Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia.
Nicotine Tob Res. 2023 Jun 9;25(7):1340-1347. doi: 10.1093/ntr/ntad035.
Tobacco use is one of the major preventable risk factors for premature death and disability worldwide. Understanding the trend of tobacco use over time is important for informed policy making.
The present study aimed to examine the changes in mean daily cigarette consumption among random samples of the Malaysian current smoker population over 20 years using an age-period-cohort (APC) approach. We conducted APC analysis using a multilevel hierarchical age-period-cohort model and data from four nationally representative, repeated cross-sectional surveys (National Health and Morbidity Survey) conducted in 1996, 2006, 2011, and 2015 among individuals aged 18 to 80 years. Analyses were also stratified by gender and ethnicity.
Overall, mean daily cigarette consumption (smoking intensity) among current smokers increased with age until 60, after which a drop was observed. There were increases in daily cigarette consumption across birth cohorts. Age and cohort trends did not vary by gender but by ethnicity. The decreasing cigarette consumption after age 60 among the current smoker population was consistent with those observed among the Chinese and Indians, a trend that was not observed in Malays and other aborigines. In contrast, the increasing cohort trend was consistent with those observed among the Malays and other bumiputras.
The present study highlighted important ethnic-specific trends for mean daily cigarette consumption among the current smoker population in Malaysia. These findings are essential in guiding the formulation of interventional strategies or implementation of national tobacco control policies and help achieve the Ministry of Health Malaysia's 2025 and 2045 targets for smoking prevalence.
This is the first APC study on smoking intensity among current smokers in a multiracial, middle-income nation. Very few studies had performed gender- and ethnic-stratified APC analyses. The ethnic-stratified APC analyses provide useful insights into the overall age and cohort trends observed among the current smoker population in Malaysia. Therefore, the present study could add evidence to the existing literature on the APC trends of smoking intensity. The APC trends are also important in guiding the government to develop, implement, and evaluate antismoking strategies.
吸烟是全球导致早逝和残疾的主要可预防风险因素之一。了解吸烟趋势随时间的变化对于制定明智的政策非常重要。
本研究旨在使用年龄-时期-队列（APC）方法，检查过去 20 年来马来西亚当前吸烟者人群中随机样本的平均每日香烟消耗量的变化。我们使用多层次分层年龄-时期-队列模型和 1996 年、2006 年、2011 年和 2015 年四次全国代表性重复横断面调查（国家健康和发病率调查）的数据进行 APC 分析，这些调查对象年龄在 18 至 80 岁之间。分析还按性别和族裔进行分层。
总体而言，当前吸烟者的平均每日香烟消耗量（吸烟强度）随年龄增长至 60 岁之前逐渐增加，之后观察到下降。各出生队列的每日香烟消耗量均有所增加。年龄和队列趋势不因性别而异，但因族裔而异。当前吸烟者群体中 60 岁以后香烟消耗量的下降趋势与华人及印度人的观察结果一致，但马来人和其他土著人的观察结果则并非如此。相反，马来人和其他土著人的增加的队列趋势与观察结果一致。
本研究强调了马来西亚当前吸烟者人群中平均每日香烟消耗量的重要族裔特异性趋势。这些发现对于指导制定干预策略或实施国家烟草控制政策至关重要，并有助于实现马来西亚卫生部 2025 年和 2045 年吸烟率目标。
这是首次在多民族、中等收入国家中对当前吸烟者的吸烟强度进行 APC 研究。很少有研究进行性别和族裔分层的 APC 分析。族裔分层的 APC 分析为马来西亚当前吸烟者人群中观察到的总体年龄和队列趋势提供了有用的见解。因此，本研究可以为吸烟强度的 APC 趋势现有文献增添证据。APC 趋势对于指导政府制定、实施和评估反吸烟策略也非常重要。
