Lei Hum Wee

Introduction: E-cigarette (EC) use is increasing among young adults in Malaysia. However, evidence on how EC-related behaviours and perceived physical activity barriers are associated with physical activity participation remains limited. This study examined the associations between EC-related behaviours and perceived physical activity barriers with physical activity status among Malaysian university students who use EC. Methods: A cross-sectional online survey was conducted between December 2023 and July 2024 across six Malaysian universities. Of 660 respondents, 564 met the age and International Physical Activity Questionnaire (IPAQ) criteria and were included in the analysis. Physical activity was classified as active and inactive. Exposures included EC use frequency, dual use, nicotine content, nicotine dependence, EC knowledge, motivations and perceptions for EC use, EC-related side effects, and perceived physical activity barrier items across personal, social and physical domains. Associations were analysed using chi-square tests and binary logistic regression, with odds ratios (ORs) and 95% confidence intervals. Results: Overall, 64.9% were classified as active. At the crude level, EC use frequency, nicotine content, and dual-use status were associated with physical activity. However, these variables were not retained in the multivariable model due to multicollinearity. Nicotine dependence emerged as one of the strongest behavioural correlates of physical inactivity, with higher dependence associated with greater odds of physical inactivity. Perceived barriers to physical activity, particularly personal and social barriers, demonstrated the strongest and most consistent associations, with substantially higher odds of inactivity across barrier levels. EC knowledge and perception variables were not independently associated after adjustment, although item-level patterns were observed. Reported EC related symptoms were mainly gastrointestinal, respiratory, and neurological but were not analysed in relation to physical activity. Conclusion: Physical activity among Malaysian university students who use EC is more consistently associated with nicotine dependence and perceived barriers, than with sociodemographic or knowledge variables. These findings suggest that interventions may benefit from addressing behavioural dependence and contextual constraints. Given the cross-sectional design, these results should be interpreted as hypothesis-generating. Implications: Physical activity among university students who use EC appears more closely associated with nicotine dependence and perceived barriers than with knowledge or sociodemographic factors. While some EC use patterns showed crude associations, nicotine dependence emerged as one of the strongest behavioural correlates of physical inactivity. Lower perceived barriers, particularly personal and social, were consistently linked to higher activity participation. These findings suggest that intervention strategies may benefit from addressing behavioural dependence alongside reducing personal and social barriers to physical activity, particularly factors related to motivation, self-confidence, and competing demands. Integrating accessible, context-specific physical activity opportunities within EC cessation or harm-reduction programmes may enhance engagement and promote healthier lifestyle behaviours among young adults.

Psychological distress is increasing among university students, especially sexual minority individuals in Malaysia, who face stigma and challenges within a sociocultural and dual legal system. This study examined the relationship between sexual minority status and both negative (psychological strain, distress, suicidality) and positive (self-esteem, purpose in life, social support, religiosity) mental health indicators among Malaysian undergraduates. A cross-sectional, multi-institutional survey was conducted utilizing an existing dataset, yielding a final analytical sample of 2244 participants (1870 heterosexual and 374 sexual minority students). Data were analyzed using Welch’s ANOVA and multiple logistic regression, controlling for demographic variables. Heterosexual students reported significantly lower depressive symptoms, anxiety, stress, and suicidality compared to gay, bisexual, and participants with other sexual orientation. In the fully adjusted model, sexual minority identity remained significantly associated with higher deprivation strain (aOR: 1.043), depression (aOR: 1.025), and suicidality (aOR: 1.117). Conversely, identifying as a sexual minority was linked to lower religious commitment (aOR: 0.961) and lower perceived family support (aOR: 0.943). Self-esteem and purpose in life lost statistical significance in the fully adjusted model. Sexual minority undergraduates in Malaysia face heightened psychological distress and suicidality, underscoring the need for comprehensive campus mental health interventions.

