Control of Tobacco Product (Amendment) Regulations 2018

CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018

A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR

NATIONAL CANCER SOCIETY MALAYSIA 2020 Published by National Cancer Society Malaysia 66 Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Wilayah Persekutuan Malaysia https://cancer.org.my/

Copyright © 2020 National Cancer Society Malaysia All rights reserved. Without limiting under copyright reserved above, no part of this publication may be reproduced, stored in, or introduced into a retrieval system or transmitted in any form by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written consent of the publisher. eISBN 978-967-11028-1-7

Printed in Kuala Lumpur, Malaysia

Editors: Dr Murallitharan M., Mandy Thoo

SUGGESTED CITATION: Murallitharan M., Mandy Thoo. Compliance of Eateries to Control of Tobacco Product (Amendment) Regulations 2018: A Cross Sectional Study in the Federal Territories of Kuala Lumpur, Putrajaya and the state of Selangor. Kuala Lumpur (Wilayah Persekutuan Kuala Lumpur): The National Cancer Society of Malaysia; 2018

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of The National Cancer Society of Malaysia concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by The National Cancer Society of Malaysia in preference to others of a similar nature that are not mentioned. The National Cancer Society of Malaysia does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The authors alone are responsible for the views expressed in this publication. Contents Page

Acknowledgements...... 1 Foreword from Director General of Health, Malaysia...... 2 Foreword from President, National Cancer Society Malaysia...... 3 About National Cancer Society Malaysia...... 5 Executive Summary...... 7-10 1.0 Introduction & Objectives...... 11-14 1.1 Introduction 1.2 Objectives 2.0 Study Methodology...... 15-25 2.1 Study Design 2.2 Study Area 2.3 Study Period 2.4 Study Population 2.5 Study Outcome 2.6 Sample and Sample Size 2.7 Sampling Technique 2.8 Inclusion and Exclusion Criteria 2.9 Data Collection Procedure 2.10 Research Instrument 2.11 Reliability and Validity 2.12 Ethical Approval 3.0 Results...... 26-108 3.1 The federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya 3.1.1 Time of observation carried out in all types of eateries 3.1.2 Compliance 3.1.3 Toxicity 3.1.4 Rubbish bin and cigarette butts around eateries 3.1.5 Point prevalence 3.2 Selangor 3.2.1 Time of observation carried out in all types of eateries 3.2.2 Compliance 3.2.3 Toxicity 3.2.4 Rubbish bin and cigarette butts around eateries 3.2.5 Point prevalence 3.3 The federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya, and the state of Selangor 3.3.1 Time of observation carried out in all types of eateries 3.3.2 Compliance 3.3.3 Toxicity 3.3.4 Rubbish bin and cigarette butts around eateries 3.3.5 Point prevalence

4.0 Discussion...... 109-116 5.0 Recommendations...... 117-121 5.0 Appendix...... 121-134 5.1 Case Report Form 5.2 Study variables and definitions 5.3 Classification of eateries 5.4 Training sessions and content 5.5 Observational area of number of cigarette butts 5.6 Definition of a cigarette butt 5.7 Members of the Study Team List of Tables

Table 01: The geographical stratification zones for federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya Table 02: The geographical stratification zones for Selangor Table 03: Time of observation carried out in all types of eateries in the Cheras zone (n=58) Table 04: Time of observation carried out in all types of eateries in the Kepong zone (n=47) Table 05: Time of observation carried out in all types of eateries in the Lembah Pantai zone (n=19) Table 06: Time of observation carried out in all types of eateries in the Putrajaya zone (n=3) Table 07: Time of observation carried out in all types of eateries in the Titiwangsa zone (n=46) Table 08: Time of observation carried out in all types of eateries in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya (n=173) Table 09: Compliance of eateries to four indicators in the Cheras zone (n= 58) Table 10: Compliance of eateries to four indicators in the Kepong zone (n= 47) Table 11: Compliance of eateries to four indicators in the Lembah Pantai zone (n=19) Table 12: Compliance of eateries to four indicators in the Putrajaya zone (n= 3) Table 13: Compliance of eateries to four indicators in the Titiwangsa zone (n= 46) Table 14: Compliance of eateries to four indicators in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya (n= 173) Table 15: Environmental toxicity of eateries observed in the Cheras zone (n=58) Table 16: Environmental toxicity of eateries observed in the Kepong zone (n=47) Table 17: Environmental toxicity of eateries observed in the Lembah Pantai zone (n=19) Table 18: Environmental toxicity of eateries observed in the Putrajaya zone (n=3) Table 19: Environmental toxicity of eateries observed in the Titiwangsa zone (n=46) Table 20: Environmental toxicity of eateries observed in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya (n=173) Table 21: Presence of rubbish bins and cigarette butts around the eateries in the Cheras zone (n=58) Table 22: Presence of rubbish bins and cigarette butts around the eatery in the Kepong zone (n=47) Table 23: Presence of rubbish bins and cigarette butts around the eatery in the Lembah Pantai zone (n=19) Table 24: Presence of rubbish bins and cigarette butts around the eatery in the Putrajaya zone (n=3) Table 25: Presence of rubbish bins and cigarette butts around the eatery in the Titiwangsa zone (n=46) Table 26: Presence of rubbish bins and cigarette butts around the eatery in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya (n=173) Table 27: Number of people actively smoking in eateries in the Cheras zone at the time of observation (n = 58) Table 28: Number of people actively smoking in eateries in the Kepong zone at the time of observation (n=47) Table 29: Number of people actively smoking in eateries in the Lembah Pantai zone at the time of observation (n=19) Table 30: Number of people actively smoking in eateries in the Putrajaya zone at the time of observation (n=3) Table 31: Number of people actively smoking in eateries in the Titiwangsa zone at the time of observation (n=46) Table 32: Number of people actively smoking in eateries in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya at the time of observation (n=173) Table 33: Time of observation carried out in all types of eateries in the Gombak district (n=56) Table 34: Time of observation carried out in all types of eateries in the Petaling district (n=50) Table 35: Time of observation carried out in all types of eateries in the Hulu Langat district (n=51) Table 36: Time of observation carried out in all types of eateries in the Hulu Selangor district (n=52) Table 37: Time of observation carried out in all types of eateries in the Kuala Langat district (n=33) Table 38: Time of observation carried out in all types of eateries in the state of Selangor (n=242) Table 39: Compliance of eateries to four indicators in the Gombak district (n= 56) Table 40: Compliance of eateries to four indicators in the Petaling district (n= 50) Table 41: Compliance of eateries to four indicators in the Hulu Langat district (n= 51) Table 42: Compliance of eateries to four indicators in the Hulu Selangor district (n= 52) Table 43: Compliance of eateries to four indicators in the Kuala Langat district (n= 33) Table 44: Compliance of eateries to four indicators in the state of Selangor (n= 242) Table 45: Environmental toxicity of eateries observed in the Gombak district (n=56) Table 46: Environmental toxicity of eateries observed in the Petaling district (n=50) Table 47: Environmental toxicity of eateries observed in the Hulu Langat district (n=51) Table 48: Environmental toxicity of eateries observed in the Hulu Selangor district (n=52) Table 49: Environmental toxicity of eateries observed in the Kuala Langat district (n=33) Table 50: Environmental toxicity of eateries observed in the state of Selangor (n=242) Table 51: Presence of rubbish bins and cigarette butts around the eatery in the Gombak district (n=56)

Table 52: Presence of rubbish bins and cigarette butts around the eatery in the Petaling district (n=50)

Table 53: Presence of rubbish bins and cigarette butts around the eatery in the Hulu Langat district (n=51)

Table 54: Presence of rubbish bins and cigarette butts around the eatery in the Hulu Selangor district (n=52)

Table 55: Presence of rubbish bins and cigarette butts around the eatery in the Kuala Langat district (n=33)

Table 56: Presence of rubbish bins and cigarette butts around the eatery in the state of Selangor (n=242)

Table 57: Number of people actively smoking in eateries in the Gombak district at the time of observation (n = 56) Table 58: Number of people actively smoking in eateries in the Petaling district at the time of observation (n = 50) Table 59: Number of people actively smoking in eateries in the Hulu Langat district at the time of observation (n = 51) Table 60: Number of people actively smoking in eateries in the Hulu Selangor district at the time of observation (n = 52) Table 61: Number of people actively smoking in eateries in the Kuala Langat district at the time of observation (n = 33) Table 62: Number of people actively smoking in eateries in the state of Selangor at the time of observation (n = 242)

Table 63: Time of observation carried out in all types of eateries in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya, and the state of Selangor (n=415). Table 64: Compliance of eateries to four indicators in the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor (n=415) Table 65: Environmental toxicity of eateries observed in the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor (n=415)

Table 66: Presence of rubbish bins and cigarette butts around the eateries in the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor (n=415) Table 67: Number of people actively smoking the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor (n=415) at the time of observation

List of Figures

Figure 01: Illustrates the time of observation carried out in all types of eateries in the federal territories of Kuala Lumpur and Putrajaya Figure 02: Illustrates the compliance compliance of eateries to four indicators in the federal territories of Kuala Lumpur and Putrajaya Figure 03: Illustrates the environmental toxicity of eateries observed in the federal territories of Kuala Lumpur and Putrajaya Figure 04: Illustrates the presence of rubbish bins and cigarette butts around the eateries in the federal territories of Kuala Lumpur and Putrajaya Figure 05: Illustrates the number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya at the time of observation Figure 06: Illustrates the number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya at the time of observation Figure 07: Illustrates the time of observation carried out in all types of eateries in state of Selangor Figure 08: Illustrates the compliance of eateries to four indicators in the state of Selangor Figure 09: Illustrates the environmental toxicity of eateries observed in the state of Selangor Figure 10: Illustrates the presence of rubbish bins and cigarette butts around the eateries in the state of Selangor Figure 11: Illustrates the number of people actively smoking in eateries in the state of Selangor at the time of observation Figure 12: Illustrates the number of people actively smoking in eateries in the state of Selangor at the time of observation. Figure 13: Illustrates the time of observation carried out in all types of eateries in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor Figure 14: Illustrates the compliance of eateries to four indicators in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor Figure 15: Illustrates the environmental toxicity of eateries observed in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor Figure 16: Illustrates the presence of rubbish bins and cigarette butts around the eateries in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor Figure 17: Illustrates the number of people actively smoking in eateries in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor the time of observation Figure 18: Illustrates the number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya and the state of Selangor at the time of observation. Authors and Editors

Dr Murallitharan M MURALLITHARAN M MD MCommHSc MSc PhD is the Medical Director of The National Cancer Society of Malaysia. He is a Public Health Physician and was a 2015/2016 Chevening Scholar at the London School of Economics and the London School of Hygiene and Tropical Medicine as well as an ASEAN Economic Community PhD Scholar at Chulalongkorn University Thailand. His research and capacity building efforts are centred around public health-related issues in non-communicable diseases especially cancer. In 2019, Dr Murallitharan was selected as one of the eight Union for International Cancer Control (UICC)'s Young Leaders.

Mandy Thoo MANDY THOO BBiotech MSc Science Communication is the current Head of Health Education, Literacy, Promotion, and Policy (HELPP) department at the National Cancer Society of Malaysia. Mandy trained in Biotechnology at the Australian National University and completed a Masters in Science Communications at the same university; before working as a science writer for various Australian research institutions. She was also a science columnist for The Star, Malaysia’s leading English daily. Mandy also leads the Society’s advocacy and policy work in non-communicable diseases, and is a scholar of the Global Tobacco Control postgraduate certificate program at the Johns Hopkins University Bloomberg School of Public Health.

Authors

Kenneth Low KENNETH LOW KIEN YONG BSc is an Assistant Manager of the Health Education, Literacy, Promotion, and Policy (HELPP) department at The National Cancer Society of Malaysia. Kenneth graduated with First Class Honours in Nutrition from University Malaysia Sabah and was a recipient of Anugerah Pelajaran DiRaja (Pingat Jaya Cemerlang), Malaysia’s highest undergraduate public university award. His work focuses on community education on cancer risk factors.

Choo Siew Li CHOO SIEW LI BSc (Hons) studied Food & Human Nutrition from Newcastle University in 2015. A UK registered voluntary nutritionist, her interest lies in the impact of food and nutrition in health. In the Health Education, Literacy, Promotion, and Policy department at The National Cancer Society of Malaysia she currently also provides nutrition counselling to people affected by cancer. She is also an active advocate of smoke-free environments and was recently selected to represent Malaysia for the 12th Asia Pacific Conference on Tobacco or Health (APACT).

Calvin C. Fernandez CALVIN C. FERNANDEZ B.Biomed is a Biomedical Science graduate from Monash University, Malaysia and is currently an Education Development Executive - Public Health at the National Cancer Society of Malaysia. He is mainly involved with developing health-related education content for the society as well as conducting comprehensive community outreach programmes to increase the rate of cancer health literacy among Malaysians.

Krystal Ng Lu Shin KRYSTAL NG LU SHIN BDiet MSc Clinical Nutrition currently serves as the dietitian of the National Cancer Society of Malaysia. After completing her Bachelor’s Degree at Universiti Sultan Zainal Abidin, her research in pursuant of her Master’s Degree at Universiti Putra Malaysia focused on the relationship between diet quality and health-related quality of life in breast cancer patients. Her expertise includes medical nutrition therapy for cancer patients and survivors. Authors

Shamenee Rajenthiran SHAMENEE RAJENTHIRAN is currently a Public Health-Education Development Executive at the National Cancer Society of Malaysia. She obtained a Bachelor’s Degree in Psychology at International Medical University. Shamenee is currently working on and is passionate about raising awareness on prevention and early detection of cancer. She also previously worked as a Special Education Teacher. Her major interests include public health and psycho-oncology.

Nadia Inez Junazli NADIA INEZ JUNAZLI BSc Pharm is an Assistant Manager of the Health Education, Literacy, Promotion, and Policy (HELPP) department at the National Cancer Society of Malaysia. She previously served as a lecturer in pharmacy education and currently advocates for the importance of cancer prevention and early detection to raise cancer awareness among Malaysians.

