Smoking among adolescents has increased within the last several years with 1 in 5 individuals aged between 10 and 19 years old are likely to be avid smokers.
This result is one of the main findings from the Tobacco and e-Cigarette Survey Among Malaysian Adolescent (TECMA) conducted by the Institute of Public Health (IKU), the first nationwide survey in assessing smoking habits among secondary school students.
The survey encompasses a total of 138 schools from 15 states involving 14,833 respondents. Using a set of questionnaires, the survey obtained smoking-related information from students including how frequent they smoke, accessibility to smoking products, knowledge on the harmful effects of smoking and exposure to smoking advertisements.
The Persistence of Tobacco Among the Youth
The survey discovered that nearly 36.8% of respondents smoked between 2 to 5 sticks a day and more than 1 in 10 individuals tends to smoke every day in a one month period. Furthermore, smoking prevalence is higher among male respondents with a prevalence rate of 26.2% compared to women which are 5.3%.
One of the more disturbing findings from this survey is the accessibility of smoking products to the student. Around 42.5% of respondents stated they purchased cigarettes from supermarkets, grocery stores, and roadside stalls while 18.6% obtained from cigarettes from others such as friends or family members followed by the 3.4% who resorted to stealing. Disturbingly, the participants of this survey were aware of that smoking below the age of 18 is against the law, therefore highlighting the lack of enforcement on restricting cigarette sales.
The economic aspect of the smoking culture among adolescents is also a primary focus in the TECMA survey. Findings include an alarmingly 71.6% of adolescent smokers spent as little as RM 9 daily which is below the RM 10 price cap. Many parties believed that these figures would be exacerbated by the expanding illegal cigarette market and weak enforcement of cigarette sales to minors.
Other survey findings indicated that more than half of the respondents stated that they were exposed to second-hand smoke more frequently at public areas such as the highway rest and relax (R&R) facilities and in public transport stations. Overall, 51% of respondents stated that they were exposed to second-hand smoke in public places while 39% said that they received exposure within their homes.
E-cigarette: An emerging smoking culture
The survey also considers the usage of e-cigarettes due to its increasing prominence as an alternative to smoking tobacco as well as a form of smoking cessation aid due to lower nicotine content compared to conventional cigarettes. The overall prevalence of current e-cigarettes users was highest among the 16 – 19-year-olds at 13% and lowest among adolescents aged 12 years or below at a mere 4.8%. 46.5% of smokers start using e-cigarettes at the age of 14. Gender wise, the pattern is similar to tobacco where the prevalence rate is higher among male smokers compared to female smokers.
43.3% of respondents stated that their introduction to e-cigarettes is through their peers and more than half of adolescents below the age of 18 were not prevented from buying them from shops and kiosk, once again indicating the lax in underage smoking prevention laws. Among e-cigarette users, 34.9% had never purchased them while 23.9% would spend below RM 50 per month. These findings highlight the price differences between e-cigarette and tobacco and its affordability among adolescent smokers.
One-third of e-cigarette smokers preferred Vape-MODS based product due to its long battery plan, durability and customization features. Gender wise, this trend can is obvious among male smokers, but female smokers tend to use rechargeable e-cigarettes containing refillable vaping liquid. Unlike tobacco products which heavily relied on advertisements to entice adolescents into smoking, e-cigarettes were promoted through free trial sessions and distribution of free samples. In this aspect, more male adolescents are prone to begin using e-cigarettes through these marketing strategies compared to female adolescents.
With e-cigarettes are highly promoted as a healthier alternative to smoking, the survey also assessed the level of perception of adolescents towards vaping. According to the survey, 41.4% stated that e-cigarettes are similar to tobacco regarding harmful effects to their health contrary to popular belief. 41.2% of female adolescents believe that e-cigarettes are more harmful than cigarettes, exceeding the male adolescents at 37.9%. This highlights the increasing public awareness of the dangers of e-cigarette to the user’s health, which for a time, downplayed due to a report by Public Health England which concluded that vaping is 95% safer than smoking. E-cigarettes advocates frequently cited the findings of this report to emphasize the safeness of vaping due to the lower levels of carcinogen and other toxic chemicals compared to tobacco cigarettes.
Shisha: A Local Pastime
The TECMA survey also considered studying the prevalence of shisha smoking. This tobacco product predates e-cigarettes as a less harmful alternative to tobacco and is widely used at public places notably restaurants. Shisha consists of aromatic tobacco flavours, making it popular among the youth. Key findings of the survey include the prevalence of ever smokers was 10.6% while the prevalence of current smokers was 3.5%. Current shisha users aged 13-15 years scored the highest prevalence rate of 4.6% is more than half smoked 1-2 days per month. 51.2% of shisha tend to smoke with shisha before the age of 14.
Achieving the Endgame of Tobacco
A comparison of the findings from the National Health and Morbidity Survey (NHMS) and the Global Adult Tobacco Survey (GATS) which was carried out in 2015 and 2011 respectively indicated that there is a mere 0.3% decrease in the prevalence of adult tobacco smokers. This revelation highlights the fact that current efforts by the government are not sufficient. The TECMA findings underscore the worsening smoking culture among students and the need for a more aggressive approach in curbing this worrying trend. The Ministry of Health has planned to raise the minimum age limit for cigarette purchases from 18 to 21 years old and enforced the Control of Tobacco Product (Amendment) Regulations 2017 which involves increased smoking prohibitions in public areas. Deputy Minister of Health Datuk Seri Dr Hilmi Yahya stated that the ministry would also consider establishing a new act to regulate tobacco advertisements. Other measures include limiting cigarette sales at public eateries and ban on cigarette shops near school areas.
Prices increase on cigarettes from RM 17.50 to RM 21 is through higher taxation rate so that students will not be able to afford them should also be considered. However, many quarters have expressed concern that this will boost the illegal cigarette market where enforcement in curbing sales cheap cigarette products has been lax. Early this year, Plantation Industries and Commodities Minister Datuk Mah Siew Kong have proposed the licensing of tobacco and tobacco products to reduce the sale of illicit cigarettes and plug in loopholes in tax collection by the government.
Studies have shown that smoking during adolescent years will lead to a stronger nicotine addiction which in turn reduces the chances of quitting. Therefore, TECMA recommended that e-cigarettes should be made illegal to be purchased by underage smokers. The study also suggested that Ministry of Education has planned to intensify their anti-smoking campaign in schools nationwide to advocate a smoke-free environment in the forms of physical activities as well as classroom lessons in subjects such as science, arts, and religion. Parents and school counsellors play an important role inculcating the importance of living a smoke-free life to students at home and school respectively. Intervention programmes such as “Kesihatan Oral Tanpa Asap Rokok”(KOTAK) at dental clinics and “Komuniti Sihat Perkasa Negara (KOSPEN) at rural areas need to be frequently carried out to keep the public informed on the dangers of smoking. Every party has a role in curbing smoking among the adolescents to preserve the health of the country’s youth and achieve the target of 30% reduction in tobacco in the prevalence of tobacco use as established by the World Health Organization (WHO) Global Non-Communicable Diseases Target by 2025.
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