Yuantao Hao

Misconceptions predict dropout and poor adherence prospectively among newly admitted first-time methadone maintenance treatment clients in Guangzhou, China.

AIMS To investigate the incidence of dropout and the prevalence of poor adherence among newly admitted first-time clients of methadone maintenance treatment (MMT) clinics, and the associations between MMT-related misconceptions and these two treatment outcomes. DESIGN A cohort study (maximum follow-up period = 17.6 months) was conducted. SETTING Three of the nine MMT clinics in Guangzhou, China participated in the study. PARTICIPANTS The sample included 158 newly admitted first-time MMT clients. MEASUREMENTS Information collected included background characteristics, history of drug use, MMT-related misconceptions, dropout during the entire study period and poor adherence within the first 6 months since admission to MMT. FINDINGS Of all newly admitted MMT clients, 98.2% possessed at least one and 50.6% possessed all four types of MMT-related misconception; 51.3% had dropped out before the completion of the study [95% confidence interval (CI): 43.5-59.1%] and 62% exhibited poor adherence within the first 6 months since admission (95% CI: 54.2-69.6%). Adjusting for significant background variables, the number of misconceived responses predicted significantly both dropout [hazard ratio (HR) = 3.80 for two to three misconceived items, HR = 7.13 for four misconceived items, with zero to one misconceived item being the reference] and poor adherence within the first 6 months [relative risk (RR) = 4.13 for two to three misconceived items; RR = 4.40 for four misconceived items, with zero to one misconceived item being the reference. CONCLUSIONS Among opiate addicts in China prescribed methadone maintenance therapy for the first time, misconceptions about this medication are prevalent and are associated with poor adherence to the medication regimen and a high a rate of dropout from the treatment programme.

Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China.

OBJECTIVE Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. METHODS Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. RESULTS Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07-1.31). Self-stigma (OR=1.08, 95% CI: 1.01-1.15), depression (OR=1.11, 95% CI: 1.05-1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35-5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32-3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10-1.16), depression (OR=1.12, 95% CI: 1.04-1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09-4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. CONCLUSIONS There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.

Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China.

PURPOSE The purpose of this paper is to assess the effectiveness of school-based intervention aimed to increase knowledge, to change attitudes and to reduce smoking-related behavior in both Linzhi Tibetan and Guangzhou Han middle school students in China. DESIGN A concurrent intervention study was conducted in both Linzhi and Guangzhou. Two schools were randomly chosen and one was randomly assigned to the intervention group and the other to the control group in both settings. SETTING/PARTICIPANTS Participants were grade one and grade two middle school students drawn from two schools in Linzhi, Tibet Autonomous Region (southwest China) and two schools in Guangzhou, Guangdong Province (south China). INTERVENTION The intervention program lasted for one year and covered three aspects: health policies in school, health environment in school and personal health skills. MAIN OUTCOME MEASURES Primary outcomes were smoking-related knowledge, attitudes and behavior (including ever smoking, daily smoking, weekly smoking and current smoking) and were measured by a self-administered questionnaire before and after the intervention. RESULTS This intervention increased smoking-related knowledge in both Tibetan (β=1.32, 95% CI (0.87-1.77)) and Han ethnic groups (β=0.47, 95% CI (0.11-0.83)). It changed attitudes toward smoking in Tibetan (β=1.47, 95% CI (0.06-2.87)) but not so in Han (β=-0.33, 95% CI (-1.68-1.01)). The intervention changed the prevalence of smoking in neither ethnic groups (P>0.05). CONCLUSIONS The impact of school-based smoking intervention is different among Tibetan and Han students. This intervention was more effective for Tibetans when compared with the Han ethnic group. More research is needed on how intervention can be adapted to address ethnic and cultural differences.

The role of quality of care and attitude towards disability in the relationship between severity of disability and quality of life: findings from a cross-sectional survey among people with physical disability in China

BackgroundPeople with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD.MethodsA cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants’ QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL.ResultsEven with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD’s attitudes towards their own disability.ConclusionsUnfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD’s QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them.

Situation-specific factors predicting nonadherence to methadone maintenance treatment: a cross-sectional study using the case-crossover design in Guangzhou, China

