Outcome and predictors for smoking cessation in a quit smoking clinic

Introduction Smoking is one of the addiction problems that needs an effective intervention. Smoking cessation studies have shown the promising result, but the central issue was to prevent relapse. A retrospective cohort study was conducted at Quit Smoking Clinic in Klinik Kesihatan Tanglin, Kuala Lumpur to determine the outcome and predictors of smoking cessation. Methods A cohort of 770 smokers attended the clinic between the year 2008 and 2015 was selected through simple random sampling. Smokers were defined as current smokers while smoking abstinence is defined as cessation for more than 6 months and relapse as any smoking episode even a puff since the quit date. Results The majority were Malays, Muslims and had at least secondary education. The mean age of smoking initiation was 17.6 years old. The majority of the respondent smokes between 11 to 20 sticks per day and had a higher nicotine dependence score (43.0%). The smoking cessation outcome was good with 52.5% of the respondent abstained from smoking at 6 months. The predictors for smoking cessation were numbered of the quit attempt (1 to 10 times) (AOR = 1.582, 95% CI = 1.012-2.472) and pharmacotherapy (aOR = 0.711, 95% CI=0.511-0.989). Conclusions More frequent follow-up was essential during the first 6 month period to enhance not only medication compliance but also a motivational aspect to smokers to maintain cessation. Emphasis should also be made for smokers who make first quit attempt

Systematic review on the effectiveness of using Carbon monoxide measurement in smoking cessation intervention

Introduction:Carbon monoxide measurement is one of the biomedical risk assessments in smoking cessation. With the advancement in medical devices, risk assessment among smoker using carbon monoxide can be an effective intervention for quit smoking. A systematic review was conducted on the effectiveness of using carbon monoxide measurement in smoking cessation intervention. Material and methods:A systematic review and narrative synthesis were done using PRISMA guideline. A broad database search on English literature was conducted including Medline, PubMed, Scopus and Science Direct from 2008 till 2017. Additional studies were also searched through snowballing technique by searching the bibliographies of selected studies. Five studies met the criteria with two studies were done in clinical settings while the other was done at population settings. The studies were conducted in the United States of America, United Kingdom and South Korea. All study were two-arm randomized controlled trials with variation in the outcome measurement mainly intention to quit, quit attempt and smoking abstinence. There was also variation in the duration of follow up ranging from 1 week to 12 months. Results:Only three studies found statistically significant increased in motivation or intention to quit smoking but only at 1 month follow up. All five study found no significant difference in frequency of quit attempt or smoking abstinence. Most of the studies recruited participants based on voluntary participation thus limiting the generalizability of the results. Conclusions:The present review has found limited studies on the effect of carbon monoxide measurement intervention forquit smoking. It may only be beneficial at the motivational level and not translated into behaviouralchanges. However, the effect too was short term and not sustained in the long term

A cluster randomised controlled trial on effectiveness of carbon monoxide measurement feedback among college smoker : a study protocol

Introduction: For the last 30 years, tobacco smoking has continued to be the leading cause of premature deaths in Malaysia. Majority of the smokers in Malaysia are at the pre- contemplation and contemplation stages. Therefore, for the purpose of increasing smoking cessation among this group, the strategies that motivate them to quit smoking have to be reviewed. Objective: This study aims to evaluate the effectiveness of carbon monoxide measurement feedback and the standard brief motivation adopted to encourage the smoker to quit. Methods: A single-blind, cluster randomised controlled trial was conducted at ten tertiary colleges in Selangor. The study recruited young adult smokers at the pre- contemplation and contemplation stages. The subjects in the control group received a standard brief motivational strategy. On the other hand, the intervention group received additional carbon monoxide measurement and a motivational feedback module. A follow up was conducted at the first, third and sixth month to measure changes in smoking cessation stage. Subsequently, the secondary outcomes of a mean number of cigarette consumption and quit smoking attempt were analysed. A total of 160 subjects were required to detect the expected difference of 17% in primary outcomes between the groups. This study utilised Generalised Estimating Equations (GEE) to handle the clustering effects. Conclusion: Biomedical risk assessment feedback mechanism by using carbon monoxide is a promising aid to motivate the smoker to quit. This mechanism is a relatively easy, quick and non-invasive technique. Thus, it can be utilised as a reinforcement relating to the harmful effect of smoking. Besides, it can also increase the smokers’ self- efficacy and decisional balance to adopt behavioural changes

