Abu Saleh M. Abdullah

Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: a preliminary investigation

RationaleThere are over 300 million Chinese smokers, but use of nicotine replacement therapy (NRT) is rare. On the other hand, data on the factors associated with quitting and adherence to NRT use are scarce in the East.ObjectivesTo describe adherence and other predictors of quitting smoking at the 12-month follow-up amongst Chinese smokers in Hong Kong.MethodsChinese smokers (1186) who attended the Smoking Cessation Health Centre from August 2000 through January 2002 were studied. Trained counsellors provided individual counselling and carried out follow-up interviews. We used structured questionnaires at baseline and at 1, 3 and 12 months and an intention-to-treat approach for analysis.ResultsAmong those who received NRT (1051/1186), the prevalence of adherence (self-reported NRT use for at least 4 weeks) was 16% (95% confidence interval 14–18%). The 7-day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27% (95% CI, CI 24–29%). Stepwise logistic regression model showed that adherence to NRT use, a higher income, good perceived health and having more confidence in quitting were significant predictors of quitting. The quit rate in the adherent group (40%) was greater than that of the non-adherent group (25%) (P<0.001). Older age, male, higher education, experience of NRT use, perceiving quitting as more difficult and willingness to pay were significant predictors of adherence.ConclusionsClinically significant smoking cessation rates can be achieved among Chinese smokers in a clinic-based smoking cessation service. The NRT adherence was low and low adherence was associated with a lower quit rate. Trials of interventions to improve adherence and increase quit rates are needed.

Lessons from the severe acute respiratory syndrome outbreak in Hong Kong.

Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak.

Patterns of Cigarette Smoking, Alcohol Use and Other Substance Use Among Chinese University Students in Hong Kong

The pattern of tobacco, alcohol, and other substance use was assessed among 1,197 Chinese undergraduates in Hong Kong. Students reported their current and past use of tobacco (13%), alcohol (61%), marijuana (2%), and other illicit drugs (0.4%). Perceptions of risk from the use of different substances were low among those who use substances and among senior students. The rate of substance use was higher among males, residents of university hall, senior students, and among those who possessed a positive attitude towards substance use. There were significant associations between different substance uses among the respondents.

Promoting smoking cessation among the elderly: what are the predictors of intention to quit and successful quitting?

Purpose: To assess the predictors of smoking cessation and intention to quit among the Chinese elderly smokers. Design: A cross-sectional survey of elderly smokers. Setting: Shamsuipo district, Hong Kong. Subject: A total of 1,318 elderly were interviewed (response rate = 83%). Measures: A structured questionnaire was used for data collection. The questionnaire sought information on the subjects sociodemographic background and smoking habits. The predictors for successful quitting and intention to quit were assessed by chi-square tests and multiple logistic regression. Results: Of the respondents, 20.2% were current smokers, 25.4% were ex-smokers, and 54.4% were never smokers. Of the smoker (current and ex-smokers) respondents, 55.7% (335/601) had successfully quit at the time of enumeration. The predictors of quitting were living with others, receiving assistance for mobility, being nondrinkers, smoking for shorter duration, and smoking more cigarettes per day. Having health problems in the past, smoking for shorter duration, and smoking fewer cigarettes per day were predictors of intention to quit smoking. Conclusion:The study identified several predictors of successful quitting that could help improve the provision of current smoking cessation services. Population-based smoking cessation programs, especially those targeted to elderly, should take these predictors into consideration in the design of interventions.

Sexually Transmitted Infections in Travelers: Implications for Prevention and Control

Sexually transmissible diseases (STDs), the most common notifiable infectious conditions, remain major threats to reproductive and public health worldwide. Travelers are particularly vulnerable to STDs, because of voluntary or involuntary sexual behavior while abroad, and are significant vectors who introduce new pathogens and resistant strains to unaffected parts of the world. This article outlines some key issues that travel medicine specialists and other clinicians should revisit when providing services to travelers. We discuss obstacles to promoting sexual health, including the diversity of the target group, unanticipated opportunities for sexual risk, ambivalent cooperation by the travel and tourism industries, poorly developed travel health sectors, illegal migration and sex tourism, and lack of research about the association between travel and STDs. We also outlined some programmatic aspects of public health that should be identified and addressed for the promotion of sexual health among travelers.

Risk factors for sexually transmitted diseases and casual sex among Chinese patients attending sexually transmitted disease clinics in Hong Kong

Background The risk factors for sexually transmitted diseases (STDs) and having casual sex among the Chinese people are unknown. Goal The goal of the study was to estimate the prevalence of STDs and to develop a profile of risk behavior among patients attending STD clinics in Hong Kong. Study Design In a clinic-based, cross-sectional study, 448 patients attending two government STD clinics were randomly sampled and interviewed by means of a structured questionnaire. Results The prevalence of STDs was 51% (70% of men and 35% of women). Attendees who had STDs diagnosed were more likely to be male, never married, and smokers and alcohol users (ever) and to have had casual sex or sex during travel with someone not their usual partner. Those who did not always use condoms were more likely to be male and never married. Having had casual sex was reported by 63% of the respondents. Those who reported having had casual sexual encounters were more likely to have the following characteristics: male; never married; no religious belief; ever smoker and alcohol user; current STD; had sex during travel; history of STD; inconsistent condom user; and perception of being at low risk for STD. After adjustment, only male gender was associated with casual sexual encounters. Conclusion The results of this study indicated several risk factors among Chinese patients for the acquisition of STDs, for not using condoms, and for having casual sex. This information is useful in strengthening and evaluating currently available STD prevention and control strategies for the Chinese population in Hong Kong and elsewhere.

Reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention

Objective: To assess the prevalence and reasons for non-use of condoms among the Hong Kong Chinese population and obtain baseline data to monitor sexual behavioural change. Methods: Cross sectional self administered questionnaire surveys in convenience sampled groups of Hong Kong Chinese residents were carried out. Results: Of the 1508 respondents, 24% reported consistent condom use and 76% inconsistent use. Overall, 17% of respondents reported having sex with strangers. People who were at increased risk for inconsistent condom use included STD clinics attendees, those who never married, and those reporting low self efficacy for condom use or sex with strangers. Common reasons for not using condoms were trust in partner, use of other contraceptives, and reduced sensation while using condoms. Conclusions: Given the reported high prevalence of travel and sexual contact with strangers, and misconceptions about condoms among the Hong Kong Chinese population, innovative condom social marketing campaigns are needed. Periodic monitoring of condom use behaviours should be an integral part of HIV/STD surveillance activity.

Health risks during travel: a population-based study amongst the Hong Kong Chinese.

Between June 1998 and October 1998, a cross-sectional survey was carried out in Hong Kong on 369 Chinese residents who had travelled to mainland China or elsewhere overseas in the previous 12 months. The aim was to collect data on which intervention strategies to minimise travel-related illness among the public might be based. In interviews by telephone, information on travel-related health problems, factors related to such problems, and barriers in the acquisition of travel-health advice was gathered using a structured, pre-tested questionnaire. Most of the subjects had travelled to countries in the Asia-Pacific region, with mainland China as the most popular destination (44%), followed by Thailand (14%). Overall, 16% of the respondents had developed health (mainly alimentary and respiratory) problems during or after their travel, 8% had received pre-travel health advice but 59% reported taking some form of precaution against travel-related illness. Although only 12% had lost at least a day of work or travel because of their travel-related health problems, 40% perceived themselves at risk of future travel-related illness, and 68% said they were willing to pay for the prevention of travel-health problems. Younger travellers and those who perceived relatively few health risks in future travel were relatively more likely to have developed health problems. There appears to be a clear need to develop appropriate health-promotion strategies to reduce travel-health risks among the residents of Hong Kong and the rest of the Asia-Pacific region.

Impact of Severe Acute Respiratory Syndrome (SARS) on travel and population mobility: Implications for travel medicine practitioners

The severe acute respiratory syndrome (SARS) outbreak, as a result of its rapid international spread, predilection for medical personnel,and relatively high case fatality ratio,captured the attention of professionals,politicians and the public worldwide. Although the number of deaths from SARS was limited to 916 worldwide, which is significantly lower than the annual mortality figures for many other infectious diseases such as influenza, HIV infection or malaria,1 it created panic among health care professionals and the public all over the world and severely disrupted businesses and travel to affected destinations. Based on figures from the World Tourism Organization (WTO), it reduced international passenger traffic by 2.6% in the first 4 months of 2003.2 Travel to Asia Pacific countries dropped by 10% to 50% in late March to April 2003,2 and this was related to the emergence of SARS. Tourist arrivals to Hong Kong in April and May, the peak SARS-affected months, dropped by 64.8% and 67.9% respectively.3 Anecdotal reports suggest that public concerns about SARS have increased travel-related enquiries to travel medicine practitioners and health care professionals. As travel medicine practiREVIEW ARTICLE

Factors Associated with Complete Home Smoking Ban among Chinese Parents of Young Children

(1) Background: The home environment is a major source of Environmental Tobacco Smoke (ETS) exposure among children especially in early childhood. ETS exposure is an important health risk among children and can cause severe and chronic diseases, such as asthma, bronchitis, and premature death. However, ETS exposure at home has often been neglected in the Chinese families. Identification of factors that facilitate or otherwise hamper the adoption of home smoking ban will help in the design and implementation of evidence-based intervention programs. This study identifies factors correlated with home smoking bans in Chinese families with children. (2) Methods: A cross-sectional survey of parents living in Nanning city, Guangxi Province, China with at least one smoker and a child in the household was conducted between September, 2013 and January, 2014. A Chi-square test was used to compare categorical variables differences between the parents who had home smoking bans and those with no home smoking ban. Multiple logistic regression analyses were used to identify factors correlated with home smoking bans. (3) Results: 969 completed questionnaires were collected with a response rate of 92.29% (969/1050). Of the respondents (n = 969), 14.34% had complete home smoking bans. Factors that were associated with home smoking bans were: having no other smokers in the family (OR = 2.173), attaining education up to high school (OR = 2.471), believing that paternal smoking would increase the risk of lower respiratory tract illnesses (OR = 2.755), perceiving the fact that smoking cigarettes in the presence of the child will hurt the child’s health (OR = 1.547), believing that adopting a no smoking policy at home is very important (OR = 2.816), and being confident to prevent others to smoke at home (OR = 1.950). Additionally, parents who perceived difficulty in adopting a no smoking policy at home would not have a home smoking ban (OR = 0.523). (4) Conclusions: A home smoking ban is not widely adopted by families of hospitalized children in Guangxi Province, China. To protect the health of children, there is a need to develop and test interventions to promote home smoking bans. Factors identified as predictors of home smoking ban should be considered in the design of interventions.