Diagnostic performance of Xpert MTB/RIF ultra in detecting Mycobacterium tuberculosis and Rifampicin Resistance in AFB Smear-negative Pulmonary and Extrapulmonary Tuberculosis samples in Malaysia.

Rapid and highly accurate diagnostic tools are critically needed to diagnose Mycobacterium tuberculosis and rifampicin resistance in AFB smear-negative samples. In this study, we evaluated the diagnostic performance of Xpert MTB/RIF Ultra (Ultra) as a rapid test to diagnose tuberculosis in smear-negative cases in Malaysia. A retrospective study of 1960 smear-negative pulmonary and extrapulmonary samples obtained from patients was conducted. Culture was used as the reference standard for the study. The overall sensitivity and specificity of Ultra on the tested samples were 88.7 % and 77.2 %, respectively, while the PPV was 32.3 % and the NPV was 98.2 %. Ultra showed slightly higher sensitivity in pulmonary (89.9 %) compared to extrapulmonary samples (86.1 %). The overall accuracy of Ultra was 78.5 % (kappa=0.37; 95 %CI: 0.32,0.42). Ultra showed good diagnostic accuracy for detecting MTB and rifampicin resistance in various AFB smear-negative samples. Ultra also had excellent capability in rifampicin resistance detection.

The effects of the COVID-19 pandemic on dengue cases in Malaysia.

Background: Globally, the COVID-19 pandemic has affected the transmission dynamics and distribution of dengue. Therefore, this study aims to describe the impact of the COVID-19 pandemic on the geographic and demographic distribution of dengue incidence in Malaysia. Methods: This study analyzed dengue cases from January 2014 to December 2021 and COVID-19 confirmed cases from January 2020 to December 2021 which was divided into the pre (2014 to 2019) and during COVID-19 pandemic (2020 to 2021) phases. The average annual dengue case incidence for geographical and demographic subgroups were calculated and compared between the pre and during the COVID-19 pandemic phases. In addition, Spearman rank correlation was performed to determine the correlation between weekly dengue and COVID-19 cases during the COVID-19 pandemic phase. Results: Dengue trends in Malaysia showed a 4-year cyclical trend with dengue case incidence peaking in 2015 and 2019 and subsequently decreasing in the following years. Reductions of 44.0% in average dengue cases during the COVID-19 pandemic compared to the pre-pandemic phase was observed at the national level. Higher dengue cases were reported among males, individuals aged 20-34 years, and Malaysians across both phases. Weekly dengue cases were significantly correlated (ρ = -0.901) with COVID-19 cases during the COVID-19 pandemic. Conclusion: There was a reduction in dengue incidence during the COVID-19 pandemic compared to the pre-pandemic phase. Significant reductions were observed across all demographic groups except for the older population (>75 years) across the two phases.

Prevalence and Determinants of Depressive Symptoms among Young Adolescents in Malaysia: A Cross-Sectional Study.

Depression is the most common mental health problem affecting adolescents globally, wherein its increasing prevalence together with the negative health impacts escalates the need for further research in this area. This work determined the prevalence and factors associated with depressive symptoms among young adolescents in Malaysia. A total of 1350 adolescent aged 13 to 14 years in school across nine secondary schools in Selangor state, Malaysia participated in a cross-sectional study. Independent variables were examined using the using the Global School-Based Student Health Survey included age, gender, ethnicity, alcohol intake, smoking and illicit drug use, loneliness, bullying, parental marital status, income and supervision; and the Health Literacy and Stigma questionnaire examined mental health literacy levels. Depressive symptoms were the dependent variable which was examined using the Center for Epidemiology Study Depression (CESD) instrument. Prevalence of depressive symptoms among all participants was 19 % (95% CI [16.9, 21.2]), with a higher prevalence of depressive symptoms being reported among females 26.3% (95% CI [23.0, 29.8]) compared to males 11.7% (95% CI [9.4, 14.4]). Determinants namely females (AOR = 3.83; 95% CI [2.66, 5.52]), smoking (AOR = 6.16; 95% CI [3.15, 12.05]), been bullied (AOR = 3.70; 95% CI [2.51, 5.47]), felt lonely (AOR = 10.46; 95% CI [7.09, 15.42]) and having no parental supervision (AOR = 1.79; 95% CI [1.26, 2.53]) significantly increased the odds of depressive symptoms among all adolescents in the multivariate model. In addition, feeling lonely, being bullied and smoking were identified as common significant determinants of depressive symptoms across both genders. Feeling lonely (65% to 71%) and being bullied (10% to 19%) were ranked as the most important determinants of depressive symptoms among young adolescents. Tackling these factors would be instrumental in helping decision makers formulate depression prevention strategies and activities for adolescents.

