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  1. Lim Kuang Kuay, Hasimah Ismail, Nur Liana Ab Majid, Thamil Arasu Saminathan, Rosnah Ramly, Chan Ying Ying, et al.
    Int J Public Health Res, 2020;10(1):1166-1173.
    MyJurnal
    The Ministry of Health, Malaysia had introduced the community based action programme (KOSPEN) to improve the early detection of non-communicable diseases (NCDs) in the population. This study aims to identify factors associated with non-participation in screening activities and its barriers.
  2. Lim, Kuang Kuay, Chan, Ying Ying, Ahmad Ali Zainuddin, Teh, Chien Huey, Hasimah Ismail, Lim, Kuang Hock, et al.
    Int J Public Health Res, 2014;4(1):419-424.
    MyJurnal
    Introduction Iodine deficiency disorders (IDD), is one of the most important micronutrient
    deficiencies which has multiple adverse effects on growth and development.
    The aim of this study was to determine the prevalence of IDD among school
    children and to elucidate the distribution of iodized salt at household level in
    Sarawak, East Malaysia.

    Methods This cross-sectional study was conducted among school children aged 8 to 10
    years in 2008. A multi-stage probability proportionate to population size
    (PPS) cluster sampling method was used to obtain a representative state
    sample of 1200 school children. Spot urine samples were collected for the
    determination of urinary iodine concentration while the iodine content in salt
    was determined using field rapid test kits. The thyroid status was determined
    by palpation.

    Results Response rate was 92.0% (n=1104/1200). The prevalence of goitre among
    school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The
    median urinary iodine concentration (UIC) among the school children was
    102.1 μg/L (IQR, 62.3-146.5 μg/L). Urban children had significantly higher
    median UIC of 109.3 μg/L (IQR, 72.4-159.0 μg/L) than their rural
    counterparts [91.9 μg/L (IQR, 55.7-140.2 μg/L)]. The salt samples tested by
    rapid test kit (RTK) showed only 46.0% of household salt contained iodine.

    Conclusions The present study revealed that the population in Sarawak were of borderline
    iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD
    control programmes need to encourage and advocate the consumption of
    iodized salt in order to eliminate IDD-related health problems in Sarawak.
  3. Hasimah Ismail, Mohd Azahadi Omar, Tahir Aris, Rashidah Ambak, Mohammad Fadhli Mohd Yusoff, Lim, Kuang Kuay, et al.
    Int J Public Health Res, 2016;6(1):677-684.
    MyJurnal
    Introduction The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide
    and many of these affected individuals remain unidentified. Undiagnosed
    T2DM may impose substantial public health implications because these
    individuals remain untreated and at risk for complications. The objective of
    this study was to determine the national prevalence of undiagnosed T2DM
    and to identify the associated risk factors.

    Methods A nationwide cross-sectional study was conducted involving 17,783
    respondents. Two-stage stratified sampling design was used to select a
    representative sample of the Malaysian adult population. Structured
    validated questionnaires with face to face interviews were used to obtain
    data. Respondents, who claimed that they were not having diabetes, were
    then asked to perform a fasting blood glucose finger-prick test by Accutrend
    GC machine.

    Results The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest
    percentage of undiagnosed T2DM was found among males (10.2%), 55-59
    years old (13.4%), highest education attainers of primary school (11.1%),
    Indians (10.3%), married (10.3%), working (8.9%) and living in the urban
    areas (9.2%). Multivariate analyses showed that factors associated with
    undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity
    and hypertension.

    Conclusion This study found an increasing trend of undiagnosed T2DM in Malaysia
    compared to 2006. This finding is alarming as risk factors associated with
    undiagnosed diabetes were related to most of the socio-demographic factors
    studied. Therefore, early diabetic screening is crucial especially among adults
    aged 30 and above to prevent more serious complications of this disease.
  4. Lim, Kuang Kuay, Jambai Endu, Chan, Ying Ying, Teh, Chien Huey, Hasimah Ismail, Lim, Kuang Hock, et al.
    Int J Public Health Res, 2015;5(2):631-636.
    MyJurnal
    Introduction Following the reveal of borderline iodine sufficiency among the Sarawakians
    from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a
    mandatory universal salt iodization (USI) was implemented in Sarawak
    thereafter. This study aimed to determine the current status of USI in
    Sarawak after a 3-year implementation of USI from 2008 to 2011.

