1,721,371 research outputs found
General parenting, smoking-specific parenting practices and adolescent smoking in Hong Kong
No full textIntroduction
Though the associations of general parenting styles and smoking-specific parenting practices with adolescent smoking have received much attention in recent years, important questions remain. Most general parenting studies focused on Caucasian parents but much less in the literature is known about Chinese parents. As for smoking-specific parenting practices in the household, anti-smoking practices have been the focus, with pro-smoking practices seldom being studied.
The objectives of the present study were: 1) to examine general parenting styles of Hong Kong fathers and mothers, and their associations with adolescent current smoking; 2) to explore potential effect modifiers of the above associations—age/sex of the adolescent and parental smoking status; 3) to estimate the prevalence of adolescents’ exposure to smoking-specific parenting practices and the coexistence of pro-smoking and anti-smoking practices within a family; and 4) to examine the associations of smoking-specific parenting practices with adolescent current smoking status and their intention to smoke.
Methods
Data from 2 large-scale school surveys were used. In the Hong Kong Student Obesity Surveillance project (HKSOS), 34,678 secondary students aged 12-17 completed an anonymous questionnaire. Current smoking denoted any smoking in the past 30 days. The parenting style of each parent was classified as authoritative (high care/high control), authoritarian (low care/high control), permissive (high care/low control) or neglectful (low care/low control). Binary logistic regressions generated adjusted odds ratios (AORs) of current smoking for parenting styles, and parental care and control.
In the Youth Smoking Survey (YSS) (2003/04), information of adolescent smoking behaviours, their exposure to smoking-specific parenting practices at home and socio-demographic characteristics was collected among 36,612 secondary 1-5 students. Pro-smoking practices included “buy cigarettes/hand cigarettes/light a cigarette/clean the ashtray for family members”, “easily see packages of cigarettes of family members at home”, “exposure to secondhand smoke at home” and “smoking among family members”. Anti-smoking practices were “parent-child communication about harms of smoking” and “anticipated control from father/mother if you were to smoke”. AORs of adolescent current smoking and their intention to smoke for each pro-smoking and anti-smoking practice were calculated.
Results
In HKSOS, over half of the fathers (51.5%) and mothers (66.2%) were authoritative. Current smoking (3.1%) was associated with lower levels of care both from father and mother, lower levels of maternal control, but higher levels of paternal control.
Compared with authoritative fathers, the AORs (95% CI) of adolescent current smoking were 0.74 (0.59-0.93) for permissive, 1.13 (0.87-1.43) for authoritarian, and 0.99 (0.77-1.28) for neglectful. The corresponding AORs for mothers were 1.30 (1.04-1.61), 1.80 (1.34-2.41), and 2.49 (1.90-3.28).
In YSS, 9.7% of adolescents were current smokers and 33.2% had the intention to smoke. About half the students (52.7%) reported pro-smoking practices and 87.8% reported anti-smoking practices at home. Anti-smoking practices were associated with lower odds of adolescent current smoking and intention to smoke, whereas pro-smoking practices were linked to higher odds.
Conclusions
Authoritative mothers and permissive fathers seemed to have protective effects against adolescent smoking. Pro-smoking practices were associated with higher odds of adolescent current smoking and intention to smoke, while anti-smoking practices were protective.published_or_final_versionCommunity MedicineMasterMaster of Philosoph
Cross-sectional and prospective associations among tobaccoadvertising, psychosocial intervening variables and smoking behavioursin Hong Kong adolescents, 1999-2003/4
No full textpublished_or_final_versionCommunity MedicineDoctoralDoctor of Philosoph
Alcohol-related harms in adolescents and a pragmatic randomized controlled trial of chat-based intervention with alcohol screening and brief intervention for adolescents with alcohol use disorder
No full textBackground: This thesis adopted the population-based approach, which aimed to use video-based health talk to prevent secondary school students from becoming regular drinkers and examine the effect of using chat-based intervention combined with alcohol screening and brief intervention (ASBI) for reducing alcohol use in current university student drinkers.
Methods: This work consists of three phases. In phase one, a pre-post study was conducted on 1244 secondary school students to examine their change in the knowledge of passive and forced drinking harms and intention to drink alcohol after the video-based health talk. In phase two, I conducted a qualitative study and interviewed 20 Hong Kong Chinese university student drinkers to explore their perceptions of using chat-based intervention for alcohol support. In phase three, current university student drinkers with Alcohol Use Disorder Identification Test score ≥ 8 were proactively recruited from 8 universities in Hong Kong to participate in a two-arm, pragmatic, randomized controlled trial. 772 participants were randomized into the intervention or control groups with a 1:1 allocation ratio. Both groups received ASBI at baseline. The intervention group further received chat-based alcohol support guided by behavior change technique for 3 months, and control group received regular text-messaging support on general health with the same duration. The primary outcome was alcohol consumption in gram per week at 6 months follow-up (3 months after treatment) by intention-to-treat. The trial was registered with ClinicalTrials.gov (NCT04025151).
