Fong Ching Chang

Relationships Among Cyberbullying, School Bullying, and Mental Health in Taiwanese Adolescents

BACKGROUND This study examined the relationships among cyberbullying, school bullying, and mental health in adolescents. METHODS In 2010, a total of 2992 10th grade students recruited from 26 high schools in Taipei, Taiwan completed questionnaires. RESULTS More than one third of students had either engaged in cyberbullying or had been the target (cybervictim) of it in the last year. About 18.4% had been cyberbullied (cybervictim); 5.8% had cyberbullied others (cyberbully); 11.2% had both cyberbullied others and been cyberbullied (cyberbully-victim). About 8.2% had been bullied in school (victim); 10.6% had bullied others (bully); and, 5.1% had both bullied others and had been bullied in school (bully-victim). Students with Internet risk behaviors were more likely to be involved in cyberbullying and/or cybervictimization; students who had cyberbullying or victimization experiences also tended to be involved in school bullying/victimization. After controlling for sex, academic performance, and household poverty, cyber/school victims and bully-victims were more likely to have lower self-esteem, and cyber/school victims, bullies and bully-victims were at a greater risk for serious depression. CONCLUSIONS Both cyberbullying and school bullying and/or victimization experiences were independently associated with increased depression.

The relationship between parental mediation and Internet addiction among adolescents, and the association with cyberbullying and depression.

OBJECTIVE This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying, substance use, and depression among adolescents. METHOD The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013. RESULTS Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression. CONCLUSION Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive mediation was associated with reductions in adolescent Internet addiction and cyberbullying.

Predictors of the initiation and persistence of Internet addiction among adolescents in Taiwan

PURPOSE The present study examined the psychosocial factors associated with the initiation and persistence of Internet addiction among adolescents in Taiwan. METHODS A total of 2315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade, in Taipei, Taiwan. Self-administered questionnaires were collected in each year to assess the pattern of changes in Internet addiction and psychosocial factors. RESULTS Of the 1602 students without an Internet addiction in the 10th grade, 253 (15.8%) had initiated Internet addiction by grade 11. Multivariate analysis results indicated that greater engagement in online activities (i.e., social network website use, online gaming), depression, and lower school bonding in grade 10 coupled with an increase in online activities, depression, and smoking from grades 10 to 11 predicted the initiation of Internet addiction. Of the 605 students with Internet addiction in the 10th grade, the addiction had persisted for 383 students (63.3%) in grade 11. An increase in the existence of depression and alcohol use from grades 10 to 11 predicted the persistence of Internet addiction. CONCLUSIONS Online activities, depression, and substance use were important predictors of youth initiation and of the persistence of Internet addiction.

Impact of the 2009 Taiwan Tobacco Hazards Prevention Act on Smoking Cessation

AIMS In January 2009, the government of Taiwan amended the 1997 Tobacco Hazards Prevention Act by extending smoke-free areas to include almost all enclosed work-places and public places, adding graphic health warnings to cigarette packages, totally banning tobacco advertisements, promotion and sponsorship and increasing tobacco taxes. This study examined the impact of the 2009 amended Act on smoking cessation in Taiwan. DESIGN Taiwan Adult Tobacco Surveys 2007 and 2010, each with a nationally representative sample of adults aged 18 years and older (n = 16 588, and n = 16 295, respectively). PARTICIPANTS All recent active smokers (current smokers plus former smokers who quit smoking within the past 12 months) were used for the analyses (n = 3783 in 2007, and n = 2777 in 2010). MEASUREMENTS Quit attempt rate and annual cessation rate (defined as having succeeded in quitting for at least 3 months) among recent active smokers were compared between the pre-Act (2007) and post-Act (2010) periods. FINDINGS The quit attempt rate increased significantly from 39.4% in 2007 to 42.9% in 2010. The annual cessation rate increased significantly from 7.1 to 8.9%. A multivariate analysis, controlling for demographic characteristics, showed that the implementation of the 2009 Act was associated with an increase in the quit attempt rate [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.03-1.25] and the annual cessation rate (OR = 1.28; 95% CI = 1.08-1.53). CONCLUSIONS The comprehensive tobacco control programme introduced in 2009 in Taiwan, which combined smoke-free legislation with a tobacco tax increase, graphic health warning labels and a total ban on tobacco advertisements, was associated with increases in quit attempt rate and annual cessation rate.

