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INTRODUCTION Smoke or aerosols from cigarettes, e-cigarettes (ECs), or heated tobacco products (HTPs) are harmful. Yet, there is little knowledge about the specific patterns of secondhand tobacco exposure by source within household settings and the socioeconomic status (SES) differences in adolescents. METHODS We used territory-representative student data from a cross-sectional school-based survey in 2020-2021 to calculate the weighted prevalence of secondhand exposure to cigarettes, e-cigarettes, and HTPs in the past seven days. Parental education and perceived family affluence were used as indicators of socioeconomic status. Generalized linear mixed models were used to analyze associations. RESULTS Among 22039 participants, 29.8% reported any secondhand tobacco exposure (SH-Any) at home, primarily from cigarettes (27.4%), followed by e-cigarettes (4.0%) and HTPs (0.9%). Tertiary parental education level was associated with lower SH-Any exposure (Adjusted odds ratio, AOR=0.49; 95% CI: 0.45-0.53, p<0.001), fewer exposure days (β= -0.685, p<0.001), lower exposure to cigarettes (SH-CC) (AOR=0.49; 95% CI: 0.45-0.54, p<0.001) and to e-cigarettes or HTPs (SH-EC/HTP) (AOR=0.57; 95% CI: 0.45-0.71, p<0.001). 'Poor' family affluence was associated with higher exposures [AOR(SH-Any) =1.14; 95% CI: 1.06-1.22, p=0.001; β(days)=0.160, p<0.001; AOR(SH-CC) =1.15; 95% CI: 1.07-1.24, p<0.001], except for SH-EC/HTP exposure, which was higher in students in an affluent family (AOR =1.66; 95% CI: 1.25-2.21, p<0.001). Significant SES differences in SH-EC/HTP exposure were found only in groups with low parental education level. Dose-response relationships were found between lower SH-Any and SH-CC and higher SES categories (p for trend<0.001). CONCLUSIONS Adolescents experienced a high prevalence of tobacco smoke exposure at home, primarily from cigarettes. Higher SES was associated with lower tobacco exposure, except for SH-EC/HTP, which was higher among adolescents from affluent families. Additionally, high parental education level was protective against exposure to SH-EC/HTP. Comprehensive control measures to reduce the use of these tobacco products are needed to protect adolescents of diverse socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

INTRODUCTION Tobacco use is associated with an increased risk of Coronavirus Disease 2019 (COVID-19) infection, severe COVID-19 outcomes requiring intensive care, and mortality. We investigated the perceived risk of and changes in cigarette, e-cigarette (EC) and heated tobacco product (HTP) use in relation to COVID-19 in Hong Kong adolescent tobacco users. METHODS We conducted semi-structured telephone interviews from January to April 2021 and in February 2022 on 40 adolescents (65% boys, Secondary school grades 2-6) who participated in our previous smoking surveys and were using cigarettes, ECs or HTPs before the first wave of the COVID-19 pandemic in January 2020. RESULTS Adolescents generally perceived higher risks of contracting and having more severe COVID-19 from using cigarettes than ECs/HTPs, but they had limited knowledge of COVID-19 risks from EC/HTP use, particularly. Both increased and reduced consumption were found in tobacco, with EC use being the less affected product. Changes also included switching to ECs for convenience and lower cost and shifting from smoking cigarettes outside to mainly at home or in hidden areas. COVID-related policies, fear of infection, non-COVID-related health concerns, less social opportunities and pocket money, and limited access to tobacco products were barriers to tobacco use. In contrast, greater freedom at home versus school and negative emotions due to social distancing were facilitators. Family/peer influence had mixed impacts. CONCLUSIONS Adolescent tobacco users perceived lower COVID risks associated with HTPs and ECs than cigarettes, and various changes in tobacco use were found amid the pandemic in Hong Kong. COVID-19 and related social changes may both facilitate or deter adolescent tobacco use. [ABSTRACT FROM AUTHOR]

Background: Information and communication technology (ICT) use may enhance social work practice and continuous professional development. Under the Hong Kong Jockey Club SMART Family-Link Project, we developed an innovative web-based training, learning, and sharing platform (i-TLS) to support not only ICT and other learning needs of Hong Kong social workers but also their practice. Objective: We developed i-TLS with 3 major components (i-Training, i-Learning, and i-Sharing) and assessed its acceptability and impact on facilitating ICT use in family services. Methods: We described the i-TLS development based on a 4-phase model and evaluated i-TLS using the platform database, Google Analytics, a self-administered survey, and individual phone interviews 1 year after launching. Results: i-TLS was launched in 12 nongovernmental organizations on July 1, 2019. The COVID-19 outbreak in December 2019 limited face-to-face services, which galvanized digital transformation in social work practice. By July 31, 2020, 313 social workers had registered with i-TLS. Approximately 79.6% (249/313) of users accessed i-TLS at least once in the past 28 days, averaging 3.2 (SD 1.35) platform visits per day and viewing 4.8 (SD 1.42) pages per visit. i-Training provided 41 mini-modules on applying ICT to family services, with 730 enrollments. Approximately 70% (511/730) of users completed the mini-modules and obtained digital mini-certificates. i-Learning provided 112 items of learning resources centered on ICT use in family services, with nearly 4000 page views. i-Sharing had 25 discussion threads with 59 posts. Approximately 53.7% (168/313) of users completed the 1-year evaluation survey, including 7.1% (12/168) who were phone interviewed. The mean i-TLS satisfaction score (out of 10) increased from light (4.99, SD 1.54) to occasional (6.15, SD 1.34) and frequent (6.31, SD 2.29) users. Frequent users showed higher scores (out of 10) than light users for an increase in knowledge (5.84, SD 1.34 vs 4.09, SD 1.74; P<.001), self-efficacy (5.23, SD 1.92 vs 3.96, SD 1.77; P=.02), and knowledge application (6.46, SD 1.33 vs 1.91, SD 1.40; P<.001). Interviewees reported increased ICT use in services and considered i-TLS an acceptable and supportive tool for learning and practice, especially during the pandemic. Conclusions: i-TLS is acceptable to social workers and enhances their learning and use of ICT in family services. This was achieved through access to self-directed and collaborative learning and sharing of experiences within their practice. Further research on enhancing web-based platforms is needed to expand participation and capacity building among social workers and other health and social care professionals. [ABSTRACT FROM AUTHOR]