Impact of nutritional intervention on the weight of B40 children in Selangor

Nutritional status is a significant measure of the overall health of the population. Among children of the most vulnerable groups to have malnutrition are those in the B40 group, with Selangor being the most populous state that has these vulnerable populations. This study aims to assess the impact of nutrition intervention in reducing underweight prevalence among children in the Selangor B40 group. The data was collected from June 2022 until October 2022 from 500 children aged 1 to 6 years old. Intervention includes a monthly food pack consisting of specialised formula milk and multivitamins alongside nutrition counselling Monthly weights were taken for 5 months using the SECA weight scale model 874 and it was monitored using the WHO AnthroPlus. The majority of the respondents were male (51.3%). Baseline results showed 20.6% underweight respondents with 14.4% moderately underweight and 6.2% who were severely underweight. Mean weight increment was observed the highest during the fifth month with 1200g, followed by 510g, 450g, and 110g for the fourth, second, and third month, respectively. A declining prevalence of underweight was observed by the fifth month (10.9%) with 9.2% moderately underweight, 1.7% remains severely underweight and 9.7% children progressing to normal weight. By giving nutrient supplementation, it helps to improve the weight of these children. However, other factors that may contribute to undernutrition such as maternal diet, food insecurity, nutrition education and complications from a variety of diseases should not be overlooked

Intracluster correlation coefficient in a college-based cluster randomised controlled trial

INTRODUCTION: Most of the public health research is conducted at the population level. More study has utilized cluster design in which a group unit is randomized instead of individuals to avoid contamination effect and more practical. However, not many studies publish their Intracluster correlation coefficient (ICC) which is the measure of the relatedness of clustered data. It is important to report the ICC that can be used to calculate effective sample size in future cluster study. Here, we aim to report the ICC from a smoking intervention among young adult. METHODS: Based on a college-based quit smoking intervention, a single level model – student nested within colleges was used. There are 10 cluster which is the community college and 16 smokers within each college. The Intracluster correlation coefficients were measured for three outcomes namely motivation to quit smoking, number of cigarette smoke per day and number of quit attempts. The ICC was measured in R studio using ICCbin package. For the binary outcome ICC was measured using variance components from the ANOVA method and Smith confidence limit equation. RESULTS: For the proportion of motivation to quit smoking, the ρ (rho) was 0.026 (95%CI: 0.00, 0.11), mean number of quit smoking, ρ=0.013 (95%CI: 0.00, 0.08) and mean number of quit attempts, ρ=0.01 (95%CI: 0.00, 0.07). DISCUSSION: The ρ in this study was small and almost similar to other reported study. The researcher must calculate and report the ICC to enable others to use in future research

Environmental influence and intention to quit smoking among college students

INTRODUCTION: Secondhand tobacco smoke is a known carcinogen and shown positive association with smoking status, susceptibility and cessation. Smoke free environment policy seem to reduce this exposure and influence intention to quit and frequency of quit attempts. Despite smoke free policy, smokers are still exposed to second hand smoke and this might influence their smoking behaviour and cessation. OBJECTIVES: To examine the association between environmental tobacco smoke exposure with intention to quit smoking among young adult in college with smoke free policy. METHODS: Data were drawn from a cluster based randomised controlled trial in 10 government colleges Selangor. Baseline characteristics of 160 college smoker were measured using adapted questionnaire. Intention to quit was measured using Transtheoretical Model and environmental influence of tobacco smoke exposure. RESULTS: The response rate was 100% (160 students) with majority of the smoker were male (99.4%), single (100%), of Malay ethnicity (94.4%) and Muslim (95.6%). Most of them are in pre-contemplation stage where they do not have any intention to quit (65.6%). On environmental influence, at work or college environmental exposure, majority were exposed between 1 to 2 hours (36.9%) and 3 to 8 hours (40.6%). On exposure at home or hostel, majority were exposed between 1 to 4 hours (44.4%) and 5 to 14 hours (21.9%). On friend's exposures, majority have most of their friend smokers (68.1%). We found no statistically significant association between environmental influence and intention to quit smoking. CONCLUSION: Although we found no relationship, future research should examine the pathway between environmental influence and smoking behaviour

