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In this study we examined the phenomena of smartphone addiction, online harassment, and school bullying/victimization to predict the prospective influence these could have on the onset and persistence of sleep problems and depression among children.Responses from 2155 fifth-grade children recruited from 30 primary schools in Taipei were assessed, and a follow-up was performed in the 6th grade. Self-administered questionnaires were collected for each year.Children who reported smartphone addictions, online harassment, and school bullying/victimization coupled with an increase in those factors were more likely to experience the onset and persistence of sleep problems. In addition, children who reported smartphone addiction, online harassment, school bullying/victimization, and poor sleep quality were more likely to experience the onset and persistence of depression.School nurses or pediatric nurses should be able to assess children's Internet use and risks to understand potential influences on sleep quality and mental status and provide recommendations for children, parents and schools.

This study assessed the discrepancies between reports from parents and children concerning children's exposure to violence/pornography on mobile devices and the impact on the psychosocial adjustment of children. Data were obtained from a sample of 2,230 parent-child dyads recruited from 16 elementary schools (1,140 dyads) in Taiwan and 9 schools (1,090 dyads) in China. A self-administered questionnaire was used. The results showed that about 30 percent of children reported being exposed to violence on mobile devices. Approximately 70 percent of their parents were unaware of their child's exposure to violence on mobile devices. About 16 percent of children reported exposure to pornography on mobile devices, and 80 percent of their parents were unaware of this exposure. Multinomial logistic regression results showed that after controlling for parent and child sociodemographic variables, factors related to parental unawareness of child exposure to violence on mobile devices included a child's ownership of mobile devices, smartphone/tablet use time, a lower level of parental understanding, and a residence in China or in a rural area, whereas the parent-child relationship and a child's smartphone/tablet use time were associated with parents who were unaware of their child's exposure to pornography. Multiple regression results showed that children who were living with household poverty, had a poor parent-child relationship, spent much time using a smartphone/tablet, and with parents who were unaware of their exposure to violence/pornography on mobile devices were more likely to have emotional and behavioral problems.

Objective:The objective of this study was to examine the relationships between students’ perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.Design:Cross-sectional study.Setting:Primary, middle and high schools in Taiwan.Participants:A nationally representative sample of 2433 primary school (5th–6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.Results:Multivariate analysis results showed that after controlling for school level, gender and age, the students’ perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools’ campaigns promoting the eating of vegetables and fruit were positively associated with students’ consumption of vegetables. In addition, schools’ initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students’ engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.Conclusions:Students’ perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

This study examined the relationships between children’s mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems.

In this digital era, young children spend a considerable amount of time looking at telephone, tablet, computer and television screens. However, preventative eye health behavior education could help avoid and relieve asthenopia. The effects of parental influence on their children’s eye health behavior through the preschool eye health education intervention program were examined. The Health Belief Model was used to develop parental involvement strategy and eye health curriculum. The study was conducted in a large public preschool with five branches in Beijing, China. A total of 248 parent–child pairs participated in the baseline and follow-up surveys, of which 129 were in the intervention group and 119 were in the comparison group. The generalized estimating equation analysis results indicated that parental involvement in preschool-based eye health intervention on screen uses had positive influence on parents’ eye health knowledge, cues to action, and parenting efficacy. The intervention program also had positive effects on the increasing level of children’s eye health knowledge, beliefs, cues to action, self-efficacy, and behaviors. The results supported the implementation of a preschool-based eye health intervention program with parental involvement, which could potentially enhance children’s and parents’ eye health beliefs and practices.

This study assessed the prevalence of the inappropriate use of over-the-counter (OTC) cold medicine among adolescents and examined the relationships between knowledge, literacy, and the inappropria...

Objective This study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine. Method A probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th–6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey. Results Overall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids. Conclusions Lower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.

This study assessed the prevalence of smartphone addiction among children in Taiwan and examined the related factors. A total of 2621 fifth-grade students and 2468 parents from 30 primary schools in Taipei, Taiwan completed self-administered questionnaires in 2016. The results showed that fifth-grade students spent 11 h per week using either smartphones or tablets. The prevalence of smartphone addiction among fifth-grade students was 15.2%. Multivariate analysis results showed that parents who had high levels of risk perception and mediation efficacy were more likely to implement restrictive mediation of their children's use of the Internet and mobile devices. In addition, multivariate analysis results showed that children who had poor academic performance, depression, owned smartphones, frequently played smartphone/tablet gaming, and regularly used SNSs and instant messaging, had low levels of parental restrictive mediation, and had lower levels of self-reported Internet safety literacy were more likely to experience smartphone addiction.

In this study, we examined excessive online gaming by adolescents and the resultant effects of their exposure to the online marketing of energy drinks and alcohol, and whether marketing literacy could serve as a mitigating factor. This cross-sectional study was conducted in 2020. Data were obtained from a sample of 2613 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted. The results showed that nearly 18% of the adolescent respondents had used energy drinks, while 75% reported seeing energy-drink advertisements on the internet in the past year. Multiple regression results indicated that factors such as being male, reporting excessive gaming, being exposed to higher levels of online energy-drink marketing, and reporting alcohol use were positively associated with energy-drink consumption. A higher level of online energy-drink marketing-affective literacy, however, was negatively associated with energy-drink consumption. In conclusion, factors that predicted energy-drink consumption among adolescents included excessive gaming and exposure to online energy-drink marketing, but marketing-affective literacy tended to lessen the impact of such advertising.

This study assessed aggression statuses and transitions among children and examined the effects that gender and exposure to online violence can exert on aggression. A sample of 2155 children recruited from 30 primary schools in Taipei, Taiwan completed surveys in both 2015 (5th grade) and 2016 (6th grade). Latent transition analysis (LTA) was performed, and the results identified three latent statuses of aggression: "None," "School aggression," and "Cyber-aggression." About 10% of children behaved aggressively. When in their 5th-grade year, boys were more likely than girls to be a school aggressor (6.48% vs. 4.04%) or a cyber-aggressor (2.37% vs. 1.64%). Among boys who originally were considered to be a school aggressor, 36.19% remained so, 58% renounced their school aggression status, and 5.81% became a cyber-aggressor. Among girls who originally were considered to be a cyber-aggressor, 22.23% remained so, 68.29% renounced their cyber-aggression status, and 9.48% became a school aggressor. Controlling for student's academic performance, household income, and parents' marital status, exposure to online violence was a statistically significant predictor of aggression status for both boys and girls. Children's exposure to online violence appeared to increase the risk of aggression.

Objective: This study assessed school principals’ understanding, attitudes and willingness to influence the implementation of the health-promoting schools (HPS) programme in Taiwan and teachers’ willingness to sustain it. Method: In 2014, a total of 1,140 school principals and 1,110 teachers (HPS coordinators) completed questionnaires concerning their perspectives on implementation and sustainability. Results: Compared with teachers, school principals reported higher levels of willingness to sustain HPS implementation. School principals’ levels of understanding of HPS and willingness to sustain it were significantly associated with higher levels of HPS implementation and an increase in teachers’ willingness to sustain HPS implementation. Conclusion: School principals’ understanding and willingness to support are central to the effective implementation and sustainability of initiatives such as HPS.

Objective: Adolescents in Taiwan generally have a low level of knowledge concerning medications. This study evaluates a school–pharmacist partnership in Taiwan and describes the impact this associa...

Objectives Work is often a barrier for women to continue breastfeeding after they have given birth. Breastfeeding support is an important part of workplace health promotion. We investigated the implementation of breastfeeding promotion and gender equality polices in workplaces with the Taiwan Badge of Accredited Healthy Workplace. Methods Our samples consisted of 1648 corporations with the badge of Accredited Healthy Workplace issued by the Bureau of Health Promotion from 2007 to 2008. Concomitantly, 2000 corporations without accreditation were randomly selected from the National Business Directory as the control group. Data were collected from self‐administered questionnaires. Logistic regression was used to examine the association with breast‐feeding promotion and other variables in Taiwanese workplaces. Results Members of accredited group of 1089/1648 (66.1%) and the control group of 526/2000 (26.3%) responded to the questionnaire. The accredited companies had more mother‐friendly settings, including breastfeeding policies and documents, appropriate breastmilk preserving equipment and settings in the workplace. In the accredited group, breastfeeding rate of mothers returning to work after giving birth was 64.3% in 2008 (1 year after giving birth) and 60.4% in 2009 (1 year after giving birth), while the rate of the control group was 59.1% in 2008 and 51% in 2009. Conclusion Accredited corporations are better at breastfeeding support than those of the control group. This might be related to the company size, location, and the implementation of tobacco control and/or occupational health promotion policies, which may increase awareness of healthy workplaces and influence maternal protection positively.

Purpose. To examine the effects of a smoking cessation campaign. Design. Data from the 2010–2011 Taiwan Adult Tobacco Surveys were analyzed. Setting. The study was set among a nationally representative sample of adults in Taiwan. Subjects. The surveys included 16,282 and 16,886 adults in 2010 and 2011, respectively, while our analyses focused on current smokers, 2518 and 2507 adults in 2010 and 2011, respectively. Intervention. In 2010 the Taiwanese government launched a national smoking cessation campaign through mass media in conjunction with community-based smoking cessation programs throughout the nation. Measures. Outcome variables include awareness of cessation services, quit attempts, intention to quit, and use of quitting method. Analysis. Multivariate logistic regressions were used to analyze data. Results. The implementation of the national smoking cessation campaign was associated with an increase in awareness of cessation services (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.20–1.53), in quit attempts (OR = 1.12; 95% CI = 1.01–1.25), in use of unassisted quitting methods (OR = 1.39; 95% CI = 1.13–1.72), and in intention to quit smoking (OR = 1.15; 95% CI = 1.02–1.30). Conclusion. The implementation of the national smoking cessation campaign through media and community programs was effective in increasing smokers’ awareness of cessation services, quit attempts, and intention to quit.

With the development of electronic technology and forms of communication such as the Internet, it has become increasing difficult for parents to identify and mitigate the new risks to which their adolescent children are exposed. In this article, we compare the ways parents and adolescents living in urban areas use the Internet with those of their counterparts who live in rural areas. We based this comparison on data obtained from a survey of Internet use in Taiwan in 2013. The survey included 1079 junior high school students and 688 parents who lived in urban areas and 838 students and 729 parents who lived in rural areas. We found that parents living in rural areas had lower levels of Internet skills and intervened less in their children’s use of the Internet when compared with parents living in urban areas. We also found that, compared with their urban counterparts, adolescents who live in rural areas have lower levels of Internet literacy but a higher frequency of Internet use and they also engage in r...

Objective To evaluate the effectiveness of the health promoting school (HPS)–community pharmacist partnership program that promotes students’ correct medication use and enhances pain medication literacy in Taiwan. Design Pre- and post-studies and intervention/comparison group comparisons. Setting Primary and middle schools, along with their communities, in Taiwan. Participants In 2013, baseline and follow-up self-administered, online surveys were received from 5,373 students enrolled in intervention primary and middle schools and from 4,643 students enrolled in comparison primary and middle schools. Main outcome measure The level of medication literacy, including correct medication use knowledge, self-efficacy, and skills. Results The development and implementation of the HPS–community pharmacist partnership program in primary and middle schools significantly enhanced students’ knowledge, self-efficacy, and skills in correct medication use and pain medication literacy ( P Conclusion The HPS–community pharmacist partnership had a positive impact on enhancing correct medication use and pain medication literacy in Taiwan.

BACKGROUND: Taiwan has advocated health-promoting schools (HPS) since 2001 and established the Health-Promoting School Supporting Network (HPSSN) in 2005 to offer administrative support and consultation. Respondents' opinions about HPSSN and the relationship between these perceptions and HPS implementation were examined. METHODS: In 2011, 800 primary and middle schools were selected through stratified random sampling. School staff members (N = 656) in charge of HPS programs reported their impressions of the HPSSN's support. RESULTS: Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components. CONCLUSIONS: HPSSN positively influenced HPS implementation; however, consultant/school partnerships and school resource allocations must be improved. Language: en

Objective This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying, substance use, and depression among adolescents. Method The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013. Results Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression. Conclusion Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive mediation was associated with reductions in adolescent Internet addiction and cyberbullying.

The present study examined factors associated with the emergence and cessation of youth cyberbullying and victimization in Taiwan. A total of 2,315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade. Self-administered questionnaires were collected in 2010 and 2011. Multiple logistic regression was conducted to examine the factors. Multivariate analysis results indicated that higher levels of risk factors (online game use, exposure to violence in media, internet risk behaviors, cyber/school bullying experiences) in the 10th grade coupled with an increase in risk factors from grades 10 to 11 could be used to predict the emergence of cyberbullying perpetration/victimization. In contrast, lower levels of risk factors in the 10th grade and higher levels of protective factors coupled with a decrease in risk factors predicted the cessation of cyberbullying perpetration/victimization. Online game use, exposure to violence in media, Internet risk behaviors, and cyber/school bullying experiences can be used to predict the emergence and cessation of youth cyberbullying perpetration and victimization.

This study examined the effects of a school-based drug use prevention programme for middle-school students in Taiwan. The curriculum consisted of 10 lessons and 4 homework assignments involving parent-child activities. A quasi-experimental design was used. The study was conducted in an urban middle-school located in Taipei city and in a middle-school located in a rural area in Taoyuan county. A total of 327 middle-school students in the intervention group and 314 students in the comparison group successfully participated in the baseline (September 2011) and follow-up surveys (November 2011). A mixed-model approach was used to examine the effects. Multivariate analysis results indicated that the school-based drug-prevention programme increased the students' drug-related knowledge, drug-prevention attitudes, enhanced life skills, and improved perceived parental involvement in the prevention of drug use. The results of this study endorse the implementation of school-based drug use prevention programmes that include parent-child activities to enhance youth drug-prevention knowledge, attitudes, and life skills. Language: en

This study was an evaluation of the Health Promoting School (HPS) program in Taiwan and its effectiveness in enhancing students' knowledge and abilities with regard to correct medication usage. In 2011, baseline and follow-up self-administered online surveys were received from 3520 middle-school and primary students from intervention schools, and 3738 students from comparison primary and secondary schools completed the same survey. The results indicated that after implementing the correct medication use HPS program, students' knowledge and abilities concerning correct medication usage (i.e., the need to express clearly personal conditions to physicians, to check information on the medication packages, to take medication correctly and adhere to prescribed medication regimens, not to buy or acquire medication from unlicensed sources, and to consult pharmacists/physicians) were significantly increased among the students in the intervention schools (p

Background Youth consumption of alcohol is a major public health problem in Taiwan, yet little research has been conducted to examine the potential influence of exposure to alcohol advertising. The present study examined the prospective influence that exposure to alcohol advertising has on the initiation and persistence of youthful drinking in Taiwan. Methods A total of 2315 students from 26 high schools in Taipei, Taiwan were assessed in the 10th grade with follow-up conducted in the 11th grade. Self-administered questionnaires were collected in 2010 and 2011 to assess the patterns of change in youth alcohol drinking behaviors, media exposure to alcohol, and risk and protective factors. Results Of the 1712 non-drinking students in the 10th grade, 285 (16.6%) had initiated drinking by the 11th grade. Of the 590 drinkers in the 10th grade, 396 (67.1%) were persistently drinking by the 11th grade. Multivariate analysis results indicated that when other potential confounders were accounted for, greater media exposure to alcohol advertising in the 10th grade was found to be significantly associated with the initiation of alcohol use and when combined with an increase in media exposure from grades 10 to 11, this was significantly associated with the persistence of alcohol use. Conclusion Exposure to alcohol advertising in the media was associated with both the initiation and the persistence of alcohol use by youth.

ObjectivesThis study assessed the incidence of transitions in smartphone addiction proneness (SAP) among children and examined the effects of gender, use patterns (social networking sites (SNSs) use and smartphone gaming) and depression on smartphone addiction transitions.MethodsA representative sample of 2,155 children from Taipei completed longitudinal surveys in both 2015 (5th grade) and 2016 (6th grade). Latent transition analysis (LTA) was used to characterize transitions in SAP and to examine the effects of gender, use patterns and depression on SAP transitions.ResultsLTA identified four latent statuses of SAP: about half of the children were in non-SAP status, one-fifth were in tolerance status, one-sixth were in withdrawal status, and one-seventh were in high-SAP status. Both boys and girls had a higher prevalence of high-SAP and tolerance in 6th grade than in 5th grade, whereas in both grades boys had a higher prevalence of high-SAP and withdrawal, and girls had a higher prevalence of non-SAP and tolerance. Controlling for parents' education, family structure, and household income, higher use of SNSs by children, increasing use of mobile gaming and higher levels of depression were individually associated with increased odds of being in one of the three SAP statuses other than non-SAP. When all three covariates were jointly entered into the model, usage of SNSs and depression remained significant predictors.ConclusionBoth boys and girls tended to transition to tolerance or high-SAP statuses, while children's depression and their usage of SNSs increased the risk of smartphone addiction.

The present study examined the relationships among parental beliefs about efficacy in the prevention of adolescent substance use, parenting practices, adolescent competence skills, and substance use. Data were obtained from a sample of 2015 parent-adolescent dyads recruited from 30 junior high schools in Taipei City and Taouyun County, Taiwan, 2010. Adolescent and parent self-administered questionnaires were collected. Multivariate analysis results showed that male adolescents from low SES families were more likely to use tobacco/alcohol, while adolescents with higher efficacy parents and with higher levels of competence skills were less likely to use tobacco/alcohol. In conclusion, parental efficacy plays a crucial role in enhancing parenting practices, promoting adolescents’ competence skills, and decreasing adolescent substance use.

Author(s): Chang, FC; Sung, HY; Zhu, SH; Chiou, ST | Abstract: Aims: In January 2009, the government of Taiwan amended the 1997 Tobacco Hazards Prevention Act by extending smoke-free areas to include almost all enclosed work-places and public places, adding graphic health warnings to cigarette packages, totally banning tobacco advertisements, promotion and sponsorship and increasing tobacco taxes. This study examined the impact of the 2009 amended Act on smoking cessation in Taiwan. Design: Taiwan Adult Tobacco Surveys 2007 and 2010, each with a nationally representative sample of adults aged 18 years and older (n=16588, and n=16295, respectively). Participants: All recent active smokers (current smokers plus former smokers who quit smoking within the past 12 months) were used for the analyses (n=3783 in 2007, and n=2777 in 2010). Measurements: Quit attempt rate and annual cessation rate (defined as having succeeded in quitting for at least 3 months) among recent active smokers were compared between the pre-Act (2007) and post-Act (2010) periods. Findings: The quit attempt rate increased significantly from 39.4% in 2007 to 42.9% in 2010. The annual cessation rate increased significantly from 7.1 to 8.9%. A multivariate analysis, controlling for demographic characteristics, showed that the implementation of the 2009 Act was associated with an increase in the quit attempt rate [odds ratio (OR)=1.14; 95% confidence interval (CI)=1.03-1.25] and the annual cessation rate (OR=1.28; 95% CI=1.08-1.53). Conclusions: The comprehensive tobacco control programme introduced in 2009 in Taiwan, which combined smoke-free legislation with a tobacco tax increase, graphic health warning labels and a total ban on tobacco advertisements, was associated with increases in quit attempt rate and annual cessation rate. © 2013 Society for the Study of Addiction.

Objective The present study examined the relationships between thin-ideal media exposure, body dissatisfaction, and disordered eating behaviors among adolescents in Taiwan. Method A total of 2992 students in the 10th grade were recruited from 26 high schools in Taipei, Taiwan to complete a questionnaire in 2010. Results The results showed that the adolescents were exposed to thin-ideal messages a few times a week. Females had higher levels of thin-ideal media exposure, media pressure to be thin, thin-ideal internalization, body dissatisfaction, and disordered eating behaviors than males. Multivariate logistic regression results indicated that media pressure and thin-deal internalization significantly increased the likelihood of body dissatisfaction, while media pressure and body dissatisfaction contributed to both restrained eating and unhealthy weight control behaviors, when all other variables were controlled for.

This study assessed the discrepancies between reports from parents and adolescents concerning family relationships and the use of tobacco and alcohol by adolescents. Data were obtained from a sample of 2015 parent–adolescent dyads recruited from 30 junior high schools in Taipei City and Taouyun County, Taiwan, in 2010. The results indicated that more than 90% of parent–adolescent dyads agreed to no tobacco/alcohol use by adolescents. More than half (38 parents; 68%) of responding parents were unaware of the tobacco use that was reported by 56 adolescents in this study. A high percentage (133 parents; 93.7%) of the responding parents were unaware of the alcohol use reported by 142 adolescents in this study. Parents reported higher levels of parent–adolescent attachment, communication, monitoring and teaching than was reported by their adolescent children. Multivariate logistic regression results showed that lower ratings by adolescents on questions of family attachment, poor academic performance and delinq...

The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.

Objective: This study assesses the effects of a 2005 increase in funding for smoking cessation services on provider participation, patient utilisation of smoking cessation services and cessation outcome at a six-month follow-up. Methods: Analyses are based on existing databases and on a follow-up study among smokers participating in the smoking cessation service. The effect of the policy is evaluated by comparing year 2004 (old policy) with year 2005 (new policy). The generalised estimating equations (GEE) method was conducted to examine the effects of increasing funding for smoking cessation services on monthly smoking cessation services provided per physician and yearly consultations received per patient. Logistic regression was used to examine the effects of increasing funding on smoking cessation outcome. Results: The study found the increased reimbursement rates and medication subsidies for smoking cessation to be positively related to the number of physicians enrolling in the programme (1841 in 2004 vs 3466 in 2005), the number of cessation consultations per month per physician (5.1 vs 14.6) and the number of cessation visits per year per patient (2.0 vs 2.5). Male providers and providers belonging to the private sector were found to offer more cessation consultations. The number of subjects receiving this counselling increased from 22 167 in 2004 to 109 508 in 2005. After adjusting for consumer and provider factors the likelihood of successful quitting among those counselled did not change. Overall, smokers who were older, had attempted to quit in the past year, had lower nicotine dependence, had gone to more smoking cessation service visits, had received consultations in the public sector and were seen by physicians delivering fewer consultations were more likely to have quit smoking at the six-month follow-up. Conclusions: Based on increases in physician enrolment and consultations and the increase in number of subjects receiving counselling and number of visits, the policy of increasing provider incentives and medication subsidies appears to have successfully promoted smoking cessation services.

