Rahmat AwangClearinghouse for Tobacco Control, Universiti Sains Malaysia, Penang

Determining the extent and nature of illicit cigarette use in Malaysia involving pack collection and interview:

Findings from the wave 4 and 5 ITC study

Effective Implementation of FCTC PoliciesPre-Conference Workshop, 15th World Conference on

Tobacco or Health, Singapore, 19 March 2012

Background• Imposing taxes on tobacco is one of the most efficient and

effective measures to reduce tobacco use:

- it can reduce consumption significantly

- increase government revenue

• Despite this, many governments are reluctant to raise taxes, due to concerns about smuggling and the possible impact on the poor.

• In Malaysia, the tobacco industry uses data showing increasing prevalence of smuggling and lobbied the government not to raise tax or to keep cigarette taxes low.

The Star, 26 April 2011

Press released by CMTM?CMTM is an industry

organization of Philip Morris International Affiliates in

Malaysia, British American Tobacco (Malaysia) Berhad

and JT International Berhad.

What CMTM reported?

3

Global Benchmarking - Illicit Cigarette Trade In 2009

Source : Global Tobacco Report– June 2010, Goldman Sachs Exhibit 23: Illicit trade a key threat but also an opportunity in some geographies, 2009 Illicit trade market share (% )

Based on the report, Malaysia ranked #1 in terms of Illicit Cigarettes Trade among 52 countries researched in 2009.

What CMTM reported?

6

10.06.0 6.9 9.0

11.8 11.916.7 14.4

5.0

2.7 2.4

0.4 0.3

0.60.3

4.0

5.57.6

9.911.2 13.1

20.121.6

1.0

0.20.7

1.0

0.4

0.1

1.1

0.4

2003 2004 2005 2006 2007 2008 2009 2010

Contraband Kreteks Contraband Whites (CMTM Member Brands)

Contraband Other Whites (Non CMTM Member Brands) Counterfeit Whites

23.7

20.0

14.417.5

20.9

10.78.410.0 12.0 12.0 13.8 20.8

25.7

36.337.5

21.9

Illicit Cigarettes Remain Critical- Contraband Other White Continues To Increase

Trend line

Numbers in %

Base : Total National sample

Figures in red indicate % for Total Illicit Whites

Source: CMTM illicit cigarette (IC) study 2010 (Oct-Dec) based on a sample size of 44,832 empty discarded cigarette packs collected in Peninsular Malaysia, Sabah & Sarawak

7

16%

14%

70%

36.3 %*

Pen. Malaysia accounts for 70% of total illicit while Sabah accounts for 14% and Sarawak accounts for

16%

Illicit Cigarettes 2010 – Contribution By Region

* Illicit Incidence

In last year (2011) national budget review, the Malaysian government did not raise tobacco taxes

They reported an upward trend from 14.4% in 2004 to the current (2010) 37%They claimed that one out of three packs of cigarettes are smuggled

Our Concern

Cigarette smuggling will lead to the availability of cheaper cigarettes that will counterbalance the effects of tax increases on lowering prevalence because the youth and the poor can now afford it.

If tax is lowered due to concern of smuggling, cigarettes will be made more affordable and this can also increase prevalence of smoking.

Main Aim of the Study

• To evaluate the extent and types of illicit cigarette trade in Malaysia.

To pilot the ITC methodology particularly telephone interview technique in addressing this issue

To provide independent and credible source of illicit cigarette trade data to the government

WHAT A GENUINE MALAYSIAN CIGARETTE PACK LOOKS LIKE ?

1. Graphic health warnings (40% covers front and 60% at the back)

2. Label: “Produk in mengandungi lebih 4,000 bahan kimia termasuk tar, nikotina dan karbon monoksida yang membahayakan kesihatan”.

