impact of smoke free melaka city project on perception, attitude and behaviour of people in melaka

International Social Work Conference 2012

Crafting Symbiotic Partnership

and Collaboration in the Asia Pacific Region

IMPACT OF SMOKE FREE MELAKA CITY PROJECT ON PERCEPTION,

ATTITUDE AND BEHAVIOUR OF PEOPLE IN MELAKA

Nur Hanani Jasni, Maizurah Omar, Noraryana Hassan, Yahya Baba, Rahmat Awang,

Anne Chiew Kin Quah, Haslina Hashim, Ahmad Shalihin Mohd Samin,

Noor Afiza Abdul Rani, Pete Drieze, Mary Thompson and Geoffrey T Fong

Abstract

Introduction: Globally, secondhand smoke (SHS) is responsible for 600,000 deaths

in 2011, 75% of these affecting women and children. SHS is responsible for causing harm to

the cardiovascular and respiratory systems. The only effective way to protect people from

SHS is to provide a 100% smoke-free environment. In Malaysia, Melaka is the first state that

has implemented a 100% smoke-free city since 15th

June 2011. This article examines the

impact of awareness, perception, attitude and behavior of smoking among people in Melaka

following the Smoke-Free Melaka city (SFMC) policy and association of the awareness of

the policy with perception of the social desirability of smoking and attitude towards smoking

among adults. Methodology: A total of 1,039 adult survey from face- to-face interview was

carried out in June 2012 within six zones in Melaka. Respondents were recruited using

systematic intercept sampling. They were asked if they have noticed advertisements on

SFMC and their perception about the social desirability of smoking. Changes of behavior of

smokers were recorded. Descriptive analysis, univariate and multiple logistic regressions

were applied by using SPSS version 18. Odd ratio and 95% CI were computed for each

corresponding variable. Results: More than 70% of the respondents have noticed the Melaka

Smoke-Free advertisements, namely, on posters/signage (92.5%), digital billboards (77.0%),

newspaper/magazines (72.8%) and inside shop/store windows (73.8%). Multivariate analysis

revealed that noticing the advertisements had significantly influenced discussion with family

and friends (OR=1.21; 95%1.12, 1.31, p<0.000) and implementation smoke-free homes and

vehicles (OR= 1.09; 95% CI 1.01, 1.18, p<0.022 and OR=1.19; 95% CI 1.09, 1.30, p<0.001

respectively). In addition, significant association was found between discussion with

family/friends and implementation of smoke free vehicles (OR=1.51; 95% 1.09-2.09,

P=0.014). Following the implementation of the policy, most smokers said that they would

not smoke in the presence of the children (83%), non-smoking family members (76.7%),

older non-smoking person (78.2%) and policy officers (86.6%). Conclusion: The

implementation of the SFMC project has resulted in positive impact on perception, attitude

and behavior of smoking on people who live or visiting the Melaka city. This project has

shown the potential to reduce exposure to secondhand smoke in both workplaces and home.




Introduction

Smoking is a serious threat to public health and the first single leading cause of

preventable disease that contributes to significant morbidity and mortality (Bergen &

Caporaso, 1999). Worldwide, tobacco is responsible for almost 6 million deaths, with more

than 15% of deaths among men and 7% of deaths among women (Michael Eriksen, 2012).

Smoking potentially produces harmful effects to almost all organs and systems in the human

body by causing numerous diseases and reducing health in general (U.S. Department of

Health and Human Services, 2004). Unfortunately, it not only has direct effects on the

smoker’s health but also on non-smokers as well. An estimated 600,000 individuals died

from exposure to SHS in 2011 of which 75% of SHS deaths occurred among women and

children (Michael Eriksen, 2012). The World Health Organization-Framework Convention

on Tobacco Control (WHO-FCTC), the world’s first global health treaty ever developed to

create measures to reduce the devastating health impact of tobacco emphasized on the

importance of implementing a 100% smoke-free policy to protect people from exposure to

tobacco smoke in all indoor workplaces and public places as well as all public transports.