Enviromental influence and intention to quit smoking among college students

Introduction: Secondhand tobacco smoke is a known carcinogen and has shown positive association with smok- ing status, susceptibility and cessation. Smoke free environment policy seem to reduce this exposure and influence intention to quit and frequency of quit attempts. Despite having a smoke free policy, smokers are still exposed to second hand smoke and this might influence their smoking behaviour and cessation. The objective of this study was to examine the association between environmental tobacco smoke exposures with intention to quit smoking among young adults in college with smoke free policy. Methods: Data were drawn from a cluster based randomised controlled trial in 10 government colleges in Selangor. Baseline characteristics of 160 college smokers were mea- sured using adapted questionnaire. Intention to quit was measured using Transtheoretical Model and environmental influence of tobacco smoke exposure. Results: Majority of the smokers were male (99.4%), single (100%), of Malay ethnicity (94.4%) and Muslim (95.6%). Most of them are in pre-contemplation stage where they do not have any intention to quit (65.6%). On environmental influence, at work or college environmental exposure, majority were exposed between 1 to 2 hours (36.9%) and 3 to 8 hours (40.6%). On exposure at home or hostel, majority were exposed between 1 to 4 hours (44.4%) and 5 to 14 hours (21.9%). In terms of friend’s exposures, majority have most of their friends smoking (68.1%). We found no statistically significant association between environmental influence and intention to quit smoking. Conclusion: Although we found no relationship, future research should examine the pathway between environmental influence and smoking behaviour

A cluster randomised controlled trial on effectiveness of carbon monoxide measurement feedback among college smoker : a study protocol

Introduction: For the last 30 years, tobacco smoking has continued to be the leading cause of premature deaths in Malaysia. Majority of the smokers in Malaysia are at the precontemplation and contemplation stages. Therefore, for the purpose of increasing smoking cessation among this group, the strategies that motivate them to quit smoking have to be reviewed. Objective: This study aims to evaluate the effectiveness of carbon monoxide measurement feedback and the standard brief motivation adopted to encourage the smoker to quit. Methods: A single-blind, cluster randomised controlled trial was conducted at ten tertiary colleges in Selangor. The study recruited young adult smokers at the precontemplation and contemplation stages. The subjects in the control group received a standard brief motivational strategy. On the other hand, the intervention group received additional carbon monoxide measurement and a motivational feedback module. A follow up was conducted at the first, third and sixth month to measure changes in smoking cessation stage. Subsequently, the secondary outcomes of a mean number of cigarette consumption and quit smoking attempt were analysed. A total of 160 subjects were required to detect the expected difference of 17% in primary outcomes between the groups. This study utilised Generalised Estimating Equations (GEE) to handle the clustering effects. Conclusion: Biomedical risk assessment feedback mechanism by using carbon monoxide is a promising aid to motivate the smoker to quit. This mechanism is a relatively easy, quick and non-invasive technique. Thus, it can be utilised as a reinforcement relating to the harmful effect of smoking. Besides, it can also increase the smokers’ selfefficacy and decisional balance to adopt behavioural changes

Mental health mobile apps during Covid-19 Pandemic to evaluate stress level in Selangor

The COVID-19 pandemic has impacted negatively on public mental health. As a result, monitoring the level of the population mental health is a priority during crises. This study aims to measure stress during the COVID-19 pandemic in Selangor. Cross-sectional study was done using SELANGKAH apps, where users are Selangor citizens. Data was collected from September 2021 until March 2022. This app was initially used as contact tracing and mental health modules (SEHAT) were added, consisting of a validated Perceived Stress Scale (PSS-10) questionnaire. Out of 42072 SEHAT users, 6411 people had completed the questionnaire. Majority were female (53.6%), Muslims (79.6%), had formal education up to secondary (49.0%), low income (89.9%), and young and middle- aged adults (59.7%). Majority have a moderate stress (66.8%), while 23.3% and 9.9% are low and high levels, respectively. High stress is significantly associated with females, high education, younger age groups, and low monthly income. Several factors could have contributed to this throughout the COVID-19 pandemic, such as online learning, uncertainty on study duration, financial constraints and limited social interactions. Moreover, as an effect of prolonged pandemic and MCO, a surge in the number of job terminations has also affected the source of income, which contributed to high levels of stress among the general population. The level of stress in Selangor was high during the pandemic as an effect of MCO