Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review.

BACKGROUND: Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings. METHODS AND FINDINGS: A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. For our search strategy, the terms "tuberculosis" AND "NCDs" (and their synonyms) AND ("delivery of healthcare, integrated" OR a range of other terms representing integration) were used. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization's (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance. A total of 22 articles published between 2011 and 2021 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case-control study, 1 prospective interventional study, and 4 were mixed methods studies. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness. CONCLUSIONS: Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB-NCD research.

Goal-Framing and Temporal-Framing: Effects on the Acceptance of Childhood Simple Obesity Prevention Messages among Preschool Children's Caregivers in China.

A range of intervention models are available for childhood obesity prevention; however, few studies have examined the effectiveness of intervention messages. This study developed childhood simple obesity prevention messages on the basis of goal-framing and temporal-framing effects to improve message acceptance among the caregivers of preschool children and explored associated factors. A cross-sectional study was conducted among 592 caregivers of preschool children in urban kindergartens in China during March to April 2019. The framing messages were developed based on prospect theory and construal level theory. The majority (48.4%) of caregivers found the gain-framed, present-oriented message most salient for acceptance. We found that gender, education background, theme, and the use of negative words have impacts on goal-framing effects; and previous participation in a health related intervention, career category, and the theme have impacts on temporal-framing effects (p < 0.001). Goal-framing effects and temporal-framing effects can influence each other (p < 0.001). The findings suggest that the gain-framed, present-oriented message could be considered a strategy to improve the acceptance of information by caregivers. When framing a message, subtle differences like using negative words might affect the exertion of framing effects.

Factors associated with smoking cessation among Chinese adults in rural China.

OBJECTIVES: To examine the factors associated with smoking cessation among adult Chinese males in rural China. METHODS: The data were collected by face-to-face interviews at the respondents' household using interviewer-administered questionnaires. RESULTS: The factors associated with quitting were being residents of Guiyang, having received junior or high school education, being unmarried, being a farmer or other job holder, smoking fewer than 20 cigarettes per day, starting smoking late, smoking for shorter duration, and having a high mean score on hedonism seeking. CONCLUSIONS: Several predictors of successful quitting were identified that could help improve smoking cessation programs in China. The findings also have implications for the need for future surveys on the quitting process among rural Chinese.

Effectiveness of a mobile smoking cessation service in reaching elderly smokers and predictors of quitting.

BACKGROUND: Different smoking cessation programmes have been developed in the last decade but utilization by the elderly is low. We evaluated a pilot mobile smoking cessation service for the Chinese elderly in Hong Kong and identified predictors of quitting. METHODS: The Mobile Smoking Cessation Programme (MSCP) targeted elderly smokers (aged 60 or above) and provided service in a place that was convenient to the elderly. Trained counsellors provided individual counselling and 4 week's free supply of nicotine replacement therapy (NRT). Follow up was arranged at 1 month by face-to-face and at 3 and 6 months by telephone plus urinary cotinine validation. A structured record sheet was used for data collection. The service was evaluated in terms of process, outcome and cost. RESULTS: 102 governmental and non-governmental social service units and private residential homes for the elderly participated in the MSCP. We held 90 health talks with 3266 elderly (1140 smokers and 2126 non-smokers) attended. Of the 1140 smokers, 365 (32%) received intensive smoking cessation service. By intention-to-treat, the validated 7 day point prevalence quit rate was 20.3% (95% confidence interval: 16.2%-24.8%). Smoking less than 11 cigarettes per day and being adherent to NRT for 4 weeks or more were significant predictors of quitting. The average cost per contact was US$54 (smokers only); per smoker with counselling: US$168; per self-reported quitter: US$594; and per cotinine validated quitter: US$827. CONCLUSION: This mobile smoking cessation programme was acceptable to elderly Chinese smokers, with quit rate comparable to other comprehensive programmes in the West. A mobile clinic is a promising model to reach the elderly and probably other hard to reach smokers.

Smoking patterns and sociodemographic factors associated with tobacco use among Chinese rural male residents: a descriptive analysis.

