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National Health and Morbidity Survey 2019 Technical Report − Volume I 316 28 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CE23 Iklan Merokok di Pasaraya Cigarette Advertising in Stores Pada 30 hari yang lalu, adakah anda perasan sebarang “iklan atau tanda promosi” di kedai rokok dijual? In the last 30 days, have you noticed any advertisements or signs promoting cigarettes in stores where cigarettes are sold?

  1. Ya / Yes
  2. Tidak / No
  3. Tidak Berkenaan / Not Applicable (-7) TT (-9) EJ CE24 Promosi Merokok / Cigarette Promotions Dalam masa 30 hari yang lepas, pernahkah anda terlihat promosi rokok seperti yang dinyatakan? In the last 30 days, have you noticed any of the following types of cigarette promotions? Baca Setiap Item / Read Each Item Sampel rokok percuma? Free samples of cigarettes?
  4. Ya / Yes
  5. Tidak / No (-7) TT (-9) EJ Jualan murah/ potongan harga? Cigarettes at sale prices?
  6. Ya / Yes
  7. Tidak / No (-7) TT (-9) EJ Kupon rokok? Coupons for cigarettes?
  8. Ya / Yes
  9. Tidak / No (-7) TT (-9) EJ Hadiah atau potongan harga barangan lain apabila membeli rokok? Free gifts or special discount offers on other products when buying cigarettes?
  10. Ya / Yes
  11. Tidak / No (-7) TT (-9) EJ Pakaian atau barangan lain yang mempunyai logo atau jenama rokok? Clothing or other items with a cigarette brand name or logo?
  12. Ya / Yes
  13. Tidak / No (-7) TT (-9) EJ Promosi rokok melalui surat? Cigarette promotions in the mail?
  14. Ya / Yes
  15. Tidak / No (-7) TT (-9) EJ CE25 Soalan CE25 hanya perlu dijawab oleh responden yang menjawab pilihan merokok setiap hari (pilihan 1) atau kurang dari setiap hari (pilihan 2) pada soalan CE01 ; iaitu (CE01 = 1 atau 2) DAN menjawab CE03 Question CE25 is to be answered by respondents who answered daily (choice No.1) or less than daily (choice No.2) for Question CE01 ; i.e.(CE01 = 1 or 2) AND answered CE03 Rokok terakhir yang dibeli – kuantiti / Last cigarette purchase – quantity Pada kali terakhir anda membeli rokok untuk diri sendiri, berapa banyakkah yang anda beli? The last time you bought cigarettes for yourself, how many cigarettes did you buy?
  16. Karton / Carton a. Berapa Bilangan karton yang dibeli? How many cartons were bought? b. Berapa Bilangan bungkus dalam setiap karton? How many packets were in each carton? c. Berapa Bilangan rokok dalam setiap bungkus?

How many cigarettes were in each packet? Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 317 29 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia 2. Bungkus / Packets

(Sekiranya kurang daripada satu karton / If less than one carton) a. Berapa Bilangan bungkus yang dibeli? How many packets were bought? b. Berapa Bilangan rokok dalam setiap bungkus? How many cigarettes were in each packet?

  1. Batang Rokok / Cigarettes (Sekiranya kurang daripada satu bungkus / If less than one packet)

  2. Lain-lain / Other
    a. Nyatakan: _______________________ Specify: __________________________ b. Berapa bilangan [nyatakan] yang dibeli? How many [FILL] were bought? c. Berapa batang rokok dalam setiap [nyatakan]? How many cigarettes were in each [FILL]?

  3. Tidak pernah MEMBELI ROKOK – Tamat, ke Modul seterusnya Never BOUGHT CIGARETTES – End, go to the next Modul
    CE26 Soalan CE26 hanya perlu dijawab oleh responden yang menjawab pilihan merokok setiap hari (pilihan 1) atau kurang dari setiap hari (pilihan 2) pada soalan CE01 ; iaitu (CE01 = 1 atau 2) DAN menjawab CE03 Question CE25 is to be answered by respondents who answered daily (choice No.1) or less than daily (choice No.2) for Question CE01 ; i.e.(CE01 = 1 or 2) AND answered CE03 Jumlah perbelanjaan / Total expenses Berapakah jumlah wang yang anda telah belanja pada kali terakhir anda membeli rokok sebelum ini. In Total, how much money did you pay for this purchase. Nyatakan: RM_________________ Specify: RM__________________ (-7) TT (-9) EJ CE27a Soalan CE27a hanya perlu dijawab oleh responden yang menjawab pilihan merokok setiap hari (pilihan 1) atau kurang dari setiap hari (pilihan 2) pada soalan CE01 ; iaitu (CE01 = 1 atau 2) DAN menjawab CE03 Question CE25 is to be answered by respondents who answered daily (choice No.1) or less than daily (choice No.2) for Question CE01 ; i.e.(CE01 = 1 or 2) AND answered CE03 Berapakah harga sebungkus rokok yang terakhir anda beli?
    How much is the price of 1 pack of cigarette in your last purchase? a. Nyatakan: RM________________

