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Chen T, Wang MP, Cheung YTD, Wang L, Lam TH, Ho SY. Patterns and socioeconomic differences in secondhand exposure to cigarettes, e-cigarettes, and heated tobacco products at home in Hong Kong adolescents. Tob Induc Dis 2024; 22:TID-22-78. [PMID: 38751548 PMCID: PMC11095092 DOI: 10.18332/tid/186047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Smoke or aerosols from cigarettes, e-cigarettes (ECs), or heated tobacco products (HTPs) are harmful. Yet, there is little knowledge about the specific patterns of secondhand tobacco exposure by source within household settings and the socioeconomic status (SES) differences in adolescents. METHODS We used territory-representative student data from a cross-sectional school-based survey in 2020-2021 to calculate the weighted prevalence of secondhand exposure to cigarettes, e-cigarettes, and HTPs in the past seven days. Parental education and perceived family affluence were used as indicators of socioeconomic status. Generalized linear mixed models were used to analyze associations. RESULTS Among 22039 participants, 29.8% reported any secondhand tobacco exposure (SH-Any) at home, primarily from cigarettes (27.4%), followed by e-cigarettes (4.0%) and HTPs (0.9%). Tertiary parental education level was associated with lower SH-Any exposure (Adjusted odds ratio, AOR=0.49; 95% CI: 0.45-0.53, p<0.001), fewer exposure days (β= -0.685, p<0.001), lower exposure to cigarettes (SH-CC) (AOR=0.49; 95% CI: 0.45-0.54, p<0.001) and to e-cigarettes or HTPs (SH-EC/HTP) (AOR=0.57; 95% CI: 0.45-0.71, p<0.001). 'Poor' family affluence was associated with higher exposures [AOR(SH-Any) =1.14; 95% CI: 1.06-1.22, p=0.001; β(days)=0.160, p<0.001; AOR(SH-CC) =1.15; 95% CI: 1.07-1.24, p<0.001], except for SH-EC/HTP exposure, which was higher in students in an affluent family (AOR =1.66; 95% CI: 1.25-2.21, p<0.001). Significant SES differences in SH-EC/HTP exposure were found only in groups with low parental education level. Dose-response relationships were found between lower SH-Any and SH-CC and higher SES categories (p for trend<0.001). CONCLUSIONS Adolescents experienced a high prevalence of tobacco smoke exposure at home, primarily from cigarettes. Higher SES was associated with lower tobacco exposure, except for SH-EC/HTP, which was higher among adolescents from affluent families. Additionally, high parental education level was protective against exposure to SH-EC/HTP. Comprehensive control measures to reduce the use of these tobacco products are needed to protect adolescents of diverse socioeconomic backgrounds.
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Affiliation(s)
- Tianqi Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Man P. Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | | | - Lijun Wang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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Wu YS, Cheung YTD, Lee JJJ, Wong CKH, Ho SY, Li WHC, Yao Y, Lam TH, Wang MP. Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial. J Med Internet Res 2024; 26:e44973. [PMID: 38739429 DOI: 10.2196/44973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 09/28/2023] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. OBJECTIVE This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. METHODS From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. RESULTS Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). CONCLUSIONS An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719.
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Affiliation(s)
- Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Jay Jung Jae Lee
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ying Yao
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Chau SL, Luk TT, Wong BYC, Wu YS, Cheung YTD, Ho SY, Kim JH, Lo HHM, Lam TH, Wang MP. A Brief Intervention With Instant Messaging or Regular Text Messaging Support in Reducing Alcohol Use: A Randomized Clinical Trial. JAMA Intern Med 2024:2817487. [PMID: 38587827 PMCID: PMC11002763 DOI: 10.1001/jamainternmed.2024.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
Importance Alcohol use is prevalent among university students. Mobile instant messaging apps could enhance the effectiveness of an alcohol brief intervention (ABI), but the evidence is scarce. Objective To evaluate the effectiveness of an ABI plus 3 months of mobile chat-based instant messaging support for alcohol reduction in university students at risk of alcohol use disorder. Design, Setting, and Participants In this randomized clinical trial, 772 students at risk of alcohol use disorder (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) were recruited from 8 universities in Hong Kong between October 15, 2020, and May 12, 2022. Participants were randomly assigned 1:1 to either the intervention or control group. Interventions Both groups received the same ABI at baseline, which consisted of face-to-face or video conferencing with research nurses who delivered personalized feedback based on the participant's AUDIT risk level, along with a 12-page booklet describing the benefits of alcohol reduction and the harmful effects of alcohol on health and social well-being. The intervention group then received 3 months of chat-based instant messaging support on alcohol reduction guided by behavioral change techniques. The control group received 3 months of short message service (SMS) messaging on general health topics. Main Outcomes and Measures All outcomes were self-reported. The primary outcome was alcohol consumption in grams per week at 6 months of follow-up. By definition, 1 alcohol unit contains 10 g of pure alcohol. Secondary outcomes at the 6-month follow-up included changes in AUDIT score, weekly alcohol consumption, intention to drink in the next 30 days, drinking frequency and any binge or heavy drinking in the past 30 days, and self-efficacy of quitting drinking. The primary analysis followed the intention-to-treat principle, and linear regression (reported as unstandardized coefficient B) and logistic regression (reported as odds ratios) were used to compare the primary and secondary outcomes between the intervention and control groups. Results The study included 772 students (mean [SD] age, 21.1 [3.5] years; 395 females [51.2%]) who were randomly assigned to either the intervention (n = 386) or control (n = 386) group. In the intention-to-treat analysis, the intervention group had lower alcohol consumption in grams per week (B, -11.42 g [95% CI, -19.22 to -3.62 g]; P = .004), a lower AUDIT score (B, -1.19 [95% CI, -1.63 to -0.34]; P = .003), reduced weekly alcohol unit consumption (B, -1.14 [95% CI, -1.92 to -0.36]; P = .004), and less intention to drink (odds ratio, 0.66 [95% CI, 0.47 to 0.92]; P = .01) at the 6-month follow-up compared with the control group. In analyses adjusted for baseline characteristics, interacting at least once with the research nurse on the instant messaging application resulted in lower estimated alcohol consumption in grams per week (adjusted B, -17.87 g [95% CI, -32.55 to -3.20 g]; P = .01), lower weekly alcohol unit consumption (adjusted B, -1.79 [95% CI, -3.25 to -0.32]; P = .02), and a lower AUDIT score (adjusted B, -0.53 [95% CI, -1.87 to -0.44]; P = .01) at 6 months. Conclusions and Relevance Results of this randomized clinical trial indicate that mobile chat-based instant messaging support for alcohol reduction in addition to an ABI was effective in reducing alcohol consumption in university students in Hong Kong at risk of alcohol use disorder. Trial Registration ClinicalTrials.gov Identifier: NCT04025151.
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Affiliation(s)
- Siu Long Chau
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Yongda Socrates Wu
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Jean H. Kim
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Herman Hay Ming Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
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Wu YS, Cheung YTD, Ho SY, Tong HSC, Lai VWY, Lam TH, Wang MP. Perception of heated tobacco products and support for regulations: a cross-sectional study in Hong Kong. Tob Control 2024; 33:e132-e135. [PMID: 36344255 DOI: 10.1136/tc-2022-057401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hong Kong has proposed banning the sale of heated tobacco products (HTPs). Perceptions of reduced harms and effectiveness for quitting combustible cigarettes (CCs) of HTPs due to their promotions may erode public support for regulations. We assessed the associations between perceptions of HTPs and support for regulations in Hong Kong. METHODS In two population-based landline surveys conducted in 2018-2019, 1985 respondents (51.4% male; 22.7% aged 60+ years) reported perceived relative harm of HTPs to CCs and effectiveness for quitting CCs, and support for five HTP regulations (ban on promotion and advertisements, use in smoke-free areas, sales to minors, registration before sale, sale licence) and a total ban on sale. Current and former smokers were oversampled due to low prevalence. Descriptive statistics were weighted to the general population. Associations were analysed, adjusting for sociodemographic characteristics, smoking status and ever HTP use. RESULTS 27.4% (N=515) of respondents perceived HTPs as less harmful, and 18.8% (N=1299) perceived them as effective for quitting CCs. Support was generally high (at least one regulation, 99.1%, N=1959; all five regulations, 66.8%, N=1114; total ban, 63.5%, N=946). Perceptions of reduced harm were associated with lower support for all five regulations (adjusted risk ratio 0.85, 0.75 to 0.96) and a total ban on sale (0.58, 0.51 to 0.66). Results were similar for perceptions of effectiveness for quitting. CONCLUSIONS Lower support for HTP regulations and a total ban on sale were associated with perceptions of reduced harm and effectiveness for quitting CCs of HTPs in Hong Kong.
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Affiliation(s)
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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Phelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, Paciorek CJ, Lhoste VPF, Carrillo-Larco RM, Stevens GA, Rodriguez-Martinez A, Bixby H, Bentham J, Di Cesare M, Danaei G, Rayner AW, Barradas-Pires A, Cowan MJ, Savin S, Riley LM, Aguilar-Salinas CA, Baker JL, Barkat A, Bhutta ZA, Branca F, Caixeta RB, Cuschieri S, Farzadfar F, Ganapathy S, Ikeda N, Iotova V, Kengne AP, Khang YH, Laxmaiah A, Lin HH, Ma J, Mbanya JCN, Miranda JJ, Pradeepa R, Rodríguez-Artalejo F, Sorić M, Turley M, Wang L, Webster-Kerr K, Aarestrup J, Abarca-Gómez L, Abbasi-Kangevari M, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Aekplakorn W, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Ågren Å, Aguenaou H, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Al-Raddadi R, Al Asfoor D, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alieva AV, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alomary SA, Alomirah HF, Alshangiti AM, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiano Etxezarreta P, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Assefa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Aurélio de Valois CJM, Auvinen J, Avdičová M, Avi S, Azad K, Azevedo A, Azimi-Nezhad M, Azizi F, Babu BV, Bacopoulou F, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Bajramovic I, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Barbosa Filho V, Barceló A, Baretić M, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JL, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedek T, Benedics J, Benet M, Benitez Rolandi GE, Benzeval M, Bere E, Berger N, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Berrios Carrasola X, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Blychfeld Magnazu M, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Botomba S, Bourne RRA, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Braithwaite T, Brajkovich I, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Bringolf-Isler B, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamnan P, Chamukuttan S, Chan A, Chan Q, Charchar FJ, Charles MA, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chee ML, Chen CJ, Chen F, Chen H, Chen LS, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clare P, Clarke J, Clays E, Cohen E, Cojocaru CR, Colorado-Yohar S, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, da Silva AG, Dacica L, Dahm CC, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis Guedes de Vasconcelos F, de Assis MAA, De Backer G, De Bacquer D, De Bacquer J, de Bont J, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, De Neve JW, Duarte de Oliveira P, De Ridder D, De Ridder K, de Rooij SR, de Sá ACMGN, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Devrishov RD, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Díaz Fernández P, Díez Ripollés MP, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Dörr M, Doua K, Dragano N, Drygas W, Du S, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dwyer T, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Ebrahimi N, Echeverría G, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Elliott P, Enang O, Endevelt R, Engle-Stone R, Erasmus RT, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Evans RG, Faeh D, Fagherazzi G, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzi Y, Fattahi MR, Fawwad A, Fawzi WW, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fisberg M, Fischer K, Foo LH, Forsner M, Fottrell EF, Fouad HM, Francis DK, Franco MDC, Fras Z, Fraser B, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gabriela SA, Gaciong Z, Gafencu M, Galán Cuesta M, Galbarczyk A, Galcheva SV, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, García Mérida MJ, García Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Gerdts E, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez Gómez JH, Gomez LF, Gómez SF, Gomula A, Gonçalves Cordeiro da Silva B, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregg EW, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerchet M, Guerrero R, Guessous I, Guimaraes AL, Gujral UP, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurinović MA, Gutiérrez González E, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hardy L, Hari Kumar R, Harmer Lassen T, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Heinen M, Hejgaard T, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Heude B, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hoogendijk E, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huidumac Petrescu C, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea J, Ibrahim MM, Ibrahim Wong N, Igland J, Ijoma C, Ikram MA, Iñiguez C, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ittermann T, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jan N, Jansson A, Janszky I, Janus E, Jarani J, Jarnig G, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jøran Kjerpeseth L, Jørgensen T, Joshi P, Joshi R, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Jurca Simina I, Juresa V, Kaaks R, Kaducu FO, Kadvan AL, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Karlsson O, Kassi Anicet A, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Kazembe BM, Ke C, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klanarong S, Klanova J, Klimek M, Klimont J, Klumbiene J, Knoflach M, Kobel S, Koirala B, Kolle E, Kolo SM, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Koussoh Simone M, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kulothungan V, Kumar RK, Kumari M, Kunešová M, Kurjata P, 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S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, 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Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Yao Y, Cheung YTD, Wu YS, Guo Z, Chan SK, Zhao SZ, Tong HSC, Lai VWY, Lam TH, Ho SY, Wang MP. Association between tobacco industry denormalisation beliefs and support for tobacco endgame policies: a population-based study in Hong Kong. Tob Control 2024:tc-2023-058393. [PMID: 38458757 DOI: 10.1136/tc-2023-058393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies. METHODS A total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018-2019) were included. TID beliefs (agree vs disagree/unsure) were measured by seven items: tobacco manufacturers ignore health, induce addiction, hide harm, spread false information, lure smoking, interfere with tobacco control policies and should be responsible for health problems. Score of each item was summed up and dichotomised (median=5, >5 strong beliefs; ≤5 weak beliefs). Support for tobacco endgame policies on total bans of tobacco sales (yes/no) and use (yes/no) was reported. Associations between TID beliefs and tobacco endgame policies support across various smoking status were analysed, adjusting for sociodemographics. RESULTS Fewer smokers (23.3%) had strong beliefs of TID than ex-smokers (48.4%) and never smokers (48.5%) (p<0.001). Support for total bans on tobacco sales (74.6%) and use (76.9%) was lower in smokers (33.3% and 35.3%) than ex-smokers (74.3% and 77.9%) and never smokers (76.0% and 78.3%) (all p values<0.001). An increase in the number of TID beliefs supported was positively associated with support for a total ban on sales (adjusted risk ratio 1.06, 95% CI 1.05 to 1.08, p<0.001) and use (1.06, 95% CI 1.05 to 1.07, p<0.001). The corresponding associations were stronger in smokers than non-smokers (sales: 1.87 vs 1.25, p value for interaction=0.03; use: 1.78 vs 1.21, p value for interaction=0.03). CONCLUSION Stronger TID belief was associated with greater support for total bans on tobacco sales and use. TID intervention may increase support for tobacco endgame, especially in current smokers.
