ISGH 3 | Vol 3. No. 1 | Oktober 2019 | ISSN: 2715-1948
INDOOR AIR POLLUTION STUDY : SMOKING HABITS RELATED WITH SYMPTOMS OF RESPIRATORY DISORDER TO WORKERS, IN FOOTWEAR HOME INDUSTRY
Ummyatul Hajrah*1, Agustin Kusumayati2, Ema Hermawati2 [email protected]
1Department of Public Health, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia
2Faculty of Public Health, Indonesia University, Indonesia ABSTRACT
Background; Most people in the world have breathed polluted air. People spend approximately 90 percent of their time indoors particularly for those who work in home industries. Prolonged exposure to air pollution can cause respiratory symptoms that can be supported by individual factors and environmental conditions Objectives; The purpose of this study was to determine the association of individual factors, a smoking habits with symptoms of respiratory disorder to footwear workers.
Methods; This study used a cross-sectional study design and chi-square analysis to determine the relationship of individuals factors, smoking habits with symptoms of respiratory disorder This study involved 96 workers and sampling was carried out using a purposive sampling method. The location of the study was conducted in 4 footwear home industry.
Results; The results obtained 52.1% of workers were smokers. The symptoms experienced were cough, get tired quickly, sore throat, snuffles, issued reak, breathless, snorting nouse. There was a significant relationship between smoking habits and symptoms of respiratory disorder with a p-value of 0,022 (p-value <0,05). OR workers who smoke 3,206 95% CI (1,265- 8,125). OR workers aged >30 1,345 (0,556 -3,252). OR workers with low education 1.034 95% CI (0,428-2,501). Conclusions; Reducing smoking is an effort to prevent early indications of more severe respiratory disorders. No smoking in the room to maintain indoor air quality.
Keywords: Smoking, respiratory symptoms, indoor air pollution.
INTRODUCTION
Environmental Protection Agency noted that people spend approximately 90 percent of their time indoors (US. EPA n.d.). Indoor environment quality is an extremely important factor in the context of the health, comfort, and performance of building users (M Kraus; P Novakova 2019). WHO (2019) estimates that around 90% of people in the world have breathed polluted air and more than 90% of air pollution is related to deaths occurring in low and middle-income countries especially in Asia and Africa followed by the Eastern Mediterranean region, Europe and the Americas. Altogether, more than 1 billion people suffer from either acute or chronic respiratory conditions. The stark reality is that each year, 4 million people die prematurely from chronic respiratory disease (World Health Organization 2014)
Indoor air pollution refers to chemical, biological and physical contamination of indoor air.
It is of great concern owing to the range of ill effects it has on health. (Kumar , et al. 2015). Smoking is one of the major contributors to indoor air pollution (Gautam, et al. 2016). The effect of smoking on the
pulmonary function of adults. Smokers have a higher prevalence of respiratory symptoms and lung function abnormalities than non-smokers (Boskabady, et al. 2012; Tantisuwat and Thaveeratitham 2014) The disease currently has become a serious health problem in Indonesia, along with increasing life expectancy and the increased exposure to risk factors, such as smokers and air pollution. Recent observations have confirmed that widespread exposure to cigarette smoke in the workplace increases the risk of respiratory problems and cardiovascular disease (Gaikwad and Shivhare 2019). Respiratory health and allergic reactions, for instance, wheezing, asthma and hay fever, are a major cause of mortality and morbidity worldwide (Fischer Walker, et al. 2013)
WHO (2015) estimated that tobacco use (not only exposure to smoke) is responsible for about 6 million death across the world each year, including about 600.000 death from the effects of second- hand smoke. Based on the results of basic health research in Indonesia in 2018 the smoking habits of the population aged ≥10 years has a national prevalence of 28.8% while the proportion of
tobacco consumption in the population 15 years and over as many as 33.8% there are 62.9% men and 4.8% women. Smoking is one of the indicators of a healthy living community movement that has not yet shown improvement compared to basic health research in 2013 (Kementerian Kesehatan RI 2018).
Indoor air pollution is a neglected public health problem evidenced in previous studies 38% of men who smoke in the home and 57% of women are unaware of the adverse effects of air pollution in the room on human health and well-being (Ruma, et al., 2018)
METHODS
This study was an observational analytic with a cross-sectional design to determine the relationship between smoking habits, individual factors with symptoms of respiratory disorder. This study involved 96 workers and sampling was carried out using a purposive sampling method. The location of the study was conducted in 4 home footwear industry in Bogor, West Java, in September 2017. Inclusion criteria for footwear workers were at least working time was one year and available to be the subject of research by agreeing and signing informed consent. Data collection methods have been carried out using interviews and observations.
