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Exposure to SHS among Workers in the Restaurants in Vientiane Capital and Luang Prabang Province
Dr. Keonakhone Houamboun, NIOPH, MOH Dr. Sengchanh Kounnavong, NIOPH, MOH
Financial support from The Rockefeller Foundation and Thai Health Promotion Foundation
Exposure to SHS among Workers in the Restaurants in Vientiane Capital and Luang Prabang Province
Dr. Keonakhone Houamboun, NIOPH, MOH Dr. Sengchanh Kounnavong, NIOPH, MOH
Editors Foong Kin, PhD Menchi G. Velasco
Southeast Asia Tobacco Control Alliance (SEATCA)
Under The Collaborative Funding Program for Tobacco Control Research
Financial support from The Rockefeller Foundation and Thai Health Foundation (ThaiHealth)
TABLE OF CONTENTS
ACKNOWLEDGEMENTS...........................................................................................4 INTRODUCTION .........................................................................................................7 LITERATURE REVIEW ..............................................................................................9 STUDY OBJECTIVES................................................................................................17 3.1 Overall Objective ...............................................................................................17 3.2 Specific Objectives ............................................................................................17 METHODS & DATA SOURCES ...............................................................................18 4.1 Research Design.................................................................................................18 4.2 Sampling Frame .................................................................................................18 4.4 Sample Size........................................................................................................19 4.5 Respiratory symptoms in the last two months ...................................................20 4.6 Data Collection Methods ...................................................................................20
4.7 Pre-testing of the Questionnaire.........................................................................21 4.8 Data Collection and its Quality Control.............................................................21 4.9 Data Processing and Analysis............................................................................22 4.10 Ethical Consideration.......................................................................................22 RESULTS ....................................................................................................................23 5.1 General Characteristics of Respondents in Both Groups...................................23 5.2 The Association between Work Site and the Risk of Developing Respiratory Symptoms ................................................................................................................27 5.3 Estimation of the Direct and Indirect Costs of Smoking-related Diseases Among the Workers Who Are Exposed to SHS in the Restaurants .....................................29 DISCUSSION ..............................................................................................................33 CONCLUSION AND RECOMMENDATIONS ........................................................35 REFERENCES ............................................................................................................36 ANNEXES...................................................................................................................40 A. Screening Form ..................................................................................................40 B. Data Collection Tool ..........................................................................................41
LIST OF TABLES
Table 1: Background characteristics of respondents, restaurant workers and officers by province Table 2: Percent distribution of respondents on policy knowledge by province Table 3: Frequency distribution of respondents by occupation with past working experience Table 4: Frequency distribution of respondents exposed to secondhand smoke by places and province Table 5: Mean and Standard deviation of hours that respondents are exposed to smoking pollution Table 6: Frequency distribution of people who are smokers that the respondents had contact with Table 7: Frequency distribution of respondents in the worksites and respiratory symptoms Table 8: Frequency distribution of respondents in worksites and respiratory symptoms by province Table 9: Frequency distribution of respondents who are exposed to passive smoking by living with smokers at home and respiratory symptoms Table 10: Frequency distribution of respondents who reported having respiratory symptoms by places of smoking exposure Table 11: Frequency distribution of respondents who reported seeking care by services Table 12: Health care cost by province 23 24 25 26 26 27 28 28 29 29 30 31
Table 13: Respiratory symptoms and health care cost by exposed and 31 non-exposed restaurants workers and officers Table 14: Respiratory symptoms and health care cost by exposed and 32 non-exposed restaurants workers and officers in two provinces
This research could not be completed without the support and encouragement of Prof. Dr. << >> 4 . all data collectors and respondents from Vientiane and Luang Prabang provinces.ACKNOWLEDGEMENTS This study received technical support from the Southeast Asia Tobacco Control Alliance (SEATCA) under The Collaborative Funding Program for Tobacco Control Research and financial support from The Rockefeller Foundation and the Thai Health Promotion Foundation (ThaiHealth). Sithath Insisiengmay. The research team would like to thank Adventist Development and Relief Agency (ADRA Lao) for their coordination and support.
612 Kips 1 (US$37. In addition.9) than the exposed office workers (197.620 Kips (US$33. among those respondents who were living with smokers.0% in the restaurant group and 6.3% in office group (OR=2.001) experienced such symptoms.7%).001)]. The study showed the strong association between exposure to secondhand smoke and respiratory symptoms including chest pain and coughing with phlegm in the morning (10. The study found that most of the workers at the restaurants had been exposed to secondhand smoke on average 11. << >> 1 1 US Dollar is equivalent to 8.0% in LPB) (p<0. The collected data was entered into Epi-info 6.3).160 Kips (US$7.7% in LPB) compared to the office workers (7. in which 284.250 Kips or US$59. p=0.3% in VTE and 38. The exposed restaurant workers spent more (513. Lao PDR aimed to provide research-based evidences to policy-makers that would support the drive to enforce tobacco control policy under the Lao PDR Act of 2001.04 dataset and analyzed using cross-tabulation and logistic regression by SPSS statistical packages version 11.001). 15.568 LAO KIPS as of August 2008 5 .5.3% in VTE and 60.7% reported having respiratory symptoms compared to 4. The respondents were mostly females in the young age group (15-35 years old). Higher rates of exposure to smoke at the work place were observed among the restaurant workers (99. The mean of total health expenditure spent on treating their illness was 319. 11. This cross-sectional study was carried out from September to October 2007 using the structured interview questionnaires to collect data on SHS exposure.6 hours per week in comparison to those who worked in the office where smoking is prohibited [1.041).7) were indirect cost. health symptoms. had completed secondary and higher education. The mean number of hours that restaurant workers in Vientiane capital city were exposed to smoking pollution was higher than those in Luang Prabang province which has smoke-free areas (20 versus 2.63 hours (p<0.2) were direct cost and 66. and most of them were single. particularly Article 4 which is the implementation of smoke-free policy in places including restaurants.315 Kips or US$23).48 hours). and cost of treatment related to health symptoms from 300 cases of workers who are exposed to SHS in the restaurants and 300 staff in smoke-free offices.6.5% among those who were not living with smokers (p=0.EXECUTIVE SUMMARY The study on exposure to secondhand smoke (SHS) among non-smoking workers in the restaurants in comparison to non-smoking officers in the smoke-free offices in Vientiane capital city (VTE) and Luang Prabang Province (LPB).
but these workplaces are least likely to be covered by laws or policies on smoking ban. pubs.The data derived from this study confirmed that public places such as restaurants are among the worksites that have high level of secondhand smoke. and other public places as mentioned in Article 4 of the tobacco control policy. << >> 6 . bars. this study provides strong evidence to support a complete ban on smoking in restaurants. therefore.
thus smoking is observed in many of the above-mentioned places. the World Health Organization (WHO) has promoted smoke-free legislations around the world by organizing the convention on tobacco control in 2003. hospitals. as a member country of the WHO. restaurants. Most recently. The smoke-free policy was also adopted in government offices in the province of Luang Prabang (4 Provincial Department: Provincial Administration Office. has adopted initiatives to implement smoke-free regulations in the country in accordance with Article 8 of the Framework Convention on Tobacco Control (FCTC). a number of researches have been conducted recently focusing mainly on the prevalence of smoking and smoking behaviors of different target groups in different places. the enforcement of the policy is very limited. Article 8 of the UN Framework Convention on Tobacco Control (FCTC) called for the expansion of smoke-free places at the national and other jurisdictional levels in signatory countries. including most of the government hospitals. for example. Lao PDR. 6 of 17 provinces of Laos have a pilot project in about 60 schools. toxicants and mutagens (Framework Convention Alliance on Tobacco Control. pipe. There are more than 4. and related organizations. The projects trained the teachers as educators who then train their school children about the dangers of smoking and secondhand smoke. Their findings showed that the prevalence of smoking in Laos continues to increase. However. or cigar. 2005). with males exceeding females. To control the risk of SHS. the Ministry of Health (MOH) approved to develop the tobacco control policy following the national conference in Vientiane capital on 24 July 2000 which was attended by 46 participants from 12 ministries. 7 << >> . as a community based survey with national representatives and the results showed that the prevalence of smoking is about 40%. Culture.800 chemicals in secondhand smoke including 69 carcinogens as well as other chemicals that are irritants. The regulation on the establishment of smoke-free places is one of 9 articles of the policy which include the banning of smoking in schools. and other public places. as well as a higher prevalence found in rural areas. In Lao PDR. mass organizations. the National Institute of Public Health conducted a health survey as part of the World Health Survey (WHS) 2003 in Lao PDR. Education and Health) and in the Ministry of Foreign Affairs. In 2000. government offices. and the smoke exhaled from the lungs of smokers.INTRODUCTION Secondhand smoke (SHS) is a mixture of the smoke given off by the burning of a cigarette. Many places have begun to implement the policy.
governmental offices. << >> 8 . the effort in implementing the tobacco control policy is not so strong as smoking is still permitted in many places such as restaurants and other public places and on public buses. there is no data available concerning SHS or passive smoking and tobacco-related diseases in Laos. The study on the exposure to SHS among workers in restaurants in Vientiane Capital and Luang Prabang Province will generate strong evidences that can be used to push for the total ban on smoking in restaurants and other smoke-free places. The regulation on smoke-free places is one of 9 articles of the policy stating that smoking should be banned in schools. Data derived from this study will also be very useful for policymakers in implementing the policy concerning tobacco control in Lao PDR.A tobacco control policy has been developed by MOH in 2001. Currently. hospitals. However. restaurants and other public places.