Specify: RM__________________ … sila ke CE27b b. Tidak pernah beli sebungkus rokok – tamat, ke Modul seterusnya

Never bought a pack of cigarettes – End, go to the next Module (-7) TT (-9) EJ Tamat, Ke Modul Seterusnya / End, Go to Next Modul Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 318 30 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CE27b Tempat Membeli Rokok Cigarette Purchase Place Di manakah ada beli rokok tersebut? (Pilih satu jawapan sahaja) Where did you buy the pack of cigarette? (Select one answer only)

  1. Di kedai runcit biasa dan setempat / At grocery store and local store
  2. Di kedai dan kiosk 24 jam / At shop and 24-hour kiosk
  3. Stesen minyak / Petrol station
  4. Gerai surat khabar/ Newsstand
  5. Pasaraya / Supermarket
  6. Gerai di tepi jalan/ Roadside stall
  7. Daripada penjual dari trak atau kereta / Seller from trak or car
  8. Kedai tentera / Military store
  9. Kedai bebas cukai / Duty free shop
  10. Di luar negara / At overseas
  11. Beli melalui internet / Buy via the internet
  12. Pasar malam / Night market
  13. Mesin vending / Vending machine
  14. Lain-lain, sila nyatakan___________________ Others, please specify_____________
  15. Tidak ingat / Do not remembe
  16. Enggan jawab / Refuse to answer CE28 Adakah responden mempunyai kotak rokok sekarang? Does respondent has cigarette pack now?
  17. Ya/ Yes
  18. Tidak/ No - ke Soalan CE31 CE29 Soalan CE29 hanya perlu dijawab oleh responden yang menjawab pilihan merokok setiap hari (pilihan 1) atau kurang dari setiap hari (pilihan 2) pada soalan CE01 ; iaitu (CE01 = 1 atau 2) DAN menjawab CE03 Question CE25 is to be answered by respondents who answered daily (choice No.1) or less than daily (choice No.2) for Question CE01 ; i.e.(CE01 = 1 or 2) AND answered CE03 Adakah kotak rokok ditunjuk oleh responden? Is the cigarette pack showed by the respondent?
  19. Ya / Yes - Jawab Soalan CE30 dan ke modul yang seterusnya
  20. Tidak / No - Jawab Soalan CE31 CE30 Penemuramah perlu memeriksa kotak rokok yang ditunjuk oleh responden dan jawab semua soalan di bawah Interviewer is required to check the cigarette pack shown by respondent and answer all the following questions CE30a Cop rasmi cukai Tax official stamp
  21. Ya / Yes
  22. Tidak / No (-7) TT
    CE30b Amaran kesihatan bergambar Health warning images
  23. Ya / Yes
  24. Tidak / No (-7) TT
    Appendix 7 Non-Communicable Diseases: Risk Factors and other Health Problems 319 31QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia CE30c Maklumat mengenai 4000 bahan kimia Information about 4000 chemicals
  25. Ya / Yes
  26. Tidak / No (-7) TT
    CE30d Maklumat tidak boleh jual kepada individu dibawah umur Information regarding prohibition of sale to minor
  27. Ya / Yes
  28. Tidak / No (-7) TT
    CE30e Nama dan alamat pengilang/pembekal Name of manufacturer/supplier
  29. Ya / Yes
  30. Tidak / No (-7) TT
    CE31 Untuk kotak rokok terakhir anda telah beli, adakah kotak mempamerkan maklumat berikut? Sila jawab semua soalan di bawah For the pack of cigarette in your last purchase, does the cigarette pack contain the following information? Please answer all the questions below. CE31a Cop rasmi cukai Tax official stamp
  31. Ya / Yes
  32. Tidak / No (-7) TT (-9) EJ CE31b Amaran kesihatan bergambar Health warning images
  33. Ya / Yes
  34. Tidak / No (-7) TT (-9) EJ CE31c Maklumat mengenai 4000 bahan kimia Information about 4000 chemicals
  35. Ya / Yes
  36. Tidak / No (-7) TT (-9) EJ CE31d Maklumat tidak boleh jual kepada individu dibawah umur Information regarding prohibition of sale to minor
  37. Ya / Yes
  38. Tidak / No (-7) TT (-9) EJ CE31e Nama dan alamat pengilang/pembekal Name of manufacturer/supplier
  39. Ya / Yes
  40. Tidak / No (-7) TT (-9) EJ Tamat, Ke Modul Seterusnya / End, Go to Next Modul Questionnaire National Health and Morbidity Survey 2019 Technical Report − Volume I 320 32 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia MODUL CJ: AMALAN PEMAKANAN / DIETARY PRACTICE KRITERIA KELAYAKAN: AHLI ISIRUMAH BERUMUR BERUMUR 18 TAHUN DAN KE ATAS ELIGIBILITY CRITERIA: MEMBER OF THE HOUSEHOLD AGED 18 YEARS AND ABOVE Bulatkan jawapan yang bersesuaian / Please circle the appropriate answer. Saya ingin bertanya beberapa soalan tentang amalan pemakanan anda dalam seminggu yang lepas. I would like to ask you a few questions about your dietary practices for the past one (1) week. CJ01a Kebiasaannya, dalam seminggu berapa hari anda minum minuman kopi/teh yang ditambah gula atau / dan susu pekat manis atau / dan krimer manis? In a typical week, how many days did you drink coffee / tea with added sugar or / and sweetened condensed milk or/and sweetened creamer?
  41. 0 hari / 0 day (skip CJ01b & CJ01c)
  42. 1 hari / 1 day
  43. 2 hari / 2 days
  44. 3 hari / 3 days
  45. 4 hari / 4 days
  46. 5 hari / 5 days
  47. 6 hari / 6 days
  48. 7 hari / 7 days (-7) TT (-9) EJ CJ01b Biasanya pada hari yang anda minum minuman kopi / teh yang ditambah gula atau / dan susu pekat manis atau / dan krimer manis, berapa cawan anda minum? Usually on the day that you drank coffee/tea with added sugar or/and sweetened condensed milk or/and sweetened creamer, how many cups did you take in a day? _____ bil. cawan (200ml) / no. of cup (200ml) (-7) TT (-9) EJ *sila rujuk kad CJ1 untuk anggaran cawan / please refer to the card CJ1 for cup estimation CJ01c Biasanya berapa sudu teh gula atau / dan susu pekat manis atau /dan krimer manis atau /dan madu anda tambah ke dalam satu cawan kopi/teh? Usually how many teaspoons of sugar or/and sweetened condensed milk or/ and sweetened creamer or/did you add in one cup of coffee/tea? _______bil. sudu teh gula / no. of teaspoon of sugar atau /dan or /and _______bil. sudu teh susu pekat manis / krimer manis / sweetened condensed milk/sweetened creamer atau /dan or /and _______bil. sudu teh madu/ no. of teaspoon of honey (-7) TT (-9) EJ *sila rujuk kad CJ2, CJ3 & CJ4 untuk anggaran cawan / please refer to the card CJ2, CJ3 & CJ4 for cup estimation Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 321 33 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia CJ02a Kebiasaannya, dalam seminggu berapa hari anda minum minuman bercoklat/ bermalta yang ditambah gula atau/dan susu pekat manis atau/dan krimer manis? In a typical week, how many days did you drink chocolate or/and malted beverages with added sugar or/and sweetened condensed milk or/and sweetened creamer?

