Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study
K. H. Lim 1,2
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Institute for Medical Research, Kuala Lumpur, Malaysia
Institute for Public Health, Kuala Lumpur, Malaysia
Klang Health Department, Bandar Botanic Clinic, Klang, Malaysia
Melaka Manipal Medical College, Bukit Baru, Malaysia
School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
Faculty of Medicine, University Teknologi Mara, Selangor, Malaysia
Faculty of Medicine and Defence Health, University of Defence, Kuala Lumpur, Malaysia
Submission date: 2015-06-09
Acceptance date: 2016-03-16
Publication date: 2016-03-21
Corresponding author
K. H. Lim   

Institute for Medical Research, Jalan Pahang, 50590 Kuala Lumpur, Malaysia
Tobacco Induced Diseases 2016;14(March):8
The determination of smoking prevalence and its associated factors among the elderly could provide evidence-based findings to guide the planning and implementation of policy in order to will help in reducing the morbidity and mortality of smoking-related diseases, thus increase their quality of life. This paper describes the rate of smoking and identifies the factor(s) associated with smoking among the elderly in Malaysia.

A representative sample of 2674 respondents was obtained via a two-stage sampling method in proportion to population size. Face-to-face interviews were conducted using a set of standardized validated questionnaire. Data was weighted by taking into consideration the complex sampling design and non-response rate prior to data analysis. Univariable and multivariable logistic regression were used to determine the factor/s associated with smoking.

The prevalence of non-smokers, ex-smokers and current smokers among Malaysians aged 60 years and above were 36.3 % (95 % CI = 32.7–39.8), 24.4 % (95 % CI = 21.2–27.5) and 11.9 % (95 % CI = 9.5–14.3), respectively. Current smokers were significantly more prevalent in men (28.1 %) than in women (2.9 %), but the prevalence declined with advancing age, higher educational attainment, and among respondents with known diabetes, hypertension and hypercholesterolemia. Multivariable analysis revealed that males (aOR, 18.6, 95 % CI 10.9-31.9) and other Bumiputras (aOR 2.58, 95 % CI 1.29-5.15) were more likely to smoke. in addition, elderly with lower educational attainment (aOR, 1.70, 95 % CI 1.24-7.41) and those without/unknown hypertension also reported higher likelihood to be current smokers (aOR 1.98, 95 % CI 1.35-2.83). However, there were no significant associations between respondents with no/unknown diabetes or hypercholesterolemia with smoking.

In short, smoking is common among elderly men in Malaysia. Therefore, intervention programs should integrate the present findings to reduce the smoking rate and increase the smoking cessation rate among the elderly in Malaysia and subsequently to reduce the burden of smoking-related disease.

