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Fulltext Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Jane Ling MY, Ahmad N, Mohd Yusoff MF, Lim KH

PLoS One, 2022;17(1):e0263355.
PMID: 35100321 DOI: 10.1371/journal.pone.0263355

BACKGROUND: Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

METHODS: We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13-18 years were included in the study. The data were analysed using STATA (v.15).

RESULTS: The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

CONCLUSION: Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.
Fatigue-related crashes involving express buses in Malaysia: will the proposed policy of banning the early-hour operation reduce fatigue-related crashes and benefit overall road safety?

Mohamed N, Mohd-Yusoff MF, Othman I, Zulkipli ZH, Osman MR, Voon WS

Accid Anal Prev, 2012 Mar;45 Suppl:45-9.
PMID: 22239931 DOI: 10.1016/j.aap.2011.09.025

Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia.
Analysis of factors associated with seatbelt wearing among rear passengers in Malaysia

Mohamed N, Mohd Yusoff MF, Isah N, Othman I, Syed Rahim SA, Paiman N

Int J Inj Contr Saf Promot, 2011 Mar;18(1):3-10.
PMID: 20496187 DOI: 10.1080/17457300.2010.487153

A cross-sectional survey using a self-administered questionnaire was conducted among 793 rear passengers in Malaysia. Logistic regression was performed to analyse the association of rear seatbelt wearing with 12 independent variables. Seven factors were significantly associated with rear seatbelt wearing. Experience of being stopped by an enforcement officer for not wearing rear seatbelt yielded the highest odds ratio 2.3 (p = 0.002) followed by self-consciousness (odds ratio 1.7; p = 0.004), attitude (odds ratio 1.5, p = 0.001), and knowledge (odds ratio 1.4, p = 0.004). Age of participants and their perception of being caught by an enforcement officer were also significantly associated with rear seatbelt wearing, odds ratios were 1.03 (p = 0.004) and 1.1 (p = 0.004), respectively. In contrast, level of education was negatively associated with rear seatbelt wearing (odds ratio 0.59, p = 0.003). It was concluded that enforcement activities, knowledge and attitude on seatbelt wearing play a very important role in improving the rate of rear seatbelt wearing. Thus, efforts to increase these factors should be the special focus in designing education and social marketing activities to advocate rear seatbelt wearing.
Fulltext Can the association between hypertension and physical activity be moderated by age?

Cheah YK, Lim KK, Ismail H, Mohd Yusoff MF, Kee CC

J Taibah Univ Med Sci, 2023 Aug;18(4):844-854.
PMID: 36852251 DOI: 10.1016/j.jtumed.2022.12.016

OBJECTIVES: Physical inactivity, hypertension and non-communicable diseases are major public concerns across the globe. To our knowledge, there is a lack of research that has investigated the moderating effect of age on the relationship between hypertension and physical activity in developing countries. This study had two objectives: (1) investigating hypertension and sociodemographic factors associated with physical activity and (2) investigating whether age moderates the relationship between hypertension and physical activity.
METHODS: Nationally representative data of Malaysia were used to generate cross-sectional evidence. The sample size was 2156 respondents. An ordered probit regression was utilized to assess factors associated with the practice of physical activity.
RESULTS: Respondents aged 40-49 years with hypertension were 7.3% less likely to participate in high-level physical activity when compared to those without hypertension. The probability of having a low level of physical activity was 12.3% higher among hypertensive patients aged ≥60. Males, married individuals, less-educated adults, low-income earners, and individuals who were aware of their BMI, had a higher tendency to indulge in a highly active lifestyle than others.
CONCLUSION: The effect of hypertension on physical activity was moderated by age. Factors influencing physical activity levels among adults were income, gender, marital status, education, employment status, and BMI awareness.
Fulltext Five-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study

Wan KS, Hairi NN, Mustapha F, Ismail M, Mohd Yusoff MF, Moy FM

PeerJ, 2022;10:e13816.
PMID: 36317122 DOI: 10.7717/peerj.13816

BACKGROUND: Patients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia.
METHODS: This was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD.
RESULTS: Among 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2-21.0) of patients without CVD and 45.8% (95% CI: 44.8-46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend.
CONCLUSIONS: The LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C.
Fulltext Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia

Ambak R, He FJ, Othman F, Michael V, Mohd Yusoff MF, Aris T

J Health Popul Nutr, 2021 05 31;40(Suppl 1):23.
PMID: 34059145 DOI: 10.1186/s41043-021-00229-y