BACKGROUND: Although evidence has shown high prevalence rates of tobacco use in the general urban populations in China, relatively little is known in its rural population. The purposes of this study were to examine smoking patterns and sociodemographic correlates of smoking in a sample of rural Chinese male residents. METHODS: The study employed a cross-sectional, multi-stage sampling design. Residents (N = 4,414; aged 15 years and older) were recruited from four geographic regions in China. Information on participants' tobacco use (of all forms), including their daily use, and sociodemographic characteristics were collected via survey questionnaires and the resultant data were analyzed using chi-square tests and logistic regression procedures. RESULTS: The overall smoking prevalence in the study sample was 66.8% (n = 2,950). Of these, the average use of tobacco products per day was 12.70 (SD = 7.99) and over 60% reported daily smoking of more than 10 cigarettes. Geographic regions of the study areas, age of the participants, marital status, ethnicity, education, occupation, and average personal annual income were found to be significantly associated with an increased likelihood of smoking among rural Chinese male residents. CONCLUSION: There is a high smoking prevalence in the Chinese rural population and smoking behaviors are associated with important sociodemographic factors. Findings suggest the need for tobacco control and intervention policies aimed at reducing tobacco use in Chinese rural smoking populations.

Attitudes and behavioral response toward key tobacco control measures from the FCTC among Chinese urban residents.

BACKGROUND: The Chinese National People's Congress ratified the WHO Framework Convention on Tobacco Control (FCTC) on 27 August 2005, signaling China's commitment to implement tobacco control policies and legislation consistent with the treaty. This study was designed to examine attitudes towards four WHO FCTC measures among Chinese urban residents. METHODS: In a cross-sectional design study, survey data were collected from two Chinese urban cities involving a sample of 3,003 residents aged 15 years or older. Through a face-to-face interview, respondents were asked about attitudes toward four tobacco control measures developed by the WHO FCTC. Data on the four dependent measures were analyzed using multivariate logistic regression analyses. Using descriptive statistics, potential change in smoking behavior that smokers might make in response to increasing cigarette prices is also reported. RESULTS: 81.8% of the respondents in the study sample supported banning smoking in public places, 68.8% favored increasing the cigarette tax, 85.1% supported health warnings on cigarette packages, and 85.7% favored banning tobacco advertising. The likelihood to support these measures was associated with gender, educational level, and personal income. Smokers were less likely to support these measures than non-smokers, with decreased support expressed by daily smokers compared to occasional smokers, and heavy smokers compared to light smokers. The proportion of switching to cheaper cigarette brands, decreasing smoking, and quitting smoking altogether with increased cigarette prices were 29.1%, 30.90% and 40.0% for occasional smokers, respectively; and 30.8%, 32.7% and 36.5% for daily smokers, respectively. CONCLUSION: Results from this study indicate strong public support in key WHO FCTC measures and that increases in cigarette price may reduce tobacco consumption among Chinese urban residents. Findings from this study have implications with respect to policymaking and legislation for tobacco control in China.

Predictors of the participation of smoking parents in a proactive telephone-based smoking cessation program.

OBJECTIVE: The objective of this study is to identify the predictors of participation by smoking parents in a proactive telephone-based smoking cessation program. METHODS: The smoking parents of young children from a birth cohort were interviewed and invited to take part in a telephone-based smoking cessation program. The characteristics of the parents and the predictors of participation were analyzed by chi-square test and by logistic regression. RESULTS: A total of 952 (82.9%) out of the 1149 smoking parents who were interviewed agreed to participate in the smoking cessation program. The analysis showed that the predictors of participation in a pro-active smoking cessation program are being from a middle-income household, being currently employed, having recently had a medical consultation or been hospitalized, being at the stage of contemplating a change in behavior, and perceiving the importance of quitting smoking. CONCLUSIONS: Recruitment approaches should be refined according to the identified factors to target those who might decline an invitation to participate in a smoking cessation program.

Smoking cessation among Chinese young smokers: does gender and age difference matters and what are the predictors?

