1. Measured and perceived addiction in predicting rational thoughts among adult smokers in Malaysia Sulastri Samsudin 1, Maizurah Omar 1, Rahmat Awang 1, Borland R 2, Geoffrey T. Fong 3, Yong HH 2 1 Clearinghouse for Tobacco Control, National Poison Centre, Universiti Sains Malaysia, 2 The Cancer Council Victoria, Melbourne, Australia 3 Department of Psychology, University of Waterloo, Canada

2. Introduction  Cigarette smoking is the single most important preventable cause of morbidity and mortality in our society.  There are approximately 1 billion cigarette smokers in the world.  Only 2 to 3 percent of smokers succeeded in smoking cessation.  Cigarette are considered among the most addicting drugs.

3.  A state, psychic and sometimes also physical, resulting in the interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, sometimes to avoid discomfort of its absences. Tolerance may or may not be present - World Health Organization (WHO). Addiction

4. Objective  To see association between measured and perceived addiction.  To test the association of measured and perceived addiction with thinking about enjoyment, harm to oneself, harm to others, money spent on smoking and quitting.

5. Evaluation Methodology Cohort study (5 years). Wave 1 International Tobacco Control Survey data (2005) Strata selected states from 6 states Samples from urban and rural areas 2006 adult smokers Face to face interview Cross sectional data

6. Evaluation Methodology Measured Addiction IndexScore Cigarette per dayTime to first cigaretteHow hard it would be to go whole day without a cigarette < 10LaterNot at all hard0 11 – 20Around breakfastSomewhat hard1 > 20EarlierVery to extremely hard2 Perceived addiction question: “Do you consider yourself addicted to cigarettes?” Level of addictionMeasured addiction scoreValue label Not at all addicted01 Somewhat addicted1 – 32 Very addicted4 – 63

7. VariableFrequencyPercentage (%) Measured level of addiction Not at all addicted904.5 Somewhat addicted134767.1 Very addicted47423.6 Perceived level of addiction Not at all addicted37618.7 Somewhat addicted113156.4 Very addicted49124.5 Distribution of smokers according to level of measured & perceived addiction

8. Perceived addiction Measured addiction Not at all addictedSomewhat addicted Very addicted Not at all addicted Somewhat addicted Very addicted 51.1% (46)21.1% (283)3.6% (17) 46.7% (42)62.8% (844)41.4% (196) 2.2% (2)10.1% (216)55.1% (261) Distribution of smokers by measured & perceived addiction P value <0.001

9. Demographic characteristics P value Level of PERCEIVED addiction Not at all addicted Somewhat addicted Very addicted Gender Male (N=1896)0.92018.8%56.5%24.6% Female (N=87)18.4%58.6%23.0% Ethnic groups Malay (N=1324)0.00118.4%59.6%22.0% Chinese (N=240)22.6%50.2%27.2% Indian (N=109)24.8%54.1%21.1% Others (N=310)15.7%49.4%34.9% Distribution of smokers by PERCEIVED addiction & demographic characteristics Age group 18 – 24 (N=290)0.00116.9%62.4%20.7% 25 – 39 (N=643)19.8%59.4%20.8% 40 – 54 (N=639)15.9%54.1%30.0% > 55 (N=375)23.4%50.5%26.1% Education level Primary (N=514)0.02519.6%51.9%28.4% Secondary (N=1186)18.4%56.9%24.7% Tertiary (N=242)19.6%62.4%18.0%

10. Demographic characteristics P value Level of MEASURED addiction Not at all addictedSomewhat addictedVery addicted Gender Male0.0044.4%70.6%25.1% Female11.9%69.0%20.5% Ethnic groups Malay0.1133.9%71.8%24.3% Chinese7.3%65.2%27.5% Indian7.4%63.9%28.7% Others5.1%71.4%23.6% Distribution of smokers by MEASURED addiction & demographic characteristics Age group 18 – 240.1776.3%71.9%21.8% 25 – 394.7%71.8%23.5% 40 – 543.9%67.7%28.5% > 555.1%71.9%23.0% Education level Primary0.0225.1%71.6%23.3% Secondary3.8%69.5%26.7% Tertiary7.7%72.5%19.7%

11. Association between measured and perceived addiction with different thoughts Independent variable Thinking about enjoymentThinking about harm to oneself OR (95%C.I.)p valueOR (95%C.I.)p value Measured addiction somewhat addicted very addicted 1.04 (0.56 -1.93) 1.71 (0.91-3.24) 0.89 0.09 1.17 (0.69-1.98) 1.12 (0.64-1.94) 0.56 0.69 Perceived addiction somewhat addicted very addicted 0.74 (0.57-0.96) 0.85 (0.58-1.25) 0.03 0.43 1.26 (0.98-1.62) 1.44 (1.01-2.04) 0.06 0.04

12. Continue… Independent variableThinking about harm to others Think seriously about quitting Think about money spent OR (95%C.I.)p value OR (95%C.I.) p valueOR (95%C.I.)p valu e Measured addiction somewhat addicted very addicted 1.07 (0.64-1.79) 0.99 (0.58-1.71) 0.79 0.98 0.65 (0.39-1.07) 0.58 (0.34-0.98) 0.09 0.04 1.09 (0.65-1.84) 1.16 (0.67-1.99) 0.74 0.60 Perceived addiction somewhat addicted very addicted 1.19 (0.93-1.52) 1.06 (0.74-1.50) 0.15 0.75 1.28 (0.98-1.66) 1.38 (0.95-1.98) 0.06 0.08 1.23 (0.96-1.58) 1.18 (0.83-1.67) 0.09 0.35

13. Conclusion These results highlight the power of addiction as a barrier to quitting. These results highlight the power of addiction as a barrier to quitting. Although not an accurate measure, smokers’ perception about their addiction protects them from enjoying smoking and motivates them to think rationally. Although not an accurate measure, smokers’ perception about their addiction protects them from enjoying smoking and motivates them to think rationally.

14. References Nursan Dede Cinar, Perceived and objective smoking addiction among University students in Sakarya, Poster presentation II, The 18 th International Nursing Research Congress Focusing on Evidence- Based Practice (11-14 July, 2007) Mark S. Gold, M.D. A publication of the University of Florida College of Medicine- Devision of Addiction.

15. International Tobacco Control Policy Evaluation Project http: / / www.itcproject.org http: / / www.roswelltturc.org Core support provided by the U.S. National Cancer Institute to the Roswell Park TTURC (P50 CA111236) Additional major funding provided by the Canadian Institutes of Health Research ITC Project Research Support