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Background and Aim: Obesity has been a global public health issue due to the increasing mortality rate and prevalence among children. However, there are scarce studies on obesity prevalence in Hong Kong children. The study aims to identify the risk factors of obesity among primary and secondary school students by assessing the relationship between sociodemographic factors, health‐related behaviors, and social relationships. Methods: Self‐administrated surveys were collected from 30 primary schools and 25 secondary schools participating in the "Quality Education Fund Thematic Network on Health Schools" project. Descriptive analysis was conducted to examine the proportions of different characteristics and to compare the disparity between primary and secondary school students with obesity. Results: A total of 4884 responses were collected. A larger proportion of primary school students with obesity were male (adjusted odds ratio [aOR]: 2.55, 95% confidence interval [CI]: 1.77–3.67, p < 0.001) and actively gamed (aOR: 1.64, 95% CI: 1.07–2.51, p = 0.024). Secondary school students with obesity were male (aOR: 1.61, 95% CI: 1.21–2.13, p = 0.001), had poor self‐perceived academic performance (aOR:1.51, 95% CI: 1.10–2.08, p = 0.011) and expressed higher life satisfaction (family) (aOR: 1.13, 95% CI: 1.01–1.26, p = 0.032). There were negative associations found between obesity and physical activity, high consumption of sugary drinks, chocolate or candies, and insufficient consumption of vegetables. Conclusion: Male sex, physical inactivity, low self‐perecived academic performance, and poor dietary behaviors were the risk factors for obesity among primary and secondary school students. The findings highlighted the importance of identifying younger individuals who were at risk of becoming clinically obese. Further studies should explore the effectiveness of various interventions through longitudinal study. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to devise and validate a clinical scoring system for risk prediction of bladder cancer to guide urgent cystoscopy evaluation among people with diabetes. Methods: People with diabetes who received cystoscopy from a large database in the Chinese population (2009–2018). We recruited a derivation cohort based on random sampling from 70% of all individuals. We used the adjusted odds ratios (aORs) for independent risk factors to devise a risk score, ranging from 0 to 5: 0–2 'average risk' (AR) and 3–5 'high risk' (HR). Results: A total of 5905 people with diabetes, among whom 123 people with BCa were included. The prevalence rate in the derivation (n = 4174) and validation cohorts (n = 1731) was 2.2% and 1.8% respectively. Using the scoring system constructed, 79.6% and 20.4% in the derivation cohort were classified as AR and HR respectively. The prevalence rate in the AR and HR groups was 1.57% and 4.58% respectively. The risk score consisted of age (18–70: 0; >70: 2), male sex (1), ever/ex‐smoker (1) and duration of diabetes (≥10 years: 1). Individuals in the HR group had 3.26‐fold (95% CI = 1.65–6.44, p = 0.025) increased prevalence of bladder than the AR group. The concordance (c‐) statistics was 0.72, implying a good discriminatory capability of the risk score to stratify high‐risk individuals who should consider earlier cystoscopy. Conclusions: The risk prediction algorithm may inform urgency of cystoscopy appointments, thus allowing a more efficient use of resources and contributing to early detection of BCa among people planned to be referred. [ABSTRACT FROM AUTHOR]

Background: Health literacy is essential in the promotion of healthy lifestyle habits and chronic disease prevention. Objective: To assess the health literacy level among Hong Kong adolescents; to evaluate the association between access of an online health information platform (GoSmart Channel) and health literacy level; and to examine the association between health literacy level and various unhealthy behaviours. Design: This study recruited students from 10 local secondary schools in Hong Kong to assess the health literacy level among adolescents. Settings and Participants: Participants were required to complete a self‐administered questionnaire on health behaviours and health literacy using the Health Literacy Measure for Adolescents (HELMA). Main Outcome Measure: Data were analysed using descriptive statistics and multivariate regression modelling. Results: A total of 777 responses were collected. Overall, most (74.4%) of the adolescents in Hong Kong have limited health literacy (HELMA score <66). The majority (63.7%) of adolescents relied on their parents for health information, while 11.4% of the respondents sought information from the GoSmart Channel. The intervention of GoSmart Channel was significantly associated with better health literacy in almost all aspects among adolescents. Desired levels of health literacy were significantly associated with better perceived health (adjusted odds ratio: 2.04, p =.001) and negatively associated with a range of unhealthy and risky behaviours including unhealthy dietary habits, poor hygienic measures and physical inactivity. Discussion and Conclusion: This study highlights the importance of improving health literacy among Hong Kong adolescents and the potential of technology‐based interventions. The findings suggest the need for continued efforts to promote health literacy and healthy behaviours among adolescents, especially given the limited health literacy levels observed in the study. Patient or Public Contribution: Members of the GoSmart.Net Built‐on Project patient and public involvement and engagement group advised about survey development. [ABSTRACT FROM AUTHOR]

