Citation

Parkinson, C., Hammond, D., Fong, G.T., Borland, R., Omar, M., Sirirassamee, B., Awang, R., Driezen, P., Thompson, M.E. (2009). Smoking beliefs and behavior among youth in Malaysia and Thailand. American Journal of Health Behavior, 33(4), 366-375.

Abstract

Objective: To characterize smoking beliefs among Thai and Malaysian youth and to examine associations with gender, antismoking media exposure, and smoking status.

Methods: Nationally representative samples of youth completed self-administered questionnaires.

Results: A substantial proportion of youth reported positive beliefs about smoking. Those reporting positive beliefs were more likely to be susceptible to smoking. Youth who noticed antismoking media were less likely to report positive beliefs about smoking.

Conclusions: As in Western countries, beliefs about smoking held by youth in Southeast Asia are associated with smoking status. Antismoking media may be an important means of targeting beliefs about smoking among youth.

Citation

Li, L., Yong, H.H., Borland, R., Fong, G.T., Thompson, M.E., Jiang, Y., Yang, Y., Sirirassamee, B., Hastings, G., Harris, F. (2009). Reported awareness of tobacco advertising and promotion in China compared to Thailand, Australia and the USA. Tobacco Control, 18(3), 222-227.

Abstract

Background: China currently does not have comprehensive laws or regulations on tobacco advertising and promotion, although it ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in October 2005 and promised to ban all tobacco advertising by January 2011. Much effort is needed to monitor the current situation of tobacco advertising and promotion in China.

Objective: This study aims to examine levels of awareness of tobacco advertising and promotion among smokers in China as compared to other countries with different levels of restrictions.

Methods: One developing country (Thailand) and two developed countries (Australia and the USA) were selected for comparison. All four countries are part of the International Tobacco Control (ITC) Policy Evaluation Survey project. Between 2005 and 2006, parallel ITC surveys were conducted among adult smokers (at least smoked weekly) in China (n=4763), Thailand (n=2000), Australia (n=1767) and the USA (n=1780). Unprompted and prompted recall of noticing tobacco advertising and promotion were measured.

Results: Chinese respondents reported noticing tobacco advertisements in a range of channels and venues, with highest exposure levels on television (34.5%), billboards (33.4%) and in stores (29.2%). A quarter of respondents noticed tobacco sponsorships, and a high level of awareness of promotion was reported. Cross-country comparison reveals that overall reported awareness was significantly higher in China than in Thailand (particularly) and Australia, but lower than in the USA.

Conclusions: There is a big gap between China and the better-performing countries such as Thailand and Australia regarding tobacco promotion restrictions. China needs to do more, including enhanced policy and more robust enforcement.

Citation

Yong, H.H., Hamann, S.L., Borland, R., Fong, G.T., Omar, M. (2009). Adult smokers' perception of the role of religion and religious leadership on smoking and association with quitting: A comparison between Thai Buddhists and Malaysian Muslims. Social Science & Medicine, 69(7), 1025-1031.

Abstract

In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.

Citation

Ross, H., Driezen, P., Sirirassamee, B., & Kin, F. (2009). Cigarette purchasing behaviour in Thailand and Malaysia: comparative analysis of a semi-monopolistic and a free-market structure. Global public health, 4(6), 588–599. https://doi.org/10.1080/17441690903072204

Abstract

A wide range of cigarette prices can undermine the impact of tobacco tax policy when smokers switch to cheaper cigarettes instead of quitting. In order to better understand this behaviour, we study socio-economic determinants of price/brand choices in two different markets: a semimonopolistic market in Thailand and a competitive market in Malaysia. The hypothesis that the factors affecting the price/brand choice are different in these two markets is analysed by employing a 2005 survey among smokers. This survey provides a unique perspective on market characteristics usually described only in business reports by the tobacco industry. We found that smokers in Thailand have fewer opportunities to trade down to save money on cigarettes, but pay lower prices than smokers in Malaysia, despite Thailand’s higher tax rate. The Malaysian market, on the other hand, offers many possibilities to shop around for cheaper cigarettes. Higher income and education increase the price paid per cigarette in both countries, but the impact of these factors is larger in Malaysia. This has implications for sensitivity to cigarette prices. Using tax policy alone should be a more effective tobacco control measure in Thailand as compared to Malaysia. The effectiveness of a tax increase in Malaysia can be improved by adding programmes focusing on smoking cessation among low-income/low-educated smokers.

Citation

Hammond, D., Kin, F., Prohmmo, A., Kungskulniti, N., Lian, T.Y., Sharma, S.K., Sirirassamee, B., Borland, R., Fong, G.T. (2008). Patterns of smoking among adolescents in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia Survey. Asia-Pacific Journal of Public Health, 20(3), 193-203.

