Redhwan Ahmed Al-Naggar

Shisha Smoking and Associated Factors among Medical Students in Malaysia

BACKGROUND The aim of the study was to determine the prevalence of shisha smoking and associated factors among medical students in Malaysia. MATERIALS AND METHODS A cross-sectional study was conducted at the Management and Science University from December 2011 until March 2012. The questionnaire consisted of five sections including socio-demographic, social environment, knowledge about shisha, psychosocial factors, and personal shisha smoking behavior. Obtained data were analyzed using Statistical Package for the Social Sciences (SPSS 13). T-test was used to determine the relationships between shisha smoking and socio-demographic characteristic. RESULTS A total number of 300 medical students participated in this study. Mean age was 22.5±2.5 years. The majority were female, Malay, single, from urban areas (67%, 54%, 97%, 73%; respectively). The prevalence of shisha smoking among medical students was found to be 20%. The study revealed that many students believed that shisha does not contains nicotine, carbon monoxide, does not lead to lung cancer, dental problems and does not lead to cardiovascular diseases (25%, 20.7%, 22.3%, 29%, 26.7%; respectively). Age and sex were found to be significantly associated with smoking shisha status among medical students (p=0.029, p<0.001; respectively). Furthermore, having parents, siblings and friends smokers of shisha were found to be significantly associated with shisha smoking status (p<0.001, p<0.001, p<0.001; respectively). Furthermore, family problems, problems with friends, financial problems and university life were found to significantly associated with shisha smoking status among medical students (p<0.001, p=0.002, p<0.001, p=0.002; respectively). CONCLUSIONS There is a high prevalence of shisha smoking and a poor knowledge about its impact on health among medical students. More attention is needed to focus on medical education in this regard. The policies that are currently employed in order to reduce the cigarettes smoking should be applied to shisha smoking and shisha products.

Lifestyle Practice among Malaysian University Students

BACKGROUND It is well established that a healthy lifestyle is of benefit in the prevention of diseases such as cancer and promotion of well-being. Therefore, the objective of this study was to determine lifestyle practice and associated factors among university students in Malaysia. MATERIALS AND METHODS A cross sectional study was conducted over six months from November 2011 until May 2012 among the students from the Management and Science University. This study was approved by its ethical committee , the students being explained the objective and invited to participate. A consent form was signed by all study participants. Questionnaire was distributed randomly to the students of the five faculties through their lecturers in different faculty. For univariate analysis t-test and ANOVA test were performed. Multiple linear regression used for multivariate analysis using SPSS 13.0. RESULTS A total number of 1100 students participated with a mean age of 22.1±2.21 (SD) years. The majority were 22 years or younger (56.3%), female (54%), Malay (61.5%), single (92.3%), with family monthly income ≥5000 Ringgit Malaysia (41.2%). Regarding lifestyle, about were 31.6% smokers, 75.6% never drank alcohol and 53.7% never exercised. Multivariate analysis showed that age, sex, race, parent marital status, participant marital status, type of faculty, living status, smoking status, exercise, residency, brushing teeth, fiber intake and avoid fatty food significantly influenced the practice of drinking alcohol among university students (p=0.006, p=0.042, p<0.001, p=0.003, p=0.002, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.003, p<0.001; respectively). It similarly showed that sex, race, parent marital status, participant marital status, monthly family income, exercise, residency, brushing teeth and fiber intake significantly influenced the practice of sun protection (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.017, p<0.001, p<0.001, p<0.001; respectively) and that age, sex, parent marital status, participant marital status, type of faculty, living status, exercise, taking non- prescribed medication, brushing the teeth, coffee consumption and fiber intake were significantly influenced the practice of fruits consumption (p=0.008, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.002, p<0.001, P<0.001; respectively). CONCLUSIONS This study showed a poor practice of healthy lifestyle among university students. Therefore universities should emphasize a healthy lifestyle in all faculties as a required subject. Socio-demographic characteristics significantly influenced practice and thus should be considered when planning preventive measures among university students. Frequent campaigns and educational seminars are to be encouraged.