This study assessed the gender and age differences in smoking cessation among the Chinese youth and identified factors associated with quitting smoking. This was a clinic based cross-sectional study with longitudinal components among 129 Chinese young smokers. All services in the clinic including one week's supply of nicotine replacement therapy (NRT) were free. We used structured questionnaires at baseline and at 1, 3 and 12 months. The analysis was by intention-to-treat basis. At 12 month follow up, the 7 day point prevalence quit rate (abstinence from tobacco smoking during the 7 days preceding the follow up) was 19% (25/129) and 36% (25/69) among all the attendees and among those who were successfully followed up, respectively. There was no significant gender or age differences in the quitting outcome but females and the older youth reported more withdrawal symptoms. Not reporting any withdrawal symptoms at 3 months follow up and adherence to use NRT for at least 4 weeks were significant predictors of quitting. A clinic-based smoking cessation service among Chinese young smokers produced an acceptable quit rate with no gender and age difference, indicating that a more general quit smoking approach could be taken for the youth.

Promoting smoking cessation among the elderly: what are the predictors of intention to quit and successful quitting?

PURPOSE: To assess the predictors of smoking cessation and intention to quit among the Chinese elderly smokers. DESIGN: A cross-sectional survey of elderly smokers. SETTING: Shamsuipo district, Hong Kong. SUBJECT: A total of 1,318 elderly were interviewed (response rate = 83%). MEASURES: A structured questionnaire was used for data collection. The questionnaire sought information on the subject's sociodemographic background and smoking habits. The predictors for successful quitting and intention to quit were assessed by chi-square tests and multiple logistic regression. RESULTS: Of the respondents, 20.2% were current smokers, 25.4% were ex-smokers, and 54.4% were never smokers. Of the smoker (current and ex-smokers) respondents, 55.7% (335/601) had successfully quit at the time of enumeration. The predictors of quitting were living with others, receiving assistance for mobility, being nondrinkers, smoking for shorter duration, and smoking more cigarettes per day. Having health problems in the past, smoking for shorter duration, and smoking fewer cigarettes per day were predictors of intention to quit smoking. CONCLUSION: The study identified several predictors of successful quitting that could help improve the provision of current smoking cessation services. Population-based smoking cessation programs, especially those targeted to elderly, should take these predictors into consideration in the design of interventions.

Investigation of Hong Kong doctors' current knowledge, beliefs, attitudes, confidence and practices: implications for the treatment of tobacco dependency.

BACKGROUND: Physicians play a crucial role in promoting smoking cessation. However, there are lack of data on Chinese doctors' knowledge, beliefs, attitudes, confidence and usual practices in relation to smoking cessation. Understanding of these indicators is important in the design of any effective intervention program targeting doctors. METHODS: To assess Chinese doctors' knowledge, beliefs, attitudes, confidence and usual practices in relation to smoking cessation, a mailed questionnaire survey was conducted among 4,000 doctors registered with the Hong Kong Medical Association (HKMA) in 2002. RESULTS: Of the 757 respondents (18.9% response rate), 78% were male, 94% were non-smokers and 50% had received no basic training on smoking cessation. More than half of the doctors did not hold adequate knowledge (53%) or favorable attitudes (55%) towards smoking cessation; 44% were less confident in their smoking cessation skills. About 77% of the doctors obtained information on their patients' smoking status and recorded it in their medical record, and 29% advised all smoking patients to quit. Doctors who gave smoking cessation advice were more likely to be aged above 50 years, with more than 30 years' practice experience, working in the private sector, non- or ex-smokers, with more positive beliefs towards smoking cessation, and with higher confidence in smoking cessation skills (p < 0.001). Different factors associated with establishing and recording smoking status, arranging follow-up sessions, acquiring more knowledge and developing a more favorable attitude and greater confidence on smoking cessation-related matters were also identified. CONCLUSION: The survey has shown that existing smoking cessation service provision in Hong Kong for patients who smoke is inadequate, and has identified a lack of smoking cessation skills among doctors. Action should be taken to train doctors in smoking cessation skills and encourage them to routinely establish the smoking status of their patients and to advise all smokers to quit smoking.

Travel-related health problems of Hong Kong residents: Assessing the need for travel medicine services.

