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Purpose: We examined the associations of soy product intake with all-cause, cardiovascular disease (CVD), and cancer mortality and mediations through CVD risk factors based on the Guangzhou Biobank Cohort Study (GBCS), and conducted updated meta-analyses. Methods: A total of 29,825 participants aged 50 + years were included. Causes of death were identified through record linkage. Soy product intake was assessed by food frequency questionnaire. Cox proportional hazards regression was used to analyze the associations between soy product intake and mortality, yielding hazard ratios (HRs) and 95% confidence intervals (CIs). Mediation analyses with CVD risk factors as mediators, and updated meta-analyses were conducted. Results: During 454,689 person-years of follow-up, 6899 deaths occurred, including 2694 CVD and 2236 cancer. Participants who consumed soy product of 1–6 portions/week, versus no consumption, had significantly lower risks of all-cause and CVD mortality (adjusted HR (95% CI) 0.91 (0.86, 0.97) and 0.87 (0.79, 0.96), respectively). In participants who consumed soy product of ≥ 7 portions/week, the association of higher intake with lower CVD mortality was modestly mediated by total cholesterol (4.2%, 95% CI 1.0–16.6%). Updated meta-analyses showed that the highest level of soy product intake, versus the lowest, was associated with lower risks of all-cause and CVD mortality (pooled HR (95% CI) 0.92 (0.88, 0.96) and 0.92 (0.87, 0.98), respectively). Conclusion: Moderate and high soy product intake were associated with lower risks of all-cause and CVD mortality. Our findings provide support for current dietary guidelines recommending moderate soy product intake, and contribute additional evidence regarding the potential protective effects of high soy product intake. [ABSTRACT FROM AUTHOR]

Aims: To test the effectiveness of intractive, instant messaging chat‐based mobile phone support versus text‐based mobile phone support integrated with brief interventions on self‐reported smoking abstinence in workplaces. Design A two‐arm parallel cluster‐randomized controlled trial with follow‐up to 12 months. Setting: Seventy‐five companies in Hong Kong, China. Participants: Daily cigarette adult smokers (92.0% male, 90.9% not ready to quit within the next 30 days) from 75 companies (clusters). Interventions: Participants were cluster‐randomized to receive text‐based support (TBS, n = 375; 38 clusters) or chat‐based support (CBS, n = 304; 37 clusters). TBS participants received automated and fix‐scheduled text messages on cessation advice and support. CBS participants received fix‐scheduled text messages and additional real‐time psychosocial and cessation support via instant messaging services (e.g. WhatsApp) by counsellors. Both groups received a 1‐hour health talk at baseline and brief telephone counselling at 1 week and 1, 3, 6 and 12 months. Measurements: The primary outcome was self‐reported 7‐day point‐prevalence abstinence at 6 months post‐treatment initiation. Secondary outcomes included 7‐day point‐prevalence abstinence at 12 months, repeated 7‐day point‐prevalence abstinence, smoking reduction, quit attempts and intervention engagement, defined as having read text messages and/or engaged in conversation with counsellors. Findings By intention‐to‐treat assuming that dropouts were smoking, self‐reported abstinence was not significantly different between the CBS and TBS groups at 6 months [18.8 versus 21.6%, risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.61, 1.23, retention = 71.3%] and 12 months (21.4 versus 24.0%, RR = 0.90, 95% CI = 0.66, 1.21, retention = 70.8%). The repeated 7‐day point‐prevalence abstinence, smoking reduction and quit attempts were similar between the groups. The participants who were engaged in the text‐ and/or chat‐based interventions had greater abstinence (adjusted RR = 2.91, 95% CI = 1.87, 4.52) at 6 months compared with unengaged participants. Conclusions: Compared with a text messaging mobile phone intervention, a chat‐based instant messaging mobile phone intervention did not improve smoking abstinence over 12 months in workplaces. Engagement in text‐based or chat‐based interventions was associated with higher quit rates compared with non‐engagement. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is associated with nasopharyngeal cancer (NPC) risk. Whether quitting reduces the risk is unclear. We investigated the associations of NPC with duration of and age at quitting in an endemic region. Methods: We investigated the associations between NPC and quitting in a multicenter case-control study in Hong Kong with 676 newly diagnosed NPC cases and 1,285 hospital controls between 2014 and 2017, using a computer-assisted self-administered questionnaire. Multivariable unconditional logistic regression yielded adjusted odds ratios (AORs) of NPC by quitting status, duration and age of quitting, combinations of duration and age of quitting, and quitting to smoking duration ratio, compared with current smoking. Results: Quitting (AOR: 0.72; 95% CI: 0.53–0.98) and never smoking (0.73, 0.56–0.95) were associated with lower NPC risk. NPC risk decreased with (i) longer quitting duration (p < 0.01), reaching significance after 11–20 (0.62, 0.39–0.99) and 21+ years (0.54, 0.31–0.92) of quitting; (ii) younger quitting age (p = 0.01), reaching significance for quitting at <25 years (0.49, 0.24–0.97); and (iii) higher quitting to smoking duration ratio (p < 0.01), reaching significance when the ratio reached 1 (0.60, 0.39–0.93). Quitting younger (age <25) appeared to confer larger reductions (49% for ≤10 years of quitting, 50% for 11+ years) in NPC risk than quitting at older ages (25+) regardless of quitting duration (16% for ≤10 years, 39% for 11+ years). Conclusions: We have shown longer duration and younger age of quitting were associated with lower NPC risk, with dose-response relations. Our findings support including smoking as a cause of NPC. Stronger tobacco control measures and quitting services are needed to prevent NPC. [ABSTRACT FROM AUTHOR]

Background: The role of dietary fiber intake on risk of nasopharyngeal carcinoma (NPC) remains unclear. We examined the associations of dietary fiber intake on the risk of NPC adjusting for a comprehensive list of potential confounders.Methods: Using data from a multicenter case-control study, we included 815 histologically confirmed NPC incident cases and 1502 controls in Hong Kong, China recruited in 2014-2017. Odds ratios (ORs) of NPC (cases vs controls) for dietary fiber intake from different sources at different life periods (age 13-18, age 19-30, and 10 years before recruitment) were evaluated using unconditional logistic regression, adjusting for sex, age, socioeconomic status, smoking and drinking status, occupational hazards, family history of cancer, salted fish, and total energy intake in Model 1, Epstein-Barr virus viral capsid antigen serological status in Model 2, and duration of sun exposure and circulating 25-hydroxyvitamin D in Model 3.Results: Higher intake of total dietary fiber 10 years before recruitment was significantly associated with decreased NPC risk, with demonstrable dose-response relationship (P-values for trend = 0.001, 0.020 and 0.024 in Models 1-3, respectively). The adjusted ORs (95% CI) in the highest versus the lowest quartile were 0.51 (0.38-0.69) in Model 1, 0.48 (0.33-0.69) in Model 2, and 0.48 (0.33-0.70) in Model 3. However, the association was less clear after adjustment of other potential confounders (e.g. EBV) in the two younger periods (age of 13-18 and 19-30 years). Risks of NPC were significantly lower for dietary fiber intake from fresh vegetables and fruits and soybean products over all three periods, with dose-response relationships observed in all Models (P-values for trend for age 13-18, age 19-30 and 10 years before recruitment were, respectively, 0.002, 0.009 and 0.001 for Model1; 0.020, 0.031 and 0.003 for Model 2; and 0.022, 0.037 and 0.004 for Model 3). No clear association of NPC risk with dietary fiber intake from preserved vegetables, fruits and condiments was observed.Conclusion: Our study has shown the protective role of dietary fiber from fresh food items in NPC risk, but no association for total dietary fiber intake was observed, probably because total intake also included intake of preserved food. Further studies with detailed dietary information and in prospective settings are needed to confirm this finding, and to explore the possible underlying biological mechanisms. [ABSTRACT FROM AUTHOR]

Background We investigated the relationship of Epstein-Barr virus viral capsid antigen (EBV VCA-IgA) serostatus with ambient and personal ultraviolet radiation (UVR) and vitamin D exposure. Methods Using data from a multicenter case-control study, we included 1026 controls subjects in 2014–2017 in Hong Kong, China. Odds ratios (ORs) and 95% confidence intervals (CIs) of the association between UVR exposure and EBV VCA-IgA (seropositivity vs seronegativity) were calculated using unconditional logistic regression models adjusted for potential confounders. Results We observed a large increase in seropositivity of EBV VCA-IgA in association with duration of sunlight exposures at both 10 years before recruitment and age 19–30 years (adjusted OR = 3.59, 95% CI = 1.46–8.77; and adjusted OR = 2.44, 95% CI = 1.04–5.73 for ≥8 vs <2 hours/day; P for trend = .005 and.048, respectively). However, no association of EBV VCA-IgA serostatus with other indicators of UVR exposure was found. In addition, both circulating 25-hydroxyvitamin D (25OHD) and genetic predicted 25OHD were not associated with EBV VCA-IgA serostatus. Conclusions Our results suggest that personal UVR exposure may be associated with higher risk of EBV reactivation, but we did not find clear evidence of vitamin D exposure (observational or genetic), a molecular mediator of UVR exposure. Further prospective studies in other populations are needed to confirm this finding and to explore the underlying biological mechanisms. Information on photosensitizing agents, and serological markers of EBV, and biomarkers related to systemic immunity and inflammation should be collected and are also highly relevant in future studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background evidence concerning the relationship between sleep quality and cognitive impairment is limited and inconsistent. Objective to examine the association of sleep quality with memory impairment and poor cognitive function in a large sample of older Chinese. Methods 15,246 participants aged 50+ years of the Guangzhou Biobank Cohort Study who attended the second physical examination from 2008 to 2012 were included. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and cognitive performance was assessed using both Delayed Word Recall Test (DWRT) and Mini-Mental State Examination (MMSE). Memory impairment was defined by DWRT score < 4 and poor cognitive function by MMSE score < 25. Results after adjusting for potential confounders, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poor cognitive function with a dose-response pattern (both P for trend <0.001). The adjusted odds ratio (OR, 95% confidence interval (CI)) for poor cognitive function in those with the sleep efficiency of 75–85%, 65–75% and <65%, versus ≥85%, was 1.31 (1.12–1.53), 1.41 (1.16–1.73) and 1.33 (1.09–1.63), respectively. No association of the global PSQI score with memory impairment or poor cognitive function was found. Conclusions in older Chinese people, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poorer cognitive function. [ABSTRACT FROM AUTHOR]

Objective: In this study, a genetic risk score (GRS) for the body mass index (BMI) tested and built using a large sample of Chinese individuals aged at least 50 years in southern China. We collected information regarding the participants' weights at 20 years of age and middle age and tested the BMI‐GRS effect modes. Methods: This study involved a prospective study design. The genetic data of the participants in from the Guangzhou Biobank Cohort Study and selected BMI‐related single‐nucleotide polymorphisms (SNPs) were used to establish the GRS. Results: We included 13 597 participants with 12 SNPs. After adjusting for covariates, the high‐GRS group was 36% (95% CI: 25%‐48%) and 34% (95% CI: 23%‐47%) more likely of being overweight at baseline and follow‐up, respectively, and 56% (95% CI: 34%‐82%) and 49% (95% CI: 29%‐72%) more likely of being obese at baseline and follow‐up, respectively, compared with the low‐GRS group (P‐value for all trends <.05). The RRs for the incidences of metabolically healthy and unhealthy obese (MHO and MUO, respectively) individuals in the high‐GRS group were 0.94 (95% CI: 0.65‐1.35) and 1.28 (95% CI: 1.00‐1.63), respectively. Conclusion: High‐GRS participants were more likely to be overweight/obese at baseline and follow‐up, and this relationship exhibited a dose‐response relationship. The GRS was also associated with MUO. [ABSTRACT FROM AUTHOR]

The article discusses developing a research agenda for understanding addiction in China, including in regard to illegal drug use, alcohol use and electronic cigarette usage. Topics, including gambling addiction, tobacco usage, smoking cessation, culturally appropriate metrics on addictive behaviours and diagnosing alcohol-related disorders, are discussed.

Purpose: Eggs are highly nutritious but concerns over their cholesterol content have led to dietary avoidance among many. There are also important international differences in relevant dietary guidance. We conducted the first prospective study in China investigating the association of egg consumption, cardiovascular disease (CVD) mortality, and a meta-analysis. Methods: We included 28,024 participants without CVD at baseline (2003-8) in Guangzhou Biobank Cohort Study. All-cause and CVD mortality were identified through record linkage. We used Cox proportional hazards regression. We followed the Meta-analysis Of Observational Studies in Epidemiology reporting guidelines. Results: During 275,343 person-years follow-up (average 9.8 years), we found 2685 all-cause and 873 CVD deaths. We found no significant difference in all-cause mortality between higher (7+ eggs/week) and low consumption (< 1 egg/week) [adjusted hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.93–1.24], and mortality from CVD (0.99, 95% CI 0.76–1.27), ischemic heart disease (IHD) (0.92, 95% CI 0.63–1.36), or stroke (0.88, 95% CI 0.57–1.35). The updated meta-analyses including our results showed that 7+ eggs/week was not associated with all-cause mortality (HR 1.09, 95% CI 0.997–1.200) or IHD (HR 0.97, 95% CI 0.90–1.05), but associated with a small reduction in stroke (HR 0.91. 95% CI 0.85–0.98). Conclusions: Eating one egg daily is not associated with increase in CVD or all-cause mortality. The small observed reduction in stroke risk needs to be confirmed. Our findings support current guidelines recommending eggs as part of a healthy diet, and should be considered in other dietary recommendations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This qualitative study describes participants' experiences with a community-based family intervention. Guided by a positive psychology framework, the brief intervention was designed to enhance positive communication among family members using cooking and dining as a platform. Our interest was in understanding perceptions of benefits and barriers, with the intention of improving future development of communitybased family programs. Purposive sampling was used to recruit focus group participants from those who had participated in the family programs. Overall, 10 focus groups including 65 participants were conducted from April to July 2013. Thematic analysis of the focus groups suggested that the intervention was effective in promoting positive communication, increasing the use of age-appropriate parenting practices, and promoting quality family mealtime. These changes in turn led to perceived positive outcomes by our participants, including a sense of happiness and enhanced family relationship. Cultural and gender beliefs were identified as challenges and are important to consider for future family interventions. Time constraint was further highlighted as an important consideration both in the context of integrating skills into the family routine as well as a barrier to participation in family programs. Our findings add to the small but steadily increasing body of knowledge, especially from qualitative studies, on the effectiveness of brief family interventions. [ABSTRACT FROM AUTHOR]

Background and aims There is inconsistent evidence that behavioural support to promote smoking reduction is effective at increasing smoking cessation. We examined the effectiveness of brief physician advice together with four very brief telephone calls in promoting smoking cessation among Chinese men via reduction compared with equivalent advice on diet and exercise. Design A two-group pragmatic randomized controlled trial. Participants and Setting Male patients attending the Endocrinology and Acupuncture out-patient clinics of a general hospital in Beijing, China. Intervention and comparators Physicians advised participants allocated to the smoking-reduction intervention (SRI, n = 181) group to reduce smoking to at least half of their current consumption within 1 month at baseline. At follow-up, a telephone counsellor repeated this advice if the participant had not reduced their cigarette consumption. Participants who had reduced consumption were encouraged to quit smoking. Physicians gave participants in the exercise and diet advice (EDA, n = 188) control group brief advice about physical activity and healthy diet at baseline, and a telephone counsellor reinforced this at each follow-up interview. Both groups had one face-to-face interview at baseline plus five telephone interviews and interventions (approximately 1 minute each) at 1 week and 1-, 3-, 6- and 12-month follow-up. Measurements The primary outcome was self-reported 6-month prolonged abstinence rate at 12-month follow-up interview. Findings By intention-to-treat, the self-reported 6-month prolonged abstinence rate at 12-month follow-up in the SRI groups (19 quitters, 15.7%) was higher, but not significantly, than the EDA control group (10 quitters, 7.8%), and the adjusted odds ratio (OR) and 95% confidence interval (CI) was 2.26 (0.97-5.26), P = 0.062. The self-reported 7-day point prevalence quit rate (secondary outcome) in the SRI group was significantly higher than the control group at each follow-up interview (at 12-month follow-up: 13.3 versus 6.9%, OR (95% CI) = 2.09 (1.01, 4.34), P = 0.049). Conclusions A very brief, proactive and low-cost smoking-reduction intervention without medications for Chinese male smokers with no intention to quit appears to increase smoking abstinence. [ABSTRACT FROM AUTHOR]

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled “Learning Families Project”, under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees’ knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees’ reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents’ survey results before and after participating in the community activities delivered by the trainees. The trainees’ learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen’s d: 0.5–1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen’s d: 0.4–0.6). The application of planning skills to implement community activities was higher at one year (Cohen’s d: 0.4), compared with baseline. At one year, the residents’ survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Objectives We studied the association between secondhand smoke (SHS) exposure and peripheral arterial disease (PAD) in Chinese non-smokers. Methods We conducted a cross-sectional study using baseline data from the Guangzhou Biobank Cohort Study: Cardiovascular Disease Sub-cohort Study (GBCS-CVD). Guangzhou residents aged ≥ 50 years were recruited between 2003 and 2008. Baseline data included measurement of ankle brachial pressure index (ABPI) and self-reported smoking status and SHS exposure. Univariate and multivariate logistic regression analyses were used to analyze the association between SHS and PAD (defined as ABPI < 0.9). Results Of the 1507 non-smokers, 24 (1.6%) had PAD. Of these, 12 were men and 12 were women. Exposure to SHS at home of ≥25 h per week was reported by 16.7% of PAD cases compared with 3.8% of those without PAD (χ2 test, p = 0.003). After adjustment for potential confounders, exposure to ≥25 h per week at home was still associated with PAD (adjusted OR 7.86, 95% CI 2.00-30.95, p = 0.003), with suggestion of a dose-response relationship. Conclusions Our results extend the US Surgeon General's 2006 report that SHS exposure is an independent risk factor for PAD. National smoke-free legislation is needed to protect all people from exposure. [ABSTRACT FROM AUTHOR]

Objective: To examine the changes in body mass index (BMI) and waist circumference (WC) in Guangzhou, South China, which is probably experiencing the most rapid economic transition in history.Methods: In this study, 17,786 Chinese aged 50+ years were recruited from 2003 to 2008 and followed up until 2012. BMI and WC were measured at two time points.Results: During the mean follow-up of 3.6 years (median = 3, interquartile = 1), age-adjusted mean BMI increased only slightly. By contrast, mean WC increased sharply by 0.94 cm (95% confidence interval 0.93-0.94) annually in men and 1.29 cm (1.28-1.29) annually in women. In 77% of women and 69% of men, WC increased, and among them, the mean annual increase was 2.01 cm and 1.70 cm, respectively. Among healthy, never-smoking participants, the incidence of central obesity was 29.0% (36.4% in women and 14.2% in men). The incidence of general obesity was 1.9% and was similarly low in both men and women (2.1% vs. 1.8%). Conversely, 20.3% of individuals with general obesity became nonobese, and 12.8% of individuals with central obesity returned to normal.Conclusions: Central obesity has risen sharply in this cohort. Such increases may have been greatly underestimated previously and should form the basis of an even stronger warning for regions undergoing economic transitions in China and elsewhere. [ABSTRACT FROM AUTHOR]

Background: In developed western populations, longer legs are a biomarker of better childhood conditions and negatively associated with cardiovascular disease risk factors. These associations are less obvious in non-western settings. However, early life is also a key immune system development phase. Aim: To examine the associations of height, leg length, sitting height and leg length/sitting height ratio with inflammatory markers (white blood, lymphocyte and granulocyte cell counts and C-reactive protein (CRP)) in a developing population of southern China. Subjects and methods: This study used multivariable linear regression to examine the adjusted associations in 30 499 Chinese (50+ years). Results: Height z-score was associated with lower white blood, lymphocyte and granulocyte cell counts. Leg length z-score was associated with lower white blood, lymphocyte and granulocyte cell counts and CRP. Sitting height z-score was associated with lower white blood and granulocyte cell counts, but not with lymphocyte cell count or CRP. Leg length/sitting height ratio z-score was associated with lower white blood, lymphocyte and granulocyte cell counts and CRP. Conclusion: Factors enabling more early growth may also lead to changes in immunity that are associated with reduced CVD risk. [ABSTRACT FROM AUTHOR]

Aims: We investigated the prevalence of various parental pro-drinking practices and its association with parental drinking status. Methods: A school-based survey was completed by 2200 students (mean age 14.8, SD 2.0; boys 51.4%) from 4 randomly selected secondary schools in Hong Kong. Students reported whether they had ever experienced each of nine parental pro-drinking practices (PPDPs). Results: Overall, 67.5% of students reported at least one PPDP, but the prevalence was much higher if both parents were drinkers (89.0%) compared with non-drinkers (38.8%). The adjusted odds ratio (AOR) (95% CI) of experiencing at least one PPDP was 6.79 (4.98, 9.26) if either parent drank and 15.71 (10.50, 23.50) if both drank compared with none (P for trend <0.001). Compared with non-drinking, the AORs (95% CI) of experiencing at least one PPDP for occasional drinking and frequent drinking were 6.72 (5.03, 8.98) and 18.11 (9.88, 33.18) in fathers (P for trend <0.001), and 7.33 (5.15, 10.44) and 5.33 (1.98, 14.45) in mothers. Conclusion: The prevalence of PPDPs was generally low in non-drinking parents, but increased dramatically with the number of drinking parents and the frequency of paternal drinking. [ABSTRACT FROM AUTHOR]

Prospective evidence of the associations of smoking cessation with chronic obstructive pulmonary disease (COPD) and other causes of death in Asia is scarce. Previous studies, which were mostly based on baseline smoking behavior only, were subject to sick-quitter bias and misclassification resulting from changes in smoking behavior during follow-up. We followed up a cohort for 18 years (1976–1994) to assess changes in smoking behavior and then for an additional 17 years (1994–2011) to examine the relationships of continuing to smoke and new quitting with mortality risk in 1,494 Chinese people (961 men, 533 women). Of the baseline current smokers, 38.7% quit between 1976 and 1994. From 1994 to 2011, a total of 488 persons (359 men, 129 women) died. Ever smokers had increased risks of lung cancer, coronary heart disease, thrombotic stroke, and COPD, with dose-response relationships. For all tobacco-related mortality, the relative risk for new quitters compared with continuing smokers was 0.68 (95% confidence interval: 0.46, 0.99) for those who had quit 2–7 years previously and 0.56 (95% confidence interval: 0.37, 0.85) for those who had quit 8 years or more previously. The corresponding relative risks were 0.69 and 0.45 for lung cancer, 0.78 and 0.51 for coronary heart disease, 0.76 and 0.84 for thrombotic stroke, and 0.89 and 0.61 for COPD, respectively. Smoking increased tobacco-related deaths, and particularly deaths from COPD, in China, whereas quitting at middle age (at approximately 50 years of age) substantially reduced the risks of death from these causes. The benefits of smoking cessation were underestimated in previous studies that did not use repeated measures. [ABSTRACT FROM PUBLISHER]

Background: Adverse lifestyle factors have been associated with increased mortality, but data are lacking on their combined effect in developing populations, which we address in the present study. Methods: In a death registry-based, case-control study among Hong Kong Chinese aged 30+y, proxy-reported lifestyle factors 10 y ago were collected for 21,363 cases (81% of all deaths) and 12,048 living controls. Risks associated with poor diet, inactivity, heavy alcohol intake, and smoking for all-cause and cause-specific mortality, adjusting for potential confounders, were determined, and excess deaths for the Chinese population were calculated. Results: Adjusted odds ratios for all-cause mortality were 1.15 (95% CI 1.09, 1.23), 1.34 (1.27, 1.43), 1.36 (1.21, 1.52), and 1.58 (1.46, 1.70) for poor diet, inactivity, heavy alcohol intake and smoking, respectively. Increasing numbers of adverse lifestyle factors were associated with a dose-dependent increase in adjusted odds ratios of 1.30 (1.20, 1.40), 1.67 (1.54, 1.81), 2.32 (2.08, 2.60), and 3.85 (3.12, 4.75) for 1, 2, 3, and 4 risk factors relative to those with none. The population attributable fraction for all-cause, all-CVD and all-cancer mortality were 26.6%, 15.0%, and 32.1%, resulting in an excess of 2,017,541; 489,884; and 607,517 deaths annually, respectively. Although smoking was associated with the greatest excess loss of life (867,530), heavy drinking (680,466), and physical inactivity (678,317) were similarly important. Conclusion: Adverse lifestyle factors contribute to one quarter of all deaths in China. Improving lifestyle practices, particularly focussing on moderating alcohol intake and increasing activity, and smoking cessation are critical to reducing the lifestyle-associated health burden. [ABSTRACT FROM AUTHOR]

Objective To assess the association between self-reported oral health ( SROH) and general health, this study examined the cross-sectional associations between SROH and nine chronic health conditions, namely cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease in Hong Kong. Methods This study included 41 641 participants recruited in the FAMILY Project cohort study during March 2009-March 2011. SROH was measured on a 5-point Likert scale. Multiple logistic regression model was used to analyze the effect of dichotomized SROH (0: very good/good/average, 1: bad/very bad) on nine chronic health conditions, adjusted for age, sex, education, personal income, smoking and drinking habits, Body mass index ( BMI), and blood pressures. Results All the nine chronic health conditions investigated were associated with SROH. SROH showed the strongest cross-sectional association with nervous system disease (odds ratio = 3.30, P < 0.001), while the odds ratio with other significant chronic health conditions ranged from 1.13 (high cholesterol, P = 0.033)-1.73 (stomach/intestinal disease, P < 0.001). Conclusions Poor SROH is associated with cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease. [ABSTRACT FROM AUTHOR]

Background: Carotid atherosclerosis should not be neglected as a cause for stroke in China, despite its low prevalence. This study was performed to evaluate the association between ultrasonographic markers for different stages of carotid atherosclerosis and metabolic syndrome. Methods: This was a community-based study in Hong Kong. Metabolic syndrome was defined as having three or more of the following conditions or receiving specific treatment for these conditions: Abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4th quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of >1.5 mm. A carotid plaque obstructing ≥50% of vessel lumen was considered as carotid stenosis. Results: A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. Metabolic syndrome was found in 188 (28.8%) subjects (30.8% in males and 27.0% in females). Mean CIMT was 0.74±0.12 mm. Increased CIMT, carotid plaque, and carotid stenosis were detected in 163 (25.0%), 95 (14.5%), and 6 (1.4%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of metabolic syndrome components ( P<0.001). In multivariate logistic regression analysis, metabolic syndrome was independently associated with increased CIMT [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.11-2.64; P=0.014), but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108). Conclusions: Metabolic syndrome may be independently associated with the early stage but not the later and advanced stages of carotid atherosclerosis in community residents in China. [ABSTRACT FROM AUTHOR]

Background Early puberty often occurs in migrants from less to more economically developed locations, particularly among girls, perhaps because of mismatched inter-generational conditions. However, migrants may differ from their host population in many ways.Objective In an ethnically homogenous Chinese population in a developed environment, we examined the association of mother's growth environment (proxied by migration status) with age at onset of puberty. We assessed differences by sex and whether associations were independent of intra-uterine growth.Methods We used interval-censored survival analyses in 3832 boys and 3279 girls (follow-up rate of 92%) from the ‘Children of 1997’ birth cohort, comprising 88% of births in Hong Kong in April and May 1997, to examine the adjusted association of mother's migration status (born and raised in mainland China or in comparatively more developed Hong Kong), with clinically assessed age at onset of puberty (Tanner stage II for breast/genital and pubic hair development).Results Children with mothers from a less developed environment had earlier onset of breast/genital [time ratio (TR) 0.987, 95% confidence intervals (CIs) 0.980–0.993] and pubic hair (TR 0.993, 95% CI 0.986–1.000) development, independent of birth size for gestational age and socio-economic position, possibly with a more marked association in girls.Conclusion Mismatch of growth conditions between mothers and children was associated with younger age at onset of puberty. Given the association of early puberty with chronic diseases, inter-generational influences may be relevant to the emerging epidemics of these diseases in rapidly developing populations where age of puberty is declining sharply. [ABSTRACT FROM PUBLISHER]

BackgroundInterleukin-6 (IL6) plays a central role in inflammation, insulin resistance, and atherogenesis. We investigated the associations of plasma IL6 and its genetic variants with hypertension in both cross-sectional and prospective study designs.MethodsPlasma IL6 was measured in 648 normotensive and 294 hypertensive subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS)-2 in 2000-2004 and three tagging single-nucleotide polymorphisms (SNPs) in the IL6 gene were genotyped. Among subjects normotensive in CRISPS-2 (baseline), 515 subjects were followed-up in CRISPS-3 in 2005-2008 and 100 of them had developed hypertension.ResultsAt baseline, plasma IL6 correlated with systolic blood pressure (SBP) (r = 0.128, P < 0.001). Hypertensive subjects had significantly higher plasma IL6 after adjusting for age and sex (geometric mean (95% confidence interval (CI) = 0.60 (0.54-0.65) vs. 0.47 (0.44-0.50) ng/l, P = 0.021). In multiple logistic regression, higher plasma IL6 was associated with hypertension in women (P = 0.009), but not in men. The minor G allele of SNP rs1800796 was associated with lower plasma IL6 (geometric mean (95% CI) = 0.46 (0.41-0.51) ng/l for CG and 0.49 (0.39-0.62) ng/l for GG vs. 0.53 (0.50-0.57) ng/l for CC, P = 0.005). However, this SNP was not associated with hypertension or blood pressure at baseline. Among subjects normotensive in CRISPS-2, plasma IL6 was not associated with the development of hypertension in CRISPS-3.ConclusionThe SNP rs1800796 affected plasma IL6 with a small effect size. Elevated plasma IL6 is associated with prevalent hypertension in women, but not incident hypertension.American Journal of Hypertension (2011). doi:10.1038/ajh.2011.141 [ABSTRACT FROM AUTHOR]

Background: Both medical and surgical abortions are popular in developing countries. However, the monetary costs of these two methods have not been compared. Methods: 430 women seeking abortions were recruited in 2008. Either a medical or surgical method was used for the abortion. We adopted the perspective of a third-party payer. Cost-minimization analysis was used based on all charges for the overall procedures in an out-patient clinic in Guangzhou, China. Results: 219 subjects (51%) chose a medical method (mifepristone and misoprostol), whereas 211 subjects (49%) chose a surgical method. The efficacy in the surgical group was significantly higher than in the medical group (100 vs. 90%, p < 0.001). Surgical abortion incurred much more costs than medical abortion on average after initial treatment. When the subsequent costs were accumulated within the 2-week follow-up, the mean total cost in the medical group increased significantly due to failure of abortion and persistent bleeding. Patients undergoing medical abortion eventually incurred equivalent expenses compared to patients undergoing surgical abortion (p = 0.42). Conclusions: There was no difference in the mean final costs between the two abortion methods. Complications of persistent bleeding and failure to abort (requiring surgical intervention) in the medical treatment group increased the final mean total cost substantially. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background In Western populations, informal child care is associated with childhood obesity. However, informal child care and obesity share social patterning making evidence from other settings valuable.Methods We used multivariable linear and logistic regression models to estimate the association of child care at 6 months and at 3, 5 and 11 years with body mass index (BMI) z-score and overweight (including obesity) at 11 years in a Hong Kong Chinese birth cohort. We assessed whether associations varied with sex or socio-economic position (SEP). We used multiple imputation for missing exposures and confounders.Results Of the original 8327 cohort members, 7933 are alive, participating and living in Hong Kong. At ~11 years, 6796 had their BMI clinically assessed. Higher SEP was associated with informal care. After imputation, informal care at each of 3, 5 or 11 years was separately associated with higher BMI z-score [3 years 0.10, 95% confidence interval (CI) 0.03–0.18, 5 years 0.12, 95% CI 0.04–0.21, 11 years 0.17, 95% CI 0.04–0.31] and with the presence of overweight [odds ratio (OR) 3 years 1.19, 95% CI 1.03–1.37, 5 years OR 1.20, 95% CI 1.03–1.40, 11 years OR 1.21, 95% CI 1.02–1.45], adjusted for sex, SEP and birth weight z-score. Current informal care had the strongest association. However, informal child care at 5 years also contributed. There was no evidence of differences by sex or SEP.Conclusions In a developed, non-Western setting, informal child care was associated with childhood obesity. Modifiable attributes of informal child care warrant investigation for obesity prevention. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the associations of parental smoking and secondhand smoke (SHS) exposure at home with smoking initiation among young children in Hong Kong. Methods: A prospective school-based survey of Hong Kong primary 2–4 students was conducted at baseline in 2006 and followed up in 2008. Self-administered anonymous questionnaires were used to collect information about smoking, SHS exposure at home, parental smoking, and sociodemographic characteristics. Cross-sectional and prospective associations of SHS exposure at home and parental smoking with student smoking were analyzed using logistic regression adjusting for potential confounders. Results: Cross-sectional association between parental smoking and ever smoking was significant with adjustment of sociodemographic characteristics but became insignificant after adjusting for home SHS exposure. Home SHS exposure mediated the association between parental smoking and students smoking (p = .03). Prospectively, parental smoking was not associated with smoking initiation after adjusting for home SHS exposure. Each day increase in home SHS exposure significantly predicted 16% excess risk of smoking initiation after adjusting for parental smoking. The prospective effect of parental smoking on smoking initiation was significantly mediated by baseline home SHS exposure (p < .01). Conclusions: Higher exposure to SHS at home predicted smoking initiation of young Chinese children in Hong Kong independent of parental smoking status. On the other hand, the effect of parental smoking on smoking initiation was mediated through SHS exposure at home. To prevent children from smoking as well as the harm of SHS exposure, parents and other family members should quit smoking or at least reduce smoking at home. [ABSTRACT FROM PUBLISHER]

ObjectiveTo study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults.DesignA prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated.SettingA hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China.SubjectsA total of 1010 Chinese adults aged 25–74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995–1996 were followed up for 9–14 years for the development of diabetes.ResultsA total of 690 (68·3 %) individuals completed follow-up during 2005–2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified (‘more snacks and drinks’, ‘more vegetables, fruits and fish’, ‘more meat and milk products’ and ‘more refined grains’). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes.ConclusionsThe more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes. [ABSTRACT FROM AUTHOR]

Background A male epidemic of ischaemic heart disease (IHD) emerges with economic development. It has previously been hypothesised that this epidemic is due to nutritionally driven levels of pubertal sex steroids, which lead to a more atherogenic body shape and lipid profile in boys but not girls, without any sex-specific effects on glucose metabolism. This study tests this hypothesis by examining the association of childhood meat eating with IHD risk in a developing Chinese population. Methods Multivariable linear and censored regression was used in a cross-sectional study of 19 418 Chinese older (≥50 years) men and women from the Guangzhou Biobank Cohort Study (phases 2 and 3) to assess the adjusted associations of childhood meat eating with waist to hip ratio (WHR), high-density lipoprotein cholesterol and fasting plasma glucose. Results Adjusted for age, childhood hunger, life-course socioeconomic position and current lifestyle childhood almost daily meat eating compared with less than weekly meat eating was associated with higher WHR (0.007, 95% CI 0.0003 to 0.01) in men but not women. No association with fasting glucose was observed. Conclusions Given the potential limitations of this study, especially the crude nature of the exposure and modest findings, the results should be considered as preliminary. However, they do lend support to the hypothesis that the male epidemic of premature IHD and sexual divergence in IHD rates that occur with economic development may be nutritionally driven in childhood. In elucidating the developmental origins of noncommunicable chronic diseases, more attention should be focused on the sociohistorical context and the role of puberty. [ABSTRACT FROM AUTHOR]

Background. Increasingly, researchers have begun to explore the association between depression and mortality. The current study examined the association between depressive symptoms and all-cause and cause-specific mortality in Chinese older people. Further to examine whether any associations were similar by sex and health status. Methods. We used the Chinese version of the 15-item Geriatric Depression Scale to measure depressive symptoms (Geriatric Depression Scale score ≥ 8) and Cox regression to examine the association with all-cause and cause-specific mortality in a population-based cohort study of all 56,088 enrollees, aged 65 years or older, from July 1998 to December 2000 at all 18 Elderly Health Centers of Department of Health of Hong Kong. The cohort was followed up for mortality till December 31, 2005. Results. Depressive symptoms were associated with all-cause mortality (hazard ratio 1.21, 95% confidence interval: 1.08–1.37) in men only (p value for sex interaction <.05) and with suicide mortality in men (hazard ratio 2.81, 95% confidence interval: 1.13–7.01) and women (hazard ratio 2.40, 95% confidence interval: 1.18–4.82) but not with other major causes of death after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. The associations did not vary with health status. Conclusions. Depressive symptoms were associated with all-cause mortality in men and with suicide in both sexes. Randomized controlled trials concerning the effects of treatment of depression on mortality are needed to clarify the causal pathways. [ABSTRACT FROM PUBLISHER]

Healthcare settings provide a major arena for administering smoking cessation interventions. However, few studies have reported differences in the frequency of practice in healthcare professionals by gender and smoking status. This might also be influenced by a difference in smoking prevalence by gender, especially in China and other developing countries. This study examined factors associated with the frequency of cessation intervention practices by smoking status among Chinese physicians in men and women. A cross-sectional survey was conducted in 2006 in physicians with direct patient contact from nine hospitals in Guangzhou with a response rate of 60.8%. Significantly more female physicians who were non-smokers (79.7%) reported 'initiation and/or advice' smoking cessation interventions than male physicians who were smokers (71.2%) and non-smokers (71.6%). Factors significantly associated with 'initiation and/or advice' were prior smoking cessation training (OR = 4.2, 95% CI 1.8-9.6) and lack of knowledge to help patients to quit (OR = 0.4, 95% CI 0.2-0.9) among male physicians who smoked; and organisational support (OR = 1.7, 95% CI 1.3-2.2) and successful past experience (OR = 0.4, 95% CI 0.2-1.0) among male physicians who did not smoke. Among female physicians who did not smoke, significant factors were agreeing that quitting smoking is the most cost-effective way to prevent chronic disease and cancer (OR = 3.0, 95% CI 1.4-6.1), helping patients stop smoking is part of expected role and responsibility (OR = 2.0, 95% CI 1.0-3.7), lack of knowledge to help patients to quit (OR = 0.5, 95% CI 0.2-1.0) and organisational support (OR = 1.3, 95% CI 1.0-1.6) for non-smoking female physicians. This study is the first to show that male physicians were less likely to provide smoking cessation counselling regardless of their smoking status while non-smoking female physicians were more active in advising patients on quitting. The findings highlight the need for developing tailored smoking cessation training programmes for physicians according to their smoking status and gender in China. [ABSTRACT FROM AUTHOR]

Objectives: To examine the time patterns and predictors of initiating a quit attempt and subsequent sustained abstinence among youth smokers after receiving a telephone smoking cessation intervention. Methods: This was a longitudinal study of 408 current youth smokers aged 12–25 years who called a smoking cessation hotline in Hong Kong. Telephone surveys were conducted at baseline; 1week; and 1, 3, and 6 months to assess smoking status and other risk factors. Nonparametric Kaplan–Meier methods and hierarchical Cox's proportional odds models were applied to explore the time patterns and predictors of the quitting process. Results: Half of the youth smokers initiated a quit attempt within 1 month after receiving the baseline telephone intervention, while the likelihood of further quit attempts decreased over time. Two thirds relapsed within the first 7 days after starting a quit attempt. Intention to quit, previous quit attempts, perceived physical unfitness, and other factors could predict the initiation of a quit attempt. Sustained abstinence was facilitated by making an immediate attempt to quit, adopting self-help strategies, and a perceived improvement in physical health. Conclusions: Our findings support the “catastrophic” pathway of youth smokers initiating a quit attempt. Counselors should capture the quitting momentum and motivate youth smokers to quit immediately. Interventions should include a health assessment and discussion of smokers’ physical fitness. During the first week of abstinence, intensive monitoring of withdrawal symptoms, together with booster counseling, is helpful in preventing smoking relapse and could remotivate those who fail to sustain their quit attempt. [ABSTRACT FROM AUTHOR]

Respiratory ill-health effects due to particulate air exposure at different geographical locations in Hong Kong that aggregate individual living locations were estimated based on satellite information. We assessed the presence of respiratory symptoms of a frequent cough or sputum in school students aged 11-20 years old (n = 9,881). Daily particulate air pollution levels at students' living locations were derived from the surface extinction coefficients measured by satellite and measurements from the air pollutant monitoring stations at ground level. Adjusted odds ratio (OR) [95% CI] of respiratory symptoms was 1.047 [1.005, 1.091] per 10 μg m-3 increase in PM10 concentration. Specificity tests showed that adjusted OR of having other symptoms is not significant (p = 0.20-0.94). Exposures to PM10 at different geographical locations is associated with increased odds of having respiratory symptoms (cough or sputum) but not with other symptoms unrelated to air pollution. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the study was to compare the impact of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on vascular function among older Chinese people. A random sample of 671 men and 603 women aged 50 to 85 years without known diabetes from the Guangzhou Biobank Study–CVD was examined in a cross-sectional study. Subjects with no previously confirmed or treated diabetes but with both fasting plasma glucose less than 5.6 mmol/L and 2-hour glucose from 7.8 to less than 11.0 mmol/L were classified as having isolated IGT, and those with no previously confirmed and treated diabetes but with both fasting plasma glucose from 5.6 to less than 7.0 mmol/L and 2-hour glucose less than 7.8 mmol/L were classified as having isolated IFG. A total of 11.0% of the men and 8.6% of the women had isolated IFG, and 17.7% of the men and 18.6% of the women had isolated IGT. The brachial-ankle pulse wave velocity and pulse pressure were increased in both the isolated IFG and isolated IGT subjects compared with the normoglycemia group (both Ps < .001). Compared with subjects with isolated IFG, those with isolated IGT appeared to have a higher age- and sex-adjusted brachial-ankle pulse wave velocity (1543 ± 22 vs 1566 ± 17, P = .07) and to be more insulin resistant (2-hour postload insulin: 54.2 ± 2.13 vs 26.8 ± 2.99 μU/mL, P < .001), had a worse lipid profile (apolipoprotein [apo] B: 1.07 ± 0.02 vs 0.97 ± 0.02g/L, P < .001; apo B/apo A-1 ratio: 0.80 ± 0.02 vs 0.69 ± 0.02, P < .001), but had lower glycosylated hemoglobin levels (6.03% ± 0.06% vs 5.86% ± 0.04%, P < .001) (values are mean ± SE). Subjects with isolated IGT had greater arterial stiffness, probably as a result of being more insulin resistant, with a worse lipid profile than those with isolated IFG. The sole use of fasting glucose level to identify prediabetic people would fail to identify a significant proportion of the at-risk population. [Copyright &y& Elsevier]

There have been several studies in Western societies on the causes and consequences of sexual satisfaction within marriage. Little is known, however about the marital sexual relationship in Chinese societies. Moreover, most published studies used married individuals rather than married couples as participants. The present study examined data from a well-established knowledge, attitude, and practice (KAP) survey of 1,124 Hong Kong Chinese couples on martial sexual relationship. A conceptual model was tested using structural equation modeling (SEM). Interest in sex was found to be the strongest predictor of both sexual satisfaction and frequency of sex for both husbands and wives. Among the sociodemographic variables, the following two were significantly associated with lower frequencies of sex: for wives, that of having a full-time job; and for husbands, the factor of age. Theoretical implications for research on the interplay among culture, marriage, and sex in non-Western societies are discussed. [ABSTRACT FROM AUTHOR]

Objectives. Better childhood conditions, inferred from height and specifically leg length, are usually protective against ischemic heart disease and its risk factors in Western countries. In other geo-ethnic populations, height is less clearly protective, casting doubt on there being a biological etiology. To clarify the role of childhood conditions, we examined the associations of height and its components with cardiovascular risk among older Chinese people. Methods. We used multivariable regression to examine the associations of height and its components with blood pressure, lipid profile, and diabetes in 10413 older Chinese adults (mean age = 64.6 years). Results. After we adjusted for age, gender, socioeconomic status, and lifestyle habits, greater sitting height was associated with diabetes and dyslipidemia. Longer legs were associated with lower pulse pressure and lower low-density lipoprotein cholesterol. Conclusions. We provide indirect anthropometric evidence for the role of prepubertal and pubertal exposures on cardiovascular risk. Pubertal exposures are stronger than are prepubertal exposures but may be influenced by osteoporotic decline in old age. Further research should establish whether the observed relations are ethnically specific or relate to the stage or trajectory of socioeconomic development. (Am J Public Health. 2007;97:1834-1841. doi:10.2105/AJPH.2006.088096) [ABSTRACT FROM AUTHOR]

OBJECTIVE -- We investigated the association of the metabolic syndrome with new-onset diabetes in the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort. RESEARCH DESIGN AND METHODS -- We followed up on 1,679 subjects without diabetes at baseline. Those with a previous diagnosis of diabetes or those who were receiving drug treatment were considered to be diabetic. The remaining subjects underwent a 75-g oral glucose tolerance test (OGTT). Diabetes was defined by plasma glucose ≥7.0 mmol/l with fasting and/or ≥11.1 mmol/l at 2 h. RESULTS -- The prevalences of the metabolic syndrome at baseline were 14.5 and 11.4%, respectively, according to U.S. National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. After a median of 6.4 years, there were 66 and 54 new cases of diabetes in men and women, respectively. The metabolic syndrome at baseline predicted incident diabetes. Hazard ratios (HRs) for the NCEP and IDF definitions of the syndrome were 4.1 [95% CI 2.8-6.0] and 3.5 [2.3-5.2], respectively. HRs for fasting plasma glucose (FPG) ≥6.1 or 5.6 mmol/l were 6.9 [4.1-11.5] and 4.1 [2.8-6.0], respectively. The NCEP and IDF criteria had 41.9 and 31.7% sensitivity and 87.5 and 90.2% specificity, respectively. Their positive predictive values were low, ∼20%, but their negative predictive values were ∼95%. CONCLUSIONS -- The metabolic syndrome, particularly its component, elevated FPG, predicts diabetes in Chinese. An individual without the metabolic syndrome is unlikely to develop diabetes, but one who has it should practice therapeutic lifestyle changes and have periodic FPG measurements to detect new-onset diabetes. [ABSTRACT FROM AUTHOR]

Abstract: This study assessed the gender and age differences in smoking cessation among the Chinese youth and identified factors associated with quitting smoking. This was a clinic based cross-sectional study with longitudinal components among 129 Chinese young smokers. All services in the clinic including one week''s supply of nicotine replacement therapy (NRT) were free. We used structured questionnaires at baseline and at 1, 3 and 12 months. The analysis was by intention-to-treat basis. At 12 month follow up, the 7 day point prevalence quit rate (abstinence from tobacco smoking during the 7 days preceding the follow up) was 19% (25/129) and 36% (25/69) among all the attendees and among those who were successfully followed up, respectively. There was no significant gender or age differences in the quitting outcome but females and the older youth reported more withdrawal symptoms. Not reporting any withdrawal symptoms at 3 months follow up and adherence to use NRT for at least 4 weeks were significant predictors of quitting. A clinic-based smoking cessation service among Chinese young smokers produced an acceptable quit rate with no gender and age difference, indicating that a more general quit smoking approach could be taken for the youth. [Copyright &y& Elsevier]

Objective To examine whether telephone counselling based on the stages of change component of Transtheoretical model of behaviour change together with educational materials could help non-motivated smoking parents of young children to cease. Design Randomised controlled trial. Setting Hong Kong Special Administrative Region, PR China. Participants 952 smoker fathers and mothers of Chinese children aged 5 years. Intervention Participants were randomly allocated into two groups: the intervention group received printed self-help materials and three-session telephone-based smoking cessation counselling delivered by trained counsellors; the control group received printed self-help materials only. A structured questionnaire was used for data collection at baseline and at 1, 3 and 6 month follow up. Main outcome measures The main outcome is 7 day point prevalence quit rate at 6 months (defined as not smoking during the 7 days preceding the 6 month follow up) determined by self reports. Other secondary outcomes were self reported 24 h point prevalence quit rate and self-reported continuous quit rate and bio-chemically validated quit rate at 6 months. Results A total of 952 smoker fathers and mothers were randomized to the intervention ( n = 467) and control ( n = 485) groups. Most were daily smokers (92.4%) and the mean number of cigarettes smoked per day was 14.5 (SD = 8.9). By using intention-to-treat analysis, the 7 day point prevalence quit rate at 6 month follow up was significantly greater in the intervention group (15.3%; 68/444) than the control group (7.4%; 34/459) ( P < 0.001). The absolute risk reduction was 7.9% (95% confidence interval: 3.78% to 12.01%). The number needed to treat to get one additional smoker to quit was 13 (95% CI: 8–26). The crude odds ratio of quitting was 2.3(95% CI: 1.5–3.5). The adjusted odds ratio was 2.1 (95% CI: 1.4–3.4) (adjusted for age, number of years smoked, and alcohol dependency). Conclusion Proactive telephone counselling is an effective aid to promote smoking cessation among parents of young children. [ABSTRACT FROM AUTHOR]

Among the many personal, social and environmental risk factors of adolescence smoking, normative beliefs stand out for their potential to be modified with factual information on smoking prevalence. To study the perceived peer smoking prevalence and its association with smoking behaviours in Hong Kong Chinese adolescents. Cross-sectional territorial-wide school-based survey conducted in 64 randomly selected secondary schools in Hong Kong. A total of 13 280 forms 1–3 students (equivalent to grades 7–9 in the United States) aged 12–16 years. Perceived peer smoking prevalence, smoking status, intention to smoke in future, other smoking-related factors and demographic information. Overestimation of peer smoking prevalence was observed regardless of gender and smoking status, and was more common in girls (69.4%) than boys (61.0%), and in experimental (74.3%) and current smokers (85.4%) than in never smokers (60.7%). Boys who overestimated and grossly overestimated (over two times) peer smoking were more likely to be current smokers, with adjusted odds ratios and 95% confidence intervals (95% CI) of 1.95 (1.24–3.07) and 3.52 (2.37–5.24) ( P for trend <0.001). Similarly, boys who grossly overestimated peer smoking were 76% (95% CI: 41–120%) more likely to have ever smoked. Overestimation of peer smoking prevalence was common in Hong Kong Chinese boys and girls, and was associated with current and ever smoking in boys. These findings have important implications on normative education in adolescence smoking prevention programmes. [ABSTRACT FROM AUTHOR]

Background Recognizing the suboptimal public health effects of a complete cessation strategy for parents and child caregivers who smoke, some researchers have called for a harm reduction approach; however, the evidence remains scanty and controversial. Objective To examine the effects of secondhand smoke and smoking hygiene on infant health and related health care costs during the first 18 months of life. Methods We conducted prospective follow-up on 8327 newborns during April and May of 1997 for 18 months in a population-based birth cohort of infants from Hong Kong, China. Main Outcome Measures Number of hospital admissions, adjusted odds ratios for ever hospitalization for each secondhand smoke exposure variable, and corresponding population attributable risks. Results Most secondhand smoke exposure came from fathers and other household contacts, whereas only 2.8% of mothers smoked postpartum. The odds ratio of ever hospitalization due to all illnesses combined for infants living in a household with any (maternal, paternal, or other) smoker who was smoking at least 3 m away from the infant, as reported by a parent, was 1.00 (95% confidence interval, 0.88-1.13) compared with those in a smoke-free household. The corresponding odds ratio for infants living with any smoker at home with poor smoking hygiene (<3 m away) was 1.28 (95% confidence interval, 1.07-1.52), which translated into 2.8% of all inpatient episodes in the first year of life, representing an additional 616 admissions. Conclusions Hospital admission was significantly more likely among infants exposed to secondhand smoke if it was accompanied by poor smoking hygiene. Harm reduction strategies should be rigorously adhered to when complete cessation is not possible. [ABSTRACT FROM AUTHOR]

Background: We propose general health promotion action (GHPA) to represent the general intention and actual practices aimed to promote health. The transtheoretical model (TTM) has not been applied to GHPA. The objectives of this study were to determine whether TTM can be applied to Chinese adults by measuring the subjects'' stage of change for GHPA, and to study whether stage for GHPA is associated with health-related lifestyle practices.Methods: Randomly selected Hong Kong Chinese subjects (3233) aged 18–64 were interviewed in telephone survey.Results: Thirty-nine percent had not taken any health promotion actions and had no intention to do so (precontemplation). Twelve percent had taken action but had no intention to continue (at-risk for relapse). Three percent had not taken any actions and intended to do so in the next 6 months, but not in the next 1 month (contemplation). Eleven percent had not taken any actions but intended to do so in the next 1 month (preparation). Fifteen percent had been taking action for less than 6 months and intended to continue (action). Twenty-one percent had been taking action for at least 6 months and intended to continue (maintenance). Precontemplators were less likely than maintainers to be never smokers (OR = 0.62; 95% CI = 0.49–0.80), exercisers (0.097; 0.077–0.12), to eat fruit twice a day (0.53; 0.41–0.69) and remove fat when eating (0.72; 0.54–0.95), with increasing trends in the odds of reporting these practices from precontemplation to maintenance.Conclusions: Our findings have provided preliminary findings on the applicability of TTM on GHPA in Chinese adults with evidences of concurrent criterion validity. [Copyright &y& Elsevier]

: PurposeTo study whether serum triglyceride (TG) was associated with coronary heart disease (CHD) mortality.: MethodsA cohort analytic study carried out in a machinery factory in Xi''an, China on 1696 subjects aged 35 years or above (1124 men and 572 women) examined in 1976 and followed up till 2000.: ResultsAt baseline, the mean serum total cholesterol (TC) and triglyceride (TG) was 4.64 and 1.16 mmol/L in men, 4.62 and 1.10 mmol/L in women, respectively. Three hundred six (239 men, 67 women) had died within 37,781 person-years of follow-up, with 49 CHD deaths (36 male, 13 female). The relative risk (95% confidence interval) of CHD mortality per mmol/L increase in TG was 2.13 (1.46–3.17) after adjusting for age, marital status, occupation, education, systolic blood pressure and TC. Dose–response relationship between TG levels by tertiles and CHD risk was found. Stratified analyses showed TG was an independent predictor for CHD mortality in subjects with lower or higher TC.: ConclusionsChinese had lower levels of TC and TG than Western populations. This study provides new evidence that TG is an independent risk factor of CHD in subjects with lower or higher TC levels, and supports the lowering of cut-off value for elevated triglyceride. [Copyright &y& Elsevier]

The prevalence of sexual media use, and factors associated with it, among Chinese young adults were studied in Hong Kong. Questions on use of sexual media were asked as part of a youth sexuality study conducted by the Family Planning Association in 1996. In a population-based cross-sectional study, 517 men and 447 women aged 18-27 years completed an anonymous structured self-administered questionnaire. The overall prevalence [95% confidence interval (CI)] of ever purchased or rented any type of sexual media was 57.8% (54.7-60.9). More men (70.2%; 95% CI: 66.3-74.2) than women (43.4%; 95% CI: 38.8-48.0) used sexual media. Of 31 independent variables tested by stepwise logistic regression, seven variables significantly predicted sexual media use: age (adjusted odds ratio OR = 1.5 for 21-24 and 1.8 for 25-28, versus 20 or below), male gender (OR = 3.0), number of sexual partner (OR = 2.2 for one and 2.8 for two or more partners), masturbation in the past week (OR = 3.2), being out of school (OR = 1.5), quarrel with family member in past 6 months (OR = 1.8), and religion (OR = 1.6 for no religion and 3.4 for traditional Chinese religion, versus Christians) (all adjusted OR:p < 0.05). [ABSTRACT FROM AUTHOR]

This population-based cross-sectional study examined the associations between smoking and perceived health in Hong Kong. 6117 healthy Chinese (3053 men, 3064 women), aged 25–74 years, were randomly selected for telephone interviews in Hong Kong in 1994–96. Adjusted odds ratios (ORs) of having poor or very poor perceived health (against good or very good) were calculated. In men, the ORs (and 95 percent confidence intervals) for current smokers in young (25–39) and middle age (40–59) were close to unity, but that of 1.97 (1.01, 3.85) in old age (60–74) was significantly raised. The adjusted ORs for male quitters were 1.98 (0.43, 9.14), 1.70 (0.75, 3.81) and 2.59 (1.23, 3.33) for young, middle and old age, respectively. Compared with current smokers, the adjusted ORs for quitters was 2.30 (1.07, 4.92) for those who had quit for less than 5 years, 2.02 (0.80, 5.11) for 5–9 years and 1.14 (0.47, 2.75) for 10 years or more. Among former smokers, each year of quitting was associated with 7 percent reduction in reporting poor or very poor perceived health with OR of 0.93 (0.85, 1.01). In women, the ORs were 1.95 (1.15, 3.28) for current and 1.54 (0.60, 3.94) for former smokers. In both genders combined, the overall ORs were 1.41 (1.04, 1.92) for current and 1.94 (1.27, 2.97) for former smokers. In conclusion, former smokers apparently had the worst perceived health but long-term quitting was beneficial. Overall, current smokers had worse perceived health than never smokers, but in men the excess risk was mainly observed in old age. The perceived health of smokers may have implications for the approaches used in smoking cessation. [Copyright &y& Elsevier]

Objective To estimate the prevalence and pattern of alcohol use and to analyse the socio-demographic and biological correlates of alcohol drinking in Hong Kong Chinese. Design A population-based cross-sectional study conducted from December 1994 to October 1996. Setting and participants 2900 randomly selected subjects age 25-74 years who participated in the Cardiovascular Risk Factor Prevalence Study in Hong Kong. Results Alcohol consumers comprised 55.4% (95% CI: 52.8-58.0) of men and 19.4% (95% CI: 17.4-21.4) of women. The median weekly ethanol consumed by male and female drinkers were 9.6 g and 3.6 g, respectively. Beer was the main source of alcohol; 61.5% of drinkers consumed beer as their main drink. In stepwise multiple regression among drinkers, male sex, smoking, high density lipoprotein cholesterol, primary or below education, diastolic blood pressure and separated or widowed marital status were associated positively with weekly ethanol consumption Conclusion In this representative sample of Hong Kong adults, the majority were either non-drinkers or very light drinkers, which can be used as a benchmark to measure changes in drinking pattern in the future. The putative protective effect of alcohol on heart disease could be due to the higher level of HDL in moderate drinkers. [ABSTRACT FROM AUTHOR]

Objective To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992. Design The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of a patient interview followed by a debriefing group tutorial. In-depth interviews with the same patient allow students to explore the impact of disease and patients' illness experience, as well as the contribution of the wider determinants of health to their condition. The debriefing tutorial frames empirical observations into theoretical models and its format reinforces habits of problem-based learning. The programme was evaluated using survey questionnaires completed by students, patients and tutors. Participants 324 first- and second-year medical students. Results Students, participating patients and tutors all rated the PCP positively in end-of-course evaluations. Specifically, 68% of students commented that the PCP had met all or most of its stated objectives, while there was nearly unanimous agreement among patients that students demonstrated understanding and empathy in the visits and interviews. Tutor appraisal of student performance also indicated the attainment of all stated aims and objectives overall. Conclusions The PCP is a valuable contribution to community-based learning and the promotion of the patient-centred clinical method. [ABSTRACT FROM AUTHOR]

Background: Low breastfeeding rates are an issue of international public health concern. Anecdotal reports suggest very low breastfeeding rates in Asia, but no population-based studies have been conducted in the region. To determine the secular trend in breastfeeding practice in an Asian postindustrialized metropolitan community, we examined data from two population-based birth cohorts of Hong Kong infants in 1987 and 1997. Methods: Annual population rates of breastfeeding initiation and duration were estimated from the birth cohorts, considering the change in breastfeeding rates over 10 years with correction for sociodemographic and birth characteristics. Factors associated with breastfeeding practice were identified using multivariate logistic regression modeling in a pooled analysis of individual data of both cohorts. Results: Overall, 26.8 percent of mothers initiated breastfeeding in 1987, and the rate increased to 33.5 percent in 1997. The rate would have been 27.4 percent in 1987 if the distributions of method of delivery, birthweight, birth order, maternal age, education, and employment status had been the same as in 1997. Only 7.6 percent of infants remained on the breast for more than 1 month in 1987 compared with 20.4 percent a decade later. Similarly, the rate for breastfeeding more than 3 months increased from 3.9 to 10.3 percent. Total breastfeeding duration was significantly longer in 1997 than 10 years earlier. Conclusions: This is the first systematic report of secular variations of breastfeeding rates in Asia. Hong Kong should set higher but realistic goals for breastfeeding that emphasize both initiation and maintenance. Given the wide latitude for improvement in terms of readily modifiable risk factors, such as smoking and cesarean section, these new goals should focus on improving rates in these targeted groups where breastfeeding rates are lowest. (BIRTH 29:3 September 2002). [ABSTRACT FROM AUTHOR]

PURPOSE: To compare the mortality risk of smoking and overall occupational exposure in Guangzhou, China.METHODS: Baseline data on smoking and occupational exposure of 82159 workers aged 30+ were retrieved from medical records established in 1988—92. Vital status and causes of death were followed through 1998.RESULTS: During follow-up 1584 workers had died. Adjusted relative risks (RR) with 95% confidence intervals (95%CI) for ever-smoking in men was 1.23 (1.07–1.41) for total deaths, 1.43 (1.17–1.74) for all cancer, 3.77 (2.31–6.14) for lung cancer and 2.54 (1.09–5.92) for stomach cancer (all showing significant linear trends with amount and duration of smoking). The RR in women of 1.10 (0.59–2.06) for total deaths and 1.60 (0.65–3.92) for all cancer were positive but not significant. No significant excess mortality risk was observed for occupational exposure in each gender. In both genders combined, the RR for total deaths was 1.23 (1.08–1.40) for smoking and 1.07 (0.96–1.19) for occupational exposure. If the relationships were causal, 12% of all deaths could be attributed to smoking but only 3% to occupational exposure.CONCLUSION: Smoking was more predictive of premature deaths than overall occupational exposures in middle aged workers. Smoking cessation should be a top priority in occupational health practice. [Copyright &y& Elsevier]