The pattern in prevalence and sociodemographic factors of smoking in Malaysia, 2011-2019: Findings from national surveys.

INTRODUCTION: Smoking is a major contributor to morbidity and mortality worldwide, with Malaysia no exception. Through the Ministry of Health and other ministries in the government of Malaysia, numerous anti-smoking measures have been introduced to prevent and control smoking in the country. Continuous monitoring of smoking prevalence in the community is essential in order to evaluate the effectiveness of anti-smoking policies. This study aims to update the sociodemographic factors associated with smoking in the past decade in Malaysia. METHODS: The study utilized data from three national household surveys in Malaysia, namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. These surveys adopted a multistage stratified sampling design that represents the population in Malaysia. Smoking status was determined based on the GATS protocol and definitions. Complex sample design estimates and complex multivariable logistic regression were used in the analysis. RESULTS: A total of 4250, 21410 and 11111 respondents aged ≥15 years participated in GATS 2011, NHMS 2015 and NHMS 2019, respectively, with a response rate between 85% and 87%. The prevalence of smoking was 23.1% (95% CI: 21.2-25.2) in 2011, 22.8% (95% CI: 21.9-23.8) in 2015 and 21.3% (95% CI: 19.9-22.8) in 2019. The prevalence was consistently higher in males (40.5-43.9%), adults aged 25-44 years (25.4-29.0%), Malay (22.6-24.7%), other ethnicities (30.0-35.0%), and the self-employed (33.7-44.6%). Multiple logistic regression analysis showed that the adjusted odds ratio (AOR) of smoking was higher in males, in younger and middle age groups, Malays, and those with lower education level. CONCLUSIONS: There were slight changes in the sociodemographic factors of smoking in the past decade in Malaysia. Stern measures and more aggressive strategies are needed to address all the risk factors in controlling smoking behavior in the country.

Small/Kiddie Cigarette Packaging Size and Its Impact on Smoking: A Systematic Review.

Background: Small cigarette pack sizes contain less than 20 cigarette sticks in a pack. Smaller packs may suggest lower costs, increasing affordability among lower-income users, especially the younger generation, which could lead to tobacco-related diseases and economic costs, including human capital lost results from tobacco-attributable morbidity and mortality. This concern has caused many countries to ban the sale of single cigarette sticks or kiddie packs. However, small cigarette pack sizes were proposed recently to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. This would demean efforts in combating tobacco consumption based on the existing tobacco control policies to prevent minors from purchasing cigarettes. Given the competing influences of affordability and availability of tobacco on consumption and the dearth of evidence-based review on the impact of pack size on smoking, this systematic review was conducted to identify the link between kiddie packs and smoking specifically on the initiation of smoking, urge/tendency to buy cigarettes among the general population and attempt to reduce cigarette consumption and prevalence of smoking using kiddie packs among current smokers. Methods: We include all studies except for reviews, guidelines, conference papers, commentaries, editorials, or opinion pieces. A database search was conducted in PubMed, EMBASE, CENTRAL, Web of Science and Scopus on 27 November 2021. The results were presented in the form of narrative synthesis under four groups: initiation of smoking; urge/tendency to buy cigarettes; the prevalence of smoking, and attempt to reduce cigarette consumption. The literature search identified 1601 articles, of which 21 articles had met the inclusion criteria. The methodological quality of all included articles was determined using a validated 16-item quality assessment tool (QATSDD). The average quality score for all papers was 34.8%. Discussion: Given the diverse study settings of the articles and despite the challenges of the methodological quality of some articles, this review provides some evidence that kiddie packs may increase the urge/tendency to buy cigarettes and mixed evidence on the attempt to reduce cigarette consumption. This review also found some evidence that kiddie pack purchasing among teenage smokers was higher compared to adults. However, we are uncertain about the link between kiddie packs and smoking initiation. Nevertheless, since most studies were of low quality, further high-quality studies are needed to conclude about the impact of kiddie packs on smoking to assist the policymakers and stakeholders in formulating new policies and strengthening existing strategies related to the kiddie packs.

