Publications by authors named "Sumarni Mohd Ghazali"

21 Publications

  • Page 1 of 1

Modelling the Effectiveness of Epidemic Control Measures in Preventing the Transmission of COVID-19 in Malaysia.

Int J Environ Res Public Health 2020 Jul 30;17(15). Epub 2020 Jul 30.

Faculty of Computer Science and Information Technology, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia.

Malaysia is currently facing an outbreak of COVID-19. We aim to present the first study in Malaysia to report the reproduction numbers and develop a mathematical model forecasting COVID-19 transmission by including isolation, quarantine, and movement control measures. We utilized a susceptible, exposed, infectious, and recovered (SEIR) model by incorporating isolation, quarantine, and movement control order (MCO) taken in Malaysia. The simulations were fitted into the Malaysian COVID-19 active case numbers, allowing approximation of parameters consisting of probability of transmission per contact (), average number of contacts per day per case (), and proportion of close-contact traced per day (). The effective reproduction number (R) was also determined through this model. Our model calibration estimated that (), (), and () were 0.052, 25 persons, and 0.23, respectively. The (R) was estimated to be 1.68. MCO measures reduce the peak number of active COVID-19 cases by 99.1% and reduce () from 25 (pre-MCO) to 7 (during MCO). The flattening of the epidemic curve was also observed with the implementation of these control measures. We conclude that isolation, quarantine, and MCO measures are essential to break the transmission of COVID-19 in Malaysia.
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http://dx.doi.org/10.3390/ijerph17155509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432794PMC
July 2020

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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http://dx.doi.org/10.1136/bmjopen-2019-031164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830643PMC
October 2019

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

Tob Induc Dis 2019 27;17:22. Epub 2019 Mar 27.

Epidemiology & Biostatistics Unit, Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.

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.
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http://dx.doi.org/10.18332/tid/102728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751970PMC
March 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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http://dx.doi.org/10.18332/tid/100692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662793PMC
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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http://dx.doi.org/10.18332/tid/96297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659477PMC
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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http://dx.doi.org/10.18332/tid/95188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659505PMC
October 2018

Clustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income country: a cross-sectional study.

BMC Public Health 2019 Aug 27;19(1):1177. Epub 2019 Aug 27.

Institute for Medical Research, Ministry of Health, Jalan Setia Murni U13/52, 40170, Seksyen U13, Bandar Setia Alam, Malaysia.

Background: Lifestyle risk behaviours such as smoking, alcohol consumption, physical inactivity, sedentary behaviour and low fruit/vegetable intake have been identified as the major causes of chronic diseases. Such behaviours are usually instigated in adolescence and tend to persist into adulthood. Studies on the clustering of lifestyle risk behaviours among adolescents are scarce, particularly in developing countries. Therefore, the present paper aimed to determine the clustering of lifestyle risk behaviours and its determinants among school-going adolescents in Malaysia.

Methods: Data were extracted from a cross-sectional study, the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study, which was conducted from May to September 2013 across 11 states in Peninsular Malaysia. A two-stage proportionate-to-size sampling method was employed to select a total of 3578 school-going adolescents aged 16-17 years from 20 selected schools in urban and rural settlements, respectively. The MyAHRB study adopted a set of self-administered questionnaires adapted from the Global School-based Student's Health Survey (GSHS) and the Youth Risk Behaviour Surveillance.

Results: The results from the analysis of 2991 school-going adolescents aged 16-17 years showed that 16 (in boys) and 15 (in girls) out of 32 combinations of lifestyle risk behaviours clustered. Girls (aOR 2.82, 95% CI: 2.32-3.43) were significantly more likely to have clustered risk behaviours than boys; however, no significant associated factors were observed among girls. In contrast, boys of Malay descent (aOR 0.64, 95% CI: 0.46-0.89) or boys who had at least three friends (aOR 0.65, 95% CI: 0.43-0.99) were less likely to engage in multiple risk behaviours.

Conclusion: The present study demonstrated the clustering of multiple risk behaviours that occurred in both genders; these results suggest that multiple behaviour intervention programmes, instead of programmes based on siloed approaches, should be advocated and targeted to the high-risk sub-populations identified in the present study.
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http://dx.doi.org/10.1186/s12889-019-7516-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712662PMC
August 2019

Association between Availability of Neighborhood Fast Food Outlets and Overweight Among 5⁻18 Year-Old Children in Peninsular Malaysia: A Cross-Sectional Study.