2002). with dramatic increases seen in the developing countries (those with low and middle incomes). 2003). In the South East Asia region alone. Dolwick & Guindon. (Shafey. in the United States. the percentage of cigarette smokers decreased from 38% to 24% (male smoking declined from 44% to 26% and female smoking declined from 32% to 22%) and similarly in the United Kingdom. about 35% were in the developed countries and 50% in the developing countries. On the average. 2002 and Guindon & Boisclair.LITERATURE REVIEW Global Trend of Tobacco Consumption and Smokers The practice of cigarette smoking is the most widespread type of tobacco consumption worldwide. total cigarette consumption increased 2. of which almost one billion were males. Mackay and Eriksen estimated that the trend of active smoking in developed countries declined during last three decades. only Japan and the Republic of Korea are experiencing decline in tobacco use prevalence. Among the male smokers in the world. with male smokers accounting for five times more than females. For example. while female daily smokers in the world was about 22% of women in developed countries and around 9% of women in developing countries (Mackay & Eriksen. The WHO estimated that there were approximately 1.786 million sticks in 2000. Mackay & Eriksen. 2002 and Shafey. the percentage of smokers dropped from 50% to 27% (55% to 28% for male smokers and 44% to 26% for female smokers) (Mackay & Eriksen. the number of cigarettes consumed increased by about 76% from 1970 to 2000. Dolwick & Guindon. 2003). 2003). The rates of tobacco use remained high in the rest of the developing nations in the Region. Among the five largest countries by population in the Region. << >> 9 . one in three cigarettes is consumed in the Western Pacific Region.3 billion people who smoke cigarettes or other products in the world in year 2003. In the last few decades. around 60% of the total consumption in the Region is by men and 6% by women. The International Agency for Research on Cancer also presented the prevalence of cigarette use among smokers in the world. while the developed countries experienced a decline. Based on the World Health Organization (WHO) estimates for 2000. The largest number of smokers in the Region is Chinese men.5 times (from 141.345 million sticks in 1970 to 363.
9% was men and 20. The Tobacco Atlas).S. and Thailand (23. 2006). 2002. and cigarette is the most prevalence form of tobacco consumption. such as carbon monoxide. Therefore.4%) (Mackay & Eriksen. The average number of cigarettes smoked was up to 20 sticks and more among male respondents (NIOPH. mercury and formaldehyde. The smoke from burning cigarettes and other type of tobacco products (sidestream smoke). Lao PDR has the second highest rate of adult smoking after Mongolia (46. Many of these substances are known to be toxic.Prevalence of Smoking in Lao PDR Lao PDR is classified under the Western Pacific Region by the WHO. of which the most common fatal illnesses include lung cancer. A number of studies illustrated that personal direct contact with tobacco smoking could lead to a wide range of diseases. especially referred to as human carcinogens.4%).3% of respondents reported that they were currently smoking. Dept.7%) followed by Cambodia (37. which is part of the World Health Survey conducted in 2003. Also. and they are harmful to the health of those who breathe in the tobacco smoke. Effects of Secondhand Smoke on Health There is a range of chemical constitutions in both sidestream and mainstream smoke. the percentage of smokers has increased among both men and women in the last few years. Malaysia (26.1%). ammonia. Vietnam (27. chronic lung disease such as chronic obstructive pulmonary disease (COPD) or asthma and cardiovascular disease and others (Royal College of Physicians. Moreover. The smoke that contaminates indoor spaces and outdoor environments by active smokers has often been referred to as Secondhand Smoke (SHS) or Environmental Tobacco Smoke (ETS). arsenic. of Health and Human Services. 2006). The survey found that 40. and smoke that is exhaled from the lung of smokers (mainstream smoke) contain a complex mixture of gases and particles. according to the Lao Health Survey. Laos has a very high proportion of adult smoking among the other nations. since non-smokers who are exposed to secondhand smoke also breathe in the same poisons as the active smokers.0%).9%). The SHS 10 >> . 2005). and the inhalation of the smoke by people who are not active smokers is commonly referred to as involuntary smoking or passive smoking (U. of which 78. they are also likely to face similar health hazards as the active smokers. It is a nation that has a high prevalence rate of smoking compared to its neighboring countries and some other countries in the Region (2000).0% was female. Myanmar (32. Definition of Secondhand Smoke << Tobacco is consumed mainly by burning tobacco products and inhaling the smoke. Compared to other neighboring countries. which comprises around 4000 different chemicals.
2006). Cigarette smoking is known as the most important risk factor for COPD. a longitudinal cohort study of adults in the US was conducted to explain the impact of SHS exposure on COPD health outcomes. Although. 2006). children who are exposed to in utero tobacco smoke from their mothers are 1. Recently. indicating that a causal relation exists for COPD (Royal College of Physicians. There have been a number of researches about an increased risk of COPD as shown by evidence of the damaging effects on lung function among adult non-smokers exposed to SHS. Asthma Children can be exposed to secondhand smoke both during fetal and early postnatal life from maternal or parental smoking and exposure to SHS is a factor for asthma development. 2006). Shortness of breath. In both diseases. there have been far fewer studies of passive smoking and respiratory system effects on adults compared to the number of research study on children. Also. referring to chronic bronchitis and emphysema. Likewise. secondhand smoke is another factor that researchers identified that can be a risk factor of this disease. at worst it could result to disability or mortality for the persons affected. The finding of this study illustrated that exposure to SHS was an important factor that influenced the severity of COPD. 2006). The exposure to maternal smoking during in utero and after birth is a risk factor for reduced lung function development that remains a serious childhood and public health issue (Moshammer et al. and wheezing are symptoms of COPD.. 2005). coughing.. The result of over two years of study by Lannerö et al.exposure not only could lead to ill health. producing sputum (mucus). In the case of shortness of breath. nonetheless. 2005). Pinsker & Prezant.8 times more likely to develop asthma and wheezing than those without in utero SHS exposure (Dhala. It was found that higher level of passive smoking exposure was associated with worse COPD severity (Eisner et al. Respiratory System Effects Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is a chronic inflammation of the airways. especially among non-smokers (University of Pittsburgh Medicine Center.. (2006) indicated that mother’s smoking during pregnancy and during the first year of a child’s life was associated with an increased risk of wheezing in the child and the development of asthma at two years of age (Lannerö et al. 11 << >> . it usually gets worse during exercise. there is chronic obstruction of the flow of air through the airways and out of the lungs.
which evaluated the respiratory health effects of secondhand smoke. 2006). Jee et al. Nishino et al. of Health and Human Services. and it has been estimated that millions of Americans face the risk of new or recurrent heart attack and around 700. results of a cross-sectional study that examined the association between SHS exposure and pulmonary function among non-smoking adults in US. indicated that high level of recent SHS exposure was related to greater asthma severity and a larger prospective risk of hospital admission for asthma (Eisner et al. including reproductive system effect. Furthermore. in 2003. including breast nasopharyngeal and cervix cancers (US Dept.. For example. has shown that exposure to cigarette smoke can significantly increase the risk of coronary heart disease mortality in non-smokers (especially. respectively in United States. there is clear evidence that they will risk facing long-term health effects. Adults who are exposed to SHS at home or in the workplace have an increased risk of around 40–60% of suffering from asthma compared to those without exposure to the smoke. 2001. Exposure to SHS also exacerbates respiratory symptoms and lung function among adults’ asthmatics (Coultas.000 and 158. and lung cancer (Dhala. exposure to SHS is also linked to several other cancers. female non-smokers whose husbands smoke) by around 30% (Royal College of Physicians. Moreover. In addition.000 persons is likely to suffer from a new or recurrent stroke each year. 2005. it was shown that exposure to passive smoking during childhood could lead to an increased prevalence of asthma in adult never-smokers.. which include coronary heart disease (CHD) and stroke. however. Cardiovascular Effects Cardiovascular disease is the leading cause of mortality in the developed nations. Pinsker & Prezant. The most important risk factor of the disease is active smoking. especially among the never-smokers who have no family history of asthma (Dhala. if people were to exposed to secondhand smoke for a long time period. focusing particularly on adults with asthma. 1999. 2005). of Health and Human Services. Pinsker & Prezant. 2005).000 deaths due to CHD and stroke. carcinogenic effects (US Dept. Recently. of Health and Human Services. 2005). smoke from tobacco is a carcinogen that also has been considered as a major risk factor for heart disease (US Dept. 1998). 2000). there were approximately 480. In a study by Dhala et al.passive smoking has been identified as a risk factor for asthma among adults... << >> 12 . a number of studies which investigated secondhand smoke and its relationship to cardiovascular disease. Kreuzer et al. 2006) . 2006).