Determining the location of research and the sample of workers carried out several stages. The initial stage is to identify areas that have home industries. Then it was chosen as one of the regions that had the most shoe making facilities. Of the 96 that met the minimum sample, the number of workers in each of the 4 selected industries in locations A = 20, B = 28, C = 24 and D = 24 was obtained in order to meet the representation of the place by applying exclusion and inclusion criteria.
The data obtained during field research are processed in stages including the steps of editing, coding, processing, cleaning and tabulating.
Data on the characteristics of workers were collected using a questionnaire through interviews consisting of, education, smoking habits, and symptoms of respiratory disorders. Descriptive analysis is used to obtain the frequency distribution of the studied variables. A chi-Square test was used to analyze the relationship between variables.
Significance value is determined if p-value<0.05.
RESULT
Workers Characteristic
The characteristics of the workers are presented in table 1. The results obtained by 55.2%
of workers aged> 30 years, 54.2% of education
more workers have low education (graduated from elementary school, not school/not graduated elementary school). The majority of workers are smokers 52.1%.
Figure 1. Overview of workers by Socio- Demographic Characteristics and Smoking Habits
Symptoms of Respiratory Disorders
The results of research on symptoms of respiratory disorder from 96 workers due to benzene exposure were obtained 70,8% of workers who experienced respiratory distress symptoms, and 29,2% did not experience symptoms. The symptoms experienced were cough, get tired quickly, sore throat, snuffles, issued reak, breathless, snorting nouse.
46% 54%
Workers by Education
a. Low education b. Middle education
52%
48%
Workers by Smoking Habit
Smoker Non smoker 45% 55%
Workers by Age group
a. > 30 years old a. ≤ 30 years old
Relationship between Age and Symptoms of Respiratory Disorders
The statistical test results obtained p-value = 0.665, it can be concluded that there is no difference proportion in the symptoms of respiratory disorder between workers who have age ≤30 years and age
>30 years. However, the value of OR (odd ratio) = 1.345, can be interpreted that workers who are >30 years old have a 1.3 times chance to experience symptoms of respiratory disorders than those aged
≤30 years.
Table 1. Relationship between Age and Symptoms of Respiratory Disorders
Age
Symptoms of respiratory disorder disorder Total
p* OR
(CI 95%)
Yes No
n % n % n %
> 30 years old 39 73,6 14 26,4 53 100 0,665 1,345
(0,556 -3,252)
≤ 30 years old 29 67,4 14 32,6 43 100
Total 68 70,8 28 29,2 96 100
*Chi-Square, continuity correction
The relationship between Education and Symptoms of Respiratory Disorders
The results of the analysis of the relationship obtained p-value 1,000 (p value> 0.05) which means that there is no statistically significant relationship between education with symptoms of
respiratory disorders. But in table 2 shows an OR value equal to 1.034, meaning that workers with low education (elementary/not graduated/not attending school) have 1 time higher chance of experiencing symptoms of respiratory disorder than those with middle education (high school/junior high).
Table 2. The Relationship between Education and Symptoms of Respiratory Disorders Education
Symptoms of respiratory disorder disorder
Total p* OR
(CI 95%)
Yes No
n % n % N %
Low education 37 71,2 15 28,8 52 100
1,000 1,034 (0,428 - 2,501)
Middle education 31 70,5 13 29,5 44 100
Total 68 70,8 28 29,2 96 100
*Chi-Square, continuity correction
Relationship between Smoking habits and Symptoms of Respiratory Disorder
The analysis results obtained p-value 0.022 (p- value <0.05) which means that there is a statistically significant relationship between smoking habits
with symptoms of respiratory disorders. Table 5 shows the OR value is 3.206, which means that workers who smoke have 3.2 times higher odds of having symptoms of respiratory disorder than workers who do not smoke.
Table 3. Relationship between Smoking habits and Symptoms of Respiratory Disorder Smoking habits
Symptoms of respiratory disorder disorder
Total
p* OR
(CI 95%)
Yes No
n % n % N %
Smoker 41 82,0 9 18,0 50 100
0,022 3,206 (1,265-8,125)
Non smoker 27 58,7 19 41,3 46 100
Total 68 70,8 28 29,2 96 100%
*Chi-Square, continuity correction
DISCUSSION
The results of this study indicate that more workers are aged over 30 years, although not significantly different from those under 30 years.
