ADOLESCENT HEALTH

A cross-sectional survey conducted in 2001 among 4500 adolescent secondary students from 14 schools in
Negeri Sembilan, Malaysia, revealed several important health issues that deserve the attention of primary
care doctors and health policy planners.
Reprints request: Dr Lee Lai Kah, laikah@gmail.com
SMOKING: 1 IN 7
Lee LK, Chen PCY, Wong KC, Jagmohni K. Smoking among secondary school students in Negeri Sembilan,
Malaysia. Asia Pac J Public Health. 2005;17(2):130 [PubMed]
The prevalence of smoking among the students was 14.0%. About a third of the students (37.8%) started
smoking at 13 to 14 years of age. The prevalence of smoking among the male students was higher (26.6%)
compared to the female students (3.1%). Adolescent smoking was associated with (1) socio-demographic
factors (age, ethnicity, rural/urban status); (2) environmental factors (parental smoking, staying with
parents); (3) behavioural factors (playing truant and risk-taking behaviours such as physical fighting, drug
use, alcohol use, sexual activity, lack of seatbelt use, riding with a drunk driver); (4) lifestyle behaviours
(being on diet and lack of exercise); (5) personal factors (feeling sad and suicidal behaviours).
EVER ATTEMPTED SUICIDE: 1 IN 20
Chen PCY, Lee LK, Wong KC, Jagmohni K. Factors relating to adolescents suicidal behavior: a cross-sectional
Malaysian school survey. J Adolesc Health. 2005;37(4):337 [PubMed]
Seven percent of the adolescent students had seriously considered attempting suicide. Among the
adolescents, 4.6% of them had attempted suicide at least once during the 12 months preceding the survey.
The female adolescents were more likely to put their suicidal thought into suicidal action than male
adolescents. Malay and Indian are more likely than Chinese in the aspect of ‘felt sad and hopeless’.
However, Malay adolescents had the lowest rate in attempting suicide. Based on multiple logistic
regression, factors significantly related to the urban adolescents suicide behavior are ‘felt sad or hopeless’,
‘number of days felt unsafe to go to school’, ‘riding with a driver who had been drinking alcohol’, ‘physical
fight’, and ‘number of days absent from school’. On the other hand, factors relating to the rural adolescent
suicide behavior are ‘felt sad or hopeless’, ‘physical fight’, ‘physical fight resulting in injury’, and ‘drive a
vehicle after drinking alcohol’.
EVER HAD SEX: 1 IN 19
Lee LK, Chen PCY, Lee KK, Jagmohni K. Premarital sexual intercourse among adolescents in Malaysia: a
cross-sectional Malaysian school survey. Singapore Med J. 2006;47(6):476-81 [PubMed]
The study showed that 5.4% of the total sample reported to have ever had sexual intercourse. The
proportion among males students who had ever had sex was higher (8.3%) compared with females students
(2.9%). The mean age at first sexual intercourse was 15 years. One percent of students reported that they
had been pregnant or had made someone else pregnant. Adolescent sexual intercourse was significantly
associated with (1) socio-demographic factors (age, gender); (2) environmental factors (staying with
parents); (3) substance use (alcohol use, cigarette smoking, drug use) even after adjustment for
demographic factors. The survey showed that 20.8% of respondents had ever taken alcohol, 14.0% had
smoked cigarettes and 2.5% had tried marijuana, 1.2% had tried ecstasy pills, 2.6% had tried glue sniffing,
0.7% had tried heroin and 0.7% had taken intravenous drugs into the body.
DYSMENORRHOEA: ONE OUT OF THREE BUT ONLY ONE IN TEN CONSULTED DOCTORS
Lee LK, Chen PCY, Lee KK, Jagmohni K. Menstruation among adolescent girls in Malaysia: a cross-sectional
Malaysian school survey. Singapore Med J. 2006;47(10):899-74 [PubMed]
A cross sectional descriptive study was carried out among 2411 secondary school adolescent females in
Negeri Sembilan. Abnormal cycle length (menstrual cycle longer than 35 days or cycle length between 14 to
20 days or irregular pattern) was common and affected 37.2% of them. Majority (74.6%) experienced
premenstrual syndrome and 69.4% had dysmenorrhoea. About 18% reported excessive menstrual loss
(use 2 pads at a time to prevent blood from soaking through or confirmed by doctor to be anaemic due to
heavy menstrual flow). Only 11.1% of schoolgirls seek medical consultation for their menstrual disorders.