Development and user testing study of MozzHub: a bipartite network-based dengue hotspot detector.

Traditionally, dengue is controlled by fogging, and the prime location for the control measure is at the patient's residence. However, when Malaysia was hit by the first wave of the Coronavirus disease (COVID-19), and the government-imposed movement control order, dengue cases have decreased by more than 30% from the previous year. This implies that residential areas may not be the prime locations for dengue-infected mosquitoes. The existing early warning system was focused on temporal prediction wherein the lack of consideration for spatial component at the microlevel and human mobility were not considered. Thus, we developed MozzHub, which is a web-based application system based on the bipartite network-based dengue model that is focused on identifying the source of dengue infection at a small spatial level (400 m) by integrating human mobility and environmental predictors. The model was earlier developed and validated; therefore, this study presents the design and implementation of the MozzHub system and the results of a preliminary pilot test and user acceptance of MozzHub in six district health offices in Malaysia. It was found that the MozzHub system is well received by the sample of end-users as it was demonstrated as a useful (77.4%), easy-to-operate system (80.6%), and has achieved adequate client satisfaction for its use (74.2%).

Validation of the Malay Version of the Decisional Balance Inventory (MDBI) among secondary school-going adolescents.

INTRODUCTION: The Decisional Balance Inventory is a tool used to measure propensity to maintain or change a habit which takes into consideration the perceived advantages and disadvantages. This study aimed to establish the validity and reliability of a Malay language version of the DBI for assessing inclination for change in smoking behavior among secondary school-going adolescents in Malaysia. METHODS: We administered the MDBI to 669 secondary school students selected through multistage sampling. The sample consisted of 60.1% male (n=398) and 39.9% (n=264) female students, more than two-thirds (69.9%, n=463) of which were from rural areas. The majority of the respondents were aged 13-14 years [13 years, 36.4% (n=241), 14 years, 40.0% (n=265), 16 years, 23.6% (n=156)]. The construct validity of the MDBI was assessed using explanatory (EFA) and confirmatory factor analysis (CFA), and the reliability of the MDBI via Cronbach's alpha. RESULTS: EFA and parallel analysis extracted three factors in the MDBI that accounted for 65.4% of the observed variance, and this was supported by CFA. Internal consistency of the three factors ranged from 0.734 to 0.867, indicating acceptable reliability. CONCLUSIONS: The MDBI has good psychometric properties and is suitable for measuring smoking intention among Malaysian secondary school-going adolescents. However, it should continue to be tested to expand its usefulness and applicability among adolescents in other sociodemographic settings.

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.

Correlates of dual/poly tobacco use among school-going adolescents in Malaysia: Findings from a nationwide school-based study.

INTRODUCTION: Dual/poly tobacco use is common among youths globally. However, in Malaysia information on dual/poly tobacco use is scarce, thus the present study examines the prevalence and factors associated with dual/poly tobacco users among school-going adolescents in Malaysia. METHODS: We derived data on tobacco and e-cigarette use among Malaysian adolescents from a nationwide school-based study conducted in 2016. A total of 13135 adolescents responded in the cross-sectional survey which used multi-stage sampling to select a representative sample of school-going adolescents aged 11-19 years. A standard validated questionnaire was used to obtain the data and multiple logistic regression was conducted to assess factors associated with dual/ poly tobacco use. RESULTS: The prevalence of dual/poly tobacco use was 6.5%, more than half of which were both conventional and e-cigarette users. Multivariable logistic regression revealed that the likelihood of dual tobacco use was significantly higher among males (AOR=14.73; 95% CI: 9.11-23.81), secondary school students, those aged 16-19 years (AOR=5.99; 95% CI: 4.04-8.87), natives of Sabah (AOR=7.41; 95% CI: 3.48-15.79), and those never been taught on the health hazards of tobacco at school, exposed to secondhand smoke (SHS) at home, school or other public areas, and had a positive perception of e-cigarettes and lower perception of the harms of tobacco smoking. CONCLUSIONS: Although the prevalence of dual/poly users was still low among Malaysian school-going adolescents, proactive measures should be taken to reduce dual tobacco use among youth in Malaysia with focus on the factors identified in this study.

Assessment of association between smoking and all-cause mortality among Malaysian adult population: Findings from a retrospective cohort study.

INTRODUCTION: Smoking is a known risk factor for many chronic diseases. Illness and death due to smoking are a significant public health burden in many countries. This study aims to address the information gap in smoking-related mortality in Malaysia by estimating the risk of cardiovascular disease and all-cause mortalities due to smoking among Malaysian adults. METHODS: We analyzed data on 2525 respondents, aged 24-64 years, of the Malaysian Non-Communicable Disease Surveillance survey conducted September 2005 to February 2006. Mortality records from the Malaysian National Registration Department were linked to the MYNCDS-1 data to determine respondents' mortality status over 12 years from 2006 to 2018. Associations between smoking and all-cause mortalities were assessed using Cox proportional hazards regression with adjustments for non-communicable disease and sociodemographic and lifestyle factors. RESULTS: The prevalence of daily smoking was 21.2% (95% CI: 19.0-23.7). During the 31668 person-years follow-up, 213 deaths from all causes occurred, where 68 deaths were among smokers (13.2%), and 452 were among non-smokers (6.3%). Smoking was associated with a significantly increased risk of all-cause mortality (adjusted hazard ration, AHR=1.79; 95% CI: 1.12- 2.97). These associations remained significant after excluding mortalities in the first two years of follow-up. CONCLUSIONS: Daily smoking is associated with a significantly higher risk of all-cause death. Behavioral and pharmacological smoking cessation interventions should be intensified among smokers to reduce the risk of mortality.

COVID-19 in Malaysia: Descriptive Epidemiologic Characteristics of the First Wave.

This study aimed to describe the characteristics of COVID-19 cases and close contacts during the first wave of COVID-19 in Malaysia (23 January 2020 to 26 February 2020), and to analyse the reasons why the outbreak did not continue to spread and lessons that can be learnt from this experience. Characteristics of the cases and close contacts, spatial spread, epidemiological link, and timeline of the cases were examined. An extended SEIR model was developed using several parameters such as the average number of contacts per day per case, the proportion of close contact traced per day and the mean daily rate at which infectious cases are isolated to determine the basic reproduction number (R0) and trajectory of cases. During the first wave, a total of 22 cases with 368 close contacts were traced, identified, tested, quarantine and isolated. Due to the effective and robust outbreak control measures put in place such as early case detection, active screening, extensive contact tracing, testing and prompt isolation/quarantine, the outbreak was successfully contained and controlled. The SEIR model estimated the R0 at 0.9 which further supports the decreasing disease dynamics and early termination of the outbreak. As a result, there was a 11-day gap (free of cases) between the first and second wave which indicates that the first wave was not linked to the second wave.

Assessing the Spatiotemporal Spread Pattern of the COVID-19 Pandemic in Malaysia.

