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Knowledge of, and attitudes to, indoor air pollution in Kuwaiti students, teachers and university faculty.
Article Type:
Report
Subject:
Students (Beliefs, opinions and attitudes)
School employees (Beliefs, opinions and attitudes)
Authors:
Khamees, Nedaa A. Al
Alamari, Hanaa
Pub Date:
12/01/2009
Publication:
Name: College Student Journal Publisher: Project Innovation (Alabama) Audience: Academic Format: Magazine/Journal Subject: Education Copyright: COPYRIGHT 2009 Project Innovation (Alabama) ISSN: 0146-3934
Issue:
Date: Dec, 2009 Source Volume: 43 Source Issue: 4
Topic:
Event Code: 290 Public affairs
Geographic:
Geographic Scope: Kuwait Geographic Code: 7KUWA Kuwait

Accession Number:
217511791
Full Text:
The concentrations of air pollutants in residences can be many times those in outside air, and many of these pollutants are known to have adverse health consequences. Despite this, there have been very few attempts to delineate knowledge of, and attitudes to, indoor air pollution. This study aimed to establish the knowledge of, and attitudes to, indoor air pollution in high school students and teachers, and in university students and faculty members, in Kuwait. A self-administered questionnaire was distributed to a representative sample of high school students and teachers and of university students and faculty members. Overall mean values for knowledge and attitudes were 7.78/19 (41%) and 3.86/5 respectively, indicating a low knowledge and suboptimal attitude. Teachers were significantly more knowledgeable than students at both secondary (OR 2.9) and university (OR 1.8) levels. Overall, books were the chief source of knowledge (57.4%) and family the lowest (25.4%). Females had significantly higher scores for attitude than did males (OR 1.6), and secondary school teachers than students (OR 1.9). There was a highly significant Pearson correlation (0.34, p <0.001) between knowledge and attitude.

Keywords: air pollution, indoor air pollution, students, teachers, Kuwait

Introduction

Studies from the United States and Europe show that persons in industrialized nations spend more than 90 percent of their time indoors (US Environmental Protection Agency, 1989). A study by the US Environmental Protection Agency (1987) found levels of volatile organic chemicals in residences up to ten times greater than in outdoor air in the vicinity of petrochemical plants. Most people are aware that outdoor air pollution can damage their health, but may not know that indoor air pollution can also have significant effects (American Lung Association/Environmental Protection Agency/Consumer Product Safety Commission/American Medical Association, 1994).

Despite the acknowledged importance of indoor air pollution, few surveys of knowledge and attitudes have been conducted. A Medline search with the terms 'knowledge', 'attitudes', and 'indoor air pollution' returned only eight relevant entries. Three of these concern environmental tobacco smoke (Walsh et al, 2002; Jochelson et al, 2003; Lund & Helgaron, 2005), two (actually one and a comment) dust mite (Callahan et al, 2003; Wild & Lopez, 2003), one radon (Eheman et al, 1996), one pesticides (Campbell et al, 1999), and one several factors related to asthma (Finkelstein et al, 2003). None attempted to assess the level of knowledge of, and attitudes to, indoor air pollution from a range of common sources or within an educational setting.

Because of its hot, arid climate, people in Kuwait tend to spend a high percentage of their time indoors, thus increasing exposure to indoor air pollutants. Further, buildings tend to be well sealed from the outside to increase the efficiency of airconditioning, again increasing the opportunity for build-up of indoor air pollutants. Despite this, and despite the well-known health effects of indoor air pollution, very little work has been done in Kuwait on knowledge of, and attitudes to, indoor air pollution. The aim of this research was to partially remedy this situation and to provide health educators with an indication of the extent of the problem, the emphasis that should be placed on its solution, and approaches that may be successful in remedying any deficiencies.

The questions this study attempted to answer were:

1. What is the extent of knowledge of indoor air pollution among Kuwaiti students and teachers?

2. What sources do they have for this knowledge?

3. What attitudes do Kuwaiti students and teachers have towards indoor air pollution?

Method

A cross-sectional school-based (secondary schools) or faculty-based (university) cluster sample design was used to produce a representative sample of students and teachers. The first stage was to determine the number of schools to be sampled in each of the six governates to reflect percentage of population in each governate, and the number of classes to be sampled within each of the faculties to represent the proportion of students enrolled in each faculty.

