Dan Wu

Global Health Professions Student Survey (GHPSS) in Tobacco Control in China.

OBJECTIVESnTo examine the prevalence of smoking, second-hand smoke exposure, and attitudes toward tobacco control and cessation training among university students in China.nnnMETHODSnWe administered the Global Health Professions Student Survey (GHPSS) to students from 50 universities offering medical/ health professional (MHP) programs and received 11,954 responses. Non-MHP students, MHP students, and third-year MHP students comprised the sample. Descriptive statistics were calculated for weighted prevalence and 95% confidence intervals. Key factors of interest and attitudes toward medical smoking cessation were examined using logistic regression.nnnRESULTSnSmoking and exposure to second-hand smoke was higher among non-MHP (15.9%, 31.9%) than MHP (7.0%, 21.2%) students. For third-year MHP students, the rates were 6.9% and 19.7%, respectively. Students held positive attitudes toward smoking bans in public places and cessation services. However, few received formal training in smoking cessation, and 37.0% agreed that light cigarettes are less harmful to health. Positive attitudes toward cessation services were related to several factors.nnnCONCLUSIONSnThis study is the first comprehensive survey of students in China providing direction for building capacity in tobacco control and smoking cessation among students in health professional programs.

Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics?

BACKGROUND: The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. OBJECTIVE: To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. METHODS: This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHSs Multiple Cause-of-Death public use files. RESULTS: Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearmans rho = 0.38; pCONCLUSION: Large interstate variation in the relative magnitude of nonhomicide drug-intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of drug-induced suicides and other drug-intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment. Language: en

The impact of regional economic reliance on the tobacco industry on current smoking in China

The purpose of this study was to conduct a preliminary assessment of province of residence and other contextual factors on the likelihood of being a current smoker in China. A cross-sectional, multistage sampling process was used to recruit participants, and their smoking status and sociodemographic characteristics were obtained through face-to-face interviews. The contextual variables were retrieved from a national database. Multilevel logistic regression analysis was performed to assess the impact of provincial economic reliance on the tobacco industry, as well as individual-level characteristics, on the likelihood of being a current smoker. Participants totaled 20,601 from 27 cities located in 26 of the 31 municipalities/provinces in China. Overall smoking prevalence was 31.3% (95% CI: 19.3-33.2%), with rates being highest in Yinchuan City in Ningxia Province (49.8%) and lowest in Shanghai (21.6%). The multilevel analysis showed an excess likelihood of being a current smoker for individuals living in provinces with the highest rate of cigarette production relative to those with the smallest (p<0.001). Findings underscore the importance of restricting cigarette production and regulating the marketing of tobacco products in China.

Comparative Stress Levels among Residents in Three Chinese Provincial Capitals, 2001 and 2008

Objectives To compare stress levels among residents in large Chinese cities between 2001 and 2008. Methods Survey data were collected in three mainland Chinese capital cities in two waves, in 2001 and 2008, respectively. Participants were recruited through a multi-stage stratified sampling process. Stress was assessed using the Perceived Stress Scale, Chinese version (CPSS). Descriptive methods were used to estimate mean stress levels and associated 95% confidence intervals. Estimates were adjusted by post-stratification weights. Results Indicating stable stress levels, respective adjusted mean stress scores for the combined samples of study participants were 23.90 (95%CI: 23.68–24.12) in 2001 and 23.69 (95%CI: 23.38–24.01) in 2008. A lower stress level in 2008 than in 2001 manifested among residents who were under 25 years of age; female; with a college or higher level education; divorced, widowed, or separated; members of the managerial and clerical group; students or army personnel; or with an annual income of at least 30,000 RMB. Conclusion The overall stress level did not change among the combined sample of residents in the three Chinese study cities between 2001 and 2008. However, levels remained high and varied across social strata, and may have reflected a national trend among urban residents. Findings indicate a need for a new health policy, and call for the design and implementation of evidence-based interventions that target the highest-risk groups.

Deliberate self-harm among Chinese medical students: A population-based study

BACKGROUNDnThe phenomenon of deliberate self-harm (DSH) among college students has received increased attention in recent decades. Adopting a psychosocial perspective, this study aims to describe self-reported DSH among Chinese medical college students, assess respective associations between uncertainty stress and social capital with DSH, and explore the mechanism linking these three phenomena.nnnMETHODSnA cross-sectional survey employing multi-stage, sampling was conducted. 4446 undergraduate students were recruited from 22 participating Chinese medical universities. Perceived stress from uncertainty and social capital were assessed among the students. The Chi-square test and multiple logistic regression models assessed correlates of DSH. Relationship among social capital, uncertainty stress, and DSH were examined by means of Structural Equation Modeling.nnnRESULTSnThe prevalence of DSH in the past 12 months among Chinese students was 9.6%. The most common types of physical DSH reported were scratching, cutting, and pinching. Age (χ(2)=26.63, p<0.01), gender (χ(2)=30.24, p<0.01), major field (χ(2)=28.13, p<0.01), and annual household income (χ(2)=11.10, p<0.05) were statistically associated with DSH. Uncertainty stress is a unique correlate of DSH, and shows a stronger association than do three certainty stressors. Social capital is also a strong correlate of DSH, especially cognitive social capital. Moreover, social capital may be indirectly associated with DSH through impacting uncertainty stress.nnnLIMITATIONSnThis study was a cross-sectional and thus could not evaluate causal relationships.nnnCONCLUSIONnWe recommend that a DSH intervention study should target uncertainty stress management and social capital accumulation. This study provides scientific evidence and theoretical foundation for future DSH interventions, with a view to enhancing the mental health of medical college students.

