Employment conditions and mental health of overseas female migrant domestic workers in Hong Kong: a parallel mediation analysis.

BACKGROUND: Female migrant domestic workers (MDW), approximately 8.5 million globally, often live in their employer's home under vulnerable conditions. In Hong Kong, MDWs currently comprise 5% of the population. This study was conducted to assess the association between employment conditions and mental health, and the mediating roles stress and job satisfaction have, among female MDWs in Hong Kong. METHODS: Participants completed an online cross-sectional survey. A total of 1,965 survey were collected between August 2020 and August 2021. Questions in the survey were related to MDWs background information, employment conditions, stress, job satisfaction, and two mental health outcomes: anxiety and depression. An employment conditions score was created to assess the cumulative effect poor employment conditions had on mental health. A multicategorical parallel mediation analysis was used to assess the direct effect employment conditions have on mental health and the indirect effects through stress and job satisfaction. RESULTS: Overall, 17.7% of MDWs were reported to be suffering from anxiety and 30.8% from depression. An increase in poor employment conditions was statistically associated with an increase in both outcomes, while stress levels and job satisfaction mediated this association. CONCLUSIONS: The findings call for increased scrutiny of employment conditions and mental well-being of MDWs.

Feasibility of introducing effective alcohol harms reduction strategies in a low regulation region: A qualitative study from Hong Kong.

To counter the harms of excessive alcohol use, the World Health Organization (WHO) outlined a series of alcohol policy recommendations, including the most cost-effective "Best Buys". This study aims to obtain key stakeholder views on feasibility of implementing various publicly endorsed alcohol policies in Hong Kong, a relatively low alcohol consumption region with few extant alcohol regulations. Between 2019 and 2021, we conducted semi-structured interviews with stakeholders involved in alcohol policy adoption and implementation. Interviewees included hospitality/alcohol sales workers (n = 13) and government officers (n = 4). The stakeholders noted that although WHO advocacy facilitated local policy considerations, the adoption of stringent measures was challenged by low political priority due to the low visibility of harms. For implementing strategies, the stakeholders cited alignment with social norms as a major facilitator, whereas law enforcement difficulties and resistance from industry/business sectors were viewed as major obstacles. There was a general belief that population-level alcohol policies would be effective for certain groups of drinkers but would also harm the local economy and detract from Hong Kong's image as a "world city". Hong Kong may not be ready to adopt a wide range of highly restrictive population-level alcohol policies. Local governments should carefully consider contextual factors when following international recommendations.

Metabolic health and adiposity transitions and risks of type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis.

BACKGROUND: Metabolic health status and levels of adiposity are prone to change over time. Mixed results have been reported regarding the extent by which changes in metabolic health and weight affect cardiometabolic risks. This systematic review and meta-analysis aims to examine the association between transitions in metabolic health and adiposity status on risk of incident type 2 diabetes (T2DM) and cardiovascular disease (CVD) events. METHODS: A systematic literature search was conducted on MEDLINE and EMBASE through August 2022 for prospective cohort studies examining transitions in metabolic health and adiposity status and risk of incident T2DM and CVDs without restrictions on language or publication status. Meta-analysis was performed to summarize hazard ratios for T2DM and composite CVD events separately using random-effects model. RESULTS: A total of 17 studies were included. Compared to stable metabolically healthy status, transition to metabolically unhealthy status significantly increased the risk of incident T2DM and composite CVD events among individuals with normal weight and individuals with overweight/obesity. Compared to stable metabolically unhealthy status, transition to metabolically healthy status significantly lowered the risk among individuals with normal weight and individuals with overweight/obesity. When metabolic health status remained unchanged, progression from normal weight to overweight/obesity significantly increased risk of CVDs but not risk of T2DM. CONCLUSION: The impact of change in metabolic health on the risks of T2DM and CVD is more prominent than that of change to body mass index category. Obesity treatment should consider prioritizing improvement in metabolic health parameters over focusing on the extent of weight loss only.

The effect of subjective social status on health-related quality of life decline in urban Chinese older adults: a four-year longitudinal study from Hong Kong.

BACKGROUND: Improving health-related quality of life (HRQOL) is becoming a major focus of old age care and social policy. Researchers have been increasingly examining subjective social status (SSS), one's self-perceived social position, as a predictor of various health conditions. SSS encompasses not only concrete socio-economic (SES) factors but also intangible aspects of status. This study's main objective was to examine the association between SSS and long-term change in HRQOL in older Chinese adults. METHODS: A longitudinal Hong Kong study recruited 2934 community-dwelling adults (age > 65 years). Participants completed SF-12 physical health (PCS) and mental health (MCS) HRQOL scales. This study analyzed baseline SSS-Society (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term HRQOL decline. After stratifying for sex, multiple-linear-regression was performed on 4-year follow-up SF-12 PCS and MCS scores after adjusting for baseline SF-12 scores, traditional SES indicators, demographic variables, clinical conditions, and lifestyle variables. RESULTS: In the multivariable analyses, lower SSS-Society was associated with declines in MCS in males (ßstandardized = 0.08, p = 0.001) and declines in PCS (ßstandardized = 0.07, p = 0.006) and MCS (ßstandardized = 0.12, p < 0.001) in females. SSS-Community was associated with declines in PCS in males (ßstandardized = 0.07, p = 0.005) and MCS in females (ßstandardized = 0.14, p < 0.001). CONCLUSIONS: SSS may be a useful supplementary tool for predicting risk of long-term HRQOL decline in older Chinese adults. Strategies to reduce perceived social inequalities may improve HRQOL in older adults.

