Nipapun Kungskulniti

Thailand has successfully forwarded Article 8, Protection from Exposure to Tobacco Smoke, of the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC). It achieved its 100% smoke-free goals in public places in 2010, next pursuing other bans in outdoor places to lower particulate matter air pollution (PM_2.5). Our aim was to expose the secondhand smoke levels in vehicles since SHS is a danger to everyone, but especially to children and youth. This is the first experimental study of its kind in Thailand. We measured PM_2.5 for 20 min under four conditions in 10 typical Thai vehicles, including commonly used sedans and small pickup trucks. We used an established protocol with two real-time air monitoring instruments to record PM_2.5 increases with different vehicle air exchange and air conditioning conditions. Monitoring was recorded in the vehicle’s front and back seats. The most common Thai ventilation condition is all windows closed with fan/air conditioning (AC) in operation because of Thai tropical conditions. Mean exposure levels were three and nearly five times (49 and 72 μg/m³) the 24 h WHO standard of 15 μg/m³ in the back and front seats, respectively. These high PM_2.5 exposure levels warrant action to limit vehicle smoking for public health protection.

Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.

Background: Tobacco companies and their associated businesses know that placement – where one can see and purchase their products – is critical to their success. Placement is one of the four fundamental Ps of marketing along with product, price and promotion. Placement includes identifying retail locations in important places such as in shopping districts, within neighborhoods, near schools, at beaches, and in parks. In Southeast Asia, counteracting tobacco company placement strategies that result in market penetration is essential to advancing the endgame, namely ending tobacco use. However, in Southeast Asia research on the placement of tobacco products has been limited. Objectives: We undertook to analyze how Philip Morris International (PMI) through its subsidiary Philip Morris Asia Inc. (PMAI), from the time the company entered Thailand’s market once it was forced open in 1990, developed its successful product placement strategies and tactics. Methods: We examined over 4,000 PMI and PMAI internal documents using an historical, iterative and thematic approach. We analyzed the most relevant and illuminating documents, particularly those in which PMAI discussed retailer supply, retailer acceptance and retailer cooperation. Results: Even before foreign tobacco brands were legally allowed to be sold in Thailand, PMAI was already doing customer research in Thailand. In 1989, PMAI conducted a study of potential Thai customers in which 24% of respondents’ lack of availability (i.e., product placement) was one of the main reasons for not smoking PMI’s products. Based on these findings, PMAI engaged in intensive internal efforts to address the placement barrier to gain share. PMAI placed considerable emphasis on “stimulating retail trade acceptance” by making payments to retailers who met agreed upon and contracted product sales targets. PMAI’s initial successes incentivizing Thai retailers by essentially buying prime retail space for placement of their brands, to crowd out local and other foreign brands, became the foundation of what evolved into a sophisticated program to make placement highly lucrative for retailers. Conclusion: PMAI viewed aggressive product placement as essential to success as a new entrant in Thailand, and their product placement strategies contributed substantially to capturing a large share of the market. Therefore, endgame strategies must focus on restricting product placement through surveillance of tobacco industry legal, investment and retailer actions and through stricter tobacco retailer licensing requirements and penalties.

Background: Smoking and exposure to secondhand smoke are leading causes of disease and premature death in low- and middle-income countries (LMICs), where over 80% of smokers live. Over 152 LMICs, including Thailand, have passed laws designating that indoor and outdoor public spaces should be smoke-free. Throughout LMICs, implementation of laws has been a persistent problem. We identified one activist in Thailand who developed his own highly effective strategy for ensuring implementation of smoke-free laws, and whose approach has potential for being a model for implementation activists in other LMICs. Objectives: We set out to describe the implementation activist’s strategy and impact, and to explore his perspective and motivations. Methods: We conducted in-depth interviews with the activist, reviewed video recordings and transcripts, and used narrative analysis to identify key themes and illuminating statements. Findings: In the implementation activist’s assessment, administrators and officials were not being held accountable for their responsibilities to enforce laws, resulting in low public compliance. The activist developed his strategy to first identify public places where no-smoking signs were not posted and/or where people were smoking; take photographs of violations and make notes; and file citizen’s complaints at police stations, submitting his photographs as evidence. The implementation activist documented over 5,100 violations of smoke-free laws throughout Thailand and reported violations to police. Often, police officers were unsure how to deal with his complaints, but when he educated them about the law, most undertook enforcement actions. The activist’s work has contributed substantially to creating smoke-free schools, sports facilities and parks. Conclusion: This implementation activist’s approach can be a model for preventing youth from using tobacco/nicotine, and preventing exposures to secondhand smoke and e-cigarette emissions. Based on his successes, we provide a list of elements that implementation activists can use to be effective, along with recommendations for policy and practice.

Migrant workers commonly face many health disparities when they relocate to a foreign work environment. Many workers migrating to Thailand are young unskilled workers from Myanmar. In this study, we examine factors associated with Myanmar migrant workers’ smoking status and characterized smoking-related knowledge, attitudes, and behavior in one seafood factory in Thailand. This descriptive study utilized person-to-person interviews among 300 Myanmar migrants in one seafood factory in Thailand, of which 94.3% were young males between 18 and 39 years of age. Results demonstrated that 90% were current daily smokers, over 90% smoked 30–60 times per month, and 95% spent less than 500 baht (US $16) per month on smoking. About 70% of current smokers had 6–10 friends who smoked, compared with 40% of non-smokers (chi-square, p-value ≤ 0.07). Among this sample of mainly male migrant workers, smoking is very common, in part driven through social contact, but levels of dependence appear relatively low. The results suggest potential intervention approaches to reduce high smoking prevalence among this population, such as targeting young males and addressing their concerns about negative attitudes by peers to tobacco use and the unhealthful exposures of women and children in their families and the larger community.

Thailand, like all nations, has a responsibility to initiate environmental actions to preserve marine environments. Low- and middle-income countries face difficulties implementing feasible strategies to fulfill this ambitious goal. To contribute to the revitalization of Thailand’s marine ecosystems, we investigated the level of tobacco product waste (TPW) on Thailand’s public beaches. We conducted a cross-sectional observational survey at two popular public beaches. Research staff collected cigarette butts over two eight-hour days walking over a one-kilometer stretch of beach. We also compiled and analyzed data on butts collected from sieved sand at 11 popular beaches throughout Thailand’s coast, with 10 samples of sieved sand collected per beach. Our survey at two beaches yielded 3067 butts in lounge areas, resulting in a mean butt density of 0.44/m². At the 11 beaches, sieved sand samples yielded butt densities ranging from 0.25 to 13.3/m², with a mean butt density of 2.26/m² (SD = 3.78). These densities show that TPW has become a serious problem along Thailand’s coastline. Our findings are comparable with those in other countries. We report on government and civil society initiatives in Thailand that are beginning to address marine TPW. The solution will only happen when responsible parties, especially and primarily tobacco companies, undertake actions to eliminate TPW.

How Thailand’s greater convergence created sustainable funding for emerging health priorities caused by globalization

The impact of secondhand smoke (SHS) on Southeast Asian children’s health has been assessed by a limited number of studies. The purpose of this study was to determine whether in Thailand, pre- and postnatal exposure to SHS is associated with acute lower respiratory conditions in young children.