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Knowledge, Attitude and Behavior in Avoiding Secondhand Smoke (SHS) Exposure among Non-Smoking People

London Journal of Research in Humanities and Social Sciences
Volume | Issue | Compilation
Authored by Nur Zainie Abd Hamid , NA
Classification: For Code: 370199
Keywords: attitude, behavior, knowledge, secondhand smoke (SHS).
Language: English

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.

               

Knowledge, Attitude and Behavior in Avoiding Secondhand Smoke (SHS) Exposure among Non-smoking People

Nur Zainie Abd Hamid

____________________________________________

  1. ABSTRACT

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.

  1. INTRODUCTION

SMOKING is one of the main causes of death in the world.  Around 6 million of death is due to tobacco smoking [1].  In fact, the number of death is predicted to be eight million in 2030 [2]. 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 [3].  

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 [4].

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 [5].  Statistic indicates that, one third of adult and about 40% of children worldwide are exposed to SHS [6] 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 [7]. 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.

  1. LITERATURE REVIEW

3.1  Knowledge about Secondhand Smoke (SHS)

SHS or known as environmental tobacco smoke or tobacco smoke pollution [1] 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 [8], 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 [9][10]. It is proven that those who are not smoking have better tobacco smoking related knowledge than those who are smoking [11]. 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 [11]. 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 [12]. 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 [9][13][14]. 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 [15]. People in the smoking area simply assumed that the SHS will not affect them since they are in the open air area [16]. 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 [17]. 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 [18].

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 [19]. 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. 

  1. METHODOLOGY

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 [20], therefore the researcher has decided to have 200 sample for the present study in which 10 samples are taken from each identified public places.

4.2  Instrument

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 [21]. Section 3 is adapted from Wang, Herting and Tung, consists of 18 items on the respondents’ efforts to avoid SHS in their contacted environment [22]. 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

Respondents’ Demographics

Frequency

Percentage (%)

Gender

Male

49

24.5

Female

151

75.5

Age

18-30

93

46.5

31-40

74

37.0

41-50

8

4.0

51-60

Highest

Primary School

3

1.5

Education

Secondary School

95

47.5

Matriculation/Diploma

39

19.5

Bachelor Degree

47

23.5

Master

13

635

PhD

3

1.5

Marital Status

Single

98

49.0

Married and live together

90

45.0

Married but separated

4

2.0

Divorced

8

4.0

Occupation

Government

93

46.5

Sector

Private

107

53.5

Area of Living

Urban

141

70.5

Rural

59

29.5

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 [4].

 

Table 2:  Perception of SHS exposure

1-2

3

4-55

1

Tobacco smoke is dangerous for non-smoker’s health

97

2.0

1.0

2

Children who are exposed to tobacco smoke

95

3.5

1.5

have more illness, such as colds

3

Exposure to tobacco smoke can

94

4.0

2.0

cause lung cancer in non-smokers.

4

Public places should be smoke-free

94

3.0

3.0

5

Parents or adults should not smoke near children

94.5

4.5

1.0

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

N

Mean

Std. Deviation

Knowledge

200

3.9908

.46219

Attitude

200

4.1042

.58323

Avoidance Behavior

200

3.4850

.34856

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

                                                       ANOVAa

Model

Sum of

Squares

df

Mean

Square

F

Sig.

1

Regression

2.302

2

1.151

10.364

.000b

Residual

21.876

197

.111

Total

24.177

199

                                          MODEL SUMMARYb

Model

R

R Square

Adjusted

R Square

Std. Error

of the estimate

1

0.309a

0.095

0.086

0.33323

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 [23].

  1. CONCLUSION

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.

REFERENCES

  1. WHO (2009). WHO Report on the Global Tobacco Epidemic, 2009: Implementing Smoke-free Environments. World Health Organization, Geneva (2009) (https://www. who.int/tobacco/mpower/2009/en/index. html, accessed 28 October 2014)
  2. Gajalakshmi, V., Asma, S. & Warren, C. W. (2004). Tobacco Survey Among Youth in South India. Asean Pacific Journal of Cancer Prevention, 5 (3), 273-278.
  3. Lim, K. H., Sumarni, M. G., Amal, N. M., Hanjeet, K., Wan Rozita, W. M. & Norhamimah, A. (2009). Tobacco use, knowledge and attitude among Malaysians age 18 and above. Journal of Tropical Medicine, 1, 92-99.
  4. Brian, A. K., Dube, S. R. & Babb, S. D. (2013). Perceptions about the harm of SHS exposure among U.S middle and high school students: findings from the 2012 National Youth survey. Tobacco Induce Disease, 5.
  5. Bloch, M., Tong, V. T., Novotny, T. E., England, L. J., Dietz, P. M., Kim, S. Y., Samet, J. M. & Tolosa, J. E. (2010). Tobacco use and SHS exposure among pregnant women in low- and middle-income countries: a call to action. Acta Obstetricia et Gynecologica Scandinavica, 89 (4), 418-422.
  6. WHO (2008). WHO report on the global tobacco epidemic 2008. The MPOWER Package. Geneva, Switzerland: World Health Organization. Retrieved on May 26, 2014 at https://www.who. int/tobacco/mpower/ mpower_ report_2008.pdf.
  7. Centers for Disease Control and Prevention: National Youth Tobacco Survey (2013). Retrieved on November 28, 2014 at https://www.cdc.gov/ tobacco/data_statistics /surveys/nyts.
  8. Labib, S., Abeer, Q. & Ahmed, A. (2013). Knowledge, attitude and practice of university students towards smoking in Irbid, Jordon. Journal of Public Health and Epidemiology, 5 (1), 29-36.
  9. Evans, K. A., Sims, M., Judge, K. & Gilmore, A. (2011). Assessing the knowledge of the potential harm to others caused by second-hand smoke and its impact on protective behaviours at home. Journal of Public Health, 1-12. https://jpubhealth. oxfordjournals.org/content/early/2011/12/26/pubmed.fdr104.full.pdf+html.
  10. Gharaibeh, H., Haddan, L., Alzyoud, S., El-Shahawy, O., Abu Baker, N. & Umlauf, M. (2011). Knowledge, Attitudes, and Behavior in Avoiding SHS Exposure Among Non- Smoking Employed Women with Higher Education in Jordan. International Journal of Environmental Research and Publich Health, 8, 4207-4219.
  11. Redhwan, A. A, Sami, A. R. A., Thekra, H. A., Chen, R. & Karim, A. (2011). Prevalence and associated factors of smoking among Malaysian university students. Asian Pacific Journal of Cancer Prevention, 12, 619-624.
  12. Abdullah (2014). Correlates of exposure to SHS (SHS) at home among non-smoking adults in Bangladesh: findings from the ITC Bangladesh survey. BMC Pulmonary Medicine, 14, 117.
  13. McGinnis & Foege (1993). Actual causes of death in United States. Journal of American Medical Association, 270 (18), 2207-2212.
  14. Huang, H. L., Yen, Y. Y., Lin, P. L., Chiu, C. H., Hsu, C. C., Hu, C. Y., Lin, Y. Y., Lee, C. H. & Chen, F. L. (2012). Household SHS exposure of elementary school children in southern Taiwan and factors associated with their confidence in avoiding exposure: a cross-sectional study. BMC Public Health, 7.
  15. Hayfaa A. Wahabi, Rasmieh A. Alzeidan, Amel A. Fayed, Samia A. Esmaeil & Zohair A. Al Aser (2011). Attitude and practice of the health care professionals towards the clinical practice guidelines in King Khalid University Hospital in Saudi Arabia. Journal of Evaluation in Clinical Practice, 17 (4): 763-767.
  16. Wadi, M. A. & Al-Sharbatti, S. S.(2011). Relationship between birth weight and domestic maternal passive smoking exposure, East Mediterranean Health Journal, 17, 290-296.
  17. Bhanji, S., Andrades, M. Taj, F. & Khuwaja, A. K. (2011). Factors related to knowledge and perception of women about smoking: a cross sectional study form a developing country. BMC Womens Health, 11-16.
  18. Helgason, A. R., Lund, K. E.(2001). Environmental tobacco smoke exposure of young children: Attitude and health risk awareness in Nordic country. Nicotine Tobacco Research, 3, 354-361.
  19. Glantz, A. S. & Jamieson, P. (2000). Attitudes toward secondhand smoke, smoking, quitting among young people, Journal of Pediatrics, 1 (3), 106.
  20. Salkind, N. J. (2014). Exploring Research (8th Edition). United States of America: Pearson Education Limited.
  21. Kurtz, M. E., Kurtz,  J. C., Contreras,  D. & Booth, C. (2003). Knowledge and attitudes of economically disadvantaged women regarding exposure to environmental tobacco smoke: a Michigan, USA study. European Journal of Public Health, 13 (2), 171-176.
  22. Wang, W. L., Herting, J. R. & Tung, Y. Y. (2008). Adolescents’ Avoidance of SHS Exposure: Model Testing. Western Journal of Nursing Research, 30 (7), 836-851.
  23. FMa, G. X., Tan, Y., Fang, C. Y., Toubbeh, J. I. & Shive, S. E. (2005). Knowledge, attitudes and behavior regarding SHS among Asian Americans. Journal of Medical Prevalence, 41 (2), 446-453.



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