Lim (2014) studying in Korea shows risks in
different age groups where young age (<18 years) and old age (> 65 years) have higher health risks than adults (18-64) due to exposure to chemical pollutants. Although this study found no significant relationship between age and symptoms of
respiratory distress (p> 0.005), it can be seen that the percentage above 30 years of age has symptoms of respiratory disorder 73.6% higher than the age below or equal to 30 years which is 67.4 %. A study (Todd , et al., 2018) using a new tool for detecting respiratory pattern disorders also found no significant differences between age groups. The value of odd ratio (OR = 1.345) can be interpreted that workers who are >30 years old have a 1.3 times chance to experience symptoms of respiratory disorders than those aged ≤30 years.
Anatomic changes in respiratory system and gas exchange due to aging are indistinguishable due to many other influencing factors such as air pollution, lifestyle, and work. Likewise, Yosefimehr (2017) in his report explained the relation to workers exposed to polluted air, in particular, containing volatile compounds that the effect of aging increases with symptoms of respiratory distress.
There was no statistically significant correlation between education and symptoms of respiratory disorders (p> 0.05). This is supported by research Perry, , et al., (2018) that there is no change in the size of the intervention according to knowledge in testing the impact of educational programs on respiratory diseases. Even though the education level of workers is 54.2% low, it is not certain that all of them do not know the negative impacts that can cause health problems. Worker education can affect a person's knowledge and understanding of matters relating to health and illness, including risks to respiratory disorders because self-protection of harm to a person begins with knowledge, understanding to the awareness of the importance of avoiding or reducing the risk of bad work.
Tobacco smoking can generate substantial indoor air pollution, specifically particulate matter (Rivas , et al., 2019). Cigarette smoke contains a mixture of thousands of chemicals produced from the burning or heating of tobacco. Hundreds of compounds including carcinogenic (can cause cancer), and harmful to health. The main poisons in cigarettes are tar, nicotine, and carbon monoxide (CO). Nicotine is a substance or pyrrolidine compound contained in Nicotiana Tabacum, Nicotiana Rustica and other types whose synthesis is addictive which can lead to dependency (Lee , et al., 2012). This nicotine can poison the nerves of the body, increase blood pressure, constrict peripheral vessels and cause addiction and dependence on the wearer (Ginting , et al., 2017).
The cigarette burns at a higher temperature during inhalation, leading to more complete
combustion in the mainstream smoke (the smoke drawn through the cigarette and inhaled by the smoker). Exposure to environmental tobacco smoke has been linked to an increased risk of several adverse health outcomes, including lung cancer and acute respiratory illness. (WHO 2018) Smoking is known as an important source of multiple pollutants, both in the gaseous and particulate phases, in indoor environments, which promotes the degradation of air quality (Kauneliene , et al., 2018)
The breath exhaled by smokers who emit several sources of pollutants in the air such as volatile organic compounds, nitrogen oxides, carbon monoxide, among others, these compounds directly affect the quality of the air inside the space and even outdoors (Canha , et al. 2019). This situation can reduce the effectiveness of mucoceles and carry volatile chemicals accompanied by dust particles in the work environment so that it is a good medium for bacterial growth.
A significant Relationship between Smoking Habits and Symptoms of Respiratory
The results of this study were obtained statistically there was a significant relationship between smoking habits with symptoms of respiratory disorder with a p-value of 0.022 (p- value <0.05). smoking can be risky and lead to the emergence of subjective complaints of respiratory and pulmonary ventilation disturbances on the labor. Giarno in Mengkidi (2006) states that workers who smoke are one of the risk factors causing respiratory diseases.
Tobacco smoking can reduce mucosal ciliary motility, increases the number of goblet cells, and excessive mucous secretion. These effects result in persistent mucosal epithelial activation and impaired mucociliary clearance, and may partially explain the higher likelihood of smokers to develop colonization and subsequent infection (Lee , et al., 2012; Strzelak 2018).
Tobacco smoke induces early origins of respiratory disease Cigarette smoke exerts cytotoxic and both pro-inflammatory and anti-inflammatory effects on nasal epithelial cells (Comer , et al., 2014;
Huang , et al., 2016; Strzelak 2018). Common smoking-related conditions that can result in chronic dyspnea, wheezing, or cough, and suggested tests for these conditions. A comprehensive evaluation of these chronic conditions should be made with a detailed history of exposures and risk factors. Symptoms of respiratory disorder in smokers with normal spirometry:
clinical significance and management considerations (Lambert and Bhatt 2019)
Adolescents who lived with a smoker, had home tobacco smoke environment, and had ≥1 hour of tobacco smoke environment were at increased risk of reporting shortness of breath, finding it harder to exercise compared with peers, wheezing during or after exercise, and dry cough at night than were unexposed participants (Merianos, , et al., 2018).
