Use of Information and Communications Technology in Family Services and Its Perceived Benefits amid the COVID-19 Pandemic in Hong Kong-Jockey Club SMART Family-Link Project.

INTRODUCTION: We examined information and communications technology (ICT) use in family services and its perceived benefits and barriers amid the COVID-19 pandemic in Hong Kong. METHODS: We invited all family service social workers of 12 NGOs to complete an anonymous online questionnaire in May 2020 (Part A) and a management representative from each NGO to provide written feedback on ICT use in January 2021 (Part B). RESULTS: In Part A, of 255 respondents (response rate: 67.3%), perceived ICT use in conducting programmes, groups, casework and preventive family programmes showed net increases of 33.9-54.5%; perceived ICT use in different work processes showed net increases of 18.8-48.6%. The three most common perceived benefits were "providing another option to service users" (74.2%), "more convenient service" (60.2%) and "maintaining normal service" (59.7%). In Part B, 12 management representatives consistently reported positive impacts of ICT use on family services. They shared actionable strategies (e.g., ICT skill-related training) and concerns about data privacy and management. CONCLUSIONS: ICT use in family services markedly increased amid the COVID-19 pandemic in Hong Kong. It helped make the services more accessible especially when the pandemic restricted face-to-face services.

Association of family wellbeing with forwarding and verifying COVID-19-related information, and mediation of family communication quality.

Objective: We assessed the associations of family wellbeing with verifying and subsequently forwarding COVID-19-related information to family members and the mediating effect of the quality of family communication on these associations among Chinese adults in Hong Kong. Methods: Under the Jockey Club SMART Family-Link Project, we conducted an online population-based survey, using Family wellbeing Scale and questions related to the family communication quality and forwarding and verifying COVID-19 information. Data were collected from 4,891 adults in May 2020. Prevalence estimates of forwarding and verifying COVID-19 information were weighted by sex, age, and education of the general population, and their associations with family wellbeing (ranged 0-10) were analyzed using generalized linear models with mutual adjustment. Their interactive effects on family wellbeing and the mediating effects of family communication quality were examined. Results: In total, 53.9% of respondents usually/always forwarded COVID-19 information related to their family, 68.7% usually/always verified it before forwarding, and 40.9% did both. Greater family wellbeing was associated with usually/always forwarding [adjusted ß (95% CI): 0.82 (0.72-0.92)] and usually/always verifying [0.43 (0.32-0.55)] (both P < 0.001) the information. Forwarding and verifying such information showed an additive effect on family wellbeing [1.25 (1.11-1.40)]. Family communication quality mediated the associations of family wellbeing with forwarding (83.7%) and verifying (86.6%) COVID-19-related information. Conclusion: Forwarding COVID-19 information to family, verifying such information, and especially doing both, were associated with greater family wellbeing, being strongly mediated by the quality of family communication. Individuals should be encouraged to verify COVID-19-related information before forwarding it to family members amidst the COVID-19 pandemic.

Associations of Face-to-Face and Instant Messaging Family Communication and Their Contents With Family Wellbeing and Personal Happiness Amidst the COVID-19 Pandemic.

Background: Both face-to-face and instant messaging (IM) communication are important for families, but face-to-face communication has reduced amidst the COVID-19 pandemic. We examined the use and contents of both communication methods amidst the pandemic, their associations with family wellbeing and personal happiness, and the mediation effects of communication quality in Hong Kong Chinese adults. Methods: This population-based online survey enrolled 4,921 respondents in May 2020, who reported (i) any face-to-face or IM family communication when the pandemic was severe; (ii) communication contents being classified as neutral, positive, supportive, and negative; and (iii) communication quality, family wellbeing and personal happiness (score 0-10). Associations of family wellbeing and personal happiness with communication methods and contents (no communication excluded) were examined using linear regressions (ß), adjusting for each other, sex, age, socioeconomic status, and the number of cohabitants. Mediating effects of communication quality on these associations were examined. Prevalence estimates were weighted by sex, age, and education of the general population. Interactions of methods and contents were examined. Results: Of 4,891 included respondents (female: 52.9%, 45-54 years: 37.7%, ≥65 years: 21.3%), 7.1% reported no communication, 12.7% face-to-face communication only, 26.7% IM only, and 53.4% both methods. More males and those at younger ages, had lower socioeconomic status, or fewer cohabitants showed no family communication or face-to-face only. More respondents reported neutral (83.1-99.3%) than positive (42.1-62.2%), supportive (37.5-54.8%), and negative (10.9-34.5%) contents despite communication methods. Communication quality was higher with both methods than IM only, face-to-face only, and no communication (scores: 6.7 vs. 4.5-6.6, all P ≤ 0.02). Better family wellbeing and personal happiness were associated with using IM only (adjusted ßs: 0.37 and 0.48) and both methods (0.37 and 0.42) than face-to-face only, and positive (0.62 and 0.74) or supportive (0.45 and 0.46) contents (all P ≤ 0.001). Communication quality mediated 35.2-93.5% of these associations. Stronger associations between positive contents and family wellbeing showed in both methods and face-to-face only than IM only (P for interaction = 0.006). Conclusions: We have first shown that, amidst the COVID-19 pandemic, family IM communication and positive and supportive contents may promote family wellbeing and personal happiness. People with no family communication may need assistance.

