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Introduction Many mental health disorders have onset during adolescence. To date, the data on the correlates of anxiety is still lacking. Therefore, this study is crucial to determine the factors associated with anxiety among school-going adolescents in Malaysia. Methods This study was based on 26,892 school-going adolescents from 212 selected schools in Malaysia. Anxiety was measured using Depression Anxiety and Stress Scale (DASS-21). Associations between anxiety, sociodemographic characteristics and variables of interest were examined using multivariable logistic regression. Results Overall, 10,540 (39.7%) school-going adolescents had anxiety. Anxiety was positively associated with female (odds ratio, OR [95% confidence interval, CI] = 1.30 [1.19,1.42]) compared to male counterpart, feeling loneliness (1.78 [1.54,2.05]) compared to not lonely, unable to sleep due to worry of something (1.79 [1.56,2.05]) compared to able to sleep, being bullied (1.66 [1.48,1.87]) compared to not being bullied, physical abuse (1.33 [1.18,1.49]) compared to no physical abuse, verbal abuse (1.47 [1.35,1.59]) compared to no verbal abuse, current drinker (1.23 [1.06,1.43]) compared to not current drinker, current drug use (1.84 [1.43,2.35]) compared to not current drug use, ever had sex (1.17 [1.01,1.36]) compared to never had sex, physically inactive (1.16 [1.06,1.26]) compared to physically active and internet addiction (2.59 [2.37,2.83]) compared to no internet addiction. Chinese ethnic (0.68 [0.50,0.93]) compared to other ethnic, and Form 2 (0.78 [0.69,0.89]) and Form 3 (0.73 [0.65,0.82]) students compared to Form 1 students, were protective of anxiety. Conclusions Prevention and intervention programs for these "at-risk" adolescents should be planned holistically towards reducing the risk factors. [ABSTRACT FROM AUTHOR]

Background: Mental health is an important marker for survival during pandemic. This article describes the study protocol on the research project "Mental Health Status of COVID-19 Patients in Malaysia (MENTALSTATCOVID)" which aims to determine the burden of mental health among COVID-19 patients in Malaysia. Materials and Methods: This is a cross-sectional study via web-based online survey involving 401 patients in the main COVID-19 hospitals in Malaysia who were selected via quota sampling. The questionnaire consists of socio-demographic profile, Patient Health Questionnaire 9 items (PHQ-9), General Anxiety Disorders 7 items (GAD-7) and Brief COPE (Coping Orientation to Problems Experienced). Result: The overall response rate was 93.47%. Discussion: The survey has proven to be convenience, feasible, simple as it did not require massive logistic preparation, and yet acceptable and effective in delivering the intended data. This is evidenced by the high response rate. Conclusion: This is the first study to address burden of mental health among hospitalized COVID-19 patients in Malaysia. The findings should benefits stakeholders and public via improvement towards risk communication and mental health surveillance programme. [ABSTRACT FROM AUTHOR]

Introduction Physical inactivity has been identified as the fourth leading risk factor for worldwide mortality with major implications towards general health. Monitoring the level of physical inactivity may reduce the burden of noncommunicable diseases (NCDs) and their risk factors. This study aims to determine the prevalence of physical inactivity and its associated factors among adults aged 18 years and above in Malaysia. Methods Data was obtained from the National Health and Morbidity Survey (NHMS) 2019. It was a cross-sectional, population-based survey which employed twostage stratified random sampling design. A total of 10,356 out of 10,472 respondents were interviewed using a short version of International Physical Activity Questionnaire (IPAQ). Results Overall, the prevalence of physical inactivity among adults aged 18 years and above in Malaysia was 24.6% (95% CI: 23.2, 26.1). Results from multivariable logistic model showed that Chinese ethnicity (aOR 1.32; 95% CI: 1.04, 1.67), urban dwellers (aOR 1.30; 95% CI: 1.07, 1.57), those who were single (including widow, widower and divorcee) (aOR 1.36; 95% CI: 1.14, 1.61), students (aOR 2.10; 95% CI: 1.30, 3.40), higher household income earners (aOR 1.34; 95% CI: 1.07, 1.68) and those with hypercholesterolaemia (aOR 1.25; 95% CI: 1.03, 1.51) were significantly more likely to be physically inactive. Conclusions Specific and appropriate intervention towards targeted group is in crucial need to increase the level of physical activity and to promote an active living towards an active and healthy Malaysia. [ABSTRACT FROM AUTHOR]

