Academic journal article Atlantic Economic Journal

Distinguishing between Non-Smokers, Casual Smokers, and Compulsive Smokers: Evidence from Malaysia

Academic journal article Atlantic Economic Journal

Distinguishing between Non-Smokers, Casual Smokers, and Compulsive Smokers: Evidence from Malaysia

Article excerpt

Introduction

Cigarette smoking causes one of every five deaths in Malaysia (Ministry of Health Malaysia 2003). As a preventable cause of morbidity and mortality, smoking also accounts for nearly 10,000 deaths in Malaysia every year. In fact, smoking related diseases, such as ischaemic heart diseases (12.9%), chronic lower respiratory diseases (2.3%), and malignant neoplasm of trachea, bronchus, or lung (2.2%) rank amongst the top ten causes of death in Malaysia in 2008 (Department of Statistics Malaysia 2010).

In terms of economic costs, the Malaysian government spends about $1 billion each year on smokers treated in public hospitals for ischaemic heart disease, lung cancer, and chronic obstructive airway diseases. This staggering cost constitutes 0.7% of the overall gross domestic product, 16.5% of the national health expenditure, and 26.1% of the overall budget of the Ministry of Health Malaysia (Institute of Public Health Malaysia 2008).

Although previous attempts have been made to study cigarette consumption patterns in Malaysia (Lee et al. 2005; Ross and A1-Sadat 2007; Ezat et al. 2008; Manaf and Shamsuddin 2008; Tan et al. 2009; among others), an extensive review of the published literature reveals that there has been little detailed analysis in distinguishing the smoking status of an individual as a non-smoker, casual smoker or compulsive smoker. Discerning individual smoking status is particularly important as studies have shown that while cigarette smokers are typically nicotine dependent, there exist casual smokers (also called chippers) who indulge in the activity without giving in to long term dependence (Shiffman 1989; Shiffman et al. 1990, 1994). Besides the influence of addiction, differences in quantum of cigarettes smoked, and regularity of smoking, the reasons of participation exhibited by these two groups of smokers may vary as well. For instance, the motives of casual or non-nicotine dependent smokers are primarily driven by positive enhancement or reinforcement and sensory pleasures. On the other hand, compulsive or nicotine dependent smokers are mainly motivated by withdrawal-relief symptoms or habitual or tension-reduction motives in their need to smoke (Shiffman et al. 1994).

Despite these differences, there also exist similarities exhibited by both casual and compulsive smokers which point to the fact that there exists no safe level of smoking (Nguyen 2010). For instance, similar to compulsive smokers, casual smokers may also be associated with respiratory health problems, such as shortness of breath or exhaustion, coughing, and sore throat (An et al. 2009). Studies also show that even casual smokers face higher risks of smoking-related cancers, including of the bladder, kidney, pancreas, esophagus/trachea, and lung (Bjerregaard et al. 2006), as well as coronary heart diseases (Rosengren et al. 1992; Luoto et al. 2000) when compared to non-smokers. At the same time, casual smokers share similarities with compulsive smokers in terms of smoking topography and physical responses to smoking (Nguyen 2010).

Given the issues of high morbidity and mortality, as well as excessive economic and social costs due to smoking, this study attempts to augment existing studies by examining the correlations between socio-demographic factors and the likelihood of an individual's smoking status as a non-smoker, casual smoker, or compulsive smoker in Malaysia. The unique racial composition in Malaysia, consisting of Malay (56%), Chinese (26%), Indian (7%), and a proportion of various other races (11%), allows for the possibility of ethnic and religious differences to influence smoking status amongst Malaysians. This issue is relevant given the high prevalence of smoking amongst Malays (27.9%), followed by the Chinese (19.2%) and Indians (16.2%) (Shahrin et al. 2007), despite the fact that smoking is considered haram (unlawful) based on religious fatwas (edicts) to the Malay Muslims majority in Malaysia (Shahrin et al. …

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