Mental health, including emotional, psychological, and social well-being, is vital at every life stage (World Health Organization, 2022;Dattani et al., 2023;Mental Health, 2024). Wellbeing, as defined by Huppert (2009) and echoed by Diener et al. (2009), Ryan and Deci (2001), and Tov (2018), is the experience of health, happiness, and prosperity. It includes good mental health, high life satisfaction, a sense of purpose, and stress management (Davis, 2019), encompassing both hedonia (subjective well-being) and eudaimonia (psychological wellbeing). This aligns with Healthy People 2030's definition of overall life satisfaction, reflecting both health and non-health factors (Office of Disease Prevention and Health Promotion, 2020).Psychological well-being (PWB) is a multifaceted concept that encompasses aspects of positive functioning, self-realization, and the ability to face life's challenges (Ryff, 1989). Various models have been proposed to explain this, such as Ryff (1989), Antonovsky (1979), Deci and Ryan (2008), and Seligman's (2011) PERMA model of well-being in positive psychology. Seligman's (2011) PERMA model in positive psychology suggests that psychological well-being is enhanced through fostering Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. Kern et al. (2016) developed the EPOCH model, a framework for optimal adolescent functioning that aligns with Seligman's PERMA model. It identifies five traits that support adult flourishing: Engagement, Perseverance, Optimism, Connectedness, and Happiness.Emerging adulthood is crucial for students to gain autonomy from parents (Sussman and Arnett, 2014) and explore opportunities on campus, laying the foundation for full social integration postgraduation (Porru et al., 2022). The five factors of the EPOCH model are believed to support well-being in adulthood, aligning with the PERMA model's key elements (Kern et al., 2016).Studies across various countries, including the US, Australia, China, Iran, and Indonesia, support the cross-cultural invariance and equivalence of the EPOCH measure, though further validation and extension to diverse adolescent groups are needed (Kern et al., 2016;Kern et al., 2019;Setyandari, 2019;Taheri et al., 2021;Zeng and Kern, 2019). University students, as a distinct age group and social role in transition from adolescence to adulthood, face a myriad of unique challenges. Research conducted in Thailand has delved into the application of the EPOCH measure among college students (Rhein and Nanni, 2022).University students have the potential to make significant societal contributions, and public awareness of their mental health issues is rising (Chen, 2024). However, anxiety, stress, depression, and challenging living circumstances remain significant barriers to students' well-being. The reports of mental health issue among students have been increasing globally (Orygen, 2023;Youth Insight, 2023). According to the report from the Healthy Minds Network (HMS) for 2022-2023, 36% of surveyed students indicated receiving counseling or therapy. In China, the prevalence of anxiety, depression, sleep problems, and suicide attempts among college students has significantly increased over the past decade (Chen et al., 2022).Studies suggest a global decline in student' well-being at universities (Riva et al., 2020). Cross-cultural research examining happiness among college students from 24 countries reported that students from Southeast Asia (including China) had lower levels of happiness when compared to students from South America, sub-Saharan Africa, and the Caribbean (Peltzer et al., 2017). Additionally, research indicates that mental health tends to worsen after students enter college, with college students generally reporting worse mental health than non-students (Worsley et al., 2022). However, research focusing specifically on Chinese students' well-being remains insufficient (Dobosz and Hetmańczyk, 2023).There have been many one-child births in China since the enactment of the policy in 1980. As the birth rate declines, there will be a substantial number of families with only one child (National Bureau of Statistics of the People's Republic of China, 2023a). Non-only children face challenges in terms of having less access to material educational resources and parenting styles that are conducive to their skill development, compared to only children (Li et al., 2024). Previous studies have increasingly suggested that the well-being of rural children was affected by the impact of parental absence (Zhao and Yu, 2016), family economic status (Wen and Lin, 2012), and neighborhood environment (Zhao et al., 2017).Financial stress is the cause of mental health deterioration, which results in poor academic performance, academic dishonesty, in addition to mental disorders such as anxiety, depression and Burnout Syndrome (Pokhrel et al., 2020). China's student financial assistance system, funded by the government and supplemented by schools and society, supports needy students and rewards high achievers. Aid is provided in tiers to address varying needs through a well-structured mechanism (State Council of the People's Republic of China, 2022). In this study, financial assistance is categorized into four classes: the first targeting specific vulnerable groups, the second for poorer families not in the first category, the third covering general poor families, and none for families receiving no assistance (State Council of the People's Republic of China, 2018).Addressing these challenges requires culturally tailored approaches to support students' well-being, recognizing variations in psychological well-being across cultures. Studies suggest that while Western cultures often define well-being through positive affectivity, hedonic balance, and individualistic traits like autonomy and self-esteem (Joshanloo, 2014), Eastern cultures, including China, emphasize moral values, contentment, harmony,...

