What are your thoughts on the ministry’s plan to raise the legal age to buy cigarettes to 21?
The Malaysian Mental Health Association welcomes the proposal to raise the minimum age to purchase cigarettes and tobacco products from 18 years to 21 .This is one the most effective measures in combatting the prevalence of smoking and decreasing the overall health burden as a result of smoking .
People in the 18-21 age group are susceptible to the addictive effects nicotine because the brain is still developing at this age. That is why most chronic smokers would have first experimented with cigarettes at this age group and not later. Experimenting with cigarettes at this age groups makes the brain “learn “ to be addicted compared to a more ‘mature’ brain at a later stage .When such an experiment is delayed there is less likely for addiction to develop. The increase is legal age is one of the more effective strategies in reducing the number of smokers in society.
How critical is the issue of smoking among teens and youth in Malaysia?
The issue is definitely critical as the dangers are not only in smoking cigarettes but other related habits like sishah smoking and vaping. Smoking can also be a gateway to other more dangerous habits like smoking marijuana and experimenting with more dangerous and addictive substances.
What leads a young girl or boy to smoke cigarette or other tobacco products?
The need to experiment with anything new or wanting to be accepted in a group or just being “cool” are some of the reasons why young people start smoking . Some also feel smoking is a form of social rebellion.
How can psychiatrists play a role in smoking cessation? How can they help young smokers to quit smoking?
Psychiatric services have introduced many smoking cessation interventions for those who are addicted to smoking. Nicotine patch and nicotine chewing gums have been around for a long time. So far, the curative component has only focused on outpatient treatment. Several studies have indicated that for chronic smokers may benefit from hospital based (involving hospital stay) cessation of smoking programmes which were found to be more effective. Obviously this would mean higher burden on the public health care system but it may result in lower relapse rates. Preventive measures like the Ministry of Health’s “Tak Nak“ campaign has not been very successful. Creating an awareness on the hazards of smoking alone is not enough. Obviously a new approach is prevention is needed focusing on behavioral changes in the individual.
What are the effects of smoking to a person’s mental health?
Regular smoking causes changes in the brain due nicotine contained in cigarettes. This can lead to nicotine addiction or dependence. Dependence is characterized by increase in the frequency and quantity of nicotine to achieve the same state of feeling “high”. Some might say that smoking helps them relax and cope with stress. While this might be true in the sense nicotine creates an immediate sense of relaxation, this feeling is temporary and soon gives way to increased cravings and withdrawal symptoms causing more anxiety and stress. Prolonged anxiety and stress can also lead to depression. People with depression or major mental illness like schizophrenia tend to smoke more heavily to cope with unwelcome pressure. People with depression or schizophrenia may also start to smoke before the onset of the illness and conversely the illness itself can encourage people to smoke more. There is a complex relationship between mental illness and smoking.
What other measures should be taken by the government, tobacco industry and stakeholders to curb the issue?
The tobacco industry’s freedom in advertising must be further curtailed. Imposing higher taxes and promoting more smoke free public spaces is a step towards this direction.
How can parents, teachers, peers and other groups help?
Parents and teachers can lead by example. Teenagers also need role models whom their identify with to be the ambassadors of anti-smoking campaigns to spread the message that one can also be “cool “ without he need to smoke.
Dato’ Dr. Andrew Mohanraj Chandrasekaran
Consultant Psychiatrist & Deputy President
Malaysian Mental Health Association
Dr. Andrew Mohanraj 