Mothers remained the most important source of information (80%). Menstrual disorders were significantly
more common in female adolescents who smoke and have suicidal behaviours (p<0.05). Absenteeism was
more common in those with increasing severity of dysmenorrhoea.
Around 5.4 million people die each year worldwide because of smoking and tobacco
related disease, according to the World Health Organization – including over
438,000 Americans, 650,000 Europeans and 1.2 million people in China.

Tobacco use will kill 1 billion people worldwide in the 21st century if current smoking trends
continue.
6.6 billion people are on this planet and 1.3 billion are smokers, the International Union against
Tuberculosis and Lung Disease (The Union) and the World Lung Foundation (WLF) told the
38th Union World Conference on Lung Health.
66 percent of all smokers live in just 15 countries, according to The Union and the WLF.
1.8 billion young people aged of 10 to 24 smoke cigarettes, according to the World Health
Organization.
* More than 85 percent of these young smokers live in developing countries (WHO).
Nearly one billion men and 250 million women use tobacco every day around the world,
according to a study presented at the 14th World Conference on Tobacco or Health.

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There are thought to be 800 million smokers in developing countries and only 1.1 billion
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45+ million Americans smoked in 2006. That's 20.8 percent of Americans, according
to estimates from the federal Centers for Disease Control and Prevention (CDC).

American men smoked at a rate of nearly 24 percent of the population, while 18 percent of
women smoked.
2.4 million cases of cancer in the US from 1999 to 2004 were caused by tobacco use, according
to the CDC.
Read on for more international smoking facts.
Grab 13 Lucky Freebies Now

• More than two thirds of the world's smokers live in just 10 countries (WHO):
1. China
2. India
3. Indonesia
4. Russia
5. US
6. Japan
7. Brazil
8. Bangladesh
9. Germany
10.Turkey
• Tobacco is a "major health problem" in Southeast Asia. "Approximately 50
percent of males smoke and youths, especially girls, continue to take up
smoking," experts from eight of the 10 Association of Southeast Asian
Nations (ASEAN) members said. ASEAN consists of Cambodia, Indonesia,
Laos, Malaysia, the Philippines, Singapore, Thailand and Vietnam.
• The global anti-smoking pact was operational beginning February 27, 2005
for countries that have actually ratified it. It was the first international treaty
against smoking, including an advertising ban, and was signed by more than
190 countries on May 21, 2003.
• In China, there are about 350 million smokers (about 25 percent of the
population). It's also one-third of the world's smokers, according to World
Health Organization statistics.
* 100 million smokers in China are under the age of 18, according to the
Chinese health ministry.
* Did you you that just 10 percent of Chinese Americans smoke in the US
as opposed to the 36 percent smoking rate in China itself?
* About 40 million of China's 130 million children aged 13 to 18
had tried smoking, according to a Health Ministry report.
* 56.8 percent male Chinese doctors smoke, highest in the world,
according to a report by the China Preventive Medicine Association.
• Spain deals low price tobacco brands a blow. 9 months after passing tough
new legislation limiting lighting up in public places, which set off a bitter price
war by tobacco manufacturers, Spain hiked cigarette tobacco taxes to 70
euros (90 dollars) per 1,000 cigarettes.
• "20 million cigarettes are smoked every day in Egypt (that's billions of
cigarettes each year). . . There are no accurate figures for shisha (hookahs)
but it is becoming a modern trend," Egyptian Health Minister Hatem al-Gabal
said.
 * "An average of 2.5 percent of household income is spent on tobacco in
Egypt, which is more than on health and leisure," Dr Fatima el-Awa, from the
World Health Organization's (WHO) regional office said.
• Did you know that the regular tobacco waterpipe (hookah) smoker is exposed
to larger amounts of nicotine, carbon monoxide and certain other toxins than
the typical cigarette smoker? (WHO).
• In India, 40 percent of all health problems were due to tobacco, according to
Health Minister, Anbumani Ramadoss.
* Nearly 17 percent of students in India, aged 15 and under, use some
form of tobacco, mainly cigarettes, according to a survey conducted by the
World Health Organization.