The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan

The present study evaluated the impact of Taiwans graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.

Quit smoking advice from health professionals in Taiwan: the role of funding policy and smoker socioeconomic status

Objectives In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counselling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007). Methods We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined. Results The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice. Conclusions During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups.

Association of thin-ideal media exposure, body dissatisfaction and disordered eating behaviors among adolescents in Taiwan

OBJECTIVE The present study examined the relationships between thin-ideal media exposure, body dissatisfaction, and disordered eating behaviors among adolescents in Taiwan. METHOD A total of 2992 students in the 10th grade were recruited from 26 high schools in Taipei, Taiwan to complete a questionnaire in 2010. RESULTS The results showed that the adolescents were exposed to thin-ideal messages a few times a week. Females had higher levels of thin-ideal media exposure, media pressure to be thin, thin-ideal internalization, body dissatisfaction, and disordered eating behaviors than males. Multivariate logistic regression results indicated that media pressure and thin-deal internalization significantly increased the likelihood of body dissatisfaction, while media pressure and body dissatisfaction contributed to both restrained eating and unhealthy weight control behaviors, when all other variables were controlled for.

Effects of financing smoking cessation outpatient services in Taiwan

Objective: This study assesses the effects of a 2005 increase in funding for smoking cessation services on provider participation, patient utilisation of smoking cessation services and cessation outcome at a six-month follow-up. Methods: Analyses are based on existing databases and on a follow-up study among smokers participating in the smoking cessation service. The effect of the policy is evaluated by comparing year 2004 (old policy) with year 2005 (new policy). The generalised estimating equations (GEE) method was conducted to examine the effects of increasing funding for smoking cessation services on monthly smoking cessation services provided per physician and yearly consultations received per patient. Logistic regression was used to examine the effects of increasing funding on smoking cessation outcome. Results: The study found the increased reimbursement rates and medication subsidies for smoking cessation to be positively related to the number of physicians enrolling in the programme (1841 in 2004 vs 3466 in 2005), the number of cessation consultations per month per physician (5.1 vs 14.6) and the number of cessation visits per year per patient (2.0 vs 2.5). Male providers and providers belonging to the private sector were found to offer more cessation consultations. The number of subjects receiving this counselling increased from 22 167 in 2004 to 109 508 in 2005. After adjusting for consumer and provider factors the likelihood of successful quitting among those counselled did not change. Overall, smokers who were older, had attempted to quit in the past year, had lower nicotine dependence, had gone to more smoking cessation service visits, had received consultations in the public sector and were seen by physicians delivering fewer consultations were more likely to have quit smoking at the six-month follow-up. Conclusions: Based on increases in physician enrolment and consultations and the increase in number of subjects receiving counselling and number of visits, the policy of increasing provider incentives and medication subsidies appears to have successfully promoted smoking cessation services.

The association of media exposure and media literacy with adolescent alcohol and tobacco use

This study examined the relationship of media exposure and media literacy to alcohol and tobacco use among adolescents in Taiwan. A total of 2992 10th-grade students recruited from 26 high schools in Taipei, Taiwan, completed a questionnaire in 2010. The multivariable analysis results indicated that the students with higher alcohol and tobacco media exposure were more likely to use alcohol and tobacco and have intentions to drink and smoke, while students with higher media literacy were less likely to use alcohol and have intentions to drink and smoke.

Relationship between Parental and Adolescent eHealth Literacy and Online Health Information Seeking in Taiwan

This study examined the relationship between parental and adolescent eHealth literacy and its impact on online health information seeking. Data were obtained from 1,869 junior high school students and 1,365 parents in Taiwan in 2013. Multivariate analysis results showed that higher levels of parental Internet skill and eHealth literacy were associated with an increase in parental online health information seeking. Parental eHealth literacy, parental active use Internet mediation, adolescent Internet literacy, and health information literacy were all related to adolescent eHealth literacy. Similarly, adolescent Internet/health information literacy, eHealth literacy, and parental active use Internet mediation, and parental online health information seeking were associated with an increase in adolescent online health information seeking. The incorporation of eHealth literacy courses into parenting programs and school education curricula is crucial to promote the eHealth literacy of parents and adolescents.