Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China and Indonesia.

INTRODUCTION: The health risks associated with e-cigarettes are currently the focus of tobacco control efforts and public health initiatives. Given that China and Indonesia have the highest rates of adult smoking worldwide, it is imperative to gain a comprehensive understanding of e-cigarette prevalence among college students in these two nations. METHODS: From May to June 2023, a cross-sectional study was employed to conduct an online questionnaire survey among college students in three universities located in Kunming (China) and Jakarta (Indonesia), respectively. The chi-squared test was utilized to compare the rates/ratios, while binary logistic regression analysis was applied to examine the factors influencing e-cigarette knowledge, attitude, and practice. RESULTS: A total of 1327 individuals were included in the investigation. The proportion of Indonesian students (75.6%) with a high level of e-cigarette knowledge was lower than that observed among Chinese students (87.4%) (χ2=29.7, p<0.001). Additionally, the prevalence of e-cigarette use among Indonesian students (9.4%) was higher compared to their Chinese counterparts (3.0%) (χ2=22.32, p<0.001). Binary logistic regression analysis revealed that age, place of residence, studies, gender, and e-cigarette use by friends and family, significantly influenced knowledge levels and attitudes toward e-cigarettes in both countries (p<0.05). CONCLUSIONS: Despite the positive knowledge, attitudes, and practices towards e-cigarettes among undergraduate students in both countries, a notable knowledge gap exists concerning the harmful effects of e-cigarettes. Chinese students had better e-cigarette knowledge and demonstrated lower usage rates, suggesting that heightened awareness plays a favorable role in preventing e-cigarette use. Furthermore, it becomes imperative for policymakers and health educators to focus on specific factors, such as the influence of close friends and family members, as well as the area of residence.

The Relationship Between the Number of Chronic Diseases and Health-Related Quality of Life Among Middle-Aged and Older Adults in Rural Areas of Yunnan Province, China: moderating Effect of Health Lifestyle.

Purpose: With population aging, individuals in underdeveloped areas may experience a higher prevalence of chronic non-communicable diseases (NCDs), a lower level of health-related quality of life (HRQoL), and distinct lifestyles. However, this triadic association remains inadequately studied, particularly regarding the role of health lifestyle. This study aims to examine the relationship between the number of NCDs and HRQoL, while considering the moderating effect of health lifestyle among middle-aged and older adults residing in resource-limited areas. Methods: This cross-sectional study was conducted in Yunnan Province from July to December 2022. Participants completed a self-report questionnaire related to socio-demographic information, NCDs conditions, health lifestyle status, and HRQoL, which was assessed using the EuroQol five-dimension five-level (EQ-5D-5L) scale. Hierarchical regression and simple slope tests were used to examine the moderating effect of health lifestyle. Results: Out of the total 2704 participants, 57.91% presented at least one NCD. The mean scores for health lifestyle and health utility value were 11.109 and 0.944 respectively. The number of NCDs was negatively associated with health utility value, while positively correlated with the health lifestyle score (P<0.001). The results of hierarchical regression indicated that health lifestyle exerted a negative moderating effect on the relationship between the number of NCDs and HRQoL (ß=0.006, P<0.001), which was also observed for specific health-related behaviors such as sleep duration (ß=0.013, P<0.001), physical examination attendance (ß=0.006, P<0.05) and physical activity (ß=0.013, P<0.001). Conclusion: These findings highlight the crucial role of a healthy lifestyle in attenuating the association between the number of NCDs and HRQoL. Recognizing the potential modulating influence of a healthy lifestyle in this relationship could be pivotal for developing effective interventions for this population, even within resource-constrained rural settings.

Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China.

BACKGROUND: Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. METHODS: A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. RESULTS: Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13-3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16-3.40). CONCLUSIONS: Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.

Temporal trends of copper-bearing intrauterine device discontinuation: a population-based birth-cohort study of contraceptive use among rural married women in China.

Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.