Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students

BACKGROUND

Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students.

METHODS

From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires.

RESULTS

The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %).

CONCLUSIONS

Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health.

LIMITATION

The cross-sectional study design limited causal inferences.

Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study

OBJECTIVES

The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless anal intercourse during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong.

METHODS

A cross-sectional study was conducted among MSM in Hong Kong. A total of 463 MSM completed a cross-sectional telephone survey between March 2021 and January 2022.

RESULTS

Among all participants, the mean number of regular sex partners, non-regular sex partners, and casual sex partners during the COVID-19 period were 1.24, 2.09, and 0.08 respectively. Among those who had sex with regular, non-regular, and casual sex partner during the COVID-19 period, respectively 52.4%, 31.8% and 46.7% reported condomless anal intercourse. Compared to the pre-COVID-19 period, participants reported significantly fewer number of regular and non-regular sex partners during the COVID-19 period. However, a higher level of condomless anal intercourse with all types of sex partners during the COVID-19 period was also observed. Adjusted for significant socio-demographic variables, results from logistic regression analyses revealed that perceived severity of COVID-19 (aOR = 0.72, 95% CI = 0.58, 0.88), COVID-19 risk reduction behaviors in general (aOR = 0.68, 95% CI = 0.48, 0.96), COVID-19 risk reduction behaviors during sex encounters (aOR = 0.45, 95% CI = 0.30, 0.66), condom negotiation (aOR = 0.61, 95% CI = 0.44, 0.86), and collective efficacy (aOR = 0.79, 95% CI = 0.64, 0.98) were protective factors of condomless anal intercourse with any type of sex partners during the COVID-19 period.

CONCLUSION

The COVID-19 control measures have caused a dramatic impact on the sexual behavior of MSM in Hong Kong. Interventions that promote condom use during the COVID-19 pandemic are still needed and such interventions could emphasize prevention of both COVID-19 and HIV.

The Vicious Cycle between Loneliness and Problematic Smartphone Use among Adolescents: A Random Intercept Cross-Lagged Panel Model

Despite extensive research on the psychological impacts of digital technology, the nuanced dynamics between adolescent loneliness and problematic smartphone use, particularly across different educational levels and genders, remain underexplored. This study aims to fill this gap by employing a Random Intercept Cross-Lagged Panel Model to dissect the bidirectional relationship between loneliness and problematic smartphone use among adolescents, with a focus on the moderating roles of educational levels and gender. Engaging 3132 students from various educational institutions in China, the research conducted a three-wave longitudinal analysis across 2022-2023. The final number of participants included 1120 adolescents (53.5% female; age in 2022: M = 14.57 years, SD = 1.57). Results reveal that loneliness significantly predicts problematic smartphone use, but not vice versa, highlighting a unidirectional influence. The study uncovers crucial differences across educational levels and gender, emphasizing the stronger effect of loneliness on problematic smartphone use among junior high students and female adolescents. These findings underscore the complexity of adolescent loneliness and its relationship with digital behavior, suggesting a need for tailored interventions considering both gender and developmental stages.

Negative emotions mediate the association between the topology of the complex brain network and smartphone use disorder: A resting-state EEG study

Background

Increasing research has examined the factors related to smartphone use disorder. However, limited research has explored its neural basis.

Aims

We aimed to examine the relationship between the topology of the resting-state electroencephalography (rs-EEG) brain network and smartphone use disorder using minimum spanning tree analysis. Furthermore, we examined how negative emotions mediate this relationship.

Methods

This study included 113 young, healthy adults (mean age = 20.87 years, 46.9% males).

Results

The results showed that the alpha- and delta-band kappas and delta-band leaf fraction were positively correlated with smartphone use disorder. In contrast, the alpha-band diameter was negatively correlated with smartphone use disorder. Negative emotions fully mediated the relationship between alpha-band kappa and alpha-band diameter and smartphone use disorder. Furthermore, negative emotions partially mediated the relationship between delta-band kappa and smartphone use disorder. The findings suggest that excessive scale-free alpha- and delta-band brain networks contribute to the emergence of smartphone use disorder. In addition, the findings also demonstrate that negative emotions and smartphone use disorder share the same neural basis. Negative emotions play a mediating role in the association between topological deviations and smartphone use disorder.

Discussion

To the best of our knowledge, this is the first study to examine the neural basis of smartphone use disorder from the perspective of the topology of the rs-EEG brain network. Therefore, neuromodulation may be a potential intervention for smartphone use disorder.

Effectiveness of a WHO self-help psychological intervention to alleviate stress among healthcare workers in the context of COVID-19 in China: a randomised controlled trial

AIMS

To examine the effectiveness of Self-Help Plus (SH+) as an intervention for alleviating stress levels and mental health problems among healthcare workers.

METHODS

This was a prospective, two-arm, unblinded, parallel-designed randomised controlled trial. Participants were recruited at all levels of medical facilities within all municipal districts of Guangzhou. Eligible participants were adult healthcare workers experiencing psychological stress (10-item Perceived Stress Scale scores of ≥15) but without serious mental health problems or active suicidal ideation. A self-help psychological intervention developed by the World Health Organization in alleviating psychological stress and preventing the development of mental health problems. The primary outcome was psychological stress, assessed at the 3-month follow-up. Secondary outcomes were depression symptoms, anxiety symptoms, insomnia, positive affect (PA) and self-kindness assessed at the 3-month follow-up.

RESULTS

Between November 2021 and April 2022, 270 participants were enrolled and randomly assigned to either SH+ (n = 135) or the control group (n = 135). The SH+ group had significantly lower stress at the 3-month follow-up (b = -1.23, 95% CI = -2.36, -0.10, p = 0.033) compared to the control group. The interaction effect indicated that the intervention effect in reducing stress differed over time (b = -0.89, 95% CI = -1.50, -0.27, p = 0.005). Analysis of the secondary outcomes suggested that SH+ led to statistically significant improvements in most of the secondary outcomes, including depression, insomnia, PA and self-kindness.

CONCLUSIONS

This is the first known randomised controlled trial ever conducted to improve stress and mental health problems among healthcare workers experiencing psychological stress in a low-resource setting. SH+ was found to be an effective strategy for alleviating psychological stress and reducing symptoms of common mental problems. SH+ has the potential to be scaled-up as a public health strategy to reduce the burden of mental health problems in healthcare workers exposed to high levels of stress.

School climate and school identification as determinants of smoking conventional cigarettes or vaping among adolescents in China: Stress-coping mediation mechanisms

INTRODUCTION

Smoking conventional cigarettes or vaping (SV) poses significant health threats to adolescents. School climate and school identification are key elements of the school environment and potential factors of SV. Based on the Stress Coping Theory, the mediations between school climate/school identification and SV, via perceived stress/active coping, were examined.