Selling World Health Organization's Alcohol "Best Buys" and Other Recommended Interventions in an Urban Chinese Population: Public Acceptability of Alcohol Harms Reduction Strategies in Hong Kong.

Background: To counter the harms caused by alcohol use, the World Health Organization (WHO) outlined a series of evidence-based recommendations, including the highly cost-effective "Best Buys" recommendations. While many Western countries have been actively introducing alcohol harms reduction strategies, it is unclear whether these cost-effective policies would be publicly acceptable in Asian regions with traditionally low alcohol consumption. This study examines the public acceptability of WHO-recommended alcohol harms reduction strategies in an Asian city with few extant alcohol regulations. Methods: A cross-sectional telephone survey of Hong Kong Chinese residents aged 18-74 (n = 4,000) was conducted from January to August 2018. Respondents were asked about their perceptions of various WHO-recommended strategies and consequences of their implementation. After reducing the strategies into several policy categories by principal component analysis, multivariable linear regression was performed to identify factors associated with endorsement of the various policies. Results: Among the "Best Buys", introduction of moderate beer/wine taxes (68.7%) and shortened alcohol retail hours (51.9%) were the most supported while bans on event sponsorships (19.5%) and public drinking events (17.7%) were the least popular. Strategies targeting young drinkers were particularly highly supported. Males, younger adults, Non-abstainers, and those who believed in drinking's social benefits were less likely to endorse stringent control measures (p < 0.05). Adults with higher household income were less supportive, partially due to concerns about infringements on local economy, lifestyles, and economic freedom. Women and older people were generally more supportive, partially because they perceived these policies would lower alcohol-related harms. Conclusion: In order to reduce barriers to implementing WHO-recommended strategies in the region, it is imperative to increase awareness of alcohol-related harms and to strengthen beliefs in the effectiveness of these countermeasures, especially among men, young adults, and drinkers.

Determinants of COVID-19 Vaccine Uptake among Female Foreign Domestic Workers in Hong Kong: A Cross-Sectional Quantitative Survey.

Globally, minority groups and non-citizens may not be sufficiently included in the COVID-19 vaccine coverage. This study seeks to understand determinants of vaccine uptake among female foreign domestic workers (FDWs) in Hong Kong. We conducted a cross-sectional study of female FDWs (n = 581) from June to August 2021. Respondents completed an online survey obtaining sociodemographic, employment, and health status information. Based upon the socio-ecological model, we obtained individual, interpersonal, and socio-structural factors that may be associated with COVID-19 vaccine uptake. Multivariable logistic regression analysis was used to examine factors associated with having received at least one dose of a COVID-19 vaccine. At the individual level, agreeing that taking COVID-19 vaccines can contribute to COVID-19 control in Hong Kong (OR 6.11, 95% CI 2.27-16.43) was associated with increased vaccine uptake, while being worried of severe side-effects from vaccination (OR 0.29, 95% CI 0.16-0.55) was associated with decreased uptake. At the interpersonal level, those being encouraged by their employer (OR 2.05, 95% CI 1.06-3.95) and family members (OR 2.27, 95% CI 1.17-4.38) were more likely to be vaccinated, while at the socio-structural level, believing vaccination would violate religious beliefs (OR 0.19, 95% CI 0.06-0.65) was associated with decreased uptake. The government can formulate a multi-level approach according to our findings to target the remaining unvaccinated FDW population.

First- and second-hand alcohol-related harms among urban Chinese: A population-based study from Hong Kong.

INTRODUCTION: Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol-related harms. This study examines the alcohol-related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation. METHODS: A cross-sectional telephone survey was conducted in 2019 on Chinese adults aged 18-74 (n = 3200). Respondents were asked about various past-year first-hand drinking harms (after one's own drinking), second-hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation. RESULTS: Of drinkers, 21.1% reported first-hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger-aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first-hand harms. Of the sample, 18.2% experienced past-year second-hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past-year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second-hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first-hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second-hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies. DISCUSSION AND CONCLUSIONS: Although high levels of alcohol-related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking-related harms.

Does Low Subjective Social Status Predict Cognitive Decline in Chinese Older Adults? A 4-Year Longitudinal Study From Hong Kong.