Int J Environ Res Public Health 2019 02 18;16(4). Epub 2019 Feb 18.

Institute for Medical Research, Jalan Pahang, Ministry of Health, Kuala Lumpur 50588, Malaysia.

A growing number of fast-food outlets in close proximity to residential areas raises a question as to its impact on childhood overweight and obesity. This study aimed at determining the relationship between the availability of fast-food outlets that were in close proximity to residential areas and overweight among Malaysian children aged 5 to 18 years. Measurement data on the weight and height of 5544 children (2797 boys, 2747 girls) were obtained from the National Health and Morbidity Survey 2011. Overweight (including obesity) is defined as BMI-for-age z-score > +1 SD based on the WHO growth reference. Geographic information system geospatial analysis was performed to determine the number of fast-food outlets within 1000 m radius from the children's residential address. Multiple logistic regression was conducted to examine the association between the availability of fast-food outlets (none or more than one outlet) and overweight with adjustment for age, sex, ethnicity, monthly household income, parental educational level, residential area and supermarket density. Our results showed that the prevalence of overweight was 25.0% and there was a statistically significant association between the density of fast-food outlets and overweight (odds ratio: 1.23, 95% confidence interval: 1.03, 1.47). Our study suggested that the availability of fast-food outlets with close proximity in residential areas was significantly associated with being overweight among children. Limiting the number of fast-food outlets in residential areas could have a significant effect in reducing the prevalence of overweight among Malaysian children.
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http://dx.doi.org/10.3390/ijerph16040593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406246PMC
February 2019

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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http://dx.doi.org/10.1136/bmjopen-2017-020304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377523PMC
February 2019

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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http://dx.doi.org/10.1136/bmjopen-2017-017203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780697PMC
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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http://dx.doi.org/10.1186/s12971-016-0108-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282817PMC
January 2017

Association of BMI with risk of CVD mortality and all-cause mortality.

Public Health Nutr 2017 May 12;20(7):1226-1234. Epub 2017 Jan 12.

1Epidemiology & Biostatistics Unit,Institute for Medical Research,Jalan Pahang,50588 Kuala Lumpur,Malaysia.

Objective: To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults.

Design: Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers.

Setting: All fourteen states in Malaysia.

Subjects: Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey.

Results: Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0-29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2).

Conclusions: Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.
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http://dx.doi.org/10.1017/S136898001600344XDOI Listing
May 2017

Factors associated with participation in physical activity among adolescents in Malaysia.

Int J Adolesc Med Health 2016 Nov;28(4):419-427

Background: The rising prevalence of non-communicable diseases (NCDs) has become a serious public health issue. Among the multi-factorial drivers behind NCDs are modifiable health risk factors, most notably, physical inactivity.

Objective: In response to the nearly global policy priority of encouraging regular participation in physical activity, the objective of the present study is to examine the factors that determine participation in physical activity among Malaysian adolescents.

Methods: Nationally representative data consisting of a large sample size was used. A censored regression model was developed to estimate the likelihood of participation and time spent on physical activity.

Results: There are significant relationships between physical activity and gender, ethnicity, self-rated academic performance, maternal education, household size and time spent on physical education.

Conclusion: The present study provides new insights into the factors affecting physical activity participation among adolescents. Specifically, self-rated excellent academic performance, household size and physical education can increase the likelihood of being physically active. Evidence of the present study implies that policy makers should pay special attention to females, Chinese, adolescents with self-rated poor academic performance and adolescents who have low maternal education.
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http://dx.doi.org/10.1515/ijamh-2015-0030DOI Listing
November 2016

Factors associated with participation in physical activity among adolescents in Malaysia.

Int J Adolesc Med Health 2016 Nov;28(4):419-427

Background: The rising prevalence of non-communicable diseases (NCDs) has become a serious public health issue. Among the multi-factorial drivers behind NCDs are modifiable health risk factors, most notably, physical inactivity.

Objective: In response to the nearly global policy priority of encouraging regular participation in physical activity, the objective of the present study is to examine the factors that determine participation in physical activity among Malaysian adolescents.

