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  1. Peltzer K, Pengpid S
    Int J Environ Res Public Health, 2015 Nov;12(11):14936-47.
    PMID: 26610542 DOI: 10.3390/ijerph121114936
    The study aimed to provide estimates of the prevalence and psychosocial correlates of unintentional injury among school-going adolescents in Malaysia. Cross-sectional data from the Global School-Based Health Survey (GSHS) included 21,699 students (predominantly ≤13 to ≥17 years) that were selected by a two-stage cluster sample design to represent all secondary school students in Forms 1 to 5. The percentage of school children reporting one or more serious injuries in the past year was 34.9%, 42.1% of boys and 27.8% of girls. The two major causes of the most serious injury were "fall" (9.9%) and motor vehicle accident or being hit by a motor vehicle (5.4%), and the most frequent type of injury sustained was cut, puncture, or stab wound (6.2%) and a broken bone or dislocated joint (4.2%). In multivariable logistic regression analysis, sociodemographic factors (being male and low socioeconomic status), substance use (tobacco and cannabis use), frequent soft drink consumption, attending physical education classes three or more times a week, other risky behavior (truancy, ever having had sex, being bullied), psychological distress, and lack of parental or guardian bonding were associated with annual injury prevalence. Several factors were identified, which could be included in injury prevention promotion programs among secondary school children.
    Study name: Global School-Based Student Health Survey (GSHS)
  2. Peltzer K, Pengpid S
    Int J Environ Res Public Health, 2016 Feb;13(2):217.
    PMID: 26891312 DOI: 10.3390/ijerph13020217
    The aim of this study was to examine the relationship between self-reported leisure time physical inactivity frequency and sedentary behaviour and lifestyle correlates among school children in the Association of Southeast Asian Nations (ASEAN) region. The analysis included 30,284 school children aged 13-15 years from seven ASEAN countries that participated in the Global School-based Student Health Survey (GSHS) between 2007 and 2013. The measure asked about overall physical activity, walking or biking to school, and on time spent sitting. Overall, the prevalence of physical inactivity was 80.4%, ranging from 74.8% in Myanmar to 90.7% in Cambodia and sedentary behaviour 33.0%, ranging from 10.5% in Cambodia and Myanmar to 42.7% in Malaysia. In multivariate logistic regression, not walking or biking to school, not attending physical education classes, inadequate vegetable consumption and lack of protective factors (peer and parental or guardian support) were associated with physical inactivity, and older age (14 and 15 years old), coming from an upper middle income country, being overweight or obese, attending physical education classes, alcohol use, loneliness, peer support and lack of parental or guardian supervision were associated with sedentary behaviour. In boys, lower socioeconomic status (in the form of having experienced hunger) and coming from a low income or lower middle income country were additionally associated with physical inactivity, and in girls, higher socioeconomic status, not walking or biking to school and being bullied were additionally associated with sedentary behaviour. In conclusion, a very high prevalence of leisure physical inactivity and sedentary behaviour among school going adolescents in ASEAN was found and several factors identified that may inform physical activity promotion programmes in school-going adolescents in ASEAN.
    Study name: Global School-Based Student Health Survey (GSHS)
  3. Pengpid S, Peltzer K
    Psychol Res Behav Manag, 2019;12:585-592.
    PMID: 31534377 DOI: 10.2147/PRBM.S209611
    Background: The investigation aimed to estimate the association between carbonated soft drink consumption frequency and externalizing and internalizing behaviour among university students in five ASEAN counties.

    Methods: A cross-sectional survey included 3353 university students from Indonesia, Malaysia, Myanmar, Thailand and Vietnam, median age 20 years (interquartile range 3 years).

    Results: In all five ASEAN countries, the study found a prevalence no soft drink consumption in the past 30 days of 20.3%, less than one time a day 44.7%, once a day 25.4% and two or more times a day 9.6%. In the adjusted logistic regression analysis, higher frequency of soft drink consumption (one and/or two or more times a day) was associated with externalizing behaviour (in physical fight, injury, current tobacco use, problem drinking, drug use, pathological internet use and gambling behaviour), and higher frequency of soft drink consumption (two or more times a day) was associated with depression in females, but no association was found for the general student population in relation to internalizing behaviour (depression, posttraumatic stress disorder, suicidal ideation, suicide plan, suicide attempt and sleeping problem).

    Conclusions: Findings suggest that carbonated soft drink consumption is associated with a number of externalizing but not internalizing health risk behaviours.

