Construct Validity and Reliability of the Malay Version of Rosenberg Self Esteem Scale (RSES) among youth in Southern Malaysia: A Confirmatory Factor Analysis IntroductionThe Rosenberg Self-Esteem Scale (RSES) is widely used to measure self-esteem among adults and youth. This study aims to determine the construct validity and reliability of the Rosenberg Self-Esteem Scale Malay version (RSES-M) among Malaysian youth using Confirmatory Factor Analysis (CFA).MethodologyWe administered the Malay-language RSES to 378 Form Four students in the Kota Tinggi District, selected through multistage sampling. The construct validity of RSES-M was assessed using confirmatory factor analysis (CFA), while internal consistency was measured using Cronbach alpha. AMOS version 26 and SPSS version 20 were used for statistical analysis. We compared three measurement models of the RSES-M for the best relative fit: one uni-dimensional model and two different two-domain models (with different items assigned to each domain for each model).ResultsThe findings indicate that the best model for the RSES-M was a two-domain model, with domain one representing positive self-esteem and domain two representing negative self-esteem. The item “I wish I could respect myself more” demonstrated a strong fit within the CFA model when included under the positive domain of self-esteem (Model 3) compared to negative domain ((Model 2) (Chi-Square/degree of freedom (df) = 3.341, goodness of fit (GFI) = 0.967, Comparative Fit Index (CFI) = 0.905, Incremental Fit Index (IFI) = 0.906, and the Root Mean Squared Error of Approximation (RMSEA) = 0.079 and substantial reliability (Cronbach's alpha for domain one = 0.765, and domain two = 0.648). This finding diverges from the original RSES developed by Morris Rosenberg in 1965, which conceptualised the RSES as a unidimensional construct, and other studies that categorised the item "I wish I could respect myself more" under the negative self-esteem domain.

Introduction: Adolescents are the future generation, and their support for smoke-free policies might create momentum for future stringent smoke-free initiatives. This study aimed to determine the levels and factors associated with support for smoking in public areas among Malaysian school-going adolescents aged 10-19 years Methods: The data were derived from the Tobacco and E-cigarettes among adolescents in Malaysia (TECMA), which employed the cross-sectional study design and multistage sampling to select the representative samples of school-going adolescents. Data was obtained through self-administered of pre-validated questionnaire. Descriptive study, cross-tabulation and multivariable analysis were used for analysis Conclusion The level of support for smoke-free initiative in public areas was high among youths in Malaysia, and this might offer promising prospects to expand the non-smoking areas to more public areas in the future.

Introduction: Multitude studies have shown perception is an integral factor associated with smoking, However, no such tool was available in Malay language. In this study, we established a Bahasa Malaysia version of PTSQ (BM-PTSQ) and tested the validity and reliability among secondary school adolescents. Methods: The English version of PTSQ originally consists of 12 items. It was translated into Bahasa Malaysia and back-translated again into English to check for consistency. After face validity (face-to-face query) was determined among 20 secondary school adolescents, only 10 items were included in the survey. Construct validity was established from 407 school adolescents through random selection in the same locality. More than 60% of the respondents were female, a majority (67.3%) were schooling in rural areas. Then, the reliability of the questionnaire was determined with Cronbach's alpha. Results: EFA has grouped PTSQ into two components, they are associated with either knowledge or attitude towards smoking. The variance and Cronbach's alpha for the first and second component were 38.24% and 0.861 (7 items) and 21.62% and 0.661 (3 items) respectively. Conclusion The PTSQ showed good validity and reliability for measurement of perception in smoking among school adolescents in Malaysia, thus this is a viable measurement tool. More importantly this study shows an urgent need to improve the smoking education among adolescents in Malaysia.

