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BACKGROUND AND AIMS Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers. DESIGN Three-arm cluster-randomized trial. SETTING General community in Hong Kong. PARTICIPANTS Daily cigarette smokers (n = 1163; 77.7% male). INTERVENTIONS Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383). MEASUREMENTS The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months. FINDINGS Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P

Aims and objectives This study mapped the quitting patterns (trajectories) of Hong Kong Chinese women smokers who had received counselling via a quitline service and examined factors correlated with different trajectories. Background Quitting smoking is always a gradual and progressive process. However, most existing studies on smoking cessation have adopted a cross-sectional approach to conduct evaluation. Little is known about the quitting trajectories of smokers, particularly those who are women after receiving smoking cessation counselling. Methods We used a retrospective longitudinal design and analysed 474 women smokers who had called the quitline. Quitting trajectories were mapped using latent growth modelling. Multinomial logistic regression was performed to identify factors associated with class membership. A STROBE checklist was completed. Results We identified three trajectory groups: 'quitters' who quit smoking at 6 months and abstained from cigarettes up to 6 years; 'reducers' who cut down cigarette consumption ≥50% at 3 years and maintained reduced levels up to 6 years; and 'increasers' who increased smoking ≥20% at 3 years and continued smoking up to 6 years. Participants who perceived more difficulties in quitting were more likely to be increasers. Those with higher daily cigarette consumption at baseline were more likely to be reducers. Conclusions We clarified three trajectory groups of women smokers. The results indicate that existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling. Relevance to clinical practice Existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling. For those who reduce smoking but fail to quit, quit plans should be developed that provide step-by-step guidance in achieving abstinence through smoking reduction. Instant messages may complement telephone counselling to deliver cessation support for those who increase their cigarette consumption.

Background and aims Few studies have investigated the effects of problematic smartphone use (PSU) in the family context. We studied the association of PSU as a predictor with family well-being and the potential mediating role of family communication in Hong Kong Chinese adults. Methods We analyzed data of 5,063 randomly selected adults [mean age (SD) = 48.1 (18.2) years; 45.0% men] from a dual landline and mobile telephone survey in 2017. PSU was assessed by the Smartphone Addiction Scale-Short Version with higher scores indicating higher levels. Family well-being was assessed by three questions on perceived family health, harmony, and happiness (3Hs) with higher scores indicating greater well-being. Perceived sufficiency and quality of family communication were rated. Multivariable regression analyses examined (a) associations of PSU with family 3Hs and well-being and (b) mediating role of family communication, adjusting for sociodemographic variables. Results PSU was negatively associated with perceived family health (adjusted β = −0.008, 95% CI = −0.016, −0.0004), harmony (adjusted β = −0.009, 95% CI = −0.017, −0.002), happiness (adjusted β = −0.015, 95% CI = −0.022, −0.007), and well-being (adjusted β = −0.011, 95% CI = −0.018, −0.004). Perceived family communication sufficiency (adjusted β = −0.007, 95% CI = −0.010, −0.005) and quality (adjusted β = −0.009, 95% CI = −0.014, −0.005) mediated the association of PSU with family well-being, with 75% and 94% of total effects having mediated, respectively. Discussion and conclusions PSU was negatively associated with family well-being, which was partially mediated by family communication. Such findings provide insights for health programs to prevent PSU and improve family well-being.

To understand the risk perceptions, behaviour, attitudes, and experiences related to smoking among hospitalized Chinese smokers.Understanding hospitalized smokers' perceptions of risks associated with smoking, along with their behaviour, attitudes, and smoking-related experiences, is essential prerequisite to design effective interventions to help them quit smoking.A phenomenological research design was adopted.A purposive sampling approach was used. Between May 2016-January 2017, 30 hospitalized smokers were invited for an interview.Four themes were generated: (a) associations between perception of illness and smoking; (b) perceived support from healthcare professionals to quit smoking; (c) impact of hospitalization on behaviour, attitudes, and experiences; and (d) perceived barriers to quitting smoking.Development of an innovative intervention that helps to demystify misconceptions about smoking through brief interventions and active referrals is recommended to enhance the effectiveness of healthcare professionals promoting smoking cessation for hospitalized smokers.To date, no study examining smoking behaviour among hospitalized patients in Hong Kong has been conducted. Misconceptions about smoking and health, barriers to quitting that outweighed perceived benefits, lack of support from healthcare professionals, and difficulty overcoming withdrawal symptoms or cigarette cravings precluded hospitalized smokers sustaining smoking abstinence after discharge. Smoking is detrimental to physical health. Smoking cessation has beneficial effects on treatment efficacy and prognosis and helps to reduce the economic burden on society from smoking-attributable diseases.目的: 为了解中国住院吸烟者与吸烟相关的风险认知、行为、态度和经验。 背景: 了解住院吸烟者对吸烟相关风险的认知,以及他们的行为、态度和与吸烟相关的经验,是设计有效干预措施帮助他们戒烟的必要前提。 设计: 采用现象学研究设计。 方法: 采用有目的抽样法。2016年5月至2017年1月期间,30名住院吸烟者应邀接受采访。 结果: 产生了四个主题:(a)疾病认知与吸烟的关系;(b)医疗专业人员对戒烟的支持;(c)住院对行为、态度和经验的影响;以及(d)戒烟的障碍。 结论: 建议制定一项创新的干预措施,通过简短的干预措施和积极的转介,帮助消除对吸烟的误解,以提高医疗保健专业人员促进住院吸烟者戒烟的效果。 影响: 迄今为止,我们并没有就香港住院病人的吸烟行为进行研究。对吸烟与健康的误解、戒烟的障碍超过了预期的好处、缺乏保健专业人员的支持、难以克服戒断症状或吸烟欲望,这些都妨碍了住院吸烟者出院后保持戒烟。吸烟有害身体健康。 戒烟对治疗效果和预后有良好的影响,有助于减轻吸烟引起的疾病给社会带来的经济负担。.