Layout & Design

Noor Syazani Md Noor NOOR SYAZANI MD NOOR Bsc Industrial Design is the Senior Creative Designer and Communications Executive at the National Cancer Society of Malaysia. She is responsible for conceptualising and developing the visual aspects of NCSM’s educational and promotional materials, including educational and promotional, as well to set the creative and design standards for the Society. The National Cancer Society of Malaysia would like to thank the following individuals and organisations for their participation, assistance, support and invaluable contributions in enabling us to undertake and complete this study as well as to publish this report.

• YBhg Tan Sri Dato’ Seri Dr Noor Hisham Abdullah, Director General of Health, Ministry of Health Malaysia, and his team including Dr Feroza binti Sulaiman

• YBhg Datuk Dr Chong Chee Keong, Deputy Director General of Health (Public Health), Ministry of Health Malaysia

• Datuk Dr Norhayati Rusli, Director of Disease Control Division, Ministry of Health Malaysia

• Dr Noraryana Hassan, Head of the FCTC Unit, Non-Communicable Disease Division, Ministry of Health Malaysia and her team including Dr Norliana Ismail, Dr Nazlinda Abu Jazid Javis and Dr Muhammad Hairul Nizam Abd Hamid

• Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur and Putrajaya, and Jabatan Kesihatan Negeri Selangor

• Professor Datuk Dr Lekhraj Rampal and the team at the Malaysian Council for Tobacco Control (MCTC) including Tn Haji Shaari and Tn Muhammad Sha’ani Abdullah

• NCD Malaysia and the Global NCD Alliance

• NCSM’s dedicated team of staff, volunteers and interns; both past and present who have worked hard alongside the study team to aid in data collection

• All of those who have supported or contributed to ensure the success of this study.

Thank you The study team

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 1

FOREWORD FROM DIRECTOR GENERAL OF HEALTH, MALAYSIA

One of the most crucial components of preventive healthcare is to reduce risk factors which are conditions or behaviours that increase the likelihood of individuals getting a disease. Reducing

the risk created by these factors is a critical task, which needs to be undertaken from all levels of society, i.e. from the highest level of government to individuals in each household.

The Ministry of Health, Malaysia has as its most tremendous responsibility to safeguard the health of all Malaysians. We remain committed through multiple strategies, including to reduce

the exposure of our citizens to various risk factors detrimental to health. Smoking and tobacco use have been proven to be one of the most significant modifiable risk factors in modern society

today for which the government is continually working towards reducing its effects on the population. The action to expand smoke-free areas to include all eateries under the Control of Tobacco Product (Amendment) Regulations 2018 is one of the efforts undertaken to protect our citizens from passive tobacco smoke as well as to denormalise smoking behaviour. This step aligns with our attentiveness as a signatory to the WHO Framework Convention on Tobacco

Control (FCTC).

Although the government has done its part to pass these regulations, sustained and complete adherence to them is highly dependent on the 'buy-in' and support from every stakeholder, especially the public. Compliance is integral to ensure that all public health measures will indeed be successful and achieve their intended outcome. This study by the National Cancer Society of Malaysia (NCSM) on compliance to the smoke-free regulations among eateries in Kuala

Lumpur, Putrajaya and the state of Selangor is a welcomed initiative from civil society organisations (CSOs) in building scientific evidence to support decision making. The Ministry of Health Malaysia thanks NCSM for taking up this task and commends all efforts for a 'whole-of-society' approach to improving the health of all Malaysians.

Tan Sri Dato' Seri Dr. Noor Hisham Bin Abdullah

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 2 Smoking remains one of the largest modifiable risk-factors for cancer. As an organisation dedicated towards fighting all aspects of cancer including in prevention, the National Cancer Society of Malaysia (NCSM) has been deeply involved with and continues to champion the cause of tobacco control. This is in line with one of NCSM’s most fundamental beliefs on reducing exposure to any form of risk factor that can cause cancer.

NCSM fully supports the Ministry of Health Malaysia and the government’s efforts to implement a wider area of ‘smoke-free’ environments as part of the country’s strategy towards reducing the usage of tobacco. This is very relevant especially as this in line with Malaysia’s commitment to the WHO’s Framework Convention on Tobacco Control (FCTC) which also requires implementing such policies. Creating ‘smoke-free’ environments are important for Malaysians at large as they help protect everyone from being exposed to second-hand and third-hand smoke; including smokers themselves. Any reduction of exposure in turn, lowers individuals’ risk of developing cancer; and this is especially more important with smoking now linked to more than thirteen different cancers.

Rather than just being a passive supporter of MOH’s efforts and watching from the side lines, NCSM has demonstrated its commitment to the cause of tobacco control wholeheartedly by taking on the responsibility of carrying out this important scientific study. The findings of this study will help to not only determine the true ‘on-the-ground’ conditions in terms of compliance to the extension of smoke-free regulations onto open-air eateries but also aid tremendously in policy-shaping and planning work towards improving implementation. Earlier in 2019, it was the preliminary results of the first phase of this study that was used by the Ministry of Health Malaysia to aid in its decision-making process; with these findings being the basis for, and subsequently quoted by Minister of Health, Malaysia (2018 to 2020) YB Datuk Seri Dr. Haji Dzulkefly Ahmad in justifying the extension of the ‘educational enforcement’ period till the end of December 31, 2019.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 3 We hope that this report will form an important part of the scientific evidence used to further enhance public health strategies in tobacco control. Through this and other strategies, we at NCSM hope to continue contributing, alongside all other stakeholders, in building a new narrative as the nation moves towards realising our vision of a ‘Smoke-Free Malaysia’.

Dr Saunthari Somasundaram President, National Cancer Society Malaysia

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 4 The National Cancer Society of Malaysia is the country’s oldest cancer control organisation. It was formed in 1996 by the country’s first oncologist, Datuk Dr S.K Dharmalingam under the patronage of then Prime Minister, YAB Tun Abdul Razak. The society today continues to be headquartered in the heart of Kuala Lumpur at 66 Jalan Raja Muda Abdul Aziz, Kuala Lumpur with branches in various states all over Malaysia. The National Cancer Society of Malaysia’s work today is centred on 3 main pillars which are Educate, Care and Support.

The Educate pillar is helmed largely via the Health Education, Literacy, Promotion and Policy (HELPP) Department, which works at multiple levels in different geographical localities all over the country. The HELPP team carries out health education and health promotion work in secondary schools, universities and colleges as well as within communities, providing them with materials and conducting awareness programmes on cancer and other non-communicable diseases (NCDs). The HELPP team also works in selected communities to increase their health literacy and improve their health behaviours as well as being actively engaged in oncology-related health systems research. NCSM also actively publishes health education material such as brochures, books, reports and digital media material which is free for use and disseminated to the public in multiple languages.

NCSM runs its Care activities largely through its Cancer Health Screening Clinic (CHSC) and Nuclear Medicine Clinic (NMC). Both clinics are physically based in the headquarters in Kuala Lumpur and provide subsidised or free health screening and diagnostic investigation tests to patients from all over Malaysia. In addition, CHSC is also actively involved in organising and running Community Health Screening programmes where it provides point-of-care testing within communities for various cancer screening and cancer preventive screening modalities. NCSM’s Support arm is materialised through its Resource Wellness Centre (RWC), Cancer Information System (CIS) and the Children’s Home of

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 5 Hope (CHH). The RWC is a centre offering psychosocial support and wellness activities for cancer survivors while the CIS is a toll-free national hotline for cancer information staffed by full-time health professionals. CHH is a half-way house for paediatric cancer patients from all over Malaysia receiving treatment in Malaysia’s largest paediatric oncology centre, the KL Women and Children’s Hospital.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 6 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 7 In 2018, the Malaysian Government amended the Control of Tobacco Product

Regulations (CTPR) 2004 to include all eateries, including open-air ones, as smoke-free areas.

This amendment (Control of Tobacco Product (Amendment) Regulations 2018) came into

effect on 1st of January, 2019. However, the Government decided to initially implement a

period of educational enforcement from 1st of January 2019 to 31st of December 2019, with the

aim of encouraging compliance over time.

This issue, which was of public health interest to stakeholders, including the

Government, civil society organisations, the food and beverage sector, and the general public,

included questions on whether the Control of Tobacco Product (Amendment)

Regulations 2018 was effective in enforcing compliance and in reducing the number of

people who smoke in these public areas. In addition, it was not yet determined if there

would be significant cigarette butt waste in areas surrounding eateries that were designated

smoke-free by the Control of Tobacco Product (Amendment) Regulations 2018.

The National Cancer Society of Malaysia (NCSM), working in collaboration with allied

organisations, thus undertook a study to answer these questions.

This cross-sectional study was carried out in 2 phases across the federal territories of

Kuala Lumpur, Putrajaya and the state of Selangor. In phase 1, trained members of the study

team used internationally validated measures to conduct observational visits in randomly

selected eateries specifically chosen from a list of eateries in Kuala Lumpur and Putrajaya

reported to a Ministry of Health complaints hotline for non-compliance. Phase 2 used similar

methodology to conduct observational visits but in this instance, for a sample that consisted

of all registered eateries in the state of Selangor.

two themes: structural and social compliance. Structural compliance was measured via two

indicators: (i) whether ‘No Smoking’ signs were clearly displayed, (ii) whether the eatery

provided ashtrays on its tables. Social compliance was also measured via two indicators: (iii)

whether there were people smoking in the eatery, and (iv) whether there were cigarette butts

within the eatery.

Of the 415 eateries observed, 340 eateries or 81.9% clearly displayed ‘No Smoking’

signs; 408 or 98.3% did not have ashtrays; 234 or 56.4% did not have people smoking within

the eatery, and 88 or 21.2% did not have cigarette butts within the eatery. The overall

compliance of eateries to the Control of Tobacco Product (Amendment) Regulations 2018

was determined to be 64.5%.

The study also found that in the area between 3 to 10 metres away from the eateries,

290 or 69.9% eateries had fewer than 50 cigarette butts; 60 or 14.4% eateries had between 50

to 100 cigarette butts; 65 or 15.7% had more than 100 cigarette butts. 93 or 22.4% of

the eateries had rubbish bins within a 3 to 10 metre radius, however 46 or 49.5% of the

rubbish bins had cigarette butts strewn around them.

672 individuals were found to be actively smoking among a total of 9,169 individuals

patronizing eateries during the observational visit, yielding a smoking point prevalence of

7.3%.

following recommendations:

While structural compliance in terms of clear display of ‘No Smoking’ signs and lack

of ashtrays on tables is adequate; social compliance needs to be improved with specific pro-

active action to be taken by non-smokers and eatery owners to speak up as well as

complementary punitive enforcement action by designated authorities.

The toxic waste from cigarette butts needs to be addressed via the placement of

specific bins to be placed within the 3 to 10 metre radius of an eatery. However placement of

the bins alone is inadequate; better enforcement of already in place no-littering regulations

needs to be an important complementary measure.

The government, civil society organisations and all stakeholders genuinely interested

in the promotion and protection of the health of all Malaysians should continue to support

this Control of Tobacco Product (Amendment) Regulations 2018 since it is a well-designed

policy which is being largely being complied to. Continued efforts to sustain and

improve the level of compliance requires cooperation and support of all levels of society,

working together.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 10 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 11 1.1 Introduction Passive smokers are non-smokers who inhale second-hand smoke which occurs when

there is tobacco smoke permeating an environment.1 Second hand smoke is a combination of

the smoke emitted from the burning end of a tobacco product and exhaled smoke from the

smoker; containing more than 6000 chemicals and is carcinogenic to humans.2 Exposure to

second-hand smoke has been significantly linked to an increased risk for various cancers

including lung, breast and cervical cancer.2,3,4,5 One of the key recommended measures of

public health protection has been the urgent need to reduce this passive exposure to tobacco

smoke.2

The World Health Organisation (WHO)’s Framework Convention on Tobacco

Control (FCTC), which came into force in 2005, is a treaty that obligates signatory nations to

implement a range of tobacco control measures designed to reduce the supply and demand of

the product.6 In 2008, WHO also made available the MPOWER technical assistance package;

a set of policies and interventions designed to be implemented by countries to assist them in

meeting their FCTC treaty commitments7. The ‘P’ in the MPOWER acronym stands for

‘protecting people from tobacco smoke’ and recommends countries to enact and enforce

legislation for smoke-free environments.7 Legislation has been demonstrated to be critical to

implementation of smoke-free environments, as self-regulation via voluntary policies have

proven to be largely ineffective.7 Research indicates that the introduction and enforcement of

smoke-free legislation, there is significant risk reduction in cancer rates amongst passive

smokers.8 In addition to protecting passive smokers from second-hand smoke, the creation of

smoke-free environments such as smoke-free public places and workplaces have been

showed to reduce consumption of tobacco by up to 4%.9

Malaysia is one of the signatories of the FCTC and ratified the treaty in 2005. The

country has made an active effort in tobacco control; and specifically introduced the Control

which the government aimed to regulate smoke-free environments.10 Amendments of the

CTPR in 2008 and 2010 prohibited smoking in various places such as hospitals or clinics,

public area or amenities such as lifts or toilets, air-conditioned restaurants or shops; public

vehicles or transport terminals; airports; government premises; educational institutions;

shopping, sports and religious complexes; and air-conditioned workplaces excluding casinos,

pubs and discotheques.11 In 2018, the government of Malaysia widened the smoke-free areas

under the legislation to include open-air eateries.12 The new regulations, which was the

widest such extension of smoke-free areas in Malaysia since the original regulations in 2004

came into force from the 1st of January 2019.12

Studies on the effectiveness of the implementation of smoke-free legislation have

been carried out in Malaysia previously in a range of public areas.13,14 However these studies

were carried out 5 and 8 years after the implementation of the 2004 smoke-free legislation

and did not specifically measure compliance to the legislation in a specific setting.

It is unclear on how good compliance is to the recently enforced smoke-free

legislation for open-air eateries in Malaysia as the legislation came into effect only from the

first day of this year and no peer reviewed studies assessing compliance is yet to be published.

This study aims to determine the compliance of eateries to the smoke-free legislation

as gazetted in the Control of Tobacco Product (Amendment) Regulations 2018 Malaysia, the

point prevalence of smokers within these surveyed eateries; and to determine the burden of

toxic cigarette butt waste in the areas allowed for smoking around these eateries in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor.