Introduction: The unprecedented COVID-19 pandemic has greatly affected human health and socioeconomic backgrounds. This study examined the spatiotemporal spread pattern of the COVID-19 pandemic in Malaysia from the index case to 291,774 cases in 13 months, emphasizing on the spatial autocorrelation of the high-risk cluster events and the spatial scan clustering pattern of transmission. Methodology: We obtained the confirmed cases and deaths of COVID-19 in Malaysia from the official GitHub repository of Malaysia's Ministry of Health from January 25, 2020 to February 24, 2021, 1 day before the national vaccination program was initiated. All analyses were based on the daily cumulated cases, which are derived from the sum of retrospective 7 days and the current day for smoothing purposes. We examined the daily global, local spatial autocorrelation and scan statistics of COVID-19 cases at district level using Moran's I and SaTScan™. Results: At the initial stage of the outbreak, Moran's I index > 0.5 (p < 0.05) was observed. Local Moran's I depicted the high-high cluster risk expanded from west to east of Malaysia. The cases surged exponentially after September 2020, with the high-high cluster in Sabah, from Kinabatangan on September 1 (cumulative cases = 9,354; Moran's I = 0.34; p < 0.05), to 11 districts on October 19 (cumulative cases = 21,363, Moran's I = 0.52, p < 0.05). The most likely cluster identified from space-time scanning was centered in Jasin, Melaka (RR = 11.93; p < 0.001) which encompassed 36 districts with a radius of 178.8 km, from November 24, 2020 to February 24, 2021, followed by the Sabah cluster. Discussion and Conclusion: Both analyses complemented each other in depicting underlying spatiotemporal clustering risk, giving detailed space-time spread information at district level. This daily analysis could be valuable insight into real-time reporting of transmission intensity, and alert for the public to avoid visiting the high-risk areas during the pandemic. The spatiotemporal transmission risk pattern could be used to monitor the spread of the pandemic.

Effectiveness of the movement control measures during the third wave of COVID-19 in Malaysia.

OBJECTIVES: Starting in March 2020, movement control measures were instituted across several phases in Malaysia to break the chain of transmission of coronavirus disease 2019 (COVID-19). In this study, we developed a susceptible-exposed-infected-recovered (SEIR) model to examine the effects of the various phases of movement control measures on disease transmissibility and the trend of cases during the third wave of the COVID-19 pandemic in Malaysia. METHODS: Three SEIR models were developed using the R programming software ODIN interface based on COVID-19 case data from September 1, 2020, to March 29, 2021. The models were validated and subsequently used to provide forecasts of daily cases from October 14, 2020, to March 29, 2021, based on 3 phases of movement control measures. RESULTS: We found that the reproduction rate (R-value) of COVID-19 decreased by 59.1% from an initial high of 2.2 during the nationwide Recovery Movement Control Order (RMCO) to 0.9 during the Movement Control Order (MCO) and Conditional MCO (CMCO) phases. In addition, the observed cumulative and daily highest numbers of cases were much lower than the forecasted cumulative and daily highest numbers of cases (by 64.4-98.9% and 68.8-99.8%, respectively). CONCLUSIONS: The movement control measures progressively reduced the R-value during the COVID-19 pandemic. In addition, more stringent movement control measures such as the MCO and CMCO were effective for further lowering the R-value and case numbers during the third wave of the COVID-19 pandemic in Malaysia due to their higher stringency than the nationwide RMCO.

Association of metabolic syndrome with risk of cardiovascular disease mortality and all-cause mortality among Malaysian adults: a retrospective cohort study.