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Affiliation(s)
- Ying Yao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yee Tak Derek Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yongda Socrates Wu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ziqiu Guo
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sik Kwan Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Shieh L, Ho SY. Heart Dose Uncertainty Caused by Heartbeat during Adjuvant Breast Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e207. [PMID: 37784867 DOI: 10.1016/j.ijrobp.2023.06.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant radiotherapy is a crucial treatment option for breast cancer. Owing to the long survival after treatment, heart toxicity has become a critical issue in those who receive radiotherapy. The heart dose is calculated using the computed tomography (CT) images acquired during simulation. The heart volume is quite different between the systolic and diastolic phases. This study used four-dimensional (4D) CT to capture the heart image and determine the ranges of the heart dose in different phases of the heart. MATERIALS/METHODS Patients with left-sided breast cancer who underwent breast conservative surgery followed by adjuvant radiotherapy to the entire breast between January 2016 and December 2021 were identified. The three-dimensional (3D) CT and 4DCT datasets of the patients were acquired to evaluate the variation in the heart dose. The heart volume in each respiratory phase was depicted in a box plot along with the dice similarity coefficient (DCS). RESULTS A total of 32 patients met the inclusion criteria. The DCS of the heart in each respiration phase was within the range of 0.91 to 0.95. Variations in the heart volume and morphology were not evident. However, these variations were not influenced by the respiratory cycle. The median relative variations in the 4DCT volume, mean dose, V20 (≥20 Gy), and V40 (40 Gy) were 6%, 14%, 19%, and 32%, respectively. All parameters showed significant variation between the maximum values in 4DCT and planning 3DCT. When parameters in planning 3DCT were compared to minimum values in 4DCT, the heart volume and V20 still showed significant differences, whereas the mean dose (p = .052) and V40 (p = .151) did not. CONCLUSION We found that the median variation in the heart volume during the respiratory cycle was 6%, which led to a 14% variation in the mean heart dose, 19% in V20, and 32% in V40. Dose variation should not be ignored. A more precise method for estimating the heart dose during treatment should be investigated.
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Affiliation(s)
- L Shieh
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Taiwan, Tainan, Taiwan
| | - S Y Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
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Ho SY, Shieh LT, Huang CC, Chang CP. Hyperbaric Oxygen Therapy Attenuates the Whole Brain Radiotherapy-Induced Progressive Cognitive Dysfunction via Promoting Hippocampal Neurogenesis in Rats. Int J Radiat Oncol Biol Phys 2023; 117:e235-e236. [PMID: 37784936 DOI: 10.1016/j.ijrobp.2023.06.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation therapy is a widely used brain tumor treatment; however, it can cause significant effects on the central nervous system, including neurogenesis impairment, microglia activation, and oxidative stress, leading to brain injury. Hyperbaric oxygen therapy (HBOT) has been shown to benefit various neurological conditions, but its effect on radiation-induced brain injury damage remains limited. This study aims to investigate the impact of HBOT on radiation-induced neurogenesis impairment, microglia activation, and lipid peroxidation levels, and also aim to assess the therapeutic potential of HBOT on preventing irradiation-induced brain injury. MATERIALS/METHODS This study used a rat model that delivered different doses (2, 4, 10 Gy) of whole-brain radiation therapy (WBRT). The rats were divided into two groups: one received HBOT, and the other acted as the control (normal baric air, NBA) group. HBOT was performed on day 8 of post-radiation once per day for five consecutive days a week for four weeks. The rats were subjected to different irradiation dosages as described, followed by administration of 5-chloro-2'-deoxyuridine (CldU) immediately at day 0 or day 0 to day 7 and 5-iodo-2'-deoxyuridine (IdU) at day 2 or day 14 to day 28 following WBRT to detect serially replicating cells. Then the rats underwent behavioral tests to assess their cognitive and motor function every week. Brain tissues were collected and analyzed to evaluate neurogenesis, microglia activation, lipid peroxidation, and antioxidant levels using immunofluorescence stain and ELISA on days 7 and 28 of post-WBRT. RESULTS The radial maze was used to measure spatial learning and memory in rats. Compared with the 0 Gy-WBRT group, the 2 Gy-, 4 Gy-, and 10 Gy-WBRT groups of rats displayed a significant increase in latency. Seven days of post-WBRT, the newly proliferation cells (IdU positive) and serial replicating cells (CldU+IdU double positive) in the hippocampal dentate gyrus were significantly increased but were coupled with apoptosis. The alterations in the cellular composition of the dentate gyrus area were observed on days 7 and 28 post-WBRT, including increased newborn neuroblast and neuron, but half underwent apoptosis, which is associated with microglia phagocytosis and results in cognitive impairment. The lipid peroxidation was significantly increased on day 28 of post-WBRT. HBOT improves cognitive function by attenuating the WBRT-induced lipid oxidation, newly-formed cell apoptosis, and microglia phagocytosis. CONCLUSION Our present study suggests that HBOT may have a potential role in mitigating the effects of irradiation-induced brain injury by maintaining neurogenesis and reducing lipid peroxidation.
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Affiliation(s)
- S Y Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - L T Shieh
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C C Huang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - C P Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
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Chen T, Wang L, Cheung YTD, Wang MP, Lam TH, Ho SY. Risk perceptions and changes in tobacco use in relation to Coronavirus Disease 2019 pandemic: A qualitative study on adolescent tobacco users in Hong Kong. Tob Induc Dis 2023; 21:92. [PMID: 37456609 PMCID: PMC10347963 DOI: 10.18332/tid/167479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Tobacco use is associated with an increased risk of Coronavirus Disease 2019 (COVID-19) infection, severe COVID-19 outcomes requiring intensive care, and mortality. We investigated the perceived risk of and changes in cigarette, e-cigarette (EC) and heated tobacco product (HTP) use in relation to COVID-19 in Hong Kong adolescent tobacco users. METHODS We conducted semi-structured telephone interviews from January to April 2021 and in February 2022 on 40 adolescents (65% boys, Secondary school grades 2-6) who participated in our previous smoking surveys and were using cigarettes, ECs or HTPs before the first wave of the COVID-19 pandemic in January 2020. RESULTS Adolescents generally perceived higher risks of contracting and having more severe COVID-19 from using cigarettes than ECs/HTPs, but they had limited knowledge of COVID-19 risks from EC/HTP use, particularly. Both increased and reduced consumption were found in tobacco, with EC use being the less affected product. Changes also included switching to ECs for convenience and lower cost and shifting from smoking cigarettes outside to mainly at home or in hidden areas. COVID-related policies, fear of infection, non-COVID-related health concerns, less social opportunities and pocket money, and limited access to tobacco products were barriers to tobacco use. In contrast, greater freedom at home versus school and negative emotions due to social distancing were facilitators. Family/peer influence had mixed impacts. CONCLUSIONS Adolescent tobacco users perceived lower COVID risks associated with HTPs and ECs than cigarettes, and various changes in tobacco use were found amid the pandemic in Hong Kong. COVID-19 and related social changes may both facilitate or deter adolescent tobacco use.
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Affiliation(s)
- Tianqi Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Lijun Wang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Yee Tak Derek Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Tai Hing Lam
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
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Sun Y, Wu YS, Cheung YTD, Wang MP, Chen J, Leung LT, Zhang X, Chak KY, Lam TH, Ho SY. Impact of mandatory masking amid the COVID-19 pandemic on outdoor smoking: an interrupted time-series analysis of a 33-month unobtrusive observational study. Front Public Health 2023; 11:1136621. [PMID: 37521998 PMCID: PMC10372439 DOI: 10.3389/fpubh.2023.1136621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background Mask-wearing in outdoor public places in Hong Kong was mandated on 29 July 2020, amid the COVID-19 pandemic. We aimed to evaluate the impact of mandatory masking with no exemption for smoking on outdoor smoking. Methods We conducted 253 unobtrusive observations at 10 outdoor smoking hotspots in 33 months from July 2019 to March 2022 and counted smokers and non-smoking pedestrians in fixed boundaries. We conducted interrupted time-series analyses on the monthly mean volume of smokers (persons per hour) using generalized linear models. The independent variables were as follows: time since the first observation, implementation of the mask regulation, time since the regulation, seasonality, and waves 1-5 outbreaks. We checked the robustness of the association using the daily mean volume of smokers as the dependent variable. Two sensitivity analyses were conducted to include the hotspot location or the number of all pedestrians as an offset. Results Monthly outdoor smoking decreased immediately after the regulation (incidence rate ratio [IRR]: 0.505, 95% confidence interval [CI]: 0.374 to 0.680, P < 0.001). Daily smoking analysis and the two sensitivity analyses supported the results. However, monthly outdoor smoking increased by 11% since the regulation (IRR: 1.110, 95% CI: 1.074 to 1.147, P < 0.001). An exception was observed at the most severe wave 5 outbreak when monthly outdoor smoking decreased (IRR: 0.415, 95% CI: 0.327 to 0.525, P < 0.001). Conclusion Outdoor smoking fell immediately after mandatory masking, rebounded to pre-pandemic levels, and decreased again at the most severe wave 5.
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Affiliation(s)
- Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Yao Y, Gong WJ, Lai AYK, Wu YS, Sit SMM, Wang MP, Ho SY, Lam TH. Associations of the perceived benefits and harms of COVID-19 with confidence in coping with the pandemic and mental health symptoms: a population-based survey in Hong Kong. Front Public Health 2023; 11:1175085. [PMID: 37408744 PMCID: PMC10318160 DOI: 10.3389/fpubh.2023.1175085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Both perceived benefits and harms of COVID-19 have been reported, but whether they affect confidence in coping with the pandemic and mental health remains uncertain. Objective To examine the association of perceived benefits and harms of COVID-19 with confidence in coping with the pandemic and mental health symptoms. Methods A population-based survey was conducted on 7,535 Hong Kong adults from 22 February to 23 March 2021, when the 4th wave of COVID-19 was under control. Information on sociodemographic characteristics, perceived benefits (10 options) and harms (12 options) of COVID-19, confidence in coping with the pandemic (range 0-10), loneliness (range 0-4), anxiety (General Anxiety Disorders-2, range 0-6) and depression (Patient Health Questionnaire-2, range 0-6) was collected. Latent profile analysis was used to identify the combined patterns of perceived benefits and harms of COVID-19. The associations of combined patterns with confidence in coping with COVID-19, loneliness, anxiety, and depression were examined using linear regression (β coefficient) adjusting for sociodemographic characteristics. Results The combined patterns of perceived benefits and harms were classified into benefit (n = 4,338, 59.3%), harm (n = 995, 14.0%), and ambivalent (n = 2,202, 26.7%) groups. Compared with the ambivalent group, the benefit group had a significantly higher level of confidence (adjusted β 0.46, 95% CI 0.33 to 0.58), and lower levels of loneliness (-0.35, -0.40 to-0.29), anxiety (-0.67, 0.76 to-0.59), and depression (-0.65, -0.73 to-0.57). The harm group had a significantly lower level of confidence (-0.35, -0.53 to-0.16), and higher levels of loneliness (0.38, 0.30 to 0.45), anxiety (0.84, 0.73 to 0.96), and depression (0.95, 0.84 to 1.07). Conclusion Perceived greater benefit from COVID-19 was associated with better mental health and stronger confidence in coping with the pandemic.
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Affiliation(s)
- Ying Yao
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wei Jie Gong
- Department of General Practice, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yongda Socrates Wu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shirley Man Man Sit
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Sun Y, Wang Z, Sun S, Cui L, Zhu X, Ho SY, Qi S. Cognitive Activities, Lifestyle Factors, and Risk of Cognitive Impairment, with an Analysis of the Apolipoprotein Epsilon 4 Genotype. Gerontology 2023; 69:1137-1146. [PMID: 37276850 DOI: 10.1159/000531109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/12/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Cognitive stimulating activities and a healthy lifestyle are associated with less cognitive impairment. However, whether the association is varied by Apolipoprotein epsilon 4 (APOE ε4) allele carrier status remains inconclusive. We aimed to investigate whether the association of cognitively stimulating activities and a healthy lifestyle with the risk of cognitive impairment varied by APOE ε4 allele carrier status. METHODS A case-control study was conducted for adults aged 60 years and above. Six province administrative units (Beijing, Shanghai, Hubei, Sichuan, Guangxi, and Yunnan) were included using stratified multistage cluster sampling. A total of 1,300 individuals were identified with cognitive impairment (cases) at enrollment and were matched 1:2 on sex, age (±2 years), and residential district with controls who were cognitively normal at the time of the evaluation. We used a standardized questionnaire to collect information on cognitive stimulating activities, lifestyle factors, demographics, and comorbidity. Cognitive stimulating activities included reading books or newspapers, playing cards or mahjong, using the Internet, socializing with neighbors, and community activities. Lifestyle factors included smoking, alcohol drinking, daily tea drinking, and regular exercise. We used logistic regression to assess the interaction between cognitive stimulating activities, lifestyle factors, and APOE ε4 allele carrier status (yes/no) on the risk of cognitive impairment. We tested for additive interaction by estimating relative excess risk (RERI) due to interaction and multiplicative interaction employing the p value of the interaction term of each lifestyle factor and APOE ε4 into the model. RESULTS Four cognitive stimulating activities were associated with less cognitive impairment regardless of APOE ε4 status. Using the Internet (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.30-0.95), daily tea drinking (OR: 0.79; 95% CI: 0.63-0.98), and regular exercise (OR: 0.78; 95% CI: 0.65-0.94) were associated with less cognitive impairment only in noncarriers. Multiplicative and additive interactions were found between community activities and APOE ε4 carrier status (multiplicative p value = 0.03; RERI 0.738, 95% CI: 0.201-1.275). CONCLUSION The associations between cognitive activities and cognitive impairment were robust regardless of the APOE ε4 carrier status, while the associations between lifestyle factors and cognitive impairment varied by APOE ε4 carrier status.
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Affiliation(s)
- Yuying Sun
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong, China
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Zhihui Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shengzhi Sun
- Department of Epidemiology and Biostatistics, Capital Medical University, Beijing, China
| | - Lu Cui
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoquan Zhu
- The Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Shige Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Etxezarreta PA, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aseffa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Auvinen J, Avdičová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Filho VB, Barceló A, Baretić M, Barkat A, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Rolandi GEB, Bere E, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Carrasola XB, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Magnazu MB, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buntinx F, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Caixeta RB, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes‐Loaiza M, Cesar JA, Chamukuttan S, Chan A, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clarke J, Clays E, Cohen E, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Cuschieri S, Czenczek-Lewandowska E, D’Arrigo G, d’Orsi E, Dacica L, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis MAA, De Backer G, De Bacquer D, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, DeGennaro V, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Fernández PD, Ripollés MPD, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Echeverría G, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Endevelt R, Engle-Stone R, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant’Angelo VF, Fattahi MR, Fawwad A, Fawzi WW, Feigl E, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fisberg M, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Fras Z, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gaciong Z, Gafencu M, Cuesta MG, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Mérida MJG, Solano MG, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Ghaderi E, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Gluškova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez JHG, Gomez LF, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, González EG, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Kumar RH, Lassen TH, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea JM, Ibrahim MM, Wong NI, Ikram MA, Iñiguez C, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jansson A, Janszky I, Janus E, Jarani J, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jørgensen T, Joshi P, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Simina IJ, Juresa V, Kaaks R, Kaducu FO, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kampmann FB, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Ke C, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klimek M, Klimont J, Klumbiene J, Knoflach M, Koirala B, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kumar RK, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, 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KM, Malyutina SK, Maniego LV, Manios Y, Manix MI, Mann JI, Mansour-Ghanaei F, Manyanga T, Manzato E, Marcil A, Margozzini P, Mariño J, Markaki A, Markey O, Ioannidou EM, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Mavrogianni C, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNairy ML, McNulty BA, Benchekor SM, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Milanović SM, Musil V, Musinguzi G, Muyer MTMC, Nabipour I, Naderimagham S, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Nardone P, Naseri T, Nauck M, Neal WA, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O’Neill TW, O’Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Pérez CM, Peterkova V, Peters A, Petersmann A, Petkeviciene J, Petrauskiene A, Kovtun OP, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Pichardo RN, Pierannunzio D, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Bao TQ, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Rao SR, Ramachandran A, Ramadan OPC, Ramires VV, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Richter A, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Robitaille C, Roccaldo R, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Moreno ER, Rusakova IA, Jonsson KR, Russo P, Rust P, Rutkowski M, Saamel M, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Martinez ES, Saleva C, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Rodríguez IS, Sandjaja, Sans S, Marina LS, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Rosario AS, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, de Moura Silva CR, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina NA, Skodje G, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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Zeng Y, Gong W, Lai AYK, Sit SMM, Wang MP, Ho SY, Lam TH. Factors associated with willingness and preferences to attend family services in Hong Kong: A population-based survey. Front Public Health 2023; 11:1057164. [PMID: 36844844 PMCID: PMC9947657 DOI: 10.3389/fpubh.2023.1057164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Objective Family services are open to the community at large as well as vulnerable groups; however, little is known about the willingness of communities to attend such services. We investigated the willingness and preferences to attend family services and their associated factors (including sociodemographic characteristics, family wellbeing, and family communication quality) in Hong Kong. Methods A population-based survey was conducted on residents aged over 18 years from February to March 2021. Data included sociodemographic characteristics (sex, age, education, housing type, monthly household income, and the number of cohabitants), willingness to attend family services to promote family relationships (yes/no), family service preferences (healthy living, emotion management, family communication promotion, stress management, parent-child activities, family relationship fostering, family life education, and social network building; each yes/no), family wellbeing, and family communication quality (both scores 0-10). Family wellbeing was assessed using the average scores of perceived family harmony, happiness and health (each score 0-10). Higher scores indicate better family wellbeing or family communication quality. Prevalence estimates were weighted by sex, age and educational level of the general population. Adjusted prevalence ratios (aPR) for the willingness and preferences to attend family services were calculated in relation to sociodemographic characteristics, family wellbeing, and family communication quality. Results Overall, 22.1% (1,355/6,134) and 51.6% (996/1,930) of respondents were willing to attend family services to promote relationships or when facing problems, respectively. Older age (aPR = 1.37-2.30, P < 0.001-0.034) and having four or more cohabitants (aPR = 1.44-1.53, P = 0.002-0.003) were associated with increased aPR of willingness for both situations. Lower family wellbeing and communication quality were associated with lower aPR for such willingness (aPR = 0.43-0.86, P = 0.018-<0.001). Lower family wellbeing and communication quality were associated with preferences for emotion and stress management, family communication promotion, and social network building (aPR = 1.23-1.63, P = 0.017-<0.001). Conclusions Lower levels of family wellbeing and communication quality were associated with unwillingness to attend family services and preferences for emotion and stress management, family communication promotion, and social network building.
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Affiliation(s)
- Yingpei Zeng
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Weijie Gong
- Department of General Practice, Health Science Center, Shenzhen University, Shenzhen, China
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Zhang X, Sun Y, Cheung YTD, Wang MP, Wu YS, Chak KY, Chen J, Leung LT, Lam TH, Ho SY. Cigarettes, heated tobacco products and dual use: exhaled carbon monoxide, saliva cotinine and total tobacco consumed by Hong Kong tobacco users. Tob Control 2023:tc-2022-057598. [PMID: 36693724 DOI: 10.1136/tc-2022-057598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking. METHODS A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression. RESULTS Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient -2.79, 95% CI -3.90 to -1.69; CCs+ECs: -1.34, 95% CI -2.34 to -0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)). CONCLUSIONS HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.
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Affiliation(s)
- Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yee Tak Derek Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Chen B, Gong W, Lai AYK, Sit SMM, Ho SY, Yu NX, Wang MP, Lam TH. Family context as a double-edged sword for psychological distress amid the COVID-19 pandemic with the mediating effect of individual fear and the moderating effect of household income. Front Public Health 2023; 11:1109446. [PMID: 37033084 PMCID: PMC10076528 DOI: 10.3389/fpubh.2023.1109446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background The COVID-19 pandemic drives psychological distress. Previous studies have mostly focused on individual determinants but overlooked family factors. The present study aimed to examine the associations of individual and family factors with psychological distress, and the mediating effect of individual fear and the moderating role of household income on the above associations. Methods We conducted a population-based cross-sectional survey on Chinese adults in Hong Kong from February to March 2021 (N = 2,251) to measure the independent variables of anti-epidemic fatigue, anti-epidemic confidence, individual and family members' fear of COVID-19, and family well-being (range 0-10), and the dependent variable of psychological distress (through four-item Patient Health Questionnaire, range 0-4). Results Hierarchical regression showed that anti-epidemic fatigue was positively (β = 0.23, 95% CI [0.18, 0.28]) while anti-epidemic confidence was negatively (β = -0.29, 95% CI [-0.36, -0.22]) associated with psychological distress. Family members' fear of COVID-19 was positively (β = 0.11, 95% CI [0.05, 0.16]) while family well-being was negatively (β = -0.57, 95% CI [-0.63, -0.51]) associated with psychological distress. Structural equation model showed that individual fear mediated the above associations except for family well-being. Multi-group analyses showed a non-significant direct effect of anti-epidemic confidence and a slightly stronger direct effect of family well-being on psychological distress among participants with lower incomes, compared to those with higher incomes. Conclusion We have first reported the double-edged effect of family context on psychological distress, with the positive association between family members' fear of COVID-19 and psychological distress fully mediated by individual fear and the negative association between family well-being and psychological distress moderated by income level. Future studies are warranted to investigate how the contagion of fear develops in the family and how the inequality of family resources impacts family members' mental health amid the pandemic.
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Affiliation(s)
- Bowen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Weijie Gong
- Department of General Practice, Medical School, Shenzhen University, Shenzhen, China
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- *Correspondence: Nancy Xiaonan Yu,
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Man Ping Wang,
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Chau SL, Wu Y, Wang MP, Ho SY. Interactive Video-Based Passive Drinking and Forced Drinking Education to Reduce Intention to Drink in Adolescents: A Pre-Post Intervention Study. Int J Environ Res Public Health 2022; 20:332. [PMID: 36612654 PMCID: PMC9820002 DOI: 10.3390/ijerph20010332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Passive and forced drinking harm was prevalent but less recognized in Chinese adolescents. We educated adolescents on such harm to reduce their intention to drink. Students (n = 1244) from seven secondary schools in Hong Kong participated in a video-based health talk on passive and forced drinking harm. Paired t-test was used to assess their change in knowledge of passive and forced drinking, and health and social harm of drinking after, the health talk. McNemar's chi-squared test and adjusted multivariable logistic regression (AOR) were used to assess their change in intention to drink and intention to quit. Students were less likely to drink (OR 0.29, 95% CI 0.19-0.42) and more likely to quit drinking (OR 3.50, 1.10-14.6) after the health talk. Increased knowledge of passive drinking was associated with less intention to drink (AOR 0.93, 0.90-0.97), increased knowledge of health harm (adjusted b 0.06, 0.05-0.08), and social harm of drinking (adjusted b 0.12, 0.10-0.16). Similar associations were observed in forced drinking (intention to drink: AOR 0.87, 0.79-0.96; health harm: adjusted b 0.16, 0.12-0.19; social harm: adjusted b 0.36, 0.28-0.43). We showed preliminary evidence that the health talk on passive and forced drinking reduced the intention to drink in adolescents.
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Affiliation(s)
- Siu Long Chau
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Yongda Wu
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Leung HT, Gong WJ, Sit SMM, Lai AYK, Ho SY, Wang MP, Lam TH. Substantial increase in perceived benefits over harms of COVID-19 outbreak but persistent socioeconomic disparities: Comparison of two cross-sectional surveys in Hong Kong from 2020 to 2021. Front Public Health 2022; 10:1012146. [PMID: 36466453 PMCID: PMC9713935 DOI: 10.3389/fpubh.2022.1012146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background We have reported both perceived benefits and harms of the COVID-19 outbreak and their socioeconomic disparities amid the pandemic in Hong Kong. We further investigated whether such perceptions and disparities had changed after 10 months. Methods Under the Hong Kong Jockey Club SMART Family-Link Project, we conducted two cross-sectional surveys online on perceived personal and family benefits and harms of the COVID-19 outbreak in Hong Kong adults in May 2020 (after Wave 2 was under control; N = 4,891) and in February and March 2021 (after Wave 4 was under control; N = 6,013). We collected sociodemographic information, including sex, age, education, household income, and housing. Using multivariate models of analysis of covariance (MANCOVA), we compared perceived benefits and harms and socioeconomic disparities between the two surveys. Results Adjusting for sex and age, the prevalence of 17 out of 18 perceived personal and family benefits of COVID-19 outbreak increased (Ps < 0.001). Six of 11 perceived personal and family harms decreased (Ps < 0.001) and 4 increased (Ps < 0.001). The total number of perceived personal and family benefits increased substantially (Ps < 0.001), whereas that of perceived personal harms decreased (P = 0.01) and family harms remained stable (P > 0.05). Socioeconomic disparities, however, persisted-more perceived benefits in those with higher socioeconomic status (Ps < 0.001) and more perceived harms in those with lower (Ps ≤ 0.005). Conclusion We have first reported that perceived personal and family benefits of the COVID-19 outbreak increased substantially over 10 months amid the pandemic, while perceived personal and family harms were lower and stable, respectively. Socioeconomic disparities of the perceived benefits and harms persisted, which need to be monitored and addressed urgently.
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Affiliation(s)
- Hiu Tin Leung
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wei Jie Gong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Department of General Practice, Health Science Center, Shenzhen University, Shenzhen, China
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Sai Yin Ho
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Man Ping Wang
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Wu YS, Chan HL, Ho SY, Zhao SZ, Luk TT, Lam TH, Wang MP. A content analysis of heated tobacco product business in Hong Kong on Facebook. Health Soc Care Community 2022; 30:e5685-e5692. [PMID: 36062525 DOI: 10.1111/hsc.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Heated tobacco products (HTPs) are increasingly popular in Hong Kong (HK) even though they have not been formally launched and the sale of duty-not-paid tobacco sticks is illegal. We investigated how Facebook was used against regulations to sell HTPs in HK. We screened Facebook pages run by HTP businesses targeting HK users in June 2019 and included pages with over 300 "Likes" for inductive content analysis by coding their "About" descriptions and all posts including comments published since January 2017. HTPs included heating devices, accessories, and tobacco sticks. Various attributes were recorded including methods of customer inquiries (telephone, Instant Messaging [IM], address), business responses (comments or private messages, PM), and services provided (warranty/repair). Among 30 pages (50.9% of all 59 eligible pages with related information on HTPs), two-thirds provided phone numbers (66.7%), IM accounts (65.5%), and addresses (66.7%). Most pages sold heating devices (26, 86.7%) and accessories (22, 73.3%) with over 72% providing phone numbers, IM accounts, or addresses. Only 8 pages (26.7%) sold tobacco sticks with 75.0% providing telephone numbers but fewer provided IM accounts (62.5%) and addresses (50.0%). All pages responded using PMs and only 12.5% also used comments. Warranty/repair services were provided by 43.3% of the pages. We found Facebook pages were used as dedicated stores to promote and sell HTPs including heating devices, accessories, and even illicit tobacco sticks in HK, a non-official market.
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Affiliation(s)
| | - Hiu Laam Chan
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
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21
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Sun Y, Wang MP, Ho SY, Chan CS, Man PKW, Kwok T, Wan ANT, Lam TH. A Smartphone App for Promoting Mental Well-being and Awareness of Anxious Symptoms in Adolescents: A Pilot Cluster Randomized Controlled Trial. Games Health J 2022; 11:393-402. [PMID: 36194074 DOI: 10.1089/g4h.2021.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To design a smartphone app and evaluate its effect on promoting mental well-being and awareness of anxious symptoms in adolescents. Materials and Methods: A pilot cluster randomized controlled trial was conducted with two secondary schools (390 students, mean age 13.1 years) randomized to the intervention and control groups. An app was designed to encourage "Sharing, Mind, and Enjoyment (SME)" between students and their parents (e.g., express gratitude), including interaction and game elements. The app was used daily over 1 month. The waitlist control group was offered the app after completing all assessments. The primary outcomes were changes in SME behaviors measured at 1 month and 3 months. Secondary outcomes included subjective happiness, well-being, personal health and happiness, family health, happiness and harmony, self-perceived knowledge, and understanding of anxious symptoms. Two focus groups of students and three individual in-depth interviews of community partners were conducted. Results: Seventeen of 152 students (11.2%) in the intervention group used the app together with parents (adherent subgroup) and 69 (45.4%) used it without involving parents. The intervention group did not show significant difference in the change of SME behaviors at 1- or 3-month follow-up compared with the control group. However, the intervention group reported greater increase in the awareness of anxious symptoms at follow-ups than the control group (d = 0.52 at 1 month and d = 0.43 at 3 month, both P < 0.001). Post hoc analysis showed a significantly greater increase in SME-related behaviors in the adherent subgroup than the control group at 3 months (d = 0.46, P = 0.04). The interviews found favorable changes in app users, but motivation to use the app was low in general. Both students and community partners suggested primary school students would be more receptive users. Conclusions: The app did not show effectiveness in increasing SME behaviors of students, but increased awareness of anxious symptoms. Further improvements and tests are warranted. Trial Registration: ClinicalTrials.gov NCT03361475.
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Affiliation(s)
- Yuying Sun
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Patrick K W Man
- School Social Work Service and Student Guidance Service, Tung Wah Group of Hospitals, Hong Kong SAR, China
| | - Tyrone Kwok
- Technology-Enriched Learning Initiative, The University of Hong Kong, Hong Kong SAR, China
| | - Alice N T Wan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Aberdeen Kai-fong Welfare Association Social Service Centre, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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22
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Wong BYM, Ho SY, Sit SMM, Gong WJ, Lai AYK, Wang MP, Lam TH. Association of family wellbeing with forwarding and verifying COVID-19-related information, and mediation of family communication quality. Front Public Health 2022; 10:948955. [PMID: 36062096 PMCID: PMC9428309 DOI: 10.3389/fpubh.2022.948955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 01/21/2023] Open
Abstract
Objective We assessed the associations of family wellbeing with verifying and subsequently forwarding COVID-19-related information to family members and the mediating effect of the quality of family communication on these associations among Chinese adults in Hong Kong. Methods Under the Jockey Club SMART Family-Link Project, we conducted an online population-based survey, using Family wellbeing Scale and questions related to the family communication quality and forwarding and verifying COVID-19 information. Data were collected from 4,891 adults in May 2020. Prevalence estimates of forwarding and verifying COVID-19 information were weighted by sex, age, and education of the general population, and their associations with family wellbeing (ranged 0-10) were analyzed using generalized linear models with mutual adjustment. Their interactive effects on family wellbeing and the mediating effects of family communication quality were examined. Results In total, 53.9% of respondents usually/always forwarded COVID-19 information related to their family, 68.7% usually/always verified it before forwarding, and 40.9% did both. Greater family wellbeing was associated with usually/always forwarding [adjusted β (95% CI): 0.82 (0.72-0.92)] and usually/always verifying [0.43 (0.32-0.55)] (both P < 0.001) the information. Forwarding and verifying such information showed an additive effect on family wellbeing [1.25 (1.11-1.40)]. Family communication quality mediated the associations of family wellbeing with forwarding (83.7%) and verifying (86.6%) COVID-19-related information. Conclusion Forwarding COVID-19 information to family, verifying such information, and especially doing both, were associated with greater family wellbeing, being strongly mediated by the quality of family communication. Individuals should be encouraged to verify COVID-19-related information before forwarding it to family members amidst the COVID-19 pandemic.
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Affiliation(s)
- Bonny Yee-Man Wong
- Department of Health Science, School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Sai Yin Ho
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wei Jie Gong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Man Ping Wang
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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23
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Gong WJ, Sit SMM, Lai AYK, Yu NX, Wang MP, Ho SY, Lam TH. Adversity coping capability and its associations with mental health and family wellbeing amid the COVID-19 pandemic in Hong Kong. BMC Psychiatry 2022; 22:553. [PMID: 35962361 PMCID: PMC9373882 DOI: 10.1186/s12888-022-04198-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adversity coping capability (ACC) is important amid the COVID-19 pandemic. We examined the associations of ACC as measured by our one-item ACC scale (ACC-1) with mental health, family well-being and validity of ACC-1 in Hong Kong. METHODS A cross-sectional survey was conducted on Hong Kong Chinese adults aged ≥ 18 years by landline, mobile phone, and online survey from February to March 2021, when the fourth wave of COVID-19 was under control. ACC-1 consisted of the question: "How do you rate your capability to cope with adversities?" with higher scores (0-10) indicating stronger ACC. The associations of ACC with socioeconomic characteristics, resilience, mental health, and family wellbeing were examined by linear regression coefficients (βs). Data were weighted by sex, age, and education of the general population. RESULTS Of 7441 respondents, after weighing, 52.2% were female and 79.1% were aged 18 to 64 years. ACC-1 showed good construct validity, with higher ACC being associated with higher levels of resilience (adjusted β = 0.29), personal happiness (0.55), family happiness (0.42), family wellbeing (0.41), and family communication quality (0.41), and lower levels of depressive symptoms (-0.30), anxiety (-0.30), loneliness (-0.15); incremental validity with additional contributions of ACC to mental health and family wellbeing; and known-group validity with older age and favorable socioeconomic characteristics showing higher ACC (all P < 0.02). Females (mean ± standard deviation: 6.04 ± 1.82 vs 6.15 ± 1.96 [male]) and unemployed respondents (5.30 ± 1.99 vs 6.11 ± 2.03 [in paid employment]) had lower ACC (all P ≤ 0.02). CONCLUSIONS We have first shown that stronger ACC was associated with better mental health and family wellbeing, and the results support ACC-1 as a simple and valid measure of ACC.
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Affiliation(s)
- Wei Jie Gong
- grid.263488.30000 0001 0472 9649Department of General Practice, Health Science Center, Shenzhen University, Shenzhen, China ,grid.194645.b0000000121742757School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Shirley Man Man Sit
- grid.194645.b0000000121742757School of Public Health, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Agnes Yuen Kwan Lai
- grid.194645.b0000000121742757School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Nancy Xiaonan Yu
- grid.35030.350000 0004 1792 6846Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China.
| | - Sai Yin Ho
- grid.194645.b0000000121742757School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- grid.194645.b0000000121742757School of Public Health, The University of Hong Kong, Hong Kong, China
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24
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Sun Y, Wang MP, Chan CS, Lo DLO, Wan ANT, Lam TH, Ho SY. Promoting positive parenting and mental wellbeing in Hong Kong Chinese parents: A pilot cluster randomised controlled trial. PLoS One 2022; 17:e0270064. [PMID: 35857769 PMCID: PMC9299310 DOI: 10.1371/journal.pone.0270064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Effective and brief positive parenting interventions could be adopted widely, but evidence is limited. We aimed to evaluate the effectiveness of a positive parenting programme in Hong Kong Chinese parents. Methods We conducted a pilot cluster randomised controlled trial in 2017 in 144 Hong Kong Chinese parents (84.7% women, mean age 42.5 [SD 5.87] years) of school-age children (mean age 10.9 [2.8] years) in 4 family service centres (clusters). The intervention included two 2-hour interactive talks (4 hours in total). The contents covered skills of giving praise, showing appreciation and playing enjoyable family games. The control group was offered the intervention after all the data were collected. Praise, appreciation and enjoyment related behaviours were measured as primary outcomes at baseline, 1 month and 3 months. The secondary outcomes were subjective happiness, wellbeing, personal health and happiness, family health, family happiness and harmony, and family relationship. After the completion of all assessments, five focus group discussions with the parents and four individual in-depth interviews with community service providers were conducted to explore their experiences. Results Compared with the control group (n = 69), the intervention group (n = 75) showed greater positive changes in appreciation and enjoyment at 3 months with small effect sizes (d = 0.42 and 0.32, respectively), and greater improvements in the secondary outcomes at 3 months with small effect sizes (d: 0.29–0.48). In the focus groups, the parents reported more praise to their children, better temper control, more focus on their children’s strengths and better family relationships. According to the service providers, most of the parents enjoyed the activities. Conclusions The brief intervention in community settings with the engagement of community service providers has shown preliminary effectiveness in promoting positive parenting and mental wellbeing of Hong Kong Chinese parents. Trial registration The authors confirm that all ongoing and related trials for this intervention are registered. The study reported in this manuscript is registered as clinical trial at clinicaltrials.gov: NCT03282071. https://clinicaltrials.gov/ct2/show/NCT03282071.
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Affiliation(s)
- Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| | - Christian S. Chan
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Alice N. T. Wan
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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25
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Zhang X, Sun Y, Cheung DYT, Wang MP, Wu Y, Chak KY, Chen J, Leung LT, Li WHC, Lam TH, Ho SY. Changes in Tobacco Use in the Early Phase of Coronavirus Disease 2019 Pandemic in Hong Kong: A Qualitative Study. Nicotine Tob Res 2022; 25:309-317. [PMID: 35716072 PMCID: PMC9384294 DOI: 10.1093/ntr/ntac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/02/2022] [Accepted: 06/15/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Changes in tobacco use and related personal and environmental factors amid the coronavirus disease 2019 (COVID-19) pandemic can be captured by qualitative studies, but they are few in non-Western populations. AIMS AND METHODS We assessed the perceived links between tobacco use and COVID-19, and changes in the use of cigarettes, electronic cigarettes (ECs), and heated tobacco products (HTPs) in the early phase of the pandemic in Hong Kong, where lockdown was not implemented. Semi-structured telephone interviews were conducted from January to June 2021 in 95 participants (36 EC users, 28 HTP users, and 32 exclusive cigarette users). Transcriptions were coded using deductive and inductive approaches, and factors for changes were nested in the social-ecological model. RESULTS Two-thirds of participants perceived their infection susceptibility was the same as never tobacco users, and 44.2% perceived more severe COVID-19 disease if infected. Amid the pandemic, tobacco use decreased overall but increased indoors for all three products. Increased tobacco use was mostly attributed to increased emotional distress, while decreases were attributed to various personal (health concerns) and environmental factors (e.g., COVID-19 regulations). Perceived convenience and lower costs were reasons for increased EC use. Limited access to HTPs was compensated by cigarette use. CONCLUSIONS Many participants were unaware of the potential harm of tobacco use on COVID-19. Overall tobacco use decreased due to COVID-19 regulations, which may not be sustainable post-pandemic. Indoor consumption increased, supporting a comprehensive smoke-free policy that covers private indoor areas. Better cessation services targeting EC, HTP, and cigarette use are needed. IMPLICATIONS Smokers need better awareness of the risk of tobacco use on COVID-19. Smoking cessation services can be improved by offering brief advice, strengthening advocacy against secondhand smoke, and covering EC and HTP use, highlighting their potential harms to users and others, and their risk of addiction and relapse to cigarette use.
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Affiliation(s)
| | | | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Yongda Wu
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, Hong Kong SAR, China,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- Corresponding Author: Sai Yin Ho, PhD, School of Public Health, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, 999077 Hong Kong SAR, China. Telephone: 852-3917-9883; Fax: 852-2855-9528; E-mail:
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26
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Abstract
Primary villous adenoma originating from the urinary tract is an infrequent entity. We present a rare case of villous adenoma arising from a prostatic urethra with no sign of malignant transformation. Villous adenoma should be considered as one of the differential diagnoses of urethral lesions, especially if it has similar magnetic resonance imaging features as its colonic counterpart. Due to its potential for malignant transformation, its complete resection is mandatory.
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Affiliation(s)
- S Y Ho
- Department of Radiology, Hospital Canselor Tuanku Muhriz, Malaysia
| | - N Rosli
- Department of Pathology, Hospital Canselor Tuanku Muhriz, Malaysia
| | - L Y Lim
- Department of Urology, Hospital Canselor Tuanku Muhriz, Malaysia
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27
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Gong WJ, Sit SMM, Wong BYM, Wu SYD, Lai AYK, Ho SY, Wang MP, Lam TH. Associations of Face-to-Face and Instant Messaging Family Communication and Their Contents With Family Wellbeing and Personal Happiness Amidst the COVID-19 Pandemic. Front Psychiatry 2022; 13:780714. [PMID: 35422721 PMCID: PMC9001841 DOI: 10.3389/fpsyt.2022.780714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Both face-to-face and instant messaging (IM) communication are important for families, but face-to-face communication has reduced amidst the COVID-19 pandemic. We examined the use and contents of both communication methods amidst the pandemic, their associations with family wellbeing and personal happiness, and the mediation effects of communication quality in Hong Kong Chinese adults. Methods This population-based online survey enrolled 4,921 respondents in May 2020, who reported (i) any face-to-face or IM family communication when the pandemic was severe; (ii) communication contents being classified as neutral, positive, supportive, and negative; and (iii) communication quality, family wellbeing and personal happiness (score 0-10). Associations of family wellbeing and personal happiness with communication methods and contents (no communication excluded) were examined using linear regressions (β), adjusting for each other, sex, age, socioeconomic status, and the number of cohabitants. Mediating effects of communication quality on these associations were examined. Prevalence estimates were weighted by sex, age, and education of the general population. Interactions of methods and contents were examined. Results Of 4,891 included respondents (female: 52.9%, 45-54 years: 37.7%, ≥65 years: 21.3%), 7.1% reported no communication, 12.7% face-to-face communication only, 26.7% IM only, and 53.4% both methods. More males and those at younger ages, had lower socioeconomic status, or fewer cohabitants showed no family communication or face-to-face only. More respondents reported neutral (83.1-99.3%) than positive (42.1-62.2%), supportive (37.5-54.8%), and negative (10.9-34.5%) contents despite communication methods. Communication quality was higher with both methods than IM only, face-to-face only, and no communication (scores: 6.7 vs. 4.5-6.6, all P ≤ 0.02). Better family wellbeing and personal happiness were associated with using IM only (adjusted βs: 0.37 and 0.48) and both methods (0.37 and 0.42) than face-to-face only, and positive (0.62 and 0.74) or supportive (0.45 and 0.46) contents (all P ≤ 0.001). Communication quality mediated 35.2-93.5% of these associations. Stronger associations between positive contents and family wellbeing showed in both methods and face-to-face only than IM only (P for interaction = 0.006). Conclusions We have first shown that, amidst the COVID-19 pandemic, family IM communication and positive and supportive contents may promote family wellbeing and personal happiness. People with no family communication may need assistance.
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Affiliation(s)
- Wei Jie Gong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bonny Yee Man Wong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Socrates Yong Da Wu
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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28
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Sun Y, Wang MP, Cheung YTD, Ho SY, Luk TT, Zhao S, Wu YS, Wong BYM, Weng X, Chen J, Zhang X, Leung LT, Chak KY, Lam TH. Changes in tobacco use at the early stage of the COVID-19
pandemic: Results of four cross-sectional surveys in Hong Kong. Tob Induc Dis 2022; 20:26. [PMID: 35342385 PMCID: PMC8895477 DOI: 10.18332/tid/145935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/15/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Changes in tobacco use since the COVID-19 outbreak differed by countries and little is known about changes in the use of specific tobacco products. METHODS We analyzed data from four cross-sectional telephone/online surveys from April to June 2020 to investigate such changes since the 1st and 2nd wave outbreaks (February to April 2020) in Hong Kong. The respondents were 1595 adults (83.2% male) who used tobacco before the COVID-19 outbreak from our previous intervention study and surveys. We investigated the changes in tobacco use, intention to quit and quit attempts during the outbreak. RESULTS About two-thirds (65.3%) of respondents reported no change in overall tobacco use, while 23.1% used less (including cessation) and 11.6% used more, resulting in a net decrease of 11.5 percentage points. A greater net decrease was observed for cigarettes (14.3% points) than heated tobacco products (HTPs, 3.3% points) and electronic cigarettes (e-cigarettes, 2.5% points). Decreased use was mainly due to the more extended stay at home (63.2%), health considerations (52.6%) and mask-wearing (47.4%), while increased use was for passing time (75.0%) and releasing stress (46.4%). Eight percent of cigarette, HTP and e-cigarette users reported a higher intention to quit since the pandemic outbreak. Nineteen percent of tobacco users (176/948) attempted to quit during the pandemic. Only 2.9% (46/1569) were abstinent at the time of the survey. CONCLUSIONS Overall tobacco use decreased after the first two waves of the COVID-19 outbreak in Hong Kong. A greater proportion of cigarette users decreased use than HTP and e-cigarette users. Given the different methods used in the four surveys, future studies should aim for a large and representative sample.
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Affiliation(s)
- Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Shengzhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | | | - Bonny Yee-Man Wong
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States
| | - Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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29
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Gong WJ, Fong DYT, Wang MP, Lam TH, Chung TWH, Ho SY. Worsening trends in self-rated health and correlates in Chinese adolescents in Hong Kong: a population-based panel study from 1999/2000 to 2014/15. BMJ Open 2022; 12:e055842. [PMID: 35165111 PMCID: PMC8845170 DOI: 10.1136/bmjopen-2021-055842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine the 15-year secular trends of self-rated health (SRH) and correlates in Chinese adolescents in Hong Kong. DESIGN A territory-wide population-based panel data study. SETTING Anonymised records of the annual health examination from the Student Health Service, Department of Health in Hong Kong. PARTICIPANTS 397 324 students in Secondary 2 (US grade 8), 335 902 in Secondary 4 and 113 892 in Secondary 6 during the academic year 1999/2000 and 2014/15. OUTCOME MEASURES SRH and lifestyles were self-reported using standardised questionnaires. Sex-standardised and age-standardised prevalence of very poor/poor SRH and its secular annual changes across sex, grade, weight status, breakfast habits, and frequency/duration of aerobic exercises were examined. Their disparities over time were examined by interactions with the academic year in generalised estimating equations. RESULTS The overall prevalence of very poor/poor SRH increased from 9.3% (95% CI: 8.9% to 9.7%) in 1999/2000 to 15.5% (15.1% to 15.8%) in 2014/15. Very poor/poor SRH was more prevalent in girls (adjusted OR: 1.02), in those having unemployed parents (1.29), being overweight (1.42) or obese (2.62), eating breakfast away from home (1.27) and skipping breakfast (1.49) or doing <1 time/week or ≤60 min/week aerobic exercises (1.78 and 1.88, respectively) than others. The corresponding disparities increased over time (ratios of OR: 1.006-1.042). CONCLUSIONS Increasing prevalence of very poor/poor SRH from 1999/2000 to 2014/15 was found among Hong Kong Chinese adolescents, which was greater in girls, adolescents being overweight/obese and those having unemployed parents or unhealthy lifestyles. Strategies to reduce health inequality should consider multiple factors, especially modifiable factors including lifestyles.
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Affiliation(s)
- Wei Jie Gong
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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Ho FK, Tung KTS, Wong RS, Chan KL, Wong WHS, Ho SY, Lam TH, Mirpuri S, Van Voorhees B, Fu KW, Chow CB, Chua G, Tso W, Jiang F, Rich M, Ip P. An Internet Quiz Game Intervention for Adolescent Alcohol Drinking: A Clustered RCT. Pediatrics 2021; 148:183428. [PMID: 34841427 DOI: 10.1542/peds.2021-051005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interventions on adolescent drinking have yielded mixed results. We assessed the effectiveness of an Internet quiz game intervention compared to conventional health education. METHODS In this cluster randomized controlled trial with parallel group design, we randomly allocated 30 participating schools to the Internet quiz game intervention or the conventional health education (comparison) group, with 1:1 ratio. Students of Hong Kong secondary schools (aged 12-15 years) were recruited. The intervention was a 4-week Web-based quiz game competition in which participating students answered 1000 alcohol-related multiple-choice quiz questions. The comparison group received a printed promotional leaflet and hyperlinks to alcohol-related information. RESULTS Of 30 eligible schools, 15 (4294 students) were randomly assigned to the Internet quiz game intervention group and 15 (3498 students) to the comparison group. Average age of participants was 13.30 years. No significant between-group differences were identified at baseline. Overall retention rate for students was 86.0%. At 1-month follow-up, fewer students in the intervention group reported drinking (9.8% vs 12.1%, risk ratio 0.79, 95% confidence interval [CI] 0.68 to 0.92; P = .003), and those who drank reported drinking less alcohol (standardized difference β -0.06, 95% CI -0.11 to -0.01; P = .02). Between-group differences remained statistically significant at 3-month follow-up (10.4% vs 11.6%, risk ratio 0.86, 95% CI 0.74 to 0.999; P = .048; β -0.06, 95% CI -0.11 to -0.01; P = .02). CONCLUSIONS The Internet quiz game intervention reduced underage drinking by 21% at 1-month and 14% at 3-month follow-up compared with conventional health education.
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Affiliation(s)
- Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Keith T S Tung
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Rosa S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong
| | - Sheena Mirpuri
- Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - King Wa Fu
- Journalism and Media Studies Centre, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun Bong Chow
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Gilbert Chua
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Winnie Tso
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Fan Jiang
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Michael Rich
- Center on Media and Child Health, Children's Hospital Boston, Boston, Massachusetts
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
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Ni MY, Canudas-Romo V, Shi J, Flores FP, Chow MSC, Yao XI, Ho SY, Lam TH, Schooling CM, Lopez AD, Ezzati M, Leung GM. Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries. Lancet Public Health 2021; 6:e919-e931. [PMID: 34774201 DOI: 10.1016/s2468-2667(21)00208-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Since 2013, Hong Kong has sustained the world's highest life expectancy at birth-a key indicator of population health. The reasons behind this achievement remain poorly understood but are of great relevance to both rapidly developing and high-income regions. Here, we aim to compare factors behind Hong Kong's survival advantage over long-living, high-income countries. METHODS Life expectancy data from 1960-2020 were obtained for 18 high-income countries in the Organisation for Economic Co-operation and Development from the Human Mortality Database and for Hong Kong from Hong Kong's Census and Statistics Department. Causes of death data from 1950-2016 were obtained from WHO's Mortality Database. We used truncated cross-sectional average length of life (TCAL) to identify the contributions to survival differences based on 263 million deaths overall. As smoking is the leading cause of premature death, we also compared smoking-attributable mortality between Hong Kong and the high-income countries. FINDINGS From 1979-2016, Hong Kong accumulated a substantial survival advantage over high-income countries, with a difference of 1·86 years (95% CI 1·83-1·89) for males and 2·50 years (2·47-2·53) for females. As mortality from infectious diseases declined, the main contributors to Hong Kong's survival advantage were lower mortality from cardiovascular diseases for both males (TCAL difference 1·22 years, 95% CI 1·21-1·23) and females (1·19 years, 1·18-1·21), cancer for females (0·47 years, 0·45-0·48), and transport accidents for males (0·27 years, 0·27-0·28). Among high-income populations, Hong Kong recorded the lowest cardiovascular mortality and one of the lowest cancer mortalities in women. These findings were underpinned by the lowest absolute smoking-attributable mortality in high-income regions (39·7 per 100 000 in 2016, 95% CI 34·4-45·0). Reduced smoking-attributable mortality contributed to 50·5% (0·94 years, 0·93-0·95) of Hong Kong's survival advantage over males in high-income countries and 34·8% (0·87 years, 0·87-0·88) of it in females. INTERPRETATION Hong Kong's leading longevity is the result of fewer diseases of poverty while suppressing the diseases of affluence. A unique combination of economic prosperity and low levels of smoking with development contributed to this achievement. As such, it offers a framework that could be replicated through deliberate policies in developing and developed populations globally. FUNDING Early Career Scheme (RGC ECS Grant #27602415), Research Grants Council, University Grants Committee of Hong Kong.
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Affiliation(s)
- Michael Y Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China; Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Vladimir Canudas-Romo
- School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, ACT, Australia
| | - Jian Shi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Francis P Flores
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mathew S C Chow
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiaoxin I Yao
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Sai Yin Ho
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tai Hing Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C Mary Schooling
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Gabriel M Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
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Luk TT, Zhao S, Weng X, Wong JYH, Wu YS, Ho SY, Lam TH, Wang MP. Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong. Tob Control 2021; 30:696-699. [PMID: 32855353 DOI: 10.1136/tobaccocontrol-2020-055960] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Health information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption. METHODS We conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that 'smoking/alcohol drinking can protect against COVID-19' from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population. RESULTS 19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that 'smoking/alcohol drinking can protect against COVID-19' from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method. CONCLUSION Our results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Shengzhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
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Lai V, Tong H, Leung LT, Ho SY, Lam TH. Will heated tobacco products be banned in Hong Kong? Int J Tuberc Lung Dis 2021; 25:956-958. [PMID: 34686242 DOI: 10.5588/ijtld.21.0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- V Lai
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - H Tong
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - L T Leung
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - S Y Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Zhang X, Huang R, Ho SY, Lo WS, Lam TH, Wang MP. Alcohol drinking, especially light drinking, and depressive symptoms in adolescents. Drug Alcohol Depend 2021; 227:108932. [PMID: 34365224 DOI: 10.1016/j.drugalcdep.2021.108932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The association of depressive symptoms with moderate and heavy drinking in adolescents have been reported in many studies, but that with light drinking is unclear. METHODS In a 2012-13 school-based survey, 20,951 secondary school students (aged 11-20 years, 51.3 % boys) from 44 schools in Hong Kong reported their sociodemographic information, depressive symptoms, drinking patterns and other lifestyle factors. The associations of depressive symptoms with drinking status, drinking frequency and quantity, and the usual type of alcohol beverage consumed were examined using robust Poisson regression accounting for school clustering and covariates. RESULTS The prevalence of current drinking and depressive symptoms was 13.6 % and 19.0 %, respectively. Depressive symptoms were associated with former drinking (adjusted prevalence ratio 1.48, 95 % confidence interval 1.30-1.68) and measures of light drinking: experimental drinking (1.29, 1.19-1.39), less-than-monthly drinking (1.40, 1.18-1.67) and consuming half a drink or less (1.33, 1.12-1.58), and such associations were stronger in younger adolescents. Associations were also observed for light drinking patterns of 1-2 drinks less than monthly (1.72, 1.40-2.11) and half a drink monthly (1.51, 1.21-1.88). Consuming fruit wine (1.51, 1.27-1.79) and beer (1.63, 1.42-1.88) with relatively low alcohol contents was also associated with depressive symptoms. CONCLUSIONS Our study provided first evidence that even light drinking in terms of the amount, frequency and type of alcohol beverages or light drinking patterns such as consuming 1-2 drinks less than monthly and half a drink monthly were associated with depressive symptoms in adolescents. Our results support total alcohol abstinence in adolescents.
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Affiliation(s)
- Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - Rong Huang
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - Wing Sze Lo
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China.
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Wang L, Mai ZM, Ngan RKC, Ng WT, Lin JH, Kwong DLW, Chiang SC, Yuen KT, Ng AWY, Ip DKM, Chan YH, Lee AWM, Lung ML, Ho SY, Lam TH. Dose-Response Reduction in Risk of Nasopharyngeal Carcinoma From Smoking Cessation: A Multicenter Case-Control Study in Hong Kong, China. Front Oncol 2021; 11:699241. [PMID: 34646762 PMCID: PMC8503184 DOI: 10.3389/fonc.2021.699241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cigarette smoking is associated with nasopharyngeal cancer (NPC) risk. Whether quitting reduces the risk is unclear. We investigated the associations of NPC with duration of and age at quitting in an endemic region. METHODS We investigated the associations between NPC and quitting in a multicenter case-control study in Hong Kong with 676 newly diagnosed NPC cases and 1,285 hospital controls between 2014 and 2017, using a computer-assisted self-administered questionnaire. Multivariable unconditional logistic regression yielded adjusted odds ratios (AORs) of NPC by quitting status, duration and age of quitting, combinations of duration and age of quitting, and quitting to smoking duration ratio, compared with current smoking. RESULTS Quitting (AOR: 0.72; 95% CI: 0.53-0.98) and never smoking (0.73, 0.56-0.95) were associated with lower NPC risk. NPC risk decreased with (i) longer quitting duration (p < 0.01), reaching significance after 11-20 (0.62, 0.39-0.99) and 21+ years (0.54, 0.31-0.92) of quitting; (ii) younger quitting age (p = 0.01), reaching significance for quitting at <25 years (0.49, 0.24-0.97); and (iii) higher quitting to smoking duration ratio (p < 0.01), reaching significance when the ratio reached 1 (0.60, 0.39-0.93). Quitting younger (age <25) appeared to confer larger reductions (49% for ≤10 years of quitting, 50% for 11+ years) in NPC risk than quitting at older ages (25+) regardless of quitting duration (16% for ≤10 years, 39% for 11+ years). CONCLUSIONS We have shown longer duration and younger age of quitting were associated with lower NPC risk, with dose-response relations. Our findings support including smoking as a cause of NPC. Stronger tobacco control measures and quitting services are needed to prevent NPC.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Zhi-Ming Mai
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Roger Kai-Cheong Ngan
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Wai-Tong Ng
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong, China
| | - Jia-Huang Lin
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Dora Lai-Wan Kwong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Shing-Chun Chiang
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
| | - Kam-Tong Yuen
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Alice Wan-Ying Ng
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Dennis Kai-Ming Ip
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
| | - Yap-Hang Chan
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Anne Wing-Mui Lee
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Maria Li Lung
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tai-Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, the University of Hong Kong, Hong Kong, China
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Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, Sophiea MK, Iurilli MLC, Lhoste VPF, Cowan MJ, Savin S, Woodward M, Balanova Y, Cifkova R, Damasceno A, Elliott P, Farzadfar F, He J, Ikeda N, Kengne AP, Khang YH, Kim HC, Laxmaiah A, Lin HH, Margozzini Maira P, Miranda JJ, Neuhauser H, Sundström J, Varghese C, Widyahening IS, Zdrojewski T, Abarca-Gómez L, Abdeen ZA, Abdul Rahim HF, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmadizar F, Ahmed SH, Ahrens W, Ajlouni K, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Aly E, Amarapurkar DN, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Auvinen J, Avdićová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Banadinović M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benson LS, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bhargava SK, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bojesen SE, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boyer CB, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Briceño Y, Brito M, Bruno G, Bueno-de-Mesquita HB, Bueno G, Bugge A, Burns C, Bursztyn M, Cabrera de León A, Cacciottolo J, Cameron C, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano V, Cardoso VC, Carlsson AC, Carvalho J, Casanueva FF, Censi L, Cervantes-Loaiza M, Chadjigeorgiou CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Cherkaoui Dekkaki I, Chetrit A, Chien KL, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Cooper C, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Cruz JJ, Csilla S, Cui L, Cureau FV, Cuschieri S, D'Arrigo G, d'Orsi E, Dallongeville J, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Demarest S, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dörr M, Doua K, Dragano N, Drygas W, Duante CA, Duboz P, Duda RB, Dulskiene V, Dushpanova A, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Fawwad A, Felix-Redondo FJ, Felix SB, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Fumihiko M, Furdela V, Furer A, Furusawa T, Gaciong Z, Galbarczyk A, Galenkamp H, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Garcia P, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Gehring U, Geleijnse JM, George R, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Goldberg M, Goldsmith RA, Gomez LF, Gomula A, Gonçalves H, Gonçalves M, Gonçalves Cordeiro da Silva B, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grosso G, Gruden G, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hari Kumar R, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He Y, Heier M, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herqutanto, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Horasan Dinc G, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ibrahim Wong N, Ikram MA, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Iwasaki M, Jackson RT, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Jóżwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalpourtzi N, Kalter-Leibovici O, Kampmann FB, Kannan S, Karaglani E, Kårhus LL, Karki KB, Katibeh M, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim DW, Kim J, Klakk H, Klimek M, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Kontto JP, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kratenova J, Kriaucioniene V, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kujala UM, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Latt TS, Le Coroller G, Le Nguyen Bao K, Le TD, Lee J, Lee J, Lehmann N, Lehtimäki T, Lemogoum D, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin X, Lin YT, Lind L, Lingam V, Linneberg A, Lissner L, Litwin M, Lo WC, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukačević Lovrenčić I, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lustigová M, Luszczki E, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marcil A, Mårild SB, Marinović Glavić M, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mascarenhas LP, Matasin M, Mathiesen EB, Mathur P, Matijasevich A, Matlosz P, Matsha TE, Mavrogianni C, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Mendoza Montano C, Menezes AMB, Menon GR, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Mirjalili MR, Mirrakhimov E, Mišigoj-Duraković M, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mostafavi SA, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muhihi AJ, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musa KI, Musić Milanović S, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Ndiaye NC, Neal WA, Nejatizadeh A, Nenko I, Neovius M, Nguyen CT, Nguyen ND, Nguyen QV, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Nikitin YP, Ninomiya T, Nishtar S, Njelekela MA, Noale M, Noboa OA, Noorbala AA, Norat T, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nunes B, O'Neill TW, O'Reilly D, Ochimana C, Oda E, Odili AN, Oh K, Ohara K, Ohtsuka R, Olié V, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Paiva KMD, Pająk A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Papandreou D, Park SW, Park S, Parnell WR, Parsaeian M, Pasquet P, Patel ND, Pavlyshyn H, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres KGDA, Peres MA, Peters A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Polašek O, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Providencia R, Puhakka SE, Puiu M, Punab M, Qasrawi RF, Qorbani M, Queiroz D, Quoc Bao T, Radić I, Radisauskas R, Rahimikazerooni S, Rahman M, Raitakari O, Raj M, Rakhimova EM, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Rarra V, Rech CR, Redon J, Reganit PFM, Regecová V, Revilla L, Rezaianzadeh A, Ribeiro R, Riboli E, Richter A, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Rusakova IA, Russo P, Rutkowski M, Sabanayagam C, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Sakarya S, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Santos LC, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Schipf S, Schmidt CO, Schnohr P, Schöttker B, Schramm S, Schultsz C, Schutte AE, Sebert S, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Servais J, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva CRDM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Sorić M, Sossa Jérome C, Soumaré A, Sparboe-Nilsen B, Sparrenberger K, Staessen JA, Starc G, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Suka M, Sun CA, Sung YT, Suriyawongpaisal P, Sy RG, Syddall HE, Sylva RC, Szklo M, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thinggaard M, Thomas N, Thorand B, Thuesen BH, Timmermans EJ, Tjandrarini DH, Tjonneland A, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Touloumi G, Traissac P, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Varbo A, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Wu FC, Wu S, Wyszynska J, Xu H, Xu L, Yaacob NA, Yan W, Yang L, Yang X, Yang Y, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zapata ME, Zaw KK, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhen S, Zheng Y, Zholdin B, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 938] [Impact Index Per Article: 312.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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Gong W, Sit SMM, Lai AYK, Wu SY, Wong BYM, Ho SY, Lam TH, Wang MP. 1399Associations of family wellbeing with face-to-face and instant messaging family communication amidst the COVID-19 pandemic. Int J Epidemiol 2021. [PMCID: PMC8499838 DOI: 10.1093/ije/dyab168.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Face-to-face communication has reduced amidst the COVID-19 pandemic. We examined the associations between family communication and family wellbeing. Methods In an online survey of the Hong Kong Jockey Club SMART Family-Link Project in May 2021, 4981 Hong Kong Chinese adults (mean age 43.5 years, response rate 24.3%) reported family communication methods of face-to-face and instant messaging (IM) when the COVID-19 pandemic was severe (yes/no), communication contents that were neutral, positive, supportive, and negative (yes/no), and communication quality (0-10). The associations of family wellbeing (health, happiness, and harmony, 0-10) with communication methods and contents were examined using linear regression (β), adjusting for each other, sex, age, socioeconomic status, and number of cohabitants. The mediating effects of communication quality on these associations were examined. Prevalence estimates were weighted by sex, age and education of general population. Results 7.1% respondents reported no communication, 12.7% face-to-face only, 26.7% IM only, and 53.4% both. More communication contents were neutral (range 83.1-99.3%) than positive (42.1-62.2%), supportive (37.5-54.8%), and negative (10.9-34.5%). Communication quality was highest in using both methods (6.7 vs 4.5-6.6, all P≤0.02). Better family wellbeing was associated with using IM only (adjusted β: 0.37) and both methods (0.37) than face-to-face only and with positive (0.62) and supportive (0.45) contents (all P≤0.001). Communication quality mediated 35.2-93.5% of these associations. Conclusions Better family wellbeing was associated with IM and face-to-face communication and their contents, partly through communication quality. Key messages Family IM communication with positive and supportive contents may enhance family wellbeing amidst the COVID-19 pandemic.
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Affiliation(s)
- Weijie Gong
- School of Public Health, The University Of Hong Kong, Hong Kong, China
| | | | | | | | | | - Sai Yin Ho
- School of Public Health, The University Of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University Of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
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Wu Y, Lee PH, Cheung DYT, Ho SY, Kwong A, Lai V, Lam TH, Wang MP. Positive perceptions of heated tobacco products were associated with weaker support for their regulations: A population-based cross-sectional survey in Hong Kong. Tob Induc Dis 2021. [DOI: 10.18332/tid/141007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wang L, Chen J, Leung LT, Ho SY, Lam TH, Wang MP. Use patterns of cigarettes and alternative tobacco products and socioeconomic correlates in Hong Kong secondary school students. Sci Rep 2021; 11:17253. [PMID: 34446733 PMCID: PMC8390664 DOI: 10.1038/s41598-021-96452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.
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Affiliation(s)
- Lijun Wang
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jianjiu Chen
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China ,grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Lok Tung Leung
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Sai Yin Ho
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Tai Hing Lam
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Man Ping Wang
- grid.194645.b0000000121742757School of Nursing, University of Hong Kong, Hong Kong, People’s Republic of China
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Lin JH, Wen CP, Jiang CQ, Yuan JM, Chen CJ, Ho SY, Gao W, Zhang W, Wang R, Chien YC, Xu L, Wu X, Jin YL, Koh WP, Hsu WL, Zhu F, Wen C, Zhu T, Lee JH, Mai ZM, Lung ML, Lam TH. Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men. Int J Epidemiol 2021; 50:975-986. [PMID: 33787881 PMCID: PMC8271191 DOI: 10.1093/ije/dyab060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of smoking in nasopharyngeal carcinoma (NPC) remains uncertain, especially in endemic regions. We conducted an individual participant data (IPD) meta-analysis of prospective cohort studies to investigate the associations between smoking exposure and risk of NPC. METHODS We obtained individual participant data of 334 935 male participants from six eligible population-based cohorts in NPC-endemic regions, including two each in Guangzhou and Taiwan, and one each in Hong Kong and Singapore. We used one- and two-stage approaches IPD meta-analysis and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of NPC for smoking exposure adjusting for age and drinking status. RESULTS During 2 961 315 person-years of follow-up, 399 NPC evens were ascertained. Risks of NPC were higher in ever versus never smokers (HRone-stage = 1.32, 95% CI = 1.07-1.63, P = 0.0088; HRtwo-stage = 1.27, 1.01-1.60, 0.04). These positive associations appeared to be stronger in ever smokers who consumed 16+ cigarettes/day (HRone-stage = 1.67, 95% CI = 1.29-2.16, P = 0.0001), and in those who started smoking at age younger than 16 (2.16, 1.33-3.50, 0.0103), with dose-response relationships (P-values for trend = 0.0028 and 0.0103, respectively). Quitting (versus daily smoking) showed a small reduced risk (stopped for 5+ years: HRone-stage = 0.91, 95% CI = 0.60-1.39, P = 0.66; for former smokers: HRtwo-stage = 0.84, 0.61-1.14, 0.26). CONCLUSIONS This first IPD meta-analysis from six prospective cohorts in endemic regions has provided robust observational evidence that smoking increased NPC risk in men. NPC should be added to the 12-16 cancer sites known to be tobacco-related cancers. Strong tobacco control policies, preventing young individuals from smoking, would reduce NPC risk in endemic regions.
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Affiliation(s)
- Jia Huang Lin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | | | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chien Jen Chen
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sai Yin Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | | | - Renwei Wang
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yin-Chu Chien
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Lin Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xifeng Wu
- Centre for Biostatistics Bioinformatics and Big Data, School of Public Health, National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wan-Lun Hsu
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Christopher Wen
- Department of Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, Irvine, CA, USA
| | - Tong Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - June Han Lee
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
| | - Zhi-Ming Mai
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Corresponding author. School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong Patrick Manson Building (North Wing), 7 Sassoon Road, Pok Fu Lam, Hong Kong, China. E-mail:
| | - Maria Li Lung
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Clinical Oncology and Centre for Cancer Research, University of Hong Kong, Hong Kong
| | - Tai-Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
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Abstract
IMPORTANCE Heated tobacco products (HTPs) are promoted as less harmful than combustible cigarettes but epidemiological evidence is scarce, especially in youth. OBJECTIVE To investigate the associations of persistent respiratory symptoms with HTP use, cigarette use, and dual use among Hong Kong youth. DESIGN, SETTING, AND PARTICIPANTS This was a territorywide cross-sectional school-based survey conducted from October 2018 to July 2019 using an anonymous questionnaire. Schools were randomly invited from a proportionate stratified sample in all 18 districts of Hong Kong. Poisson regression models using generalized estimating equations yielded adjusted prevalence ratios (APRs) of respiratory symptoms in (1) former and current HTP (vs never) users in the whole sample and stratified by cigarette use status and (2) exclusive HTP and dual users vs exclusive cigarette users. Statistical analysis was performed from October 2020 to March 2021. EXPOSURES Former and current use of cigarettes, HTPs, e-cigarettes, and other tobacco products. MAIN OUTCOMES AND MEASURES Respiratory symptoms for 3 consecutive months in the past 12 months. RESULTS The study included 33 627 students with a mean (SD) age of 14.8 (1.9) years; 51.3% (18 171) were boys. Respiratory symptoms were reported by 16.3% (n = 5549) of all students, 29.3% (n = 226) of current users of e-cigarettes, 31.2% (n = 314) of current users of cigarettes, and 33.5% (n = 179) of current users of HTPs. Respiratory symptoms were associated with former (APR, 1.30; 95% CI, 1.06-1.59) and current (APR, 1.59; 95% CI, 1.23-2.06) vs never HTP use and current vs never cigarette use (APR, 1.50; 95% CI, 1.30-1.74) after adjusting for various tobacco use. Associations between respiratory symptoms and current vs never HTP use were observed in never (APR, 1.88; 95% CI, 1.36-2.59) and former (APR, 2.15; 95% CI, 1.12-4.12) cigarette users, but not in current cigarette users (APR, 1.24; 95% CI, 0.97-1.59). Respiratory symptoms were associated with exclusive ever HTP use (APR, 1.46, 95% CI, 1.15-1.86) and ever dual use (APR, 1.29; 95% CI, 1.08-1.54) vs exclusive ever cigarette use. There was no association between exclusive current HTP (vs cigarette) use and respiratory symptoms (1.40; 95% CI, 0.93-2.11). CONCLUSIONS AND RELEVANCE This cross-sectional study found that former and current HTP use were associated with persistent respiratory symptoms among youth, especially among never and former cigarette users. Respiratory symptoms were more prevalent in ever exclusive HTP users and ever dual users than ever exclusive cigarette users. These findings suggest that using HTPs instead of cigarettes may not reduce health risks.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, Hong Kong, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Zhi-Ming Mai
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
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42
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Cheung YTD, Jiang N, Jiang CQ, Zhuang RS, Gao WH, Zhou J, Lu JH, Li H, Wang JF, Lai YS, Sun JS, Wu JC, Ye C, Li N, Zhou G, Chen JY, Ou XY, Liu LQ, Huang ZH, Ho SY, Li HCW, Su SH, Yang Y, Jiang Y, Zhu WH, Yang L, Lin P, He Y, Cheng KK, Lam TH. Physicians' very brief (30-sec) intervention for smoking cessation on 13 671 smokers in China: a pragmatic randomized controlled trial. Addiction 2021; 116:1172-1185. [PMID: 32918512 PMCID: PMC8246886 DOI: 10.1111/add.15262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
| | - Nan Jiang
- Department of Population Health, Grossman School of MedicineNew York UniversityNew YorkNYUSA
| | | | - Run Sen Zhuang
- Shenzhen Health Education and Promotion CentreShenzhenChina
| | - Wen Hui Gao
- Shenzhen Health Education and Promotion CentreShenzhenChina
| | - Jian Zhou
- Department of Respiratory MedicineGuangzhou Medical University Second Affiliated HospitalGuangzhouChina
| | - Jin Hong Lu
- Traditional Chinese Medical Hospital of HuangpuGuangzhouChina
| | - Hui Li
- Shenzhen Bao'an District Songgang People's Hospital, Hongqiaotou Community Health Service CenterShenzhenChina
| | - Jun Feng Wang
- The Fifth Affiliated Hospital of Sun Yat‐sen University, ZhongshangChina
| | - Yi Sheng Lai
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Jun Sheng Sun
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Jiu Chang Wu
- Shenzhen Bao'an District Fuyong HospitalShenzhenChina
| | - Chiang Ye
- Division of EndocrinologyShenzhen Bao'an District People's HospitalShenzhenChina
| | - Na Li
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Gang Zhou
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Jing Ying Chen
- Shenzhen Longgang District Second People's HospitalShenzhenChina
| | - Xiu Yan Ou
- ZhongShan City People's Hospital, ZhongShanChina
| | - Liu Qing Liu
- Longhua District People's Hospital Yansong Community CenterShenzhenChina
| | - Zhuang Hong Huang
- The First Affiliated Hospital of Shantou University Medical College Guan Bu Zhai Mei Healthcare StationShantouChina
| | - Sai Yin Ho
- School of Public HealthThe University of Hong KongHong Kong, China
| | | | - Sheng Hua Su
- Health Care Center for Cadre of Guangdong ProvinceGuangzhouChina
| | - Yan Yang
- Tobacco Control Office, Chinese Center for Disease Control and PreventionChina
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and PreventionChina
| | - Wei Hua Zhu
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Lie Yang
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Peiru Lin
- Guangzhou First Municipal People's Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Yao He
- Institute of Geriatrics, Chinese PLA General HospitalBeijingChina
| | - Kar Keung Cheng
- Institute of Applied Health ResearchUniversity of BirminghamUK
| | - Tai Hing Lam
- School of Public HealthThe University of Hong KongHong Kong, China
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Guo N, Guo Z, Zhao S, Ho SY, Fong DYT, Lai AYK, Chan SSC, Wang MP, Lam TH. Digital inequalities in health information seeking behaviors and experiences in the age of web 2.0: A population-based study in Hong Kong. PLoS One 2021; 16:e0249400. [PMID: 33784362 PMCID: PMC8009409 DOI: 10.1371/journal.pone.0249400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inequalities in health information seeking behaviors (HISBs) using mass media and internet websites (web 1.0) are well documented. Little is known about web 2.0 such as social networking sites (SNS) and instant messaging (IM) and experiences of HISBs. METHODS We surveyed representative Hong Kong Chinese adults (N = 10143, 54.9% female; 72.3% aged 25-64 years) on frequency of HISBs using traditional sources, internet websites, SNS (e.g., Facebook, Twitter), and IM (e.g., WhatsApp, WeChat) and experiences measured using Information Seeking Experience Scale. Adjusted prevalence ratios (aPRs) for HISBs and experiences by sociodemographic and health-related characteristics were yielded using multivariable Poisson regression with robust variance estimators. aPRs for experiences by HISBs using internet websites, SNS, and IM adjusting for sociodemographic and health-related characteristics were also yielded. RESULTS Being female, higher educational attainment, not smoking, and being physically active were associated with HISBs using any source (all P<0.05). Older age had decreased aPRs for HISBs using traditional sources (P for trend = 0.03), internet websites (P for trend<0.001), and SNS (P for trend<0.001) but not for IM (aged 45-64 years: aPR = 1.48, 95% CI 1.07, 2.03). Lower educational attainment and income were associated with negative experiences including feelings of effort and difficulties in understanding the information (all P for trend<0.05). Older age had increased aPRs for difficulties in understanding the information (P for trend = 0.003). Compared with internet websites, HISBs using IM was associated with feelings of frustration (aPR = 1.39, 95% CI 1.08, 1.79), difficulties in understanding the information (aPR = 1.36, 95% CI 1.12, 1.65), and quality concern (aPR = 1.20, 95% CI 1.08, 1.32). CONCLUSIONS We identified correlates of web-based health information seeking and experiences in Hong Kong Chinese adults. Providing greater access to and improved information environment of web 2.0 to the target groups may help address digital inequalities.
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Affiliation(s)
- Ningyuan Guo
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Ziqiu Guo
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Shengzhi Zhao
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | | | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Iurilli MLC, Zhou B, Bennett JE, Carrillo-Larco RM, Sophiea MK, Rodriguez-Martinez A, Bixby H, Solomon BD, Taddei C, Danaei G, Di Cesare M, Stevens GA, Riley LM, Savin S, Cowan MJ, Bovet P, Damasceno A, Chirita-Emandi A, Hayes AJ, Ikeda N, Jackson RT, Khang YH, Laxmaiah A, Liu J, Miranda JJ, Saidi O, Sebert S, Sorić M, Starc G, Gregg EW, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Ghaffar SA, Rahim HFA, Abu-Rmeileh NM, Garba JA, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Lahou B, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiri P, Amougou N, Amouyel P, Bo Andersen L, Anderssen SA, Ängquist L, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Auvinen J, Avdicová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MVG, Basit A, Bastos JLD, Bata I, Batieha AM, Batista RL, Battakova Z, Batyrbek A, Baur LA, Beaglehole R, Bel-Serrat S, Belavendra A, Romdhane HB, Benedics J, Benet M, Bergh IH, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhutta ZA, Bi H, Bi Y, Bia D, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Brinduse L, Brophy S, Bruno G, Bueno-de-Mesquita HB, Bugge A, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Capková N, Capuano E, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Li Chee M, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Chetrit A, Chikova-Iscener E, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, Dacica L, Re Saavedra MÁD, Dallongeville J, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, Jr DeGennaro V, Dehghan A, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Donati MB, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Li Duan J, Duante CA, Duboz P, Duda RB, Duleva V, Dulskiene V, Dumith SC, Dushpanova A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Engle-Stone R, Enguerran M, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, la Peña JED, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant'Angelo VF, Farzadfar F, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furusawa T, Gaciong Z, Gafencu M, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Garcia-de-la-Hera M, García-Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Giampaoli S, Gianfagna F, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Godos J, Gogen S, Goldberg M, Goldsmith RA, Goltzman D, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonzalez-Chica DA, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutiérrez-González E, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Kumar RH, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, He J, He Y, He Y, Heidinger-Felso R, Heinen M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera VM, Herter-Aeberli I, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Ibarluzea JM, Ibrahim MM, Wong NI, Ikram MA, Iotova V, Irazola VE, Ishida T, Islam M, Islam SMS, Iwasaki M, Jacobs JM, Jaddou HY, Jafar T, James K, Jamil KM, Jamrozik K, Janszky I, Janus E, Jarani J, Jarvelin MR, Jasienska G, Jelakovic A, Jelakovic B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jørgensen T, Joshi P, Joukar F, Jovic DP, Jóźwiak JJ, Juolevi A, Jurak G, Simina IJ, Juresa V, Kaaks R, Kaducu FO, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kampmann FB, Kanala KR, Kannan S, Kapantais E, Karakosta A, Kårhus LL, Karki KB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Kengne AP, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, 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Milkowska K, Miller JC, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Durakovic M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Molbo D, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Morin SN, Mortensen EL, Moschonis G, Mossakowska M, Mostafa A, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muc M, Mugoša B, Muiesan ML, Mukhtorova P, Müller-Nurasyid M, Murphy N, Mursu J, Murtagh EM, Musa KI, Milanovic SM, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Ei K Nang E, Nangia VB, Nankap M, Narake S, Nardone P, Nauck M, Neal WA, Nejatizadeh A, Nekkantti C, Nelis K, 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SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Ko Zaw K, Zdrojewski T, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Cisneros JZ, Zuziak M, Ezzati M, Filippi S. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shoaib Afzal
- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
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- Council for Agricultural Research and Economics
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Chetrit
- The Gertner Institute for Epidemiology and Health Policy Research
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- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
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- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute
- University of Basel
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- World Health Organization Regional Office for the Eastern Mediterranean
| | | | | | | | | | | | | | | | | | | | | | | | - Mihai Gafencu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcel Goldberg
- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
| | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jie Hao
- Beijing Institute of Ophthalmology
| | | | | | | | | | | | | | - Yuan He
- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
| | | | | | | | | | | | - Ana Henriques
- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | | | | | | | | | - Roya Kelishadi
- Research Institute for Primordial Prevention of Non-communicable Disease
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Slawomir Koziel
- PASs Hirszfeld Institute of Immunology and Experimental Therapy
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- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
| | | | | | | | | | | | - Lijuan Liu
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xu Ma
- National Research Institute for Health and Family Planning
| | | | | | | | | | - Stefania Maggi
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | - Bernard Maire
- French National Research Institute for Sustainable Development
| | | | | | - Päivi Mäki
- Finnish Institute for Health and Welfare
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jaume Marrugat
- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Capital Institute of Pediatrics
| | | | | | | | | | | | | | - GK Mini
- Women’s Social and Health Studies Foundation
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- University of Strasbourg
- Strasbourg University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Motta
- Instituto Conmemorativo Gorgas de Estudios de la Salud
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jana Námešná
- Banska Bystrica Regional Authority of Public Health
| | | | | | | | | | | | | | | | | | | | - Keiu Nelis
- National Institute for Health Development
| | - Liis Nelis
- National Institute for Health Development
| | | | | | | | | | | | | | | | - Yury P Nikitin
- SB RAS Federal Research Center Institute of Cytology and Genetics
| | - Guang Ning
- Shanghai Jiao-Tong University School of Medicine
| | | | | | - Marianna Noale
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | | | | | | | | | | | - Eha Nurk
- National Institute for Health Development
| | | | | | | | | | | | | | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
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- Institute for Cancer Research, Prevention and Clinical Network
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- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
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- Korea Centers for Disease Control and Prevention
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- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
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- Leibniz Institute for Prevention Research and Epidemiology - BIPS
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- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
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- Institut Hospital del Mar d'Investigacions Mèdiques
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- Victor Babes University of Medicine and Pharmacy Timisoara
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- Amrita Institute of Medical Sciences
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- World Health Organization Regional Office for Europe
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- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
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- National Institute of Health Doutor Ricardo Jorge
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- Institute of Food Sciences of the National Research Council
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- Ahvaz Jundishapur University of Medical Sciences
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- Research and Education Institute of Child Health
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- French National Research Institute for Sustainable Development
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- University of New South Wales
- The George Institute for Global Health
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- Center for Oral Health Services and Research Mid-Norway
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- Institute of Food Sciences of the National Research Council
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- London School of Hygiene & Tropical Medicine
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- Institute of Public Health
- Ss. Cyril and Methodius University
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- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Traissac
- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
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- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yi Zeng
- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
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- Jiangsu Provincial Center for Disease Control and Prevention
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- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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Chau SL, Wang MP, Wu Y, Cheung DYT, Kong A, Lai V, Lam TH, Ho SY. Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015-17). BMC Public Health 2021; 21:307. [PMID: 33549071 PMCID: PMC7866759 DOI: 10.1186/s12889-021-10341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. METHOD A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015-2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. RESULTS Eighty-four point one percent (95% CI 81.4-86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4-18.6%) were current polytobacco product users, 12.3% (10.2-14.8%) used one tobacco product and 2.52% (1.59-3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75-8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44-2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12-3.61), younger age (AORs range from 1.34-4.65, P for trend < .001) and less ready to quit (2.08, 1.09-3.97). CONCLUSIONS Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.
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Affiliation(s)
- S L Chau
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - M P Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Y Wu
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - D Y T Cheung
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - A Kong
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - V Lai
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - T H Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
| | - S Y Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
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X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Wang L, Chen J, Ho SY, Leung LT, Wang MP, Lam TH. Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes. BMC Public Health 2020; 20:1349. [PMID: 32887586 PMCID: PMC7650221 DOI: 10.1186/s12889-020-09422-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. Methods The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. Results Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). Conclusions Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
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Fung SSW, Lam TH, Sun Y, Man PKW, Ip JCM, Wan ANT, Stewart S, Ho SY. A cluster randomized controlled trial of more appreciation and less criticism in Hong Kong parents. J Fam Psychol 2020; 34:731-739. [PMID: 31944801 DOI: 10.1037/fam0000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Our cluster randomized controlled trial tested, respectively, 2 brief interventions to promote more appreciation and less criticism in Hong Kong Chinese parents toward their children and to enhance family well-being. We randomized 56 primary schools and community service centers (clusters of parents of primary grades 3-6 students) to the more appreciation (MA) or less criticism (LC) intervention arms, or fruit and vegetable control arm (FV). A total of 803 parents received a 2-hr workshop on increasing appreciation (19 clusters, n = 270), reducing criticism (21 clusters, n = 336), or increasing fruit and vegetable consumption (16 clusters, n = 197) and were assessed at baseline, immediately after the workshop, at 2 weeks, and at 6 weeks. Primary outcomes were parents' frequency of appreciation and criticism behaviors. Secondary outcomes were family well-being and potential behavioral determinants proposed by the Health Action Process Approach, including outcome expectancies, self-efficacy, intention, and planning behavior. At 6 weeks, the MA and LC arms reported greater increases in appreciation behavior than the FV arm, and the LC arm reported greater decreases in criticism than the FV arm, with small effect sizes. Specific improvements were also observed in the behavioral determinants at various time points compared with the FV arm. Similar improvements in family well-being were observed across all arms. Our findings were the first to show that brief Health Action Process Approach-based workshops on Chinese parents were effective in promoting positive parental behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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T, Lachat C, Laid Y, Lam TH, Lambrinou CP, Lanska V, Lappas G, Larijani B, Latt TS, Laugsand LE, Lazo-Porras M, Lee J, Lee J, Lehmann N, Lehtimäki T, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lin YT, Lind L, Linneberg A, Lissner L, Liu J, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Ma G, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekzadeh F, Malekzadeh R, Rao KM, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marques-Vidal P, Martorell R, Mascarenhas LP, Mathiesen EB, Matsha TE, Mavrogianni C, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene-Benchekor S, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Menezes AMB, Menon GR, Merat S, Mereke A, Meshram II, Metcalf P, Meyer HE, Mi J, Michels N, Miller JC, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, 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Repositioning of the global epicentre of non-optimal cholesterol. Nature 2020; 582:73-77. [PMID: 32494083 PMCID: PMC7332422 DOI: 10.1038/s41586-020-2338-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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Wu YS, Wang MP, Ho SY, Li HCW, Cheung YTD, Tabuchi T, Kwong AC, Lai V, Lam TH. Heated tobacco products use in Chinese adults in Hong Kong: a population-based cross-sectional study. Tob Control 2020; 29:277-281. [PMID: 31005892 DOI: 10.1136/tobaccocontrol-2018-054719] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | | | | | - Takahiro Tabuchi
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | - Vienna Lai
- Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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