Introduction: Hypercholesterolemia is an important modifiable risk factor for coronary heart disease. Lifestyle changes in diet and physical activity can improve cholesterol levels. This study aimed to compare the fruits and vegetables (FV) intake and physical activity (PA) between hypercholesterolemic adults and non-hypercholesterolemic adults in Malaysia, and to investigate factors associated with meeting the recommended levels of FV intake and PA in a hyper-cholesterolemic population. Methods: This study was based on 17,988 participants (response rate 98.7%) aged 18 years and above who responded to the hypercholesterolemia questionnaire in the 2011 Malaysian National Health and Morbidity Survey (NHMS), a cross-sectional study with two-stage stratified sampling design. Data were obtained by trained enumerators via face-to-face interviews and were analysed by descriptive analysis, chi-square test, and univariable and multivariable logistic regression. Results: Out of Results: the total population assessed, 39.0% had hypercholesterolemia. The prevalence of consuming five or more servings of FV per day is low (7.8%) while 36.0% were physically inactive among the hypercholesterolemic adults. No significant differences were observed in FV intake and PA between hypercholesterolemic and non-hypercholesterolemic populations. Gender, age and educational levels were associated with FV intake and PA among hypercholesterolemic adults. Hypercholesterolemic adults who were underweight or obese were less likely to consume FV, while those who were former smokers and those who had diabetes and heart disease were less likely to be physically active. Conclusion: These findings are relevant for future health promotion strategies, suggesting that more intensive interventions are needed to increase FV intake and PA level in hypercholesterolemic population and in the general population.

Reducing the prevalence of smoking among teenagers who smoked by increasing the rate of smoking cessation is among the feasible long term measures to reduce health problems related to smoking among Malaysian population. However, previous studies have revealed that addiction to nicotine is one of the identified barriers for adolescent smokers to quit smoking (1). Identification of their addiction levels enables the planning and administration of the appropriate measures to in crease the rate of smoking cessation. A simple and valid but not intrusive instrument is the prerequisites for the measurement of nicotine addiction among the smokers. The Fagerstrom Test for Cigarette Dependence (FTCD) which consists of six items and was modified from the Fagerstrom Tol erance Questionnaire (FTQ) is among the widely used instruments for measurement of nicotine ad diction among the smokers(2) due to its non-invasiveness, simplicity and easiness to understand and can rapidly assess nicotine dependence (3). In light of the high prevalence of smoking among adoles cents in Malaysia, and the lack of a valid instrument to measure the nicotine addiction as well as the incur of social and cultural bias if direct adaptation of the validated FTCD were used as Malay sian adolescents may interpret the items in the instrument differently from the adolescents from other countries, the present study was conducted to determine the validity and reliability of the Ba hasa Malaysia version of FTCD-BM among 130 secondary school students aged 13-16 years before it is being used to measure nicotine addiction among the Malaysian adolescents. Our study indicated that the FTCD-BM was of good construct validity as demonstrated by a good value of 0.699 from the Kaiser-Mayer-Olkin measure of sampling adequacy, a significant value from the Bartlett’s test of sphericity in the exploratory factor analysis. In addition, Varimax rotation also revealed that 41% of the variations in determining nicotine addiction among Malaysian adolescents were explained by the FTCD-BM. On the other hand, the reliability of the FTCD-BM was of moderate level with Cronbach alpha value of 0.61. Of note, to the best of our knowledge, the present study, which investigated the validation of FTCD among daily adolescent smokers, is Lim et al.: Reliability and Validity of the Fagerstrom Test for Cigarettes Dependence … Available at: http://ijph.tums.ac.ir 105 the first study in Malaysia, thus far. Using the FTCD-BM, this study revealed that 14% of the daily adolescent smokers were moderately or highly addicted to nicotine. This rate was lower than 60% as reported by Salameh and colleague (2013) (4) among university students in Lebanon, 45% among university students in USA (5) and 30% among college students in Saudi Arabia (6). However, notwithstanding the lower rate of nicotine dependence among Malaysian adolescent smokers as compared to other countries, adequate attention should be given and all possible interventional strategies and educational measures should be undertaken in order to curb or reduce the nicotine addiction level among these adolescents since many previous studies had reported that addicted adolescent smokers tend to continue their smoking behavior till their adulthood (7)