Background: Problematic smartphone use (PSU) has been associated with screen time in general, but little is known about the effect of different screen-based activities. We examined the associations of self-reported time spent on overall and specific screen-based activities with PSU and its addictive symptoms in Hong Kong Chinese adults.Methods: We analyzed data from 562 smartphone owners (56.5% female; 82.1% aged 25–64 years) in a population-based telephone survey in 2017. PSU was measured using Smartphone Addiction Scale-Short Version (range 10–60) which includes symptoms of daily-life disturbance, withdrawal, cyberspace-oriented relationship, overuse, and tolerance. Screen time was self-reported as average hours per day spent on the internet, online book/newspaper/magazine, online video, and social networking sites (SNS). Multivariable linear regression analyzed the associations of self-reported screen time with PSU severity and symptoms. Interaction effects of sex, age group, educational attainment, and monthly household income were examined.Results: Self-reported time spent on overall screen-based activities was associated with PSU severity (β = 1.35, 95% CI 0.15, 2.55) and withdrawal and overuse symptoms, after adjusting for sociodemographic and health-related variables. Independent association was observed for self-reported SNS time with PSU severity (β = 1.42, 95% CI 0.35, 2.49) and symptoms of withdrawal and cyberspace-oriented relationship, after mutually adjusting for time on other activities. The strongest association between self-reported SNS time and PSU severity was observed in younger than older adults (β = 4.36, 95% CI 2.58, 6.13; P for interaction = 0.004).Conclusions: The independent association of self-reported SNS time with PSU and core addictive symptoms highlighted the addiction potential of SNS use, particularly in younger users.

Background Inequalities in health information seeking behaviors (HISBs) using mass media and internet websites (web 1.0) are well documented. Little is known about web 2.0 such as social networking sites (SNS) and instant messaging (IM) and experiences of HISBs. Methods We surveyed representative Hong Kong Chinese adults (N = 10143, 54.9% female; 72.3% aged 25–64 years) on frequency of HISBs using traditional sources, internet websites, SNS (e.g., Facebook, Twitter), and IM (e.g., WhatsApp, WeChat) and experiences measured using Information Seeking Experience Scale. Adjusted prevalence ratios (aPRs) for HISBs and experiences by sociodemographic and health-related characteristics were yielded using multivariable Poisson regression with robust variance estimators. aPRs for experiences by HISBs using internet websites, SNS, and IM adjusting for sociodemographic and health-related characteristics were also yielded. Results Being female, higher educational attainment, not smoking, and being physically active were associated with HISBs using any source (all PP for trend = 0.03), internet websites (P for trendP for trendP for trendP for trend = 0.003). Compared with internet websites, HISBs using IM was associated with feelings of frustration (aPR = 1.39, 95% CI 1.08, 1.79), difficulties in understanding the information (aPR = 1.36, 95% CI 1.12, 1.65), and quality concern (aPR = 1.20, 95% CI 1.08, 1.32). Conclusions We identified correlates of web-based health information seeking and experiences in Hong Kong Chinese adults. Providing greater access to and improved information environment of web 2.0 to the target groups may help address digital inequalities.

Background and aims Problematic smartphone use (PSU) is an emerging but understudied public health issue. Little is known about the epidemiology of PSU at the population level. We evaluated the psychometric properties of the Smartphone Addiction Scale – Short Version (SAS-SV) and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong. Methods A random sample of 3,211 adults aged ≥18 years (mean ± SD: 43.3 ± 15.7, 45.3% men) participated in a population-based telephone survey in Hong Kong and completed the Chinese SAS-SV. Multivariable linear regressions examined the associations of sociodemographic factors, health behaviors, and chronic disease status with SAS-SV score. Data were weighted by age, sex, and education attainment distributions of the Hong Kong general population. Results The Chinese SAS-SV is internally consistent (Cronbach’s α = .844) and stable over 1 week (intraclass correlation coefficient = .76, p ps Discussion and conclusions The Chinese SAS-SV was found valid and reliable for assessing PSU in Hong Kong adults. Several sociodemographic and health behavioral factors were associated with PSU at the population level, which may have implication for prevention of PSU and future research.

PURPOSE: Family happiness is one major theme of family well-being in Chinese culture. We investigated the reliability and validity of the single-item Self-reported Family Happiness Scale (SFHS-1) with the score of 0-10, based on two studies in Hong Kong Chinese. METHODS: Study 1 was a territory-wide population-based telephone survey (n = 4038) conducted in 2016. Study 2 was a community-based family intervention program conducted during 2012-2013 (n = 1261) to enhance family communication and well-being. Test-retest reliability of the SFHS-1 was assessed over 1 month in Study 2. Family APGAR (Adaption, Partnership, Growth, Affection, Resolve) Scale, Family Communication Scale, Subjective Happiness Scale, 12-item Short Form Health Survey Version 2, and 2-item Patient Health Questionnaire were used to assess the convergent and discriminant validities of the SFHS-1 in both studies. Multiple regression analysis was used to assess the incremental validity by identifying the additional contribution of the SFHS-1 score in predicting subjective happiness. RESULTS: The 1-month test-retest reliability assessed by intraclass correlation was 0.76. Family happiness was moderately to strongly correlated with family function, family communication, subjective happiness, mental health-related quality of life and depression, but weakly correlated with physical health-related quality of life. Furthermore, the score of the SFHS-1 added predictive power to mental health-related quality of life and depression in assessing subjective happiness. CONCLUSIONS: Our results have shown the SFHS-1 as a reliable and valid measurement of family happiness in Hong Kong Chinese, suggesting SFHS-1 is highly practicable for future large epidemiological and community-based intervention studies.

The literature has provided substantial evidence for the positive associations between family meals and well-being. The underlying mechanism of this relationship has not been explicitly examined. The Happy Family Kitchen II project was a cluster randomized controlled trial of a community-based family intervention. Using data from this project, this article examined the direct and indirect associations among family meal practices, family communication time and quality, and well-being in Hong Kong. A total of 1,261 participants completed a self-administered questionnaire at baseline, 4 weeks, and 12 weeks. Cross-sectional and prospective mediation analyses showed that family meal and family meal preparation indirectly influenced family health, happiness and harmony, subjective happiness, and mental and physical quality of life through their effects on family communication quality. In contrast, family communication time was a weaker mediator of these effects. These findings highlight the role of quality rather than quantity of family communication in promoting well-being.

Objectives To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. Methods A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. Results At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). Conclusion These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. Practice implications It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients., published_or_final_version

This qualitative study describes participants' experiences with a community-based family intervention. Guided by a positive psychology framework, the brief intervention was designed to enhance positive communication among family members using cooking and dining as a platform. Our interest was in understanding perceptions of benefits and barriers, with the intention of improving future development of communitybased family programs. Purposive sampling was used to recruit focus group participants from those who had participated in the family programs. Overall, 10 focus groups including 65 participants were conducted from April to July 2013. Thematic analysis of the focus groups suggested that the intervention was effective in promoting positive communication, increasing the use of age-appropriate parenting practices, and promoting quality family mealtime. These changes in turn led to perceived positive outcomes by our participants, including a sense of happiness and enhanced family relationship. Cultural and gender beliefs were identified as challenges and are important to consider for future family interventions. Time constraint was further highlighted as an important consideration both in the context of integrating skills into the family routine as well as a barrier to participation in family programs. Our findings add to the small but steadily increasing body of knowledge, especially from qualitative studies, on the effectiveness of brief family interventions.

