Thai Journal of Health Education

Prevalence of E-Cigarette Use and Factors Associated with E-Cigarette Smoking Behaviors among Upper Secondary School Students in Pak Chong District, Nakhon Ratchasima Province

2025-09-11T16:50:46+07:00

The use of electronic cigarettes (e-cigarettes) among Thai adolescents has been rapidly increasing, while misconceptions regarding their harmful effects persist. This study aimed to investigate the prevalence of e-cigarette use and identify factors associated with such behavior, in order to provide evidence for public health policy and the development of prevention programs for adolescents. A cross-sectional analytic study was conducted among 330 upper secondary school students in Pak Chong District, Nakhon Ratchasima Province, in July 2025. Data were collected using a validated online questionnaire. Multiple logistic regression analysis was employed to determine associated factors, and the results were reported using Adjusted Odds Ratios (AORs), 95% Confidence Intervals (95% CI), and p-values.

The prevalence of e-cigarette use was 23.94%. Significant factors included parental occupation: students whose parents worked as daily laborers (AOR = 18.22; 95% CI: 2.03–163.47) or owned private businesses (AOR = 16.30; 95% CI: 1.43–185.29) were more likely to use e-cigarettes compared to those whose parents were government officers. Regarding attitudes, students with moderate (AOR = 0.39; 95% CI: 0.19–0.83) and high attitudes (AOR = 0.18; 95% CI: 0.06–0.49) were less likely to use e-cigarettes than those with low attitudes. Social influences also played a role: indirect media exposure (AOR = 0.41; 95% CI: 0.21–0.51), having peers who smoked (AOR = 2.92; 95% CI: 1.25–6.83), and having family members who smoked (AOR = 10.24; 95% CI: 4.53–23.17) significantly affected e-cigarette use.

In conclusion, the prevalence of e-cigarette use among students in this study was higher than the national average (16.5% in 2024). Family background, attitudes, and social influences were key determinants of e-cigarette use. These findings provide essential evidence to support school-based health promotion, strengthen family engagement, and inform policies to regulate adolescent access to e-cigarettes effectively.

Effects of Health Literacy Promotion Program on Self-Care Behavior and HbA1c Level in Patients with Uncontrolled Type 2 Diabetes People Receiving Services at the Chronic Disease Clinic, Kukaeo Hospital, KuKaeo District, UdonThani Province

2025-09-01T13:24:03+07:00

This quasi-experimental study employed a one-group pretest-posttest design to examine the effects of a health literacy promotion program on self-care behaviors and HbA1c levels among patients with uncontrolled type 2 diabetes mellitus attending the chronic disease clinic at Gu Kaew Hospital, Udon Thani Province. A total of 30 participants were recruited through consecutive sampling and participated in six program sessions over a 10-week period, with outcomes assessed at week 12. Research instruments included questionnaires on personal data, health literacy, self-care behavior, and records of HbA1C levels. Data were analyzed using descriptive statistics and paired t-tests at a significance level of 0.05.

The results showed that after participating in the program, participants had significantly higher overall and domain-specific health literacy scores, improved self-care behavior scores, and a statistically significant reduction in HbA1c levels from 11.43 ± 2.71% to 8.53 ± 1.45%, percentage a 2.90% decrease (95%CI = 2.29, 3.49; p-value < 0.001).

The program successfully enhanced participants’ health literacy, leading to improved self-care behaviors and better glycemic control. It is recommended that the program be implemented in similar settings to strengthen care systems for patients with type 2 diabetes.