The increasing prevalence of electronic cigarette (e-cigarette) use among Malaysian youths highlights the inadequacy of current health education initiatives in addressing cessation challenges. This study aims to evaluate the content and face validity of educational infographics to support e-cigarette cessation among youth e-cigarette users in Malaysia. This study employed a cross-sectional study design and involved experts and youth e-cigarette users. Upon the development, 17 experts specialising in smoking or e-cigarette cessation, with a mean age of 39.10 years and a mean years of experience of 12.24 years, were recruited for content validation. Meanwhile, for the face validation, 10 Malaysian youth e-cigarette users, with a mean age of 24.00, were purposively selected to assess the clarity of the infographics and provide feedback. Content validity indices (CVI) and face validity indices (FVI) were calculated for each topic, with thresholds of > 0.74 and 0.83 indicating acceptable content. The infographics demonstrated strong content and face validity, with average CVI of 0.98 (range: 0.94, 1.00; 95% CI: 0.95, 1.00) and average FVI of 0.96 (range: 0.70, 1.00; 95% CI: 0.87, 1.00), respectively. The infographics can be utilised to promote e-cigarette cessation after the trial and implementation phase, to assess their real-world effectiveness.

(1) Background: University students face increasing mental health challenges, with sociodemographic disparities shaping well-being outcomes and highlighting the need for machine learning approaches to identify distinct psychological profiles. (2) Methods: This cross-sectional study surveyed 4911 Chinese university students (aged 18–25) using the EPOCH Questionnaire, which measures Engagement, Perseverance, Optimism, Connectedness, and Happiness. Data were collected via WenjuanXing (WJX), with recruitment promoted through official channels. Well-being profiles were identified through exploratory K-means clustering, with internal validity and the optimal cluster number assessed using the silhouette coefficient. (3) Results: Cluster analysis identified two distinct groups: Cluster 0 (41.09%) with higher well-being scores and Cluster 1 (58.91%) with lower scores. Differences across all five EPOCH dimensions exceeded 1.0, most notably in Optimism (Δ = 1.31) and Happiness (Δ = 1.37). A subgroup of concern within Cluster 1 (n = 92), primarily male sophomores from rural, low-income, multi-child families receiving financial aid, showed particularly low scores in Connectedness (Δ = −0.57) and Happiness (Δ = −0.43). In contrast, a high well-being subgroup in Cluster 0 (n = 108), mainly urban female freshmen from high-income, only-child families, exhibited elevated scores, especially in Connectedness (Δ = 0.69) and Happiness (Δ = 0.65). (4) Conclusions: This exploratory clustering study identified distinct well-being profiles among Chinese university students, with demographic and socioeconomic vulnerabilities associated with diminished psychological well-being, particularly in Connectedness, Happiness, and Optimism. These findings highlight the need for targeted interventions that integrate psychosocial support with financial assistance to reduce inequalities and promote flourishing.

In Malaysia, tobacco smoking continues to be one of the leading public health concerns; hence, the tobacco control community aims to see a generation free of tobacco use by 2040. Drafted and presented to the parliament, the Malaysian Control of Smoking Products for Public Health Bill 2022 highlighted the Generational Endgame (GEG) policy, which forbids the use and sale of tobacco products and smoking substances to individuals born on or after 1 January 2007. Stakeholders, including government and non-governmental organisations, policymakers, healthcare professionals, tobacco industry representatives and retailers, have expressed differing opinions indicating non-support of the policy. The Attorney General Chamber deemed the policy as ‘unconstitutional’ for discriminating against those within the implementation age range, which prompted its omission from the revised Control of Smoking Products for Public Health 2023 Bill. This paper discusses the obstacles and possible implications of the GEG policy implementation in Malaysia and details its implementation in other countries. This paper also proposes several recommendations for future directions in tackling the obstacles mentioned more effectively.

Electronic cigarettes (ECs) users’ profiles and behaviors during the COVID-19 pandemic remain unclear. This cross-sectional study aimed to explore Malaysian EC users’ profiles and their associations with related behaviors during the pandemic. The EC users (N = 351) were recruited from an official national vape entity. Respondents were predominantly of Malay ethnicity (90.6%), aged 31 to 35 years (27.6%), males (97.7%), married (68.7%), from Malaysia’s west region states (63.5%) and tertiary educated (69.2%). The majority (80.3%) were non-dual users, and most purchased their vaping products online (77.2%), liked that they can vape while working at home (83.8%) and vaped more because of boredom (55.3%), had low and moderate nicotine addiction levels (94.9%), had low motivation level to quit EC use (92.6%) and were more likely to perceive that vaping did not increase the chances of complications from COVID-19. Respondents with moderate to high addiction levels had twice the odds of checking on their current EC supplies, whilst respondents with low motivation to quit had higher odds of using their tank/pod until the last drop and distancing from others when vaping. EC users should be encouraged to quit EC use, especially during the COVID-19 pandemic.