Positive psychology interventions commonly involve behavioral exercises to improve psychosocial well-being. Intervention effect on behavior is unclear. The Happy Family Kitchen project, one of the community-based brief intervention projects under The FAMILY: A Jockey Club Initiative for a Harmonious Society, was conducted in Hong Kong to develop and evaluate the effectiveness of a positive psychology family intervention. We have previously reported positive intervention effects on family communication, family well-being, and subjective happiness. This paper aims to explore the effectiveness of the intervention on behavioral outcomes and their associations with psychosocial well-being. A total of 23 social service units organized and conducted intervention programs for 1419 individuals from 612 families in Hong Kong. Each intervention was developed with emphasis on one of five positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at pre-intervention, immediate post-intervention, and 6 weeks and 12 weeks post-intervention. Results showed that family communication time and frequency of meal preparation with family members increased with sustainable small effects up to 12 weeks. Theme-specific behavior change was observed in the gratitude, flow, and happiness interventions, respectively. Family communication time, frequency of eating with family members, and theme-specific behaviors, including gratitude, flow, happiness behavior, health attitude, and health behavior, were positively associated with psychosocial well-being. Qualitative data provided additional evidence of effectiveness with in-depth insights into behavior change. The positive associations between target behaviors and well-being suggest that improvements in well-being as a function of the intervention may be associated with behavior change.

Purpose The psychological and social factors associated with smoking initiation and continuation are different for young and adult smokers. Before 2005, there were no population-based smoking cessation interventions targeting young smokers in Hong Kong, China. This study describes the processes and outcomes of an individualized "Youth Quitline" service for young Hong Kong Chinese smokers over a 10-year period. Methods A retrospective population-based study was conducted to evaluate the effectiveness of the Quitline and identify the predictors of quitting. Telephone records were used to obtain information of each call. Young smokers of the Quitline completed a questionnaire at baseline and 6-month follow-up. Data were collected between August 2005 and August 2015. Results Over the 10-year period, the Youth Quitline received 7,720 telephone inquiries and provided smoking cessation counseling to 1,684 young smokers. At the 6-month follow-up, 16.9% had reduced cigarette consumption by more than 50%, 33.8% had tried quitting, and 23.6% had successfully quit smoking. Logistic regression analyses indicated that 7 factors, including (1) age; (2) daily cigarette consumption; (3) level of nicotine dependence; (4) intention to quit; (5) having made at least one quit attempt; (6) level of self-efficacy; and (7) adherence to telephone counseling, significantly predicted smoking cessation at 6 months. Conclusions During the first 10 years of the Youth Quitline, we trained many youths to become smoking cessation peer counselors. The Youth Quitline successfully increased youths' awareness of the risks of smoking and smoking cessation services and provided individualized smoking cessation counseling services to young smokers.

Problematic smartphone use (PSU) has been associated with anxiety and depression, but few explored its mental well-being correlates that could co-occur with or be independent of mental symptoms. We studied the associations of PSU with anxiety, depression, and mental well-being in Hong Kong Chinese adults in a probability-based survey (N = 4054, 55.0% females, mean age &plusmn, SD 48.3 &plusmn, 18.3 years). PSU was measured using Smartphone Addiction Scale-Short Version. Anxiety and depression symptoms were evaluated using General Anxiety Disorder screener-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). Mental well-being was measured using Subjective Happiness Scale (SHS) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Multivariable regression analyzed associations adjusting for sociodemographic and lifestyle-related variables. Associations of PSU with mental well-being were stratified by symptom severity of anxiety (GAD-2 cutoff of 3) and depression (PHQ-2 cutoff of 3). We found that PSU was associated with higher odds of anxiety and depression symptom severity and lower scores of SHS and SWEMWBS. Associations of PSU with lower SHS and SWEMWBS scores remained in respondents who screened negative for anxiety or depression symptoms. To conclude, PSU was associated with anxiety, depression, and impaired mental well-being. Associations of PSU with impaired mental well-being could be independent of anxiety or depression symptoms.

Clinicians have an opportunity to provide smoking cessation interventions to smokers who present to emergency departments (EDs). The effectiveness of a brief intervention based on self-determination theory for smoking cessation is uncertain.To examine the effectiveness of a brief intervention based on self-determination theory for smoking cessation (immediate or progressive) among Chinese smokers presenting at EDs in Hong Kong.This single-blind, multicenter intent-to-treat randomized clinical trial was conducted at the EDs of 4 major acute care hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major EDs between July 4, 2015, and March 17, 2017, were randomized into an intervention group (n = 787) and a control group (n = 784).The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet.Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months.Participants (N = 1571) included 1381 men (87.9%); the mean (SD) age at baseline was 47.4 (16.4) years. Among participants who self-reported abstinence at 6 months, 50.3% (85 of 169) had biochemical validation by both an exhaled carbon monoxide test and a saliva cotinine test. Compared with the control group, the intervention group had statistically higher biochemically validated abstinence at 6 months: 6.7% (53 of 787) vs 2.8% (22 of 784) (P .001), with an adjusted relative risk of 3.21 (95% CI, 1.74-5.93; P .001). The intervention group also had higher self-reported quit rates at 6 months (12.2% [96 of 787] vs 9.3% [73 of 784], P = .04) and 12 months (13.0% [102 of 787] vs 8.5% [67 of 784], P .01), as well as higher biochemically validated abstinence at 12 months (7.0% [55 of 787] vs 3.7% [29 of 784], P .001). The additional cost for each intervention group participant was US $0.47, with an estimated gain of 0.0238 quality-adjusted life-year. The incremental cost per quality-adjusted life-year (US $19.53) fell within acceptable thresholds.This brief, low-cost self-determination theory-based intervention for smokers presenting at EDs effectively increased the biochemically validated quit rate at 6 months. If delivered routinely, such a simple intervention may offer a cost-effective and sustainable approach to help many smokers quit smoking.ClinicalTrials.gov identifier: NCT02660957.