Practice and Barriers of Mammography among Malaysian Women in the General Population

OBJECTIVE The objective of this study was to determine the practice and barriers of mammography and associated factors among Malaysian women in the general population. METHODOLOGY A cross-sectional study was conducted among 200 women in Shah Alam, Selangor; Malaysia. The questionnaire contained 27 questions and was comprised of two sections; socio-demographic characteristics and practices, knowledge and barriers of mammography. All the data were analyzed using the Statistical Package for the Social Sciences (SPSS) 13.0. RESULTS Of the 200 Malaysian women who participated in this study, the majority were under the age of 50 years (65.5%), Malay (86%), and married (94.5%). Regarding any family history of cancer in general, the majority of the participants had none (78%). However, some did report a close relative with breast cancer (16.5%). While the majority of them knew about mammography (68%), 15% had had a mammogram once in their life and only 2% had the procedure every two or three years. Univariate analysis showed that age, family history of cancer, family history of breast cancer, regular supplement intake, regular medical check-up and knowledge about mammogram were significantly associated with mammogram practice among the general population (p=0.007, p=0.043, P=0.015, p=0.01, p=0.001, p<0.001; respectively). Multivariate analysis using multiple linear regression test showed that age, regular medical check-up and knowledge about mammography testing were statistically associated with the practice of mammography among the general population in Malaysia (p=0.035, p=0.015 and p<0.001; respectively). Lack of time, lack of knowledge, not knowing where to go for the test and a fear of the test result were the most important barriers (42.5%, 32%, 21%, 20%; respectively). CONCLUSION The practice of mammogram screening is low among Malaysian women.

Practice of Breast Self-Examination Among Women in Malaysia

OBJECTIVES The objective of this study was to examine the practice and associated factors of breast self- examination (BSE) among Malaysian women. METHODS For this cross-sectional study 250 women were selected by a simple random sampling technique. The questionnaire was consisted of three parts: socio-demographic characteristics, knowledge about BSE, and practice of BSE. Obtained data was analyzed using SPSS version 13. T-test and ANOVA test were used to explore the relation between socio-demographic characteristics and the practice of BSE. RESULTS About 32% of the participants reported that they have had family history of cancer and about 20% of the participants reported that they have had family history of breast cancer. The majority of the participants (88.8%) have heard about breast cancer and 78.4% of the participants have heard about BSE. Race, marital status, residency, regular exercise, awareness about breast cancer, belief that breast cancer can be detected early, belief that early detection improves the chance of survival, family history of cancer, family history of breast cancer, awareness about BSE, and belief that BSE is necessary, significantly influenced the practice of BSE among women. Practice of BSE on monthly basis was found to be 47.2% among the study participants. CONCLUSION The socio-demographic characteristics significantly influence the practice of BSA among women in Malaysia. The findings of this study might not only influence the planning of specific screening interventions and strategies in Malaysia but might also be important for the relevant international communities, interested in the peculiarities of BSE incidence in different countries.

Perceptions and Opinions about Male Breast Cancer and Male Breast Self-Examination: A Qualitative Study

OBJECTIVE While the relatively common nature of female breast cancer has resulted in a high level of general awareness, male breast cancer is still comparatively unknown to the general public and to healthcare professionals. The objective of this study is to explore the perceptions and opinions about male breast cancer and male breast self-examination among male university students. METHODOLOGY In-depth interviews were conducted among 36 male university students from the Management and Science University, Malaysia, selected by simple random sampling. The themes of the interview were: knowledge of male breast cancer and male breast self-examination, sources of knowledge and attitudes towards male BSE. The data obtained were classified into various categories and analyzed manually. RESULTS The majority of participants mentioned that there is a low possibility for males to get breast cancer. They also believed that the cause of breast cancer among men is due to the carcinogens from cigarettes. The majority of participants mentioned that they know about breast self-examination from the mass media and that the presence of a lump in the breast is the main symptom of breast cancer in men. The majority of participants mentioned that they encourage their family members to practice breast self-examination but considered that BSE is not important for men because they have a low probability of getting breast cancer. CONCLUSIONS Misconceptions regarding male breast cancer and breast self-examination among men still exist among male university students. Therefore special attention should be given to educate men about male breast cancer and male BSE.

