Combined Effect of Healthy Lifestyle Factors and Risks of Colorectal Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality: Systematic Review and Meta-Analysis.

Background: In addition to adiposity, lifestyle factors such as poor diet, low physical activity, alcohol intake and smoking are noted to be associated with the development of colorectal cancer (CRC). This study aims to investigate the association and dose-response relationship between adherence to a healthy lifestyle and CRC risk. Methods: A systematic literature search was conducted in MEDLINE and EMBASE for studies examining multiple lifestyle factors with risk of CRC, incident colorectal adenoma (CRA), and CRC-specific mortality through June 2021 without restrictions on language or study design. Meta-analysis was performed to pool hazard ratios using random-effects model. Subgroup analyses were performed based upon study and sample characteristics. Random-effects dose-response analysis was also conducted for CRC risk to assess the effect of each additional healthy lifestyle factor. Results: A total of 28 studies (18 cohort studies, eight case-control studies, and two cross-sectional study) were included. When comparing subjects with the healthiest lifestyle to those with the least healthy lifestyle, the pooled HR was statistically significant for CRC (0.52, 95% CI 0.44-0.63), colon cancer (0.54, 95% CI 0.44-0.67), rectal cancer (0.51, 95% CI 0.37-0.70), CRA (0.39, 95% CI 0.29-0.53), and CRC-specific mortality (0.65, 95% CI 0.52-0.81). The pooled HR for CRC was 0.91 (95% CI: 0.88-0.94) for each increase in the number of healthy lifestyles. The inverse association between healthy lifestyle and CRC risk was consistently observed in all subgroups (HR ranging from 0.26 to 0.86). Conclusions: Adoption of a higher number of healthy lifestyles is associated with lower risk of CRC, CRA, and CRC-specific mortality. Promoting healthy lifestyle could reduce the burden of CRC. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=231398, identifier CRD42021231398.

The role of body mass index in the association between dietary sodium intake and blood pressure: A mediation analysis with NHANES.

BACKGROUND AND AIMS: Recent research demonstrated that obesity and high dietary sodium intake, the two established risk factors for hypertension, were associated with each other. The objective was to investigate the potential indirect effect of sodium intake on blood pressure via body mass index (BMI). METHODS AND RESULTS: Using ten years data from US NHANES (2007-2016), the study included adult participants (>20 years old) who were not taking antihypertensive medications and without baseline diseases (n = 12,262). BMI was modelled as the mediator of sodium intake on systolic and diastolic blood pressure, adjusted for age, sex, socioeconomic status, smoking, drinking, physical activity, calorie intake, fluid intake and potassium intake. Mediation analysis was performed to evaluate total effect, direct effect and indirect effect via BMI. Subgroup analyses based on three age subgroups (20-40, 41-60 and ≥61 years old) were performed. The mean age was 39.29 (13.4) years and 53.1 (0.45) % were males. The mean BMI was 27.8 (6.20) kg/m2. Overall, 1 g/d increase in sodium intake was associated with an increased systolic blood pressure by 0.36 (95% confidence interval 0.14 to 0.58) mmHg, with a direct effect (0.14 (0.09-0.19)) and an indirect effect via BMI (0.23 (0.02-0.44)). The indirect effect was mainly observed in participants ≤60 years old. CONCLUSION: Sodium intake showed both direct effect and indirect effect (via BMI) on systolic blood pressure in US NHANES. The findings provide evidence for combining sodium restriction and weight reduction measures for prevention of hypertension. Cautions should be taken when generalizing the findings to other populations with lower average BMI.

Food Avoidance Beliefs and Behaviors Among Chinese Cancer Patients: Validation of a New Measurement Tool.

OBJECTIVE: Restrictive food avoidance behavior among Chinese cancer patients is common. Yet, to the authors' knowledge, no study has investigated factors associated with such behavior. This study attempted to validate a new measurement tool, the Cancer Patients Food Avoidance Behaviors Scale (CPFAB), that assessed cancer patients' belief regarding 5 perceived benefits of practicing food avoidance, and to test its applicability. DESIGN: Cross-sectional face-to-face interviews. SETTING: Two outpatient oncology clinics in 2 different districts of Hong Kong. PARTICIPANTS: A total of 245 patients with nasopharyngeal and colorectal cancer. MAIN OUTCOME MEASURES: Assessment of psychometric properties of the CPFAB. ANALYSIS: Principal components method with oblique (Promax) rotations was performed to investigate the factor structure of the CPFAB. RESULTS: Psychometric properties, which included test-retest intraclass correlations (mean = 0.72; SD = 0.12), Cronbach α (.88-.94), floor (0.4% to 5.7%) and ceiling (0% to 7.3%) effects, and item-subscale (0.67-0.79) and subscale-total (0.68-0.89) correlations, were satisfactory. CONCLUSIONS AND IMPLICATIONS: The CPFAB, a new instrument used to assess food avoidance, was developed and validated. It showed satisfactory psychometric properties and can be used to evaluate interventions that seek to modify food avoidance attitudes among cancer patients.