    Methods The IDD survey was conducted between Jun 2011 to July 2011 involving six
    districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The
    schools were selected via multistage proportionate-to-population size
    sampling technique and the children were randomly selected via systematic
    sampling. A total of 19 schools and 661 children were recruited into the
    survey. Thyroid size was determined by palpation and was and graded
    according to the classification of the World Health Organization (grade 0-2).
    The iodine excretion level in spot morning urine was measured using inhouse
    microplate method. The urinary iodine concentration (UIC) values
    were compared by Kruskal-Wallis test and Chi-square tests were used to
    compare categorical variables.

    Results A total of 610 school children were participated in the study (92.3%). The
    TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC
    level was 154.2 (IQR, 92.7 - 229.8) μg/L, with the highest median UIC been
    observed in Sarikei [178.0 (IQR, 117.6 - 308.9) μg/L], followed by Mukah
    [174.8 (IQR, 99.0 - 224.3) μg/L)], Miri [158.6 (IQR, 92.3 - 235.4) μg/L],
    Sibu [147.0 (IQR, 89.8 - 221.4) μg/L], Bintulu [142.3 (IQR, 52.8 - 245.1)
    μg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) μg/L]. One in every ten child was
    of iodine deficient (UIC < 50μg/L) while a third of the child (32%) were of
    adequate level of UIC.

