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  1. Fulltext Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006
    Sreeramareddy CT, Ramakrishnareddy N, Harsha Kumar H, Sathian B, Arokiasamy JT
    Subst Abuse Treat Prev Policy, 2011;6:33.
    PMID: 22185233 DOI: 10.1186/1747-597X-6-33
    BACKGROUND: Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.
    METHODS: A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.
    RESULTS: Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.
    CONCLUSIONS: Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.
    Matched MeSH terms: Smoking/prevention & control
  2. Malaysia steps up anti-tobacco legislation
    Ashraf H
    Lancet, 2002 Aug 24;360(9333):627.
    PMID: 12241947
    Matched MeSH terms: Smoking/prevention & control*
  3. BAT flouts tobacco-free World Cup policy
    Assunta M
    Tob Control, 2002 Sep;11(3):277-8.
    PMID: 12198283
    In Malaysia, British American Tobacco flouted the World Cup of football's no-tobacco ruling
    Matched MeSH terms: Smoking/prevention & control
  4. Regret and rationalization among smokers in Thailand and Malaysia: findings from the International Tobacco Control Southeast Asia Survey
    Lee WB, Fong GT, Zanna MP, Omar M, Sirirassamee B, Borland R
    Health Psychol, 2009 Jul;28(4):457-64.
    PMID: 19594270 DOI: 10.1037/a0014669
    OBJECTIVE: To test whether differences of history and strength in tobacco control policies will influence social norms, which, in turn, will influence quit intentions, by influencing smokers' regret and rationalization.
    DESIGN: The data were from the International Tobacco Control (ITC) Policy Evaluation Southeast Asia Survey, a cohort survey of representative samples of adult smokers in Thailand (N = 2,000) and Malaysia (N = 2,006). The survey used a stratified multistage sampling design.
    MAIN OUTCOME MEASURES: Measures included regret, rationalization, social norms, and quit intention.
    RESULTS: Thai smokers were more likely to have quit intentions than Malaysian smokers. This difference in quit intentions was, in part, explained by the country differences in social norms, regret, and rationalization. Reflecting Thailand's history of stronger tobacco control policies, Thai smokers, compared with Malaysian smokers, perceived more negative social norms toward smoking, were more likely to regret, and less likely to rationalize smoking. Mediational analyses revealed that these differences in social norms, accounted, in part, for the country-quit intention relation and that regret and rationalization accounted, in part, for the social norm-quit intention relation.
    CONCLUSION: The results suggest that social norms toward smoking, which are shaped by tobacco control policies, and smokers' regret and rationalization influence quit intentions
    Matched MeSH terms: Smoking/prevention & control*
  5. Malaysia: Standing firm on trade and tobacco
    Nordin AS, Bullen C
    Tob Control, 2014 Jan;23(1):4-5.
    PMID: 24479154
    Matched MeSH terms: Smoking/prevention & control*
  6. Fulltext Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium
    Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, et al.
    BMJ, 2015 Apr 20;350:h1551.
    PMID: 25896935 DOI: 10.1136/bmj.h1551
    OBJECTIVE: To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures.

    DESIGN: Individual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis.

    RESULTS: Overall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar.

    CONCLUSIONS: Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.

    Matched MeSH terms: Smoking/prevention & control
  7. Fulltext Beliefs and behavior of deceivers in a randomized, controlled trial of anti-smoking advice at a primary care clinic in Kelantan, Malaysia
    Jackson AA, Manan WA, Gani AS, Eldridge S, Carter YH
    Southeast Asian J. Trop. Med. Public Health, 2004 Sep;35(3):748-55.
    PMID: 15689099
    Smoking deception is often ignored, but is important in health care. In this trial it was assessed at both study entry and outcome. At study entry, 1,044 males at a primary care clinic were asked smoking status and tested for breath carbon monoxide (CO). Of self-reported non-smokers, 57/402 (14%) were actually smokers, as were 59/251 (24%) of self-reported ex-smokers. The self-reported smokers (n=387) entered a randomized, controlled trial where the intervention comprised four questions on knowledge and beliefs about smoking, standardized verbal advice against smoking, and a leaflet. At follow-up, subjects were also questioned about beliefs. Follow-up was difficult, but 191/387 (49%) attended at three or six months. Of 27 who claimed to have quit, 6 (22%) were deceivers and 21 were confirmed quitters. Cessation did not differ between intervention and control groups. Overall confirmed cessation at six months was 16/387 (4.1 %). Confirmed quitters were significantly lighter smokers than deceivers and still smokers. There were non-significant trends between the outcome groups whereby deceivers had least knowledge and most lay beliefs, and quitters had most knowledge and fewest lay beliefs. The lay beliefs may prevent some smokers from quitting.

    Study site: open-access outpatients
    clinic (KPM) attached to the teaching hospital
    (HUSM) of Universiti Sains Malaysia
    Matched MeSH terms: Smoking/prevention & control
  8. Fulltext Industry sponsored youth smoking prevention programme in Malaysia: a case study in duplicity
    Assunta M, Chapman S
    Tob Control, 2004 Dec;13 Suppl 2:ii37-42.
    PMID: 15564218
    OBJECTIVE: To review tobacco company strategies of using youth smoking prevention programmes to counteract the Malaysian government's tobacco control legislation and efforts in conducting research on youth to market to them.
    METHODS: Systematic keyword and opportunistic website searches of formerly private internal industry documents. Search terms included Malay, cmtm, jaycees, YAS, and direct marketing; 195 relevant documents were identified for this paper.
    RESULTS: Industry internal documents reveal that youth anti-smoking programmes were launched to offset the government's tobacco control legislation. The programme was seen as a strategy to lobby key politicians and bureaucrats for support in preventing the passage of legislation. However, the industry continued to conduct research on youth, targeted them in marketing, and considered the teenage market vital for its survival. Promotional activities targeting youth were also carried out such as sports, notably football and motor racing, and entertainment events and cash prizes. Small, affordable packs of cigarettes were crucial to reach new smokers.
    CONCLUSION: The tobacco industry in Malaysia engaged in duplicitous conduct in regard to youth. By buying into the youth smoking issue it sought to move higher on the moral playing field and strengthen its relationship with government, while at the same time continuing to market to youth. There is no evidence that industry youth smoking prevention programmes were effective in reducing smoking; however, they were effective in diluting the government's tobacco control legislation.
    Matched MeSH terms: Smoking/prevention & control*
  9. "The world's most hostile environment": how the tobacco industry circumvented Singapore's advertising ban
    Assunta M, Chapman S
    Tob Control, 2004 Dec;13 Suppl 2:ii51-7.
    PMID: 15564221
    To review how tobacco transnational companies conducted their business in the hostile environment of Singapore, attempting to counter some of the government's tobacco control measures; to compare the Malaysian and the Singaporean governments' stance on tobacco control and the direct bearing of this on the way the tobacco companies conduct their business.
    Matched MeSH terms: Smoking/prevention & control
  10. Fulltext A mire of highly subjective and ineffective voluntary guidelines: tobacco industry efforts to thwart tobacco control in Malaysia
    Assunta M, Chapman S
    Tob Control, 2004 Dec;13 Suppl 2:ii43-50.
    PMID: 15564220 DOI: 10.1136/tc.2004.008094
    OBJECTIVE: To describe tobacco industry efforts in Malaysia to thwart government efforts to regulate tobacco promotion and health warnings.
    METHODS: Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement and secondary websites; relevant information from news articles and financial reports.
    RESULTS: Commencing in the 1970s, the industry began to systematically thwart government tobacco control. Guidelines were successfully promoted in the place of legislation for over two decades. Even when the government succeeded in implementing regulations such as health warnings and advertising bans they were compromised and acted effectively to retard further progress for years to come.
