Associated factors of smoking behaviors among industrial workers in Myanmar: the role of modifying factors and individual beliefs, guided by the Health Belief Model

Myo Zin Oo¹Soe Sandi Tint²Alessio Panza³Sathirakorn Pongpanich³Pramon Viwattanakulvanid³Somdeth Bodhisane³Amaraporn Rerkasem¹Kittipan Rerkasem^1*

• ¹Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
• ²Chiang Mai University Department of Family Medicine, Chiang Mai, Thailand
• ³Chulalongkorn University College of Public Health Sciences, Bangkok, Thailand

Introduction: Smoking is a preventable behavioral risk factor for both communicable and noncommunicable diseases, with particularly strong impacts on noncommunicable diseases. We aimed to examine the associations between modifying factors, individual beliefs, and smoking behaviors, including quit attempts and smoking intensity, among industrial workers in Myanmar. Methods: Our cross-sectional study utilized baseline data collected in 2018 from a longitudinal quasi-experimental study involving 292 male industrial workers in Mandalay, Myanmar. Employing the Health Belief Model, we examined the associations of modifying factors (age, sex, marital status, education, income, smoking initiation age, duration, quit intention, and health knowledge) and individual beliefs (perceived susceptibility, severity, barriers, benefits, and self-efficacy) with smoking behaviors, specifically quit attempts and smoking intensity. Data were collected via structured interviews and analyzed using descriptive statistics and multivariable logistic regression models adjusted for potential confounders, with significance set at p<0.05. Results: The median age of participants was 28 years, with 90.4% not having attempted to quit smoking and 47.6% identified as high-intensity smokers. Health knowledge was significantly associated with lower odds of being a high-intensity smoker in both crude (OR=0.65, 95% CI:0.49, 0.88, p=0.005) and adjusted models (AOR=0.53, 95% CI:0.38, 0.75, p<0.001). Higher self-efficacy also significantly reduced the odds of being a high-intensity smoker in the adjusted model (AOR=0.93, 95% CI:0.86, 0.99, p=0.044). Conclusion: Our study reveals complex interactions between modifying factors and individual beliefs associated with smoking behaviors among industrial workers in Myanmar. The need for tailored health education interventions for industrial workers to enhance health knowledge and self-efficacy.