This study examined the relationship between parental and adolescent eHealth literacy and its impact on online health information seeking. Data were obtained from 1,869 junior high school students and 1,365 parents in Taiwan in 2013. Multivariate analysis results showed that higher levels of parental Internet skill and eHealth literacy were associated with an increase in parental online health information seeking. Parental eHealth literacy, parental active use Internet mediation, adolescent Internet literacy, and health information literacy were all related to adolescent eHealth literacy. Similarly, adolescent Internet/health information literacy, eHealth literacy, and parental active use Internet mediation, and parental online health information seeking were associated with an increase in adolescent online health information seeking. The incorporation of eHealth literacy courses into parenting programs and school education curricula is crucial to promote the eHealth literacy of parents and adolescents.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Aims This 3-year longitudinal study examined changes in patterns of risk factors and protective factors of smoking initiation and cessation among vocational high school students in Taipei, Taiwan. Design and setting In 2000, a total of 2151 10th grade students from 16 vocational high schools were assessed and followed up in the 11th and 12th grades. Self-administered questionnaires were collected in each year to assess the pattern of changes in smoking behaviors, and risk and protective factors. Findings Of the 1654 non-smokers in the 10th grade, 227 students initiated smoking by the 12th grade. Higher risk factors such as peer smoking, peers offering cigarettes, alcohol use and lower protective factors, such as refusal self-efficacy, antismoking attitude and belief in the 10th grade predicted youth initiation by grade 12. Increases in risk factors and decreases in protective factors during the years from 10th to 12th grades were associated significantly with youth smoking initiation. Of the 494 smokers in the 10th grade, 76 students quit smoking by the 12th grade. Lower risk factors and higher protective factors in 10th grade smokers predict youth smoking cessation by grade 12. Decreases in risk factors and increases in protective factors were associated significantly with youth smoking cessation. Conclusions The risk factors (i.e. social influences) and protective factors (i.e. self-efficacy) examined in this study predict both youth smoking initiation and youth smoking cessation.

This study examined factors associated with the unwanted exposure to online pornography and unwanted online sexual solicitation victimization and perpetration of youth in Taiwan. A total of 2315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade. Self-administered questionnaires were collected. Multivariate analysis results indicated that higher levels of online game use, pornography media exposure, Internet risk behaviors, depression, and cyberbullying experiences predicted online sexual solicitation victimization, while higher levels of Internet chat room use, pornography media exposure, Internet risk behaviors, cyberbullying experiences, and offline sexual harassment predicted online sexual solicitation perpetration.

This study examined the relationship of media exposure and media literacy to alcohol and tobacco use among adolescents in Taiwan. A total of 2992 10th-grade students recruited from 26 high schools in Taipei, Taiwan, completed a questionnaire in 2010. The multivariable analysis results indicated that the students with higher alcohol and tobacco media exposure were more likely to use alcohol and tobacco and have intentions to drink and smoke, while students with higher media literacy were less likely to use alcohol and have intentions to drink and smoke.

Purpose The present study examined the psychosocial factors associated with the initiation and persistence of Internet addiction among adolescents in Taiwan. Methods A total of 2315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade, in Taipei, Taiwan. Self-administered questionnaires were collected in each year to assess the pattern of changes in Internet addiction and psychosocial factors. Results Of the 1602 students without an Internet addiction in the 10th grade, 253 (15.8%) had initiated Internet addiction by grade 11. Multivariate analysis results indicated that greater engagement in online activities (i.e., social network website use, online gaming), depression, and lower school bonding in grade 10 coupled with an increase in online activities, depression, and smoking from grades 10 to 11 predicted the initiation of Internet addiction. Of the 605 students with Internet addiction in the 10th grade, the addiction had persisted for 383 students (63.3%) in grade 11. An increase in the existence of depression and alcohol use from grades 10 to 11 predicted the persistence of Internet addiction. Conclusions Online activities, depression, and substance use were important predictors of youth initiation and of the persistence of Internet addiction.

In January 2009, the government of Taiwan amended the 1997 Tobacco Hazards Prevention Act by extending smoke-free areas to include almost all enclosed work-places and public places, adding graphic health warnings to cigarette packages, totally banning tobacco advertisements, promotion and sponsorship and increasing tobacco taxes. This study examined the impact of the 2009 amended Act on smoking cessation in Taiwan.Taiwan Adult Tobacco Surveys 2007 and 2010, each with a nationally representative sample of adults aged 18 years and older (n = 16 588, and n = 16 295, respectively).All recent active smokers (current smokers plus former smokers who quit smoking within the past 12 months) were used for the analyses (n = 3783 in 2007, and n = 2777 in 2010).Quit attempt rate and annual cessation rate (defined as having succeeded in quitting for at least 3 months) among recent active smokers were compared between the pre-Act (2007) and post-Act (2010) periods.The quit attempt rate increased significantly from 39.4% in 2007 to 42.9% in 2010. The annual cessation rate increased significantly from 7.1 to 8.9%. A multivariate analysis, controlling for demographic characteristics, showed that the implementation of the 2009 Act was associated with an increase in the quit attempt rate [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.03-1.25] and the annual cessation rate (OR = 1.28; 95% CI = 1.08-1.53).The comprehensive tobacco control programme introduced in 2009 in Taiwan, which combined smoke-free legislation with a tobacco tax increase, graphic health warning labels and a total ban on tobacco advertisements, was associated with increases in quit attempt rate and annual cessation rate.

Hsueh-Yun Chi , Fong-Ching Chang , Hsueh-Ju Lin , Li-Jung Huang , Jung-Chen Chang , Ming-Kung Yeh , Jaw-Jou Kang g a Department of Health Developing and Marketing, Kainan University, Taoyuan, Taiwan, ROC b Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC c Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan, ROC d Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan, ROC e Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC f Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan, ROC g Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC

Taiwan launched its evidence-based health-promoting school (HPS) program via an action-research approach in 2010. The program featured a collaborative partnership between schools, local education authorities and university support networks. This study was focused on examining whether an HPS action-research approach was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011, questionnaires were sent to 900 sample schools in Taiwan. A total of 621 schools returned the questionnaire, including 488 primary schools and 133 middle schools. The response rate was 69%. This study compared the difference in HPS implementation status, perceived HPS impact and perceived HPS efficacy between those schools that had implemented action-research HPS (138 schools) and those that had not (483 schools). The univariate analysis results indicated that the HPS implementation levels for components that included school health policies, physical environment, social environment, teaching activities and school-community relations were significantly higher in action-research schools than in non-action-research schools. Teachers in action-research schools reported significantly higher levels of HPS impact and HPS efficacy than non-action-research schools. The multivariate analysis results indicated that after controlling for school level and HPS funding, the HPS action-research approach was significantly positively related to greater levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

BACKGROUND: This study examined the relationships among cyberbullying, school bullying, and mental health in adolescents. METHODS: In 2010, a total of 2992 10th grade students recruited from 26 high schools in Taipei, Taiwan completed questionnaires. RESULTS: More than one third of students had either engaged in cyberbullying or had been the target (cybervictim) of it in the last year. About 18.4% had been cyberbullied (cybervictim); 5.8% had cyberbullied others (cyberbully); 11.2% had both cyberbullied others and been cyberbullied (cyberbully-victim). About 8.2% had been bullied in school (victim); 10.6% had bullied others (bully); and, 5.1% had both bullied others and had been bullied in school (bully-victim). Students with Internet risk behaviors were more likely to be involved in cyberbullying and/or cybervictimization; students who had cyberbullying or victimization experiences also tended to be involved in school bullying/victimization. After controlling for sex, academic performance, and household poverty, cyber/school victims and bully-victims were more likely to have lower self-esteem, and cyber/school victims, bullies and bully-victims were at a greater risk for serious depression. CONCLUSIONS: Both cyberbullying and school bullying and/or victimization experiences were independently associated with increased depression. Language: en

This study evaluated the effects of mobilizing community coalitions and implementing prevention intervention concerning public awareness, knowledge, and perception of the risks associated with club drug use by Taiwanese urban youth. A quasi-experimental design was used. Three communities in Taipei city were included in the present study. A total of 328 residents successfully participated in the baseline survey (April 2008), and 276 residents were successfully interviewed for the follow-up survey (September 2008). The generalized estimating equation (GEE) method was used. The percentage of the intervention respondents who reported having seen or heard antidrug messages increased significantly between the time of the baseline survey (63.7%) and the follow-up survey (77.4%), while the percentage of attendance at antidrug events increased from 23.1% to 38.7% during the same time interval. In addition, community knowledge and perception of the problem of club drug use by youth rose significantly between the baseline and the follow-up in the intervention communities. The study's limitations are noted.