Factors Correlated with COVID-19 Booster Vaccination Uptake among Parents of Children Aged 5-11 Years in Udon Thani Province

2025-08-09T12:22:44+07:00

The analytical cross-sectional study aimed to examine the baseline characteristics, level of knowledge and health belief model, the COVID-19 booster vaccination uptake among the parents of children aged 5-11 years in Udon Thani province, and its correlation. A total of 382 parents were selected using a multistage random sampling, with the sample size determined by the Krejcie and Morgan table. Data were collected from October 2022 to April 2023 using a questionnaire that included sections on baseline characteristics, COVID-19 knowledge, the health belief model, and booster vaccination status. Baseline characteristics, knowledge, and HBM levels were analyzed using descriptive statistics, presented as frequency, percentage, mean, and standard deviation. Simple and multivariable logistic regression analyses were conducted to identify factors associated with COVID-19 booster vaccination uptake.

The findings revealed that only 19.90% of parents had received a booster vaccine. The majority (62.04%) were female, with a mean age of 38.92 ± 10.35 years. Most parents showed high levels of COVID-19 knowledge and perceived severity; but also reported high levels of perceived barriers. Multivariable logistic regression identified gender (AOR=1.88: 95%CI=1.07- 3.31: p-value=0.022) and perceived severity (AOR=1.93: 95%CI=1.03-3.65: p-value=0.031) as statistically significant factors associated with COVID-19 booster vaccination uptake. The study suggests that health communication strategies should target male parents and emphasize the severity of COVID-19 to improve vaccine uptake and promote COVID-19 booster vaccine.

Factors Affecting the Household Solid Waste Management with Circular Economy Concept in Muang District at Nan Province

2025-10-24T08:28:46+07:00

This study aimed to determine factors influencing household solid waste management with the circular economy concept among residents of Thuem Tong Subdistrict, Muang District, Nan Province. The conceptual framework was based on the PRECEDE–PROCEED Model. The study sample comprised 334 household heads or their representatives in Thuem Tong Subdistrict. Data were collected using a structured questionnaire and analyzed through descriptive statistics and stepwise multiple regression analysis to examine relationships and predictive factors.

The results founded that the majority of the sample were male (51.5%) with a mean age of 41.55 years (S.D. = 10.12). The mean scores for knowledge, attitude, and participation were 10.83 (S.D. = 2.69), 52.51 (S.D. = 5.81), and 13.71 (S.D. = 4.65), respectively, with most sample demonstrating moderate levels at 46.7%, 72.2%, and 53.3%, respectively. The mean score for information perception was 6.56 (S.D. = 0.91), and the mean score for household solid waste management with the circular economy concept was 29.62 (S.D. = 5.35), with the majority scoring at a very good level of 74.6% and 78.1%, respectively. Knowledge, attitude, participation, and information perception collectively predicted household solid waste management with the circular economy concept among residents of Thuem Tong Subdistrict, Muang District, Nan Province, accounting for 35.9% (Adjusted R² = 0.359, F = 47.722, p < 0.001). The predictive equation is as follows: Z’ MA = 0.377 Z’PAR + 0.350 Z’IN + 0.130 Z’AT + 0.103 Z’KN

Therefore, this study concluded that knowledge, attitudes, participation, and information perception factors influence household solid waste management based on the circular economy concept among residents in Muang District, Nan Province. Together, these factors could predict 35.9% of the variance, reflecting that promoting people’s knowledge, understanding, positive attitudes, and continuous participation can enhance the effectiveness of household solid waste management.

Development of a Model to Promote Drowning Prevention Literacy among Caregivers and Children Aged 3–5 Years

2025-10-07T09:09:04+07:00

Drowning is a major threat to child health and a leading cause of premature mortality, despite being a preventable event. This research and development (R&D) study aimed to: (1) examine factors associated with drowning prevention in children aged 3–5 year, (2) develop a health literacy promotion model, and (3) evaluate the developed model’s effectiveness. The study was conducted in three phases. Phase 1 investigated drowning prevention factors among children aged 3–5 years using a researcher-developed questionnaire. Phase 2 developed the health literacy promotion model based on expert consultation and pilot testing. Phase 3 evaluated model’s effectiveness through a quasi-experimental design with 34 participants per group. The experimental group participated in a four-session program during four weeks. Data were collected using questionnaires. Descriptive statistics were employed to analyze general characteristics of participants. The Chi-square test was employed to examine the relationship between variables, while independent t-test, paired t-test and McNemar test were used to compare the results within groups and between the experimental and comparison groups.