Introduction Internet usage has changed the way adolescents socialize. This study aims to determine the determinants of internet addiction among school-going adolescents in Malaysia. Methods This study was a cross-sectional study involving 27,455 school-going adolescents from 212 selected schools in Malaysia, as part of the 2017 National Health and Morbidity Survey that implemented a two-stage stratified cluster sampling design. Data collection via a self-administered questionnaire was conducted from March till May 2017. Results Overall, 8,049 (29.0%) school-going adolescents had internet addiction. Internet addiction was positively associated with male (odds ratio, OR [95% confidence interval, CI] = 1.20 [1.08,1.34]) compared to female, Chinese ethnicity (1.67 [1.12,2.48]) compared to other ethnicity, feeling loneliness (1.37 [1.20,1.57]) compared to never feel lonely, unable to sleep due to worrying of something (1.40 [1.17,1.67]) compared to able to sleep, insufficient parental supervision (1.30 [1.14,1.48]) compared to sufficient parental supervision, depression (1.67 [1.48,1.89]) compared to no depression, anxiety (2.12 [1.95,2.30]) compared to no anxiety and stress (2.26 [1.96,2.61]) compared to no stress. The odds of having internet addiction increase from Form 2 (1.51 [1.28,1.78]), Form 3 (2.37 [2.01,2.80]), Form 4 (2.60 [1.76,3.85]) to Form 5 adolescents (2.96 [1.98,4.41]) compared to Form 1 adolescents. Conclusions Our results suggest that being a male, of Chinese ethnicity, higher form level, feeling loneliness, unable to sleep due to worrying of something, insufficient parental supervision, depression, anxiety and stress were positively associated with internet addiction among school-going adolescents. [ABSTRACT FROM AUTHOR]

Introduction The rapid spread of the Coronavirus disease 2019 (COVID-19) worldwide has led the World Health Organization to declare COVID-19 outbreak as a pandemic on March 11, 2020. As the local studies on factors leading to the absence or presence of clinical illness among the COVID-19 cases are sparse, the study aims to determine the factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia. Methods Data on COVID-19 patients were extracted from the database of confirmed cases in Petaling District Health Office, Selangor, Malaysia from 3rd February 2020 to 30th April 2020. An asymptomatic laboratory-confirmed case is a person infected with COVID-19 who does not develop any symptoms. The study included socio-demographic variables, the detailed information on clinical manifestations and co-morbidity of the patients. Descriptive and multiple logistic regression analyses were conducted to determine the factors associated with asymptomatic patients. Results The overall COVID-19 patients in Petaling District were 434. Approximately 70% (n= 292) of the patients were symptomatic while 32.7% (n= 142) were asymptomatic. Multivple logistic regression analyses revealed that factors significantly associated with asymptomatic patients were age below 40 years old (aOR: 1.79, 95% CI 1.11, 2.86), non-Malaysians (aOR: 3.22, 95% CI 1.44, 7.19) and local cases (aOR: 2.51, 95% CI 1.42, 4.42). Gender, ethnicity, comorbidity and township were not significantly associated with asymptomatic patients. Conclusions Approximately one-third of COVID-19 patients were asymptomatic and the risk factors identified were younger age, non-Malaysians and local cases. Rigorous epidemiological investigation is helpful in identifying COVID-19 cases among these group of people who are asymptomatic. [ABSTRACT FROM AUTHOR]

