Non-Communicable Diseases:
Risk Factors and other Health Problems
081
6.1 Smoking
Current Tobacco Smoker
Overall, the prevalence of current smoker was 21.3% (95% CI:
19.86, 22.75). There was a slight reduction compared to the
prevalence reported in the National Health and Morbidity
Survey (NHMS) 2015 [22.8% (95% CI: 21.9, 23.8)]. It was
estimated that 4.8 million Malaysians aged 15 years and above
currently smoke. The prevalence was highest in Kedah [27.6%
(95% CI: 23.44, 32.24)], followed by Sabah [25.3% (95% CI:
20.02, 31.45)] and Terengganu [23.9% (95% CI: 20.37, 27.82)];
while the lowest prevalence was in WP Putrajaya [12.2%; (95%
CI: 9.91, 14.97)]. The proportion of current smokers was more
than 30 times higher among males compared to females
[40.5% (95% CI: 37.90, 43.06) vs 1.2% (95% CI: 0.85, 1.70)]. It
was also observed that the prevalence of male smokers had
reduced from 43.0% (95% CI: 41.4, 44.6) in 2015 to 40.5%
(95% CI: 37.90, 43.06) while the smoking prevalence among
females had reduced slightly from 1.4% (95% CI: 1.1, 1.8) in
2015 to 1.2% (95% CI: 0.84, 1.70) in the current survey.
Higher prevalence of tobacco use was observed among
respondents in rural areas [25.4% (95% CI: 22.55, 28.54)] as
compared to respondents in urban areas [20.1% (95% CI:
18.47, 21.77)]. The prevalence of current smokers for the 15-19
years old age group was 12.3% (95% CI: 9.72, 15.46) and the
prevalence peaked in the 30-34 years age group [27.1% (95%
CI: 23.01, 31.61)]. The lowest prevalence was reported among
those in the 75+ age group with the prevalence of 7.5% (95%
CI: 5.20, 10.74).
Respondents with tertiary education had the lowest prevalence [13.0% (95% CI: 11.10, 15.16)] when compared to respondents with primary education [24.3% (95% CI: 20.71, 28.27)] and secondary education attainment [24.6% (95% CI: 22.65, 26.59)]. The highest prevalence of current smokers was among those who were self-employed [33.7% (95% CI: 29.38, 38.31)] followed by private sector employees [30.1% (95% CI: 27.39, 32.99)] which were significantly higher than the prevalence reported by government employees [18.2% (95% CI: 14.68, 22.27)]. Current Cigarette Smoker Approximately one fifth of the respondents [20.8% (95% CI: 19.43, 22.30)] currently smoked cigarettes. The prevalence was remarkably higher among male current smokers [39.6% (95% CI: 37.08, 42.19)] as compared to female current smokers [1.2% (95% CI: 0.84, 1.69)]. Cigarette use was also higher among those residing in rural areas [24.9% (95% CI: 22.07, 28.00)] compared to those in urban areas [19.6% (95% CI: 18.07, 21.33)]. The respondents with primary education [24.1% (95% CI: 20.57, 28.10)] had the highest prevalence while those with tertiary education attainment reported the lowest prevalence [12.5% (95% CI: 10.62, 14.63)]. Among daily cigarette smokers, the mean number of cigarettes smoked daily was 12.4 sticks per day. About one third [30.5% (95% CI: 26.84, 34.47)] of daily cigarette smokers smoked 15 to 24 sticks of cigarette per day while only 4.2% (95% CI: 3.18, 5.65) smoked 25 or more sticks per day. Majority of male daily cigarette smokers smoked 15 to 24 sticks of cigarette per day [30.9% (95% CI: 27.22, 34.91)] while majority of female smoked less than 5 sticks of cigarette per day [41.5% (95% CI: 25.28, 59.89)]. Smokeless Tobacco Use The prevalence of smokeless tobacco use among Malaysian population aged 15 years and above was 6.5% (95% CI: 5.63, 7.58) which was lower than the findings in 2015 [10.9% (95% CI: 10.1, 11.7)]. The prevalence was highest in Sabah [9.4% (95% CI: 5.62, 15.26)] and Putrajaya [9.4% (95% CI: 6.62, 13.23)]. The use of smokeless tobacco among male current smokers were almost 17 times higher than females [12.1% (95% CI: 10.41, 14.12) vs 0.7% (95% CI: 0.44, 1.05)].
