{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:41:14Z","timestamp":1784590874170,"version":"3.55.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,3,5]],"date-time":"2023-03-05T00:00:00Z","timestamp":1677974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Research and Development Fund"},{"DOI":"10.13039\/501100013885","name":"Ministry of Health Malaysia","doi-asserted-by":"publisher","award":["P42-251-170000-00500033"],"award-info":[{"award-number":["P42-251-170000-00500033"]}],"id":[{"id":"10.13039\/501100013885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013885","name":"Ministry of Health Malaysia","doi-asserted-by":"publisher","award":["NMRR-10-757-6837"],"award-info":[{"award-number":["NMRR-10-757-6837"]}],"id":[{"id":"10.13039\/501100013885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013885","name":"Ministry of Health Malaysia","doi-asserted-by":"publisher","award":["NMRR-14-1064-21877"],"award-info":[{"award-number":["NMRR-14-1064-21877"]}],"id":[{"id":"10.13039\/501100013885","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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\u2019s 2025 and 2045 targets for smoking prevalence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntad035","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T05:18:20Z","timestamp":1678166300000},"page":"1340-1347","source":"Crossref","is-referenced-by-count":8,"title":["Age, Period, and Cohort Analysis of Smoking Intensity Among Current Smokers in Malaysia, 1996\u20132015"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-9965","authenticated-orcid":false,"given":"Chien Huey","family":"Teh","sequence":"first","affiliation":[{"name":"Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia"},{"name":"Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia , Setia Alam , Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0105-6407","authenticated-orcid":false,"given":"Sanjay","family":"Rampal","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang Hock","family":"Lim","sequence":"additional","affiliation":[{"name":"Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia , Setia Alam , Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Azahadi","sequence":"additional","affiliation":[{"name":"Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia , Setia Alam , Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris","family":"Tahir","sequence":"additional","affiliation":[{"name":"Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia , Setia Alam , Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,5]]},"reference":[{"key":"2023061004440545500_CIT0001","author":"World Health Organisation."},{"key":"2023061004440545500_CIT0002","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12971-016-0073-z","article-title":"Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study","volume":"14","author":"Lim","year":"2016","journal-title":"Tob Induc Dis"},{"key":"2023061004440545500_CIT0003","first-page":"29","article-title":"A review of smoking research in Malaysia","volume":"71","author":"Wee","year":"2016","journal-title":"Med J Malaysia."},{"key":"2023061004440545500_CIT0004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18332\/tid\/82190","article-title":"Prevalence and factors associated with smoking among adults in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2015","volume":"16","author":"Lim","year":"2018","journal-title":"Tob Induc Dis"},{"key":"2023061004440545500_CIT0005","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.socscimed.2014.09.008","article-title":"Life-course and cohort trajectories of mental health in the UK, 1991-2008--a multilevel age-period-cohort analysis","volume":"120","author":"Bell","year":"2014","journal-title":"Soc Sci Med."},{"key":"2023061004440545500_CIT0006","author":"Institute for Public Health.","year":"1997"},{"key":"2023061004440545500_CIT0007","author":"Institute for Public Health.","year":"2008"},{"key":"2023061004440545500_CIT0008","author":"Institute for Public Health.","year":"2011"},{"key":"2023061004440545500_CIT0009","author":"Institute for Public Health.","year":"2015"},{"key":"2023061004440545500_CIT0010","author":"Institute for Public Health.","year":"2015"},{"key":"2023061004440545500_CIT0011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/j.1467-9531.2006.00175.x","article-title":"A mixed models approach to the age-period-cohort analysis of repeated cross-section surveys, with an application to data on trends in verbal test scores","volume":"36","author":"Yang","year":"2006","journal-title":"Sociol Methodol"},{"key":"2023061004440545500_CIT0012","doi-asserted-by":"crossref","first-page":"333","DOI":"10.4054\/DemRes.2014.30.11","article-title":"Another \u201cfutile quest?\u201d A simulation study of Yang and Land\u2019s hierarchical age-period-cohort model","volume":"30","author":"Bell","year":"2014","journal-title":"Demographic Res"},{"issue":"6","key":"2023061004440545500_CIT0013","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1007\/s13524-013-0243-z","article-title":"Assessing validity and application scope of the intrinsic estimator approach to the age-period-cohort problem","volume":"50","author":"Luo","year":"2013","journal-title":"Demography."},{"issue":"7","key":"2023061004440545500_CIT0014","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1016\/j.socscimed.2009.12.018","article-title":"What is a cohort effect? Comparison of three statistical methods for modeling cohort effects in obesity prevalence in the United States, 1971-2006","volume":"70","author":"Keyes","year":"2010","journal-title":"Soc Sci Med"},{"key":"2023061004440545500_CIT0015","doi-asserted-by":"crossref","first-page":"e058903","DOI":"10.1136\/bmjopen-2021-058903","article-title":"Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework","volume":"12","author":"Kim","year":"2022","journal-title":"BMJ Open"},{"issue":"6","key":"2023061004440545500_CIT0016","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3961\/jpmph.20.159","article-title":"Age-period-cohort analysis of healthy lifestyle behaviors using the National Health and Nutrition Survey in Japan","volume":"53","author":"Okui","year":"2020","journal-title":"J Prev Med Public Health"},{"issue":"4","key":"2023061004440545500_CIT0017","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/eurpub\/ckz243","article-title":"Prevalence of three lifestyle factors among Australian adults from 2004 to 2018: an age-period-cohort analysis","volume":"30","author":"Peng","year":"2020","journal-title":"Eur J Public Health."},{"issue":"8","key":"2023061004440545500_CIT0018","doi-asserted-by":"crossref","first-page":"e0201881","DOI":"10.1371\/journal.pone.0201881","article-title":"Trends in smoking initiation in Europe over 40 years: a retrospective cohort study","volume":"13","author":"Marcon","year":"2018","journal-title":"PLoS One."},{"issue":"5","key":"2023061004440545500_CIT0019","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1111\/add.15696","article-title":"Understanding long-term trends in smoking in England, 1972\u20132019: an age\u2013period\u2013cohort approach","volume":"117","author":"Opazo Breton","year":"2022","journal-title":"Addiction."},{"key":"2023061004440545500_CIT0020","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.healthplace.2014.12.001","article-title":"Using cross-classified multilevel models to disentangle school and neighborhood effects: an example focusing on smoking behaviors among adolescents in the United States","volume":"31","author":"Dunn","year":"2015","journal-title":"Health Place"},{"key":"2023061004440545500_CIT0021","first-page":"779","article-title":"The role of age, period, and cohort effects on smoking among the students of Tehran University of Medical Science","volume":"3","author":"Sahebi","year":"2014","journal-title":"Eur Online J Nat Soc Sci"},{"key":"2023061004440545500_CIT0022","doi-asserted-by":"crossref","first-page":"e2016010","DOI":"10.4178\/epih.e2016010","article-title":"Age-period-cohort analysis of smoking prevalence among young adults in Korea","volume":"38","author":"Jee","year":"2016","journal-title":"Epidemiol Health"},{"issue":"1","key":"2023061004440545500_CIT0023","doi-asserted-by":"crossref","first-page":"7","DOI":"10.34172\/aim.2021.02","article-title":"Age, period and cohort analysis of smoking prevalence in Iranian population over a 25-Year period","volume":"24","author":"Ghelichkhani","year":"2021","journal-title":"Arch Iran Med."},{"key":"2023061004440545500_CIT0024","author":"Institute for Public Health.","year":"2016"},{"issue":"5","key":"2023061004440545500_CIT0025","doi-asserted-by":"crossref","first-page":"266","DOI":"10.3961\/jpmph.14.032","article-title":"Age at smoking initiation and subsequent smoking among Korean adolescent smokers","volume":"47","author":"Hwang","year":"2014","journal-title":"J Prev Med Public Health"},{"issue":"7","key":"2023061004440545500_CIT0026","doi-asserted-by":"crossref","first-page":"e014381","DOI":"10.1161\/JAHA.119.014381","article-title":"Childhood\/adolescent smoking and adult smoking and cessation: the international childhood cardiovascular cohort (i3C) consortium.","volume":"9","author":"Hu","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"2023061004440545500_CIT0027","doi-asserted-by":"crossref","first-page":"214","DOI":"10.2105\/AJPH.86.2.214","article-title":"Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences","volume":"86","author":"Breslau","year":"1996","journal-title":"Am J Public Health."},{"issue":"6","key":"2023061004440545500_CIT0028","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1089\/jwh.2007.0621","article-title":"Gender differences in smoking behaviors in an Asian population","volume":"17","author":"Tsai","year":"2008","journal-title":"J Womens Health."},{"issue":"1","key":"2023061004440545500_CIT0029","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1017\/S0022463400013977","article-title":"Industrial and occupational change in Peninsular Malaysia","volume":"13","author":"Hirschman","year":"1982","journal-title":"J Southeast Asian Stud"},{"key":"2023061004440545500_CIT0030","article-title":"National Health and Morbidity Survey 2015","author":"Institute for Public Health.","year":"2015"},{"key":"2023061004440545500_CIT0031","article-title":"National Health and Morbidity Survey 2019","author":"Institute for Public Health.","year":"2019"},{"issue":"1","key":"2023061004440545500_CIT0032","first-page":"80","article-title":"Prevalence and reasons for smoking among upper secondary schoolboys in Hulu Langat, Malaysia","volume":"2","author":"Khairani","year":"2007","journal-title":"Med Health."