Eriksen & Lin.Economic Effects of SHS Exposure to SHS is significantly associated with increased morbidity and mortality from a wide range of diseases. In the United States. >> Trend in the Exposure to SHS of Non-smokers Exposure to SHS by non-smokers will depend upon the smoking prevalence (percentage of smokers) and the number of cigarettes smoked by each smoker per unit time that non-smokers are in contact with. << The study on tobacco-related socio-economic cost of stroke. over a period of 14 years (1988 to 2002) based on examination of the blood fluid cotinine levels over four periods of time. 2. The mean total health care cost during hospitalization was 4. approximately 126 million Americans were estimated to have been 13 .85 billion was spent on medical care for non-smokers who were suffering from lung cancer. nearly all non-smokers were exposed to tobacco smoke.310 Kips (US$310) for COPD (Chu Vang et al. including direct medical costs. This is a public health problem and a considerable economic burden on both the individual and household. and national levels.150. the trend showed that the number of non-smokers who are exposed to SHS has significantly decreased to approximately 70% overall. In the first phase. 6.720 Kips (US$790) for stoke range. an estimated US$3. lung cancer. 2007). or 88% of the survey population from 1988-1991 and the proportion continuously declined to 80% (1991-1994). 2005). The number of people exposed to SHS decreased to 51% during 1999-2000 and further decreased to 43% in 2001-2002. For example.081. It results in excess cost of morbidity and mortality.862 Kips (US$464) for lung cancer. They are: lung cancer (US$469 million). and chronic obstructive pulmonary diseases in Lao PDR revealed that the rate of tobacco smoking is significantly higher in patients suffering from the 3 diseases (62%).10 billion due to disability and premature deaths from 3 categories of diseases caused by exposure to secondhand smoke. COPD (US$886 million). in the United States in 2004.413. COPD and CHD as a result of exposure to secondhand smoke. Thus. costs associated with disability or mortality and the opportunity costs of unpaid caregivers. and CHD (US$2. the number of people exposed to SHS in these countries would have decreased as well.752 million) (Behan. Diseases caused by SHS exposure not only incur increased direct medical costs. Additionally. as well as the value of lost household services estimated at about US$4. they also result in lost of economic value due to lost wages and fringe benefits. with the decline in smoking prevalence in the last few decades in the developed countries.
000 men and 108. Positive results can been seen in California where one to two months after the establishment of a ban on smoking in bars and taverns in the state. D. in China during 2000-2001 estimated that 147. Their respiratory and sensory symptoms were reduced and their respiratory function has also improved (Menzies et al. About 8. there were 191. where the prevalence of tobacco consumption and the percentage of smokers are the highest. the function of pulmonary has improved following a decreased in SHS exposure in their workplace (Eisner. BS Smith & Blanc. however.358. there was a rapid improvement in the health of the bar staff.. there are still a huge number of non-smokers exposed to SHS. Although the number of non-smoking persons who experienced inhalation of tobacco smoke appreciably dropped over a period of one decade. and 86 million non-smoking adults aged 20 years or more (US Dept. As 80% of the world’s population reside in the developing countries. After three months following a ban on smoking in public place. human health and the economies of a huge number of populations worldwide. a cross-sectional study of Gu et.000 women were exposed to SHS at home.402.000 Chinese women aged between 35-74 years of age were current cigarette smokers. For example. It makes one wonder about the trend of exposure to SHS by people in the developing countries.000 Chinese men and 15. Smoke-free Law SHS exposure affects. the number of non-smokers who suffers from the SHS would be enormous.658. In total. of Health and Human Services.504. This can reduce the health risks to non-smokers.372. al. 2004). et al. the majority of bartenders who initially were suffering from respiratory and sensory irritation symptoms have reported that these symptoms have appreciably declined. Similar results were reported by the recent study by Menzies et al. in Scotland.. 2006). at varying degrees. Also. 18 million non-smoking youth aged 12 to 19 years.000 non-smoking Chinese who experienced SHS exposure during that period (Gu.895.072. 1998). 2006). << >> 14 . particular the group of people who are not smokers but are subjected to SHS because of their occupation.000 men and 55. A number of countries have responded by trying to reduce the health risks and burden of the population by restricting or prohibiting smoking in worksites and public places by imposing “smoke-free laws”.exposed to SHS in 2000.000 women were exposed to Environmental Tobacco Smoke (ETS) in their workplaces. including around 22 million children aged 3 to 11 years. and 19. especially those of non-smokers.
public places such as restaurants. malls. the results of the first study showed that the average level of particulate matter pollution in the bars surveyed was at least 10 times higher than the Environmental Protection Agency’s (EPA) outdoor air safety levels. particularly the non-smokers. are also important contributors to SHS exposure for clients and staff who do not smoke. (2005). No nicotine was detected in the hair of non-smoking employees working in a smoke-free bar. especially children. but they are least likely to be afforded protection from the health risk. Furthermore. The harmful effects of exposure to SHS on non-smokers are clearly established. the advantage of having smoke-free workplaces is that not only would it reduce health risks or hazards among people who do not smoke. but it could also reduce cigarette consumption among smokers (Eisner. tend to suffer from the effects of high level of exposure to SHS. While public places such as bars and restaurants have been identified as worksites where SHS exposure is high (Edwards et al. 1998). an occupational mortality study found that being a waitress was the most hazardous occupation for women. indicating that involuntary exposure to tobacco smoke occurs in Baltimore bars. it is therefore potentially the most important place for SHS exposure especially for those who live with regular tobacco smokers. and being a bartender ranks among the seven most hazardous occupations (Siegel. and bars. worksites. EM. nonetheless. This is particularly true of pubs and bars which are places of refuge for smokers. while high levels of nicotine were detected in the hair from non-smoking employees working in bars where smoking is allowed. Hence. OY. pubs. spend most of their time in. Because the home is where many people. M.Moreover. BS Smith & Blanc. Although the home and workplaces are important sites where non-smokers are exposed to SHS. According to two studies conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. bars etc. & Osinubi.. Barbeau. and public places including restaurants. The result of the second study showed that air nicotine was detected in all the bars where smoking was allowed. and this could lead to a decrease in morbidity and mortality of smokers as well as reduce the economic costs related to smoking. these workplaces are least likely to be covered by laws or policies that ban smoking. workers in these worksites.. These places contribute to personal exposures in varying degrees across different groups. Tobacco Smoking Sites and Exposure to SHS The Report of the Surgeon General in 2006 confirmed that the three main places where exposures to secondhand smoke often occur were homes. 2006). Risk of SHS has not only been shown to be the main cause of human lung carcinogen. but it 15 << >> . The workplace is the second most important site for SHS exposure because it is a place where adults spend most of their time.
chest tightness. wheezing.also increases the risk of respiratory system illness in both children of all ages and adults (American College of Chest Physicians. 1998 and Menzies et al. The short-term respiratory effect that often occurs is respiratory symptoms. SHS also results in acute and chronic respiratory ill health in non-smokers. recent studies have demonstrated that reduced SHS exposure of waitress or bartenders in their workplaces has decreased respiratory symptoms that they had previously suffered (Eisner. However. which is an acute pulmonary effect of SHS. These symptoms are linked to exposure to SHS. 2006).. of Health and Human Services. and difficulty in breathing. including coughing. but they have not consistently included asthma and some other environmental factors (US Dept. A number of studies have attempted to evaluate the relationship between SHS exposure and respiratory symptoms. 1995). 2006). << >> 16 . BS Smith & Blanc.
STUDY OBJECTIVES 3. To compare health status (respiratory syndromes) between the workers who are exposed to SHS in the restaurants and unexposed workers to SHS in smoke-free offices. particularly Article 4 on the establishment of smoke-free places including restaurants 3. To investigate the association between non-smoking workers in restaurants and the smoke-free offices on the risk of developing respiratory syndromes. To estimate the direct and indirect costs of smoking-related diseases among the workers who are exposed to SHS in the restaurants/offices • << • >> • 17 .2 Specific Objectives • To investigate the association between passive smoking at restaurants with environmental tobacco smoke exposure and the risk of developing respiratory syndromes.1 Overall Objective To provide the evidence based information on health-related issues caused by secondhand smoke to policy-makers in order to push for the adoption of the tobacco control policy of Lao PDR Act of 2001.