BACKGROUND: Although there has been a marked increase in travel among Hong Kong residents, travel-related health risks have not been well characterized nor has their use of travel medicine services. OBJECTIVES: To assess the travel health care needs of Chinese residents in Hong Kong by examining travel health problems of returning Hong Kong residents and by understanding their use of travel health services before or after travel. METHODS: Review of available data followed by a cross-sectional telephone survey of 280 travellers and 15 service providers. A structured pre-tested questionnaire was used for data collection. Household members, who were ethnic Chinese, aged 15-64 years, able to communicate in Cantonese, and who had travelled at least once during the preceding 12 months were invited to participate. RESULTS: There was a scarcity of travel medicine services in Hong Kong. The most common destinations for travellers were countries in the Asia-Pacific region, especially mainland China (33%). Twenty percent of the respondents developed health problems during or shortly after travel. Although only 9% of respondents had received pre-travel health advice, 61% used some form of precautions. Twelve percent had lost at least a day due to travel-related health problems. The service providers agreed that there are demands for travel health services. However, half of the service providers had not been trained in travel or tropical medicine. CONCLUSIONS: This study indicates the need for specialized travel medicine services in Hong Kong to improve the health of travellers.

Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: a preliminary investigation.

RATIONALE: There are over 300 million Chinese smokers, but use of nicotine replacement therapy (NRT) is rare. On the other hand, data on the factors associated with quitting and adherence to NRT use are scarce in the East. OBJECTIVES: To describe adherence and other predictors of quitting smoking at the 12-month follow-up amongst Chinese smokers in Hong Kong. METHODS: Chinese smokers (1186) who attended the Smoking Cessation Health Centre from August 2000 through January 2002 were studied. Trained counsellors provided individual counselling and carried out follow-up interviews. We used structured questionnaires at baseline and at 1, 3 and 12 months and an intention-to-treat approach for analysis. RESULTS: Among those who received NRT (1051/1186), the prevalence of adherence (self-reported NRT use for at least 4 weeks) was 16% (95% confidence interval 14-18%). The 7-day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27% (95% CI, CI 24-29%). Stepwise logistic regression model showed that adherence to NRT use, a higher income, good perceived health and having more confidence in quitting were significant predictors of quitting. The quit rate in the adherent group (40%) was greater than that of the non-adherent group (25%) (P<0.001). Older age, male, higher education, experience of NRT use, perceiving quitting as more difficult and willingness to pay were significant predictors of adherence. CONCLUSIONS: Clinically significant smoking cessation rates can be achieved among Chinese smokers in a clinic-based smoking cessation service. The NRT adherence was low and low adherence was associated with a lower quit rate. Trials of interventions to improve adherence and increase quit rates are needed.

Smoking cessation intervention in parents of young children: a randomised controlled trial.

OBJECTIVE: To examine whether telephone counselling based on the stages of change component of Transtheoretical model of behaviour change together with educational materials could help non-motivated smoking parents of young children to cease. DESIGN: Randomised controlled trial. SETTING: Hong Kong Special Administrative Region, PR China. PARTICIPANTS: 952 smoker fathers and mothers of Chinese children aged 5 years. INTERVENTION: Participants were randomly allocated into two groups: the intervention group received printed self-help materials and three-session telephone-based smoking cessation counselling delivered by trained counsellors; the control group received printed self-help materials only. A structured questionnaire was used for data collection at baseline and at 1, 3 and 6 month follow up. MAIN OUTCOME MEASURES: The main outcome is 7 day point prevalence quit rate at 6 months (defined as not smoking during the 7 days preceding the 6 month follow up) determined by self reports. Other secondary outcomes were self reported 24 h point prevalence quit rate and self-reported continuous quit rate and bio-chemically validated quit rate at 6 months. RESULTS: A total of 952 smoker fathers and mothers were randomized to the intervention (n = 467) and control (n = 485) groups. Most were daily smokers (92.4%) and the mean number of cigarettes smoked per day was 14.5 (SD = 8.9). By using intention-to-treat analysis, the 7 day point prevalence quit rate at 6 month follow up was significantly greater in the intervention group (15.3%; 68/444) than the control group (7.4%; 34/459) (P < 0.001). The absolute risk reduction was 7.9% (95% confidence interval: 3.78% to 12.01%). The number needed to treat to get one additional smoker to quit was 13 (95% CI: 8-26). The crude odds ratio of quitting was 2.3(95% CI: 1.5-3.5). The adjusted odds ratio was 2.1 (95% CI: 1.4-3.4) (adjusted for age, number of years smoked, and alcohol dependency). CONCLUSION: Proactive telephone counselling is an effective aid to promote smoking cessation among parents of young children.