Methods: Nationally representative data consisting of a large sample size was used. A censored regression model was developed to estimate the likelihood of participation and time spent on physical activity.

Results: There are significant relationships between physical activity and gender, ethnicity, self-rated academic performance, maternal education, household size and time spent on physical education.

Conclusion: The present study provides new insights into the factors affecting physical activity participation among adolescents. Specifically, self-rated excellent academic performance, household size and physical education can increase the likelihood of being physically active. Evidence of the present study implies that policy makers should pay special attention to females, Chinese, adolescents with self-rated poor academic performance and adolescents who have low maternal education.
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http://dx.doi.org/10.1515/ijamh-2015-0030DOI Listing
November 2016

Smoking among Secondary School Students in Kota Tinggi, Johor, Malaysia--Findings from a Cross-Sectional Study.

Asian Pac J Cancer Prev 2015 ;16(11):4563-70

Institute of Public Health, Kuala Lumpur, Malaysia E-mail :

Background: Smoking is a learnt behavior during adolescence and understanding the factor/s associated with smoking will assist in identifying suitable measures in combating the rising prevalence of smoking among adolescents. This research aimed to identify the factor/s associated with smoking among form four students in Kota Tinggi, Johor. Multistage sampling was used to select a representative sample of students in 2008 and data were collected using a self-administered validated questionnaire. This study revealed that the overall smoking prevalence was 19.0% with a significantly higher proportion of male smokers (35.8%) as compared to females (3.15%). Adolescents who were male (aOR 6.6, 95%CI 2.61-16.4), those who had peer/s who smoked (aOR 4.03, 95% CI 1.31-12.4), and those who studied in rural areas and Felda Settlements ( aOR 4.59, 95 CI 1.11-18.0; aOR 9.42, 95%CI 3.91-29.1) were more likely to smoke in the past one week. On the other hand, adolescents with better knowledge on the hazards of smoking and negative attitudes towards smoking were less likely to smoke (aOR 0.51, 95%CI 0.37-0.72; aOR 0.67, 95%CI 0.46-0.99). Future promotional and interventional programmes on smoking should be considered and the above identified risk factors integrated to reduce smoking prevalence among students of school-going ages in Kota Tinggi. Johor.
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http://dx.doi.org/10.7314/apjcp.2015.16.11.4563DOI Listing
March 2016

Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults.

BMC Public Health 2015 Jan 31;15:68. Epub 2015 Jan 31.

Institute for Medical Research, Kuala Lumpur, Malaysia.

Background: To determine the prevalence and sociodemographic correlates of multiple risk factors for cardiovascular disease (CVD) among Malaysian adults.

Methods: We analysed data on 1044 men and 1528 women, aged 24-64 years, participants in the Non Communicable Disease Surveillance 2005/2006, a nationally representative, population-based, cross-sectional study. Prevalence of obesity, high blood pressure, dyslipidaemia, hyperglycemia, physical inactivity, smoking, risky drinking, low vegetable and fruit intake were determined and multivariable logistic regression was used to identify sociodemographic factors associated with having ≥3 of these cardiovascular disease risk factors.

Results: The response rate was 84.6% (2572/3040). Overall, 68.4% (95% CI: 63.2, 73.1) had at least three risk factors. Among men, older age and Indian ethnicity were independently associated with having ≥3 CVD risk factors; while among women, older age, low education, and housewives were more likely to have ≥3 CVD risk factors.

Conclusion: The prevalence of cardiovascular risk factors clustering among Malaysian adults is high, raising concerns that cardiovascular disease incidence will rise steeply in the near future if no immediate preventive measures are taken. The current national health education and promotion programmes pertaining to modifiable risk factors can be further improved by taking into account the sociodemographic variation in CVD risk factors clustering.
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http://dx.doi.org/10.1186/s12889-015-1432-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319230PMC
January 2015

Correlates of susceptibility to smoking among secondary school students in Kota Tinggi district, Johor, Malaysia.

Asian Pac J Cancer Prev 2013 ;14(11):6971-8

Institute of Public Health, Ministry of Health, Kuala Lumpur, Malaysia E-mail :

Background: Smoking among adolescents has been linked to a variety of adverse and long term health consequences. "Susceptibility to smoking" or the lack of cognitive commitment to abstain from smoking is an important predictor of adolescent smoking. In 2008, we conducted a study to determine the psycho-sociological factors associated with susceptibility to smoking among secondary school students in the district of Kota Tinggi, Johor.