Saysetha.1 Research Design This is a cross-sectional study that was carried out using structured interview questionnaires (Face to face interview) as data collection tool among non-smoking restaurant workers and non-smoking workers in smoke-free offices. After obtaining such a list. A total of 70 restaurants in VTE and 65 restaurants registered with Luang Prabang provincial travel authorities were in the frame for the first sampling unit. The restaurants were classified into 3 types as (1) Air-conditioned enclosed Restaurants.METHODS & DATA SOURCES 4. The sampling frame was based on the following criteria: • Restaurants with more than 5 workers and that allow smoking in both VTE and LPB municipality. the researchers visited the restaurants. Chanthabury. Sisattanack. • Smoke-free offices in both VTE and LPB municipality. the research team therefore conducted a pilot survey first in Vientiane capital city by collecting a list of all available restaurants that are registered at the district travel authorities of 5 districts namely Sikhottabong. A screening form (Annex 1) based on the above mentioned criteria was used to list all target population for further sampling in addition to obtaining information about personal smoking habits.2 Sampling Frame Vientiane capital city (VTE) and Luang Prabang (LPB) municipality were selected because they are popular tourist sites with many existing restaurants. • Workers of both sexes who have at least one year of working experience in either of the two places. • Workers at restaurants e.g. and Saythany. (2) Mixed enclosed/open air Restaurants. 4. followed by Luang Prabang municipality.3 Sampling Method Due to the lack of information about the restaurants or offices where smoking is allowed or prohibited. the waiters or waitress should have environmental tobacco smoke (ETS) exposure 4. << >> 18 . and (3) Open-air Restaurants.
They were also classified into 3 types as mentioned above. In VTE. and about 27% of presence of any respiratory symptoms. The estimated sample for each province was 150 restaurant workers and 150 office workers with a sub-total of 300 in each site and with a total of 600 in the two provinces. << >> 19 . 30 restaurants from 70 restaurants were randomly selected for the first selection. and P of exposure = 27 %. 2007).All offices which were included in this study were smoke-free offices. All restaurants which had 5 or more staff were included in the sampling frame. detecting an OR of 2.1. and the presence of any respiratory symptoms with adjusted odds ratios of 1. a total of 30 offices were randomly selected from all 90 offices in VTE and 62 offices in Luang Prabang province. 90% power. throat problems. SHS was associated significantly with frequent colds.05. all offices which had 5 staff or more were included in the sampling frame and to get 150 respondents. Y. In a second step. The respondents who smoke or ever smoked were excluded from the sampling frame to avoid bias.4 Sample Size The selection of the restaurants and office workers were made randomly from the list of restaurants and smoke-free offices provided by provincial/district travel authorities. a total of 70 restaurants were registered with the travel district authorities.04 of unmatched case-control. cough and phlegm. For the Office group. β = 0. Zβ =1. α = 0. The sample size was determined with 95% confident interval. et al. All these offices prohibit smoking in the workplaces. In order to get 150 cases for the restaurant group. OR = 2. Five workers from each restaurant was then selected proportional to size (PPS) using simple random sampling.β. The same procedure was done in Luang Prabang province. 90% power or 1. the calculation was made using software EPI 6. 4.96.89 (95% confidence interval) (Ho S. visits were made to the selected restaurants and a list of staff members working in each restaurant was obtained.28. Z α =1. Based on the 95% confident interval.
we based self-reported exposure to passive smoking. including workplace and home exposures as well as their past smoking history. The first was respiratory health of bar workers abbreviated IUALD reproduced with permission of Mark D.4. Non-smoking workers from both the restaurant and office groups were asked in a standard interview on matters relating demographic and their past exposure to secondhand smoke. University of California and the second was the questionnaire prepared for the Respiratory Disease Committee of the International Union Against Tuberculosis and Lung Disease (UNION) by Burney P et al.5 Measurement of Outcomes Exposure to Secondhand Smoke • By living with smokers • Time exposure in the last seven days (number of hours) • Contact with smokers (household member. others) Respiratory symptoms in the last two months • • • • • Wheeze and tightness in the chest Shortness of breath Cough and phlegm from the chest Breathing difficulty Asthma 4. in Bangkok. >> 20 . Thailand. and the last was a standard respiratory symptom questionnaire developed by Hedley et al. customer. To assess tobacco exposure. These questionnaires were revised accordingly to suit the objectives and situation of Lao PDR by the national research team with the technical assistance of the experts from SEATCA. (2006).6 Data Collection Methods << Structured Interview Questionnaires (Face to face interview) The 3 structured interview questionnaires were provided during the regional workshop in December 21-22. co-worker. The questionnaire was also designed to capture information about the characteristics of the respondent’s workplace with respect to passive smoking and secondhand smoking related to health care cost (Annex). Eisner. 2006.
<< Question by Question review was done in order to familiarize members of the research team with and to ensure that they understand all the questions in the questionnaire. two teams with 4 enumerators were formed and each team was assigned the responsibility to collect the data in each study site. and one day of revision of all the contents of the survey tool plus feedback from the field practice. the questionnaire was translated into Lao language and pre-testing was conducted in Vientiane capital city.4. The training sessions included theory (2 days). The pilot survey in Luang Prabang started on 25 August with the same procedure as that conducted in VTE capital city and data collection started on 10 September 2007 and was completed on the 25 September 2007. The research team was divided into two groups of 4 persons each. The first group was responsible for interviewing 15 non-sampled restaurant workers and the other group was responsible for the same number of office workers. the questionnaire was revised accordingly. 4. Limitation The study could not draw on a non-exposed group of respondents from restaurants to compare with exposed non-smoking workers in the restaurants. Data collection started in VTE capital city soon after the pilot from 20 August to 5 September 2007. All the data collectors have had experience in many national surveys in the past. Soon after the training. The five-day training of 8 data collectors and 2 supervisors was conducted in mid-August 2007 with the aim to make the data collectors understand the objectives of the survey and the methodology on how to select targets for case and control groups. After the completion of the pre-testing.8 Data Collection and its Quality Control Training of interviewers and supervisors was performed before the collection of the data. The total number of pre-testing questionnaire respondents was 30. One supervisor was assigned to take care of data collection in each site.7 Pre-testing of the Questionnaire The questionnaire was developed in English and after it was finalized. role play in the class (1 day) and field practice (1 day). Research team members then provided comments and suggestions on how to improve the quality of data collection. as during the pilot survey it was not possible to find non-exposed restaurant workers as there were no 21 >> .
such as banks. The matching selection of both groups was non-smokers and never-smoked and worked at the current place for more than 1 year. an Ethical clearance was issued and approved by the National Ethical Committee for Health Research. Therefore. Ministry of Health Lao PDR.9 Data Processing and Analysis All 600 questionnaire forms were checked for completeness and consistency by those 8 data collectors by exchanging them between the teams.10 Ethical Consideration In order to ensure that ethical aspects of the subjects were protected.5 for further analysis. The frequencies. All questionnaire forms were completely entered one week after receiving all forms from each study site. the team decided to include offices that have similar environments to restaurants. 4. and proportions were calculated. travel agencies.restaurants which prohibited clients from smoking. to obtain a non-exposed group as an initial plan of this study. Logistic regression was performed. standard deviations. >> 22 .0 program. The 95% confidence interval and the chi-square test were used to compare differences between groups and provinces. All entered data was then transferred to SPSS statistical package version 11. The objectives of the study were explained to all subjects recruited for the study who gave their verbal informed consents on a voluntary basis. mean. << 4. telecommunication offices where smoking is not allowed. Data entry set was developed by one of the team members using Epi-info 10.
0) 104 (69.8) Total number << >> Sex Male Female Age groups 15-24 25-34 35-44 45+ Marital status Single Married Educational level Primary school Secondary school College/ University 7 (4.3) N (%) 265 (44.3) 35 (23.0) 0 17 (11.0) 87 (58.8%). and officers .8%).0) 27 (18.7) 100 (66.0) 3 (2. Table 1: Background characteristics of respondents .3) 133 (88. Most of the female respondents have secondary school and higher education.0) 33 (22. in the mean age of 27.1 General Characteristics of Respondents in Both Groups A total of 600 respondents were recruited for the study.3) 20 (13.3) 33(22.3) 15 (10.0) LPB N (%) 70(46.3) 49 (32.3) 100 (66.3) 117 (78.8) 72 (12.7) 47 (31.8) 245 (40. range 15 to 55) with a high concentration in the age group 25 to 34 years old (44.7) 5(3.3) 7 (4.7) 2 (1. respectively).0) 39 (26.8) 269 (44.7) 4 (2.by province Restaurant workers VTE capital N (%) 74 (49.0) LPB N (%) 60 (40.3) 79 (52.09 years old (±6.0) 14 (2.7) 101 (67.0) Officers VTE capital N (%) 61(40. In each province. a total of 150 non-smoking restaurant workers and 150 non-smoking officers from smoke-free offices were recruited.7) 23 (3.0) 23 .8) 211 (35. More than half of the restaurant workers sampled were in the age group 15-24 years old (59% and 69% for Vientiane (VTE) and Luang Prabang (LPB).3) 13 (8.restaurant workers.7) 80 (53.2) 251 (41. single (78% and 74%) and had secondary education (67% and 53%).0) 78 (52. while most of the office workers sampled were in the age group of 25-34 years old (58% and 67%).0) 133 (88.7) 2 (1.3) 349 (58.2) 366 (61.7) 89 (59.0) 72 (48.7) 43 (28. Most of the respondents were female (55. 300 respondents from Luang Prabang province and 300 participants from Vientiane capital city.8SD.7) 25 (16.2) 335 (55.7) 111 (74.7) 88 (58.RESULTS 5.0) 90 (60.7) 14 (9.3) 76 (50.7) 57 (38. married (52% and 67%) and had college/university education (89% and 89%) (Table 1).
