Cigarette, e-cigarette and dual use among Malaysian adolescents: A secondary analysis of the 2017 and 2022 adolescent health surveys.

INTRODUCTION: Tobacco usage continues to pose a considerable public health challenge in Malaysia, with a predominant number of smokers initiating use during adolescence. The rapid increase of alternative nicotine products, especially e-cigarettes, has changed tobacco consumption trends among adolescents. This study examined changes in the prevalence of cigarette, e-cigarette, and dual use among Malaysian adolescents between 2017 and 2022. METHODS: This was a secondary analysis of cross-sectional data from the National Health and Morbidity Survey (NHMS) 2017 and 2022 Adolescent Health Survey (AHS), which employed a consistent multistage, stratified, cluster sampling design. Data were collected via self-administered questionnaires. Primary outcomes were past 30-day cigarette-only use, e-cigarette-only use, and dual use of both products. Weighted prevalence estimates and multivariable logistic regression analyses were applied to identify associated factors. RESULTS: The survey achieved response rates of 89.0% in both 2017 and 2022. Between 2017 and 2022, cigarette-only use declined from 4.9% to 0.9% (p<0.001), while e-cigarette-only use increased from 6.3% to 8.4% (p=0.002). Dual use decreased slightly from 5.6% to 4.5% (p=0.045). Multivariable logistic regression revealed that males, upper secondary students, and those with parental tobacco use had higher odds of tobacco use across all categories. Ethnic differences were also observed. CONCLUSIONS: The nicotine landscape among Malaysian adolescents has shifted significantly, with a sharp decline in cigarette smoking but a concerning rise in e-cigarette use. Males, upper secondary students, and those with parental tobacco use remain at higher risk. Future longitudinal studies should examine initiation patterns and the influence of peer factors, socioeconomic status, and regulatory changes.