Background: This cross‐sectional study aimed to investigate the association between negative mental health conditions and demographic characteristics, socioeconomic background and health‐related parameters in both Hong Kong's primary and secondary school students. Methods: A self‐administrated survey was conducted and investigated the prevalence of negative mental health conditions (psychological stress, depression and suicidality) in students from 30 primary schools and 25 secondary schools in Hong Kong in 2017. The Kessler Psychological Distress Scale (K6) was chosen as the instrument to evaluate non‐specific psychological distress. Depression was evaluated using the prolonged feeling of despair as a proxy. Suicidality was measured by four questions on whether they had ever intentionally injured themselves, seriously considered attempting suicide, planned how they would attempt suicide and had attempted suicide. Multiple logistic regression models examined the explanatory factors' association with mental health conditions after adjusting for confounding, using the enter method. Results: A total of 4884 responses were collected. It is found that both very high and low parent expectations were risk factors for multiple conditions, namely suicidality and psychological distress among primary school students, and psychological distress among secondary school students. As for primary school students, the experience of being bullied was a significant risk factor for all conditions. A significant association was found between having one's own bedroom and suicidality amongst primary school students; whilst having three close friends or more and higher life satisfaction levels were significantly associated with a lower risk of negative mental health conditions among secondary school students. Conclusions: It was found that having one's own bedroom was a risk factor for suicidality among primary school student. Parents should be alert to the risky behaviours of children, have more involvement in children's daily life and build a supportive and caring family environment for children. For secondary school students, as the importance of friends is greatly increased, teachers should encourage students to engage in extra‐curricular activities in school. [ABSTRACT FROM AUTHOR]

Background: Worldwide, gastric cancer is a leading cause of cancer incidence and mortality. This study aims to devise and validate a scoring system based on readily available clinical data to predict the risk of gastric cancer in a large Chinese population. Methods: We included a total of 6,209,697 subjects aged between 18 and 70 years who have received upper digestive endoscopy in Hong Kong from 1997 to 2018. A binary logistic regression model was constructed to examine the predictors of gastric cancer in a derivation cohort (n = 4,347,224), followed by model evaluation in a validation cohort (n = 1,862,473). The algorithm's discriminatory ability was evaluated as the area under the curve (AUC) of the mathematically constructed receiver operating characteristic (ROC) curve. Results: Age, male gender, history of Helicobacter pylori infection, use of proton pump inhibitors, non‐use of aspirin, non‐steroidal anti‐inflammatory drugs (NSAIDs), and statins were significantly associated with gastric cancer. A scoring of ≤8 was designated as "average risk (AR)". Scores at 9 or above were assigned as "high risk (HR)". The prevalence of gastric cancer was 1.81% and 0.096%, respectively, for the HR and LR groups. The AUC for the risk score in the validation cohort was 0.834, implying an excellent fit of the model. Conclusions: This study has validated a simple, accurate, and easy‐to‐use scoring algorithm which has a high discriminatory capability to predict gastric cancer. The score could be adopted to risk stratify subjects suspected as having gastric cancer, thus allowing prioritized upper digestive tract investigation. [ABSTRACT FROM AUTHOR]