This study had three main objectives:

i) To determine the compliance of eateries to the smoke-free legislation as gazetted in the

Control of Tobacco Product (Amendment) Regulations 2018 Malaysia in the two federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor.

ii) To determine the burden of toxic cigarette butt waste in the areas allowed for smoking

around eateries as gazetted in the Control of Tobacco Product (Amendment) Regulations

2018 Malaysia in the two federal territories of Kuala Lumpur, Putrajaya and the state of

Selangor.

iii) To determine the point prevalence of smoking in and around eateries in the two federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor surveyed under the study for

the purpose of determination of compliance to the smoke-free legislation as gazetted in the

Control of Tobacco Product (Amendment) Regulations 2018 Malaysia.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 14 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 15 2.1 Study Design

This study was a cross-sectional study divided into two phases; with the first phase covering

the two federal territories of Kuala Lumpur and Putrajaya and the second phase covering the

state of Selangor.

2.2 Study Area

The study areas for this study were the two federal territories of Kuala Lumpur, Putrajaya and

the state of Selangor. The boundaries of these two federal territories and the state of Selangor

state were as defined according to the Atlas Kebangsaan Malaysia, the Malaysian

government’s official mapping survey15.

2.3 Study Period

This study was conducted in two phases as mentioned above:

Phase 1: federal territories of Kuala Lumpur and Putrajaya - conducted in a 4-month period

from April 2019 to July 2019

Phase 2: state of Selangor – conducted in a 4-month period from September 2019 to

December 2019

2.4 Study Population

The population of this study differed as per the two phases mentioned above:

Phase 1: Eateries located in the two federal territories of Kuala Lumpur and Putrajaya

reported to a Ministry of Health complaint hotline.

state of Selangor

2.5 Study Outcomes

The study had two sets of measurable outcomes according to the determined objectives as

adapted from the John Hopkins Bloomberg School of Public Health and International Union

Against Tuberculosis and Lung Disease guide on conducting compliance studies16.

The John Hopkins Bloomberg School of Public Health and International Union Against

Tuberculosis and Lung Disease guide on conducting compliance studies defined the

categories of compliance to the smoking ban as:

a) Presence of no smoking signage – whether the pictorial warning as determined by the

Ministry of Health, Malaysia was clearly displayed in the eatery

b) Absence of smoking aids such as ash trays in the eateries which is a proxy indicator on

whether smoking is permitted in the eatery

c) Absence of active smoking at the time of observation

d) Absence of cigarette butts as an indicator that no recent smoking had taken place

For the objective of determining the burden of toxic cigarette waste in the areas allowed for

smoking around eateries, cigarette butt counting in the determined area was the method used.

This was taken as the number of cigarette butts within a radius of three to 10 metres from the

end of the prohibited smoking zone of the eatery17.

the following definition was used as per the recommendation from the US Centres for

Disease Control (CDC) 18:

Number of current cases Population at the same Point prevalence (new and preexisting) at a specified point in time specified point in time – Denominator – Numerator

For this study, point prevalence was calculated as:

The number of people observed to be actively smoking within the eatery up to a radius

of three metres as defined by the Control of Tobacco Product (Amendment) Regulations

2018 (numerator)

The total number of people seated within the eatery up to a radius of three metres as defined

by the Control of Tobacco Product (Amendment) Regulations 2018 (denominator)

2.6 Sample and Sample Size

The various outcomes for the first objective were defined as qualitative binary outcomes. For

such outcomes with cross-sectional studies, the formula for calculation of sample size was

defined as: 19, 20

2 N= Z1- α/2 p(1-p )

Where N= desired sample size

- Z1- α/2 = the standard normal variate (at 5% type 1) error =1.96 p= expected proportion in population based on previous studies d= absolute error or precision- set at this study at 5% = 0.05

similar methodology yielding the following results: 21

i) % displaying signage – 89.5%, p = 0.895, N= 144

ii) % with no smoking aids – 88.3%, p=0.883, N=159

iii) % with no active smoking – 94.2%, p=0.942, N=84

iv) % with no cigarette butts – 95.3%, p=0.953, N= 69

The outcome for the second objective was defined as a quantitative numerical outcome.

However as the sampling unit for the study is in eateries and not in the mean number of

cigarette butts collected, the sample size was calculated using a similar formula as the one

above, defining the p as the proportion of eateries that had a mean of cigarette butts more

than one established in literature.

For the second set of outcomes, a previous study carried out for quantifying cigarette butts in

a high-waste area found that the mean of cigarette butts collected was determined to be 38.1

with a standard deviation of 18.8722.

A pilot study carried out by the study team found that the percentage of eateries (n=30)

having the mean number of cigarette butts more than 18.87 was 91.4%.

% having number of cigarette butts exceeding 18.87 – 91.4%, p=0.914, N = 121

In total, the largest single sample size for an outcome was determined to be 159. At this

sample size, it was estimated that all other outcomes could be assessed in an accurate fashion,

thus this sample size was deemed adequate to estimate the necessary population effects from

the study.

Thus the sample size determined for this study was a minimum of 159.

To ensure that each phase was reportable as its own study, the study team determined that the

sample size would be applied to each phase separately. Thus the study sampled a minimum

of 159 eateries separately for Phase 1 and Phase 2.

2.7 Sampling Technique

The sampling method for this study involved multi-stage sampling involving two different

types of sampling; namely stratified sampling strategy as well as simple random sampling

strategy. The detailed strategies carried out are as detailed below:

Phase 1: federal territories of Kuala Lumpur and Putrajaya

In stage 1, the stratified sample strategy was carried out for a population comprising

of non-compliant eateries provided by the Ministry of Health Malaysia. These eateries,

including names and addresses, were ones reported by the public to the Ministry of Health

Malaysia via a specific hotline. All eateries complained on starting from 1 January 2019 – the

first day on which the smoking ban came into effect – to 27 February 2019 were listed in

alphabetical order. Based on this list, eateries were stratified into five geographical zones as

geographical zone, which was then visited by members of the study team. From the minimal

sample size of 159, the eateries were sampled proportionately from each category. Following

an alphabetical arrangement of the eateries in each category, a randomized number generator

(available at www.random.org) was used to sample the eateries to make up a total number of

159. If the selected eatery was closed during the visit by the members of the study team,

another on the list was selected via random sampling.

Phase 2: State of Selangor

The sample population for this phase consisted of all registered eateries in the state of

Selangor. In order to obtain a sample, three stages of sampling were carried out. First, 5 out

of 9 districts in the state of Selangor were selected via simple random sampling, designed to

ensure that more than half of the districts making up the entire state of Selangor was sampled.

Eateries were subsequently stratified into geographical zones for each district as

detailed in Table 2. Then, a list was compiled of eateries registered with the Ministry of

Health Malaysia as per existing legal requirements under the Food Hygiene Regulations 2009

within each geographic zone. This list included the eateries’ names and addresses. Eateries

were subsequently stratified into five geographical zones as detailed in Table 2. Simple

random sampling was then used to choose the eateries in each geographical zone, which was

then visited by members of the study team. From the minimal sample size of 159, the eateries

were sampled proportionately from each category. Following an alphabetical arrangement of

the eateries in each category, a randomized number generator (available at www.random.org)

was used to sample the eateries to make up a total number of 159. If the selected eatery was

closed during the visit by the members of the study team, another on the list was selected via

random sampling.

2 Lembah Pantai 3 Titiwangsa 4 Kepong 5 Putrajaya

Table 1: The geographical stratification zones for federal territories of Kuala Lumpur and Putrajaya

Zone District Geographic zones 1 Gombak Melawati, Ukay Perdana, Ukay Heights, Sri Ukay, Ukay Bistari, Ulu Klang, Gombak, Taman Selayang, Selayang, Bandar Baru Selayang, Batu Caves, Rawang 2 Petaling Bandaraya Petaling, Bandaraya Subang Jaya, Damansara, Puchong, Seri Kembangan, Sungai Buloh 3 Kuala Langat Bandar Kuala Langat, Batu (Tg Sepat), Jugra, Kelanang, Morib, Tanjung Dua Belas, Teluk Panglima Garang 4 Hulu Langat Bandar Kajang, Bandar Ampang (Ampang Mewah, Bandar Baru Ampang), Hulu Semenyih, Semenyih, Beranang 5 Hulu Selangor Serendah, Batang Kali, Rasa, Ulu Yam, Kuala Kubu Bharu, Kerling, Kalumpang, Ulu Bernam

Table 2: The geographical stratification zones for Selangor

Inclusion criteria for Phase 1:

1. Eateries located within the two federal territories of Kuala Lumpur and Putrajaya

2. Eateries that were reported to the Ministry of Health complaint hotline

Inclusion criteria for Phase 2:

1. Eateries located within the state of Selangor

2. Eateries that were registered with the Ministry of Health as per exiting legal

requirements under the Food Hygiene Regulations 2009.

Exclusion criteria for Phase 1 and Phase 2

1. Multiple eateries located within a food court area/complex

2. Eateries located in higher floors of buildings

3. Eateries that had been closed down permanently during the time of the observation

visit

4. Eateries that were closed at the time of the observation visit

2.9 Data Collection Procedure

For each eatery included in the study, data collection was conducted by two personnel who

acted as data collectors. Prior to the data collection, all members of the study team were

trained on:

1. Assessing the site and determining the distance for data collection

2. Recognising cigarette butts

3. Understanding and adhering to the safety procedures during data collection, such as

the use of gloves and surgical masks

conducted the data collection, and filled in the Case Report form. The data was then compiled

by other specific members of the study team for validation.

2.10 Research Instrument

The primary data collection method for this study was on-site observation by trained

investigators; with the observations being recorded in a Case Report Form. The case report

form was modified from the Johns Hopkins Bloomberg School of Public Health, the

International Union against Tuberculosis and Lung Disease, and Kumar et. al. to capture the

outcomes for this study17, 23.

The case report form consisted of 23 questions in total, including questions that were

not required based on a previous answer. This was separated into 8 different sections to

capture the variable required to measure the outcomes as detailed in the Appendix.

2.11 Reliability and Validity

The validity of the instrument is high as it was specifically designed for this purpose

and tested in multiple settings including previously conducted studies carried out by the

Johns Hopkins Bloomberg School of Public Health, the International Union against

Tuberculosis and Lung Disease, and Kumar et. al.17,23

Reliability measures put in place for this study included the use of two investigators

being deployed to each site, and having the observation, data collection, as well as case report

form entry for the same eatery carried out by each investigator separately. Other members of

the study team then assessed the different data sets to determine discrepancies. Any

discrepancies were resolved through discussions with the investigators to reach a consensus.

This study received ethical approval from the Malaysian Research Ethics Committee

(MREC) and was registered in the National Medical Research Register (NMRR). The registration number for the study was NMRR-19-1160-47813.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 25 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 26 Kuala Lumpur and Putrajaya

Table 3 details the time of observation carried out in all types of eateries in the Cheras zone

(n=58).

Table 3: Time of observation carried out in all types of eateries in the Cheras zone (n=58)

A total of 58 eateries were observed in the Cheras zone. In total, 60.3% (n=35) were

observed in the morning/noon, 34.5% (n=20) were observed in the afternoon/night, and 5.2%

(n=3) were observed at late night.

Among the 6 air-conditioned eateries placed in a permanent structure, 66.7% (n=4) were

observed in the morning/noon, 16.7% (n=1) were observed in the afternoon/night while the

remaining 16.7% (n=1) were observed at late night. As for the 50 non-air-conditioned

eateries placed in a permanent structure, 60% (n=30) were observed in the morning/noon, 36%

(n = 18) were observed in the afternoon/night and the remaining 4% (n=2) were observed at

late night. For the 2 non-air-conditioned eateries placed in a non-permanent structure, 50% (n

= 1) were observed in the morning/noon while 50% (n = 1) of the observations were observed

in the afternoon/night.

(n=47).

Table 4: Time of observation carried out in all types of eateries in the Kepong zone (n=47)

A total of 47 eateries were observed in the Kepong zone. In total, 53.2% (n=25) were

observed in the morning/noon, 36.2% (n=17) were observed in the afternoon/night, and 10.6%

(n=5) were observed at late night.

Among the 3 air-conditioned eateries placed in a permanent structure, 66.7% (n=2) were

observed in the morning/noon while 33.3% (n=1) were observed in the afternoon/night. As

for the 41 non-air-conditioned eateries placed in a permanent structure, 53.7% (n=22) were

observed in the morning/noon, 34.1% (n=14) were observed in the afternoon/night, and 12.2%

(n=5) were observed at late night. For the 3 non-air-conditioned eateries placed in a non-

permanent structure, 33.3% (n = 1) were observed in the morning/noon while 66.7% (n= 5)

were observed in the afternoon/night.

Pantai zone (n=19).

Table 5: Time of observation carried out in all types of eateries in the Lembah Pantai zone

(n=19)

A total of 19 eateries were observed in the Lembah Pantai zone. In total, 73.7% (n=14) were

observed in the morning/noon and 26.3% (n=5) were observed in the afternoon/night. Among

the 19 air-conditioned eateries placed in a permanent structure, 100% (n=5) were observed in

the morning/noon. As for the 14 non-air-conditioned eateries placed in a permanent structure,

64.3% (n=9) were observed in the morning/noon while 35.7% (n=5) were observed in the

afternoon/night.

zone (n=3).

Table 6: Time of observation carried out in all types of eateries in the Putrajaya zone (n=3)

A total of three eateries were observed in the Putrajaya zone. 100% (n=3) were observed in

the afternoon/night. All of the observations were conducted in non-air-conditioned eateries

placed in a permanent structure.

zone (n=46).

Table 7: Time of observation carried out in all types of eateries in the Titiwangsa zone (n=46)

A total of 46 eateries were observed in the Titiwangsa zone. In total, 41.3% (n=19) were

observed in the morning/noon and 58.7% (n=27) were observed in the afternoon/night.

Among air-conditioned eateries placed in a permanent structure, 50% (n=3) were observed in

the morning/noon, and the remaining 50% (n=3) were observed in the afternoon/night. For

observation among the non-air-conditioned eateries placed in a permanent structure, 41.7%

(n=15) were observed in the morning/noon while 58.3% (n=21) were observed in the

afternoon/night. For non-air-conditioned eateries placed in a non-permanent structure, 25%

(n=1) were observed in the morning/noon and the remaining 75% (n=3) were observed in the

afternoon/night.

territories of Kuala Lumpur and Putrajaya (n=173).