BACKGROUND: Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population.
METHODS: MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey.
RESULTS: Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference.
CONCLUSION: Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS's findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.
Fulltext Hydrogen gas sensing performance of a carbon-doped boron nitride nanoribbon at elevated temperatures

Taib AK, Johari Z, Abd Rahman SF, Mohd Yusoff MF, Hamzah A

PLoS One, 2023;18(3):e0282370.
PMID: 36897883 DOI: 10.1371/journal.pone.0282370

In this study, computational simulations were used to investigate the performance of a carbon-doped boron nitride nanoribbon (BC2NNR) for hydrogen (H2) gas sensing at elevated temperatures. The adsorption energy and charge transfer were calculated when H2 was simultaneously attached to carbon, boron, and both boron and nitrogen atoms. The sensing ability was further analyzed considering the variations in current-voltage (I-V) characteristics. The simulation results indicated that the energy bandgap of H2 on carbon, boron, and both boron and nitrogen exhibited a marginal effect during temperature variations. However, significant differences were observed in terms of adsorption energy at a temperature of 500 K, wherein the adsorption energy was increased by 99.62% of that observed at 298 K. Additionally, the evaluation of charge transfer indicated that the strongest binding site was achieved at high adsorption energies with high charge transfers. Analysis of the I-V characteristics verified that the currents were considerably affected, particularly when a certain concentration of H2 molecules was added at the highest sensitivity of 15.02% with a bias voltage of 3 V. The sensitivity at 298 K was lower than those observed at 500 and 1000 K. The study findings can form the basis for further experimental investigations on BC2NNR as a hydrogen sensor.
Fulltext Factors associated with the severity of hypertension among Malaysian adults

Mahadir Naidu B, Mohd Yusoff MF, Abdullah S, Musa KI, Yaacob NM, Mohamad MS, et al.

PLoS One, 2019;14(1):e0207472.
PMID: 30605462 DOI: 10.1371/journal.pone.0207472

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41-3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02-1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.
Fulltext Socio-demographic factors and healthy lifestyle behaviours among Malaysian adults: National Health and Morbidity Survey 2019

Khaw WF, Nasaruddin NH, Alias N, Chan YM, Tan L, Cheong SM, et al.

Sci Rep, 2022 Oct 04;12(1):16569.
PMID: 36195767 DOI: 10.1038/s41598-022-20511-1

This study aimed to investigate the association between socio-demographic factors and designated healthy lifestyle behaviours in a nationally-representative sample of Malaysian adults aged 18 years and above. Secondary data involving 7388 participants aged 18-96 years from the National Health and Morbidity Survey 2019, a national cross-sectional survey, was used in this study. A healthy lifestyle score (0-5 points) was calculated based on five modifiable lifestyle factors: non-smoker, body mass index
Fulltext Patterns of polysubstance use among adults in Malaysia-A latent class analysis

Rodzlan Hasani WS, Robert Lourdes TG, Ganapathy SS, Ab Majid NL, Abd Hamid HA, Mohd Yusoff MF

PLoS One, 2023;18(1):e0264593.
PMID: 36649298 DOI: 10.1371/journal.pone.0264593

INTRODUCTION: Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.
OBJECTIVE: To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.
METHODOLOGY: This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.
RESULTS: Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).
CONCLUSION: Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.
Fulltext Baseline treatments and metabolic control of 288,913 type 2 diabetes patients in a 10-year retrospective cohort in Malaysia

Wan KS, Mustapha F, Chandran A, Ganapathy SS, Zakariah N, Ramasamy S, et al.

Sci Rep, 2023 Oct 13;13(1):17338.
PMID: 37833402 DOI: 10.1038/s41598-023-44564-y

Diabetes is one of the quickest-growing global health emergencies of the twenty-first century, and data-driven care can improve the quality of diabetes management. We aimed to describe the formation of a 10-year retrospective open cohort of type 2 diabetes patients in Malaysia. We also described the baseline treatment profiles and HbA1c, blood pressure, and lipid control to assess the quality of diabetes care. We used 10 years of cross-sectional audit datasets from the National Diabetes Registry and merged 288,913 patients with the same identifying information into a 10-year open cohort dataset. Treatment targets for HbA1c, blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were based on Malaysian clinical practice guidelines. IBM SPSS Statistics version 23.0 was used, and frequencies and percentages with 95% confidence intervals were reported. In total, 288,913 patients were included, with 62.3% women and 54.1% younger adults. The commonest diabetes treatment modality was oral hypoglycaemic agents (75.9%). Meanwhile, 19.3% of patients had ≥ 3 antihypertensive agents, and 71.2% were on lipid-lowering drugs. Metformin (86.1%), angiotensin-converting enzyme inhibitors (49.6%), and statins (69.2%) were the most prescribed antidiabetic, antihypertensive, and lipid-lowering medications, respectively. The mean HbA1c was 7.96 ± 2.11, and 31.2% had HbA1c > 8.5%. Only 35.8% and 35.2% attained blood pressure
Prevalence of diabetic kidney disease and the associated factors among patients with type 2 diabetes in a multi-ethnic Asian country