E-cigarette/Vape Use The prevalence was highest in Putrajaya [8.2% (95% CI: 5.53, 12.03)] followed by Terengganu [7.3% (95% CI: 5.04, 10.43)] and Sabah [6.9% (95% CI: 3.42, 13.44)]. The use of e-cigarette/ vape among male current smokers was almost 31 times higher than females [9.4% (95% CI: 7.80, 11.26) vs 0.3% (95% CI: 0.13, 0.59)]. The prevalence of e-cigarette/vape use was highest among those in the 20 to 24 years age group [14.7% (95% CI: 9.89, 21.33)]. 6.2 Exposure To Secondhand Smoke The prevalence of exposure to secondhand smoke at home by all respondents (smokers and non-smokers) was 31.0% (95% CI: 29.15, 32.82) while exposure at work was 27.2% (95% CI: 24.29, 30.28). At the eateries, the prevalence of exposure differs between air-conditioned and non-air-conditioned eateries [8.5% (95% CI: 7.17, 10.17) vs 48.1% (95% CI: 45.83, 50.32)].
National Health and Morbidity Survey 2019
Technical Report − Volume I
082
6.3 Smoking Cessation Behavior
Quit Attempt
Less than half [48.9% (95% CI: 45.02, 52.70)] of the current
smokers made an attempt to quit smoking in the past 12
months. A comparison across the age groups showed that
the percentage of quit attempt was highest among current
smokers in 15 to 19 years age group [56.4% (95% CI: 44.02,
67.98)]. The prevalence of quit attempt increases as the
education background increases.
Current Smokers Who Visited Healthcare Provider in the
Past 12 Months Advised to Quit Smoking by Healthcare
Provider
Less than 10% [7.4% (95% CI: 5.99, 9.12)] of current smokers
visited a healthcare provider in the past 12 months. More
than three quarters [77.3% (95% CI: 64.32, 86.56)] of current
smokers who visited healthcare services in the past 12 months
had been advised to quit smoking by healthcare providers.
6.4 Awareness of Anti-Smoking Campaign
Noticing Anti-Cigarette Smoking Information During the
Last 30 Days in Newspaper or Magazine
Nearly half [48.7% (95% CI: 46.55, 50.91)] of the respondents
had noticed anti-smoking information in newspapers or
magazines during the last 30 days. There was increasing
trend of noticing anti-smoking information with increasing
educational background.
Noticing Anti-Cigarette Smoking Information During the
Last 30 Days on Television
The prevalence of the respondents noticing anti-smoking
information on television during the last one month was
63.7% (95% CI: 61.54, 65.74). Females had higher prevalence
of noticing anti-cigarette smoking information during the last
30 days on television than male [67.7% (95% CI: 65.02, 70.20)
vs 60.4% (95% CI: 57.44, 63.26)].
6.5 Awareness of Cigarette Advertising and
Promotion
Noticing Cigarette Advertising During the Last 30 Days in
Stores
A total of 21.2% (95% CI: 19.47, 23.03) of Malaysians aged
15 years and above noticed cigarettes advertising in stores
during the last 30 days.
Noticing Cigarette Promotion During the Last 30 Days
Small and insignificant prevalence of noticing cigarette
promotion by various approaches were as follows:
• Free sample
1.3% (95% CI: 1.01, 1.79)
• Sales price
1.8% (95% CI: 1.23, 2.64)
• Coupon
0.6% (95% CI: 0.34, 1.00)
• Free gift / discounts on
other product
0.5% (95% CI: 0.33, 0.90)
• Clothing / items with
brand name or logo
1.1% (95% CI: 0.82, 1.40)
• Promotion on cigarettes
through mail
0.4% (95% CI: 0.24, 0.67)
Conclusion
The overall prevalence of current smokers aged 15 years
and above had reduced slightly from 22.8% in 2015 to 21.3%
in 2019. It was also observed that the prevalence of both
male and female current smokers had reduced (43.0% in
2015 to 40.5% in 2019 vs 1.4% in 2015 to 1.2 in 2019) in the
current survey. The number of cigarette sticks smoked per
day has considerably reduced since 2015. The prevalence of
smokeless tobacco product use had reduced from 10.9% in
2015 to 6.5% in 2019. The proportion of current smoker having
attempt to quit smoking has dipped slightly from 52.3% in
2015 to 48.9% in 2019. The exposure to secondhand cigarette
smoke at non-air-conditioned eateries was high (48.1%).