Prevalence of Cigarette Smoking and Associated Factors among Secondary School Teachers in Malaysia

OBJECTIVE The smoking prevalence in Malaysia is high, especially among men and adolescents. This study aimed to determine the prevalence and associated factors towards cigarette smoking among school teachers in Malaysia. METHODOLOGY This study was a school-based cross-sectional study conducted among 495 secondary school teachers. The questionnaire used in this study consisted of 29 questions categorized into two sections: socio-demographic characteristics and smoking behaviour. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) program 13.0. ANOVA; t-tests were used in univariate analysis; multiple linear regression was applied for multivariate analysis. RESULTS The majority of the participants were female (81.6%), in the age group ranged between 30-39 years (44%), Malay (90.1%), married (89.7%), degree holders (85.1%), with monthly income ranged between 3000-3999 Ringgit Malaysia (33.5%), from urban areas (94.7%), their specialty is social studies (33.9%) and with no family history of cancer (83.6%). The prevalence of smoking among school teachers in Malaysia was found to be 7.8%. Regarding reasons to start smoking among school teachers: the major reason was found to be relaxation (33.3%), followed by stress-relief (28.2%). Univariate analysis showed that sex, educational status, monthly income and residency were significantly associated with smoking among school teachers (p<0.001, p=0.004, p=0.031, p=0.010; respectively). Multivariate analysis showed that gender and marital status were significantly associated with smoking among school teachers (p<0.001, p=0.033; respectively). CONCLUSION The prevalence of smoking among school teachers in Malaysia was found to be relatively low. Sex, marital status, educational status, monthly income and residency were significantly associated with smoking among school teachers.

Pattern of Shisha and Cigarette Smoking in the General Population in Malaysia

BACKGROUND Smoking is a primary risk factor for cancer development. While most research has focused on smoking cigarettes, the increasing popularity of shisha or water pipe smoking has received less attention. This study measured the prevalence and risk factors for shisha and cigarette smoking and related knowledge. MATERIALS AND METHODS This cross-sectional analytical study was conducted in Shah Alam, Malaysia. Participants aged ≥ 18 years were selected from restaurants. Data regarding demographic variables, smoking patterns, and knowledge about shisha smoking were collected in local languages. Logistic regression was performed to assess risk factors. RESULTS Of 239 participants, 61.9 % were male and 99.2% revealed their smoking status. Some 57.4% were smokers: 50.7% only cigarettes, 5.9% only shisha and 42% both. Mean age of starting cigarette smoking was 17.5 ± 2.4 years and for shisha smoking 18.7 ± 2.0 years. In a univariate model, male gender, age 33-52 years and monthly income > MYR 4,000 increased the risk and unemployment and being a student decreased the risk. In a multivariate model, male gender increased the risk of smoking, while being a student decreased the risk, adjusting for age and income. The perception of shisha being less harmful than cigarettes was present in 14.6% and 7.5% had the opinion that shisha is not harmful at all, while 21.7% said that it is less addictive than cigarettes, 39.7% said that shisha did not contain tar and nicotine, 34.3% said that it did not contain carbon monoxide and 24.3% thought that shisha did not cause health problems. CONCLUSIONS Prevalence of shisha and cigarette smoking is high in the general population in Malaysia and knowledge about shisha smoking is relatively low. The findings of our study might have implications for understanding similarities and differences in incidence of shisha and cigarette smoking in other cultural/geographic regions.

Practice and Barriers towards Cervical Cancer Screening among University Staff at a Malaysian University

Objective: The objective of this study was to determine the practice and barriers towards the Pap smear test among Malaysian women. Methodology: This is a cross-sectional survey of female university staff. Data was collected by a self-administered questionnaire from a total of 117 women. T-test and ANOVA test were conducted to determine if there was a significant difference between the study parameters. Results: A total number of 117 female university staff participated in this study. The majority of them were Malays, single, and living in the city (92.3%, 58.1%, and 92.3%; respectively). Regarding lifestyle practices, the majority consumed vitamin and mineral supplements regularly, and exercised once a week, (55.6%, and 41%, respectively). As for their knowledge about cervical cancer, the majority have heard about the Pap smear test before (81.2%). Regarding the practice of Pap smear test, only 22.2% ever had a Pap smear test done. As for the barriers toward having a Pap smear test done, the most common barrier among study participants was lack of time (29.9%), followed by the excuse that the Pap smear test is a painful procedure (17.9%). Regarding the factors that influenced the practice of having a Pap smear test were marital status, occupation, regular vitamin and mineral supplements intake, daily fruits intake, regular medical check-up, educational and income level significantly influenced the practice (p=0.001, p=0.002, p=0.034, p=0.001, p=0.001, p=0.024, p=0.001; respectively). Conclusion: The majority of participants in this study showed good knowledge about the Pap smear test. However, the practice of Pap smear test was very low due to the following barriers: lack of time and the perception of it being a painful procedure. Marital status, healthy lifestyle, educational and income levels significantly influenced the practice of having the Pap smear test done.

