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Smoking raises the risk of cardiovascular diseases in active and passive smokers throughout life. Taking a life-course approach, we reviewed current literature on the familial and lifestyle factors of smoking initiation and cessation. Single-parent and parental smoking are risk factors of smoking in young people, while smoking cessation of parents and family support predict quitting in both young and adult smokers. Results on the familial influences on relapses are limited and mixed in adolescents and adults. Regarding behavioral factors, poor eating habits and alcohol drinking would increase, and a high physical activity level would decrease, the likelihood of smoking in both adolescents and adults. Nutritional status of children improves with parental smoking cessation. In addition, disordered eating may hinder smoking cessation in women. Familial and behavioral factors interplay in their associations with smoking initiation and cessation in the life-course, which warranted further investigations for formulating better smoking prevention and cessation programs.

Overdosing is an accessible method adopted by people attempting suicide in city settings.This study aimed to compare the trends and characteristics of people attempting suicide by drug overdose and by other methods in Singapore.This study examined the medical records of 628 patients who were admitted to a university hospital in Singapore, between January 2004 and December 2006. Patients were classified as overdose and non-overdose persons attempting suicide for comparisons of demographic and suicidal characteristics. Logistic regression was used to determine the odds ratios of various factors associated with self-perceived lethality of the suicide attempt. Patterns of monthly and weekly variations in the frequencies of suicide attempts were also analyzed.The percentages of Chinese people was higher in the non-overdose group (71.5% vs. 62.9%), while the percentages of Malay and Indian people were higher in the overdose group (31.6% vs. 18.5%). The female gender (OR=0.36, p=0.04) and admission of suicide intention (OR=7.11, p0.001) were significantly associated with higher perceived lethality of the suicide method in the non-overdose group. Suicide attempts occurred more frequently between May and November, and on Tuesdays.Gender and ethnic differences between overdose and non-overdose people attempting suicide were found. Temporal variations of suicidal cases were also noted.

Depressive disorder is treatable but costly, thus influencing quality of life of people.Determine direct and indirect costs incurred by depressive disorder in Singapore.A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined.Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs.Medical cost saving strategies should focus on indirect costs.

This study investigates the associations between percentage body fat (%BF) and anthropometric parameters in adolescents of mixed weight status. Anthropometric parameters including height, weight, and waist circumference (WC), and %BF were assessed in 903 Hong Kong Chinese students (mean age 14.7 years). The calculated body mass index (BMI) and waist-to-stature ratio (WSR) were used to classify students into different weight status groups and central obesity groups, respectively. The %BF/BMI and %BF/WC relationships were examined by partial correlation coefficients and linear regression models. The %BF correlated significantly with BMI, except in underweight boys. BMI predicted %BF better (adjusted R (2): 0.40 in boys; 0.85 in girls) than WC (adjusted R (2): 0.34 in boys; 0.63 in girls) or WSR (adjusted R (2): 0.33 in boys; 0.60 in girls). In general, BMI predicts %BF better than WC or WSR in Hong Kong adolescents, but these relationships are sex and weight status specific.

This study compared the nutritional status before pregnancy, as well as dietary profiles and biomarkers during first trimester, between never-smokers and antenatal quitters among Japanese women. One hundred fifty pregnant women (79 never-smokers and 71 antenatal quitters) from two obstetrics and gynecology clinics were recruited in Japan. Subjects' prepregnancy nutritional status was indicated by their body mass index (BMI). In the first trimester, their dietary profiles were assessed by the Brief Diet-History Questionnaire (BDHQ) and pregnancy outcomes were screened by biomarker tests. Generalized linear regression was used to examine the differences of energy-adjusted dietary intakes and biomarker results between the two smoking groups, with adjustment of maternal age, BMI, gestation week, and parity. The results showed that antenatal quitters were more likely to have a prepregnancy underweight status than never-smokers. During the first trimester, antenatal quitters had significantly higher intakes of unsaturated fatty acids and antioxidants (vegetable lipids and isoflavone), and lower intakes of total cholesterol than never-smokers. Moreover, antenatal quitters had a significantly higher level of serum homocysteine (6.36 nmol/mL vs 4.88 nmol/mL) than never-smokers. In conclusion, antenatal quitters are more likely to have a poor nutritional status before pregnancy than never-smokers. Quitting smoking before pregnancy and having a good nutritional profile during the trimester may not sufficiently reverse the adverse effects of former smoking behaviors on pregnancy outcomes.