Table 8: Time of observation carried out in all types of eateries in the federal territories of

Kuala Lumpur and Putrajaya (n=173)

Time of observation carried out in all types of eateries in the federal territories of Kuala Lumpur and Putrajaya

100 Permanent Structure (Air- 90 conditioned) 80 Permanent Structure (Non-air- 70 conditioned) 60 Non-permanent Structure (Non-air- 50 structured)

Frequency 40 30 All structures 20 10 0 Morning/Noon Afternoon/Night Late Night Time of the Day

Figure 1: Illustrates the time of observation carried out in all types of eateries in the federal

territories of Kuala Lumpur and Putrajaya

Putrajaya. In total, 53.8% (n=93) were observed in the morning/noon, 41.6% (n=72) were

observed in the afternoon/night and 4.6% (n=8) were observed at late night.

Among air-conditioned eateries placed in a permanent structure, 70% (n=14) were observed

in the morning/noon, 25% (n=5) were observed in the afternoon/night and 5% (n=1) were

observed at late night. For non-air-conditioned eateries placed in a permanent structure, 52.8%

(n=76) were observed in the morning/noon, 42.4% (n=61) were observed in the

afternoon/night while 4.9% (n=7) were observed at late night. As for non-air-conditioned

eateries placed in a non-permanent structure, 33.33% (n=3) were observed in the

morning/noon and 66.7% (n=6) were observed in the afternoon/night.

Table 9: Compliance of eateries to four indicators in the Cheras zone (n= 58)

A total of 58 eateries were observed in the Cheras zone. In total, 74.1% (n=43) eateries

clearly displayed ‘No Smoking’ sign, 98.3% (n=57) eateries did not have ashtrays, 62.1%

(n=36) of the eateries did not have anyone smoking at the time of observation and 15.5%

(n=9) of the eateries were absent of cigarette butts within the eatery at the time of observation.

Based on the findings, the criteria that had the highest rate of compliance in the Cheras zone

was the absence of ashtrays in the eateries (98.3%), followed by the clear display of ‘No

Smoking’ signs (74.1%), and the absence of people smoking in the eatery (62.1%). The

criteria with the lowest compliance was the absence of cigarette butts within the eateries

(15.5%).

Table 10: Compliance of eateries to four indicators in the Kepong zone (n= 47)

A total of 47 eateries were observed in the Kepong zone. In total, 83% (n=39) eateries clearly

displayed ‘No Smoking” sign, 100% (n=47) eateries did not have ashtrays, 55.3% (n=26) of

the eateries did not have anyone smoking at the time of observation and 23.4% (n=11) of the

eateries were absent of cigarette butts within the eatery at the time of observation.

Based on the findings, the criteria that had the highest compliance in the Kepong zone was

the absence of ashtrays in the eateries (100%), followed by the clear display of ‘No Smoking’

signs (83.0%), and the absence of people smoking in the eatery (55.3%). The criteria with the

lowest compliance was the absence of cigarette butts within the eateries (23.4%).

zone (n=19).

Table 11: Compliance of eateries to four indicators in the Lembah Pantai zone (n=19)

A total of 19 eateries were observed in the Lembah Pantai zone. In total, 84.2% (n=16)

eateries clearly displayed ‘No Smoking’ signs, 100% (n=19) eateries did not have ashtrays,

57.9% (n=11) of the eateries did not have anyone smoking at the time of observation and

21.1% (n=4) of the eateries were absent of cigarette butts within the eatery at the time of

observation.

Based on the findings, the criteria that had the highest compliance in the Lembah Pantai

zone was the absence of ashtrays in the eateries (100%), followed by the clear display of ‘No

Smoking’ signs (84.2%), and the absence of people smoking in the eatery (57.9%). The

criteria with the lowest compliance was the absence of cigarette butts within the eateries

(21.1%).

(n=3).

Table 12: Compliance of eateries to four indicators in the Putrajaya zone (n= 3)

A total of three eateries were observed in the Putrajaya zone. In total, 66.7% (n=2) eateries

clearly displayed ‘No Smoking’ sign, 100% (n=3) eateries did not have ashtrays, 66.7% (n=2)

of the eateries did not have anyone smoking at the time of observation and 0% (n=0) of the

eateries were absent of cigarette butts within the eatery at the time of observation.

Based on the findings, the criteria that had the highest compliance in the Putrajaya zone was

the absence of ashtray in the eateries (100%), followed by the clear display of ‘No Smoking’

signs (66.7%), and the absence of people smoking in the eatery (66.7%). The criteria with the

lowest compliance was the absence of cigarette butts within the eateries (0%).

Table 13: Compliance of eateries to four indicators in the Titiwangsa zone (n= 46)

In the Titiwangsa zone, a total of 46 eateries were observed. In total, 67.4% (n=31) eateries

clearly displayed ‘No Smoking’ sign, 95.7% (n=44) eateries did not have ashtrays, 63%

(n=29) of the eateries did not have anyone smoking at the time of observation and 13% (n=6)

of the eateries were absent of cigarette butts within the eatery at the time of observation.

The criteria that shows the highest compliance is the Titiwangsa zone was the absence of

ashtrays in the eatery (95.7%), followed by the clear display of ‘No Smoking’ signs (67.4%),

and the absence of people smoking in the eatery (63.0%). The criteria with the lowest

compliance was the absence of cigarette butts within the eateries (13.0%).

Kuala Lumpur and Putrajaya (n=173).

Table 14: Compliance of eateries to four indicators in the federal territories of Kuala Lumpur

and Putrajaya (n= 173)

Note: Average compliance (%) = 62.85

100.0 80.0 Permanent Structure (Air- conditioned) 60.0 Permanent Structure (Non-air- 40.0 conditioned) Percentage% 20.0 Non-permanent Structure (Non-air- 0.0 conditioned) Display of 'No Absence of Absence of Absence of Smoking' signs ashtrays people smoking cigarette butts in the eatery within the eatery Compliance Indicators

Figure 2: Illustrates the compliance of eateries to four indicators in the federal territories of

Kuala Lumpur and Putrajaya

Overall, 173 eateries were observed in the federal territories of Kuala Lumpur and

Putrajaya. The overall compliance to the smoke-free law was 62.85%.

In total, 75.7% (n=131) eateries clearly displayed ‘No Smoking’ signs, 98.3% (n=170)

eateries did not have ashtrays, 60.1% (n=104) of the eateries did not have anyone smoking at

the time of observation and 17.3% (n=30) of the eateries were absent of cigarette butts within

the eatery at the time of observation.

Based on the findings, the criteria that has the highest compliance in the federal territories of

Kuala Lumpur, Putrajaya was the absence of ashtrays (98.3%), followed by the clear

display of ‘No Smoking’ signs (75.5%), and the absence of people smoking (60.1%). The

criteria with the lowest compliance was the absence of cigarette butts within the eatery

(17.3%).

(n=58).

Table 15: Environmental toxicity of eateries observed in the Cheras zone (n=58)

Among the 58 eateries observed in the Cheras zone, within 3 to 10 metres of the eatery: 20.7%

(n=12) had 0-49 cigarette butts, 34.5% (n=20) had 50-99 cigarette butts, 22.4% (n=13) had

100-199 cigarette butts, and 22.4% (n=13) had more than 200 cigarette butts.

(n=47).

Table 16: Environmental toxicity of eateries observed in the Kepong zone (n=47)

Among the 47 eateries observed in the Kepong zone, within 3 to 10 metres of the eatery:

68.1% (n=32) of the eateries had 0-49 cigarette butts, 23.4% (n=11) had 50-99 cigarette butts,

8.5% (n=4) had 100-199 cigarette butts and 0% of the eateries had more than 200 cigarette

butts.

zone (n=19).

Table 17: Environmental toxicity of eateries observed in the Lembah Pantai zone (n=19)

Among the 19 eateries observed in the Lembah Pantai zone, within 3 to 10 metres of the

eatery: 73.7% (n=14) of the eateries had 0-49 cigarette butts, 15.8% (n=3) had 50-99 cigarette

butts, 10.5% (n=2) had 100-199 cigarette butts and none of the eateries had more than 200

cigarette butts.

(n=3).

Table 18: Environmental toxicity of eateries observed in the Putrajaya zone (n=3)

Among the 3 eateries observed in the Putrajaya zone, within 3 to 10 metres of the eatery:

33.3% (n=1) of the eateries had 100-199 cigarette butts and 66.7% had more than 200

cigarette butts.

zone (n=46).

Table 19: Environmental toxicity of eateries observed in the Titiwangsa zone (n=46)

Among the 46 eateries observed in the Titiwangsa zone, within 3 to 10 metres of the eatery:

67.4% (n=31) of the eateries had 0-49 cigarette butts, 19.6% (n=9) had 50-99 cigarette butts,

10.9% (n=5) had 100-199 cigarette butts and 2.2% (n=1) had more than 200 cigarette butts.

territories of Kuala Lumpur and Putrajaya (n=173).

Table 20: Environmental toxicity of eateries observed in the federal territories of Kuala

Lumpur and Putrajaya (n=173)

Environmental toxicity of eateries observed in the federal territories of Kuala Lumpur and Putrajaya 120

100

80 Permanent Structure (Air- conditioned)

60 Permanent Structure (Non-air- conditioned)

Frequency Non-permanent Structure (Non-air- 40 conditioned) All structures

0 0-49 50-99 100-199 >200 Number of cigarette butts within 3 to 10 metres

Figure 3: Illustrates the environmental toxicity of eateries observed in the federal territories

of Kuala Lumpur and Putrajaya

within 3 to 10 metres of the eatery: 63.0% (n=109) of the eateries had 0-49 cigarette butts,

20.8% (n=36) had 50-99 cigarette butts, 11.0% (n=19) had 100-199 cigarette butts and 5.2%

(n=9) had more than 200 cigarette butts.

Table 21 below details the presence of rubbish bins and cigarette butts around the eateries in

the Cheras zone (n=58).

Table 21: Presence of rubbish bins and cigarette butts around the eateries in the Cheras zone

(n=58)

A total of 58 eateries were observed in the Cheras zone. In total, 25.9% (n=15) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 15 rubbish bins, 40%

(n=6) were found to have cigarette butts around them.

the Kepong zone (n=47).

Table 22: Presence of rubbish bins and cigarette butts around the eatery in the Kepong zone

(n=47)

A total of 47 eateries were observed in the Kepong zone. In total, 19.1% (n=9) of the eateries

were found to have rubbish bins 3 to 10 metres away. Out of the 9 rubbish bins, 11.1% (n=1)

were found to have cigarette butts around them.

the Lembah Pantai zone (n=19).

Table 23: Presence of rubbish bins and cigarette butts around the eatery in the Lembah Pantai

zone (n=19)

A total of 19 eateries were observed in the Lembah Pantai zone. In total, 36.8% (n=7) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 4 rubbish bins, 57.1%

(n=4) were found to have cigarette butts around them.

the Putrajaya zone (n=3).

Table 24: Presence of rubbish bins and cigarette butts around the eatery in the Putrajaya zone

(n=3)

A total of 3 eateries were observed in the Putrajaya zone. In total, 66.7% (n=2) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 2 rubbish bins, 100%

(n=2) were found to have cigarette butts around them.

the Titiwangsa zone (n=46).

Table 25: Presence of rubbish bins and cigarette butts around the eatery in the Titiwangsa

zone (n=46)

A total of 46 eateries were observed in the Titiwangsa zone. In total, 39.1% (n=18) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 13 rubbish bins,

72.2% (n=13) were found to have cigarette butts around them.

the federal territories of Kuala Lumpur and Putrajaya (n=173)

Table 26: Presence of rubbish bins and cigarette butts around the eatery in the federal

territories of Kuala Lumpur and Putrajaya (n=173)

Compliance of eateries to four indicators in the federal territories of Kuala Lumpur and Putrajaya 120.0

100.0 80.0 60.0 Permanent Structure (Air- conditioned) 40.0

Percentage% Permanent Structure (Non-air- 20.0 conditioned) 0.0 Non-permanent Structure (Non-air- Display of 'No Absence of Absence of Absence of conditioned) Smoking' signs ashtrays people cigarette butts smoking in the within the eatery eatery Compliance Indicators

Figure 4: Illustrates the presence of rubbish bins and cigarette butts around the eateries in the

federal territories of Kuala Lumpur and Putrajaya

Putrajaya. In total, 29.5% (n=51) of the eateries were found to have rubbish bins 3 to 10

metres away. Out of the 51 rubbish bins, 51.0% (n=26) were found to have cigarette butts

around them.

Table 27 below details the number of people actively smoking in eateries in the Cheras zone

at the time of observation (n=58).

Table 27: Number of people actively smoking in eateries in the Cheras zone at the time of

observation (n = 58)

Among the 1,379 people present in eateries in the Cheras zone at the time of observation, 50

individuals (3.6%) were actively smoking. In air-conditioned eateries placed in a permanent

structure, 2 (0.6%) out of 343 individuals were actively smoking. In non-air-conditioned

eateries placed in a permanent structure, 48 (4.7%) out of 1,025 individuals were actively

smoking. In non-air-conditioned eateries placed in a non-permanent structure, 0 (0%) out of

11 individuals were actively smoking.

at the time of observation (n=47).

Table 28: Number of people actively smoking in eateries in the Kepong zone at the time of

observation (n=47)

Among the 1,006 people present in eateries in the Kepong zone at the time of observation, 45

individuals (4.5%) were actively smoking. In air-conditioned eateries placed in a permanent

structure, 3 (9.1%) out of 33 individuals were actively smoking. In non-air-conditioned

eateries placed in a permanent structure, 40 (4.4%) out of 917 individuals were actively

smoking. In non-air-conditioned eateries placed in a non-permanent structure, 2 (3.6%) out of

56 individuals were actively smoking.

Pantai zone at the time of observation (n=19).

Table 29: Number of people actively smoking in eateries in the Lembah Pantai zone at the

time of observation (n=19)

Among the 436 people present in eateries in the Lembah Pantai zone at the time of

observation, 44 individuals (10.1%) were actively smoking. In air-conditioned eateries placed

in a permanent structure, 2 (1.9%) out of 108 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 42 (12.8%) out of 328 individuals were

actively smoking.

zone at the time of observation (n=3).

