Razali Mohd Firdaus, Riyadzi Mohd Ruhaizie, Abd Hamid Hamizatul Akmal, Wan-Fei Khaw, Yusoff Ummi Nadiah
Institute for Public Health, National Institute of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
Institute for Public Health, National Institute of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
BMJ Open. 2025 Jul 25;15(7):e097974. doi: 10.1136/bmjopen-2024-097974.
To determine the prevalence and its associated factors of dual tobacco use among Malaysian adolescents in developing effective public health strategies.
Cross-sectional study.
This study analysed data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey (AHS), a nationwide cross-sectional survey conducted among secondary school students across Malaysia.
This cross-sectional study used data from the NHMS 2022: AHS, which included a representative national sample of Malaysian adolescents between the ages of 13 and 17. Using a two-stage stratified sampling approach, this study included participation from 33 523 adolescents from 240 schools nationwide.
The primary outcome was the prevalence of dual tobacco use among Malaysian school-going adolescents aged 13-17, defined as self-reported concurrent use of conventional cigarettes and e-cigarettes in the past 30 days. Secondary outcomes included the factors associated with dual tobacco use, such as sociodemographic characteristics, dual tobacco use behaviour, marital status of parents, tobacco use of parent or guardian, supervision, connectedness, bonding and respect for privacy of parent or guardian, along with peer support and truancy. A complex sample analysis was performed using SPSS V.27.0, maintaining a 95% CI and multiple logistic regression was applied.
Out of 33 380 Malaysian adolescents surveyed, 1728 (5.5%; 95% CI: 4.88% to 6.28%) reported dual tobacco use. The prevalence was significantly higher among males (9.7%; 95% CI: 8.54% to 10.98%) compared with females (1.4%; 95% CI: 1.15% to 1.70%) and highest among 17 years (8.6%; 95% CI: 7.05% to 10.41%), with a decreasing trend in younger age groups. Predominant vapers constituted the largest proportion (9.9%, 95% CI: 8.66% to 10.13%) among adolescents who reported dual tobacco use, followed by predominant smokers (6.2%, 95% CI: 5.53% to 7.06%), dual daily users (4.5%, 95% CI: 3.18% to 5.64%) and non-daily dual users (3.9%, 95% CI: 2.79% to 4.39%). Dual tobacco use was more prevalent among adolescents whose parents or guardians used tobacco (8.1%; 95% CI: 7.10% to 9.20%). Multiple logistic regression analysis suggested that significant predictors of dual tobacco use included older age (adjusted OR (AOR) for 17 years: 2.92; 95% CI: 2.19 to 3.89), male sex (AOR: 8.53; 95% CI: 6.78 to 10.74), 'others' ethnicity (AOR: 1.82; 95% CI: 1.40 to 2.35), predominant vapers (AOR 2.65, 95% CI: 1.96 to 2.72), separated or widowed parental status (AOR: 1.69; 95% CI: 1.42 to 2.02), parental or guardian tobacco use (AOR: 2.47; 95% CI: 2.08 to 2.94), lack of bonding (AOR: 1.79; 95% CI: 1.49 to 2.14), lack of privacy respect (AOR: 1.53; 95% CI: 1.29 to 1.81), lack of peer support (AOR: 1.65; 95% CI: 1.39 to 1.96) and truancy (AOR: 1.81; 95% CI: 1.55 to 2.10).
This study highlights a concerning prevalence of dual tobacco use (5.5%) among Malaysian adolescents, which is notably higher than the current prevalence of exclusive cigarette smoking (6.2%) and closely approaches that of e-cigarette use (14.9%). Compared with previous national surveys and international benchmarks, the prevalence of dual use among Malaysian youth appears to be rising and represents a significant public health concern. These findings underscore the urgent need for targeted prevention and control strategies addressing both conventional and emerging tobacco products in this population.
确定马来西亚青少年双重烟草使用的患病率及其相关因素，以制定有效的公共卫生策略。
横断面研究。
本研究分析了2022年全国健康与发病率调查（NHMS）：青少年健康调查（AHS）的数据，这是一项在马来西亚全国中学生中进行的横断面调查。
这项横断面研究使用了2022年NHMS：AHS的数据，其中包括13至17岁马来西亚青少年的具有代表性的全国样本。采用两阶段分层抽样方法，本研究纳入了全国240所学校的33523名青少年。
主要结局是13至17岁马来西亚在校青少年双重烟草使用的患病率，定义为在过去30天内自我报告同时使用传统香烟和电子烟。次要结局包括与双重烟草使用相关的因素，如社会人口学特征、双重烟草使用行为、父母的婚姻状况、父母或监护人的烟草使用情况、监督、联系、亲密关系以及对父母或监护人隐私的尊重，以及同伴支持和逃学情况。使用SPSS V.27.0进行复杂样本分析，保持95%置信区间，并应用多因素逻辑回归。
在接受调查的33380名马来西亚青少年中，1728人（5.5%；95%置信区间：4.88%至6.28%）报告有双重烟草使用。男性的患病率（9.7%；95%置信区间：8.54%至10.98%）显著高于女性（1.4%；95%置信区间：1.15%至1.70%），17岁青少年的患病率最高（8.6%；95%置信区间：7.05%至10.41%），且在较年轻年龄组中有下降趋势。在报告双重烟草使用的青少年中，主要使用电子烟者占比最大（9.9%，95%置信区间：8.66%至10.13%），其次是主要吸烟者（6.2%，95%置信区间：5.53%至7.06%）、每日双重使用者（4.5%，95%置信区间：3.18%至5.64%）和非每日双重使用者（3.9%，95%置信区间：2.79%至4.39%）。父母或监护人使用烟草的青少年中双重烟草使用更为普遍（8.1%；95%置信区间：7.10%至9.20%）。多因素逻辑回归分析表明，双重烟草使用的显著预测因素包括年龄较大（17岁的调整比值比（AOR）：2.92；95%置信区间：2.19至3.89）、男性（AOR：8.53；95%置信区间：6.78至10.74）、“其他”种族（AOR：1.82；95%置信区间：1.40至2.35）、主要使用电子烟者（AOR 2.65，95%置信区间：1.96至2.72）、父母分居或丧偶状态（AOR：1.69；95%置信区间：1.42至2.02）、父母或监护人使用烟草（AOR：2.47；95%置信区间：2.08至2.94）、缺乏亲密关系（AOR：1.79；95%置信区间：1.49至2.14）、缺乏对隐私的尊重（AOR：1.53；95%置信区间：1.29至1.81）、缺乏同伴支持（AOR：1.65；95%置信区间：1.39至1.96）和逃学（AOR：1.81；95%置信区间：1.55至2.10）。
本研究突出了马来西亚青少年中令人担忧的双重烟草使用患病率（5.5%），这明显高于目前单纯吸烟的患病率（6.2%），且接近电子烟使用的患病率（14.9%）。与之前的全国调查和国际基准相比，马来西亚青少年中双重使用的患病率似乎在上升，这是一个重大的公共卫生问题。这些发现强调了迫切需要针对该人群制定针对传统和新兴烟草产品的有针对性的预防和控制策略。
