Abstract:
The mix-methods was conducted to study the effect of cigarette promotional items towards with the social marketing. The pictorial health warnings (PHW) towards smoking behavior among teenagers in education institute were studied. The research areas were Chaing Rai, Sa Kaeo, Phetchaburi, Ubon Ratchathani, and Surat Thani. The teenagers were randomly selected by multi-stage sampling method. The cigarette promotional items shops in community, in tourist attraction, and places of amusement near education institute were selected by snowball techniques. The data were collected from 1,317 teenagers in research areas by using self-administered questionnaire. The depth interview was conducted among 6 of merchants who sale the cigarette promoting items in Phetchaburi province, and the cigarette promoting items were surveyed around the research area. The quantitative data were analyzed by using descriptive statistics and chi-square test. The qualitative data were analyzed by content analysis. The results show that about 26% of teenagers have ever seen the cigarette promotional item or the items that look like cigarette. The most seen of items were cloths (40.6%), keychain (40.2%), and ashtray (31.0%6), respectively. The most of selling places were flea market, shopping center, and temple festival. The reasons to buy were wanting to use, giving to someone, looking interested, and wanting to collect. The cloths was the most of collected items, followed by keychain. The reasons of collecting were favorite on items (77.8%6) and getting from someone in family (22.2%). About 70% of teenagers who have collected cigarette promotional items or the items that look like cigarette were bought items by themselves. About 93.1 96 of them have the low level of knowledge (Mean of knowledge score = 2.58, SD= 1.88). About half of them have high level of attitude towards on buying, collecting, and having the cigarette promotional items or the items that look like cigarette (Mean of attitude score = 56.74, SD= 13:34). Most of them felt fun, favorite, affordable, cheap and cool that the buying, collecting, and having the cigarette promotional items or the items that look like cigarette. It is the hobby. Among teenagers who were interested in and would like to buy the cigarette promotional items or the items that look like cigarette, about 52.396 of them had the high level of buying or collecting motivation. They would buy those items although it is expensive or illegal. The results also show that the buying, having and collecting the cigarette promotional items or the items that look like cigarette effects on the buying cigarette intention. The buying, having and collecting the cigarette promotional items or the items that look like cigarette made the feeling more curious and is more interested in cigarette (64.5%6). Moreover, the buying, having and collecting the cigarette promotional items or the items that look like cigarette effects on smoking intention. The buying, having and collecting the cigarette promotional items or the items that look like cigarette made the feeling want to smoke (59.6%6), brand recognizing (12.896), interesting (12.896) and cool (2.196). The results also revealed that income was association with the buying the cigarette promotional items or the items that look like cigarette (p=0.045). The teenagers who did not have allowance from parents had higher proportion of buying the cigarette promotional items or the items that look like cigarette than those having allowance from their guidance or working. The teenagers having behavior to buy the cigarette promotional items or the items that look like cigarette had the relationship with their smoking behavior (p=0.021). The teenagers who smoked or returned to smoke had higher proportions of buying the cigarette promotional items or the items that look like cigarette than non-smokers or quit. However, there was no relationship between collecting behavior and smoking behavior of teenagers. About 80%6 of teenagers have ever seen the pictorial health warnings (PHW) and labels health warning on cigarette pack. Among those, most of them had the high level of perception on the pictorial health warnings (PHW) and labels health warning on cigarette pack. The high level of perception in severity was found in teenagers who had ever seen the pictorial health warnings (PHW) and labels health warning on cigarette pack. (70.4%6) They knew that cigarette was the causes of premature death, harmful to smokers and other people and their self-images. The high level of perception in health risk was found in teenagers who had ever seen the pictorial health warnings (PHW) and labels health warning on cigarette pack. They knew that tobacco smoke is toxic to smokers and other people. The smokers were likely to have cancer in the future. The smokers had a bad image and smokers had a chance of developing respiratory disease. The moderate to level of perception in barrier was found in teenagers who had ever seen the pictorial health warnings (PHW) and labels health warning on cigarette pack. About 43.0% of them agreed that the pictorial health warnings (PHW) made them to perceive the burden of illness cost. About 6.296 of teenagers in education institute had ever smoked. The average time of smoking quit were 7.83 months with standard deviation 11.94 months. More than 80% of them was non-smoking. About 45.2%6 of smokers were smoking every days. The average number of cigarettes that smoked per day were 5.78 with standard deviation 3.82. Another 54.8% of smokers were smoking in some days. The average number of cigarettes that smoked per day were 3 with standard deviation 2.19. More than 7096 of smokers had smoking behavior before recruited in the current school. The average age of first smoking was 14.12 years with standard deviation 3.29 years. The minimum of age at first smoking was 7 years. The most smoked cigarette (83.2%). About 50% of smokers had paid for cigarettes less than 500 baht/month. The most of them did not buy cigarette in pack, but they would buy separately by the cigarette numbers (65.4%6). The motivation of smoking were following smoking teachers (47.8%6), superstars and singers (46.496), family members (42.096) and needs of social acceptance (32.196), respectively. The motivation of intention to smoking quit were health problem (22.5%6) followed by the effects of the pictorial health warning (19.7%6) and disgusting (17.4%6). About half of smokers revealed that there was a plan to smoking quit by themselves. About 14.96 of smokers had the idea to smoking quit in next few days (about 20.56 days).About 20% of smokers had ever think to smoking quit but they could not do (about 14.12 months in the pass). About 36.11% of teenagers in educational institute agreed that the pictorial health warnings effects to intention to buy the cigarette. The reasons were feeling fear when see the picture (57.696) followed by knowing the harmful of smoking (24.396), do not want to buy (9.9%), and risks toward diseases (6.696). About 39.996 of teenagers indicated that the pictorial health warnings effects to intention of smoking. The pictorial health warnings effects made those teenage feeling fear (40.4%6), following by knowing the harmful of smoking (26.9%6), do not want to buy (21.6%6), and awareness of their health (11.5%6). Moreover, the pictorial health warnings (PHW) and labels health warning on cigarette pack were found the significant association with the smoking behaviors of teenagers. (p-value< 0.001) The perception on problems, perception on barriers and perception on benefit had the relationship with the smoking behavior among teenagers. (p-value < 0.001) The teenagers having moderate and high levels of perceptions had higher proportion of non-smoking behavior than those having low levels of perception. The surveys of cigarette promotional items were conducted in 27 areas in 5 target provinces. There found cigarette promotional items in 15 areas from all area (55.6%6). The most of cigarette promotional items in the shops were hat, T-Shirt, lighter, cigarette case, lucky draw, keychain and mobile case. Most of them were second hand items and were imported from international, and some items were copied items produced in Thailand. "Malboro" was the most of brand that founded for cigarette promotional items. The promotion campaign from produced cigarette company was to produce the cigarette promotional items and then distribute to distribution shops for giving to customers. The motivations of sale were due to customers needed to buy and merchant needed to sale. The other motivations of sale were due to these items were fashion and favorite. The in-depth interviewed concluded that most of merchant did not know about laws of tobacco control, Act of Tobacco control 1992. According to the pictorial health warnings on the cigarette pack, merchants revealed that they have ever seen. Some of them felt fear and some of them did not feel anything. Most of merchants had smoking behavior, and they do not intend to quit smoking. The suggestion from this study were that the laws about tobacco control should be forced and implemented. The laws of tobacco control should be educated and transferred to all stakeholders. Moreover, the surveillance system of importing the cigarette promotional items from international and online shopping should be aware. It could make the difficulty access among teenagers and could protect teenagers to recognize cigarette brands.
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