Malaysia even though a signatory to the WHO-FCTC have yet to implement a

comprehensive national legislation that protects all people from SHS, although sub-national

jurisdictions do have the authority to implement laws that ban smoking in public places

(Food Act 1983, 2004). Thus, some workplaces and public places have partial smoking area:

for example, one-third of location designated as smoking area in air-conditioned restaurants,

public transport terminals, and designated smoking rooms in airports. As a result, an

estimated 7 for every 10 adults (8.6 million) in Malaysia are exposed to secondhand smoke in

public environment and 4 for every 10 adults (7.6 million) are exposed to secondhand smoke

at home (Malaysia, 2011).




Not until recently however, there have been some interests to implement smoke-free

projects in different locations in the country. In June 2011, Melaka became the first

Malaysian state that initiated a 100% smoke-free project in some of its cities. The idea of

creating a Smoke-Free Melaka city (SFMC) was mooted by the Malaysian Women's Action

for Tobacco Control and Health (MyWATCH) and the Southeast Asia Tobacco Control

Alliance (SEATCA) in December 2008 with the aim of protecting the health of non-smokers

especially women and children living with smokers. However, it was not until 7 April 2010

that a proposal to implement the project was prepared and accepted in the Meeting of the

Melaka State Council and later announced by the State’s Chief Minister of Melaka on 11

April 2010. Following this, a series of meetings including a strategic planning session were

carried out involving a number of government departments and agencies including the

Clearinghouse for Tobacco Control, National Poison Centre, Universiti Sains Malaysia (C-

Tob, USM) and the Malaysia Health Promotion Board (MySihat). In order to ensure the

participation of non-governmental organizations in the state, an alliance known as

GaNMBAR was established and their role in the smoke-free project was clearly spelt out in

the report of the strategic planning. Two MOUs were signed related to the project: 1)

between MySihat, the funder of the Smoke-Free Melaka project, and GaNMBAR and 2)

between GaNMBAR, MySihat with USM to evaluate the impact of the project. Enforcement

of non-smoking zones in the Melaka state came into effect on 15 June 2011.

Figure 1.0: Conceptual framework for the evaluation of smoke free policy




The evaluation of SFMC project was planned based on the conceptual framework for

the evaluation of smoke free policies (Figure 1.0) from the IARC Handbooks of Cancer

Prevention (IARC, 2007). The main objective of smoke free policies is to reduce secondhand

smoke exposure to further improve health outcomes. Three studies were planned based on

this framework: 1) intercept study to observe immediate impact of the smoke-free policies

which is compliance, 2) indoor air quality study to evaluate secondhand smoke exposure and,

3) cohort study to observe changes in psychosocial behavior over time among those with

ongoing relationships with Melaka.

Objectives

The objectives of this study are 1) to examine the outcome of this project particularly

on awareness, perception, attitudes and behavior of people in Melaka and 2) to evaluate the

association between awareness of the SFMC policy with perception on the social desirability

of smoking and attitude towards smoking among adults.

Methods

Sample and data collection procedures

The intercept survey took place in June 2012 through face-to-face interview co-

ordinated by a team of experienced interviewers from the Research Call Centre of Ctob,

USM, and the Melaka State Health Department. A total of 1,039 respondents were

interviewed in this study. The survey covered workers, students, housewives and tourists

from a range of public places within the smoke-free areas. Sampling included both smokers

and non-smokers aged 18 years old and above. The six sampling areas were: Jonker Walk,

Jalan Kota, Melaka International Trade Centre (MITC), Bandar Warisan Dunia, Jasin City

Centre and Alor Gajah City Centre. All these have been gazetted by the Melaka State

Government as smoke-free areas. Respondents were interviewed at all types of venues,

indoors and outdoors. Every fifth person passing an interview station was approached to take




part in the survey, if eligible. If the selected person does not fulfil the criteria or refused to

participate, the following person passing the station was approached. The interview took

approximately 15-20 minutes to complete. All respondents received a token for participating

in the survey. The questionnaire used in the survey was adapted from Woodstock, Ontario,

Canada outdoor smoking ban and from the International Tobacco Control Policy (ITC)

Smoke Free Evaluation. Questions were selected according to the objectives of Smoke-Free

Melaka. The original questionnaire was developed in English and translated into local Malay

language. The developed questionnaire was validated through Delphi Method process (a

panel of experts in the field of tobacco control particularly smoke free evaluation) and pilot

testing of the questionnaire was conducted with 30 respondents prior to the survey. Two

versions of the questionnaires were available: Malay and English.