Non-Communicable Diseases: Risk Factors and other Health Problems 083 Recommendations The implementation of the National Strategic Plan on Tobacco Control 2015-2020 needs to be strengthened in order to achieve its targets. All the elements of the WHO FCTC MPOWER strategies should be enhanced to the best of Malaysia capability. Smoking cessation services such as the ‘mQuit’ program must be strengthened by enhancing access to smoking cessation services and pharmacotherapy. The tobacco product display ban at point of sale policy would be effective in reducing tobacco products promotion at the store. With the new regulation of smoking ban at all eateries, it is hoped that the public would be further protected from secondhand smoke exposure. With focused tobacco control strategies, the smoking prevalence can be reduced further to achieve the ‘Endgame’ of tobacco in Malaysia. Table 6.1: Smoking Trend in Malaysia 2011 2015 2019 Current Smokers 23.1 22.8 21.3 References 1. Malaysian fact sheet. The Tobacco Atlas, American Cancer Society. 2019. https://files.tobaccoatlas.org/wp-content/uploads/pdf/malaysia-country- facts-en.pdf 2. Pelan Strategik Kebangsaan bagi Kawalan Tembakau 2015-2020. Ministry of Health Malaysia. Putrajaya. 2015. http://www.moh.gov.my/moh/ resources/Penerbitan/Rujukan/NSP_Tobacco_buku_bind_24oct2015.pdf
National Health and Morbidity Survey 2019 Technical Report − Volume I 084 Table 6.2: Prevalence of Smokers Among Respondents Aged 15 Years and Above in Malaysia by Socio-Demographic Characteristics (n=11,058) Sociodemographic Characteristics Current Smokers Current Cigarette Smokers Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 2,064 4,877,697 21.3 19.86 22.75 2,016 4,776,548 20.8 19.43 22.30 State Johor 163 566,904 21.9 17.45 27.19 156 540,042 20.9 16.67 25.87 Kedah 148 391,658 27.6 23.44 32.24 144 376,678 26.6 22.25 31.39 Kelantan 75 185,593 15.1 11.75 19.19 73 182,286 14.8 11.59 18.77 Melaka 99 93,976 14.9 10.63 20.49 93 89,336 14.2 9.74 20.16 Negeri Sembilan 99 150,934 20.2 14.83 26.85 94 144,228 19.3 14.26 25.54 Pahang 152 255,537 23.1 18.45 28.40 150 253,726 22.9 18.24 28.31 Pulau Pinang 127 238,811 18.3 13.09 25.07 127 238,811 18.3 13.09 25.07 Perak 124 398,269 23.8 18.64 29.81 122 391,908 23.4 18.35 29.32 Perlis 109 35,398 20.6 16.83 24.89 106 33,714 19.6 15.94 23.83 Selangor 206 902,041 18.5 15.27 22.22 205 896,337 18.4 15.15 22.11 Terengganu 155 194,709 23.9 20.37 27.82 153 192,583 23.6 20.04 27.65 Sabah 174 729,360 25.3 20.02 31.45 171 725,720 25.2 19.89 31.34 Sarawak 152 444,764 22.2 18.62 26.28 147 424,697 21.2 17.94 24.89 WP Kuala Lumpur 92 268,416 19.8 15.44 24.93 89 265,416 19.5 15.16 24.82 WP Labuan 73 7,677 12.2 9.91 14.97 70 7,417 11.8 9.48 14.60 WP Putrajaya 116 13,650 20.3 15.63 26.06 116 13,650 20.3 15.63 26.06 Location Urban 1,172 3,569,016 20.1 18.47 21.77 1,143 3,494,313 19.6 18.07 21.33 Rural 892 1,308,682 25.4 22.55 28.54 873 1,282,235 24.9 22.07 28.00 Sex Male 2,007 4,742,418 40.5 37.90 43.06 1,961 4,642,861 39.6 37.08 42.19 Female 57 135,280 1.2 0.85 1.70 55 133,687 1.2 0.84 1.69 Age Group (Years) 15-19 111 323,110 12.3 9.72 15.46 106 303,831 11.6 9.12 14.58 20-24 202 726,574 25.5 20.12 31.77 195 708,892 24.9 19.49 31.20 25-29 228 737,504 24.7 20.82 29.02 223 721,048 24.1 20.26 28.50 30-34 232 718,979 27.1 23.01 31.61 227 708,883 26.7 22.64 31.22 35-39 254 567,510 24.0 20.63 27.71 252 561,424 23.7 20.43 27.39 40-44 199 470,340 25.7 21.67 30.12 197 467,773 25.5 21.52 29.99 45-49 175 380,829 22.9 19.21 27.12 171 370,447 22.3 18.62 26.48 50-54 206 348,327 22.7 19.24 26.61 203 346,587 22.6 19.12 26.50 55-59 154 232,558 17.6 14.33 21.50 148 228,541 17.3 14.03 21.21 60-64 129 1,649,230 14.9 11.91 18.50 124 158,443 14.3 11.43 17.80 65-69 77 99,319 12.4 9.19 16.58 75 97,236 12.2 8.96 16.30 70-74 51 58,729 10.7 7.46 15.04 49 54,454 9.9 6.82 14.15 75 & above 46 48,989 7.5 5.20 10.74 46 48,989 7.5 5.20 10.74 Ethnicity Malaya 1,428 2,676,767 22.6 21.23 24.00 1,396 2,622,955 22.1 20.77 23.55 Chinese 161 653,557 13.7 10.62 17.55 155 628,247 13.2 10.20 16.89 Indian 83 155,188 11.5 8.50 15.41 79 151,268 11.2 8.24 15.11