Results: In phase one, secondary school students who attended the video-based health talk with increased knowledge of passive drinking were associated with less intention to drink (adjusted [odds ratio] OR, 0.93; 95% CI, 0.90 to 0.97, P = 0.001), and increased knowledge of health harm (adjusted [unstandardized coefficient] B, 0.06; 95% CI, 0.05 to 0.08, P = 0.001), and social harm of drinking (adjusted B, 0.12; 95% CI, 0.10 to 0.16, P = 0.001). In phase two, interviewees perceived the mobile instant messaging app as a feasible and acceptable platform for chat-based intervention. They preferred to receive messages on personalized problem-solving, drinking harms from credible sources, timely psychosocial support, and goal setting. In phase three, 772 university student drinkers were recruited and randomized into the intervention (n = 385) or control groups (n = 385). The retention rate was 85% at 6 months follow-up. At 6 months, the intervention group had significantly lower alcohol consumption in gram per week (B [gram], -11.42; 95% CI, -19.22 to -3.62; P = 0.004), AUDIT score (B [AUDIT], -1.19; 95% CI, -1.63 to -0.34; P = 0.003), weekly alcohol unit consumption (B [alcohol unit], -1.14; 95% CI, -1.92 to -0.36; P = 0.004), and intention to drink (OR, 0.66; 95% CI, 0.47 to 0.92; P = 0.01).
Conclusions: The quasi-experimental study showed that the video-based health talk was effective in educating them on the harms of alcohol use and reducing their intention to drink. The trial showed that chat-based intervention combined with ASBI was effective in reducing alcohol use in university student drinkers in Hong Kong.published_or_final_versionNursing StudiesDoctoralDoctor of Philosoph
Parental pro-drinking practices and alcohol drinking in Hong Kong adolescents
No full textBackground: Although parental drinking is associated with adolescent drinking, the impacts of parental alcohol-related actions were controversial. The present study aims to 1) examine the prevalence of parental pro-drinking practices (PPDPs), 2) examine the association between PPDPs and parental drinking, 3) identify the factors associated with PPDPs among adolescents with drinking parents, 4) examine the association between PPDPs and adolescent drinking, and 5) explore the experience of PPDPs and alcohol use in adolescents and parents qualitatively.
Methods: A cross-sectional survey was conducted among 2200 secondary 1 to 6 students from 4 randomly selected local schools. Students were asked if they have experienced each of 9 PPDPs including 1) saw parents drank and being drunk; 2) heard parents saying benefits of drinking and certain alcohol tasted good; 3) helped parents buy alcohol, open bottle and pour alcohol; and 4) parental action in encouraging drinking and training of drinking capacity. Logistic regression was used to compute the adjusted odds ratios (AORs) and 95% confidence interval (95% CI) of each PPDP by the number of drinking parents, and the drinking frequency of each parent adjusting for socio-demographic variables. Moreover, correlates of PPDPs were identified among students with at least one drinking parent. Furthermore, the AORs and 95% CI of student drinking and drinking intention by each PPDP were computed. A total of 40 families (33 student-parent pairs, 6 students and 1 parent) were then selected for telephone interview.
Results: Overall, 67.5% of students experienced at least 1 PPDP with the prevalence of PPDPs ranging from 9.3% for hearing the benefits of drinking to 51.0% for seeing parents drank. The prevalence of PPDP increased dramatically with the number of drinking parents (none 38.8%, either 81.6%, both 89.0%).
PPDPs were associated with parental drinking frequency and various socio-demographic factors. For instance, adolescent girls (AOR: 2.28) were more likely to have received parental training of drinking capacity than boys. Frequent paternal and maternal drinking were most strongly associated with helping parents buy alcohol (AOR: 6.55) and training of drinking capacity (AOR: 5.14), respectively.
In general, most PPDPs were significantly associated with ever drinking and monthly drinking in students. Both ever and monthly drinking in adolescents were strongly associated with parental training of drinking capacity with AORs of 6.20 and 8.20, respectively. Similarly, each PPDP was significantly associated with adolescent drinking intention with AORs ranging from 1.50 for helping parents buy alcohol to 3.53 for being encouraged by parents to drink.
