Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Tobacco Induced Diseases
Published in: Tobacco Induced Diseases 1/2017

Open Access 01-12-2017 | Research

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

Authors: Kuang Hock Lim, Hui Li Lim, Chien Huey Teh, Chee Cheong Kee, Yi Yi Khoo, Shubash Shander Ganapathy, Miaw Yn Jane Ling, Sumarni Mohd Ghazali, Eng Ong Tee

Published in: Tobacco Induced Diseases | Issue 1/2017

Login to get access

Abstract

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%, 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).

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.
Literature
1.
World Health Organization. WHO report on the global tobacco epidemic, 2011. Geneva: World Health Organization; 2011. Accessed 7 Apr 2015.
2.
3.
Institute of Public Health. Burden of disease and injury in Malaysia. 2012.
4.
Al-Junid SM. Health care costs of smoking in Malaysia. 2007.
5.
Fleming R, Leventhal H, Glynn K, Ershler J. The role of cigarettes in the initiation and progression of early substance use. Addic Behav. 1989;14(3):261–72.CrossRef
6.
Jackson C, Sweeting H, Haw S. Clustering of substance use and sexual risk behaviour in adolescence: analysis of two cohort studies. BMJ Open. 2012;2:e000661.CrossRefPubMedPubMedCentral
7.
Busch V, Van Stel HF, Schrijvers AJ, de Leeuw JR. Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study. BMC Public Health. 2013;13:1118.CrossRefPubMedPubMedCentral
8.
U.S. Department of Health and Human Services. The health consequences of smoking: a report of the surgeon general. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
9.
Park SH. Smoking behavior and predictors of smoking initiation in childhood and early adolescence. J Korean Acad Nurs. 2009;39(3):376e85.CrossRef
10.
Millar WJ, Chen J. Age of smoking initiation: implications for quitting. Health Rep. 1998;9(4):39e46.
11.
12.
Lim KH, Sumarni MG, Kee CC, Christopher VM, Noruiza Hana M, Lim KK, Amal NM. Prevalence and factors associated with smoking among form four students in Petaling District, Selangor, Malaysia. Trop Biomed. 2010;27(3):394–403.PubMed
13.
Naing NN, Zulkifli A, Razlan M, et al. Factors related to smoking habits of male adolescents. Tob Induced Dis. 2004;2:133–40.CrossRef
14.
Shamsuddin K, Haris MA. Family influence on current smoking habits among secondary school children in Kota Bharu, Kelantan. Singapore Med J. 2000;41(4):167–71.PubMed
15.
Lim KH, Amal NM, Hanjeet K, Mashod MY, Wan Rozita WM, Sumarni MG, Hadzrik NO. Prevalence and factors related to smoking among secondary school students in Kota Tinggi District, Johor, Malaysia. Tinggi District, Johor, Malaysia. Tinggi District, Johor, Malaysia. Trop Biomed. 2006;23(1):75–84.PubMed
16.
Norbanee TH, Norhayati MN, Norsa’adah B, Naing NN. Prevalence factors influencing smoking amongst Malay primary school in Tumpat, Kelantan. Southeast Asian J Trop Med Public Health. 2006;37(1):23–8.
17.
Nor A, Zulkefli M, Rahmah MA, Lye MS, Md Said S, Fazilah S, Shamsul Azhar S. smoking behavior among adolescents in rural schools in Malacca, Malaysia - a case-control study. Pertanika J Sci & Technol. 2015;23(1):13–28.
18.
Saari AJ, Kentala J, Matilla KJ. Weaker self-esteem in adolescence predicts smoking. BioMed Res Int. 2015;2015:1–5.
19.
20.
21.
Jamil MBY. Validity and reliability study of Rosenberg self-esteem scale inSeremban school children. Malaysian J Psychiatry. 2006;15:35–8.
22.
Jeganathan PD, Hairi NN, Al Sadat N, Chinna K. Smoking stage relations to peer, school and parental factors among secondary school students in Kinta, Perak. Asian Pac J Cancer Prev. 2013;14(6):3483–9.CrossRefPubMed
23.
Page RM, Dennis M, Lindsay GB, Merrill RM. Psychosocial distress and substance use among adolescents in four countries: Philippines, China, Chile, and Namibia. Youth Soc. 2011;43:900–30.CrossRef
24.
Rao S, Aslam SK, Zaheer S, Shafique K. Anti-smoking initiatives and current smoking anti-smoking initiatives and current smoking among 19,643 adolescents in south asia: findings from the global youth tobacco survey. Harm Reduc J. 2014;11:8.CrossRef
25.
Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European Union. Prev Med. 2005;40:756–64.CrossRefPubMed
26.
Graham H. Smoking prevelance among women in the European community 1950–1990. Soc Sci Med. 1996;43:243–54.CrossRefPubMed
27.
Bandura A. Social learning theory. New Jersey: Prentice-Hall, Inc; 1977.
28.
Sirirassamee T, Sirirassamee B, Borland R, Maizurah O. Smoking behavior among adolescents in thailand and Malaysia. Southeast Asian J Trop Med Public Health. 2011;4(2):218–24.
29.
Malaysian Food Act. The control of tobacco product (amendment) regulations, 2004 Government Gazette P.U.(A) 324. 1993.
30.
Zulkifli A, Rogayah I. Cigarette sales to minors in Kelantan. Med J Malaysia. 1998;53:128–30.
31.
Nazarzadeh M, Bidel Z, Ayubi E, Bahrami A, Jafari F, Mohammadpoorasl A, Delpisheh A, Taremian F. Smoking status in Iranian male adolescents: a cross-sectional study and a meta-analysis. Addic Behav. 2013;38(6):2214–8.CrossRef
32.
33.
34.
Widome R, Forster JL, Hannan PJ, Perry CL. Longitudinal pattern of youth access to cigarettes and smoking progression: Minnesota Adolescent Community Cohort (MACC) study (2000–2003). Prev Med. 2007;45:442–6.CrossRefPubMedPubMedCentral
35.
DiFranza JR. Adolescent acquisition of cigarettes through non commercial source. J Adoles Heal. 2003;32(5):331–2.CrossRef
36.
Eun ES, Ji YY. Factors associated with early smoking initiation among Korean adolescents. Asian Nurs Res. 2015;9(2):115–9.CrossRef
37.
Goldade K, Choi K, Bernat DH, Klein EG, Okuyemi KS, Forster J. Multilevel predictors of smoking initiation among adolescents: findings from the Minnesota Adolescent Community Cohort (MACC) study. Prev Med. 2012;54(3–4):242–6.CrossRefPubMedPubMedCentral
38.
Santrock JW. Adolescence. 11th ed. Boston: McGraw-Hill; 2005.
39.
Rajan KB, Leroux BG, Arthur V, Peterson Jr, Bricker JB, Andersen MR, Kealey CA, Sarason IG. Nine-year prospective association between older siblings smoking and children’s daily smoking. J Adoles Healt. 2003;1:25–30.CrossRef
40.
Woodruff SI, Laniado-Laborín R, Candelaria JI, Villaseñor A, Sallis JF. Parental prompts as risk factors for adolescent trial smoking: Results of a prospective cohort study. Addic Behav. 2004;9:1869–73.CrossRef
41.
Scalici F, Schulz JP. Influence of perceived parent and peer endorsement on adolescent smoking intentions: parents have more say, but their influence wanes as kids get older. plos one. 2014;9(7):1–7.
42.
Gilman SE, Rende R, Boergers J, Abrams DB, Buka SL, Clark MA. Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control. Pediatrics. 2009;123(2):e274–81.CrossRefPubMedPubMedCentral
43.
Blokland Exter EA, Engels RC, Hale WW, Meeus W, Willemsen MC. Lifetime parental smoking history and cessation and early adolescent smoking behavior. Prev Med. 2004;38:359–68.CrossRef
44.
Bandura A. Self-efficacy mechanism in physiological activation and health and promoting behavior. In: Madden J, Matthysse S, Barchas J, editors. Adaptation, learning and affect. New York: Raven; 1989. p. 1169–88.
45.
Bandura A. Social cognitive theory. In: Vasta R, editor. Annals of child development, Six theories of child development, vol. 6. Greenwich: JAI Press; 1989. p. 1–60.
46.
Kodl MM, Mermelstein R. Beyond modeling: parenting practices, parental smoking history, and adolescent cigarette smoking. Addict Behav. 2004;29:17–32.CrossRefPubMed
47.
Chassin L, Presson C, Seo DC, Sherman SJ, Macy J, Wirth RJ, Curran P. Multiple trajectories of cigarette smoking and the intergenerational transmission of smoking: a multigenerational, longitudinal study of a Midwestern community sample. Heal Psycho. 2008;27:819–28.CrossRef
48.
Sargent JD, Dalton M. Does parental disapproval of smoking prevent adolescents from becoming established smokers? Pediatrics. 2001;108(6):1256–62.CrossRefPubMed
49.
Bricker JB, Andersen MR, Rajan KB, Sarason IG, Peterson AV. The role of schoolmates’ smoking and non-smoking in adolescents’ smoking transitions: a longitudinal study. Addiction. 2007;102:1665–75.CrossRefPubMed
50.
Morin AJ, Rodriguez D, Fallu JS, Maïano C, Janosz M. Academic achievement and smoking initiation in adolescence: a general growth mixture analysis. Addiction. 2012;107(4):819–28.CrossRefPubMed