INTRODUCTION Changes in tobacco use since the COVID-19 outbreak differed by countries and little is known about changes in the use of specific tobacco products. METHODS We analyzed data from four cross-sectional telephone/online surveys from April to June 2020 to investigate such changes since the 1st and 2nd wave outbreaks (February to April 2020) in Hong Kong. The respondents were 1595 adults (83.2% male) who used tobacco before the COVID-19 outbreak from our previous intervention study and surveys. We investigated the changes in tobacco use, intention to quit and quit attempts during the outbreak. RESULTS About two-thirds (65.3%) of respondents reported no change in overall tobacco use, while 23.1% used less (including cessation) and 11.6% used more, resulting in a net decrease of 11.5 percentage points. A greater net decrease was observed for cigarettes (14.3% points) than heated tobacco products (HTPs, 3.3% points) and electronic cigarettes (e-cigarettes, 2.5% points). Decreased use was mainly due to the more extended stay at home (63.2%), health considerations (52.6%) and mask-wearing (47.4%), while increased use was for passing time (75.0%) and releasing stress (46.4%). Eight percent of cigarette, HTP and e-cigarette users reported a higher intention to quit since the pandemic outbreak. Nineteen percent of tobacco users (176/948) attempted to quit during the pandemic. Only 2.9% (46/1569) were abstinent at the time of the survey. CONCLUSIONS Overall tobacco use decreased after the first two waves of the COVID-19 outbreak in Hong Kong. A greater proportion of cigarette users decreased use than HTP and e-cigarette users. Given the different methods used in the four surveys, future studies should aim for a large and representative sample. [ABSTRACT FROM AUTHOR]

Background: Little is known about the longitudinal relations of environment attributes and leisure-time physical activity (PA) in adolescents, and the moderating effects of individual characteristics. This study examined the longitudinal association of the perceived availability of neighborhood sport facilities with leisure-time PA, and the potential moderating effects of age, past PA behavior, and weight status in adolescents. Methods: Among 20,933 follow-up subjects (60.9% of 34,369 baseline subjects), 9993 from 32 Hong Kong secondary schools were successfully matched with baseline (mean duration 16 months; SD 1.7) and had complete information. At baseline and follow-up, respondents reported their leisure-time PA, weight, height, and the presence of sport facilities in the neighborhood. Results: Increased perceived availability of sport facilities from baseline to follow-up predicted more leisure-time PA at follow-up (ß = 1.029; 95% CI: 1.011-1.047) overall. This effect was modified by baseline PA, with a significant effect observed only among those who had engaged in leisure-time PA more than 3 times a week. Conclusions: Increasing awareness of neighborhood sport facilities or building more such facilities may help active adolescents maintain or increase their leisure-time PA. However, more comprehensive multilevel interventions that aim at enhancing potential social, personal, and environmental PA-related factors may be needed to motivate inactive adolescents. [ABSTRACT FROM AUTHOR]

INTRODUCTION Never smokers' responses to tobacco control policy are often overshadowed by the opposition from smokers and tobacco industry during policy advocacy and legislation. Very few studies have examined never smokers' exposure to point-of-sale (POS) tobacco displays and their effects. Therefore, we investigated the exposure, pro-smoking responses due to and attitudes towards such displays in never smokers in Hong Kong. METHODS We conducted two-stage, randomized cross-sectional telephone-based surveys in 2015 and 2016 of 1833 never-smoking adults. They were asked how often they noticed POS displays in the past 30 days (often, sometimes, never), whether they found POS displays attractive, felt encouraged to smoke, perceived POS displays as advertisements, and if they supported banning them. The distributions of the outcomes were analyzed by descriptive statistics with weighting to the general population. Risk ratios (RR) from Poisson regression models adjusted for sociodemographic characteristics were used to analyze the associations. RESULTS Our results showed that, in never smokers, the younger were more likely to often notice POS displays (RR=0.80, 95% CI: 0.72-0.89, p<0.01). Finding POS displays attractive was associated with primary (RR=2.52, 95% CI: 1.51-4.22, p<0.01) and secondary education (RR=1.68, 95% CI: 1.16-2.44, p=0.01) versus tertiary education. Often noticing displays was associated with perceived attractiveness (RR=1.90, 95% CI: 1.32-2.75, p<0.01). The positive association between often noticing displays and being encouraged to smoke was marginally significant (RR=4.05, 95% CI: 0.98-16.85, p=0.054). Respondents who often noticed POS displays (RR=0.87, 95% CI: 0.77-0.98, p=0.02) and did not perceive them as advertisements (RR=0.70, 95% CI: 0.61-0.98, p<0.01) showed less support on banning them than those who did not notice them. CONCLUSIONS Frequent exposure to POS displays was associated with greater perceived attractiveness and lower support for banning them. A total ban on POS displays is needed to eliminate the advertising and normalization effect of POS displays. [ABSTRACT FROM AUTHOR]

Introduction: Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents.Methods: In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression.Results: Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively.Conclusions: Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke.Implications: In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed. [ABSTRACT FROM AUTHOR]

Objective To examine the associations of perceived interparental relationship, family harmony and family happiness with smoking intention in never-smoking Chinese children and adolescents in Hong Kong. Design, settings and participants Cross-sectional surveys of 15 753 primary (grades 4-6) and 38 398 secondary (grades 7-12) never-smoking students from 71 to 75 randomly selected primary and secondary schools in Hong Kong, 2012-2013. Measurements Outcome variable was smoking intention which denoted any affirmative response to smoke within the coming year or when a cigarette was offered by a good friend. Exposure variables were perceived interparental relationship and family harmony each measured on a fivepoint scale from 'very good' to 'very bad' and perceived family happiness on a four-point scale from 'very happy' to 'not happy at all'. Potential confounders included age, sex, family structure, perceived family affluence, parental smoking and sibling smoking. Results In primary students, the adjusted ORs (AORs) (95% CI) of smoking intention generally increased with more negative perception of the family relationship: up to 3.67 (1.91 to 7.05) for interparental relationship, 7.71 (4.38 to 13.6) for family harmony and 5.40 (3.41 to 8.55) for family happiness. For secondary students, the corresponding AORs (95% CI) were 2.15 (1.64 to 2.82) for interparental relationship, 2.98 (2.31 to 3.84) for family harmony and 2.61 (1.80 to 3.79) for family happiness. All p for trend <0.001. Conclusions More negatively perceived interparental relationship, family harmony and family happiness were associated with higher odds of smoking intention with dose-response relationships in never-smoking Chinese children and adolescents in Hong Kong. Children's perception of their family relationship may be an important intervening point for preventing youth from initiating smoking. [ABSTRACT FROM AUTHOR]