Materials And Methods: Two thousand seven hundred students were randomly selected by proportional stratified sampling. Analyses on 1,736 non-smoking students revealed that prevalence of adolescents susceptible to smoking was 16.3%.

Results: Male gender (aOR=2.05, 95%CI= 1.23-3.39), poor academic achievement (aOR 1.60, 95%CI 1.05-2.44), ever-smoker (aOR 2.17, 95%CI 1.37-3.44) and having a smoking friend (aOR 1.76, 95%CI 1.10-2.83) were associated with susceptibility to smoking, while having the perception that smoking prohibition in school was strictly enforced (aOR 0.55, 95%CI 0.32-0.94), and had never seen friends smoking in a school compound (aOR 0.59, 95%CI 0.37-0.96) were considered protective factors

Conclusions: These results indicate that follow-up programmes need to capitalise on the modifiable factors related to susceptibility to smoking by getting all stakeholders to be actively involved to stamp out smoking initiation among adolescents.
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http://dx.doi.org/10.7314/apjcp.2013.14.11.6971DOI Listing
August 2014

Stages of smoking cessation among Malaysian adults--findings from national health morbidity survey 2006.

Asian Pac J Cancer Prev 2013 ;14(2):805-10

Institute for Public Health, Jalan Pahang, Kuala Lumpur, Malaysia.

Increasing the rate of smoking cessation will reduce the burden of diseases related to smoking, including cancer. Understanding the process of smoking cessation is a pre-requisite to planning and developing effective programs to enhance the rate of smoking cessation.The aims of the study were to determine the demographic distribution of smokers across the initial stages of smoking cessation (the pre-contemplation and contemplation stages) and to identify the predictors of smoking cessation among Malaysian adult smokers. Data were extracted from a population-based, cross-sectional survey carried out from April 2006 to July 2006. The distribution of 2,716,743 current smokers across the pre-contemplation stage (no intention to quit smoking in the next six months) or contemplation stage (intended to quit smoking in the next six months) was described. Multivariable logistic regression analysis was used to examine the relationship between socio-demographic variables and the stages of smoking cessation. Of the 2,716,743 current smokers, approximately 30% and 70% were in the pre-contemplative and contemplative stages of smoking cessation respectively. Multivariable analysis showed that male gender, low education level, older age group, married and those from higher income group and number of cigarettes smoked were associated with higher likelihood of pre-contemplation to cease smoking in the next six months. The majority of current smokers in Malaysia were in the contemplative stage of smoking cessation. Specific interventions should be implemented to ensure the pre-contemplative smokers proceed to the contemplative stage and eventually to the preparation stage.
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http://dx.doi.org/10.7314/apjcp.2013.14.2.805DOI Listing
July 2014

Non-practice of breast self examination and marital status are associated with delayed presentation with breast cancer.

Asian Pac J Cancer Prev 2013 ;14(2):1141-5

Epidemiology and Biostatistics Unit, Institute for Medical Research, Kuala Lumpur, Malaysia.

Delay in seeking treatment for breast cancer is a barrier to the early diagnosis and management of the disease, resulting in a poorer prognosis. We here estimated the prevalence of delayed presentation for breast cancer and identified possible influential sociodemographic factors in a cross-sectional study of 250 patients diagnosed with primary breast cancer at the Radiotherapy and Oncology Clinic in Kuala Lumpur Hospital. Data were collected by face-to-face interview using a structured questionnaire and from medical records. We examined associations between delayed presentation (presenting to a physician more than 3 months after self-discovery of a symptom) and sociodemographic characteristics, practice of breast self examination (BSE), history of benign breast disease, family history of breast cancer and type of symptom, symptom disclosure and advice from others to seek treatment using multiple logistic regression. Time from self-discovery of symptom to presentation ranged from tghe same day to 5 years. Prevalence of delayed presentation was 33.1% (95%CI: 27.4, 39.3). A significantly higher proportion of delayers presented with late stages (stage III/IV) (58.3% vs. 26.9%, p<0.001). Divorced or widowed women (OR: 2.23, 95% CI: 1.11, 4.47) had a higher risk of delayed presentation than married women and women who never performed breast self examination were more likely to delay presentation compared to those who regularly performed BSE (OR: 2.74, 95% CI: 1.33, 5.64). Our findings indicate that delayed presentation for breast cancer symptoms among Malaysian women is high and that marital status and breast self examination play major roles in treatment-seeking for breast cancer symptoms.
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http://dx.doi.org/10.7314/apjcp.2013.14.2.1141DOI Listing
July 2014

Epidemiology of smoking among Malaysian adult males: prevalence and associated factors.

