Ways to reduce the smoking scourge

FORTY-SIX years and two days. It has been that long since I kicked the noxious habit. The last cigarette was crushed just after three puffs at 6pm on Nov 18, 1978.

For smokers, it is one of the most difficult things to do because nicotine, the main stimulant in cigarettes, is highly addictive.

Research has shown that it is the third most addictive drug after heroin and cocaine.

It triggers the brain to release neurotransmitters, such as dopamine, beta-endorphin and serotonin, which regulate pleasure, mood, emotion and pain relief.

Withdrawal symptoms can be severe and might last for weeks or months. They include irritability, depression, anxiety, inability to focus and restlessness.

Not many people have the willpower to overcome the torment.

Although the prevalence of smoking has dropped from 21.3% to 19% from 2011 to 2023, tobacco use continues to be an epidemic in Malaysia, especially with the soaring rise in vaping among young people.

The age of initiation for smoking is also getting younger, which leads to increased nicotine dependence and other high-risk behaviours, including drug abuse.

According to the 2023 Global Adult Tobacco Survey (GATS) released by the Health Ministry in May, the usage of both tobacco and e-cigarettes rose from 0.8% to 3.9% during the period – a 387.5% rise.

Vaping skyrocketed even higher by 625%, with 5.8% of people aged 15 and above using e-cigarettes, compared with only 0.8% in 2011.

The three main reasons cited for vaping were the variety of flavours from e-cigarettes, more enjoyment and the perception of lower risks from vaping compared with cigarettes.

The GATS survey also revealed that the number of smokers who had quit and those who had tried to quit over the past year had remained stagnant.

There’s no denying that smoking is a deadly habit.

Besides nicotine, cigarettes have 7, 000 other chemicals, including 69 which are known to cause cancer.

Tobacco use now leads to 17% of all deaths in the country.

On average, 29,457 Malaysians die from smoking each year – that’s more than 80 people daily.

Smoking is also a major risk factor for the four main non-communicable diseases: cancer, heart disease, respiratory disease and diabetes. The economic cost is also substantial.

The country has been paying a very high price for its smokers in the form of healthcare expenses for treatment of smoking-related diseases, medication and loss of productivity due to illnesses and premature deaths. These amount to a whopping RM15.8bil every year and are expected to go higher.

Health Minister Datuk Seri Dr Dzulkefly Ahmad told the Dewan Rakyat last week that the cost of treating e-cigarette and vaping product use-associated injuries (Evali) could spike up to RM368mil a year by 2030, citing a case where RM150,892 was spent on one patient warded for 12 days in a hospital.

Yet, Malaysians spent a colossal RM4bil on tobacco products last year.

For smokers in the B40 lower income category, the money burnt through smoking and vaping results in a major financial strain for families that need to rise out of poverty.

The government is banking on the Control of Smoking Products for Public Health Act 2024, also known as Act 852, to reduce the national rampancy of smoking and vaping. It was passed by Parliament in November last year but only came into effect on Oct 1 this year, nine months after being gazetted.

Act 852 includes regulations on the sale, packaging and labelling of smoking products, and restrictions on smoking in public places. It also bars the sale of smoking products to minors.

Among the aims of the new law is to control the use of electronic cigarettes, which was previously unregulated, especially among younger people.

The law also stipulates that health warnings must be displayed on packaging for both nicotine and non-nicotine vape products, like for regular cigarette packs.

There are now 28 non-smoking areas compared with only 23 under the Food Act’s Control of Tobacco Product (Amendment) Regulations 2018.

While some parts of Act 852 will be enforced in phases, the ban on smoking and vaping in specific areas is already in force.

Dr Dzulkefly has expressed confidence that the prevalence of smoking can drop to below 15% next year from the current 19% with the enforcement of Act 852.

According to Health deputy director-general Datuk Dr Norhayati Rusli, 2,548 warning notices have been issued since Act 852 came into force, while three compound notices were also issued for smoking in areas where smoking is prohibited.

The ministry has so far conducted 108 operations and checked 2,930 premises during routine enforcement of the smoking ban at eateries, restaurants and public places.

But going by past experience, enforcing smoking bans has largely been lax, especially in eateries and night spots.

Friends who frequent pubs, for example, say that people still puff away in these places, despite the prominently displayed “No Smoking/No Vaping” signs.

Do our enforcement agencies have the necessary resources, including personnel and funding, to monitor and penalise violators effectively, across the country?

The Health Ministry must keep in mind that the biggest challenge facing Act 852 is ensuring unswerving and effectual enforcement.

And like always in Malaysia, there is a risk of enforcement officers being bribed to overlook violations, which undermines the potency of the law.

Much more also needs to be done to educate people, both users of tobacco and e-cigarettes, on the importance of adhering to the new law.

Addressing these challenges requires concerted effort from the government, public health organisations and communities to ensure that Act 852 achieves the intended goals of reducing smoking and protecting public health.

Media consultant M. Veera Pandiyan likes this observation by Spanish-American philosopher George Santayana: Habit is stronger than reason. The views expressed here are entirely the writer’s own.