Measures

Demographic Characteristic

Demographic characteristic variables assessed included gender, age group, race, level

of education, presence of children at home and smoking status. In this study, age was

generated in years and then grouped into one of the following four categories, 1) 18 to 24

years old, 2) 25 to 39 years old, 3) 40 to 54 years old and 4) 55 years old and above while

level of education were categorized as primary, secondary and tertiary. Respondents were

considered smokers if they had smoked 100 or more cigarettes or other tobacco products in

their life and smoked at least once a week.

Awareness of advertisement of Smoke-Free Melaka

Awareness of advertisement of the SFMC was assessed using the following

questions: (1) in the last 6 months, have you heard or seen anything about the SFMC

campaign? and, (2) in the last 6 months, have you noticed a Smoke-Free Melaka

advertisement, or, information on the dangers of smoking, or quit smoking messages from




the radio, posters/signage, billboards/digital billboards, newspaper/magazines, in shop/stores

windows or inside shop/stores, on pubic vehicle or printed on T-shirts. Both of the questions

required a: “Yes, I have seen”, “No, I have not seen” or “Never heard anything”. If the

answer is, “Yes, I have seen”, the respondent was marked for corresponding questions and

summed in total to produce an index score (0-9), the composite measure of having the

knowledge about SFMC policy (independent variable). The distribution of the index was

very highly skewed, then recoded into a dichotomous item by median split (median=6), “no”

(score<6) and “yes” (>=6) for use as outcome.

Discussion about Smoke Free Melaka city policy among family or friends

Discussion about Smoke Free Melaka among family or friends was assessed with the

question: ‘Has any of this advertising and campaign led to discussion on SFMC among your

family or friends’. This question had a ‘yes’ and ‘no’ option.

Perception regarding norms of smoking

Perception regarding norms of smoking was measured with the question ‘Has this

advertising and campaign made smoking less socially desirable’. This question consists of

three responses; 1) Yes, a little, 2) Yes, a lot, and, 3) No, not at all. This variable was recoded

into a dichotomous outcome variable; “Yes” (a little and a lot) and “No” (No, not at all).

Policy enhanced smoke-free home and smoke free private vehicles

Smokers were asked to describe smoking inside their homes and vehicles respectively

after the implementation of smoke-free policy by the Melaka state government. These

questions had three response options; 1) smoking is not allowed, 2) smoking is allowed only

in some areas/vehicles and 3) no rules or restrictions. Response of “smoking is not allowed”

was indicated as “positive reaction” and response for “smoking is allowed only in some

areas/vehicles” and “no rules or restrictions” were recoded as “negative reaction”. These

dichotomous variables were treated as separately outcomes in this study.




Statistical analysis

SPSS 18 was used for all analyses. McNemar test were applied to see the difference

of attitudes among people in Melaka prior and after implementation of the policy. Univariate

and multivariate were applied in the study to test the association. Odd ratio and 95% CI were

computed for each corresponding variables. P value less than 0.05 was considered as

statistically significant.

