Evaluating the impact of sugar-sweetened beverages tax on overweight, obesity, and type 2 diabetes in an affluent Asian setting: A willingness-to-pay survey and simulation analysis.

BACKGROUND: The potential health effects of taxing sugar-sweetened beverages (SSBs) has been insufficiently examined in Asian contexts. This study aimed to assess the impact of SSB taxation on the prevalence of obesity/overweight and type 2 diabetes mellitus (T2DM) in Hong Kong using a willingness-to-pay (WTP) survey and simulation analysis. METHODS: A random telephone survey was conducted with 1000 adults from May to June 2020. We used a contingent valuation approach to assess individuals' WTP for SSBs under four tax payment scenarios (5%, 10%, 40%, and 50% of the current market price). Based on the WTP, a simulation analysis was conducted to project changes in SSB purchase and associated reductions in the prevalence of obesity/overweight and T2DM over a 10-year simulation period. FINDINGS: When 5% and 10% taxation rates were introduced, approximately one-third of the population were unwilling to maintain their SSB purchase. Our simulation demonstrated a gradual decline in the prevalence of obesity/overweight and diabetes with a more pronounced decrease when higher taxation rates were introduced. 10% taxation resulted in a mean reduction of 1532.7 cases of overweight/obesity per 100 thousand population at the sixth year, while T2DM prevalence decreased by 267.1 (0.3%). CONCLUSIONS: This study underscores the effects of an SSB tax on purchase behaviors and health outcomes in an affluent Asia setting, with a more pronounced influence on adult population. These findings are expected to inform policymakers in making decisions regarding an effective and equitable tax rate on SSBs.

Protein food avoidance behaviour among cancer patients - perspectives of nutrient intake and diet quality.

BACKGROUND AND OBJECTIVES: Previous study reported that high proportion of Chinese cancer patients practise food avoidance behaviour for fear of cancer recurrence. The present study aims at documenting the degree of food avoidance behaviours and its association with nutrient intake and diet quality among Chinese cancer patients. METHODS AND STUDY DESIGN: Cross-sectional face-to-face interviews were conducted with 245 patients suffering from nasopharyngeal and colorectal cancer to investigate their food avoidance behaviour. Participant's nutrient intake was assessed by 3-day diet record. Diet quality was measured by Diet Quality Index - International (DQI-I). RESULTS: As many as 86% cancer participants reported practicing food avoidance behaviours. The nutrients to which less than half of the participants met its daily requirement include vitamin D (0%), vitamin E (0.4%), calcium (7.8%), zinc (26.1%) and vitamin B1 (32.2%). Among all participants, only 47.8% met their daily energy requirement. Those reported having high degree of food avoidance behaviours are more likely to have low intake of protein, zinc and iron. However, there was no association between FAB and overall diet quality although the Variety subscale of DQI-I showed that food avoidance behaviours negatively link to participant's dietary sources of protein. CONCLUSIONS: Degree of practicing food avoidance behaviour is negatively associated with nutrients of animal origin, in particular protein. However, the overall diet quality was not affected by such. The study results provided important information to frontline clinical workers who are dealing with cancer patients practising non-mainstream diet.

Change in eating habits and physical activities before and during the COVID-19 pandemic in Hong Kong: a cross-sectional study via random telephone survey.

BACKGROUND: Hong Kong is a densely populated city with a low incidence and mortality of coronavirus disease 2019 (COVID-19). The city imposed different levels of social distancing including, the closure of sports venues and restrictions on eateries. This inevitably affects the eating behaviour and physical activities of the population. We examined the changes in eating behavior and physical activities before and during the COVID-19 pandemic, and identified sociodemographic factors associated with the behavioral changes. METHODS: This was a cross-sectional study via a random telephone survey of Chinese adults conducted in Hong Kong from May to June, 2020 - a period in which social distancing measures were being imposed. We measured the physical activity habits from four aspects and dietary consumption patterns from seven aspects before and during the pandemic based on the World Health Organization's guidelines and previous publications. RESULTS: In total, 724 participants were recruited. Individuals were found to cook more frequently at home (p < 0.001) and order take-out (p < 0.001) during the COVID-19 pandemic. While no significant change in the frequency of fast food consumption was observed, we found significant increases in the frequency of eating fruits (p < 0.001) and vegetables (p = 0.004). The frequencies of walking, moderate-intensive sports, and high-intensity sports were significantly reduced (p < 0.001). We found that healthy lifestyle behaviors during the pandemic were negatively associated with participants' economic status. CONCLUSIONS: Social distancing measures likely provided an opportunity for individuals to stay home and thus eat healthier. However, in a prolonged period of social restrictions, a lower physical activity level poses a risk to public health. Public health officials are thus advised to monitor physical health on a population-wide basis. The findings highlighted the importance of interventions tailored to individuals who have prolonged home stays - particularly for individuals in the low economic group.

