How Legislation Paves The Way To A Smoke-Free Culture

Anti-tobacco advocates say the law is the first step to forming a smoke-free culture, like in developed countries, citing ongoing Malaysian anti-tobacco educational programmes in school and homes.

KUALA LUMPUR, August 11 — Tobacco control legislation can eventually lead to a culture of no smoking in public areas even without visible law enforcement like in developed countries, local anti-tobacco advocates said. 

They stressed that the main purpose of the Control of Tobacco Product and Smoking Bill 2022 – which would be Malaysia’s first ever tobacco control Act if passed by Parliament – was not to criminalise smokers or vapers, but to create a “normative” smoke-free culture.

“Nobody dares pick up a cigarette in the UK or smoke in public…and the joke is there is no police there, there is no policing, right? But society has evolved to that norm,” National Cancer Society of Malaysia (NCSM) managing director Dr Murallitharan Munisamy told CodeBlue last Friday.

A vote on the contentious Control of Tobacco Product and Smoking Bill was deferred to the next Parliament meeting in October after various parliamentarians, lawyers, and human rights activists widely opposed provisions on enforcement powers that they saw as excessive. 

Lawmakers like Muar MP and Muda president Syed Saddiq Syed Abdul Rahman and Seputeh MP Teresa Kok from the DAP have voiced their dissatisfaction and concerns over the criminalisation and victimisation of youths under the generational end game (GEG) that prohibits smoking or vaping, and personal use of tobacco or vape products, by anyone born from January 1, 2007.

However, Dr Murallitharan and other tobacco control advocates do not view the proposed legislation as an attack on young people, agreeing instead with Health Minister Khairy Jamaluddin’s explanation to the Dewan Rakyat on August 2 during debate on the bill. 

Khairy had said enforcement powers provided for in the tobacco bill like entering premises; taking samples; stop, search, and seize conveyance were targeted at manufacturers, importers, and distributors, although these provisions do not specifically exempt application to offences by individual users from the GEG group. 

NCSM asserted that penalties proposed in the bill are heavier on the seller than the consumer, and the parts of the law that affect the GEG are milder than those found in other developed countries.

In answering a question at a press conference by tobacco control advocates last Friday, Muhammad Sha’ani Abdullah, tobacco control coordinator for the Federation of Malaysian Consumers Associations (Fomca), drew attention to existing laws in Malaysia that carry a heavier penalty than those targeted at the GEG group in the tobacco bill. 

One such law he alluded to was Section 25(1) of the National Registration Act 1990 (amended 2001) that states that an individual caught without their MyKad can be fined between RM3,000 and RM20,000 or face a three-year jail sentence. 

The Control of Tobacco Product and Smoking Bill tabled in Parliament moots a maximum RM5,000 fine for individuals born from 2007 who are convicted of the offences of purchase, possession, and use of tobacco and vape products, as well as smoking or vaping. 

During the parliamentary debate, Khairy agreed to drop the offence of possession and to reduce penalties upon conviction for GEG offenders to a maximum RM500 fine or community service.

Nonetheless, Muhammad Sha’ani and the rest of the panel of anti-tobacco advocates at the press conference agreed that while the tobacco control bill is under review by a newly formed Dewan Rakyat special select committee (PSC) chaired by Khairy, things are still subject to change.

Dr Murallitharan, in summarising the panel’s stance, reiterated that anti-tobacco advocates welcomed efforts that do not criminalise people. Criminalising people, the public health physician said, was not their objective and in fact, the Ministry of Health (MOH) had accepted the “soft landing” suggestion put forth by non-governmental organisations (NGOs).

The idea of a soft landing was so that the NGOs would have one to two years to soften, refine, and educate the public, bringing about social normative change. To illustrate his point, Dr Murallitharan brought up Singapore’s chewing gum law that fines an individual for an amount not exceeding SG$100,000 or imprisonment for a term not exceeding two years, or both. 

Using the example, he postulated that “you need the legal aspect for the first few years” to bring about a change in culture.

Laws are the first in a long line of hurdles to achieve a smoke-free Malaysia for anti-tobacco advocates. 

Roslizawati Md Ali, president of Malaysian Women’s Action For Tobacco Control and Health (MyWatch), told CodeBlue: “It’s got to start from the house, the family institution.” 