Study objective: To examine the association of sleep duration and insomnia symptoms with happiness. Methods: A random sample of 1691 Chinese adult (mean age 54 &plusmn, 20.1, male 51%) were interviewed in a population-based telephone survey. Happiness was measured by the subjective happiness scale (SHS) and the one-item global happiness index (GHI). Information on sleep included mean past seven-day sleep duration (&lt, 6 h, &ge, 6 to &lt, 8 h and &ge, 8 h) and insomnia symptoms: Difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA). Adjusted beta-coefficient (&beta, ) of SHS and adjusted odds ratio (aOR) of GHI in relation to sleep problems were calculated. Interaction effects by age (18&ndash, 65 vs. &ge, 65) and by sex were assessed. Results: Compared to &ge, 8 h of sleep, having &lt, 6 h of sleep had lower SHS (adjusted &beta, &minus, 0.32, 95% CI &minus, 0.46 to &minus, 0.17) and GHI (aOR 0.54, 95% CI 0.38 to 0.78). The associations were stronger in younger adults and in women (p &lt, 0.05). DIS, DMS, and EMA were associated with lower SHS (adjusted &beta, ranged from &minus, 0.20 to &minus, 0.06) and GHI (aOR ranged from 0.57 to 0.89). Dose-response association between the number of insomnia symptoms and lower SHS was observed (p &lt, 0.001). These associations were generally stronger in older adults and among women. Conclusions: Lower levels of happiness were observed, particularly in younger adults and females with short sleep duration and older adults and females with insomnia symptoms. Prospective studies are needed to confirm the findings and understand the mechanisms between sleep and happiness.

PURPOSE: To evaluate the reliability and validity of the 7-item Chinese Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) in Hong Kong Chinese. METHODS: Under "A Jockey Club Initiative for a Harmonious Society" project, a random telephone survey was conducted in 2017 on 1331 Hong Kong Chinese residents aged ≥ 18. A confirmatory factor analysis (CFA) was conducted to test the factorial validity. The Spearman correlations of the SWEMWBS with other scales including the 12-item short form health survey (SF-12), family well-being, self-rated health, the global happiness item (GHI), subjective happiness scale (SHS), and patient health questionnaire-4 (PHQ-4), were used to evaluate the convergent and divergent validity. Known-group validity was also assessed. We calculated congeneric reliability based on standardized factor loadings and error variances. Two-week test-retest reliability was assessed in 100 randomly selected respondents using intraclass correlation coefficient (ICC). RESULTS: Among the weighted sample, 55.9% were female and 72.9% were 25 to 64 years old. The CFA indicated good validity of the SWEMWBS. The SWEMWBS had moderate correlations with SHS, SF-12 mental component, PHQ-4 and GHI, but a weak correlation with SF-12 physical component. Older respondents, those with higher education level, married, working, with higher household income reported higher level of well-being. The congeneric reliability of the SWEMWBS was 0.85. Moderate to good test-retest reliability was observed (ICC 0.70, 95% CI 0.55 to 0.80). CONCLUSION: The Chinese SWEMWBS showed good validity and reliability for measuring well-being in the general population of Hong Kong.

Summary Background Mobile instant messaging apps offer a modern way to deliver personalised smoking cessation support through real-time, interactive messaging (chat). In this trial, we aimed to assess the effect of chat-based instant messaging support integrated with brief interventions on smoking cessation in a cohort of smokers proactively recruited from the community. Methods In this two-arm, pragmatic, cluster-randomised controlled trial, we recruited participants aged 18 years or older who smoked at least one cigarette per day from 68 community sites in Hong Kong, China. Community sites were computer randomised (1:1) to the intervention group, in which participants received chat-based instant messaging support for 3 months, offers of referral to external smoking cessation services, and brief advice, or to the control group, in which participants received brief advice alone. The chat-based intervention included personalised behavioural support and promoted use of smoking cessation services. Masking of participants and the research team was not possible, but outcome assessors were masked to group assignment. The primary outcome was smoking abstinence validated by exhaled carbon monoxide concentrations lower than 4 parts per million and salivary cotinine concentrations lower than 10 ng/mL at 6 months after treatment initiation (3 months after the end of treatment). The primary analysis was by intention to treat and accounted for potential clustering effect by use of generalised estimating equation models. This trial is registered with ClinicalTrials.gov , number NCT03182790 . Findings Between June 18 and Sept 30, 2017, 1185 participants were randomly assigned to either the intervention (n=591) or control (n=594) groups. At the 6-month follow-up (77% of participants retained), the proportion of validated abstinence was significantly higher in the intervention group than in the control group (48 [8%] of 591 in intervention vs 30 [5%] of 594 in control group, unadjusted odds ratio 1·68, 95% CI 1·03–2·74; p=0·040). Engagement in the chat-based support in the intervention group was low (17%), but strongly predicted abstinence with or without use of external smoking cessation services. Interpretation Chat-based instant messaging support integrated with brief cessation interventions increased smoking abstinence and could complement existing smoking cessation services. Funding Hong Kong Council on Smoking and Health.

Background Large amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown. Purpose We evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids. Methods A three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong “Quit to Win” Contest. Biochemically validated quitters of the early-informed (n = 379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n = 385, notified at 3-month follow-up) received the incentive at 3 months. The validated quitters of the control group (n = 379) received the incentive at 6 months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24 h) and use of cessation aids at 3-month follow-up. Results By intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24 h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR) = 1.32, 95% CI 1.03–1.69, p = 0.03), but they had similar abstinence (9.2% vs. 9.7%, OR = 0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR = 1.56, 95% CI 1.12–2.18, p Conclusions The small cash incentive with early notification increased quit attempt by “self-directed help” but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.

Urban families worldwide are often characterized by busy working lives which leave little time for family gatherings and communication. The Happy Family Kitchen project, which emphasized cooking and dining with family members, was conducted in a deprived district in Hong Kong. We hypothesized that the community-based family intervention, derived from a positive psychology framework, can improve family communication, family well-being, and subjective happiness. Twenty-three social service units organized and delivered the intervention programs for 1,419 individuals from 612 families. The core intervention was developed with emphasis on 1 of 5 positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at preintervention, immediate postintervention, and 6 weeks and 12 weeks postintervention. Results showed that family communication, family well-being, and subjective happiness improved with small effect sizes which were sustained up to 12 weeks. The gratitude intervention improved all of the outcome measures. Qualitative data provided additional evidence for effectiveness with in-depth insights into family dynamics. We concluded that this brief intervention was a low-cost and simple approach to improve family communication and well-being. (PsycINFO Database Record

Increased outdoor smoking is a common phenomenon after indoor smoking bans were in place. A series of observational studies were conducted to evaluate a novel, proactive, and brief smoking cessation intervention at outdoor smoking "hotspots," i.e., outdoor public areas where ashtrays were available and smokers clustered to smoke. The number of smokers at 26 selected hotspots were observed and counted for two consecutive days. Further observations of the smokers' characteristics and brief smoking cessation intervention were conducted at ten of the hotspots with the greatest number of smokers. Responses of the smokers to the brief intervention, including a leaflet and brief smoking cessation advice using AWAR protocol delivered by trained smoking cessation ambassadors, were assessed. A total of 24,034 smokers were observed within 464 h, which equals 51.8 smokers per hour. Of the 5070 pedestrians observed at the ten hotspots during the intervention sessions, 1228 (24.2 %) were smokers. In the 1228 smokers who were approached during our intervention sessions, about two thirds were willing to receive the self-help leaflet on smoking cessation whereas about half received the brief smoking cessation advice. Recruiting smokers and delivering brief smoking cessation interventions at smoking hotspots are feasible and likely effective to reach large numbers of smokers. Studies to evaluate the effectiveness of using this approach for smoking cessation are warranted.