Consistent with quantitative data, the interviews revealed that almost half the students reported PPDPs (N=17/39) and it was common for students to see parents drink (N=7). Of the 17 families reporting involvement in PPDPs, all had at least one drinking parent.
Conclusions: Most students experienced PPDPs and its prevalence increased with the number of drinking parents. In drinking parents, PPDPs were associated with socio-demographic factors and parental drinking frequency. Most PPDPs were associated with adolescent drinking and intention to drink. These results suggested that parents should avoid PPDPs to prevent adolescent drinking.published_or_final_versionPublic HealthMasterMaster of Philosoph
Preventing and reducing tobacco use in children and adolescents in Hong Kong
No full textAlthough the prevalence of tobacco use in Hong Kong is low, children and adolescents may still be susceptible to tobacco use. I investigated the personal and environmental risk factors of tobacco use and evaluated the effects of a drama intervention, pictorial warnings on cigarette packets, and parental involvement in preventing and reducing tobacco use in children and adolescents.
This thesis comprises 3 studies. The first study was a drama intervention on tobacco industry denormalisation, which recruited 5497 Primary 2-4 students from 30 randomly selected schools in 2018-19. Their 1) knowledge of nicotine, thirdhand smoke, and electronic cigarettes, 2) attitudes towards the tobacco industry, 3) susceptibility to tobacco use, 4) intention to encourage smoking parents to quit, and 5) sociodemographics were assessed. The second study was a cross-sectional study that recruited 26648 Secondary 1-6 students from 83 randomly selected schools in 2016/17. They provided information on 1) parental comments on tobacco-related issues, 2) family and others’ awareness of their tobacco use behaviours, 3) parental intervention in their tobacco use behaviours, and 4) sociodemographics. The third study was a focus group study that explored the perceptions of 35 Primary 4 to Secondary 3 students towards 4 types of cigarette packets (with 50% pictorial health warnings, with 85% pictorial health warnings, drab brown plain packets, and lime green plain packets) in 2017. Chi-square tests, Fisher’s exact tests, McNemar’s tests, and Poisson regressions were used to analyse categorical dependent variables. T-tests and one-way ANOVA were used to analyse continuous dependent variables, whereas Mann-Whitney U tests and Kruskal-Wallis tests were used for continuous dependent variables that were not normally distributed.
One in 7 (14.1%) Primary 2-4 children were susceptible to tobacco use and 37.3% had a positive attitude towards the tobacco industry, particularly those who were living with tobacco users. The drama intervention improved their tobacco-related cognitions and increased their intention to encourage parental smoking cessation, particularly in students who had never used tobacco. Cigarette packets with 50% branding elements were still perceived as attractive to the students. Enlarging pictorial warnings from 50% to 85% and plain packets reduced perceived attractiveness, increased perceived harmfulness, addictiveness, and effectiveness in deterring smoking. Among adolescents, pro-cigarette parental comments were associated with a higher susceptibility to smoke, whereas anti-tobacco parental comments were associated with less positive attitudes towards tobacco use, but not tobacco cessation. Only around half (56.1%) of the adolescent ever tobacco users were identified by parents, of whom around one-third of parents did not intervene. Nevertheless, adolescents who were intervened by parents reported lower consumption level of cigarettes and more quit attempts. Current tobacco use was most commonly known by friends or classmates (68.2%), followed by family members (67.2%), school staff (20.2%), others (9.8%) and health professionals (4.2%).published_or_final_versionPublic HealthDoctoralDoctor of Philosoph
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Nasopharyngeal carcinoma and smoking : evidence from observational and genetic studies
No full textNasopharyngeal carcinoma (NPC) is rare globally but has high incidence and mortality in North Africa and Southeast Asia, especially in Southern China, such as Hong Kong and Guangzhou. NPC is a highly malignant, fast progressing and asymptomatic cancer deeply located in the centre of the head. These characteristics make it difficult to detect at early stages with over 70% of NPC in high-risk regions diagnosed at advanced stages (stage III and IV), creating a heavy disease burden to society.
Tobacco is a well-known causal factor for head and neck cancers, but not for NPC. In both high- and low-risk regions, most studies on the association between smoking and NPC were case-control studies and prospective cohort studies were few. Significant positive associations between smoking and NPC were mainly observed in low-risk regions, but findings in high-risk regions were mixed. The distinct geographic distribution of high- and low-risk regions supports that the association between NPC and smoking should better be examined separately in high- and low-risk regions. Therefore, the present thesis focuses on high-risk regions.