METHODS

A cross-sectional survey was conducted among secondary school students from February to March 2022 in Taizhou, China. Structural equation modeling was used.

RESULTS

The prevalence of SV among the 7526 participants was 4.7% (singular use of conventional cigarettes: 3.2%; singular use of electronic cigarettes: 3.6%; dual use: 2.1%). School climate, school identification, and active coping were positively, and perceived stress (family stress, academic stress, and peer-related stress) were negatively associated with SV. The association between school climate and SV was fully mediated via: 1) school climate → perceived stress → SV; 2) school climate → active coping → SV; and 3) school climate → perceived stress → active coping → SV. The effect sizes were 52.1%, 43.8%, and 6.3%, respectively. Similar partial mediation mechanisms were found between school identification and SV, with relatively small effect sizes (<10%).

CONCLUSIONS

This study observed the prevalence of SV among Chinese secondary school students. School climate and school identification had both significant direct and indirect (via perceived stress/active coping) effects on SV. Positive school environments may reduce students' stress and promote active coping. The stress coping mechanisms explained the association between school climate and SV better than between school identification and SV.

Very tall female young adults tended to be smokers: A large-scale exploratory cross-sectional survey of 26,405 college students in China

OBJECTIVE

This study investigated the sex-specific prevalence of smoking (past 30 days) and the associations with height among university/college students.

PARTICIPANTS

25,405 (11,579/14,826 males/females) college students in Xi'an China.

METHODS

A cross-sectional, self-administered survey.

RESULTS

The male and female prevalence of smoking (past 30 days) was 32.9% and 7.4%, respectively. The prevalence of smoking of the male height groups ranged from 29.8% to 36.9%; only the ≥188 cm height group showed significantly higher prevalence than the reference group (i.e., 173-177cm; 33.0%). The female prevalence of smoking was 4.0-8.2% in the ≤170cm groups and increased to 12.3% in the 171-175 cm group and 36.1% in the ≥176 cm group, while it was 6.5% for the reference group (161-165 cm).

CONCLUSIONS

This exploratory study firstly revealed the significantly higher prevalence of smoking among the "tallest" height groups, especially among females. Future studies are warranted to confirm such findings and explore related mechanisms.

Level and factors of support for the Living with the Virus policy in a Chinese adult general population: a mediation analysis via positive and negative attitudes toward the policy

Background

This study investigated the public's support for the Living with the Virus (LWV) policy, its associated factors, and related mediations at a time when more countries were considering adopting the LWV policy amid the COVID-19 pandemic.

Methods

A random, population-based telephone survey was conducted among 500 Chinese adults in Hong Kong during March/April 2022.

Results

39.6% of the participants were supportive/strongly supportive of the LWV policy. Perceived efficacy of the control measures was negatively associated with the support and was partially mediated via the perception that the policy would greatly improve the economy/daily life of the policy. Perceived physical harms of the Omicron variant was negatively associated with the support and was fully mediated via perceived negative impacts of the policy. 26.2%/54.6% believed that the policy would improve the economy/daily life greatly; about 40% perceived negative impacts on deaths and the medical system due to the policy. COVID-19 ever infection did not significantly moderate the studied associations.

Conclusion

The public was split regarding the support for the LWV policy and whether it would cause better economy/daily life, unnecessary deaths, and the collapse of the medical system. Health communication is needed in shifting toward the LWV policy.

The intention to get COVID-19 booster vaccination and its association with cognitive and emotional factors: A survey of Chinese COVID-19 infected people in Hong Kong

BACKGROUND

Although the pandemic has ended officially, COVID-19 remains impactful. Booster COVID-19 vaccination is still needed to protect individuals against COVID-19 and the disease's harmful consequences. This study investigated the prevalence of the intention to get booster COVID-19 vaccination after receiving the COVID-19 diagnosis and its associated factors among people reporting prior COVID-19.

METHODS

A population-based anonymous telephone survey was conducted in Hong Kong, China from June to August 2022 among Chinese people reporting prior COVID-1 between February and August 2022 and having taken up ≥2 doses of COVID-19 vaccines prior to COVID-19 diagnosis.

RESULTS

The prevalence of the intention to get booster vaccination was 59.2 %. Older age (>60 years), being currently married, not employed full-time, and having chronic diseases were positively associated with the intention to get booster vaccination. Adjusted for the background factors, higher levels of the cognitive factors of perceived susceptibility to COVID-19, perceived acquired moderate-to-strong immunity against COVID-19, and perceived adequate knowledge of COVID-19 were positively associated with the intention to get booster vaccination; stronger perceived severity of prior infection despite vaccination was negatively associated with the intention outcome. In contrast, stronger mental distress due to COVID-19, illness concern, and emotional representation were positively associated with the intention. Self-perceived long COVID status was not a significant factor.

DISCUSSION

The prevalence of the intention to get booster COVID-19 vaccination was limited, especially among younger people reporting prior COVID-19. Health promotion is still required among people reporting prior COVID-19 and may emphasize the significant cognitive factors positively associated with the intention. Future studies are needed to confirm the findings, clarify the role of emotional factors on booster vaccination, and explore other factors of the intention to get booster vaccination among people reporting prior COVID-19.

Illness representation of COVID-19 affected public's support and anticipated panic regarding the living with the virus policy: a cross-sectional study in a Chinese general population

Background

There is a global trend for countries to adopt the Living with the Virus (LWV) policy regarding COVID-19. Little is known about the public's supportiveness and emotional responses (e.g., anticipated panic) related to this policy. Such responses may be associated with illness representations of COVID-19 (i.e., how people think and feel about COVID-19). This novel topic was investigated in this study to facilitate policy-making and health communication.

Methods

A random, population-based telephone survey interviewed 500 adults aged ≥18 of the Hong Kong general adult population from March to April 2022.

Results

The prevalence of the public's support and anticipated panic regarding the LWV policy, which were negatively correlated with each other, was 39.6 and 24.2%, respectively. The illness representation constructs of consequences, timeline, identity, illness concern, and emotional representations were negatively associated with supportiveness and positively associated with anticipated panic regarding the LWV policy. Illness coherence was significantly associated with policy support but not with anticipated panic. The associations between personal control/treatment control and supportiveness/anticipated panic were statistically non-significant. Moderation analyses showed that the above significant associations were invariant between those with and without previous COVID-19 infection.

Conclusion

Policymakers need to be sensitized about the public's supportive/unsupportive attitude and potential worry (panic) when adopting the LWV policy. Such attitudes/emotional responses may be affected by people's illness representations of COVID-19. In general, those who found COVID-19 involving a milder nature and less negative emotions would be more supportive and anticipated less panic under the LWV policy.

Development and validation of the resource loss due to reduction in gaming time scale among adolescent internet gamers in China

BACKGROUND

Adolescent internet gaming disorder (IGD) is prevalent and positively associated with gaming time, a reduction of which is a common means of IGD prevention/treatment. Personal/interpersonal resource losses due to the reduction in gaming time (RL-RGT) are plausible. According to the Conservation of Resource (COR) theory, RL-RGT may cause mental distress and maladaptive behaviors. No study has investigated such relationships, partially due to the lack of validated tools assessing RL-RGT. This study aimed to develop and validate such a scale (RL-RGTS).

METHODS

A cross-sectional survey was conducted in four secondary schools in Guangzhou, China (October to December 2019). Secondary school students who had played internet games in the last 12 months participated in this study (n = 944), irrespective of their IGD status and intention to reduce gaming time. Using a deductive approach, an expert panel generated the 19 scale items. The half-split method was used to conduct exploratory and confirmatory factor analyses.

RESULTS

The prevalence of IGD and intention to reduce gaming time were 10.9% and 74.2%, respectively. The exploratory and confirmatory factor analyses identified a 2-factor model (personal loss and interpersonal loss). Psychometric properties (internal consistency, no ceiling effect, and concurrent validity) were satisfactory, but noticeable floor effects were observed.

CONCLUSIONS

The RL-RGTS could be applied to understand potential side effects and obstacles regarding interventions reducing IGD through reducing gaming time. The findings support the COR theory and extend its applications to internet gaming research. Validations in other populations are warranted.

Levels and Determinants of COVID-19 Vaccination at a Later Phase among Chinese Older People Aged 60 Years or Older: A Population-Based Survey

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February-July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February-July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021-January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic.

The mediating role of resilience on the association between family satisfaction and lower levels of depression and anxiety among Chinese adolescents

PURPOSE

This study aimed to explore the association between family satisfaction, resilience, and anxiety and depression among adolescents, and the mediating role of resilience in these relationships.

METHODS

A cross-sectional study was conducted among grade 8 to 9 students from 4 secondary schools in Hong Kong. A total of 1,146 participants completed the survey.

RESULTS

Respectively 45.8% and 58.0% of students scored above the cut-off for mild anxiety and mild depression. Results from linear regression analyses showed that family satisfaction was positively associated with resilience, and both family satisfaction and resilience were and negatively associated with anxiety and depression. The mediating effects of resilience on the relationship between family satisfaction and anxiety/ depression (26.3% and 31.1% effects accounted for, respectively) were significant.

CONCLUSIONS

Both family satisfaction and resilience have important influence on adolescent mental health. Interventions that seek to promote positive family relationships and resilience of adolescents may be effective in preventing and reducing anxiety and depression symptoms among adolescents.

Prospective relationships between college adjustment, self-esteem, and mental health status among Chinese undergraduates

Objective: This three-wave longitudinal study tested the prospective relationships between college adjustment, self-esteem, and mental health status (ie, subjective well-being, anxiety, and depression). Participants: The study recruited 265 Chinese undergraduate students. Methods: Demographic, college adjustment, self-esteem, and mental health status data were collected. Results: College adjustment and self-esteem were moderate in magnitude and maintained a reasonable stability over time. College adjustment and self-esteem at Year 1 and Year 2, and mental health status at Year 3, were significantly correlated with each other. College adjustment at Year 1 and Year 2, and self-esteem at Year 1 significantly predicted mental health status at Year 3. Conclusions: Interventions to improve self-esteem and college adjustment may benefit long-term mental health outcomes.

Reduction in COVID-19 related resource loss and decline in prevalence of probable depression in Chinese adults: an application of the Conservation of Resource Theory

BACKGROUND

The levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses.

METHODS

Two serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively.

RESULTS

The prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen's d = 0.88), future control (Cohen's d = 0.39), social resource (Cohen's d = 0.60), and family resource (Cohen's d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (β = - 0.46), which in turn was positively associated with probable depression (β = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (β = - 0.08), indicating a full mediation effect of resource losses.

CONCLUSIONS

The lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals' COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting.

Validation of the Revised Illness Perception Questionnaire of Obstructive Sleep Apnea among Elderly Chinese in the General Population

PURPOSE

The prevalence of under-diagnosis among individuals with obstructive sleep apnea (OSA) is alarming, and may be associated with perceptions regarding OSA. To facilitate future studies on OSA, this study validated the revised version of the Illness Perception Questionnaire (IPQ-R) for OSA in a general population.

METHODS

A random anonymous population-based telephone survey interviewed 580 adults aged ≥ 50 years in Hong Kong, who self-reported not having been told by doctors as having OSA, from February 5 to March 19, 2021.

RESULTS

The confirmatory factor analysis identified a modified 7-factor model (i.e., timeline chronic, consequence, personal control, treatment control, illness coherence, timeline cyclical, and emotional representation) that showed satisfactory model fit index and internal consistency. Nine items were removed from the original version because of low factor loadings. No floor and ceiling effects were observed. Convergent validity was supported by the positive associations between the consequence subscale with perceived negative outcomes of OSA and between the illness coherence subscale and perceived understanding of OSA symptoms. The participants tended to endorse the items of timeline chronic, treatment control, and illness coherence but not with those of emotional representations. The mean scores of the IPQ-R subscales differed by age and education level.

CONCLUSION

The modified IPQ-R of OSA showed acceptable psychometric properties. It is applicable to assessing illness perceptions of OSA in the Chinese general population aged ≥ 50 years not having received OSA diagnosis. The validated tool would support future studies and health practices related to OSA.

Time to Lift up COVID-19 Restrictions? Public Support towards Living with the Virus Policy and Associated Factors among Hong Kong General Public

The fifth wave of the COVID-19 pandemic has caused an unprecedented toll on Hong Kong. As more countries are starting to lift COVID-19 restrictions, it would be important to understand the public attitudes towards lifting COVID-19 restrictions and to identify its associated factors. The present study examined the level of support towards the living with the virus (LWV) policy for COVID-19 among the public in Hong Kong and to identify the associations between resilient coping, self-efficacy and emotional distress with support towards the LWV policy. A random population-based telephone survey was conducted among 500 Hong Kong Chinese adults from 7 March to 19 April 2022, i.e., during the fifth wave of COVID-19 outbreak. Of the respondents, 39.6% showed a supportive attitude towards the LWV policy. Results from the structural equational modeling showed a positive correlation between resilient coping and self-efficacy. Resilient coping was associated with support towards the LWV policy directly and indirectly through a lower level of emotional distress. Self-efficacy had a direct association with support towards the LWV policy but its indirect association through emotional distress was not significant. Interventions that foster resilient coping and self-efficacy would be effective in reducing public emotional distress and promoting their positive view towards the LWV policy.

