BackgroundOverweight and obesity are growing health problems both worldwide and in Malaysia due to such lifestyle changes as decreased physical activity (PA), increased sedentary behavior and unhealthy eating habits. This study examined the levels and patterns of PA among normal-weight and overweight/obese adults and to investigate the association between PA level and overweight/obesity in Malaysian adults.MethodsThis study used data from the 2015 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey that implemented a two-stage stratified random sampling design. Respondents aged 18 years and above (n = 17,261) were included in the analysis. The short version of International Physical Activity Questionnaire (IPAQ) was administered to assess the respondents’ PA levels. The respondents’ height and weight were objectively measured and body mass index (BMI) was calculated. The respondents were categorized according to BMI as either normal-weight (18.5–24.9 kg/m2) or overweight/obese (≥ 25 kg/m2). Descriptive and complex sample logistic regression analyses were employed as appropriate.ResultsOverall, approximately 1 in 2 respondents (51.2%) were overweight/obese, even though the majority (69.0%) reporting at least a moderate level of PA (total PA ≥ 10 MET-hours/week). In both normal-weight and overweight/obese groups, a significantly higher prevalence of high PA (total PA ≥ 50 MET-hours/week) was observed among men than women (p < 0.001), but women reported a significantly higher prevalence of low and moderate PA than men (p < 0.001). Men reported significantly higher activity levels (in MET-hours/week) than women with regard to walking, vigorous-intensity PA and total PA (p < 0.001). Overweight/obese men reported a significantly lower level of vigorous-intensity PA and total PA than normal-weight men (p < 0.001). A low level of PA was associated with the risk of overweight/obesity (Adjusted OR = 1.14; 95% CI: 1.01–1.30) compared to a high level of PA among men but not among women.ConclusionsThe levels of PA were inversely related to the risk of overweight/obesity in men but not in women. Programs designed to reduce overweight/obesity rates should encourage the practice of moderate- to vigorous-intensity PA. Future research should consider using longitudinal and prospective approaches that simultaneously measure dietary intake, PA and BMI among Malaysian adults to investigate the actual relationship between PA and overweight/obesity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4772-z) contains supplementary material, which is available to authorized users.

BackgroundA 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.MethodsA 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.ResultsThis 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%, p < 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).ConclusionThis 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.

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.

INTRODUCTION The continuous monitoring of smoking prevalence and its associated factors is an integral part of anti-smoking programmes and valuable for the evaluation of the effectiveness of anti-smoking measures and policies. This study aimed at determining prevalence of smoking and identifying socio-demographic factors associated with smoking among adults in Malaysia aged 15 years and over. METHODS This is a cross-sectional study with a representative sample of 21 445 adults in Malaysia, aged 15 years and over, selected via a stratified, two-stage proportionate-to-size sampling method. Data were obtained from face-to-face interviews by trained research assistants, using a standard validated questionnaire. Multivariable logistic regression was performed to determine socio-demographic factors associated with smoking among Malaysians. RESULTS The overall prevalence of smoking was 22.8% (95% CI: 21.9-23.8%), with males having a significantly higher prevalence compared to females (43.0%, 95% CI: 41.1-44.6 vs 1.4%, 95% CI: 1.1-1.7). The highest smoking prevalence was observed among other ethnicities (35.7%), those aged 25-44 years (59.3%), and low educational attainment (25.2%). Males, those with lower educational attainment and Malays were significantly associated with smoking. CONCLUSIONS The prevalence of smoking among Malaysians, aged 15 years and over, remains high despite the implementation of several anti-smoking measures over the past decades. Specially tailored anti-smoking policies or measures, particularly targeting males, the Malays, younger adults and those with lower educational attainment, are greatly warranted to reduce the prevalence of smoking in Malaysia. AFFILIATION

Background: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013. Methods: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators. Results: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%). Conclusions: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia.

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.

ObjectivesSecondhand 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.DesignData 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.ResultsThe 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.ConclusionsThe 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.

Internet addiction (IA) among adolescents is an issue of growing concern with adverse effects on adolescents’ health and social functioning. This study aims to determine the prevalence of IA among school-going adolescents in Malaysia and its associated factors—specifically, lifestyle factors. A nationwide cross-sectional school-based health survey was conducted in 2017 among 27,497 students from 212 randomly selected secondary schools. Information regarding sociodemography, lifestyle, and internet use was obtained using a self-administered questionnaire. IA was measured using the Malay Version of Internet Addiction Test (MVIAT). The prevalence of internet addiction was 29.0%. A multivariable logistic analysis revealed that inadequate fruit and vegetable intakes, consumed carbonated soft drinks at least once a day, consumed fast food at least three days/week, sedentary behavior, current E-cigarette users, and ever/current alcohol drinkers were lifestyle factors significantly associated with IA. Adolescents from urban schools, of higher school grade, and those whose parents are married but living apart were also found to have a greater risk for internet addiction. A positive association was found between IA with unhealthy dietary and lifestyle behaviors among adolescents. The modification of lifestyle factors needs to be considered while developing strategies and interventions for awareness-raising and prevention of IA among adolescents.