Findings from a Nationwide Study on Alcohol Consumption Patterns in an Upper Middle-Income Country.

Alcohol consumption is a risk factor for various diseases, especially non-communicable diseases (NCDs) and injuries. The reduction of the harmful use of alcohol is mentioned in Target 3.5 of the Sustainable Developmental Goals (SDG). This study aimed to determine factors associated with current alcohol drinking among Malaysians aged 15 years and above. Data from the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional nationwide survey using a two-stage stratified random sampling design, was used. Current alcohol drinking was defined as having consumed any alcoholic beverage in the past 12 months. Descriptive statistics and multiple logistic regression analysis were employed. The prevalence of current drinkers was 11.5%; 95% CI: 9.8, 13.5. The majority (65%) consumed alcoholic beverages in Category 2, which is mainly beer. Current drinkers consumed alcohol mostly once a month (59.0%), one or two drinks (71.1%), on a typical day. Most respondents had six or more drinks less than once a month (27.6%). Sex, age, ethnicity, education, employment, and smoking were found to be significantly associated with current alcohol drinking. Marital status, locality of residence, and household income were not significantly associated. Alcohol drinking is a problem among certain vulnerable groups and should be tackled appropriately.

Anemia among Men in Malaysia: A Population-Based Survey in 2019.

This study aimed to determine the prevalence of anemia and factors associated with anemia among men in Malaysia. The researchers used data from the 2019 National Health and Morbidity Survey (NHMS). The hemoglobin levels of men aged 15 years and above who gave their consent was measured using the HemoCue® Hb 201+ System©. The majority of them (87.2%) were men aged 15-59 years, referred to as the younger age group in this study. The prevalence of anemia among men was 12.6% (95% confidence interval (CI): 10.9, 14.5). The prevalence was higher among older men (30.7%; 95% CI: 26.6, 35.1) than younger men (10.0%; 95% CI: 8.2, 12.2). Anemia among men was associated with older age (adjusted odds ratios (aOR) = 3.1; 95% CI: 2.1, 4.4) and those with diabetes (aOR = 1.5; 95% CI: 1.2, 2.1) via a logistic regression analysis. In conclusion, older men were more affected by anemia than younger men in this study. Anemia among older men in Malaysia is at the level of moderate to severe public health significance. The likelihood of developing anemia is increased among older men with diabetes compared to older men without diabetes. These often-overlooked issues among men need to be detected and treated early in order to prevent complications and improve their quality of life.

The Implementation of Childhood Obesity Related Policy Interventions in Malaysia-A Non Communicable Diseases Scorecard Project.

(1) Background: The prevalence of overweight and obesity among children has increased tremendously in the ASEAN region, including Malaysia. In Malaysia, the National Strategic Plan for Non-Communicable Diseases (2015-2025) provides the overall framework for its response to the non-communicable diseases (NCD) epidemic. Preventing childhood obesity is one of the key strategies for early intervention to prevent NCDs. The objective of this research is to examine the current status of policy interventions in addressing childhood obesity in Malaysia. (2) Methods: A panel of 22 stakeholders and experts from Malaysia, representing the government, industry, academia and non-governmental organizations, were sampled using a modified Delphi technique. Data were collected using a modified NCD scorecard under four domains (governance, risk factors, surveillance and research and health systems response). A heat map was used to measure the success of the four realms of the NCD scorecard. For each domain of the NCD scorecard, the final score was grouped in quintiles. (3) Results: A total of 22 participants responded, comprising of eight (36.4%) males and 14 (63.4%) females. All the domains measured in implementing policies related to childhood obesity were of low progress. Nine governance indicators were reported as 22.5% (low progress), four in the risk factors domain, and two in the surveillance. This shows that timely and accurate monitoring, participatory review and evaluation, and effective remedies are necessary for a country's surveillance system. (4) Conclusion: Although Malaysia has published several key strategic documents relating to childhood obesity and implemented numerous policy interventions, we have identified several gaps that must be addressed to leverage the whole-of-government and whole-of-society approach in addressing childhood obesity in the country.

Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017.

BACKGROUND: Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia. METHODS: This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied. RESULTS: The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7). CONCLUSION: Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.

Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study.

BACKGROUND: The prevalence of chronic kidney disease (CKD) in Malaysia was 9.07% in 2011. We aim to determine the current CKD prevalence in Malaysia and its associated risk factors. METHODS: A population-based study was conducted on a total of 890 respondents who were representative of the adult population in Malaysia, i.e., aged ≥18 years old. Respondents were randomly selected using a stratified cluster method. The estimated glomerular filtration rate (eGFR) was estimated from calibrated serum creatinine using the CKD-EPI equation. CKD was defined as eGFR < 60 ml/min/1.73m2 or the presence of persistent albuminuria if eGFR ≥60 ml/min/1.73m2. RESULTS: Our study shows that the prevalence of CKD in Malaysia was 15.48% (95% CI: 12.30, 19.31) in 2018, an increase compared to the year 2011 when the prevalence of CKD was 9.07%. An estimated 3.85% had stage 1 CKD, 4.82% had stage 2 CKD, and 6.48% had stage 3 CKD, while 0.33% had stage 4-5 CKD. Hypertension (aOR 3.72), diabetes mellitus (aOR 3.32), increasing BMI (aOR 1.06), and increasing age (aOR 1.06) were significantly associated with CKD. CONCLUSION: Our study has shown that CKD has become one of the leading public health issues in Malaysia. Thus, there is an urgent need to screen for CKD and prevent its progression, associated morbidity, and mortality at the national level.

A systematic review protocol on small/kiddie cigarette packaging size and its impact on smoking.

BACKGROUND: Small/kiddie cigarette packs consist of less than 20 cigarette sticks. Kiddie packs were recently proposed to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. By reintroducing kiddie packs, cigarettes will inevitably be more affordable and this would appeal to lower-income consumers especially teens. In this systematic review, we aimed to identify the impact of kiddie packs on smoking, specifically on smoking initiation, the urge/tendency to buy cigarettes and attempts to reduce cigarette consumption. METHODS: This systematic review will be based on the review of original articles on the impact of kiddie packs on smoking. There is no restriction on the publication dates. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science and Scopus will be searched to retrieve potential original articles. Additional records identified through other sources: Google Scholar, as well as Journal of Substance Use and Tobacco Control, are also to be searched. These will include original articles in any language which included all study designs (randomised controlled trials, quasi experimental and experimental studies, observational cross-sectional and cohort studies) comparing kiddie packs with regular cigarette packs. The primary outcomes of interest will be initiation of smoking and urge/tendency to buy cigarettes in the general population and attempts to reduce cigarette consumption among current smokers. Secondary outcomes will be the prevalence of smoking using kiddie packs among the current smokers. DISCUSSION: This systematic review will provide evidence to support the impact of kiddie packs on smoking in terms of smoking initiation, smoking prevalence, urge/tendency to purchase cigarettes and attempts to reduce cigarette consumption. The findings from this review could be helpful to policymakers in regulating kiddie packs to control the consumption of tobacco. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018102325.

Prevalence and Factors Associated With Physical Abuse at Home Among School-Going Adolescents in Malaysia: A Population-Based Nationwide Study.

We assessed the current situation of physical abuse among adolescents at home in Malaysia. A total of 27 497 school-going adolescents answered a self-administered questionnaire during the Malaysian National Health and Morbidity Survey 2017. A complex sampling analysis was applied to identify factors associated with physical abuse among adolescents using multivariate logistic regression analysis. The prevalence of physical abuse at home among students was 11.8%. Our result shows that adolescents aged 13 years had significantly higher odds of such abuse, with odds decreasing as the adolescents age. Girls and adolescents from Indian ethnicity (minority ethnic group) had higher odds of such abuse. Other associated factors were mental health problems, substance abuse, and problems at school. Physical abuse among adolescents at home should be countered with appropriate measures.

Body Weight, Body Weight Perception, and Bullying Among Adolescents in Malaysia.

Body weight is a factor, with body weight perception a mediator, toward being a victim of bullying. This study aimed to explore the association between body weight, body weight perception, and bullying among students 13 to 17 years of age in Malaysia. Data were collected using a self-administered questionnaire. A 2-stage stratified cluster sampling design was used, and 212 schools across Malaysia were selected for this survey. Body weight was measured and body weight perception was the student's reflection of their body weight. The prevalence of being bullied among adolescents in Malaysia was 16.2%. Being too thin or being obese increased the probability of being bullied. Students with a normal body mass index, but with a misperception of their body weight, also had increased odds of being bullied. Obesity prevention, together with instilling positive body weight perception, should be part of all programs directed toward tackling the problem of bullying.

Factors Associated With E-Cigarette Usage and the Reasons for Initiation Among Malaysian Adolescents.

Electronic cigarettes (e-cigarettes) are handheld devices that deliver an aerosol by heating a solution made up of propylene glycol and/or glycerol with or without flavoring agents and nicotine. This nationwide cross-sectional survey examined factors associated with e-cigarette usage and reasons for its initiation among 13 162 Malaysian adolescents. Data from TECMA (Tobacco and E-Cigarette Survey among Malaysian Adolescents) were used. Nine percent of adolescents had used e-cigarettes in the past month. Males (adjusted odds ratio [aOR] = 4.08; 95% confidence interval [CI] = 3.36-4.95), 16 to 19 year olds (aOR = 2.64; 95% CI = 2.13-3.26), Malays (aOR = 2.25; 95% CI = 1.79-2.83), Sabah and Sarawak Bumiputeras (aOR = 2.25; 95% CI = 1.61-3.15), and cigarette smokers (aOR = 13.16; 95% CI = 11.14-15.54) were more likely to use e-cigarettes. Three main reasons for e-cigarette initiation among adolescents were its taste and smell, experimentation, and popularity. Sale of e-cigarettes with or without nicotine to people aged younger than 18 years should be banned. Flavored e-cigarettes should also be banned since there is evidence suggesting increased appeal among the younger generation.

Prevalence of Nonfatal Serious Injury Due to Motor Vehicle Accidents Among Malaysian School-Going Adolescents: Findings From the Adolescent Health Survey 2017.

Serious injury due to motor vehicle accidents (MVAs) significantly contributes to the adolescents' health status. The objective of this study was to estimate the prevalence of nonfatal injury due to MVAs and its associated factors among Malaysian school-going adolescents. Nationally representative samples were selected via 2-stage stratified cluster sampling. Data was collected using a validated self-administered questionnaire. Logistic regression analysis was conducted to examine the associations between the variables. A total of 1088 out of 27 497 adolescents reported that they had sustained serious injury due to MVAs with a prevalence of 4.1% (95% confidence interval [CI] = 3.7-4.5). Serious injury due to MVAs among adolescents was positively associated with being current cigarette smokers (adjusted odds ratio [aOR] = 2.5; 95% CI = 2.2-2.9), followed by Malay ethnicity (aOR = 2.4; 95% CI = 1.9-3.0), current drug users (aOR = 2.3; 95% CI = 1.9-3.0), boys (aOR = 2.1; 95% CI = 1.8-2.4), Indian ethnicity (aOR = 1.8; 95% CI = 1.2-2.5), and those who were in upper secondary school (aOR = 1.3; 95% CI = 1.2-1.5). Targeted intervention and curbing substance use among boys may reduce the morbidities from MVAs and its resulting complications.

Cigarette Smoking Among Secondary School-Going Male Adolescents in Malaysia: Findings From the National Health and Morbidity Survey 2017.