Wan KS, Hairi NN, Mustapha F, Mohd Yusoff MF, Mat Rifin H, Ismail M, et al.

Sci Rep, 2024 Mar 25;14(1):7074.
PMID: 38528132 DOI: 10.1038/s41598-024-57723-6

The actual prevalence of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D) in Malaysia is unknown. We aimed to determine the prevalence of DKD and its associated risk factors among T2D patients in Malaysia. An analytical cross-sectional study was conducted using the year 2022 clinical audit dataset from the National Diabetes Registry. DKD was defined as albuminuria, a decreased glomerular filtration rate, or both. Among 80,360 patients, 62.2% were female, 68.4% were Malay, and the mean age was 61.4 years. A total of 56.7% (95% CI 56.4-57.1%) of patients were found to have DKD. Increasing age, male sex, Malay ethnicity, longer duration of diabetes, overweight, obesity, hypertension, diabetic retinopathy, diabetic foot ulcer, nontraumatic lower-extremity amputation, ischaemic heart disease, stroke, insulin, higher numbers of antihypertensive agents, antiplatelet agents, poorer HbA1c control, higher systolic blood pressure, non-achievement of triglyceride target, and non-attainment of HDL-cholesterol goal were independent risk factors associated with DKD. Clinicians, program managers, and health policymakers should target modifiable factors to manage DKD and prevent its progression to end-stage kidney disease in Malaysia.
Methodology and Representativeness of the Adolescent Health Survey 2017 in Malaysia

Awaluddin SM, Ibrahim Wong N, Rodzlan Hasani WS, Omar MA, Mohd Yusoff MF, Nik Abd Rashid NR, et al.

Asia Pac J Public Health, 2019 11;31(8_suppl):8S-17S.
PMID: 31226891 DOI: 10.1177/1010539519854884

Health risk behaviors and mental health problems are associated with morbidity and premature mortality among adolescents. Understanding the magnitude of the problem may improve adolescent health status. The Adolescent Health Survey was conducted to collect data on health risk behaviors among Malaysian school-going adolescents using self-administered questionnaires. A 2-stage stratified cluster sampling design was used and samplings weights were calculated to ensure representativeness to the general population. A total of 27 497 out of 30 823 school-going adolescents completed the questionnaires, yielded an 89.2% overall response rate. The methodology was robust to ensure valid estimation on the prevalence of health problems among Malaysian school-going adolescents.
Fulltext Prevalence of obesity and its associated risk factors among the elderly in Malaysia: Findings from The National Health and Morbidity Survey (NHMS) 2015

Ariaratnam S, Rodzlan Hasani WS, Krishnapillai AD, Abd Hamid HA, Jane Ling MY, Ho BK, et al.