The etiology of symptoms of respiratory disorder is quite difficult to ascertain because of the ambient conditions in the workplace such as home industry there are various sources of pollution.
Symptoms with a less specific diagnosis can be supported by a medical check-up to know the symptoms of the actual disease of respiratory system. Indoor air pollutants are generally released from smoking, building materials, air conditioning, house cleaning or air refreshing products, heating, lighting, and wood, fuel, or coal usage in cooking.
(Gautam , et al. 2016). Most respiratory diseases are preventable by improving the quality of the air.
Common sources of unhealthy air are tobacco smoke, indoor and outdoor air pollution, and air containing microbes, toxic particles, fumes or allergens. Reducing tobacco consumption is the most important first step. Controlling unhealthy air in the workplace can prevent occupational lung disease. Check health regularly can prevent serious respiratory disease. Improving respiratory health also entails strengthening healthcare systems, using established guidelines for health promotion and disease prevention, training medical personnel, research, and educating the populace (Sheffield 2017).
CONCLUSION
This study found a significant relationship between smoking habits and symptoms of respiratory disorder. Based on these findings it is recommended to workers who smoke can reduce smoking, make a no-smoking regulation at work. To avoid smoke pollution impact on individuals, there should be no smoking in the room. As for the symptoms of respiratory disorders, if it continues, it is advisable to immediately conduct an early health examination so that it is not too late to find out serious respiratory disorders. Further research can identify various sources of hazard to study that can be found indoor to learn more about the determinants of indoor air quality decline.
ACKNOWLEDGMENT
The authors are grateful for the constructive and valuable comments provided by Mrs. Agustin Kusumayati, Mrs. Ema Hermawati and reviewer for
direction and insights who supported research and preparation of this article. This research is self- financing.
CONFLICT OF INTEREST The authors report no competing interest.
ETHICAL CLEARANCE Taken from University of Indonesia Ethics Commission
REFERENCE
Boskabady, Mohammad Hossein, , et al. 2012.
“Comparison of Pulmonary Function and Symptoms of respiratory disorder in Water Pipe and Cigarette Smokers.” Respirology 17(6): 950–56.
Canha, Nuno , et al. 2019. “Comparison of Indoor Air Quality during Sleep in Smokers and Non- Smokers’ Bedrooms: A Preliminary Study.”
Environmental Pollution: 248–56.
https://doi.org/10.1016/j.envpol.2019.03.021.
Comer, David M., Joseph S. Elborn, and Madeleine Ennis. 2014. “Inflammatory and Cytotoxic Effects of Acrolein, Nicotine, Acetylaldehyde and Cigarette Smoke Extract on Human Nasal Epithelial Cells.” BMC Pulmonary Medicine 14(1).
Fischer Walker, Christa L. , et al. 2013. “Global Burden of Childhood Pneumonia and Diarrhoea.” The Lancet 381(9875): 1405–16.
Gaikwad, Asha, and Niharika Shivhare. 2019.
“INDOOR AIR POLLUTION- A Threat.”
07(05): 1463–67.
Gautam, Sneha, Ankit Yadav, Chuen Jinn Tsai, and Prashant Kumar. 2016. “A Review on Recent Progress in Observations, Sources, Classification and Regulations of PM2.5in Asian Environments.” Environmental Science and Pollution Research 23(21): 21165–75.
http://dx.doi.org/10.1007/s11356-016-7515-2.
Ginting, Surita;Silalahi, Elny Lorensi;Ariani, Wiwik Dwi. 2017. “The Effectiveness of Respiratory Tracts in the Post-Inhalation General Anesthesia In Smoking and Non- Smoking Patients in the Recovery Room.”
4(2): 126–33.
Huang, Chien Chia;Wang, Chun Hua;Fu, Chia Hsiang, and Ta Jen Huang, Chi Che;Chang, Po Hung;Chen, Yi Wei;Wu, Chia Chen;Wu, Pei Wen;Lee. 2016. “Association between Cigarette Smoking and Interleukin-17A Expression in Nasal Tissues of Patients with Chronic Rhinosinusitis and Asthma.” Medicine (United States) 95(47).
Kauneliene, Violeta; Akhtarieva, Marija,
Martuzevicius, Dainius. 2018. “A Review of the Impacts of Tobacco Heating System on Indoor Air Quality versus Conventional Pollution Sources.”
Kementerian Kesehatan RI. 2018. “Hasil RISKESDAS 2018.”
Kumar, Raj , et al. 2015. “Indoor Air Pollution and Asthma in Children at Delhi, India.”
Pneumonologia i Alergologia Polska 83(4):
275–82.
Lambert, Allison A, and Surya P Bhatt. 2019.
“Symptoms of respiratory disorder in Smokers with Normal Spirometry : Clinical
Significance and Management
Considerations.” 25(2): 138–43.
Lee, J.;Taneja, V.;Vassallo, R. 2012. “Cigarette Smoking and Inflammation: Cellular and Molecular Mechanisms.” Journal of Dental Research 91(2): 142–49.
Lim, Seong; , et al. 2014. “Risk Assessment of Volatile Organic Compounds Benzene, Toluene, Ethylbenzene, and Xylene (BTEX) in Consumer Products.” Journal of Toxicology and Environmental Health, Part A 77(22–24):
1502–21.
http://dx.doi.org/10.1080/15287394.2014.955 905.
M Kraus; P Novakova. 2019. “Assessment of the Indoor Environment for Education.”
Mengkidi, Dorce. 2006. “Gangguan Fungsi Paru Dan Faktor-Faktor Yang Mempengaruhinya Pada Karyawan PT . Semen Tonasa Pangkep Sulawesi Selatan.”
Merianos, Ashley L.;Jandarov, Roman A.;Mahabee-Gittens, Melinda. 2018.
“Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use.” Pediatrics 142(3).
Perry, Tamara T.;Halterman, Jill S.;Brown, Rita H.;Luo, Chunqiao;Randle, Shemeka M.;Hunter, Cassandra R.;Rettiganti, Mallikarjuna. 2018. “Results of an Asthma Education Program Delivered via Telemedicine in Rural Schools.” Annals of Allergy, Asthma and Immunology 120(4): 401–
8. https://doi.org/10.1016/j.anai.2018.02.013.
Rivas, Ioar;Fussell, Julia C.;Kelly, Frank J.;Querol, Xavier. 2019. 2019-Janua Issues in Environmental Science and Technology Indoor Sources of Air Pollutants.
Ruma, Dutta; Dinesh, Raja; Timsi, Jain; Gomathy,
Parasuraman; Prashanth; Sivaprakasaman.
2018. “Indoor Air Pollution an Ignored Public Health Issue : Study to Find the Awareness and Practices Regarding Indoor Air Pollution in a Rural Setting near Chennai.” Indian Journal of Public Health Research & Development 9(12):
80–84.
Sheffield, European Respiratory Society. 2017.
Forum of International Respiratory Societies The Global Impact of Respiratory Disease.
Strzelak, Agnieszka. 2018. “Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation , Allergy , Asthma and Other Lung Diseases : A Mechanistic Review.”
Tantisuwat, Anong, and Premtip Thaveeratitham.
2014. “Effects of Smoking on Chest Expansion, Lung Function, and Respiratory Muscle Strength of Youths.” Journal of Physical Therapy Science 26(2): 167–70.
Todd, Sarah;Walsted, Emil S., Rebecca Grillo, Lizzie;Livingston, and James H. Menzies- Gow, Andrew; Hull. 2018. “Novel Assessment Tool to Detect Breathing Pattern Disorder in Patients with Refractory Asthma.” Respirology 23(3): 284–90.
US. EPA. “Indoor Air Quality.”
WHO. 2015. “WHO Global Report on Trends in Prevalence of Tobacco Smoking.”
https://apps.who.int/iris/bitstream/handle/1066 5/156262/9789241564922_eng.pdf;jsessionid
=18318DE7B3C3CE50967CF3B71C8B4B5D
?sequence=1.
———. 2018. WHO GLOBAL REPORT ON TRENDS IN PREVALENCE OF TOBACCO 2000-2025.
https://www.who.int/tobacco/publications/sur veillance/trends-tobacco-smoking-second- edition/en/.
———. 2019. “9 out of 10 People Worldwide Breathe Polluted Air, but More Countries Are Taking Action.”
World Health Organization. 2014. “Global Status Report on Noncommunicable Diseases.”
Yosefimehr, Atefeh, Mohsen Jalilian, Maedeh Kamalvandi, and Nematullah Kurd. 2017.
“Evaluation of Respiratory and Neurobehavioral Symptoms Due To Exposure with Volatile Organic Compounds among Employees of Petrol Stations in Dezful City : A Cross Sectional Study.” 5(3): 315–19.