Changes in tobacco use at the early stage of the COVID-19 pandemic: Results of four cross-sectional surveys in Hong Kong.

INTRODUCTION: Changes in tobacco use since the COVID-19 outbreak differed by countries and little is known about changes in the use of specific tobacco products. METHODS: We analyzed data from four cross-sectional telephone/online surveys from April to June 2020 to investigate such changes since the 1st and 2nd wave outbreaks (February to April 2020) in Hong Kong. The respondents were 1595 adults (83.2% male) who used tobacco before the COVID-19 outbreak from our previous intervention study and surveys. We investigated the changes in tobacco use, intention to quit and quit attempts during the outbreak. RESULTS: About two-thirds (65.3%) of respondents reported no change in overall tobacco use, while 23.1% used less (including cessation) and 11.6% used more, resulting in a net decrease of 11.5 percentage points. A greater net decrease was observed for cigarettes (14.3% points) than heated tobacco products (HTPs, 3.3% points) and electronic cigarettes (e-cigarettes, 2.5% points). Decreased use was mainly due to the more extended stay at home (63.2%), health considerations (52.6%) and mask-wearing (47.4%), while increased use was for passing time (75.0%) and releasing stress (46.4%). Eight percent of cigarette, HTP and e-cigarette users reported a higher intention to quit since the pandemic outbreak. Nineteen percent of tobacco users (176/948) attempted to quit during the pandemic. Only 2.9% (46/1569) were abstinent at the time of the survey. CONCLUSIONS: Overall tobacco use decreased after the first two waves of the COVID-19 outbreak in Hong Kong. A greater proportion of cigarette users decreased use than HTP and e-cigarette users. Given the different methods used in the four surveys, future studies should aim for a large and representative sample.

A Population Study on COVID-19 Information Sharing: Sociodemographic Differences and Associations with Family Communication Quality and Well-Being in Hong Kong.

Family support through the sharing of information helps to shape and regulate the health and behaviours of family members, but little is known about how families are sharing COVID-19-related information, or about its associations with family communication quality and well-being. We examined the associations of COVID-19 information sharing methods with sociodemographic characteristics, the perceived benefits of information communication and technology (ICT) methods, and family communication quality and well-being in Hong Kong. Of 4852 respondents (53.2% female, 41.1% aged over 55 years), the most common sharing method was instant messaging (82.3%), followed by face-to-face communication (65.7%), phone (25.5%) and social media (15.8%). Female sex (adjusted prevalence ratio (aPR) 1.09), older age (aPRs 1.14-1.22) and higher household income (aPR 1.06) (all p ≤ 0.04) were associated with instant messaging use, while post-secondary education was associated with face-to-face (aPR 1.10), video call (aPR 1.79), and email (aPR 2.76) communications (all p ≤ 0.03). Each ICT sharing method used was associated with a higher likelihood of both reported benefits (aPRs 1.26 and 1.52), better family communication quality and family well-being (adjusted ßs 0.43 and 0.30) (all p ≤ 0.001). We have first shown that COVID-19 information sharing in families using both traditional methods and ICTs, and using more types of methods, was associated with perceived benefits and better family communication quality and well-being amidst the pandemic. Sociodemographic differences in COVID-19 information sharing using ICTs were observed. Digital training may help enhance social connections and promote family well-being.

