Abstract
Smoking has remained prevalent and plateaued for decades in Malaysia. Smoke-free laws (SFL) and policies could deter smoking by strengthening anti-smoking norms, impacting cessation behaviour due to decreased social acceptability of smoking in public spaces. With socioeconomic status (SES) affecting smoking risk factors, disparities in health outcomes post-SFL implementation are likely. Furthermore, regional and international assessments show Malaysia’s poor performance due to ineffective smoking bans and enforcement. Local studies revealed inadequate SFL implementation and enforcement, leading to high secondhand smoke (SHS) exposure. Understanding these challenges and opportunities is crucial for improving policy implementation and enforcement to enhance public health outcomes. This study examined the association between SFL and quit intention among Malaysian smokers, exploring the mediating role of smoking social norms and SFL support while considering SES as a moderator. Challenges and opportunities in implementing and enforcement of SFL and policies were also explored. This study employed a convergent parallel mixed-methods approach, incorporating secondary data analysis of the International Tobacco Control Malaysia Survey 2020 and semi-structured individual in-depth interviews (IDI) with local tobacco control experts. Quantitative cross-sectional survey data was managed and analysed using Stata version 17.0 and Smart-PLS 4.0.9.2, employing descriptive analysis and the Partial Least Squares Structural Equation Modeling method. Semi-structured IDI between May and December 2022, with purposive sampling of selected participants, provided insight into implementing and enforcing SFL. Framework method and NVivo 1.6.1 software were used to analyse the qualitative data. Triangulation of findings provided a comprehensive evaluation of SFL through SWOT analysis. Smoking prevalence was highest in night-time entertainment venues (85.4%), non-air-conditioned eateries (46.7%), and indoor workplaces (36.3%). Fewer smokers (14.2%) observed smoking at air-conditioned eateries. While most smokers report comprehensive smoke-free rules in public places, including eateries (both non-air-conditioned at 78.2% and air-conditioned at 74.9%) and indoor workplaces (69.2%), fewer observe such regulations in night-time entertainment venues (24.4%). Support for comprehensive SFL in public venues was substantial among smokers, particularly in non-air-conditioned eateries (66.7%), workplaces (65.5%), and night-time entertainment venues (49.9%). Although SFL has minimal direct impact on quit intentions, its influence on smokers’ decisions to quit, mediated by perceived societal norms against smoking, is significant. Lower SES smokers may be more responsive to societal attitudes against smoking concerning quitting intentions. Effective implementation and enforcement of SFL face challenges such as tobacco industry interference, stakeholder attitudes, social norms, resource scarcity, and political and organizational barriers. However, community-led initiatives, multi-faceted advocacy, synergistic collaborative efforts, and proactive enforcement offer opportunities for improvement, requiring commitment and leadership from local champions and authorities. This study suggests that SFL could protect non-smokers from SHS and encourage anti-smoking norms, aiding adult cessation efforts. This is particularly important for smokers who find smoking socially unacceptable in public and those actively attempting to quit, especially within lower SES groups. Expert’s insights regarding the challenges and opportunities of SFL implementation and enforcement strategies strengthen the justification for promoting smoke-free environments across governance levels. They are pivotal in refining these strategies, particularly at the grassroots level, and in fostering further local initiatives.
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@phdthesis{drph-gan-shiz-yee-2024,
title = {Assessment of Implementation and Enforcement of Smoke-Free Laws and Policies Among Malaysian Smokers: A Mixed Method Approach},
author = {Gan Shiz Yee },
year = {2024},
date = {2024-12-18},
urldate = {2024-12-18},
abstract = {Smoking has remained prevalent and plateaued for decades in Malaysia. Smoke-free laws (SFL) and policies could deter smoking by strengthening anti-smoking norms, impacting cessation behaviour due to decreased social acceptability of smoking in public spaces. With socioeconomic status (SES) affecting smoking risk factors, disparities in health outcomes post-SFL implementation are likely. Furthermore, regional and international assessments show Malaysia’s poor performance due to ineffective smoking bans and enforcement. Local studies revealed inadequate SFL implementation and enforcement, leading to high secondhand smoke (SHS) exposure. Understanding these challenges and opportunities is crucial for improving policy implementation and enforcement to enhance public health outcomes. This study examined the association between SFL and quit intention among Malaysian smokers, exploring the mediating role of smoking social norms and SFL support while considering SES as a moderator. Challenges and opportunities in implementing and enforcement of SFL and policies were also explored. This study employed a convergent parallel mixed-methods approach, incorporating secondary data analysis of the International Tobacco Control Malaysia Survey 2020 and semi-structured individual in-depth interviews (IDI) with local tobacco control experts. Quantitative cross-sectional survey data was managed and analysed using Stata version 17.0 and Smart-PLS 4.0.9.2, employing descriptive analysis and the Partial Least Squares Structural Equation Modeling method. Semi-structured IDI between May and December 2022, with purposive sampling of selected participants, provided insight into implementing and enforcing SFL. Framework method and NVivo 1.6.1 software were used to analyse the qualitative data. Triangulation of findings provided a comprehensive evaluation of SFL through SWOT analysis. Smoking prevalence was highest in night-time entertainment venues (85.4%), non-air-conditioned eateries (46.7%), and indoor workplaces (36.3%). Fewer smokers (14.2%) observed smoking at air-conditioned eateries. While most smokers report comprehensive smoke-free rules in public places, including eateries (both non-air-conditioned at 78.2% and air-conditioned at 74.9%) and indoor workplaces (69.2%), fewer observe such regulations in night-time entertainment venues (24.4%). Support for comprehensive SFL in public venues was substantial among smokers, particularly in non-air-conditioned eateries (66.7%), workplaces (65.5%), and night-time entertainment venues (49.9%). Although SFL has minimal direct impact on quit intentions, its influence on smokers’ decisions to quit, mediated by perceived societal norms against smoking, is significant. Lower SES smokers may be more responsive to societal attitudes against smoking concerning quitting intentions. Effective implementation and enforcement of SFL face challenges such as tobacco industry interference, stakeholder attitudes, social norms, resource scarcity, and political and organizational barriers. However, community-led initiatives, multi-faceted advocacy, synergistic collaborative efforts, and proactive enforcement offer opportunities for improvement, requiring commitment and leadership from local champions and authorities. This study suggests that SFL could protect non-smokers from SHS and encourage anti-smoking norms, aiding adult cessation efforts. This is particularly important for smokers who find smoking socially unacceptable in public and those actively attempting to quit, especially within lower SES groups. Expert’s insights regarding the challenges and opportunities of SFL implementation and enforcement strategies strengthen the justification for promoting smoke-free environments across governance levels. They are pivotal in refining these strategies, particularly at the grassroots level, and in fostering further local initiatives.},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}
