How the legislation paves the way for a smoke-free culture

KUALA LUMPUR, August 11 – Smoke-free legislation may eventually lead to a culture of no-smoking in public spaces, even without visible law enforcement like in developed countries, local tobacco control advocates have said.

They pointed out that the main purpose of the Tobacco Products and Tobacco Control Bill 2022 – which would be Malaysia’s first-ever tobacco control law if passed by Parliament – was not to criminalize smokers or vapers, but to create a “normative” smoke-free culture. .

“No one dares to have a cigarette in the UK or smoke in public…and the joke is there are no police there, there are no police, right ? But society has moved towards that standard,” said National Cancer Society of Malaysia (NCSM) chief executive Dr Murallitharan Munisamy. code blue last Friday.

A vote on the controversial Tobacco Products and Smoking Control Bill has been postponed until Parliament’s next meeting in October after various parliamentarians, lawyers and human rights activists widely objected to the provisions on enforcement powers they considered excessive.

Legislators like Muar MP and Muda President Syed Saddiq Syed Abdul Rahman and the deputy of Seputeh Therese Kok of the DAP expressed their displeasure and concern over the criminalization and victimization of young people under the Generational Final Game (GEG) which prohibits smoking or vaping, and the personal use of tobacco or vaping products , by anyone born on or after January 1, 2007.

However, Dr Murallitharan and other tobacco control advocates do not view the bill as an attack on young people, instead accepting Health Minister Khairy Jamaluddin’s explanation to Dewan Rakyat on August 2 during the debate on The law project.

Khairy had stated that the enforcement powers provided for in the Tobacco Bill such as entering premises; sample collection; stop, search and seize means of transport targeted manufacturers, importers and distributors, although these provisions do not specifically exempt the application to offenses committed by individual users of the GEG Group.

NCSM claimed that the penalties proposed in the bill are heavier on the seller than the consumer, and that the parts of the law that affect the GEG are milder than those found in other countries. developed.

Answering a question at a press conference by tobacco control advocates last Friday, Muhammad Sha’ani Abdullah, tobacco control coordinator for the Federation of Malaysian Consumer Associations (Fomca), drew attention to existing laws in Malaysia which carry a heavier penalty than those targeted at the GEG group in the Tobacco Bill.

One such law he referred to was Section 25(1) of the National Registration Act 1990 (as amended 2001) which states that an individual caught without their MyKad may be fined RM3,000 to RM20,000 or a three-year prison term. .

The Tobacco Products and Smoking Control Bill tabled in Parliament provides for a maximum fine of RM5,000 for persons born on or after 2007 who are convicted of the offenses of purchase, possession and use of tobacco and vaping products, as well as smoking or vaping.

During parliamentary debate, Khairy agreed to drop the possession offense and reduce the penalties if convicted for GEG offenders to a maximum fine of RM500 or community service.

Nonetheless, Muhammad Sha’ani and the rest of the panel of tobacco control advocates at the press conference agreed that although the Tobacco Control Bill is being considered by a special select committee ( PSC) Dewan Rakyat newly formed and chaired by Khairy, things are still subject to change.

Dr. Murallitharan, summarizing the panel’s position, reiterated that tobacco control advocates welcome efforts that do not criminalize people. Criminalizing people, said the public health doctor, was not their goal and in fact the Ministry of Health (MOH) had agreed to the “soft landing” suggestion put forward by non-governmental organizations (NGOs). ).

The idea of ​​a soft landing was to give NGOs one to two years to soften, refine and educate the public, by provoking social normative change. To illustrate his point, Dr Murallitharan referred to the situation in Singapore chewing gum law which imposes on an individual a fine not exceeding S$100,000 or imprisonment for a term not exceeding two years, or both.

Taking the example, he postulates that “it takes the legal aspect the first years” to bring about a change in culture.

The laws are the first in a long line of hurdles to achieve a smoke-free Malaysia for tobacco control advocates.

Roslizawati Md Ali, chairwoman of Malaysian Women’s Action for Tobacco Control and Health (MyWatch), said Code blue: “It has to start with the home, the family institution.”