The results of Phase 1 revealed that personal factors including education level, occupation, and income sufficiency, environmental factors and parental/caregiver factors were significantly associated with children’s drowning prevention skills (p < 0.05). Phase 2, the developed model consisting knowledge provision, demonstration, knowledge exchange, simulated scenarios, and practical training. Phase 3, the developed model was effective. The mean health literacy score of the experimental group increased from 11.53 to 15.09, significantly higher than that of the comparison group (p < 0.001). The children’s drowning prevention skills in the experimental group improved from 26.47% to 67.65%, better than those of the comparison group. Meanwhile, participants’ satisfaction with the developed model was reported to be at a high level (mean = 4.41, S.D. = 0.75). In conclusion, the health literacy promotion program for drowning prevention was found to be feasible and effective in enhancing caregivers’ health literacy and skills, as well as improving drowning prevention skills among children aged 3–5 years.

The Effect of a Protection Motivation-Based Program on Behaviors to Delay Renal Function Decline in Type 2 Diabetes Patients in Secondary Healthcare Units

2025-09-09T08:55:27+07:00

This quasi-experimental study aimed to investigate the effect of a disease prevention motivation program on renal function delay behaviors in type 2 diabetes patients at secondary healthcare facilities. The study utilized the Protection Motivation Theory (PMT) framework. The sample size was calculated using the formula for comparing the means of two independent groups (α = 0.05, 80% power factor) and adding a 10% loss margin, resulting in 34 participants per group. Systematic random sampling was used to select type 2 diabetes patients from healthcare facilities based on inclusion and exclusion criteria. The quality assurance of the instrument included content validity (IOC ≥ 0.5) assessed by three experts, and reliability consisted of knowledge of diabetes and renal complications was assessed using KR-20 = 0.75. perceived risk, perceived severity, expected outcome, perceived self-efficacy, and behaviors to delay renal function loss had Cronbach’s alpha = 0.81, 0.71, 0.89, 0.84, and 0.78 respectively. The intervention lasted 12 weeks, followed by a 4-week post-intervention follow-up. Outcomes were compared between groups pre-intervention, post-intervention, and post-intervention using ANCOVA, and clinical outcomes were compared and analyzed using t-test.

The results revealed that after comparing the results between groups, the experimental group had significantly higher scores on knowledge about diabetes and kidney complications, perceived risk of diabetes complications, perceived severity of diabetes and kidney complications, expected outcomes, self-efficacy of diabetic patients, and behaviors to delay kidney function loss. Furthermore, clinical outcomes were significantly improved at the 0.05 level compared to the control group.

The Roles of District Public Health Assistant Officers in Health Region 10 in Promoting Vulnerable Group Health and Implementing Environmental Health Operations According to the Public Health Act B.E. 2535

2025-10-24T15:10:56+07:00

This research aimed to study the roles of Sub-district Public Health Assistants in Health Region 10 in promoting the health of vulnerable groups and implementing environmental health operations in accordance with the Public Health Act B.E. 2535 (1992), as well as examining factors associated with their role performance. The study employed a cross-sectional analytical research design. The sample consisted of 63 Sub-district Public Health Assistants in Health Region 10. The research instruments included a questionnaire verified for content validity (IOC = 0.87) and reliability (Cronbach's Alpha = 0.82). Data were analyzed using descriptive statistics and Pearson Correlation at a significance level of 0.05.

The findings revealed that most participants were male (68.3%), with an average age of 45.5 years, and held at least a bachelor's degree (58.7%). The majority occupied administrative positions (73.0%). The performance of roles related to health promotion for vulnerable groups was at a moderate to low level (mean = 19.1 out of 40, 95% CI = 18.2-19.9), as were environmental health operations (mean = 19.6 out of 30, 95% CI = 18.8-20.4). All psychosocial factors showed significant positive correlations with role performance (p < 0.01), particularly social support (r = 0.650 and 0.552) and policy and program awareness (r = 0.580 and 0.544). In conclusion, there remains a performance gap between expected and actual role performance, which is influenced by psychosocial factors, social support, and policy perception. Continuous personnel capacity development, data system improvement, network strengthening, and clearer role delineation are recommended to enhance their effectiveness.