Smoking is a learned behavior during adolescence, and it is found predominantly among male adolescents in Malaysia. Our study aimed to investigate the prevalence and predictive factors of current cigarette smoking among school-going male adolescents in Malaysia. Data were derived from the National Health and Morbidity Survey: Adolescent Health Survey 2017, a cross-sectional study that utilized a 2-stage stratified cluster sampling to select a nationally representative sample of school-going adolescents in Malaysia (n = 27 497). Multiple logistic regression analysis was performed to identify factors associated with current cigarette smoking among male adolescents in Malaysia. Male adolescents aged 16 to 17 years (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.41-1.70), current illicit drug users (AOR = 8.14; 95% CI = 6.37-10.41), current alcohol users (AOR = 1.92; 95% CI = 1.65-2.23), those from rural schools (AOR = 1.60; 95% CI = 1.46-1.76), those whose parents were widowed/divorced/separated (AOR = 1.37; 95% CI = 1.21-1.55), and those whose parents/guardians were tobacco product users (AOR = 3.47; 95% CI = 2.33-5.16) were more likely to be current cigarette smokers. Tobacco control strategies should be aimed at both adolescents at risk and at promoting parental smoking cessation.

Bullying Victimization Among School-Going Adolescents in Malaysia: Prevalence and Associated Factors.

This study aimed to assess the prevalence and factors associated with bullying victimization from a nationwide school-based survey among 27 458 students aged 13 to 17 years. The overall prevalence of having been bullied in the past 30 days was 16.2%; this decreased with age. Multivariate logistic regression analysis revealed that factors most strongly associated with bullying victimization were exposure to physical attacks (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 2.17-2.79), illicit drug use (aOR = 2.44, 95% CI = 1.78-3.34), involvement in physical fights (aOR = 1.97, 95% CI = 1.74-2.23), being younger than 14 years (aOR =1.95, 95% CI = 1.59-2.38), and having ever attempted suicide (aOR = 1.83, 95% CI = 1.51-2.21). Other significantly associated factors include loneliness, truancy, making suicidal plans, and symptoms of depression, anxiety, and stress. Exposure to bullying victimization can result in negative lifelong sequelae and important associated factors should be considered in planning effective school-based anti-bullying interventions.

Risk Factors for Illicit Drug Use Among Malaysian Male Adolescents.

This study was carried out to determine the prevalence of illicit drug use and its associated factors among male adolescents in Malaysia. Data of 13 135 adolescents were extracted from the National Health and Morbidity Survey 2017, a cross-sectional survey among school-going adolescents in Malaysia aged between 13 and 17 years, using a 2-stage stratified cluster sampling. A complex sample design analysis and multiple logistic regression analysis were applied. The overall prevalence of lifetime illicit drug use among male adolescents was 6.6%. The multivariable model showed that illicit drug use among male adolescents were associated with younger age, rural school area, marital status of parent, current smoker, ever having sex, truancy, involved in physical fight, and lack of peer support. The findings from this study can assist community and relevant authorities in their efforts to combat illicit drug usage among adolescents using intervention programs that diminishes risk factors and enhances the protective factors.

Cessation of E-Cigarette Use Among Adolescents and Its Associated Factors.

We assessed the prevalence of cessation of e-cigarette and its associated factors among adolescents in Malaysia. This study analyzed data from the Tobacco and E-Cigarette Survey among Malaysian Adolescent (TECMA) in 2016, a cross-sectional study with 2-stage stratification cluster sampling. A total of 14 832 school-going adolescents aged 10 to 19 years participated in this survey. A complex sampling design and multiple logistic regression analysis were applied. Nearly half of the adolescents (49.9%; 95% confidence interval [CI] = 44.9-55.0) who had ever used e-cigarette ceased the usage. Based on multivariate analysis, adolescents were more likely to quit e-cigarette because they could not afford the e-cigarette (adjusted odds ratio [aOR] = 2.39, 95% CI = 1.78-3.20), if they are aged 13 year and older (aOR = 1.80, 95% CI = 1.25-2.61), and those who claimed their e-cigarette does not contain nicotine (aOR = 1.35, 95% CI = 1.03-1.78). E-cigarette prevention efforts among adolescents could consider the cessation factors described in this study.