Abstract

At present, 70% of the world's 1.1 billion smokers are in developing countries, with over 50% in Asia alone. The current study examined patterns of youth smoking in Thailand and Malaysia. Respondents were 2002 youths between the ages of 13 and 17 from Thailand (n = 1000) and Malaysia (n = 1002). Respondents were selected using a multistage cluster sampling design and surveyed between January 2005 and March 2005. Approximately 3% of youth between the ages of 13 and 17 were current smokers, with an additional 10% to 12% reporting experimental smoking. Males were between 7 and 15 times more likely to report smoking behavior than females. Less than 1% of females respondents in either country met the criteria for current smoking, and less than 5% met the criteria for experimental smoking. In contrast, more than 50% Thai males and approximately one-third of Malaysian males aged 17 met the criteria for either experimental or current smoking.

Citation

Hosking, W., Borland, R., Yong, H.H., Fong, G.T., Zanna, M.P., Laux, F., Thrasher, J.F., Lee, W.B., Sirirassamee, B., Omar, M. (2009). The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four western nations: A cross-cultural comparison. Psychology & Health, 24(1), 95-107.

Abstract

This research investigated the influence of smoking attitudes and norms on quitting intentions in two predominantly collectivistic countries (Malaysia and Thailand) and four predominantly individualistic Western countries (Canada, USA,UK and Australia). Data from the International Tobacco Control Project (N¼13,062) revealed that higher odds of intending to quit were associated with negative personal attitudes in Thailand and the Western countries, but not in Malaysia; with norms against smoking from significant others in Malaysia and the Western countries, but not in Thailand; and with societal norms against smoking in all countries. Our findings indicate that normative factors are important determinants of intentions, but they play a different role in different cultural and/or tobacco control contexts. Interventions may be more effective if they are designed with these different patterns of social influence in mind.

Citation

Fong, G.T., Hammond, D., Hitchman, S.C. (2009). The impact of pictures on the effectiveness of tobacco warnings. Bulletin of the World Health Organization, 87(8), 640-643.

Abstract

Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond and by the International Tobacco Control (ITC) Policy Evaluation Project.

Citation

Sirirassamee, T., Sirirassamee, B., Jampaklay, A., Borland, R., Fong, G.T. (2009). Risk factors of tobacco use among Thai adolescents: Finding from International Tobacco Control Policy Survey Southeast Asia (ICT-SEA). Journal of the Medical Association of Thailand, 92(3), 4-8.

Abstract

To determine the risk factors of tobacco use among Thai adolescents. A cross-sectional study was conducted among 706 adolescents sampled from 5 regions of Thailand using stratified multistage sampling. Participants were asked to complete self-administered questionnaires about tobacco use and psychosocial factors. A logistic regression model of risk factors for tobacco use was estimated using backward stepping. The prevalence of smoking in Thai adolescent was 15 percent (27.8% in males, 2.3% in females). Older age (OR = 1.25, 95% CI = 1.02-1.51), number of close friend smoking (OR = 1.61, 95% CI = 1.35-1.93), number of older sibling smoking (OR = 1.44, 95% CI = 1.01-2.04), heavy alcoholic consumption (OR = 3.99, 95% CI = 1.87-8.49), low self-worth (OR = 3.16, 95% CI = 1.71-5.84) were risk factors of smoking in Thai adolescents. Females (OR = 0.10, 95% CI = 0.04-0.24), currently studying in school (OR = 0.33, 95% CI = 0.18-0.59) and religious beliefs guide actions (OR = 0.41, 95% CI = 0.22-0.77) were protective factors against smoking. Male adolescents are target group for tobacco control in Thailand. The strong correlation between smoking and alcoholic consumption indicate that anti-smoking campaign should be done in parallel with anti-alcohol campaign.

Citation

Yong, H.H., Borland, R., Hammond, D., Sirirassamee, B., Ritthiphakdee, B., Awang, R., Omar, M., Kin, F., Zain, Z., Lee, W.B., Siahpush, M., Fong, G.T. (2008). Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey. Tobacco Control, 17(1), 46-52.

Abstract

Aim: To examine the impact of tobacco advertising policy on adult smokers’ awareness of tobacco promotion in two developing countries—Malaysia and Thailand.

Methods: Data from 2004 Malaysian and 2000 Thai adult smokers who participated in the baseline wave of the International Tobacco Control Southeast Asia survey (ITCSEA). Respondents were asked in a face-to-face interview conducted between January and March 2005 to indicate their levels of awareness of tobacco advertising and promotional activities in the last six months.

Results: Unprompted awareness of any tobacco marketing activities was very low in Thailand (20%) but significantly higher in Malaysia (53%; OR=5.6, 95% CI: 3.5 to 8.9, p<0.001). When prompted about specific locations, Thai adult smokers reported very low recall of tobacco advertising where it was banned, being highest around point of sale, particularly street vendors (7.5%). In contrast, Malaysian adult smokers reported significantly higher levels of awareness of tobacco advertising in all locations (range=17.7% noticing in disco lounges to 59.3% on posters) including where they are nationally banned (for example, billboards).

