Demographic Information of the Respondents
The demographic data was analyzed and presented based on the age group, marital status, gender of the respondents and levels of education. Out of 100 respondents who were considered for the interview, 69.0% were males, 30.0% were females and 1.0 % were unspecified. Furthermore, 21.0% and 26.0% were within the age range of 21-25 and 26-30 respectively. While 19.0% and 10.0% of the respondent were in the age range of 31-35 and 36-40 respectively. Furthermore, 9.0%, and 12.0% of the respondents were in the age range of 15-20, and 41-50 with 6.0% of respondents found within the age range of 50 and above.
On the other hand, 48.0% of the respondent were single, 37.0% were married, while 7.0% were either divorced or separated and 1.0% were found to have been widowed. Furthermore,31.0% of the respondents attained senior secondary school education, followed by 19.0% and 20.0% who had attained tertiary and junior secondary school education respectively, 12.0% attained senior primary school education and 12.0% attained primary school education, while 3.0% never attained any education. Table 1 below shows the demographic information of the respondents who were interviewed in the study area.
A total of 81.0% of the respondents smoked at least a cigarette for the past 6 months, 19.0% had not smoked a cigarette for the past 6 months. Furthermore, 55.0% considered smoking as bad, while 32.0% considered smoking as good for health, while the other 7.0% were unsure as in whether smoking is good or bad to their health. 6.0% preferred not to provide any opinion towards this perimeter. Figure 1 below, shows respondents smoking experiences and general health perspective towards combustible cigarette smoking.
The majority (56.0%) indicated willingness to quit smoking combustible cigarettes. On the other hand, 29.0% were unwilling to quit smoking, while 15.0% were not sure of their decision on whether to quit smoking or not. On the otherhand, 68.0% attempted to quit smoking, 32.0% never tempted to quit smoking at an given point. Figure 2 below shows respondents willingness to quit and quitting attempts respectively.
Quitting Succesful Rates
Out of a total of 68% who attempted to quit smoking, 38.0% were unsuccessful in their quiting attempts while 30.0% managed quit smoking. Out of the 30.0% who managed to quit smoking, 13.0% ,9.0% and 6.0% of the respondents employed will-power, harm reduction products and counselling as means to help them quit smoking, while 2.0% of the respondents revealed that they quitted smoking due to illiness and requirements for medications. Table 2 below show quitting rates and means employed for quitting.
Out of 30.0% of respondent who rused various means to quitting smoking, 6.0% managed to quit smoking completely, 16.0% managed to quit but partially, while the 12.0% did not to manage to quit smoking despite using various means. It has to be noted that, out of the 16.0% of individuals who managed to quit smoking but partially, 5.0% rmanaged to stay without smoking more more than a years, 2.0% managed to stay for a year without smoking, 2.0% managed to stay without smoking for a period of 2-6 months, 3.0% of the individuals managed to stay without smoking for more than a month, 1.0% were found to have stayed without smoking for a less than a week and more than 2 weeks respectively. Table 3, below showing Success rates in quitting attempts using various means and withdraw period among those who tempted to quit smoking.
Access to Information on Tobacco Harm Reduction and Snus as A Tobacco Harm Reduction Product
A total of 52.0% highlighted that they have ever heard of Tobacco Harm Reduction, 48.0% have never heard of the concept. On the otherhand, 36.0% have heard of snus as a tobacco harm reduction product, while the majority (64.0%) have not heard about snus as a Tobacco harm reduction product or safer nicotine product. Figure 3 below, highlights respondents who have heard of the concept of Tobacco Harm Reduction and Snus as a Tobacco Harm Reduction Product.
Knowledge and Sources of Information on usage of Snus as a Tobacco Harm Reduction Product
Out of 36.0% of individuals, 24.0% had information on how snus is used as a Tobacco Harm Reduction product, 8.0% did not know how snus is used as a Tobaco Harm Reduction Product, 4.0% were uncertain. Acquantances (friends and relative) were the most realiable and easly accessible source of information as indicated by 24.0% of the respondents ,12.0% indicated social media, radio and workshops were identified by10.0% and 5.0% of the respondents respectively with television and other means such as newpapers identified by 1.0% each. Table 4 shows responses on knowledge and sources of information regarding snus as a Tobacco Harm Reduction product.
Availability and Accessibility of Snus as a Tobacco Harm Reduction Product
A total of 42.0% were not sure if snus as a tobacco harm reduction product was available on the market as none of them has ever come across it, 30.0% revealed that snus was not available on the markets, while 28.0% indicated that snus was available on the market. Out of 28.0% who responded on the availability of snus, 25.0% revealed that snus was accessible on the market, 3.0% indicated that snus as not available at the local market. On the otherhand, 24.0% of the respondents indicated that snus was also affordable on the market as compared to the 4.0% of the respondents found to be unsure on the affordability of snus on the market. Table 5 below highlights responses on the availability, accessibility and afforability of snus on the market.
