Smokers may not seek help out of shame
STIGMAS associated with smoking can be a major hurdle to Malaysia’s initiatives for smoking reduction and harm reduction.
Not only does it make it more difficult for smokers to seek help or support as they may feel ashamed or even embarrassed about their habits, it could also lead to a reluctance to seek out necessary resources, according to a study conducted by the US National Centre for Biotechnology Information.[1]
While smoking prevalence in Malaysia has been a major public health issue for many years, there has been improvements from previous years, with smoking prevalence having decreased steadily over the past few decades.
However, smoking remains a significant public health issue, with smoking-related illnesses accounting for a significant proportion of morbidity and mortality in Malaysia.
Socioeconomic barriers
Based on a report by the World Health Organisation (WHO), about 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries [1], where the burden of tobacco-related illness and death is heaviest.
For smoking-related stigma, it can lead to a reluctance to seek assistance in transitioning to less harmful alternatives, and a tendency to conceal smoking behaviours from one’s health care provider.
Other social determinants of health can also impact smoking cessation and harm reduction strategies for the country.
For instance, populations with lower income may have less access to healthcare resources and be more likely to live in environments where smoking is more prevalent.
Numerous public health researchers also note that "cigarette affordability is a significant predictor of smoking behaviour in Malaysia" but can be limited to lower-income groups in terms of efficacy.[2]
Socioeconomic hurdles can make it more difficult for them to look for tobacco replacement therapy, as they may not have the same level of access to support or resources as those with higher incomes.
Proactive programme
To address stigma and to help smokers who aren’t ready to quit cold turkey, targeted interventions are needed to improve access to smoking cessation and harm reduction resources for people in marginalised communities.
Education and awareness campaigns can help to change societal attitudes towards smoking. These campaigns can highlight the health risks of smoking, promote the benefits of smoking cessation and harm reduction, and provide information about available resources and support.
Similarly, people with lower levels of education may have less knowledge about the health risks of traditional cigarettes. This can make it more difficult for them to make informed choices about their smoking and may lead to a reliance on ineffective or harmful approaches if they decide to quit.
Another possible approach to addressing stigma is to provide peer support programmes for smokers in transition.
A slow transition
It is important to remember that nicotine dependence makes successful cessation difficult.
A separate study by International Journal of Environmental Research and Public Health found that “in many countries, while more than half of current smokers want to quit smoking, and one-third made at least three attempts in the previous year, less than half succeed in quitting before the age of 60.” [3]
One strategy to allow cigarette smokers to transition is by using smoke-free products such as heated tobacco products (HTPs) or e-cigarettes (vape).
HTPs are battery-powered devices that heat tobacco instead of burning it – producing a nicotine aerosol that is inhaled by the user. Unlike traditional cigarettes, HTPs do not produce smoke and have been shown to emit lower levels of harmful chemicals than traditional, combustible cigarettes.
According to Philip Morris International Global Scientific Engagement vice president Gizelle Baker in her interview with Business Recorder, “over 85% of environmental tobacco smoke is generated from sidestream smoke, which comes directly from burning cigarettes, cigars, or smoking pipes.”
“There is no sidestream smoke in a heated tobacco product since they just heat tobacco, which means that 85% of smoke is eliminated immediately. Also, there is a reduction in aerosol exhaled which is 90%-95% less toxic than regular smoke”. [4]
Therefore, it could be argued that alternatives to cigarettes present significant harm reduction potential if smokers were to completely transition to using these products.
By implementing targeted interventions or policy interventions alongside scientifically backed harm reduction methods, we can create a more supportive and equitable environment for smokers to switch to less harmful alternatives.
References:
- WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition. WHO, Geneva, 2021. https://www.who.int/publications/i/item/9789240039322
- Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015. Tobacco induced diseases, 16, 01. https://doi.org/10.18332/tid/82190
- Who Are More Likely to Have Quit Intentions among Malaysian Adult Smokers? Findings from the 2020 ITC Malaysia Survey. International journal of environmental research and public health, 19(5), 3035. https://doi.org/10.3390/ijerph19053035
- Interview with Gizelle Baker - Vice President Global Scientific Engagement Philip Morris International - BR Research - Business Recorder (brecorder.com). https://www.brecorder.com/news/40224579