Table 30: Number of people actively smoking in eateries in the Putrajaya zone at the time of

observation (n=3)

Among the 73 people present in non-air-conditioned eateries placed in a permanent structure

in the Putrajaya zone at the time of observation, 3 individuals (4.1%) were actively smoking.

zone at the time of observation (n=46).

Table 31: Number of people actively smoking in eateries in the Titiwangsa zone at the time

of observation (n=46)

Among the 792 people present in eateries in the Titiwangsa zone at the time of observation,

51 individuals (6.4%) were actively smoking. In air-conditioned eateries placed in a

permanent structure, 15 (14.3%) out of 105 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 36 (5.4%) out of 664 individuals were

actively smoking. In non-air-conditioned eateries placed in a non-permanent structure, 0 (0%)

out of 23 individuals were actively smoking.

territories of Kuala Lumpur and Putrajaya at the time of observation (n=173).

Table 32: Number of people actively smoking in eateries in the federal territories of Kuala

Lumpur and Putrajaya at the time of observation (n=173)

Number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya at the time of observation 4000

3500

3000

Permanent Structure (Air- 2500 conditioned) Permanent Structure (Non-air- 2000 conditioned)

Frequency Non-permanent Structure (Non-air- 1500 conditioned) All structures 1000

500

0 Number of occupants during Number of people smoking observation visit

Figure 5: Illustrates the number of people actively smoking in eateries in the federal

territories of Kuala Lumpur and Putrajaya at the time of observation

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 61 Number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya at the time of observation 6

4 Permanent Structure (Air- 3 conditioned) Permanent Structure (Non-air- 2 conditioned) Point PrevalencePoint (%) 1 Non-permanent Structure (Non- air-conditioned) 0 Permanent Structure Permanent Structure Non-permanent (Air-conditioned) (Non-air-conditioned) Structure (Non-air- conditioned) Types of Eateries

Figure 6: Illustrates the number of people actively smoking in eateries in the federal

territories of Kuala Lumpur and Putrajaya at the time of observation

Among the 3,686 people present in eateries in the federal territories of Kuala Lumpur and

Putrajaya at the time of observation, 193 individuals (5.2%) were actively smoking.

In air-conditioned eateries placed in a permanent structure, 22 (0.6%) out of 589 individuals

were actively smoking. In non-air-conditioned eateries placed in a permanent structure, 169

(5.6%) out of 3007 individuals were actively smoking. In non-air-conditioned eateries placed

in a non-permanent structure, 2 (2.2%) out of 90 individuals were actively smoking.

Time of observation carried out in all types of eateries

Table 33 states the time of observation carried out in all types of eateries in the Gombak

district (n=56).

Table 33: Time of observation carried out in all types of eateries in the Gombak district

(n=56)

A total of 56 eateries were observed in the Gombak district. In total, 30.4% (n=17) were

observed in the morning/noon, 32.1% (n=32.1) were observed in the afternoon/night, and

37.5% (n=21) were observed at late night. Among 7 air-conditioned eateries placed in a

permanent structure, 42.9% (n=3) were observed in the morning/noon while 57.1% (n=4)

were observed in the afternoon/night. As for non-air-conditioned eateries placed in a

permanent structure, 30.4% (n=14) were observed in the morning/noon, 28.3% (n=13) were

observed in the afternoon/night and 41.3% (n=19) were observed at late night. For non-air-

conditioned eateries placed in a non-permanent structure, 33.3% (n=1) were observed in the

afternoon/night while the remaining 66.7% (n=2) were observed at late night.

district (n=50).

Table 34: Time of observation carried out in all types of eateries in the Petaling district (n=50)

A total of 50 eateries were observed in the Petaling district. In total, 36% (n=18) were

observed in the morning/noon, 32% (n=16) were observed in the afternoon/night, and 32%

(n=16) were observed at late night. Among air-conditioned eateries placed in a permanent

structure, 32.0% (n=8) were observed in the morning/noon, 48.0% (n=12) were observed in

the afternoon/night while 20.0% (n=5) were observed at late night. As for non-air-

conditioned eateries placed in a permanent structure, 37.5% (n=9) were observed in the

morning/noon, 16.7% (n=4) were observed in the afternoon/night and 45.8% (n=11) were

observed at late night. For non-air-conditioned eateries placed in a non-permanent structure,

100% (n=1) were observed in the morning/noon.

district (n=51).

Table 35: Time of observation carried out in all types of eateries in the Hulu Langat district

(n=51)

A total of 51 eateries were observed in the Hulu Langat district. In total, 37.3% (n=19) were

observed in the morning/noon, 27.5% (n=14) were observed in the afternoon/night, and 35.3%

(n=18) were observed at late night. Among air-conditioned eateries placed in a permanent

structure, 50% (n=3) were observed in the morning/noon and 50% (n=3) were observed in the

afternoon/night. For non-air-conditioned eateries placed in a permanent structure, 37.5%

(n=15) were observed in the morning/noon, 25% (n=10) were observed in the afternoon/night

and 37.5% (n=15) were observed at late night. In non-air-conditioned eateries placed in a

non-permanent structure, 20.0% (n=1) were observed in the morning/noon, 20.0% (n=1) were

observed in the afternoon/night while the remaining 60.0% (n=3) were observed at late night.

Selangor district (n=52).

Table 36: Time of observation carried out in all types of eateries in the Hulu Selangor district

(n=52)

A total of 52 eateries were observed in the Hulu Selangor district. In total, 28.8% (n=15)

were observed in the morning/noon, 38.5% (n=20) were observed in the afternoon/night, and

32.7% (n=17) were observed at late night.

For air-conditioned eateries placed in a permanent structure, 20.0% (n=1) were observed in

the morning/noon, 60.0% (n=3) were observed in the afternoon/night while the remaining

20.0% (n=1) were observed at late night. For non-air-conditioned eateries placed in a

permanent structure, 27.5% (n=11) were observed in the morning/noon, 32.5% (n=13) were

observed in the afternoon/night while the remaining 40.0% (n=16) were observed at late

night. As for non-air-conditioned eateries placed in a non-permanent structure, 42.9% (n=3)

were observed in the morning/noon and 57.1% (n=4) were observed in the afternoon/night.

Langat district (n=33).

Table 37: Time of observation carried out in all types of eateries in the Kuala Langat district

(n=33)

A total of 33 eateries were observed in the Kuala Langat district. In total, 30.3% (n=10)

were observed in the morning/noon, 27.3% (n=9) were observed in the afternoon/night, and

42.4% (n=14) were observed at late night. For air-conditioned eateries placed in a permanent

structure, 100% (n=1) were observed in the afternoon/night. For non-air-conditioned eateries

placed in a permanent structure, 28.6% (n=8) were observed in the morning/noon, 28.6%

(n=8) were observed in the afternoon/night and 42.9% (n=12) were observed at late night.

For non-air-conditioned eateries placed in a non-permanent structure, 50.0% (n=2) were

observed in the morning/noon and the remaining 50.0% (n=2) were observed at late night.

(n=242).

Table 38: Time of observation carried out in all types of eateries in the state of Selangor

(n=242)

The time of observation carried out in all types of eateries in the state of Selangor 100 90 80 70 Permanent Structure (Air- 60 conditioned) 50 Permanent Structure (Non-air- conditioned)

Frequency 40 Non-permanent Structure (Non-air- 30 conditioned) 20 All structures 10 0 Morning/Noon Afternoon/Night Late Night Time of the Day

Figure 7: Illustrates the time of observation carried out in all types of eateries in state of

Selangor

observed in the morning/noon, 31.8% (n=77) were observed in the afternoon/night and 35.5%

(n=86) were observed at late night. Among air-conditioned eateries placed in a permanent

structure, 34.1% (n=15) were observed in the morning/noon, 52.3% (n=23) were observed in

the afternoon/night and 13.6% (n=6) were observed at late night. For non-air-conditioned

eateries placed in a permanent structure, 32.0% (n=57) were observed in the morning/noon,

27.0% (n=48) were observed in the afternoon/night while 41.0% (n=73) were observed at late

night.As for non-air-conditioned eateries placed in a non-permanent structure, 35.0% (n=7)

were observed in the morning/noon, 30.0% (n=6) were observed in the afternoon/night and

35.0% (n=7) were observed at late night.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 70 Compliance

Table 39 below details the compliance of eateries to four indicators in the Gombak district

(n=56).

Table 39: Compliance of eateries to four indicators in the Gombak district (n= 56)

A total of 56 eateries were observed in the Gombak district. In total, 85.7% (n=48) eateries

clearly displayed the ‘No Smoking’ sign, 100% (n=56) eateries did not have ashtrays, 55.4%

(n=31) of the eateries did not have anyone smoking at the time of observation and 35.7%

(n=20) of the eateries were absent of cigarette butts within the eatery at the time of

observation.

Based on the findings, the criteria that had the highest rate of compliance in the Gombak

district was the absence of ashtrays in the eateries (100%), followed by the clear display of

‘No Smoking’ signs (85.7%), and the absence of people smoking in the eatery (55.4%). The

criteria with the lowest compliance was the absence of cigarette butts within the eateries

(35.7%).

(n=50).

Table 40: Compliance of eateries to four indicators in the Petaling district (n= 50)

A total of 50 eateries were observed in the Petaling district. In total, 78% (n=39) eateries

clearly displayed the ‘No Smoking’ sign, 94% (n=47) eateries did not have ashtrays, 50%

(n=25) of the eateries did not have anyone smoking at the time of observation and 26% (n=13)

of the eateries were absent of cigarette butts within the eatery at the time of observation.

Based on the findings, the criteria that had the highest compliance in the Petaling district was

the absence of ashtrays in the eateries (94.0%), followed by the clear display of ‘No Smoking’

signs (78.0%), and the absence of people smoking in the eatery (50.0%). The criteria with the

lowest compliance was the absence of cigarette butts within the eateries (26.0%).

district (n=51).

Table 41: Compliance of eateries to four indicators in the Hulu Langat district (n= 51)

A total of 51 eateries were observed in the Hulu Langat district. In total, 88.2% (n=45)

eateries clearly displayed the ‘No Smoking’ sign, 100% (n=51) eateries did not have ashtrays,

37.3% (n=19) of the eateries did not have anyone smoking at the time of observation and

15.7% (n=8) of the eateries were absent of cigarette butts within the eatery at the time of

observation.

Based on the findings, the criteria that had the highest rate of compliance in the Hulu Langat

district was the absence of ashtrays in the eateries (100%), followed by the clear display of

‘No Smoking’ signs (88.2%), and the absence of people smoking in the eatery (37.3%). The

criteria with the lowest compliance was the absence of cigarette butts within the eateries

(15.7%).

district (n=52).

Table 42: Compliance of eateries to four indicators in the Hulu Selangor district (n= 52)

A total of 52 eateries were observed in the Hulu Selangor district. In total, 86.5% (n=45)

eateries clearly displayed ‘No Smoking’ sign, 98.1% (n=51) eateries did not have ashtrays,

67.3% (n=35) of the eateries did not have anyone smoking at the time of observation and 25%

(n=13) of the eateries were absent of cigarette butts within the eatery at the time of

observation.

Based on the findings, the criteria that had the highest rate of compliance in the Hulu

Selangor district was the absence of ashtrays in the eateries (98.1%), followed by the clear

display of ‘No Smoking’ signs (86.5%), and the absence of people smoking in the eatery

(67.3%). The criteria with the lowest compliance was the absence of cigarette butts within the

eateries (25.0%).

district (n=33).

Table 43: Compliance of eateries to four indicators in the Kuala Langat district (n= 33)

In the Kuala Langat district, a total of 33 eateries were observed. In total, 97% (n=32)

eateries clearly displayed ‘No Smoking’ sign, 100% (n=33) eateries did not have ashtrays,

60.6% (n=20) of the eateries did not have anyone smoking at the time of observation and

12.1% (n=4) of the eateries were absent of cigarette butts within the eatery at the time of

observation.

Based on the findings, the criteria that had the highest rate of compliance in the Kuala Langat

district was the absence of ashtrays in the eateries (100%), followed by the clear display of

‘No Smoking’ signs (97.0%), and the absence of people smoking in the eatery (60.6%). The

criteria with the lowest compliance was the absence of cigarette butts within the eateries

(12.1%).

(n=242).

Table 44: Compliance of eateries to four indicators in the state of Selangor (n= 242)

Note: Average compliance (%) = 65.6

The compliance of eateries to four indicators in the state of Selangor 120

100

60 Permanent Structure (Air- conditioned) 40 Percentage% Permanent Structure (Non-air- 20 conditioned)

0 Non-permanent structure (Non-air- conditioned) Display of 'No Absence of Absence of Absence of Smoking' signs ashtrays people smoking cigarette butts in the eatery within the eatery Compliance Indicators

Figure 8: Illustrates the compliance of eateries to four indicators in the state of Selangor

smoke-free law in the state of Selangor was 65.6%.

In total, 86.4% (n=209) eateries clearly displayed ‘No Smoking’ sign, 98.3% (n=238) eateries

did not have ashtrays, 53.7% (n=130) of the eateries did not have anyone smoking at the time

of observation and 24.0% (n=58) of the eateries were absent of cigarette butts within the

eatery at the time of observation.

Based on the findings, the criteria that has the highest compliance was the absence of ashtrays

in the eateries (98.3%), followed by the clear display of ‘No Smoking’ signs, and the absence

of people smoking in the eatery (53.7%). The criteria that has the lowest compliance was the

absence of cigarette butts within the eatery (24.0%).

district (n=56).

Table 45: Environmental toxicity of eateries observed in the Gombak district (n=56)

Among the 56 eateries observed in the Gombak district, within 3 to 10 metres of the eatery:

71.4% (n=40) had 0-49 cigarette butts, 8.9% (n=5) had 50-99 cigarette butts, 5.4% (n=3) had

100-199 cigarette butts, and 14.3% (n=8) had more than 200 cigarette butts.

(n=50).

Table 46: Environmental toxicity of eateries observed in the Petaling district (n=50)

Among the 50 eateries observed in the Petaling district, within 3 to 10 metres of the eatery:

84.0% (n=42) of the eateries had 0-49 cigarette butts, 6.0% (n=3) had 50-99 cigarette butts,

10.0% (n=5) had 100-199 cigarette butts and 0% of the eateries had more than 200 cigarette

butts.

district (n=51).