Results

In total, 1,039 respondents were interviewed in this study (Appendix 1). Overall,

76.7% of them were male and aged between 25 to 39 years (36.3%) followed by 18 to 24

years (34.6%) and 45 to 54 years (20.0%). Majority of the respondents were of secondary

(57.5%) and tertiary of education level (33.5%). 57.8% of respondents were reported as

smokers whereas 42.2% were non-smokers. Respondents were predominantly permanent

resident of the state (68.1%), visitors 24.0% and temporary residents 7.9%. Overall,

respondents (94.5%) reported that they have seen or heard something about the Smoke-Free

Melaka campaign in the last six months, mostly from posters/signage (92.5%),

billboards/digital billboards (77.0%), shop windows/inside of shops (73.8%),

newspaper/magazines (72.8%), on buses (63.3%) and radio (60.8%). The study also revealed

that advertising and campaign does not result in the topic being discussed among family or

friends (60.6%) but majority said it made smoking less socially desirable (70.5%). After the

implementation of the SFMC, more than 50% of the respondent said that smoking was not

allowed inside their homes (55.1%) and vehicle (63.0%). Univariate and multivariate tests

for association between demographic characteristic and awareness of the SFMC campaign

and advertisement showed that among the demographic factors examined, race, level of

education and status of residency were found to be associated with noticing the campaign and

advertisement (Appendix 2). Logistic regression analysis showed that there was an




association between being aware of the SFMC campaign and advertisements and discussions

with family and friends (Appendix 3). Being aware of the SFMC campaign and

advertisement was significantly and positively associated with the desire to make homes and

vehicles smoke free (Appendix 4). Implementation of the policy also resulted in significantly

higher number of smokers committing to not smoking in the many of the situations listed

below: if non-smokers are present (from 44% to 60%) , if a non-smoking family member is

present (from 67% to 77%) , if an older non-smoking person is present (from 69% to 78%) ,

if a policy officer or by-law officer is present (83% to 87%), if other smokers are present

(from 14 to 27%) and if there is visible signage reminding you that it is a smoke-free area

(from 70% to 75%). The number of smokers not smoking in the presence of children

continues to be high before and after (81-83%) the implementation of this policy (Appendix

5).

Discussion

This is the first study conducted in Malaysia to examine the impact of the SFMC

Project in particular Melaka on the awareness, perception, attitudes and behavior of its

people and visitors; and to evaluate the association between awareness of the policy with

perception on the social desirability of smoking and attitude towards smoking in adults. In

this study, the awareness of the SFMC project was very high, with most respondents noticed

the message in various media channels. The most frequent channel where advertisement

caught their attention was from posters or signage followed by billboards/digital billboards,

shop windows/inside of shops, newspapers/magazines, on buses, radio and trishaws.

Respondents also noticed information printed on T-shirts worn by people in Melaka. This

finding suggests that the project was very well promoted and supported by the people. In

addition, local residents, Malays and those that have higher education seem to be more

sensitive to the message. While it is expected that the local residents tend to be more aware




about the project because they frequent or pass through these places more frequently, a large

proportions of non-resident and foreign visitors were also aware of this project, again

suggesting that the project have been very well promoted and executed. Regarding those that

have higher education being more aware of the project, there are research to suggest that

media campaigns are more effective among higher educated group (Niederdeppe, Kuang,

Crock, & Skelton, 2008) and that this group learnt more from the media than the less-

educated group (Tichenor PJ, 1970).

Awareness of this SFMC project has also been found to lead people to discuss among

their family and friends. This finding is in agreement with existing theories and empirical

research findings that describe the role of media in promoting interpersonal discussions about

smoking with such discussions being seen as a positive developmental steps towards

changing smokers’ attitude and behavior (Wakefield M, Flaty B, & Nichter M et al, 2005).