Background: Evidence on the effects of lack of physical exercise, alcohol drinking and smoking on happiness is limited and inconsistent. We examined the associations of unhappiness with sociodemographic factors and these unhealthy behaviours in Chinese adolescents. Methods: In a school-based survey in 2012-13 in Hong Kong, 45 857 secondary school students (mean age 14.8 years, 54.0% boys) reported their happiness level (not happy at all/not very happy/happy/very happy), frequency of physical exercise, alcohol drinking status, smoking status and sociodemographic factors. A main and a sensitivity analysis examined the associations of unhappiness with the study factors, treating unhappiness as a binary (combining 'not happy at all' and 'not very happy') and a four-level ordered variable, respectively. Results: The main and the sensitivity analysis both showed that unhappiness was associated with older age, very poor families, non-intact families, more co-residing smokers, lack of physical exercise and alcohol drinking; current smokers were unhappier than never and ex-smokers; unhappiness also increased significantly with the number of unhealthy behaviours (P for trend < 0.001). Conclusions: In Chinese adolescents, unhappiness levels were higher in those who had a very poor family, a non-intact family and more coresiding smokers, and in those who were physically inactive, drank alcohol and smoked. [ABSTRACT FROM AUTHOR]

Background Adolescent drinking in Western countries has been associated with older age and high socioeconomic status, but the association with family structure was inconsistent. Methods In a 2012-2013 school-based survey in Hong Kong, 23 096 students (mean age 14.7 years, SD 1.8 years) completed an anonymous questionnaire. Current drinking was defined as any drinking and binge drinking as consuming at least 5 drinks on one occasion, both in the past 30 days. Multilevel logistic regression was used to examine the association of sociodemographic characteristics with current drinking, binge drinking and type of alcohol consumed. Results Current drinking was associated with age (≥ vs ≤14 years) (adjusted OR 1.87, 95% CI 1.74 to 2.02), higher perceived family affluence versus low affluence (1.11, 1.02 to 1.21 for medium affluence; 1.55, 1.38 to 1.75 for high affluence), private housing versus public housing (1.11, 1.01 to 1.21) and non-intact family versus intact family (1.31, 1.19 to 1.45 for separated/divorced parents; 1.40, 1.21 to 1.62 for one or both deceased parents). Similar risk factors were observed for binge drinking. Girls were more likely to drink fruit wine (1.48, 1.36 to 1.62), while they were less likely to drink beer (0.85, 0.79 to 0.92) and spirits (0.69, 0.54 to 0.87). Students who reported high family affluence were more likely to drink wine (1.91, 1.59 to 2.30) and spirits (2.23, 1.54 to 3.24). Conclusions Generally, adolescents who were older and had higher socioeconomic status were more likely to drink. High family affluence was associated with wine and spirits drinking. Beer and spirits were preferred more by boys, and fruit wine by girls. These results indicated high-risk groups for adolescent alcohol interventions. [ABSTRACT FROM AUTHOR]