Efficiency-Improvement Screening and Registration Model of Pulmonary Tuberculosis among High-Risk Populations in Loei Province

2025-11-27T09:13:38+07:00

This action research aimed to examine the current situation and develop an efficiency-improvement model for screening and registration of pulmonary tuberculosis among high-risk populations in Loei Province. Additionally, it sought to compare the efficiency in screening, detection, and registration for pulmonary tuberculosis patients among at-risk populations before and after implementing the developed model. The study sample comprised 52,789 individuals across seven identified high-risk groups. Data were collected through in-depth interviews, focus group discussions and screening records from the NTIP database. Content analysis was applied to qualitative data, while quantitative data employed descriptive statistics presented as percentages, means, standard deviations, and paired t-test—a descriptive and inferential statistic.

The findings showed that the efficiency-improvement model for screening and registration of pulmonary tuberculosis among high-risk populations in Loei Province consisted of eight steps: 1) identifying target screening groups; 2) promoting health literacy; 3) workforce development; 4) screening of high-risk populations; 5) tuberculosis screening data management; 6) reporting and registration for treatment; 7) supervision, monitoring, and evaluation; and 8) strengthening participation and collaboration among the partnership network. Results revealed that tuberculosis screening coverage among all seven high-risk groups reached 88.98%. The mean district-level screening coverage rate across the 14 districts was 88.02% (S.D. = 2.42), representing an increase of 9.98 (95%CI 2.05-19.92, p-value<0.001) from the period prior to implementing the developed model. Before the model was introduced, the screening coverage among the seven high-risk groups was 78.52%, with an average district-level coverage of 78.04% (S.D. = 3.52). This improvement was statistically significant at the 0.05 level. The improvement in pulmonary tuberculosis screening efficiency among the high-risk population was achieved by integrating passive screening services within healthcare facilities with systematic proactive community-based screening, promoting health literacy to reduce stigma, fear, and anxiety among target populations, and strengthening participation and collaboration among the partnership network. These factors collectively contributed to a more effective screening and registration process in Loei Province.

Factors Effecting to Blood Pressure Control Behaviors among Hypertension Patients in Bo Pho Sub-district Health Promoting Hospital, Nakhonthai District, Phitsanulok Province

2025-11-03T15:27:01+07:00

This cross-sectional analytical study aimed to study the predictors of blood pressure control behavior among hypertension patients. Population in this study consisted of 320 hypertension patients in Bo Pho Sub-district Health Promoting Hospital, Nakhonthai District, Phitsanulok Province, in fiscal year 2023. The sample size calculating used Daniel formula for 194 cases, and systematic random sampling was determining for collecting data. Data collected by questionnaire composed of characteristics, health literacy and blood pressure control behavior. In addition to check questionnaire standardization, validity was checked by 3 experts and try out testing reliability by cronbach’s coefficient alpha about 0.867. Data analyzed using statistical as Pearson product moment correlation coefficient and Stepwise multiple regression analysis.

It was found that factors were positively association with blood pressure control behavior among hypertension patients with statistic significant level 0.05 included access skill, cognitive skill, media literacy skill, decision skill, respectively. The Stepwise Multiple Regression Analysis revealed that overall selected factors accounted for 69% of the variance blood pressure control behavior among hypertension patients including; access skill (p-value < 0.001) cognitive skill (p-value < 0.001) media literacy skill (p-value = 0.001) decision skill (p-value = 0.002).

The Proposed Policy: The Epidemiological Study of Streptococcus suis Infections in Nakhon Ratchasima Province

2025-11-05T11:00:22+07:00

Streptococcus suis infection is a zoonotic disease that remains a significant public health problem in Nakhon Ratchasima Province. This study aimed to investigate epidemiological characteristics, develop a disease forecasting model, analyze risk factors, and propose disease prevention and control guidelines. Methods: This mixed-methods research comprised: 1) A descriptive epidemiological study using DDS database of 120 confirmed cases with positive cultures from sterile site specimens between January 1 and December 31, 2024; 2) Development of a monthly forecasting model using ARIMA technique based on 10 year data; 3) A matched case-control study in Mueang Nakhon Ratchasima District with 16 cases matched to 64 controls, analyzed using Conditional Logistic Regression.

Results A total of 120 cases were identified with an incidence rate of 4.60 per 100,000 population, 1.53 times higher than the regional level. Nine deaths occurred, yielding a case fatality rate of 7.5%. Most patients were male (70.83%) with a median age of 61 years (IQR 52-70), working as laborers (34.17%) and farmers (20.83%). Cases were distributed across 26 districts, with Non Daeng District having the highest rate (16.15 per 100,000, RR=3.51). Disease occurrence increased during hot and rainy seasons, peaking in July (17 cases) and June (15 cases). Common clinical manifestations included high fever (95.05%), meningitis (70.30%), and hearing loss/deafness (64.36%). The ARIMA(1,1,1)(0,1,1) model showed the best fit, forecasting 8-13 cases per month for 2025, with the high-risk period in June-July (12-13 cases per month). The case-control study revealed that consumption of raw pork or raw pig blood was the primary risk factor (adjusted OR=7.10, 95% CI=1.70-29.74, p=0.007). Among cases, 82.50% consumed raw pork products within 14 days before symptom onset.

Conclusion The disease situation remains at a severe level requiring continuous surveillance. Recommendations include behavior change campaigns targeting high-risk groups, implementation of disease forecasting systems for preparedness, active surveillance in high-incidence areas, and sustainable integration of the One Health approach.

Environmental Health Literacy and Preventive Behaviors Against Health Effects from Particulate Matter Less Than 2.5 Microns (PM2.5) among Village Health Volunteers (VHVs) in Sukhothai Province

2025-10-09T10:39:45+07:00

This survey research aimed to examine the relationship between environmental health literacy and health-protective behaviors against particulate matter with an aerodynamic diameter of ≤2.5 micrometers (PM_2.5) among Village Health Volunteers (VHVs) in Sukhothai Province. The sample consisted of 375 VHVs. Data were collected using a questionnaire adapted from the Health Impact Assessment Division, Department of Health, Ministry of Public Health. Statistical analyses included frequency, percentage, mean, standard deviation, and Pearson’s product–moment correlation coefficient.

The results revealed that: 1) Overall environmental health literacy among the participants was at a moderate level (mean = 4.00), while health-protective behaviors against PM_2.5 were at a high level (mean = 4.24). 2) Access to environmental health information (r = 0.18, p = 0.011) and decision-making regarding self-protection from PM_2.5 (r = 0.15, p < 0.001) were significantly associated with health-protective behaviors against PM_2.5 at the 0.05 level. 3) Understanding and appraisal of environmental health information were not significantly associated with health-protective behaviors against PM_2.5. Overall, environmental health literacy was significantly associated with self- and community health surveillance behaviors (r = 0.11, p = 0.041), behaviors to prevent exposure to PM_2.5 (r = 0.13, p = 0.010), and health-protective behaviors against PM_2.5 (r = 0.12, p = 0.016) at the 0.05 significance level.

The Relationship between Health Literacy in Early Childhood Caregiving among Primary Caregivers and Children’s Nutritional Status and Development in Nursery Schools in Thawi Watthana District, Bangkok

2025-11-16T11:53:17+07:00

This analytical cross-sectional study aimed to examine the relationship between health literacy in early childhood caregiving among primary caregivers and children’s nutritional status and developmental outcomes in nursery schools in Thawi Watthana District, Bangkok. The sample consisted of 111 pairs of primary caregivers and early childhood children, selected using simple random sampling. Research instruments included a questionnaire on caregivers’ personal characteristics, a health literacy questionnaire for early childhood caregiving among primary caregivers, and an early childhood health assessment form covering personal information, nutritional status, and child development. Data were analyzed using descriptive statistics, including percentages, means, and standard deviations, and relationships were examined using the chi-square test.

The results revealed that primary caregivers had a moderate level of health literacy in early childhood caregiving (mean = 3.17, S.D. = 0.04). Health literacy was significantly associated with children’s nutritional status at the 0.05 level (χ²= 95.581, p < 0.001). In addition, health literacy was significantly associated with child development at the 0.05 level (χ²= 7.358, p = 0.025). Therefore, the findings suggest that health literacy among primary caregivers and early childhood teachers should be enhanced, particularly in the areas of appraisal, decision-making, and communication skills, to improve the effectiveness of promoting children’s nutritional status and developmental outcomes. Furthermore, collaborative activities to promote nutrition and child development should be implemented in conjunction with public health service agencies and relevant organizations, with continuous monitoring and evaluation.

Factors Associated with Pesticide Use Behavior among Orchard Farmers in Tha Luang Subdistrict, Makham District, Chanthaburi Province

2025-11-07T10:28:09+07:00

The use of chemical pesticides remains common among farmers because they effectively control pests. However, they also pose adverse effects on human health and environment. This study aimed to examine pesticide use behaviors among orchard farmers and to analyze factors associated with pesticide use behaviors in Tha Luang Subdistrict, Makham District, Chanthaburi Province. A cross-sectional study was conducted between August and December 2024, involving 285 farmers selected through purposive sampling. Data was collected using a structured questionnaire. Data were analyzed using descriptive statistics and Chi-square tests or Fisher’s exact test at a significant level of 0.05.

The results showed that most respondents were female (82.1%), over 55 years old (44.2%), and had completed lower secondary education (44.2%). Agriculture was the primary source of income for 59.6% of respondents. Overall, 50.53% of farmers demonstrated a moderate level of pesticide use behavior consistent with recommended practices. Factors significant associated with safe pesticide use behavior included age, education level, household income, debt amount, contact with agricultural extension officers, topics discussed during consultations, participation in training or study visits, and sources of agricultural information. Farmers who were older, had higher incomes, and avoiding the use of insecticides were more likely to adopt correct and safe practices. Furthermore, levels of knowledge regarding pesticide use, access to agricultural information, awareness of health impacts, and understanding of environmental consequences were positively associated with safe pesticide use behavior.

Knowledge, Attitudes, and Risky Behaviors Related to Smoking The First Cigarette among Primary School Children in Western Thailand

2025-11-27T13:23:36+07:00

The objective of a cross-sectional survey research was to study the level of knowledge, attitude, risky behavior, and factors related to risky behavior in smoking the first cigarette of primary school students in the western region of Thailand. The sample comprised of 388 primary school students using Multistage randomization. The instrument used was a questionnaire on youth smoking behavior. Data were analyzed using descriptive statistics, including percentage, mean, standard deviation, minimum and maximum values, and Pearson's product moment correlation coefficient to analyze the relationship between variables.

The findings revealed that 90.5% of the sample had low to moderate level of knowledge about the dangers of cigarettes, 79.1% had moderate level of attitudes toward smoking, and 9.0% had moderate to high level of risk behaviors. In addition, age was positively related to knowledge and risk behaviors with statistical significance at the 0.05 level, while knowledge was positively related to attitudes and risk behaviors, and attitudes were statistically significantly related to risk behaviors at the 0.01 level.

The sample had inappropriate knowledge and attitudes toward smoking and were at a risky of starting to smoke at a level that required attention. Therefore, activities to provide knowledge and create positive attitudes should be conducted to reduce such risks.