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Open Access Study protocol

Cohort study on clustering of lifestyle risk factors and understanding its association with stress on health and wellbeing among school teachers in Malaysia (CLUSTer) – a study protocol

Foong Ming Moy1*, Victor Chee Wai Hoe12, Noran Naqiah Hairi1, Brian Buckley34, Petra A Wark5, David Koh267, HB(as) Bueno-de-Mesquita11089 and Awang M Bulgiba1

Author Affiliations

1 Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2 Centre for Occupational and Environmental Health-UM, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

3 Department of General Practice, National University of Ireland, Galway, Ireland

4 Department of Surgery, University of Manila, Manila, Philipines

5 Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom

6 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei, Brunei Darussalam

7 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

8 Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment, Bilthoven, The Netherlands

9 Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands

10 Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom

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BMC Public Health 2014, 14:611  doi:10.1186/1471-2458-14-611

Published: 17 June 2014



The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes.


This study is being conducted in six states within Peninsular Malaysia. From each state, schools from each district are randomly selected and invited to participate in the study. Once the schools agree to participate, all teachers who fulfilled the inclusion criteria are invited to participate. Data collection includes a questionnaire survey and health assessment. Information collected in the questionnaire includes socio-demographic characteristics, participants’ medical history and family history of chronic diseases, teaching characteristics and burden, questions on smoking, alcohol consumption and physical activities (IPAQ); a food frequency questionnaire, the job content questionnaire (JCQ); depression, anxiety and stress scale (DASS21); health related quality of life (SF12-V2); Voice Handicap Index 10 on voice disorder, questions on chronic pain, sleep duration and obstetric history for female participants. Following blood drawn for predefined clinical tests, additional blood and urine specimens are collected and stored for future analysis. Active follow up of exposure and health outcomes will be carried out every two years via telephone or face to face contact. Data collection started in March 2013 and as of the end of March 2014 has been completed for four states: Kuala Lumpur, Selangor, Melaka and Penang. Approximately 6580 participants have been recruited. The first round of data collection and blood sampling is expected to be completed by the end of 2014 with an expected 10,000 participants recruited.


Our study will provide a good basis for exploring the clustering of lifestyle risk factors and stress and its association with major chronic medical conditions such as obesity, hypertension, impaired glucose tolerance, diabetes mellitus, coronary heart diseases, kidney failure and cancers among teachers.

Teachers; Cohort study; Work related stress; Clustering of lifestyle risk factors