BACKGROUND: Sleep problems may have different influences on students' academic performance. We investigated the prevalence of sleep patterns, naps, and sleep disorders, and their associations with academic performance in Hong Kong adolescents. METHODS: In 2007-2008, 22,678 students aged 12-18 (41.6% boys) completed a questionnaire on sociodemographic characteristics, sleep patterns and problems, and lifestyle factors including exercise, smoking, alcohol drinking, and academic performance. RESULTS: The prevalence of having >8 hours of sleep was higher on holiday nights (86.4%) than on school-day nights (27.4%). Sleeping after midnight was more common before holidays (49.3%) than before school days (19.9%). Symptoms of insomnia and obstructive sleep apnea (OSA) were reported by 21.5% and 34.4% of students. Having >2 hours of weekend sleep delay was associated with poor academic performance with an odds ratio (OR) (95% confidence interval) of 1.46 (1.29-1.65). However, having 1-2 hours and >2 hours of weekend wake-up delay were both associated with less likelihood of poor academic performance with ORs of 0.64 (0.56-0.73) and 0.69 (0.59-0.80). Other factors associated with poor academic performance included >2 hours of sleep debt, OR of 1.17 (1.03-1.33); having any insomnia symptoms in the past 30 days, OR of 1.27 (1.17-1.37); and having any OSA symptoms at least weekly, OR of 1.23 (1.14-1.32). Napping in the past 5 school days was only marginally associated with poor school performance with an OR of 1.08 (1.00-1.16). CONCLUSION: Poorer academic performance was associated with sleep debt, and symptoms of insomnia and OSA. Sleep compensation but not naps may be a protective factor of poor academic performance.

It remains unclear whether anxiety and depressive symptoms are more prevalent in adolescents with asthma when compared with healthy individuals. This meta-analysis aimed to evaluate the difference in the aggregate prevalence of depressive and anxiety symptoms between adolescents with asthma and healthy controls and to explore the underlying moderators that potentially explain the heterogeneity of the effect size. A meta-analysis of published work was performed using the random effects model. The differences in aggregate prevalence of depressive and anxiety symptoms between adolescents with asthma and healthy controls were determined. Meta-regression and subgroup analysis were performed to identify factors that may contribute to heterogeneity. A total of eight studies were eligible for analysis. The aggregate prevalence of depressive and anxiety symptoms was significantly higher among 3546 adolescents with asthma than that of 24,884 controls (depression, 0.27; 95% CI, 0.18.6-0.39 vs. 0.13; 95% CI, 0.09-0.19; anxiety, 0.33; 95% CI, 0.19-0.52 vs. 0.21; 95% CI, 0.12-0.33). The risk of developing depression and anxiety is significantly higher among adolescents with asthma when compared with controls (depression: pooled odds ratio, 2.09; 95% CI, 1.65-2.64; p < 0.001; anxiety: pooled odds ratio, 1.83; 95% CI, 1.63-2.07; p < 0.001). Meta-regression revealed that the proportions of Caucasian (p = 0.008) and smokers (p < 0.001) were significant moderators which explained the significant heterogeneity when comparing the risk of developing depressive symptoms among adolescent asthma patients vs. controls while age, gender, and severity of asthma were not significant. Family doctors, pediatricians, and healthcare providers should formulate strategies to detect depressive and anxiety symptoms in adolescents with asthma and offer psychological interventions to reduce the burden of psychiatric comorbidity.

A total of 4,746 Hong Kong students, aged 14–15, participated in the 2000–2001 Health Related Behavior Survey. Results produced by the logistic regression models revealed that non-private housing was significantly associated with ever-use of ecstasy in boys. Moreover, girls in non-private housing were significantly more likely to have been persuaded to use ecstasy, ketamine, and marijuana, as well as to have ever used ecstasy. Furthermore, having older siblings was significantly associated with ever-use of ecstasy in girls. These findings suggest that low family affluence and having older siblings may contribute to exposure to illicit drugs in early adolescence.