7) 2 (1.1 Types of Workplaces The number of seats in the restaurants surveyed differed from one restaurant to another.6 SD (range from 37 up to 800).7% of the workers in the restaurants and 25. Approximately 37.7% in VTE stated that smoking was allowed inside the building. Agricultural Promotion Bank).7) 22 (14. the result showed that for the restaurant group in Luang Prabang.0) 5.3) 61 (40.0% of the officers had previously worked elsewhere.7) 2 (1. Library (NUOL).5. and the restaurants without air conditioning on.3) 87 (58. Lao-Viet Bank.3) 6 (4.0) 124 (82. (2) with and without air condition. 92% of respondents stated that smoking was not allowed inside the building while 40.0% of the respondents in the office group in LPB and 82.2 Working Hours The workers in the restaurants in both provinces worked on average 54 to 56 hours per week and the officers work on average 40-42 hours per week. Meanwhile 84.3) << >> Restaurant LPB group VTE Office group LPB VTE Smoking allowed No (%) 2 (1.1. Of those 113 restaurant workers who had previous 24 . Table 2: Percent distribution of respondents on policy knowledge by province Type Province Policy knowledge Smoking not allowed inside Special place for the building smoking No (%) No (%) 138 (92. Most of the restaurant workers and officers have been working in their current workplaces for more than one year. an average had 76 seats ± 60 SD (range from 28 to 150). Telecommunication office (ETL). The number of seats in the restaurant which had room with air condition and open room without air condition was around 60. There were 3 types of restaurants surveyed. On the question asked of all respondents with regards to policy knowledge.7) 20 (13.7% in VTE stated that smoking was not allowed inside the building (Table 2).0) 126 (84.1. (1) with air condition only. The restaurants with air conditioning had on average 157 ± 126. The offices selected for the office workers group included bank offices (BCEL. Public bank. Social Security Organization. with an average of 15 seats (range from 3 to 140).0) 10 (6. and (3) without air condition. and City Development Organization.
7) 75 (25.6) Restaurants or hotel 32 (55.3) 2 (9.5) 21 (18.6) 6 (5.2) 46 (83. (%) Prabang No.7% in LPB (p 0.experience.1) 14 (63. Much higher rates of exposure to smoke at the workplace were observed among the restaurant workers (99.1) 53 (35.3) 8 (7.0% in LPB) (p<0. >> 25 . and at leisure places.3% in VTE and 38.3) Officers at enterprise 6 (11. a list of questions were asked if the respondents were exposed to cigarette smoking at home. There is no difference between the groups in terms of exposure to smoke at home.001). The study found that most of the respondents in both groups were living with smokers.3 Exposure to Smoke In order to determine the main places that respondents in both groups have exposures to secondhand smoke.3) Restaurants or hotel 9 (17.3% in VTE and 82.0) Office group Government officers 17 (32.3) Officers at private company 18 (31.7) << 5. while of the 75 office workers who had worked elsewhere before.1) Officers at enterprise 4 (6.7% in LPB) compared to the office workers (7.2) 25 (33.7) 55 (36.1% of them worked in restaurants or hotels. at 63.7% had experience working in the restaurants or hotels (Table 3).3) 22 (14.7) Restaurant group Government officers 4 (6.3% in VTE and 60.9) 2 (3. Table 3: Frequency distribution of respondents by occupation with past working experience VTE capital Luang Total No. 69.9) 4 (7.6) 4 (18.3% in LPB compared to the office group.7) Officers at private company 21 (39.1.6) 78 (69.1) 8(10.015).0) 3(5. (%) 58 (38.7) 113 (37.6) 31 (41.0% in VTE and 95.1) 11 (14. There was little difference between the groups where exposure to smoke at leisure was concerned (Table 4).09) 2 (9. with higher rates recorded by the restaurant group at 100. 14. at their workplaces. (%) No.
7) 92 (61.0) 5 (1.3) 148 (49.4 Number of Hours that Respondents Spend with Smoking Pollution and Person Who Smokes The study found that restaurant workers were exposed to secondhand smoke for much longer periods than the office group with an average of 11.6 hours per week for the restaurant group (range from 0 to 70) and 1.001 << >> 26 .Table 4: Frequency distribution of respondents exposed to secondhand smoke by places and province Living with smoker No.3) 308 (51.35 13.78 group (n=143) Office group 1.3) 124 (82.63 (n=219) Total (n=512) 7.3) Exposure at home No.3) Exposure at leisure No.0) 49 (27.0) 160 (53.065 0 70 * p<0.0) 2 (1.3) 73 (48.0) 85 (28.3) 57 (38.24 16.422 0 28 2.479 0 28 Total Restaurant 15.62* 70 group (n=293) Office group 2.8) 5. Deviation Minimum Maximum VTE capital city Restaurant 18.3) 133 (47.63 hours for the office group (range from 0 to 15 hours (p<0.156 0 70 20.7) 65 (43. (%)* 72 (48.7) 267 (89. (%)* 149 (99.7) 213 (35. (%) Restaurant group Office group VTE LPB VTE LPB Total VTE LPB Total 150 (100.8) 278 (46.7) 245 (81.0) 63 (42.588 0 15 2.5) Exposure at workplace No.3) 99 (60.3) 95 (63.05 group (n=150) Office group 2. (%) 52 (34.94 3.0) 143 (95.657 0 70 Luang Prabang Restaurant 4.98 (n=124) Total (n=267) 1.3) 35 (22.121 0 15 1.0) 3 (2.7) 35 (5.892 0 11.3) 30 (10.7) 11 (7.3) 128 (42.3) 145 (49.000) (Table 5).48 (n=95) Total (n=245) 13. Table 5: Mean and Standard deviation of hours that respondents are exposed to smoking pollution Province Mean Std.3) Exposure at other public places 9 (6.0) 512 (85.0) 21 (14.1.367 0 10 .
8)* 29 (19.0) 84 (58.9) Colleagues 65 (43. Table 7).2) 96 (77. in the bars. relatives.9) 5 (5. night clubs. Table 6: Frequency distribution of people who are smokers that the respondents had contact with VTE capital city Luang Prabang Total Number (%) Number (%) Number (%) * P<0. p=0.4) Colleagues 22(23.001. probably due to exposure to passive smoking at work. chest pain in the morning. wake up at night with short breath.5) 84 (38.4) 118 (53.9)* Office group HH members 35 (36.8) 49 (39.6) 24 (11. people at parties. It was found that customers were the main source of SHS for restaurant’s workers.6. coughing in the early morning or at night.2) Others 35 (11.3) 6 (4. and the risk of developing respiratory symptoms (OR=2.2 The Association between Work Site and the Risk of Developing Respiratory Symptoms Respondents in both groups were asked about respiratory symptoms including wheezing in the chest. 27 . and with phlegm in the morning.) (Table 6). and asthma.There were 5 cases which reported having been exposed to SHS for up to 70 hours per week (approximately 10 hours per day).001 Restaurant group HH members 52 (34.3) 19 (15.3) Customers 24 (11.7) Customers 231 (78. The respiratory symptoms reported by the respondents in this study included chest pain in the morning and coughing in the morning with phlegm.5) << >> 5.7) 147 (98. The time frame was in the last two months. short breath without workload.9) Others 93 (42.3% in the office group experienced these symptoms.7) 65 (45.0) 69 (72. etc.3) 60 (42. The study showed a strong association between worksites. while for the office group it was their colleagues and others ((friends.0% reported having such symptoms while 6. Among the restaurant group 15.5) 117 (39.0) 125 (42.
487 Upper 4.3) 281 (93.0% and 8.7) 536 (89.7) 140 (93.5%) (p=0.3) Lower 2.7) 9 (6.799 4.7% and 6. Table 8: Frequency distribution of respondents in work sites and respiratory symptoms by province Restaurant Office Total OR 95% CI P value VTE No (%) No (%) No (%) Lower Upper Having 16 (10.7% of respondents in both groups reported having respiratory symptoms.3) 261 symptoms (87.0) 3.7% in LPB.7) 39 (13.041) (Table 9).001 The percentage of respondents having respiratory symptoms was higher among those residing in LPB compared to those in Vientiane at 13.355 1.3%.871 0.Table 7: Frequency distribution of respondents in work sites and respiratory symptoms Restaurant Office Total OR 95% CI Having Respiratory symptoms No symptoms No (%) 45 (15.002 respiratory symptoms No 121 (80. << >> 28 .7) No (%) No (%) No (%) Lower Upper LPB Having 29 (19. a higher percentage of those in the restaurant group reported respiratory symptoms compared to the office group at 10. In both provinces.0) 274 symptoms (91.7) No (%) 64 (10.571 7.166 0.149 symptoms No 134 (89.378 0.610 1.3) 141 (94.0% in VTE and 19. with a higher rate recorded among those living with smokers (11.3% and 6.0) The results showed that 10.7%) than those who were not living with smokers (4.0) No (%) 19 (6.0) 255 (85.0) 25 (8.3) respiratory 1. respectively. respectively (Table 8).3) 10 (6.580 P value 0.