Aim: To investigate the risk factors associated with physical inactivity of young children in Hong Kong. Methods: This follow‐up study was part of a prospective cohort study named Studying Impact of Nutrition on Growth (SING) initiated in 2015. Subjects were recruited from randomly selected local nurseries and kindergartens in Hong Kong. Self‐administrated questionnaires were distributed to parents in 2016–2017 to collect information on: (i) socio‐economic background; (ii) health‐related factors, including gestation at time of birth, and hospitalisation of the child since birth; (iii) types of leisure activities, including time spent on electronic games and physical activity. Results: A total of 1681 responses were collected. A higher likelihood of physical inactivity on weekdays was associated with being female, not being the firstborn, having been hospitalised three or more times since birth, and having physically inactive care givers. Meanwhile, children whose mother was unemployed/retired, and who spent more than 1 h on electronic games per day were significantly less likely to be physically inactive. Similarly, being female, being the secondborn or the thirdborn, and having a care giver with low physical activity level were associated with a higher chance of physical inactivity on weekends. Conclusions: Parental support could play a pivotal role in determining a child's physical activity level. Public health policies should be implemented to promote family‐based physical activities. [ABSTRACT FROM AUTHOR]

Background and Aim: Worldwide, colorectal cancer (CRC) is the third most common cancer and ranks second among the leading causes of cancer death. This study aims to devise and validate a scoring system based on metabolic parameters to predict the risk of advanced colorectal neoplasia (ACN) in a large Chinese population. Methods: This was a cohort study of 495 584 symptomatic subjects aged 40 years or older who have received colonoscopy in Hong Kong from 1997 to 2017. The algorithm's discriminatory ability was evaluated as the area under the curve (AUC) of the mathematically constructed receiver operating characteristic curve. Results: Age, male gender, inpatient setting, abnormal aspartate transaminase/alanine transaminase, white blood cell, plasma gamma‐glutamyl transferase, high‐density lipoprotein cholesterol, triglycerides, and hemoglobin A1c were significantly associated with ACN. A scoring of < 2.65 was designated as "low risk (LR)." Scores at 2.65 or above had prevalence higher than the overall prevalence and hence were assigned as "high risk (HR)." The prevalence of ACN was 32% and 11%, respectively, for HR and LR groups. The AUC for the risk score in the derivation and validation cohort was 70.12%. Conclusions: This study has validated a simple, accurate, and easy‐to‐use scoring algorithm, which has a high discriminatory capability to predict ACN in symptomatic patients. Future studies should examine its predictive performance in other population groups. [ABSTRACT FROM AUTHOR]

In January 2021, the eHealth App was launched in Hong Kong by the Hong Kong government to support the Electronic Health Record Sharing System (eHRSS). A Health Management Module in the eHealth App introduced new functions to record blood pressure, blood sugar, and heart rate, and downloading and sharing records. This study aims to compare the level of glycaemic control between users of the eHealth App and non-users. Type 2 diabetes patients who have joined the eHRSS with existing haemoglobin A1c (HbA1c) level records are recruited. Correlations between predictors and optimal HbA1c control (<7%) are examined using logistic regression analyses. A total of 109,823 participants are included, with 76,356 non-users of eHealth App, 31,723 users of eHealth App, and 1744 users of the eHealth Management Module together with the App. We collect HbA1c values from Jan 2021 to May 2022, and they are 6 months after the use of the App on average. Users of the eHealth Management Module are found to have more optimal HbA1c levels across all subgroups, with the strongest effect observed in younger females (aOR = 1.66, 95% CI = 1.27–2.17). eHealth App usage is also positively associated with optimal HbA1c levels, particularly amongst younger females (aOR = 1.17, 95% CI = 1.08–1.26). Overall, users of eHealth App and eHealth Management Module demonstrate more optimal HbA1c levels when compared with non-users, particularly among younger adults and females. These findings support its potential adoption in diabetes patients. Future studies should examine the impact of eHealth interventions on other clinical targets and diabetes complications. [ABSTRACT FROM AUTHOR]

