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De Leon AN, Dvorak RD, Perrotte JK, Klaver SJ, Peterson R, Magri TD, Burr EK, Leary AV, Aguilar B. The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults. ETHNICITY & HEALTH 2024; 29:553-577. [PMID: 38714915 DOI: 10.1080/13557858.2024.2345916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking. DESIGN Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation. RESULTS Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy. CONCLUSIONS Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.
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Affiliation(s)
- Ardhys N De Leon
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Robert D Dvorak
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | | | - Samantha J Klaver
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Roselyn Peterson
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Tatiana D Magri
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Emily K Burr
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Angelina V Leary
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Bradley Aguilar
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Hernandez-Vallant A, Votaw VR, Herron JL, Stein ER, Swan JE, Ulrich DM, Blackwell MA, McCrady BS. A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic. Psychol Serv 2024; 21:305-316. [PMID: 36689373 PMCID: PMC10363250 DOI: 10.1037/ser0000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Victoria R. Votaw
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Jalene L. Herron
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Elena R. Stein
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Julia E. Swan
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | | | | | - Barbara S. McCrady
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
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Vallentin-Holbech L, Karsberg SH, Nielsen AS, Feldstein Ewing SW, Rømer Thomsen K. Preliminary evaluation of a novel group-based motivational interviewing intervention with adolescents: a feasibility study. Front Public Health 2024; 12:1344286. [PMID: 38510360 PMCID: PMC10951374 DOI: 10.3389/fpubh.2024.1344286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Drinking is closely intertwined with social life among many adolescents, particularly in Europe. Group-based interventions, such as group-based motivational interviewing (group MI), have shown the capacity to prevent and reduce hazardous drinking and related problems among adolescents, but few examinations have been conducted in a European high school setting. This study examines the preliminary outcomes of a pilot group MI intervention among Danish adolescents. High school students (ages 15-18 years) were randomly allocated to two 1-h group MI sessions delivered in a school setting (N = 65) or an assessment only control condition (N = 67). Data were collected in August and November 2020 using online self-administrated questionnaires regarding the acceptability of the intervention and past month alcohol use. The pilot group MI intervention showed high feasibility and acceptability in this setting and with this age group. Group MI adolescents significantly reduced peak drinks per drinking day compared to assessment only adolescents (-2.7 drinks, p < 0.05). Results are discussed in relation to the metrics being evaluated during COVID-19 lockdown, including increased social restrictions at follow-up compared to baseline. Group MI shows promise for reducing hazardous alcohol use among Danish adolescents. In addition, the findings indicate the importance of building on and extending this work in future larger, better-powered randomized controlled trials.
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Affiliation(s)
| | | | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sarah W. Feldstein Ewing
- Centre for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
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Platts K, Scott E, Griffiths K, Carter A. Attitudes to and perceptions of workplace health promotion amongst employees from ethnic minorities in the UK: A scoping review. Work 2024:WOR230576. [PMID: 38393877 DOI: 10.3233/wor-230576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Ethnic minorities make up approximately 14% of the UK workforce. Despite the disproportionate burden of ill-health amongst ethnic minorities, and the increased interest in Diversity, Equity & Inclusion (DE&I) in the workplace, workplace health and wellbeing interventions are still most often designed for the ethnic majority. OBJECTIVE The purpose of this scoping review was to explore the depth and breadth of evidence on the attitudes to and perceptions of health and wellbeing interventions in the workplace within ethnic minority groups in the UK, and to identify gaps in evidence that would provide direction for future research needs. METHODS A scoping review with quality appraisal was undertaken, supplemented by a review of grey literature and a narrative review exploring related evidence from the knowledge bases related to community and cultural adaptation. RESULTS Only three peer-reviewed studies met inclusion criteria, preventing broad conclusions. 14 papers from the community and cultural adaptation literature provided additional information about how health promotion may be approached effectively in the workplace, including the importance of culturally sensitive, people-centred design, and the use of established adaptation frameworks. CONCLUSION The literature suggests a need for improvements in four key areas: (1) reporting of ethnic minorities in data relating to workplace health and wellbeing research, (2) more thorough review of perceptions and attitudes of ethnic minority workers in the UK, (3) design of culturally appropriate interventions that are tested for impact, and (4) testing of the effectiveness of culturally adapted interventions.
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Contreras-Pérez ME, Wagner E, Hospital M, Morris S, Colby S, Magill M. Outcomes of a Brief Motivational Intervention for Heavy Alcohol Use in Racial or Ethnic Minority Compared to White Emerging Adults. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:75-89. [PMID: 37766623 DOI: 10.1080/26408066.2023.2263454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE This study used secondary data from a randomized controlled trial of a Brief Motivational Intervention (BMI) to examine whether Non-White participants had different treatment results compared to White participants. METHODS The outcome variables of this study were divided into primary outcomes (heavy drinking and consequences associated with alcohol use) and secondary outcomes (cognitive variables such as motivation to change alcohol use, and behavioral variables, including protective behavioral strategies). Linear regression analyses were conducted with the PROCESS macro for SPSS, to test if race or ethnicity moderated the relationship between BMI and each treatment outcome. Data was collected at two time points, six weeks and three months after treatment. RESULTS This study showed that race or ethnicity did not moderate treatment results for the four outcome variables. Additional within-group effect sizes were calculated for all racial and ethnic categories, showing that Hispanic/Latine and Black participants had larger effect sizes in all the outcome variables. DISCUSSION The discussion examines the potential strength of Motivational Interviewing due to its client-centered spirit, which naturally allows for incorporating values and identity-based factors, such as culture, into the session. CONCLUSION The results suggest similar BMI outcomes among White and Non-White emerging adults who engage in heavy drinking, potentially due to its client-centered approach. This is a preliminary study, and the results are therefore tentative.
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Affiliation(s)
- María Eugenia Contreras-Pérez
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Eric Wagner
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Michelle Hospital
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Staci Morris
- Community-Based Research Institute, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Robert Stempel School of Social Work, Florida International University, Miami, Florida, USA
| | - Suzanne Colby
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
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Fredriksen-Goldsen KI, Jones BR, Hoy-Ellis C, Kim HJ, Emlet CA, La Fazia D, McKenzie G, Petros R, Teri L. Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA). Contemp Clin Trials Commun 2023; 35:101169. [PMID: 37638227 PMCID: PMC10448412 DOI: 10.1016/j.conctc.2023.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods This paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. Results The virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. Discussion The virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.
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Affiliation(s)
| | - Brittany R. Jones
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles Hoy-Ellis
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles A. Emlet
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - David La Fazia
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ryan Petros
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Linda Teri
- University of Washington, School of Nursing, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
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Scales D, Gorman JM, DiCaprio P, Hurth L, Radhakrishnan M, Windham S, Akunne A, Florman J, Leininger L, Starks TJ. Community-oriented Motivational Interviewing (MI): A novel framework extending MI to address COVID-19 vaccine misinformation in online social media platforms. COMPUTERS IN HUMAN BEHAVIOR 2023; 141:107609. [PMID: 36531901 PMCID: PMC9745298 DOI: 10.1016/j.chb.2022.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
Researchers have linked circulating misinformation in online platforms to low COVID-19 vaccine uptake. Two disparate literatures provide relevant initial guidance to address the problem. Motivational Interviewing (MI) effectively reduces vaccine hesitancy in clinical environments; meanwhile, social scientists note inoculation, rebuttal, and appeals to accuracy are persuasive in digital contexts. A tension is inherent in these approaches. MI in digital forums may induce an 'illusory truth effect,' wherein falsehoods appear more accurate through repetition. Yet, rebutting misinformation directly may elicit backfire or reactance effects, motivating some to amplify their presentation of misinformation. Building on Identity Process Theory, we propose a theoretical framework for conducting MI-based infodemiology interventions among digital communities that conceptualizes the community in toto (rather than one specific person) as the unit of focus. Case examples from interventions on public Facebook posts illustrate three processes unique to such interventions: 1) Navigating tension between addressing commenters and "bystanders"; 2) Activating pro-vaccine bystanders; and 3) Reframing uncertainty or information individuals might find concerning or threatening according to implied collective values. This paper suggests community-oriented MI can maximize persuasive effects on bystanders while minimizing potential reactance from those with committed beliefs, thereby guiding community-oriented public health messaging interventions enacted in digital environments.
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Affiliation(s)
- David Scales
- Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Critica, Bronx, NY, USA
| | | | | | | | | | | | | | | | | | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of the City University of New York, New York, NY, USA
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8
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Fox KR, Neville SP, Grant VR, Vannatta K, Jackson JL. Ambivalence is associated with decreased physical activity and cardiorespiratory fitness among adolescents with critical congenital heart disease. Heart Lung 2023; 58:198-203. [PMID: 36587561 PMCID: PMC9992114 DOI: 10.1016/j.hrtlng.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescents with congenital heart disease (CHD) are insufficiently physically active. Given that increasing physical activity may reduce their cardiovascular risk, it is important to identify correlates of this behavior. Perceived benefits of and barriers to physical activity are associated with physical activity engagement. Existing research has only considered these constructs separately. This population may be ambivalent toward physical activity (i.e., perceive both strong benefits and barriers). The association of ambivalence and physical activity related outcomes is unknown among this at-risk population. OBJECTIVE Determine the association of ambivalence and sedentary behavior, moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness (VO2Peak) among adolescents with CHD. METHODS The present study is an analysis of data from an eligibility assessment for a randomized clinical trial of an intervention to promote MVPA among adolescents aged 15 to 18 years with moderate or complex CHD. Participants (N = 84) completed a survey assessing perceived benefits and barriers from which ambivalence toward physical activity was calculated, an exercise stress test to measure VO2Peak, and wore an accelerometer for one week to determine their engagement in sedentary behavior and MVPA. Linear regression analyses determined associations between ambivalence and physical activity related outcomes. RESULTS: Greater ambivalence toward physical activity was associated with increased sedentary behavior, decreased MVPA, and reduced VO2Peak, adjusting for demographic and clinical covariates. CONCLUSIONS Ambivalence is associated with objectively measured physical activity (sedentary behavior, MVPA) and a biomarker of cardiovascular health (VO2Peak). Screening for ambivalence may help clinicians identify those most likely to benefit from physical activity-related education.
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Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205.
| | - Steven P Neville
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205
| | - Victoria R Grant
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH, USA 43210
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH, USA 43210
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Tse N, Tse S, Wong PW. Collective Motivational Interviewing for Individuals with Drug Use Problems: A Pre-Post-Follow-Up, Uncontrolled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16344. [PMID: 36498414 PMCID: PMC9737559 DOI: 10.3390/ijerph192316344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Collective motivational interviewing (CMI) is a novelty motivational approach which optimises the motivational interviewing (MI) for individuals from collectivistic cultures. While MI has been empirically tested as an effective intervention for addictive disorders and has had a positive effect on facilitating lifestyle changes, CMI has retained the potency of MI as an individualistic intervention, and it further invites the social network resources to strengthen the level of motivation and cultivate a joint change partnership. This pilot study was the first clinical study of CMI to work with individuals with drug use problems (IDUPs) by involving concerned significant others (CSOs) in the three-session intervention, and the fidelity control was assessed by the Collective Motivational Interviewing Treatment Integrity (CMITI) scale. This pre-post−follow-up and uncontrolled feasibility study was conducted between 2017 and 2019, with dyads of 20 IDUPs and their CSOs. The potential impacts of CMI were examined by measures at baseline, post-intervention, and 1-month and 3-month post-intervention. All clinical sessions were audio-recorded, and four cases were randomly selected for fidelity review by two trained coders. The normality of data at the baseline was checked by a Shapiro−Wilk test. Non-parametric Wilcoxon-signed-rank test and repeated-measures ANOVA were employed for quantitative analysis. The results showed that six IDUPs had reduced drug use, and ten maintained drug abstinence with the support of CSOs, whereas four IDUPs remained unchanged or increased drug use. Overall, at the 3-month follow-up, drug use was reduced (p > 0.05), social support was strengthened (p < 0.05), and the IDUPs’ motivation for change was enhanced (p < 0.05). However, the small sample sizes, non-random sampling, and lack of control group may limit the generalizability and confirmation of the outcomes and of the “real effects”. This finding of the study suggests that the CMI is a feasible and acceptable therapeutic tool to motivate IDUPs with the support of CSOs to achieve mutually agreed-upon goals. Further development and evaluation with robust methodology are warranted.
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Affiliation(s)
- Nick Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Applied Social Sciences, HKCT Institute of Higher Education, Hong Kong Special Administrative Region, Hong Kong, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Paul W.C. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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