Introduction
This chapter presents the main research findings from both qualitative and quantitative analysis of data collected from the respondents through questionnaire and key informants and the interpretation in-line with the analyzed information. The study aimed at assessing the benefits and challenges of adopting snus in Low-and-Middle income countries, with the main objective to assess factors that may affect the availability and accessibility of snus in Malawi.
The data presented in this chapter were collected, analyzed and were presented in frequency distribution such as tables and graphs in form of frequencies and percentages. The findings are presented separately with the discussion to avoid information overrode and easier understanding among readers.
Demographic data of the respondents
The demographic data were analyzed in each group of respondents. The data were generally based on gender of the respondents, age, marital status and level of education.
Demographics of respondents
The demographic data was analyzed and presented based on the age group, marital status, gender of the respondents and levels of education. Table 1 below shows the demographic information of the respondents who were interviewed in various districts where the study was being conducted. The study revealed that out of 100 respondents which were considered for the interview, 69.0% were males, while the remaining 30.0% comprised of females and 1.0 % were unwilling to disclose. 21.0% and 26.0% of the total of the respondents, were within the age range of 21-25 and 26-30 respectively. While 19.0% and 10.0% of the respondent were found to be within the age range of 31-35 and 36-40 respectively.
Furthermore, 9.0%, and 12.0% of the respondents were found to be within the age range of 15-20, and 41-50 with the least number of respondents found to be within the age range of 50 and above having registered 6.0% of the respondents. On the other hand, the highest percentage of the respondent were single, registering 48.0% of the total respondent followed by the 37.0% who were married, while 7.0% of the respondents revealed that they were either divorced or separated. While 1.0% were found to have been widowed.
In addition to the above demographics, the study further revealed that 31.0% of the respondents attended senior secondary school level, followed by 19.0% and 20.0% who had attended tertiary and junior secondary school levels respectively, as compared to 12.0% who revealed to have attended senior primary school with another 12.0% indicated to have attended primary school level, while 3.0% of the respondent were found to have not attained any level of education.
Demographics of key informants
On the other hand, the age 87.5% (14) of the key informants were within the age range of 25-30 while 6.25% were with the age ranges of 31-35 and 36-40. Additionally, 100% (16) of the key informants were found to have attained a college degree. This ensured their ability to provide responses on the topic based on proper analysis.
On the other hand, only 12.5% (2) of the key informants were found to be in tobacco sector under tobacco companies, while the majority 87.5% (14) were found to be players in other sectors such as public health, nursing, nutritionists, quality control, policy and economic analysts.
This ensures diversity in the information that was being collected to avoid bias and ensure that the information covers a wide section of key players in the public health, policy and tobacco sector of which all play a role in forming policies on regarding tobacco consumption in the country.
Table 1: Social and demographic information for the respondents and key informants
Variable
|
Frequency (n=100)
|
Percentage (%)
|
Gender
Male
Female
Unwilling to disclose
|
69
30
1
|
71.1
27.8
1.0
|
Age
|
|
|
15-20
|
9
|
9.3
|
21-25
|
20
|
20.6
|
26-30
|
26
|
26.8
|
31-35
|
17
|
17.5
|
36-40
|
10
|
10.3
|
41-45
|
6
|
6.2
|
46-50
|
3
|
3.1
|
50-above
|
6
|
6.2
|
Marital Status.
|
|
|
Divorced
|
7
|
7.2
|
Married
|
35
|
36.1
|
Separated
|
7
|
7.2
|
Single
|
47
|
48.5
|
Widowed
|
1
|
1.0
|
Level of Education
|
|
|
Junior Primary
|
12
|
12.4
|
Junior Secondary
|
20
|
20.6
|
None
|
3
|
3.1
|
Senior Primary
|
12
|
12.4
|
Senior Secondary
|
31
|
32.0
|
Tertiary
|
19
|
19.6
|
Key Informant Information
|
N=16
|
|
Gender
Male
Female
|
7
9
|
43.75
56.25
|
Age
25-30
31-35
36-40
|
14
1
1
|
87.5
6.25
6.25
|
Education Level
College
|
16
|
100
|
Smoking Experiences.
In order to establish smoking experiences and quitting attempts, respondents were directed towards a set of questions which aimed at examining their smoking experience; health general view on smoking; quitting attempts; quitting success rates and quitting techniques. In this view, the research established that, 81.0% of respondents smoked at least a cigarette for the past 6 months, which was contrary to the 19.0% of the respondents who revealed that they had not smoked a cigarette for the past 6 months. As shown in figure 2 below:
The study revealed varying opinions among combustible cigarette consumers towards general health perspective of which 55.0% of the respondents revealed that they consider smoking as bad for their health, as compared to the 32.0% who considered it as good for health, while the other 7.0% of the respondents were unsure as in whether smoking is good or bad to their health, followed by 6.0% of the respondents who preferred not to provide any opinion towards this perimeter, while on the other hand, 100% (16) of key informants interviewed, revealed to have considered smoking as bad for human health. Figure 3 below, shows respondents smoking experiences and general health perspective towards combustible cigarette smoking.