Table 47: Environmental toxicity of eateries observed in the Hulu Langat district (n=51)

Among the 51 eateries observed in the Hulu Langat district, within 3 to 10 metres of the

eatery: 58.8% (n=30) had 0-49 cigarette butts, 15.7% (n=8) had 50-99 cigarette butts, 11.8%

(n=6) had 100-199 cigarette butts, and 13.7% (n=7) of the eateries had more than 200

cigarette butts.

district (n=52).

Table 48: Environmental toxicity of eateries observed in the Hulu Selangor district (n=52)

Among the 52 eateries observed in the Hulu Selangor district, within 3 to 10 metres of the

eatery, 78.8% (n=41) had 0-49 cigarette butts, 11.5% (n=6) had 50-99 cigarette butts, 1.9%

(n=1) had 100-199 cigarette butts and 7.7% (n=4) of the eateries had more than 200 cigarette

butts.

district (n=33).

Table 49: Environmental toxicity of eateries observed in the Kuala Langat district (n=33)

Among the 33 eateries observed in the Kuala Langat district, within 3 to 10 metres of the

eatery: 84.8% (n=28) had 0-49 cigarette butts, 6.1% (n=2) had 50-99 cigarette butts, 0% had

100-199 cigarette butts, and 9.1% (n=3) had more than 200 cigarette butts.

Selangor (n=242).

Table 50: Environmental toxicity of eateries observed in the state of Selangor (n=242)

Environmental toxicity of eateries observed in the state of Selangor 200

180

160

140

120 Permanent Structure (Air- conditioned)

100 Permanent Structure (Non-air- conditioned)

Frequency Non-permanent Structure (Non-air- 80 conditioned) All structures 60

0 0-49 50-99 100-199 >200 Number of cigarette butts within 3 to 10 metres

Figure 9: Illustrates the environmental toxicity of eateries observed in the state of Selangor

74.8% (n=181) of the eateries had 0-49 cigarette butts, 9.9% (n=24) had 50-99 cigarette butts,

6.2% (n=15) had 100-199 cigarette butts and 9.1% (n=22) had more than 200 cigarette butts.

Table 51 below details the presence of rubbish bins and cigarette butts around the eateries in

the Gombak district (n=56).

Table 51: Presence of rubbish bins and cigarette butts around the eatery in the Gombak

district (n=56)

A total of 56 eateries were observed in the Gombak district. In total, 25.0% (n=14) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 14 rubbish bins,

57.1% (n=8) were found to have cigarette butts around them.

Petaling district (n=50).

Table 52: Presence of rubbish bins and cigarette butts around the eatery in the Petaling

district (n=50)

A total of 50 eateries were observed in the Petaling district. In total, 20.0% (n=10) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 10 rubbish bins,

60.0% (n=6) were found to have cigarette butts around them.

Hulu Langat district (n=51).

Table 53: Presence of rubbish bins and cigarette butts around the eatery in the Hulu Langat

district (n=51)

A total of 51 eateries were observed in the Hulu Langat district. In total, 19.6% (n=10) of

the eateries were found to have rubbish bins 3 to 10 metres away. Out of the 10 rubbish bins,

50.0% (n=5) were found to have cigarette butts around them.

Hulu Selangor district (n=52).

Table 54: Presence of rubbish bins and cigarette butts around the eatery in the Hulu Selangor

district (n=52)

A total of 51 eateries were observed in the Hulu Selangor district. In total, 7.7% (n=4) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 4 rubbish bins, none

(0) were found to have cigarette butts around them.

Kuala Langat district (n=33).

Table 55: Presence of rubbish bins and cigarette butts around the eatery in the Kuala Langat

district (n=33)

A total of 51 eateries were observed in the Kuala Langat district. In total, 12.1% (n=4) of

the eateries were found to have rubbish bins 3 to 10 metres away. Out of the 4 rubbish bins,

25.0% (n=1) was found to have cigarette butts around it.

state of Selangor (n=242).

Table 56: Presence of rubbish bins and cigarette butts around the eatery in the state of

Selangor (n=242)

Presence of rubbish bins and cigarette butts around the eateries in the state of Selangor 35

25 Permanent Structure (Air- 20 conditioned) 15 Permanent Structure (Non-air- conditioned) Percentage% 10 Non-permanent Structure (Non-air- 5 conditioned) 0 Presence of rubbish bins Presence of cigarette butss between 3-10 metres away from around the rubbish bins the eatery

Figure 10: Illustrates the presence of rubbish bins and cigarette butts around the eateries in

the state of Selangor

A total of 242 eateries were observed in the state of Selangor. In total, 17.4% (n=42) of the

eateries were found to have rubbish bins 3 to 10 metres away. Out of the 42 rubbish bins,

47.6% (n=20) were found to have cigarette butts around them.

Table 57 below details the number of people actively smoking in eateries in the Gombak

district (n = 56) at the time of observation.

Table 57: Number of people actively smoking in eateries in the Gombak district at the time of

observation (n = 56)

Among the 1,551 people present in eateries in the Gombak district at the time of observation,

146 individuals (9.4%) were actively smoking. In air-conditioned eateries placed in a

permanent structure, 1 (0.9%) out of 114 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 143 (10.4%) out of 1,370 individuals

were actively smoking. In non-air-conditioned eateries placed in a non-permanent structure, 2

(3.0%) out of 67 individuals were actively smoking.

district (n = 50) at the time of observation.

Table 58: Number of people actively smoking in eateries in the Petaling district at the time of

observation (n = 50)

Among the 934 people present in eateries in the Petaling district at the time of observation,

80 individuals (8.6%) were actively smoking. In air-conditioned eateries placed in a

permanent structure, 33 (7.7%) out of 431 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 47 (10.1%) out of 465 individuals were

actively smoking. In non-air-conditioned eateries placed in a non-permanent structure, 0 (0%)

out of 38 individuals were actively smoking.

district (n = 51) at the time of observation.

Table 59: Number of people actively smoking in eateries in the Hulu Langat district at the

time of observation (n = 51)

Among the 1,579 people present in eateries in the Hulu Langat district at the time of

observation, 169 individuals (10.7%) were actively smoking. In air-conditioned eateries

placed in a permanent structure, 4 (2.2%) out of 182 individuals were actively smoking. In

non-air-conditioned eateries placed in a permanent structure, 140 (11.2%) out of 1,253

individuals were actively smoking. In non-air-conditioned eateries placed in a non-permanent

structure, 25 (17.4%) out of 144 individuals were actively smoking.

Selangor district (n = 52) at the time of observation.

Table 60: Number of people actively smoking in eateries in the Hulu Selangor district at the

time of observation (n = 52)

Among the 866 people present in eateries in the Hulu Selangor district at the time of

observation, 54 individuals (6.2%) were actively smoking. In air-conditioned eateries placed

in a permanent structure, 0 (0%) out of 64 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 45 (6.4%) out of 708 individuals were

actively smoking. In non-air-conditioned eateries placed in a non-permanent structure, 9

(9.6%) out of 94 individuals were actively smoking.

Langat district (n = 33) at the time of observation.

Table 61: Number of people actively smoking in eateries in the Kuala Langat district at the

time of observation (n = 33)

Among the 553 people present in eateries in the Kuala Langat district at the time of

observation, 30 individuals (5.4%) were actively smoking. In air-conditioned eateries placed

in a permanent structure, 0 (0%) out of 6 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 24 (5.2%) out of 458 individuals were

actively smoking. In non-air-conditioned eateries placed in a non-permanent structure, 6

(6.7%) out of 89 individuals were actively smoking.

Selangor (n = 242) at the time of observation.

Table 62: Number of people actively smoking in eateries in the state of Selangor at the time

of observation (n = 242)

The number of people actively smoking in eateries in the state of Selangor at the time of observation 6000

5000 Permanent Structure (Air- 4000 conditioned) Permanent Structure (Non-air- 3000 conditioned)

Frequency Non-permanent Structure (Non-air- 2000 conditioned) All structures 1000

0 Number of occupants during Number of people smoking observation visit

Figure 11: Illustrates the number of people actively smoking in eateries in the state of

Selangor at the time of observation

8 Permanent Structure (Air- 6 conditioned) 4 Permanent Structure (Non-air- conditioned)

Point PrevalencePoint (%) 2 Non-permanent Structure (Non- 0 air-conditioned) Permanent Structure Permanent Structure Non-permanent (Air-conditioned) (Non-air-conditioned) Structure (Non-air- conditioned) Types of Eateries

Figure 12: Illustrates the number of people actively smoking in eateries in the state of

Selangor at the time of observation.

Among the 5,483 people present in eateries in the state of Selangor at the time of observation,

479 individuals (8.7%) were actively smoking. In air-conditioned eateries placed in a

permanent structure, 38 (4.8%) out of 797 individuals were actively smoking. In non-air-

conditioned eateries placed in a permanent structure, 399 (9.4%) out of 4,254 individuals

were actively smoking. In non-air-conditioned eateries placed in a non-permanent structure,

42 (9.7%) out of 432 individuals were actively smoking.

Time of observation carried out in all types of eateries

Table 63 below details the time of observation carried out in all types of eateries in the

federal territories of Kuala Lumpur, Putrajaya and the state of Selangor (n=415).

Table 63: Time of observation carried out in all types of eateries in the federal territories of

Kuala Lumpur, Putrajaya and the state of Selangor (n=415).

Time of observation carried out in all types of eateries in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor 200 180 160 140 Permanent Structure (Air-

120 conditioned) 100 Permanent Structure (Non-air- conditioned) 80 Frequency Non-Permanent Structure (Non-air- 60 conditioned) 40 All structures 20 0 Morning/Noon Afternoon/Night Late Night Time of the Day

Figure 13: Illustrates the time of observation carried out in all types of eateries in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor

Putrajaya, and the state of Selangor. In total, 41.4% (n=172) were observed in the

morning/noon, 35.9% (n=149) were observed in the afternoon/night, and 22.7% (n=94) were

observed at late night.

Among the 64 air-conditioned eateries placed in a permanent structure, 45.3% (n=29) were

observed in the morning/noon, 43.8% (n=28) were observed in the afternoon/night while the

remaining 10.9% (n=7) were observed at late night. As for the 322 non-air-conditioned

eateries placed in a permanent structure, 41.3% (n=133) were observed in the morning/noon,

33.9% (n = 109) were observed in the afternoon/night and the remaining 24.8% (n=80) were

observed at late night. For the 29 non-air-conditioned eateries placed in a non-permanent

structure, 34.5% (n=10) were observed in the morning/noon while 41.4% (n=12) were

observed in the afternoon/night, and the remaining 24.1% (n=7) were observed at late night.

Table 64 below details the compliance of eateries to four indicators in the federal territories

of Kuala Lumpur, Putrajaya and the state of Selangor (n=415).

Table 64: Compliance of eateries to four indicators in the federal territories of Kuala Lumpur,

Putrajaya and the state of Selangor (n=415)

Compliance of eateries to four indicators in the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor 120

100 80 60 Permanent Structure (Air- 40 Conditioned) Percentage % Percentage 20 Permanent Structure (Non-air- conditioned) 0 Display of 'No Absence of Absence of Absence of Non-Permanent Structure (Non-air- Smoking' Signs ashtrays people smoking cigarette butts conditioned) in the eatery within the eatery Compliance Indicators

Figure 14: Illustrates the compliance of eateries to four indicators in the federal territories of

Kuala Lumpur, Putrajaya and the state of Selangor

Putrajaya, and the state of Selangor. The overall compliance to the smoke-free law was

64.45%.

In total, 81.9% (n=340) eateries clearly displayed the ‘No Smoking” sign, 98.3% (n=408)

eateries did not have ashtrays, 56.4% (n=234) of the eateries did not have anyone smoking at

the time of observation and 21.2% (n=88) of the eateries were absent of cigarette butts within

the eatery at the time of observation.

Based on the findings, the criteria that has the highest compliance in the federal territories

of Kuala Lumpur, Putrajaya and the state of Selangor was the absence of ashtrays

(98.3%), followed by the clear display of ‘No Smoking’ signs (81.9%), and the absence of

people smoking (56.3%). The criteria with the lowest compliance was the absence of

cigarette butts within the eatery (21.2%).

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 102 Toxicity

Table 65 below details the environmental toxicity of eateries observed in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor (n=415).

Table 65: Environmental toxicity of eateries observed in the federal territories of Kuala

Lumpur, Putrajaya and the state of Selangor (n=415)

Environmental toxicity of eateries observed in the federal territories of Kuala Lumpur and Putrajaya and the state of Selangor 350

300

250 Permanent Structure (Air- Conditioned) 200 Permanent Structure (Non-air- 150 conditioned) Frequency Non-Permanent Structure (Non-air- 100 conditioned) 50 All structures

0 0-49 50-99 100-199 >200 Number of cigarette butts within 3 to 10 metres

Figure 15: Illustrates the environmental toxicity of eateries observed in the federal territories

of Kuala Lumpur, Putrajaya and the state of Selangor

and the state of Selangor, within 3 to 10 metres of the eatery: 69.9% (n=290) had 0-49

cigarette butts, 14.4% (n=60) had 50-99 cigarette butts, 8.2% (n=34) had 100-199 cigarette

butts, and 7.5% (n=31) had more than 200 cigarette butts.

Table 66 below details the presence of rubbish bins and cigarette butts around the eateries in

the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor (n=415).

Table 66: Presence of rubbish bins and cigarette butts around the eateries in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor (n=415)

Presence of rubbish bins and cigarette butts around the eateries in the federal territories of Wilayah Persekutuan Kuala Lumpur and Putrajaya, and the state of Selangor. 35

25 Permanent Structure (Air- 20 Conditioned) 15 Permanent Structure (Non-air- conditioned) Percentage% 10 Non-Permanent Structure (Non-air- 5 conditioned)

0 Presence of rubbish bins Presence of cigarette butts between 3-10 metres away from around the rubbish bins the eateries Figure 16: Illustrates the presence of rubbish bins and cigarette butts around the eateries in

the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor

Putrajaya. In total, 22.4% (n=93) of the eateries were found to have rubbish bins 3 to 10

metres away. Out of the 93 rubbish bins, 49.5% (n=46) were found to have cigarette butts

around them.

Table 67 below details the number of people actively smoking in eateries in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor (n=415) at the time of

observation.