Department of Statistic and Economic Planning Unit Malaysia. Malaysia population size and age structure 2001-2010. 2008.
Karim HA. The elderly in Malaysia: Demographic trend (Global Theme Issue). Med J Malaysia. 1997;52(3):206–12.
Government of Malaysia. Seventh Malaysia Plan 1996-2000. Kuala Lumpur: National Printing Department, 1996-2000; 1997.
Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37(4):433–40.
World Health Organization. Active Ageing: A Policy Framework. 2002. Geneva: World Health Organization; 2002.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):15–9.
Nicita-Mauro V, Balbo CL, Mento A, et al. Smoking, aging and the centenarians. Exp Gerontol. 2008;43(2):95-101.
World Health Organization (Tobacco Free Initiative) 2010. Fact sheet about health benefits of smoking cessation.2010http://www.who.inttobacco/quitting/en_tfi_quitting_fact_sheet.pdf. (Accessed on 20.5.2015).
Lim SH, Tai BC, Yuan JM, Yu MC, Koh WP. Smoking cessation and mortality among middle-aged and elderly Chinese in Singapore: the Singapore Chinese Health Study. Tob Control. 2013;22(4):235–40.
Lim KH, Amal NM, Hanjeet K, Wan Rozita WM, Sumarni. Prevalence, knowledge and attitude towards Risk of smoking among elderly males aged 60 years and above in Malaysia. Mal J Public Health Med. 2005;5(2):32–8.
Institute of Public Health, Ministry of Health Malaysia. National Health and Morbidity Survey Volume 17. Kuala Lumpur: Institute of Publish Health; 2008. Smoking.
Institute for Public Health (IPH). Report of the Global Adult Tobacco Survey (GATS) Malaysia, 2011. Kuala Lumpur: Ministry of Health Malaysia, 2012.
Ministry of Health Malaysia. Clinical Practice Guideines on treatment of Tobacco use and dependence 2003. (Accessed on 19 May 2014).
Pomerleau J, Gilmore A, McKee M, Rose R, Haerpfer CW. Determinants of smoking in eight countries of the former Soviet Union: results from the living conditions, lifestyles and health study. Addiction. 2004;99:1577–85.
Suwala M, Gerstenkorn A, Kaczmarczyk-Chalas K, Drygas W. Tobacco smoking by elderly people according to CINDI WHO research. Przegl Lek. 2005;62 Suppl 3:55–9.
Zhu BP, Giovino GA, Mowery PD, Eriksen MP. The relationship between cigarette smoking and education revisited: implications for categorizing persons’ educational status. Am J Public Health. 1996;86(11):1582–9.
Kim SK, Park JH, Lee JJ, Lee SB, Kim TH, Han JW, Youn JC, Jhoo JH, Lee DY, Kim KW. Smoking in elderly Koreans: prevalence and factors associated with smoking cessation. Arch Gerontol Geriatr. 2013;56(1):214–9.
Heshmati H, Charkezi A, Asnaashari R, Khhhsar F. Prevalence of smoking and related factors among the elderly in Kashmar, Iran. Health Scope. 2014;3(1):e13996.
Zainuddin R, Abdullah N, Mat Din SY, Yeow SO, Loo HS. A study of public health awareness among the elderly in an industrially developing country. J Soc Sci. 2011;7(2):152–7.
Marinho V, Laks J, Freire Coutinho ES, Blay SL. Tobacco use among the elderly: a systematic review and meta-analysis. Cad Saude Publica. 2010;26(12):2213–33.
Bratzler DW, Oehlert WH, Austelle A. Smoking in the elderly: it’s never too late to quit. J Okla State Med Asso. 2002;95:185–91.
Fadhli Y, Azahadi O, Noor Ani A, Balkish M, Ahmad Jessree K, Tahir A. Approaches in methodology of a population-based study in Malaysia: The National Health and Morbidity Survey 2011 (NHMS 2011. Mal J Med Heal Sci. 2013;9(2):25–33.
Gurpreet K, Tee GH, Karuthan C. Evaluation of the accuracy of the Omron HEM-907 blood pressure device. Med J Malaysia. 2008;63(3):239–43.
Joint National Committee 7. Complete report: seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension. 2003;42:1206–652.
Noor Ani A, Ummi Nadiah Y, Noor Azah D, Hamizatul Akmal AH, Tahir A. Sensitivity and specificity of CardioChek ®PA in detecting individuals with abnormal cholesterol and glucose level. Int J Biomed. 2012;2(2):132.135.
Ministry of Health Malaysia. Clinical practice guidelines: management for type 2 diabetes mellitus. 4th ed. Kuala Lumpur: Ministry of Health Malaysia; 2009.
Ministry of Health Malaysia. Clinical practice guidelines: management for dsylipidemia 4th ed. Kuala Lumpur: Ministry of Health Malaysia; 2011.
Archer KJ, Lemeshow S, Hosmer DW. Goodness-of-fit tests for logistic regression models when data are collected using a complex sampling design. Comput Stat Data An. 2007;51:4450–64.
Chaaya M, Mehio-Sibai A, El-Chemaly S. Smoking patterns and predictors of smoking cessation in elderly populations in Lebanon. Int J Tuberc Lung. 2006;10(8):917–23.
Lugo A, Vecchia CL, Boccia S, Murisic B, Gallus S. Patterns of smoking prevalence among the elderly in Europe. Int J Environ Res Public Health. 2013;10(9):4418–31.
Stotts RC, Smith CK Smoking Patterns Among Rural Elderly. Southern Online J Nurs Resh, 2002; 4(3). Availabe from (Accessed on 28 January 2016).
Honda K. Psychosocial correlates of smoking cessation among elderly ever-smokers in the United States. Addic Behav. 2005;30(2):375–81.
Tsai CH, Lin YH, Tsai HJ. Predictors of smoking cessation in 55-66 years old male Taiwanese smokers: A 7 year National Cohort Study. Arch Gerontol Geriatr. 2012;55:296–300.
Lim KH, Sumarni MG, Amal NM, Hanjeet K, Wan Rozita WM, Norhamimah A. Tobacco use, knowledge and attitude among Malaysian aged 18 and above. Trop Biomed. 2009;26(1):92–9.
Benjamin-Garner R, Oakes JM, Meischke H, Meshack A, Stone EJ, Zapka J, et al. Sociodemographic differences in exposure to health information. Ethnic Dis. 2002;12(1):124–34.
Hiscock R, Judge K, Bauld L. Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation? J Public Health. 2011;33(1):39–47.
Lindström M, Isacsson SO, Malmö Shoulder-Neck Study Group. Smoking cessation among daily smokers, aged 45-69 years: a longitudinal study in Malmö, Sweden. Addiction. 2002;97(2):205–15.
Piexoto SV, Araújo Firmo JO, Lima-Costa MF. Factors associated to smoking habit among older adults (The Bambuí Health and Aging Study). Rev Saude Publica. 2005;39(5):745–53.
Lee C, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007;97(8):1503e1509.
Yang T, Abdullah AS, Mustafa J, Chen B, Yang X, Feng X. Factors associated with smoking cessation among Chinese adults in rural China. Am J Health Behav. 2009;33:125–34.
Schoenbom C. Marital status and health: United States, 1999–2002, advance data from vital and health statistics. Huattsville: National Center for Health; 2004.
Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European union: comparing education and income. Prev Med. 2005;40:756–64.
Gilmore ABC, McKee M, Telishevska M, Rose R. Epidemiology of smoking in Ukraine. Prev Med. 2001;33:453–61.
Aekplakorn W, Hogan MC, Tiptaradol S, Wibulpolprasert S, Punyaratabandhu P, Lim SS. Tobacco and hazardous or harmful alcohol use in Thailand: joint prevalence and associations with socioeconomic factors. Addict Behav. 2008;33:503–14.
Cho HJ, Khang YH, Jun HJ, Kawachi I. Marital status and smoking in Korea: the influence of gender and age. Soc Sci Med. 2008;66:609–19.
Lim SG, Chung WJ, Kim HJ, Lee SM. The influence of housing tenure and marital status on smoking in South Korea. Health Policy. 2010;94:101–10.
Honjo K, Iso H, Inoue M, Tsugane S. Smoking cessation: predictive factors among middle-aged Japanese. Nicotine Tob Res. 2010;12:1050–4.
Kim YJ. Predictors for successful smoking cessation in Korean adults. Asian Nurs Res. 2014;8(1):1–7.
Hyland A, Li Q, Bauer JE, Giovino GA, Steger C, Cummings KM. Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res. 2004;6 Suppl 3:S363–9.
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