OBJECTIVES: This study is aimed at determining the association between metabolic syndrome and risk of cardiovascular disease (CVD) mortality and all-cause mortality among Malaysian adults. DESIGN: Retrospective cohort study. SETTING: The Malaysian Non-Communicable Disease Surveillance (MyNCDS-1) 2005/2006. PARTICIPANTS: A total of 2525 adults (1013 men and 1512 women), aged 24-64 years, who participated in the MyNCDS-1 2005/2006. METHODS: Participants' anthropometric indices, blood pressure, fasting lipid profile and fasting blood glucose levels were evaluated to determine the prevalence of metabolic syndrome by the Harmonized criteria. Participants' mortality status were followed up for 13 years from 2006 to 2018. Mortality data were obtained via record linkage with the Malaysian National Registration Department. The Cox proportional hazards regression model was applied to determine association between metabolic syndrome (MetS) and risk of CVD mortality and all-cause mortality with adjustment for selected sociodemographic and lifestyle behavioural factors. RESULTS: The overall point prevalence of MetS was 30.6% (95% CI: 28.0 to 33.3). Total follow-up time was 31 668 person-years with 213 deaths (111 (11.3%) in MetS subjects and 102 (6.1%) in non-MetS subjects) from all-causes, and 50 deaths (33 (2.9%) in MetS group and 17 (1.2%) in non-MetS group) from CVD. Metabolic syndrome was associated with a significantly increased hazard of CVD mortality (adjusted HR: 2.18 (95% CI: 1.03 to 4.61), p=0.041) and all-cause mortality (adjusted HR: 1.47 (95% CI: 1.00 to 2.14), p=0.048). These associations remained significant after excluding mortalities in the first 2 years. CONCLUSIONS: Our study shows that individuals with MetS have a higher hazard of death from all-causes and CVD compared with those without MetS. It is thus imperative to prescribe individuals with MetS, a lifestyle intervention along with pharmacological intervention to improve the individual components of MetS and reduce this risk.

Seroprevalence of diphtheria toxoid IgG antibodies in the Malaysian population.

BACKGROUND: Despite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population. METHODS: A total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (< 0.1 IU/mL) to C. diphtheriae infection. RESULTS: Among the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1-2 years old (0.59 IU/mL) and 6-7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4-6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p < 0.001)], gender [Adults: χ2 = 5.58(df = 1),p = 0.018] and ethnicity [Adults: χ2 = 21.49(df = 5),p = 0.001] with diphtheria toxoid IgG antibody level. CONCLUSIONS: About 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5-6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.

Prevalence and factors related to secondhand smoke exposure among secondary school-going adolescents in Malaysia: Findings from Malaysia Global Health School Survey 2012 and 2017.

INTRODUCTION: Secondhand (SHS) smoke exposure has caused various health problems. Therefore, continuous monitoring of SHS exposure is important to determine the efficacy of various anti-tobacco measure implemented. The study aims to compare the prevalence and factor(s) associated with SHS exposure among secondary school-going adolescents in Malaysia during 2012 and 2017. METHODS: We derived data from the Global School Health Survey (GSHS) 2012 and GSHS 2017, which was carried out in Malaysia using multistage sampling to select representative samples of secondary school-going adolescents. Both surveys used similar questionnaires to measure SHS exposure. Descriptive and multivariate logistic regression was used to determine the prevalence and factors associated with SHS exposure. RESULTS: Approximately four in ten respondents were exposed to SHS in the past week in both surveys (41.5% in GSHS 2012 and 42.0% in GSHS 2017, respectively). Both surveys revealed a significantly higher SHS exposure among respondents who smoked than among non-smokers and higher among males compared to females. The likelihood of SHS exposure in both surveys was also similar, with a higher likelihood of SHS exposure among smoking adolescents and non-smoking adolescents who had at least one smoking parent/guardian, regardless of their own smoking status. Male adolescents had a higher risk of SHS exposure compared to their female counterparts. Meanwhile, SHS risk also increased with age, regardless of smoking status. CONCLUSIONS: Our findings suggested that there were no changes in the prevalence of SHS exposure and recorded only a slight change in the factors associated with exposure to SHS among school-going adolescents in Malaysia between the years 2012 and 2017. A more pro-active, extensive and comprehensive programme should be implemented to address the problem of SHS exposure. Parents should be advised to stop smoking or abstain from smoking in the presence of their children, and smoking cessation interventions are necessary for smoking adolescents and their parents.

Prevalence and factors associated with secondhand smoke exposure among Malaysian adolescents.