OBJECTIVE: Subjective social status (SSS), one's self-perceived social position, encompasses not only concrete socio-economic (SES) factors (e.g., income) but also intangible aspects of status (e.g., social capital). In recent years, there has been increasing research interest in SSS as a predictor of a vast array of health outcomes but very few studies examining effects on cognitive functioning. This study's main objective was to examine the association between SSS and long-term cognitive decline in older Chinese adults. DESIGN: A 4-year longitudinal study. SETTING: Hong Kong, China. PARTICIPANTS: Chinese adults (aged ≥65) (n = 3,153). MEASUREMENTS: This study analyzed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term cognitive decline. Multiple-linear-regression was performed on 4-year follow-up Mini-Mental-Status-Examination (MMSE) cognitive function score (score range: 0-30) after adjusting for baseline MMSE scores, traditional SES indicators (e.g., education), demographic variables (e.g., sex), clinical conditions (e.g., stroke history, depression), and lifestyle variables (e.g., physical activity levels). RESULTS: Lower SSS-Community but not SSS-Hong Kong was associated with greater cognitive decline (unstandardized coefficient (95% CI) = 0.13 (0.07, 0.19) standardized ß-coefficient = 0.08, after adjusting for objective SES measures and other background and clinical factors. The standardized ß-coefficients for the SSS-Community variable were similar in magnitude to those for depression and diabetes. CONCLUSION: Cognitive decline is influenced by self-perceived rank in proximal reference groups rather than socioeconomic comparison with society at-large. SSS-Community is a useful, single-item supplementary instrument to improve prediction of cognitive decline in elderly Chinese.

Does subjective social status predict depressive symptoms in Chinese elderly? A longitudinal study from Hong Kong.

BACKGROUND: Subjective social status (SSS), one's self-perceived social status, has been gaining interest among researchers as a risk/protective factor of many health outcomes. SSS encompasses both socio-economic factors (eg, income) and intangible aspects of status (eg, esteem from peers). This study's main objective was to examine the association between SSS and future risk of depression in elderly Chinese. METHODS: Using data from the ongoing Mr/Mrs Os study, a longitudinal study of Hong Kong Chinese elderly, this study analysed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of Geriatric Depression Scale (GDS) score at year 4 (n=3153). The models adjusted for baseline depression scores, socio-economic status indicators, demographic variables, clinical conditions and functional status variables. RESULTS: Higher depression scores at follow-up were independently associated with lower SSS-Hong Kong (standardised ß-coefficient= -0.040, p=0.017), lower SSS-Community (standardised ß-coefficient= -0.057, p=0.001), in addition to older age, female gender and stroke history. After stratifying by dementia status, higher baseline SSS was associated with less depressive symptoms only in the non-dementia group. In the multivariable models that included both SSS variables, only SSS-Community was significantly associated with year 4 GDS score. However, both SSS variables were independently associated with year 4 depression status in the logistic regression analysis. CONCLUSION: In Chinese elderly, SSS captures aspects of social status that are not captured by traditional socio-economic indicators. SSS can be a useful supplementary tool for assessing future risk of developing mental health conditions.

Urban Chinese midwives' knowledge, attitudes and practices toward umbilical cord blood donation.

OBJECTIVE: This study aimed to assess the knowledge, attitudes and factors associated with promotion of umbilical cord blood (CB) donation by Chinese midwives to expectant mothers. DESIGN: An anonymous cross-sectional survey using self-administered questionnaires. SETTING: Hong Kong, China. PARTICIPANTS: One-hundred-and-forty-seven registered Chinese midwives were recruited by convenience sampling from government obstetric clinics and public and private hospitals. MEASUREMENTS AND FINDINGS: In addition to collecting demographic background information, the study examined the midwives' cord blood-related knowledge and perceptions as well as past-year practices and future intention of giving cord blood advice. Hong Kong midwives generally showed high levels of knowledge about the medical uses of cord blood but they were not as familiar with the administrative, legal and financial aspects of donation and storage. Only about 10% had received formal cord blood training and the majority felt that it should be integrated into midwifery program curricula. Although the midwives showed strong positive attitudes towards cord blood donation, only 10.9% consistently gave information and 7.5% consistently advised cord blood donation to expectant mothers in the preceding year while slightly higher percentages planned to do so in the future. In the multivariable models, higher educational attainment and hospital employment were the most consistent predictors of past-year practices of giving cord blood information and future intention to provide advice. Higher score in cord blood-related attitudes was significantly associated with giving past-year cord-blood advice, future intention to provide advice and future intention to recommend donation in the multivariable models. Key barriers to advising expectant mothers were the lack of a formal work protocol, lack of time in the clinic routine and fear of criticism by peers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Increasing education, improving perceptions and changing workplace protocols will likely increase cord blood advising by Hong Kong midwives to their patients.