Introduction. Disability has adverse effects on health, wellbeing, and life quality. Vision disorder is one of the top-ranked causes of disability in the elderly population. This study aims to determine the prevalence and factors associated with vision disability among the elderly in Malaysia. Methodology. Data collection from National Health and Morbidity Survey (NHMS) 2018 was obtained. This survey focused on elderly health by using two-stage stratified cluster sampling design. The Washington Group Extended Question Set on Functioning (WG ES-F) was used to determine the vision disability. The data were analyzed using SPSS version 21.0 utilizing a complex sample design with multivariable logistic regression analysis to determine the prevalence and associated factors to vision disability. Results. A total of 3,977 elderly completed the vision disability questionnaire. The overall prevalence of vision disability among those who were 60 years old and above was 4.5%. Multiple logistic regression revealed that no formal education (AOR: 6.69, 95% CI: 1.52, 29.49), only primary education (AOR: 4.26, 95% CI: 1.01, 18.03), unemployed/retiree or homemaker (AOR: 3.25, 95% CI: 1.79, 5.89), hypertension (AOR: 1.45, 95% CI: 1.00, 2.09), and malnourished elderly (AOR: 2.84, 95% CI: 1.76, 461) had higher odds for having vision disability. Conclusion. The findings suggest that a low education level, unemployment, hypertension, and malnourishment are significant risk factors for VD among Malaysia's elderly. Strengthening awareness campaigns to increase VD awareness and provide high-quality rehabilitation services must target specific groups, such as the elderly with a low level of education and the unemployed. Empower primary healthcare providers with the knowledge and skills necessary to improve the quality of eye care delivery and expand eye screening in settling VD issues nationally. [ABSTRACT FROM AUTHOR]

Background: HIV Stigma impeded the screening, treatment and compliance of HIV/AIDS management. Therefore, the data on the burden of HIV stigma is vital. This study aims to examine the cross-cultural translation adaption of the Malay version of HIV Stigma Questionnaires and also examine its validity and reliability. Materials and Methods: The standard English version of the HIV Stigma Questionnaire by The Global Stigma and Discrimination Indicator Working Group (GSDIWG) and STRIVE research consortium was undergone a Malay translation via forward-backward methods. Content validity by the expert committees and reliability by preliminary pilot testing was done. Results: The content validity was approved by the expert committees with acceptable reliability during the preliminary survey analysis. Internal consistency was acceptable with Cronbach's alpha value was 0.76. Conclusion: The validation of the Malay version of HIV Stigma questionnaire reveals an excellent cross-cultural adaption, content validation and reliability. This Malay version is open for potential Malaysia's HIV Stigma studies in the future in parallel with our national strategic planning on HIV to end HIV by 2030. [ABSTRACT FROM AUTHOR]

Introduction The Ministry of Health, Malaysia had introduced the community based action programme (KOSPEN) to improve the early detection of non-communicable diseases (NCDs) in the population. This study aims to identify factors associated with non-participation in screening activities and its barriers. Methods This cross sectional study was conducted from May to June 2016 in KOSPEN localities. A total of 2354 adults aged 18 years and above were selected using a two-stage stratified cluster sampling design. The data were obtained through face-to-face interviews using validated questionnaires. Multiple logistic regression analysis was used to determine the sociodemographic factors associated with non-participation in health screening. Results Out of 2156 respondents interviewed (response rate of 91.6%), approximately 75% (n=1624) of the respondents did not participate in the KOSPEN health screening programme. Multivariable logistic regression analyses revealed that, males (aOR: 2.35, 95% CI 1.21, 4.55) and those working in private sector (aOR: 2.11, 95% CI 1.21, 3.67) were more likely to not participate in health screening. While, age, ethnicity, level of education, marital status and household income were not significantly associated with non-participation in health screening. The barrier for not participated were "did not know health screening was conducted in their localities" (39.3%) and had no time to attend the programme (18.2%). Conclusions The study findings are of public health concern as about three quarters of the respondents failed to participate in this programme because they didn't know that there were health screening activities conducted in their localities beside the time constraint problems. Thus, KOSPEN health screening activities should be made known to the community especially males who are mostly working in the private sector. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is an important gender-based, social, and public health problem that affects women worldwide, including women who are pregnant or have recently given birth. Studies have shown that violence against women often increases during pregnancy and the postpartum period. This study aims to examine lifetime and past-year prevalence of IPV among postpartum women in Malaysia, and to determine the socio-demographic as well as husband's/partner's behavioral factors associated with IPV exposure. This is a nationwide, cross-sectional and clinic-based study involving a total of 5727 women at 6 to 16 weeks postpartum, who attended randomly selected government health clinics between July to November 2016. Face-to-face interviews were conducted by trained female enumerators based on a pre-validated structured questionnaire, using mobile devices as data collection tools. Chi-squared tests and multivariable logistic regressions were used to investigate selected factors associated with IPV exposure. The lifetime and past-year prevalence of any form of IPV among postpartum women were 4.94% (95% CI [3.81,6.39]) and 2.42% (95% CI [1.74,3.35]) respectively, with the highest prevalence being emotional violence, followed by physical and sexual violence. Multivariable analysis showed that husband's/partner's behaviors, such as frequent alcohol use, drug use, fighting habits and controlling behaviour were significantly associated with both lifetime and past-year IPV (all p < 0.001 for past-year IPV). These findings suggest that prevention and intervention strategies for IPV should consider the prevention of substance use and reducing controlling behaviors by husband/partner, as well as raising awareness to build healthy relationships through education. [ABSTRACT FROM AUTHOR]

