Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe

Background

Adverse childhood experiences (ACEs) are associated with higher depressive risks in adulthood. Whether respondents' ACEs are associated with their own depressive symptoms in adulthood and whether this association extends to their spouses' depressive symptoms remain unexplored.

Methods

Data were 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). ACEs were categorized into overall, intra-familial, and extra-familial ACEs. Correlations of couples' ACEs were calculated using Cramer's V and partial Spearman's correlation. Associations of respondents' ACEs with spousal depressive symptoms were assessed using logistic regression, and mediation analyses were conducted to explore the mediating role of respondents' depressive symptoms.

Results

Significant associations between husbands' ACEs and wives' depressive symptoms, with odds ratios (ORs) and 95% confidence intervals (CIs) of 2.09 (1.36-3.22) for 4 or more ACEs in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more ACEs in HRS and SHARE. However, wives' ACEs were associated with husbands' depressive symptoms only in CHARLS and SHARE. Findings in intra-familial and extra-familial ACEs were consistent with our main results. Additionally, respondents' depressive symptoms mediated more than 20% of the effect of respondents' ACEs on spousal depressive symptoms.

Conclusion

We found that ACEs were significantly correlated between couples. Respondents' ACEs were associated with spousal depressive symptoms, with respondents' depressive symptoms mediating the association. The bidirectional implications of ACEs on depressive symptoms should be considered within household and effective interventions are warranted.

A Descriptive Study on Multiple Health-Risk Behaviors among Chinese Adults in Hong Kong

This study investigated the prevalence and clustering patterns of multiple health-risk behaviors and their associations with non-communicable diseases among Chinese adults in Hong Kong. A large sample survey was conducted in all 18 districts of Hong Kong between 21 June and 31 August 2021. A total of 5737 adults completed the survey. Overall, 4605 (80.3%) had at least one health-risk behavior and 2696 (47.0%) had two or more health-risk behaviors. Multiple health-risk behaviors were more prevalent among men. The prevalence of smoking and alcohol consumption among Hong Kong Chinese women was considerably lower than in most Western countries. In contrast to previous findings, this study revealed that a high proportion of adults with high educational attainment or household income had multiple health-risk behaviors. In addition, this study revealed that the health-risk behaviors in Chinese adults co-occurred in clusters, with smoking and alcohol consumption co-occurring with other health-risk behaviors. Those who smoked or consumed alcohol had the highest proportion of multiple health-risk behaviors and the highest proportion of non-communicable diseases. The findings of this study add further evidence that health-risk behaviors co-occur in clusters and can contribute to non-communicable diseases.

Evaluating the experiences of parents of children with cancer engaging in a mobile device-based resilience training programme: a qualitative study

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Trial registration

NCT04038242, registered 17 July 2019.

Structured online training for university students to deliver peer-led addiction counselling for young drug abusers in China: Effect on improving knowledge, attitude, confidence, and skills

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.

The Lived Experience of Resilience in Parents of Children With Cancer: A Phenomenological Study

BACKGROUND

Resilience is vital in parents of children with cancer as it can promote parental well-being and minimize maladaptation in the face of the children's cancer. Although existing quantitative studies investigated the influence factors of resilience in the parents, it has not been fully explored about the factors contributing to the resilience of parents and how they respond to and cope with their children's cancer.

OBJECTIVE

To investigate the lived experience of resilience in the parents of children with cancer from a qualitative perspective to complement existing findings in quantitative studies.

METHODS

A phenomenological approach was used. Purposive sampling was performed to recruit parents of children with cancer from two tertiary hospitals in mainland China, followed by one-to-one semi-structured interviews. All of the interviews were audio-recorded and data were analyzed using thematic analysis.

RESULTS

Twenty-three parents, comprising 15 mothers and eight fathers, of children with cancer participated in the interview. Four themes were identified: positive and negative experiences of their children's disease, going through hardships, perceived competence and perceived social support. The most prominent facilitating factor of resilience was the presence of positive attitudes toward the children's cancer, while low level of confidence was the main obstacle.

CONCLUSION

This study identified certain factors that affect resilience in parents of children with cancer. The findings of this study provide important implications for the development of targeted resilience training programs to enhance resilience in parents of children with cancer. It is crucial for future interventions to focus on cultivating parental resilience to promote parents' mental well-being and improve their quality of life.

CLINICALTRIALSGOV ID

NCT03631485; URL: https://clinicaltrials.gov/ct2/show/NCT03631485.

Effectiveness of a Mobile Device-Based Resilience Training Program in Reducing Depressive Symptoms and Enhancing Resilience and Quality of Life in Parents of Children With Cancer: Randomized Controlled Trial

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; P<.001) and lower levels of depressive symptoms (mean 40.17, SD 9.9 vs mean 46.04, SD 10.9; P<.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience (β=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.

TRIAL REGISTRATION

Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242.

Perceptions, behaviours and attitudes towards smoking held by the male partners of Chinese pregnant women: a qualitative study

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11966-4.

Physicians' very brief (30-sec) intervention for smoking cessation on 13 671 smokers in China: a pragmatic randomized controlled trial

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.

Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial

INTRODUCTION

Evidence-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 ANALYSIS

This 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 <4 ppm and salivary cotinine <10 ng/mL) at 3 and 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, quit attempts and the use of smoking cessation services at 3 and 6 months. Intention-to-treat approach and regression models will be used in primary analyses.

ETHICS AND DISSEMINATION

This 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 NUMBER

ClinicalTrials.gov Registry NCT03565796.

Effects of simple active referrals of different intensities on smoking abstinence and smoking cessation services attendance: a cluster-randomized clinical trial

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 < 0.05]. The corresponding validated abstinence rates at 6 months were 7.6, 7.8 and 3.9% (OR for TMR versus control = 2.02, 95% CI = 1.07-3.81; OR for TMR versus control = 2.07, 95% CI = 1.10-3.92; both P < 0.05). Self-reported and validated abstinence were similar at 18 months. OSR groups had higher rates of smoking cessation service use than the control group at all follow-ups (all P < 0.001). The smoking reduction rates were similar in continuing smokers.

CONCLUSIONS

Simple active referrals (in person or via text messaging) to smoking cessation services increased abstinence rates among smokers in Hong Kong compared with general brief cessation advice. On-site active referral increased the use of smoking cessation services compared with general brief cessation advice.

Heated tobacco products use in Chinese adults in Hong Kong: a population-based cross-sectional study

INTRODUCTION

We 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.

METHODS

A 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.

RESULTS

Overall, 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 p<0.003). In never HTP users, intention to use HTPs (7.3%, 4.9%-10.8%) were more prevalent in respondents with similar characteristics (all p<0.008). More current (vs never) smokers were aware of HTPs, intent to use HTPs and had ever used HTPs (all p<0.001).

CONCLUSION

Higher socioeconomic status was associated with HTP use and intention to use. Public health education on HTPs is needed especially for this high-risk group.

Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol

INTRODUCTION

Nausea 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 ANALYSIS

A 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 DISSEMINATION

The 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 NUMBER

CRD42019135404.

Exploratory study on the relationship between smoking and other risk behaviours among young smokers

AIMS AND OBJECTIVES

To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong.

BACKGROUND

There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored.

DESIGN

This is a mixed-method retrospective population-based study.

METHODS

A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study.

RESULTS

In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers.

CONCLUSIONS

This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong.

RELEVANCE TO CLINICAL PRACTICE

Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.

Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial

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 3months. The validated quitters of the control group (n=379) received the incentive at 6months 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 24h) 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 24h) 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<0.01).

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.

Online Social Support for the Prevention of Smoking Relapse: A Content Analysis of the WhatsApp and Facebook Social Groups

BACKGROUND

Online social groups have been increasingly used for smoking cessation intervention.

INTRODUCTION

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.

MATERIALS AND METHODS

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.

RESULTS

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.

DISCUSSION

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.

CONCLUSION

Quitters who participate in the online social groups can benefit from peer support and information sharing, and hence prevent smoking relapse.

Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial

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)

An evaluation study of a gender-specific smoking cessation program to help Hong Kong Chinese women quit smoking

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.

Smoking among Hong Kong Chinese women: behavior, attitudes and experience

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.

Effective Prevention and Management of Tumor Lysis Syndrome in Children With Cancer

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.

Effectiveness of a parental training programme in enhancing the parent-child relationship and reducing harsh parenting practices and parental stress in preparing children for their transition to primary school: a randomised controlled trial

Background

Entering primary school is an important childhood milestone, marking the beginning of a child’s formal education. Yet the change creates a time of vulnerability for the child, the parents and the parent–child relationship. Failure to adjust to the transition may place the family in a psychologically devastating position. The aims of this study were to test the effectiveness of a parental training programme in enhancing the parent–child relationship and decreasing parental stress by reducing harsh parenting in preparing children for the transition to primary school.

Methods

A randomised controlled trial incorporating a two-group pre-test and repeated post-test was conducted in one of the largest public housing estates in Hong Kong. A total of 142 parents were recruited, with 72 parents randomly assigned to the experimental group and 70 to the control group. Harsh parenting practices, parent–child relationships and parental stress were assessed.

Results

In comparison to parents in the control group, those in the experimental group engaged in less harsh parenting practices and reported better parent–child relationships. However, parental stress scores did not differ significantly between the two groups.

Conclusion

This study addressed a gap in the literature by examining the effectiveness of the training programme for enhancing parent–child relationship and decreasing parental stress at the time of a child’s transition to primary school. The findings from this study provide empirical evidence of the effectiveness of the parental training programme and highlight the significance of parenting in promoting a smooth transition for children from kindergarten to primary 1.

Trial registration

ClinicalTrials.gov: NCT01845948.

Predisposing Factors to the Quality of Life of Childhood Cancer Survivors

The aim of this study was to examine the predisposing factors to the quality of life of Hong Kong Chinese childhood cancer survivors. A cross-sectional study was conducted with 153 survivors (9-16 years of age) during follow-up at the oncology outpatient clinic. The study found that depressive symptoms are a strong predictor of quality of life in childhood cancer survivors and that systematic screening of this population is important. It is essential for health care professionals to develop, plan, and evaluate interventions with the aim of alleviating depressive symptoms for childhood cancer survivors so as to enhance their quality of life.

Herth hope index: psychometric testing of the Chinese version

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 80 years 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.

Relationships among mental health, self-esteem and physical health in Chinese adolescents: an exploratory study

This study explored the relationships among mental health, self-esteem and physical health in Hong Kong Chinese adolescents. Chinese students (N = 1945) between the ages of 12 and 19 from four secondary schools of different regions were invited to participate in the study. This study revealed that a significant number of adolescents in Hong Kong are experiencing depressive symptoms. The overall results indicated that self-esteem of adolescents was correlated to and a predictor of their physical and mental health. Health care professionals should take a more assertive role in promoting relevant health education to the community with emphasis on helping adolescents develop positive self-esteem.

Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: a randomized controlled trial study

PURPOSE

This paper aims to examine the effectiveness and appropriateness of using therapeutic play in preparing children for surgery.

DESIGN/METHOD

A randomized controlled trial was employed. Children (7-12 years of age; n = 203) admitted for surgery during a 13-month period were recruited.

RESULTS

The results support the effectiveness and appropriateness of using therapeutic play in preparing children for surgery.

PRACTICE IMPLICATIONS

The study results promote awareness in nurses and parents that play is a very important part of children's lives, and heighten the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.

Evaluating the effectiveness of preoperative interventions: the appropriateness of using the children's emotional manifestation scale

AIMS

This study aimed to compare the effectiveness of two preoperative nursing interventions and examining the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative interventions.

BACKGROUND

There is some evidence that the Children's Emotional Manifestation Scale can be used as an objective assessment tool in documenting children's emotional responses. However, it is uncertain from previous study that whether the scale can be used in evaluating the effectiveness of preoperative interventions.

DESIGN

A randomized controlled trial, between subjects design was carried out in a well-established day surgery unit.

METHOD

Children (7-12 years of age; n = 203) admitted for elective day surgery during a 13-month period, were recruited. By using a simple randomization method, 97 of children were assigned to the experimental group receiving therapeutic play intervention and 106 children were assigned to the control group receiving routine information preparation.

RESULTS

Children receiving therapeutic play preparation reported statistically significant lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures than children receiving information preparation. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction and were associated with faster heart rates and higher mean blood pressures.

CONCLUSION

The study demonstrates the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative nursing interventions and presents clear evidence to support the effectiveness of therapeutic play intervention in preparing children for surgery when compared with the information preparation approach.

RELEVANCE TO CLINICAL PRACTICE

This study contributes towards enriching the experience of using child-sensitive research tools in evaluating the effectiveness of preoperative nursing interventions. The findings heighten the awareness of the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.

Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery

The purpose of this study was to examine the effects of therapeutic play on outcomes of children undergoing day surgery. Two hundred and three children admitted for day surgery were invited to participate in a randomized controlled trial. The experimental group received therapeutic play; the control group received routine information preparation. Children in the experimental group reported significantly lower state anxiety scores in pre- and postoperative periods and exhibited fewer negative emotions at induction of anesthesia than children in the control group. No significant differences were found between the two groups in postoperative pain. The study provides some evidence that therapeutic play is effective in pre- as opposed to postsurgical management of children.

Development and validation of a short form of the Chinese version of the State Anxiety Scale for Children

BACKGROUND

There is a lack of a simplified instrument for use in busy clinical settings to measure and differentiate anxiety levels of children.

OBJECTIVES

To develop a short form of the Chinese version of the State Anxiety Scale for Children (CSAS-C) and test psychometric properties of the new form.

DESIGN

The study was divided into two phases with phase one aimed at developing a short form of the CSAS-C, while phase two aimed at testing psychometric properties of the new form. A test-retest, within-subjects design was employed. Children (7-12 years of age) admitted for surgery in a day surgery unit during two consecutive years' summer holiday were invited to participate in the study. In phase one, selected participants (N=112) were asked to respond to the CSAS-C. In phase two, selected participants (N=82) were asked to respond to the short form of the CSAS-C.

RESULTS

Using exploratory factor analysis, a subset of 10 items, which was highly correlated with scores obtained from the full form (r=0.92) and, which had acceptable internal consistency (r=0.83) was developed. The psychometric properties of this short form have been empirically tested, showing adequate internal consistency reliability, good concurrent validity, and excellent construct validity.

CONCLUSION

This study addresses a gap in the literature by developing a 10-item short form of the CSAS-C. Results indicate that this short form is an appropriate and objective assessment tool for measuring anxiety levels of Chinese children in a busy clinical setting where time constraints make unfeasible the use of the full form.

Psychoeducational preparation of children for surgery: the importance of parental involvement

OBJECTIVE

To examine the effects of therapeutic play intervention on outcomes of children undergoing day surgery, and to highlight the importance of parental involvement in the psychoeducational preparation of children for surgery.

METHODS

A randomized controlled trial, two group pre-test and repeated post-test, between subjects design was employed. Hong Kong Chinese children (7-12 years of age; n=203) admitted for elective surgery in a day surgery unit, along with their parents during a 13-month period, were invited to participate in the study. By using a simple complete randomization method, 97 of children with their parents were assigned to the experimental group receiving therapeutic play intervention, and 106 children with their parents were assigned to the control group receiving routine information preparation.

RESULTS

The results showed that both children and their parents in the experimental group reported lower state anxiety scores in pre- and post-operative periods. Children in the experimental group exhibited fewer instances of negative emotional behaviors and parents in the experimental group reported greater satisfaction. The results, however, find no differences in children's post-operative pain between the two groups.

CONCLUSION

The study provides empirical evidence to support the effectiveness of using therapeutic play intervention and the importance of parental involvement in the psychoeducational preparation of children for surgery.

PRACTICE IMPLICATIONS

The findings heighten the awareness of the importance of integrating therapeutic play and parental involvement as essential components of holistic and quality nursing care to prepare children for surgery.

Assessing children's emotional responses to surgery: a multidimensional approach

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.

Do trait anxiety and age predict state anxiety of school-age children?

AIM

The aim of this study was to determine whether the trait anxiety scores and age of children could predict their state anxiety scores under stressful and relaxing situations.

BACKGROUND

Surgery can cause considerable stress and anxiety that can have a profound effect on children. It is crucial for nurses to differentiate preoperative anxiety levels in children and to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery before any intervention can be appropriately planned, provided and evaluated.

METHODS

A test-retest within subjects design was used. Five hundred and nineteen primary school-age children were invited to participate in the study. Participants were asked to respond to the Chinese version of the State-Trait Anxiety Inventory for Children under stressful (pre-academic examination) and relaxing (post-academic examination) situations.

RESULT

Multiple regression analysis showed that the trait anxiety of children was a strong predictor of their state anxiety in a stressful situation but not in a relaxed one. Compared to trait anxiety, age was found to be a weak predictor of the state anxiety of children in either situation.

CONCLUSION

This study confirmed that trait anxiety of children could be predicted from their state anxiety under a stressful situation.

RELEVANCE TO CLINICAL PRACTICE

The trait anxiety scale could be a useful screening tool for nurses to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery. Understanding the trait anxiety of children in advance could help nurses implement appropriate preoperative psychological intervention that can meet the individual needs of the child and thus promote better recovery.

Children's Emotional Manifestation Scale: development and testing

AIMS AND OBJECTIVES

The objectives of this study were to develop an objective and operationalized behavioural observation scale that can be used to document children's emotional responses during stressful medical procedures, and to test the psychometric properties of this newly developed scale.