  1. 0 hari / 0 day (CJ02b & CJ02c)
  2. 1 hari / 1 day
  3. 2 hari / 2 days
  4. 3 hari / 3 days
  5. 4 hari / 4 days
  6. 5 hari / 5 days
  7. 6 hari / 6 days
  8. 7 hari / 7 days (-7) TT (-9) EJ CJ02b Biasanya pada hari yang anda minum minuman bercoklat/bermalta yang ditambah gula atau/dan susu pekat manis atau/dan krimer manis, berapa cawan anda minum? Usually on the day that you drank chocolate/malted beverages with added sugar or/and sweetened condensed milk or/and sweetened creamer, how many cups did you take in a day? _____ bil. cawan (200ml) / no. of cup (200ml) (-7) TT (-9) EJ
  • sila rujuk kad CJ5 untuk anggaran cawan / please refer to the card CJ5 for cup estimation CJ02c Biasanya berapa sudu teh gula atau/dan susu pekat manis atau/dan krimer manis atau/dan madu anda tambah ke dalam satu cawan minum tersebut? Usually how many teaspoons of sugar or/and sweetened condensed milk or/and sweetened creamer or/and honey did you add in one cup of chocolate/malted beverages? _______bil. sudu teh gula / no. of teaspoon of sugar atau /dan or /and _______bil. sudu teh susu pekat manis / krimer manis / sweetened condensed milk/sweetened creamer atau /dan or /and _______bil. sudu teh madu/ no. of teaspoon of honey (-7) TT (-9) EJ *sila rujuk kad CJ2, CJ3 & CJ4 untuk anggaran cawan / please refer to the card CJ2, CJ3 & CJ4 for cup estimation CJ03a Kebiasaannya, dalam seminggu berapa hari anda minum minuman pra campuran (2-in-1, 3-in-1 dan 4-in-1)? In a typical week, how many days did you drink pre-mixed drinks (2-in-1, 3-in-1 and 4-in-1)?
  1. 0 hari / 0 day (skip CJ03b)
  2. 1 hari / 1 day
  3. 2 hari / 2 days
  4. 3 hari / 3 days
  5. 4 hari / 4 days
  6. 5 hari / 5 days
  7. 6 hari / 6 days
  8. 7 hari / 7 days (-7) TT (-9) EJ CJ03b Biasanya pada hari yang anda minum minuman pra campuran (2-in-1, 3-in-1 dan 4-in-1), berapa peket anda minum? Usually on the day that you drank pre-mixed drinks (2-in-1, 3-in-1 and 4-in-1), how many sachets did you take? _____ bil. peket /no. of sachet (-7) TT (-9) EJ
  • sila rujuk kad CJ6 untuk anggaran cawan / please refer to the card CJ6 for cup estimation Questionnaire
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