Background Most smokers do not use smoking cessation (SC) services although it increases successful quits. Passive referral providing SC information to smokers is commonly used in SC studies. Little was known about active referral in the community setting. This study aims to motivate community smokers to quit by brief SC advice using a validated AWARD model (Ask, Warn, Advise, Refer and Do-it-again) that adjunct with active referral of smokers to various SC services in Hong Kong. Methods/Design This is a single-blinded, parallel three-armed cluster randomized controlled trial (RCT) with two treatment groups of (1) brief SC advice using the AWARD model, active referral to SC services plus a referral card and a health warning leaflet (active referral group) and (2) brief SC advice using AWARD model and health warning leaflet (brief advice group) and a control group receives general very brief advice with a self-help booklet. A total of 1291 smokers will be recruited from 66 clusters (recruitment sessions) with 22 will be allocated to each of the two intervention and one control groups. SC ambassadors will be trained for delivering the interventions and conducting telephone follow-up. The primary outcomes are self-reported 7-days point prevalence (PP) abstinence at 3 and 6 months follow-up. Intention-to-treat principle and multi-level regressions will be used for data analysis. Discussion This is the first RCT on assessing a model combining brief advice and active referral to SC services among community smokers. The results will inform the practices of SC services and intervention studies. Trial registration NCT02539875 (ClinicalTrials.gov registry; registered retrospectively on 22 July 2015)

Background Electronic devices (eDevices) may have positive or negative influences on family communication and well-being depending on how they are used. Objective We examined eDevice use during family time and its association with the quality of family communication and well-being in Hong Kong Chinese adults. Methods In 2017, a probability-based 2-stage random sampling landline telephone survey collected data on eDevice use in daily life and during family time (eg, family dinner) and the presence of rules banning eDevice use during family dinner. Family communication quality was rated from 0 to 10 with higher scores being favorable. Family well-being was calculated as a composite mean score of 3 items each using the same scale from 0 to 10. The associations of family communication quality and well-being with eDevice use in daily life and during family time were estimated using beta-coefficient (β) adjusting for sociodemographics. The mediating role of family communication quality in the association between eDevice use and family well-being was analyzed. Results Of the 2064 respondents (mean age 56.4 [SD 19.2] years, 1269/2064 [61.48%] female), 1579/2059 (76.69%) used an eDevice daily for a mean of 3.6 hours (SD 0.1) and 257/686 (37.5%) used it for 30+ minutes before sleep. As much as 794/2046 (38.81%) often or sometimes used an eDevice during family time including dinner (311/2017, 15.42%); 713/2012 (35.44%) reported use of an eDevice by family members during dinner. Lower family communication quality was associated with hours of eDevice use before sleep (adjusted β=–.25; 95% CI –0.44 to –0.05), and often use (vs never use) of eDevice during family dinner by oneself (adjusted β=–.51; 95% CI –0.91 to –0.10) and family members (adjusted β=–.54; 95% CI –0.79 to –0.29). Similarly, lower family well-being was associated with eDevice use before sleep (adjusted β=–.26; 95% CI –0.42 to –0.09), and often use during family dinner by oneself (adjusted β=–.48; 95% CI –0.83 to –0.12) and family members (adjusted β=–.50; 95% CI –0.72 to –0.28). Total ban of eDevice use during family dinner was negatively associated with often use by oneself (adjusted odds ratio 0.49; 95% CI 0.29 to 0.85) and family members (adjusted odds ratio 0.41; 95% CI 0.28, 0.60) but not with family communication and well-being. Lower family communication quality substantially mediated the total effect of the association of eDevice use time before sleep (61.2%) and often use at family dinner by oneself (87.0%) and by family members (67.8%) with family well-being. Conclusions eDevice use before sleep and during family dinner was associated with lower family well-being, and the association was substantially mediated by family communication quality. Our results suggest that interventions on smart use of eDevice may improve family communication and well-being.

IntroductionEvidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers.Methods and analysisThis ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow‐ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide Ethics and disseminationThis protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences.Trial registration numberClinicalTrials.gov Registry NCT03565796.

Background Hong Kong has a high rate of electronic device (e-device; computer, smartphone, and tablet) use. However, little is known about the associations of the duration of e-device use before and after sleep with psychological symptoms. Objective This study aimed to investigate the associations of the duration of e-device use before and after sleep with psychological distress. Methods A probability-based telephone survey was conducted on 3162 Hong Kong adults (54.6% female; mean age 47.4 years, SD 18.3 years) in 2016. Multivariate linear and Poisson regressions were used to calculate adjusted regression coefficients (aBs) and prevalence ratios (aPRs) of anxiety and depressive symptoms (measured by Patient Health Questionnaire-4) for the duration from waking to the first e-device use (≥61, 31-60, 6-30, and ≤5 minutes) and the duration of e-device use before sleeping (≤5, 6-30, 31-60, and ≥61 minutes). Results The first e-device use in ≤5 (vs ≥61) minutes after waking was associated with anxiety (aB 0.35, 95% CI 0.24-0.46; aPR 1.74, 95% CI 1.34-2.25) and depressive symptoms (aB 0.27, 95% CI 0.18-0.37; aPR 1.84, 95% CI 1.33-2.54). Using e-devices for ≥61 (vs ≤5) minutes before sleeping was also associated with anxiety (aB 0.17, 95% CI 0.04-0.31; aPR 1.32, 95% CI 1.01-1.73) and depressive symptoms (aB 0.17, 95% CI 0.05-0.28; aPR 1.47, 95% CI 1.07-2.02). E-device use both ≤5 minutes after waking and for ≥61 minutes before sleeping was strongly associated with anxiety (aB 0.68, 95% CI 0.47-0.90; aPR 2.64, 95% CI 1.90-3.67) and depressive symptoms (aB 0.55, 95% CI 0.36-0.74; aPR 2.56, 95% CI 1.69-3.88). Conclusions E-device use immediately (≤5 minutes) after waking and use for a long duration (≥61 minutes) before sleeping were associated with anxiety and depressive symptoms among Chinese adults in Hong Kong.

BackgroundAdvances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. ObjectiveThis study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. MethodsWe conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. ResultsParticipants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. ConclusionsThis qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial.

Evidence on behavioural abnormalities in children exposed to secondhand smoke is limited. This study examined the relation between infant/ toddler cotinine concentration, a biomarker of secondhand smoke exposure, and behavioural problems in preschoolers who were unexposed to maternal smoking during gestation. A prospective cohort of 301 non-smoking mothers with their young children aged ≤18 months visiting postnatal primary care clinics in Hong Kong was enrolled in 2012 and followed by telephone survey 3 years afterwards. Saliva was collected at baseline for cotinine assay. Child behavioural health at 3-year follow-up was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). We conducted multivariable linear regressions to compute regression coefficients (b) of SDQ scores in relation to salivary cotinine level. Mean ± SD age of children at follow-up was 3.7 ± 0.5 years and 50.8% were boys. After adjusting for age, sex, birthweight, household income, housing type, maternal education and depressive symptoms, greater cotinine concentrations during early childhood were associated with greater conduct problems (b = 0.90, 95% CI 0.03–1.76) and hyperactivity/ inattention (b = 1.12, 95% CI 0.07–2.17) at preschool age. This study corroborates previous findings on the potential role of secondhand smoke in development of child behavioural problems.

Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers.This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (4 ppm) and salivary cotinine (10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat.This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.

Actively referring smokers to smoking cessation (SC) services could increase quitting and is scalable for the population. The objective of this study is to compare 2 different intensities of SC active referral for smokers in the community of Hong Kong. This is a single-blind, parallel 3-armed cluster randomized controlled trial (cRCT) consisting of high-intensity SC active referral (HAR Group), low-intensity SC referral by text messaging on promoting SC services use (Text Group) and a control group receives general very brief advice. Biochemically validated daily smokers will be proactively recruited in the community from 68 clusters (recruitment sessions). The primary outcome is self-reported 7-days point prevalence abstinence (PPA) at the 3- and 6- month follow-ups. Secondary outcomes are SC service use, smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (exhaled CO

To ease the shortage of professionals, lay volunteers were trained to become health promoters and role models for a large community program to enhance physical activity, well-being, and neighborhood cohesion in socioeconomically disadvantaged groups in Hong Kong. This study aimed to examine the effects on health promoters (trainees) and the feasibility and acceptability of capability-building train-the-trainer workshops (TTTs) using Zero-time Exercise (ZTEx) to implement a community program for about 1,000 participants. A four-session (totally 8 hours) TTT introduced an evidence-based ZTEx intervention to enhance physical activity and well-being, and build capacity for community program implementation. Twenty-eight trainees actively participated in the TTT. Twenty-five and 21 trainees completed the 1- and 3-month questionnaires, respectively. Eleven trainees attended the 1-year focus group interview. Repeated measures analysis of variance and Friedman test were used to compare the parametric and nonparametric data, respectively. Qualitative data were analyzed using thematic content analysis. The trainees reduced their sedentary behavior and improved their interpersonal communication skills, knowledge, and attitude toward ZTEx, grip strength, balance, and perceived well-being. The community participants reported improvements in neighborhood cohesion and grip strength. The 1-year qualitative results supported the 3-month quantitative findings. This brief and innovative TTT affirmed the feasibility of using ZTEx and the role modeling approach for lay health promoters to reduce sedentary behavior and enhance physical activity, fitness, and well-being. They then contributed to the successful implementation of community programs that benefited many. This study provides a new model for building capacity for health promotion in the community.

Background Females are less willing than males to seek help from smoking cessation services; the present study examined how the use of these services by females could be enhanced by training young female ambassadors to deliver a brief intervention. Methods We collaborated with the Hong Kong Girl Guides Association. Fifty of the association's Girl Guides served as smoking cessation and reduction ambassadors to deliver a brief intervention to at least two female smokers. The effectiveness of the intervention was evaluated by a one-group pre-test and repeated post-test design. We undertook data collection at baseline and at 1, 3 and 6 months. Results In all, 106 female smokers received the brief intervention. At 6-month follow-up, the self-reported abstinence was 12.2%; the biochemically verified prevalence of quitting was 5.7%. Approximately 7% of participants were motivated to use smoking cessation services between baseline and 6 months. Conclusions This study supports the effectiveness of a brief intervention in promoting smoking cessation for community-living female smokers in Hong Kong. However, the intervention could be enhanced by further promoting the use of smoking cessation services to female smokers.

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside.

Aims To describe the self-reported frequency of Chinese nurses’ interventions to help smokers quit, using the 5 As (i.e. Ask, Advise, Assess, Assist, Arrange), attitudes towards tobacco control and differences in consistency interventions by demographic and professional characteristics prior to an educational intervention to increase nurses’ support for quit efforts. Background Tobacco use is the leading cause of preventable death in China; quitting smoking reduces health risks and premature death. The China Tobacco Cessation Treatment Guideline supports the 5 As model for intervention, but nurses’ frequency of delivering smoking cessation interventions is unknown. Design Descriptive survey using a convenience sample. Methods Nurses from eight hospitals in Beijing and Hefei, China completed a web-based survey in 2012. Differences in consistency of the 5 As by nurse characteristics were determined using multivariate logistic regression. Overall importance of nurses in tobacco control was evaluated on a 1-5 scale (5 = most important). Results Nurses (N = 2440; 1404 Beijing, 1036 Hefei) participated. 64% consistently asked about smoking status, 85% advised patients to quit, 52% assessed readiness to quit and assisted with smoking cessation and 17% arranged for follow-up. Interventions varied by nurses’ education and clinical setting. Nurses positively viewed involvement in tobacco control (4·3/5) and thought nurses should be smoke-free role models (4·8/5·0). Conclusions This study demonstrates that the majority of nurses asked about smoking status, but few assisted patients with quitting. Further efforts are needed to help nurses actively promote smoking cessation interventions.

The present trial examined the effectiveness of brief interventions for smokers who joined the Hong Kong Quit to Win Contest to quit smoking. A block randomized controlled trial allocated 1003 adult daily smokers to three groups: (i) The TEL group (n = 338) received a 5-min nurse-led telephone counselling; (ii) The SMS group (n = 335) received eight text messages through mobile phone and (iii) The CONTROL group (n = 330) did not receive the above interventions. Participants with biochemically verified abstinence at 6-month follow-up could receive cash incentive. The primary outcome was the self-reported 7-day point prevalence (PP) of tobacco abstinence at 6-month follow-up. The abstinence rate in the TEL, SMS and CONTROL group was 22.2, 20.6 and 20.3%, respectively (P for TEL versus CONTROL = 0.32; P for SMS versus CONTROL = 0.40). When abstinence at 2-, 6- and 12-month follow-up was modelled simultaneously, the TEL group had a higher abstinence than the CONTROL group (Adjusted OR = 1.38, 95% CI = 1.01-1.88, P = 0 .04). In the Quit to Win Contest, the brief telephone counselling might have increased abstinence, but the text messages had no significant effect. Further studies on intensive intervention and interactive messaging services are warranted.

