Page 40 - FINAL COMPENDIUM 2020-2021 27.2.2022

PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS: COMPLIANCE AND PUBLIC
UNDERSTANDING AMONG ADULTS IN MELAKA, PENINSULAR MALAYSIA
NMRR-18-3430-45394

‘Ainun Mardhiah MAH, Marhazlinda J, Roslan S

Introduction: Pictorial health warnings (PHWs) on cigarette packs, is one of the tobacco-
free initiatives, targeting both smokers and non-smokers. Although PHW has been
implemented in Malaysia since 2009, little is known whether the PHWs on cigarette packs
in the Malaysian market comply with the PHW indicators, and are well-understood by the
public. Objectives: This study 1) determined the prevalence of legal and illicit cigarettes
in Melaka, 2) compared the compliance level of PHWs with the Malaysian law and FCTC’s
between cigarette’s brands and variants, its legal status, types of POS, and locations; 3)
explored the public’s understanding, and 4) recommendations to improve the existing
PHWs in Malaysia, among adults. Material and methods: This multi-mode research
consisted of a quantitative and qualitative study. The PHW compliance level of each
cigarette pack was assessed using a modified protocol from the International Tobacco
Pack Surveillance System (TPSS) involving 52 multi-types cigarette points of sale in urban
and rural areas in Melaka. Four Focus Group Discussions (FGDs) involving 24 adults
(including non-smokers, smokers, and ex-smokers) were conducted to elicit the public’s
understanding and recommendations related to the existing PHWs. Data were analysed
using the SPSS Ver 20.0 and Atlas.ti Version 8.0. Results: Of 121 variants of cigarettes, i)
the majority of cigarettes obtained were legal cigarettes (83.5%), ii) 84.3% complied with
the requirement to display the gazetted PHWs , iii) 94.2% complied with five requirement
indicators, namely, having PHWs present on the packs, PHWs printed in full colour, PHW
printed on the designated location, having the correct label elements and text elements
& size, mainly contributed by legal cigarettes, iv) more than half of the cigarette variants
showed a high compliance level to the overall 12 PHW indicators, contributed by the legal
cigarette variants, those sold in the petrol stations, and in the urban areas ( p<0.05), v)
The overall PHW compliance level and scores differ between cigarette brands and within
variants of the same brand (not statistically significant), also between cigarettes legal
status, types of POS and cigarettes sold in urban and locations (p<0.05), vi) Adults in this
study easily understood PHWs showing effects on the lung and those related to oral
health; contributed to early and frequent exposure of those effects via the education
system, health programs conducted in school and social media. Gaps observed in the
knowledge of smoking effects, misunderstanding, and misperceptions for PHWs, related
explicitly to gangrene and pregnancy-related images. Our participants perceived the
existing PHWs effective only to non-smokers and non-chronic smokers. vii) the existing
PHWs in Malaysia were more effective than those from other ASEAN countries. However,
there were weaknesses arising from the images, form, contents, desensitisation of
Malaysian PHWs, etc., that affect its impact.

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