Background: Little is known about electronic cigarette (e-cigarette) use among Chinese adolescents. We examined the prevalence of current (past 30-day) e-cigarette use and its associated factors in a large sample of adolescents in Hong Kong.Methods: We analyzed data of the School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (mean age: 14.8 ± 1.9). We conducted chi-square tests and t-test to compare current e-cigarette use by covariates. We used multivariable logistic regression to examine the association between current e-cigarette use and demographic variables, parental smoking, peer smoking, knowledge about the harm of cigarette smoking, attitudes toward cigarette smoking, cigarette smoking status, use of other tobacco products, and alcohol consumption.Results: Overall, 1.1% of students reported current e-cigarette use. Of e-cigarette users, 11.7% were never-cigarette smokers, 15.8% were experimental cigarette smokers, 39.3% were former cigarette smokers, and 33.2% were current cigarette smokers. Current e-cigarette use was associated with male sex, poor knowledge about the harm of smoking, cigarette smoking, use of other tobacco products, and alcohol consumption.Conclusions: Surveillance and intervention efforts should address a wide range of tobacco products, including e-cigarettes. Tobacco cessation programs should also address alcohol use collectively. Policies prohibiting e-cigarette sales to minors may help prevent e-cigarette uptake among adolescents. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between parental pro-drinking practices (PPDPs) and alcohol drinking in Hong Kong Chinese adolescents. Design: A cross-sectional study. Setting: 4 randomly selected secondary schools in Hong Kong. Participants: 1738 students (mean age 14.6 years ±2.0, boys 67.8%). Main outcome measures: Drinking status, drinking intention and exposure to 9 PPDPs (eg, seeing parents drunk, helping parents buy alcohol, encouraged to drink by parents) were reported by students. Logistic regression was used to compute adjusted ORs (AORs) of drinking and intention to drink by each PPDP and the number of PPDPs (0, 1-2, 3-4, 5 or above), adjusting for sociodemographic characteristics, parental drinking and school clustering. Results: Nearly half (48.6%) of the students were ever-drinkers, 16.2% drank monthly (at least once per month) and 40.3% intended to drink in the next 12 months. Most PPDPs were significantly associated with ever drinking (AORs 1.40-6.20), monthly drinking (AORs 1.12-8.20) and intention to drink (AORs 1.40-5.02). Both ever and monthly drinking were most strongly associated with parental training of drinking capacity (ability to drink more without getting drunk) with AORs of 6.20 and 8.20 (both p<0.001), respectively. Adolescent drinking intention was most strongly associated with parental encouragement of drinking and training of drinking capacity with AORs of 3.19 and 5.02 (both p<0.001), respectively. Conclusions: Exposure to PPDPs was associated with ever drinking, monthly drinking and drinking intention in Hong Kong Chinese adolescents. More studies, especially prospective studies, should be conducted to confirm these results, followed by interventional studies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between parental pro-drinking practices (PPDPs) and alcohol drinking in Hong Kong Chinese adolescents. Design: A cross-sectional study. Setting: 4 randomly selected secondary schools in Hong Kong. Participants: 1738 students (mean age 14.6 years ±2.0, boys 67.8%). Main outcome measures: Drinking status, drinking intention and exposure to 9 PPDPs (eg, seeing parents drunk, helping parents buy alcohol, encouraged to drink by parents) were reported by students. Logistic regression was used to compute adjusted ORs (AORs) of drinking and intention to drink by each PPDP and the number of PPDPs (0, 1-2, 3-4, 5 or above), adjusting for sociodemographic characteristics, parental drinking and school clustering. Results: Nearly half (48.6%) of the students were ever-drinkers, 16.2% drank monthly (at least once per month) and 40.3% intended to drink in the next 12 months. Most PPDPs were significantly associated with ever drinking (AORs 1.40-6.20), monthly drinking (AORs 1.12-8.20) and intention to drink (AORs 1.40- 5.02). Both ever and monthly drinking were most strongly associated with parental training of drinking capacity (ability to drink more without getting drunk) with AORs of 6.20 and 8.20 (both p<0.001), respectively. Adolescent drinking intention was most strongly associated with parental encouragement of drinking and training of drinking capacity with AORs of 3.19 and 5.02 (both p<0.001), respectively. Conclusions: Exposure to PPDPs was associated with ever drinking, monthly drinking and drinking intention in Hong Kong Chinese adolescents. More studies, especially prospective studies, should be conducted to confirm these results, followed by interventional studies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate secondhand smoke (SHS) exposure at home from neighbours in Hong Kong adolescents and its association with respiratory symptoms in never-smokers. Design: A cross-sectional study. Setting: 79 randomly selected secondary schools in Hong Kong. Participants: 61 810 secondary 1 (USA grade 7) to 7 students, in which 50 762 never-smokers were identified and included in the analysis of the association between SHS exposure at home from neighbours and respiratory symptoms. Main outcome measures: Smoking status, family smoking status, SHS exposure at home from inside the home and from neighbours in the past 7 days, respiratory symptoms and sociodemographic characteristics were reported. Adjusted ORs (AORs) of respiratory symptoms for SHS exposure from the 2 sources in never-smokers were calculated using logistic regression. Results: In all students, 33.2% were exposed to SHS at home, including 16.2% from inside the home only, 10.0% from neighbours only and 7.0% from both. The prevalence of SHS exposure from neighbours was 17.1%, including 13.5% for 1-4 days/week and 3.6% for 5-7 days/week. In never-smokers (n=50 762), respiratory symptoms were significantly associated with SHS exposure from neighbours with AORs (95% CI) of 1.29 (1.20 to 1.39) for any exposure (p<0.001), 1.21 (1.12 to 1.31) for 1-4 days/week (p<0.001) and 1.63 (1.44 to 1.86) for 5-7 days/week (p<0.001) (P for trend <0.001). Compared with no SHS exposure at home from any source, the AORs were 1.16 (1.07 to 1.25) for SHS from inside the home only (p<0.001), 1.20 (1.11 to 1.31) from neighbours only ( p<0.001), and 1.74 (1.56 to 1.94) from both (p<0.001). Conclusions: SHS exposure at home from neighbours was prevalent in Hong Kong adolescents, and was associated with respiratory symptoms in never-smokers. SHS exposure at home may be underestimated by ignoring the neighbouring source. Smoke-free housing policy is needed to protect children and adolescents from harms of SHS. [ABSTRACT FROM AUTHOR]

This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferredmultiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong. Design: Cross-sectional study. Setting: Secondary schools in Hong Kong. Participants: A total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools. Outcome measures: An anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1-2 and 3-7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed. Results: More than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1-2 days/week and 1.70 (1.41 to 2.06) for 3-7days / week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed. Conclusions: Alcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined how common physicians assess various weight-related variables and patient characteristics that predict such assessments based on adolescents’ reports. We aimed to examine how common adolescents received weight-related physical measurements and lifestyle enquiries (dietary habits and physical activity) from private practitioners and to identify factors associated with these assessments. Methods: In the Hong Kong Student Obesity Surveillance (HKSOS) project, 33692 students (44.9% boys; mean age 14.8, SD 1.9 years, age range 11–18) from 42 randomly selected schools completed an anonymous questionnaire. The students were asked “In the past 12 months, has any private practitioners (or their nurses) measured or asked about these items?” Response options included height, weight, waist circumference (WC), blood pressure (BP), BMI, diet, and physical activity. Weight status was based on self-reported weight and height. Logistic regression was used to identify student characteristics associated with each assessment. Analyses were conducted using STATA 10.0. Results: Among 13283 students who had doctor consultations in the past 12 months, 37.9% received physical measurements or lifestyle enquiries, with weight (20.8%), height (16.8%) and blood pressure (11.5%) being the most common, followed by diet (8.1%), BMI (6.3%), WC and physical activity (both 4.6%). In general, adolescents who were female, older, underweight or overweight/obese, had parents with higher education level, and had actively asked private practitioners for advice about weight were more likely to receive assessments of weight-related factors. Conclusions: Weight-related factors in adolescents were infrequently assessed by private practitioners in Hong Kong. Generally, unhealthy weight, higher parental education and advice-seeking by adolescents predicted these assessments. [ABSTRACT FROM AUTHOR]

Background: To compare the performance of Stunkard's current body size (CBS) with self-reported body mass index (BMI), waist circumference (WC) and waist to stature ratio (WSR) in predicting weight status in Chinese adolescents, and to determine the CBS cutoffs for overweight/obesity and underweight. Methodology:This cross-sectional study was conducted in a sample of 5,418 secondary school students (45.2% boys; mean age 14.7 years). Height and weight were measured by trained teachers or researchers. Subjects were classified as underweight, normal weight, or overweight/obese according to the International Obesity Task Force cutoffs. Subjects were asked to select the figure that best resembled their CBS on the Stunkard's figure rating scale. Self-reported height, weight, WC and WSR were also obtained. The performance of CBS, self-reported BMI, WC and WSR as a weight status indicator was analysed by sex-specific receiver operating characteristic curves. The optimal CBS cutoffs for underweight and overweight/ obesity were determined based on the Youden Index. Principal Findings: Apart from self-reported BMI, CBS had the greatest area under curve (AUC) for underweight in boys (0.82) and girls (0.81). For overweight/obesity, CBS also had a greater AUC (0.85) than self-reported WC and WSR in boys, and an AUC (0.81) comparable to self-reported WC and WSR in girls. In general, CBS values of 3 and 5 appeared to be the optimal cutoffs for underweight and overweight/obesity, respectively, in different sex-age subgroups. Conclusions/Significance: CBS is a potentially useful indicator to assess weight status of adolescents when measured and self-reported BMI are not available. [ABSTRACT FROM AUTHOR]

This study aimed to establish the normative values for the 12-item Short Form Health Survey version 2 (SF-12v2) and examine demographic differences among Hong Kong Chinese adolescents. A total of 28 981 Hong Kong Chinese adolescents aged 12-18 participated in a school-based survey in 2006-2007. Sex- and age-specific SF-12v2 scores were obtained. Ordinal logistic regression models and linear regression models were used to examine the demographic differences for the eight subscales including physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health, and two component summary scores of Physical Component Summary and Mental Component Summary. The mean (standard deviation) Physical Component Summary score was 50.28 (6.82) for boys and 49.37 (6.47) for girls. The corresponding Mental Component Summary score was 45.86 (9.86) for boys and 44.77 (9.56) for girls. Ceiling effects were observed in some of the eight subscales but not the two component summary scores. Ordinal logistic regression showed that girls had significantly lower scores than boys in most subscales including physical functioning with odds ratio (95% confidence interval) of 0.89 (0.84-0.93); role physical, 0.94 (0.90-0.98); bodily pain, 0.76 (0.73-0.80); general health, 0.55 (0.53-0.57); vitality, 0.72 (0.69-0.75); role emotional, 0.78 (0.74-0.81); and mental health, 0.91 (0.88-0.95). In general, older and non-local-born adolescents had lower component summary scores than their peers. This study has provided norms and identified demographic differences of the Chinese SF-12v2. [ABSTRACT FROM AUTHOR]

Non-exercise physical activity (NEPA) is an important part of energy expenditure. This study aimed to investigate the prevalence of exercise and NEPA among adolescents. In the HKSOS project 2006-2007, the proportions of Hong Kong Chinese adolescents (N = 32,005) achieving 60-minute exercise and 60-minute NEPA per day were analyzed. Exercise was defined as structured and planned physical activities, and NEPA was defined as unstructured and unplanned physical activities including walking for transportation and climbing stairs. The prevalence of exercise was higher in boys than girls (after school: 63.8% vs 39.6%; holidays: 78.7% vs 60.0%), but the prevalence of NEPA in boys was similar to that in girls (after school: 72.2% vs 68.0%; holidays: 80.3% vs 79.4%). In general, the prevalence of both exercise and NEPA decreased with age in boys and girls, but was more marked for exercise than NEPA. In conclusion, the prevalence of exercise was lower in adolescent girls than boys, and decreased more rapidly with age than NEPA. NEPA seems to be easier to accumulate than exercise among adolescents regardless of sex and age. [ABSTRACT FROM AUTHOR]

Objectives. To examine the percentile distribution of waist-to-stature ratio (WSR) and derive WSR cut-offs for underweight, normal weight, and overweight based on the International Obesity Task Force (IOTF) and local weight-for-height standards in Hong Kong Chinese adolescents. Methods. In the Hong Kong Student Obesity Surveillance project in 2006–2007, height, weight and waist circumference of 13 568 (40.3% boys) Chinese adolescents aged 12–18 were measured. Smoothed percentile distributions of WSR by age and sex were examined using Lambda-Mu-Sigma (LMS) regression. The sex- and age-specific WSR values corresponding to underweight and overweight, as defined by the IOTF and local weight-for-height standards, were determined using receiver operating characteristic curves. Results. The percentile values of WSR were stable across age in both sexes. In general, WSR values of 0.40 and 0.46 corresponded to underweight and overweight, respectively, as defined by both IOTF and local weight-for-height standards. As a reference for normal weight status, the median weight-for-height values corresponded to a WSR value of 0.42 in most sex-age subgroups. Conclusion. Sex and age independent WSR cut-off values for underweight, median weight and overweight in Hong Kong adolescents were identified. WSR is potentially a practical indicator for adolescents to monitor their weight status. [ABSTRACT FROM AUTHOR]

Objective. To examine the effects of perceived availability of fast-food shops, restaurants, and convenience stores on adolescent dietary intakes. Methods. Survey data from 34 369 students in 42 Hong Kong secondary schools were collected in 2006–7. Respondents reported the availability of fast-food shops, restaurants and convenience stores in the neighbourhood, and their intakes of fruit, vegetables, high-fat foods and junk food/soft drinks. For intakes of high-fat foods and junk food/ soft drinks, ≤once a week was defined as low consumption and the rest moderate/high consumption. At least three servings of vegetables and two servings of fruit daily were defined as sufficient consumption. Logistic regression yielded adjusted odds ratios (OR) for each dietary intake in relation to the reported food shops. Potential effect modifications by socio-demographic factors were also examined. Results. Perceived availability of fast-food shops and convenience stores were positively associated with moderate/high consumptions of high-fat foods (ORfast =1.10 and ORcon =1.15) and junk food/soft drinks (ORfast=1.10 and ORcon =1.10). Significant negative associations of the perceived availability of restaurants with intakes of vegetables and fruit were observed (ORveg =0.87 and ORfruit =0.83). The positive relationship between reporting fast-food shops with intake of junk food/soft drinks were observed only in boys and those with low perceived family affluence. The negative association of reporting restaurants with fruit consumption was found in those with low and middle perceived family affluence only. Conclusions. Perceived availability of neighbourhood fast-food shops, restaurants, and convenience stores may have a negative impact on adolescent dietary intakes particularly for those from poorer families. [ABSTRACT FROM AUTHOR]

Background Behavioral theories suggest that a past quit attempt influences psycho-social determinants to predict smokers' intention to quit, although no study has tested the hypothesis among youth smokers. Methods A sample of 1561 Chinese secondary students, who were current smokers, were collected in a cross-sectional school-based survey in Hong Kong. Results For the 943 students with past quit attempts, those with lower daily cigarette consumption; who perceived smoking would not elicit positive social responses from others; who had one parent/teacher who prohibited them to smoke; who were aware of the health hazards of smoking and being male smokers, were more likely to have an intention to quit smoking. For the 618 students without a past quit attempt, those who did not perceive any benefit from smoking; who had parents and teachers to prohibit them to smoke and who received social support to quit, were more likely to have an intention to quit smoking. Conclusion Strengthening the prohibition of smoking and providing social support may help initiate the intention to quit among youth smokers without a past quit attempt, while de-normalizing social images of smoking, providing information about the health hazards of smoking and relieving nicotine addiction may sustain quitting intentions among youth smokers with past quit attempts. [ABSTRACT FROM AUTHOR]

Objective. To examine the independent, competing, and interactive effects of perceived availability of specific types of media in the home and neighborhood sport facilities on adolescents’ leisure-time physical activity (PA). Methods. Survey data from 34 369 students in 42 Hong Kong secondary schools were collected (2006–07). Respondents reported moderate-to-vigorous leisure-time PA, presence of sport facilities in the neighborhood and of media equipment in the home. Being sufficiently physically active was defined as engaging in at least 30 minutes of non-school leisure-time PA on a daily basis. Logistic regression and post-estimation linear combinations of regression coefficients were used to examine the independent and competing effects of sport facilities and media equipment on leisure-time PA. Results. Perceived availability of sport facilities was positively (ORboys = 1.17; ORgirls = 1.26), and that of computer/Internet negatively (ORboys = 0.48; ORgirls = 0.41), associated with being sufficiently active. A significant positive association between video game console and being sufficiently active was found in girls (ORgirls = 1.19) but not in boys. Compared with adolescents without sport facilities and media equipment, those who reported sport facilities only were more likely to be physically active (ORboys = 1.26; ORgirls = 1.34), while those who additionally reported computer/Internet were less likely to be physically active (ORboys = 0.60; ORgirls = 0.54). Conclusions. Perceived availability of sport facilities in the neighborhood may positively impact on adolescents’ level of physical activity. However, having computer/Internet may cancel out the effects of active opportunities in the neighborhood. This suggests that physical activity programs for adolescents need to consider limiting the access to computer-mediated communication as an important intervention component. [ABSTRACT FROM AUTHOR]

Background: The effects of the built environment on walking in seniors have not been studied in an Asian context. To examine these effects, valid and reliable measures are needed. The aim of this study was to develop and validate a questionnaire of perceived neighborhood characteristics related to walking appropriate for Chinese seniors (Neighborhood Environment Walkability Scale for Chinese Seniors, NEWS-CS). It was based on the Neighborhood Environment Walkability Scale - Abbreviated (NEWS-A), a validated measure of perceived built environment developed in the USA for adults. A secondary study aim was to establish the generalizability of the NEWS-A to an Asian high-density urban context and a different age group. Methods: A multidisciplinary panel of experts adapted the original NEWS-A to reflect the built environment of Hong Kong and needs of seniors. The translated instrument was pre-tested on a sample of 50 Chinese-speaking senior residents (65+ years). The final version of the NEWS-CS was interviewer-administered to 484 seniors residing in four selected Hong Kong districts varying in walkability and socio-economic status. Ninety-two participants completed the questionnaire on two separate occasions, 2-3 weeks apart. Test-rest reliability indices were estimated for each item and subscale of the NEWS-CS. Confirmatory factor analysis was used to develop the measurement model of the NEWS-CS and cross-validate that of the NEWS-A. Results: The final version of the NEWS-CS consisted of 14 subscales and four single items (76 items). Test-retest reliability was moderate to good (ICC > 50 or % agreement > 60) except for four items measuring distance to destinations. The originally-proposed measurement models of the NEWS-A and NEWS-CS required 2-3 theoreticallyjustifiable modifications to fit the data well. Conclusions: The NEWS-CS possesses sufficient levels of reliability and factorial validity to be used for measuring perceived neighborhood environment in Chinese seniors. Further work is needed to assess its construct validity and generalizability to other Asian locations. In general, the measurement model of the original NEWS-A was generalizable to this study context, supporting the feasibility of cross-country and age-group comparisons of the effect of the neighborhood environment on walking using the NEWS-A as a tool to measure the perceived built environment. [ABSTRACT FROM AUTHOR]

Background: The family plays a vital role in shaping adolescent behaviours. The present study investigated the associations between family structure and substance use among Hong Kong Chinese adolescents.Methods: A total of 32,961 Form 1 to 5 (grade 7-12 in the US) Hong Kong students participated in the Youth Smoking Survey in 2003-4. An anonymous questionnaire was used to obtain information about family structure, daily duration of parent-child conversation, smoking, alcohol drinking and drug use. Logistic regression was used to calculate the adjusted odds ratios (OR) for each substance use by family structure.Results: Adjusting for sex, age, type of housing, parental smoking and school, adolescents from non-intact families were significantly more likely to be current smokers (OR = 1.62), weekly drinkers (OR = 1.72) and ever drug users (OR = 1.72), with significant linear increases in ORs from maternal, paternal to no-parent families compared with intact families. Furthermore, current smoking (OR = 1.41) and weekly drinking (OR = 1.46) were significantly more common among adolescents from paternal than maternal families. After adjusting for parent-child conversation time, the ORs for non-intact families remained significant compared with intact families, but the paternal-maternal differences were no longer significant.Conclusions: Non-intact families were associated with substance use among Hong Kong Chinese adolescents. The apparently stronger associations with substance use in paternal than maternal families were probably mediated by the poorer communication with the father. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate the relation between health-related physical fitness and weight status in Hong Kong adolescents. Methods: 3,204 students aged 12-18 years participated in the Hong Kong Student Obesity Surveillance (HKSOS) project in 2006-2007. Anthropometric measures (height, weight) and health-related fitness (push-up, sit-up, sit-andreach, 9-minute run) were assessed. Body mass index (BMI) was computed to classify participants into normal weight, underweight (Grade I, II/III), overweight, and obese groups. The associations of health-related physical fitness with BMI and weight status were examined by partial correlation coefficients and analysis of covariance, respectively. Results: More boys than girls were overweight or obese (18.0% vs 8.7%), but more girls than boys were underweight (22.3% vs 16.7%). Boys performed significantly (P < 0.001) better in sit-up (38.8 vs 31.6 times/min) and 9-minute run (1632.1 vs 1353.2 m), but poorer in sit-and-reach (27.4 vs 32.2 cm) than girls. All four physical fitness tests were significantly positively correlated with each other in both sexes, and BMI was only weakly correlated with sit up and sit-and-reach tests in boys. Decreasing performance (P for trend < 0.05) was observed from normal weight to overweight and obese for push-up, sit-up, and 9-minute run in both sexes. From normal weight to Grade I and Grade II/III underweight, decreasing performance (P for trend < 0.05) for sit-up and sit-and-reach in both sexes and for push-up in boys was observed. Conclusions: The relations between BMI and health-related physical fitness in adolescents were non-linear. Overweight/obese and underweight adolescents had poorer performance in push-up and sit-up tests than normal weight adolescents. Different aspects of health-related physical fitness may serve as immediate indicators of potential health risks for underweight and overweight adolescents. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prospective effects of weight perception of self and weight comments by others on psychological health problems among Chinese adolescents. Methods: In the Hong Kong Student Obesity Surveillance project, 8716 adolescents (41.3% boys) aged 14.2 ± 1.7 years were followed prospectively. Logistic regression yielded odds ratios (ORs) for psychological health problems at 1-year follow-up by weight comments received and weight perception at baseline (2006), adjusting for each other sociodemographic factors and body mass index. Results: Perceived fatness at baseline predicted subsequent headache and feeling stressful with adjusted ORs (95% confidence intervals) of 1.17 (1.03–1.33) and 1.20 (1.03–1.39), respectively. Perceived thinness at baseline did not predict any subsequent health problems. Receiving incorrect weight comments at baseline also predicted headache, feeling stressful and feeling depressed at follow-up, with adjusted ORs of 1.19 (1.08–1.31), 1.26 (1.04–1.53) and 1.38 (1.10–1.74) respectively. No gender difference was found in the effects of weight perception and weight comments on psychological outcomes. Conclusions: In adolescents, perceived fatness and incorrect weight comments predicted psychological health problems at 1-year follow-up. Family members, peers and other social contacts should realize the potential adverse effects of their weight comments, and adolescents should be taught how to correctly assess their weight status. [ABSTRACT FROM AUTHOR]

Background: Weight comments are commonly received by adolescents, but the accuracy of the comments and their effects on weight misperception are unclear. We assessed the prevalence and accuracy of weight comments received by Chinese adolescents from different sources and their relation to weight misperception. Methods: In the Hong Kong Student Obesity Surveillance (HKSOS) project 2006-07, 22612 students aged 11-18 (41.5% boys) completed a questionnaire on obesity. Students responded if family members, peers and professionals had seriously commented over the past 30 days that they were "too fat" or "too thin" in two separate questions. The accuracy of the comments was judged against the actual weight status derived from self-reported height and weight. Self-perceived weight status was also reported and any discordance with the actual weight status denoted weight misperception. Logistic regression yielded adjusted odd ratios for weight misperception by the type of weight comments received. Results: One in three students received weight comments, and the mother was the most common source of weight comments. Health professional was the most accurate source of weight comments, yet less than half the comments were correct. Adolescents receiving incorrect comments had increased risk of having weight misperception in all weight status groups. Receiving conflicting comments was positively associated with weight misperception among normal weight adolescents. In contrast, underweight and overweight/obese adolescents receiving correct weight comments were less likely to have weight misperception. Conclusion: Weight comments, mostly incorrect, were commonly received by Chinese adolescents in Hong Kong, and such incorrect comments were associated with weight misperception. [ABSTRACT FROM AUTHOR]

Background: In observational studies moderate alcohol use reduces cardio-respiratory mortality. However observational studies may be biased by many factors including residual confounding by unmeasured differences between moderate alcohol users and other groups or by changes in alcohol use with ill-health and aging. We used two different analytic strategies in an under-studied population, i.e. southern Chinese, to provide an assessment of the specific impact of moderate alcohol use on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary diseases (COPD). Methods: In a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998, we used adjusted logistic regression to compare alcohol use in decedents aged ≥ 60 years from IHD (2270) and COPD (1441) with 10,320 living and 9043 dead controls (all non-alcohol related deaths). We also examined whether the association of alcohol use with death from IHD or COPD varied with sex or smoking status. Results: Using living controls and adjusted for age, socio-economic status and lifestyle, occasional and moderate alcohol use were generally associated with lower mortality from IHD and COPD. However, using dead controls the protection of occasional and moderate alcohol use appeared to be limited to ever-smokers for IHD (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.46 to 0.73 for moderate compared to never-use in ever-smokers, but OR 1.07, 95% CI 0.76 to 1.50 in never-smokers), and possibly to men for COPD. High alcohol use was associated with lower IHD mortality and possibly with lower COPD mortality. Conclusion: High levels of alcohol use in an older Chinese population were associated with lower IHD mortality. Moderate alcohol use was less consistently protective against IHD mortality. Alcohol use was associated with lower COPD mortality particularly in men, either due to some yet to be clarified properties of alcohol or as the artefactual result of genetic selection into alcohol use in a Chinese population. Given the increasing use of alcohol in China with economic development, other designs and analytic strategies are needed to assess the impact of alcohol in this population, so that an evidence-based public health policy can be formulated. [ABSTRACT FROM AUTHOR]

Background: Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong. Methodology: We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong. Principal Findings: After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socioeconomic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)]. Conclusions: Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations. [ABSTRACT FROM AUTHOR]

Background: Little is known about the effect of physical exercise on influenza-associated mortality. Methods and Findings: We collected information about exercise habits and other lifestyles, and socioeconomic and demographic status, the underlying cause of death of 24,656 adults (21%aged 30-64, 79% aged 65 or above) who died in 1998 in Hong Kong, and the weekly proportion of specimens positive for influenza A (H3N1 and H1N1) and B isolations during the same period. We assessed the excess risks (ER) of influenza-associated mortality due to all-natural causes, cardiovascular diseases, or respiratory disease among different levels of exercise: never/seldom (less than once per month), low/moderate (once per month to three times per week), and frequent (four times or more per week) by Poisson regression. We also assessed the differences in ER between exercise groups by case-only logistic regression. For all the mortality outcomes under study in relation to each 10% increase in weekly proportion of specimens positive for influenza A+B, never/seldom exercise (as reference) was associated with 5.8% to 8.5% excess risks (ER) of mortality (P<0.0001), while low/moderate exercise was associated with ER which were 4.2% to 6.4% lower than those of the reference (P<0.001 for all-natural causes; P = 0.001 for cardiovascular; and P = 0.07 for respiratory mortality). Frequent exercise was not different from the reference (change in ER 20.8% to 1.7%, P =0.30 to 0.73). Conclusion: When compared with never or seldom exercise, exercising at low to moderate frequency is beneficial with lower influenza-associated mortality. [ABSTRACT FROM AUTHOR]