Aims and objectives To investigate the smoking behaviours, perceptions about quitting smoking and factors associated with intention to quit in patients with type 2 diabetes mellitus. Background Smoking causes type 2 diabetes mellitus. There has been limited research on the needs and concerns of smokers with type 2 diabetes mellitus about quitting smoking. Design The study used a qualitative design. Methods Patients diagnosed with type 2 diabetes mellitus who had a history of smoking were recruited at the outpatient diabetic clinics of two major local hospitals in Hong Kong for a semi-structured interview (n = 42), guided by the theory of planned behaviour. Results At data saturation, 22 current smokers and 20 ex-smokers with type 2 diabetes mellitus were recruited. The current smokers reported they had not quit smoking because of satisfaction with present health status, and misconceptions about the association between diabetes and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive opinion about quitting smoking, accepted advice about quitting from health professionals and received more family support than current smokers. Psychological addiction and weight gain after cessation made quitting challenging. Conclusions Satisfaction with health status, inadequate knowledge about the relationship between type 2 diabetes mellitus and smoking, and misconceptions about quitting smoking resulted in negative attitudes toward quitting by type 2 diabetes mellitus smokers. Smoking peers, psychological addiction and post-cessation weight gain hindered the quitting process. Relevance to clinical practice Education on the causal link between smoking, type 2 diabetes mellitus and its complications is important to raise health awareness and counter misconceptions about quitting smoking. Behavioural counselling with weight control strategies should be part of a comprehensive smoking cessation intervention for type 2 diabetes mellitus smokers.

AIMS AND OBJECTIVES To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong. BACKGROUND There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored. DESIGN This is a mixed-method retrospective population-based study. METHODS A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study. RESULTS In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers. CONCLUSIONS This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong. RELEVANCE TO CLINICAL PRACTICE Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.

Background Having a disease and requiring medical attention present an excellent 'teachable moment' for smoking cessation interventions. However, nicotine is addictive and quitting is difficult, with a high rate of relapse, particularly among chronic smokers. Our previous smoking cessation projects in the community have revealed that many smokers who are reluctant to quit are interested in reducing the number of cigarettes they smoke per day. Therefore, smoking reduction may be an important alternative strategy for promoting smoking cessation. This Phase 2 randomized controlled trial of smokers who had medical follow-ups in an outpatient clinic compared the effectiveness of two approaches to smoking cessation: quitting immediately and cutting down to quit. Methods A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone, and their smoking status was assessed. The primary outcomes were self-reported 7-day point prevalence of abstinence at 6 and 12 months. Intention-to-treat analysis was employed. Results On average, subjects had smoked 11.31 cigarettes per day over 37 years and 96% had mild nicotine dependence. At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). Conclusions These data suggest that quitting immediately might be more effective than cutting down to quit in smokers who need to quit sooner, such as those with diseases requiring medical attention. Nevertheless, the effectiveness of the cut down to quit approach requires further testing.

Background and challenges to implementation Studies found that actively referring smokers to smoking cessation (SC) services increased quitting. We compared 2 different intensities of SC active referral for community smokers in Hong Kong. Intervention or response A single-blinded, parallel three-armed cluster randomized controlled trial was conducted among smokers who joined 2016 “Quit-to-Win” Contest organized by the Hong Kong Council on Smoking and Health. Biochemically validated (CO >4ppm) daily smokers were proactively recruited and randomly assigned to onsite SC active referral (Group A) (n= 395), text messaging on promoting and encouraging smokers to attend SC services (Group B) (n=385) and control group on general brief SC advice (Group C) (n=383). Group A and B also received model guided (AWARD) brief SC advice with a warning leaflet and a referral card at baseline and telephone brief advice at 1-month and 2-month. Telephone survey at 3-month (retention rate 63.4%) to assess primary outcome: self-reported 7-day point prevalence abstinence (PPA) and secondary outcomes: smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (CO < 4ppm). Analyses were done by intention to treat. Results and lessons learnt Group A, B and C had self-reported PPA: 14.4%, 13.0% and 8.6% (A vs. C; B vs. C, p 0.05), respectively. Corresponding SRRs were 18.7%, 16.9% and 16.2% (all p>0.05). Compared with Group C, Group A had a higher odds ratio (OR) of 1.65 (95% CI 1.08-2.52) and Group B smokers had a higher OR of 1.56 (95% CI 1.02 - 2.04) for self-reported PPA, adjusting for baseline intention to quit and clustering effect. Conclusions and key recommendations Proactive intervention with AWARD guided brief SC advice and onsite active referral or text messaging may be effective in increasing quitting at 3-month compared with general brief SC advice in community smokers.

Background Smokers who are in physical discomfort attended to emergency departments present an excellent 'teachable moment' for smoking cessation interventions. Nevertheless, most cessation programmes generally take 20 to 30 minutes or more to implement and are thus not feasible in busy clinical settings. This study aimed to address the gap in existing literature by evaluating the effectiveness of using a brief, self-determination intervention on smoking cessation among people attending emergency departments. Methods A multi-centre randomized controlled trial was conducted in emergency departments of four acute hospitals in Hong Kong. A total of 1571 patient were recruited, with 787 being randomized into the experimental group and 784 into the control group. Subjects in the experimental group were allowed to select their own schedules of quitting (immediate or progressive). They received a leaflet plus a brief intervention on smoking cessation. Subjects in the control group received a leaflet on smoking cessation. Four consecutive (1, 3, 6 and 12 months) follow-ups were conducted over the telephone. The primary outcome measure was biochemically validated abstinence at 6 months. Secondary outcomes included (i) biochemically validated abstinence at 12 months and (ii) self-reported 7-day point prevalence of abstinence at 6 and 12 months. Intention-to-treat analysis was adopted. Results Subjects in the experimental group had a statistically significantly higher self-reported quit rate than those in the control group at 12 months (11.2% vs 6.8%, p=0.03). The biochemically validated abstinence was also statistically significantly higher in the experimental group than in the control group at 6 (6.6% vs 2.6%, p< .001) and 12 months (6.0% vs 3.0%, p=0.04). Conclusions The brief, self-determination intervention was shown to be effective in promoting smoking cessation for people attending emergency departments. Such intervention should therefore be a more cost-effective and sustainable approach to helping smokers quit smoking, and consequently may save more lives.

