1. Determining the extent and nature of illicit cigarette use in Malaysia involving pack collection and interview: Findings from the wave 4 ITC study
Rahmat Awang, Maizurah Omar
(Clearinghouse for Tobacco Control, USM, Penang)
Ron Borland and Hua Yong
(Cancer Vic, Melbourne)
Geoffrey Fong, Mary Thompson, Anne CK Quah
(University of Waterloo, Canada)
Zarihah Zain
(Malaysian Ministry of Health)
Dato’ Azizah Idris
(Malaysian Royal Custom)
Effective Implementation of FCTC Policies
Pre-Conference Workshop, 15th World Conference on
Tobacco or Health, Singapore, 19 March 2012

2. Background
Over the last 10 years, the Malaysian government has been increasing cigarette tax and currently the tax is about 56%.
Since 2003, the Confederation of Malaysian Tobacco Manufacturers (CMTM) continuously lobbied the Malaysian Government
They recently reported an upward trend from 14.4% in 2004 to the current (2010) 37%
One out of three packets of cigarettes are smuggled
To date, no evidence from other sources (apart from the industry) regarding this issue

3. 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.
The Star, 26 April 2011

4. What CMTM reported?

5. Main Aim of the Study
To evaluate the extent of illicit cigarette trade in Malaysia.
To provide independent and credible source of illicit cigarette trade data to the government
To pilot the ITC methodology particularly telephone interview technique in addressing this issue.

7. SPECIFIC OBJECTIVES
Do illicit products carry a tax stamp or security ink and do these labels follow the government’s specification?
Do illicit products carry a health warning and prohibition to minors?
Do illicit products carry the message “about 4000 chemical constituents of cigarette”?
Are illicit products sold in the same location as legal products?
Are illicit products more attractive compared to legal products? Why and among whom?
Are illicit products cheaper than the legal products?
What is the magnitude of the difference in average price between illicit and legal products?
Do illicit products taste better than the legal products?
Are illicit product easily accessible to the smokers?
Who is more likely to buy illicit products, men or women, urban or rural residents?
What are the locally existing illicit packages and their representative companies?
Do our illicit cigarette findings different from industry findings?

8. METHODOLOGY Cross-sectional data of the ITC Wave 4 survey
Conducted between July 2009 and December 2009
Multi-stage stratified cluster sampling technique
Participants were interviewed through telephone
Currently used cigarette pack were mailed.
Total number of factory made cigarette smokers in the study: 1744
Total packs received were from 692 smokers
Each collected pack undergone physical observations to identify whether they were genuine or illicit packages

9. 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

10. Current Graphic Health Warning Labels

11. Duck to verify the security ink

12. Tax Stamps Fine line security Two types of tax stamp Alphanumeric
and status
tax stamps
Yellow fluorescence
by using UV light
Custom logo
Micro text

13. Characteristics of respondents who sent and not sent the packs
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 )
a32.08(sd-13.02)
weighted data. a mean, sd- standard deviation

14. Characteristics of respondents who sent and not sent the packs cont...
Not Received
Received
Income (N=1479)
Low
64.4%
35.6%
Middle
59.3%
40.7%
High
63.5%
36.5%
Gender (N=1711)
Male
63.1%
36.9%
Race (N=1705)
Malay
59.6%
40.4%
Others
78.6%
21.4%
Employment (N=1479)
Professional
81.9%
18.1%
Non-Professional
57.9%
42.1%
Technical
61.5%
38.5%
Unemployed
64.1%
35.9%
weighted data

15. Relationship between characteristics of respondents and pack sent or not sent
Univariate
P-value
OR (95%CI)
States
n=1711
Sabah & Sarawak
Ref ***
Kedah
3.09 ( )
Penang
2.23 ( )
Selangor
1.72 ( )
Terengganu
2.55 ( )
Johor
1.42 ( )
Residential
Urban
RefNS
Rural
1.05 ( )
Education
n=1578
Primary
Secondary
1.12 ( )
Tertiary
1.28 ( )
Reported OR and 95% CI were from multiple logistic regression. NS Not significant, *p<0.05, **p<0.01, ***p<0.001
n- number of respondents in univariate analysis.

16. Relationship between characteristics of respondents and packs sent or not sent cont...
Univariate
P-value
OR (95%CI)
Income (n=1429)
Low
Ref ***
Middle
1.23 ( )
High
1.04 ( )
Age (n=1711)
T-TEST
t(1684)=-1.35, p=0.176a
Race (n=1705)
Malay
Others
0.40 ( )
Employment (n=1479)
Professional
Non-Professional
3.24 ( )
Technical
2.78 ( )
Unemployed
2.49 ( )
Compare to low income people, middle and high income respondents significantly more likely to send the packs.
Reported OR and 95% CI were from multiple logistic regression. NS Not significant, *p<0.05, **p<0.01, ***p<0.001
Significant age*State interaction present (P<0.001). a p value independent sample T-Test. n-number of respondents in univariate analysis

17. Percentage of ILLICIT packs received (N=685)

18. Types of popular cigarettes packs identified as ILLICIT
Brand Product
(n=total pack collected)
Companies
% of total illicit cig (% illicit of total pack received from same pack)
Dunhill
(n=286)
British American Tobacco
3.5 (0.7)
Marlboro
(n=37)
Philip Morris
9.2 (32)
Winston
(n=75)
Japan Tobacco International
13.5 (24)
Gudang Garam
(n=56)
36.8 (84)
Total brands as illicit = 16

19. ILLICIT cigarette packages received based on check list

20. Characteristics of respondents who sent illicit or genuine packs
State (n=685)
Sabah /Sarawak
39.4%
60.6%
Kedah
92.0%
8.0%
Penang
90.0%
10.0%
Selangor
84.6%
15.4%
Terengganu
86.4%
13.6%
Johor
92.2%
7.8%
Residential (n=685)
Urban
81.6%
18.4%
Rural
79.0%
21.0%
Education (n=651)
Primary
82.9%
17.1%
Secondary
78.3%
21.7%
Tertiary
84.8%
15.2%
Employment (n=613)
Professional
88.2%
11.8%
Non-Professional
80.3%
19.7%
Technical
85.3%
14.7%
Unemployed
78.7%
21.3%
Illicit
*weightage data

21. Characteristics of respondents who sent illicit or genuine packs (cont
Gender (N=685)
Male
80.9%
19.1%
Age (N=679)
Race
(N=684)
Malay
86.5%
13.5%
Others
30.3%
69.7%
Income (N=578)
Low
76.3%
23.7%
Middle
84.5%
15.5%
High
89.3%
10.7%
Reason for choosing particular brand
Taste (N=662) No
20.5%
24.1%
Yes
79.5%
75.9%
Price (N=664)
62.0%
34.6%
38.0%
65.4%
Health (N=652)
80.8%
76.9%
19.2%
23.1%
Illicit
*weightage data

22. Relationship between characteristics of respondents and received ILLICIT or genuine packs
Univariate
P-value, OR (95%CI)
States
n=685
Sabah /Sarawak
Ref ***
Kedah
0.06 ( )
Penang
0.08 ( )
Selangor
0.12 ( )
Terengganu
0.11 ( )
Johor
0.06 ( )
Residential
Urban
RefNS
Rural
1.17 ( )
Education
n=651
Primary
Secondary
1.35 ( )
Tertiary
0.89 ( )
Employment
Professional
Non-Profaessional
1.94 ( )
Technical
1.35 ( )
Unemployed
2.12 ( )
Income
n=578
Low
Middle
0.58 ( )
High
0.36 ( )
Compare to sabah/sarawak significantly less likely contraband
packs in other states.
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

23. Relationship between characteristics of respondents and received ILLICIT or genuine packs
Univariate
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 ( )
Reason for choosing particular brand
Taste
n= 662 No
RefNS
Yes
0.81 ( )
Price
n=664
Ref***
3.07 ( )
Health
n=652
1.28 ( )
Compare to Malays, other races odds 3.46 times more likely to use contraband packs.
Odds of 6.39 times more likely to use illicit cigarette because of the price.
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< a p value independent sample T Test

24. Places where ILLICIT packs were bought (N=139)

25. Conclusions
In our study, about 19% of Malaysian smokers use illicit cigarette
All states documented illicit cigarette use but Sabah and Sarawak were among the highest user
State, race and price are significantly associated with smoking illicit cigarette.
Illicit cigarettes are easily accessible in convenience stores. .
The ITC methodology using telephone interview and requesting pack once demonstrated its potential for measuring extent of illicit use cigarette in the country.

26. ACKNOWLEDGEMENT
The ITC-SEA Project is supported by grants P50 CA (Roswell Park Transdisciplinary Tobacco Use Research Center),
R01 CA 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.

27. ITC Project Research Support ITC Project Research Organizations
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
ITC Project Research Organizations

28. Thank You