The project also have brought about changes in the thinking of people that smoking is not

socially acceptable. This finding is consistent with that of a study conducted in

Massachusetts, in the US, where strong smoke-free regulations were associated with

smokers’ perceptions that smoking was socially unacceptable (Albers, Siegel, Cheng, Biener,

& Rigotti, 2007). It has also been suggested that smoke free policies do change the perceived

norms related to smoking in a community, making smoking less socially acceptable (Levy &

Friend, 2001). The study also showed SFMC project has an effect on both implementation of

smoke-free inside homes and vehicles. These results are consistent with previous studies

indicating exposure to smoke-free policies in some public places has led smokers to institute

voluntary smoke-free home policies (Borland, et al., 2006) and another study in New Zealand

where 76% adult smokers disagreed that it is “okay” to smoke around non-smokers inside

cars even when there are windows down (Gillespie, Milne, & Wilson, 2005). This finding

suggests that awareness about harmful effects of smoking generated through campaign such

https://www.researchgate.net/publication/7027981_Determinants_and_consequences_of_smoke-free_homes_Findings_from_the_International_Tobacco_Control_ITC_Four_Country_Survey?el=1_x_8&enrichId=rgreq-f4f882da-a373-42c0-8b77-dc187da70f84&enrichSource=Y292ZXJQYWdlOzIzMzgzMjYxODtBUzoxMDEyNDY5MjkyMTEzOTZAMTQwMTE1MDU1NzI1Mw==




as the SFMC campaign/advertisement can be an important factor that pushes people to want

to implement smoke-free homes and vehicles. Another important result of the SFMC project

was the findings that there is significant increase in the number of smokers who would take

effort not to smoke at all social settings. This finding is partly in agreement with the

Wellington study where 51% of the respondents did not smoke around children and a further

17% smoked less when they were around children (Al-Delaimy, Luo, Woodward, &

Howden-Chapman, 1999).

Conclusion

This study provides further evidence in support of the anticipated effects of

implementation a smoke free project particularly with respect to the protection of people

from secondhand smoke. Even though the SFMC project has just started over a period of less

than 3 years, we have started to see the changes that happen to the people who are exposed to

the project either directly as residents or indirectly as visitors. Clearly, we see a change in

perception, attitude and behavior both non-smokers and smokers in support of this initiative.

References

Al-Delaimy, W., Luo, D., Woodward, A., & Howden-Chapman, P. (1999). Smoking

hygiene: a study of attitudes to passive smoking. N Z Med J, 112(1081), 33-36.

Albers, A. B., Siegel, M., Cheng, D. M., Biener, L., & Rigotti, N. A. (2007). Effect of

smoking regulations in local restaurants on smokers' anti-smoking attitudes and

quitting behaviours. Tob Control, 16(2), 101-106.

Bergen, A. W., & Caporaso, N. (1999). Cigarette smoking. J Natl Cancer Inst, 91(16), 1365-

1375.

Borland, R., Yong, H. H., Cummings, K. M., Hyland, A., Anderson, S., & Fong, G. T.

(2006). Determinants and consequences of smoke-free homes: findings from the

International Tobacco Control (ITC) Four Country Survey. Tob Control, 15 Suppl 3,

iii42-50.

Food Act 1983 (2004). Control of Tobacco Product Regulations (CTPR) Malaysia.




Gillespie, J., Milne, K., & Wilson, N. (2005). Secondhand smoke in New Zealand homes and

cars: exposure, attitudes, and behaviours in 2004. N Z Med J, 118(1227), U1782.

IARC (2007). Methods for Evaluating Tobacco Control Policies (Vol. 12). Lyon, France:

International Agency for Research on Cancer.

Levy, D. T., & Friend, K. (2001). A framework for evaluating and improving clean indoor air

laws. J Public Health Manag Pract, 7(5), 87-96.

Malaysia (2011). Global Adult Tobacco Survey (GATS) Malaysia 2011. Malaysia: Ministry

of Health Malaysia, Institute of Public Health, Center for Disease Control and

Prevention, World Health Organization.

Michael Eriksen, J. M., Hana Ross, (Ed.). (2012). The Tobacco Atlas: Atlanta, Georgia, USA

: American Cancer Society, Inc.

Niederdeppe, J., Kuang, X., Crock, B., & Skelton, A. (2008). Media campaigns to promote

smoking cessation among socioeconomically disadvantaged populations: what do we

know, what do we need to learn, and what should we do now? Soc Sci Med, 67(9),

1343-1355.

Tichenor PJ, D. G., Olien CN (1970). Mass media flow and diffrential growth in knowledge.

