Socioeconomic characteristics and domestic work as correlates of family satisfaction in Hong Kong mothers of young children.

BACKGROUND: Family life satisfaction is an important contributor to the mental health of mothers with young children, who are particularly vulnerable to various sources of stressors. However, there is a dearth of studies on this topic in this demographic, the determinants of which likely differ across geographical and cultural contexts. We examined indicators of maternal socioeconomic status (SES) and domestic help as correlates of family satisfaction in Hong Kong mothers of young children. METHODS: Mothers (N = 322) of young children (3-5 years old) were recruited from neighbourhoods stratified by SES and population density. They self-completed a survey containing items on socio-demographics, SES characteristics (including household income and maternal education and employment status), maternal family satisfaction and division of domestic work in the household and family. Confounder-adjusted associations of maternal SES indicators and participation in housework and childcare activities by various agents (e.g., mother, spouse, other residents) were estimated. We also estimated the moderating effects of household income on the associations between maternal employment and family satisfaction, and those of maternal employment on the associations between domestic work division and family satisfaction. RESULTS: Household income and maternal education were positively related to maternal family satisfaction. Mothers in part-time employment had lower family satisfaction than non-working mothers and mothers working full-time. The latter reported higher family satisfaction than non-working mothers only if their household income was below HK$ 15,000. Domestic work performed by non-residents was predictive of higher family satisfaction, while mothers' housework and child(ren) tutoring were predictive of lower family satisfaction. Only part-time employed mothers benefited from spouse's assistance with domestic work. The interaction effects of maternal employment status on the associations between the division of child tutoring and family satisfaction were complex. CONCLUSIONS: In Hong Kong, mothers of young children with lower education and household income, who hold a part-time job and participate in housework and child tutoring activities have the lowest levels of family satisfaction and, hence, are at higher risk of mental health problems. Spouses' and non-resident family members' participation in domestic work, as well as the establishment of more family-friendly employment practices, may help mitigate this risk. TRIAL REGISTRATION: N/A.

Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities.

BACKGROUND: Preschool-aged children's physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children's PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples - Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA). METHODS: The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children's PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child's ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects. RESULTS: Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children's PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children's PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children's PA and negatively related to ST, while parental promotion of ST was positively associated with children's ST. Correlates of children's PA and ST did not differ by city. CONCLUSIONS: The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children's health-promoting activity levels.

Associations of socio-demographic, perceived environmental, social and psychological factors with active travel in Hong Kong adolescents: the iHealt(H) cross-sectional study.

Adolescent active travel (AT) can contribute to health-enhancing physical activity, sense of community, social interactions, spatial and navigational skills and is a sustainable form of transport. Data analysed were from surveys with validated scales, translated and adapted for Chinese speaking Hong Kong adolescents and their parents, and administered to 1,299 adolescent/parent dyads. Using hierarchical modelling, this study examined independent associations of socio-demographic, perceived environmental, social and psychological factors (in that order) with adolescent AT to/from school (ATS) and AT to other destinations in Hong Kong. Moderation by gender and age on perceived environmental and social factors and number of household vehicles on proximity to destinations with AT were also estimated. The adolescents participating in ATS (58%), averaged 7.93 trips and 139.79 min per week. Adolescents averaged 7.68 trips/week to destinations other than school. Perceived proximity of school to home and social support for PA from peers were independently associated with higher odds of engaging in ATS. Social support for PA from household adults was associated with lower odds of engaging in ATS, especially in older adolescents. Trip frequency in those who engaged in ATS was positively associated with perceived proximity of school, access to services and parental transport-related PA. Perceived proximity of school was negatively associated with weekly minutes of ATS. Gender modified the association between social support for PA from peers and ATS frequency, and that of perceived proximity to public transport from home with weekly minutes of ATS. Perceived environmental, social and psychological factors were independently associated with AT to destinations other than school. In conclusion, Hong Kong adolescents appear to have high frequencies of ATS and AT to other destinations than reported elsewhere. Social support from peers, parental AT and having schools and other destinations within walking distance from home may independently contribute to adolescents' AT.

Validity of a scale of neighbourhood informal social control relevant to pre-schoolers' physical activity: A cross-sectional study.