* Can you believe some 37 percent of kids below the age of 10 tried
smoking cigarettes? This, however, is down from 49 percent of Indian
children who tried their first cigarette (from WHO study above).
* Teaching tobacco use? More than a third of school personnel, including
teaching staff, are tobacco users (from WHO study above).

Numbers Don't Lie: Percentage of International Smokers

• Mexico has 13 million smokers within its population of 105 million.

* Around half the adult population are smokers or ex-smokers, according to
the National Statistics Institute.
• In Russia, 60 percent of men smoke and 30 percent of women as well.
* In 1992, 7 percent of Russian women smoked vs almost 15 percent by
2003, according to a journal Tobacco Control report (see below).
* The number of Russian men who smoke rose from 57 percent to 63
percent.
• In India, an estimated 120 million people smoke. But unlike Western
countries, smoking is on the rise in India.
* Cigarettes compromise just 19 percent of tobacco consumption. Bidis
account for 53 percent, according to the Bidi Smoking and Public Health
report by the Union Ministry of Health and Family.
* Did you know that 800 million bidis are sold in India each year (see
above)
* Bidis contain more tar, nicotine and other toxic substances but less
tobacco than traditional cigarettes.
• In Egypt, nearly 60 percent of the men use tobacco in some form in a country
of 79 million people. Nearly half the men smoke.
• In South Korea, about 50 percent of men smoked, until 2006, when for the
first time, the number of male smokers fell below 50 percent.
• In Vietnam, not long ago more than 70 percent of men and nearly 5 percent
of women regularly light up. Now just 56% of men and 1.8% of women
smoker.
* Young smokers make 31% of the total.
• In Turkey, nearly 66 percent of men, 20 percent of women and 11.7 percent
of school children smoke. That's 25 million smokers in a country of 75 million
smoking 115 billion cigarettes a year. Wow!
• Around half of Venezuela's 26 million people smoke.
• In Greece, 45 percent of people smoke.
* Around one in three 12-18 year olds tried smoking.
* 10 percent of Greek 12-18 year olds is addicted to smoking, according to a
2007 survey.
• In Italy, between 14 and 16 million people smoke out of a total population of
58 million. In 2004, more than 26 percent of Italians smoked. That dropped to
24.3 percent in 2006 following the country's ban on January 10, 2005.
• Over a third of Indonesia's 230 million people smoke vs. just over 25 percent
about a decade ago. This reverses smoking trends worlwide.
* Indonesia is the world's 5th largest cigarette market.
* A traditional clove cigarette, called "kretek", first introduced in the late
19th century to ward off illnesses, is still the cigarette of choice in Indonesia
for about 90 percent of smokers.
* "Kreteks" have about twice the nicotine and tar levels of ordinary
cigarettes.
* Some Indonesians smokers begin as early as 5 years old, government
figures show.
• In Japan, 26 percent of adults smoke, a record low. The number of Japanese
smokers has continued to fall since 1996. Young 20-something smokers
clocked in at 14.3 percent, while 32.7 percent of those age 60 and up
smoked, according to the annual survey by Japan Tobacco Inc, Japan's largest
tobacco maker.
* Japanese men's smoking rate was 60 percent in 1990 and currently 40
percent.
* Japanese women's smoking rate was 12 percent to 15 percent.
• In the Philippines, up to 35 percent of the country's 89 million people use
tobacco.
* 4 million Filipino young people between 11 and 19 years old smoke.
About 21.6 percent of all young Filipino smokers vs about 18 percent in 2005
and 15 percent in 2003. And that number may continue to grow, in spite of
new restrictions on tobacco ads, according to a 2007 survey commissioned
by the World Health Organisation (WHO) and the Philippines health
department.
* 1.8 million of these young smokers were girls.
* Put your money where your butt is. Rural Green Bank of Caraga
(Agusan del Norte province) offers an alternative quit-smoking program, a
savings account. They teamed up with the non-government group
Innovations for Poverty Action (IPA). A smoker, wanting to quit, opens a
savings account where they deposit the money he would have spent on
cigarettes for 6 months. If they are smoke-free aftter 6 months they can
claim the account and are encouraged to start a small enterprise. Failure
means the amount deposited goes to charity (there is a second follow up
nicotine test made 3 weeks later).
