Yaqiong Yan

Application of the Protection Motivation Theory in predicting cigarette smoking among adolescents in China

Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West - such as the Protection Motivation Theory (PMT) - may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N=553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.

A Protection Motivation Theory-Based Scale for Tobacco Research among Chinese Youth

Rates of tobacco use among adolescents in China and other lower and middle-income countries remain high despite notable prevention and intervention programs. One reason for this may be the lack of theory-based research in tobacco use prevention in these countries. In the current study, a culturally appropriate 21-item measurement scale for cigarette smoking was developed based on the core constructs of Protection Motivation Theory (PMT). The scale was assessed among a sample of 553 Chinese vocational high school students. Results from correlational and measurement modeling analysis indicated adequate measurement reliability for the proposed PMT scale structure. The two PMT Pathways and the seven PMT constructs were significantly correlated with adolescent intention to smoke and actual smoking behavior. This study is the first to evaluate a PMT scale for cigarette smoking among Chinese adolescents. The scale provides a potential tool for assessing social cognitive processes underlying tobacco use. This is essential for understanding smoking behavior among Chinese youth and to support more effective tobacco use prevention efforts. Additional studies are needed to assess its utility for use with Chinese youth in other settings.

Relationships Between Stress, Negative Emotions, Resilience, and Smoking: Testing a Moderated Mediation Model.

ABSTRACT Objective: More effective tobacco prevention and cessation programs require in-depth understanding of the mechanism by which multiple factors interact with each other to affect smoking behaviors. Stress has long been recognized as a risk factor for smoking. However, the underlying mediation and moderation mechanisms are far from clear. The purpose of this study was to examine the role of negative emotions in mediating the link between stress and smoking and whether this indirect link was modified by resilience. Methods: Survey data were collected using audio computer-assisted self-interview (ACASI) from a large random sample of urban residents (n = 1249, mean age = 35.1, 45.3% male) in Wuhan, China. Perceived stress, negative emotions (anxiety, depression), resilience were measured with reliable instruments also validated in China. Self-reported smoking was validated with exhaled carbon monoxide. Results: Mediation analysis indicated that two negative emotions fully mediated the link between stress and intensity of smoking (assessed by number of cigarettes smoked per day, effect =.082 for anxiety and.083 for depression) and nicotine dependence (assessed by DSM-IV standard, effect =.134 for anxiety and.207 for depression). Moderated mediation analysis demonstrated that the mediation effects of negative emotions were negatively associated with resilience. Conclusions: Results suggest resilience interacts with stress and negative emotions to affect the risk of tobacco use and nicotine dependence among Chinese adults. Further research with longitudinal data is needed to verify the findings of this study and to estimate the effect size of resilience in tobacco intervention and cessation programs.

Time trends and age-period-cohort analyses on incidence rates of nasopharyngeal carcinoma during 1993-2007 in Wuhan, China.

BACKGROUNDnDeclines in incidence rates of nasopharyngeal carcinoma (NPC) were observed in Hong Kong and Taiwan but not other high-risk regions in China, while evidences from low-risk regions in China are still lacking. This study aimed to examine the time trends (1993-2007) of NPC in Wuhan (a low-risk region) and assess the birth cohort and calendar period effects on the observed temporal trends.nnnMETHODnUsing data from Wuhan Cancer Registry, age-standardized annual incidence rates of NPC were calculated by the direct method using the WHO World Standard Population (2000) as the reference. Trend in incidence rates of NPC during 1993-2007 was evaluated. Age-period-cohort models were also applied to assess the effects of age, calendar time and birth cohort on the observed temporal trends.nnnRESULTSnA total of 1685 new NPC cases (1210 males and 475 females) were diagnosed during 1993-2007 in Wuhan. The annual percentage change in incidence rates of NPC were 0.15% (95% confidence interval: -3.88% to 4.34%) for males and -1.17% (95% confidence interval: -4.85% to 2.66%) for females. No obvious cohort or period effect on the incidence rates of NPC was observed.nnnCONCLUSIONnThe incidence rates of NPC remained stable during 1993-2007 in Wuhan, a low-risk region in China.

The Essential Resilience Scale: Instrument Development and Prediction of Perceived Health and Behaviour.

Further advancement in stress and health research calls for better tools to assess resilience. In this study, we developed the Essential Resilience Scale (ERS) and investigated the association between ERS scores and several health and behaviour measures. We developed the ERS with an operationalized definition of resilience-an individuals capability to anticipate, be flexible with and bounce back from three types of traumatic and adverse events (physical, emotional and social). The 15-item ERS was assessed using survey data from a diverse sample (nu2009=u2009238, aged 18-45u2009years, 76 rural-to-urban migrants, 85 rural residents, 77 urban residents) recruited in Wuhan, China. Results showed a high reliability of the ERS (αu2009=u20090.94). Confirmatory factor analysis demonstrated a satisfactory fit of the proposed second-order ERS measurement model (goodness-of-fit indexu2009=u20090.94, comparative fit indexu2009=u20090.98, root mean square error of approximationu2009=u20090.06, chi-square/dfu2009=u20091.75). Multivariate regression analysis indicated that ERS scores significantly predicted perceived health status, stress, anxiety, depression and cigarette smoking after controlling for important covariates. Findings of this study indicate high reliability and validity of the scale and its potential use in advancing stress and health research. Further studies are implied to provide additional support for the ERS and its relations with other health outcomes. Copyright

Persistent effect at 30-month post intervention of a community-based randomized trial of KM2H 2 in reducing stroke and heart attack among senior hypertensive patients

BackgroundThe effect of the Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) program at 6-month post interventionxa0has beenxa0assessed. xa0The purpose of this study is to evaluate the KM2H2 program at 30-month post intervention.MethodsA total of 450 senior hypertensive patients from 12 community health centers were randomized by center to either receive KM2H2 plus standard care (6 centers, nu2009=u2009232) or standard care only (6 centers, nu2009=u2009218). Data for outcome measures at 30-month post intervention were analyzed. New cases of stroke and heart attack were verified with medical records; levels of physical activity were assessed using self-reported questionnaire. In addition to comparative analysis, adjusted incidence rate and program effects were determined using mixed effects modeling method.ResultsAt the 30-month follow-up, the adjusted incidence rate [95% CI] of stroke was 11.81% [5.90, 17.72] for patients in the intervention group and 19.78% [14.07, 25.50] (pu2009=u20090.03) for the control group. The adjusted incidence rate of heart attack was 3.34% [1.91, 8.58] and 6.68% [1.64, 11.73] for the intervention and control groups (pu2009=u20090.16), respectively; the proportion and the duration of engaging in regular physical activity were significantly greater for the intervention group than the control group. The reductions in blood pressure between the intervention and the control was not statistically significant.ConclusionsThe KM2H2 program showed a persistent effect up to 30xa0months post intervention in enhancing physical activity and reducing the risk of cardio-cerebrovascular events, particularly stroke. These findings demonstrate the persistent effect of the KM2H2 and suggest the need for a full-scale evaluation of the intervention program for practical use.Trial registrationISRCTN Register ISRCTN12608966. Registered 03 March 2015. Retrospectively registered.

Association between Spouse/Child Separation and Migration-Related Stress among a Random Sample of Rural-to-Urban Migrants in Wuhan, China

Background Millions of people move from rural areas to urban areas in China to pursue new opportunities while leaving their spouses and children at rural homes. Little is known about the impact of migration-related separation on mental health of these rural migrants in urban China. Methods Survey data from a random sample of rural-to-urban migrants (n = 1113, aged 18–45) from Wuhan were analyzed. The Domestic Migration Stress Questionnaire (DMSQ), an instrument with four subconstructs, was used to measure migration-related stress. The relationship between spouse/child separation and stress was assessed using survey estimation methods to account for the multi-level sampling design. Results 16.46% of couples were separated from their spouses (spouse-separation only), 25.81% of parents were separated from their children (child separation only). Among the participants who married and had children, 5.97% were separated from both their spouses and children (double separation). Spouse-separation only and double separation did not scored significantly higher on DMSQ than those with no separation. Compared to parents without child separation, parents with child separation scored significantly higher on DMSQ (mean score = 2.88, 95% CI: [2.81, 2.95] vs. 2.60 [2.53, 2.67], p < .05). Stratified analysis by separation type and by gender indicated that the association was stronger for child-separation only and for female participants. Conclusion Child-separation is an important source of migration-related stress, and the effect is particularly strong for migrant women. Public policies and intervention programs should consider these factors to encourage and facilitate the co-migration of parents with their children to mitigate migration-related stress.

Development and Evaluation of the Brief Sexual Openness Scale-A Construal Level Theory Based Approach.

Obtaining reliable and valid data on sensitive questions represents a longstanding challenge for public health, particularly HIV research. To overcome the challenge, we assessed a construal level theory (CLT)-based novel method. The method was previously established and pilot-tested using the Brief Sexual Openness Scale (BSOS). This scale consists of five items assessing attitudes toward premarital sex, multiple sexual partners, homosexuality, extramarital sex, and commercial sex, all rated on a standard 5-point Likert scale. In addition to self-assessment, the participants were asked to assess rural residents, urban residents, and foreigners. The self-assessment plus the assessment of the three other groups were all used as subconstructs of one latent construct: sexual openness. The method was validated with data from 1,132 rural-to-urban migrants (mean age = 32.5, SD = 7.9; 49.6% female) recruited in China. Consistent with CLT, the Cronbach alpha of the BSOS as a conventional tool increased with social distance, from .81 for self-assessment to .97 for assessing foreigners. In addition to a satisfactory fit of the data to a one-factor model (CFI = .94, TLI = .93, RMSEA = .08), a common factor was separated from the four perspective factors (i.e., migrants’ self-perspective and their perspectives of rural residents, urban residents and foreigners) through a trifactor modeling analysis (CFI = .95, TLI = .94, RMSEA = .08). Relative to its conventional form, CTL-based BSOS was more reliable (alpha: .96 vs .81) and valid in predicting sexual desire, frequency of dating, age of first sex, multiple sexual partners and STD history. This novel technique can be used to assess sexual openness, and possibly other sensitive questions among Chinese domestic migrants.

Probability Sampling by Connecting Space with Households Using GIS/GPS Technologies

Abstract Sampling methods for survey studies are challenged by the replacement of landline telephones with mobile phones, the lack of timely census data, and the growing need for studies to address new health challenges. GIS/GPS-assisted methods provide a promising alternative, but these methods need further improvement. We established a stratified 3-stage GIS/GPS-assisted sampling method in which residential areas of a target population are divided into mutually exclusive cells – geographic units (geounits) as the primary sampling frame (PSF). Geounits with residential households were randomly selected from the PSF with a semi-automatic algorithm implemented in R. Novel methods were used to sample households and participants. Simulations and application studies indicated adequate feasibility, efficiency and validity of the method in sampling rural-to-urban migrants from a large city with complex residential arrangements. With this method, researchers can determine sample size and number of geounits, households and participants to be sampled; optimally allocate geounits; determine area size of sampled geounits and estimate sample weights; and complete sampling for field data collection in a short period. Our method adds an integrative approach for GIS/GPS-assisted random sampling with a de facto population assumption. Additional evaluation studies are needed to assess the utility of this method in different settings.

Sex differentials in relationships between functional fitness and cognitive performance in older adults: a canonical correlation analysis

This study aimed to explore the sex differentials in correlations between functional fitness (FF) and cognitive impairment (CI) in older adults without dementia. A community-based cross-sectional study was conducted using 2096 adults more than 65 years of age. The Senior Fitness test and Mini-mental State Examination (MMSE) were used to measure FF and cognitive performance. Canonical correlation analysis (CCA) was performed to evaluate the relationships between FF and MMSE. Our results confirmed the relationships between FF and CI, furthermore FF and MMSE were significantly different between men and women (Pu2009<u20090.05). CCA results showed overall FF was positively correlated with overall MMSE in both men (canonical coefficientu2009=u20090.37, Pu2009<u20090.0001) and women (first canonical coefficientu2009=u20090.42, Pu2009<u20090.0001; second canonical coefficientu2009=u20090.17, Pu2009=u20090.004). Among men, 30s-arm curl and language were most highly correlated with FF and MMSE, respectively. Whereas among women, 30s-arm curl and eight-foot up-and-go were most highly correlated with FF, and orientation and recall were most highly correlated with MMSE. In conclusion, there was a sex difference in the relationships between FF and MMSE, which facilitated generating insight into cognitive performance improvement from the perspective of FF enhancement by sex. Prospective studies are needed to explore the causality between FF and cognitive performance.