Abstract:

Introduction: Currently worldwide 3 million deaths annually estimated to be responsible for smoking. On average, everyday Malaysian adult smoker smoked 14 cigarettes per day. Most smokers were aware of the deleterious of smoking and had strong intentions to quit smoking but they were not motivated enough to stop.

Aim: To assess awareness on smoking health warning and its impacts among Muar Community.

Methodology: It was a quantitative survey done on 383 respondents from Bandar Maharani, Muar. The participants were aged 13-70 years. This was a descriptive, cross-sectional study using two- step sampling methods which are cluster sampling and simple random sampling. Data analysis including descriptive statistics was used to describe participants’ socio-demographic characteristics and texts, tables, graphs, percentages and independent t-test was used to present the results.

Result: The highest smoking rate noted between the ages of 25-44. Among the races, Malays were the highest smokers which was 74 %.( p=0.019). Smokers (64.1%) are married and there were significantly difference (p = 0.000) between the marital status and the smokers. Majority of the smokers were employed with 77.1% and it was significantly different (p=0.000). Greater number of smokers and non-smokers (90.9%) were aware about the presence of smoking health warning on cigarette packs. Smokers with 75% were planning to quit and about 58.3% of them perceived that cigarette health warning does not influence to prevent or to stop smoking (p=0.000). Majority of the smokers and non-smokers selected the graphic models based on its threatenig effects compared to other models.

Conclusion: Majority of the respondents has good awareness on smoking health warning and have seen or read the smoking health warning on the cigarette packs. The influence of cigarette health warning had no effect on smokers to stop smoking. Among the 6 models shown, graphic image lung cancer (Model A) has the highest number of choice by the smokers (32.3%) and non-smokers (27.2%). Threatening images was the most preferable choice among the respondents.

Recommendations: Each workplace recommended to set-up smoking cessation programs. Hospital based intervention program should be given by health practitioners in the hospital setting on pre-admission clinic for smokers. There must be tobacco rehabilitation programs in all levels of healthcare service centers for easy accessibility and promote their services for better outcomes. Existing graphic health warning should be improved in terms of size, appearance and message to be more effective. Current quitline services should be promoted more through the web sites and social media pages.

Keywords: Smoking, awareness, health warning, threatening, health

References:

[1]. A report of the Surgeon General how tobacco smoke causes disease : What it means to you. (2010). Washington, D.C.: U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

[2]. Addiction to Nicotine., (2010.)., Gender, Women and the Tobacco Epidemic., World Health Organisation., 137-149

[3]. Bansal-Travers, M., Hammond, D., Smith, P., & Cummings, K. (2011). The Impact of Cigarette Pack Design, Descriptors, and Warning Labels on Risk Perception in the U.S. American Journal of Preventive Medicine, 40(6), 674-682. doi:10.1016/j.amepre.2011.01.021

[4]. Borzekowski, D., & Cohen, J. (2014). Young children’s perceptions of health warning labels on cigarette packages: A study in six countries. J Public Health Journal of Public Health, 22, 175-185. doi:10.1007/s10389-014-0612-0

[5]. Brown, T., Platt, S., & Amos, A. (2014). Equity impact of population-level interventions and policies to reduce smoking in adults: A systematic review. Drug and Alcohol Dependence, 138, 7-16. doi:10.1016/j.drugalcdep.2014.03.001

[6]. Choudhury K, Hanifi SMA, Mahmood SS, Bhuiya A (2007). Sociodemographic Characteristics of tobacco consumers in a rural area of Bangladesh. J Health Population Nutrition, 25, 456-64.