  4. Pengpid S, Peltzer K
    Eat Weight Disord, 2018 Jun;23(3):349-355.
    PMID: 29681011 DOI: 10.1007/s40519-018-0507-0
    PURPOSE: Since there is a lack of information on eating disorders attitudes in Association of Southeast Asian Nations (ASEAN), the aim of this study was to explore the prevalence of eating disorder attitude and its relation to mental distress among university student populations in Indonesia, Malaysia, Myanmar, Thailand and Vietnam.

    METHODS: A cross-sectional questionnaire survey and anthropometric measurement were conducted with undergraduate university students that were randomly recruited. The Eating Attitudes Test (EAT-26) was utilized to determine the prevalence of disordered eating attitudes. The sample included 3148 university students, with a mean age of 20.5 years, SD = 1.6.

    RESULTS: Using the EAT-26, 11.5% of the students across all countries were classified as being at risk for an eating disorder, ranging from below 10% in Indonesia, Thailand and Vietnam to 13.8% in Malaysia and 20.6% in Myanmar. In multivariable logistic regression analysis, sociodemographic factors (wealthier subjective economic status, and living in a lower middle income country), underweight and overweight body weight perception, psychological factors (depression symptoms and pathological internet use), and being obese were associated with eating disorder risk.

    CONCLUSIONS: Relatively high rates of eating disorder risk were found. This result calls for increased awareness, understanding of eating disorders and related risk factors and interventions in university students in ASEAN.

    LEVEL OF EVIDENCE: Level V, descriptive cross-sectional survey.

  5. Peltzer K, Pengpid S
    Nagoya J Med Sci, 2017 02;79(2):123-133.
    PMID: 28626248 DOI: 10.18999/nagjms.79.2.123
    The aim of this study was to investigate dental health status and oral health behavior and associated factors among university students in five ASEAN countries (Indonesia, Malaysia, Myanmar, Thailand and Vietnam). Using anonymous questionnaires, data were collected from 3,344 undergraduate university students (mean age 20.5, SD=1.6; 58.3% female) from five ASEAN countries. Results indicate that 27.7% of students reported to have sometimes, most of the time or always having tooth ache in the past 12 months, 39.4% reported to have one or more cavities, 20.3% did not brush their teeth twice or more times a day, and 30.9% had never been to a dentist (or did not know it). In multivariate logistic regression analysis, older age, living in a lower middle income country, consumption of chocolate or candy, having made a dental care visit, and poor mental health was associated with tooth ache in the past 12 months. Being male, being 20 to 21 years old, coming from a wealthier family background, living in a lower middle income country, frequent consumption of soft drinks, not having consulted with a dentist in the past 12 months and weak beliefs in the benefits of tooth brushing were associated with inadequate tooth brushing frequency (
  6. Hong SA, Peltzer K
    Subst Use Misuse, 2019;54(2):288-296.
    PMID: 30463459 DOI: 10.1080/10826084.2018.1517797
    BACKGROUND: Though alcohol and tobacco are the most commonly used substances among adolescents, little is known about the patterning of early adolescent substance use in Association of South-East Asian Nations (ASEAN) member states.

    OBJECTIVES: This study examined past month patterns of substances use and its gender difference among adolescents.

    METHODS: Cross-sectional samples among adolescents aged 13-16 years who completed the Global School-based Student Health Survey (GSHS) from eight ASEAN countries were included in the analysis (n = 40,212).

    RESULTS: Prevalence of past month any tobacco use was relatively high in Brunei, Indonesia, Malaysia, Thailand, and the Philippines (11-15%), but prevalence of dual cigarette and other forms of tobacco use was about 2-5% in the five countries. Past month alcohol consumption prevalence was also high in Thailand, Viet Nam, and the Philippines (16-24%), compared to the rest countries (1.4-8.2%). Moreover, prevalence of the concurrent alcohol and tobacco use was higher in Thailand and the Philippines (7 and 10%, respectively), particularly in boys (13 and 15%, respectively). Conclusions/importance: Almost 30-40% of the boys and 10-20% of girls in Malaysia, Philippines, Thailand, and Viet Nam are engaged in at least one of the two risk behaviors, and the concurrent alcohol and tobacco use was also relatively high among boys in those countries (5-15%). This study may provide some valuable insights on alcohol and tobacco policy in the region and requires to begin prevention and treatment programs in ASEAN member states.