Methadone maintenance treatment (MMT) is a key risk reduction measure for controlling HIV transmission among drug users. Studies using traditional methods exist to distinguish between drop outs and nondrop outs. However, many nondrop outs use MMT discontinuously and no study has identified situation-specific factors predicting their showing or not showing up. This study used a case-crossover design comparing situation-specific factors appearing on the last episode of attendance versus those of the last episode of nonattendance. A total of 133 participants were recruited from two MMT clinics in Guangzhou, China. Participants were asked separately whether various situation-specific factors existed in the last episodes of nonattendance and attendance of MMT. Matched odds ratios (ORs) based on conditional logistic regression analysis were presented. The results showed that the participants attended the MMT clinics on average for 25 days in the last month. Situation-specific factors significantly predicting nonattendance included: (1) physical and mental health status: in illness (OR = 33.0, P < 0.001), in a bad mood (OR = 7.5, P < 0.001), and occurrence of an unhappy event (OR = 18.0, P < 0.001); (2) other engagement: work engagement (OR = 40.0, P < 0.001), trip to other places (OR = 83.0, P < 0.001), and social activities (OR = 10.0, P = 0.012); (3) interpersonal relationship: conflicts with family (OR = 19.0, P = 0.004); and (4) structural situational factors: financial difficulty (OR = 19.0, P = 0.004) and worrying about police arrest (OR = 12.0, P = 0.003). Other factors such as interaction with drug users and heroin use were marginally significant, while reduced methadone dosage was nonsignificant. Interventions to improve MMT adherence need to consider situation-specific factors. Ancillary psychosocial services should be integrated with current MMT; MMT should also provide more flexible services to the clients. Furthermore, efforts should be taken to build up interdisciplinary teams and to connect with MMT in order to provide holistic harm reduction, rehabilitation, and health care.

Depression, suicidal ideation, and related factors of methadone maintenance treatment users in Guangzhou, China.

ABSTRACT Mental health problems are prevalent among drug users. Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction; however, there are few studies investigating depression, suicidal ideation, and their related factors among MMT users. In this cross-sectional study, 648 MMT users were recruited from six MMT clinics in Guangzhou, China. Data were collected through face-to-face interviews by trained interviewers. Of all participants, 270 (42.7%) exhibited probable depression (Depression Subscale of the Chinese short version of Depression, Anxiety, and Stress Scale (DASS-D), score ≥ 10) and 99 (15.3%) reported having suicidal ideation in the last six months. After adjusting for significant socio-demographic characteristics, all studied variables, including drug use history, social support, family support for MMT use, and satisfaction toward MMT services were significantly associated with both probable depression and suicidal ideation in the last six months. Furthermore, depression fully mediated the associations between drug use history, satisfaction toward MMT services, and suicidal ideation. In the final multivariate models, probable depression was associated with social support (OR = 0.88, 95% CI = 0.83–0.93) and satisfaction toward MMT services provided by doctors (OR = 0.59, 95% CI = 0.40–0.86), while for suicidal ideation, social support (OR = 0.85, 95% CI = 0.78–0.92) and probable depression (OR = 5.94, 95% CI = 3.39–10.42) were significant. The findings suggest that there are unmet mental health needs among MMT users. For countries with limited resources of psychological services, mental health care toward MMT users should be implanted into current health care settings and incorporate components such as social support, familys understanding of MMT, and service satisfaction.

Preventive Behaviors and Mental Distress in Response to H1N1 Among University Students in Guangzhou, China:

Objective. To investigate the level of and factors involved in influenza virus subtype H1N1 (H1N1)-related preventive behaviors and mental distress among university students in Guangzhou. Participants. Self-administered questionnaires were used to collect data for 825 students from 2 universities. Results. A total of 49.7% of the participants held misconception(s) concerning H1N1 transmission. Less than 30% washed their hands >10 times/d; 72.3% did not reduce the frequency of touching their mouths, noses, and eyes; only 9.3% would wear face masks if they had influenza-like symptoms. However, 45% worried that one/one’s family would contract H1N1, 10.7% were panicking/feeling depressed/feeling emotionally disturbed as a result of H1N1, and 14.9% were fearful about the WHO’s H1N1 pandemic announcement. Almost all cognitive variables of this study were significantly associated with mental distress caused by fear of H1N1 (odds ratio [OR] = 0.29-3.81), but very few were associated with adoption of preventive measures (OR = 0.65-1.90). Conclusions. Preventive measures are warranted to alleviate distress in the population studied via health education and promotion.

Anticipated Negative Responses by Students to Possible Ebola Virus Outbreak, Guangzhou, China.