Acceptance of Problem Based Learning among Medical Students

Aim: The objective of this study is to determine the acceptance of Problem Based Learning (PBL) among medical students. Material and Methods: This study was conducted among 350 Medical students at the Management and Science University (MSU), Malaysia, during the academic year 2011-2012. A cross sectional study was carried out among first, second, third and fourth year medical students. Students were explained the objective of the study and were invited to participate. Informed verbal consent to participate was obtained and all participants were assured. Data obtained were analyzed using SPSS version 13. T-test and ANOVA test which were conducted to determine if there was a significant difference between the study parameters. Multiple linear regressions were used in multivariate analysis. Results: The majority of the surveyed students were older than, or equal, to 22 years old, Malays, from year 2, with Cumulative Grade Point Average (CGPA) more than 3.3 and family monthly income less than 10,000 Malaysian ringgits (60.3%, 52.3%, 44.0%, 37.1%, 85.4% respectively). Race, year and CGPA were found to be significantly associated with PBL acceptance among medical students (p = 0.001, p = 0.003, p = 0.003; respectively). Overall, the acceptance of PBL among medical students was quite low (39.7%). In multivariate analysis, age and race were significantly associated with PBL acceptance. Conclusion: The acceptance of PBL among the surveyed medical students was low. This suggests that more rigorous and practical training should be given to tutors and students in order to understand the philosophy of PBL.

Lung Cancer Knowledge among Secondary School Male Teachers in Kudat, Sabah, Malaysia

BACKGROUND The objective of this study is to determine knowledge about lung cancer among secondary school male teachers in Kudat, Sabah, Malaysia. MATERIALS AND METHODS A cross-sectional study was conducted among three secondary schools located in Kudat district, Sabah, Malaysia during the period from June until September 2012. The protocol of this study was approved by ethics committee of Management and Science University, Malaysia. The aims were explained and a consent form was signed by each participant. Respondents were chosen randomly from each school with the help of the headmasters. Self-administrated questionnaires, covering socio-demographic characteristics and general knowledge of lung cancer, were distributed. Once all 150 respondents completed the questionnaire, they passed it to their head master for collecting and recording. All the data were analyzed using Statistical Package for the Social Sciences (SPSS) version 13. ANOVA and t-test were applied for univariate analysis; and multiple linear regression for multivariate analysis. RESULTS A total of 150 male secondary school teachers participated in this study. Their mean age was 35.6 ∓ 6.5 (SD); maximum 50 and minimum 23 years old. More than half of the participants were Malay and married (52%, 79%; respectively). Regarding the knowledge about lung cancer, 57.3% of the participants mentioned that only males are affected by lung cancer. Some 70.7% mentioned that lung cancer can be transmitted from one person to another. More than half (56.7%) reported that lung cancer is not the leading cause of death in Malaysian males. As for risk factors, the majority reported that family history of lung cancer is not involved. However, 91.3% were aware that cigarettes are the main risk factor of lung cancer and more than half (52%) believed that second-hand smoking is one of the risk factor of lung cancer. More than half (51.3%) were not aware that asbestos, ionizing radiation and other cancer causing substances are risk factors for lung cancer. Quitting smoking, avoiding second-hand smoking and avoiding unnecessary x-ray image of the chest (53.3%, 96.0%, 87.3%; respectively) are the main preventive measures mentioned by the participants. For the factors that influence the participants knowledge, univariate and multivariate analysis showed that only race was significant. CONCLUSIONS Overall, the knowledge of school male teachers about lung cancer was low. However, few items were scored high: cigarettes are the main risk factor; avoiding second-hand smoking; and avoiding x-rays. Interventions to increase lung cancer awareness are needed to improve early detection behavior. Increase the price of pack of cigarettes to RM 20 and banning smoking in public places such as restaurants are highly recommended as primary preventive measures.