Background: The male excess risk of premature ischemic heart disease (IHD) mortality may be partially due to an unknown macro-environmental influence associated with economic development. We examined whether excess male risk of IHD mortality was higher with birth in an economically developed environment. Methods: We used multivariable logistic regression in a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998 to compare sex differences in IHD mortality (1,189 deaths in men, 1,035 deaths in women and 20,842 controls) between Hong Kong residents born in economically developed Hong Kong or in contemporaneously undeveloped Guangdong province in China. Results: Younger (35-64 years) native-born Hong Kong men had a higher risk of IHD death than such women (odds ratio 2.91, 95% confidence interval 1.66 to 5.13), adjusted for age, socioeconomic status and lifestyle. There was no such sex difference in Hong Kong residents who had migrated from Guangdong. There were no sex differences in pneumonia deaths by birth place. Conclusion: Most of these people migrated as young adults; we speculate that environmentally mediated differences in pubertal maturation (when the male disadvantage in lipids and fat patterning emerges) may contribute to excess male premature IHD mortality in developed environments [ABSTRACT FROM AUTHOR]

Objective: We examined the psychometric properties of the Eating Disorder Diagnostic Scale (EDDS) in a community sample of Hong Kong school children. Method: Participants (359 boys and 387 girls), aged 12 to 19 years, were assessed on the EDDS on two occasions, one month apart. Factor structure, internal consistency, test-retest reliability, and validity against the Eating Disorders Examination–Questionnaire (EDE-Q) and Center for Epidemiological Studies-Depression (CES-D) were investigated. Results: Four groupings emerged on exploratory factor analysis: body dissatisfaction, bingeing behaviors, bingeing frequency, and frequency of compensatory behaviors. Items loaded on the same factors for boys and girls. Internal consistency for these factors was acceptable. Test-retest reliability was high for body dissatisfaction factor but weak to moderate for other factors and for diagnoses. High concurrent validity with the EDE-Q, and correlation with the CES-D was shown. Conclusion: We offer preliminary reliability and validity evidence to support the further development of the EDDS as a screening instrument to assess eating disturbances in Hong Kong youth. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Although the harms of smoking are well established, it is unclear how they extend into old age in the Chinese. Aim: To examine the relationship of smoking with all-cause and major cause-specific mortality in elderly Chinese men and women, respectively, in Hong Kong. Methods: Mortality by smoking status was examined in a prospective cohort study of 56 167 (18 749 men, 37 416 women) Chinese aged ≥ 65 years enrolled from 1998 to 2000 at all the 18 elderly health centres of the Hong Kong Government Department of Health. Results: After a mean follow-up of 4.1 years, 1848 male and 2035 female deaths occurred among 54 214 subjects (96.5% successful follow-up). At baseline, more men than women were current smokers (20.3% vs 4.0%) and former smokers (40.8% vs 7.9%). The adjusted RRs (95% CI) for all-cause mortality in former and current smokers, compared with never smokers, were 1.39 (1.23 to 1.56) and 1.75 (1.53 to 2.00) in men and 1.43 (1.25 to 1.64) and 1.38 (1.14 to 1.68) in women, respectively. For current smokers, the RRs (95% CI) for all-cause mortality were 1.59 (1.39 to 1.82), 1.72 (1.48 to 2.00) and 1.84 (1.43 to 2.35) for daily consumption of 1-9, 10-20 and > 21 cigarettes, respectively (p for trend < 0.001 ). RRs (95% CI) were 1.49 (1.30 to 1.72) and 2.20 (1.88 to 2.57) in former and current smokers for all deaths from cancer, and 1.24 (1.04 to 1.47) and 1.57 (1.28 to 1.94) for all cardiovascular deaths, respectively. Quitters had significantly lower risks of death than current smokers from all causes, lung cancer, all cancers, stroke and all cardiovascular diseases. Conclusions: In old age, smoking continues to be a major cause of death, and quitting is beneficial. Smoking cessation is urgently needed in rapidly ageing populations in the East. [ABSTRACT FROM AUTHOR]

Objectives The main objectives were to examine the relation between age-comparative (self vs others of same age) self-rated health (SRH) and time-comparative (self this year vs last year) SRH, and to evaluate which was more strongly associated with specific physical health problems. Methods Cross-sectional data on two SRH measures and various physical health problems from 18749 male and 37413 female clients aged 65 or over from 18 Elderly Health Centres in Hong Kong were analysed using logistic regression with adjustment for potential confounders. Results Men were more likely to report ‘better’ and less likely to report ‘worse’ SRH than women. ‘Normal’ was the most common option but the proportions choosing this decreased with age on both SRH measures. There was a fairly weak but statistically significant correlation between these two measures, with Kappa coefficients of 0.125 and 0.167 for men and women, respectively. For both men and women, there were significantly positive linear trends between age-comparative SRH options from ‘better’ to ‘worse’ and physical health problems, such as respiratory diseases, musculoskeletal diseases, any active chronic diseases, functional disability, depressive symptoms, taking medication regularly, and admission to hospital last year. However, for time-comparative SRH, those who rated ‘normal’ had the smallest odds ratios in all of the physical health problems above than those who rated ‘better’ or ‘worse’. Conclusions The two SRH measures correlated with each other weakly but significantly. Age-comparative SRH was linearly, and time-comparative SRH was curvilinearly associated with physical health problems. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article examines the relationship between obesity and mortality in a prospective cohort population of older people in China. The effect of body mass index on mortality varied with baseline health status. Furthermore, understanding the role of obesity and inactivity in older adults is urgent in the country. Findings suggest that for persons in poor health, physical activity is not associated with lower mortality.