents’ knowledge and attitudes towards secondhand exposure and the avoidance towards SHS.
V. FINDINGS AND DISCUSSIONS
Again, this study provides a review on knowledge, attitudes and avoidance behavior of SHS exposure between adults’ male and female. This section presents analysis of findings from the data generated in data collection process.
5.1 Demographic Characteristics
Table 1 shows the demographic characteristics of the respondents. There were 49 (24.5%) male and 151 (75.5%) female respondents involved in the study. Respondents’ age ranged between 18-60 years old. The results showed that, 93 (46.5%) were working in the government sector, while 107 (53.5%) were working in the private sector. Most of the participants live in urban area, with single status and got the highest education level in secondary school.
Table 1: Demographic Background of Respondents
Married and live together
Married but separated
Area of Living
5.2 Perception towards SHS exposure
Table 2 shows most of the respondents (97%) perceived that tobacco smoke is dangerous for non-smoker’s health. The respondents held negative perceptions towards SHS exposure since the response remain consistent above 90% for all indicators. They believed, SHS may dangerous their health status and children, can cause lung cancer and they agreed that smoking should not be allowed in public place especially the children areas. This is consistent with Brian, Shanta and Stephen where their finding among students in middle and high school revealed that the respondents perceived SHS has the potential to harm their current status of health .
Table 2: Perception of SHS exposure
Tobacco smoke is dangerous for non-smoker’s health
Children who are exposed to tobacco smoke
have more illness, such as colds
Exposure to tobacco smoke can
cause lung cancer in non-smokers.
Public places should be smoke-free
Parents or adults should not smoke near children
5.3 Knowledge, Attitude and Behavior of Avoiding SHS
Multiple regression is conducted to see if knowledge and attitude predicted the avoidance behavior towards SHS. Basic descriptive statistic is shown in table 3. Three variables were transformed; knowledge, attitude and avoidance behavior of the respondents towards SHS exposure. The findings showed, respondents did not have sufficient knowledge and required level of attitude towards SHS exposure. All the three items held by respondents suggested that they are uncertain and unaware of the hazardous effects of SHS exposure. This is against the finding revealed by Evans, et. al. and Gharaibeh, et. al. [9-10].
Table 3: Descriptive Statistic
Using the enter method, the analysis of variance and model summary in Table 4 found that knowledge and attitudes explain a significant amount of the variance in the avoidance behavior towards SHS exposure (F (2, 197) = 10.364, p < 0.05, R² = 0.095, R² Adjusted = 0.086). The prediction model was only accounted for approximately 9.5% of the variance in avoidance behavior towards SHS exposure.
Table 4: Analysis of variance and model summary
of the estimate
a. Predictors: (Constant), Knowledge, Attitude
b. Dependent Variable: Avoidance Behavior
Table 5 illustrates correlation coefficient of the regression analysis. It indicates how much the dependent variable varies with an independent variable when all other independent variables are held constant. The unstandardized coefficient, B1 for knowledge is equal to 0.211 and attitude is equal to 0.026. This means when a person’s knowledge and a person’s attitude towards avoiding behavior towards SHS exposure is increase, there will be also an increase in a person’s avoidance behavior towards SHS exposure. The data findings show that only knowledge (Beta 0.280, t(3.204, p <0.05) did significantly predict the avoidance behavior of SHS exposure in the population area, while attitude (Beta = 0.043, t = 0.493, p >0.05) did not. In other words, the finding suggested that the knowledge held by someone influence someone’s avoidance behavior towards SHS exposure. This is consistent with Ma, Tan, Fang, Taubbeh & Shive .
SHS is perceived to be dangerous to non-smokers. The findings of the study support the need to reduce the prevalence of smoking, specifically in Malaysia. It suggested the urgency to conduct prevention efforts. It is highly recommended for the responsible body to held intervention program in order to increase people’s awareness on the danger of SHS in the public. Some of the efforts may include making available more smoking-free area and held campaign or carnival especially in places that include high-risk groups (teenagers, children and pregnant mothers). It is hoped, future research will include smokers as respondents of the study in order to make comparison of their awareness, attitude and perception with non-smokers.
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