Association of smoking with increasing vascular involvement in type 2 diabetic Chinese patients.

PURPOSE: To identify the relationship between smoking and the metabolic profile and existing vascular disease in Chinese type 2 diabetic patients. METHODS: 1710 diabetic patients were screened for complications, and biochemical and anthropometric vascular risk factors. As most smokers were male, differences were only compared between male current (n = 196) and never smoking patients (n = 300). RESULTS: The smokers had higher glycosylated haemoglobin levels (8.2 +/- 2.0 vs. 7.6 +/- 1.8%, p < 0.001) than never smokers, despite a greater proportion receiving hypoglycaemic agents (87.5 vs. 79.6%, p = 0.003). Male smokers compared to never smokers had lower HDL-cholesterol levels (1.12 +/- 0.31 vs. 1.20 +/- 0.30 mmol/L, p = 0.006), and elevated albumin-to-creatinine ratio (3.57 [2.68-4.75] vs. 2.47 [1.99-3.05] mg/mmol, p = 0.040). However, diastolic blood pressure was lower in the smoking group (78 +/- 12 vs. 82 +/- 12 mmHg, p = 0.001) even though they received less blood pressure-lowering treatments (23.8 vs. 33.2%, p = 0.034). The prevalence of peripheral vascular disease was increased in the diabetic patients who smoked compared to nonsmokers (7.1 vs. 2.8%, p = 0.039). CONCLUSIONS: Smoking was associated with a more adverse metabolic profile and peripheral vascular disease. As mainland China undergoes rapid modernisation and urbanisation, the observed effects of smoking means tobacco control becomes increasingly important to prevent or minimise potential health impacts and chronic disease.

Narrowing sexual behavioural differences between Chinese and non-Chinese populations in Hong Kong: implications for sexually transmitted infection (STI) transmission.

Information on sexual networking between different ethnic groups, in particular between Chinese and non-Chinese, is scarce. This study compared patterns of sexual behaviour and determinants of unsafe sexual behaviours amongst the Chinese and non-Chinese residents of Hong Kong. Of the 2,060 respondents (2060/4157; 50% response rate), 73% identified themselves as being ethnic Chinese. Overall, having a non-regular partner was more common amongst the non-Chinese (36%) than the Chinese (17%) respondents. Chinese people who were at increased risk of having had sex with a non-regular partner included social hygiene clinic attendees and airport travellers, males and ever smokers. For non-Chinese this was inconsistent condom use and being aged 18-45. Predictors of inconsistent condom use for Chinese included being aged 18-45, never having been married, and having had sex with non-regular partners; for non-Chinese the predictors were being aged 18-45, having had sex with non-regular partners and being unafraid of AIDS. We conclude that there are similarities and differences in sexual risk-taking behaviours between Chinese and non-Chinese residents in Hong Kong. To maximize potential public health benefits, behavioural interventions should be designed to address the different risk profiles of Chinese and non-Chinese populations separately.

Smoking and sexual dysfunction in Chinese males: findings from men's health survey.

To describe the prevalence of erectile dysfunction (ED) and its association with smoking among the Chinese in Hong Kong, we conducted a cross-sectional study among 819 men (aged 31-60 years) who were randomly selected among the Hong Kong residents and interviewed by trained interviewers. A structured questionnaire was used for data collection. We found that current smokers who smoked 20 cigarettes or more daily had more dissatisfaction, erection difficulty and ED than never smokers. The prevalence of dissatisfaction, difficulty in erection and ED increased significantly (P<0.05) with increasing age. Compared with never-smokers, current smokers of more than 20 cigarettes daily had a greater risk of ED (age-adjusted odds ratio=1.47, 95% confidence interval: 1.00-2.16). Our results support that there are association between ED and smoking among the Chinese and suggest linking ED with smoking in the antismoking campaign and promoting smoking cessation to reduce ED among smokers.

Factors related to non-participation in physical activity among the students in Hong Kong.

The patterns and determinants of physical inactivity among the Chinese youths are unknown. This study assessed the prevalence and predictors of physical inactivity among students in a Hong Kong university. A cross-sectional survey of year 1 and year 3 Chinese undergraduate students in 1997, using a structured, self-administered questionnaire was carried out. Questionnaires were returned by 64 % (1189/1849) of the students. Thirty-one percent of the respondents did not participate in physical activity. Being female, not a university resident, studying in the Faculty of Arts and rating current health status as poor or very poor were predictors of physical inactivity. No time and no interest were the most common reasons for non-participation in physical activity among the students. This study showed that about one-third of Chinese university students are physically inactive and would gain health benefits from organized intervention. Awareness among the students about the risks of physical inactivity should be enhanced and efforts made to increase physical activity should be reinforced. Factors identified as predictors of physical inactivity should be taken into account in the design of intervention.

Smoking cessation among Hong Kong Chinese smokers attending hospital as outpatients: impact of doctors' advice, successful quitting and intention to quit.

To identify factors affecting current smokers' intention to quit smoking and factors associated with successful quitting among ex-smokers in Hong Kong. A cross-sectional survey of Chinese patients attending medical and surgical Specialist Outpatient Clinics (SOPCs) of public hospitals in Hong Kong, using a structured questionnaire. Results of the 642 respondents, 21% were current smokers, 9% were ex-smokers and 69% were non-smokers. 74% of the smokers reportedly received quitting advice from doctors. Among the current smokers, past quitting attempts, receiving information from sources other than doctors, believing that doctor's advice was useful, believing that all smokers should quit smoking and a positive attitude towards quitting were associated with intention to quit. Among those who had attempted to quit, being older (aged 50 or above), being retired/unemployed and consuming more than 10 cigarettes per day were associated with successful quitting. We found that advice from doctors on quitting smoking did not have any impact on Chinese smokers quitting or future intention to quit and reflect the inadequacy of advice given by Hong Kong doctors. The predictors of intention to quit and successful quitting identified in the study could be used to design future smoking cessation services.

Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline?

OBJECTIVE: To describe the characteristics of the Chinese subjects who utilised the first telephone smoking cessation service in Hong Kong, and to evaluate its effectiveness. METHODS: The Quitline provided Hong Kong residents with free telephone smoking cessation services which was publicised through a press conference, media reports, pamphlets, and posters at public and private hospitals and clinics. Callers who completed an initial interview from 13 December 2000 to 31 May 2002 were included. Smokers were interviewed using a structured record sheet and provided with stage matched counselling. A follow up interview was carried out after six months. Analysis was conducted by intention-to-treat. RESULTS: Of the 1120 callers who completed initial assessments, 1047 were current smokers and 872 consented to follow ups. Compared to the general smoking population, the Quitline attracted more of those who were female, younger, single, unemployed, higher educated, smoking more than 20 cigarettes per day, and those with quitting experience. At six months, 12% (95% confidence interval 10% to 15%) of the participants reported that they had not smoked a cigarette for the past seven days. A stepwise logistic regression model showed that the use of nicotine replacement therapy at the present attempt to quit, having made one or more serious attempts to quit in the past, perceiving less difficulties in quitting, and smoking the first cigarette at age 15 years or above were significant predictors of quitting. CONCLUSION: This first Quitline in Asia appears to be acceptable to Chinese smokers, with quit rate comparable to those of better funded Quitlines in the West. A low cost Quitline is a promising model for smoking cessation services in the East.

Promotion of smoking cessation in developing countries: a framework for urgent public health interventions.

The rapid rise in smoking in many developing countries will have devastating consequences; by 2030 the developing world is expected to have 7 million deaths annually from tobacco use. Many smokers express a desire to quit, but they often fail because they are addicted to tobacco. Although a number of cessation aids are now available in the developed world, their applicability and affordability in developing countries is less clear. Successful interventions will require many stakeholder groups to take action at the local, national, and international levels. We discuss smoking cessation as a means of reducing disease burden, examine factors that may limit the promotion of smoking cessation in developing countries, and propose a framework for public health action. This framework should comprise intervention with healthcare professionals, strengthening national commitment, development of a model for developing countries, changing the social acceptability of smoking, strengthening community participation, integration of smoking cessation with other healthcare services, specifying the role of healthcare professionals, development of guidelines, mobilisation of the business community, provision of financial incentives, establishing population specific smoking cessation services, increased collaboration between countries, and development of international initiatives.