* Fr. Robert Reyes, a priest whose brother Vincent died of smoking,
 continues his brother’s P500,000 damage suit against Philip Morris and urges
smokers to sue cigarette companies.
• In Iran, there are more than 12 million smokers.
• In Nepal, 49 percent of the men and 29 percent of the women are smokers.
• Around 38 percent of the Slovak population of 5.5 million smoked (2006).
• British adults smoke were about 25 percent of the population. That's 10
million people.
* Dance, dine and then quit smoking. Smokers first get tips to cook up
tasty treats at a Preston restaurant; next they receive salsa dancing lessons;
and finally, they are shown how to quit smoking by the NHS Central
Lancashire Stop Smoking Service along with The Olive Press in Winckley
Square, Preston, Lancashire.
• South African smoking has declined 40%: They smoked around 2 billion packs
of cigarettes in 1990 vs 1.3 billion packs in 2005, according to a WHO report.
* In the the 1990s, tobacco tax rates skyrocketed 250 percent (see above).
• About 33 percent of adults smoke in Argentina. The country is also one of the
world's top 10 tobacco suppliers.
• About 33 percent of Uruguay's 3.4 million people smoke, anti-smoking groups
estimate.
• In the Balkans, 30% to 40% of all adults smoking, making this European
region one of the highest in Europe.
• 37 percent of Bosnians actively smoke and about 95 percent of 13-15 year
old children are exposed to secondhand smoke at home.
• In Croatia, 32 percent of the 4.4 million people who live there smoke.
• The Czech Republic smoking rate is 26.6 percent. Unfortunately it was 26.2
percent 10 years ago.
* In 2006, 8.4 percent of Czech 15 year olds smoked, up from 5.8 percent in
1994.
• Around 30 percent of Europeans aged 16 or more admit to being smokers,
according to a study by pollsters at Eurobarometer published by the
European Commission. Highlights of their findings:
* Greece with 42 percent of responders saying they smoked daily or
occasionally.
* Bularia 39 percent
* Latvia 37 percent
* France 34 percent
* England 28 percent
* Sweden 25 percent
* Slovaks at 22 percent * 5 percent of the 26,500 European polls calling
themselves occasional smokers
* 10 percent of smokers claimed they had gone to another EU country to buy
cheaper smokes in the past year
* Less than a third of respondents believe the smoking kills warning on
cigarette packets was effective
* 20 percent of smokers said the smoking kills warnings would persuade
 them to cut down or quit
* 22 percent of those surveyed said they quit smoking
* 46 percent of respondents said they had never smoked
• In Iceland, about 24 percent of Icelanders smoke, 2005 was the most recent
year statistics were avaiable.
• 22 percent of Finns smokes, Finalnd.
• In Sweden, 14 percent of the population smokes, according to The Swedish
National Institute of Public Health (Dagen's Nyheter newspaper). Low for
Western Europe.
* 200,000 Swedes are no longer regular smokers in the past 5 years.
* Women smoke than men in Sweden. This is rare.
* Men who were sick or on disability were the only segment that increased
smoking, up 19 percent.
* Swedes are turning to suns as a smokeless tobacco replacement for
cigarettes, especially wonen.
* 14 percent.
• In Hong Kong, around 14 percent, or 800,000 of the city's 7 million people
have the smoking habit. A low number compared to most countries.
• In Malaysia 21.5 percent of the adult population smoked in 2006, down from
25 percent in 1996, according to the Third National Health and Morbidity
Survey.
* The percentage of Malaysian women smokers has doubled to 480,000 in
recent years, according to Health Ministry parliamentary secretary Lee Kah
Choon.
* There were more than 2 million smokers overall.
* Malaysian smoking is increasing despite increasing prices and stepping
up campaigns on smoking's health risks.
* 467,000 smokers were between 13 and 17 years old with almost 10
percent being girls.
• In Thailand, the number of smokers fell to 9.4 million (17 percent) out of a
population of 65 million.
* Thai smokers puff through 110 million cigarettes daily.
• In Australia, 19 percent of the population smokes. That's down from 34
percent in 1980
* 140,000 Aussie children are weekly smokers.
* Australian asthmatics health problems and increased risks fail to spur them to quit
smoking, according to a report by the Australian Centre for Asthma Monitoring.
