Demographic and lifestyle factors associated with perception about risk of passive smoking in the Malaysian adolescent population

Exposure to passive smoking among adolescents is a public health concern. This study aims to explore demographic and lifestyle factors associated with perception of passive smoking risk and the mediating effects of exposure to anti-smoking advertisements and education about the dangers of smoking on the relationship between grade levels and the perception. Data from the Tobacco and E-Cigarette Survey among Malaysian Adolescents ( = 13,117) were analysed. Ordered probit models were used to assess factors associated with passive smoking risk perception (i.e. not harmful, probably not harmful, probably harmful, harmful). About one-third of adolescents did not perceive that passive smoking was harmful (30.4%). Adolescents with the perception that passive smoking was not harmful were more likely to be students at low grade levels, be males, be non-Malays and be low-pocket-money recipients and those who used e-cigarettes and who smoked. Being aware of anti-smoking advertisements (direct effect = 0.174; indirect effect = 0.012) and taught on the dangers of smoking (direct effect = 0.179; indirect effect = 0.003) partially mediated the positive relationship between grade levels and perceived risk of passive smoking. Policies implemented to reduce exposure to passive smoking should highlight the important role of demographic factors, lifestyle profiles, anti-smoking advertisements and education about the dangers of smoking in improving passive smoking risk perception among adolescents.