Willingness to pay for preventive travel health measures among Hong Kong Chinese residents.

BACKGROUND: The effectiveness of preventive measures in combating travel-related illnesses is well recognized. However, there is a lack of information on the economic value of any travel-associated preventive measures in the literature. OBJECTIVES: The purpose of this article is to report the values of willingness to pay (WTP) to prevent travel health problems in Hong Kong's travelers. METHODS: A cross-sectional telephone survey for a sample of Hong Kong population was conducted in 1998 using a random digit dialing technique. The sample WTP values were elicited using an open-ended question. Logistic regression was performed to identify predictors of WTP. Mean WTP was estimated using Heckman's sample selection model on log-WTP. RESULTS: Of the subjects interviewed, 77% (285/369) offered positive values of WTP to prevent travel health problems. The observable WTP (zero excluded) had a higher mean (447 Hong Kong dollars) than did the zero-inclusive data (351 Hong Kong dollars). The median values were 200 Hong Kong dollars in both cases because there were a large number of protest responses. Age, travel frequency, ability to assess travel health risk, precautionary behavior, and previous exposure to health protection materials explained one's willingness to pay a positive amount for preventing travel health problems. Age, education level, and precautionary behavior were predictors of the WTP levels. CONCLUSION: The findings of this study suggest that Chinese travelers are willing to pay for the prevention of travel-related illnesses. The predictors of WTP identified could be used to suggest policy changes. However, future studies are needed to explore further the relationship between the experience of travel illnesses, the magnitude of travel health risks, and WTP.

Intention to quit smoking, attempts to quit, and successful quitting among Hong Kong Chinese smokers: population prevalence and predictors.

PURPOSE: To assess the prevalence of each step in the smoking-cessation process (intention to quit, attempts to quit, and successful quitting) and to examine the factors associated with them among Chinese smokers. DESIGN: A cross-sectional survey of subjects from randomly selected households. SETTING: Four thousand one hundred forty-two households in Hong Kong. SUBJECTS: A total of 11,779 persons, aged 15 years or older, were enumerated (response rate = 74.0%). MEASURES: A validated structured questionnaire was used for data collection. The questionnaire sought information on the subject's sociodemographic background, smoking habits, and workplace attitude to smoking. The predictors for successful quitting, past quitting attempts, and intention to quit were assessed by chi2 tests and multiple logistic regression. RESULTS: Of the respondents, 14.4% were current smokers, 7.5% were ex-smokers, and 78.1% were nonsmokers. Of the daily smokers, 52% intended to quit. The factors associated with quitting were being married, being in the student/retired/others category, being older, having received higher education, not smoking to kill time, and smoking because of curiosity. Being married and not smoking to kill time were associated with past quitting attempts. Being male, married, and not smoking to kill time were associated with the intention to quit smoking. CONCLUSION: The findings of this study indicate that differing predictors may contribute to the different transitional stages of smoking cessation. Population-based smoking-cessation programs should take these predictors into consideration in the design of interventions.

Validity of self-reports and reliability of spousal proxy reports on the smoking behavior of Chinese parents with young children.

This study aims to examine the validity of self-reports and reliability of spousal proxy reports of smoking behavior among Chinese parents with young children. Agreement of self-reported smoking status with expired CO concentration among parents in the intake interview was significant with kappa at 0.70. Agreement of the mothers' and fathers' proxy reports on their spouses' smoking status and cigarette consumption by ICC were 1.0 and 0.58, and 0.82 and 0.33, respectively. Self-report and proxy reports of smoking status are considered valid and reliable to assess smoking behavior of parents with young children in Hong Kong.

How far should we promote smoking reduction in order to promote smoking cessation?