Policies and Regulation Guiding Tobacco/ Cigerrette Consumption or Smoking, and promotion of Tobacco Harm Reduction in Malawi
A total of 43.0% were not sure about about the existence of any policy and regulation guiding the consumption of tobacco or cigerrete in the country, 36.0% were not aware of such policies in the country while 21.0% indicated that the country has such policies and regulations. On the otherhand, 41.0% were not sure if the country has any policies and regulations set to promote tobacco harm reduction strategies, 33.0% indicated that the country has no policies and regulations to promote Tobacco harm reduction strategies, 26.0% indicated that such policies and regulations exist in the country. Figure 4 highlights responses on knowledge of Policies and regulation set to guide tobacco consumption and promoting tobacco harm reduction in the country.
Bodies or Institutions Set to Monitor and Regulate use and Consumption of Tobacco in Malawi
A total of 43.0% were not sure about the existence of institutions that were set to monitor and regulate the use and consumption of tobacco and its related products, while on the other hand 31.0% were not aware of such bodies and institutions in the country, 26.0% indicated to have heard or know about such institutions in the country.
The 26.0% of respondents who indicated to have knowledge of institution set to monitor the use and consumption of tobacco in the country were further asked to identify such institution of which, 7.0% indicated that they were not aware of such bodies, while 2.0% indicated the ministry of education, Save the Children Fund and Malawi Police Service, 5.0% indicated the ministry of health, while United Nations Children Fund (UNICEF) was identified by 3.0% of the respondents. The Malawi Bureau of Standards, Human Rights Groups, The Tobacco Control Commission, Rehabilitation Centers and the World Health Organization (WHO) was identified by 1.0% each. Table 6 below, highlights responses based on the boards set to monitor and regulate Tobacco use and Consumption in the country.
Government Efforts Towards Reducing Smoking as the Major Cause of Non-Communicable Diseases
A total of 39.0% were not so sure of what the government is doing to reduce smoking as the major cause of non-communicable disease, while 36.0% indicated that there was nothing that the government was doing to reducing smoking as the major cause of non-communicable diseases in the country. On the other hand, 25.0% indicated that the government is putting up efforts to reduce smoking as the major cause of non-communicable diseases.
Out of the 25.0% of the individuals who were positive on government’s efforts, 6.0% were unable to mention any of such efforts despite previously indicating to be sure of the efforts, 14.0% indicated that the government, through the ministry of health conducts awareness campaigns on hazards of smoking and encouraging people to quit through radio and television programs and in schools, while 2.0% indicated that the government conducts sensitization meetings and trainings with the communities on effects of smoking while also encouraging young people under the age of 18 not to smoke. On other-hand, another 2.0% of respondents indicated that the government uses adverts and stickers, and warning written on cigarettes packs indicting about the hazards of smoking to health.
On the other hand, out of 36.0% who indicated that the government is not putting effort in reducing smoking as major cause of non-communicable disease, 9.0% indicated lack of political will and commitment by government as one of the reasons the government was not putting up efforts, while the other 9.0% were not sure on why the government were not putting efforts; lack of resources by the government was indicated by 4.0% of respondents, while 2.0% of the respondents indicated that the government is focusing on reducing poverty and communicable diseases unlike causes of non-communicable diseases.
Furthermore, 7.0% of the respondents indicated that the government is not putting up efforts to reduce smoking as a cause non communicable diseases because it is the source of government’s revenue; while 3.0% of respondents were of the view that government left the role in the hands of tobacco companies citing the warnings on the cigarette packs; 2.0% indicated poor access of information as another reason behind lack of government efforts towards the cause. Table 7 below indicating responses based on respondent’s view of government efforts towards reducing smoking as the major cause of non-communicable diseases.
Respondents Perspective on Political will towards Tobacco Harm Reduction as a concept of Reducing Harms caused by Tobacco Smoking
The study revealed that 47.0% were of the view that there was no political willingness in the country, while 28.0% were not so sure, on the other hand, 25.0% indicated that the country was willing to reduce the harm being caused by tobacco smoking, Additionally, 80.0% of the respondents indicated to have no knowledge about the Framework Convention on Tobacco Control (FCTC) which Malawi is not a signatory, while 19.0% indicated to have knowledge of FCTC. Figure 5 below highlights the perception on political willingness of country towards Tobacco Harm Reduction.
A total of 66.0% of the respondents indicated that they perceive the non-adoption policy of controls highlighted by the FCTC as having a bearing on smoking prevalence in the country, 24.0% of the respondents were not sure, while 10.0% indicated that lack of control by FCTC has no bearing on smoking prevalence in the country.
On the other hand, 41.0% further revealed that the lack of controls by FCTC may have a negative impact on the promotion of Tobacco Harm Reduction products such as snus in the country, while 19.0% further indicated that lack of these control may not have a bearing on the promotion of Tobacco Harm Reduction products in the country as compared to 40.0% who were not sure. Figure 6 below highlight the responses on the impact of lacking control set by FCTC on smoking prevalence and on promoting on tobacco harm reduction products such as snus.
