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What is more alarming is that you don’t need to be a smoker to be at risk. The Global Adult Tobacco Survey 2012 on Malaysia revealed that four out of 10 adults were found to be exposed to secondhand smoke at home (7.6 million adults), and four out of 10 were found to be exposed to secondhand smoke indoors at their workplace (2.3 million adults). Among those adults who visited a restaurant in the past 30 days, seven out of 10 would have been exposed to secondhand smoke (8.6 million adults). 4. Another critical area of consideration is economics. Tobacco use reduces overall national incomes by up to 3.6%. At the society level, direct costs are estimated from public and private medical costs of treating cigarette-related diseases. According to a study reported by Bernama in 2007, three smoking-related diseases – ischemic heart disease, lung cancer and chronic obstructive pulmonary disease – consumed about RM3.5bil of Malaysia’s healthcare budget. 5. More importantly, a 2007 study demonstrated that retailer compliance with laws limiting sales to minors appears to be significant in reducing youth access to cigarettes.

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Drug and Alcohol Dependence Passage of BBW may have a substantial impact on the utilization of certain medications. In 2009, the FDA required a black box warning (BBW) on bupropion and varenicline, the two commonly prescribed smoking cessation agents due to reports of adverse neuropsychiatric events. We investigated if there was a decline in use of bupropion and varenicline after the BBW by comparing the percent using these medications before and after BBW. We conducted a retrospective observational study using data from the Medical Expenditure Panel Survey from 2007 to 2014. The study sample consisted of adult smokers, who were advised by their physicians to quit smoking. We divided the time period into “pre-warning”, “post-warning: immediate”, and “post-warning: late.” Unadjusted analysis using chi-square tests and adjusted analyses using logistic regressions were conducted to evaluate the change in bupropion and varenicline use before and after the BBW. Secondary analyses using piecewise regression were also conducted. On an average, 49.04% of smokers were advised by their physicians to quit smoking. We observed a statistically significant decline in varenicline use from 22.1% in year 2007 to 9.23% in 2014 (p value < 0.001). In the logistic (Adjusted Odds Ratio = 0.36, 95% CI = 0.22–0.58) and piecewise regressions (Odds Ratio = 0.64, 95% CI = 0.41–0.99) smokers who were advised to quit smoking by their physicians were less likely to use varenicline in the immediate post-BBW period as compared to pre-BBW period.

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