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Fulltext Source of cigarettes among youth smokers in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA)

Lim KH, Teh CH, Heng PP, Pan S, Ling MY, Yusoff MFM, et al.

Tob Induc Dis, 2018;16:51.
PMID: 31516448 DOI: 10.18332/tid/96297

INTRODUCTION: Understanding how and where youth obtain tobacco products are major factors in the development of suitable intervention programs to reduce youth smoking. This study aimed to determine the source of cigarettes and the associated factors among Malaysian school adolescent smokers.

METHODS: Our sample consisted of 1348 youth aged 10-17 years who were current smokers (having smoked at least once in the last 30 days). The source of cigarettes (commercial, over-the-counter purchases; or social, borrowing or obtaining from someone else) was the dependent variable, and multivariable logistic regression was employed to determine its association with independent variables (i.e. sociodemographics, smoking behavior, and knowledge of laws prohibiting sales of cigarettes to youth).

RESULTS: Over half (54.3%) of current smokers obtained cigarettes from commercial sources, with a proportion nearly two times higher (84.2% vs 43.7%) among frequent smokers (i.e. those smoking more than 20 days per month) compared to less-frequent smokers, and among young males (56.5% vs 32.0%) compared young females. Multivariable logistic regression indicated that in urban areas, young females (AOR=12.5, 95% CI: 1.38-99.8) frequent smokers (AOR=4.41, 95% CI: 2.05-9.46), and those studying in lower (AOR=3.76, 95% CI: 1.41-10.02) and upper secondary (AOR=4.74, 95% CI: 1.72-13.06) school students were more likely to obtain cigarettes from a commercial source. On the other hand, in rural areas, only frequent smokers were more likely to get their cigarettes from commercial sources, whilst other variables were not significant.

CONCLUSIONS: The proportion of youth smokers who obtained cigarettes from commercial sources appeared to be high, suggesting that law enforcement and health promotion activities should be enhanced to reduce the rate of smoking among Malaysian youth.

Matched MeSH terms: Smoking
Fulltext The use of e-cigarettes among university students in Malaysia

Wan Puteh SE, Manap RA, Hassan TM, Ahmad IS, Idris IB, Sham FM, et al.

Tob Induc Dis, 2018;16:57.
PMID: 31516454 DOI: 10.18332/tid/99539

INTRODUCTION: E-cigarette use is an emerging phenomenon with increasing recognition and acceptance globally. This study aims to create a profile of e-cigarette users among university students in Malaysia.

METHODS: The study was conducted using a cross-sectional research involving six universities in Malaysia. A semi-structured questionnaire was distributed to 1302 randomly selected students, who either smoked cigarettes and/or e-cigarettes. The 2011 version of Global Adult Tobacco Surveys (GATS) tool was used to record the respondents' sociodemographic data.

RESULTS: The study revealed that 74.9% of the respondents smoked e-cigarettes; 40.3% used both cigarettes and e-cigarettes (dual users), and 34.5% were exclusive e-cigarette users. The exclusive use of e-cigarettes was related to gender (OR=0.18, 95% CI: 0.09-0.39). Also, male respondents were the majority users (95%). Of the respondents, 75.2 % were Malays, 98.0% single and most believed they have no health problems (92.1%). Further findings revealed the occurrence of adverse effects, dizziness 14.4%, cough 14.1%, and headaches 12.4%. Overall, 57.8% of the respondents used e-cigarettes as a smoking cessation tool, while others consider e-cigarettes a self-image enhancing tool or as part of social activities.

CONCLUSIONS: Further research on the use of e-cigarettes should be conducted on a large number of respondents in other settings to augment the findings of this study, and also guide policy making on and prevention practice of e-cigarette use, among the general student population in Malaysia.

Matched MeSH terms: Smoking Cessation
Fulltext Burden of smoking in Asia-Pacific countries