Acceptability of HPV vaccines and associations with perceptions related to HPV and HPV vaccines among men who have sex with men in Hong Kong.

HPV vaccines are available to men but there are few studies investigating the acceptability of HPV vaccines among men who have sex with men (MSM), a high risk group. We assessed the intention to take up HPV vaccines among MSM in Hong Kong and the associated factors related to cognitions on HPV and HPV vaccines, basing on the Health Belief Model (n = 542). The acceptability of HPV vaccines was 20% (unconditional on efficacies and price), 29.2% (conditional on efficacies and market price), 51.7% (conditional on efficacies and discounted price) and 79.1% (conditional on efficacies and free price). Adjusting for background variables, composite scores of perceived susceptibility, perceived severity, perceived barriers and cue to actions were significantly associated with acceptability of HPV vaccines conditional on specific efficacies and the market price. Acceptability of HPV vaccines was highly price sensitive. Future studies need to use conditional measures. Implementation and translational researches are warranted.

University binge drinking patterns and changes in patterns of alcohol consumption among chinese undergraduates in a Hong Kong university.

OBJECTIVE: To examine patterns of binge drinking and changes in drinking patterns among Chinese university students. PARTICIPANTS AND METHODS: Responses to an anonymous questionnaire were compared between a random sample of 411 second year Chinese undergraduate students in 2006 and 2,630 first year students from the previous year. Students reporting any symptoms of alcohol abuse were classified as alcohol abusers whereas those reporting repeated inability to curtail use were categorized as alcohol dependent. RESULTS: After 1 year of university, greatly increased rates of past-month drinking of different degrees were found in both genders. Binge drinking among second year undergraduates was significantly correlated with male gender, living in a student residence hall, smoking, drinking to relieve stress, and having friends who frequently drank. CONCLUSIONS: Alcohol misuse is a health hazard to Chinese students in a university environment. Proactive policies aimed at preventing harmful alcohol use should be considered by university authorities.

Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: a population-based study of Chinese adults in Hong Kong.

AIMS: To examine the patterns of drinking, the relationship between binge drinking, alcohol abuse, and dependence, and the sociodemographic factors associated with problem drinking among Hong Kong Chinese. METHOD: An anonymous, random telephone survey was conducted on 9860 Hong Kong Chinese adults from April to June, 2006. RESULTS: The age-adjusted prevalence amongst men for binge drinking was 14.4% with 5.3% of males being alcohol abusers and 2.3% dependent on alcohol. The corresponding figures for women were all lower at 3.6%, 1.4%, and 0.7%, respectively. Younger age groups showed the highest prevalence of these drinking problems. Among male binge drinkers, 18.7% were also alcohol abusers and 12.3% were alcohol dependent. Among female binge drinkers, 16% reported alcohol abuse and 9.9% reported dependence. Male binge drinkers were less likely to be older, less likely to be students but more likely to be employed in the service industry. Female binge drinkers were less likely to be over 60 years of age or married but more likely to be smokers. In both genders, smoking was significantly associated with the likelihood of binge drinking (OR = 3.6-12.3), alcohol abuse (OR = 3.0-12.1), and dependence (OR = 5.2-20.6). CONCLUSIONS: Although binge drinking has been well tolerated in Chinese culture, it is strongly associated with alcohol abuse and dependence in both genders in Hong Kong. Our findings suggest that prevalence of problematic alcohol consumption warrants greater promotion of alcohol harms awareness. Higher rates of heavy drinking in younger-aged individuals may reflect changing lifestyle behaviors and herald higher future levels of alcohol-related health and social problems.

Perceptions about status and modes of H5N1 transmission and associations with immediate behavioral responses in the Hong Kong general population.

