10 September 2017:
Puad (not his real name) was only five when he picked up his first cigarette.
That initial puff left an impression on him, and at nine, he started smoking regularly after seeing his dad smoke.
From his pocket money, Puad would allocate RM2 a week to purchase individual sticks from the kedai runcit near his house.
“My parents didn’t know I smoked because I never smoked at home or in front of them. When my friends offered me a cigarette, I would gladly accept it because I thought it was cool. I know smoking is bad and tried to quit many times, but was unsuccessful,” says Puad, 14, who finally kicked the habit last year.
At 12, Tommy (not his real name) started smoking after his friend offered him a cigarette.
He got hooked on nicotine and continued to smoke “for fun” until he quit last year.
Now 15, he says, “My father smokes, but he didn’t know I smoked. My mother knew, and for three years, she would frequently advise me to quit, but I didn’t know how until I went through a programme. It was tough, but I’m happy I succeeded.”
Change in culture needed
Like Puad and Tommy, there are 500,000 Malaysian teenagers who smoke (based on the 2015 National Health and Morbidity Survey), and all of them are at risk of reduced lung function and growth, as well as heart damage.
Last year, the National Cancer Society of Malaysia (NCSM) and the Institute for Medical Research carried out a quit smoking programme for secondary school students (ages 13 to 17) and successfully managed to wean 64% of them off cigarettes.
Four urban boys’ schools in Kuala Lumpur were selected for the inaugural programme, and for six months, apart from helping 143 teenage smokers quit, NCSM also carried out a study to determine their knowledge, attitude and practices on smoking.
It involved regular carbon monoxide tests (to determine if the children were still smoking), individual counselling sessions, a buddy programme to stop relapses, and knowledge-building games.
To provide a safe, supportive environment for the students, the survey was done with the knowledge of the school, but not the parents.
“When we did the study last year, we took a different approach. We looked at it from the student’s viewpoint, to find out the triggers.
“Most young smokers know the dangers of tobacco and that it is linked to cancer, think smoking is a waste of money, and want to quit immediately. Awareness doesn’t lead to behaviour change, so how do we enable that?” asks NCSM medical director and president Dr Saunthari Somasundaram.
“The majority don’t like smoking and though they wanted to quit, they didn’t realise how difficult it was. Cigarettes are harmful and addictive, but it is difficult for teens to understand what addiction is. We have to strengthen the environment so that they don’t start smoking,”
The results revealed that 85% know smoking causes cancer, 95% know smoking is bad for their health, 85% think smoking is a waste of money, 70% started smoking between 12 to 15 years of age, 50% have parents who smoke, and 45% bought their cigarettes from supermarkets, roadside stalls or kedai runcit.
Due to the easy accessibility, many youngsters have also experimented with e-cigarettes, vapes, shishas, chewing tobacco and other age-inappropriate substances.
Dr Saunthari says, “In our culture, we don’t stigmatise smokers. Children tend to mimic what they see and we need to stop that.
“This is hard in our population. We think it’s ‘none of my business’ and stay silent, which is very detrimental because then we cannot change the culture.
“This apathy comes from excuses. We need to be a vocal majority when it comes to tobacco – the number one killer in the world. That’s why we need a tobacco control act!”
Regardless of the type of products used, smoking is linked to 16 types of cancer, 25 life-threatening diseases, and results in the death of 20,000 Malaysians each year.
“Tobacco control is not just a health problem and should not be left to only one ministry, or tackled from the health angle alone.
“The WHO Framework Convention on Tobacco Control, of which Malaysia is a signatory, calls for the help of all ministries.
“Increasing tobacco tax is not the sole solution to curb smoking. It is most effective when complemented with other tobacco control initiatives, one of which is reducing access.
“People may be more tempted to smoke if they can buy cigarettes easily from anywhere, including coffee shops,” says Dr Saunthari.
Proud to quit
Nationwide, there is an overall spike in the percentage of smokers, and although the number of male smokers has decreased, the number of female smokers has increased.
According to Sister Swinder Jit, the leader of the programme, many parents are unaware that their children are smoking.
“It is the duty of every parent to find out what their teenagers are up to. For example, they can smell the uniform to check if the child has been smoking, or check the school bag for lighters and matches.
“If you find something, don’t punish the child because that doesn’t solve the problem.
“Instead, talk to them like a friend and find out the problem.
“If the parent cannot help, bring the child to our Quit Smoking clinics so we can share stories,” she says.
NCSM has been conducting follow-up sessions with the respective students, and so far, it’s been almost a year since the survey was done and 70% of the students continue to be smoke-free.
The success rate of the programme, sponsored by Berjaya Cares Foundation, is higher than a number of American-based quit smoking programmes.
Sister Swinder says, “The unsuccessful ones try again. With kids, pictures leave an impact as they’re more impressionable.
“Once they know the dangers, they try to find ways to kick the addiction themselves. You’ll be surprised at the traditional methods they try – everything from chewing gum to consuming green apples and budu (fermented seafood product), only to no avail!”
Whether they succeed or not, the students are given a t-shirt, certificate and medal.
“They even tell us ‘saya rasa bangga’. We want more children to stay smoke-free and be proud about it, and we hope for more funds to run the programme in many more schools,” adds Dr Saunthari.