Effects of Ramadan environment on nicotine dependence among Malay male smokers at a municipal council, Selangor, Malaysia

Introduction: Nicotine dependence is one of the major issues that are causing massive failure in the effort to stop or quit smoking. Various strategies and preventive methods have been planned and implemented, but smoking is still a major public health issue in Malaysia. Fasting during Ramadan is one of the major challenges for smokers to abstain from smoking. Objective: The aim of this study is to identify the effect of Ramadan environment on the nicotine dependence of the smokers who work at Majlis Perbandaran Subang Jaya (MPSJ), Selangor. Methodology: The study was conducted from June to August 2015 as the quasi experimental; one-group pretest-posttest study design to evaluate the effect of Ramadan environment on nicotine dependence among a group of male smokers who work at MPSJ. The respondents for this study were selected by using systematic sampling method. Both nicotine dependence self-reported measurement and biomarker measurement were used which were FTND and saliva cotinine biomarker. The data was collected three times which were one week before Ramadan, 21 days of Ramadan, and 21 days after Ramadan. The FTND questionnaire used in this study was already translated into Bahasa Malaysia and validated from previous study. The saliva cotinine were measured by using SalivaBio oral swab (SOS) and cotinine biomarker research salivary assay kits and protocols by Salimetrics with the sensitivity of 0.15ng/ml. Data analysis was conducted by using repeated measure One-way ANOVA, paired t-test, Pearson correlation, simple linear regression, Chi square test, Fisher’s exact test, and logistic regression by using IBM Statistical Package for the Social Sciences version 22. All hypothesis tests were two-sided and level of significance is set at 0.05. Results: A total of 61 Malay, Muslim, male and current smokers were recruited. The mean ± SD age was 32 ± 6.6 years old. Most respondents have good level (70.5%) of knowledge on environment related smoking behaviour. By using paired sample t-test, the result of the study found that there is a significant positive changes of FTND score from before to during Ramadan (t (60) = 3.47, p = 0.001) and also from before to after Ramadan (t (60) = 3.25, p = 0.002). Similarly, there is also a significant positive changes in the saliva cotinine level from before to during Ramadan (t (60) = 3.66, p = 0.001). Factors that are associated with the changes of FTND are marital status (p= 0.017 & 0.035), level of attitude (p= 0.031), educational level (p= 0.023), and employment position (p= 0.020). Marital status (p= 0.044) is the only factor that is associated with the changes of saliva cotinine. The predictors of changes in FTND are marital status (AOR= 4.871, 95% CI: 1.160, 20.444), educational level (AOR= 3.523, 95% CI: 1.081, 11.486) and level of attitude (AOR= 3.250, 95% CI: 1.094, 9.651). Conclusion: Majority of the respondents have positive changes in the nicotine dependence during Ramadan. Marital status, educational level and level of attitude are the significant predictor of nicotine dependence changes. This information should be used as golden opportunity to support the smoker in quitting smoking through smoking cessation programs during Ramadan.

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