Lee VWY, Li A, Li JTS

Tob Induc Dis, 2021;19:28.
PMID: 33867905 DOI: 10.18332/tid/133633

INTRODUCTION: Smoking is a modifiable risk factor for many diseases. The public should recognize the impact of smoking on their health and their wealth. The current study aimed to evaluate the cost burden of smoking to target Asia-Pacific countries.
METHODS: The current study estimated the annual spending and lifetime spending of smokers in the target Asia-Pacific countries (Hong Kong, Malaysia, Thailand, South Korea, Singapore, and Australia) on purchasing cigarettes, as well as predicted the revenue that could be generated if smokers spent the money on investment instead of buying cigarettes. Smokers' spending on cigarettes and the potential revenue generated from investment were estimated based on the selling prices of cigarettes, Standards & Poor's 500 Index, and life expectancies of smokers. Data were extracted from reports released by the World Health Organization or government authorities.
RESULTS: The annual expenses (in US$) on purchasing one pack of cigarettes, in decreasing order, were: Australia ($5628.30), Singapore ($3777.75), Hong Kong ($2799.55), Malaysia ($1529.35), South Korea ($1467.30), and Thailand ($657.00). The lifetime spending on purchasing one pack of cigarettes each day were: Australia ($308993.67), Singapore ($207398.48), Hong Kong ($151735.61 for male and $166853.18 for female), South Korea ($80261.31), Malaysia ($72338.26), and Thailand ($31207.50).
CONCLUSIONS: The cost burden of smoking is high from a smoker's perspective. Smokers should recognize the high economic burden and quit smoking to enjoy better health and wealth.

Matched MeSH terms: Smoking; Smoking Cessation
Fulltext Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015

Lim KH, Teh CH, Pan S, Ling MY, Yusoff MFM, Ghazali SM, et al.

Tob Induc Dis, 2018;16.
DOI: 10.18332/tid/82190

INTRODUCTION The continuous monitoring of smoking prevalence and its associated factors is an integral part of anti-smoking programmes and valuable for the evaluation of the effectiveness of anti-smoking measures and policies. This study aimed at determining prevalence of smoking and identifying socio-demographic factors associated with smoking among adults in Malaysia aged 15 years and over.
METHODS This is a cross-sectional study with a representative sample of 21 445 adults in Malaysia, aged 15 years and over, selected via a stratified, two-stage proportionate-to-size sampling method. Data were obtained from face-to-face interviews by trained research assistants, using a standard validated questionnaire. Multivariable logistic regression was performed to determine socio-demographic factors associated with smoking among Malaysians.
RESULTS The overall prevalence of smoking was 22.8% (95% CI: 21.9–23.8%), with males having a significantly higher prevalence compared to females (43.0%, 95% CI: 41.1–44.6 vs 1.4%, 95% CI: 1.1–1.7). The highest smoking prevalence was observed among other ethnicities (35.7%), those aged 25–44 years (59.3%), and low educational attainment (25.2%). Males, those with lower educational attainment and Malays were significantly associated with smoking.
CONCLUSIONS The prevalence of smoking among Malaysians, aged 15 years and over, remains high despite the implementation of several anti-smoking measures over the past decades. Specially tailored anti-smoking policies or measures, particularly targeting males, the Malays, younger adults and those with lower educational attainment, are greatly warranted to reduce the prevalence of smoking in Malaysia.
Study name: National Health and Morbidity Survey (NHMS-2015)

Matched MeSH terms: Smoking
Fulltext An online survey of Malaysian long-term e-cigarette user perceptions

Abdulrahman SA, Ganasegeran K, Loon CW, Rashid A

Tob Induc Dis, 2020;18:26.
PMID: 32292316 DOI: 10.18332/tid/118720

INTRODUCTION: The use of e-cigarettes (EC) has reached alarming proportions among Malaysians. On a national level, little is known about the profile and perceptions of Malaysian EC users. This study aimed to explore the prevalence of long-term EC usage and its associated factors among EC users in Malaysia.

METHODS: This nationwide online questionnaire survey was administered among 694 EC users across 13 states and 1 Federal Territory in Malaysia, between January and April 2018. A survey link was e-mailed to EC users that were recruited from an official national vape entity through their Facebook association page. We obtained information on respondents' sociodemographic characteristics, smoking habits, long-term e-cigarette usage and perceptions of EC use. We estimated long-term EC user prevalence and fitted multivariate regression models to predict factors associated with long-term EC usage. Statistical significance was set at p<0.05.

RESULTS: Respondents were predominantly Malays (87.6%), aged >30 years (68.1%) and tertiary educated (71%). The majority were employed (93.1%) with a monthly household income of MYR 4000 or less (56.6%). About 84% were former smokers, while 10% were current smokers. The prevalence of long-term EC usage in this study was 82.3%. Most users believed that EC had helped them to cut down tobacco smoking (94.8%), reduced the urge to smoke (88.3%) and ultimately helped them to quit smoking (87.2%). Respondents aged >30 years and those who perceived that EC has helped them stop smoking were significantly more likely to be long-term EC users.

CONCLUSIONS: Most respondents engaged in EC use to quit smoking. They were more likely to be long-term EC users if they were older and perceived that EC has helped them to quit smoking. This information is valuable for targeted prevention, health promotion and policy regulations.