Introduction: The prevalence of e-cigarette smoking is increasing. Many people still have a poor understanding of the risks of e-cigarettes. The purpose of this study is to examine sociodemographic factors associated with knowledge about e-cigarettes with a focus on the perception that e-cigarettes are less dangerous than regular cigarettes. Methods: Multivariable logistic regressions are utilised to estimate the effects of sociodemographic factors on the likelihood of having the perception that e-cigarettes are less dangerous than regular cigarettes. These regressions are stratified by ethnic groups. A Malaysian nationwide survey that consists of a large sample size (n = 4176) is used for secondary analysis. Results: Age, gender and educational level are associated with the perception about e-cigarettes. Older individuals are less likely to think that e-cigarettes are less dangerous than regular cigarettes compared with younger individuals. Males are more likely to have the perception that e-cigarettes are less dangerous than regular cigarettes relative to females. Having primary or secondary educational level rather than tertiary educational level is associated with a reduced likelihood of having the perception that e-cigarettes are less dangerous than regular cigarettes. Conclusions Sociodemographic factors play an important role in determining the perception about e-cigarettes. Nationwide policies directed toward improving knowledge about e-cigarettes among individuals who think that e-cigarettes are less dangerous than regular cigarettes may be effective in lowering the risk of suffering from the currently unknown long-term negative effect of e-cigarettes.

Introduction: The use of e-cigarettes has increased rapidly around the world including in Malaysia. However, a significant proportion of people who started using e-cigarettes later discontinued using them. The aim of this study is to identify prevalence of former e-cigarette use and factors associated with quitting, among Malaysian adults. Methods: This study is a part of a national household survey examining the use of e-cigarettes among Malaysian adults aged 18 years and above in 2016. A multistage stratified cluster sampling method was used in the survey. A bilingual (Malay and English) structured questionnaire was used and data was collected via face-to-face interview. Prevalence of current e-cigarette use and former e-cigarette use were determined. A multiple logistic regression model was used to identify factors associated with quitting e-cigarettes. Results: A total of 4,288 adults participated in the survey, where 110 (3.2%) and 289 (8.6%) were identified as current and former e-cigarette users respectively. The following factors were significantly associated with quitting e-cigarette use: e-cigarette users who had no exposure to e-cigarettes at the workplace (aOR = 2.70; 95% CI: 1.39, 5.24); the perception that e-cigarette is more harmful to others compared to tobacco smoke (aOR = 2.46; 95% CI: 1.22, 4.97); and the perception that e-cigarettes do not help people to maintain cigarette abstinence (aOR = 2.19; 95% CI: 1.23, 3.92). Conclusions This study contributes to a better understanding of the factors associated with cessation of e-cigarettes. Findings from this study can assist any e-cigarette cessation intervention measures.

Introduction: The objective of the present study was to investigate the influences of sociodemographic factors on consumption of high-sodium foods among adults in Malaysia. Methods: Data were extracted from the Malaysian Community Salt Survey (MyCoSS) (n=1046). A seemingly unrelated regression (SUR) was utilised to assess factors associated with the number of servings of high-sodium foods (nasi lemak, roti canai, fried rice, fried noodles, and fried vermicelli) consumed per week. The independent variables were sociodemographic factors. Results: Younger individuals consumed more high-sodium foods than their older counterparts. Adults with secondary level education consumed more high-sodium foods compared with those with tertiary level education. Consumption of high-sodium foods was higher among males and Malays compared to females and non-Malays. Conclusion: Consumption of high-sodium foods was common in the population. Sociodemographic factors, such as age, education level, gender, and ethnicity, play an important role in influencing the decisions of people to consume high-sodium foods.