OBJECTIVES: Perceptions and associated behavioral responses to H5N1 avian influenza were investigated. METHODS: A random telephone survey interviewed 805 Hong Kong adults in November 2005. RESULTS: Of respondents, 37.9% believed that bird-to-human transmission had occurred somewhere in the last year (Hong Kong: 17.3%). Similar figures for human-to-human transmission were 16.8% (some locale) and 6.8% (Hong Kong). Many perceived bird-to-human H5N1 are transmittable via long-distance airborne transmission (35.8%), contaminated water sources (44%) and insect bites (48%). Corresponding figures for human-to-human H5N1 transmission were 47.9%, 47.3% and 48.9% respectively. In the last 3 months, 49.4% of the respondents exhibited one of the 4 studied behavioral responses; the variable was associated with unconfirmed beliefs that past-year human-to-human H5N1 transmission had occurred in Hong Kong (adjusted OR=2.08). Beliefs that human-to-human transmission had occurred somewhere were associated with the 4 individual behaviors studied (adjusted OR=1.58-4.24). Perceptions that human-to-human H5N1 should be transmittable via contaminated water sources was associated with avoidance of visiting hospitals and eating less poultry (adjusted OR=1.69 and 1.64). Belief about airborne transmission of human-to-human H5N1 was associated with perceived stress (adjusted OR=2.32). CONCLUSIONS: Widespread unconfirmed beliefs about status of HN51 epidemic are associated with the general public's behavioral responses. Timely dissemination of up-to-date information is greatly warranted.

The relationship between physical maltreatment and substance use among adolescents: a survey of 95,788 adolescents in Hong Kong.

PURPOSE: To determine the prevalence of corporal punishment and the infliction of injuries from a beating occurring without provocation in the previous 6 months among secondary school children in Hong Kong, and to examine the associations between these two forms of physical maltreatment with substance-use-related behaviors and attitudes. METHODS: Using secondary data, a cross-sectional, self-administered, anonymous survey of 95,788 secondary school students was conducted in Hong Kong. RESULTS: The prevalence of physical maltreatment showed statistically significant associations with younger age, attendance in Chinese-speaking day schools, temporary housing, residence with only one parent, poorer parental relationship, greater peer influence, perceptions of excessive academic pressure, and feelings of being blamed for poor academic performance. Adolescents who had experienced corporal punishment were more likely to be current users of alcohol (OR = 1.11), tobacco (OR = 1.31), psychoactive substances (OR = 1.60), or heroin (OR = 1.90). Those who had been beaten to injury by a family member without provocation within the past 6 months also were more likely to be current users of alcohol (OR = 1.35), tobacco (OR = 1.65), psychoactive substances (OR = 2.39), and heroin (OR = 3.07). Additionally, students who experienced physical maltreatment were more likely to be acquainted with habitual substance users, have better access to psychoactive substances, to have engaged in sex after abusing drugs, have obtained money from illegal sources to purchase drugs, and believe that psychoactive substances are not harmful or addictive. CONCLUSIONS: Physical maltreatment showed strong associations with drug-related behaviors and attitudes, after adjusting for potential confounders. Further longitudinal studies are required to understand the causal direction of the relationship.

Prevalence, health outcomes, and patterns of psychotropic substance use in a Chinese population in Hong Kong: a population-based study.

Two anonymous population-based surveys were conducted between August 2001 and April 2002 using computer-assisted telephone interviews of 3793 male and 3244 female randomly selected residents of Hong Kong in order to estimate the prevalence of psychotropic substance use and identify risk factors and associations with health outcomes among users in Hong Kong. The study cohort was comprised of ethnically Chinese adults between the ages of 18 and 60 years of age. In the last 12 months, 5% of males and 1.8% of females had used psychotropic substances such as cannaboids, methylamphetamines, ketamines, cocaine, opiates, barbiturates, and benzodiazepines. Of the male drug users, almost one-third had done so outside of Hong Kong. "Risk factors" for substance use included: younger age, unemployment, being an early school leaver, being unmarried, "heavy alcohol consumption," and smoking. Psychotropic substance use in the past year was strongly associated with increased prevalence of long-lasting (> or =3 months) sexual health problems during the past year and with a higher prevalence of HIV/STD risk behaviors. The prevalence of substance use in Hong Kong has been under-reported. Although significant correlations were noted between substance use and various respondent attributes, the directionality of the associations needs to be determined with longitudinal studies. It may be prudent to integrate substance use and HIV/STD prevention efforts.