The correlates of depressed mood in adolescents in Hong Kong.

PURPOSE: Most studies of depressed mood and its correlates in adolescents have been conducted in Western countries. This study examined the relationship between a broad range of stressors and depressed mood in a community sample of Hong Kong adolescents. METHODS: Secondary school students (n = 996) completed the Chinese Beck Depression Inventory (C-BDI), provided demographic information, and indicated their perceptions of family and peer relationships, school function and pressures, and subjective health, and some measures salient to the Hong Kong environment: triad gang pressure, religiosity, and intent to emigrate. The correlation between C-BDI and these variables was assessed in bivariate and multivariate analyses. RESULTS: Hong Kong adolescents reported higher levels of depressive symptoms than a comparison group of Western teenagers. Girls showed more symptoms than boys. All stressors correlated in bivariate analyses with C-BDI, indicating similar influences on depressed mood in Western and Hong Kong teenagers. In multivariate analyses, the stressors contributed cumulatively to the C-BDI score. Perceptions of a lack of parental understanding and peer acceptance appeared as the strongest variables in predicting depressed mood. CONCLUSIONS: Depressed mood is highly prevalent among Hong Kong teenagers. Stressors play a cumulative role in their relationship to mood. Our findings point to the importance of broad screening of this vulnerable population.

Passive smoking exposure of sick children in Hong Kong.

1. This study aims to investigate the extent of passive smoking exposure of sick children in Hong Kong; their father's smoking behaviors and their mother's action to protect the child from environmental tobacco smoke (ETS). 2. This cross-sectional survey was the first phase of a randomized controlled trial on a health education intervention provided by nurses in the general paediatric wards of four major hospitals in Hong Kong. The subjects are non-smoking mothers of sick children admitted to hospital and with a smoking husband living together in the same household with the child. Eligible subjects completed a self-administered baseline questionnaire before entering into the trial. 3. All the 848 children whose mothers completed the questionnaire during December 1997 to April 1998 had a smoking father. They constituted about 24% (95% CI: 22.6-24.9%) of all the sick children during the same period. More than half of the children's fathers (55%; 51.6-58.3%) smoked 1-14 cigarettes per day and about 68% (64.7-71.0%) of them were daily smokers for over 10 years. Over half (53%; 49.4-56.2%) of the fathers smoked 1-14 cigarettes at home every day. About 21% of the fathers smoked near the child occasionally and 31% (27.4-33.6%) smoked 1-14 cigarettes near the child per day. About 16% of the children lived with more than one smoker (2-3). About 86% (83.3-88.0%) of the children had 1-3 smokers who smoked at home and 61% (58.1 - 64.7%) of them had 1-3 smokers who smoked near them every day. However, 70% of the children were reported by their mothers as exposed to ETS at home. This percentage (70%) was less than the percentage (86%) of smokers who smoked at home daily. About 31.1% of the mothers reported symptoms of coughing and running nose (20.6%) in their children when they were exposed to ETS. To protect the child from ETS exposure, 43% of the mothers requested the father not to smoke near the child, 33.1% requested the father to smoke less cigarettes and 31.5% advised the father to quit smoking. 4. In conclusion, sick children in Hong Kong are at risk of exposure to ETS, but not all mothers are aware of the health risks and their actions were inadequate. There is a critical need to promote awareness of ETS exposure and the health risks in the family in Hong Kong so as to reduce illness and hospital admission in children.

A prospective analysis of stress and academic performance in the first two years of medical school.

AIM: This study provides prospective, longitudinal data on the relationship between stress-related measures and academic performance during the first two years of medical school. METHODS: First year medical students (n = 121) were surveyed prior to beginning classes (wave 1), and again 8 months later (wave 2). Personality variables predisposing to distress (optimism and trait anxiety), stress response (depression and state anxiety), and stress management strategies were assessed at wave 1 and wave 2. Pre-medical academic scores, and grades at the end of five assessment periods over the course of the first 2 years of medical school were also obtained. RESULTS AND CONCLUSIONS: As expected, pre-medical-school academic performance strongly predicted performance in medical school. Academic performance before and during medical school was negatively related to reported stress levels. On bivariate correlations, there were numerous significant relationships between stress reported at waves 1 and 2, and medical school academic performance assessed after these measures. In addition there were modest negative correlations between self-reported coping strategies of 'humour' and 'wishful thinking', and consequent academic performance. However, the predictive value of stress and its management on prospective academic performance was much decreased once pre-medical-school performance was statistically controlled.

Respiratory symptoms due to active and passive smoking in junior secondary school students in Hong Kong.

BACKGROUND: Evidence on respiratory symptoms due to smoking and passive smoking in children is mainly derived from studies in Western countries. Evidence from the East was required to support stronger tobacco control policy in Asia. This study aimed to analyse the relationship between respiratory symptoms and smoking status in junior secondary students and between respiratory symptoms and family smoking in never-smoking students. METHODS: In a cross-sectional survey in 1994, anonymous questionnaires were administered to a two-stage cluster probability sample of 6304 students, aged mostly 12-15 years, from 172 classes of 61 schools in Hong Kong. RESULTS: Significant linear trends were found between smoking and the prevalence of throat and nose problems, cough and phlegm, and wheezing. The odds ratio (OR), after adjustment for age, gender, area of residence, type of housing and correlation within schools and classes (cluster effects), for smoking at least weekly ranged from 1.35 to 4.84. In never-smoking children, significant trends were found between the number of smokers living with the children and throat and nose problems, cough and phlegm, and recent wheezing. The adjusted OR and 95% confidence interval (CI) for any cough or phlegm symptoms was 1.19 (95% CI: 1.01-1.47) for one smoking household member, 1.38 (95% CI: 1.07-1.79) for two and 1.85 (95% CI: 1.19-2.85) for three (P for trend <0.001). Increased OR were found for father and mother smoking. CONCLUSIONS: This study provides strong evidence that both active and passive smoking can cause respiratory ill health in Chinese children in Hong Kong. Urgent measures are needed to protect children from the health hazards of active and passive smoking in Asia.

Tobacco advertisements: one of the strongest risk factors for smoking in Hong Kong students.

STUDY OBJECTIVE: To describe the prevalence of smoking in junior secondary school students in Hong Kong and to analyse the relationship between a range of risk factors and ever-smoking experience, including tobacco advertisements. METHODS: Cross-sectional survey using an anonymous standardised self-administered questionnaire. SETTING: 61 randomly selected secondary schools in Hong Kong. PARTICIPANTS: 6,304 form 1 to 3 Chinese students from 172 classes (51% girls and 49% boys; 90% were aged 12 to 15 years). RESULTS: The smoking status (95% confidence interval) was: (1) never smoker, 71.1% (70.0%-72.2%), (2) tried only, 15.5% (14.6%-16.4%), (3) used to smoke but not now, 4.2% (3.7%-4.7%), (4) smoked < 1 cigarette per week, 2.9% (2.5%-3.4%), (5) smoked 1-6 per week, 1.7% (1.4%-2.0%), and (6) smoked > 6 per week, 4.5% (4.0%-5.0%). In a backward stepwise logistic regression model, ever-smoking (including categories 2 to 6 above) was independently associated with thirteen factors, including gender (boys), increasing age, place of birth (outside Hong Kong, mainly China), poor knowledge of the hazards of smoking, positive attitudes to smoking, smoking in family members, participation in tobacco promotional activities, and perception of cigarette advertisements as attractive. Among the strongest associations observed was the youth's perception of cigarette advertisements as attractive, with the adjusted odds ratio (95% confidence interval) of 2.68 (2.33-3.07). CONCLUSIONS: Smoking among young people is an important public health problem. Although the causes are multifactorial, in Hong Kong environmental tobacco advertising is an important risk factor that can be removed by banning all forms of tobacco promotion to young people.

A comprehensive study of smoking in primary school children in Hong Kong: implications for prevention.

STUDY OBJECTIVE: To identify factors associated with smoking behaviour in primary school children in Hong Kong. DESIGN: A cross sectional survey in which both children and parents completed questionnaires. The main outcome measure was the smoking status of the children; and risk factors (knowledge of and attitude to smoking and demographic and socioeconomic background) were identified as predictors of ever/never smoking. SETTING AND SUBJECTS: Altogether 9598 primary school children, aged 8-13 years, and attending 27 schools from two districts in Hong Kong participated. MAIN RESULTS: The prevalence of ever-smoking was 12% (1119)-15% (760) in boys and 7% (359) in girls. It ranged from 3% in 8 year old girls to 52% in 13 year old boys. The factors associated with ever-smoking included the following: being a boy (adjusted odds ratio 2.21; 95% confidence interval 1.89, 2.59), increasing age per year (1.48; 1.40, 1.57), living in Kwai Tsing district (1.29; 1.10, 1.50), having one or more smokers at home (2.07; 1.78, 2.39), and having a father who was not working (1.41; 1.19, 1.67). Children who were ever-smokers had both seen and approved of their friends' smoking (8.79; 5.33, 14.50), had a more positive attitude towards smoking (3.35; 2.21, 5.09), and were more successful in recognising cigarette brand names and logos (1.67; 1.42, 1.96), but they lacked confidence (1.78; 1.32, 2.39). CONCLUSIONS: The influences on child smoking are multifactorial and programmes in Hong Kong are falling to curb them. The control of these risk factors must be incorporated in the smoking prevention policy of Hong Kong and supported by future enforced legislation.

Evaluation of two videotape instruction programmes on how to break bad news--for Cantonese-speaking medical students in Hong Kong.

OBJECTIVES: To evaluate a culture-specific videotape on how to 'break bad news' and another videotape produced by a western university, and to determine if the language of presentation influenced the students' perceived abilities to execute basic skills. SUBJECTS: Third year medical students at the Faculty of Medicine, the University of Hong Kong. DESIGN: Longitudinal study with experimental design. INTERVENTION: Two instructional tapes on breaking bad news; one using Chinese speaking role models and one using English. RESULTS: In both groups, self-efficacy summed scores increased from 26.8 (95% CI = 25.9-27.7) at the pre-test to 29.0 (95% CI = 28.4-29.6). The biggest changes occurred in perceived self-efficacy regarding specific skills. However, students using the Chinese tape rated skills as more useful than those using the English tape. CONCLUSION: The videotapes were useful in teaching communication skills. Culturally relevant audiovisual materials were more effective.