Corrigendum: Associations of Delay in Doctor Consultation With COVID-19 Related Fear, Attention to Information, and Fact-Checking.

[This corrects the article DOI: 10.3389/fpubh.2021.797814.].

Associations of Delay in Doctor Consultation With COVID-19 Related Fear, Attention to Information, and Fact-Checking.

Background: Delaying doctor consultation is harmful. Fear of COVID-19 leads to delays in seeking medical care at a time when pandemic information overflows. However, little is known about the role of COVID-19 related fear, attention to information, and fact-checking in such delay. Objective: Under the Hong Kong Jockey Club SMART Family-Link Project, we examined the associations of delay in doctor consultation amidst the pandemic with sociodemographic characteristics, COVID-19 related fear, attention to information, and fact-checking. Methods: We conducted a population-based online cross-sectional survey in May 2020 on Hong Kong Chinese adults. Respondents reported whether the pandemic caused any delay in doctor consultation (yes/no), level of COVID-19 related fear, attention to information and fact-checking (all on a scale of 0 to 10 and recoded into tertiles of low, moderate, high). Regression analyses were used to examine the associations of delay and fear with sociodemographic characteristics, attention and fact-checking, adjusting for covariates. Data were weighted by sex, age and education level of the population. Results: Of 4,551 respondents (46.5% male, 59.7% aged over 45 years), 10.1% reported delay in doctor consultation. The mean score was 6.4 for fear, 8.0 for attention and 7.4 for fact-checking. Delay was more common in males and increased with age and fear. High vs. low level of fear was associated with delay [adjusted odd ratios (AOR) 2.68, 95% confidence interval (CI) 2.08, 3.47]. Moderate level of fact-checking was negatively associated with delay (AOR 1.28, 95% CI 0.98, 1.67). Females reported greater fear and fear decreased with age. Fear increased with attention to information and decreased with fact-checking. Fear substantially mediated the association of delay with attention (96%) and fact-checking (30%). Conclusions: We have first shown that delay in doctor consultation increased with fear of COVID-19 and decreased with fact-checking amidst the pandemic. Fear also increased with attention to COVID-19 related information and decreased with fact-checking. Understanding these associations can help policymakers develop targeted communication and support to the public to reduce delayed doctor consultations and the associated COVID-19-related or unrelated morbidity and mortality in the community.

Family E-Chat Group Use Was Associated with Family Wellbeing and Personal Happiness in Hong Kong Adults amidst the COVID-19 Pandemic.

Instant messaging (IM) is increasingly used for family communication amidst the COVID-19 pandemic. However, evidence remains scarce on how family e-chat groups were used and their associations with family and individual wellbeing amidst the pandemic. The numbers of family e-chat groups, functions used, and messages sent and received daily in groups were reported by 4890 adults in May 2020, and their associations with family wellbeing and personal happiness and the mediation effect of family communication quality were examined. Results showed that sending/receiving text messages was most commonly used, followed by receiving/sending photos/pictures, making voice calls, receiving/sending short videos and voice messages, and making video calls. Women and older people used more non-text functions. Higher levels of family wellbeing and personal happiness were associated with having more groups, receiving/sending photos/pictures, video calls, more IM functions used, and more IM messages received/sent daily. Forty-six point two to seventy-five point five percent of their associations with more groups and more functions used were mediated by family communication quality. People having more family e-chat groups and using more IM functions may be more resilient amidst the pandemic, while those without or with low use of family e-chat groups amidst the pandemic would need more attention and assistance in the presence of social distancing.

Association of Mobile Instant Messaging Chat Group Participation With Family Functioning and Well-Being: Population-Based Cross-sectional Study.