Matched MeSH terms: Smoking; Smoking Cessation
TPPA and tobacco control: threats to APEC countries

Sy DK, Stumberg RK

Tob Control, 2014 Nov;23(6):466-70.
PMID: 25170023 DOI: 10.1136/tobaccocontrol-2014-051900

Twelve-member countries of the Asia Pacific Economic Cooperation (APEC) are negotiating the Trans-Pacific Partnership Agreement (TPPA), a free trade agreement to facilitate international trade and investment. As reported by multiple sources, the TPPA would grant the same trade benefits and legal protections to tobacco products, services and investments that it would provide to other sectors. Malaysia proposed excluding tobacco control measures from the scope of all TPPA chapters while the US proposed only to establish a consultation process in tobacco-related disputes and to declare that tobacco control measures serve a health objective within the scope of the general exceptions.

Matched MeSH terms: Smoking Cessation/legislation & jurisprudence*
Fulltext Malaysia: empowering dentists into smoking cessation

Nordin AS, Kadir RA

Tob Control, 2014 Jul;23(4):284.
PMID: 25061647
Matched MeSH terms: Smoking/prevention & control*; Smoking Cessation/methods*
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/economics*; Smoking/prevention & control
Cigarette price level and variation in five Southeast Asian countries

Liber AC, Ross H, Ratanachena S, Dorotheo EU, Foong K

Tob Control, 2015 Jun;24(e2):e137-41.
PMID: 24500266 DOI: 10.1136/tobaccocontrol-2013-051184

OBJECTIVES: To monitor and analyse impacts of the interaction between tobacco excise tax policy and industry price strategy, on the price level and variation of cigarettes sold in five Southeast Asian countries (Indonesia, Cambodia, Lao PDR, the Philippines and Vietnam).
METHODS: Prices of cigarette sold by sticks and packs were collected through an in-person survey of retailers during 2011. Mean cigarette prices and price variation were calculated in each study country for single cigarettes, whole packs and brand groups.
RESULTS: Price variation of whole packs was greater in countries with ad-valorem excise tax structures (Cambodia, Lao PDR and Vietnam) than in countries with multitiered specific excise taxes (Indonesia and the Philippines). The price variation for single sticks appeared to be driven by local currency denomination. Cigarettes sold individually cost more per stick than cigarettes sold in whole packs in every brand group except for Indonesia's domestic brands.
CONCLUSIONS: Tobacco industry strategy and excise tax structure drove the price level and variation of cigarettes sold in packs, while currency denominations influence the selling price of single sticks. To maximise the effectiveness of tobacco tax policies, countries should adopt specific excise tax structures to decrease cigarette price variation, which would minimise opportunities for smokers to 'trade down' to a cheaper brand to avoid a tax-driven price increase.
KEYWORDS: Low/Middle Income Country; Packaging and Labelling; Price; Surveillance and Monitoring; Taxation

Matched MeSH terms: Smoking/economics*
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*; Smoking Cessation*
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/adverse effects*; Smoking/legislation & jurisprudence; Smoking/prevention & control; Smoking Cessation/methods
Health warning messages on tobacco products: a review

Hammond D

Tob Control, 2011 Sep;20(5):327-37.
PMID: 21606180 DOI: 10.1136/tc.2010.037630

OBJECTIVE: To review evidence on the impact of health warning messages on tobacco packages.
DATA SOURCES: Articles were identified through electronic databases of published articles, as well as relevant 'grey' literature using the following keywords: health warning, health message, health communication, label and labelling in conjunction with at least one of the following terms: smoking, tobacco, cigarette, product, package and pack.
STUDY SELECTION AND DATA EXTRACTION: Relevant articles available prior to January 2011 were screened for six methodological criteria. A total of 94 original original articles met inclusion criteria, including 72 quantitative studies, 16 qualitative studies, 5 studies with both qualitative and qualitative components, and 1 review paper: Canada (n=35), USA (n=29) Australia (n=16), UK (n=13), The Netherlands (n=3), France (n=3), New Zealand (n=3), Mexico (n=3), Brazil (n=2), Belgium (n=1), other European countries (n=10), Norway (n=1), Malaysia (n=1) and China (n=1).
RESULTS: The evidence indicates that the impact of health warnings depends upon their size and
DESIGN: whereas obscure text-only warnings appear to have little impact, prominent health warnings on the face of packages serve as a prominent source of health information for smokers and non-smokers, can increase health knowledge and perceptions of risk and can promote smoking cessation. The evidence also indicates that comprehensive warnings are effective among youth and may help to prevent smoking initiation. Pictorial health warnings that elicit strong emotional reactions are significantly more effective.
CONCLUSIONS: Health warnings on packages are among the most direct and prominent means of communicating with smokers. Larger warnings with pictures are significantly more effective than smaller, text-only messages.