AIDS-defining cancers in Western Europe, 1994-2001.

To determine the recent trends in AIDS-defining cancers in Western Europe, we analyzed the June 2002 European Non-Aggregate AIDS Data Set. We obtained the percentage of people with AIDS aged 15 years or older (n = 125,691; males, 99,560, females, 26,131) who had cancers as the initial AIDS-defining illness in 17 European countries. Overall, from 1994 through 2001, declines were noted in the number of people with AIDS (25,324 to 8929), the proportion of people with AIDS who were homosexual/bisexuals (38.8% to 26.6%) or intravenous drug users (male, 41.7% to 34.8%; female, 50.2% to 26.4%). Among males, between 1994 and 2001, the percentage with any AIDS-defining, cancers declined (14.4% to 13.1%, p for trend = 0.091) because of a decline in Kaposi's sarcoma (KS; 10.7% to 7.9%) mostly among homosexual/bisexual men (22.7% to 18.8%) (p for trends < 0.05). Between 1994 and 2001, the percentage of males with all types of lymphomas increased (3.8% to 5.2%, p for trend = 0.012). Among females, AIDS-defining cancers increased (7.3% to 8.5%) due to increase in lymphomas (all types, 2.6% to 4.0%) (p for trend = 0.05). Cervical cancer remained the most common cancer among females, the percentage of which declined between 1994 and 2001 (2.8% to 2.0%, p for trend = 0.37) mostly among women who were 15 to 29 years old, most of whom acquired HIV heterosexually. In summary, declines were noted for the two leading AIDS-defining cancers at initial AIDS diagnosis among certain population groups. KS declined among men who had sexually transmitted HIV infection. Cervical cancer declined among young females and heterosexuals.

Understanding sexual risk taking behaviour in Hong Kong university students. A health promotion perspective.

BACKGROUND: Levels of sexual experience among Chinese university students are considerably lower than in western countries. Measuring sexual risk-taking behavior of Chinese students is important in designing any effective preventive health programs. This study assessed the prevalence and factors associated with high-risk sexual behavior among students in a Hong Kong university. METHODS: A cross-sectional survey conducted among year 1 and year 3 Chinese undergraduate students in 1997, using a structured, self-administered questionnaire. RESULTS: Of the 1197 students surveyed, only 11% were sexually active (ever had sexual intercourse). Reported sexual activity was higher among year 3 (17%) than year 1 (6.6%) students and higher among males (14.4%) than females (8.3%). Consistent (always) use of condoms was reported by only 43% of the sexually active respondents. Males were more likely to think that premarital sex was acceptable than were females. About 1 in 20 students (55 of 1197) were categorized as belonging to a "greater risk behavior" group, defined by inconsistent or nonuse of condoms during sexual intercourse and having had three or more sexual partners in the past 3 months, or having has sex with prostitutes or ever having a sexually transmitted disease, or using alcohol or other stimulating drugs during sexual intercourse. Males with favorable attitudes toward premarital sex were more likely to belong to the greater risk behavior group. CONCLUSIONS: This study demonstrated the potential risk for contracting sexually transmitted diseases among a substantial proportion of university students, suggesting the need for promotion of preventive education programs.

Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong.

Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice.

Reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention.

OBJECTIVE: To assess the prevalence and reasons for non-use of condoms among the Hong Kong Chinese population and obtain baseline data to monitor sexual behavioural change. METHODS: Cross sectional self administered questionnaire surveys in convenience sampled groups of Hong Kong Chinese residents were carried out. RESULTS: Of the 1508 respondents, 24% reported consistent condom use and 76% inconsistent use. Overall, 17% of respondents reported having sex with strangers. People who were at increased risk for inconsistent condom use included STD clinics attendees, those who never married, and those reporting low self efficacy for condom use or sex with strangers. Common reasons for not using condoms were trust in partner, use of other contraceptives, and reduced sensation while using condoms. CONCLUSIONS: Given the reported high prevalence of travel and sexual contact with strangers, and misconceptions about condoms among the Hong Kong Chinese population, innovative condom social marketing campaigns are needed. Periodic monitoring of condom use behaviours should be an integral part of HIV/STD surveillance activity.