After conducting a comprehensive critical literature review, I found insufficient high-level evidence to support smoking as a causal factor for NPC. Hence, I conducted a series of epidemiological (observational) studies from low- to high-level of evidence to examine the association in high-risk regions. The Hong Kong Multicentre Case-control Study with 821 NPC incident cases and 1,868 controls (1,512 hospital controls and 356 community controls) was analysed to evaluate the association of active smoking, passive smoking and smoking cessation with the risk of NPC. To understand the mechanism of how smoking causes NPC, genetic analysis of the nicotine dependence single nucleotide polymorphisms- rs1051730 was also conducted. The Guangzhou Biobank Cohort Study (GBCS), a large prospective study (n=26,399) in the NPC high-risk region was analysed to evaluate the association of smoking and NPC risk in elderly adults (aged 50 or above) with 51 NPC incident cases and NPC deaths. The individual participant data (IPD) meta-analysis is considered to be the ‘gold standard’ of systematic review and can provide the strongest observational evidence to support causality. In the present thesis, the IPD meta-analysis on cohort studies of NPC in high-risk regions was the first IPD meta-analysis to study the association between smoking and NPC.
The results from the present Hong Kong case-control study, GBCS and the IPD meta-analysis found sufficient evidence that active smoking is causally associated with NPC in high-risk regions. Passive smoking is probably associated with an increased risk of NPC. Smoking cessation is probably associated with a lower risk of NPC. The harms of active and passive smoking in NPC and the benefit of smoking cessation highlight the importance of implementing strict tobacco control strategies in high-risk regions.published_or_final_versionPublic HealthDoctoralDoctor of Philosoph
The effects of milk consumption on body mass index in children
No full textpublished_or_final_versionCommunity MedicineMasterMaster of Philosoph
Heated tobacco product use in Hong Kong adults : use pattern, health effects and correlates with tobacco industry denormalisation beliefs and COVID-19
No full textHeated tobacco products (HTPs) are aggressively marketed with the claim of reduced harm despite insufficient evidence. Current regulations on HTPs vary by country. To inform HTP control, this thesis examined 1) awareness, ever use and perceptions of HTPs, and associated factors; 2) the levels of exhaled carbon monoxide (CO) and salvia cotinine in a real-life setting; 3) HTP use in relation to depressive and anxiety symptoms; 4) tobacco industry denormalisation (TID) beliefs in relation to HTP use and public support for banning HTPs; and 5) influence of COVID-19 on HTP and other tobacco use, in Hong Kong adults.
A territory-wide survey was conducted on 5000 households (7101 participants) in 2019/20 and 1255 households (1849 participants) in 2020/21. Sociodemographic factors, depressive and anxiety symptoms, and TID beliefs were measured and assessed for associations with HTP outcomes using logistic/Poisson regression with robust standard errors. A hotspot survey was conducted at outdoor smoking hotspots in 2019/20 on 1299 tobacco users. Exhaled CO from the hotspot survey (n=780) and saliva cotinine from household and hotspot surveys (n=620) were measured, and their differences among users of different products were examined using the Kruskal-Wallis test. The differences in average daily consumption were examined using linear regression. In 2021, I conducted in-depth interviews with 95 tobacco users over the phone. Deductive and inductive methodologies were used to code transcriptions, and factors for changes in tobacco use amid the COVID-19 outbreak were nested in the social-ecological model.
Over half of Hong Kong adults were aware of HTPs but only 0.7% had ever used them, with higher percentages in conventional cigarette (CC) and electronic cigarette (EC) users. Positive perceptions of HTPs were more common in current and former HTP users. CC users, regardless of other tobacco use, had a higher CO level than exclusive HTP users. Saliva cotinine levels were similar between HTP and CC users. Dual users of CCs and HTPs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total. Depressive and anxiety symptoms were associated with current HTP use and dual use of HTPs and CCs. TID beliefs were inversely associated with ever HTP use in current cigarette non-users but positively associated with ever HTP use in current cigarette users. Support for banning HTPs was associated with TID beliefs both in current users and current non-users. The perceived odourlessness of HTPs increased consumption of HTPs indoors when living with family members. Limited access to HTPs was compensated by cigarette use amid the COVID-19 outbreak.
In conclusion, HTP use was uncommon in Hong Kong but higher in CC and EC users. Dual users of CCs and HTPs consumed more tobacco in total and had higher depressive and anxiety symptoms than exclusive CC users. HTP users compensated by smoking cigarettes when HTPs were unavailable. Our findings support quitting of CC smokers instead of switching to or concurrent use of HTPs, and promoting TID to increase public support for banning HTPs. Better cessation services targeting HTP and cigarette use are needed to help quit all tobacco.published_or_final_versionPublic HealthDoctoralDoctor of Philosoph
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