Out of the 41.0% who perceived that lack of controls set under FCTC has an impact on promotion of Tobacco Harm Reduction products such as snus in the country, 27.0% further perceived the impact as being negative towards the promotion of Tobacco Harm Reduction, while 14.0% perceived the impact as being positive towards the promotion of Tobacco Harm Reduction products in the country, 76.0% were of the opinion that that government should ratify to the FCTC, 18.0% were of the opinion that the country should not ratify, while 6.0% of the data was deemed invalid. Figure 7 below shows Impacts due to lack of FCTC controls and opinions towards ratification to FCTC.
Impact of Snus Availability on Cigarette Consumption and Entire Tobacco Industry
In the study, 67.0% were of the view that the availability of snus in the country will have a direct impact on the consumption of combustible cigarettes in the country, on the other hand 7.0% were of the view that, the availability of snus will not have a direct impact on consumption of snus, while 26.0% were not sure whether it will directly affect the consumption of cigarette in the country.
In addition to this, the study has further indicated that, 18.0% of the respondents were of the opinion that despite the fact that the availability of snus might affect the consumption of snus but it may not affect the entire tobacco industry, however, 44.0% of the respondents were of the view that the availability of snus in the country may also affect the entire tobacco industry citing a decline in cigarette demand which may also lead to reduced demand for tobacco, which may reduce government revenue and returns for the farmers, while 38.0% were not sure about the impact it may bring on the entire tobacco industry. Figure 8, highlights the impact of snus availability on Cigarette consumption and entire tobacco industry.
Projected Responses by cigarette Companies towards the Increased Availability and Accessibility of snus in the Country
In order to project the behavior by tobacco related companies towards snus availability and accessibility in the country, the study further conducted interviews of which out of the 100 respondents considered for the study, 42.0% were uncertain on the response by the tobacco related companies, while 30.0% and 15.0% were of the view that the companies will be aggressive and very aggressive respectively while 13.0% were of the opinion that the companies would be friendly.
Means of increasing Affordability
50.0% preferred that snus be sold at a lower price than the current cigarette price, 45.0% suggested that snus should be sold at a slightly lower price than current cigarette to facilitate affordability, 15.0% suggested it must be sold at the same price as the current cigarettes price, while 5.0% suggested that snus must be sold at a slightly higher price as compared to the current cigarette price, 1.0% of the respondents suggested other unspecified means.
Means of Increasing Snus Accessibility
74.0% were of the opinion that snus must be sold in both pharmacies, shops and places such as drinking joints, 32.0% suggested that snus should be made accessible at both wholesalers and retail shops, 19.0% of the respondents were of the view that snus should be sold alongside various cigarettes brands in various places, while 8.0% suggested that snus should be should be sold in pharmacies only for easy accessibility.
Means of Increasing Availability
60.0% suggested that government must accommodate Tobacco Harm reduction in its policies which will further facilitate the availability of snus and other THR products in the country, while 45.0% suggested that government must provide a conducive environment for local snus manufacturers and market protection from aggressive competitors, 26.0% suggested that snus must be fairly taxed below combustible cigarettes, while 16.0% further suggested that government must regulate the availability, accessibility and use/consumption of both Tobacco Harm Reduction products and combustible cigarettes.
On the other hand, 7.0% of the respondents suggested that snus must be highly taxed above combustible cigarettes, while 4.0% suggested that snus must be taxed equally with combustible cigarettes. Table 8 below, highlights the projected responses towards snus availability and means of increasing snus availability, accessibility and affordability in the country.
Attitudes Towards Snus as a Harm Reduction Product
88.0% perceived snus as good for health, while 6.0% perceived snus as not good for health, and 6.0% were found to without responses. Furthermore, 89.0% of the respondents said that they would recommend snus to individuals who are willing to quit combustible cigarette, while 11.0% were of the opinion that they would not recommend snus for individuals willing to quit smoking combustible cigarette. Figure 9 highlighting health perspective towards snus.
Health Risks Associated with Snus Use.
18.0% perceived snus as having some health risk that they may prevent them from recommending it to others, which include tuberculosis as indicated by 7.0% of the respondents out of 18.0%, while on the other hand, 31.0% indicated that they perceive snus as having no any health risk associated with it, on the other hand, 51.0% were not sure whether there is health risk associated with snus consumption. Additionally, 57.0% indicated that it was possible to reduce risk of harms to smokers who are unable to quit by using snus, while 34.0% were not sure, 9.0% indicated that it is possible to use snus as a mean of helping people to quit smoking. Figure 10, highlights opinion towards health risks associated with snus consumption.
Opinions Towards Reducing Harms through the use of Snus
64.0% were of the view that consumption of snus could be an opportunity for smokers to attain their full health potential by switching to snus as a harm reduction product, on the other hand, 1.0% of the respondents were of different opinion towards the assumption, while 29.0% were not sure if snus consumption is an opportunity for smokers to attain their health potential.
A total of 83.0% were of the view that government should recommend snus as a tobacco harm reduction product to be available and accessible by individuals, while 4.0% were of the view that government should not recommend snus in the country, on the other hand, 13.0% were found to be not so sure about whether snus should be recommended by the government or not. On rating, the study revealed that, 75.0% of the respondents rated snus as good for health, 21.0% were not sure, while 4.0% rated snus as bad for health. Table 9 below highlights general opinion towards snus usage.