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

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          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.


          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.


          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).


          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.

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          Most cited references 53

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          Theorizing Religious Effects Among American Adolescents

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            Inequalities in the prevalence of smoking in the European Union: comparing education and income.

            The aim of the study was to determine whether education or income was more strongly related to smoking in the European Union at large, and within the individual countries of the EU, at the end of the 1990s. We related smoking prevalence to education and income level by analyzing cross-sectional data on a total of 48,694 men and 52,618 women aged 16 and over from 11 countries of the European Union in 1998. Both education and income were related to smoking within the European Union at large. After adjustment of the other socioeconomic indicator, education remained related to smoking in the EU at large, but income only remained so among men. Educational inequalities were larger than income-related inequalities among younger and middle-aged men and women. Educational inequalities were larger than income-related inequalities among men in all individual countries, and among women in Northern Europe. For women from Southern European countries, the magnitude of education- and income-related inequalities was similar. Education is a strong predictor of smoking in Europe. Interventions should aim to prevent addiction to smoking among the lower educated, by price policies, school-based programs, and smoking cessation support for young adults.
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              Social learning theory


                Author and article information

                Tob Induc Dis
                Tob Induc Dis
                Tobacco Induced Diseases
                BioMed Central (London )
                31 January 2017
                31 January 2017
                : 15
                [1 ]ISNI 0000 0001 0687 2000, GRID grid.414676.6, , Institute for Medical Research, ; Jalan Pahang, 50588 Kuala Lumpur, Malaysia
                [2 ]ISNI 0000 0004 0621 7163, GRID grid.415265.1, , Melaka Manipal Medical College, ; Jalan Batu Hampar, Kuala Lumpur, 75150 Melaka Malaysia
                [3 ]Institute for Public Health, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
                [4 ]Allied Health College, Jalan Hospital, 47000 Sg. Buloh, Malaysia
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: institute for Medical Research, Malaysia
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