    CONCLUSION: Counter-measures to delay or thwart government efforts to regulate tobacco were initiated by the industry. Though not unique to Malaysia, the main difference lies in the degree to which strategies were used to successfully counter stringent tobacco control measures between 1970 and 1995.
    Matched MeSH terms: Smoking/prevention & control*
  11. Fulltext Smoking behaviours and attitudes toward tobacco control among assistant environmental health officer trainees
    Tee GH, Gurpreet K, Hairi NN, Zarihah Z, Fadzilah K
    Int J Tuberc Lung Dis, 2013 Dec;17(12):1652-5.
    PMID: 24200284 DOI: 10.5588/ijtld.12.0241
    Assistant environmental health officers (AEHO) are health care providers (HCPs) who act as enforcers, educators and trusted role models for the public. This is the first study to explore smoking behaviour and attitudes toward tobacco control among future HCPs. Almost 30% of AEHO trainees did not know the role of AEHOs in counselling smokers to stop smoking, but 91% agreed they should not smoke before advising others not to do so. The majority agreed that tobacco control regulations may be used as a means of reducing the prevalence of smoking. Future AEHOs had positive attitudes toward tobacco regulations but lacked understanding of their responsibility in tobacco control measures.
    Matched MeSH terms: Smoking/prevention & control*
  12. Fulltext Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation (ITC) Project
    Guindon GE, Driezen P, Chaloupka FJ, Fong GT
    Tob Control, 2014 Mar;23 Suppl 1:i13-22.
    PMID: 24227541 DOI: 10.1136/tobaccocontrol-2013-051074
    Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes in reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes.
    Matched MeSH terms: Smoking/prevention & control
  13. Fulltext Patterns of smoking among adolescents in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia survey
    Hammond D, Kin F, Prohmmo A, Kungskulniti N, Lian TY, Sharma SK, et al.
    Asia Pac J Public Health, 2008;20(3):193-203.
    PMID: 19124313 DOI: 10.1177/1010539508317572
    At present, 70% of the world's 1.1 billion smokers are in developing countries, with over 50% in Asia alone. The current study examined patterns of youth smoking in Thailand and Malaysia. Respondents were 2002 youths between the ages of 13 and 17 from Thailand (n = 1000) and Malaysia (n = 1002). Respondents were selected using a multistage cluster sampling design and surveyed between January 2005 and March 2005. Approximately 3% of youth between the ages of 13 and 17 were current smokers, with an additional 10% to 12% reporting experimental smoking. Males were between 7 and 15 times more likely to report smoking behavior than females. Less than 1% of females respondents in either country met the criteria for current smoking, and less than 5% met the criteria for experimental smoking. In contrast, more than 50% Thai males and approximately one-third of Malaysian males aged 17 met the criteria for either experimental or current smoking.
    Matched MeSH terms: Smoking/prevention & control*
  14. The lower effectiveness of text-only health warnings in China compared to pictorial health warnings in Malaysia
    Elton-Marshall T, Xu SS, Meng G, Quah AC, Sansone GC, Feng G, et al.
    Tob Control, 2015 Nov;24 Suppl 4:iv6-13.
    PMID: 26420242 DOI: 10.1136/tobaccocontrol-2015-052616
    In 2009, China changed its health warnings on cigarette packs from side-only text warnings to two text-only warnings on 30% of the bottom of the front and back of the pack. Also in 2009, Malaysia changed from similar text warnings to pictorial health warnings consistent with Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines.
    Matched MeSH terms: Smoking/prevention & control*
  15. How the Malaysian tobacco industry exploits loopholes in pictorial health warnings
    Tan YL, Foong K
    Tob Control, 2012 Jan;21(1):55-6.
    PMID: 21803928 DOI: 10.1136/tc.2011.042713
    Matched MeSH terms: Smoking/prevention & control
  16. Empowering Malaysian dentists to tobacco dependence treatment conduct
    Nordin AS, Kadir RA, Yahya NA, Zakaria H, Rashid RA, Habil MH
    Int Dent J, 2014 Aug;64(4):206-12.