To the Editor: In 2014, a serious Ebola virus disease (EVD) outbreak occurred in West Africa (1). In a study on EVD-related perceptions, 85% of US respondents mistakenly believed that EVD could be transmitted through airborne droplets from patients’ sneezes or coughs (2). EVD-related panic was reported in the United States (3) and the United Kingdom (4). During November 15–December 20, 2014, we conducted a cross-sectional survey of 1,295 undergraduate students in Guangzhou, China, where the population of immigrants from Africa is high, who had heard of EVD (Technical Appendix). Our aim was to measure students’ anticipated negative emotional responses and avoidance activities (dependent variables) to a possible outbreak of EVD (5). We constructed scales for the dependent and independent variables to assess EVD-related perceptions: 1) misconceptions/knowledge about transmission modes, 2) scenarios of an EVD outbreak in Guangzhou (chances, severity, control), 3) efficacy of preventive measures and self-protection, and 4) public stigma toward EVD survivors. MLwiN 2.30 (Centre for Multilevel Modeling, University of Bristol, Bristol, UK) was used for multilevel regression analyses (Technical Appendix). We analyzed data from 1,155 (89.2%) students who have heard of EVD. To the example of 2–3 EVD cases detected in Guangzhou, 31.0% showed >4 types of anticipated negative emotions (e.g., fear, panic, worry); 59.5% showed >3 types of anticipated unnecessary avoidance. Most (80.0%) indicated >1 misconception regarding transmission mode (e.g., believed it was droplet or waterborne) but knew that direct contact with the corpse of an infected person (69.0%) and body fluids (81.4%) could lead to infection and perceived EVD as fatal (85.6%,) and highly infectious (81.6%). About half of respondents believed that effective treatment and a vaccine were unavailable (51.9% and 59.1%, respectively); 22.2% anticipated EVD outbreaks among Africans in Guangzhou (during the next 12 months). Many students perceived severe consequences if a small EVD outbreak occurred in Guangzhou and believed an outbreak would have a high fatality rate (70.5%), EVD is highly infectious (65.4%), an outbreak would be of long duration (47.5%), and the number of infected persons would be high (39.9%); 52.5%–79.2% of respondents lacked confidence in the government’s ability to control an outbreak (e.g., ability to provide adequate vaccines, medication, protective gear). Half or more of respondents believed that restricting travel by Africans to and from Africa and avoiding visiting African-inhabited areas were effective means of prevention. About 40% were confident that they could protect themselves or family members from EVD (Technical Appendix Tables 1, 2). Older age, female sex, longer school years, and rural origin were associated with negative emotional responses, avoidance, or both (Technical Appendix Table 3). In multivariate analyses that adjusted for significant background variables, we found positive associations between both dependent variables and the following independent variables: perceived fatality of EVD, perceived nonavailability of treatment, misconceptions regarding modes of transmission, perceived severity of a Guangzhou outbreak, perceived efficacy of restricting Africans’ travel, perceived efficacy of avoiding African-inhabited areas, and public stigma toward EVD survivors. Confidence in governmental control was negatively associated with both dependent variables. Some variables were positively associated with emotional response but not avoidance (perceived irreversible harm, perceived chance of outbreak in Guangzhou and in other parts in China, perceived self-efficacy for protection); 2 variables (perceived nonavailability of vaccine and knowledge of transmission mode) were positively associated with avoidance measures but not with emotional responses (Table). Table Factors associated with anticipated responses to EVD, adjusted for sociodemographic variables, Guangzhou, China, 2014* Because EVD causes serious physical harm, negative emotional responses and unnecessary avoidance practices were anticipated. Such negative community responses might cause individual and societal harm, as witnessed during the epidemic of severe acute respiratory syndrome (6). Misconceptions concerning transmission modes were prevalent and significantly correlated with both dependent variables. More than 80% of respondents perceived that the virus was highly infectious, another significant factor. About 20% of participants believed that an EVD outbreak would occur in Guangzhou in the next year. Among all participants, many anticipated severe outcomes but were not confident that the government was prepared for and could control such an outbreak. The concentration of immigrants from Africa in this region might have increased perceived chances of an EVD outbreak and thus lead to avoidance of this population. The high percentages of those who believed that restricting Africans’ travel was effective also might result in discrimination. Public stigmatization toward EVD survivors, another significant factor, was a prominent attitude (7,8). Fear, misconceptions, and perceived likelihood of EVD to cause death may lead to patient stigmatizing, which could hinder case detection and patients’ service seeking. The relationship between stigmatization and EVD-related perceptions should be investigated. The study’s limitations included the inability to assess real responses, inability to generalize findings to all university students and the general public, and the use of scales that had not been validated. Also, some students might have given exaggerated responses. In summary, misconceptions and perceptions regarding EVD may result in negative community responses in Guangzhou. Health education is needed to clarify that EVD is not airborne or waterborne or highly infectious and that avoidance is not an effective preventive measure. In addition, the government should start developing and publicizing its preparedness plans. Technical Appendix. Detailed methods and background variables of the study participants in Guangzhou, China, the frequency distribution of items related to Ebola virus disease (EVD), associations between sociodemographic factors and anticipated responses to an EVD outbreak, and univariate associations between independent variables and anticipated responses to EVD by participants. Click here to view.(269K, pdf)

Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou, China

ABSTRACT A considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor–Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD = 15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, ORu = 0.96 and 0.96, p < .01). In multivariate models adjusting for both background and other psycho-social factors, resilience was independently associated with probable depression (ORa = 0.97, 95% CI: 0.93–0.99) and anxiety (ORa = 0.96, 95% CI: 0.94–0.99). Resilience was independently associated with depression and anxiety. As resilience is changeable, interventions targeting mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.