Publications by authors named "Hui Li Lim"

10 Publications

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

BMJ Open 2019 10 28;9(10):e031164. Epub 2019 Oct 28.

School of Pharmacy, Monash University, Malaysia Campus, Bandar Sunway, Malaysia.

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.
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October 2019

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.

Tob Induc Dis 2019 7;17:51. Epub 2019 Jun 7.

School of Science, Monash University Malaysia, Subang Jaya, 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.
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June 2019

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

Tob Induc Dis 2018 5;16:51. Epub 2018 Nov 5.

Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia.

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.
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November 2018

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

Tob Induc Dis 2018 24;16:49. Epub 2018 Oct 24.

Institute for Medical Research, Kuala Lumpur, Malaysia.

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.
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October 2018

Support for smoke-free policy among Malaysian adults: findings from a population-based study.

BMJ Open 2019 02 12;9(2):e020304. Epub 2019 Feb 12.

Institute for Medical Research, Kuala Lumpur, Malaysia.

Objective: Public opinion and support can be powerful mandates for smoke-free policy. However, the scarcity of evidence on public opinion among Malaysians necessitates further investigation. Therefore, this study aimed to determine the level of support for smoke-free policy at various public domains and its associated factors among Malaysian adults.

Design: Data were derived from the Global Adult Tobacco Survey, Malaysia (GATS-M). GATS-M is a nationwide study that employed a multistage, proportionate-to-size sampling strategy to select a representative sample of 5112 Malaysian adults aged 15 years and above. Multiple logistic regression was used to identify factors associated with support for smoke-free policy in selected public domains that is, workplaces, restaurants, bars, hotels, casinos, karaoke centres, public transport terminals and shopping centres.

Results: The level of support for enactment of a smoke-free policy at selected public domains varied from 37.8% to 94.4%, with the highest support was for gazetted smoke-free domains, namely, shopping centres (94.4%, 95% CI: 93.2% to 95.3%) and public transport terminals (85.2%, 95% CI: 83.3% to 86.9%). Multiple logistic regression revealed that non-smokers were more likely to support smoke-free policy at all domains. In addition, respondents who worked in workplaces with total or partial smoking restrictions were more likely to support a smoke-free policy ((total restriction adjusted OR (AOR): 14.94 (6.44 to 34.64); partial restriction AOR: 2.96 (1.138 to 6.35); non-restriction was applied as a reference).

Conclusion: A majority of the Malaysian adult population supported the smoke-free policy, especially at gazetted smoke-free domains. Therefore, expansion of a total smoking ban to workplaces, restaurants, bars, hotels, casinos and karaoke centres is strongly recommended to reduce exposure to secondhand smoke and to denormalise smoking behaviour.
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February 2019

Vinorelbine-Cyclophosphamide compared to cyclophosphamide in peripheral blood stem cell mobilization for multiple myeloma.

Hematol Oncol Stem Cell Ther 2018 Dec 23;11(4):225-232. Epub 2018 Apr 23.

Department of Haematology-Oncology National University Cancer Institute, National University Health System, Singapore; Department of Laboratory Medicine, National University Health System, Singapore.

Background: High dose Cyclophosphamide (Cy) and Vinorelbine Cyclophosphamide (Vino-Cy) are stem cell (SC) mobilisation options for patients with multiple myeloma (MM). We present a comparison of mobilisation outcomes using these regimens.

Patients And Methods: Vino-Cy patients received Vinorelbine 25 mg/m on day 1, cyclophosphamide 1500 mg/m on day 2, and pegylated GCSF on day 4 or GCSF 10 mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000 mg/m on day 1 and GCSF10 mcg/kg/day from day 5 onwards. The target CD34 + SC collection was 5 × 10 per kg/BW.

