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
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
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
What CMTM reported?
Global Benchmarking - Illicit Cigarette Trade In 2009
Illicit Cigarettes Remain Critical
- Contraband Other White Continues To Increase
Based on the report,
Malaysia ranked #1 in
terms of Illicit Cigarettes
Trade among 52 countries
researched in 2009.
Contraband Kreteks
Contraband Whites (CMTM Member Brands)
Contraband Other Whites (Non CMTM Member Brands)
Counterfeit Whites
37.5
Numbers in %
36.3
0.1
25.7
Trend line
23.7
20.9
20.0
17.5
14.4
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 (%)
1.0
1.0
4.0
3
0.7
10.0
10.0
Illicit Cigarettes 2010 – Contribution By Region
2003
Pen. Malaysia accounts for 70% of total illicit
while Sabah accounts for 14% and Sarawak accounts for
16%
* Illicit Incidence
70%
16%
7
13.1
0.4
0.3
8.4
2.4
0.6
6.0
6.9
2004
2005
1.1
10.7
21.6
0.3
7.6
12.0
9.0
2006
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
14%
36.3 %*
2.7
11.2
9.9
0.2
5.5
5.0
20.1
0.4
0.4
11.8
2007
12.0
11.9
2008
13.8
16.7
20.8
2009
14.4
21.9
2010
Base : Total National sample
Figures in red indicate % for Total Illicit Whites
6
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.
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?
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
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
Current Graphic Health Warning Labels
Duck to verify the security ink
Tax Stamps
Fine line security
Two types of tax stamp
Micro text
Custom logo
Alphanumeric
and status
tax stamps
Yellow fluorescence
by using UV light
CHARACTERISTICS OF RESPONDENTS WHO
SENT AND NOT SENT THE PACKS
CHARACTERISTICS
Not Received
Received
Sabah /Sarawak
74.5%
25.5%
Kedah
48.5%
51.5%
State
Penang
56.9%
43.1%
(N=1711)
Selangor
63.0%
37.0%
Terengganu
53.4%
46.6%
Johor
67.3%
32.7%
Residential Urban
63.4%
36.6%
(N=1711)
Rural
62.4%
37.6%
Primary
65.5%
34.5%
Secondary
62.7%
37.3%
Tertiary
59.5%
40.5%
Education
(N=1578)
Age
a35.01
weighted data. a mean, sd- standard deviation
(sd- 57.92)
a32.08(sd-13.02)
CHARACTERISTICS OF RESPONDENTS WHO
SENT AND NOT SENT THE PACKS CONT...
CHARACTERISTICS
Income
(N=1479)
Gender
Not Received
Received
Low
64.4%
35.6%
Middle
59.3%
40.7%
High
63.5%
36.5%
63.1%
36.9%
Malay
59.6%
40.4%
Others
78.6%
21.4%
Professional
81.9%
18.1%
Non-Professional
57.9%
42.1%
Technical
61.5%
38.5%
Unemployed
64.1%
35.9%
Male
(N=1711)
Race (N=1705)
Employment
(N=1479)
weighted data
RELATIONSHIP BETWEEN CHARACTERISTICS OF
RESPONDENTS AND PACK SENT OR NOT SENT
Univariate
CHARACTERISTICS
P-value
OR (95%CI)
Sabah & Sarawak
Ref ***
Kedah
3.09 (1.95-4.91)
States
Penang
2.23 (1.44-3.45)
n=1711
Selangor
1.72 (1.29-2.31)
Terengganu
2.55 (1.86-3.50)
Johor
1.42 (1.02-1.98)
Residential
Urban
RefNS
n=1711
Rural
1.05 (0.85-1.29)
Primary
Education
n=1578
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<0.001
n- number of respondents in univariate analysis.
RELATIONSHIP BETWEEN CHARACTERISTICS OF
RESPONDENTS AND PACKS SENT OR NOT SENT CONT...
Univariate
CHARACTERISTICS
P-value
OR (95%CI)
Ref ***
Income
Low
(n=1429)
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)
Ref ***
Professional
Employment
Non-Professional
3.24 (1.89-5.56)
(n=1479)
Technical
2.78 (1.57-4.93)
Unemployed
2.49 (1.40-4.45)
NS Not
Reported OR and 95% CI were from multiple logistic regression.
significant, *p<0.05, **p<0.01, ***p<0.001
a
Significant age*State interaction present (P<0.001). p value independent sample T-Test. n-number of respondents
in univariate analysis
PERCENTAGE OF ILLICIT
PACKS RECEIVED (N=685)
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)
Gudang Garam
36.8 (84)
Total brands as illicit = 16
ILLICIT CIGARETTE PACKAGES RECEIVED
BASED ON CHECK LIST
CHARACTERISTICS OF RESPONDENTS WHO
SENT ILLICIT OR GENUINE PACKS
CHARACTERISTICS
Genuine (%)
Illicit (%)
Sabah /Sarawak
39.4%
60.6%
Kedah
92.0%
8.0%
State
Penang
90.0%
10.0%
(n=685)
Selangor
84.6%
15.4%
Terengganu
86.4%
13.6%
Johor
92.2%
7.8%
Residential
Urban
81.6%
18.4%
(n=685)
Rural
79.0%
21.0%
Primary
82.9%
17.1%
Secondary
78.3%
21.7%
Tertiary
84.8%
15.2%
Professional
88.2%
11.8%
Employment
Non-Professional
80.3%
19.7%
(n=613)
Technical
85.3%
14.7%
Unemployed
78.7%
21.3%
Education
(n=651)
*weightage data
CHARACTERISTICS OF RESPONDENTS WHO SENT
ILLICIT OR GENUINE PACKS (CONT...)
CHARACTERISTICS
Genuine (%)
Illicit (%)
Male
80.9%
19.1%
Race
Malay
86.5%
13.5%
(N=684)
Others
30.3%
69.7%
Low
76.3%
23.7%
Middle
84.5%
15.5%
High
89.3%
10.7%
No
20.5%
24.1%
Yes
79.5%
75.9%
No
62.0%
34.6%
Yes
38.0%
65.4%
No
80.8%
76.9%
Yes
19.2%
23.1%
Gender (N=685)
Age (N=679)
Income (N=578)
Reason for choosing particular brand
Taste (N=662)
Price (N=664)
Health (N=652)
*weightage data
RELATIONSHIP BETWEEN CHARACTERISTICS OF
RESPONDENTS AND RECEIVED ILLICIT
OR GENUINE PACKS
Univariate
CHARACTERISTICS
P-value, OR (95%CI)
Sabah /Sarawak
States
n=685
Residential
n=685
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)
Urban
RefNS
Rural
1.17 (0.78-1.75)
Primary
Education
n=651
1.35 (0.56-3.25)
Tertiary
0.89 (0.37-2.13)
RefNS
Non-Profaessional
1.94 (0.42-8.85)
Technical
1.35 (0.28-6.58)
Unemployed
2.12 (0.44-10.27)
Low
Income
n=578
RefNS
Secondary
Professional
Employment
n=651
Ref ***
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
CHARACTERISTICS
Age n=679
Univariate
P-value, OR (95%CI)
T-Test
T(679)=0.018, P=0.985a
Race
Malay
Ref ***
n=684
Others
14.54 (8.19-25.81)
Reason for choosing particular brand
Taste
No
RefNS
n= 662
Yes
0.81 (0.50-1.31)
Price
No
Ref***
n=664
Yes
3.07 (1.99-4.74)
Health
No
RefNS
n=652
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 (N=139)
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.
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 Organizations
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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