BMC Public Health 2013 Jan 7;13. Epub 2013 Jan 7.

Proposal Development Section, Institute of Public Health, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia.

Background: Three National Health and Morbidity Surveys (NHMSs) had been conducted in Malaysia in 10-year intervals from 1986-2006. Based on the latest NHMS survey in 2006, we describe the prevalence of smoking and identify the social and demographic factors associated with smoking among adult males in Malaysia.

Methods: A cross-sectional study among 15,639 Malaysian adult males aged 18 years and above was conducted using proportional to size stratified sampling method. The socio-demographic variables examined were level of education, occupation, marital status, residential area, age group and monthly household income.

Results: The prevalence of smoking among adult males in Malaysia was 46.5% (95% CI: 45.5-47.4%), which was 3% lower than a decade ago. Mean age of smoking initiation was 18.3 years, and mean number of cigarettes smoked daily was 11.3. Prevalence of smoking was highest among the Malays (55.9%) and those aged 21-30 years (59.3%). Smoking was significantly associated with level of education (no education OR 2.09 95% CI (1.67-2.60), primary school OR 1.95, 95% CI (1.65-2.30), secondary school OR 1.88, 95% CI (1.63-2.11), with tertiary education as the reference group). Marital status (divorce OR 1.67, 95% CI (1.22-2.28), with married as the reference group), ethnicity (Malay, OR 2.29, 95% CI ( 1.98-2.66; Chinese OR 1.23 95% CI (1.05-1.91), Other Bumis OR 1.75, 95% CI (1.46-2.10, others OR 1.48 95% CI (1.15-1.91), with Indian as the reference group), age group (18-20 years OR 2.36, 95% CI (1.90-2.94); 20-29 years OR 3.31 , 95% CI 2.82-3.89; 31-40 years OR 2.85 , 95% CI ( 2.47-3.28); 41-50 years OR 1.93, 95% CI (1.69-2.20) ; 51-60 years OR 1.32, 95% CI (1.15-1.51), with 60 year-old and above as the reference group) and residential area (rural OR 1.12 , 95% CI ( 1.03-1.22)) urban as reference.

Conclusion: The prevalence of smoking among Malaysian males remained high in spite of several population interventions over the past decade. Tobacco will likely remain a primary cause of premature mortality and morbidity in Malaysia. Continuous and more comprehensive anti-smoking policy measures are needed in order to further prevent the increasing prevalence of smoking among Malaysian men, particularly those who are younger, of Malay ethnicity, less educated, reside in rural residential area and with lower socio-economic status.
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http://dx.doi.org/10.1186/1471-2458-13-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549287PMC
January 2013

Obesity among schoolchildren in Kuala Selangor: a cross-sectional study.

Trop Biomed 2006 Dec;23(2):148-54

Epidemiology & Biostatistics Unit, Institute for Medical Research, Kuala Lumpur.

Childhood obesity is an established problem in many countries and emerging in others. Epidemiological data on obesity in children is essential in order to plan public health policy and services. A study was conducted to determine the prevalence of obesity in schoolchildren in the fifth grade of elementary school (10-12 years old) in the district of Kuala Selangor. Ten schools of which five are in urban and five in rural areas were selected consisting of 699 eleven year old schoolchildren from the three major ethnic groups. Using international cut-off points for obesity, we report an overall prevalence of obesity of 7.2%. Prevalence of obesity in urban children is 7.2% whereas in rural children it is 7.0 %. Analysed by gender, there were 8.9% obese boys and 5.3% obese girls. Among the 3 major ethnic groups, the Malays had the highest prevalence of obesity at 9.3% followed by the Chinese with 6.6% while among Indians 3.0%. The data obtained from this study suggests that obesity in Kuala Selangor children is a cause for concern in urban and rural areas.
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December 2006