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Background: Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. Aim: To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. Design: A scoping review performed in accordance with the Arksey and O’Malley framework. Data sources: A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. Results: Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. Conclusions: The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.

Hope plays an extremely important role in protecting childhood cancer patients from psychological distress caused by cancer. The availability of a valid and reliable instrument that can accurately assess hope is crucial for the development of interventions to enhance hope among childhood cancer patients. This study aimed to examine the psychometric properties of the Chinese version of the Herth Hope Index (HHI). Chinese childhood cancer patients aged 8–17 years (n = 412) were invited to participate in this cross-sectional study. Participants completed the Chinese translated version of the HHI, the Center for Epidemiology Studies Depression Scale for Children and the Paediatric Quality of Life Inventory 3.0 Cancer Module. Exploratory factor analysis and confirmatory factor analysis were conducted to assess the structural validity of the HHI. Content validity, convergent validity, internal consistency, and test–retest reliability at 2 weeks were also examined. The content validity index for items ranged from 0.8 to 1.0, and that for the scale was 0.9, demonstrating appropriate content validity. There was a positive correlation between HHI and Center for Epidemiology Studies Depression Scale for Children scores and a negative correlation between HHI and Paediatric Quality of Life Inventory 3.0 Cancer Module scores. The results indicated that the Chinese version of the HHI showed reasonable convergent validity and discriminant validity. Exploratory factor analysis yielded a three-factor model, which could explain 82.74% of the total variance. The confirmatory factor analysis results showed that χ2/df was 2.20, comparative fit index was 0.98, goodness of fit index was 0.94, and root-mean-square error of approximation was 0.07. Cronbach’s alpha was 0.78, indicating good internal consistency. The findings of the study showed that the Chinese version of the HHI (11-item) is a reliable and valid instrument for assessing hope among Chinese childhood cancer patients. Evidence-based interventions can be provided to enhance hope in this population.

BackgroundSpiritual well-being is a strength for childhood cancer patients to cope with cancer. The availability of a valid and reliable instrument for assessing spiritual well-being is crucial. This study translated and adapted the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp) for Chinese childhood cancer patients and examined the psychometric properties and factor structure in this population.MethodsThis was a methodological study. The FACIT-Sp was translated into Chinese. Adaptation was based on our qualitative study. For psychometric evaluation, a convenience sample of 412 were recruited based on the suggested sample size for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Childhood cancer patients were included if they aged 8–17 years, with parental consent to participate, able to communicate that they were being treated for cancer, and able to communicate and read Chinese. Participants answered the Chinese version of the adapted FACIT-Sp, the Center for Epidemiology Studies Depression Scale for Children (CES-DC), and the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL). Content validity, convergent validity, internal consistency and test–retest reliability were examined. Both EFA and CFA assessed the structural validity of the adapted FACIT-Sp.ResultsThe content validity index values for items ranged 0.8–1.0 and that for the scale was 0.84, indicating appropriate content validity. The scale had good internal consistency, with a Cronbach’s alpha of 0.815. The FACIT-Sp scores positively correlated with the CES-DC scores, and negatively correlated with PedsQL scores, suggesting that the Chinese version of the adapted FACIT-Sp had reasonable convergent validity. EFA yielded a four-factor (meaning, peace, faith, and connection with others) model. The CFA results revealed that the four-factor model achieved a better fit than the original three-factor model (Chi-Square Mean/Degree of Freedom = 2.240 vs. 3.557, Comparative Fit Index = 0.953 vs. 0.916, Goodness of Fit Index = 0.909 vs. 0.884, Root Mean Square Error of Approximation = 0.078 vs. 0.112).ConclusionThe Chinese version of the adapted FACIT-Sp is a reliable and valid instrument for assessing spiritual well-being among Chinese childhood cancer patients. This instrument can be applied in clinical settings for routine assessment.

There is growing concern about mental health problems among juveniles. Evidence shows that adventure-based training can reduce depressive symptoms in school children. However, a rigorous empirical investigation of the effectiveness of such training in enhancing resilience among juveniles has not yet been performed. In this study, a randomized controlled trial was conducted to examine the effectiveness of adventure-based training in enhancing resilience and self-esteem and reducing depressive symptoms among juveniles. Secondary school students from grades 7 to 9 (aged 12-16 years) who attended the Integrated Children and Youth Services Centre in a large public housing estate in Hong Kong from December 20, 2018 to November 25, 2019 were invited to participate in this study. We randomly assigned 228 eligible adolescents to an experimental group (n = 115) that received a 2-day/1-night adventure-based training or a placebo control group (n = 113) that received 2 days of leisure activities organized by the Integrated Children and Youth Services Centre. Data were collected at baseline and 3 and 6 months after the corresponding interventions. The primary outcome was resilience at 6 months. The secondary outcomes were depressive symptoms and self-esteem at 6 months. Compared with the placebo control group, the experimental group showed significantly higher resilience (p = 0.001) and fewer depressive symptoms (p = 0.02) at 6 months, and significantly higher self-esteem at 3 months (p = 0.04), but not at 6 months (p = 0.12). However, the generalizability of the findings is limited as we used a convenience sample.