Childhood vaccination is crucial to protect young children from harmful infectious diseases. This study aimed to investigate the recent childhood immunization rate of recommended and additional vaccinations and identify the factors affecting the vaccination uptake of young children in Hong Kong. The self-administrated questionnaires were distributed to parents of toddlers aged 2 to 5. They were asked to provide information on (1) socioeconomic demographic factors; (2) experiences during pregnancy; and (3) the medical history of the toddler. A total of 1799 responses were collected. Children were more likely to be fully vaccinated when they were at a younger age (aOR = 0.61, 95% CI: 0.48–0.78, p < 0.001), the first child in the family (aOR second-born = 0.62, 95% CI: 0.48–0.81, p < 0.001; aOR third-born = 0.33, 95% CI: 0.19–0.55, p < 0.001), had a higher household income (aOR HKD 15,000–HKD 29,999 = 1.80, 95% CI: 1.27–2.55, p = 0.001; aOR ≥ HKD 30,000 = 3.42, 95% CI: 2.39–4.90, p < 0.001; compared with

Invasive pneumococcal disease (IPD) is a leading cause of disability and mortality worldwide, particularly in the elderly population. With the implementation of the Government Vaccination Programme (GVP) and the Vaccination Subsidy Scheme (VSS), enabling factors and barriers in service provider scheme participation and vaccination uptake were examined in 32 interviews with doctors and 16 interviews with vaccine recipients. Interview data were analysed in NVivo 11.0 with reference to the Consolidated Framework for Implementation Research (CFIR) and the REAIM Framework to develop codes and themes. Barriers to pneumococcal vaccination uptake included concerns on vaccine efficacy and poor understanding of the disease and vaccine schemes, whilst service provider participation was hindered by ill-defined parameters for patient eligibility and time, location, and logistical constraints. Enabling factors to improve intervention implementation were involvement of the government and physicians to encourage participation, clarifying eligibility criteria, and improving individual knowledge of IPD and vaccination schemes. As participation rates in the GVP and VSS remains low in Hong Kong, efforts concentrating on health promotion strategies encouraging pneumococcal vaccination amongst the elderly population are recommended. [ABSTRACT FROM AUTHOR]

• We compared strategies of influenza and 23-valent polysaccharide vaccine (PPV23). • When compared with no vaccine, all vaccine strategies were cost-effective. • The earlier age of PPV23 was cost-effective in comparison with current programme. • Our findings could help inform design and implementation of vaccination strategies. Pneumococcal infection is a leading cause of morbidity and mortality. We aimed to evaluate the cost-effectiveness of 23-valent polysaccharide vaccine (PPV23) together with influenza vaccination or pneumococcal vaccination alone in adults starting from 50 years vs. 65 years in Hong Kong. A hypothetical population of 100,000 older adults was included in a Markov model with age ranging from 50 to 85 years to calculate the cost and quality-adjusted life-years (QALYs) gained for vaccination strategies, including: (1) annual influenza vaccine and PPV23 at 50 and 65 years; (2) annual influenza vaccine and PPV23 at 65 years (similar with the current vaccination programme); (3) PPV23 at 50 and 65 years; (4) PPV23 at 65 years; and (5) no vaccination. We evaluated the incremental cost-effectiveness ratio (ICER) and used Monte Carlo simulation for probabilistic sensitivity analysis. The cost-effectiveness threshold was extracted from previous literature. In comparison with no vaccination, all strategies were cost-effective with ICERs less than the threshold (US$24,302 per QALY gained). When compared with no vaccination, strategies 1–4 saved US$ 49.5, US$ 94.9, US$ 584.3, and US$ 1114.2 to gain one QALY respectively. In comparison with strategy 2, strategy 1 spent US$ 195.3 to gain one QALY, whilst strategies 3 and 4 showed less effectiveness with increased costs. All vaccination strategies were cost-effective, among which the strategy of PPV23 at 50/65 years with annual influenza vaccine was cost-effective even in comparison with current vaccination programme. These findings could help inform the design and implementation of vaccination strategies. [ABSTRACT FROM AUTHOR]