3. Label: Warning against selling to minors.

4. Label: Info line number

5. Contain genuine security ink or tax stamp

Current Graphic Health Warning Labels

Tax Stamps

Fine line security

Micro text

Alphanumeric and status tax stamps

Custom logo

Two types of tax stamp

Yellow fluorescence by using UV light

Duck to verify the security ink

New tools introduced in late 2009 to verify the security ink

SPECIFIC OBJECTIVES

1. Do illicit products carry a tax stamp or security ink and do these labels follow the government’s specification?

2. Do illicit products carry a health warning and prohibition to minors?

3. Do illicit products carry the message “about 4000 chemical constituents of cigarette”?

4. Are illicit products sold in the same location as legal products?

5. Are illicit products more attractive compared to legal products? Why and among whom?

6. Are illicit products cheaper than the legal products?

7. What is the magnitude of the difference in average price between illicit and legal products?

8. Do illicit products taste better than the legal products?

9. Are illicit product easily accessible to the smokers?

10. Who is more likely to buy illicit products, men or women, urban or rural residents?

11. What are the locally existing illicit packages and their representative companies?

12. Do our illicit cigarette findings different from industry findings?

CHECK LIST TO DETERMINE ILLICIT CIGARETTE PACK

Absence of any of the following check list items was considered as illicit pack:

1. Graphic health warnings (40% covers front and 60% at the back)

2. Label: “Produk in mengandungi lebih 4,000 bahan kimia termasuk tar, nikotina dan karbon monoksida yang membahayakan kesihatan”.

3. Label: Warning against selling to minors.

4. Label: Info line number

5. Contain genuine security ink or tax stamp

• Cross-sectional data of the ITC Wave 4 and wave 5 surveys

• Conducted between July 2009 and December 2009 for wave 4; and

between September 2011 and February 2012 for wave 5

• Multi-stage stratified cluster sampling technique

METHODOLOGY

• Participants were interviewed through telephone; in wave 5 they were asked

to provide the bar code number of the cigarette pack that they used at the

time of interview

• Currently used cigarette pack at time of interview were mailed.

• Total number of factory made cigarette smokers in the study: 1744 (wave 4)

and 1605 (wave 5)

• Total packs received were from 692 smokers (wave 4) & 872 (wave 5)

• Each collected pack undergone physical observations to identify whether they

were genuine or illicit packages. Verification carried out by the custom

officers.

CHARACTERISTICS OF RESPONDENTS WHO SENT AND NOT SENT THE PACKS (WAVE 4)

CHARACTERISTICS Not Received Received

State

(N=1711)

Sabah /Sarawak 74.5% 25.5%

Kedah 48.5% 51.5%

Penang 56.9% 43.1%

Selangor 63.0% 37.0%

Terengganu 53.4% 46.6%

Johor 67.3% 32.7%

Residential

(N=1711)

Urban 63.4% 36.6%

Rural 62.4% 37.6%

Education

(N=1578)

Primary 65.5% 34.5%

Secondary 62.7% 37.3%

Tertiary 59.5% 40.5%

Age a35.01 (sd- 57.92) a32.08(sd-13.02) weighted data. a mean, sd- standard deviation

RELATIONSHIP BETWEEN CHARACTERISTICS OF RESPONDENTS AND PACK SENT OR NOT SENT (WAVE 4)

CHARACTERISTICS

Univariate

P-value

OR (95%CI)

States

n=1711

Sabah & Sarawak Ref ***

Kedah 3.09 (1.95-4.91)

Penang 2.23 (1.44-3.45)

Selangor 1.72 (1.29-2.31)

Terengganu 2.55 (1.86-3.50)

Johor 1.42 (1.02-1.98)

Residential

n=1711

Urban RefNS

Rural 1.05 (0.85-1.29)

Education

n=1578

Primary RefNS

Secondary 1.12 (0.74-1.69)

Tertiary 1.28 (0.86-1.93)

Reported OR and 95% CI were from multiple logistic regression. NS Not significant, *p<0.05, **p<0.01, ***p<0.001n- number of respondents in univariate analysis.

RELATIONSHIP BETWEEN CHARACTERISTICS OF RESPONDENTS AND PACKS SENT OR NOT SENT (WAVE 4) CONT...