    Conclusion The present findings indicate that the mandatory USI successfully improves
    the iodine level of children in Sarawak. However, regular and proper
    monitoring of the UIC level in the communities is needed to prevent
    excessive iodine intake.
  5. Lim, Hui Li, Chong, Siew Man, Heng, Pei Pei, Lim, Kuang Kuay, Sumarni Mohd Ghazali, Kee, Chee Cheong, et al.
    Int J Public Health Res, 2020;10(2):1215-1218.
    MyJurnal
    Introduction Community-based health promotion programme has been recognised to reduce modifiable lifestyle risk behaviours for non-communicable diseases. The aim of this study was to evaluate the proportion of the awareness, knowledge and acceptance of a community-based intervention programme, “Komuniti Sihat, Pembina Negara“ (KOSPEN) (Healthy Community, Developed Nation). This cross-sectional study employed a two-stage proportionate sampling method to select a representative sample of communities in the Southern states of Peninsular Malaysia, Negeri Sembilan, Malacca, and Johor. Face-to-face interviews by trained research assistants using pre-validated questionnaires was the study tool applied. The study revealed that approximately two thirds of respondents were aware of the KOSPEN programme (65.5%) and almost half (45.4%) of them were involved in the health promotion activities, namely health screenings (84.8%), health talks (66.4%), and providing plain water in formal occasion (52.9%). About two thirds and one-quarter of them have a very good (73.4%) and good (24.1%) general view on this programme. Four out of ten respondents faced difficulties joining the activities. Lack of time (83.0%) was reported as the main barrier. The KOSPEN programme in overall was moderately accepted by the community. However, the need for future improvement has to be highlighted in order to enhance the involvement and participation of the communities.
  6. Lim, Kuang Kuay, Chan, Ying Ying, Ahmad Ali Zainuddin, Teh, Chien Huey, Rusidah Selamat, Kee, Chee Cheong, et al.
    Int J Public Health Res, 2013;3(1):198-203.
    MyJurnal
    Iodine deficiency is still prevalent worldwide and it is the main cause of goiter, thyroid dysfunction and mental retardation. The aim of the study was to determine the iodine status and goiter prevalence among the school children in Terengganu. The representative sample consists of 1163 primary school children aged 8-10 years old randomly selected from urban and rural schools in Terengganu using stratified systematic random sampling technique. Urinary iodine levels in spot urine were determined by in house modified micro-method while goiter assessment was carried out by palpation of thyroid gland. The status of iodine deficiency was determined by the median urinary iodine concentrations (UIC) and total goiter prevalence (TGP) in accordance with the WHO criteria. The result showed the median [inter-quartile range (IQR)] urinary iodine concentrations was 78.7µg/L (50.1µg/L -120.0µg/L) indicating the iodine intake was slightly lower than recommended range of 100 µg/L. The rural school children had a significantly lower Iodine levels (median UIC=72.4µg/L, IQR=46.7µg/L -113.0µg/L) than the urban school children (median UIC=87.7µg/L, IQR=54.5 µg/L - 127.5µg/L). The total goiter prevalence (TGP) was 5.7%. The prevalence of goiter was significantly higher in rural (TGP=6.9%) compared to urban areas (TGP=3.6%). The study revealed that school children in Terengganu showed mild iodine deficiency and the condition is more pronounced in children from rural areas. The findings emphasize the importance of intervention implementation, universal salt iodization to ensure sufficient intake of iodine among the Terengganu school children.
  7. Ismail H, Aris T, Ambak R, Lim KK
    Int J Public Health Res, 2014;4(2):465-471.
    MyJurnal
    Introduction Healthy dietary practice is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing the rate of diabetes complication development. It is, therefore, important at all levels of diabetes prevention. The objective of this study was to determine the association of dietary practice with glycaemic control among Type 2 diabetes mellitus (T2DM) patients, who received treatment from an urban Health Clinic in Kuala Lumpur.
    Methods A total of 307 patients with T2DM aged 18 years and above participated in this study. A pre-tested structured questionnaire with guided interview was used to collect information on socio-demographic, clinical and dietary practice. Anthropometric and biological measurements were also taken. Descriptive statistics and Chi-square were used in the data analysis. Good glycaemic control was defined as HbA1c level less than 6.5%.
    Results The prevalence of good glycaemic control was only 27% (n=83). The highest percentage of good glycaemic control were among male patients (29.1%), aged 60 and above (33.3%), educational level of primary school (35.4%) and those with monthly income group between RM1001 to RM1500 (32.0%). About three quarter of T2DM patient (n=224) had poor control of HbA1c (≥6.5%). Age (p=0.045) and working status (p=0.039) had significant relationship with the level of HbA1c. Dietary practice showed no significant relationship with the HbA1c level.
    Conclusions Effective interventional health education strategies are needed, focussing on modification of dietary behaviour in order to achieve glycaemic control among diabetic patients.
    Study site: Klinik Kesihatan, Kuala Lumpur, Malaysia
  8. Cheah YK, Kee CC, Lim KK, Cheong YL
    J Child Adolesc Psychiatr Nurs, 2024 May;37(2):e12468.
    PMID: 38654575 DOI: 10.1111/jcap.12468
    OBJECTIVE: Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking.

    DESIGN AND MEASURES: Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems).

    RESULTS: School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems.

    CONCLUSION: Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.

  9. Cheah YK, Lim KK, Kee CC, Tan LK
    PMID: 39579044 DOI: 10.1177/17579139241296476
    AIMS: Exposure to passive smoking among adolescents is a public health concern. This study aims to explore demographic and lifestyle factors associated with perception of passive smoking risk and the mediating effects of exposure to anti-smoking advertisements and education about the dangers of smoking on the relationship between grade levels and the perception.

    METHOD: Data from the Tobacco and E-Cigarette Survey among Malaysian Adolescents (n = 13,117) were analysed. Ordered probit models were used to assess factors associated with passive smoking risk perception (i.e. not harmful, probably not harmful, probably harmful, harmful).

    RESULTS: About one-third of adolescents did not perceive that passive smoking was harmful (30.4%). Adolescents with the perception that passive smoking was not harmful were more likely to be students at low grade levels, be males, be non-Malays and be low-pocket-money recipients and those who used e-cigarettes and who smoked. Being aware of anti-smoking advertisements (direct effect = 0.174; indirect effect = 0.012) and taught on the dangers of smoking (direct effect = 0.179; indirect effect = 0.003) partially mediated the positive relationship between grade levels and perceived risk of passive smoking.