Pneumococcal infection is a leading cause of disability and death globally. The Hong Kong Government has launched two programmes for pneumococcal vaccination - The Vaccination Subsidy Scheme (VSS) and the Government Vaccination Programme (GVP). This study aimed to examine the enabling factors, obstacles and perception of pneumococcal vaccination, and their association with its uptake in a general Chinese population. We performed a population-based, telephone survey in the general public aged 65 or above via simple random sampling. A validated survey based on the Health Belief Model (HBM) was used. Their socio-demographic information; history of previous participation in the GVP or VSS; and self-perceived health status were captured. Binary logistic regression models were constructed to examine the factors independently associated with vaccination. A total of 1,000 respondents were enrolled in the study, with 402 (40.2%) respondents having intention to join the GVP/VSS in 12 months. Respondents with long-term medical consultant and medication (adjusted odds ratios [aOR] = 1.541, 95% confidence interval (CI): 1.008–2.356, p = 0.046); high levels of perceived susceptibility of infections (aOR = 3.624, 95 %CI: 2.318–5.665, p < 0.001); high levels of perceived benefits of vaccine (aOR = 1.699, 95 %CI: 1.153–2.504, p < 0.001); recommendations from government (aOR = 8.025, 95 %CI: 4.771–13.497, p < 0.001) or physicians (aOR = 7.399, 95 %CI: 3.472–15.764, p = 0.008); and high levels of self-efficacy (aOR = 3.045, 95 %CI: 1.458–6.362, p = 0.003) were more likely to have intention to participate in the vaccination programme. The acceptance rate of pneumococcal vaccination programme remained suboptimal in the population. The government and physicians should be involved in the promotion of pneumococcal vaccination and GVP/VSS by increasing perceived benefits and self-efficacy, and reducing barriers towards vaccination among the target population. More studies are required to confirm our findings in other settings. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate how the knowledge and perception towards colorectal cancer (CRC) screening had been changed in a large population, and identified factors associated with its participation based on factors pertinent to the Health Belief Model (HBM). Methods: Data from 3600 screening participants and 3600 non‐participants were collected through a telephone survey via simple random sampling of telephone numbers in a territory‐wide directory from December 2016 to November 2018. Sociodemographic factors; the enabling factors of screening as well as the barriers of screening were collected. The changes in these factors were evaluated by Pearson's chi‐square trend test. A logistic regression model was constructed to identify the association between the above factors and CRC screening participation. Results: The knowledge level (67.9% to 85.4%, p < 0.001), perceived severity of having CRC (37.7%–42.8%, p < 0.01), perceived benefits of screening (54.9%–72.1%, p < 0.001), and reductions in barriers (14.1%–5.1%, p < 0.001) of CRC screening significantly improved among the non‐users. Subjects with older age (adjusted odds ratio (AOR): 2.01, p < 0.001), higher knowledge level of screening methods (AOR: 6.68, p < 0.001), greater perceived severity (AOR: 2.04, p < 0.001) and coverage of insurance (AOR: 1.22, p < 0.01) were more likely to participate. In contrast, more affluent subjects (AOR: 0.69, p < 0.001), female individuals (AOR: 0.63, p < 0.001), higher level of perceived psychological (AOR: 0.54, p < 0.001) and access barriers (AOR: 0.55, p < 0.001) were associated with poorer participation. Conclusion: These findings demonstrated a substantial increase in the enabling factors of CRC screening, including knowledge, perceived severity and perceived benefits. The study also identified the target groups such as younger individuals, females and more affluent people among whom more intensive educational initiatives are needed to enhance their participation. [ABSTRACT FROM AUTHOR]

