Lt Leung

Electronic Cigarette Use and Respiratory Symptoms in Chinese Adolescents in Hong Kong

2. Montgomery KS. Apgar scores: examining the long-term significance. J Perinat Educ. 2000;9(3):5-9. 3. Iliodromiti S, Mackay DF, Smith GC, Pell JP, Nelson SM. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet. 2014;384(9956):1749-1755. 4. Ray JG, Urquia ML, Berger H, Vermeulen MJ. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units. CMAJ. 2012;184(18): E956-E962. 5. Bateman BT, Mhyre JM, Hernandez-Diaz S, et al. Development of a comorbidity index for use in obstetric patients. Obstet Gynecol. 2013;122(5): 957-965. Electronic Cigarette Use and Respiratory Symptoms in Chinese Adolescents in Hong Kong Electronic cigarettes (e-cigarettes) are increasingly used, but their health effects remain unclear. The primary ingredients of e-cigarette liquid, propylene glycol and flavoring chemicals (eg, diacetyl or diketone), are respiratory irritants and harmful to the lungs.1 Well-documented respiratory toxicants, such as particulate matters, volatile organic compounds, and metals, were found in e-cigarette aerosol, although in lower concentrations than conventional cigarettes.2 Figure. Relative Risk for Postpartum Maternal Admission to the Intensive Care Unit (ICU) Associated With the Newborn’s 5-Minute Apgar Score

Electronic cigarette use and its association with smoking in Hong Kong Chinese adolescents

BACKGROUND Electronic cigarettes (e-cigarettes) are increasingly used in adolescents with unknown impacts on conventional cigarette smoking. We examined the associations of e-cigarette use with smoking intention, nicotine addiction and smoking cessation in Chinese adolescents. METHODS A total of 45,128 students (age 14.6 ± 1.9; boys 51.4%) from 75 randomly selected schools in Hong Kong reported e-cigarette use (in the past 30 days), conventional cigarette use and socio-demographic characteristics in an anonymous questionnaire survey. Adjusted odds ratios (AORs) of intention to smoke, morning smoking urge, intention to quit and quit attempts; and beta-coefficient (β) of cigarette consumption per day were calculated in relation to e-cigarette use. RESULTS E-cigarette use was associated with intention to smoke with an AOR (95% CI) of 1.74 (1.30-2.31) in all students, 2.18 (1.12-4.23) in never and 2.79 (2.05-3.79) in ever smokers (non-significant interaction by smoking status). The associations were also significant in experimental and former smokers but not in current smokers. In current smokers, e-cigarette use was significantly associated with heavier smoking (β 2.54, 95% CI 1.28-3.81) and morning smoking urge (AOR 2.54, 95% CI 1.50-3.11), and non-significantly associated with lower quit intention (0.76, 0.52-1.09) and attempts (0.80, 0.56-1.23). CONCLUSIONS E-cigarette use was associated with smoking intention in never, experimental and former smokers in Hong Kong Chinese adolescents. In current smokers, e-cigarette use was associated with nicotine addiction but not quit intention and attempts. Prospective studies with detailed measurements on e-cigarette use are warranted for further studies.

Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents

Introduction Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. Methods In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Results Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Conclusions Although Hong Kongs smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. Implications In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.

Exposure to secondhand smoke from neighbours and respiratory symptoms in never-smoking adolescents in Hong Kong: a cross-sectional study

Objectives To investigate secondhand smoke (SHS) exposure at home from neighbours in Hong Kong adolescents and its association with respiratory symptoms in never-smokers. Design A cross-sectional study. Setting 79 randomly selected secondary schools in Hong Kong. Participants 61 810 secondary 1 (USA grade 7) to 7 students, in which 50 762 never-smokers were identified and included in the analysis of the association between SHS exposure at home from neighbours and respiratory symptoms. Main outcome measures Smoking status, family smoking status, SHS exposure at home from inside the home and from neighbours in the past 7 days, respiratory symptoms and sociodemographic characteristics were reported. Adjusted ORs (AORs) of respiratory symptoms for SHS exposure from the 2 sources in never-smokers were calculated using logistic regression. Results In all students, 33.2% were exposed to SHS at home, including 16.2% from inside the home only, 10.0% from neighbours only and 7.0% from both. The prevalence of SHS exposure from neighbours was 17.1%, including 13.5% for 1–4 days/week and 3.6% for 5–7 days/week. In never-smokers (n=50 762), respiratory symptoms were significantly associated with SHS exposure from neighbours with AORs (95% CI) of 1.29 (1.20 to 1.39) for any exposure (p<0.001), 1.21 (1.12 to 1.31) for 1–4 days/week (p<0.001) and 1.63 (1.44 to 1.86) for 5–7 days/week (p<0.001) (P for trend <0.001). Compared with no SHS exposure at home from any source, the AORs were 1.16 (1.07 to 1.25) for SHS from inside the home only (p<0.001), 1.20 (1.11 to 1.31) from neighbours only (p<0.001), and 1.74 (1.56 to 1.94) from both (p<0.001). Conclusions SHS exposure at home from neighbours was prevalent in Hong Kong adolescents, and was associated with respiratory symptoms in never-smokers. SHS exposure at home may be underestimated by ignoring the neighbouring source. Smoke-free housing policy is needed to protect children and adolescents from harms of SHS.

The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents

INTRODUCTION Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. METHODS We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. RESULTS Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19). CONCLUSIONS Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.

Associations of perceived interparental relationship, family harmony and family happiness with smoking intention in never-smoking Chinese children and adolescents: a cross-sectional study

Objective To examine the associations of perceived interparental relationship, family harmony and family happiness with smoking intention in never-smoking Chinese children and adolescents in Hong Kong. Design, settings and participants Cross-sectional surveys of 15 753 primary (grades 4–6) and 38 398 secondary (grades 7–12) never-smoking students from 71 to 75 randomly selected primary and secondary schools in Hong Kong, 2012–2013. Measurements Outcome variable was smoking intention which denoted any affirmative response to smoke within the coming year or when a cigarette was offered by a good friend. Exposure variables were perceived interparental relationship and family harmony each measured on a five-point scale from ‘very good’ to ‘very bad’ and perceived family happiness on a four-point scale from ‘very happy’ to ‘not happy at all’. Potential confounders included age, sex, family structure, perceived family affluence, parental smoking and sibling smoking. Results In primary students, the adjusted ORs (AORs) (95% CI) of smoking intention generally increased with more negative perception of the family relationship: up to 3.67 (1.91 to 7.05) for interparental relationship, 7.71 (4.38 to 13.6) for family harmony and 5.40 (3.41 to 8.55) for family happiness. For secondary students, the corresponding AORs (95% CI) were 2.15 (1.64 to 2.82) for interparental relationship, 2.98 (2.31 to 3.84) for family harmony and 2.61 (1.80 to 3.79) for family happiness. All p for trend <0.001. Conclusions More negatively perceived interparental relationship, family harmony and family happiness were associated with higher odds of smoking intention with dose–response relationships in never-smoking Chinese children and adolescents in Hong Kong. Children’s perception of their family relationship may be an important intervening point for preventing youth from initiating smoking.

Exclusive and concurrent use of cigarettes and alternative tobacco products among Hong Kong adolescents

INTRODUCTION The use of alternative tobacco products (ATPs) is becoming increasingly popular among the youth. This study aimed to assess cigarette-only smoking, exclusive ATP use, and concurrent use (cigarettes and ATPs) among adolescents in Hong Kong. METHODS We analyzed data of the Hong Kong School-based Survey on Smoking among Students 2012/13 from a representative sample of 45 857 secondary school students. Weighted prevalence of cigarette-only smoking, exclusive ATP use, and concurrent tobacco use were calculated. Multinomial logistic regression examined correlates of exclusive ATP use and concurrent use relative to cigarette-only smoking. Among current (past-30-days) cigarette smokers, multivariable logistic regression assessed whether ATP use was associated with nicotine dependence, quit intention and quit attempt. RESULTS Overall, 5.8% of adolescents reported current tobacco use (2.1% cigarette-only smoking, 2.5% exclusive ATP use and 1.2% concurrent use). Compared with cigarette-only smoking, exclusive ATP use and concurrent tobacco use were associated with younger age, higher perceived family financial status, absence of cigarette smoking peers, poor knowledge about smoking and more frequent alcohol use. Among current cigarette smokers, ATP use was negatively associated with cigarette quit intention and quit attempt. CONCLUSIONS ATP use was as prevalent as cigarette smoking among adolescents, and ATP users were different from cigarette smokers in many demographic and psychosocial factors. Tobacco control programs among youth should target different types of tobacco users and address all forms of tobacco products.

Favourable Perceptions of Electronic Cigarettes Relative to Cigarettes and the Associations with Susceptibility to Electronic Cigarette Use in Hong Kong Chinese Adolescents

We investigated favourable perceptions of electronic cigarettes (ECs) relative to cigarettes and their associations with EC use susceptibility in adolescents. Hong Kong Chinese Secondary 1–6 (U.S. grade 7–12) students (n = 40,202) were surveyed in 2014/2015 on EC use, cigarette smoking, favourable perceptions of ECs relative to cigarettes, EC use susceptibility, family smoking, and socio-demographic characteristics. Cox regression yielded adjusted prevalence ratios (APRs) of EC use susceptibility in never users, excluding those unaware of ECs. In all students, 8.9% were ever EC users, 47.2% reported favourable perceptions of ECs relative to cigarettes, such as less likely to cause accidents (25.2%) and less harmful to users (24.5%), and 28.9% did not know ECs. Among never EC users who were aware of ECs (n = 24,663), EC use susceptibility was associated with each of the favourable perceptions, especially greater attractiveness (APR 2.84, 95% CI 2.53–3.19), and better parental (2.75, 2.41–3.15) and school acceptability (2.56, 2.15–3.05). An increased number of favourable perceptions of ECs relative to cigarettes was associated more strongly with the susceptibility (p for trend < 0.001). Our findings inform strategies to reduce unwarranted favourable perceptions and prevent adolescent EC use.

Perceived family relationship quality and use of poly-tobacco products during early and late adolescence

BACKGROUND The role of family relationship in adolescent use of emerging tobacco products, which have become increasingly popular, is unknown. We examined the associations of perceived family relationship quality with current use of poly-tobacco products including cigarettes, electronic cigarettes (e-cigarettes), waterpipe and smokeless tobacco in adolescents. METHODS Data from a representative sample of 42,250 US grade 7-12 equivalent students (mean ± SD age 14.6 ± 1.9 years; 51.3% boys) from 75 randomly selected secondary schools in Hong Kong (2012-13) were analysed. Logistic regressions yielded adjusted odds ratios (AORs) for current (past 30-day) use of cigarettes, e-cigarettes, waterpipe, smokeless tobacco and poly-tobacco (≥2 products) in relation to perceived family relationship quality, adjusted for age, sex, perceived family affluence, parental education, family structure, parental and sibling smoking and secondhand smoke exposure at home. Subgroup analyses were conducted to compare the associations in early (aged ≤14 years) versus late (>14) adolescents. RESULTS The odds of current use increased with worse perceived family relationship quality with AORs (95% confidence interval) of up to 2.92 (2.32-3.68) for cigarettes, 7.28 (4.71-11.2) for e-cigarettes, 5.04 (3.44-7.40) for waterpipe, 8.09 (4.87-13.4) for smokeless tobacco and 5.25 (3.45-8.01) for poly-tobacco products use (all P for trend <.001). The associations for all tobacco use outcomes were stronger in early than late adolescents (all P for interaction <.001). CONCLUSIONS Dose-response relationships were found between negatively perceived family relationship quality and current poly- and individual tobacco product use by Hong Kong Chinese secondary students. The associations were stronger for alternative tobacco products and in early adolescents.