Conclusions: These findings demonstrate that comprehensive tobacco advertising legislation when well implemented can lead to dramatic decline in awareness of tobacco promotion, thus supporting strong implementation of Article 13 of the Framework Convention on Tobacco Control.

Citation

Young, D., Yong, H.H., Borland, R., Ross, H., Sirirassamee, B., Kin, F., Hammond, D., O’Connor, R.J., Fong, G.T. (2008). Prevalence and correlates of roll-your-own smoking in Thailand and Malaysia: Findings of the ITC-South East Asia Survey. Nicotine & Tobacco Research, 10(5), 907-915.

Abstract

Roll-your-own (RYO) cigarette use has been subject to relatively limited research, particularly in developing countries. This paper seeks to describe RYO use in Thailand and Malaysia and relate RYO use to smokers’ knowledge of the harmfulness of tobacco. Data come from face-to-face surveys with 4,004 adult smokers from Malaysia (N=2,004) and Thailand (N=2000), collected between January and March 2005. The prevalence of any use of RYO cigarettes varied greatly between Malaysia (17%) and Thailand (58%). In both countries, any RYO use was associated with living in rural areas, older average age, lower level of education, male gender, not being in paid work, slightly lower consumption of cigarettes, higher social acceptability of smoking, and positive attitudes toward tobacco regulation. Among RYO users, exclusive use of RYO cigarettes (compared with mixed use) was associated with older age, female gender (relatively), thinking about the enjoyment of smoking, and not making a special effort to buy cheaper cigarettes if the price goes up. Finally, exclusive RYO smokers were less aware of health warnings (RYO tobacco carries no health warnings), but even so, knowledge of the health effects of tobacco was equivalent.

Citation

Siahpush, M., Borland, R., Yong, H.H., Kin, F., Sirirassamee, B. (2008). Socio-economic variations in tobacco consumption, intention to quit and self-efficacy to quit among male smokers in Thailand and Malaysia: Results from the International Tobacco Control-South-East Asia (ITC-SEA) Survey. Addiction, 103(3), 502-508.

Abstract

Aim: To examine the association of socio-economic position (education, income and employment status) with cigarette consumption, intention to quit and self-efficacy to quit among male smokers in Thailand and Malaysia.

Design and setting: The data were based on a survey of adult smokers conducted in early 2005 in Thailand and Malaysia as part of the International Tobacco Control–South-East Asia (ITC– SEA) project.

Participants: A total of 1846 men in Thailand and 1906 men in Malaysia.

Measurement: Participants were asked questions on daily cigarette consumption, intention to quit and self-efficacy to quit in face-to-face interviews.

Findings: Analyses were based on multivariate regression models that adjusted for all three socio-economic indicators. In Thailand, higher level of education was associated strongly with not having self-efficacy, associated weakly with having an intention to quit and was not associated with cigarette consumption. Higher income was associated strongly with having self-efficacy, associated weakly with high cigarette consumption and was not associated with having an intention to quit. Being employed was associated strongly with having an intention to quit and was not associated with cigarette consumption or self-efficacy. In Malaysia, higher level of education was not associated with any of the outcomes. Higher income was associated strongly with having self-efficacy, and was not associated with the other outcomes. Being employed was associated moderately with higher cigarette consumption and was not associated with the other outcomes.

Conclusion: Socio-economic and cultural conditions, as well as tobacco control policies and tobacco industry activities, shape the determinants of smoking behaviour and beliefs. Existing knowledge from high-income countries about disparities in smoking should not be generalized readily to other countries.

Citation

Thrasher, J.F., Chaloupka, F., Hammond, D., Fong, G.T., Borland, R., Hastings, G., Cummings, K.M. (2006). Evaluación de las políticas contra el tabaquismo en paises Latino Americanos en la era del Convenio Marco para el Control del Tabaco [Evaluating tobacco control policy in Latin American countries during the era of the Framework Convention on Tobacco Control]. Salud Publica de Mexico, 48(Suppl 1), S155-S166.

Abstract

Objective: The Framework Convention on Tobacco Control (FCTC) aims to coordinate tobacco control policies around the world that reduce tobacco consumption. The FCTC's recommended policies are likely to be effective in low- and middle-income countries. Nevertheless, policy evaluation studies are needed to determine policy impact and potential synergies across policies.

Materials and methods: The International Tobacco Control Policy Evaluation Project (ITC) is an international collaboration to assess the psychosocial and behavioral impact of the FCTC's policies among adult smokers in nine countries. The ITC evaluation framework utilizes multiple country controls, a longitudinal design, and a theory-driven conceptual model to test hypotheses about the anticipated effects of given policies.

Results: ITC Project results generally confirm previous studies that form the evidence base for FCTC policy recommendations, in particular: the use of graphic warning labels; banning of "light" and "mild" descriptors; smoking bans; increasing tax and price; banning advertising; and using new cigarette product testing methods.

Conclusions: Initial findings from the ITC Project suggest that Latin American countries could use similar methods to monitor and evaluate their own tobacco control policies while contributing to the evidence base for policy interventions in other countries.