    CONCLUSION: Policies implemented to reduce exposure to passive smoking should highlight the important role of demographic factors, lifestyle profiles, anti-smoking advertisements and education about the dangers of smoking in improving passive smoking risk perception among adolescents.

  10. Lim KK, Wong M, Mohamud WN, Kamaruddin NA
    Asia Pac J Clin Nutr, 2013;22(1):41-7.
    PMID: 23353609 DOI: 10.6133/apjcn.2013.22.1.02
    BACKGROUND: This research was performed to determine the prevalence of iodine deficiency disorder (IDD) and the effects of iodized salt supplementation on thyroid status amongst Orang Asli in Hulu Selangor, Malaysia.
    METHODS: Study respondents were from three target groups, i.e. pre-school children (PSC), primary school-going children (SGC) and adult women. Each household was supplied with iodized salt fortified with iodate fortificant for a period of 12 months and the iodine levels in the salt ranged from 20 to 30 μg/L. Samples collected before and after 6 and 12 months of introduction to iodized salt were urine from all groups, as well as serum samples from adult women.
    RESULTS: A total of 200 respondents were recruited; 58 (29.0%) PSC, 65 (32.5%) SGC and 77 (38.5%) adult women. The median urine-iodine concentration (mUIC) in all groups were of moderately low before the iodized salt intervention, but increased significantly in all study groups after 6 and 12 months of intervention. However, at the end of the study, there was an increase in severe iodine deficiency (mUIC <20 μg/L) from 7.5% to 12% and about 9% of PSC and SGC respondents had mUIC level of more than 300 μg/L while the adult women showed a significant increase in free triiodothyronine (fT3) levels.
    CONCLUSION: The study demonstrated that iodized salt supplementation was able to show an improvement in iodine level amongst Orang Asli. However, an increase in severe iodine deficiency and iodine excess indicated that the iodized salt programme needs to be carefully monitored.
  11. Lim KK, Chan YY, Mahmud NA, Ismail H, Tan BC, Chua BK, et al.
    Int J Public Health Res, 2018;8(2):980-986.
    MyJurnal
    Introduction Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after introduction of mandatory universal salt iodisation (USI) for seven years.
    Methods A total of 508 first trimester PW attending government Maternal and Child Health Care clinics in all 11 divisions in Sarawak between 1st April and 15th June 2015 were recruited. Urine samples were obtained and analysed for urinary iodine concentration (UIC) using the modified Sandell-Kolthoff reaction method. For pregnant women, an adequate iodine intake was defined as a median UIC between 150-249 µg/L according to the WHO/UNICEF/ICCIDD’s criterion. For further analyses, the 11 divisions were then combined into 3 regions, namely Northern (Miri, Bintulu, Limbang), Central (Kapit, Mukah, Sibu, Sarikei, Betong) and Southern (Kota Samarahan, Kuching, Sri Aman).
    Results TThe median UIC of the PW in Sarawak was 105.6 µg/L, indicating iodine deficiency. A total of 330 (65.0%) PW had UIC<150 µg/L. In terms of urinary iodine levels by region, the median UIC in Northern, Central and Southern regions were 136.3 µg/L, 85.5 µg/L and 97.4 µg/L respectively. The differences in median UIC between regions were significant. In addition, the Northern region (p = 0.001), Malay/Melanau ethnicity (p = 0.015) and parous parity (p = 0.014) were significantly associated with higher median UIC. No significant association was found for locality, age nor gravida.
    Conclusions This study indicates inadequate iodine status among PW in Sarawak despite seven years of mandatory USI. In fact, the majority of PW appear not to be protected against IDD and its consequences. In future, a comprehensive study should be carried out to determine the levels of iodine in salt at the retail outlets, villages and households in Sarawak.
    Keywords Iodine deficiency disorders - Pregnant women - Mandatory USI - Sarawak
  12. Sabtu MY, Lim KK, Ismail H, Mohd Zaki NA, Lim KH
    Med J Malaysia, 2015;70 Suppl 1:70.
    Introduction: The Ministry of Health had initiated a national programme known as “KOSPEN” to study the prevalence of Non Communicable Diseases (NCDs) and its risk factors among the population. The aim of this study is to assess the awareness, knowledge and acceptance of KOSPEN programme among
    Community Development Department (KEMAS) personnel in Southern Zone, Malaysia.
    Methods: The cross-sectional study was conducted between October and mid December 2014. The study used validated self-administered questionnaires to collect data from the 2375 KEMAS staff from the state of Johor, Malacca and Negeri Sembilan. SPSS version 20 was used for data analysis.
    Results: The results revealed that only 25.5% of respondents were aware that they were on the KOSPEN committee and 65.7% said that they knew the functions of KEMAS in KOSPEN. 90.8% were aware that their responsibilities included identifying localities for KOSPEN, identifying volunteers (85.7%) and attending KOSPEN training (75.3%). In terms of knowledge, most of them knew the objectives of KOSPEN, such as “KEMAS will add on the value of the programmes and its activities” (84.3%) and “to establish trained health volunteers in the community” (85.9%). They also knew that healthy eating habits (94.7%), active lifestyle (93.4%), body weight management (87.0%), no smoking (86.8%) and health screening (92.2%) were the components of KOSPEN. Majority of the respondents perceived that the components for intervention in the community were good. The highest accepted component was health
    screening (83.5%), follow by healthy eating habits (82.0%), active lifestyle (80.4%), no smoking habit (76.9%) and body weight management (76.1%).
    Conclusion: the awareness, knowledge and acceptance of KOSPEN programme by KEMAS personnel are good. Several measures are currently being carried out to improve and strengthen the implementation of KOSPEN programme such as funding, screening equipment and health education materials.
  13. 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.

