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Tobacco Health Warnings in Malaysia and Thailand:

Tobacco Health Warnings in Malaysia and Thailand:. Different or similar trends in the prediction of knowledge and quitting. Ahmed I. Fathelrahman 1 , Maizurah Omar 1 , Rahmat Awang 1 , Ron Borland 2 , Geoffrey T. Fong 3 , & Zarihah Zain 4

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Tobacco Health Warnings in Malaysia and Thailand:

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  1. Tobacco Health Warnings in Malaysia and Thailand: Different or similar trends in the prediction of knowledge and quitting Ahmed I. Fathelrahman1, Maizurah Omar 1, Rahmat Awang 1, Ron Borland 2, Geoffrey T. Fong 3, & Zarihah Zain4 1 Clearing House for Tobacco Control, National Poison Center, Universiti Sains Malaysia, Minden 11800 Pulau Pinang, Malaysia, 2 Cancer Control Research Institute, the Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC 3053, Australia, 3 Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, 4 Tobacco Control Unit, Department of Public Health, Ministry of Health, Malaysia CPA-MPS August 2007

  2. INTRODUCTION • Each year, tobacco is responsible for about 5 million worldwide deaths (Jha et al, 2006). • Efforts, exerted by policy makers, to control tobacco consumptions, worldwide, have included packaging and labeling regulations. • Strahan and associates (2002) recommended group of content and process principles to enhance the effectiveness of cigarette pack warning labels. CPA-MPS August 2007

  3. INTRODUCTION • warning labels were found to be significantly associated with increased awareness of smoking related health hazards (Borland and Hill, 1997). • Evidences have shown the importance of awareness and Information about health hazards in the prediction of quitting behaviors (Yong et al., 2005 ). CPA-MPS August 2007

  4. Objectives of the present work • The general objective of the present work was to evaluate the Malaysian and Thai cigarette pack warning labels in terms of their perceived impact on adult smokers' knowledge and quitting behaviors. • We concerned also about evaluating similarities and differences among adult smokers of the two countries CPA-MPS August 2007

  5. Objectives of the present work Specifically we aimed • to examine association between noticing cigarette pack warning labels and knowledge of health hazards among adult smokers in Malaysia and Thailand. • to determine the importance of knowledge of health hazards and noticing cigarette pack warning labels as predictors of current quitting intention and history of previous quitting attempts, • to determine the effect of combining the two variables "knowledge of health hazards" and "noticing cigarette pack warning labels" in one rating scales variable on the supposed above associations. CPA-MPS August 2007

  6. Methodology • This work was a part of the 2005 ITC-Malaysian and Thai projects. 2006 and 2000 adult smokers were recruited as a cohort sample, from each country respectively, using multistage clustering technique. • Smokers were surveyed by face to face household's interview using standardized questionnaire. • Descriptive statistics, Chi-square test, binary logistic and backward stepwise logistic regression were used when ever applicable. Crude and adjusted odds ratios were computed for each predictor variable. CPA-MPS August 2007

  7. Table 1: surveyed Malaysian and Thai smokers according to knowledge of smoking health hazards, noticing tobacco warning labels, quit intentions and history of previous quitting attempts RESULTS CPA-MPS August 2007 *The reported response was yes, a Chi-square, b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores

  8. RESULTS Table2: Association between knowledge of smoking health hazards and noticing cigarette pack warning labels among adult Malaysian and Thai smokers (Univariate analysis using binary logistic statistic) a Reference category "No knowledge (zero score)"; b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores; c When controlled for hand-rolled versus factory made cigarettes, odds ratios for lower knowledge, average knowledge and higher knowledge were 1.21 (0.41-3.56) at p value= 0.727, 2.05 (0.74-5.72) at p value= 0.169 & 2.68 (0.97-7.38) at p value = 0.057, respectively; d Adjusted for country CPA-MPS August 2007

  9. RESULTS Table3: knowledge about smoking health hazards and noticing cigarette pack warning labels predicting previous quitting attempts among the Malaysian and Thai smokers (Univariate analysis using binary logistic statistic) a Reference category "No knowledge (zero score)"; b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores; c Adjusted for country CPA-MPS August 2007

  10. RESULTS Table4: knowledge about smoking health hazards and noticing cigarette pack warning labels predicting current quit intention among the Malaysian and Thai smokers (Univariate analysis using binary logistic statistic) a Reference category " No knowledge (zero score)"; b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores; c Among Thai smokers the number of those who were with no knowledge and have quit intention was zero which indicate very high association between knowledge and quit intention to the extend that actual data produced infinite odds ratios. We solved this by supposing one case with this criterion; d Adjusted for country; e Reference category " No- lower knowledge & didn't notice"; f No-lower knowledge= 0-3, average knowledge= 4-5, higher knowledge = 6-7 scores CPA-MPS August 2007

  11. RESULTS Table5: knowledge about smoking health hazards and noticing cigarette pack warning labels predicting previous quitting attempts among the Malaysian and Thai smokers (multivariate analysis using binary logistic statistic) All analyses were adjusted for age group, gender, education, employment status, urban/rural aReference category "No knowledge (zero score)"; b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores; c Adjusted for country; d When controlled for hand-rolled versus factory made cigarettes, adjusted odds ratios for lower knowledge, average knowledge, higher knowledge and noticing warning labels were 2.74 (0.97-7.76) at p value= 0.058, 3.24 (1.21-8.67) at p value= 0.019, 4.53 (1.71-12.02) at p value= 0.002 & 1.10 (0.83-1.44) at p value = 0.510, respectively. CPA-MPS August 2007

  12. RESULTS Table6: knowledge about smoking health hazards and noticing cigarette pack warning labels predicting current quit intention among the Malaysian and Thai smokers (multivariate analysis using binary logistic statistic) All analyses were adjusted for age group, gender, education, employment status, urban/rural. a Reference category "No knowledge (zero score)"; b lower knowledge= 1-3, average knowledge= 4-5, higher knowledge = 6-7 scores; c Adjusted for country; d Among Thai smokers the number of those who were with no knowledge and have quit intention was zero which indicate very high association between knowledge and quit intention to the extend that actual data produced infinite odds ratios. We solved this by supposing one case with this criterion; e When controlled for hand-rolled versus factory made cigarettes, adjusted odds ratios for lower knowledge, average knowledge, higher knowledge and noticing warning labels were 5.59 (0.71-44.08) at p value= 0.102, 7.39 (0.97-56.22) at p value= 0.053, 13.47 (1.78-101.98) at p value= 0.012 & 1.19 (0.92-1.53) at p value = 0.178, respectively. CPA-MPS August 2007

  13. Main Findings • Thai smokers were found to be more knowledgeable about different health hazards of smoking. • Among Malaysian, the increase in knowledge was significantly associated with an increase in the chance of noticing warning labels. • In the two countries, smokers who had noticed the warning labels were more likely to have previous quitting attempts. CPA-MPS August 2007

  14. Main Findings • Knowledge scores were associated with an increase in previous quitting attempts only among Thai. • Nevertheless, between Malaysians who had noticed warning labels, knowledge scores were highly associated with quitting attempts. • Amongst Thai, both of the variables “noticing warning labels” and “knowledge scores” predicted quit intentions, and within those who had noticed the labels, a dramatic increase of odds ratios was seen with each increase in knowledge scores. CPA-MPS August 2007

  15. CONCLUSION Noticing warning labels seems to have different relationships in the two countries. • The finding that more Malaysian than Thai were noticing labels was not expected since the warning labels in Thailand were more prominent than the Malaysian, and may be smokers in the two countries had responded to question differently. CPA-MPS August 2007

  16. REFERENCES • Jha, P., Chaloupka, F.J., Moore, J., Gajalakshmi, V., Gupta, P.C., Peck, R., Asma, S., & Zatonski, W. (2006). Tobacco addiction. In Jamison, D.T., Breman, J.G., Measham, A.R., Alleyne, G., Claeson, M., Evans, D.B., Jha, P., Mills, A., Musgrove, P. editors. Disease control priorities in developing countries. 2nd edition. Washington (DC): IBRD/ The World Bank and Oxford University Press. • WHO. (2004). Building blocks for tobacco control: a handbook. (Tools for advancing tobacco control in the 21st century). France: World Health Organization. • WHO. (2005). WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization. • Fong, G.T., Cummings, K.M., Borland, R., Hastings, G., Hyland, A., Giovino, G.A., Hammond, D. & Thompson, M.E. (2006). The conceptual framework of the international tobacco control (ITC) policy evaluation project. Tob Control. 15 (suppl III): iii3-iii11. CPA-MPS August 2007

  17. REFERENCES • Fong, G.T. (2001). A review of the research on tobacco warning labels, with particular emphasis on the new Canadian warning labels. Report; Department of psychology, University of Waterloo. • Borland, R., & Hill, D. (1997). Initial impact of the new Australian tobacco health warnings on knowledge. Tob Control. 6: 317-325. • Strahan, E.J., White, K., Fong, G.T., Fabrigar, L.R., Zanna, M.P. & Cameron, R. (2002). Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective. Tob Control. 11: 183- 190. • Hammond, D., Fong, G.T., McDonald, P.W., Cameron, R., Brown, K.S. (2003). Impact of the graphic Canadian warning labels on adult smoking behavior. Tob Control. 12: 391-395. • Koval, J.J., Aubut, J.L., Pederson, L.L., O'Hegarty, M. & Chan, S.S.H. (2005). The potential effectiveness of warning labels on cigarette packages. Canadian Journal of Public Health. 96 (5): 353-356. CPA-MPS August 2007

  18. THANKS CPA-MPS August 2007

  19. CPA-MPS August 2007

  20. Characteristics of effective labels using combined social psychological principles Content Principles Process Principles • Promote attitudes and beliefs towards alternative behavior • Utilize gain-framed messages • Use fear appeal • Emphasize subjective norms • Focus on relevant attitudes of the target group • Increase perceived self efficacy • Encourage interpersonal communication • Salience, noticeability • Using vivid colors • Use depicted pictures (photos) and pictograms • Location of warning labels • Size of warning labels (30-50%) • Rotating labels to overcome wear- out (overexposure) effect CPA-MPS August 2007

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