BACKGROUND: Convenient and quality family communication improves family functioning and well-being. Using mobile instant messaging (IM) for family communication is increasingly popular, but its association with family functioning and family well-being has not been reported. OBJECTIVE: The aim of this study was to examine the association of the use of family IM chat groups with family functioning and well-being, and the mediating effect of family communication quality among Chinese adults in Hong Kong. METHODS: We analyzed data from the Family and Health Information Trend Survey (FHInTS), a territory-wide, probability-based telephone survey conducted in 2017. The quality of family communication, family functioning, and well-being was assessed using the Family Communication Scale; Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale; and Family Well-Being Scale (family heath, harmony, and happiness), respectively. Respondents also reported the number of family IM chat groups (0, 1, 2, ≥3), and numbers of IM messages received (<1, 1-2, 3-10, 11-20, >20) and sent (<1, 1-2, 3-10, 11-20, >20) daily. The frequency of family IM chat interaction (range 0-8) was calculated by combining the number of messages received from and sent to the family IM chat groups daily. Covariates included sociodemographic characteristics and the frequency of family face-to-face communication (often, sometimes, seldom, or never). Data were weighted by sex, age, and education of the general population. Adjusted ß coefficients of family functioning and well-being in relation to having a family IM chat group, and numbers of messages received and sent were calculated. The mediation effects of family communication on these associations were assessed, controlling for the covariates. RESULTS: A random sample of 1638 Chinese adults (45.6% men; 78.1% aged 25 to 64 years) were interviewed (response rate: 74.4%). Female, younger age, being married or cohabiting, higher education, higher income, better family functioning, and well-being were associated with having at least one family IM chat group (all P<.01). Higher scores of family communication, family APGAR, and family well-being were associated with having more family IM chat groups and more messages received from and sent to family IM chat groups daily (all P for trend <.01). More frequent family IM chat interaction was associated with higher scores of family communication, family APGAR, and family well-being (ß=.16-.83, all P for trend <.001). The associations of family IM chat interaction with family functioning and well-being were moderately (51.0%-59.6%) mediated by family communication. CONCLUSIONS: Use of a family IM chat group was associated with higher family functioning and well-being, and the association was partially mediated by family communication.

Fear of COVID-19 and its associations with perceived personal and family benefits and harms in Hong Kong.

Fear of COVID-19 is associated with public health compliance but also with negative well-being; however, no articles have reported associations of such fear with perceived benefits and harms. We assessed the level of fear of COVID-19 in Hong Kong adults and its associations with sociodemographic factors and perceived benefits and harms of COVID-19. In a 6-day population-based cross-sectional online survey in May 2020, 4,890 adults provided data on fear and perceived benefits and harms, personal happiness and family well-being, and sociodemographic characteristics. Linear regression was used to analyze associations. The level of fear was moderate (mean score 6.3/10). Fewer respondents reported perceived benefits (10.6%-21.7%) than harms (13.4%-43.5%). Females, younger age groups, and respondents with lower education or more cohabitants had greater fear. Fear was associated with perceived personal (increased knowledge of personal epidemic prevention) and family benefits (improved family hygiene), both with a very small effect size (Cohen's d = 0.03). Fear was also associated with lower personal happiness and perceived personal (increased negative emotions, feeling depressed and anxious, decreased income, and decreased work efficiency) and family harms (increased conflicts and negative emotions among family members), with small effect sizes (0.08-0.37). We have first shown sociodemographic differences in the fear of COVID-19 and such fear was associated with both perceived personal and family benefits and harms of COVID-19. Our findings may guide the management of fear to reduce sociodemographic differences, and maximize benefits and minimize harms.

Perceived Benefits and Harms of the COVID-19 Pandemic on Family Well-Being and Their Sociodemographic Disparities in Hong Kong: A Cross-Sectional Study.

We assessed the perceived benefits and harms of COVID-19 on family and their associations with sociodemographic factors in Chinese adults in Hong Kong. We conducted an online population-based survey and collected 4891 responses in 6 days. Prevalence estimates were weighted by sex, age, and education of the general population, and associations were analyzed using logistic regression. Our results showed both perceived benefits: 19.0% for family physical health, 7.2% family mental health, and 13.5% family relationships; and harms: 2.3% for family physical health, 37.9% family mental health, 18.6% family relationships, and 37.8% decreased family income. More female or older respondents reported perceived benefits but fewer of them reported perceived harms. More respondents with higher than lower socioeconomic scores (SES) reported perceived benefits on family physical and mental health and family relationships, but more respondents with lower than higher SES reported perceived harm on family income. As the pandemic continues with uncertainties, further studies on the dynamics of benefits and harms are needed. Urgent and additional assistance to underprivileged families and at-risk individuals are needed to reduce the inequities amidst the COVID-19 pandemic.