  14. Awaluddin SM, Mahjom M, Lim KK, Shawaluddin NS, Tuan Lah TMA
    J Environ Public Health, 2023;2023:1798434.
    PMID: 36761248 DOI: 10.1155/2023/1798434
    INTRODUCTION: Working people are exposed to occupational hazards and are at risk of having occupational disease or injury in a rapidly industrializing country like Malaysia. This study aims to review and summarize the occupational disease and injury in Malaysia from 2016 to 2021.

    METHODS: This study used PubMed and Scopus databases to conduct a systematic literature search using a set of keywords. The selected records dated from 1 January 2016 to 8 September 2021 were extracted into the Mendeley Desktop and ATLAS.ti 8 software. Systematic screening was conducted by two independent researchers and finalized by the third researcher. Data were coded and grouped according to the themes. The results were presented as the table for descriptive analysis and cross-tabulation between the themes.

    RESULTS: A total of 120 records were included in this study. Under the theme of main health problems, the findings showed that mental health, infectious disease, and work-related musculoskeletal disorders are the top three problems being discussed in the literature for the working people in Malaysia. The findings also showed an increasing trend of mental health problems during pandemic COVID-19 years. In addition, hospital was the highest workplace where the occupational health problems were reported.Discussion/Conclusion. There was substantial work on the mental health problem, infectious diseases, and work-related musculoskeletal disorders as the main health problem among workers in Malaysia in the past five years. The employers must report any occupational health and injury case to the authority and prompt intervention can be initiated.

  15. Kee CC, Mohd Ghazali S, Lim KH, Subenthiran S, Teh CH, Lim KK, et al.
    Diabetes Metab Syndr, 2015 Apr-Jun;9(2):74-8.
    PMID: 25819369 DOI: 10.1016/j.dsx.2015.02.006
    OBJECTIVES: Many studies have suggested that there is variation in the capabilities of BMI, WC and WHR in predicting cardiometabolic risk and that it might be confounded by gender, ethnicity and age group. The objective of this study is to examine the discriminative abilities of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (high blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and high fasting plasma glucose) among the adult Malaysian population by gender, age group and ethnicity.
    METHODS: Data from 2572 respondents (1044 men and 1528 women) aged 25-64 years who participated in the Non Communicable Disease Surveillance 2005/2006, a population-based cross sectional study, were analysed. Participants' socio-demographic details, anthropometric indices (BMI, WC and WHR), blood pressure, fasting lipid profile and fasting glucose level were assessed. Receiver operating characteristics curves analysis was used to evaluate the ability of each anthropometric index to discriminate MetS cases from non-MetS cases based on the area under the curve.
    RESULTS: Overall, WC had better discriminative ability than WHR for women but did not perform significantly better than BMI in both sexes, whereas BMI was better than WHR in women only. Waist circumference was a better discriminator of MetS compared to WHR in Malay men and women. Waist circumference and BMI performed better than WHR in Chinese women, men aged 25-34 years and women aged 35-44 years.
    CONCLUSIONS: The discriminative ability of BMI and WC is better than WHR for predicting two or more non-adipose components of MetS. Therefore, either BMI or WC measurements are recommended in screening for metabolic syndrome in routine clinical practice in the effort to combat cardiovascular disease and type II diabetes mellitus.
    Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
    KEYWORDS: Adult; Body mass index; Metabolic syndrome; Waist circumference; Waist–hip ratio
    Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
  16. Lim KH, Ghazali SM, Lim HL, Cheong KC, Teh CH, Lim KK, et al.
    BMJ Open, 2019 Oct 28;9(10):e031164.
    PMID: 31662384 DOI: 10.1136/bmjopen-2019-031164
    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.