Background: The Hong Kong Government released a Reference Framework (RF-HT) for Hypertension Care for Adults in Primary Care Settings since 2010. No studies have evaluated its adoption by primary care physicians (PCPs) since its release. Aim: We aimed to evaluate the level of PCPs’ adoption of the RF-HT and the potential barriers of its use in family practice. Design and setting: A cross-sectional study was conducted by a self-administered validated survey among all PCPs in Hong Kong through various means. Methods: We assessed the level of and factors associated with its adoption by multivariate logistic regression modelling. Result: A total of 3,857 invitation episodes were sent to 2,297 PCPs in 2014–2015. We received 383 completed questionnaires. The average score of adoption was 3.43 out of 4.00, and 47.5% of PCPs highly adopted RF-HT in their daily consultations. Male practitioners (adjusted odds ratio [aOR] = 0.524, 95% CI = 0.290–0.948, p = 0.033) and PCPs of public sector (aOR = 0.524, 95% CI = 0.292–0.940, p = 0.030) were significantly less likely to adopt the RF-HT. PCPs with higher training completion or being academic fellow are more likely to adopt RF-HT than those who were “nil to basic training completion” (aOR = 0.479, 95% CI = 0.269–0.853, p = 0.012) or “higher trainee” (aOR = 0.302, 95% CI = 0.093–0.979, p = 0.046). Three most-supported suggestions on RF-HT improvement were simplification of RF-HT, provision of pocket version and promoting in patients. Conclusion: Among PCP respondents, the adoption level of the RF-HT was high. These findings also highlighted some factors associated with its adoption that could inform targeted interventions for enhancing its use in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The Public Private Interface-Electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not been comprehensively assessed.Objective: This study aimed to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and the general public.Methods: From December 2012 to January 2013, 2435 telephone interviews were performed by trained interviewers to survey randomly selected patients who were enrolled or not enrolled in the PPI-ePR system. In addition, self-administered surveys were sent by postal mail to 4229 registered doctors in Hong Kong. The questionnaires for both patients and doctors contained questions on subjects' awareness, acceptance, and perceptions of the PPI-ePR, perceived benefits and obstacles of participating in the program, reasons for not using the system after enrolling, and perceived areas for service improvement of the system.Results: More than 53.1% (266/501) of enrolled patients believed that the PPI-ePR system would improve health care quality by reducing duplicate tests and treatments, while more than 76.8% (314/409) of enrolled doctors emphasized timely access to patients' medical records as the biggest benefit of their enrollment. Among nonenrolled patients, unawareness of the project was the most popular obstacle to enrolling in the PPI-ePR system (483/1200, 40.3%). Regarding nonenrolled doctors, the complicated registration process hindered them from participating in the program the most (95/198, 48.0%). Television, newspaper, and magazine advertisements and medical profession newsletters or journals were suggested as the most effective means to encourage participation in the program among surveyed patients (1297/1701, 76.2%) and doctors (428/610, 70.2%), respectively. Lack of clinical indication requiring data extraction from other hospitals was the main reason for low level of PPI-ePR use.Conclusions: This study comprehensively assessed the popularity, perceived benefits, and hindering factors of enrolling in the PPI-ePR system in Hong Kong. Low levels of awareness, few privacy concerns, and inactive use of the PPI-ePR system were among the key features for patients and physicians. Public promotions, simplified logistics, and a user-friendly online interface were suggested to improve the coverage and effectiveness of health information exchange between private and public health care sectors. [ABSTRACT FROM AUTHOR]

Screening for colorectal cancer can reduce mortality, yet, participation rate is suboptimal in various countries. We aimed to evaluate the effectiveness of a pilot programme for colorectal cancer screening on increasing the enabling factors of screening in a large Chinese population, and identified factors associated with its participation based on variables pertinent to the Health Belief Model. We collected data from 3600 screening participants who were randomly selected using a telephone list for 2016, 2017, and 2018, from the government colorectal cancer screening programme. We also collected data from 3600 non-screening participants through a telephone survey via simple random sampling of telephone numbers in a territory-wide directory for the years 2016, 2017, and 2018. We collected sociodemographic factors, the enabling factors of screening (such as knowledge levels of colorectal cancer, perceptions of colorectal cancer screening, cues to actions), and barriers of screening. We constructed a logistic regression model to identify the association between these factors and participation in colorectal cancer screening adjusted for age, gender, educational level, and household income. The study was approved by the Joint Chinese University of Hong Kong − New Territories East Cluster Clinical Research Ethics Committee (reference number 2016.485). Verbal consent was obtained from the study participants. The knowledge level of colorectal cancer screening tools (from 67·9% to 85·4%, p<0·001), perceived severity of having colorectal cancer (from 37·7% to 42·8%, p<0·001), perceived benefits of screening (from 54·9% to 72·1%, p<0·001), and reductions in access barriers of colorectal cancer screening (from 18·5% to 7·5%, p<0·001) significantly improved from 2016 to 2018. People with older age (adjusted odds ratio [AOR] 2·02, 95% CI 1·77–2·30, p<0·001), higher level of knowledge of screening methods (6·70, 4·40–10·20, p<0·001), greater perceived severity (2·03, 1·69–2·43, p<0·001), and coverage of insurance (1·25, 1·09–1·43, p<0·01) were more likely to participate in screening. By contrast, more affluent people (0·68, 0·57–0·80, p<0·001), female individuals (0·64, 0·56–0·72, p<0·001), higher level of perceived psychological barriers (0·54, 0·42–0·69, p<0·001), and access barriers (0·57, 0·44–0·73, p<0·001) were associated with poorer participation. These findings demonstrate the effectiveness of the screening programme on increasing the enabling factors and identify the target groups such as younger individuals, females, and more affluent people among whom more intensive educational initiatives are needed to enhance their participation. Health and Medical Research Fund (No. 6904168), Food and Health Bureau, Hong Kong, China. [ABSTRACT FROM AUTHOR]

• From 1200 telephone interviews, the COVID-19 vaccine acceptance rate was 37.2%. • Acceptance rate was the highest in adults aged 18–24 years then increased with age. • Government recommendation was the strongest predictive factor of vaccine acceptance. • A key obstacle of acceptance included lack of confidence on vaccine manufacturers. • These predictors provide evidence-based formulation of vaccination strategies. Vaccines for COVID-19 are anticipated to be available by 2021. Vaccine uptake rate is a crucial determinant for herd immunity. We examined factors associated with acceptance of vaccine based on (1). constructs of the Health Belief Model (HBM), (2). trust in the healthcare system, new vaccine platforms and manufacturers, and (3). self-reported health outcomes. A population-based, random telephone survey was performed during the peak of the third wave of COVID-19 outbreak (27/07/2020 to 27/08/2020) in Hong Kong. All adults aged ≥ 18 years were eligible. The survey included sociodemographic details; self-report health conditions; trust scales; and self-reported health outcomes. Multivariable regression analyses were applied to examine independent associations. The primary outcome is the acceptance of the COVID-19 vaccine. We conducted 1200 successful telephone interviews (response rate 55%). The overall vaccine acceptance rate after adjustment for population distribution was 37.2% (95% C.I. 34.5–39.9%). The projected acceptance rates exhibited a "J-shaped" pattern with age, with higher rates among young adults (18–24 years), then increased linearly with age. Multivariable regression analyses revealed that perceived severity, perceived benefits of the vaccine, cues to action, self-reported health outcomes, and trust in healthcare system or vaccine manufacturers were positive correlates of acceptance; whilst perceived access barriers and harm were negative correlates. Remarkably, perceived susceptibility to infection carried no significant association, whereas recommendation from Government (aOR = 10.2, 95% C.I. 6.54 to 15.9, p < 0.001) was as the strongest driving factor for acceptance. Other key obstacles of acceptance included lack of confidence on newer vaccine platforms (43.4%) and manufacturers without track record (52.2%), which are of particular relevance to the current context. Governmental recommendation is an important driver, whereas perceived susceptibility is not associated with acceptance of COVID-19 vaccine. These HBM constructs and independent predictors inform evidence-based formulation and implementation of vaccination strategies. [ABSTRACT FROM AUTHOR]

The potential benefits of aquatic environments for public health have been understudied in Asia. We investigated the relationships between blue space exposures and health outcomes among a sample of predominantly older adults in Hong Kong. Those with a view of blue space from the home were more likely to report good general health, while intentional exposure was linked to greater odds of high wellbeing. Visiting blue space regularly was more likely for those within a 10-15 min walk, and who believed visit locations had good facilities and wildlife present. Longer blue space visits, and those involving higher intensity activities, were associated with higher recalled wellbeing. Our evidence suggests that, at least for older citizens, Hong Kong's blue spaces could be an important public health resource. [ABSTRACT FROM AUTHOR]