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At the society level, direct costs are estimated from public and private medical costs of treating cigarette-related diseases. According to a study reported by Bernama in 2007, three smoking-related diseases – ischemic heart disease, lung cancer and chronic obstructive pulmonary disease – consumed about RM3.5bil of Malaysia’s healthcare budget. 5. More importantly, a 2007 study demonstrated that retailer compliance with laws limiting sales to minors appears to be significant in reducing youth access to cigarettes. In fact, the Government’s 2012 International Tobacco Control Report stated that tobacco taxes and prices have not increased at a rate high enough to offset income growth, so cigarettes are becoming more affordable to consumers. We must persist with the Government’s recommendation that the price be kept high through taxation as this works as a measure to help smokers quit and also as a deterrent to young people. As a nation, we simply cannot turn our backs on the responsibility of protecting our youths and children from any threat to their lives. Evidence from several studies suggest that the observed decline in many countries in coronary heart disease mortality, one of the most important non-communicable diseases in terms of burden of disease, is through prevention rather than treatment. This means mitigating risk factors such as tobacco use.

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Drug and Alcohol Dependence Much less is known about the effects of smoking on subcortical regions. We compared smokers and non-smokers on regional subcortical volumes, and predicted that smokers demonstrate greater age-related volume loss across subcortical regions than non-smokers. Non-smokers (n = 43) and smokers (n = 40), 22–70 years of age, completed a 4 T MRI study. Bilateral total subcortical lobar white matter (WM) and subcortical nuclei volumes were quantitated via FreeSurfer. In smokers, associations between smoking severity measures and subcortical volumes were examined. Smokers demonstrated greater age-related volume loss than non-smokers in the bilateral subcortical lobar WM, thalamus, and cerebellar cortex, as well as in the corpus callosum and subdivisions. In smokers, higher pack-years were associated with smaller volumes of the bilateral amygdala, nucleus accumbens, total corpus callosum and subcortical WM. Results provide novel evidence that chronic smoking in adults is associated with accelerated age-related volume loss in subcortical WM and GM nuclei. Greater cigarette quantity/exposure was related to smaller volumes in regions that also showed greater age-related volume loss in smokers.

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