Quitting Attempts of Consumers of Combustible Cigerrettes.
In assessing the quitting attempts, 56.0% of the respondent, making up the majority indicated willingness to quit smoking combustible cigarettes, 29.0% of the respondents revealed that they were unwilling to quit smoking, , while 15.0% were not sure of their decision on whether to quit smoking or not. The study further revealed that 68.0% of the respoendents have attempted to quit smoking as compared to the 32.0% who never tempted to quit smoking at an given point. Figure 4 below shows respondents willingness to quit and quitting attempts respectively.
Information on Knowledge of Tobacco Harm Reduction and Snus as A Tobacco Harm Reduction Product
Information on knowledge about snus as a tobacco harm reduction was collected and analysed in a manner that provide the research with a clear picture of the context in accessing other factors that are more likely to affect the availability, accessibility and affordability of snus in the country, hence knowledge of snus among combustible cigerette consumers was also considered.
The study revealed that out of 100 respondents who were considered for the study 52.0% highlighted that they have ever heard of Tobacco Harm Reduction as compared to the 48.0% of those who indicated not to have ever heard of the concept.
Despite this being the case, only 36.0% of the respondents indicated to have heard of snus as a tobacco harm product, while the majority of 64.0% were found to have not heard about snus as a Tobacco harm reduction product or safer nicotine product. Figure 5 below, highlights respondents who have heard of the concept of Tobacco Harm Reduction and Snus as a Tobacco Harm Reduction Product.
On the otherhand, 93.3% (14) of the key informants revealed that they have heard of Tobacco Harm Reduction while 6.67% (1) indicated to have not heard of tobacco harm reduction. Furthermore, 80.0% (12) further highlighted that they have heard of snus as a safer nicotine product. Figure 6 below highlight the knowledge of snus and tobacco harm reduction among key informants.
Availability of Snus as a Tobacco Harm Reduction Product
On the availability of snus as a tobacco harm reduction product, the study has revealed that out of the 100 respondents who were interviewed, 42 respondents indicated that they 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, on the other hand, 30 of the respondents revealed that snus was not available on the markets as campared to the 28 who indicated that snus was available on the market.
On the otherhand, out of 16 key informants who were involved, 10 indicated that snus was not available in the country, while 4 were not sure, 2 of the key informant indicaed that snus was available in the country as higlighted in the figure 7 below:
Policies and Regulation Guiding Tobacco/ Cigerrette Consumption or Smoking, and promotion of Tobacco Harm Reduction in Malawi
In order to better understand the factors that could affect the availability and accessibility of snus in the country, the study went further to analyse the context by learning about the existing policies and regulation that guide the use and consumption of cigerrette and tobacco in the country.
Based on the interviews that were conducted, the study has revealed that 43.0% of the respondents indicated that they were not sure about about the exstence of any policy and regulation guiding the consumption of tobacco or cigerrete in the country, furthermore, 36.0% of the respondents indicated that there were no such policies in the country as compared to the 21.0% who indicated that the country has such policies and regulations.
On the other hand, 41.0% of the respondents also indicated that they were not sure if the country has any policies and regulations set to promote tobacco harm reduction in the country, while 33.0% of these respondents indicated that the country has no policies and regulations to promote Tobacco harm reduction, this was in contrary to the responses provided by 26.0% of the respondents who indicated that such policies and regulations exist in the country. Figure 8 highlights responses on knowledge of Policies and regulation set to guide tobacco consumption and promoting tobacco harm reduction in the country.
On the other hand, 12 key informants indicated that they were not sure if there were any laws, policies and regulations in the country to guide consumption of tobacco and Harm reduction products, while 3 key informants indicated that the country has such policies and regulations, highlighting, tobacco control policy, smoke free zones and prohibiting smoking in public places, while on the other hand, 1 key informant indicated that the country has no such policies and regulations, as highlighted in the figure 9 below:
Bodies or Institutions Set to Monitor and Regulate use and Consumption of Tobacco in Malawi
In order to learn about the bodies or Institutions set to monitor and regulate the use and consumption of Tobacco and tobacco products in Malawi, the research further conducted in depth interviews of which out of 100 interviews that were conducted, 43 indicated that they were not sure about the existence of anybody or institutions that were set to monitor and regulate the use and consumption of tobacco and its related products.
On the other hand, 31 of the respondents were not aware of such bodies and institutions in the country, while 26 respondents indicated to have heard or know about such institutions in the country, citing the tobacco control commission, World Health Organization, United Nations Children Fund, Ministry of Health, and Malawi Bureau of Standard.
On the other hand, out of the 16 key informants who were involved in the study, 14 indicated that there are no such policies, bodies and institutions in the country, while 2 indicated that such institution and bodies were present, citing the Ministry of Health, Ministry of Trade and the consumer association of Malawi. The results were summarized in the figure 10 below:
Government Efforts Towards Reducing Smoking as the Major Cause of Non-Communicable Diseases
The study further explored how individuals perceive government’s efforts towards reducing non-communicable diseases caused by smoking in the country, out of the 100 respondents interviewed on this particular parameter, 39 were found to be not so sure of what the government is doing to reduce smoking as the major cause of non-communicable disease.
Furthermore, 36 indicated that there was nothing that the government was doing to reducing smoking as the major cause of non-communicable diseases in the country, highlighting lack of political will and commitment, government focus on communicable diseases and poverty reduction, lack of funds and other resources, poor access to accurate information on the subject, tobacco industry as the major source of revenue for the government and also the role is solely left in hands of cigarette manufacturing companies as resource for deterring government efforts.
Furthermore, 25 indicated that the government is putting up efforts to reduce smoking as the major cause of non-communicable diseases, citing awareness and sensitization campaigns by health experts on dangers of smoking combustible cigarettes, advertisement policy indicating health warning of smoking to human health as some of the efforts being put in place by the government.
On the other hand, 10 of the key informants indicated that they were not sure of the government is putting up efforts to reduce smoking as the major cause of Non-communicable Infections, while 2 indicated that the government is not putting up efforts, while 4 of the key informants indicated that the government is putting up efforts highlighting campaigns by the ministry of health through the NCD’s section on dangers of tobacco smoking. Figure 11 below highlight the responses as revealed above.
Political willingness towards Tobacco Harm Reduction Reducing Harms.
In order to assess the political willingness of the country towards tobacco harm reduction as the means of reducing harms caused by smoking, 100 respondents were interviewed to get their perspective in order to understand the political landscape of the country towards tobacco harm reduction. The study revealed that 47 were of the view that there was no political willingness in the country, while 28 were found to be not so sure whether there was political willingness or not, on the other hand, 25 indicated that the country was willing to reduce the harm being caused by tobacco smoking.
On the other hand, out of the 16 key informants considered for the study, 11 (68.75%) indicated that there was no political willingness towards Tobacco Harm Reduction or address such related issues citing the inability of the government of Malawi to ratify to the Framework Convention on Tobacco Control (FCTC), while 5 (31.25%) of the key informants indicated that there was political willingness towards Tobacco Harm Reduction, as highlighted in 12 below:
Means of Increasing the Availability, Affordability and Accessibility of snus.
The respondents further provided feedbacks on way of increasing affordability of snus in the country of which 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 that for snus to be affordable , 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.
On the other hand, in order to ensure, accessibility of snus in the country, the study further reveals that, 74.0% of the respondent were of the opinion that snus must be sold in both pharmacies, shops and places such as drinking joints, while 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 and availability.
Furthermore, the study has revealed that in order to make snus available in the country, 60.0% of the respondents suggested that government must accommodate Tobacco Harm reduction in its policies which will further facilitate the availability of snus in the country, while 45.0% suggested that government must provide a conducive environment for local snus manufacturers and market protection from aggressive competitors. Furthermore, 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 2 below, highlights the projected responses towards snus availability and means of increasing snus availability, accessibility and affordability in the country.
Table 2:Projected Responses Towards Snus Availability and Means of Increasing Accessibility, Affordability and Availability
Variables
|
Frequency
|
Percentage
|
Increasing Snus Affordability
|
|
|
Be sold at a lower price than the current cigarette price.
|
50
|
50
|
Be sold at a slightly higher price than the current cigarette price
|
45
|
45
|
Be sold at the same price as the current cigarette price
|
15
|
15
|
Be sold at a higher price than the current cigarette price
|
6
|
6
|
Be sold slightly higher than the current cigarette price
|
5
|
5
|
Other means. (unspecified)
|
1
|
1
|
Increasing Snus Accessibility.
|
|
|
Be sold in both pharmacies, shops and other places
|
74
|
74
|
Be made accessible at wholesale and retail shops
|
32
|
32
|
Sold alongside tobacco cigarettes brands in various places
|
19
|
19
|
Be sold in pharmacies only
|
8
|
8
|
Increasing Snus Availability.
|
|
|
Government must accommodate Tobacco Harm Reduction in its policies
|
45
|
45
|
Government must provide a conducive environment for local snus manufactures and market protection against aggression
|
26
|
26
|
Snus must be fairly taxed below combustible cigarettes
|
60
|
60
|
Government must regulate the availability, accessibility and consumption of snus and combustible cigarettes
|
16
|
16
|
Snus must be highly taxed above combustible cigarettes
|
7
|
7
|
Snus must be taxed equally with combustible cigarettes
|
4
|
4
|
Attitudes Towards Snus as a Harm Reduction Product
The study has further revealed that, out of 100 respondents considered for the study, 88 perceived snus as good for health, while 6 were of the perspective that snus is not good for health, and 6 were found to without responses. Furthermore, out of 16 key informants, 10 were of the opinion that snus can help could help to reduces the risks to consumers since it is good for health, while 5 key informants were not sure, and 1 key informant indicated that snus would not reduce the risks. Figure 13 below highlighting respondents’ perspective towards snus.
Chapter summary
This chapter presented the findings obtained from the analysis done on the data collected. The findings were organized in line with the objectives of the study. Chapter five will dwell much on the discussion of the findings presented in this chapter.