The MyWatch leader has been vocal in her need to reform the youth. She and Dr Murallitharan spoke passionately about the anti-tobacco work they have done in schools – with the Tobacco Free Generation program and the Oral health without smoking (Kotak) — and in homes with the My house program.

“We also work on normative campaigns and transformation, and we’ve been strong advocates for the government to tell them that…nicotine is much, much, much more addictive than heroin,” said Dr. Murallitharan.

Dr. Murallitharan and Roslizawati were both opposed to the use of vapes or e-cigarettes as a way to reduce the harms of smoking tobacco.

Dr. Murallitharan has three reasons to oppose vaping: more carcinogens found in vaping than previously thought, people are known to smoke and vape, and its purported role as a gateway drug does not does not lend itself well to harm reduction.

The American Lung Association lists carcinogens among various toxic chemicals and metals found in e-cigarettes that heat vaping juices as vapor inhaled by users.

However, Cancer research in the UK says studies so far show “e-cigarettes are much less harmful than smoking” because most of the toxic chemicals found in cigarettes are not present in e-cigarettes, although he also warned electronic cigarettes are not without risk.

“Some potentially dangerous chemicals have been found in e-cigarettes. But the levels are generally low and usually much lower than those of tobacco cigarettes. Exposure may be the same as for people using tobacco replacement therapy. nicotine (TRN) such as patches or gum,” said the UK cancer research group. “There is no strong evidence that vaping causes cancer.”

Dr Murallitharan, however, said he would only support vaping “if it is genuinely for harm reduction”. He went on to mention that the Malaysian Tobacco Control Bill allows smokers to use vaping as a tobacco harm reduction measure, and that the proposed law only restricts potential insiders who have never smoked from get into the habit of vaping.

Roslizawati, on the other hand, disagrees with vaping as harm reduction, as she sees it as a way to introduce children to the habit.

“We’ve seen kids as young as three months old vaping, parents giving (their kids) the vape,” she said. code blue.

“The rate of increase in vaping and e-cigarettes has accelerated, especially… among girls – among young girls. And what they don’t understand will impact them in their future – reproductive health and things like that.

However, data on the effects of e-cigarette vapor exposure on human reproductive health are limited and based on animal models. A mouse study published in 2019 in the Journal of the Endocrine Society found that after exposure to e-cigarette vapor, female mice showed a decrease in embryo implantation and a significant delay in the onset of pregnancy with the first litter. Female offspring exposed to e-cigarettes in utero also did not gain as much weight as control mice after 8.5 months.

“We found that preconception e-cigarette use significantly delayed implantation of a fertilized embryo in the uterus, thereby delaying and reducing fertility (in mice),” said the corresponding author of the study, Kathleen Caron, of the University of North Carolina. say in a September 2019 press release by the US-based Endocrine Society, a worldwide community of physicians and scientists in the field of hormonal science and public health.

“We also found that e-cigarette use throughout pregnancy altered the long-term health and metabolism of female offspring – conferring lifelong second-generation effects on the growing fetus.”

A study 2020 published in the International Journal of Environmental Research and Public Healthwho analyzed the effects of electronic cigarette refill liquids, with or without nicotine, on rats showed that in male rats, the number of epididymal sperm decreased when rats were exposed to e-liquids with and without nicotine, with lower epididymal counts recorded for rats without nicotine.

Although there were no published results on the effects of e-cigarettes on sperm, this study cited a presentation by Helen O’Neill, at the 2017 British Fertility Society conference, which indicated that male fertility could be damaged by toxic chemicals in e-cigarettes. aromas. In her experiment, she found that certain flavors reduced sperm motility in men and damaged germ cells – which are crucial for fertility – in the testicles of mice.

For Roslizawati, the change comes with a variety of smoking cessation programs that offer support to smokers trying to quit. This is a view consistent with that of the United States Centers for Disease Control and Prevention (CDC) own position on smoking cessation, which involves a combination of telephone counseling and Food and Drug Administration (FDA)-approved medications.

Ultimately, it should be noted that there are many programs that are underway to foster normative culture. Roslizawati and Dr Murallitharan agree the government should devote more resources to nicotine reversal

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