Browsing by Author "Chee Cheong Kee"
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- PublicationAbdominal obesity and its associated factors among older adults in Malaysia(2020)
;Azli Baharudin@Shaharuddin ;Nur Shahida Abdul Aziz ;Mohamad Hasnan Ahmad ;Jayvikramjit Singh Manjit Singh ;Ying Ying Chan ;Lalitha Palaniveloo ;Chee Cheong Kee ;Norlida Zulkafly ;Norazizah Ibrahim Wong ;Ruhaya SallehRusidah SelamatAim: The rise in the prevalence of abdominal obesity (AO), in particular, has become a major concern as it contributes to diabetes, hypertension, high cholesterol, heart disease and certain types of cancer. The aim of this study is to determine the prevalence and associated factors of AO among older adults aged ≥60 years in Malaysia. Methods: This was a nationwide cross‐sectional study using two‐stage stratified random sampling. In total, 3977 older adults aged ≥60 years were involved in this study. Socio‐demography characteristics were obtained using self‐administered questionnaire. AO was measured using waist circumference and classified according to the cut‐off values of ≥90 cm for men and ≥80 cm for women based on the WHO recommendation. Descriptive and multiple logistic regression analysis using a complex sample design were performed for data analysis. Results: Our findings showed that 2371 (67.3%) older adults had AO. Older adults who were from urban areas (69.7%), of women (78.4%), married (66.7%), with tertiary education (73.6%) and unemployed (70.9%) had the highest prevalence of AO. Those from urban areas (adjusted odds ratio [aOR] = 1.29), women (aOR = 3.12), unemployed (aOR = 1.14), diagnosed with hypertension (aOR = 1.56) and diabetes mellitus (aOR = 2.08) were also significantly associated with a higher risk of AO. Conclusions: This study identified several risk factors that are associated with AO among older adults in Malaysia. Such information is important and needed to improve the healthcare system systematically, enable nutrition screening and appropriate intervention to combat the growing AO in Malaysia. Geriatr Gerontol Int 2020; 20: 68–72. - PublicationAssociation of BMI with risk of CVD mortality and all-cause mortality(Cambridge University Press, 2017)
;Chee Cheong Kee ;Mohd Ghazali Sumarni ;Kuang Hock Lim ;Sharmini Selvarajah ;Jamaiyah Haniff ;Guat Hiong Helen Tee ;Kaur Gurpreet ;Yusoff Ahmad FaudziNasir Mustafa AmalObjective To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults. Design Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers. Setting All fourteen states in Malaysia. Subjects Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey. Results Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0–29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2). Conclusions Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted. - PublicationAssociation of physical activity with blood pressure and blood glucose among Malaysian adults: a population-based study(2015)
;Chien Huey Teh ;Ying Ying Chan ;Kuang Hock Lim ;Chee Cheong Kee ;Kuang Kuay Lim ;Pei Sien Yeo ;Omar Azahadi ;Yusoff Fadhli ;Aris Tahir ;Han Lim LeeWasi Ahmad NazniBackground: 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. Methods: Data were extracted from the 2011 National Health and Morbidity Survey (NHMS), a nationally representative, cross-sectional study. A two-stage stratified sampling method was used to select a representative sample of 18,231 Malaysian adults aged 18 years and above. The PA levels of the respondents were categorised as low, moderate or high according to the International Physical Activity Questionnaire (IPAQ)-short form. Blood pressure and fasting blood glucose levels were measured using a digital blood pressure-measuring device and finger-prick test, respectively. Results: Systolic blood pressure (SBP) level was positively associated with PA level (p = 0.02) whilst no significant association was noted between PA level and diastolic blood pressure (DBP). In contrast, respondents with low (adjusted coefficient = 0.17) or moderate (adjusted coefficient = 0.03) level of PA had significantly higher blood glucose level as compared to those who were highly active (p = 0.04). Conclusions: A significant negative association was observed between PA level and blood glucose only. Future studies should employ an objective measurement in estimating PA level in order to elucidate the actual relationship between PA, hypertension and diabetes for the development of effective interventions to combat the increasing burden of premature-mortality and cardiovascular disease-related morbidity in Malaysia. - PublicationAwareness of body mass index and its associated factors: A cross-sectional study(2022)
;Yong Kang Cheah ;Kuang Kuay Lim ;Hasimah Ismail ;Ruhaya Salleh ;Chee Cheong Kee ;Kuang Hock LimYoon Ling CheongThis study explores the correlates of sociodemographic factors, smoking, and caloric knowledge to body mass index awareness with a focus on Malaysia. Logistic regressions were estimated to examine sociodemographic factors associated with body mass index awareness. More than half of respondents were unaware of their body mass index (54.8%). Age was negatively associated with body mass index awareness. Adults without formal education were less likely to know their body mass index than those with tertiary‐level education. Adults were less likely to be aware of their body mass index if they engaged in smoking. Adults with knowledge of the definition of calories were more aware of their body mass index than others. The findings emphasize the urgent need for a forthcoming sociodemographic factors‐specific policy directed toward improving body mass index awareness to lower the prevalence of obesity in Malaysia. - PublicationClustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income country: a cross-sectional study(2019)
;Chien Huey Teh ;Ming Woey Teh ;Kuang Hock Lim ;Chee Cheong Kee ;Mohd Ghazali Sumarni ;Pei Pei Heng ;Tajul Hassan Mohd Zahari ;Ying Ying Chan ;Md Iderus Nuur Hafiza ;Eng Ong TeeKamaludin FadzilahBackground: Lifestyle risk behaviours such as smoking, alcohol consumption, physical inactivity, sedentary behaviour and low fruit/vegetable intake have been identified as the major causes of chronic diseases. Such behaviours are usually instigated in adolescence and tend to persist into adulthood. Studies on the clustering of lifestyle risk behaviours among adolescents are scarce, particularly in developing countries. Therefore, the present paper aimed to determine the clustering of lifestyle risk behaviours and its determinants among school-going adolescents in Malaysia. Methods: Data were extracted from a cross-sectional study, the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study, which was conducted from May to September 2013 across 11 states in Peninsular Malaysia. A two-stage proportionate-to-size sampling method was employed to select a total of 3578 school-going adolescents aged 16–17 years from 20 selected schools in urban and rural settlements, respectively. The MyAHRB study adopted a set of self-administered questionnaires adapted from the Global School-based Student’s Health Survey (GSHS) and the Youth Risk Behaviour Surveillance. Results: The results from the analysis of 2991 school-going adolescents aged 16–17 years showed that 16 (in boys) and 15 (in girls) out of 32 combinations of lifestyle risk behaviours clustered. Girls (aOR 2.82, 95% CI: 2.32–3.43) were significantly more likely to have clustered risk behaviours than boys; however, no significant associated factors were observed among girls. In contrast, boys of Malay descent (aOR 0.64, 95% CI: 0.46–0.89) or boys who had at least three friends (aOR 0.65, 95% CI: 0.43–0.99) were less likely to engage in multiple risk behaviours. Conclusion: The present study demonstrated the clustering of multiple risk behaviours that occurred in both genders; these results suggest that multiple behaviour intervention programmes, instead of programmes based on siloed approaches, should be advocated and targeted to the high-risk sub-populations identified in the present study. - PublicationFactors associated with participation in physical activity among adolescents in Malaysia(2015)
;Yong Kang Cheah ;Hock Kuang Lim ;Chee Cheong KeeSumarni Mohd GhazaliBackground: The rising prevalence of non-communicable diseases (NCDs) has become a serious public health issue. Among the multi-factorial drivers behind NCDs are modifiable health risk factors, most notably, physical inactivity. Objective: In response to the nearly global policy priority of encouraging regular participation in physical activity, the objective of the present study is to examine the factors that determine participation in physical activity among Malaysian adolescents. Methods: Nationally representative data consisting of a large sample size was used. A censored regression model was developed to estimate the likelihood of participation and time spent on physical activity. Results: There are significant relationships between physical activity and gender, ethnicity, self-rated academic performance, maternal education, household size and time spent on physical education. Conclusion: The present study provides new insights into the factors affecting physical activity participation among adolescents. Specifically, self-rated excellent aca demic performance, household size and physical education can increase the likelihood of being physically active. Evidence of the present study implies that policy makers should pay special attention to females, Chinese, adolescents with self-rated poor academic performance and adolescents who have low maternal education. - PublicationHealth warnings on cigarette packages and interest in quitting: findings from five countries conducted the Global Adult Tobacco Survey in 2011-2012(2017)
;Guat Hiong Tee ;Tahir Aris ;Mohd Azahdi Omar ;Muhammad Fadhli Mohd Yusoff ;James Rarick ;Chee Cheong KeeSorina IrimieThis study examines findings from the Global Adult Tobacco Surveys in five countries: Argentina, Indonesia, Malaysia, Nigeria, and Romania in assessing the effects of health warnings (HWs) on cigarette packages and interest in quitting. This was a household survey using multistage cluster sample design. Data were collected from one respondent per household aged 15 years and above via interviewer-administered questionnaires. The impact of HWs within each gender were analyzed by age group and education level using bivariate analysis. Among current smokers, Romanian (98.0%) and Malaysian (94.1%) men, Romanian (97.6%) and Argentina (89.3%) women had the highest percentages of noticing health warnings on cigarette packages. However, less than 50% of men in all five countries and women in Indonesia, Romania and Argentina thought about quitting smoking. In addition, less than 50% of men and women tried to quit smoking in the past 12 months. These analyses provide great opportunity for countries to assess the effectiveness of their health warnings in communicating the risk of smoking to all current smokers. Countries can use these evidence-based findings to target tobacco control interventions to increase quit rates among current smokers and prevent smoking initiation among non-smokers. - PublicationPhysical activity and overweight/obesity among Malaysian adults: findings from the 2015 National Health and morbidity survey (NHMS)(2017)
;Ying Ying Chan ;Kuang Kuay Lim ;Kuang Hock Lim ;Chien Huey Teh ;Chee Cheong Kee ;Siew Man Cheong ;Yi Yi Khoo ;Azli Baharudin ;Miaw Yn Ling ;Mohd Azahadi OmarNoor Ani AhmadBackground: Overweight 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. Methods: This 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. Results: Overall, 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. Conclusions: The 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. - PublicationPrevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015(Elsevier, 2019)
;Ying Ying Chan ;Rajini Sooryanarayana ;Noraida Mohamad Kasim ;Kuang Kuay Lim ;Siew Man Cheong ;Chee Cheong Kee ;Kuang Hock Lim ;Mohd Azahadi Omar ;Noor Ani AhmadNoran Naqiah Mohd HairiMalaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on sociodemographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (< 5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia - PublicationSmoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study(2017)
;Kuang Hock Lim ;Hui Li Lim ;Chien Huey Teh ;Chee Cheong Kee ;Yi Yi Khoo ;Shubash Shander Ganapathy ;Miaw Yn Jane Ling ;Sumarni Mohd GhazaliEng Ong TeeBackground: 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. - PublicationSource of cigarettes among youth smokers in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA)(European Publishing, 2018)
;Kuang Hock Lim ;Chien Huey Teh ;Pei Pei Heng ;Sayan Pan ;Miaw Yn Ling ;Muhammad Fadhli Mohd Yusoff ;Sumarni Mohd Ghazali ;Chee Cheong Kee ;Rafiza ShaharudinHui Li LimIntroduction: Understanding how and where youth obtain tobacco products are major factors in the development of suitable intervention programs to reduce youth smoking. This study aimed to determine the source of cigarettes and the associated factors among Malaysian school adolescent smokers. Methods: Our sample consisted of 1348 youth aged 10–17 years who were current smokers (having smoked at least once in the last 30 days). The source of cigarettes (commercial, over-the-counter purchases; or social, borrowing or obtaining from someone else) was the dependent variable, and multivariable logistic regression was employed to determine its association with independent variables (i.e. sociodemographics, smoking behavior, and knowledge of laws prohibiting sales of cigarettes to youth). Results: Over half (54.3%) of current smokers obtained cigarettes from commercial sources, with a proportion nearly two times higher (84.2% vs 43.7%) among frequent smokers (i.e. those smoking more than 20 days per month) compared to less-frequent smokers, and among young males (56.5% vs 32.0%) compared young females. Multivariable logistic regression indicated that in urban areas, young females (AOR=12.5, 95% CI: 1.38–99.8) frequent smokers (AOR=4.41, 95% CI: 2.05–9.46), and those studying in lower (AOR=3.76, 95% CI: 1.41– 10.02) and upper secondary (AOR=4.74, 95% CI: 1.72–13.06) school students were more likely to obtain cigarettes from a commercial source. On the other hand, in rural areas, only frequent smokers were more likely to get their cigarettes from commercial sources, whilst other variables were not significant. Conclusions: The proportion of youth smokers who obtained cigarettes from commercial sources appeared to be high, suggesting that law enforcement and health promotion activities should be enhanced to reduce the rate of smoking among Malaysian youth. - PublicationStages of Smoking Cessation among Malaysian Adults - Findings from National Health Morbidity Survey 2006(2013)
;Kuang Hock Lim ;Normala Ibrahim ;Sumarni Mohd Ghazali ;Chee Cheong Kee ;Kuang Kuay Lim ;Ying Ying Chan ;Chien Huey Teh ;Eng Ong Tee ;Wai Yee Lai ;Mohd. Haniki Nik MohamadSherina Mohd SidekIncreasing the rate of smoking cessation will reduce the burden of diseases related to smoking, including cancer. Understanding the process of smoking cessation is a pre-requisite to planning and developing effective programs to enhance the rate of smoking cessation.The aims of the study were to determine the demographic distribution of smokers across the initial stages of smoking cessation (the pre-contemplation and contemplation stages) and to identify the predictors of smoking cessation among Malaysian adult smokers. Data were extracted from a population-based, cross-sectional survey carried out from April 2006 to July 2006. The distribution of 2,716,743 current smokers across the pre-contemplation stage (no intention to quit smoking in the next six months) or contemplation stage (intended to quit smoking in the next six months) was described. Multivariable logistic regression analysis was used to examine the relationship between socio-demographic variables and the stages of smoking cessation. Of the 2,716,743 current smokers, approximately 30% and 70% were in the pre-contemplative and contemplative stages of smoking cessation respectively. Multivariable analysis showed that male gender, low education level, older age group, married and those from higher income group and number of cigarettes smoked were associated with higher likelihood of pre-contemplation to cease smoking in the next six months. The majority of current smokers in Malaysia were in the contemplative stage of smoking cessation. Specific interventions should be implemented to ensure the pre-contemplative smokers proceed to the contemplative stage and eventually to the preparation stage.