  17. Chan YY, Teh CH, Lim KK, Lim KH, Yeo PS, Kee CC, et al.
    BMC Public Health, 2015;15:754.
    PMID: 26246019 DOI: 10.1186/s12889-015-2080-z
    BACKGROUND: Self-rated health (SRH) has been demonstrated as a valid and appropriate predictor of incident mortality and chronic morbidity. Associations between lifestyle, chronic diseases, and SRH have been reported by various population studies but few have included data from developing countries. The aim of this study was to determine the prevalence of poor SRH in Malaysia and its association with lifestyle factors and chronic diseases among Malaysian adults.
    METHODS: This study was based on 18,184 adults aged 18 and above who participated in the 2011 National Health and Morbidity Survey (NHMS). The NHMS was a cross-sectional survey (two-stage stratified sample) designed to collect health information on a nationally representative sample of the Malaysian adult population. Data were obtained via face-to-face interviews using validated questionnaires. Two categories were used to measure SRH: "good" (very good and good) and "poor" (moderate, not good and very bad). The association of lifestyle factors and chronic diseases with poor SRH was examined using univariate and multivariate logistic regression.
    RESULTS: Approximately one-fifth of the Malaysian adult population (20.1 %) rated their health as poor (men: 18.4 % and women: 21.7 %). Prevalence increases with age from 16.2 % (aged 18-29) to 32.0 % (aged ≥60). In the multivariate logistic regression analysis, lifestyle factors associated with poor SRH included: underweight (OR = 1.29; 95 % CI: 1.05-1.57), physical inactivity (OR = 1.25; 95 % CI: 1.11-1.39), former smoker (OR = 1.38; 95 % CI: 1.12-1.70), former drinker (OR = 1.27; 95 % CI: 1.01-1.62), and current drinker (OR = 1.35; 95 % CI: 1.08-1.68). Chronic diseases associated with poor SRH included: asthma (OR = 1.66; 95 % CI: 1.36-2.03), arthritis (OR = 1.87; 95 % CI: 1.52-2.29), hypertension (OR = 1.39; 95 % CI: 1.18-1.64), hypercholesterolemia (OR = 1.43; 95 % CI: 1.18-1.74), and heart disease (OR = 1.85; 95 % CI: 1.43-2.39).
    CONCLUSIONS: This study indicates that several unhealthy lifestyle behaviours and chronic diseases are significantly associated with poor SRH among Malaysian adults. Effective public health strategies are needed to promote healthy lifestyles, and disease prevention interventions should be enhanced at the community level to improve overall health.
    Study name: National Health and Morbidity Survey (NHMS-2011)
  18. Chan YY, Lim KK, Teh CH, Lim KH, Abd Hamid HA, Omar MA, et al.
    PMID: 24968689
    Using data from the Third National Health and Morbidity Survey (NHMS III) in 2006, this study examined the association between socio-demographic factors and physical inactivity in a sample of 33,949 adults aged 18 years and above by gender. Physical activity levels were measured using the Global Physical Activity Questionnaire (GPAQ vers 1). Physical inactivity was defined as having a total physical activity level of less than 600 metabolic equivalents-minutes per week (METs-minutes/week) contributed by all three different life domains.Logistic regression analyses were conducted.The prevalence of overall physical inactivity was 43.7% (95% CI: 42.9-44.5). The mean total physical activity level was 894.2 METs-minutes/ week. The means METs-minutes/week for the domain of work, travelling, and leisure time were 518.4, 288.1, and 134.8, respectively. Multivariable logistic regression analyses indicated that females were more likely to be physically inactive than males were (aOR=1.62; 95% CI: 1.53-1.72). Among women, being a housewife (aOR = 1.78; 95% CI: 1.56-2.03), widow/divorcee (aOR = 1.23; 95% CI: 1.05-1.43), and those with no formal education (aOR = 1.20; 95% CI: 1.01-1.43) were found to be significantly associated with physical inactivity.Urban residents, older adults aged 65 years and above, private employees, nonworking group, and those with a monthly household income level of MYR5,000 and above appeared to be consistently associated with physical inactivity across men, women, and combined group (both). Specific health intervention strategies to promote physical activity should be targeted on population subgroups who are inactive.
    Study name: National Health and Morbidity Survey (NHMS-2006)
  19. Lim KK, Chan YY, Teh CH, Ismail H, Yusof R, Muhi J, et al.
    Asia Pac J Clin Nutr, 2017 8 15;26(5):861-866.
    PMID: 28802296 DOI: 10.6133/apjcn.092016.06
    BACKGROUND AND OBJECTIVES: In 2000, legislation on mandatory universal salt iodisation was enacted in Sabah, Malaysia, to reduce the incidence of iodine deficiency disorders among its population. To evaluate the iodine levels among pregnant women from selected rural divisions in Sabah 13 years after the enactment of the universal salt iodisation programme.

    METHODS AND STUDY DESIGN: This cross-sectional study was conducted from 1 May to 30 June, 2013, in three rural divisions of Sabah (the Interior, the West Coast, and Kudat). Data regarding domestic iodised salt use and iodine-containing supplement consumption were obtained from respondents through face-to-face interviews; goitre enlargement was examined through palpation and graded according to the World Health Organization classification. Spot urine samples were also obtained to assess urinary iodine levels by using an in-house modified micromethod.

    RESULTS: In total, 534 pregnant women participated. The prevalence of goitre was 1.0% (n=5), noted only in the West Coast and Kudat divisions. Although all pregnant women consumed iodised salt, overall median urinary iodine concentration was only 106 μg/L, indicating insufficient iodine intake, with nearly two-thirds of the women (60%) having a median urinary iodine concentrations of <150 μg/L.

    CONCLUSIONS: Pregnant women from the rural divisions in Sabah still exhibit iodine deficiency disorder despite the mandatory universal salt iodisation programme. Iodine supplementation programmes targeting pregnant women are warranted.

  20. Teh CH, Chan YY, Lim KH, Kee CC, Lim KK, Yeo PS, et al.
    BMC Public Health, 2015;15:1205.
    PMID: 26630916 DOI: 10.1186/s12889-015-2528-1
    The health-enhancing benefits of physical activity (PA) on hypertension and diabetes have been well documented for decades. This study aimed to determine the association of PA with systolic and diastolic blood pressure as well as blood glucose in the Malaysian adult population.
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