Demographics, Knowledge and Smoking: An Instrumental Variable Approach

Smoking is one of the main factors that causes various diseases. The objective of the present study is to investigate factors determining smoking behaviour among adults. The present study used instrumental variable (IV) regressions to estimate the effects of demographic and knowledge factors on participation decision and amount decision of smoking. Nationally representative data of a developing country (Malaysia) was used. Contrary to popular belief, knowledge was found to be positively associated with the propensity to smoke, as well as the amount of smoking. Age, gender, wealth index, educational 2 Journal of Business Management and Accounting, Vol. 11, Number 2 (July) 2021, pp: 1–24 level, ethnicity, marital status and house locality were significantly associated with smoking. Males were more likely to smoke and smoked more than females. Educational level reduced the likelihood and amount of smoking. Malays and married individuals were less likely to smoke than non-Malays and unmarried individuals. Urban dwellers smoked more cigarette relative to rural dwellers. In terms of policy implication, it is suggested that intervention measures directed toward reducing the prevalence of smoking should not pay too much attention to improving the knowledge of health effects of smoking among Malaysian adults. Anti-smoking policies must be designed carefully by taking into account of the demographic factors which are correlated with the likelihood and amount of smoking. The present study is the first of its kind that includes knowledge as a separate variable for analyses and uses IV regressions to analyse participation decision and amount decision of smoking

Exploring the effects of knowledge on smoking: An analysis of adults in Malaysia

In an effort to reduce the prevalence of smoking, the present study attempts to examine the factors that determine smoking. The present study uses two-tiered model to estimate the effects of demographic and knowledge factors on smoking participation and cigarette expenditure.As anticipated, knowledge is found to be negatively associated with an individual’s propensity to smoke.In addition, the findings suggest that age, gender, wealth index, education, ethnicity and house locality are significantly associated with smoking.In particular, males are more likely to smoke than females.Education reduces the likelihood of smoking.Urban dwellers tend to spend more on cigarette than rural dwellers.Policies directed toward reducing the prevalence of smoking may need to consider improving the knowledge of smoking among the adults.The policies must also be designed carefully to take into account of the demographic factors which are correlated with smoking

National E-cigarette Survey (NECS) 2016 in Malaysia method and population characteristic

E-cigarette and vape (ECV) use has become a worldwide phenomenon since 2010. This study aims to determine the prevalence of ever user, current user and factors associated with ECV use among Malaysian adults. This will provide evidence for policy makers to formulate appropriate measures towards regulation of ECV in Malaysia and can become a reference for other similar countries. Method: Complex sampling design was used to represent 19 million of Malaysian adult household. Samples were stratified by states and urbanity. Sampling units were districts, enumeration blocks and living quarters. All adults from the selected houses were invited to participate in this survey. Analysis was done using sampling weight and complex sampling analysis. Results: A total of 4,288 individual responded in this survey. Majority of the respondents were at 25-44 years of age group (44%), completed at least secondary level of education (69%), of Malay ethnicity (73%), Muslim (79%) and married (68%). Male and female were equally represented. Seventy two percent of the respondents were from the urban residential area (n=2,123). The prevalence of current ECV users was 3.2%, with an estimated number of 602,122 in the population. The prevalence was 3.3% and 2.9% in urban and rural respectively. ECV users were common among 18-24 years old, male and those with tertiary level education. Discussion: This study able to represent Malaysia and results can be used to guide healthcare managers to manage e-cigarette use in the country

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

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

The prevalence of e-cigarette use among adults in Malaysia

Electronic cigarettes (e-cigarettes) are a new method for the consumption of nicotine. A nationwide survey among 4288 Malaysian adults was conducted in 2016 to measure the prevalence and to describe the population characteristics of e-cigarette users. A complex sampling design was used, and data were collected using a face-to-face questionnaire. The overall prevalence of current, ever, former, and dual users of e-cigarettes in Malaysia were 3.2% (95% confidence interval [CI] = 2.5-4.1), 11.9% (95% CI = 10.5-13.5), 8.6% (95% CI = 7.5-9.8), and 2.3% (95% CI = 1.8-3.1), respectively. The prevalence of all type of e-cigarette use was higher in urban than in rural areas. Current e-cigarette users were likely to be younger, males, and with higher education level. Among current e-cigarette users, 74% (95% CI = 64-82) also smoked conventional cigarettes (dual user). E-cigarette use is prevalent in Malaysia. It is common among younger adults, males, and cigarette smokers

Cessation of e-cigarette use among adults in Malaysia : findings from a nationwide survey

The use of e-cigarettes has increased rapidly around the world including in Malaysia. However, a significant proportion of people who started using e-cigarettes later discontinued using them. The aim of this study is to identify prevalence of former e-cigarette use and factors associated with quitting, among Malaysian adults. This study is a part of a national household survey examining the use of e-cigarettes among Malaysian adults aged 18 years and above in 2016. A multistage stratified cluster sampling method was used in the survey. A bilingual (Malay and English) structured questionnaire was used and data was collected via face-to-face interview. Prevalence of current e-cigarette use and former e-cigarette use were determined. A multiple logistic regression model was used to identify factors associated with quitting e-cigarettes. A total of 4,288 adults participated in the survey, where 110 (3.2%) and 289 (8.6%) were identified as current and former e-cigarette users respectively. The following factors were significantly associated with quitting e-cigarette use: e-cigarette users who had no exposure to e-cigarettes at the workplace (aOR = 2.70; 95% CI: 1.39, 5.24); the perception that e-cigarette is more harmful to people compared to tobacco smoke (aOR = 2.46; 95% CI: 1.22, 4.97); and the perception that e-cigarettes do not help people to maintain cigarette abstinence (aOR = 2.19; 95% CI: 1.23, 3.92). This study contributes to a better understanding of the factors associated with cessation of e-cigarettes. Findings from this study can assist any e-cigarette cessation intervention measures such as strengthening on policy that prohibit e-cigarette use at workplace and increase advocacy on not using e-cigarette as a method to stop smoking

Perception of harms and benefits of electronic cigarettes among adult Malaysian men: a comparison by electronic cigarette use and smoking status

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.312.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies

Training is an important factor for community health workers in performing KOSPEN health screening activities in Malaysia : community health workers (KOSPEN) 2016

Community health workers/volunteers (CHW) are health workers who are trained but do not possess a formal professional certificate. They are members of the community who live and work in that particular community. This study aimed to determine factors associated with not performing health screening activities by volunteers under KOSPEN; a community-based intervention programme, initiated by Ministry of Health Malaysia in October 2013. Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used,a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. The response rate was 94.9%. A pre-tested, self-administered questionnaire was used. Descriptive statistics andlogistic regression analysis was applied using Statistical Package for Social Sciences (SPSS) version 20. 700 volunteers were included in this study. Majority were female (65.7%), aged 50-59 years (30.9%), had secondary education (65.3%), employed (55.7%.) and married (80.4%). Several issues were identified by the volunteers; funding (47.2%), module content and comprehensibility (11.4% respectively), submitting returns (17%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely did not perform screening activities in the community. Volunteers who were not trained and those who felt the content of the training module was inadequate did not carry out screening activities. These findings will be useful for stakeholders to make improvements to the programme for a more successful implementation

Prevalence and factors associated with attempts to quit and smoking cessation in Malaysia

Smoking cessation significantly reduces risk of smoking-related diseases and mortality. This study aims to determine the prevalence and factors associated with attempts to quit and smoking cessation among adult current smokers in Malaysia. Data from the National E-Cigarette Survey 2016 were analyzed. Forty nine percent of current smokers had attempted to quit at least once in the past 12 months and 31.4% of the respondents were former smokers. Multivariable analysis revealed that current smokers with low nicotine addiction and aged below 45 years were more likely to attempt to quit smoking. Being married, older age group, and having tertiary education were significantly associated with smoking cessation. Only half of the current smokers ever attempted to quit smoking and only a third of smokers quit. Stronger tobacco control policies are needed in Malaysia to encourage more smokers to quit smoking. Improved access to cessation support for underprivileged smokers is also needed

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups