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ImportanceAdverse childhood experiences are associated with higher depressive risks in adulthood. Whether respondents’ adverse childhood experiences are associated with their adulthood depressive symptoms and further contribute to spousal depressive symptoms was unexplored.ObjectiveTo assess the spousal concordance of adverse childhood experiences, the association of respondents’ adverse childhood experiences with spousal depressive symptoms and the mediating role of respondents’ depressive symptoms in this association.DesignThis cohort study was conducted based on data from China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). Data were analyzed from June through July 2022.SettingThe study was based on three cohorts in China, the US, and Europe.ParticipantsCouples aged 50 years or older with complete data on ACEs and covariates.ExposuresAdverse childhood experiences.Main Outcomes and MeasuresThe 10-item Center for Epidemiological Studies Depression Scale, the eight-item Center for Epidemiologic Studies Depression Scale, and the Europe-depression scale were respectively applied in CHARLS, HRS, and SHARE to define depressive symptoms.ResultsCouples’ adverse childhood experiences were noticeably correlated in the three cohorts. Significant associations between husbands’ adverse childhood experiences and wives’ depressive symptoms in the three cohorts, with ORs and 95% CIs of 2.09 (1.36-3.22) for 4 or more adverse childhood experiences in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more adverse childhood experiences in HRS and SHARE. However, wives’ adverse childhood experiences were associated with husbands’ depressive symptoms in only CHARLS and SHARE. Findings in intra-familial and extra-familial adverse childhood experiences were consistent with our main results. Additionally, respondents’ depressive symptoms mediated more than 20% of the effect of respondents’ adverse childhood experiences on spousal depressive symptoms.Conclusion and RelevanceIn the CHARLS, HRS, and SHARE databases, we found that adverse childhood experiences were significantly correlated between couples. Respondents’ adverse childhood experiences were associated with spousal depressive symptoms, with respondents’ depressive symptoms mediating the association. The two-way implications of adverse childhood experiences on depressive symptoms should be considered at couple level and effective interventions are warranted.Key PointsQuestionWhether respondents’ adverse childhood experiences are associated with their adulthood depressive symptoms and further contribute to spousal depressive symptoms?FindingThis study found significant associations between husbands’ adverse childhood experiences and wives’ depressive symptoms. Additionally, respondents’ depressive symptoms mediated more than 20% of the effect of respondents’ adverse childhood experiences on spousal depressive symptoms.MeaningThe implications of childhood adversity on later-life depressive symptoms at the couple level should be considered and strengthening the effective interventions of adverse childhood experiences and depressive symptoms is needed.

Objectives To measure the effect of a structured online training programme on improving the knowledge, attitude, confidence, and skills of university students to deliver peer-led addiction counselling to young drug abusers. Methods A structured training programme was designed for university students with a background in health-related disciplines. Pre- and post-training evaluations were conducted for 245 university students with health-related backgrounds who completed the training programme. The participants’ knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were evaluated and compared before and after the training. Counselling skills were assessed using a simulated standardised case. Results A paired test indicated that after attending the training programme, the participants’ knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were significantly improved. Most of the trained participants demonstrated satisfactory counselling skills. Conclusion Participation in a one-day structured addiction training programme significantly improved students’ knowledge of and attitudes towards drug abuse and their confidence and skills to deliver addiction counselling. Practice implication Future research should elucidate the implementation of the counselling skills in terms of the counselling outcomes and successful referral. The clients’ health outcomes should be assessed to reflect the peer counsellors’ skills.

Background Direct associations of tobacco exposure during pregnancy with pregnancy complications and adverse birth outcomes have been proven. Previous studies suggest that expecting a child provides a valuable opportunity to promote behavioural changes, such as smoking cessation, among the male partners of pregnant women. Thorough understandings of Chinese expectant fathers’ smoking behaviour during the transition to fatherhood is a prerequisite to the development of appropriate interventions to facilitate smoking cessation. This study aimed to explore the perceptions, behaviours and attitudes related to smoking among male partners of pregnant women in China. Methods A descriptive phenomenological approach was adopted. A purposive sample of expectant fathers aged 18 years or older who had a tobacco use history within the past year were recruited at obstetrics and gynaecology clinics and invited to participate in one-to-one, 20–30-min semi-structured interviews. The data analysis followed Colaizzi’s descriptive phenomenological method. Results Twenty-five expectant fathers were interviewed. Four themes were generated: 1) the benefits of smoking and respondents’ misperceptions of the impact of smoking and SHS and neglectful attitude of the impact of smoking, which were given as the major reasons for continuing to smoke; 2) factors contributing to smoking cessation, including concern for the potential health impact of continued smoking on the pregnant partner and baby, the role of being father, and the encouragement to quit from family members; and 3) perceived barriers to smoking cessation, including withdrawal symptoms or cigarette cravings, absence of smoking cessation support, and increasing stress. Conclusion This study provides a comprehensive understanding of the perception, behaviours, and attitudes related to smoking among Chinese expectant fathers. The findings of this study can guide healthcare professionals and policymakers in combining the distribution of educational information about the hazards of SHS for maternal and neonatal health with smoking cessation assistance for expectant fathers through policy initiatives and other types of incentives and programmes targeted to enhance smoking cessation among this population. Trial registration Prospectively registered at clinicaltrial.org (NCT03401021) on 8 Jan 2018.

Background and aims Three to 10 minutes of smoking cessation advice by physicians is effective to increase quit rates, but is not routinely practised. We examined the effectiveness of physicians' very brief (approximately 30 sec) smoking cessation intervention on quit rates among Chinese outpatient smokers. Design A pragmatic, open-label, individually randomized controlled trial. Setting Seventy-two medical outpatient departments of hospitals and/or community health centers in Guangdong, China. Participants Chinese adults who were daily cigarette smokers (n = 13 671, 99% males) were invited by their physician to participate during outpatient consultation. Smokers who were receiving smoking cessation treatment or were judged to need specialist treatment for cessation were excluded. Interventions The intervention group (n = 7015) received a 30-sec intervention including physician's very brief advice, a leaflet with graphic warnings and a card with contact information of available cessation services. The control group (n = 6656) received a very brief intervention on consuming vegetables and fruit. A total of 3466 participants in the intervention group were further randomized to receive a brief booster advice from trained study personnel via telephone 1 month following their doctor visit. Measurements The primary outcome was self-reported 7-day point prevalence abstinence (PPA) in the intervention and control groups at the 12-month follow-up. Secondary outcomes included self-reported 30-day abstinence and biochemically validated abstinence at 12-month follow-up. Findings By intention-to-treat, the intervention (versus control) group had greater self-reported 7-day abstinence [9.1 versus 7.8%, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.03-1.26, P = 0.008] and 30-day abstinence (8.0 versus 6.9%, OR = 1.14, 95% CI = 1.03-1.27, P = 0.01) at 12-month follow-up. The effect size increased when only participants who received the intervention from compliant physicians were included (7-day PPA, OR = 1.42, 95% CI = 1.11-1.74). The group difference in biochemically validated abstinence was small (0.8 versus 0.8%, OR = 1.00, 95% CI = 0.71-1.42, P = 0.99). Conclusion A 30-sec smoking cessation intervention increased self-reported abstinence among mainly male smokers in China at 12-month follow-up (risk difference = 1.3%), and should be feasible to provide in most settings and delivered by all health-care professionals.

BACKGROUND AND AIMS Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers. DESIGN Three-arm cluster-randomized trial. SETTING General community in Hong Kong. PARTICIPANTS Daily cigarette smokers (n = 1163; 77.7% male). INTERVENTIONS Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383). MEASUREMENTS The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months. FINDINGS Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P

A mobile device-based resilience training programme has been found to improve psychological well-being in parents of children with cancer. However, the essential elements underlying the programme's efficacy and the factors that affect parents' advocacy of the online resilience training remain unknown. This study explored the lived experience of engaging in a mobile device-based resilience training programme in parents of children with cancer.A descriptive phenomenological approach was used. Parents of children with cancer who had received the mobile device-based resilience training in a previous randomised controlled trial were selected to attend one-to-one semi-structured interviews. All interviews were audio-recorded. Data were analysed using Colaizzi's descriptive phenomenological method.Twenty-one parents, comprising 15 mothers and 6 fathers, of children with cancer participated in the interview. The two following themes were identified: perceptions about the training (be beneficial for psychological well-being, be beneficial for parent-child communication and be beneficial for coping) and evaluation of the training (increased knowledge and skills, be satisfied with the intervention form and content, challenges to adhere to the programme and recommendations for future interventions).This study explored which features of a mobile device-based resilience training programme improved the psychological well-being of parents of children with cancer. Its findings highlight the importance of providing a resilience training programme that is based on the parents' intervention form preferences and their mental health needs.NCT04038242, registered 17 July 2019.

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.

BACKGROUND Caring for children with cancer can be a stressful experience for parents and may have negative effects on their physical and psychological well-being. Although evidence has shown that resilience is associated with positive psychological well-being, few interventions have been specifically designed to enhance the resilience of parents of children with cancer. OBJECTIVE The aim of this study is to examine the effectiveness of a mobile device–based resilience training program in reducing depressive symptoms and enhancing resilience and quality of life (QoL) in parents of children with cancer. METHODS Parents of children diagnosed with cancer were recruited from the pediatric oncology wards of 3 tertiary hospitals in China. The participants were randomly assigned to either the experimental group (52/103, 50.5%) to undergo an 8-week mobile device–based resilience training program or to the control group (51/103, 49.5%) to receive an 8-week program of placebo information. The study outcomes included resilience, depressive symptoms, and QoL, as measured by the Connor–Davidson Resilience Scale, the Self-Rating Depression Scale, and the Short Form of the 6-Dimension Health Survey, respectively. All data were collected at baseline and at 2 and 6 months of follow-up. The data analysis followed the intention-to-treat principle. A generalized estimating equation was used to examine the effects of the intervention. RESULTS The participants were mostly female (72/103, 69.9%), and their mean age was 33.6 (SD 5.2) years. The participants in the experimental group showed significantly higher levels of resilience (mean 67.96, SD 15.8 vs mean 58.27, SD 19.0; PPβ=6.082; P=.01) and decreasing depressive symptoms (β=−2.772; P=.04) relative to the control group. The QoL score in the experimental group was higher than that in the control group at 6 months of follow-up (mean 0.79, SD 0.2 vs mean 0.76, SD 0.3; P=.07); however, no statistically significant intervention effect was detected (β=.020; P=.38). CONCLUSIONS The mobile device–based resilience training program effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that health care professionals incorporate this resilience training program when providing psychological care to parents of children with cancer. CLINICALTRIAL Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242

Caring for children with cancer is considerably stressful for parents and may negatively affect their physical and psychological well-being. Resilience plays a pivotal role in maintaining psychological well-being in the face of stress and adversity. The aim of this systematic review was to evaluate the effectiveness of psychological interventions in promoting resilience among parents of children with cancer. Five English databases and two Chinese databases were subjected to a systematic search from inception to March 2020. The methodological quality of the included randomised controlled trials was evaluated using the Cochrane risk of bias tool (RoB 2.0). Meta-analyses and descriptive analyses were used. Subgroup analyses of the intervention modes and time since diagnosis were also conducted. Five studies involving 308 participants were included. The systematic review identified three types of psychological intervention, namely resilience training, self-disclosure and peer support, which had different essential components and characteristics. The meta-analyses of three randomised controlled trials revealed that the psychological interventions enhanced parents’ resilience with a large effect size (Hedges’ adjusted g 0.92; 95% CI 0.22, 1.62; p = .01). Evidence supports the effectiveness of psychological interventions for enhancing resilience in the parents of children with cancer. Healthcare professionals can incorporate evidence-based psychological interventions to enhance resilience to help these parents better navigate adversity, adapt to their children’s situations and improve their psychological well-being.

Physical activity during treatment is an important way to promote health and quality of life for children with cancer. Nurses play a pivotal role in creating and supporting physical activity interventions. In this chapter we present information on the impact of a cancer diagnosis and treatment on a child’s activities and physical functioning. In addition, we offer evidence that nurses can readily translate into their practice to promote physical activity in this vulnerable population. By applying principles of precision health offered in this chapter, the nurse can identify the child, family, disease, and environmental factors that influence physical activity and use this information to develop successful interventions across the childhood cancer trajectory. The chapter also offers insights into the role that nurses play in mobilizing resources to address barriers to physical activity, including multidisciplinary care and family influences. Finally, we examine the state of the science about physical activity and childhood cancer and suggest avenues for nursing research to expand the frontier of this important field.

In the UK, there has been growing concern about young people’s understanding of sexual consent, with the views of young people themselves often lost in academic and educational policy debates. However, the focus on high rates of sexual violence has meant a lack of attention on the everyday negotiation of consensual heterosexual activity, leading to assumptions being made regarding young people’s lack of understanding of sexual consent. This paper emerges from a wider study of over 500 young people which sought to uncover their understanding of the issues. Drawing on data from workshops and the open text responses to an on-line survey the findings presented in this paper show that the majority of heterosexual young people understood the complexity of sexual consent as an embodied process, which can be difficult to define, talk about or practice uniformly. This complex understanding, in which sexual consent is a continuum rather than a dichotomy, has implications for sexual education initiatives. We argue that it is only by providing a closer understanding of how - within consensual sexual activities - young people understand and enact sexual consent through a range of embodied communication strategies that education surrounding sexual assault will become meaningful.

Online social groups have been increasingly used for smoking cessation intervention.This study aimed to explore the social support components of the online discussion through WhatsApp and Facebook, how these components addressed the need of relapse prevention, and how the participants evaluated this intervention.We coded and analyzed the posts (N = 467) by the 82 recent quitters in WhatsApp and Facebook social groups, who were recruited from the eight smoking cessation clinics in Hong Kong to participate in a pragmatic randomized trial of relapse prevention. Participants' postintervention feedback was collected from the 13 qualitative interviews after the intervention.The WhatsApp social groups had more participants' posts than the Facebook counterparts. The participants' posts in the online social groups could be classified as sharing views and experiences (55.5%), encouragement (28.7%), and knowledge and information (15.8%). About half of the participants' posts (52.9%) addressed the themes listed in the U.S. Clinical Practice Guideline for preventing smoking relapse. The participants perceived the posts as useful reminders for smoking cessation, but avoidance of reporting relapse, inactive discussions, and uninteresting content were barriers to the success of the intervention.Online social groups provided a useful platform for the delivery of cessation support and encouragement of reporting abstinence, which support relapse prevention. The effectiveness of such intervention can be improved by encouraging more self-report of relapse, active discussions, sharing of interesting content, and using an appropriate discussion platform.Quitters who participate in the online social groups can benefit from peer support and information sharing, and hence prevent smoking relapse.

Background Large amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown. Purpose We evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids. Methods A three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong “Quit to Win” Contest. Biochemically validated quitters of the early-informed (n = 379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n = 385, notified at 3-month follow-up) received the incentive at 3 months. The validated quitters of the control group (n = 379) received the incentive at 6 months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24 h) and use of cessation aids at 3-month follow-up. Results By intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24 h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR) = 1.32, 95% CI 1.03–1.69, p = 0.03), but they had similar abstinence (9.2% vs. 9.7%, OR = 0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR = 1.56, 95% CI 1.12–2.18, p Conclusions The small cash incentive with early notification increased quit attempt by “self-directed help” but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.

IntroductionEvidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers.Methods and analysisThis ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow‐ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide Ethics and disseminationThis protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences.Trial registration numberClinicalTrials.gov Registry NCT03565796.

Background Secondhand smoke can cause adverse pregnancy outcomes, yet there is a lack of effective smoking cessation interventions targeted at expectant fathers. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers. Methods and findings A single-blind, 3-arm, randomized controlled trial was conducted at the obstetrics registration centers of 3 tertiary public hospitals in 3 major cities (Guangzhou, Shenzhen, and Foshan) in China. Smoking expectant fathers who registered with their pregnant partners were invited to participate in this study. Between 14 August 2017 to 28 February 2018, 1,023 participants were randomized to a video (n = 333), text (n = 322), or control (n = 368) group. The video and text groups received videos or text messages on the risks of smoking for maternal and child health via instant messaging. The control group received a leaflet with information on smoking cessation. Follow-up visits were conducted at 1 week and at 1, 3, and 6 months. The primary outcome, by intention to treat (ITT), was validated abstinence from smoking at the 6-month follow-up. The secondary outcomes included 7-day point prevalence of abstinence (PPA) and level of readiness to quit at each follow-up. The mean age of participants was 32 years, and about half of them were first-time expectant fathers. About two-thirds of participants had completed tertiary education. The response rate was 79.7% (815 of 1,023) at 6 months. The video and text groups had higher rates of validated abstinence than the control group (video group: 22.5% [75 of 333], P < 0.001; text group: 14.9% [48 of 322], P = 0.02; control group: 9.2% [34 of 368]) with adjusted odds ratios (ORs) of 2.80 (95% confidence interval [CI]: 1.79–4.37, P < 0.001) in the video group and 1.70 (95% CI: 1.06–2.74, P = 0.03) in the text group. The video and text groups differed in the rates of validated abstinence (22.5% versus 14.9%, P = 0.008; adjusted OR: 1.64, 95% CI: 1.10–2.46, P = 0.02). The video and text groups had higher rates of 7-day PPA than the control group at 6 months (video group: 24.6% [82 of 333] versus 11.4% [42 of 368], P < 0.001; text group: 17.4% [56 of 333] versus 11.4% [42 of 368], P = 0.02). The video and text groups also differed in the rates of 7-day PPA (24.6% versus 17.4%, P = 0.02). Excluding the quitters, the video and text groups had higher levels of readiness to quit than the control group at 6 months (video group: 43.5% [109 of 251] versus 31.6% [103 of 326], P = 0.002; text group: 40.6% [108 of 266] versus 31.6% [103 of 326], P = 0.01), No such difference was detected between the video and text groups (43.5% versus 40.6%, P = 0.29). The study was limited in that the long-term effectiveness of the intervention is uncertain. Conclusions This smoking cessation intervention for expectant fathers that focused on explaining the ramifications of smoking on maternal and child health was effective and feasible in promoting quitting, and video messages were more effective than texts in delivering the information. Trial registration ClinicalTrials.gov: NCT03236025., Wei Xia and colleagues reveal the benefit of a video-based intervention to help expectant fathers quit smoking., Author summary Why was this study done? Exposure to secondhand smoke can cause adverse pregnancy and childbirth outcomes and negatively affect maternal and child health. Video has been used in multiple types of behavioral interventions, but there is a paucity of evidence on its effectiveness in changing addictive behaviors such as smoking. The aim of the study was to evaluate the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers. What did the researchers do and find? A total of 1,023 smoking expectant fathers were randomly allocated to a video-based, text, or control group. Participants received four 1-minute videos (video group) or 4 text messages (text group) on the risks of smoking for maternal and child health via instant messaging every 2 weeks or a leaflet on smoking cessation (control group). At 6-month follow-up, participants who received the videos or texts had higher rates of validated abstinence than the controls. The video-based intervention was more effective than the text-based intervention. What do these findings mean? This trial provides evidence that videos incorporating information on the adverse effects of secondhand smoke on maternal and child health are effective in helping expectant fathers to quit smoking. Using instant messaging to deliver smoking cessation videos is feasible and acceptable to participants.

BACKGROUND: The effects of hematologic cancer and its treatment on Chinese children's physical activity level and quality of life (QoL) remain unclear despite numerous studies conducted in Western countries and Hong Kong.OBJECTIVE: The aim of this study was to examine the effects of hematologic cancer and its treatment on the physical activity level and QoL among Chinese children.METHODS: A cross-sectional study was conducted. One hundred twenty-five children who were admitted for treatment of hematologic cancer and 243 healthy counterparts of similar age participated in this study. All participants were asked to complete the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth and Pediatric Quality of Life Inventory. The children with hematologic cancer also completed a therapy-related symptom checklist.RESULTS: There were statistically significant differences in the mean physical activity and QoL between children with hematologic cancer and their healthy counterparts. Multiple regression analyses showed that physical activity levels and the adverse effects of hematologic cancer treatment had statistically significant effects on the children's QoL.CONCLUSIONS: Physical activity level and QoL in children with hematologic cancer were both lower than those in their healthy counterparts.IMPLICATIONS FOR PRACTICE: This study provides further evidence that hematologic cancer and the adverse effects of its treatment have negative effects on Chinese children's QoL. Although a lack of physical activity is deeply embedded in Chinese culture, nurses should take a proactive role in effecting change by educating parents about the benefits to their children's physiologic and psychological well-being of physical activity during and after treatment.

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.

Background and challenges to implementation Many smoking cessation clinics are passive and dependent on motivated smokers to proactively seek help. Also, smoking cessation clinics are not well publicized. Most healthcare professionals are unaware of the existing smoking cessation services, and rarely refer smokers to these clinics. Many smokers who want to quit do not proactively visit these clinics or call the quitline. Most if not all these clinics and services are not receiving the expected number of smokers and some are dormant or closed down quietly. Intervention or response This project, commissioned by the Hong Kong Tobacco Control Office, was to develop and publish an evaluation tool (E-tool, version 1.1) for smoking cessation clinics and services. The project team gathered documentations and data from smoking cessation clinics in Hong Kong, Guangzhou and Beijing. Stakeholders discussed and agreed on what would be the most appropriate items for the E-tool. The E-tool draft was pilot-tested by 27 smoking cessation clinics and hospitals in Hong Kong, China Mainland and Southeast Asian countries (from the WHO Fellowship Programme on Tobacco Control, organized by Hong Kong Tobacco Control Office). Results and lessons learnt The finalized E-tool (version 1.1) consists of 33 most basic and essential items in 4 assessment components: Organization assessment (17 points), Environmental assessment (14 points), Process assessment (28 points) and Outcome assessment (11 points). The E-tool and user manual have English, traditional Chinese and simplified Chinese versions. All materials can be freely accessed in https://mrct.sph.hku.hk/web/. Conclusions and key recommendations The E-tool for smoking cessation clinics and services can be used to evaluate the quality and outcomes of existing clinics and services, and provide an outcome-oriented guidance for setting up new clinics and services. We invite all kinds of smoking cessation clinics and services in any territories to use this E-tool, and to provide feedback for the development of more advanced E-tools in the future.

Background Smokers who are in physical discomfort attended to emergency departments present an excellent 'teachable moment' for smoking cessation interventions. Nevertheless, most cessation programmes generally take 20 to 30 minutes or more to implement and are thus not feasible in busy clinical settings. This study aimed to address the gap in existing literature by evaluating the effectiveness of using a brief, self-determination intervention on smoking cessation among people attending emergency departments. Methods A multi-centre randomized controlled trial was conducted in emergency departments of four acute hospitals in Hong Kong. A total of 1571 patient were recruited, with 787 being randomized into the experimental group and 784 into the control group. Subjects in the experimental group were allowed to select their own schedules of quitting (immediate or progressive). They received a leaflet plus a brief intervention on smoking cessation. Subjects in the control group received a leaflet on smoking cessation. Four consecutive (1, 3, 6 and 12 months) follow-ups were conducted over the telephone. The primary outcome measure was biochemically validated abstinence at 6 months. Secondary outcomes included (i) biochemically validated abstinence at 12 months and (ii) self-reported 7-day point prevalence of abstinence at 6 and 12 months. Intention-to-treat analysis was adopted. Results Subjects in the experimental group had a statistically significantly higher self-reported quit rate than those in the control group at 12 months (11.2% vs 6.8%, p=0.03). The biochemically validated abstinence was also statistically significantly higher in the experimental group than in the control group at 6 (6.6% vs 2.6%, p< .001) and 12 months (6.0% vs 3.0%, p=0.04). Conclusions The brief, self-determination intervention was shown to be effective in promoting smoking cessation for people attending emergency departments. Such intervention should therefore be a more cost-effective and sustainable approach to helping smokers quit smoking, and consequently may save more lives.

Aim To examine the effects of a therapeutic play intervention for children on parents' perioperative anxiety, the relationship between parents' and their children's anxiety and to explore parents' perceptions of the intervention. Background Therapeutic play intervention was found to reduce children's perioperative anxiety. Little is known about how such an intervention for children affects their parents' anxiety. Design A mixed method of randomized controlled trial with qualitative process evaluation was used. Methods Ninety-five pairs of parents and children were recruited between November 2011–August 2013 and randomized into a control or an intervention group. The State Anxiety Scale for Children and the State Anxiety Scale for Adults were used to measure children's and parents' anxiety, respectively, at baseline, on surgery day and around 24 hours after surgery. Parents were interviewed about their perceptions of the intervention. Data were analysed using SPSS version 22·0 and thematic analysis. Results There was no difference in parents' anxiety after participating with their child in the intervention compared with usual care. There were significantly positive relationships between parents' and their children's baseline anxiety and parents' postoperative anxiety and their children's pre-operative anxiety. Four themes were identified: reducing anxiety, increasing knowledge and understanding about anaesthetic procedure, the worthiness of attending the intervention and suggestions for improvement of the intervention. Conclusions Therapeutic play intervention had no significant effect on parents' perioperative anxiety. Parents' and their children's perioperative anxiety are correlated. Parents perceived the intervention as helpful preparation for themselves and for their children undergoing elective surgery.

The practice guidelines aimed to identify appropriate nursing management for the prevention and treatment of tumor lysis syndrome, in line with the current evidence-based medical guidelines. Using a systematic approach, 15 relevant articles were identified for the review. The evaluation of patient risk factors for tumor lysis syndrome and the appropriate medical and nursing assessment were identified. The treatment algorithms for the prevention of tumor lysis syndrome from both the medical and nursing perspectives have been established. In particular, the guidelines highlight the importance of pediatric oncology nurses in contributing to the prevention and management of tumor lysis syndrome.

Background Research indicates that regular physical activity is associated with numerous physiological and psychological health benefits for childhood cancer survivors. A review of the literature reveals that no study has so far examined the physical activity levels and behavior of Hong Kong Chinese childhood cancer survivors, and how the cancer and its treatment affect the physical activity and other behavior of these children remains unclear. Objective The aims of this study were to assess the physical activity levels of Hong Kong Chinese childhood cancer survivors and to explore the factors that affect their adherence to and maintenance of regular physical activity. Methods A cross-sectional study was used. A total of 128 childhood cancer survivors (9-16-year-olds) who underwent medical follow-up in the outpatient clinic were invited to participate in the study. Results There was a significant decline in physical activity levels among childhood cancer survivors. Most of them did not take physical exercise regularly. Concern about academic performance, fatigue, and a decrease in physical strength and endurance after remission prevented them from engaging in regular physical activity. Conclusions This study indicates that many childhood cancer survivors did not engage in regular physical activity and that they overlooked or underestimated its importance. Implications for practice It is essential for nurses to correct misconceptions about physical activity among childhood cancer survivors and their parents and, most importantly, to advocate the principle of regular physical activity for these children, with the aim of enhancing their physical and psychological well-being.

IntroductionNausea and vomiting are two most common symptoms reported by children with cancer when they undergo active treatment. However, pharmacological treatment is not sufficient to manage these two symptoms, with over 40% of children still experience nausea and vomiting after receiving antiemetics. There has been an exponential growth of studies to demonstrate the effectiveness of different complementary complementary medicine (CAM) to control nausea and vomiting during cancer treatment. Appropriate application of CAM enhances the effectiveness of antiemetics, thus reducing the symptom burden on children as well as improving their general condition and quality of life during cancer treatment. Nevertheless, it remains unclear which CAM is the best approach to help children to prevent or reduce nausea and vomiting during and after cancer treatment. This paper describes a protocol for identifying, analysing and synthesising research evidence on the effectiveness of CAM on nausea and vomiting in children with cancer.Methods and analysisA total of 10 databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials which meet the inclusion criteria will be included. The primary outcome is the changes in nausea and vomiting either assessed by self-reported and/or objective measures. Review Manager 5.3 will be used to synthesise the data, calculate the treatment effects, perform any subgroup analysis and assess the risk of bias.Ethical and disseminationThe results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required.PROSPERO registration numberCRD42019135404.

IntroductionWe investigated heated tobacco products (HTPs) use and associated factors in Chinese adults in Hong Kong where HTPs are not formally marketed yet, and cigarette smoking prevalence was the lowest in the developed world.MethodsA population-based landline telephone survey in 2017 interviewed 5131 (45.2% male; 26.7% aged ≥60) adults to collect information on awareness, intention to use, ever use of HTPs, cigarette smoking status and sociodemographic characteristics. Descriptive statistics were weighted by the age, sex and smoking status of the Hong Kong adult population. Sociodemographics were mutually adjusted in logistic regression to yield adjusted ORs (AORs) for awareness of HTPs, controlling for smoking status.ResultsOverall, 11.3% (95% CI 10.0% to 12.7%) were aware of HTPs and 1.0 % (0.8%–1.2%) had ever used it. Awareness was associated with aged 40–49 years (AOR 1.37, 95% CI 1.01 to 1.87) or 30–39 years (2.03, 1.41–2.91) (vs ≥60 years), born in Hong Kong (1.37, 1.11–1.68) and higher monthly household income (p for trend 0.001). Ever HTP users had higher educational attainment and monthly household income, and more were aged 30–39 and economically active (all pConclusionHigher socioeconomic status was associated with HTP use and intention to use. Public health education on HTPs is needed especially for this high-risk group.

CancerChildrenConfirmatory factoranalysisPediatric Quality-of-LifeInventoryQuality of lifeBackground: Before the Chinese version of the Pediatric Quality-of-Life InventoryCancer Module can be used to assess the multidimensional construct of qualityof life among Hong Kong Chinese pediatric patients with cancer, its psychometricproperties need to be further empirically tested. Objective: The objectivesof the study were to establish the construct validity, including hypothesis testingand a confirmatory factor analysis of factor structure, of the Chinese version of thePediatric Quality-of-Life Inventory Cancer Module. Methods: A cross-sectionalstudy was used; 200 children hospitalized with cancer (9- to 16-year-olds) wererecruited. Participants were asked to respond to the Chinese version of the CancerModule, Therapy-Related Symptom Checklist, and Rosenberg’s Self-esteem Scale.Results: The results showed that there was a strong positive correlation betweenchildren’s self-esteem and quality of life (r = 0.50) and a strong negative correlationbetween children’s therapy-related symptoms and quality of life (r = j0.65).Confirmatory factor analysis indicated that there were 7 factors underlyingthe Chinese version of the Cancer Module. Conclusion: The study addedfurther evidence of the construct validity of the Chinese version of the CancerModule, patient version. Implication for Practice: The Cancer Modulecan be used to assess and evaluate psychological interventions directedtoward promoting the quality of life of children hospitalized with cancer.Chinese Version of the PedsQL Cancer Module

Background Research indicates that increased survival rates are accompanied by an increase in associated psychosocial problems. Whereas much of the attention has focused on the physiological care of childhood cancer survivors, the consequences of cancer and its treatments on psychosocial well-being and quality of life remain relatively underexplored. Objective The aim of this study was to describe the psychosocial well-being and quality of life of Hong Kong Chinese childhood cancer survivors. Methods A cross-sectional study was used. A total of 137 childhood cancer survivors (9- to 16-year olds) who underwent medical follow-up in the outpatient clinic were invited to participate in the study. Results A significant number of childhood cancer survivors had low self-esteem and experienced high levels of depression. The study also indicated that greater symptoms of depression in childhood cancer survivors were associated with higher state anxiety, lower self-esteem, and poor quality of life. Conclusions Cancer and its treatments can have adverse effects on the psychosocial well-being and quality of life of survivors. Implications for practice It is essential for nurses to develop and evaluate interventions with the aim of promoting psychosocial well-being and quality of life for childhood cancer survivors. Knowing the self-esteem and coping behavior of survivors can help design appropriate and effective psychosocial interventions to promote their psychosocial well-being.

Aim: This article is a report on psychometric testing of the Chinese version of the Herth Hope Index. Background. The availability of a valid and reliable instrument that accurately measures the level of hope in patients with heart failure is crucial before any hope-enhancing interventions can be appropriately planned and evaluated. There is no such instrument for Chinese people. Methods: A test-retest, within-subjects design was used. A purposive sample of 120 Hong Kong Chinese patients with heart failure between the ages of 60 and 80years admitted to two medical wards was recruited during an 8-month period in 2009. Participants were asked to respond to the Chinese version of the Herth Hope Index, Hamilton Depression Rating Scale and Rosenberg's Self-Esteem Scale. The internal consistency, content validity and construct validity and test-retest reliability of the Chinese version of the Herth Hope Index were assessed. Results: The newly translated scale demonstrated adequate internal consistency, good content validity and appropriate convergent and discriminant validity. Confirmatory factor analysis added further evidence of the construct validity of the scale. Conclusion: Results suggest that the newly translated scale can be used as a self-report assessment tool in assessing the level of hope in Hong Kong Chinese patients with heart failure.

li h.c.w., chung o.k.j., wong m.l.e. & ho k.y. (2010) Coping behaviour checklist for Chinese children: development and psychometric testing. Journal of Advanced Nursing 66(7), 1633–1643. Abstract Title. Coping behaviour checklist for Chinese children: development and psychometric testing. Aim. This paper is a report of development and psychometric testing of the coping behaviour checklist for Chinese children. Background. An understanding of the coping behaviour of children is an essential prerequisite for the design of an appropriate psychological intervention to enhance children’s ability to cope with stressful medical procedures and hospitalization. Review of literature reveals that there is lack of child-sensitive measurement tools in the Chinese culture for assessing coping behaviours of children with good psychometric properties. Methods. An instrument development and validation study was conducted. Phase 1 was designed to develop a checklist of coping behaviour for Chinese children, while in phase 2 the psychometric properties of the new scale were tested. A total of 168 (phase 1) and 236 (phase 2) children between the ages of 7 and 12 years, were invited to participate in this study in 2008 and 2009, respectively; 228 completed both phases of data collection. Results. On the basis of the results of qualitative interview data, the coping behaviour checklist for Chinese children was developed. The newly developed scale had adequate internal consistency reliability and test–retest reliability, high content validity and appropriate construct validity. Confirmatory factor analysis further added evidence of the construct validity of the scale. Conclusion. The instrument can be used to identify the coping behaviour of Hong Kong Chinese children aged between 7 and 12 years. Knowing the coping behaviour of children in advance can help nurses to shape and design appropriate psychological interventions that can help children better cope with stressful medical procedures and hospitalization.

The diagnosis and treatment of cancer are a stressful and threatening experience, which can be emotionally devastating to children. Despite the improved prognosis, the course of cancer treatment has tremendous impact on children. This article aims to examine the impact of cancer on physical, emotional, and psychosocial well-being of Hong Kong Chinese children, an area of research that has been underrepresented in the literature. Ninety-eight Hong Kong Chinese children aged 7 to 15 years, admitted for treatment of cancer in 2 pediatric oncology units of 2 different hospitals, were invited to participate in the study. Findings from this study indicated that the children scored considerably high state anxiety on admission, and more than half of the participants presented some depressive symptoms during their stay in the hospital. Moreover, semistructured interviews indicated that nearly all children expressed different degrees of sadness and worry. The findings suggested that there is a room for improvement in existing nursing intervention regarding preparing children for hospitalization and treatment of cancer. There is an imperative need for nurses to evaluate appropriate nursing interventions that can help children resume their normal growth and development, in particular, to help them ease the physical, emotional, and psychological burden of life-threatening disease.

Objectives: This study investigated the relationship between children's locus of control and their state anxiety scores, and determined whether children's locus of control could predict their state anxiety scores before academic examinations. Design: A test-retest within subjects design was used. Sample: 519 school children were invited to participate in the study. Measurements: Participants were asked to respond to the Chinese version of the Nowicki-Strickland locus of control scale and state anxiety scale for children in stressful and nonstressful situations. The data were collected in 2005. Results: There were significant strong positive correlations between the state anxiety and locus of control scores in the period before academic examinations. Multiple regression analysis showed that the Nowicki-Strickland locus of control score was a good predictor of children's state anxiety in a stressful situation. Conclusions: This study supports the use of the Nowicki-Strickland locus of control scale as a screening tool to identify school children who are most likely to exhibit high levels of anxiety before academic examinations. Understanding children's locus of control in advance is a necessary step toward designing appropriate interventions to reduce their stress and bolster their coping mechanisms.

Background There is a lack of population-based smoking cessation interventions targeting woman smokers in Hong Kong, and in Asia generally. This study aimed to evaluate the effectiveness of a gender-specific smoking cessation program for female smokers in Hong Kong. Methods To evaluate the effectiveness of the service, a total of 457 eligible smokers were recruited. After the baseline questionnaire had been completed, a cessation counseling intervention was given by a trained counselor according to the stage of readiness to quit. Self-reported seven-day point prevalence of abstinence and reduction of cigarette consumption (≥50 %) and self-efficacy in rejecting tobacco were documented at one week and at two, three and six months. Results The 7-day point prevalence quit rate was 28.4 % (130/457), and 21.9 % (100/457) had reduced their cigarette consumption by at least 50 % at the six-month follow-up. The average daily cigarette consumption was reduced from 8.3 at baseline to 6.3 at six months. Moreover, both internal and external stimuli of anti-smoking self-efficacy increased from baseline to six months. Conclusions The study provides some evidence for the effectiveness of the gender-specific smoking cessation program for female smokers. Furthermore, helping smokers to improve their self-efficacy in resisting both internal and external stimuli of tobacco use can be a way of enhancing the effectiveness of a smoking cessation intervention.

Background: Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence. Objective: Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently. Methods: This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days. Results: Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators’ posts (median 60, IQR 25 vs median 32, IQR 7; P =.05) and participants’ posts (median 35, IQR 50 vs median 6, IQR 9; P =.07) than their Facebook counterparts, but the difference was insignificant. Conclusions: The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness. ClinicalTrial: Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG) [J Med Internet Res 2015;17(10):e238]

Background The numbers of women smoking have risen 72.5% since 1990 with the increasing population – from 56,100 to 96,800 in 2012, reflecting an alarming situation in Hong Kong. The study aimed to describe the smoking behaviour, attitudes and associated factors among women in Hong Kong. Methods A qualitative cross-sectional study involving semi-structured interview was conducted with Chinese women from five community centres in different districts in Hong Kong in 2010. A purposive sample of 73 female participants (24 current smokers, 20 ex-smokers and 29 never-smokers) were recruited. The 73 women were classified by their smoking status and age to form 15 focus groups. Results Most informants knew about the general health hazards of smoking, such as cancer and heart or respiratory diseases, but not about the female-specific health consequences of smoking. A few smokers considered smoking to be a weight control strategy, fearing a gain in weight if they gave up. Moreover, a few relied on smoking as a coping strategy to relieve negative emotions and stress. Additionally, a few smokers had misconceptions about giving up: that a loss of concentration would result, that continued smoking would not further affect their health as they had become desensitised to the chemicals in tobacco smoke or that quitting would harm their health. Conclusions This study generates new knowledge about the behavior, attitudes, and experiences related to smoking of current female smokers, ex-smokers and non-smokers in Hong Kong, which is unique as a Chinese but highly westernized community but with a very low female smoking prevalence.

Aim. This paper reports a study to assess the interrelationships between physiological measures of children's heart rates and blood pressure, subjective measures of children's level of anxiety, and direct behavioural observations in children's emotional responses to surgery. Background. Psychological upset has been described as a multidimensional phenomenon which includes behavioural, subjective, and physiological components. However, a majority of previous studies have employed only one or two measures of psychological upset. Most importantly, the interrelationships among these three components of psychological upset have seldom been explored. Methods. A cross-sectional design was employed, and 106 Chinese children admitted for day surgery during the summer of 2004 were invited to participate in the study. They were asked to respond to the Chinese version of the State Anxiety Scale for Children. Their mean arterial blood pressure and heart rates were recorded in the operating theatre after being transferred to the operating table but before anaesthesia induction. A research nurse used the Children's Emotional Manifestation Scale to document the children's emotional behaviours during anaesthesia induction. The data were collected in 2004. Results. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction. Those with more negative emotional behaviour or high levels of state anxiety also had faster heart rates and higher mean arterial blood pressure. Conclusion. A child's response to stressful medical procedures can be varied. The emotional responses of children to surgery need to be understood as a multidimensional phenomenon. To gain a more comprehensive understanding of the effects of surgery on children, it is recommended that assessment strategies used should reflect the multidimensional phenomenon of the emotional upset.