Background: Vaccination is an important preventive measure for preparing against the influenza pandemics. This study investigated the attitudes and perceptions of influenza vaccination among doctors and medical students in Hong Kong. Methods: A cross-sectional survey was conducted among 204 doctors and 242 medical students in a teaching hospital in 2009. Participants’ demographic and job characteristics, and influenza experience and vaccination in the previous year were assessed in the questionnaire. Logistic regression models were used to examine the associations between uptake of influenza vaccination and the perceived benefits. Results: Medical students were more likely to have receive an influenza vaccination in the previous year (66.9 vs. 39.7%) and acknowledged the related benefits than doctors. Moreover, uptake of influenza vaccine was associated with perceived benefits of vaccination in both doctors and medical students. Conclusions: The perceived benefits of influenza vaccination are an important factor in vaccine uptake for both doctors and medical students in Hong Kong, and should be reinforced in the professional training.

This study examined the associations of body esteem with gender, age, and Body Mass Index (BMI) among 905 Hong Kong adolescents using the Body-Esteem Scale (BES). Older age, male gender and lower BMI were associated with better body esteem. Multiple regression analyses indicated significant main effects of gender, age and weight on BES-Total. Significant interaction effects of gender × BMI and gender × age × BMI were also found on BES-Weight (beta = −0.149, p = .028) and BES-Total (beta = −0.139, p = .044). Improvement of body esteem with age may be associated with age-related BMI differences.

Background The psychometric properties of the Revised Restraint Scale (RRS) have been well established in western populations but not in Chinese adolescents. Purpose This study investigated the psychometric properties of RRS and its validity in different subgroups for Hong Kong Chinese adolescents. Method In 2007, 909 Hong Kong students aged 12 to 18 years (55.3% boys) completed a questionnaire including demographic items, RRS, Eating Attitudes Test (EAT-26), and Motivation for Eating Scale (MFES)-physical. Moreover, subjects’ height and weight were measured. To examine the factor structure of RRS, the whole sample was randomly split into two groups (sample 1: N=454 and sample 2: N=455) for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Convergent and discriminant validity of RRS were investigated by correlating the RRS with EAT-26 and MFES-physical. Multigroup CFA was conducted to test the three-factor model of RRS in different sex, age, and weight status subgroups. Results Results of EFA for sample 1 revealed three strongly correlated factors for the RRS construct, and were supported by the CFA results in sample 2. Multigroup CFA further suggested that the three-factor model of RRS was stable across sex, age, and weight status subgroups. Conclusions A new three-factor model is proposed for Hong Kong adolescents in this study. In general, RRS is a reliable and valid measure of restrained eating for adolescents, regardless of sex, age, and weight status.

This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed.

The Revised Chen Internet Addiction Scale (CIAS-R) was developed to assess Internet addiction in Chinese populations, but its psychometric properties in adolescents have not been examined. This study aimed to evaluate the factor structure and psychometric properties of CIAS-R in Hong Kong Chinese adolescents. 860 Grade 7 to 13 students (38 % boys) completed the CIAS-R, the Young’s Internet Addiction Test (IAT), and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a survey. The prevalence of Internet addiction as assessed by CIAS-R was 18 %. High internal consistency and inter-item correlations were reported for the CIAS-R. Results from the confirmatory factor analysis suggested a four-factor structure of Compulsive Use and Withdrawal, Tolerance, Interpersonal and Health-related Problems, and Time Management Problems. Moreover, results of hierarchical multiple regression supported the incremental validity of the CIAS-R to predict mental health outcomes beyond the effects of demographic differences and self-reported time spent online. The CIAS is a reliable and valid measure of internet addiction problems in Hong Kong adolescents. Future study is warranted to validate the cutoffs of the CIAS-R for identification of adolescents with Internet use problems who may have mental health needs.

The relationships between self-estimated adiposity using Stunkard's body silhouette scale with general and central adiposity in adolescents are unclear. This study examines the criterion validity of Stunkard's body silhouette scale as a self-estimated rating of adiposity against anthropometric measures of adiposity and percentage body fat in Hong Kong adolescents.The body composition of 903 adolescents (55.7% boys) was assessed by measured waist circumference (WC), waist-to-stature ratio (WSR), body mass index (BMI) and percentage body fat (%BF). Self-estimated adiposity was subjectively assessed using Stunkard's body silhouette scale. The association between self-estimated adiposity and body composition was examined by Spearman correlation coefficients and hierarchical multiple regression analyses.Self-estimated adiposity correlated significantly and positively with BMI (boys: r = 0.65; girls: r = 0.59), WC (boys: r = 0.62; girls: r = 0.51), WSR (boys: r = 0.55; girls: r = 0.42) and %BF (boys: r = 0.47; girls: r = 0.55).Self-estimated adiposity using the Stunkard's body silhouette scale was positively associated with actual measures of adiposity; however, the association was modest at best. It is unlikely that the Stunkard's body silhouette scale provides a suitably accurate substitute for actual body composition measures in Chinese adolescents.

Purpose This study aimed (1) to compare the skeletal maturity and activity participation pattern between children with and without developmental coordination disorder (DCD); and (2) to determine whether activity participation pattern was associated with the skeletal development among children with DCD. Materials and methods Thirty-three children with DCD (mean age: 7.76 years) and 30 typically developing children (mean age: 7.60 years) were recruited. Skeletal maturity was assessed with the Sunlight BonAge system. Motor ability was evaluated by the Movement assessment battery for Children-2 (MABC-2). Participation patterns were evaluated using the Children Assessment of Participation and Enjoyment assessment. Analysis of variance was used to compare the outcome variables between the two groups. Multiple regression analysis was performed to examine the relationship between skeletal development, motor performance and activity participation intensity in children with DCD. Results The DCD group had significantly delayed skeletal development, lower MABC-2 derived scores, and participated less intensely in various types of physical activities than their typically developing peers. After accounting for the effects of age and sex, activity participation intensity score remained significantly associated with delay in skeletal development, explaining 28.0% of the variance ( F change1, 29 = 11.341, p = 0.002). Conclusion Skeletal development is delayed in pre-pubertal children with DCD. Limited activity participation intensity appears to be one of the contributing factors.

BACKGROUND: Tobacco smoke has detrimental effects on the respiratory system. This study investigated the associations of active and passive smoking with asthma symptoms in Hong Kong adolescents. METHODS: A total of 6,494 Hong Kong secondary school students, with a mean SD age of 15.0 1.21 years, participated in the Health Related Behavior General Survey in 2000–2001. They reported their demographic factors (sex, age, housing type, district of living), lifestyles (smoking, drinking, extracurricular sports, eating), and asthma symptoms (exercise-induced bronchospasm [EIB] and nocturnal cough) in the questionnaire. In addition, number of smoking parents (none/one/both) and presence of a smoking best friend (yes/no) were assessed. Logistic regression models were used to determine the odds ratios (OR) of frequently having the asthma symptoms for different smoking status of students, parents, and best friend, with adjustment for demographic factors and lifestyles. RESULTS: The prevalence of former, light, and heavy smokers was 17.5%, 7.7%, and 1.0%, respectively. Moreover, 35.1% of the participants had one and 3.8% had 2 parents who smoked. Heavy smokers were more likely to experience EIB with OR (95% CI) of 2.27 (1.30–3.97) and nocturnal cough with OR (95% CI) of 3.45 (1.52–7.81), as well as both symptoms with OR (95% CI) 4.69 (1.88–11.73) when compared to those who never smoked. The corresponding OR (95% CI) for having at least one smoking parent and a smoking best friend was 1.45 (1.17–1.81), 1.61 (1.06–2.42), and 2.43 (1.37–4.31), when compared with those without a parent or best friend who smoked. CONCLUSIONS: Adolescents who are heavy smokers and having parents and a best friend who smoke are more likely than others to have asthma symptoms. Both active and passive smoking are related to asthma symptoms in adolescents. Key words: active smoking; passive smoking; asthma symptoms; adolescents. [Respir Care 2012;57(9):1398–1404. © 2012 Daedalus Enterprises]

Most reviews on weight status have focused on obesity, and little information on underweight children is available. This review aimed to examine the prevalence and trends of underweight status among Asian children and adolescent populations in the last two decades. A systematic review of publications between the years 1990 and 2010 was conducted. Underweight in children and adolescents was relatively more prevalent in the South and West Asian countries than in the East Asian countries. In general, underweight was more prevalent in boys within the South and West Asian countries, while it was more prevalent in girls within the East Asian countries. Increasing trends of prevalence of underweight were common among children and adolescents in South and West Asia. Specific public health policies should be formulated to combat the underweight problems in less-developed countries.

To examine the percentile distribution of waist-to-stature ratio (WSR) and derive WSR cut-offs for underweight, normal weight, and overweight based on the International Obesity Task Force (IOTF) and local weight-for-height standards in Hong Kong Chinese adolescents.In the Hong Kong Student Obesity Surveillance project in 2006-2007, height, weight and waist circumference of 13 568 (40.3% boys) Chinese adolescents aged 12-18 were measured. Smoothed percentile distributions of WSR by age and sex were examined using Lambda-Mu-Sigma (LMS) regression. The sex- and age-specific WSR values corresponding to underweight and overweight, as defined by the IOTF and local weight-for-height standards, were determined using receiver operating characteristic curves.The percentile values of WSR were stable across age in both sexes. In general, WSR values of 0.40 and 0.46 corresponded to underweight and overweight, respectively, as defined by both IOTF and local weight-for-height standards. As a reference for normal weight status, the median weight-for-height values corresponded to a WSR value of 0.42 in most sex-age subgroups.Sex and age independent WSR cut-off values for underweight, median weight and overweight in Hong Kong adolescents were identified. WSR is potentially a practical indicator for adolescents to monitor their weight status.

Background. This study was designed to investigate the relation between health-related physical fitness and weight status in Hong Kong adolescents. Methods. 3,204 students aged 12-18 years participated in the Hong Kong Student Obesity Surveillance (HKSOS) project in 2006-2007. Anthropometric measures (height, weight) and health-related fitness (push-up, sit-up, sit-and-reach, 9-minute run) were assessed. Body mass index (BMI) was computed to classify participants into normal weight, underweight (Grade I, II/III), overweight, and obese groups. The associations of health-related physical fitness with BMI and weight status were examined by partial correlation coefficients and analysis of covariance, respectively. Results. More boys than girls were overweight or obese (18.0% vs 8.7%), but more girls than boys were underweight (22.3% vs 16.7%). Boys performed significantly (P < 0.001) better in sit-up (38.8 vs 31.6 times/min) and 9-minute run (1632.1 vs 1353.2 m), but poorer in sit-and-reach (27.4 vs 32.2 cm) than girls. All four physical fitness tests were significantly positively correlated with each other in both sexes, and BMI was only weakly correlated with sit up and sit-and-reach tests in boys. Decreasing performance (P for trend < 0.05) was observed from normal weight to overweight and obese for push-up, sit-up, and 9-minute run in both sexes. From normal weight to Grade I and Grade II/III underweight, decreasing performance (P for trend < 0.05) for sit-up and sit-and-reach in both sexes and for push-up in boys was observed. Conclusions. The relations between BMI and health-related physical fitness in adolescents were non-linear. Overweight/obese and underweight adolescents had poorer performance in push-up and sit-up tests than normal weight adolescents. Different aspects of health-related physical fitness may serve as immediate indicators of potential health risks for underweight and overweight adolescents. © 2010 Mak et al; licensee BioMed Central Ltd., published_or_final_version