},{"key":"2023061004440545500_CIT0033","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12971-016-0108-5","article-title":"Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study","volume":"15","author":"Lim","year":"2017","journal-title":"Tob Induc Dis"},{"key":"2023061004440545500_CIT0034","doi-asserted-by":"crossref","first-page":"51","DOI":"10.18332\/tid\/96297","article-title":"Source of cigarettes among youth smokers in Malaysia: findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA)","volume":"16","author":"Lim","year":"2018","journal-title":"Tob Induc Dis"},{"key":"2023061004440545500_CIT0035","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1136\/tc.2004.008987","article-title":"The tobacco industry\u2019s accounts of refining indirect tobacco advertising in Malaysia","volume":"13","author":"Assunta","year":"2004","journal-title":"Tob Control."},{"issue":"10","key":"2023061004440545500_CIT0036","first-page":"CD003439","article-title":"Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours","volume":"2011","author":"Lovato","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2023061004440545500_CIT0037","author":"Zack","year":"2022"},{"issue":"4","key":"2023061004440545500_CIT0038","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1080\/13556219871930","article-title":"Gender differences in the pharmacology of nicotine addiction","volume":"3","author":"Benowitz","year":"1998","journal-title":"Addict Biol."},{"issue":"10082","key":"2023061004440545500_CIT0039","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/S0140-6736(17)30819-X","article-title":"Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015","volume":"389","author":"GBD. 2015 Tobacco Collaborators.","year":"2017","journal-title":"Lancet."},{"key":"2023061004440545500_CIT0040","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.3389\/fpsyg.2020.01593","article-title":"Conscientiousness and smoking: do cultural context and gender matter?","volume":"11","author":"Lee","year":"2020","journal-title":"Front Psychol."},{"issue":"1","key":"2023061004440545500_CIT0041","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1046\/j.1360-0443.2003.00295.x","article-title":"A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins","volume":"98","author":"Li","year":"2003","journal-title":"Addiction."},{"issue":"9","key":"2023061004440545500_CIT0042","doi-asserted-by":"crossref","first-page":"e1005498","DOI":"10.1371\/journal.pgen.1005498","article-title":"A genome-wide association study of a biomarker of nicotine metabolism","volume":"11","author":"Loukola","year":"2015","journal-title":"PLoS Genet."},{"issue":"2","key":"2023061004440545500_CIT0043","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/ije\/29.2.248","article-title":"Nicotine dependence and its familial aggregation in Chinese","volume":"29","author":"Niu","year":"2000","journal-title":"Int J Epidemiol."},{"issue":"9","key":"2023061004440545500_CIT0044","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1093\/hmg\/ddi132","article-title":"Ethnic- and gender-specific association of the nicotinic acetylcholine receptor a4 subunit gene (CHRNA4) with nicotine dependence","volume":"14","author":"Li","year":"2005","journal-title":"Hum Mol Genet."},{"issue":"1","key":"2023061004440545500_CIT0045","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejmhg.2015.08.002","article-title":"\u03b1-4 subunit of nicotinic acetylcholine receptor polymorphisms exhibit no association with smoking behavior among Malay Males in Kelantan, Malaysia","volume":"17","author":"Ruzilawati","year":"2016","journal-title":"Egypt J Med Hum Genet"},{"key":"2023061004440545500_CIT0046","first-page":"22","article-title":"Prevalence and factors associated with secondhand smoke exposure among Malaysian adolescents","volume":"17","author":"Ghazali","year":"2019","journal-title":"Tob Induc Dis"},{"key":"2023061004440545500_CIT0047","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.addbeh.2015.03.018","article-title":"A systematic review of secondhand tobacco smoke exposure and smoking behaviors: Smoking status, susceptibility, initiation, dependence, and cessation","volume":"47","author":"Okoli","year":"2015","journal-title":"Addict Behav."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntad035\/49589908\/ntad035.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/7\/1340\/50565157\/ntad035.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/7\/1340\/50565157\/ntad035.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T04:44:37Z","timestamp":1686372277000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/25\/7\/1340\/7069853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,5]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,3,5]]},"published-print":{"date-parts":[[2023,6,9]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntad035","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2023,3,5]]}}}