041 The study found that in VTE.3%.0) 0.8) 133 (95.2) 18 (11.0) 5. from where and how much they spent on health care cost related to smoking exposure.1) 13 (6. 11.035 17 (12.8) 261 (87.3) 10 (6.3) 512 with smoker 4 (4.3 Estimation of the Direct and Indirect Costs of Smoking-related Diseases Among the Workers Who Are Exposed to SHS in the Restaurants A total of 221 respondents who had reported having the above respiratory symptoms were asked if they had sought care and if yes.3) 600 P=0.901 No symptoms >> 73 (85.7) 145 (93. Table 10: Frequency distribution of respondents who reported having respiratory symptoms by places of smoking exposure << Exposure at home Yes No P-value Exposure to smoking at work place Yes No P-value Exposure to smoking at leisure Yes No P-value Total VTE (n=300) Having Respiratory symptoms 12 (14.2) 145 (86.7) 150 (87. while in LPB exposure to smoke at home was associated with respiratory symptoms (Table 10).0 13 (8.7) 452 (88.5) 88 No Total 64 (10. respectively).0) 135 (91. 10.9) 202 (94.7) 116 (87.920 39 (13.Table 9: Frequency distribution of respondents exposed to passive smoking by living with smokers at home and respiratory symptoms Having respiratory symptoms Total Yes No Living Yes 60 (11.8) 22 (13.2) 126 (82. exposure to smoke at home.227 25 (8.1) 0.3%.7) 536 (89.5) 275 (91.0) 0.2) 0.035 No symptoms LPB (n=300) Having Respiratory symptoms 17 (13. 29 .8) 0.9) 130 (89.8) 26 (17.1%.3) 142 (88.057 15 (10.5) 0.3) 7 (5.5) 84 (95. at the work place and at leisure was associated with having respiratory symptoms (14.3) 22 (12.0) 111 (86.
>> 30 .612 Kips (US$37.9) compared to that of the office workers (197. Table 11: Frequency distribution of respondents who reported seeking care by services Place of seeking care Government hospital Private clinic Private pharmacy Self medication Total Restaurant group (n=94) VTE (n=45) 4 ((8. as well as higher in restaurant workers than in office workers.0) 0 5 (10.2) Office group (n=91) VTE (n=39) 3 (7.1) 1 (2.7%).0) << Those who sought care at a health facility reported both their direct and indirect costs.0) 1 (2.620 Kips (US$33.1) 1 (1. and 66. but they are not statistical significant (Table 12).5) LPB (n=49) 3 (6.0) (Table 13).3).1) 4 (8.A total of 185 respondents (84 respondents in VTE and 101 respondents in LPB) responded to this part of the survey.9) 16 (35. Mean direct.1) 2 (5. 250 Kips (US$59. The mean health care cost related to reported respiratory symptoms was higher for restaurant workers in the exposed group at 513.7) 10 (25. drug.7) are indirect cost. those office workers who were exposed to smoke were more likely to have respiratory symptoms (6. and as such the former had more respiratory symptoms (14. The number of respondents who were exposed to smoke at any place was higher among restaurant workers (96%) compared to office workers (75%).7) 5 (11.0% ) compared to those in the non-exposed group (0.6) LPB (n=52) 12 (23. Similarly. Most participants in both restaurant and office groups had sought care at government hospitals and private pharmacies (Table 11). The mean of the total health expenditure spend per person for care of their illness related to respiratory symptoms was 319.315 Kips) (US$23.1) 0 12 (23.2) are direct cost such as doctor fees.7) 2 (5. The respondents who were restaurant workers and were exposed to smoke in both VTE and LPB had more respiratory symptoms than those office workers and only those in the exposed group either restaurant workers or officers reported having to spend on health care related to respiratory symptoms (Table 14).9) 3 (6. and total cost spending for respiratory symptoms in Luang Prabang is higher than in Vientiane capital city.0%) compared to those who were not exposed to smoke (0.7%). in which 284. indirect.1) 3 (7.160 Kips (US$7.9) 25 (48.
160 25 175.49 470.828 Province VTE capital city Mean N Std.41 78.064 0. Deviation Luang Prabang Mean N Std.500 18 955.7) - >> 31 .7) Officers Exposed to Not-exposed to smoke smoke at any at all place (n=225) 18 (6.250 (n=12) 2 (0.315 (n=75) 2 (0.696 INDIRECT COST 34.944 18 999. Deviation << Table 13: Respiratory symptoms and health care cost by exposed and non-exposed restaurant workers and officers Restaurant workers Exposed to Not-exposed smoke at any to smoke at place all Respiratory symptoms Mean health care cost (Kips) (n=288) 42 (14.620 29 761.0) (n=12) 513.090 11 136.661 13 134497.444 18 205.146 Total Health Expenditures 142.492.338 284.585 66.208 319.09 392.916 0.Table 12: Health care cost by province DIRECT COST 108.440 0.0) (n=18) 197. Deviation P-value Total Mean N Std.612 31 778.571 7 38789.
3) Nonexposed (n=26) - << >> 32 .7) (n=5) 81.3) 2 (1.571 Respiratory symptoms Mean health care cost (Kips) Nonexposed (n=7) 2 (1.0) 27 (18.Table 14: Respiratory symptoms and health care cost by exposed and non-exposed restaurant workers and officers in two provinces Restaurant workers Vientiane LPB capital Exposed NonExposed exposed (n= 145) (n=5) (n=143) 15 (10.0) (n=8) 127.750 (n=4) 284.250 Officers Vientiane LPB capital Exposed NonExposed exposed (n=101) (n=49) (n=124) 8 (5.800 (n=10) 238.3) 10 (6.
but they are least likely to be afforded protection from the health risk. & Osinubi. EM.0% in Vientiane capital city. thus from the perspective of an occupational mortality study. High rates of exposure to smoke at workplaces such as restaurants were observed in the restaurant group.. This may be because the policy is still at its infancy and. particular the non-smokers.3 times more likely to have respiratory symptoms then those who live in a smoke-free environment and also confirmed that the rate of respiratory symptoms in non-smokers who worked in the SHS environment is higher than those who work in smoke-free places. Barbeau. OY. (2005). some respondents still reported having been exposed to smoke at the workplace. After the implementation of a smoke-free policy in the city in Luang Prabang. & Osinubi. the study found that non-smoking restaurant workers were exposed to smoking pollution at an average of 2. being a waitress was the most hazardous occupation for women (Siegel. EM. The study confirmed that those who live with smokers are 2. In accordance with the report by the Surgeon General in 2006. It has been a major SHS exposure site because it is a place where adults spend most of their time (Edwards et al. chest pain and difficulty breathing as reported by Ho SY et al. the workers in these worksites tend to suffer adverse effects from the high level of SHS exposure.78 hours per week compared to 20.7% in Luang Prabang compared with 98. Those who work in restaurants are likely to be exposed to secondhand smoke for long periods of time.DISCUSSION Most of the respondents in both restaurant and office groups were females. The cross-sectional and << >> 33 . (2005). therefore. even though the smoke-free policy has been declared and smoking indoor was not allowed since 2007. The percentage of respondents who reported of exposure to customers' smoke was 58.. compliance among smokers is poor. 2006). The respiratory symptoms reported by the respondents include cough and phlegm. in particular those who worked in the restaurants. however. M.. M. a world heritage city. and thus restaurant jobs are among the seven most hazardous occupations (Siegel. but these workplaces are least likely to be covered by smoking laws or policies banning smoking. OY.05 hours per weeks for non-smoking workers in the restaurants in Vientiane capital city. Hence. Barbeau. In LPB. this study confirms that the workplace is the main place for respondents who are workers in restaurants to be exposed to SHS.