BACKGROUND: Weight comments are commonly received by adolescents, but the accuracy of the comments and their effects on weight misperception are unclear. We assessed the prevalence and accuracy of weight comments received by Chinese adolescents from different sources and their relation to weight misperception. METHODS: In the Hong Kong Student Obesity Surveillance (HKSOS) project 2006-07, 22612 students aged 11-18 (41.5% boys) completed a questionnaire on obesity. Students responded if family members, peers and professionals had seriously commented over the past 30 days that they were 'too fat' or 'too thin' in two separate questions. The accuracy of the comments was judged against the actual weight status derived from self-reported height and weight. Self-perceived weight status was also reported and any discordance with the actual weight status denoted weight misperception. Logistic regression yielded adjusted odd ratios for weight misperception by the type of weight comments received. RESULTS: One in three students received weight comments, and the mother was the most common source of weight comments. Health professional was the most accurate source of weight comments, yet less than half the comments were correct. Adolescents receiving incorrect comments had increased risk of having weight misperception in all weight status groups. Receiving conflicting comments was positively associated with weight misperception among normal weight adolescents. In contrast, underweight and overweight/obese adolescents receiving correct weight comments were less likely to have weight misperception. CONCLUSION: Weight comments, mostly incorrect, were commonly received by Chinese adolescents in Hong Kong, and such incorrect comments were associated with weight misperception., published_or_final_version

Background: This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature.Methods: Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR).Results: Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001).Conclusions: IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety. © 2014 Ho et al.; licensee BioMed Central Ltd.

BACKGROUND: The family plays a vital role in shaping adolescent behaviours. The present study investigated the associations between family structure and substance use among Hong Kong Chinese adolescents. METHODS: A total of 32,961 Form 1 to 5 (grade 7-12 in the US) Hong Kong students participated in the Youth Smoking Survey in 2003-4. An anonymous questionnaire was used to obtain information about family structure, daily duration of parent-child conversation, smoking, alcohol drinking and drug use. Logistic regression was used to calculate the adjusted odds ratios (OR) for each substance use by family structure. RESULTS: Adjusting for sex, age, type of housing, parental smoking and school, adolescents from non-intact families were significantly more likely to be current smokers (OR = 1.62), weekly drinkers (OR = 1.72) and ever drug users (OR = 1.72), with significant linear increases in ORs from maternal, paternal to no-parent families compared with intact families. Furthermore, current smoking (OR = 1.41) and weekly drinking (OR = 1.46) were significantly more common among adolescents from paternal than maternal families. After adjusting for parent-child conversation time, the ORs for non-intact families remained significant compared with intact families, but the paternal-maternal differences were no longer significant. CONCLUSIONS: Non-intact families were associated with substance use among Hong Kong Chinese adolescents. The apparently stronger associations with substance use in paternal than maternal families were probably mediated by the poorer communication with the father., published_or_final_version

Background Peer review is the major method used by biomedical journals for making the decision of publishing an article. This cross-sectional survey assesses views concerning the review system of biomedical journals among academics globally. Methods A total of 28,009 biomedical academics from high-ranking universities listed by the 2009 Times Higher Education Quacquarelli Symonds (THE-QS) World University Rankings were contacted by email between March 2010 and August 2010. 1,340 completed an online survey which focused on their academic background, negative experiences and views on biomedical journal peer review and the results were compared among basic scientists, clinicians and clinician scientists. Results Fewer than half of the respondents agreed that the peer review systems of biomedical journals were fair (48.4%), scientific (47.5%), or transparent (25.1%). Nevertheless, 58.2% of the respondents agreed that authors should remain anonymous and 64.4% agreed that reviewers should not be disclosed. Most, (67.7%) agreed to the establishment of an appeal system. The proportion of native English-speaking respondents who agreed that the “peer review system is fair” was significantly higher than for non-native respondents (p = 0.02). Similarly, the proportion of clinicians stating that the “peer review system is fair” was significantly higher than that for basic scientists and clinician-scientists (p = 0.004). For females, (β = −0.1, p = 0.03), the frequency of encountering personal attacks in reviewers’ comments (β = −0.1, p = 0.002) and the frequency of imposition of unnecessary references by reviewers (β = −0.06, p = 0.04) were independently and inversely associated with agreement that “the peer review system is fair”. Conclusion Academics are divided on the issue of whether the biomedical journal peer review system is fair, scientific and transparent. A majority of academics agreed with the double-blind peer review and to the establishment of an appeal system. Female academics, experience of personal attacks and imposition of unnecessary references by reviewers were related to disagreement about fairness of the peer review system of biomedical journals.