Childhood physical activity (PA) is important for health across the lifespan. Time pre-schoolers spend outdoors, which has been associated with more PA, is likely influenced by parents' perception of neighbourhood informal social control relevant to pre-schoolers' PA, defined as the willingness of neighbours to intervene to ensure social order and a safe community environment for young children's active play. To advance measurement of this construct, we assessed factorial and construct validities of the PA-related neighbourhood informal social control scale for parents of pre-schoolers (PANISC-PP). In 2013-2014, Hong Kong primary caregivers (n=394) of 3-5 year-old children completed a socio-demographic questionnaire, the preliminary version of the PANISC-PP, and self-report measures of theoretical neighbourhood correlates of PA-related neighbourhood informal social control (perceived signs of physical and social disorder, community cohesion, perceived stranger danger, risk of unintentional injury and traffic safety). The fit of the data to an a priori measurement model of the PANISC-PP was examined using confirmatory factor analyses. As the a priori model showed inadequate fit to the data, the factor structure was re-specified based on theoretical considerations. The final measurement models of the PANISC-PP showed acceptable fit to the data and consisted of three correlated latent factors: "General informal supervision", "Civic engagement for the creation of a better neighbourhood environment" and "Educating and assisting neighbourhood children". The internal reliability of the subscales was good (Cronbach's α values 0.82-0.89). Generalised additive mixed models indicated that all subscales were positively associated with community cohesion and scores on the subscale "Educating and assisting neighbourhood children" were related in the expected direction to all indicators of traffic and personal safety, supporting construct validity of the PANISC-PP. This study suggests that the PANISC-PP is a reliable and valid instrument for assessing parents' perceived neighbourhood informal social control related to pre-schoolers' PA.

Promoting Sex Education Among Teenagers Through an Interactive Game: Reasons for Success and Implications.

OBJECTIVES: A game application, "Making Smart Choices", was developed to fill the gap of limited easy-to-access resources available on sex education in Hong Kong and to disseminate correct knowledge and positive attitudes toward sex to teenagers using popular platforms such as tablets, Facebook, and the Web. SUBJECTS AND METHODS: Three versions of the game (iPAD, Facebook, and Web-based) were developed using HTML5. A theoretical framework that involved game-based learning and participatory design approach was used to design, develop, modify, and optimize the game for use with secondary school students (n=1176) 12-16 years of age. Pre- and post-test scores of students' safer sex knowledge were compared to test the effectiveness of the game. Students' survey and interviews were analyzed to assess participant feelings and attitudes toward the game. RESULTS: The Wilcoxon Signed-Rank test indicated that students' sex knowledge (n=788) improved with a medium effect size (0.477) after playing the game. Increases in positive attitudes toward sex and relationship and in awareness of making smart sexual choices were reported from student surveys and interviews. Students described the game as "interesting," "interactive," "informative," and "real-to-life." CONCLUSIONS: We advocate that the participatory design approach, which supports collaborative efforts of different stakeholders, is an effective framework for developing game-based learning tools for sex education. Our work provides preliminary findings that suggest game-based learning, preferably delivered through popular interactive platforms, can be effective in promoting sex education to teenagers.

Development and reliability of a scale of physical-activity related informal social control for parents of Chinese pre-schoolers.

BACKGROUND: Parents' perceived informal social control, defined as the informal ways residents intervene to create a safe and orderly neighbourhood environment, may influence young children's physical activity (PA) in the neighbourhood. This study aimed to develop and test the reliability of a scale of PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers (children aged 3 to 5 years) living in Hong Kong. METHODS: Nominal Group Technique (NGT), a structured, multi-step brainstorming technique, was conducted with two groups of caregivers (mainly parents; n = 11) of Hong Kong pre-schoolers in June 2011. Items collected in the NGT sessions and those generated by a panel of experts were used to compile a list of items (n = 22) for a preliminary version of a questionnaire of informal social control. The newly-developed scale was tested with 20 Chinese-speaking parents/caregivers using cognitive interviews (August 2011). The modified scale, including all 22 original items of which a few were slightly reworded, was subsequently administered on two occasions, a week apart, to 61 Chinese parents/caregivers of Hong Kong pre-schoolers in early 2012. The test-retest reliability and internal consistency of the items and scale were examined using intraclass correlation coefficients (ICC), paired t-tests, relative percentages of shifts in responses to items, and Cronbach's α coefficient. RESULTS: Thirteen items generated by parents/caregivers and nine items generated by the panel of experts (total 22 items) were included in a first working version of the scale and classified into three subscales: "Personal involvement and general informal supervision", "Civic engagement for the creation of a better neighbourhood environment" and "Educating and assisting neighbourhood children". Twenty out of 22 items showed moderate to excellent test-test reliability (ICC range: 0.40-0.81). All three subscales of informal social control showed acceptable levels of internal consistency (Cronbach's α >0.70). CONCLUSIONS: A reliable scale examining PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers living in Hong Kong was developed. Further studies should examine the factorial validity of the scale, its associations with Chinese children's PA and its appropriateness for other populations of parents of young children.

Measurement of resting energy expenditure in healthy children.

BACKGROUND: The role that the components of energy expenditure play in the etiology of childhood obesity has highlighted the need for greater accuracy and standardized protocols for the measurement of resting energy expenditure (REE). However, protocols used to assess REE in children are varied, and consensus on a suitable method for measuring REE in children has not been reached. This study was undertaken to determine the effect of measurement time and measurement device (mask or mouthpiece) on REE in healthy children. DESIGN: Following a 12-hour fast and abstinence from exercise, 23 children (age, 7-12 years) completed two 35-minute protocols: one with a face mask and the other with a mouthpiece/noseclip. Energy expenditure was measured continuously via indirect calorimetry, while device acceptability was assessed using a 6-point comfort rating scale. RESULTS: Repeated measures ANOVA indicated that there was no significant difference in REE when measured after 10, 15, 20, or 25 minutes of rest compared to 30 minutes for either the mask or mouthpiece/noseclip (REE range, 1371-1460 kcal/d). Examination of the percentage coefficient of varia tion (CV) in energy expenditure for each time period by device showed that the least variation existed after 20 minutes of measurement using the mask (CV 6%). Paired t test analysis indicated significantly less discomfort when wearing the mask compared to the mouthpiece/noseclip. CONCLUSION: It would appear that a 20-minute protocol using a mask may increase compliance and prove to be a more practical protocol for measuring REE in children.

Energy expenditure and cardiovascular responses to seated and active gaming in children.

OBJECTIVE: To examine energy expenditure and cardiovascular responses in children during seated and active gaming. DESIGN: Comparison study. SETTING: Children's Exercise Laboratory, University of Hong Kong. PARTICIPANTS: Eighteen children (aged 6-12 years) recruited from local primary schools. MAIN EXPOSURE: Active and seated computer games played by all participants. MAIN OUTCOME MEASURES: Resting energy expenditure and heart rate measured before gaming, during seated gaming, and during use of 2 active gaming formats (XaviX bowling and XaviX J-Mat; SSD Company Ltd, Shiga, Japan). We used repeated-measures analyses of variance to compare the outcome measures. RESULTS: The energy expenditure was significantly higher during seated gaming (mean [SD], 1.31 [0.19] kcal/min(-1); P < .001), XaviX bowling (1.89 [0.45] kcal/min(-1); P < .001), and XaviX J-Mat gaming (5.23 [1.63] kcal/min(-1); P < .001) compared with rest. The energy expended above rest was significantly higher for the 2 active gaming formats (P < .001 for both) compared with seated gaming. The heart rate was significantly higher during XaviX bowling (mean [SD, ]102 [20] beats/min(-1); P < .001) and XaviX J-Mat gaming (160 [20] beats/min(-1); P < .001) compared with rest. Heart rate during the XaviX J-Mat gaming was significantly higher than during seated gaming (P < .001). CONCLUSIONS: This study has shown that using active gaming media results in meaningful increases in energy expenditure and heart rate compared with the seated screen environment. Manipulating the gaming environment can provide children with appealing activity alternatives, and further development of "exertainment" interventions is warranted, in particular determination of sustainability.