Results: 149 patients were included. SC collection was lower in the Vino-Cy group (8.20 × 10/Kg BW) compared to the Cy group (11.43 × 10/Kg BW), with adjusted geometric mean ratio of 0.59 (95% CI 0.41 to 0.86, p = 0.006). Time taken to achieve an adequate PB SC count was shorter for Vino-Cy (9 ± 1 day compared to 12 ± 2 days for Cy, adjusted absolute mean difference -3.95, 95% CI -4.85 to -3.06, P < .001). Mobilisation related toxicities (in particular, neutropaenic fever) were greater for Cy.

Conclusion: Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity.
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December 2018

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.

BMJ Open 2018 01 8;8(1):e017203. Epub 2018 Jan 8.

Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, 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.
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January 2018

Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study.

Tob Induc Dis 2017 31;15. Epub 2017 Jan 31.

Allied Health College, Jalan Hospital, 47000 Sg. Buloh, Malaysia.

Background: A multitude of studies have revealed that smoking is a learned behaviour during adolescence and efforts to reduce the incidence of smoking has been identified as long-term measures to curb the smoking menace. The objective of this study was to determine the prevalence as well as the intra and inter-personal factors associated with smoking among upper secondary school students in selected schools in Peninsular Malaysia.

Methods: A study was carried out in 2013, which involved a total of 40 secondary schools. They were randomly selected using a two-stage clustering sampling method. Subsequently, all upper secondary school students (aged 16 to 17 years) from each selected school were recruited into the study. Data was collected using a validated standardised questionnaire.

Results: This study revealed that the prevalence of smoking was 14.6% (95% CI:13.3-15.9), and it was significantly higher among males compared to females (27.9% vs 2.4%,  < 0.001). Majority of smokers initiated smoking during their early adolescent years (60%) and almost half of the respondents bought cigarettes themselves from the store. Multivariable analysis revealed that the following factors increased the likelihood of being a current smoker: being male (aOR 21. 51, 95% CI:13.1-35), perceived poor academic achievement (aOR 3.42, 95% CI:1.50-7.37) had one or both parents who smoked (aOR 1.80, 95% CI:1.32-2.45; aOR 6.50, 95 CI%:1.65-25.65), and always feeling lonely (aOR 2.23, 95% CI:1.21-4.43). In contrast, respondents with a higher religiosity score and protection score were less likely to smoke (aOR 0.51, 95% CI:0.15-0.92; aOR 0.71, 95% CI 0.55-0.92).

Conclusion: This study demonstrated that the prevalence of smoking among Malaysian adolescents of school-going age was high, despite implementation of several anti-smoking measures in Malaysia. More robust measures integrating the factors identified in this study are strongly recommended to curb the smoking epidemic among adolescents in Malaysia.
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January 2017

Analysis of sharps injury occurrences at a hospital in Singapore.

Int J Nurs Pract 2002 Oct;8(5):274-81

Alexandra Hospital, 378 Alexandra Road, Singapore 159964.

Relatively little attention has been directed to investigating the risks of sharps injuries in Singapore. This study examines the epidemiology and causes of sharps injuries at a university teaching hospital. The type of instruments, site of injuries and personnel involved in each sharps injury were determined retrospectively by reviewing the Incident Reports forms and Infection Control records between 1997 and 2000. Descriptive information on the forms and records were extracted and collected on standard charts. The data were then analysed using SPSS Windows software. The rates of sharps injuries were 11.0 per 100 medical staff and 6.9 per 100 nursing staff. Medical staff yielded highest proportion of sharps injuries rendering 33 cases (40.2%), followed by 24 cases involving nursing staff (29.3%) and 12 cases of nursing students (14.6%). In total, 62.2% of injuries were caused by hollow bore needles (51 cases). Non-hollow bore needle injuries only accounted for 17.1% of total injuries (14 cases). Hollow bore needles accounted for the highest proportion of sharps injuries in this study, corresponding to findings in other studies. Rates of injuries were similar to the rates found at another local hospital. At the hospital studied, sharps with safety features had effectively produced no reported cases of sharps injuries.
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October 2002