• New Zealand's smoking rate is 19.9 percent for people age 15 and older, the
lowest level in more than 30 years. There are 150,000 fewer smokers in New
Zealand now.
• In lreland, smoking has increased since the 2004 smoking ban. 33% of the
population smoked in 1998 that decreased to 27% by 2002 but rose to 29%
in 2007, according to the Irish Government-commissioned National Health
and Lifestyle Survey (SLÁN 2007).
• In Canada, 5 million people smoke or 17 percent, according to the Ministry of
Health.
 * Canada's target for smokers in the country by 2011, 12 percent of the
population. That's down from the current down from 19 percent of Canadians
that smoke, according to Health Minister Tony Clement.
* WOW! 58 percent of Canadian Inuits smoke on a daily basis.
* Since 1999, more than 1 million Canadians have quit smoking
(Canadian Cancer Society).
* Canada estimates $16 billion dollars is paid by its government each year
because of smoking and tobacco, including $4.4 billion in direct health care
costs. * The 22 percent rate of Quebecers who smoke has held steady for 4
years.
• In Saudi Arabia, an estimated 35 to 40 percent of those above the age of 15
smoke.
* Around 24 percent of 13 to 15 year old male students smoke.
* 8 percent of girl students in the Kingdom smoke.
* The Saudi Arabian government spent about SR12 billion treating smoke-related
ailments between 2000 and 2004.
* Smokers in the Kingdom must now pay higher premiums for their health insurance.
* In Riyadh, Saudi Arabia, a state-of-the-art smoking treatment clinic is being set up in
2009.
* There are more than 50 regular anti-smoking clinics in the kingdom now.
* Purchasing, supplies and maintenance departments in the Health ministry can't do
business with tobacco companies (no more contracts).
* Tobacco companies and their board members can no longer register as contractors with
the Health ministry.
* The Kingdom is the top Arabian tobacco importer with Iran in 2nd place, Jordan
3rd, Turkey 4th, Morocco 5th and Egypt 6th (using 2007 statistics).
• In Syria with nearly 20 million people, up to 60 percent of men and 24
percent of women smoke, according to a report by an official Syrian tobacco
institution (the state news agency SANA).
* There has been a 15 percent rise in the number of smokers in Syria's
smokers in spite of bans on tobacco ads and public place smoking (2006).
* Around 26 billion Syrian pounds (600 million dollars) is spent on tobacco
and cigarettes by smokers each year.
* Around 8 percent of Syrian smoker's income is spent on 3.6 kilogrammes
(about 8 pounds) of tobacco per smoker each year.
• Singapore’s Malay smokers faced the 2009 Muharam Challenge in which
Malays ended the month long challenge with a 15% success rate of people
quitting smoking vs. last year’s 10.5 percent.
• Bulgaria, where 52.4 of men are active smokers, is the third most active
smoking nation among European members, according to a survey by the
organizers of the "Help - a life without smoking" campaign.
* 50% of Bulgarians pregnant women are active smokers.
* 38% of wone smoke today vs. 19% in 1986.
* About 33% of kids aged 10 to 19 is an active smoker.
* 1.9 million Bulgarians smoke an average of a pack a day.
• In France 2008 cigarette sales were down 2.3 percent from 2007, a record
low, according to research by British American Tobacco.
 * 54.4 billion cigarettes were sold in 2008 at 5.30 euros a packet.
* 1998 cigarettes sales were almost 85 billion at 2.96 euros a packet.
• UK: In 2008, 4,068 expected to quit on the Island out of 190,000 people
estimated to attempt quitting in the South East, according to Smoking Toolkit
study by Professor Robert West, a leading tobacco control expert.
* More than 164,000 people have stopped smoking since the England and
Wales smoking bans started.
* Dundee, Scotland will give smokers from poor parts of the city $25 a
week to buy fresh food. They must take weekly tests to prove they did not
start back smoking again.
* In 2008, over 12,000 people contacted Stop Smoking Wales to help them
quit smoking.
* 32 percent of Welsh smokers said they were smoking fewer
cigarettes as a result of the ban.
• Governments lost more than $40 billion in taxes because about 600 billion
cigarettes were smuggled in 2006 or 11 percent of the world's consumption,
according to the Framework Convention Alliance (FAC), an umbrella group of
hundreds of anti-tobacco organizations, estimates.