Introduction: Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after introduction of mandatory universal salt iodisation (USI) for seven years. Methods: A total of 508 first trimester PW attending government Maternal and Child Health Care clinics in all 11 divisions in Sarawak between 1st April and 15th June 2015 were recruited. Urine samples were obtained and analysed for urinary iodine concentration (UIC) using the modified Sandell-Kolthoff reaction method. For pregnant women, an adequate iodine intake was defined as a median UIC between 150-249 µg/L according to the WHO/UNICEF/ICCIDD's criterion. For further analyses, the 11 divisions were then combined into 3 regions, namely Northern (Miri, Bintulu, Limbang), Central (Kapit, Mukah, Sibu, Sarikei, Betong) and Southern (Kota Samarahan, Kuching, Sri Aman). Results: The median UIC of the PW in Sarawak was 105.6 µg/L, indicating iodine deficiency. A total of 330 (65.0%) PW had UIC<150 µg/L. In terms of urinary iodine levels by region, the median UIC in Northern, Central and Southern regions were 136.3 µg/L, 85.5 µg/L and 97.4 µg/L respectively. The differences in median UIC between regions were significant. In addition, the Northern region (p = 0.001), Malay/Melanau ethnicity (p = 0.015) and parous parity (p = 0.014) were significantly associated with higher median UIC. No significant association was found for locality, age nor gravida. Conclusions: This study indicates inadequate iodine status among PW in Sarawak despite seven years of mandatory USI. In fact, the majority of PW appear not to be protected against IDD and its consequences. In future, a comprehensive study should be carried out to determine the levels of iodine in salt at the retail outlets, villages and households in Sarawak. [ABSTRACT FROM AUTHOR]

Background: Suicidal ideation, defined as thoughts, ideas and the desire to commit suicide, is becoming a major public health problem among adolescents. Indeed, suicidal ideation is known as a key predictor of future suicide risk.Objective: This study aims to determine the prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia.Methods: This study used data from the 2013 Malaysian adolescent health risk behavior (MyAHRB) study, a cross-sectional school survey conducted in Peninsular Malaysia among school-going adolescents aged 16-17 years (n=2789). Logistic regression analysis was used to determine the risk factors associated with suicidal ideation among Malaysian adolescents.Results: The overall prevalence of suicidal ideation among the adolescents was 6.2%. The prevalence was significantly higher among females than males (7.6% vs. 4.7%; p=0.002). Multivariate regression analysis revealed that adolescents who were females [odds ratio (OR)=2.02; 95% confidence interval (CI): 1.40-2.92] or of Indian ethnicity (OR=2.32; 95% CI: 1.35-3.98) were more likely to report suicidal ideation. Loneliness (OR=2.54; 95% CI: 1.57-4.11), anxiety or worry (OR=2.70; 95% CI: 1.70-4.31), no close friends (OR=2.71; 95% CI: 1.43-5.14), and lack of supportive peers (OR=1.69; 95% CI: 1.15-2.47) were identified as risk factors for adolescents' suicidal ideation. Adolescents who ever had sexual intercourse (OR=2.70; 95% CI: 1.48-4.92) and had been in a physical fight (OR=2.45; 95% CI: 1.62-3.70) were also reported to have higher risks of suicidal ideation.Conclusion: This study provides evidence on risk factors associated with suicidal ideation among Malaysian adolescents. Targeted mental health and health risk behavioral interventions for high-risk adolescents are recommended. [ABSTRACT FROM AUTHOR]