To investigate the association between the health literacy and hand hygiene practices of the older adults to help them fight against infectious diseases in Hong Kong.

BACKGROUND: Proper hand hygiene helps prevent infectious diseases, while health literacy plays a critical role in preventive health behaviors. It remains unclear as to why proper hand hygiene practices cannot be sustained and what role health literacy plays in older adults fight against infectious diseases. METHODS: A convenience sample of 433 old adults aged 65 and above was recruited. Their hygiene practices and health literacy were evaluated using a structured questionnaire adopted from the Centre for Health Protection and the Chinese version of the HLS-Asia-Q questionnaire. RESULTS: The percentage distribution of the hand hygiene performance, from always to never, was 18%-10%. A majority 63.28% (274) of them were classified as having inadequate health literacy (0-25), while a meager 1.62% (7) of them as having excellent health literacy (42.01-50). The Spearman correlation showed a significant positive relationship (P < 0.05) between the participants' health literacy and their hand hygiene practices. CONCLUSIONS: Health literacy and hand hygiene are positively related in helping the older adults fight against infectious diseases. To sustain proper hand hygiene practices is to provide frequent hand hygiene training to the older adults.

Cardiovascular Health of Construction Workers in Hong Kong: A Cross-Sectional Study.

BACKGROUND: Given a shortage of construction workers, it is important to develop strategies to avoid early retirement caused by cardiovascular diseases in Hong Kong. OBJECTIVES: (1) to describe the cardiovascular health of construction workers in Hong Kong, (2) to examine the demographic differences in cardiovascular health, and (3) to examine the association between health behaviors and cardiovascular health factors. METHODS: 626 registered construction workers were included in the analysis. Blood chemistry, blood pressure, weight, and height were measured. Face-to-face questionnaire interviews for health behaviors were conducted. RESULTS: Approximately two-thirds of the construction workers achieved only three out of the seven “ideal” cardiovascular health metrics. The younger, more educated, and female subjects had better cardiovascular health scores than the older, less educated, and male counterparts. Fish and seafood consumption was associated with (1) ideal weight status and (2) ideal cholesterol level, whereas less soft drink consumption was associated with ideal cholesterol level. CONCLUSIONS: The findings highlighted the importance of promoting cardiovascular health in the construction industry. This study provided some insights for future interventions, which should include increasing fish and seafood intake, decreasing soft drink consumption, and enhancing the health literacy amongst older, less educated, and male construction workers.

Paternal smoking and maternal protective behaviors at home on infant's saliva cotinine levels.

BackgroundWe investigated the association between paternal smoking, avoidance behaviors and maternal protective actions and smoke-free home rules with infant's saliva cotinine in Hong Kong.MethodsSix hundred and seventy-five non-smoking mothers (mean age 32.6 years) who attended the maternal-child health clinics with their newborns aged ≤18 months completed a questionnaire about paternal smoking and avoidance behaviors, maternal protective actions, smoke-free rules at home, and infant's second-hand smoke (SHS) exposure. Three hundred and eighty-nine infants provided saliva sample and its cotinine was tested.ResultsThe geometric mean of infant's saliva cotinine was 1.07 ng/ml (95% confidence interval (CI): 0.98, 1.16). Infants living in smoking families with SHS exposure had significantly higher cotinine level than in non-smoking families (adjusted ß=0.25, 95% CI: 0.16, 0.33). Paternal smoking near infants (within 1.5 m) was associated with higher cotinine level (adjusted ß=0.60, 95% CI: 0.22, 0.98), which was not reduced by avoidance behaviors (e.g., smoking in kitchen or balcony). Even fathers smoking ≥3 m away from infants was associated with higher cotinine level than non-smoking families (adjusted ß=0. 09, 95% CI: 0.01, 0.16). Maternal protective actions and smoke-free home rules were not significantly associated with reduced cotinine level.ConclusionPaternal smoking avoidance, maternal protective actions, and smoke-free policy at home did not reduce infant's saliva cotinine.

Effects of Praise Dance on the Quality of Life of Chinese Women.