Introduction The information of prevalence and associated factor(s) with smoking cessation among the elderly will assist in formulating the suitable policies and reducing the mortality among Malaysian elderly due to smoking-related diseases. This paper aims to describe the prevalence and factors associated with smoking cessation among Malaysian elderly. Methods We carried out the population-based study using the cross-sectional study design and a sample size of 2,674 respondents obtained via a multistage sampling method. Validated questionnaire and face-to-face interviews approach were the methodologies employed to collect data from the selected respondents. The interview was conducted by trained enumerator using a standardized and validated questionnaire. Descriptive and multiple logistic regression were used in data analysis. Results The present findings demonstrated that almost 1 out of 10 of Malaysian elderly are current smokers. The prevalence of smoking was significantly higher among men (28.1%) compared to women (2.9%). Multivariable analysis showed that females (AOR 2.33, 95 CI 1.66-4.55) and those with advancing age were more likely to stop smoking compared to the younger-aged elderly (70-74 year, AOR 2.38(95 CI 1.24-4.53), 75 year and above, AOR 2.82, (95CI, 1.57-5.05. 60-64 years as reference), whiles other ethnicities (AOR 0.11, 95 CI 0.02-0.61) were less likely to cease smoking compared to elderly from Chinese descent. Based on multivariate analysis, diabetes, hypertension and hypercholesterolemia were not significant factors associated with smoking cessation. Conclusions The study has shown a low proportion of Malaysian elderly is ex- smoker. Suitable measures and programmes should be formulated and implemented to focus on the elderly groups identified in this study, to increase the quit smoking rate among them and subsequently to increase the quality of life by reducing the burden of smoking-related disease among the Malaysian elderly. Keywords Malaysian elderly - smoking cessation - chronic diseases.

The study aims to determine the relationship of attitude and social-norm with intention to smokein the future among non-smoking youth. Data were derived from astudy on smoking among form four students in selected secondary school in Peninsular Malaysia, which utilised apre-validated questionnaire to obtain data from the selected respondents. Descriptive statistics and structural equation modelling (SEM) were used in data analysis. The study revealed independentvariables accounted for 22.6% of the variance inintention to initiate smoking and the model had good fit. Asignificant relationship was observed between subjective norm and intention to initiate smoking (R=0.46). The study revealed that attitude and social norm substantially explained intention to smoke among non-smoking adolescents. Future measures should concentrate oncorrectingthe subjective norms to reduce intentionto initiate smokingamong non-smoking youth.

Studies have shown that parents and peers are among the dominant factors that contribute to smoking initiation among non-smoking adolescents. The paucity of this information in Malaysia warrants a longitudinal study to determine the actual factors associated smoking initiation. The study aims to address the gaps in our knowledge on the factors that associated with smoking initiation among non-smoking school-going adolescents. We carried out a longitudinal study among non-smoking secondary school-going adolescents in Kota Tinggi district, Johor. A representative sample of 1682 was selected via multi-stage sampling and respondents were followed-up for a period of one year. A pre-validated questionnaire was used to collect data from the selected respondents and multivariable logistic regression was employed to determine the factors associated with smoking initiation among non-smoking school-going adolescents. Approximately 1 in 10 non-smoking school-going adolescents-initiated smoking at the end of follow-up. Having peers and a father who smokes were significantly associated with smoking in univariate analysis, similarly relationship was also observed in multivariable analysis between parents who smoked with smoking initiation after the effect of other independent variables were controlled (Adjusted relative risk: 1.81, 95% CI 1.06-2.95). The study revealed that parental influence was more dominant than peer influence with regards to smoking initiation. Therefore, intervention programmes should involve parents/guardians to enhance their chances of success and reduce the incidence of smoking among non-smoking school-going adolescents.

The present study examines age and education determinants of consumption of medical care using Malaysian data. The present study offers a better understanding of the effects of age and education on medical care and assists policy makers in developing more effective intervention measures to improve population health. A nationally representative data with a large sample size (n = 14838) was used for analyses. Several important findings are noteworthy. First, age and education are positively associated with consumption of medical care. Second, the impact of education on medical care varies across age. Third, there is no diminishing marginal effect of education on medical care. Findings of the present study suggest that age and education play an important role in determining consumption of medical care. When designing policies to improve population health, consideration should be given to the effects of age and education factors on consumption of medical care. It is important for policy makers to understand which age group and education level of people are more or less likely to use medical care.