51.
Dhavan P, Stigler MH, Perry CL, Arora M, Reddy KS. Is tobacco use associated with academic failure among government school students in urban India? J Sch Health. 2010;80(11):552–60.CrossRefPubMed
52.
Aloise-Young PA, Cruickshank C, Chavez EL. Cigarette smoking and perceived health in school dropouts: a comparison of mexican american and non-hispanic white adolescents. J PediatrPsychol. 2002;27(6):497–507.
53.
Page RM. Loneliness and adolescent health behavior. Health Educ. 1990;21:14–7.
54.
Stickley A, Koyanagi A, Koposov R, Schwab-Stone M, Ruchkin V. Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional. BMC Public Health. 2014;14:366.CrossRefPubMedPubMedCentral
55.
Heinrich LM, Gullone E. The clinical significance of loneliness: a literature review. Clin Psychol Rev. 2006;26:695–718.CrossRefPubMed
56.
Rotenberg KJ, McDougall P, Boulton MJ, Vaillancourt T, Fox C, Hymel S. Cross-sectional and longitudinal relations among peer-reported trustworthiness, social relationships, and psychological adjustment in children and early adolescents from the United Kingdom and Canada. J exp Child Psychol. 2004;88:46–67.CrossRefPubMed
57.
Fadhli Y, Zulkifli A, Razlan M. Religious perception and other associated factors of smoking among male secondary school students in Kota Baru, Kelantan. Mal J Pub Heal Med. 2005;5(2):58–63.
58.
Nor Afiah MZ, Rahmah MA, Salmiah MS, Fazilah S, Shamsul Azhar S. Religiosity personality and smoking among form two students in rural schools in Malacca, Malaysia. Int Med J Malaysia. 2012;11(2):39–44.
59.
Nonnemaker J, McNeely C, Blumb RW. Public and private domains of religiosity and adolescent. Soc Sci Med. 2006;62:3084–95.CrossRefPubMed
60.
Wallace JM, Forman T. Religion’s role in promoting health and reducing risk among American youth. Health Educ Behav. 1998;25:721–41.CrossRefPubMed
61.
Choi WS, Ahluwalia JS, Harris KJ, Okuyemi K. Progression to established smoking: the influence of tobacco marketing. Am J Prev Med. 2002;22(4):228–33.CrossRefPubMed
62.
Coleman JS. Social capital and the creation of human capital. Am J Sociol. 1998;94:S95–120.CrossRef
63.
Smith C. Theorizing religious effects among theorizing religious effects among theorizing religious effects among american adolescents. J Sci Study Relig. 2003;42(1):17–30.CrossRef
64.
Shakib S, Hong Z, Johnson CA, Chen XG, Ping S, Palmer PH. Family characteristics and smoking among urban and rural adolescents living in China. Prev Med. 2005;40(1):83–91.CrossRefPubMed
65.
Wan X, Sheenassa SD. Interaction between parenting and neighbourhood quality on the risk of adolerscents regular smoking. Nicotine Tobacco Res. 2012;14(3):313–22.CrossRef
66.
Wang Y, Krishnakumar A, Narine L. Parenting practices and adolescent smoking in mainland China: the mediating effect of smoking-related cognitions. J Adolescent Health. 2014;37:915e925.
Metadata
Title
Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study
Authors
Kuang Hock Lim
Hui Li Lim
Chien Huey Teh
Chee Cheong Kee
Yi Yi Khoo
Shubash Shander Ganapathy
Miaw Yn Jane Ling
Sumarni Mohd Ghazali
Eng Ong Tee
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Tobacco Induced Diseases / Issue 1/2017
Electronic ISSN: 1617-9625
DOI
https://doi.org/10.1186/s12971-016-0108-5

Other articles of this Issue 1/2017

Tobacco Induced Diseases 1/2017 Go to the issue

Research

Secondhand smoke exposure and risk of wheeze in early childhood: a prospective pregnancy birth cohort study

Research

A longitudinal study of the relationship between receptivity to e-cigarette advertisements and e-cigarette use among baseline non-users of cigarettes and e-cigarettes, United States

Research

Universal electronic-cigarette test: physiochemical characterization of reference e-liquid

Research

In-person retail marketing claims in tobacco and E-cigarette shops in Southern California

Research

Factors associated with implementation of the 5A’s smoking cessation model

Research

Effect of cigarette smoke on gustatory sensitivity, evaluation of the deficit and of the recovery time-course after smoking cessation
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits