The Association of Problematic Smartphone Use with Family Well-Being Mediated by Family Communication in Chinese Adults: A Population-Based Study

Background and aims: Few studies have investigated the effects of problematic smartphone use (PSU) in the family context. We studied the association of PSU as a predictor with family well-being and the potential mediating role of family communication in Hong Kong Chinese adults. Methods: We analyzed data of 5,063 randomly selected adults [mean age (SD) = 48.1 (18.2) years; 45.0% men] from a dual landline and mobile telephone survey in 2017. PSU was assessed by the Smartphone Addiction Scale-Short Version with higher scores indicating higher levels. Family well-being was assessed by three questions on perceived family health, harmony, and happiness (3Hs) with higher scores indicating greater well-being. Perceived sufficiency and quality of family communication were rated. Multivariable regression analyses examined (a) associations of PSU with family 3Hs and well-being and (b) mediating role of family communication, adjusting for sociodemographic variables. Results: PSU was negatively associated with perceived family health (adjusted β = −0.008, 95% CI = −0.016, −0.0004), harmony (adjusted β =−0.009, 95% CI = −0.017, −0.002), happiness (adjusted β =−0.015, 95% CI = −0.022, −0.007), and well-being (adjusted β= −0.011, 95% CI = −0.018, −0.004). Perceived family communication sufficiency (adjusted β = −0.007, 95% CI =−0.010, −0.005) and quality (adjusted β = −0.009, 95% CI =−0.014, −0.005) mediated the association of PSU with family well-being, with 75% and 94% of total effects having mediated, respectively. Discussion and conclusions: PSU was negatively associated with family well-being, which was partially mediated by family communication. Such findings provide insights for health programs to prevent PSU and improve family well-being

Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates

Background and aims: Problematic smartphone use (PSU) is an emerging but understudied public health issue. Little is known about the epidemiology of PSU at the population level. We evaluated the psychometric properties of the Smartphone Addiction Scale – Short Version (SAS-SV) and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong. Methods: A random sample of 3,211 adults aged ≥18 years (mean ± SD: 43.3 ± 15.7, 45.3% men) participated in a population-based telephone survey in Hong Kong and completed the Chinese SAS-SV. Multivariable linear regressions examined the associations of sociodemographic factors, health behaviors, and chronic disease status with SAS-SV score. Data were weighted by age, sex, and education attainment distributions of the Hong Kong general population. Results: The Chinese SAS-SV is internally consistent (Cronbach’s α = .844) and stable over 1 week (intraclass correlation coefficient = .76, p < .001). Confirmatory factor analysis supported a unidimensional structure established by previous studies. The weighted prevalence of PSU was 38.5% (95% confidence interval: 36.9%, 40.2%). Female sex, younger age, being married/cohabitated or divorced/separated (vs. unmarried), and lower education level were associated with a higher SAS-SV score (all ps <.05). Current smoking, weekly to daily alcohol drinking, and physical inactivity predict greater PSU after controlling for sociodemographic factors and mutual adjustment. Discussion and conclusions: The Chinese SAS-SV was found valid and reliable for assessing PSU in Hong Kong adults. Several sociodemographic and health behavioral factors were associated with PSU at the population level, which may have implication for prevention of PSU and future research

Efficacy, Usability, and Acceptability of a Chatbot for Promoting COVID-19 Vaccination in Unvaccinated or Booster-Hesitant Young Adults: Pre-Post Pilot Study

BackgroundCOVID-19 vaccines are highly effective in preventing severe disease and death but are underused. Interventions to address COVID-19 vaccine hesitancy are paramount to reducing the burden of COVID-19. ObjectiveWe aimed to evaluate the preliminary efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination and examine the factors associated with COVID-19 vaccine hesitancy. MethodsIn November 2021, we conducted a pre-post pilot study to evaluate “Vac Chat, Fact Check,” a web-based chatbot for promoting COVID-19 vaccination. We conducted a web-based survey (N=290) on COVID-19 vaccination at a university in Hong Kong. A subset of 46 participants who were either unvaccinated (n=22) or were vaccinated but hesitant to receive boosters (n=24) were selected and given access to the chatbot for a 7-day trial period. The chatbot provided information about COVID-19 vaccination (eg, efficacy and common side effects), debunked common myths about the vaccine, and included a decision aid for selecting vaccine platforms (inactivated and mRNA vaccines). The main efficacy outcome was changes in the COVID-19 Vaccine Hesitancy Scale (VHS) score (range 9-45) from preintervention (web-based survey) to postintervention (immediately posttrial). Other efficacy outcomes included changes in intention to vaccinate or receive boosters and willingness to encourage others to vaccinate on a scale from 1 (not at all) to 5 (very). Usability was assessed by the System Usability Scale (range 0-100). Linear regression was used to examine the factors associated with COVID-19 VHS scores in all survey respondents. ResultsThe mean (SD) age of all survey respondents was 21.4 (6.3) years, and 61% (177/290) of respondents were female. Higher eHealth literacy (B=–0.26; P<.001) and perceived danger of COVID-19 (B=–0.17; P=.009) were associated with lower COVID-19 vaccine hesitancy, adjusting for age, sex, chronic disease status, previous flu vaccination, and perceived susceptibility to COVID-19. The main efficacy outcome of COVID-19 VHS score significantly decreased from 28.6 (preintervention) to 24.5 (postintervention), with a mean difference of –4.2 (P<.001) and an effect size (Cohen d) of 0.94. The intention to vaccinate increased from 3.0 to 3.9 (P<.001) in unvaccinated participants, whereas the intention to receive boosters increased from 1.9 to 2.8 (P<.001) in booster-hesitant participants. Willingness to encourage others to vaccinate increased from 2.7 to 3.0 (P=.04). At postintervention, the median (IQR) System Usability Scale score was 72.5 (65-77.5), whereas the median (IQR) recommendation score was 7 (6-8) on a scale from 0 to 10. In a post hoc 4-month follow-up, 82% (18/22) of initially unvaccinated participants reported having received the COVID-19 vaccine, whereas 29% (7/24) of booster-hesitant participants received boosters. ConclusionsThis pilot study provided initial evidence to support the efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination in young adults who were unvaccinated or booster-hesitant

Early childhood exposure to secondhand smoke and behavioural problems in preschoolers

Abstract Evidence on behavioural abnormalities in children exposed to secondhand smoke is limited. This study examined the relation between infant/ toddler cotinine concentration, a biomarker of secondhand smoke exposure, and behavioural problems in preschoolers who were unexposed to maternal smoking during gestation. A prospective cohort of 301 non-smoking mothers with their young children aged ≤18 months visiting postnatal primary care clinics in Hong Kong was enrolled in 2012 and followed by telephone survey 3 years afterwards. Saliva was collected at baseline for cotinine assay. Child behavioural health at 3-year follow-up was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). We conducted multivariable linear regressions to compute regression coefficients (b) of SDQ scores in relation to salivary cotinine level. Mean ± SD age of children at follow-up was 3.7 ± 0.5 years and 50.8% were boys. After adjusting for age, sex, birthweight, household income, housing type, maternal education and depressive symptoms, greater cotinine concentrations during early childhood were associated with greater conduct problems (b = 0.90, 95% CI 0.03–1.76) and hyperactivity/ inattention (b = 1.12, 95% CI 0.07–2.17) at preschool age. This study corroborates previous findings on the potential role of secondhand smoke in development of child behavioural problems

Effectiveness of personalized smoking cessation intervention based on ecological momentary assessment for smokers who prefer unaided quitting: protocol for a randomized controlled trial

IntroductionEcological momentary assessment (EMA)-based smoking cessation intervention may help personalize intervention for smokers who prefer to quit smoking unaided. This study aims to evaluate the effectiveness of EMA-based phone counseling and instant messaging for smoking cessation.Methods/designThis is a two-arm, accessor-blinded, simple individual randomized controlled trial (allocation ratio 1:1). Participants will be recruited from community sites and online platforms in Hong Kong. Interventions will be delivered via a phone call and instant messaging. Current adult smokers who (1) self-report no intention to use smoking cessation services and medication in the coming month and (2) have not used smoking cessation services or nicotine replacement therapy in the past 7 days will be recruited. Recruited participants will be randomized to intervention or control groups via an online randomizer. All participants will be required to complete EMAs (five times per day for 7 consecutive days). The intervention group (n = 220) will receive a nurse-led brief phone counseling immediately after the 1-week EMAs and 10-week EMA-based advice via instant messaging applications (e.g., WhatsApp, WeChat). The 10-week EMA-based advice covers a summary of the 1-week EMAs, and tailored cessation support focused on personalized smoking triggers. The control group (n = 220) will not receive any intervention during the same period. The primary outcomes are participants' progression toward smoking cessation assessed by the Incremental Behavior Change toward Smoking Cessation (IBC-S) and biochemically validated abstinence at the 3-month follow-up. Secondary outcomes include self-reported and biochemically validated tobacco abstinence at the 6-month follow-up.DiscussionThe findings will provide evidence that the EMA-based tailored smoking cessation intervention can be adapted as a new health promotion strategy for current smokers who are unwilling to use smoking cessation aids.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT05212220, identifier: NCT05212220

Associations of changes in smoking-related practices with quit attempt and smoking consumption during the COVID-19 pandemic: A mixed-methods study

Introduction How changes in smoking routine due to COVID-19 restrictions (e.g. refraining from smoking outdoors and stockpiling tobacco products) influence smoking behaviors remains understudied. We examined the associations of changes in smoking-related practices with quit attempts and smoking consumption in current smokers using a mixed-methods design. Methods In a community-based telephone survey conducted between the second and third wave of the COVID-19 pandemic in Hong Kong, 659 smokers (87.1% male; 45.2% aged 40–59 years) were asked about quit attempts and changes in cigarette consumption and five smoking-related practices since the COVID-19 outbreak. Logistic regression was used to calculate adjusted odds ratio (AOR), adjusting for sex, age, education level, chronic disease status, heaviness of smoking (HSI), psychological distress (PHQ-4) and perceived danger of COVID-19. A subsample of 34 smokers provided qualitative data through semi-structured interviews for thematic analyses. Results Favorable changes in smoking-related practices, including having avoided smoking on the street (prevalence: 58.9%) and reduced going out to buy cigarettes (33.5%), were associated with a quit attempt (AOR: 2.09 to 2.26; p<0.01) and smoking reduction (AOR: 1.76 to 4.97; p<0.05). Avoiding smoking with other smokers (50.5%) was associated with smoking reduction (AOR=1.76; p 0.05). Unfavorable changes, including having increased smoking at home (25.0%) and stockpiled tobacco products (19.6%), were associated with increased smoking (AOR: 2.84 to 6.20; p<0.05). Low HSI (0–2) was associated with favorable changes (p<0.01), while high HSI score (3–6) was associated with unfavorable changes (p<0.01). Qualitative interviews revealed a double-edged effect of staying at home on smoking consumption and that pandemic precautionary measures (e.g. mask-wearing) reduced outdoor smoking. Conclusions Amid the pandemic, favorable changes in smoking-related practices in smokers were mostly associated with quit attempts and smoking reduction, while unfavorable changes were associated with increased smoking. Smokers with higher nicotine dependence were more negatively impacted

Exposure to secondhand smoke infiltration at home amongst Hong Kong residents: a population-based study

Background Secondhand smoke (SHS) contributes to significant morbidity and mortality worldwide including Hong Kong, a densely-populated city with the lowest daily smoking prevalence (10.5%) in the developed world. Most Hong Kong citizens reside in multiunit housing where SHS can transmit from one unit to another because of the shared ventilation system and crowded living environment. We explored the prevalence of SHS infiltration and its sociodemographic correlates in the Hong Kong general population. Methods A cross-sectional sample of 5151 randomly selected Hong Kong residents aged 15+ were interviewed by telephone (response rate = 85.8%) for the Hong Kong Tobacco Control Policy-related Survey in 2016. Participants reported the number of days experiencing SHS infiltration from neighbour at home in the past 7 days, and their sociodemographic characteristics and smoking status. Data were weighted by the Hong Kong official data on age, gender and smoking status distributions. Chi-square tests and multivariable logistic regression examined the associations of home SHS infiltration with sociodemographic and smoking status. Results Overall, the prevalence (95% CI) of ever and daily SHS infiltration at home in the past 7 days were 22.2% (20.3 to 24.2%) and 5.8% (4.8 to 7.1%) respectively. SHS infiltration was individually associated with female (P = 0.002), younger age (P < 0.001) and never smoking status (P < 0.001) but not with indices of socioeconomic status including highest education level (P = 0.07), family income (P = 0.43), employment (0.89) or immigrant (P = 0.09) statuses. Multivariable regression analyses showed that current smokers were less likely to report home SHS infiltration (OR = 0.43, 95% CI 0.32-0.58). Conclusions In Hong Kong, the prevalence of home SHS infiltration was very high given the low prevalence of smoking and did not vary with socioeconomic status. Implementation of smoke-free policy in multiunit housing is imperative to safeguard its residents from passive smoking

Problematic Smartphone Use and Mental Health in Chinese Adults: A Population-Based Study

Problematic smartphone use (PSU) has been associated with anxiety and depression, but few explored its mental well-being correlates that could co-occur with or be independent of mental symptoms. We studied the associations of PSU with anxiety, depression, and mental well-being in Hong Kong Chinese adults in a probability-based survey (N = 4054; 55.0% females; mean age &plusmn; SD 48.3 &plusmn; 18.3 years). PSU was measured using Smartphone Addiction Scale-Short Version. Anxiety and depression symptoms were evaluated using General Anxiety Disorder screener-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). Mental well-being was measured using Subjective Happiness Scale (SHS) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Multivariable regression analyzed associations adjusting for sociodemographic and lifestyle-related variables. Associations of PSU with mental well-being were stratified by symptom severity of anxiety (GAD-2 cutoff of 3) and depression (PHQ-2 cutoff of 3). We found that PSU was associated with higher odds of anxiety and depression symptom severity and lower scores of SHS and SWEMWBS. Associations of PSU with lower SHS and SWEMWBS scores remained in respondents who screened negative for anxiety or depression symptoms. To conclude, PSU was associated with anxiety, depression, and impaired mental well-being. Associations of PSU with impaired mental well-being could be independent of anxiety or depression symptoms