  7. Peltzer K, Pengpid S
    Cent Asian J Glob Health, 2017;6(1):288.
    PMID: 30881756 DOI: 10.5195/cajgh.2017.288
    Introduction: There has been a global increase in illicit drug use among young people. The aim of this study was to estimate the prevalence of lifetime cannabis and amphetamine use, as well as to explore factors associated with substance use among adolescents in five Asian countries: Iraq, Kuwait, Malaysia, Mongolia, and Vietnam.
    Methods: 38,941 school children (mean age 15.4 years, SD=1.5) completed the cross-sectional Global School-Based Student Health Survey (GSHS). Topics covered in the questionnaire included cannabis and amphetamine use. Personal, parental, and environmental attributes were explored as predictors of cannabis and amphetamine use. Logistic regression was used to assess the contribution of potential predictors on lifetime cannabis and lifetime amphetamine use.
    Results: Overall, the prevalence of lifetime cannabis use was 0.9% and lifetime amphetamine use was 1.0% among research participants. Cannabis use was influenced by male gender (Kuwait, Mongolia), parental smoking habits (Kuwait, Iraq), and current cigarette smoking in all countries. Amphetamine use was associated with suicidal ideation (Kuwait, Malaysia, Vietnam), school truancy (Malaysia, Mongolia, Vietnam), being a victim of physical assault (Kuwait, Mongolia), bullying victimization (Iraq, Malaysia, Vietnam), as well as anxiety and current cigarette use in all countries.
    Conclusions: Our preliminary results show the importance of personal attributes such as mental distress and environmental stressors on lifetime cannabis and lifetime amphetamine use. Future prospective studies are needed to identify causal relationships among personal attributes, parental attributes, environmental stressors, and illicit substance use.
    Study name: Global School-Based Student Health Survey (GSHS)
  8. Pengpid S, Peltzer K
    PMID: 27244964
    The aim of this study was to assess overweight or obesity and associated factors in school-going adolescents in the Association of Southeast Asian Nations (ASEAN) member countries. The analysis included 30,284 school children 13-15 years of age from seven ASEAN members participating in the Global School-based Student Health Survey (GSHS) between 2007 and 2013. The overall prevalence of overweight or obesity across seven ASEAN countries (excluding Brunei) was 9.9%, significantly higher in boys (11.5%) than in girls (8.3%). Among eight ASEAN countries, the highest prevalence of overweight or obesity was in Brunei Darus-salam (36.1%), followed by Malaysia (23.7%), and the lowest was in Myanmar (3.4%) and Cambodia (3.7%). Multivariate logistic regression analysis found that younger age, coming from an upper middle country, never been hungry, and not walking or biking to school were associated with overweight or obesity. In addition, among boys, having three or more servings of vegetables per day and having no close friends, and among girls, having fast foods two or more times per week, been victims of bullying and having peer support were additional factors associated with overweight or obesity. Increased strategies utilizing a number of the risk factors identified are needed to prevent and treat overweight or obesity in adolescents in ASEAN member countries.
    Study name: Global School-Based Student Health Survey (GSHS)
  9. Peltzer K, Yi S, Pengpid S
    Asian J Psychiatr, 2017 Apr;26:32-38.
    PMID: 28483087 DOI: 10.1016/j.ajp.2017.01.019
    A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.
  10. Yi S, Ngin C, Peltzer K, Pengpid S
    Subst Abuse Treat Prev Policy, 2017 06 26;12(1):32.
    PMID: 28651601 DOI: 10.1186/s13011-017-0117-2
    BACKGROUND: Heavy drinking among university students has been globally recognized as a major public health burden. In the Association of Southeast Asian Nations (ASEAN) region, studies on this issue have been scant, country-specific and in different time frames. The aim of this study was to identify social and behavioral factors associated with binge drinking among university students in nine ASEAN countries.

    METHODS: This cross-sectional study was conducted in 2015 among 8809 undergraduate university students from 13 universities in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam using self-administered questionnaire. Multivariate logistic regression analyses were conducted to explore the associated factors.

    RESULTS: More than half (62.3%) of the study sample were female with a mean age of 20.5 (SD = 2.0) years. Of total, 12.8% were infrequent (

  11. Yi S, Peltzer K, Pengpid S, Susilowati IH
    Subst Abuse Treat Prev Policy, 2017 04 06;12(1):9.
    PMID: 28381234 DOI: 10.1186/s13011-017-0096-3
    BACKGROUND: Illicit drug use among university students has been recognized as a global public health issue in recent years. It may lead to poor academic performance that in turn leads to poor productivity in their later life. This study explores prevalence of and factors associated with illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN).

    METHODS: This multi-country cross-sectional study was conducted in 2015 in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. A multi-stage cluster sampling was used to select undergraduate students from one or two universities in each country for self-administered questionnaire survey. Multivariate logistic regression analyses was performed to explore risk factors related to illicit drug use.