    PMID: 24835463 DOI: 10.1111/idj.12110
    As a signatory to the World Health Organisation 2003 Framework Convention on Tobacco Control, Malaysia has policies in place and funded 300 public Quit clinics. Unfortunately, government dentists are not included to run tobacco dependence treatment. A cross-sectional exploratory survey was carried out to seek Malaysian dentists' opinion on their knowledge, perception and willingness to conduct tobacco dependence treatment. Participation was voluntary from those who attended a specially designed one-day, four-module workshop on tobacco cessation intervention. Data were collected using the Audience-Response-System equipment which tracked immediate responses covering four domains namely: smoking as a public health problem, smoking as an addiction, the role of dentists in the programme and confidence in conducting smoking cessation in the clinic. Sample comprised more female dentists (73.5%), mean age 33.6 (SD 8.99) years and with more than 3 years working experience. Findings indicated that the majority agreed Malaysia has a rising problem in the prevalence of smoking (71.6%) and predicted that it will affect mostly the young (81.9%). Only half of the dentists surveyed (58.9%) routinely recorded their patients' smoking habits. The majority (71.6%) believed that dentists are effective in helping their patient to stop smoking and 76.3% agreed that dentists should discuss the smoking habit with their patients; however, 60% agreed that doing so is too time consuming. In addition, only 24.7% knew of more ways to treat a smoking habit. The majority felt comfortable giving advice to patients about changing their habits (76.5%) or discussing treatment options (60.5%): 75% would opt for a combined programme of counselling and use of medication if they have to do, 15% would choose to go on counselling only, while 8% did not want to treat. In conclusion, the findings suggest that dentists have a strong potential to contribute significantly to providing smoking cessation treatment if adequately trained.
    Matched MeSH terms: Smoking/prevention & control
  17. Fulltext Attitudes towards smoking and tobacco control among pre-clinical medical students in Malaysia
    Tee GH, Hairi NN, Hairi F
    Int J Tuberc Lung Dis, 2012 Aug;16(8):1126-8.
    PMID: 22668450 DOI: 10.5588/ijtld.11.0254
    Physicians should play a leading role in combatting smoking; information on attitudes of future physicians towards tobacco control measures in a middle-income developing country is limited. Of 310 future physicians surveyed in a medical school in Malaysia, 50% disagreed that it was a doctor's duty to advise smokers to stop smoking; 76.8% agreed that physicians should not smoke before advising others not to smoke; and 75% agreed to the ideas of restricting the sale of cigarettes to minors, making all public places smoke-free and banning advertising of tobacco-related merchandise. Future physicians had positive attitudes towards tobacco regulations but had not grasped their responsibilities in tobacco control measures.
    Matched MeSH terms: Smoking/prevention & control*
  18. Fulltext Family influence on current smoking habits among secondary school children in Kota Bharu, Kelantan
    Shamsuddin K, Haris MA
    Singapore Med J, 2000 Apr;41(4):167-71.
    PMID: 11063181
    Objectives: To measure the prevalence of cigarette smoking among male secondary school children and assess their family influence especially that of their fathers' smoking habits on their current smoking habits.
    Methodology: A cross-sectional study was carried out in Kota Bharu, Kelantan in April 1997 where 460 male form four students, aged 15-16 years were randomly selected from six secondary schools. Data on smoking habits, sociodemographic profile and family characteristics particularly parents and siblings' smoking habits, perceived parental supervision and communication were collected through self-administered questionnaires.
    Results: The prevalence of cigarette smoking among male secondary school children was 33.2%. Crude analysis shows family factors, fathers' and siblings' smoking habits, and lack of parental supervision were significantly associated with the students' current smoking habit. Among students who smoked compared to non-smokers, father's smoking habit gives a crude Odds Ratio = 1.8, 95% C.I. 1.08 - 3.16. Further analysis shows that the effect of their father's smoking habit on the student's current smoking habit is still significant after controlling for other familial and non-familial factors including parental supervision, academic performance, reported influence of cigarette advertisement, having friends who smoked and the student's poor knowledge of the ill-effects of smoking and other factors (Odds Ratio = 1.9, 95% C.I 1.05 - 3.32). In conclusion, family factors especially the father's smoking habit is an important factor that influences a student's current smoking habit and the presence of negative role models within the home need to be seriously considered in any cigarette smoking prevention programs among secondary school adolescents.