PLoS One, 2020;15(9):e0238566.
PMID: 32915860 DOI: 10.1371/journal.pone.0238566

BACKGROUND: Obesity is a crucial public health problem and is rising globally. This study was conducted to determine the prevalence of obesity and its associated factors among the elderly in Malaysia.
METHODS: Data were obtained from the National Health and Morbidity Survey (NHMS) 2015. This was a cross sectional population-based study using a two stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected using pre-tested self-administered questionnaire in the form of sociodemographic profile, non-communicable diseases (NCD) comorbidities (status on hypertension, diabetes and hypercholesterolemia) and NCD risk factors (current smoker and physical activity). Obesity has been defined using the World Health Organization (WHO) Body Mass Index (BMI) guideline, 1998. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for obesity were identified using Multiple Logistic Regression analysis.
RESULTS: A total of 3794 respondents were included in this study. The prevalence of obesity among Malaysian elderly was 30.2%. The prevalence of obesity among the elderly was significantly higher in females, respondents from urban areas and Indians. Approximately one third of the elderly with non-communicable diseases such as hypertension (33.1%) and diabetes (38.8%), respectively, were obese. Among elderly who were obese, majority of them (89.8%) had at least one NCD. The prevalence of obesity was 16.8% among current smokers (aOR 0.59). Multiple logistic regression analysis revealed that elderly females (aOR [adjusted odds ratio] 1.52), having secondary education (aOR 1.96) with household income of RM 3000 and above (aOR 1.57) as well as being hypertensive (aOR 1.61) and diabetic (aOR 1.50) were more likely to be obese. In contrast, the Chinese elderly respondents (aOR 0.62) and current smokers (aOR 0.59) were less likely to be obese. There were no significant associations of obesity with hypercholesterolemia or with physical activity.
CONCLUSIONS: A substantial proportion of Malaysian elderly were obese, and factors associated with obesity among them were being female, having secondary education with a household income of RM 3000 and above and being hypertensive or diabetic. Enhanced health promotion and education should be targeted at younger people in order to prevent obesity in the later years.
Study name: National Health and Morbidity Survey (NHMS-2015)
Fulltext Prevalence of cigarette smoking and its associated factors among male adolescents in Malaysia [Abstract]

Ling JMY, Hasani WSR, Mohd Yusoff MF, Abd Hamid HA, Lim KH, Tee GH, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):34-34.
MyJurnal

ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected
Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3rd-5th September 2019
Introduction: Smoking kills 5 million people a year and it is known to cause several types of cancer and chronic diseases. Majority of smokers started smoking during adolescence and therefore preventing tobacco use among adolescents is critical to prevent them from future smoking. Our study aims to investigate the prevalence of current cigarette smoking and its associated factors among male adolescents in Malaysia.
Methods: Data was obtained from the National Health and Morbidity Survey (NHMS): Adolescent Health Survey (AHS) 2017 which was a cross-sectional study. A two-stage stratified cluster sampling design was used to select a nationally representative sample of school-going adolescents in Malaysia. Data collection was conducted using a validated self-administered questionnaire. Multiple logistic regression analysis was performed to identify the associated factors of current cigarette smoking among male adolescents in Malaysia.
Results: Approximately one-fifth (22.4%) of male adolescents were current cigarette smokers. Male adolescents who aged 16-17 years, from rural schools, those whose parents were widowed/ divorced/ separated, those who had either one or both parents/guardians who used tobacco product, those who were current illicit drug users and current alcohol users were more likely to be current cigarette smokers.
Conclusion: A substantial percentage of Malaysian male adolescents were current cigarette smokers. Anti-smoking campaigns and tobacco prevention initiatives should be targeted at adolescents at risk to prevent them from becoming cigarette smokers.
Study name: National Health and Morbidity Survey (NHMS-2017)
Self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia

Ab Majid NL, Rodzlan Hasani WS, Mat Rifin H, Robert Lourdes TG, Jane Ling MY, Saminanthan TA, et al.

Geriatr Gerontol Int, 2020 Dec;20 Suppl 2:79-84.
PMID: 33370854 DOI: 10.1111/ggi.13968

AIM: The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors.
METHODS: The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting.
RESULTS: The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia.
CONCLUSIONS: Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.
Fulltext Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering

Chan YY, Sahril N, Rezali MS, Kuang Kuay L, Baharudin A, Abd Razak MA, et al.

Int J Environ Res Public Health, 2021 07 27;18(15).
PMID: 34360235 DOI: 10.3390/ijerph18157941

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60-69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.
Fulltext Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017

Rodzlan Hasani WS, Saminathan TA, Ab Majid NL, Miaw Yn JL, Mat Rifin H, Abd Hamid HA, et al.

PLoS One, 2021;16(1):e0245593.
PMID: 33476329 DOI: 10.1371/journal.pone.0245593

BACKGROUND: Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia.
METHODS: This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied.
RESULTS: The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7).
CONCLUSION: Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.
Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure

Wan KS, Moy FM, Mohd Yusoff MF, Mustapha F, Ismail M, Mat Rifin H, et al.

Sci Rep, 2024 Jun 01;14(1):12625.
PMID: 38824234 DOI: 10.1038/s41598-024-63617-4

Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and 'others' ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.
Fulltext A systematic review protocol on small/kiddie cigarette packaging size and its impact on smoking

Mat Rifin H, Rodzlan Hasani WS, Ling MYJ, Robert Lourdes TG, Saminathan TA, Ab Majid NL, et al.

Syst Rev, 2020 01 13;9(1):13.
PMID: 31931868 DOI: 10.1186/s13643-019-1263-6

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

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