INTRODUCTION: Exposure to secondhand smoke (SHS) has been proven to be detrimental to health. However, there is little information on SHS exposure among Malaysian adolescents. This study aims to assess the magnitude of and factors associated with SHS exposure among school-going adolescents in Malaysia. METHODS: We performed secondary analysis on data from 25461 respondents of the Global School Health Survey in Malaysia. Descriptive analyses and multivariable logistic regression were performed to determine factors associated with SHS exposure. RESULTS: Respondents were adolescents of mean age 14.84 (SD=1.45) years, 50.2% of which were male and 49.8% female. Approximately four in ten respondents were exposed to SHS in the past week (41.5%). SHS exposure was significantly higher among respondents who smoked than among non-smokers (85.8% vs 35.7%, p<0.001). The likelihood of exposure to SHS was higher among smoking adolescents (Adjusted OR=1.66, 95% CI: 1.07-2.56) and non-smoking adolescents (AOR=3.15, 95% CI: 1.48-4.71) who had at least one smoking parent/guardian regardless of their own smoking status. Male adolescents had higher risk of SHS exposure compared to their female counterparts (current smoker AOR=1.66, 95% CI: 1.07-2.56; non-smoker AOR=1.50, 95% CI: 1.12-2.00) and increased with age, regardless of their smoking status. CONCLUSIONS: Our findings suggest that prevalence of exposure to SHS among school-going adolescents in Malaysia is high. Parents should be advised to stop smoking or abstain from smoking in the presence of their children. Education programmes are recommended to increase awareness on avoidance of SHS as well as smoking cessation interventions for both adolescents and their parents.

Smoking susceptibility among non-smoking school-going adolescents in Malaysia: findings from a national school-based survey.

OBJECTIVE: The identification of susceptible non-smoking adolescents is an essential step in reducing smoking initiation among adolescents. The aim of this study was to examine the prevalence and factors associated with smoking susceptibility among non-smoking school-going adolescents in Malaysia. DESIGN: Cross-sectional study. SETTING: Primary and secondary schools in Malaysia. PARTICIPANTS: 11 246 non-smoking school-going adolescents. OUTCOME MEASURES: The prevalence and factors associated with smoking susceptibility among non-smoking school-going adolescents in Malaysia. RESULTS: Approximately 14% of non-smokers were susceptible to smoking, and the prevalence of susceptibility was significantly higher among males, ever-smokers and e-cigarette users. The odds of susceptibility to smoking were higher among males, e-cigarette users, those aged 12 years and under and those who had ever smoked or tried cigarettes. Students from schools with educational programmes on the health effects of second-hand smoke (SHS) and who perceived smoking to be harmful were less likely to be susceptible to smoking. CONCLUSION: Smoking susceptibility is prevalent among school-going adolescents. A comprehensive approach that enhances or reinforces health education programmes on the adverse health effects of smoking and SHS among school children, that considers multiple factors and that involves all stakeholders is urgently needed to reduce the prevalence of smoking susceptibility among vulnerable subgroups, as identified from the present findings.

Is the implementation of smoke-free policies at workplaces associated with living in a smoke-free home?: Findings from a national population-based study in Malaysia.

INTRODUCTION: Studies have shown that the implementation of smoke-free policies at workplaces have shifted the social norms towards secondhand smoke (SHS) exposure at home. This study aimed to investigate whether working in a smoke-free workplace is associated with living in a smoke-free home (SFH). METHODS: The data were derived from the Malaysian Global Adult Tobacco Survey (GATS-M), collected in 2011-2012, involving 4250 respondents. Data analyses involved 1343 respondents reported to be in the working population. RESULTS: More than half of the respondents (58.5%) were reportedly working in smoke-free workplaces. Almost a quarter (24.8%) of those who worked in smoke-free workplaces stayed in smoke-free homes, which was more than two times higher than their counterparts who worked at non-smoke-free workplaces (24.8% vs 12.0%, p<0.001). Multivariable analyses further substantiated this finding (AOR=2.01, 95% CI: 1.11-3.61, reference group = worked at non-smoke-free workplaces). CONCLUSIONS: This study found an association between living in smoke-free homes and working at smoke-free workplaces, which could suggest a positive impact of implementing smoke-free workplaces.

Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia.

OBJECTIVES: Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables. DESIGN: Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis. RESULTS: The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas. CONCLUSIONS: The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.

Secondhand smoke (SHS) exposure at home and at the workplace among non-smokers in Malaysia: Findings from the Global Adult Tobacco Survey 2011.

INTRODUCTION: Understanding the prevalence of secondhand smoke (SHS) exposure and the associated factors is beneficial for the formulation of effective measures to reduce exposure to SHS. The purpose of this study was to determine SHS exposure at home and workplace, and its associated factors among non-smoker Malaysian adults. METHODS: Data were extracted from the Global Adult Tobacco Survey-Malaysia (GATS-M) that involved a representative sample of 5112 Malaysian adults. Logistic regression analyses were performed to examine the association between SHS exposure, sociodemographic factors, knowledge on the danger of SHS, and smoking restrictions at home and at work among non-smokers. RESULTS: Among non-smoker Malaysians, age ≥15 years, 27.9% (equivalent to approximately 4.21 million non-smokers) and 33.9% (equivalent to approximately 1.37 million non-smokers) reported that they were exposed to SHS at home and the workplace, at least once a month, respectively. Women (AOR=2.12, 95% CI: 1.61-2.78), young individuals (AOR=3.06, 95% CI: 1.48-6.33), Malays (AOR=2.39, 95% CI: 1.56-3.64) or other Bumiputra ethnic groups (AOR=2.40, 95% CI: 1.39-4.19) and those who worked as other than government employees were more likely to report SHS exposure at home (non-government employee: AOR=1.88, 95% CI: 1.06-3.36). Respondents with a total smoking restriction at home did not report any SHS exposure at home. Similarly, those whose workplace had smoking restrictions were less likely to report SHS exposure at the work compared to their counterparts whose workplace had partial (AOR=3.08, 95% CI: 1.84-5.15) or no smoking restrictions (AOR=15.33, 95% CI: 6.75-34.86). CONCLUSIONS: A substantial proportion of Malaysian adults were exposed to SHS at home and at work. The findings emphasize the need for policies on smoking restrictions at work and the need to promote the adoption of a completely smoke-free home, among the Malaysian population.

Source of cigarettes among youth smokers in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA).

INTRODUCTION: Understanding how and where youth obtain tobacco products are major factors in the development of suitable intervention programs to reduce youth smoking. This study aimed to determine the source of cigarettes and the associated factors among Malaysian school adolescent smokers. METHODS: Our sample consisted of 1348 youth aged 10-17 years who were current smokers (having smoked at least once in the last 30 days). The source of cigarettes (commercial, over-the-counter purchases; or social, borrowing or obtaining from someone else) was the dependent variable, and multivariable logistic regression was employed to determine its association with independent variables (i.e. sociodemographics, smoking behavior, and knowledge of laws prohibiting sales of cigarettes to youth). RESULTS: Over half (54.3%) of current smokers obtained cigarettes from commercial sources, with a proportion nearly two times higher (84.2% vs 43.7%) among frequent smokers (i.e. those smoking more than 20 days per month) compared to less-frequent smokers, and among young males (56.5% vs 32.0%) compared young females. Multivariable logistic regression indicated that in urban areas, young females (AOR=12.5, 95% CI: 1.38-99.8) frequent smokers (AOR=4.41, 95% CI: 2.05-9.46), and those studying in lower (AOR=3.76, 95% CI: 1.41-10.02) and upper secondary (AOR=4.74, 95% CI: 1.72-13.06) school students were more likely to obtain cigarettes from a commercial source. On the other hand, in rural areas, only frequent smokers were more likely to get their cigarettes from commercial sources, whilst other variables were not significant. CONCLUSIONS: The proportion of youth smokers who obtained cigarettes from commercial sources appeared to be high, suggesting that law enforcement and health promotion activities should be enhanced to reduce the rate of smoking among Malaysian youth.