    Keywords: smoking, male students, adolescents, family influence, father’s smoking habit
    Matched MeSH terms: Smoking/prevention & control
  19. Smoking habits and attitudes among secondary school teachers
    Yaacob I, Harun MH
    Southeast Asian J. Trop. Med. Public Health, 1994 Mar;25(1):74-9.
    PMID: 7825029
    A questionnaire survey to study the smoking habits and attitudes toward smoking among secondary school teachers in Kelantan, Malaysia was conducted between July and September 1992. Questionnaires were sent to 5,112 teachers through their respective headmasters. Sixty-three percent (3,208 teachers; 61% males, 39% females) responded satisfactorily. Overall, 625 teachers (20%) were current smokers, 141 (4%) were occasional smokers, 317 (10%) were ex-smokers and 2,123 (67%) had never smoked. Only six (0.8%) of the 766 regular and occasional smokers were females. The rates of smoking among parents and siblings of smokers were higher than parents and siblings of non-smokers. Seventy-four percent of the smoking teachers admitted to smoking in the school premises. The teachers' attitudes about the health effects of smoking were statistically different between smokers and non-smokers. However, both smoking and non-smoking teachers had similar views regarding methods to control the smoking habit which included banning cigarette sales, putting a halt to the tobacco industry and banning cigarette advertisements.
    Matched MeSH terms: Smoking/prevention & control
  20. Fulltext Does the duration of smoking cessation have an impact on hospital admission and health-related quality of life amongst COPD patients?
    Abu Hassan H, Abd Aziz N, Hassan Y, Hassan F
    Int J Chron Obstruct Pulmon Dis, 2014;9:493-8.
    PMID: 24868154 DOI: 10.2147/COPD.S56637
    BACKGROUND: Lack of awareness among ex-smokers on the benefits of sustaining smoking cessation may be the main cause of their smoking relapse. This study explored health-related quality of life (HRQoL) and hospital admission amongst chronic obstructive pulmonary disease (COPD) patients according to the duration of smoking cessation.
    MATERIALS AND METHODS: This study recruited COPD patients from a chest clinic who agreed to participate in a medication therapy-adherence program from January to June 2013. They were interviewed during their visits to obtain information regarding their smoking history and HRQoL. They were divided into three groups according to smoking status (sustained quitters, quit ≥5 years; quitters, quit <5 years; and smokers, smoking at least one cigarette/day). The effects of the duration of cessation on HRQoL and hospital admission were analyzed using a multinomial logistic model.
    RESULTS: A total of 117 participants with moderate COPD met the inclusion criteria, who were comprised of 41 sustained quitters, 40 quitters, and 36 smokers. Several features were similar across the groups. Most of them were married elderly men (aged >64 years) with low-to-middle level of education, who smoked more than 33 cigarettes per day and had high levels of adherence to the medication regimen. The results showed that sustained quitters were less likely to have respiratory symptoms (cough, phlegm and dyspnea) than smokers (odds ratio 0.02, confidence interval 0-0.12; P<0.001). The hospital admission rate per year was increased in quitters compared to smokers (odds ratio 4.5, confidence interval 1.91-10.59; P<0.005).
    CONCLUSION: A longer duration of quitting smoking will increase the benefits to COPD patients, even if they experience increased episodic respiratory symptoms in the early period of the cessation. Thus, the findings of this study show the benefits of early smoking cessation.
    KEYWORDS: HRQoL; chronic obstructive pulmonary disease (COPD); hospital admission and hospital stay
    Study site: Chest Clinic, Hospital Melaka, Malaysia
    Matched MeSH terms: Smoking/prevention & control*
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