000 Kips (US$20.612 Kips (US$37. Workers at the restaurants spend more time at their workplace than the office group . the mean health care expenditure for the treatment is relatively high compared to the overall health care expenditure at national level (NHS. In the United States. The study found that eventhough few workers were ill and seeked care at health facilities. Eriksen & Lin. so they are at a greater risk of getting respiratory symptoms than those office workers working in a smoke-free environment as reported by Wakefield M et al. No nicotine was detected in the hair of non-smoking employees working in a smoke-free bar. 2000) at 319. 2005). approximately US$7. air nicotine was detected in all the bars where smoking was allowed.4). throat problems. cough and phlegm.96 billion in economic value was lost each year due to morbidity as a result of only 3 diseases as well as disability or premature death caused by exposure to passive smoking (Behan. which is significantly associated with increased morbidity and mortality from a wide range of diseases.prospective studies showed that SHS was associated significantly with frequent colds. and the presence of any respiratory symptoms. indicating that involuntary exposure to tobacco smoke occurs in Baltimore bars. << >> 34 . Exposure to SHS is a public health problem.3) versus 175. pubs. while high levels of nicotine were detected in the hair of non-smoking employees working in bars where smoking is allowed. especially in people who do not smoke as well as imposes considerable economic burden at both individual or household and national levels. According to the study at Baltimore by researchers at the Johns Hopkins Bloomberg School of Public Health. frequent cough. The mean health care cost reported by respondents in LPB was higher than in VTE. sore eyes. This cross-sectional study confirmed that exposure to SHS at work for part of the day was significantly associated with an increased risk of wheeze. and sore throat and this study had provided evidence that non-smoking workers are affected by exposure to SHS at work and underlined the importance of imposing a 100% smoking ban in the restaurants. who took self-treatment the first time and had to spend more for health check up (X-ray and blood test). and bars to protect the health of restaurant workers as well as other office workers as stated in the Article 4 of the policy on tobacco control. as there was one case who had repeated respiratory symptoms.
160 Kips (US$7.620 Kips (US$33.7%) than those who are not living with smokers (4.7% in LPB) compared to the office workers (7. in which 284. Higher rates of exposure to smoke at the workplace were observed among the restaurant workers (99.3% in VTE and 38.3% of respondents in restaurants in VTE were aware of this ruling. had completed secondary and higher education.63 hours (p<0. The study found that most of the workers at the restaurants were exposed to secondhand smoke on average 11. and the majority were single. and bars to protect the health of non-smoking restaurant workers and office workers as stated in Article 4 of the policy on tobacco control.041). while only 1.7% of respondents in both restaurant and office groups reported respiratory symptoms with a higher rate in those living with smokers (11.0).7% in LPB). more so in restaurant workers than in officer workers who were also exposed to SHS. more cases of respiratory symptoms were reported by restaurant workers than by the office workers.CONCLUSION AND RECOMMENDATIONS The respondents were mostly females in the young age group (15-35 years old).6 hours per week compared to 1.001) by those who worked in offices where smoking was prohibited. respectively. << >> 35 .7% versus 6.250 Kips or US$59.7) are indirect cost.2) are direct cost and 66.0% in VTE and 19. The percentage of respondents in both restaurant and office groups who were living with smokers was higher among the restaurant group (100.7% in LPB.315 Kips or US$23. Ninety two percent of respondents in restaurants in Luang Prabang recognized that smoking s not allowed inside the building.0% in VTE and 95. with higher cost spent by exposed restaurant workers (513. The mean total health expenditure spent to treat their illness is 319.0% in LPB). at 10. Most participants in both restaurant and office groups had sought care at government hospitals and private pharmacies. pubs. The study showed that there is an association between respiratory symptoms including chest pain.9) than exposed office workers (197. The results showed that 10.5%) (p=0. coughing with phlegm in the morning and exposure to secondhand smoke.3% versus 6. This study provides strong evidence that non-smoking workers are affected by exposure to SHS at work and underlines the importance of having a total ban on smoking in restaurant.612 Kips (US$37.3% in VTE and 60. In both provinces.3% in VTE and 82. (63.3% in LPB) compared to the office group.3).
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Lannero. 2001. (March.S. Available at URL: http://www1. the tobacco control..151 (3):241–50. << Jee. National Center for Chronic Disease Prevention and Health Promotion. Ohrr. and Mechanisms. Switzerland. & Nordvall. Cigarette Smoking and Exposure to Environmental Tobacco Smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia. Ann Epidemiology 2007. Respiratory health of bar workers abbreviated. M. Current and Future Trends in Tobacco Use. Maternal Smoking During Pregnancy Increases the Risk of Recurrent Wheezing During the First Years of Life (BAMSE). Office on Smoking and Health. H. Department of Health and Human Services. Cross-Sectional and Prospective Associations Between Passive Smoking and Respiratory Symptoms at the Workplace. Carcinogens.org/tobacco/publications. 1972-1976. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Centers for Disease Control and Prevention. (2006). 2005. Geneva. et al. Medicine University of California. SH. Vientiane capital >> 37 . Ho Sai Yin et al. Mark D. Past.S. Adapted and updated with permission from the 2000 World Conference on Tobacco OR Health fact sheets. L. 2003). Atlanta. GA: U. BioMed Central. (2004).worldbank. Jöckel K-H. D. 7 (3). Effects of Husbands’ Smoking on the Incidence of Lung Cancer in Korean Women.. Kreienbrock L.E. Coordinating Center for Health Promotion.Framework Convention Alliance on Tobacco Control. . Pershagen. American Journal of Public Health. Department of Health and Human Services. Kreuzer M. 94 (11). & Kim. San Francisco Ministry of Health..17:126-131. Environmental Tobacco Smoke and Lung Cancer: A Case-control Study in Germany. D. G. (2006). IS. Lao PDR. Wichmann H-E. Respiratory Research. Cigarette Smoking: Cancer Risks. Langenbecks Arch Surg. American Journal of Epidemiology 2000. Eisner et al . E. World Bank. (2006). & Boisclair. (1999). 2007. In U. Krauss M.asp Hecht. Gu. Guindon. Wickman. SS. G..
at Work and in Public Places. Going Smoke-free: The Medical Case for Clean Air in the Home. Atlanta. S.int/publications/2002/9241562099. Pulmonary Function. et al.. In U.. 1255-1263. Lao PDR. EM. Second Edition. (2005). Respiratory Symptoms. Tobacco control country profiles. National Institute of Public Health.who.pdf Menzies et al. supported by WHO). Parental Smoking and Lung Function in Children. The Tobacco Atlas. (2005).. 2005 Shafey. 2002). & Osinubi. Health Status of the People in Lao PDR (as part of the world health survey. Kanemura. S. Vientiane capital Royal College of Physicians. Dolwick. Moshammer.S.Mackay. Department of Health and Human Services. (2006). S. World Health Organization. I.E. Tsubono. 31. Tsuji. (June. 5 (1). (2001). and Marker of Inflammation Among Bar Workers Before and After a Legislation Ban on Smoking in Public Places. O.. << >> 38 . Available at URL: http://whqlibdoc. Centers for Disease Control and Prevention. GA: U. July. 2003. (2006). & Eriksen. & Guindon. Y. A report on passive smoking by the Tobacco Advisory Group of the Royal College of Physicians. Y. J. 296 (14). Komatsu. Barbeau. JAMA. Department of Health and Human Services. 173. Am J Respir Crit Care Med. M. . Clin Occup Environ Med. Nakatsuka & al. National Center for Chronic Disease Prevention and Health Promotion.42. 1742-1748. M. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Nishino. Ministry of Health.. (2006). Office on Smoking and Health. OY. The Impact of Tobacco Use and Secondhand Smoke on Hospitality Workers. Passive Smoking at Home and Cancer Risk: A Population-based Prospective Study in Japanese Non-smoking Women. Lao health survey as part of the World Health Survey (WHS) in Lao PDR. Siegel. H. Geneva: World Health organization. National Institute of Public Health. G. Coordinating Center for Health Promotion. Vientiane: National Institute of Public Health.S.. (2003). Ministry of Health of Lao PDR.. (2006).
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Less than one year in this restaurant /office? 2. No. More than one year Asking for consent to participate in the study Stop to Q2 Stop Stop to Q3 Stop next << >> 40 . Screening Form ID: __ __ __ Q1. Yes 2. No Q2. occasionally cigars. or pipes? 3.ANNEXES A. Yes. Have you ever smoked? 1. Do you currently smoke any 1. Yes. daily tobacco product such as cigarettes. 2. not at all Q3. How long have you been working 1.
...... ALL THE INFORMATION WE OBTAINED WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE IDENTIFIED.... Vientiane capital city << B.. Result of interview: Name.......... Mixed enclosed/open air Restaurants 3.. I WOULD LIKE TO TALK TO YOU ABOUT THIS.. Restaurant/Office information Q7...... Supervisor name and number: Q3........ May I start now? IF PERMISSION IS GIVEN.......... Data entry clerk name and number: B............ Data Collection Tool Questionnaire on Exposure to Second Hand Smoke (SHS) among Workers in the Restaurants in Vientiane Capital and Luang Prabang Province............. Seating capacity ___ ___ ___ seats C.............. 04 B1.-02 A3. 03 A4....... Saisetha. Name of Restaurant/Office Q8...... Interviewer name and number: Q2.. Respondent's Socio Demographic Characteristics I would like to start by asking you some background questions before asking you questions on 41 .... Luang Prabang. 01 A2... Lao PDR WE ARE FROM THE MINISTRY OF HEALTH AND PROVINCIAL HEALTH DEPARTMENT......................... Note for enumerators: Fill in the answers in the blank or circle the suitable answers A.. Sikhottabong. Luangprabang A1.......... THE INTERVIEW WILL TAKE ABOUT 30 MINUTES... 01 Q1... DURING THIS TIME I WOULD LIKE TO SPEAK WITH YOU.. Sisattanack........B.......... BEGIN THE INTERVIEW... Type of ventialtion: Name _______________________ ___ ___ Name _______________________ ___ ___ :_________________________ Code ___ ___ 1. Chanthabury ........... Data editor Q6. Open air Restaurants Q9..... Air conditioned enclosed Restaurants 2. General Information Province: Vientiane capital city…………………………01 Luangprabang …………………………………06 District: A................ WE ARE WORKING ON A PROJECT CONCERN WITH SMOKING AND HEALTH....... ___ ___ Name_________________________ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___ Completed Refused Other (specify) 1 2 8 >> Q5.... Day/Month/Year of interview: Q4...........