Public Opin Q, 34, 70-159.

U.S. Department of Health and Human Services (2004). The Health Consequences of

Smoking: A Report of the Surgeon General.

Wakefield M, Flaty B, & Nichter M et al (2005). Role of media in influencing trajectories of

youth smoking (Manuscript under review by Drug and Alcohol

Dependence).Unpublished manuscript.




Appendix 1

Table 1.0: Sample characteristic of respondents

VARIABLES PERCENTAGE

(%)

Gender (N=1039)

Male

Female

76.7%

23.3%

Age Group (N=1039)

18-24 years

25-39 years

40-54 years

More than 55 years

34.6%

36.3%

20.0%

9.0%

Race (N=1038)

Malay

Chinese

Indian

Other specify

76.4%

17.2%

4.2%

2.1%

Level of Education (N=1037)

Primary

Secondary

Tertiary

9.0%

57.5%

33.5%

Residency status (N=1037)

Resident

Visitor

Temporary resident

68.1%

24.0%

7.9%

Smoking status (N=1039)

Non Smoker

Smoker

42.2%

57.8%

Having children below than 18 years at home (N=1035)

No

Yes

50.8%

49.0%

Seen or heard anything about Smoke Free Melaka Campaign in

the last six months (N=1030)




No

Yes

5.5%

94.5%

Noticed Melaka Smoke Free advertisement or information that

talks about the dangers of smoking,

or encourages quitting

On posters/signage (N=967)

On billboards/digital billboards (N=960)

On shop windows/Inside shops (N=951)

On newspaper/magazines (N=938)

On side buses (N=928)

On radio (N=927)

On t-shirts (N=943)

On trishaw s (N=866)

92.5%

77.0%

73.8%

72.8%

63.3%

60.8%

32.0%

27.6%

Has any of this advertising and campaign led to discussion

amongst your family or friends about Smoke-free Melaka?

(N=954)

No

Yes

60.6%

39.4%

Has this advertising and campaign made smoking less socially

desirable? (N=973)

Yes, a little

Yes, a lot

No, not at all

56.8%

13.7%

29.5%

Which of the following best describes smoking inside your

home? (N=1034)

No rule/allowed in some indoor areas

Smoking is not allowed in any indoor area

44.9%

55.1%

Which of the following best describes smoking inside your

vehicle? (N=992)

No rule/allowed in some vehicles

Smoking is not allowed in any vehicles

37.0%

63.0%

Appendix 2




Table 2: Logistic regression results showing association of demographic characteristic with

noticing Smoke Free Melaka campaign and advertisement

Noticing of Smoke Free Melaka

Campaign and advertisement

PREDICTORS

Univariate

Adj OR

(95% CI)

Multivariate

N=947

Adj OR (95% CI)

Demographic characteristic

Gender

Female

Male

N=1030

Ref NS

1.21(0.90,1.62)

Ref NS

0.89(0.60,1.33)

Age group

18 to 24

25 to 39

40 to 54

More than 55

N=1030

Ref NS

0.99(0.74,1.33)

1.14(0.81,1.61)

0.73(0.46,1.16)

Ref NS

1.08(0.78,1.48)

1.37(0.92,2.06)

0.88(0.50,1.52)

Race

Malay

Others

N=1029

2.42(1.80,3.26)

Ref****

2.82(2.03,3.92)

Ref***

Level of education

Primary

Secondary

Tertiary

N=1029

Ref**

2.25(1.43,3.53)***

1.07(1.19,3.05)**

Ref*

1.90(1.13,3.18)**

1.99(1.12,3.52)**

Have children under 18 at

home

No

Yes

N=1026

Ref NS

1.001(0.78,1.29)

Ref NS

0.85(0.64,1.12)

Status of smoking

Non Smoker

Smoker

N=1030

Ref NS

0.80(0.63,1.03)

Ref NS

0.71(0.50,1.00)