Table 67: Number of people actively smoking the federal territories of Kuala Lumpur,

Putrajaya and the state of Selangor (n=415) at the time of observation

Number of people actively smoking in eateries in the federal territories of Kuala Lumpur, Putrajaya and the state of Selangor at the time of observation

10000 9000 8000 Permanent Structure (Air- 7000 Conditioned) 6000 Permanent Structure (Non-air- 5000 conditioned) 4000 Frequency Non-Permanent Structure (Non-air- 3000 conditioned) 2000 All structures 1000 0 Number of occupants during Number of people smoking observation visit

Figure 17: Illustrates the number of people actively smoking in eateries in the federal

territories of Kuala Lumpur, Putrajaya and the state of Selangor the time of observation

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 107 The number of people actively smoking in eateries in the federal territories of Kuala Lumpur and Putrajaya, and the state of Selangor at the time of observation. 9 8 7 6 5 Permanent Structure (Air- 4 conditioned) 3 Permanent Structure (Non-air- 2 conditioned)

Point PrevalencePoint (%) 1 0 Non-permanent Structure (Non- Permanent Structure Permanent Structure Non-permanent air-conditioned) (Air-conditioned) (Non-air-conditioned) Structure (Non-air- conditioned) Types of Eateries

Figure 18: Illustrates the number of people actively smoking in eateries in the federal

territories of Kuala Lumpur and Putrajaya and the state of Selangor at the time of

observation.

Among the 9,169 people present in eateries in the federal territories of Kuala Lumpur,

Putrajaya and the state of Selangor at the time of observation, 672 individuals (7.3%) were

actively smoking. In air-conditioned eateries placed in a permanent structure, 60 (4.3%) out

of 1,386 individuals were actively smoking. In non-air-conditioned eateries placed in a

permanent structure, 568 (7.8%) out of 7,261 individuals were actively smoking. In non-air-

conditioned eateries placed in a non-permanent structure, 44 (8.4%) out of 522 individuals

were actively smoking.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 108 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 109 DISCUSSION

This study, which was a survey to assess the compliance of eateries to the Control of

Tobacco Product (Amendment) Regulations 2018, was carried out in the federal territories of

Wilayah Persekutuan Kuala Lumpur, Putrajaya and the state of Selangor. A total of 415

eateries were sampled for the study. Based on the findings: (i) 340 eateries or 81.9% clearly

displayed ‘No Smoking’ signs; (ii) 408 or 98.3% did not have ashtrays; (iii) 234 or 56.4% did

not have people smoking within the eatery, and (iv) 88 or 21.2% did not have cigarette butts

within the eatery. The overall compliance of eateries to the Control of Tobacco Product

(Amendment) Regulations 2018 was determined to be 64.5%.

At a distance of between 3 to 10 metres away from the eateries surveyed, it was

determined that 290 or 69.9% eateries had fewer than 50 cigarette butts; 60 or 14.4% eateries

had between 50 to 100 cigarette butts; 65 or 15.7% had more than 100 cigarette butts. The

study also determined that 93 or 22.4% of the eateries had rubbish bins 3 to 10 metres away,

and 46 or 49.5% of the rubbish bins had cigarette butts around them. Among the 9,169

people found to be patronising these eateries, 672 or 7.3% were found to be actively smoking.

Compliance

This study assessed two distinct categories of compliance: structural compliance,

which includes the clear display of ‘No Smoking’ signs and the absence of ashtrays, and

social compliance, which includes the absence of people actively smoking in the eatery and

the absence of cigarette butts within the eatery.

Structural compliance requires the cooperation of owners of the eateries, which was

found to be high at more than 80%. This was despite the fact that the period during which the

survey was conducted was a period of educational rather than punitive enforcement. This

showed a positive willingness to change and comply with the Control of Tobacco Product

(Amendment) Regulations 2018 amongst owners of the eateries. This kind of behavioural

fines, showed that there was some level of ‘buy-in’ to the regulations amongst eatery owners

at the ground level.

The primary indicator for social compliance was the absence of people actively

smoking in the eatery during the observation visit, which was found to be only about 56.4%.

The primary indicator for social compliance was the absence of people actively

smoking in the eatery during the observation visit, which was found to be only about 56.4%.

This is because social compliance requires two components: the willingness of owners of the

eateries to stop people from actively smoking within their eatery, as well as the self-

motivation of people to not actively smoke at the eatery. What the study observation showed

was that the willingness of the owners of the eateries to display the required signages

unfortunately did not extend to them being willing to reprimand customers who smoked in

their eatery. This was most likely due to the fact that most of these eateries continued to

display and sell cigarettes in their establishment and prohibiting customers from smoking on-

site as this would mean a loss of revenue to the eatery owners.

During the observational visits, it was also observed that social compliance during

night and late night was poorer than that of morning, noon, and afternoon i.e. many more

smokers actively smoked at night openly in the eateries. It is possible that the higher

compliance during day time was motivated by the anticipation of enforcement activity. This

perhaps reflected that compliance to the regulation was not driven by self-motivation but

rather reliant on enforcement (or the expectation of it).

As this study was of cross-sectional design, we were inherently aware of the possible bias in

terms of assessing compliance based one visit. Thus the secondary indicator for social

compliance, which was the absence of cigarette butts, was a representation of compliance

within the eatery is carried out in shifts, which meant that people had recently smoked, and

that the cigarette butts had not been swept off. The study determined the compliance for this

indicator to be 21.2%. Thus the possible social compliance rate is likely to be between that of

the two indicators, 21.2% and 56.4%.

The overall compliance rate for the federal territories of Kuala Lumpur and Putrajaya

(62.8%) was similar to that of the state of Selangor (65.6%). This was despite the different

time periods during which the study was carried out as well as the different populations in

which they were carried out as well.

The observation of eateries for the federal territories of Kuala Lumpur and Putrajaya

was carried out three months after Control of Tobacco Product (Amendment) Regulations

2018 came into force while for Selangor it was carried out 11 months after the beginning of

the gazettement period. Despite the gap in time between the two phases, the almost similar

levels of compliance indicated that the regulation was being adhered to at a sustained level

across time.

In addition, another indirect triangulator of the validity of the compliance measure was

the difference in the population sampled for Kuala Lumpur and Putrajaya and the state of

Selangor. The population sampled for Kuala Lumpur and Putrajaya were of eateries that had

been reported and were expected to have an observational finding of a low rate of

compliance. On the other hand, the randomised sampling of eateries all over the state of

Selangor were expected to have a higher rate of compliance. The lack of dissimilarity between

the rate of compliance between these two samples also seem to validate the premise above as

to the overall compliance rate. Thus, even though the observational findings of this study may

be an estimate, it can indicate sustained improvement in overall compliance.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 112 Toxicity

The study determined that very few eateries had more than 50 cigarette butts within a

3-10 metre radius. The areas observed to be within the 3-10 metre radius, on which most of

the cigarette butts were found, included the curb below the eatery, parking spots, bus stops,

roads, as well as grassy areas on curbs, (non-eatery) shops or houses on the opposite side of

the road. Such a wide dispersal of cigarette butts inherently reflected on a greater area of

spread of toxicity. The numbers of cigarette butts discovered from the observations were

likely lower than true numbers as this did not, in fact, capture butts that were trapped beneath

cars, transported by car tires or floating in water bodies or sewerage drains. Thus, the areas of

toxic exposure from cigarette butt waste were bound to be much higher than the rates

captured within the observational study.

It the study, rubbish bins were rarely found around the 3 to 10 metre radius of the

eateries. Even among rubbish bins found by the study team, very few cigarette butts were

seen within or around the bin; but rather cigarette butts continued to be strewn across the

observational areas as described above. Two problems can be highlighted from these findings.

First, that there is a lack of rubbish bins in the public space in the observed outdoor areas of

Kuala Lumpur, Putrajaya and the state of Selangor. Second, this perhaps reflected a poor

behavioural culture among Malaysians who continue to litter, even when there are already

clear regulations precluding the smoke-free regulation which prohibit littering.

The National Health and Morbidity Survey (NHMS) 2013 revealed that 23% of

people in Malaysia smoke. The observations from this study, however, determined that point

prevalence, i.e. the number of people actively smoking among occupants in the eatery during

the observation visit, was less than 10%. Although the cross-sectional design of the study

precludes any ability to be able to measure the effectiveness of Control of Tobacco Product

(Amendment) Regulations 2018 in terms of reducing the prevalence of public smoking; this

may be a proxy comparator to indicate that this is being achieved. Of course, more rigorous

methodology is needed to objectively prove this hypothesis and is one of the areas to be

worked on in the future.

As this was a cross-sectional study, there is a possibility of selection bias, and the

eateries observed in the study may not have been a representative sample of all eateries. The

cross-sectional study design also is unable to determine causality on whether any compliance

observed was different following the implementation of the Control of Tobacco Product

(Amendment) Regulations 2018, or whether it remains unchanged prior to the

implementation.

It was also possible that since study team members were public health trained, there

maybe have been a confirmation bias inherently present within them when they made their

observational findings- i.e. that they expected to find people smoking or eateries being

structurally non-compliant. While this was possible, active steps had been taken to overcome

this and ensure a higher validity as highlighted in the protocol section. This included actions

such as setting objective indicators, as detailed in ‘Strengths of the study’ below.

Observationally, there may have been some discrepancy in terms of the absolute

number of cigarette butts found around eateries, especially if the observations were carried on

during dusk, twilight or at night. However the chance of these discrepancies cropping up was

also reduced as the study team consisted of two different members who were keying in the

data individually into their own study instrument.

The strengths of this study included the following: i) a rigorous methodology; ii)

random sampling with adequate power, and iii) a wide sample as it was carried out across the

entire geographic variability of the federal territories of Kuala Lumpur and Putrajaya, as well

as the state of Selangor. Stratification of the samples in this study was also used to reveal the

compliance ‘behaviour’ in different types of eateries. The cross-sectional study continues to

be the only one to provide a ‘snapshot’ of compliance to the Control of Tobacco Product

(Amendment) Regulations 2018 over the period of time (January 2019 to December 2019) at

this given point in time in the whole of Malaysia.

In addition, the validity of the measures of this study is high. The compliance

indicators used in the study have been tested and validated by leading tobacco control

organisations as well as studies worldwide, including the Johns Hopkins Bloomberg School

of Public Health and the International Union Against Tuberculosis and Lung Disease,

and Kumar et. al. 17, 23 The use of objective, rather than subjective, indicators allowed

members of the team to avoid confounding bias. The indicator for types of tobacco products

smoked was also comprehensive, as it included electronic cigarettes as well as waterpipe

(shisha).

The study also had high reliability: members of the study team are health science

professionals who have received training on the data collection process prior to the study.

The protocol required at least two members to key in the data for each eatery independently

from each other, with any discrepancies resolved when the data was analysed.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 116 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 117 RECOMMENDATIONS

Based on the findings of the study, the study team makes the following

recommendations:

Overall, eateries showed high structural compliance. However, improvements can be

made in terms of clearer display of ‘No Smoking’ signs (currently at 81.9%). There should be

no hurdles in a 100% compliance rate to structural compliance measures i.e. both clearer

display of ‘No Smoking’ signs as well as in the removal of ashtrays from the eateries. The

study team also strongly recommends to improve on social compliance measures, namely

absence of people smoking (56.4%) and absence of cigarette butts within the eatery (21.2%).

Social compliance can be improved from self-driven motivation as well as peer-

motivation. It is possible that more awareness of the Control of Tobacco Product

(Amendment) Regulations 2018 could be beneficial to everyone including people who smoke

and those who do not. While people who smoke may become more aware that smoking is

banned in eateries, people who do not smoke should similarly become more aware that they

have a role to play in encouraging compliance. They can do this by voicing out their

dissatisfaction to people who smoke actively in eateries; an act of social policing which

further de-normalises such actions. Media and social media campaigns such as the

RESTART (Restoran Tanpa Asap Rokok Tembakau) and the ‘Speak Out’ campaign have

been beneficial in pushing this narrative continuously and efforts must be continued along

this vein.

The other aspect of social compliance is dependent on the willingness of owners to fully

enforce the regulation. While some owners have already removed the economic inducement

of selling cigarettes in their premises, others continue to be driven by it. For this group, a

greater economic incentive may be needed in the sense of stricter punitive enforcement.

Targeted enforcement, especially during night time when compliance is highly reduced may

Only this may be successful to overcome the economic incentives which deter them from

enforcing the regulation on their premises.

However, in the long run, efforts could also be made to empower owners of premises to

enforce the CTPR amendments, especially since one of their largest complaints is that they

are afraid to lose the customers’ business as well as the possible threat of physical abuse from

recalcitrant customers. The installment of cigarette waste disposal bins where customers

could be asked to go and discard their ash and cigarette butts would also go a long way

towards this.

The presence of widely dispersed cigarette butts in the 3 to 10 metre areas around the

eateries reveal that there is a need for collection area for cigarette butts as well as cigarette

ash. Thus there should be cigarette waste disposal bins placed within a 3 to 10 metre radius of

eateries so that smokers smoking outside eateries can smoke and dispose of their cigarette

waste in a way that reduces toxicity to the environment. The placement of these cigarette

waste disposal bins are likely to be undertaken by the local municipal authorities. Since many

eateries, especially those in link shophouses, are clustered together, the numbers of these

cigarette waste disposal bins and thus the costs of installing them are unlikely to be so high

so as to be a deterrent.

The study team makes clear here that a cigarette waste disposal bin is not a smoking

zone as being touted by certain quarters. This is because as the current Control of Tobacco

Product Regulations stand, only the few gazetted areas are prohibited for smoking while

individuals are able to smoke in all other places in Malaysia. This makes a specific smoking

zone as being unnecessary.

found everywhere except in the bin indicates that there still another important behavioural

component that needs to be tackled. This component is not contained within the Control of

Tobacco Product (Amendment) Regulations 2018, or even under any smoking regulations

but rather within the requirement to not litter in any case, which includes cigarette butts. This

is reflective of a greater social apathy of Malaysian society in terms of general environmental

cleanliness and moral values. It is strange when Malaysians go abroad, they need to comply

with existing regulations of whichever country they are in to not litter, but are not expected to

practice similar habits even when in Malaysia despite similar regulations being in place.