BACKGROUND

The availability of a valid and reliable instrument that accurately documents the manifestation of children's emotions prior to undergoing surgery or during stressful medical procedures is crucial before any intervention can be appropriately planned and evaluated. There is a lack of such an instrument with effective psychometric properties in the literature.

DESIGN

A cross-sectional study was employed. A convenience sample of 82 children admitted for day surgery was recruited in this study.

METHOD

Based on systematic literature search, a number of observable emotional behaviours with different levels or intensities were identified. A panel of nurse experts was set up to review this finding and develop the scale. Intra-class correlation was used to estimate the inter-rater reliability coefficient. Internal consistency reliability was assessed by determining the Cronbach's alpha. Content validity was established by six nurse experts' ratings. The validity of the scale was also confirmed by convergent validity.

RESULTS

The results showed that there was adequate inter-rater reliability, high internal consistency reliability, good content validity and excellent convergent validity.

CONCLUSIONS

This study has addressed a gap in the literature by developing an objective tool to document children's emotional responses during stressful medical procedure, which are under-researched in the literature.

RELEVANCE TO CLINICAL PRACTICE

The Children's Emotional Manifestation Scale was developed to provide a simple, objective and consistent method for nurses to document children's emotional behaviour during stressful medical procedures. Clinical nurses can also use this scale to evaluate preoperative interventions directed towards minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.

Chinese translation and validation of the Nowicki-Strickland locus of control scale for children

The objective of this study is to evaluate the psychometric properties of the Chinese version of the Nowicki-Strickland Locus of Control Scale for Children for its utility in clinical research and nursing practice. The scale was translated from the original English language into the Chinese language and the reliability and validity of the translated scale were tested. Results showed that there was high test re-test reliability, acceptable internal consistency reliability, appropriate content validity, concurrent validity and construct validity. It is concluded that the psychometric properties of the Chinese version of the Nowicki-Strickland Locus of Control Scale for Children presented in this paper supports its feasibility as a research instrument to measure children's locus of control objectively and appropriately in the Chinese population.

The reliability and validity of the Chinese version of the trait anxiety scale for children

The availability of a valid and reliable tool that accurately measures and differentiates pre-operative anxiety level of children is crucial before any intervention can be appropriately planned, provided, and evaluated. The purposes of this study were to translate the original Trait Anxiety Scale for Children into Chinese and evaluate the psychometric properties of the newly translated scale for its utility in clinical practice and research. Five hundred and nineteen children from a primary school were recruited for this study. The instrument demonstrated adequate internal consistency reliability, and strong evidence of content and construct validity. Factor analysis confirmed the construct validity of the scale with a good fit between the factor structure of the scale and the observed data. Results suggest that the Chinese version of the Trait Anxiety Scale for Children can be used as a self-report assessment tool in measuring trait anxiety level of Chinese children ages 7-12 years.

Psychometric evaluation of the Chinese version of the state anxiety scale for children

The assessment of anxiety in children undergoing surgery must be addressed before any intervention can be appropriately planned, provided, and evaluated. The purpose of this study was to evaluate the psychometric properties of the Chinese version of the State Anxiety Scale for Children. Two hundred and thirty-seven children from a primary school and 112 children admitted for day surgery were recruited for this study. The instrument demonstrated adequate internal-consistency reliability, appropriate concurrent validity, and construct validity. Factor analyses further confirmed the construct validity of the scale, with a good fit between the factor structure of the scale and the observed data. Results suggest that the Chinese version of the State Anxiety Scale for Children can be used as a self-report assessment tool in measuring the anxiety level of Chinese children ages 7-12 years.

Paediatric day surgery: impact on Hong Kong Chinese children and their parents

Paediatric day surgery is a potentially stressful and threatening experience for children and parents. The purposes of this study were to investigate the effects of paediatric day surgery on anxiety level of Hong Kong Chinese children and their parents, and to examine the relationship between children's preoperative anxiety and their level of cooperation during induction and postoperative periods. A total of 112 children admitted for circumcision with their parents in a day surgery unit were recruited. The state anxiety level for both children and parents was assessed at the time of admission and again at 4 hours after operation. Children's level of cooperation during the induction and the postoperative periods were also assessed. The results showed that the preoperative anxiety level for both children and their parents was relatively high. Children with high preoperative anxiety levels were associated with lower levels of cooperation during induction and postoperative periods. The results also indicated that parents' high state anxiety was associated with their children's high state anxiety. This study designated that preoperative intervention to minimize children and parents' anxiety is crucial and that there is still room for improvement.