Using the common-sense model to explicate the role of illness representation in self-care behaviours and anxiety symptoms among patients with Type 2 diabetes

OBJECTIVES

Based on the common-sense model of self-regulation, this study aimed to explicate the mechanism underlying the effect of illness representations on self-care behaviours and anxiety symptoms among patients with type 2 diabetes.

METHODS

A telephone survey was administered to 473 patients in Hong Kong. Structural equation modelling was used to test if threat and control perceptions regarding diabetes would be associated with self-reported self-care behaviours and anxiety symptoms through adoption of adaptive/maladaptive coping strategies and diabetes-related self-efficacy.

RESULTS

Control perceptions but not threat perceptions were positively associated with self-care behaviours. Control perceptions had a positive indirect association with self-care behaviours through more problem-focused coping and diabetes-related self-efficacy. Threat perceptions simultaneously had a positive indirect association through more problem-focused coping and a negative indirect association through more avoidant coping and lower diabetes-related self-efficacy. In contrast, threat and control perceptions were positively and negatively, respectively, associated with anxiety symptoms. Problem-focused and avoidant coping consistently mediated the indirect association between threat perceptions and anxiety symptoms.

CONCLUSION

Threat and control perceptions were associated with diabetes self-care behaviours and anxiety symptoms through different self-regulation pathways.

PRACTICE IMPLICATIONS

Our findings inform possible targets for self-management interventions to simultaneously enhance self-care behaviours and alleviate diabetes-associated anxiety.

Validation of the Internet Gaming Disorder Symptoms Checklist Based on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders in Chinese Adolescents

This study aims to develop and validate a checklist for IGD symptoms of Chinese adolescents based on the fifth edition of the diagnostic and statistical manual of mental disorders (DISCA). We recruited 2144 secondary school students who reported that they had played Internet games in the past 12 months in two large cities of China. The 9 item of DISCA were all significantly and positively correlated and the scale reliability was satisfactory. The unidimensional structure of the scale was confirmed by Confirmatory Factor Analysis (CFA), χ²/df = 246.18/27, CFI = .95, RMSEA = .06. Measurement invariance across gender and city groups was confirmed by Multiple-group CFA. Criterion validity was demonstrated by the significant positive associations between DISCA score and self-identified IGD, loss of control regarding time spent on Internet gaming, time spent on playing Internet games, depression, and suicidal ideation. DISCA is a brief, reliable, and validated assessment to measure adolescent IGD.

The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study

BACKGROUND

The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM.

OBJECTIVE

This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored.

METHODS

With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted.

RESULTS

The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD.

CONCLUSIONS

IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD.

Development and Validation of the Outcome Expectancy Scale for COVID-19 Vaccination in the Adult General Population

Promotion of COVID-19 vaccination requires understanding its determinants, an important one of which is outcome expectancy. However, reliable and valid measurement tools are absent. This study thus developed and validated an Outcome Expectancy Scale for COVID-19 Vaccination (OES-COVID-19). An inductive approach was used for scale development; content validity of the items was then assessed by an independent evaluation expert panel. Iteratively, 17 scale items were created and validated in a population-based telephone survey conducted among 500 adults of the general population in Hong Kong, China, from August to September 2021. Using half of the sample (n = 249), exploratory factor analyses identified four factors of the OES-COVID-19, including (a) positive contribution to society, (b) functional benefits, (c) protective effect, and (d) negative impacts. Confirmatory factor analysis of these factors conducted on the second subsample (n = 251) was satisfactory. The OES-COVID-19 showed good psychometric properties in terms of internal consistency, absence of floor/ceiling effects, and concurrent validity. The newly created and validated OES-COVID-19 is deemed suitable for application. It may advance future studies related to COVID-19 vaccination behavior and intention, and potentially allows for comparisons across studies. Further validation with modifications across countries, populations, and phase of the pandemic are warranted.

Psychometric Properties of the Abbreviated Version of the Dual School Climate and School Identification Measure-Student (SCASIM-St15) among Adolescents in China

School climate and school identification are two distinct yet closely interrelated components of school environment; both are associated with adolescents' multiple health behavioral changes. The 15-item Abbreviated version of the Dual School Climate and School Identification Measure-Student (SCASIM-St15) and its 5-factor model simultaneously and separately assess these two constructs. This study validated the Chinese version of SCASIM-St15 among 1108 students from junior middle schools, senior middle schools, and vocational high schools in Taizhou city, Zhejiang, China, via an anonymous, self-administered cross-sectional survey. Confirmatory factor analysis supports the 5-factor model of the original SCASIM-St15 with a satisfactory model fit. Its four factors (i.e., student-student relations, staff-student relations, academic emphasis, and shared values and approach) assess school climate; its fifth factor assesses school identification. The subscales of the SCASIM-St15 demonstrate good psychometric properties, including measurement invariance (across sex and school type), good internal consistency, an absence of floor effect, and good external validity with four external variables (depression, peer victimization, classmate support, and teacher-student relationship). However, some substantial ceiling effects were observed. The five subscales differ significantly across the school types but not between males and females. The validated SCASIM-St15 can be applied to simultaneously understand school climate/school identification among Chinese adolescents, which may greatly facilitate future related observational and intervention research.

Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population

This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.

Positive Affect Moderates the Influence of Perceived Stress on the Mental Health of Healthcare Workers during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has posed a profound psychological impact on healthcare workers. However, the role of positive affect in moderating the effect of perceived stress on the psychological states of healthcare workers remains unknown. This study aimed to analyze the moderating effect of positive affect on the association between stress and the mental health of healthcare workers during the COVID-19 pandemic. This cross-sectional study evaluated the relationships between perceived stress (the Perceived Stress Scale), positive affect (the Positive and Negative Affect Schedule), depression (the Patient Health Questionnaire-9), and anxiety (the Generalized Anxiety Disorder 7-item Scale) during the COVID-19 pandemic in 644 Chinese healthcare workers who completed online self-reports. The results revealed a significant negative association between positive affect and psychological problems, including stress, depression, and anxiety. At the total group level, multiple regression analysis showed that positive affect alleviated the influence of perceived stress on depression, but no significant moderating effect was found for anxiety. In the subgroups divided by perceived stress, the moderating effect of positive affect on depression was only significant in healthcare workers with a high level of perceived stress. These results suggested that positive affect played a moderative role in alleviating the effect of stress on depression among healthcare workers, particularly those with a high level of stress, thus emphasizing the importance of positive affect as an intervention strategy for promoting the mental health of healthcare workers in the context of the ongoing COVID-19 pandemic.

A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the 'COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context

BACKGROUND

While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5).

METHODS

We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake.

DISCUSSION

Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.

Understanding the Pathways from Mindfulness to COVID-19 Vaccination Intention via Positive Psychology Attributes among Health Care Workers in China

OBJECTIVE

The present study aims to examine the association between mindfulness and COVID-19 vaccination intention, and the mediating role of presence of meaning in life and moral elevation in such association.

METHOD

In a cross-sectional study design, a total of 1733 health care workers (81.1% females, M_age = 34.16 ± 9.03) from four cities in China were recruited and completed an online survey that measured mindfulness, moral elevation, presence of meaning in life and COVID-19 vaccination intention.

RESULTS

It has been found that 73.1% of the participants reported an intention to receive COVID-19 vaccination. Mindfulness was positively associated with COVID-19 vaccination intention; Mediation analyses using structural equation modeling showed a significant indirect effect of mindfulness on COVID-19 vaccination intention, accounting for 42.4% of the total effect. Mindfulness was positively associated with COVID-19 vaccination intention directly via presence of meaning in life, and indirectly via moral elevation and presence of meaning in life.

CONCLUSIONS

The findings add knowledge of how mindfulness may increase COVID-19 vaccination intention, and underscore the potential need for mindfulness training, positive emotion promotion, presence of meaning in life interventions to improve acceptance of COVID-19 vaccination among health care workers.

Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function

The present study examined the prevalence and pattern of comorbidity among Chinese patients with first-ever acute ischemic stroke, and assessed the associations of specific comorbidity patterns with physical and cognitive functioning after stroke occurrence. A hospital-based cross-sectional study was conducted among 2,151 patients with first-ever ischemic stroke (age ≥40 years; 64.2% men) who were admitted to two university hospitals in Shandong, China between 2016 and 2017. Data on demographics, lifestyles, chronic health conditions, and use of medications were collected through in-person interviews, clinical examinations, and laboratory tests. Physical functioning was assessed by the Barthel index (BI) and the modified Rankin Scale (mRS) while cognitive functioning was assessed by the Montreal Cognitive Assessment test. The results showed that comorbidity was present in 90.9% of the stroke patients (women vs. men: 95.2 vs. 88.7%, P &lt; 0.001). Exploratory factor analysis identified three patterns of comorbidity, i.e., patterns of degenerative-cardiopulmonary, heart-gastrointestinal-psychiatric, and metabolic-kidney diseases. The number of comorbidities was significantly associated with a higher likelihood of moderate-to-severe physical dependence [odds ratio (95% CI) = 1.15 (1.06–1.25) for BI and 1.12 (1.04–1.21) for mRS, all P &lt; 0.01] and cognitive impairment [odds ratio (95% CI) = 1.11 (1.02–1.20), P = 0.017], after adjusting for multiple covariates. Almost all the three comorbidity patterns were associated with increased likelihoods of physical dependence (range for odds ratios: 1.26–1.33) and cognitive impairment (range for odds ratios: 1.25–1.34). No significant association was found between degenerative-cardiopulmonary pattern and mRS. These findings suggest that comorbidity is associated with poor physical and cognitive functioning during the acute phase of ischemic stroke. Routine assessments of comorbidity and cognitive and physical function among patients with acute ischemic stroke should be considered in stroke research and clinical practice.

Mental health service utilisation among transgender women sex workers who are at risk of mental health problems in Shenyang, China: An application of minority stress theory

Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut-off for probable depression or probable anxiety or had suicidal ideation (N = 126); subsample 2: perceived needs for mental health services (N = 109)]. A cross-sectional survey was conducted among TGSW in Shenyang, China during 2017-2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non-affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations.

Would Illness Representations of COVID-19 and COVID-19 Fears During Clinic Visits Promote or Reduce Behavioral Intention to Seek Medical Consultations for Flu Symptoms? A Random Telephone Survey in Hong Kong, China

Background

The study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population.

Methods

A random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed.

Results

Of the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS.

Conclusions

Promotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.

Uptake of an app-based case management service for HIV-positive men who have sex with men in China: a process evaluation study (Preprint)

BACKGROUND

Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model.

OBJECTIVE

We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework.

METHODS

Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders.

RESULTS

A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as "very helpful" or "helpful." The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (β=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group.

CONCLUSIONS

The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence.

TRIAL REGISTRATION

Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-020-8171-5.

Resilience and intention of healthcare workers in China to receive a COVID-19 vaccination: The mediating role of life satisfaction and stigma

Aims

The present study investigated the association between resilience, stigma, life satisfaction and the intention to receive a COVID‐19 vaccination among Chinese HCWs. It also explored the mediating role of stigma and life satisfaction on the association between resilience and intention to receive a COVID‐19 vaccination.

Design

An anonymous cross‐sectional survey.

Methods

1733 HCWs from five hospitals in four provinces of mainland China completed a cross‐sectional online survey in October and November 2020.

Results

Among the HCWs, the rate of intention to receive a COVID‐19 vaccination was 73.1%. Results from structural equation modelling showed that resilience was associated both directly, and indirectly with greater intent to receive a COVID‐19 vaccination through two pathways: first by increasing life satisfaction, and second by reducing stigma and increasing life satisfaction.

Conclusion

Promoting the resilience of HCWs has the potential to increase the COVID‐19 vaccination uptake rate among HCWs in China.

Impact

This study tested the relationship between several psychological factors and the COVID‐19 vaccination intention of HCWs in China, finding that resilience played a significant role in improving COVID‐19 vaccination intention rates by reducing stigma and increasing life satisfaction.

Work-related factors on mental health among migrant factory workers in china: Application of the Demand-Control and Effort-Reward Imbalance Model

Mental health problems are prevalent among migrant workers in China. The present study examined the prevalence of mental health problems (depression, anxiety and suicidal ideation) among migrant workers in China, and identified the work-related factors associated with their mental health problems based on the Demand-Control and Effort-Reward Imbalance Model. A total of 807 migrant workers were recruited from three factories in Shenzhen using stratified randomized sampling. The prevalence of moderate-to-severe anxiety, mild-to-severe depression and suicidal ideation in the past year was 17.8%, 60.3% and 4.8% respectively. Results from stepwise regression analyses reported that role conflict and effort were risk factors, whereas utilization of job skills and reward were protective factors for anxiety and depression. Social support was also associated with lower level of depression. Effort was the only factor associated with suicidal ideation in the stepwise analysis. Interventions to improve their mental health are warranted and they should work to reduce their role conflict, improve effort-reward balance, promote utilization of skills and increase social support.

Association between relationship adaptation and Internet gaming disorder among first-year secondary school students in China: Mediation effects via social support and loneliness

Adolescents encounter numerous challenges and need to restructure their social relationships when they enter secondary schools. Relationship adaptation is critical and failure in adaptation may be associated with Internet gaming disorder (IGD). This novel study investigated the association between relationship adaptation and IGD and related mediation mechanisms via social support and loneliness among first-year secondary school students in Shanghai and Xi'an, China in 2018. Of 2573 participants, the prevalence of IGD was 13.1%. Relationship adaptation, social support, and loneliness were all significantly associated with IGD. The association between relationship adaptation and IGD was fully mediated by three indirect paths, including relationship adaptation → social support → IGD (effect size = 35.5%), relationship adaptation → loneliness → IGD (effect size = 34.3%), and relationship adaptation → social support → loneliness → IGD (effect size = 6.1%). In conclusion, the observed high prevalence of IGD among first-year secondary school students in China was associated with poor relationship adaptation. The full mediation effects via social support and loneliness suggest that modification of these two psychosocial attributes may effectively reduce the harmful impacts of poor relationship adaptation on adolescent IGD. Future longitudinal studies are warranted to confirm the findings.

Potential joint effects of perceptions related to COVID-19 and future social development on depressive symptoms: a Chinese population-based study

BACKGROUND

The COVID-19 pandemic has caused significant negative socio-political, economic, and psychological consequences.

AIMS

To investigate the impact of individual-level (illness representations of COVID-19) and structurally derived (anticipated social-political development in the economy, security, and social harmony in the next year) factors, and their potential moderation effects on depressive symptoms.

METHODS

An anonymous population-based telephone survey was conducted among the general public of Hong Kong, China during 3-10 April 2020 (n = 300, response rate 56%). Depressive symptoms were assessed by the validated Chinese version of the Patient Health Questionnaire-9.

RESULTS

Of the participants, 8.7% showed probable moderate-to-severe depression. Hierarchical linear regression models showed that illness representations of personal/treatment control and emotional responses and anticipated deterioration in social harmony were independently and significantly associated with depressive symptoms. Anticipated deterioration in security significantly moderated the associations between perceived consequence/treatment control of COVID-19 and depressive symptoms, such that the associations were stronger among people who anticipated a strong deterioration in security.

CONCLUSIONS

The findings suggested that perceptions of COVID-19 and future social-political development jointly and interactively contributed to depressive symptoms during the COVID-19 pandemic. Mental health professionals and promotions should take the multiple-level mental health determinants into account.

Working from home and positive/negative experiences due to social distancing as interacting factors of depressive symptoms during the COVID-19 pandemic in a Chinese general population

PURPOSE

This study investigated the associations between some factors related to working from home status (WFHS) and positive/negative experiences due to social distancing and their interactions effects on depressive symptoms during the COVID-19 pandemic.

METHODS

A random population-based telephone survey interviewed income-earning adults in the Hong Kong general population during April 21-28, 2020 (n = 200).

RESULTS

Mild to severe depression (according to PHQ-9) was reported by 12% of the participants. The prevalence of WFHS categories was 14% for 3-7 days and 13% for ≥ 8 days (past 2 weeks). The multivariable regression analysis showed that, social isolation (β = 0.36; p < 0.001), relaxation feeling in daily life (β = - 0.22; p = 0.002), and WFHS ≥ 8 days (β = 0.15; p = 0.027), but not perceived huge inconvenience and improved family relationship, were associated with depressive symptoms. Statistically significant interaction effects were found. Some positive experiences buffered the potential harms of some negative experiences of social distancing on depressive symptoms; WFHS ≥ 8 days significantly moderated the risk/protective effects of social isolation, improved family relationship, and relaxation feeling on depressive symptoms.

CONCLUSIONS

Social distancing is double-edged. Positive experiences should be maximized while negative experiences be minimized, as both were directly and interactively associated with depression. Intensive but not mild to moderate (< 80%) WFHS may impact depressive symptoms negatively via its direct association with depression; it also moderated the associations between positive/negative experiences due to social distancing and depression. Further research is required to discern the inter-relationships among WFHS, positive/negative experiences of social distancing, and depression to better cope with the stressful pandemic.

Levels and factors derived from the Health Action Process Approach of behavioral intentions to take up COVID-19 vaccination: A random population-based study

Objectives

COVID-19 vaccination needs a high population coverage to achieve herd immunity. We investigated prevalence of three scenarios of intention of free COVID-19 vaccination involving: 1) 80% effectiveness and rare and mild side effects (Scenario 1), 2) 50% effectiveness and rare and mild side effect RMSE (Scenario 2), and 3) immediate vaccination (Scenario 3), and their associated factors derived from the pre-intentional motivational phase of the Health Action Process Approach (HAPA).

Methods

A random population-based telephone survey interviewed 450 Chinese adults in the general population (September 16–30, 2020). The four HAPA constructs included a) risk perception scale, b) overall scale/four subscales of positive outcome expectancy of COVID-19 vaccination, c) overall scale/three subscales of negative outcome expectancy of COVID-19 vaccination, and d) the overall scale/two subscales of self-efficacy of COVID-19 vaccination.

Results

The prevalence of intention of COVID-19 vaccination under Scenarios 1 to 3 was 38.0%, 11.1%, and 13.1%, respectively. Logistic regression analyses adjusted for background factors showed that 1) the associations between risk perception and the three scenarios of intention were non-significant; 2) the overall scale/four subscales of positive outcome expectancy were in general positively associated with two scenarios of intention (80% effectiveness and immediate vaccination); 3) the overall scale/three subscales of negative outcome expectancy were in general negatively associated with all three scenarios of intention; 4) the overall scale/two subscales of self-efficacy were only positively associated with the intention that involved 80% effectiveness. When all the four overall scales were entered into an adjusted model, positive and negative outcome expectancy, but not risk perception and self-efficacy, were independently associated with the three scenarios.

Conclusions

In this study population, the prevalence of intention of COVID-19 vaccination was very low and might not result in population protection. Health promotion should modify outcome expectancies to increase intention of COVID-19 vaccination.

Dualistic Determinants of COVID-19 Vaccination Intention among University Students in China: From Perceived Personal Benefits to External Reasons of Perceived Social Benefits, Collectivism, and National Pride

Vaccination is one of the most effective ways of controlling the COVID-19 pandemic. However, vaccine hesitancy is prevalent, and relatively few studies have explored how variables related to personal and external motives have affected the intention to vaccinate. The present study investigated the association between perceived personal benefits, variables reflecting external motives (i.e., perceived social benefits, collectivism, and national pride) and intention to receive COVID-19 vaccination among university students in China. The interaction between perceived personal benefits and the three factors reflecting external motives on intention to receive COVID-19 vaccination was also examined. A total of 6922 university students from five provinces of China completed a cross-sectional survey. Results showed that adjusting for significant background variables, perceived personal benefits, perceived social benefits, collectivism, and national pride were all significant factors of intention to receive COVID-19 vaccination. Results from interaction analyses also showed that the association between perceived personal benefits and COVID-19 vaccination intention was stronger among those with lower levels of national pride. Findings highlighted the important role of self-directed interest and external motives in promoting uptake of COVID-19 vaccination.

Effectiveness of a Community-Based Organization-Private Clinic Service Model in Promoting Human Papillomavirus Vaccination among Chinese Men Who Have Sex with Men

This study evaluated the effectiveness of the community-based organization (CBO)-private clinic service model in increasing human papillomavirus (HPV) vaccination uptake among unvaccinated men who have sex with men (MSM) in Hong Kong during a 12-month follow-up period. A CBO-private clinic model was implemented to promote HPV vaccination among Chinese MSM. A CBO with good access to MSM approached MSM aged 18–45 years who had never received an HPV vaccination, invited them to receive an online health promotion, and referred them to receive HPV vaccination at gay-friendly private clinics. A baseline survey and a follow-up evaluation at Month 12 were conducted. A total of 350 participants completed the baseline survey. Among 274 participants who were followed up at Month 12, 46 (16.8%) had taken up at least one dose of HPV vaccination. After adjusting for significant baseline characteristics, the perceived susceptibility (AOR:1.25, p = 0.002) and perceived severity (AOR:1.21, p = 0.003) of HPV and HPV-related diseases, perceived benefits (AOR:1.16, p = 0.03), self-efficacy to receive HPV vaccination (AOR:1.37, p = 0.001), and behavioral intention to take up HPV vaccination at baseline (AOR:6.99, p < 0.001) significantly predicted HPV vaccination uptake. The process evaluation of the program was positive. The CBO-private clinic service model was helpful in increasing HPV vaccination uptake among MSM.

The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses

COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.

Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: a cross-sectional online survey

This study investigated parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese parents who are healthcare workers. A closed online survey among full-time doctors or nurses employed by the five collaborative hospitals who had access to smartphones was conducted. Facilitated by the hospital administrators, prospective participants received an invitation sent by the research team via the existing WeChat/QQ groups to complete an online questionnaire. A total of 2,281 participants completed the survey. This study was a sub-analysis of 1332 participants who had at least one child under the age of 18 years. Among the participants, 44.5% reported that they would likely or very likely to have their children under the age of 18 years take up COVID-19 vaccination in the next six months. After adjusting for significant background characteristics, perceived higher vaccine efficacy, longer protection duration, perceived high/very high chance for China to prevent another wave of COVID-19 outbreak with vaccines in place and willingness to receive a COVID-19 vaccination for themselves were associated with higher parental acceptability of COVID-19 vaccination. At interpersonal level, higher frequency of information exposure through social media and direct interpersonal communication were associated with higher parental acceptability of COVID-19 vaccination, while knowing some people who experienced serious side effects following COVID-19 vaccination were associated with lower parental acceptability of COVID-19 vaccination. Despite their important roles in vaccination promotion, Chinese doctors and nurses showed low parental acceptability of COVID-19 vaccination. Effective health promotion is needed when COVID-19 vaccination become available.

Roles of Psychosocial Factors on the Association Between Online Social Networking Use Intensity and Depressive Symptoms Among Adolescents: Prospective Cohort Study

BACKGROUND

The potential mechanisms underlying the association between online social networking use intensity and depressive symptoms are unclear and underresearched.

OBJECTIVE

We aimed to investigate the potential roles of interpersonal psychosocial factors on the association between online social networking use intensity and depressive symptoms among early adolescents.

METHODS

A total of 4237 adolescents from a 9-month longitudinal study were included. Score changes (indicated as △) for the social function use intensity (SFUI) and entertainment function use intensity (EFUI) subscales of the Online Social Networking Activity Intensity Scale and for friendship quality, perceived family support, perceived friend support, parent-adolescent conflict, social nonconfidence, and depressive symptoms were analyzed. The potential mediation effects of unfavorable psychosocial factors and suppression effects of favorable psychosocial factors on the association of △SFUI with △CES-D and the association of △EFUI with △CES-D were tested using hierarchical regression models.

RESULTS

The association between △SFUI and △CES-D was partially mediated by △mother-adolescent conflict (mediation effect size 5.11%, P=.02) and △social nonconfidence (mediation effect size 20.97%, P<.001) but partially suppressed by △friendship quality, △perceived family support, and △perceived friend support, with suppression effects of -0.011 (P=.003), -0.009 (P=.003), and -0.022 (P<.001), respectively. The association between △EFUI and △CES-D was partially mediated by △social nonconfidence (mediation effect size 30.65%, P<.001) but partially suppressed by △perceived family support and △perceived friend support, with suppression effects of -0.036 (P<.001) and -0.039 (P<.001), respectively.

CONCLUSIONS

The association between online social networking use intensity and depressive symptoms was partially mediated through the indirect increase in social nonconfidence and mother-adolescent conflict; however, better perceived social support and friendship quality would partially compensate for the harmful impact of online social networking use intensity on depressive symptoms among early adolescents.

Finding the silver linings in the COVID-19 pandemic: Psychosocial correlates of adversarial growth among Filipina domestic helpers in Hong Kong

OBJECTIVE

The coronavirus (COVID-19) pandemic has disrupted many people's life. Negative impacts of pandemic measures and economic hardship on psychological well-being are common among the global populations. In Hong Kong, the pandemic not only affects the local populations, but also the migrant Filipina domestic helpers (FDH). Despite the distress, evidence suggests that people still experience positive changes (aka adversarial growth) amid the COVID-19 pandemic. We expect the same applies to FDH in Hong Kong. Studies have shown that coping resources (e.g., resilience, social support, literacy of trauma-related information), cognitive appraisal, and coping strategies are associated with adversarial growth among individuals living with highly stressful events. Relevant studies for migrant populations in the COVID-19 context are limited. This study examined the psychosocial correlates of adversarial growth among FDH in Hong Kong.

METHOD

By convenient sampling, FDH (N = 266) recruited from public gathering venues were asked to complete a cross-sectional survey. Their COVID-19-related distress, work-related stress, COVID-19 information literacy, emotional and material support, resilience, cognitive appraisals (harm, threat, challenge), and coping strategies (religious coping, positive reframing, acceptance) were measured.