    RESULTS: Participants included 7,923 students with a mean age of 20.6 years (SD = 2.8), ranging from 18-30 years. The overall prevalence of frequent (≥10 times), infrequent (1-9 times) and ever (at least once) illicit drug use in the past 12 months was 2.2, 14.7, and 16.9%, respectively. After adjustment, male students were significantly less likely to be infrequent (1-9 times vs. never), but significantly more likely to be ever users compared to females. Compared to those living with parents/guardians, students living away from parents/guardians were significantly less likely to be frequent (≥10 times vs. never) and infrequent users. Students from lower-middle-income countries were significantly more likely to be frequent and infrequent users, but significantly less likely to be ever users compared to those from upper-middle or high-income countries. Students with poor subjective health status were significantly more likely to be frequent users compared to those who reported good subjective health status. Students who reported binge drinking in the past month were significantly more likely to be infrequent users, but significantly less likely to be ever users.

    CONCLUSIONS: Our findings indicate that prevalence of illicit drug use among university students in the ASEAN region varied by country. Concerted social intervention programs should be designed to address related health and behavioral problems such as illicit drug use and alcohol drinking with particular emphasis on at-risk subgroups of this young population.

  12. Susilowati IH, Nugraha S, Sabarinah S, Peltzer K, Pengpid S, Hasiholan BP
    Malays Fam Physician, 2020;15(1):30-38.
    PMID: 32284802
    Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians.

    Methods: This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk.

    Results: In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting.

    Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

  13. Peltzer K, Pengpid S, Sychareun V, Ferrer AJG, Low WY, Huu TN, et al.
    BMC Cardiovasc Disord, 2017 08 23;17(1):230.
    PMID: 28835205 DOI: 10.1186/s12872-017-0666-3
    BACKGROUND: Existing evidence suggests that the cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. The aim of this study was to evaluate the prevalence of prehypertension, hypertension and to identify psychosocial risk factors for prehypertension among university students in Association of South East Asian Nation (ASEAN) countries.
    METHODS: Based on a cross-sectional survey, the total sample included 4649 undergraduate university students (females = 65.3%; mean age 20.5, SD = 2.9, age range of 18-30 years) from 7 ASEAN countries (Indonesia, Laos, Malaysia, Myanmar, Philippines, Thailand and Vietnam). Blood pressure, anthropometric, health behaviour and psychosocial variables were measured.
    RESULTS: Overall, 19.0% of the undergraduate university students across ASEAN countries had prehypertension, 6.7% hypertension and 74.2% were normotensives. There was country variation in prehypertension prevalence, ranging from 11.3% in Indonesia and 11.5% in Malaysia to above 18% in Laos, Myanmar and Thailand. In multivariate analysis, sociodemographic variables (male gender, living in an upper middle income country, and living on campus or off campus on their own), nutrition and weight variables (not being underweight and obese, having once or more times soft drinks in a day and never or rarely having chocolate or candy), heavy drinking and having depressive symptoms were associated with prehypertension.
    CONCLUSION: The study found a high prevalence of prehypertension in ASEAN university students. Several psychosocial risk factors including male gender, obesity, soft drinks consumption, heavy drinking and depression symptoms have been identified which can help in intervention programmes.
  14. Pengpid S, Peltzer K, Sathirapanya C, Thitichai P, Faria de Moura Villela E, Rodrigues Zanuzzi T, et al.
    Int J Public Health, 2022;67:1604398.
    PMID: 35645703 DOI: 10.3389/ijph.2022.1604398
    Objectives: To investigate psychosocial factors associated with adherence to COVID-19 preventive measures in low- and middle-income countries (LMICs). Methods: This online cross-sectional survey included 10,183 adults (median age 45 years) from nine LMICs. Participants were asked about adhering to four COVID-19 preventive measures (physical distancing, wearing a face mask, hand, and cough hygiene); a composite adherence score was calculated, ranging from 0-4 positive responses. Psychosocial measures included worry, anxiety, depression, social and demographic, and COVID-19 related factors. Results: Factors associated with adherence to more preventive measures included being a participant from Malaysia or Bangladesh, older age, higher education, belonging to the healthcare sector (either as or worker), having health personnel as a trusted source of COVID-19 information/advice, possessing correct COVID-19 knowledge, worry or fear about being (re)infected with COVID-19, and screening negative for general anxiety symptoms. Conclusion: Moderate to high adherence to COVID-19 preventive measures was found, with significant variations across countries. Psychosocial factors (worry, anxiety, knowledge, education, age, and country) seemed determinant in predicting the number of measures to which participants adhered.
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