Health compromising behaviors among Chinese adolescents: role of physical abuse, school experience, and social support.

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.

To unfold a hidden epidemic: prevalence of child maltreatment and its health implications among high school students in Guangzhou, China.

OBJECTIVE: This study investigated the prevalence of child maltreatment as perpetrated by parents, its associated health outcomes, and its resilient factors among high school students in China. METHODS: A multi-level stratified random school-based survey was conducted in 2005. Twenty four high schools were randomly chosen from eight districts in Guangzhou, South China (three from each district). Two classes were randomly selected from each of Form 1 to Form 3 (aged 12-16) in each selected school. Data from 6,593 students were analyzed. A number of locally validated tools were used to measure various types of maltreatment as well as physical and psychological conditions of students. RESULTS: The half-year prevalence of psychological aggression, minor physical maltreatment, severe physical maltreatment, and very severe physical maltreatment were 78.3%, 23.2%, 15.1%, and 2.8% respectively; while the half-year prevalence of sexual abuse was .6%. Maltreated students were more likely to report physical and psychological problems, and a positive relationship was also found between the severity of maltreatment and the likelihood of negative health outcomes. Male gender or having higher levels of social support and life satisfaction were identified as resilient factors to physical health of maltreated students. CONCLUSIONS: Child maltreatment as perpetrated by parents is common among high school students in Guangzhou, China. More public education programs are needed to raise public awareness of this problem. Intervention programs that target at improving social support and life satisfaction of students are potentially beneficial.

Determinants of work among older adults in urban China.

OBJECTIVE: We examined the role of personal, family and institutional factors on the work status of older adults in urban China. METHOD: The analysis was based on data from a large population survey (N = 7381) of community-dwelling urban Chinese aged 60 years and older. Multivariate logistic regression was used to model work status. RESULTS: Demographic variables such as gender, ethnicity, age and self-perceived health status were identified as important determinants of work status. Having material assets, savings, a public pension and health insurance were all negatively correlated with remaining in the workforce, whereas earning a high income was positively correlated. CONCLUSIONS: Our findings have implications regarding the impact of health policy and pension reform on employment retention. While economic growth may create an incentive for some to continue working, the lack of widespread public and private old-age support may force others to remain in the workforce out of economic necessity.

Are post-menopausal women "half-a-man"?: sexual beliefs, attitudes and concerns among midlife Chinese women.

The objective of this study was to explore the concerns and issues specific to sexual behaviors and interests among postmenopausal women in a metropolitan urban city in Southern China. This was a qualitative study using semi-structured focus group discussions (FGDs). Twenty-two informants aged 50 and above recruited through an ongoing research project on early post-menopausal women under the purview of the School of Public Health at the Chinese University of Hong Kong. The main outcome measures were themes identified as health concerns towards sex among postmenopausal women. Contrary to prior expectations and stereotypes, we found that the respondents were very open in discussing their sexual concerns and shared extensively from their personal experiences. Our respondents perceived significant differences in sexual needs between older men and women. Many respondents identified the effects of menopause and general health problems, as well as environmental limitations and communication problems between spouses as barrier to healthy sexual relationships within their marriages. Conversely, sexual disharmony was seen as an important cause of marital strife among older couples. There is a growing need in studying health concerns among the fast-growing, Chinese middle-aged and older population. Our qualitative study revealed a wide gap in the knowledge regarding general and sexual health issues among post-menopausal Chinese women. Raising awareness among health professionals of these issues is essential in addressing health concerns regarding this traditionally taboo subject within the Chinese context.

Environmental health and safety of Chinese sex workers: a cross-sectional study.

AIM: This paper presents a Hong Kong (HK) data on the effect that sex work has on women's environmental health and safety. An outreach role that highlights safety and human rights is suggested for nurses working with female sex workers (FSWs) as clients. BACKGROUND: In HK it was estimated that there were at least 200,000 FSWs in 2002 and the total population involved as workers, support staff, clients and partners of the clients exceeded half a million in a city of 6.8 million people. Despite these numbers, both locally and internationally there are very limited outreach nursing services that address the FSW's occupational health needs. METHOD: A cross-sectional survey, was undertaken over a 5 month period commencing in October 2003. A validated Chinese version of the World Health Organisation Quality of Life Measure was administered to a convenience sample of 89 female street sex workers. A focus group interview was later conducted to gain contextual information. RESULTS: The predominantly mainland Chinese FSWs had a mean age of 36.1 years. These women tended to be less educated and older than the general population of FSWs. They worked long hours with most of their income sent back home to China. Many lived in sub-optimal conditions and risked being abused while at work. The women scored significantly lower in the environmental domains when compared to the general female population. CONCLUSION: Highlighted is the critical importance of developing a new role, both international and within the Asian region, for community nurses working in an outreach capacity. This role should be visible, affordable and accessible, for at risk populations such as FSWs. The primary focus of the new role would be to establish a close working relationship between sex workers, sex industry owner/operators, health agencies and local authorities. Risk awareness programs developed and conducted by community nurses should embrace the complexity of occupational health issues. Such programs would also have the benefit of affirming the health rights of sex workers and public health.

Silent killers of the night: an exploration of psychological health and suicidality among female street sex workers.

This article examines factors that relate to psychological health (as measured by the World Health Organization Quality of Life Instrument) as well as suicide attempts among female street sex workers (FSSWs) in Hong Kong. On average, our sampled FSSWs scored significantly lower on the psychological health domain in comparison to the general Hong Kong female population. Factors associated with the working environment in the sex industry were significantly associated with poor psychological health and suicidality. Greater attention is needed to examine the physical and emotional harm intrinsic to certain occupations and the role of financial needs in the experience of psychological stress.

Female street sex workers in Hong Kong: moving beyond sexual health.

BACKGROUND: For many years, the sex industry in Hong Kong has appeared to be an integral and ever-expanding component of the city's sociocultural and economic structure. Accordingly, the physical and psychological health of sex workers is becoming an increasing concern for the workers themselves, the public, and government policy. METHODS: A cross-sectional survey on the quality of life (World Health Organization Quality of Life [WHOQOL]) of female sex workers (FSWs) in Hong Kong was used to investigate the physical and psychological well-being of street FSWs, and the results were compared with those of non-sex-working Hong Kong women after adjusting for age, educational level, marital status, and health status. RESULTS: The 89 FSWs surveyed scored significantly lower on QOL--WHOQOL-BREF (HK)--measures compared with the non-sex-working women. One common aspect among these sex workers was their negative view of themselves and of life. Many sex workers were at risk of being abused while at work, and many women worked without legal protection. Most of the women surveyed engaged in sex work to support their families. Because their income was often insufficient, some of their needs, especially those concerning health, were often neglected. CONCLUSIONS: The low WHOQOL-BREF (HK) scores in FSWs indicate feelings of helplessness and entrapment, which may well result in detrimental effects on sex workers' health, self-esteem, and confidence when asserting their basic rights, such as access to healthcare and safety. The conclusion highlights the vulnerability of this population to apparent weaknesses in Hong Kong's current healthcare system.

Patterns of health care utilization and health behaviors among street sex workers in Hong Kong.

OBJECTIVE: To describe the current use of health services by the street-based female sex workers (FSWs) and to explore beliefs behind these health behaviors. STUDY SETTING: Community outreach approach in a few red-light districts in Hong Kong. STUDY DESIGN: A 30 min face-to-face interview was carried out in 89 women by direct approach and snowballing, followed by a focus group discussion drawn from the participants of the questionnaire. RESULTS: While these FSWs' perception of personal health was good, a considerable proportion suffered from illnesses but the consultation rate was a third of the mean rate of the general population in Hong Kong. Many street workers experienced difficulty in utilizing health service in Hong Kong and even when they did, it was mainly for acute problems. Affordable access to health public services was excluded and many found private services unaffordable due to the high price charged by the practitioners. It was common for these women to self-medicate, delay in seeking medical help, or travel back to China for treatment. CONCLUSION: The current empirical understanding of the health and health service utilization by sex workers is unbalanced. In order to reduce sexually transmitted infections (STIs) and HIV among the street sex workers, it is essential to address the fundamental issue of health care access.

AIDS education, condom demand, and the sexual activity of American youth.

This paper examines the effects of AIDS education at school and at home on the sexual behavior of American youth. Multinomial logit equations of the probabilities of abstinence, sexual intercourse with a condom, and intercourse without a condom are estimated using data from the Youth Risk Behavior Supplement of the 1992 National Health Interview Survey. We find no significant effects of AIDS education on the probability of abstinence, but we do find that AIDS education significantly raises the likelihood of condom-protected relative to unprotected intercourse. These results indicate that risk-altering and risk-revealing AIDS education dominate any utility-altering effects favoring intercourse over abstinence. We also find that young women are influenced by AIDS education to a greater extent than young men. Overall, our results suggest that educating young people about AIDS does not promote sex and encourages safer sex, reducing the likelihood of HIV transmission and lowering the subsequent social costs.