Matched MeSH terms: Smoking/adverse effects*; Smoking Cessation/methods
Smoking behaviour and associated factors of illicit cigarette consumption in a border province of southern Thailand

Ketchoo C, Sangthong R, Chongsuvivatwong V, Geater A, McNeil E

Tob Control, 2013 Jul;22(4):255-60.
PMID: 22174006 DOI: 10.1136/tobaccocontrol-2011-050008

BACKGROUND:
Illicit cigarette consumption has increased worldwide. It is important to understand this problem thoroughly.

OBJECTIVES:
To investigate behaviours and factors associated with illicit cigarette consumption in southern Thailand.

DESIGN:
A survey and qualitative study were conducted in a border province in southern Thailand next to Malaysia. A modified snowballing technique was used to recruit 300 illicit and 150 non-illicit cigarette smokers. A questionnaire was used to interview subjects. Illicit cigarette packs were obtained in order to identify their characteristics. Bivariate and multivariate logistic regression was used for data analysis.

RESULTS:
Smoking of illicit cigarettes has become accepted in the communities. They were available in supermarkets and vendor shops. Friends and other illicit smokers known by illicit cigarette smokers were an important source of information for access to illicit cigarette products. The main factors associated with smoking illicit cigarettes, compared with smoking non-illicit cigarettes, were younger age, higher education and higher average monthly expenditure on cigarettes (most illicit smokers smoked illicit cigarettes (average price per packet = 33 THB (US$1.1), while most non-illicit smokers smoked hand-rolled cigarettes (average price per packet = 7 THB (US$0.2)) and knowledge of other illicit cigarette smokers. The low price of illicit cigarettes was the main reason for their use. Selling strategies included sale of singles, sale in shops and direct sale through social networking.

CONCLUSIONS:
Illicit cigarette consumption has become more acceptable especially among young adult smokers. Age and extent of social networks are important factors associated with smoking illicit cigarettes.

KEYWORDS:
Smoking behaviour; border province; cessation; cigarette consumption; global health; hand-rolled/RYO tobacco; health services; illegal tobacco products; illicit cigarette

Matched MeSH terms: Smoking/economics; Smoking/legislation & jurisprudence*
Fulltext Malaysian and Thai smokers' beliefs about the harmfulness of 'light' and menthol cigarettes

King B, Yong HH, Borland R, Omar M, Ahmad AA, Sirirassamee B, et al.

Tob Control, 2010 Dec;19(6):444-50.
PMID: 20852322 DOI: 10.1136/tc.2009.034256

This study explored the extent to which Malaysian and Thai smokers believe "light" and menthol cigarettes are less harmful than "regular" cigarettes and the correlates of these beliefs.

Matched MeSH terms: Smoking/adverse effects*
Fulltext Linking data to tobacco control program action among students aged 13-15 in Association of Southeast Asian Nations (ASEAN) member states, 2000-2006

Sirichotiratana N, Sovann S, Aditama TY, Krishnan M, Kyaing NN, Miguel-Baquilod M, et al.

Tob Control, 2008 Dec;17(6):372-8.
PMID: 18669557 DOI: 10.1136/tc.2007.024190

The Association of Southeast Asian Nations (ASEAN) has made tobacco use prevention a primary health issue. All ASEAN countries except Indonesia have ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), the world's first public health treaty on tobacco control.

Matched MeSH terms: Smoking/legislation & jurisprudence; Smoking/prevention & control*; Smoking Cessation
Fulltext Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey

Yong HH, Borland R, Hammond D, Sirirassamee B, Ritthiphakdee B, Awang R, et al.

Tob Control, 2008 Feb;17(1):46-52.
PMID: 18218808 DOI: 10.1136/tc.2007.021964

To examine the impact of tobacco advertising policy on adult smokers' awareness of tobacco promotion in two developing countries--Malaysia and Thailand.

Matched MeSH terms: Smoking/adverse effects; Smoking/psychology*
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/economics; Smoking/legislation & jurisprudence; Smoking/prevention & control*
"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/legislation & jurisprudence*; Smoking/prevention & control
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/legislation & jurisprudence; Smoking/prevention & control*
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/adverse effects; Smoking/prevention & control*; Smoking Cessation/psychology*

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