COVID-19 has significant impacts on young smokers in their smoking behaviors. This qualitative study summarises the lived experience of young smokers during COVID-19. Moreover, through their lived experience, we aim to understand how the COVID-19 pandemic influence tobacco use behaviours in this population. A purposive sampling of 48 smokers aged between 17–25 years old is individually interviewed for 30 to 45 min. All interviews are transcribed in verbatim and analysed by two researchers separately using Colaizzi’s method of descriptive phenomenology. The results reveal the following six important themes, which could explain the mixed pattern of smoking behaviour changes in young smokers: (1) perceptions of COVID-19 and its association with smoking, (2) more time at home, (3) taking masks off to smoke, (4) the effects of COVID-19 on smokers’ financial status and academic performance, (5) reduced social gatherings, and (6) restricted access to tobacco products. To conclude, this pandemic and the anti-pandemic measures, i.e., mask mandates, stay-at-home and work-from-home orders, and class suspension, result in both new obstacles and new advantages for smoking cessation among young people. More studies should be performed to monitor any transition of tobacco products and the trajectory of use in this population during this pandemic, thus informing public health policy making.

Aims and objectives This study mapped the quitting patterns (trajectories) of Hong Kong Chinese women smokers who had received counselling via a quitline service and examined factors correlated with different trajectories. Background Quitting smoking is always a gradual and progressive process. However, most existing studies on smoking cessation have adopted a cross-sectional approach to conduct evaluation. Little is known about the quitting trajectories of smokers, particularly those who are women after receiving smoking cessation counselling. Methods We used a retrospective longitudinal design and analysed 474 women smokers who had called the quitline. Quitting trajectories were mapped using latent growth modelling. Multinomial logistic regression was performed to identify factors associated with class membership. A STROBE checklist was completed. Results We identified three trajectory groups: 'quitters' who quit smoking at 6 months and abstained from cigarettes up to 6 years; 'reducers' who cut down cigarette consumption ≥50% at 3 years and maintained reduced levels up to 6 years; and 'increasers' who increased smoking ≥20% at 3 years and continued smoking up to 6 years. Participants who perceived more difficulties in quitting were more likely to be increasers. Those with higher daily cigarette consumption at baseline were more likely to be reducers. Conclusions We clarified three trajectory groups of women smokers. The results indicate that existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling. Relevance to clinical practice Existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling. For those who reduce smoking but fail to quit, quit plans should be developed that provide step-by-step guidance in achieving abstinence through smoking reduction. Instant messages may complement telephone counselling to deliver cessation support for those who increase their cigarette consumption.

This cross-sectional study examined the level of hope among Hong Kong childhood cancer survivors and investigated the relationships among hope, depressive symptoms, self-esteem and health-related quality of life. We recruited 176 survivors aged 10–16 years who underwent medical follow-ups at the outpatient clinic. This study revealed that lower levels of hope were associated with an increase in depressive symptoms and reductions in self-esteem and health-related quality of life. Our results contribute to novel findings by demonstrating that hope may be a significant factor associated with health-related quality of life. This understanding could increase healthcare professionals’ awareness about the psychological needs of childhood cancer survivors.

To understand the risk perceptions, behaviour, attitudes, and experiences related to smoking among hospitalized Chinese smokers.Understanding hospitalized smokers' perceptions of risks associated with smoking, along with their behaviour, attitudes, and smoking-related experiences, is essential prerequisite to design effective interventions to help them quit smoking.A phenomenological research design was adopted.A purposive sampling approach was used. Between May 2016-January 2017, 30 hospitalized smokers were invited for an interview.Four themes were generated: (a) associations between perception of illness and smoking; (b) perceived support from healthcare professionals to quit smoking; (c) impact of hospitalization on behaviour, attitudes, and experiences; and (d) perceived barriers to quitting smoking.Development of an innovative intervention that helps to demystify misconceptions about smoking through brief interventions and active referrals is recommended to enhance the effectiveness of healthcare professionals promoting smoking cessation for hospitalized smokers.To date, no study examining smoking behaviour among hospitalized patients in Hong Kong has been conducted. Misconceptions about smoking and health, barriers to quitting that outweighed perceived benefits, lack of support from healthcare professionals, and difficulty overcoming withdrawal symptoms or cigarette cravings precluded hospitalized smokers sustaining smoking abstinence after discharge. Smoking is detrimental to physical health. Smoking cessation has beneficial effects on treatment efficacy and prognosis and helps to reduce the economic burden on society from smoking-attributable diseases.目的: 为了解中国住院吸烟者与吸烟相关的风险认知、行为、态度和经验。 背景: 了解住院吸烟者对吸烟相关风险的认知,以及他们的行为、态度和与吸烟相关的经验,是设计有效干预措施帮助他们戒烟的必要前提。 设计: 采用现象学研究设计。 方法: 采用有目的抽样法。2016年5月至2017年1月期间,30名住院吸烟者应邀接受采访。 结果: 产生了四个主题:(a)疾病认知与吸烟的关系;(b)医疗专业人员对戒烟的支持;(c)住院对行为、态度和经验的影响;以及(d)戒烟的障碍。 结论: 建议制定一项创新的干预措施,通过简短的干预措施和积极的转介,帮助消除对吸烟的误解,以提高医疗保健专业人员促进住院吸烟者戒烟的效果。 影响: 迄今为止,我们并没有就香港住院病人的吸烟行为进行研究。对吸烟与健康的误解、戒烟的障碍超过了预期的好处、缺乏保健专业人员的支持、难以克服戒断症状或吸烟欲望,这些都妨碍了住院吸烟者出院后保持戒烟。吸烟有害身体健康。 戒烟对治疗效果和预后有良好的影响,有助于减轻吸烟引起的疾病给社会带来的经济负担。.

Spiritual well-being is the fourth dimension of health, as equally important as physical, mental, and social well-being. The shadow of death associated with cancer triggers children to explore their personal values, meanings, and life goals throughout the illness trajectory, enabling them to identify their unique spiritual needs. Chinese children are generally non-religious, unlike Western children, which affects their spiritual needs. To address the literature gaps, we applied a qualitative, descriptive, phenomenological approach for exploring the spiritual needs of Chinese children hospitalized with cancer. Purposive sampling was conducted in two public hospitals with special wards for pediatric oncology patients in Hunan Province, China. Consequently, 22 children, hospitalized with cancer, were recruited and individually interviewed using a semi-structured interview format. We conducted a thematic analysis of the interview transcripts. Four important themes were identified: the need for self-exploration, inner needs, need for a connection with others, and need for a connection with gods, supernatural powers, and fictional characters. We found that culture significantly influenced the spiritual needs of Chinese children with cancer. Hope was a key factor motivating the children to continue cancer treatment. To address their unique spiritual needs, culturally specific interventions should be developed and incorporated into their care to enhance their spiritual well-being.

Background Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure. Methods A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis. Results The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70. Conclusion The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost. Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

Adolescents and young adults mostly drink alcohol because of social activities. However, some drink outside of normative social contexts, exhibiting a behaviour pattern known as solitary drinking. Increasing evidence indicates that solitary drinking is strongly associated with problematic drinking in adolescents and young adults. However, it remains unclear why individuals initiate and maintain this drinking habit. To address this gap in the existing literature, the current study explored the factors contributing to solitary drinking in this population. Descriptive phenomenology was used. A convenience sample of 44 solitary drinkers aged between 10 and 24 were invited to undergo individual semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. The data were analysed by two researchers separately using Colaizzi’s method. Using qualitative descriptions, the following factors were identified as explaining the initiation and continuation of solitary drinking among adolescents and young adults: (1) enhancement and coping drinking motives, (2) social discomfort, (3) reduced self-control, (4) automatic mental process, and (5) a desperate response to stressors. Since reduced self-control plays an important role in long-term addiction, future studies should be conducted to determine potential applications of mindfulness-based interventions to improve self-control, which may prevent the progression from solitary drinking to alcohol use disorder.

BACKGROUND Evidence has shown that survivors of pediatric brain tumors have more negative psychological sequela, particularly depression, than do survivors of other childhood cancers. This study examined the efficacy of a musical training program in reducing depressive symptoms and enhancing self-esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors. METHODS A prospective randomized controlled trial, two-group pretest and repeated posttest, between-subjects design was conducted to 60 pediatric brain tumor survivors (8-5 years old). Participants in the experimental group received a weekly 45-min lesson on musical training for 52 weeks. Participants in the control group received a placebo intervention. The primary outcome was depressive symptoms at 12 months. Secondary outcomes were self-esteem and quality of life at 12 months. Data were collected at baseline and 6 and 12 months after the intervention began. RESULTS Participants in the experimental group reported statistically significant fewer depressive symptoms (P

Cancer-related fatigue is one of the most distressing symptoms reported by childhood cancer survivors. Despite the body of evidence that regular physical activity helps alleviate cancer-related fatigue, insufficient participation in physical activity is frequently observed among childhood cancer survivors.This study examined the effectiveness of an adventure-based training programme in promoting physical activity, reducing fatigue, and enhancing self-efficacy and quality of life among Hong Kong Chinese childhood cancer survivors.A prospective randomised controlled trial.A paediatric oncology outpatient clinic, a non-governmental organisation, and a non-profit voluntary organisation.Hong Kong Chinese childhood cancer survivors aged 9-16 years who reported symptoms of fatigue and had not engaged in regular physical exercise in the past 6 months.The experimental group underwent a 4-day adventure-based training programme. The control group received a placebo intervention. The primary outcome was fatigue at 12 months. Secondary outcomes were physical activity levels, self-efficacy and quality of life at 12 months. Data collection was conducted at baseline, and 6 and 12 months after the intervention began. We performed intention-to-treat analyses.From 6 January, 2014 to 8 June, 2015, we randomly assigned 222 eligible childhood cancer survivors to either an experimental (n = 117) or a control group (n = 105). The experimental group showed statistically significantly lower levels of cancer-related fatigue (P 0.001), higher levels of self-efficacy (P 0.001) and physical activity (P 0.001), and better quality of life (P 0.01) than the control group at 12 months.This study provides evidence that adventure-based training is effective in promoting physical activity, reducing cancer-related fatigue, and enhancing self-efficacy and quality of life among Hong Kong Chinese childhood cancer survivors. These results may help inform parents and healthcare professionals that regular physical activity is crucial for the physical and psychological wellbeing and quality of life of childhood cancer survivors.

Objectives To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. Methods A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. Results At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). Conclusion These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. Practice implications It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients., published_or_final_version

Clinicians have an opportunity to provide smoking cessation interventions to smokers who present to emergency departments (EDs). The effectiveness of a brief intervention based on self-determination theory for smoking cessation is uncertain.To examine the effectiveness of a brief intervention based on self-determination theory for smoking cessation (immediate or progressive) among Chinese smokers presenting at EDs in Hong Kong.This single-blind, multicenter intent-to-treat randomized clinical trial was conducted at the EDs of 4 major acute care hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major EDs between July 4, 2015, and March 17, 2017, were randomized into an intervention group (n = 787) and a control group (n = 784).The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet.Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months.Participants (N = 1571) included 1381 men (87.9%); the mean (SD) age at baseline was 47.4 (16.4) years. Among participants who self-reported abstinence at 6 months, 50.3% (85 of 169) had biochemical validation by both an exhaled carbon monoxide test and a saliva cotinine test. Compared with the control group, the intervention group had statistically higher biochemically validated abstinence at 6 months: 6.7% (53 of 787) vs 2.8% (22 of 784) (P .001), with an adjusted relative risk of 3.21 (95% CI, 1.74-5.93; P .001). The intervention group also had higher self-reported quit rates at 6 months (12.2% [96 of 787] vs 9.3% [73 of 784], P = .04) and 12 months (13.0% [102 of 787] vs 8.5% [67 of 784], P .01), as well as higher biochemically validated abstinence at 12 months (7.0% [55 of 787] vs 3.7% [29 of 784], P .001). The additional cost for each intervention group participant was US $0.47, with an estimated gain of 0.0238 quality-adjusted life-year. The incremental cost per quality-adjusted life-year (US $19.53) fell within acceptable thresholds.This brief, low-cost self-determination theory-based intervention for smokers presenting at EDs effectively increased the biochemically validated quit rate at 6 months. If delivered routinely, such a simple intervention may offer a cost-effective and sustainable approach to help many smokers quit smoking.ClinicalTrials.gov identifier: NCT02660957.

Objective The study aim was to investigate how the integrated experiential training programme with coaching could motivate children undergoing cancer treatment to adopt and maintain physical activity. Methods A descriptive phenomenological approach was used. A purposive sample of 23 children and their parents participated in one-to-one 25–30-minute semistructured interviews. Interviews were tape-recorded and transcribed. Colaizzi’s method of descriptive phenomenological data analysis was used. Results The integrated programme motivated children with cancer by increasing children’s and parents’ knowledge of physical activity, enhancing confidence in physical activity and improving physical and psychological well-being. Moreover, the programme provided children with encouragement and psychological support through coach companionship. The programme also facilitated children’s participation in physical activity and modified perceptions of physical activity. Conclusion This study addressed a gap in the literature by exploring how an integrated programme promoted and maintained physical activity in childhood cancer patients. Practice Implications The integrated experiential training programme is feasible and can be easily sustained. Future studies could extend the programme beyond aspects of physical activity to help people change their health practices and maintain a healthy lifestyle.

The recent development of smoking cessation interventions for smokers with chronic diseases has focused heavily on brief interventions. However, these interventions are too brief to make an impact on these smokers, especially when most of them are without any intention to quit. Previous studies showed that smokers who did not want to quit might be interested in changing other health behaviours. Also, once people engage in a health behaviour, they are found more likely to change other unhealthy habits. Hence, a general health promotion approach could be a feasible approach to motivate smokers who do not want to quit to first engage in any desirable health behaviour, and later quit smoking when they intend to do so. This study aims to determine the potential efficacy and effect size of such intervention approach in promoting smoking cessation for smokers with chronic diseases. This is a randomized controlled trial. A convenience sample of 60 smokers with chronic diseases will be randomly assigned into either experimental (n = 30) or control group (n = 30). Smokers in the experimental group will receive an individual face-to-face brief motivational interviewing (MI) with generic advice on selected health behaviour. More brief MI messages will be delivered to them via WhatsApp/WeChat for 6 months. For subject in the control group, they will be asked to indicate their desirable health-related practice. However, no MI and booster interventions will be given. All subjects will complete a questionnaire at 1, 3, 6 and 12 months. Subjects abstinent from cigarettes at 12 months will perform a biochemical validation. The primary outcome is biochemically validated smoking abstinence at 12 months. Effect size of the intervention will be estimated by the odd ratios using intention-to-treat. This is the first study to determine the potential efficacy for the use of a personalized general health promotion approach in promoting smoking cessation for smokers with chronic diseases. If our proposed intervention is effective, we will able to assist smokers with chronic disease to quit smoking and change their health behaviour simultaneously. CinicalTrials.gov NCT03983330 (Prospectively registered), registered on June 12, 2019.

Aims and objectives To test the effectiveness of a musical training programme in promoting happiness and quality of life of Hong Kong Chinese underprivileged preschool children. Background The impact of poverty and income disparity on the psychological well-being of children remains a profound global public health concern. There is substantial evidence that poverty and income disparity have many negative impacts on children's psychological well-being, adversely affecting their quality of life. Methods A nonequivalent, quasi-experimental, two-group, pretest and post-test, between-subjects design was conducted with 171 Hong Kong Chinese underprivileged preschool children (aged 3-6 years). Participants (n = 100) in the experimental group attended a weekly 1-hr musical training lesson for 12 weeks conducted by the Music Children Foundation. Participants (n = 71) in the wait list control group received the same training after all data had been collected. Data collection for both groups was conducted at baseline and 12-week follow-up. The measured outcomes were happiness level and quality of life. A TREND checklist was completed. Results Participants in the experimental group reported significantly higher levels of happiness (p = .002) and quality of life (p = .44) than those in the wait list control group. Conclusions The present study indicates the effectiveness of a musical training programme in promoting happiness and quality of life of Hong Kong Chinese underprivileged preschool children. It also demonstrated the feasibility of implementing the programme in a community context. Relevance to clinical practice This study aids to inform nurses the beneficial effect of the musical training programme in improving underprivileged children's psychological well-being and quality of life. Indeed, community nurses may act as facilitators to promote the musical training programme to underprivileged children. The involvement of community nurses may greatly enhance the sustainability of the programme, thus making it to be a routine health promotion activity.

Background More than a third of Chinese expectant fathers are smokers. Secondhand smoke can cause adverse pregnancy outcomes. The implementation of interventions to help expectant fathers quit smoking is crucial. Video-based intervention has been increasingly used in health promotion. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in helping expectant fathers quit smoking. Methods We did an open-label, investigator-blind, multicentre, three-arm, randomised controlled trial at the obstetrics and gynaecology registration centres of three Chinese tertiary public hospitals. Expectant fathers (≥18 years) were eligible for this study if they had smoked at least one cigarette per day in the past 30 days and had a carbon monoxide concentration in expired air of four parts per million or higher, had smartphones, and were able to read Chinese and communicate in Mandarin. We excluded those who were unable to provide informed consent or receive counselling because of impaired mental status, cognitive impairment, or communication barriers identified from their medical records, or if they had participated in other smoking cessation programmes or services. After providing written informed consent, eligible participants were randomly (1:1:1) allocated using random-number tables into a video-based group, a text message-based group, or a control group. The participants received four 1-min videos (video-based group) or four text messages (text message-based group) on the risks of smoking for maternal and child health via instant messaging every 2 weeks, or a smoking cessation leaflet only (control group). Follow-up visits were done at 1 week and at 1 month, 3 months, and 6 months. The primary outcome, assessed by intention-to-treat, was biochemically validated abstinence at 6 months. This trial was approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (UW 17-269) and Institutional Review Board of the Shenzhen Hospital, and registered with ClinicalTrials.gov (trial number NCT03236025). Findings From Aug 14, 2017, to Feb 28, 2018, 1023 eligible expectant fathers were randomly assigned to a video-based (n=333), text message-based (n=322), or control (n=368) group. At 6 months, we found the video-based group had a significantly higher prevalence of validated abstinence than the text message-based group (75 [22·5%] of 333 participants vs 48 [14·9%] of 322, p=0·013) and control group (75 [22·5%] of 333 vs 34 [9·2%] of 368; p Interpretation The video-based smoking cessation intervention focusing on maternal and child health was effective and feasible in helping expectant fathers quit smoking. The findings could guide health-care professionals to incorporate this simple and effective innovation to promote smoking cessation and other lifestyle habits in clinical practice. Funding Sanming Project of Medicine in Shenzhen, China (SZSM201612018).

ObjectivesPatients admitted to hospitals represent an excellent teachable moment for smoking cessation, as they are required to abstain from tobacco use during hospitalisation. Nevertheless, smoking behaviours of hospitalised patients, and factors that lead to smoking abstinence thereafter, remain relatively underexplored, particularly in a Hong Kong Chinese context. This study aimed to examine the smoking behaviours of hospitalised patients and explore factors leading to their abstaining from cigarette use after being hospitalised.DesignA cross-sectional design was employed.SettingThis study was conducted in three outpatient clinics in different regions in Hong Kong.ParticipantsA total of 382 recruited Chinese patients.Primary and secondary outcome measuresThe patients were asked to complete a structured questionnaire that assessed their smoking behaviours before, during and after hospitalisation.ResultsThe results indicated 23.6% of smokers smoked secretly during their hospital stay, and about 76.1% of smokers resumed smoking after discharge. Multivariate logistic regression analysis found that number of days of hospitalisation admission in the preceding year (OR 1.02; 95% CI 1.01 to 1.27; p=0.036), patients’ perceived correlation between smoking and their illness (OR 1.08; 95% CI 1.01 to 1.17; p=0.032), withdrawal symptoms experienced during hospitalisation (OR 0.75; 95% CI 0.58 to 0.97; p=0.027) and smoking cessation support from healthcare professionals (OR 1.18; 95% CI 1.07 to 1.36; p=0.014) were significant predictors of smoking abstinence after discharge.ConclusionsThe results of this study will aid development of appropriate and innovative smoking cessation interventions that can help patients achieve more successful smoking abstinence and less relapse.Trial registration numberNCT02866760.

Background A reliable and valid instrument that accurately measures resilience is crucial for the development of interventions to enhance the resilience of adolescents and promote their positive mental well-being. However, there is a lack of adolescent resilience assessment tools with good psychometric properties suitable for use with Hong Kong participants. This study aimed to evaluate the psychometric properties of the traditional Chinese version of the Resilience Scale-14. Methods Between October 2017 and January 2018, a stratified random sample of 1816 Grade 7 (aged 11–15 years) students from all 18 districts of Hong Kong were invited to participate in the study. Subjects were asked to respond to the traditional Chinese version of the Resilience Scale-14, the Center for Epidemiologic Studies Depression Scale for children, and Rosenberg’s Self-Esteem Scale. The psychometric properties, including the internal consistency, content validity, convergent and discriminant validity, exploratory and confirmatory factor analyses, and test–retest reliability of the Resilience Scale-14 were assessed. Results The translated scale demonstrated good internal consistency and test–retest reliability, excellent content validity, and appropriate convergent and discriminant validity. The results of the confirmatory factor analysis supported the two-factor structure of the traditional Chinese version of the Resilience Scale-14. Conclusions Results suggest that the translated scale is a reliable and valid tool to assess the resilience of young Hong Kong Chinese adolescents. Healthcare professionals could use the newly translated scale to assess resilience levels among Hong Kong adolescents and develop interventions that can help them combat mental health problems and lead healthier lives. Trial registration Clinicaltrials.gov ID NCT03538145 (retrospectively registered on May 15, 2018).

Background Females are less willing than males to seek help from smoking cessation services; the present study examined how the use of these services by females could be enhanced by training young female ambassadors to deliver a brief intervention. Methods We collaborated with the Hong Kong Girl Guides Association. Fifty of the association's Girl Guides served as smoking cessation and reduction ambassadors to deliver a brief intervention to at least two female smokers. The effectiveness of the intervention was evaluated by a one-group pre-test and repeated post-test design. We undertook data collection at baseline and at 1, 3 and 6 months. Results In all, 106 female smokers received the brief intervention. At 6-month follow-up, the self-reported abstinence was 12.2%; the biochemically verified prevalence of quitting was 5.7%. Approximately 7% of participants were motivated to use smoking cessation services between baseline and 6 months. Conclusions This study supports the effectiveness of a brief intervention in promoting smoking cessation for community-living female smokers in Hong Kong. However, the intervention could be enhanced by further promoting the use of smoking cessation services to female smokers.

AIMS AND OBJECTIVES To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong. BACKGROUND There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored. DESIGN This is a mixed-method retrospective population-based study. METHODS A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study. RESULTS In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers. CONCLUSIONS This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong. RELEVANCE TO CLINICAL PRACTICE Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.

Objective This study examined the effectiveness of an integrated programme in promoting physical activity, reducing fatigue, enhancing physical activity self-efficacy, muscle strength and quality of life among Chinese children with cancer. Methods A randomised controlled trial was conducted in a Hong Kong public hospital. Seventy eligible children were randomly assigned to an experimental group (n = 37) or a control group (n = 33). The experimental group received an integrated programme with 28 home visits from coaches over a 6-month period. The control group received a placebo intervention. The primary outcome was fatigue at 9 months (3 months after intervention completion). Secondary outcomes were physical activity levels, physical activity self-efficacy, muscle strength and quality of life at 9 months, assessed at baseline, and 6 and 9 months after starting the intervention. Results The experimental group reported significantly lower levels of cancer-related fatigue, higher levels of physical activity and physical activity self-efficacy, greater right- and left-hand grip strength and better quality of life than the control group at 9 months. Conclusion The programme is effective and feasible to implement among children with cancer and offers an alternative means of ameliorating the healthcare burden. Practice implications Healthcare professionals should build multidisciplinary partnerships to sustain such programmes.

Background Youth smoking continues to be a significant global public health concern. To ensure healthier lives for youths, healthcare professionals need to increase awareness among the youth of the health risks and addictive nature of smoking, strengthen their ability to resist negative peer influence and curiosity, and help those who smoked to quit. The Smoke-free Teens Programme was launched in 2012 to equip youngsters with up-to-date information about smoking and global trends in tobacco control and to encourage them to play a pioneering role in tobacco control. This paper describes the process and outcomes of this programme for youths in Hong Kong. Methods The Smoke-free Teens Programme contained three major components: (i) a 2-day-1-night training camp; (ii) creative activities to promote smoke-free messages in schools and the community; and (iii) an award presentation ceremony to recognize the efforts of outstanding Smoke-free Teens in establishing a smoke-free culture. All secondary school students or teenagers aged 14 to 18 years from secondary schools, youth centres and uniform groups were invited to join the programme. The outcome measures were changes in (1) knowledge about smoking hazards; (2) attitudes towards smoking, tobacco control, and smoking cessation; and (3) practices for promoting smoking cessation. Results A total of 856 teenagers were recruited during the study period (July 2014 to March 2017). The results showed statistically significant changes in participants’ knowledge about smoking hazards, attitudes towards tobacco control, and practice for promoting smoking cessation. Conclusions The Smoke-free Teens Programme demonstrated effectiveness in equipping youngsters with up-to-date information about smoking and global trends in tobacco control and in encouraging them to play a pioneering role in tobacco control. The trained Smoke-free Teens not only promoted the smoke-free messages among their schoolmates, friends, and families, but also gathered community support for a smoke-free Hong Kong. The programme has been instrumental in fostering a new batch of Smoke-free Teens to advocate smoke-free culture and protect public health. Trial registration Clinicaltrials.gov ID NCT03291132 (retrospectively registered on September 19, 2017).

© 2016 The Author(s). Background: Despite compelling evidence demonstrating the negative impact of poverty and income disparity on children's psychological well-being, there has been a lack of qualitative information which addresses its contributing factors. This study aimed to shed light on this area by comparing the experiences toward daily life between children living in low- and high-income families. Methods: A qualitative study using a phenomenological approach was conducted from May 2012 to January 2013. A random sample of 42 children aged 10-13, with 25 from low- and 17 from high-income families were asked to voluntarily response to a demographic sheet and undergo individual semi-structured interviews which lasted about 25-30 min. Content analysis was used to analyze the data. Approval for the study was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference UW 12-237). Results: The findings of this study revealed that the living environment, physical health, social life and ability to function at school of children from low-income families are severely impaired. Conclusions: It fills a gap in the literature by showing how poverty and income disparity affect the daily lives of children from low-income families on different levels. Also, adopting a sedentary lifestyle and unhealthy eating habits are possible factors mediating the effects of poverty and income disparity on the psychological well-being of children from low-income families. It is vital for healthcare professionals going beyond their normal roles to give advice on healthy lifestyles and behaviors by building multidisciplinary partnerships with schools and the community. Additionally, healthcare professionals should also target on these two possible factors to develop and implement appropriate interventions for promoting the psychological well-being among children living in poverty. Trial registration NCT02877719. 19 August 2016 retrospectively registered, published_or_final_version