[7]. Crone, M., Reijneveld, S., Willemsen, M. Leerdam, F., Spruijt, R., Sing, R.,(2003). Prevention of smoking in adolescents with lower education: A school based intervention study. Journal of Epidemiology & Community Health, 57, 675-680. http://jech.bmj.com/content/57/9/675.Short

[8]. D. FuadFuad, M., Fairuz, A., M N A, B., GhassanIbraheem, N., &Ayob, A. (2014). Smoking among Malay Upper Secondary School Students in Shah Alam, Selangor, Malaysia. International Journal of Collaborative Research on Internal Medicine & Public Health 6(1), 28, http://internalmedicine.imedpub.com/smoking-among-malay-upper-secondary schoolstudents-in-shah-alam-selangor-malaysia.pdf

[9]. Dibello, A., Neighbors, C., & Ammar, J. (2015). Self-affirmation theory and cigarette smoking warning images. Addictive Behaviors, 41, 87-96. doi:10.1016/j.addbeh.2014.09.026

[10]. Encouraging People to Stop Smoking.,(2001), Behavioural Science Learning Modules, World Health Organization., 55 http://www.who.int/mental_health/evidence/stop_smoking_whomsdmdp01_4.pdf

[11]. Farrelly, M. (2003). Youth tobacco prevention mass media campaigns: Past, present, and future directions. Tobacco Control, 12, 35i-47. http://tobaccocontrol.bmj.com/content/12/suppl_1/i35.full.pdf+html

[12]. Flandorfer, P., Wegner, C., Buber, I, (2010), Gender Roles and Smoking Behaviour, Vienna Institute of Demography Austrian Academy of Sciences, 25, http://www.oeaw.ac.at/vid/download/WP2010_07.pdf

[13]. Global Adult Tobacco Survey (GATS) Russian Federation Country Report, 2009., World Health Organization, 69 http://www.who.int/tobacco/surveillance/en_tfi_gats_russian_countryreport.pdf

[14]. Hammond, D., Fong, G. T., Borland, R., Cummings, K. M., McNeill, A., &Driezen, P. (2007). Text and graphic warnings on cigarette packages: Findings from the International Tobacco Control Four Country study. American Journal of Preventive Medicine, 32, 202–209., http://www.tobaccofreekids.org/pressoffice/hammond0207.pdf

[15]. Innabi, A., Ammari, D., & Tuqan, W. (2014). Awareness and Knowledge of Smoking-Related Cancers Among University Students in Jordan. AJCP American Journal of Cancer Prevention, 2(2), 20-23. doi:10.12691/ajcp-2-2-1

[16]. Institute for Global Tobacco Control, (2013), State of Evidence Review: Health Warning Labels on Tobacco Products. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health http://globaltobaccocontrol.org/sites/default/files/HealthWarnings_state_of_evidence_final_11_18_2013_web_0.pdf

[17]. Institute for Public Health (IPH),(2012), Report of the Global Adult Tobacco Survey (GATS) Malaysia 2011, Ministry of Health Malaysia, http://www.who.int/tobacco/surveillance/survey/gats/malaysia_country_report_2011.pdf

[18]. ITC Project (2011), ITC Bangladesh Report on Tobacco Warning Labels. University of Waterloo, Ontario, Canada and University of Dhaka, 6, http://www.itcproject.org/files/Report_Publications/National_Report/itcbdwarninglabelreportmay11finalmay2011.pdf

[19]. Khor Yoke, Lim and Foong Kin,(2003), Tobacco Advertising and Smoking Amongst Adolescents: A Qualitative Study in Malaysia, Southeast Asia Tobacco Control Research, 25, http://www.seatca.org/dmdocuments/17_tobacco_advertising_and_smoking_amongst_adolescents_a_qualitative_study_in_malaysia.pdf

[20]. Lim, H., Ghazali, S., Kee, C., Lim, K., Chan, Y., Teh, H., Salleh, S. (2013). Epidemiology of smoking among Malaysian adult males: Prevalence and associated factors. BMC Public Health, 13(8), 8-8. doi:10.1186/1471-2458-13-8

[21]. Lim, K.H., Sumarni, M.G., Amal, N.M., Hanjeet, K., Wan Rozita., W.M. and Norhamimah, A.,(2009), Tobacco use, knowledge and attitude among Malaysians age 18 and above, Tropical Biomedicine 26(1): 92–99, http://www.msptm.org/files/92_-_99_Lim_K_H.pdf