In the case of secondary schools, schools within each governate were then selected with probability proportional to school enrolment size. Classes within selected schools or within each faculty were then selected by systematic equal probability sampling, with ali classes within selected schools and within each faculty and all students and teachers in selected classes eligible to participate.

Teachers of selected classes were contacted in person, had the concept of the study explained to them, and were invited to participate personally and to invite their students to participate. All students able to understand the instructions and willing to participate in the study were included. Participation was anonymous and voluntary.

With reference to the differences in Kuwait University Colleges and differences of student numbers in each college, majors were separated into three groups: Science colleges (Science, Applied health, Engineering, Medicine, Dental, Pharmaceutics), Art colleges(Literature, Law, Administrative Sciences, Social Sciences, Mass media, and Shariaa), and College of Education since it contained the highest number of students in the university.

The instrument was a questionnaire designed by the investigator and self-administered by the subjects (Tables 1 and 2). For the knowledge section, correct answers were scored as 1 and incorrect answers as 0. The attitude section was scored on a 5-level Likert scale, with 1 for strongly disagree to 5 for strongly agree or the reverse as appropriate. Reliability was measured using Cronbach's Alpha (0.46).

Some of the questionnaires were discarded due to incomplete information, most of them were from Mubarak Al Kabeer and Hawally districts. This resulted in both districts having the least amount of participants.

The data were expressed as percentages and, where appropriate, as 95% confidence intervals. Student's t-test was used to analyse for inter-gender differences, while between-group (secondary school students, secondary school teachers, university students, university teachers) and between-governate differences were analysed by one-way ANOVA and Scheffe procedure. Odds ratios were calculated for these differences.

The correlation between knowledge and attitude was investigated using Pearson correlation.

Results

1871 questionnaires were returned, 1090 (58.3%) from females and 781 (41.7%) from males. Of these, 666 (345 (51.8%) males and 321 (48.2%) female) were from secondary school students, 210 (85 (40.5%) males and 125 (59.5%) females) from secondary school teachers, 888 (272 (30.6%) males and 616 (69.4%) females) university students, and 107 (79 (73.8%) males and 28 (26.2%) females) university teachers.

Of the secondary school students and teachers, 251 (28.7%) were from City, 183 (20.9%) from Farwania, 161 (18.4%) from Almahdi, 146 (16.7%) from Jahra, 73 (8.3%) from Mubarak, and 62 (7.1%) from Hawalli.

Of the university students, 305 (34.3 %) were from the College of Art, 304 (32.4%) from the College of Sciences, and 279 (31.4%) from the College of Education. University teachers numbered 42 (39.3%), 29 (27.1%) and 36 (33.6%) respectively from the same colleges.

Mean score on the knowledge test was 7.78 (41%). There were significant differences (p < 0.05) between secondary school students (mean [+ or -] SD = 7.21 [+ or -] 2.91) and secondary school teachers (9.41 [+ or -] 3.31), university students (7.70 [+ or -] 2.91), and university teachers (8.89 [+ or -] 3.23); and between university students and secondary school teachers and university teachers.

Mean score for the attitude section was 3.86 out of 5. Again, secondary school students (3.79 [+ or -] 0.37) showed significant differences from secondary school teachers (3.89 [+ or -] 0.30), university students (3.89 [+ or -] 0.31), and university teachers (3.94 [+ or -] 0.28).

People from City had lower mean scores for knowledge (7.09 [+ or -] 2.92) than those in Jahra (7.82 [+ or -] 2.56), Mubarak (8.48 [+ or -] 3.62), and Ahmadi (8.52 [+ or -] 3.3), and lower mean scores for attitude (4.49 [+ or -] 4.66) than those in Jahra (4.64 [+ or -] 4.66). There were no significant differences between those in different colleges.

Table 3 shows the number of people who obtained information about indoor air pollution from various sources. Overall, books were the most important source, with school, and radio and television not far behind. Only a little over a quarter acknowledged family as a source of information.

Secondary school teachers were 2.9 times as likely to have a higher knowledge of indoor air pollution than their students, while for university teachers versus their students the ratio was 1.8.

Secondary school teachers were also significantly more likely (OR 1.9) to have a better attitude towards indoor air pollution than their students. However, there was no significant difference between university teachers and their students.

Females were 1.6 times more likely to have a high ranking score for attitude to indoor air pollution than males, but the difference in knowledge between males and females was not significant.