Species of Saccostrea are common oysters on Indo-Pacific rocky shores. The taxonomy of this genus is unclear, however, because of morphological plasticity among its constituent species. Oyster samples with distinct morphotypes were collected from shores experiencing different degrees of wave exposure in Japan, Taiwan, China, Vietnam, Singapore and Australia. Intraspecific and interspecific variations in shell characters have been identified. Only S. kegaki could be readily differentiated from S. cucullata-B, S. cucullata-C and S. mordax by multivariate shell allometric analyses. Phylogenetic analyses using partial mitochondrial 16S DNA sequences of approximately 513 base pairs identified two clades that correspond to superspecies, i.e. putative S. cucullata and putative S. mordax, comprising nine and two lineages from the Indo-West Pacific, respectively. These are S. cucullata-A, B, C, D, E, F, G, S. kegaki and S. glomerata in one clade, and S. mordax-A and B in the other. Interspecific sequence divergence (Kimura-2-parameter values) between lineages ranged from 1.02% to 11.74%. Both S. cucullata-C and S. kegaki are restricted to the northern hemisphere, whereas S. glomerata seems to be a temperate species from the southern hemisphere. S. cucullata-D occurs only in Taiwan. Other species, i.e. S. cucullata-A, B, D, E and F and S. mordax-A and B, have a wide range on rocky shores in the tropical and subtropical Western Pacific and in both northern and southern hemispheres.

Purpose Despite the evidence that regular physical activity can have beneficial effects on the physical and psychological well-being of cancer patients, a review of the literature reveals that a majority of young cancer patients fail to attain the same levels of physical activity that they had before contracting the disease. This study is to examine the impact of cancer and its treatment on the physical activity levels and quality of life of young Hong Kong Chinese cancer patients. Method A cross-sectional study was conducted, with 76 young cancer patients admitted for treatment to a pediatric oncology unit, and another similar age group of 148 healthy counterparts from the two integrated child and youth service centers were invited to join the study. Results The study found that the current physical activity levels of young cancer patients were markedly reduced when compared with their pre-cancer situation. Moreover, they were significantly less active in performing physical exercise, and reported lower levels of self-efficacy and quality of life than their healthy counterparts. The results of the hierarchical multiple regression analysis showed that physical activity is an important indicator of quality of life among young cancer patients. Conclusion The results provide further evidence that cancer and its treatment have negative effects on physical and psychological well-being and quality of life among young cancer patients. There is an imperative need for healthcare professionals to promote the adoption of regular physical activity among such patients, even during the treatment itself.

Two sympatric species of Platygyra have been identified from Hong Kong waters: i.e., P. sinensis and P. pini. The former has been further subdivided into 4 morphotypes based on colony growth form as follows: classic, encrusting, hillocky, and long-valley. Taxonomic confusion raised by overlapping morphological variations and frequent sympatric occurrences, however, has posed problems in relation to Platygyra ecology and population dynamics. This study attempted to differentiate Platygyra pini and morphotypes of P. sinensis by both morphological and ITS1, 5.8S, and partial ITS2 ribosomal DNA sequence analysis. Morphological data based on 9 skeletal characters were subjected to multivariate analysis. No clear groupings were obtained using a multidimensional scaling plot. Most parsimony analysis was conducted using either the rDNA data set including ITS1, 5.8S, and partial ITS2 or the ITS1 region only. Maximum parsimony (MP) and neighbor-joining (NJ) trees obtained from both data sets, clustered samples of P. sinensis and P. pini into 2 clades. The interspecific Kimura 2-parameter sequence divergence value (k2) obtained by the former rDNA data set was 14.275 +/- 0.507%, which is greater than the intraspecific values (1.239 +/- 1.147% for P. sinensis and 0.469 +/- 0.364% for P. pini), indicating that this marker of ITS1, 5.8S, and ITS2 contains substantially high levels of inherent diversity and is useful in resolving the problematic taxonomy of Platygyra.

Ostrea angasi is the only large native ostreine species in southern Australian waters (i.e. New South Wales, Victoria, Tasmania, South Australia and Western Australia (WA)). It has also been recorded as a fossil from Late Pliocene calcarenites of the Roe Plain along the south-eastern coast of WA. Wild populations were harvested for food before and after European settlement. A sample of flat oysters from Oyster Harbour, Albany, WA, was typed for 16S and cytochrome oxidase 1 (CO1) mitochondrial (mt) DNA markers previously shown to be diagnostic for species of Ostreidae. Ostrea edulis was identified in the sample at an approximate 30% occurrence with O. angasi. Interspecific partial 16S and CO1 mtDNA sequence divergences, estimated using Kimura's two-parameter model, were 0.83% and 1.45%, respectively. The occurrence of O. edulis among native O. angasi populations has not hitherto been suspected and, thus, there has not been a legitimate morphological separation of the two. These results emphasise the value of molecular markers in: (1) discriminating morphologically plastic and closely related species; and, thus (2) the monitoring of species introduced into morphologically similar stocks. We caution against such introductions because of the possibility of the importation of oyster diseases (e.g. bonamiasis) and of this and other adverse impacts upon native species.