Prevalence and reasons for use of heated tobacco products among Malaysian adults who smoked: Findings from the 2020 International Tobacco Control Malaysia Survey.

INTRODUCTION: There have been rapid expansions in heated tobacco products (HTPs) outside of Japan and the Republic of Korea. In November 2018, HTPs were first introduced in Malaysia and since then, no studies have been conducted on Malaysians' use of HTPs. This study is the first to examine the prevalence of HTP use and reasons for use among Malaysian adults who smoked cigarettes. METHODS: Data came from the 2020 ITC Malaysia Survey, a web-based survey of a nationally representative sample of adults who smoked (n=1047) aged 18 and older. They were asked on ever heard of, ever used, and currently using HTPs, and their reasons for using HTPs. RESULTS: Overall, 25.4% (n= 324; 95% CI:22.3%-28.7%) of Malaysians who smoked reported ever used HTPs with 6.7% (n=85; 95% CI:22.3%-28.7%) were using them daily and 8.1% (n=110; 95% CI:6.4% -10.2%) were using HTPs non-daily. Most of them (57.2%) who dual use were of aged 25-39 and 97.3% were males. Among those who smoked daily, almost half (49.3%) were also using HTP daily. Among those who used HTPs daily and non-daily, curiosity (84.2%, 95% CI:78.4%-90.0%), taste (83.2%, 95% CI:77.3%-89.1%), and appealing technology (78.5%, 95% CI:71.3%-85.6%) were the most reported reasons. Among those who used HTPs daily, curiosity was the top reason (87.9%, 95% CI:78.9%-93.4%), while among non-daily, taste good was the top reason (81.9%, 95% CI:71.9%-88.8%). CONCLUSIONS: The very high use of HTPs among Malaysians who smoked requires continued public health surveillance that can inform the regulation of these novel tobacco products.

Methods of the 2020 (Wave 1) International Tobacco Control (ITC) Malaysia survey.

The ITC Malaysia Project is part of the 31-country ITC Project, of which the central objective is to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC). This article describes the methods used in the 2020 International Tobacco Control (ITC) Malaysia (MYS1) Survey. Adult smokers and non-smokers aged ≥18 years in Malaysia were recruited by a commercial survey firm from its online panel. Survey weights, accounting for smoking status, sex, age, education, and region of residence, were calibrated to the Malaysian 2019 National Health and Morbidity Survey. The survey questions were identical or functionally similar to those used in other ITC countries. Questions included demographic measures, patterns of use, quit history, intentions to quit, risk perceptions, beliefs and attitudes about cigarettes, e-cigarettes, and heated tobacco products. Questions also assessed measures assessing the impact of tobacco demand-reduction domains of the FCTC: price/tax (Article 6), smoke-free laws (Article 8), health warnings (Article 11), education, communication and public awareness (Article 12), advertising, promotion, and sponsorship restrictions (Article 13), and support for cessation (Article 14). The total sample size was 1253 (1047 cigarette smokers and 206 non-smokers). Response rate was 11.3%, but importantly, the cooperation rate was 95.3%. The 2020 ITC MYS1 Survey findings will provide evidence on current tobacco control policies and evidence needed by Malaysian government regulatory agencies to develop new or strengthen existing tobacco control efforts that could help achieve Malaysia's endgame, i.e. a tobacco-free nation by 2040.

E-cigarette prevalence among Malaysian adults and types and flavors of e-cigarette products used by cigarette smokers who vape: Findings from the 2020 ITC Malaysia Survey.

INTRODUCTION: E-cigarettes (ECs) have become increasingly common in many countries, including Malaysia. The prevalence of EC use increased in Malaysia from 0.8% in 2011 to 4.9% in 2019. Three quarters of Malaysian EC users also smoke combustible cigarettes, and the prevalence of EC use among Malaysian smokers in 2014 was consistent with the prevalence of use among smokers from Canada and the US in 2016. The purpose of this study was to estimate the prevalence of EC use among Malaysian adults aged ≥18 years in 2020 and the types of EC products and flavors used by cigarette smokers who also used ECs at least monthly. METHODS: Data came from 1253 adults aged ≥18 years who participated in the 2020 International Tobacco Control Malaysia Wave 1 Survey. Weighted descriptive statistics were used to estimate the prevalence of adults who reported ever using ECs and the prevalence who used ECs either monthly, weekly, or daily. The types of EC products and flavors used were compared by frequency of EC use among current smokers who used ECs at least monthly (n=459). RESULTS: Overall, 5.4% (95% CI: 3.7-7.5) of Malaysian adults reported using ECs on a daily basis in 2020. Among current cigarette smokers who used ECs daily, 81.0% (95% CI: 72.5-87.7) used nicotine in their ECs, 46.2% (95% CI: 37.8-54.7) used pre-filled ECs, and 60.4% (95% CI: 51.9-68.6) reported being somewhat/very addicted to ECs. The most common EC flavors were fruit, coffee, and menthol/ mint. CONCLUSIONS: Continued surveillance of EC use is necessary to monitor EC use in non-tobacco using populations while longitudinal research is needed to determine the extent to which ECs are, or are not, related to quitting smoking.

Reasons for using e-cigarettes and support for e-cigarette regulations: Findings from the 2020 ITC Malaysia Survey.

INTRODUCTION: Malaysia has the largest e-cigarette (EC) market in Southeast Asia, and it has been estimated that 17% of adult daily cigarette smokers also used ECs on a daily basis in 2020. However, few studies have examined the reasons people use ECs in Malaysia. This cross-sectional study of adult cigarette smokers from Malaysia assessed reasons for EC use and their support for key proposed EC regulations. METHODS: Data are from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey of adult (aged ≥18 years) smokers who reported that they used ECs at least monthly (N=459 out of 1047 smokers). Weighted analyses were conducted on EC users' reasons for using ECs and their support for various EC regulations. RESULTS: Smokers who used ECs at least monthly were more likely to be male, aged 25-39 years, of Malay ethnicity, married, more highly educated, and living in Peninsular Malaysia. Smokers who used ECs daily reported using ECs to reduce the number of cigarettes smoked (91.3%), pleasant taste (90.1%), to quit smoking (87.9%), and enjoyment (87.5%). Smokers who used ECs less than daily reported using ECs for their pleasant taste (weekly 89.4%, monthly 87.5%), curiosity (weekly 79.5%, monthly 88.8%), being offered EC by someone (weekly 76.3%, monthly 81.6%), and to reduce the number of cigarettes smoked (weekly 76.2%, monthly 77.6%). Smokers who also used ECs were most likely to support EC regulations requiring a minimum purchasing age (88.3%) and limiting nicotine concentration (79.6%), and least likely to support regulations banning EC fruit and candy flavors (27.1%). CONCLUSIONS: The most prevalent reasons for using ECs in Malaysia are comparable to those of other ITC countries, including Canada, US, England, and Australia. An understanding of use patterns of ECs, especially their interaction with cigarettes, are important in developing evidence-based regulations in Malaysia.

Health innovation for patient safety improvement.

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.