The MyWatch leader was vehement in expressing her need to reform youth. Both she and Dr Murallitharan spoke ardently about the anti-tobacco work they have done in schools — with the Tobacco-Free Generation Programme and the Oral Health Without Smoking (Kotak) programme — and in homes with the MyHouse programme.

“We are also working at normative campaigns and transformation, and we’ve been strong advocates to the government to tell them that…nicotine is much, much, much more addictive than heroin,” said Dr Murallitharan.

Both Dr Murallitharan and Roslizawati were averse to the use of vapes or e-cigarettes as a means of harm reduction to smoking tobacco.  

Dr Murallitharan has three reasons for opposing vape: higher carcinogenic substances found in vape than previously thought, people have been known to both smoke and vape, and its purported role as a gateway drug do not lend itself well to harm reduction.

The American Lung Association lists carcinogens among various toxic chemicals and metals found in e-cigarettes that heat up vape juices as a vapour breathed in by users. 

However, Cancer Research UK states that studies so far show that “e-cigarettes are far less harmful than smoking”, as most of the toxic chemicals in cigarettes are not present in e-cigarettes, although it also cautioned that e-cigarettes are not risk-free.

“Some potentially dangerous chemicals have been found in e-cigarettes. But levels are usually low and generally far lower than in tobacco cigarettes. Exposure may be the same as people who use nicotine replacement therapy (NRT) such as patches or gum,” said the UK cancer research group. “There is no good evidence that vaping causes cancer.”

Dr Murallitharan did, however, say that he would support vaping only “if it’s genuinely for harm reduction”. He went on to mention that Malaysia’s tobacco control bill does allow vaping to be used by smokers as tobacco harm reduction, and that the proposed law only prevents would-be initiates who have never smoked from taking up the vaping habit.  

Roslizawati, on the other hand, disagrees with vaping as harm reduction as she sees it very much as a way to initiate children into the habit. 

“We saw children as young as three-months-old vaping, parents giving the vape (to their kids),” she told CodeBlue

“The rate of increase of vaping and e-cigarettes has escalated, especially…on girls — on young girls. And this they don’t understand will have an impact on them in their future — reproductive health and things like that.”

However, data on the effects of exposure to e-cigarette vapours on human reproductive health is limited and based upon animal models. A mouse study published 2019 in the Journal of the Endocrine Society found that after exposure to e-cigarette vapour, female mice showed decreased embryo implantation and a significant delay in the onset of pregnancy with the first litter. Female offspring exposed to e-cigarettes in utero also failed to gain as much weight as control mice by the 8.5 month mark.

“We found that e-cigarette usage prior to conception significantly delayed implantation of a fertilised embryo to the uterus, thus delaying and reducing fertility (in mice),” the study’s corresponding author, Kathleen Caron, from the University of North Carolina, was quoted saying in a September 2019 press release by the Endocrine Society based in the United States, a global community of physicians and scientists in hormone science and public health. 

“We also discovered that e-cigarette usage throughout pregnancy changed the long-term health and metabolism of female offspring — imparting lifelong, second-generation effects on the growing foetus.”

A 2020 study published in the International Journal of Environmental Research and Public Health, which analysed the effects of e-cigarette refill liquids, with or without nicotine, on rats showed that when it came to male rats, the number of epididymal spermatozoa decreased when the rats were exposed to e-liquids with and without nicotine, with lower epididymal counts registered for the nicotineless rats. 

Although there were no published results on the effects of e-cigarettes on spermatozoa, that study cited a presentation from Helen O’Neill, at the 2017 British Fertility Society Conference, that indicated that men’s fertility could be damaged from toxic chemicals in e-cigarette flavourings. In her experiment, she found that certain flavours reduced the motility of spermatozoa in men and damaged germ cells — which are crucial for fertility — in mice’s testes. 

For Roslizawati, change comes with a variety of smoking cessation programmes that offer support for smokers who are trying to quit. It is a view that is in line with the United States’ Centers for Disease Control and Prevention’s (CDC) own stance on smoking cessation, which involves a combination of telephone counseling and Food and Drug Administration (FDA) approved medication. 

In the end, it must be noted that there are plenty of programmes that are being run to foster normative culture. Both Roslizawati and Dr Murallitharan agree that the government should spend more resources on reversing nicotine

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