Despite this, there was a highly significant correlation between knowledge and attitude, both overall (Pearson correlation 0.34, p < 0.001) and within each group.

Discussion

Overall knowledge of indoor air pollution in Kuwaiti students and teachers was poor, and the average attitude towards it mediocre. It is obvious that more effort is required to bring this knowledge and awareness to this group. Probably, this applies to the population in general; the failure of the family, in most cases, to supply such knowledge may well be simply because they don't have it.

It is also quite feasible that the utilisation of sources found in this survey reflects, as much as anything, the amount of such information available from them. Whether or not, school is an important source and may need to play a still greater role. On the other hand, the significant gap in knowledge between students and teachers at both levels indicates that teachers are not completely successful at passing on their knowledge to students.

Nevertheless, the absence of a significant gap in attitude between students and teachers at the university level may indicate that teachers are at least improving attitudes.

The highly significant correlation between knowledge and attitudes both overall and within each student or teacher subset probably shows a mutually reinforcing effect. Attitudes, though suboptimal, tended to be much nearer the desired mark than knowledge. Thus, we are probably seeing an unfilled desire to learn. Schools and the university should make a greater attempt to fulfil this desire and need, whether through syllabus material or by directing the attention of students to relevant books and television and radio programs.

That the family and the environment are also important factors may be seen, however, in the differences between results from the different governates. Results for knowledge of factors in indoor air pollution can be split into two categories. In the better category are Ahmahdi, Mubarak and Jarah, while Farwania and Hawalli and City constitute a 'less satisfactory' grouping. The people of Ahmadi and Jahra are largely Bedouin and have a tendency to be more conservative and traditionalist, Muslim, little involved in social activities, and with a strong culture of study as a means of advancement. Families in the new area of Mubarak are mostly educated middle class.

Researchers may not be surprised to find that Farwania and Hawalli are high density areas populated mainly by nonKuwaiti foreign work force which make up the minimum wage society. They may, however, be surprised to discover that City is peopled largely by professionals, higher management and others of upper class citizens. The reason that this group does relatively worse may be that families in this area tend to be more 'progressive', much more given to social activities, place much less emphasis on study, and exercise a looser discipline on children's education.

Citizens in Jahra may also be more aware of pollution in general because of the presence of higher pollution levels from waste plants and many other materials which contain depleted uranium that exists near their suburbs.

A further study will look at actual behaviours in relation to indoor pollution, symptoms suffered that may be related to indoor pollution, and whether or not sufferers link these symptoms to indoor pollution.

References

American Lung Association, Environmental Protection Agency, Consumer Product Safety Commission, and American Medical Association (1994): Indoor air pollution: an introduction for health professionals. US Government Printing Office Publication No. 1994-523-217/81322

Callahan, K.A., Eggleston, P.A., Rand, C.S., Kanchanaraksa, S., Swartz, L.J. and Wood, R.A. (2003): Knowledge and practice of dust mite control by specialty care. Annals of Allergy, Asthma & Immunology. 90, 302-307.

Campbell, M.E., Dwyer, J.J., Goettler, F., Ruf, F. and Vittiglio, M. (1999). A program to reduce pesticide spraying in the indoor environment: evaluation of the 'roach coach' project. Canadian Journal of Public Health. 90,277-281.

Eheman, C.R., Ford, E., Garbe, P. and Stachling, N. (1996). Knowledge about indoor radon in the United States: 1990 National Health interview Survey. Archives of Environmental Health. 51,245-247.

Finkelstein, J.A., Fuhlbrigge, A., Logano, P., Grant, E.N., Shulruff, R., Arduino, K.E. and Weiss, K.B. (2002). Parent-reported environmental exposures and environmental control measures for children with asthma. Archives of Pediatrics and Adolescent Medicine. 156, 258-264.

Jochelson, T., Hua, M. and Rissel, C. (2003). Knowledge, attitudes and behaviours of caregivers regarding children's exposure to environmental tobacco among Arabic and Vietnamese-speaking communities in Sydney, Australia. Ethnicity & Health. 8, 339-351.

Lund, K.E. and Helgason, A.R. (2005). Environmental tobacco smoke in Norwegian homes, 1995 and 2001: changes in children's exposures and parents' attitudes and health risk awareness. European Journal of Public Health. 15, 123-127.

US Environmental Protection Agency, Office of Acid Deposition, Environmental Monitoring and Quality Assurance. (1987). Project summary: the total exposure assessment methodology (TEAM) study. EPA-600-S6-87-002.

US Environmental Protection Agency, Office of Air and Radiation. (1989). Report to congress on indoor air quality. Volume II: Assessment and control of indoor air pollution, pp.1, 4-14. EPA 400-1-89-001C.

Walsh, R.A., Tzelepis, F., Paul, C.I. and McKenzie, J. (2002). Environmental tobacco smoke in homes, motor vehicles and licensed premises: community attitudes and practices. Australian and New Zealand Journal of Public Health. 25,536-542.

Wild, L.G. and Lopez, M. (2003). Does knowledge of environmental control for dust mite avoidance ensure compliance? Annals of Asthma, Allergy & Immunology. 90, 281.

DR. NEDAA A AL KHAMEES

DR. HANAA ALAMARI

College of Education-Curriculum & Instruction Department-Kuwait University
Table 1: Knowledge questionnaire
Tick each of the following according to whether they increase,
decrease, or do not affect pollution

                                               Increase   Decrease

1     Incense and aromatic candles
2     Air fresheners
3     Gas stove for cooking
4     Fixed carpets
5     Paints for walls and furniture
6     Glue for fixing furniture, carpets, etc
7     Plywood
8     Electrical appliances
9     Dry cleaning
10    Reducing the level of humidity
      inside the home
11    Using naphthalene to et rid of moulds
12    Wall paper
13    Disinfectants used in swimming pools
14    Smoking
15    Raisin pets, birds inside home
16    Plastic floor tiles
17    Indoor lams
18    Air exhaust in kitchens and bathrooms
19    Clothes dryer inside the house

                                                No affect    Don't
                                                             know

1     Incense and aromatic candles
2     Air fresheners
3     Gas stove for cooking
4     Fixed carpets
5     Paints for walls and furniture
6     Glue for fixing furniture, carpets, etc
7     Plywood
8     Electrical appliances
9     Dry cleaning
10    Reducing the level of humidity
      inside the home
11    Using naphthalene to et rid of moulds
12    Wall paper
13    Disinfectants used in swimming pools
14    Smoking
15    Raisin pets, birds inside home
16    Plastic floor tiles
17    Indoor lams
18    Air exhaust in kitchens and bathrooms
19    Clothes dryer inside the house

Table 2: Attitudes questionnaire

Do you agree or disagree with the following statements?

                                             Strongly   Agree   Not
                                              agree             sure
1     There must be laws protecting the
      consumer from toxic chemicals in
      household products.
2     Indoor pollution can be double the
      amount of pollutants outdoors.
3     It is better to use a gas stove for
      cooking at home.
4     The presence of indoor plants is
      necessary.
5     There is no connection between
      incense and indoor pollution.
6     Daily cleaning and the use of heavy
      duty vacuum cleaners help reduce
      indoor pollution.
7     Using household cleaning products
      may cause some health problems
8     It is necessary to have labelling
      showing the contents of the product
      in both English and in Arabic.
9     Indoor pollution may be related to
      some health problems that a person
      may be suffering from.
10    It is difficult to reduce the rate
      of indoor pollution.
11    The presence of air exhaust in the
      kitchen and in toilets is important
      to expel air outside the house.

                                             Disagree   Strongly
                                                         agree
1     There must be laws protecting the
      consumer from toxic chemicals in
      household products.
2     Indoor pollution can be double the
      amount of pollutants outdoors.
3     It is better to use a gas stove for
      cooking at home.
4     The presence of indoor plants is
      necessary.
5     There is no connection between
      incense and indoor pollution.
6     Daily cleaning and the use of heavy
      duty vacuum cleaners help reduce
      indoor pollution.
7     Using household cleaning products
      may cause some health problems
8     It is necessary to have labelling
      showing the contents of the product
      in both English and in Arabic.
9     Indoor pollution may be related to
      some health problems that a person
      may be suffering from.
10    It is difficult to reduce the rate
      of indoor pollution.
11    The presence of air exhaust in the
      kitchen and in toilets is important
      to expel air outside the house.

Table 3: Sources of information about indoor pollution

Source of information about   Number of
indoor pollution               people         %

Family                          475          25.4
Friends                         681          36.4
Newspapers & Magazines          737          39.4
Radio & TV                      1018         54.4
School                          1020         54.5
Books                           1074         57.4
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