Smoking is the greatest preventable cause of death worldwide. In recent years considerable efforts have been devoted to reducing exposure to tobacco and related products. The ultimate aim has been to persuade people to stop smoking. It is generally recognized that smoking cessation is effective in reducing the burden of disease associated with smoking. However, smoking is an addiction to nicotine and relatively few people can quit successfully without professional help. Many do not want even to try. There is evidence that a reduction in cigarette consumption could result in improved health and provide an intermediate step before complete cessation, especially for those smokers who are not ready or willing to quit. Smoking reduction intervention with counselling and/or nicotine replacement therapy (NRT) have been shown by randomised controlled trials to be effective in reducing cigarette consumption for the general smoking population. We here present the argument that there may be a case for promoting smoking reduction both as a desirable goal in itself and as a first step towards smoking cessation.

Effectiveness of smoking reduction intervention for hardcore smokers.

BACKGROUND: The prevalence and correlates of hardcore smokers, who have high daily cigarette consumption, no quitting history and no intention to quit, have been studied in several western developed countries, but no previous trials of smoking cessation have tested intervention effectiveness for these smokers. The current study examined if hardcore smokers can benefit from smoking reduction intervention to achieve cessation, and explored the underlying reasons. METHODS: A posteriori analysis was conducted on data from a randomized controlled trial of smoking reduction intervention on 1,154 smokers who did not want to quit. Odds ratios of 7-day point prevalence of abstinence, smoking reduction by at least 50% and quit attempt at the 6-month follow-up comparing subgroups of smokers were analyzed. RESULTS: In hardcore smokers, the odds ratio comparing the quit rate between the intervention and control group was 4.18 (95% CI: 0.51-34.65), which was greater than non-hardcore smokers (OR = 1.58, 95% CI: 0.98-2.54). The number needed to treat for hardcore and non-hardcore smokers was 8.33 (95% CI: 5.56-16.67) and 16.67 (95% CI: 8.33-233.64), respectively. In smokers who did not have quit attempt experience and those who smoked more than 15 cigarettes daily, the odds ratio comparing intervention and control group was 3.29 (95% CI: 0.72-14.98) and 1.36 (95% CI: 0.78-2.36), respectively. CONCLUSIONS: The a posteriori analysis provided pilot results that smoking reduction intervention may be effective to help hardcore smokers to quit and reduce smoking. Having no previous quit attempt was identified as more important than having large cigarette consumption in explaining the greater effectiveness of the intervention.

Sexually transmitted infections in travelers: implications for prevention and control.

Sexually transmissible diseases (STDs), the most common notifiable infectious conditions, remain major threats to reproductive and public health worldwide. Travelers are particularly vulnerable to STDs, because of voluntary or involuntary sexual behavior while abroad, and are significant vectors who introduce new pathogens and resistant strains to unaffected parts of the world. This article outlines some key issues that travel medicine specialists and other clinicians should revisit when providing services to travelers. We discuss obstacles to promoting sexual health, including the diversity of the target group, unanticipated opportunities for sexual risk, ambivalent cooperation by the travel and tourism industries, poorly developed travel health sectors, illegal migration and sex tourism, and lack of research about the association between travel and STDs. We also outlined some programmatic aspects of public health that should be identified and addressed for the promotion of sexual health among travelers.

Determinants of HIV antibody testing among selected groups of Chinese residents in Hong Kong.

HIV testing is promoted to the public as a tool for HIV prevention in many countries. However, the patterns and determinants of HIV antibody testing among the Chinese people are unknown. To describe the prevalence and determinants of HIV antibody testing amongst the Hong Kong Chinese a cross-sectional anonymous survey was carried out among 1,027 subjects from different population groups (airport travellers, business sector workers, service sector workers, university staff, and STD clinic attendees). Subjects were categorized into either 'STD population' (respondents from STD clinics) versus 'all others' (respondents from other settings) groups. Forty-five percent of the respondents reported ever having had a test for HIV antibody. 'STD population' group members were almost three times more likely to have had an HIV test than were 'all others' group members (77% vs 20%). After adjustments, 'STD population' group members who reported having tested for HIV were more often aged 45 years or older, alcohol drinkers, with high self-efficacy scores, and inconsistent condom users; members in the 'all others' group, more often had had sex with strangers, drank alcohol, and favoured having multiple sex partners. Awareness among the public about the risk behaviours for HIV should be enhanced and efforts should be made to reduce high-risk behaviours among those tested by emphasizing the importance of maintaining safer sex behaviour and having follow-up tests during post-test counselling.