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.

Modelling an Unhealthy Behaviour Index among School-Going Adolescents in Timor-Leste: A Two-Part Approach IntroductionThe burden of unhealthy behaviours in the adolescent population is a worldwide public health concern. This study develops an unhealthy behaviour index and examines its associated factors within a large sample of adolescents from Timor-Leste.MethodsThe data of 3455 adolescents from a nationally representative sample were analysed. The unhealthy behaviour index was developed based on the number of involvements in unhealthy behaviours (consumption of soft drink and fast food, low intake of fruit and vegetables, physical inactivity, smoking, alcohol drinking, illicit drug use). A two-part model was applied to assess the influences of demographic, environmental, personal and parental factors on the participation decisions of unhealthy behaviours and the unhealthy behaviour index.ResultsParental closeness was associated with participation decisions. Age, being involved in physical fights, suicide attempt and parental connectedness were correlated with unhealthy behaviour index. Bullying victimisation and truancy affected both participation and index. There were interaction effects of gender and loneliness on the unhealthy behaviour index.ConclusionsAdolescents who engage in unhealthy behaviours are more likely to be younger, be involved in physical fights, experience bullying, attempt suicide, play truant and have no parental closeness and connectedness. The specific policy recommendations include discouraging male adolescents who do not encounter loneliness as well as those in lower-secondary education from indulging in unhealthy lifestyles. Additionally, parents should collaborate with educators on monitoring adolescents’ environmental stressors, mental health condition and class attendance, and be prepared to provide support in a timely manner.

Introduction: The rising prevalence of human immunodeficiency virus (HIV) among people who inject drugs is a major public health issue. This study intends to explore education and demographic correlates of use of condoms among male drug users in Malaysia. Methods: Data were extracted from the Integrated Biological and Behavioral Surveillance Survey 2017. Pearson’s chi-square tests and a logistic regression were used to examine the associations between condom use and education, and demographic factors. Results: Only a small proportion of drug users used condoms (25.7%). Educational backgrounds, age, ethnicity and marital status were associated with condom use. The likelihood of using condoms was lower among less educated drug users (aOR: 0.308–0.339). There was an interaction effect of education and age on condom use (aOR: 0.116–0.308). Chinese (aOR: 3.117) and those of other ethnicities (aOR: 2.934) were more likely to use condoms when compared with Malays. Being married (aOR: 0.291) or divorced/widowed (aOR: 0.346) was associated with reduced odds of using condoms. Conclusion: Education and demographic factors play an important role in influencing the decisions of Malaysian drug users to use condoms. Therefore, HIV-preventive measures targeting drug users could benefit by paying special attention to these factors.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

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 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: This study examined how waist circumference (WC) varied across sociodemographic characteristics of Malaysian adults using a nationally representative data. Methods: Data from the Malaysian Adult Nutrition Survey 2014 (n = 2696) was used. In the sample, 46.55% were males and 53.45% were females. The outcome variable was WC. Waist circumference was categorised into four ordinal outcomes: very low, low, high and very high. The explanatory variables were age, monthly individual income, education, gender, marital status, ethnicity, employment status and household location. Ordered probit models were utilised. Results: The majority of males had a low WC (54.66%), and only a small proportion had a very high WC (0.96%). Similarly, a high proportion of females had a low WC (55.59%), and only 1.94% had a very high WC. Younger males were more likely to have a high WC than their older counterparts. Males who had monthly income of RM2000-2999 or RM3000-3999 were more likely to have a high WC compared with those who had monthly income of ≤RM999. Chinese and Indian males were more likely to have a high WC than Bumiputera males. For females, those who were married, widowed/divorced and Bumiputera were likely to have a high WC. Conclusion: WC was associated with various sociodemographic profiles of males and females. In particular, there were positive associations between the likelihoods of having a high WC and younger age group, higher income, Chinese, Indian, and being married. Our findings provided policy makers with better information on formulating intervention measures.

The present study examines the factors affecting fruit and vegetable (FV) consumption in Malaysia. A nationally representative data that consists of a large sample size is used. Hence, the findings can provide inferential information. The present study uses secondary data from the Malaysian Household Expenditure Survey 2009/2010. The survey was carried out using a two-stage stratified sampling. The first stage was based on Enumeration Blocks, while the second stage was based on Living Quarters. A lognormal hurdle model is used to estimate the consumption decision and amount decision of FV across ethnic groups. The results suggest that household size, income, gender, marital status, age and education play significant roles in FV consumption. The probability of consuming FV and amount spent increase with household size (p<0.05). Higher income earners are more likely to consume FV than lower income earners (p<0.05). Being male (p<0.05) and unmarried (p<0.05) seem to reduce the consumption likelihood and amount spent. Compared to younger household heads, older household heads have a higher tendency to consume FV (p<0.05). In terms of policy implication, an intervention measure directed toward increasing FV consumption should focus particularly on those who are associated with low FV consumption. In conclusion, household heads’ sociodemographic and household characteristics are important in determining consumption decision and amount decision of FV among Malaysian households.

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.

Introduction: Consumption of confectioneries is a determinant of health risk. However, how health risk determines the intake of confectioneries remains unclear. The objective is to examine how waist circumference (WC) as a measurement of health risk influences the consumption of confectioneries among adults. The research question is that do high-risk people consume more confectioneries than low-risk people? Methods: A quantitative research design with a focus on establishing a correlation between the measurement of health risk and consumption of confectioneries was adopted. Secondary analysis of a nationally representative cross-sectional data was used. The population of interest was the Malaysian population, regardless of being obese or non-obese. Analyses stratified by body mass index (BMI) or WC were not conducted. An instrumental variable (IV) approach was used to estimate the regression of consumption of confectioneries. BMI was used as an IV for WC. In the first stage, we regressed WC on all exogenous variables, including BMI. Then, we replaced the original values of WC with the fitted values of WC. Results: BMI was an appropriate IV for WC. An additional cm of WC was associated with a 0.022 unit of reduction in the serving of confectioneries per week. The negative relationship between WC and consumption of confectioneries indicated that adults who had high health risk consumed lesser confectioneries than adults who had low health risk. Conclusion: Drawing from the IV regression results, the present study highlighted that people with high health risk, rather than people with low health risk, were less likely to consume confectioneries.