Malaysia has faced the profound impact of tobacco use, a primary cause of preventable disease and death for many years. Public health campaigns and tobacco control policies have driven traditional cigarette smoking rates down, albeit modestly.
But now, our country is confronting a new and more complex epidemic: the skyrocketing and alarming increase in electronic cigarette (vape) use, especially among our youth.
The prevalence of e-cigarette use increased from 0.8 per cent in 2011 to 5.8 per cent in 2023, based on Global Adult Tobacco Survey (GATS) 2023 data, with the largest increase among 15 to 24-year-olds.
This turn is not a victory over tobacco, but a changing of its shape, ushering in an array of new challenges for quitting and regulation. This is not merely a change in substance but in the addiction ecosystem – more discreet, more available, and alarmingly normalised.
As an addiction psychiatrist, I am now seeing more and more adolescents and young adults who are downplaying the dangers of vaping and who see it as no different from any other harmless lifestyle choice.
This image is furthered by the visible spectacle of vapes being sold in convenience stores, sometimes in close proximity to schools, and the highly intrusive online marketing of coloured, shiny devices that taste like a variety of interesting flavours.
Vape giveaways, influencer-driven promotions, and the easy reach of online sales have led to a landscape in which nicotine addiction sets in sooner and is more difficult to shake.
Traditional smoking cessation interventions including pharmacotherapy and behavioural counselling, are necessary but not sufficient. We must also use technology. With Malaysians using their smartphones for an average of four hours and 37 minutes a day, well above the global average, mobile health apps are not just fashionable but strategic, scalable interventions.
Furthermore, the ITC Malaysia 2020 survey indicates that smokers who used quit apps were 2.58 times more likely to make a quit attempt than smokers who did not. I have been fortunate to have been involved in the development of GEMPAQ (Getting Every Malaysian Smoker to Participate and Quit), a culturally tailored, evidence-based mobile smoking cessation intervention.
GEMPAQ V2.0, designed by the Nicotine Addiction Research Collaborating Group (NARCC) of the Universiti Malaya Centre for Addiction Science Studies (UMCAS), is based on a user-centric approach and utilises the Big Five Personality Traits Theory to personalise its modules. It is designed to maximise engagement and long-term retention by aligning users’ preferences for quitting with their personality profiles from the outset.
Beyond behaviour and digital interventions, we should consider neurostimulation, which is an expanding frontier in addiction neuroscience. Options include transcranial direct current stimulation and magnetic stimulation, which provide non-invasive, brain-based interventions that alter neural circuits implicated in craving and reward.
Research demonstrates that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) decreases cue-induced cravings.
We are currently undertaking the development of a home-based tDCS device in collaboration with the MERCi Team (Monash Medicine-Engineering-Information Technology Research Collaboration Initiative).
The goal of this innovation is to democratise access to brain stimulation treatment for smoking cessation and bring safe, guided protocols for stimulation into homes. The aim is to connect this with mobile applications such as GEMPAQ, to combine digital-behavioural and neurobiological support.
This may transform mCessation by providing people with a treatment using safe, supervised brain stimulation that they administer themselves as part of a personally tailored quit plan.
As any public health expert will tell you, prevention works better than treatment, and it is particularly relevant to the fight against tobacco use disorder. As educational and medical leaders, we have a direct and central role in advancing tobacco-free environments and defining present practice and future policy.
Universities are more than places of learning–they are incubators of culture change and public health leadership. We are committed, as an institution, to developing a campus environment where tobacco prevention is part of the culture and not purely the result of any single intervention.
These include tobacco-free campus initiatives that use storytelling to raise awareness and reshape behaviour among students and employees,and integrating science of addiction information directly into medical school training so that up-and-coming physicians learn about addiction’s neurobiology and can apply science-based strategies to intervene.
In doing so, we focus on brief intervention and cessation counselling skills training, so as to train not only informed medical students but also clinically prepared ones, who can assist their patients who are trying to quit.
Most importantly, we understand that lasting change occurs when we empower the next generation to be advocates for health. This year, we are working with the Nicotine Addiction Research Collaborating Group (NARCC) and UMcare (the groups that set up HEBAT – the youth-led and youth-inspired movement of tobacco control).
HEBAT (Henti Elak Basmi Asap Tembakau) seeks to activate student ambassadors and peer educators in offices embedded within PHUs, schools, and other community networks.
These young leaders are rigorously trained to provide peer education; they must receive comprehensive training based on evidence-based and culturally appropriate ‘best practices’ for delivering messages via language and with themes relevant to their peers.
By the central role that young people play in prevention activities, such an approach harnesses the social influence and the social networks that young people belong to bring about behaviour change.
It also shifts the portrayal of youth from passive receptacles of health messages into the role of agents of change, building a community-driven movement towards smoke-free living while promoting long-term prevention through engagement, relatability, and empowerment.
We are also in the process of setting up a Mental Health and Tobacco Research Centre at Clinical School JB-Monash University Malaysia. This centre comprises interdisciplinary individuals who are interested in mental health and tobacco research.
It will serve as a southern base for clinical innovation that integrates state-of-the-art digital health research, interventional psychiatry, neurostimulation modalities, and community outreach in one location.
This core will have a particular focus on tobacco, with the aim of establishing this centre as a regional leader in the provision of evidence-based tobacco control and positioning Malaysia as a respected leader in the struggle to address one of the most persistent public health challenges of the day.
Malaysia is not just fighting a war against tobacco; it is waging war in a changing addiction ecosystem. From e-cigarettes to social media marketing, from smartphones to neurostimulation, the tools of harm as well as healing are evolving.
As a physician and scientist specialising in the treatment of addiction, I am convinced that sustainable tobacco control depends on the integration of science and technology with policy and people. The most promising solutions must be hybrid, mixing personalisation with wider accessibility and use, guided by the principles of brain science.
The future of tobacco cessation in Malaysia is one of education and empowerment, a relationship with the smoker and not just with the government, and which happens via a tool that is personal, portable, and proven.
Assoc Prof Anne Yee Hway Ann is from the Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. Her clinical practice emphasises men’s health within the context of addiction treatment, acknowledging the high prevalence of issues such as smoking, alcohol, and illicit drug use among men.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