Residency

Resident

N=1028

1.71(1.08,2.71)*

1.67(1.02,2.74)*

0.35(0.20,0.60)




Visitor

Temporary resident

0.41(0.24,0.68)**

Ref***

Ref***

Appendix 3

Table 3: Logistic regression results showing the association of noticing Smoke Free Melaka

campaign and advertisement with discussion with family and friends and perception

regarding norms of smoking

PREDICTORS

Discussion with family and friends Perception smoking less socially

desirable

Univariate

Adj OR

(95% CI)

Multivariate

N=947

Adj OR (95% CI)

Univariate

Adj OR

(95% CI)

Multivariate

N=1022

Adj OR(95% CI)

Noticed Smoke Free

Melaka

Campaign/Advertisement

N=954

1.28(1.19,1.37)*** 1.21(1.12,1.31)***

N=965

1.04(0.99,1.11) NS

1.05(0.98,1.12) NS

Note: CI=confidence interval; OR=Odd ratio; *p< 0.005, **p<0.001, ***P<0.001

Adjusted odds ratio for the other variables in the table plus the following variables not

reported in the table: level of education.




Appendix 4

Table 4: Results showing the association of noticing Smoke Free Melaka campaign and

advertisement with policy enhanced smoke free home and smoke free private vehicles

PREDICTORS

Implementation smoke free inside

home

Implementation smoke free inside

vehicle

Univariate

Adj OR

(95% CI)

Multivariate

N=891

Adj OR

(95% CI)

Univariate

Adj OR

(95% CI)

Multivariate

N=854

Adj OR

(95% CI)

Noticed Smoke Free Melaka

Campaign and

Advertisement

N=1025

1.06(1.01,1.12)**

1.09(1.01,1.18)** N=983

1.11(1.05, 1.174)***

1.19(1.09,1.30)***

Perception smoking less

socially desirable

Yes, a little

Yes, a lot

Not, at all

N=970

1.48(1.11,1.97)**

2.30(1.49,3.54)***

Ref ***

1.41(1.03,1.92)

1.92(1.20,3.09)

Ref*

N=932

1.40(1.04,1.89)*

2.12(1.34,3.37)**

Ref**

1.29(0.92,1.81)

1.44(0.85,2.46)

Ref NS

Discussion with family or

friends

No

Yes

N=950

Ref **

1.38(1.06,1.80)**

Ref NS

1.28(0.95,1.72)

N=910

Ref ***

1.69(1.28,2.24)

Ref *

1.51(1.09,2.09)*

Note: CI=confidence interval; OR=Odd ratio; *p< 0.005, **p<0.001, ***P<0.001

Adjusted odds ratio for the other variables in the table plus the following variables not

reported in the table: gender, race, level of education and having children below than 18

years at home.




Appendix 5

Table 5: Reported attitude of smokers in different social settings before and after

implementation of Smoke Free Melaka City Policy

VARIABLES

Before implementation

of Smoke Free Melaka

city policy

N (%)

After implementation

of Smoke Free Melaka

city policy

N (%)

P

ValueMC

If non-smokers are present

N=595

263 (44.2)

N=594

354 (59.6)

P=0.00***

If children are present

N=595

482 (81.0)

N=599

497 (83.0)

P=0.305NS

If a non-smoking family

member is present

N=594

397(66.8)

N=597

458 (76.7)

P=0.00***

If an older non-smoking

person is present

N=594

408 (68.7)

N=593

464 (78.2)

P=0.00***

If a policy officer or

bylaw officer is present

N=586

485(82.8)

N=596

516 (86.6)

P=0.008**

If other smokers are

present

N=596

85 (14.3)

N=600

159 (26.5)

P=0.00***

If there is visible signage

reminding you that it is a

smoke-free area

N=592

409(69.1)

N=596

446 (74.8)

P=0.006**

Note: The reported responses was based on those who answered as “would not smoke”,MC

McNemar test, *p< 0.005, **p<0.001, ***P<0.001

impact of smoke free melaka city project on perception, attitude and behaviour of people in melaka

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