OBJECTIVE: Religion, spirituality, and health are inseparable in human history. Yet, the effects of religion and spirituality on health are controversial. The objective of this study was to investigate the effects of praise dance on the quality of life (QoL) of women with or without medically diagnosed diseases. METHOD: This was a pretest-posttest study with one convenience sample that took place at Praise Dance Association Hong Kong (PDA) centers. Two hundred and fifty-six Chinese adult females participated. They were aged ≥45 years and had joined the PDA centers within 4 weeks of the commencement of this study. The intervention lasted for 12 weeks, and the subjects practiced praise dance three times a week in a group with a coach in the first four weeks and subsequently on their own or with the same group at least once a week. Each dancing session lasted for 30 min. The subjects completed the World Health Organization Quality of Life (WHOQOL)-BREF (HK) questionnaire before and after the intervention of the praise dance. RESULTS: The findings showed significant improvement in the psychological well-being of the participants, regardless of their religious background. The improvement in their physical domain was statistically marginal. CONCLUSION: This is the first empirical study to test the benefit of praise dance on QoL. Promoting praise dance could be beneficial to the psychological well-being of women, regardless of their religious backgrounds. The effect of religion or spirituality on QoL warrants further investigation.

Longitudinal relations of perceived availability of neighborhood sport facilities with physical activity in adolescents: an analysis of potential moderators.

BACKGROUND: Little is known about the longitudinal relations of environment attributes and leisure-time physical activity (PA) in adolescents, and the moderating effects of individual characteristics. This study examined the longitudinal association of the perceived availability of neighborhood sport facilities with leisure-time PA, and the potential moderating effects of age, past PA behavior, and weight status in adolescents. METHODS: Among 20,933 follow-up subjects (60.9% of 34,369 baseline subjects), 9993 from 32 Hong Kong secondary schools were successfully matched with baseline (mean duration 16 months; SD 1.7) and had complete information. At baseline and follow-up, respondents reported their leisure-time PA, weight, height, and the presence of sport facilities in the neighborhood. RESULTS: Increased perceived availability of sport facilities from baseline to follow-up predicted more leisure-time PA at follow-up (ß = 1.029; 95% CI: 1.0111.047) overall. This effect was modified by baseline PA, with a significant effect observed only among those who had engaged in leisure-time PA more than 3 times a week. CONCLUSIONS: Increasing awareness of neighborhood sport facilities or building more such facilities may help active adolescents maintain or increase their leisure-time PA. However, more comprehensive multilevel interventions that aim at enhancing potential social, personal, and environmental PA-related factors may be needed to motivate inactive adolescents.

Mode shifting in school travel mode: examining the prevalence and correlates of active school transport in Ontario, Canada.

BACKGROUND: Studies examining the correlates of school transport commonly fail to make the distinction between morning and afternoon school trips. The purpose of this study was to examine the prevalence and correlates of mode shift from passive in the morning to active in the afternoon among elementary and secondary school students in Ontario, Canada. METHODS: Data were derived from the 2009 cycle of the Ontario Student Drug Use and Health Survey (OSDUHS). 3,633 students in grades 7 through 12 completed self-administered questionnaires. Socio-demographic, behavioural, psychological, and environmental predictors of active school transport (AST) were assessed using logistic regression. RESULTS: Overall, 47% and 38% of elementary school students reported AST to and from school, respectively. The corresponding figures were 23% and 32% for secondary school students. The prevalence of AST varied temporarily and spatially. There was a higher prevalence of walking/biking found for elementary school students than for secondary school students, and there was an approximate 10% increase in AST in the afternoon. Different correlates of active school transport were also found across elementary and secondary school students. For all ages, students living in urban areas, with a shorter travel time between home and school, and having some input to the decision making process, were more likely to walk to and from school. CONCLUSIONS: Future research examining AST should continue to make the analytic distinction between the morning and afternoon trip, and control for the moderating effect of age and geography in predicting mode choice. In terms of practice, these variations highlight the need for school-specific travel plans rather than 'one size fits all' interventions in promoting active school transport.

GIS measured environmental correlates of active school transport: a systematic review of 14 studies.