Individuals and organisations need to support social change in getting the public to take

ownership over littering as well as to call out people who litter; including people who smoke.

This helps immensely in de-normalising littering behaviour, and will also go a long way

towards reducing the environmental toxicity caused by cigarette butts.

Based on the findings of this study, it could be surmised that the Control of Tobacco

Product (Amendment) Regulations 2018, is being complied with. The recommendations

serve to underline the principle that a multi-faceted approach intended to bring about

sustained behavioural change rather than merely punitive action underpins this effort, and

will ultimately ensure its success. This study should act to strengthen the commitment of all

stakeholders to continue working towards creating greater compliance; and through this,

moving towards fulfilling the greater goal of the requirements of the Framework Convention

on Tobacco Control (FCTC).

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 120 References 1. International Agency for Research on Cancer (IARC), 2012. Monographs on the evaluation of carcinogenic risks to humans. In: Personal Habits and Indoor Combustions.Vol. n° 100E Available at: http://monographs.iarc.fr/ENG/Monographs/vol100/mono100E.pdf 2. Moritsugu, K.P., 2007. The 2006 Report of the Surgeon General: the health consequences of involuntary exposure to tobacco smoke. Am. J. Prev. Med. 32, 542– 543. 3. Hori M, Tanaka H, Wakai K, Sasazuki S, Katanoda K. Secondhand smoke exposure and risk of lung cancer in Japan: a systematic review and meta-analysis of epidemiologic studies. Japanese journal of clinical oncology. 2016 Oct 1;46(10):942- 51. 4. Su B, Qin W, Xue F, Wei X, Guan Q, Jiang W, Wang S, Xu M, Yu S. The relation of passive smoking with cervical cancer: A systematic review and meta-analysis. Medicine. 2018 Nov; 97(46). 5. Macacu A, Autier P, Boniol M, Boyle P. Active and passive smoking and risk of breast cancer: a meta-analysis. Breast cancer research and treatment. 2015 Nov 1; 154(2):213-24. 6. World Health Organization. WHO Framework Convention on Tobacco Control, Article 8. Geneva, World Health Organization, 2003 (updated reprints 2004, 2005) (http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf) 7. World Health Organisation (WHO). MPOWER: a policy package to reverse the tobacco epidemic. Available at: http://www.who.int/tobacco/mpower/mpower_english.pdf (accessed Feb 2, 2017). 8. Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical Journal, 2002, 325(7357):188. 9. García-Esquinas E, Jiménez A, Pastor-Barriuso R, Jones MR, Perez-Gomez B, Navas-Acien A, Tellez-Plaza M. Impact of declining exposure to secondhand tobacco smoke in public places to decreasing smoking-related cancer mortality in the US population. Environment international. 2018 Aug 31;117:260-7. 10. Malaysia Food Act, (1983). (2004). Control of Tobacco Product Regulations 2004, Part IV: Prohibition on Smoking; International Law Book Services, p. 335-348. 11. Abidin EZ. Smoke-free legislation in Malaysia: a comprehensive review. Asia Pacific Environmental and Occupational Health Journal. 2016 Jan 18;2(1). 12. Malaysia Food Act, (1983). (2018). Control of Tobacco Product (Amendment) Regulations 2018. P.U (A) 329/2018. Available at www.federalgazette.agc.gov.my/outputp/pua_20181224_P.U.%20(A)%20329.pdf 13. Lee J, Lim S, Lee K, et al. (2010). Secondhand smoke exposures in indoor public places in seven Asian countries. International Journal of Hygiene Environmental Health, 213(5):348-351. doi:10.1016/j.ijheh.2010.05.007. 14. Abidin, E. Z., Hashim, Z., & Semple, S. (2013). Second-hand smoke in public spaces: How effective has partial smoke-free legislation been in Malaysia? Asian Pacific Journal of Cancer Prevention, 14, 6845–6850.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 121 15. Department of Survey and Mapping Malaysia (JUPEM). Atlas Kebangsaan Malaysia (OCLC: 1039476728). Kuala Lumpur: JUPEM; 2016 16. Campaign for Tobacco Free Kids, John Hopkins Bloomberg School of Public Health and International Union Against Tuberculosis and Lung Disease. Assessing compliance with smoke free laws: A “how to” guide for conducting compliance studies. Washington DC: Campaign for Tobacco‑Free Kids, 2011. Available from: http://tobaccofreecenter.org/files/pdfs/en/smoke_free_compliance_guide.pdf 17. Lee JG, Ranney LM, Goldstein AO. Cigarette butts near building entrances: what is the impact of smoke-free college campus policies?. Tobacco Control. 2013 Mar 1;22(2):107-12. 18. Centres for Disease Control (CDC), US Department of Health & Human Services. 2012. Principles of Epidemiology in Public Health Practice, Third Edition: An Introduction to Applied Epidemiology and Biostatistics. Morbidity Frequency Measures. Atlanta, US. Available at: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section2.html 19. Charan J, Biswas T. How to calculate sample size for different study designs in medical research?. Indian journal of psychological medicine. 2013 Apr;35(2):121. 20. Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. John Wiley & Sons; 2013 Jun 12. 21. Goel S, Ravindra K, Singh RJ, Sharma D. Effective smoke-free policies in achieving a high level of compliance with smoke-free law: experiences from a district of North India. Tobacco control. 2014 Jul 1;23(4):291-4. 22. Marah M, Novotny TE. Geographic patterns of cigarette butt waste in the urban environment. Tobacco control. 2011 May 1;20(Suppl 1):i42-4. 23. Kumar R, Chauhan G, Satyanarayana S, Lal P, Singh RJ, Wilson NC. Assessing compliance to smoke-free legislation: results of a sub-national survey in Himachal Pradesh, India. WHO South-East Asia journal of public health. 2013 Jan 1;2(1):52.

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 122 COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 123 APPENDIX 1

CASE REPORT FORM

Q1. Investigator's name/Nama pegawai

Q2. Please enter current date/Sila nyatakan tarikh hari ini

Q3. Please select what day it is/Sila pilih hari yang berkenaan

Weekday/ Hari Kerja Weekend or Public Holiday/ Hari Hujung Minggu atau Cuti Umum

Q4. Please select current time period/Sila pilih tempoh masa sekarang

8.00am - 1.59pm 2.00pm - 9.59pm 10.00pm - 7.59am

Q5. Please enter the current specific time/Sila nyatakan masa sekarang

Q6. Select the current weather condition/Sila pilih keadaan cuaca sekarang yang tepat

Raining/ Hujan Not raining/ Tidak hujan

Q7. Please select your location zone/Sila pilih zon lokasi

Cheras Kepong Lembah Pantai Titiwangsa Putrajaya

Q9. Is the restaurant open or close for business/Adakah restoran buka atau tutup untuk perniagaan?

Open/ Buka Close/ Tutup

Q10. What type of environment and structure does the restaurant have?/Apakah jenis struktur dan persekitaran restoran ini?

Air-conditioned in a permanent building/ Berhawa dingin dalam bangunan tetap Not air-conditioned in a permanent building/ Tidak berhawa dingin dalam bangunan tetap Not air-conditioned in a non-permanent building/ Tidak berhawa dingin dalam bangunan sementara

Q11. Number of seats in the restaurant (calculate the number of chairs)/ tempat duduk disediakan di restoran (bilangan kerusi)

Q12. Number of customers seated observable (calculate the number of people present)/Jumlah pelanggan di restoran yang boleh dilihat (bilangan orang)

Q13. Is the no smoking signage clearly seen?/Tanda larangan merokok jelas terlihat?

Yes/ Ya No/ Tidak

Q14. Are there ashtrays provided in the eatery?/Adakah dulang abu disediakan dalam restoran?

Yes/ Ya No/ Tidak

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 125 Q15. Do you see anyone smoking or lighting up a cigarette within 3 meters of the furthest chair or roof of the restaurant?/Adakah orang merokok atau menyalakan rokok dalam jarak 3 meter dari kerusi atau bumbung restoran?

Yes/ Ya No/ Tidak

Q16. State the number of people smoking/Nyatakan bilangan orang yang sedang merokok.

Q17. Are there any cigarette butts in the restaurant (up to 3 metres of either the furthest chair or the roof from the restaurant)/Adakah punting rokok ditemui dalam restoran (termasuk dalam kawasan 3 meter dari kermis tau bumbung yang paling jauh dari restoran tersebut)?

Yes/ Ya No/ Tidak

Q18. How many cigarette butts found between 3 - 10 meters of either the furthest chair or roof from the restaurant?/ Berapakah puntung rokok dijumpai dalam jarak 3 hingga 10 meter dari kerusi atau bumbung yang paling jauh dari restoran?

Q19. Is there a rubbish bin/ bin from 3 - 10 meters around the restaurant? Adakah tong sampah/tong disediakan dalam kawasan 3-10 meter dari restoran

Yes/ Ya No/ Tidak

Q20. Do you see any cigarettes around the bin?/ Adakah puntung rokok yang boleh dilihat di sekitar tong/ tong sampah?

Yes/ Ya No/ Tidak

Survey ends

The following variables were collected during the study:

Variable Question Justification

General Data collector’s name Data verification and Data Management

purposes

Date of data collection Data verification and Data Management

purposes

Day of data collection Whether it was a working or public

holiday, which may affect the number of

patrons in eateries.

Time of data collection Time of the day may have affected

likelihood of patrons visiting eateries.

Current weather condition. Answering either it was raining or not.

Rain could have altered positions of

cigarette butts and presence of patrons in

the eateries.

Environment of eatery and To determine the variable which was

it’s type of structure used as a measure for study outcomes.

Name of eatery Restaurant name selection Selection of the specific eatery being

observed. Selected the eateries as

randomised according to category.

Eatery Whether the eatery is open Answered as either Open/ Close. To

Availability or closed ensure that the availability is traceable to

their business hours, and whether a

Compliance Is the no smoking sign Answered as either Yes/ No. To record

Observation clearly seen? whether the pictorial warning as

determined by the Ministry of Health,

Malaysia was clearly displayed in the

eatery

Are there ashtrays provided Answered as either Yes/ No. Recorded

in the eatery? as this can be a proxy indicator on

whether smoking is permitted in the

eatery.

Number of seats available in Investigators were required to estimate

the restaurant. (calculate the the capacity of the eateries using the

number of chairs) guidelines set below which are common

for eateries in Klang Valley, Malaysia:

Small round table: 4 patrons

Medium round table: 6 patrons

Large round table: 10 patrons

Small square table: 4 patrons

Large square table: 8 patrons

The answer should have been in digits

between 0-10,000.

Number of customers seated The number of patrons seated directly

observable (calculate the affected the probability of incompliance.

number of people present) Answer should be in digits between 0-

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 128 10,000.

How many cigarette butts This was a measure of environmental

found between 3 – 10 impact.

meters of either the furthest Answer should be in digits 0-10,000.

chair or roof from the

restaurant?

Cigarettes butts Records prevalence of Gauged the environmental impact of the

around bins cigarette butt littering. smoking ban.

Presence of Records the active Observations of a variable directly

smokers incompliance at the time of related to the study outcomes.

observation at the eatery.

Number of Records the number of Observations of a variable directly

smokers active incompliances at the related to the study outcomes.

time of observation at the

eatery.

CLASSIFICATION OF EATERIES

Following the visit by the study team members, the eateries were classified into the following

three categories according to the definitions as outlined in the table below.

Category Definition

Air-conditioned Eateries situated within a sheltered permanent site such as a within

permanent structure a building or a row of shops and were air-conditioned or partially

air-conditioned

Non-air-conditioned Eateries situated within a sheltered permanent site such as within a

permanent structure building or a row of shops but were not air-conditioned.

Non-air-conditioned Eateries situated in temporary/ ramshackle/ mobile structures such

non-permanent as in wooden shacks

structure

TRAINING SESSIONS AND CONTENT

The training session was 3 hours long and consisted of the following components:

Explaining to the data collectors:

1. The purpose of the study

2. The procedures of data collection:

a. Safety procedures: gloves and surgical masks were to be used at all times of the

data collection. Also, investigators were to leave the site in the event of conflict at the

eatery.

b. Familiarisation of the digital platform of data collection: trainers briefed

investigators on the questions asked in the report form (available on the digital

platform), and carried out a mock session of filling in the report form.

c. Parameters assessment: trainers taught investigators to determine the parameters of

the data collection, i.e. within three metres away from the outermost table/chair and

ten metres.

d. Cigarette butt determination: trainers taught investigators to determine what

constitutes a cigarette butt, using pictorial samples whenever possible.

e. The collection of cigarette butts: trainers taught investigators on picking up

cigarette butts (using gloves), and the capturing of photos as evidence.

OBSERVATIONAL AREA OF NUMBER OF CIGARETTE BUTTS

The definition of the 3 to 10 metre area surrounding eatery where cigarette butts were to be

collected to assess the environmental burden was as depicted below:

DEFINITION OF A CIGARETTE BUTT

For the purposes of the study, one cigarette butt was defined to fit any one of the following

images visually described below:

MEMBERS OF THE STUDY TEAM

Members of the study team consisted of:

 Abd Rahim, Intisar Nuha

 Abd Hamid, Dr Muhammad Hairul Nizam

 Abu Jazid Javis, Dr Nazlinda

 Chew, Wan Ling

 Choo, Siew Li

 Fernandez, Calvin

 Harun, Haniz Latiffa

 Hassan, Dr Aryana

 Junazli, Nadia Inez

 Kim, Wai Parn

 Lee, Xin Yun

 Low, Kenneth Kien Yong

 M., Dr Murallitharan

 Ng, Jefferson Kai Qiang

 Ng, Krystal Lu Shin

 Ong, Shi Joe

 Pillai, Navi Indran

 Rajenthiran, Shamenee

 Thoo, Mandy

COMPLIANCE OF EATERIES TO CONTROL OF TOBACCO PRODUCT (AMENDMENT) REGULATIONS 2018 A CROSS SECTIONAL STUDY IN THE FEDERAL TERRITORIES OF KUALA LUMPUR, PUTRAJAYA AND THE STATE OF SELANGOR 134 National Cancer Society Malaysia, No. 66, Jln Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia T: 03 2698 7300 F: 03 2698 4300 E: [email protected]

www.cancer.org.my

National Cancer ncsmalaysia nationalcancer National Cancer Society Malaysia societymy Society of Malaysia

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