RESULTS

Controlled for covariates, hierarchical regression results showed that higher levels of resilience (β = .21), emotional support (β = .16), COVID-19-related information literacy (β = .15), and religious coping (β = .16) were associated with higher adversarial growth (ps < .05).

CONCLUSIONS

FDH in Hong Kong reported positive changes amid the COVID-19 pandemic. Based on our findings, facilitating those FDH's resilience, emotional support, COVID-19 information literacy, and religious coping might be important strategies to enhance their adversarial growth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and Factors of the Performed or Scheduled COVID-19 Vaccination in a Chinese Adult General Population in Hong Kong

BACKGROUND

Globally, COVID-19 vaccination programs have been rolled out. To inform health promotion, this study investigated the prevalence and associated factors of performance or being scheduled to perform at least one dose of COVID-19 vaccination (PSCV) in a Chinese adult general population.

METHODS

An anonymous, random telephone survey interviewed 500 adults aged 18-75 in Hong Kong, China from 14-27 May 2021.

RESULTS

The prevalence of PSCV was 21.0%, which was significantly lower among females and those aged ≤30. Positively associated factors of PSCV included perceived protection effect of vaccination, self-perceived physical fitness for vaccination, compulsory COVID-19 testing experience, perceived need to travel, general trust toward the government, and trust toward the governmental vaccination program, while negatively associated factors included perceived low efficacy of vaccination, concerns about side effects, and chronic disease status. Furthermore, the association between sex and PSCV was fully mediated by stronger concern about side effects and lower levels of self-perceived physical fitness for COVID-19 vaccination among females than males.

CONCLUSION

Moderately low prevalence of COVID-19 vaccination was observed in Hong Kong, where there was no shortage of vaccine supply. To achieve herd immunity, health promotion is greatly warranted and may incorporate messages based on the findings of this study.

Coping skills and glycaemic control: the mediating role of diabetes distress

AIMS

The present study examined the mediating role of diabetes distress on the relationship between coping and glycaemic control, and evaluated if the afore-mentioned mediation was moderated by insulin treatment in people with type 2 diabetes.

METHODS

A total of 473 adults with type 2 diabetes were recruited from an outpatient clinic in Hong Kong and invited to take part in a survey that measured adaptive coping, maladaptive coping, and diabetes stress. Glycaemic control was measured by glycated haemoglobin values extracted from medical records. PROCESS v3.4 macro was used to test the moderated mediation model.

RESULTS

Adaptive coping was negatively associated with diabetes distress (-0.29, 95% CI: -0.53, -0.06), whereas maladaptive coping was positively associated with diabetes distress (1.82, 95% CI: 1.12, 2.51). Diabetes distress had a positive relationship with glycated haemoglobin (0.04, 95% CI: 0.02, 0.05), but no correlations were found between glycated haemoglobin and adaptive coping or maladaptive coping. Insulin treatment not only weakened the diabetes distress-glycaemic control relationship (-0.04, 95% CI: -0.06, -0.01), but also weakened the mediation effect of maladaptive coping-glycaemic control relationship via diabetes distress (-0.07, 95% CI: -0.12, -0.02).

CONCLUSIONS

The study findings revealed the role of diabetes distress and insulin treatment in the link between coping skills and glycaemic control. Interventions to help boost confidence and autonomy in people with diabetes could help them lessen diabetes distress.

Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study

BACKGROUND

In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM's main tasks and goals.

METHOD

Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%).

RESULTS

The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM's main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field.

CONCLUSION

The consensus on definition and scope of behavioral medicine and ISBM's tasks and goals provides a foundational step toward achieving these goals.

Prevalence and associated factors of intention of COVID-19 vaccination among healthcare workers in China: application of the Health Belief Model

Healthcare workers (HCWs) are at an increased risk of coronavirus disease 2019 (COVID-19) and warrant COVID-19 vaccination to reduce nosocomial infections. This study investigated: (1) the prevalence of behavioral intention of COVID-19 vaccination (BICV) under eight scenarios combining vaccines' effectiveness/safety/cost, plus two general scenarios of free/self-paid vaccination given governmental/hospital recommendations, (2) perceptions involving preferred timing of COVID-19 vaccination and impacts of various attributes on BICV, and (3) factors of BICV based on the Health Belief Model. An anonymous online cross-sectional survey was conducted among 2,254 full-time doctors/nurses in three Chinese provinces during 10/2020-11/2020. The prevalence of BICV was 75.1%/68.0% among nurses/doctors under the most optimum scenario of this study (free/80% effectiveness/rare mild side effects); it dropped to 64.6%/56.5% if it costed 600 Yuan (USD90). Similar prevalence was obtained (72.7%/71.2%) if the vaccination was recommended by the government/hospitals but dropped to <50% if effectiveness was 50% or mild side effects were common; 13.0% preferred to take up COVID-19 vaccination at the soonest (81.8% would wait and see). Scientific proof (completion of phase III clinical trials and approval from health authorities) was rated the highest in its impacts on vaccination decision, followed by vaccines' performance, and then logistics. Multivariable logistic regression analyses showed that perceived severity, perceived barriers, cues to action, and self-efficacy (but neither perceived susceptibility nor perceived barriers) were significantly associated with the two BICV outcomes. The coverage of COVID-19 vaccination would be high only if the vaccines perform well. Health promotion may take the findings into account.

Factors Predicting Uptake of Sexually Transmitted Infections Testing among Men Who Have Sex with Men Who Are "Pre-Exposure Prophylaxis Tourists"-An Observational Prospective Cohort Study

The term “Pre-exposure prophylaxis (PrEP) tourists” refers to individuals who obtain PrEP in other countries and use it in their home countries. A prospective observational cohort study was conducted among a group of men who have sex with men (MSM) who obtained PrEP in private clinics in Thailand and used it in Hong Kong. Participants completed two web-based self-administered surveys when obtaining PrEP in Thailand and three months afterwards. Out of 110 participants at baseline, 67 completed the follow-up. The prevalence of sexually transmitted infection (STI) testing was 47.8% during the follow-up period. Eleven participants received an STI diagnosis, and seven of them were incident infections in the past three months. Participants who perceived a higher chance for STI infection (adjusted odds ratios (AOR): 1.90, 95% CI: 1.00, 3.75) and reported higher intention to take up STI testing at baseline (AOR: 1.62, 95% CI: 1.05, 2.50) were more likely to receive STI testing during the follow-up period. Baseline perceptions that service providers would think they were having risky behaviors because of PrEP use was negatively associated with the dependent variable (AOR: 0.51, 95% CI: 0.31, 0.86). Service planning and health promotion related to STI testing is needed for MSM “PrEP tourists”.