[22]. Liu.H., &Tan.W.,(2009) The effect of anti-smoking media campaign on smoking behavior: The california experience. Annals of Economics and Finance, 10(1), 29-47. http://aeconf.com/articles/may2009/aef100103.pdf

[23]. Niederdeppe, J., Farrelly, M., &Haviland, M. (2004). Confirming "truth": More Evidence Of A Successful Tobacco Countermarketing Campaign In Florida. American Journal of Public Health, 94, 255-257. http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.94.2.255

[24]. Pechmann, C.(n.d.) Changing Adolescent Smoking Prevalence :Impact of Advertising Interventions. Smoking and Tobacco Control Monograph, 14, 171-182 http://cancercontrol.cancer.gov/brp/tcrb/monographs/14/14_10.pdf

[25]. Riordan, M, The Campaign for Tobacco-Free Kids, March 19, 2013, https://www.tobaccofreekids.org/research/factsheets/pdf/0051.pdf

[26]. Rohrbach, L., Howard-Pitney, B., Unger, J., Dent, C., Howard, K., Cruz, T. Johnson, C.(2002). Independent Evaluation of the California Tobacco Control Program: Relationships Between Program Exposure and Outcomes, 1996–1998. Am J Public Health American Journal of Public Health, 92(6), 975-984. doi10.4236/ojpm.2011.12006

[27]. Sharma, A., &Misra, A. (2015). Backward bifurcation in a smoking cessation model with media campaigns. Applied Mathematical Modelling, 39, 1087-1098. doi:10.1016/j.apm.2014.07.022

[28]. Siahpush, M., McNeill, A., Hammond, D., & Fong, G. (2006). Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: Results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15, Iii65-Iii70. doi:10.1136/tc.2005.013276

[29]. Siegel, M., &Biener, L. (2000). The impact of an antismoking media campaign on progression to established smoking: Results of a longitudinal youth study. American Journal of Public Health, 90(3), 380-386. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446163/pdf/10705855.pdf

[30]. Smoking and Cancer, ASH Fact Sheet, (2013). http://ash.org.uk/files/documents/ASH_109.pdf

[31]. Statistics on Smoking England, (2014)., Health and Social Care Information Centre, 74, http://www.hscic.gov.uk/catalogue/PUB14988/smok-eng-2014-rep.pdf

[32]. Smoking statistics. (2015). ASH Fact Sheet., http://www.ash.org.uk/files/documents/ASH_93.pdf

[33]. Smoking statistics who smokes and how much, ASH Fact Sheet, 2015). http://ash.org.uk/files/documents/ASH_106.pdf

[34]. The Health Consequences of Smoking-50 Years of progress: A Report of the Surgeon General.,(2014), PsycEXTRA Dataset. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf

[35]. Unger JB, Shakib S, Cruz TB, et al (2003). Smoking behavior among urban and rural Native American adolescents in California. Am J Prev Med, 25, 251-4.

[36]. Velasco, M. (2009). Indonesian's awareness on smoking health warning andits impact, Southest Asia Tobacco Control Research, 60. http://www.seatca.org/dmdocuments/4_indonesians_awareness.pdf

[37]. White, V., Webster, B., & Wakefield, M. (2008). Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviours? Addiction, 103, 1562-1571. doi:10.1111/j.1360-0443.2008.02294.x

[38]. Wilson N.(2007). Review of the Evidence for Major Population-Level Tobacco Control Intervention. Wellington: Ministry of Health http://www.ccdhb.org.nz/Meetings/CPHACpapers/2007_06_14/infoonly/review-evidence-major-population-level-tobacco-control-interventions.pdf

[39]. Wolburg, J. (2008). Smoking cessation: Why do smokers fail? Journal of Consumer Marketing, 25(2), 72-73. doi:10.1108/07363760810858800

[40]. Zhao, X., Nan, X., Yang, B., & Iles, I., (2014) Cigarette warning labels: Graphics, framing, and identity. Health Education, 114(2), 101-117. doi:10.1108/HE-06-2013-0024