Is "Perceived Water Insecurity" Associated with Disaster Risk Perception, Preparedness Attitudes, and Coping Ability in Rural China? (A Health-EDRM Pilot Study).

Water security is essential for maintaining health and well-being, and for reducing a population's vulnerability in a disaster. Among resource-poor villagers in China, water-related disasters and climate change may increasingly affect people's water security. The purpose of this study was to explore the relationship between perceived water security and disaster risk perception in a rural ethnic minority community. A cross-sectional household survey was conducted in 2015 in Xingguang village, Chongqing, China, examining the association between villagers' perceptions of household water security, disaster risk, and sociodemographic variables. Among 52 household representatives, 84.6% relied on rainwater as their main water source and 63.5% reported having insufficient water on a regular basis. Only 32.7% perceived themselves to be living in a high-risk area, of which climate-related disasters such as storms (44.4%) and droughts (38.9%) were the most frequently reported disasters in their area. Insufficient water quantity, previous disaster experience, and household members on chronic disease medication were found to be associated with higher disaster risk perception. Perceived water security indicators were not found to be predictors of preparedness attitudes and coping ability. Addressing water sufficiency in both disaster risk reduction strategies and long-term water management will be necessary to improve the health and livelihood of rural villagers in the coming decades.

Food-Related Health Emergency-Disaster Risk Reduction in Rural Ethnic Minority Communities: A Pilot Study of Knowledge, Awareness and Practice of Food Labelling and Salt-intake Reduction in a Kunge Community in China.

Food safety and unhealthy dietary pattern are important global health problems. Understanding food-related health needs and providing corresponding support are important to health risk reduction. A needs assessment, education intervention for food labelling, and another intervention for salt-intake reduction were conducted in a rural Kunge community in Yunnan, China in 2014, 2015 and 2016, respectively. Not checking the expiry date of packaged food (37.1%) and a high salt diet (53.9%) were the most common problems in the community. Both topics were selected for education intervention. Pre- and post-intervention questionnaires were used to evaluate the effectiveness. Education interventions were found effective in improving food-health-related knowledge, changing attitudes toward behaviors such as willingness to read food labels before buying and consuming packaged food. However, no significant improvements were found for the attitudes toward not consuming expired food, controlling salt-intake, and decreasing the consumption of cured food. Health education was shown to be effective in promoting food-health-related knowledge but was limited in changing relevant behaviors in a rural ethnic minority community.

Comparing nutrient intake and body weight status amongst adolescent substance users, institutionalised abstainers and never users.

BACKGROUND: Improved nutrition intake in drug rehabilitation programmes enhances quality sobriety and prevents relapses. However, little is known about the nutritional status of substance users and institutionalised abstainers. Previous nutritional studies have mainly focused on methamphetamine, whereas ketamine has not been investigated despite its popularity amongst adolescents. OBJECTIVES: To compare nutrient intake and underweight status amongst three groups of adolescents -current substance users, institutionalised abstainers and never users (controls) - and examine the association between ketamine use and nutrient intake. DESIGN: This is a cross-sectional questionnaire survey which was conducted using face-to-face interview. Substance users (n = 202) and never users (n = 100) were invited through the outreach social workers of three non-government organisations. Abstainers (n = 50) were recruited from three drug rehabilitation centres. Nutrient intake was assessed through two 24-h recalls. Other information collected included anthropometrics, socio-demographic characteristics and substance type used over the previous month. RESULTS: Only 20.8 and 15.9% of male and female substance users met the daily energy requirements. Male users were less likely to meet the recommended intake of energy [odds ratio (OR) = 0.37] and protein (OR = 0.10) than controls. Overall, abstainers had better intake of beneficial nutrients than substance users. However, abstainers were more likely to overconsume harmful nutrients, such as cholesterol and sodium. Regarding weight status, female substance users (56.1%) were more likely to be underweight than abstainers (14.8%) (OR = 8.85). Amongst underweight female substance users, 52.2% were still trying to lose more weight. Moreover, ketamine users tended to have lower intake of nutrients from animal sources than the users of other drugs. CONCLUSIONS: Adolescent substance users are at risk of energy and nutrient inadequacy. Misconceptions about body weight are disseminating amongst them. The study findings provide valuable information for frontline workers taking care of young substance users and for institutions providing residential rehabilitation programmes.