Background: Recruitment is central to any research project, and recruitment itself should be well-documented and researched. We describe our recruitment efforts for a community-based research project – entitled the Learning Families Project, conducted in Hong Kong. Methods: In collaboration with community stakeholders, residents from a public housing estate were recruited to participate in family programs aimed at enhancing family wellbeing. Various recruitment strategies were employed including the distribution of 19,200 leaflets, 688 posters, a banner, a kick-off ceremony, 10 promotion activities, 1000 direct calls, word of mouth, 51 mobile counters, and 10 door-to-door visits. Drawing on field notes, research logs, short questionnaires, and focus group conducted with our community partners and residents we describe and discuss our recruitment strategies, challenges, and lessons learned. Results: Over a 9-month period, 980 participants were recruited and participated in our study, exceeding our recruitment goal (860 participants). Several observations were made including active recruitment strategies (i.e., door-to-door and mobile counter) being more effective than passive strategies (i.e., posters and leaflets); the importance of raising project awareness to facilitate recruitment; and the challenges encountered (i.e., burn-out and loss of motivation of staff, decreased community capacity in collaborating in research projects). Conclusion: The lessons learned include the importance of engaging Chinese communities, utilizing a positive outreach approach, and setting realistic expectations. Although similar recruitment strategies have been reported the West, a number of cultural differences should be taken into account when working with Chinese population. Further research is needed to examine the effectiveness of tailoring recruitment strategies to various populations.

A brief intervention using Zero-time Exercise (ZTEx), a foot-in-the-door approach, was developed to reduce sedentary behaviour and increase physical activity. ZTEx refers to the integration of simple strength- and stamina-enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. This paper presents the development, feasibility, and preliminary evidence for the effectiveness of this intervention under the Hong Kong Jockey Club FAMILY Project. Needs assessments were conducted with social workers from the Christian Family Services Center(CFSC) and the Social Welfare Department (SWD). This single group prospective ZTEx intervention trial, guided by the Health Action Process Approach, included a 3-hr core session at baseline and a 1-hr booster session at 1-month follow-up. Fifty-six participants (social and service-related workers) from CFSC (n = 28) and SWD (n = 28) received the intervention and completed the self-administered questionnaires at baseline. Forty-nine and 43 participants completed the 1-month and 3-month self-administered questionnaires, respectively. Fifteen participants attended the focus group interviews to share their feedback on ZTEx intervention after implementing their community-based ZTEx activities. Intention-to-treat analysis was conducted with missing data replaced by baseline values. Participants reported significant decreases in sitting time by 27 (2, 52) minutes (mean [95% confidence interval]) and 36 (0.2, 71) minutes on a weekday, increases in physical activity while seated by 0.7 (0.2, 1.4) days and 1.1 (0.6, 1.7) days in a week, and improvements in perceived knowledge, outcome expectancies and plan on doing ZTEx at the 1-month and 3-month follow-up, respectively. Balance and muscle strength significantly improved at the 1-month follow-up. The effect ranged from small to large (Cohen's d: 0.27-1.05, all p < 0.05). The qualitative feedbacks support the quantitative findings. Our findings show early evidence that ZTEx effectively reduced sedentary behaviour and enhanced physical activity and fitness. Further trials on this simple and low-cost intervention as the first step to promote higher intensity exercise are warranted.

Background Youth smoking continues to be a significant global public health concern. To ensure healthier lives for youths, healthcare professionals need to increase awareness among the youth of the health risks and addictive nature of smoking, strengthen their ability to resist negative peer influence and curiosity, and help those who smoked to quit. The Smoke-free Teens Programme was launched in 2012 to equip youngsters with up-to-date information about smoking and global trends in tobacco control and to encourage them to play a pioneering role in tobacco control. This paper describes the process and outcomes of this programme for youths in Hong Kong. Methods The Smoke-free Teens Programme contained three major components: (i) a 2-day-1-night training camp; (ii) creative activities to promote smoke-free messages in schools and the community; and (iii) an award presentation ceremony to recognize the efforts of outstanding Smoke-free Teens in establishing a smoke-free culture. All secondary school students or teenagers aged 14 to 18 years from secondary schools, youth centres and uniform groups were invited to join the programme. The outcome measures were changes in (1) knowledge about smoking hazards; (2) attitudes towards smoking, tobacco control, and smoking cessation; and (3) practices for promoting smoking cessation. Results A total of 856 teenagers were recruited during the study period (July 2014 to March 2017). The results showed statistically significant changes in participants’ knowledge about smoking hazards, attitudes towards tobacco control, and practice for promoting smoking cessation. Conclusions The Smoke-free Teens Programme demonstrated effectiveness in equipping youngsters with up-to-date information about smoking and global trends in tobacco control and in encouraging them to play a pioneering role in tobacco control. The trained Smoke-free Teens not only promoted the smoke-free messages among their schoolmates, friends, and families, but also gathered community support for a smoke-free Hong Kong. The programme has been instrumental in fostering a new batch of Smoke-free Teens to advocate smoke-free culture and protect public health. Trial registration Clinicaltrials.gov ID NCT03291132 (retrospectively registered on September 19, 2017).

This paper describes a program of brief, universal, positive psychology-based interventions to increase targeted behaviors that enhance family relationships, developed and delivered to over 1500 participants using a community-based participatory approach. The cluster-randomized design combined interventions based on one of three themes (gratitude, hope, or open-mindedness) in one of two structures (intervention, or intervention with planning). The latter structure supplemented with materials and exercises derived from the Health Action Process Approach model of behavior change. Planning was more effective in increasing attitude and intention to perform behaviors, frequency of the targeted behaviors, and family health and happiness (Cohen’s ds: 0.10–0.16, p

Objective: We examined how quantity and trajectory of smoking reduction influence later abstinence in smokers without intention to quit and being prescribed free nicotine replacement therapy (NRT). Method: We conducted an a posteriori analysis from a data archive of adult smokers in a randomized controlled trial of smoking reduction using counseling and free NRT (n = 928). Reduction was analyzed as the absolute and percentage decrease in self-reported daily cigarette consumption at three follow-ups (1 week, 1 and 3 months) compared with the baseline. Logistic regression model and multiple imputation were used to examine the association between early reduction and abstinence at 6 months. Results: Reducing 10% of cigarette consumption at the three follow-ups was associated with 16% (95% CI 5–28%), 23% (95%CI 11–36%) and 27% (95% CI 13–42%) increase in abstinence, respectively. Greater reduction predicted abstinence when the percentage reduction was more than one-third (above 31.4%). Progressive increase in the percentage reduction predicted more abstinence (OR = 1.90, 95%CI 1.01–3.58). Conclusions: Greater percentage reduction by at least one-third and progressive reduction predicted abstinence in those who reduced smoking. Such new evidence can guide the improvement of clinical service for tobacco dependency treatment and support further studies on smoking reduction and cessation.