Abstract
This cross sectional survey was conducted to determine the support in making Penang UNESCO World Heritage Site (GTWHS) smoke free and to determine the influence of tolerance towards smoking on this support. This is the first phase in making Penang, Malaysia a smoke free state. A multistage sampling process was done to select a sample of respondents to represent the population of GTWHS. Attitude towards smoking was assessed using tolerance as a proxy. A total of 3,268 members of the community participated in the survey. A big majority (n = 2969; 90.9%) of the respondents supported the initiative. Support was lowest among the owners and residents/tenants, higher age groups, the Chinese, men, respondents who had poor knowledge of the places gazetted as smoke free, and respondents with poor knowledge of the health effects on smokers and on passive smokers. The odds (both adjusted and unadjusted) of not supporting the initiative was high among those tolerant to smoking in public areas. Tolerance towards smoking was associated with 80.3% risk of non-support in the respondents who were tolerant to smoking and a 57.2% risk in the population. Health promotion and education concerning the harm of tobacco smoke in Malaysia, which has mainly targeted smokers, must change. Health education concerning the risks of second hand smoke must also be given to non-smokers and efforts should be made to denormalize smoking.
Highlights
Smoking prevalence has reduced worldwide, both in men and women, the number of smokers has increased significantly and cigarette smoking is still the chief preventable killer in most countries [1,2,3]
Respondent Type Owner Employee Clients/customers/patrons/tourists/general public Residents/tenants Age #24 25–44 45–64 $65 Gender Men Women Marital Status Married Divorce Widow/widower Single Race Malay Chinese Indian Others Highest Level of Education Illiterate Non formal Primary Secondary Tertiary Income #RM1000 RM1001 to 3000 $RM3001 Smoking status Never smokers Past smokers Current smokers Awareness on the existence of national laws prohibiting smoking in certain areas Yes No Unsure Knowledge of places which are smoke free according to law Poor knowledge Good knowledge Health effects on smokers Poor knowledge Good knowledge Health effects on passive smokers Poor knowledge
Malaysia is relatively new in actively adopting tobacco control policies, the ministry of health and several Non-Governmental Organizations (NGO) have been actively and consistently disseminating information pertaining to the risks associated with smoking to the public
Summary
Smoking prevalence has reduced worldwide, both in men and women, the number of smokers has increased significantly and cigarette smoking is still the chief preventable killer in most countries [1,2,3]. In Malaysia, according to the Global Adult Tobacco Survey (GATS) 2011, 31% of adults aged 15 years and older were current tobacco smokers, more men (43.9%) than women (1.0%) and highest in the 25 to 44 age group. Cigarette smokers have an average 10 years reduced life span and the mortality among cigarette smokers is two to three times the mortality among persons who had never smoked [6]. In Malaysia, tobacco related diseases accounted for the main causes of deaths in the hospitals operated by the Ministry of Health. Smoking effects morbidity and mortality and quality of life, participation in workplace and increased health care costs [2]
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