BACKGROUND: Emerging frameworks to examine active school transportation (AST) commonly emphasize the built environment (BE) as having an influence on travel mode decisions. Objective measures of BE attributes have been recommended for advancing knowledge about the influence of the BE on school travel mode choice. An updated systematic review on the relationships between GIS-measured BE attributes and AST is required to inform future research in this area. The objectives of this review are: i) to examine and summarize the relationships between objectively measured BE features and AST in children and adolescents and ii) to critically discuss GIS methodologies used in this context. METHODS: Six electronic databases, and websites were systematically searched, and reference lists were searched and screened to identify studies examining AST in students aged five to 18 and reporting GIS as an environmental measurement tool. Fourteen cross-sectional studies were identified. The analyses were classified in terms of density, diversity, and design and further differentiated by the measures used or environmental condition examined. RESULTS: Only distance was consistently found to be negatively associated with AST. Consistent findings of positive or negative associations were not found for land use mix, residential density, and intersection density. Potential modifiers of any relationship between these attributes and AST included age, school travel mode, route direction (e.g., to/from school), and trip-end (home or school). Methodological limitations included inconsistencies in geocoding, selection of study sites, buffer methods and the shape of zones (Modifiable Areal Unit Problem [MAUP]), the quality of road and pedestrian infrastructure data, and school route estimation. CONCLUSIONS: The inconsistent use of spatial concepts limits the ability to draw conclusions about the relationship between objectively measured environmental attributes and AST. Future research should explore standardizing buffer size, assess the quality of street network datasets and, if necessary, customize existing datasets, and explore further attributes linked to safety.

Validity and test-retest reliability in assessing current body size with figure drawings in Chinese adolescents.

OBJECTIVE: The reliability and validity of Stunkard's Figure Rating Scale (FRS) as a measure of current body size (CBS) was established in Western adolescent girls but not in non-Western population. We examined the validity and test-retest reliability of Stunkard's FRS in assessing CBS among Chinese adolescents. Methods. In a school-based survey in Hong Kong, 5666 adolescents (boys: 45.1%; mean age 14.7 years) provided data on self-reported height and weight, CBS, perceived weight status, and health-related quality of life using the Medical Outcomes Study Short-Form version 2 (SF-12v2). Height and weight were also objectively measured. Spearman's correlation was used to assess construct validity, concurrent validity and test-retest reliability. RESULTS: Convergent and discriminant validity were good: CBS correlated strongly with weight and self-reported/measured BMI, but only weakly with SF-12v2. CBS correlated strongly with perceived weight status, showing concurrent validity. Spearman's correlation (r) for CBS was 0.78 for girls and 0.72 for boys indicating good test-retest reliability. Validity and reliability results did not differ significantly between senior and junior grade adolescents. CONCLUSION: Our findings support the use of Stunkard's FRS to measure body size among Chinese adolescents.

Neighbourhood food environment and dietary intakes in adolescents: sex and perceived family affluence as moderators.

OBJECTIVE: To examine the effects of perceived availability of fast-food shops, restaurants, and convenience stores on adolescent dietary intakes. METHODS: Survey data from 34 369 students in 42 Hong Kong secondary schools were collected in 2006-7. Respondents reported the availability of fast-food shops, restaurants and convenience stores in the neighbourhood, and their intakes of fruit, vegetables, high-fat foods and junk food/soft drinks. For intakes of high-fat foods and junk food/ soft drinks, ≤ once a week was defined as low consumption and the rest moderate/high consumption. At least three servings of vegetables and two servings of fruit daily were defined as sufficient consumption. Logistic regression yielded adjusted odds ratios (OR) for each dietary intake in relation to the reported food shops. Potential effect modifications by socio-demographic factors were also examined. RESULTS: Perceived availability of fast-food shops and convenience stores were positively associated with moderate/high consumptions of high-fat foods (OR(fast) =1.10 and OR(con) =1.15) and junk food/soft drinks (OR(fast)=1.10 and OR(con) =1.10). Significant negative associations of the perceived availability of restaurants with intakes of vegetables and fruit were observed (OR(veg) =0.87 and OR(fruit) =0.83). The positive relationship between reporting fast-food shops with intake of junk food/soft drinks were observed only in boys and those with low perceived family affluence. The negative association of reporting restaurants with fruit consumption was found in those with low and middle perceived family affluence only. CONCLUSIONS: Perceived availability of neighbourhood fast-food shops, restaurants, and convenience stores may have a negative impact on adolescent dietary intakes particularly for those from poorer families.