Reported OR and 95% CI were from multiple logistic regression. NS Not significant, *p<0.05, **p<0.01, ***p<0.001Significant age*State interaction present (P<0.001). a p value independent sample T-Test. n-number of respondents in univariate analysis

CHARACTERISTICS

Univariate

P-value

OR (95%CI)

Income

(n=1429)

Low Ref ***

Middle 1.23 (0.98-1.55)

High 1.04 (0.76-1.44)

Age (n=1711)   T-TEST

t(1684)=-1.35, p=0.176a 

Race (n=1705) Malay Ref ***

Others 0.40 (0.30-0.54)

Employment

(n=1479)

Professional Ref ***

Non-Professional 3.24 (1.89-5.56)

Technical 2.78 (1.57-4.93)

Unemployed 2.49 (1.40-4.45)

PERCENTAGE OF ILLICIT PACKS RECEIVED AT WAVE 4 (N=685)

TYPES OF POPULAR CIGARETTES PACKS

IDENTIFIED AS ILLICIT (WAVE 4)

Total brands as illicit = 16

ILLICIT CIGARETTE PACKAGES RECEIVED BASED ON CHECK LIST (WAVE 4)

RELATIONSHIP BETWEEN CHARACTERISTICS OF RESPONDENTS AND RECEIVED ILLICIT

OR GENUINE PACKS (WAVE 4)

CHARACTERISTICSUnivariate

P-value, OR (95%CI)

Statesn=685

Sabah /Sarawak Ref ***

Kedah 0.06 (0.02-0.17)Penang 0.08 (0.03-0.21)Selangor 0.12 (0.07-0.21)Terengganu 0.11 (0.06-0.19)Johor 0.06 (0.02-0.13)

Residential n=685

Urban RefNS

Rural 1.17 (0.78-1.75)

Education n=651

Primary RefNS

Secondary 1.35 (0.56-3.25)Tertiary 0.89 (0.37-2.13)

Employment n=651

Professional RefNS

Non-Profaessional 1.94 (0.42-8.85)

Technical 1.35 (0.28-6.58)Unemployed 2.12 (0.44-10.27)

Income n=578

Low RefNS

Middle 0.58 (0.36-0.93)High 0.36 (0.16-0.81)

Weighted data. n- number of respondents in univariate analysis.Reported OR and 95% CI were from univariate & multiple logistic regression. NS Not significant, *p<0.05, **p<0.01, ***p<0.001

RELATIONSHIP BETWEEN CHARACTERISTICS OF RESPONDENTS AND RECEIVED ILLICIT OR GENUINE PACKS (WAVE 4)

CHARACTERISTICSUnivariate

P-value, OR (95%CI)

Age n=679 T-Test

T(679)=0.018, P=0.985a

Race

n=684

Malay Ref ***

Others 14.54 (8.19-25.81)

Reason for choosing particular brand

Taste

n= 662

No RefNS

Yes 0.81 (0.50-1.31)

Price

n=664

No Ref***

Yes 3.07 (1.99-4.74)

Health

n=652

No RefNS

Yes 1.28 (0.78-2.11)Weighted data. n- number of respondents in univariate analysis.Reported OR and 95% CI were from univariate . NS Not significant, *p<0.05, **p<0.01, ***p<0.001. a p value independent sample T Test

PLACES WHERE ILLICIT PACKS WERE BOUGHT IN WAVE 4 (N=139)

WAVE 5 DATA: Cigarette Packs

Sent.

* Unweighted data.

WAVE 5

* Unweighted data.

WAVE 5

* Unweighted data.

Distribution of Non-White Illicit Packs According to Manufacturer

* Unweighted data.

Distribution of Non-White Illicit packs according to checklist criteria-Local Manufacturer

* Unweighted data.

Distribution of Non-White Illicit packs according to checklist criteria-Foreign Manufacturer

* Unweighted data.

CONCLUSIONS

• The ITC methodology using telephone interview and requesting pack has the potential to provide the types and extent of illicit cigarette use.

• This method has the potential to provide the profile of people who smoked illicit cigarettes as well as the factors that influence this practice.

ACKNOWLEDGEMENT

The ITC-SEA Project is supported by grants P50 CA111236 (Roswell Park Transdisciplinary Tobacco Use Research Center),

R01 CA100362 from the National Cancer Institute of the United States,

Canadian Institutes of Health Research (79551),

Ontario Institute for Cancer Research, ThaiHealth Promotion Foundation, and the Malaysian Ministry of Health.

We would also like to acknowledge the other members of the ITC Project team.

 

ITC Project Research Support

Core support provided by the U.S. National Cancer Institute to the Roswell Park TTURC (P01

CA138389)

Additional major funding provided by the Canadian

Institutes of Health Research

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