No Q25. Have you. Customer 4. Smoking policy of the restaurant Q 23. Who are the smoker 1. at work place 3. Cohabiting Q14. Do you live with a smoker? 1. What is your current marital status? 1. 1. Respiratory symptom/illness of respondent F. at any time in the last 2 months. Smoking is not allowed in any indoor area smoking policy where you work? 2. Less than primary school 3. Others. at home 2. No. Male 2. Yes. Female Q12. Separated 4. No formal schooling 2. Which of the following best describes the 1. Secondary school completed 5. at any time in the last 2 months. This information is confidential and will only be used for research purposes. 42 1. What is the highest level of education? 1.<< your health. where did _____________________ you work? For how long? D. not at all If no Go to Q23 ___ ___ hours Q21. specify 4. Before starting this current job. Never married 2. College/pre-university/University completed 7. Record sex as observed 1. Yes >> . High school (or equivalent) completed 6. Currently married 3. Name of Respondent: Line No: ___ ___ ______________________________ Q11. Smoking is allowed only in some indoor area 3. specify _______________ E. Have you. Higher education Q15. Others. Widowed 6. Household member 2. How many hours last week were you exposed to smoke in total (their estimate)? Q22. Q10. Yes had wheezing or whistling in your chest? 2. Don’t know/unsure F. Average number of hours per week ___ ___ hours working in restaurant/office: Q 19. Yes. How old are you? (Years) ___ ___ years Q13. Exposure to environmental tobacco smoke (ETS) Q20. Smoking is allowed everywhere 4. Co-worker 3. What is your current job? __________________ Q 16. What is your job title? __________________ Q17. Number of years working in ___ ___ Months restaurant/office: Q18. Primary school completed 4. Divorced 5.1 Wheeze and tightness in the chest Q24.
2 Shortness of breath Q27. been 1. I get repeated trouble with my breathing but it always gets completely better 3. Have you. Have you. had an 1. No chest first thing in the morning? Q 26. Before F. Do you usually cough up phlegm from your chest 1. Yes woken at night by an attack of coughing? 2. No attack of shortness of breath that came on after you stopped exercising? Q29. Have these kinds of symptoms appeared 1. Yes 2. at any time in the last 2 months. Yes attack of shortness of breath that came on during the 2. Yes as much as 3 months per year? 2. Yes first thing in the morning? 2. Have you. No day when you were not doing anything strenuous? 1. Which of the following statements best check only one: describes your breathing? 1.4 Breathing Q 35. First time is this the first time? 2. been 1. Have these kinds of symptoms appeared before or 1. Yes as much as 3 months per year? 2. at any time in the last 2 months. No Q 30. No >> 43 . feathers Q 36. How many years have you had this cough? 1. No Q32. Yes 2.<< woken up with a feeling of tightness in your 2. Before F. cats or horses) or near feathers (including pillows and quilts) do you ever: Q 36a. I never or only rarely have trouble with my breathing 2. Before F. Yes 2. No Q32b. Yes woken at night by an attack of shortness of breath? 2. Do you have a cough like this most mornings for 1. How many years have you had this phlegm? ___ ___ years Q 34. When you are in a dusty part of the house or with animals (for example. First time is this the first time? 2. dogs. Yes 2. Do you usually cough first thing in the morning? 1. No Q 36b. Have you. dust. Get a feeling of tightness in your chest? 1. had an 2. No Q33b. Do you have phlegm like this most mornings for 1. No If no go to Q 35 Q32a. Yes Q28. My breathing is never quite right F. Have these kinds of symptoms appeared before or 1. at any time in the last 2 months. First time before or is this the first time? 2. No Q33. at any time in the last 2 months. Start to feel short of breath? 1.3 Cough and phlegm from the chest Q31. No If no go to Q 35 Q33a.5 Animals.
Yes time in the last 2 months? 2. For your last illness mentioned above. if do not have any of the above mentioned symptoms.1 Health care provider’s fees 44 8. circle “not applicable. Others. If respondent did not have tests or drugs. No care where did you seek care 1. not have”] A. DK 8. if having one of the above mentioned symptoms. how much did you or your household pay? [Write 0 if the service was free. Direct cost Q 43. Yes (including inhalers. end the interview by thanking the respondent for his/her cooperation and go back to Q4 at the first page to record the results of interview G. DK . Health center 4. No Q39. DK Q 42.6 Asthma Q37. Private pharmacy 5. 0. 1. 3 Tests 8. specify_______________ Q 42. etc.5 Others (Food.2 Medicines 8. ask the following questions 2. Indirect cost Q 42.4 Transport 8. DK B. circle “not applicable. Private clinic 3. DK << >> Q 42. No asthma? 40. Tobacco related diseases management costs Q 41.) 8. If respondent did not have tests or drugs. lodging. Traditional healer 7.1 Health care provider’s fees Q 42. Are you currently taking any medicines 1. how much did you or your household pay? [Write 0 if the service was free. DK Q. 42. Direct cost Q 42. No Q 37 a. Thinking about your last hospital stay for your last illness mentioned above. How long has your asthma symptoms _____ ____ months started? Q38. Have you had an attack of asthma at any 1. aerosols or tablets) for 2. Yes 2. Drug store 6.6 Income lost a) Salary b) others income per day Q 43. Thinking about your last visit to the health facilities for your last illness mentioned above. not have”] A. Public hospital 2. Have you ever had asthma? 1. Self medication 8.F.
Q 43. please specify _______________________ Note for enumerator: End the interview by thanking the respondent for his/her cooperation and go back to Q4 at the first page to record the results of interview << >> 45 .4 Total costs for traveling to hospital and back home Q 44. Health care cost paid by: a) Government/hospital _______________________ b) Insurance company _______________________ c) Pocket money _______________________ d) Others.6 Income loss for care provider a) Salary ______________________ ______________________ a) Salary _______________ b) Other income b) Other income_________ Q 44.7 Income loss for patient a) Salary a) Salary _______________ b) Other income b) Other income_________ Q 45. 3 Tests B. Indirect cost Q 44.2 Medicines Q 43.5 Food costs Q 44.
MOH Co-investigator: Dr. NIOPH. Bounyai Mr. Somchit Ms. Manithong Vonglokham. MOH Data management: Cleaning. NIOPH. MOH Dr. Khouanchai Soundavong. Dalaphone Sithideht. NIOPH. Dalaphone Sithideth. The Research Study Team Principal Investigator: Dr. Manithong Vonglokham. MOH Data collectors in Luangprabang province: << Ms. NIOPH. NIOPH. MOH Dr. NIOPH. Sengchanh Kounnavong. MOH Co-ordination: Dr. Sengchanh Kounnavong. MOH Dr. Khouanchai Soundavong. MOH Dr. Keonakhone Houamboun. Dalaphone Sithideth. MOH Dr. NIOPH. Phonevilay Supervisor for Luangprabang team: Dr. MOH 46 >> . Keonakhone Houamboun. NIOPH. Vilavanh Xayaseng. Seng-aly Mr. processing and analysis Dr. NIOPH. NIOPH. MOH Dr. NIOPH. ADRA Lao Team members: Data collectors in Vientiane capital city: Dr. NIOPH. MOH Report writing: Dr. Maniphanh Vongphosy. NIOPH. MOH Dr. MOH Dr. Sengchanh Kounnavong. NIOPH. NIOPH. MOH Data entry clerk Dr. Vilavanh Xayaseng.C. Manithong Vonglokham.
org. By adopting a regional policy advocacy mission. it has supported member countries to ratify and implement the WHO Framework Convention on Tobacco Control (FCTC) Contact persons: Ms.seatca. Velasco: SEATCA Research Program Manager Email: menchi@seatca. THAILAND Tel.<< …………………………………………………………………………………………………. Nakornchaisri Dusit. to enhance local capacity through advocacy fellowship program. Bangkok 10300. Menchi G. . and to be catalyst in policy development through regional forums and in-country networking./Fax: +662 241 0082 Website: http://www.. Bungon Ritthiphakdee: SEATCA Director Email: email@example.com …………………………………………………………………………………………………. 115 Thoddamri Rd.com Southeast Asia Tobacco Control Alliance (SEATCA) Address: Thakolsuk Apartment Room 2B.. About SEATCA The Southeast Asia Tobacco Control Alliance (SEATCA) works closely with key partners in ASEAN member countries to generate local evidence through research programs.org Ms. menchi55@yahoo..
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