Background: Reliable national data on disability which is internationally comparable is needed in Malaysia. This study aims to examine the prevalence of disability among adults in Malaysia and its determinants, particularly the socioeconomic factors and comorbidities.Methods: This study was based on the disability module, which is part of the National Health and Morbidity Survey 2015. This survey was implemented using a multi-stage stratified sampling design. A locally validated Washington Group questionnaire was used to collect data on disability.Results: Based on the definition of having at least one domain scored "a lot of difficulty or unable to do at all" or at least "some difficulty" scored in two domains, the prevalence of disability among adults in Malaysia was 11.8% (95% CI: 11.15, 12.53). Logistic regression analysis performed showed that population at risk of having disability in Malaysia were those of older people, ethnic minority, low level of education, single, obese, physically inactive and having mental health problems. Among older people, disability was significantly higher among those with no formal education, having mental health problems and physically inactive.Conclusions: The prevalence of disability among adults in Malaysia is comparable to WHO estimates and most developing countries. Planning for healthcare services should consider at-risk population, particularly older people and those from disadvantaged background to ensure equity healthcare. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity are growing health problems both worldwide and in Malaysia due to such lifestyle changes as decreased physical activity (PA), increased sedentary behavior and unhealthy eating habits. This study examined the levels and patterns of PA among normal-weight and overweight/obese adults and to investigate the association between PA level and overweight/obesity in Malaysian adults.Methods: This study used data from the 2015 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey that implemented a two-stage stratified random sampling design. Respondents aged 18 years and above (n = 17,261) were included in the analysis. The short version of International Physical Activity Questionnaire (IPAQ) was administered to assess the respondents' PA levels. The respondents' height and weight were objectively measured and body mass index (BMI) was calculated. The respondents were categorized according to BMI as either normal-weight (18.5-24.9 kg/m2) or overweight/obese (≥ 25 kg/m2). Descriptive and complex sample logistic regression analyses were employed as appropriate.Results: Overall, approximately 1 in 2 respondents (51.2%) were overweight/obese, even though the majority (69.0%) reporting at least a moderate level of PA (total PA ≥ 10 MET-hours/week). In both normal-weight and overweight/obese groups, a significantly higher prevalence of high PA (total PA ≥ 50 MET-hours/week) was observed among men than women (p < 0.001), but women reported a significantly higher prevalence of low and moderate PA than men (p < 0.001). Men reported significantly higher activity levels (in MET-hours/week) than women with regard to walking, vigorous-intensity PA and total PA (p < 0.001). Overweight/obese men reported a significantly lower level of vigorous-intensity PA and total PA than normal-weight men (p < 0.001). A low level of PA was associated with the risk of overweight/obesity (Adjusted OR = 1.14; 95% CI: 1.01-1.30) compared to a high level of PA among men but not among women.Conclusions: The levels of PA were inversely related to the risk of overweight/obesity in men but not in women. Programs designed to reduce overweight/obesity rates should encourage the practice of moderate- to vigorous-intensity PA. Future research should consider using longitudinal and prospective approaches that simultaneously measure dietary intake, PA and BMI among Malaysian adults to investigate the actual relationship between PA and overweight/obesity. [ABSTRACT FROM AUTHOR]

Background: The health-enhancing benefits of physical activity (PA) on hypertension and diabetes have been well documented for decades. This study aimed to determine the association of PA with systolic and diastolic blood pressure as well as blood glucose in the Malaysian adult population.Methods: Data were extracted from the 2011 National Health and Morbidity Survey (NHMS), a nationally representative, cross-sectional study. A two-stage stratified sampling method was used to select a representative sample of 18,231 Malaysian adults aged 18 years and above. The PA levels of the respondents were categorised as low, moderate or high according to the International Physical Activity Questionnaire (IPAQ)-short form. Blood pressure and fasting blood glucose levels were measured using a digital blood pressure-measuring device and finger-prick test, respectively.Results: Systolic blood pressure (SBP) level was positively associated with PA level (p = 0.02) whilst no significant association was noted between PA level and diastolic blood pressure (DBP). In contrast, respondents with low (adjusted coefficient = 0.17) or moderate (adjusted coefficient = 0.03) level of PA had significantly higher blood glucose level as compared to those who were highly active (p = 0.04).Conclusions: A significant negative association was observed between PA level and blood glucose only. Future studies should employ an objective measurement in estimating PA level in order to elucidate the actual relationship between PA, hypertension and diabetes for the development of effective interventions to combat the increasing burden of premature-mortality and cardiovascular disease-related morbidity in Malaysia. [ABSTRACT FROM AUTHOR]