Violent injuries and regional correlates among women in China: results from 21 cities study in China

BACKGROUNDnEcological models depict violent injuries against women being influenced by both individual and environmental characteristics. However, only few studies examined the association between regional variables and the likelihood of violent injuries. Our study is a preliminary assessment of the impact of regional variables on the likelihood that a woman has experienced violent injuries.nnnMETHODSnParticipants were 16 866 urban residents, who were identified through a multi-stage sampling process conducted in 21 Chinese cities. Out of the sampled population, 8071 respondents were female. Subsequent analyses focused solely on the female sample. Multilevel logistic regression analyses were performed to examine regional variation in violent injuries.nnnRESULTSnPrevalence of violent injuries against women is 10.7% (95% CI: 7.8%, 15.5%). After controlling for individual-level characteristics, higher regional male-female ratio (OR: 1.97, P < 0.05), population growth rate (OR: 4.12, P < 0.01) and unemployment rate (OR: 2.45, P < 0.01) were all associated with an elevated risk of violent injuries among Chinese women caused by physical attack.nnnCONCLUSIONSnThe results suggest violent injuries among Chinese women caused by physical attack have become an important social and public health problem. The findings point to the importance of developing effective health policies, laws and interventions that focuses on the unequal economic development between different regions.

Second hand smoke exposure in public venues and mental disorder: a representative nationwide study of China

IntroductionMany studies have clearly linked exposure to Second Hand Smoke (SHS) to various somatic diseases, however, few studies have examined the relationship between SHS and mental disorders and those that have were only conducted with specific groups. The purpose of this study was to examine the association between SHS exposure and mental disorders among Chinese residents in both worksites and public places.MethodsA cross-sectional multistage sampling design was used to interview subjects from 21 selected cities in China. Using a standardized questionnaire including demographic characteristics, SHS exposure, and mental health information was collected. Multiple logistic regression analysis was used to assess the association between SHS exposure and mental disorders.ResultsSixteen-thousand-eight-hundred-sixty-six valid questionnaires were collected and utilized in this study. Of 11,206 non-smokers, SHS exposure prevalence in workplaces and public places were respectively 78.4xa0% (95xa0% C.I.:74.3–82.5xa0%) and 80.7xa0% (95xa0% C.I.:74.6–86.5xa0%). Multiple logistic regressions showed SHS exposures in these venues were positively related to mental disorder.ConclusionsThese findings further support the health hazards of SHS exposure. Findings underscore the importance of controlling SHS exposure, and can be used to inform future SHS control policies and reinforce the need for public education in China.

Who smokes in smoke-free public places in China? Findings from a 21 city survey

Efforts toward controlling secondhand smoke in public places have been made throughout China. However, in contrast to the western world, significant challenges remain for effectively implementing smoke-free regulations. This study explores individual and regional factors which influence smoking in smoke-free public places. Participants included 16 866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. The reported smoking prevalence in smoke-free public places was 41.2%. Of those who smoked in smoke-free public places, 45.9% had been advised to stop smoking. Participants stated that no-smoking warnings/signs with please in the statement had a better likelihood of gaining compliance and preventing smoking in public spaces. Multilevel logistic regression analysis showed that ethnicity, education, occupation, type of smoking, age of smoking initiation, smoking situation, stress, household smoking restrictions and city population were all associated with smoking in smoke-free public places. Interestingly local smoke-free regulations were not associated with smoking in public places. The findings underscore that efforts to restrict smoking in public places in China should emphasize strong enforcement, while simultaneously raising public awareness of the perils of second hand smoke.

Smoking cessation in an urban population in China.

OBJECTIVEnTo examine smoking cessation among urban-based Chinese.nnnMETHODSnMulti-stage random sampling was used to obtain a sample from 21 cities in China. Two logistic regression models were established to identify factors influencing quit intention and smoking cessation.nnnRESULTSnPrevalence of smoking cessation was 10.1%; 45.5% of smokers intended to quit. Women and professionals had higher cessation rates than men and nonprofessionals. Rates of quit intention were highest among managers and clerks, and lowest among those who used gifted tobacco, smoked alone, and reported addiction to nicotine.nnnCONCLUSIONnIndividual and city level factors are associated with quit intention and smoking cessation among urban-dwelling Chinese smokers. This information should guide smoking cessation programs and inform health policy.

The Effects of Tobacco-Related Health-Warning Images on Intention to Quit Smoking among Urban Chinese Smokers.

Objective: The purpose of this study was to explore the effects of different tobacco health-warning images on intention to quit smoking among urban Chinese smokers. The different tobacco health-warning images utilised in this study addressed the five variables of age, gender, cultural-appropriateness, abstractness and explicitness. Design: Participants were administered a questionnaire that contained 10 graphic anti-smoking images. Of the 10 images, two each represented the independent variables of age, gender, cultural-appropriateness, abstractness and explicitness. The dependent variable in this study was intention to quit smoking. Setting: A cross-sectional survey was conducted using face-to-face interviews with 699 residents of Hangzhou, China. The study focused on 202 of those residents who self-reported as smokers. Method: Data were collected using a multi-stage sampling design. A Likert-type scale was used to measure quitting intentions after viewing graphic health-warning images. Data analysis was conducted using SAS version 9.3, and paired Chi-square tests were performed to analyse the effect of different graphic tobacco health-warning images on intention to quit smoking among current smokers. Results: More than 50% of smokers studied reported they were interested in quitting smoking after viewing the graphic images. Images featuring children and women, real pictures of damaged lungs and pictures that were more explicit produced higher intentions to quit smoking than abstract, male-dominated or less explicit images. Conclusion: When designing tobacco-related health-warning images for mass media campaigns, utilising more explicit photos and photographs involving women and children is potentially most effective. These findings provide evidence that the Chinese government should consider when initiating future anti-smoking campaigns utilising such images. Furthermore, these images should appear on all cigarette packages replacing the current text-only warnings.