Introduction: Following the reveal of borderline iodine sufficiency among the Sarawakians from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a mandatory universal salt iodization (USI) was implemented in Sarawak thereafter. This study aimed to determine the current status of USI in Sarawak after a 3-year implementation of USI from 2008 to 2011. Methods: The IDD survey was conducted between Jun 2011 to July 2011 involving six districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The schools were selected via multistage proportionate-to-population size sampling technique and the children were randomly selected via systematic sampling. A total of 19 schools and 661 children were recruited into the survey. Thyroid size was determined by palpation and was and graded according to the classification of the World Health Organization (grade 0-2). The iodine excretion level in spot morning urine was measured using inhouse microplate method. The urinary iodine concentration (UIC) values were compared by Kruskal-Wallis test and Chi-square tests were used to compare categorical variables. Results: A total of 610 school children were participated in the study (92.3%). The TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC level was 154.2 (IQR, 92.7 - 229.8) μg/L, with the highest median UIC been observed in Sarikei [178.0 (IQR, 117.6 - 308.9) μg/L], followed by Mukah [174.8 (IQR, 99.0 - 224.3) μg/L)], Miri [158.6 (IQR, 92.3 - 235.4) μg/L], Sibu [147.0 (IQR, 89.8 - 221.4) μg/L], Bintulu [142.3 (IQR, 52.8 - 245.1) μg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) μg/L]. One in every ten child was of iodine deficient (UIC < 50μg/L) while a third of the child (32%) were of adequate level of UIC. Conclusion: The present findings indicate that the mandatory USI successfully improves the iodine level of children in Sarawak. However, regular and proper monitoring of the UIC level in the communities is needed to prevent excessive iodine intake. [ABSTRACT FROM AUTHOR]

Background: Lifestyle risk behaviours such as smoking, alcohol consumption, physical inactivity, sedentary behaviour and low fruit/vegetable intake have been identified as the major causes of chronic diseases. Such behaviours are usually instigated in adolescence and tend to persist into adulthood. Studies on the clustering of lifestyle risk behaviours among adolescents are scarce, particularly in developing countries. Therefore, the present paper aimed to determine the clustering of lifestyle risk behaviours and its determinants among school-going adolescents in Malaysia.Methods: Data were extracted from a cross-sectional study, the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study, which was conducted from May to September 2013 across 11 states in Peninsular Malaysia. A two-stage proportionate-to-size sampling method was employed to select a total of 3578 school-going adolescents aged 16-17 years from 20 selected schools in urban and rural settlements, respectively. The MyAHRB study adopted a set of self-administered questionnaires adapted from the Global School-based Student's Health Survey (GSHS) and the Youth Risk Behaviour Surveillance.Results: The results from the analysis of 2991 school-going adolescents aged 16-17 years showed that 16 (in boys) and 15 (in girls) out of 32 combinations of lifestyle risk behaviours clustered. Girls (aOR 2.82, 95% CI: 2.32-3.43) were significantly more likely to have clustered risk behaviours than boys; however, no significant associated factors were observed among girls. In contrast, boys of Malay descent (aOR 0.64, 95% CI: 0.46-0.89) or boys who had at least three friends (aOR 0.65, 95% CI: 0.43-0.99) were less likely to engage in multiple risk behaviours.Conclusion: The present study demonstrated the clustering of multiple risk behaviours that occurred in both genders; these results suggest that multiple behaviour intervention programmes, instead of programmes based on siloed approaches, should be advocated and targeted to the high-risk sub-populations identified in the present study. [ABSTRACT FROM AUTHOR]