Frequency of health care provider recommendations for HPV vaccination: a survey in three large cities in China.

Introduction: Human papillomavirus (HPV) infection, an important pathogenic factor for cervical cancer, can be prevented by the HPV vaccine. Health care provider (HCP) recommendations contribute to improve HPV vaccination coverage. The aim of this study was to assess the frequency of HCP recommendations for HPV vaccination and associated factors. Methods: From Nov 8 to Dec 6 in 2018, a cross-sectional study was conducted through online questionnaires among HCPs (n = 1,371) from hospitals in three large cities in China (Shanghai, Guangzhou, and Shenzhen). Data on demographic characteristics, the frequency of HPV vaccination recommendations, HPV knowledge and related attitudes were collected through the questionnaires. Results: Among 1,371 participants, only 30.2% reported that they frequently recommended HPV vaccination. Multivariate analyses indicated that female sex, being employed in obstetrics or gynecology departments and community health service centers, and having higher self-reported and actual knowledge of HPV were factors associated with a higher recommendation frequency. Factors including a self-perceived non-obligation to provide recommendations and difficulties in discussing sexual topics were significantly correlated with less frequent recommendations. Employment in a community health service center (OR = 2.068, 95% CI: 1.070-3.999) was the strongest factor associated with the frequency of HCPs' recommendations for HPV vaccination. Discussion: The frequency of HCPs' recommendations for HPV vaccination in China was much lower than that in many developed countries. To enhance the recommendation frequency, medical institutions should help HCPs gain more knowledge of HPV and master communication skills. At the same time, the government should take measures to enhance the accessibility of HPV vaccines. The media should help to alleviate people's concerns and encourage them to face up sexual health.

Changes in cigarette consumption and intention to quit in response to the COVID-19 pandemic in China.

INTRODUCTION: Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess changes in smoking behavior and intention to quit during the early stage of the COVID-19 pandemic in China and to investigate the associated factors. METHODS: An online cross-sectional survey was conducted among Chinese adult smokers. Participants were recruited through snowball sampling from 19 March to 2 April 2020. RESULTS: A total of 1388 smokers participated in this study. Of those, 1014 (73.0%) reported not changing their cigarette consumption, 104 (7.5%) reported smoking more and 268 (19.3%) reported smoking less due to the pandemic. Average daily cigarette consumption among all participants decreased from 15.0 (IQR: 10.0-20.0) to 13.0 (IQR: 8.0-20.0) (W=6.919, p<0.001). For intention to quit, 270 (19.5%) respondents reported becoming more willing to quit, and 91 (6.6%) reported becoming less willing to quit. Multivariate analyses showed that tobacco addiction, overall knowledge about the relationship between smoking and COVID-19, level of attention devoted to COVID-19, anxiety, living alone, and number of smokers in the family were significantly correlated with cigarette consumption and intention to quit, and living alone was the strongest factor associated with increased cigarette consumption (AOR=5.29; 95% CI: 1.51-18.56). CONCLUSIONS: The COVID-19 pandemic led to a slight decrease in cigarette consumption and an increase in quitting intention among Chinese smokers. During the early stages of the pandemic, it was important to focus on the anxiety of smokers, dispel smokers' misunderstandings of smoking and COVID-19 and create a supporting environment in the family to help smokers quit.

Development of a simplified version of the smoking rationalization belief scale for Chinese male smokers.

Objective: The goal of this study was to simplify the smoking rationalization belief (SRB) scale among Chinese male smokers and provide a convenient measuring tool with good reliability and validity to promote the assessment and further intervention of SRB among smokers. Methods: Through purposive sampling, a questionnaire survey was conducted among adult male smokers in three districts in Shanghai, and 1,307 valid questionnaires were collected. Exploratory factor analysis was used to analyze the simplified scale, and Pearson correlation analysis, multiple linear regression, and Cronbach's α were used to test the reliability and validity of the simplified scale. Results: The SRB scale was simplified from 26 items to 8 items and had good overall reliability (Cronbach's α = 0.757). There was a strong correlation between the simplified scale and the original scale (P < 0.001, r = 0.911), and the scores of SRB measured by the two scales were both negatively associated with a willingness to quit smoking (P < 0.001), which reflected the practical effectiveness of the simplified version. Conclusion: The simplified version of the SRB scale showed good reliability and validity among Chinese smokers, which facilitates smoking cessation-related research and practice.

Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak.

BACKGROUND: Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak. METHODS: A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates. RESULTS: The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence. CONCLUSION: It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.

Predictors of Willingness to Receive the COVID-19 Vaccine after Emergency Use Authorization: The Role of Coping Appraisal.

The current study aims to identify psychosocial factors based on protection motivation theory (PMT) influencing Chinese adults' willingness to receive the COVID-19 vaccine after the emergency use authorization of the New Coronavirus Inactivated Vaccine in China. A cross-sectional online survey was conducted among Chinese residents aged 18-59 years, and 2528 respondents from 31 provinces and autonomous regions were included in the current study. Based on PMT, threat appraisals and coping appraisals were measured. Hierarchical multiple regressions and multivariate logistic regressions were used to identify the relationships between the PMT constructs and vaccination willingness after other covariates were controlled for. A total of 1411 (55.8%) respondents reported being willing to receive the COVID-19 vaccine. The PMT model explained 26.6% (p < 0.001) of the variance in the vaccine willingness. The coping appraisals, including response efficacy, self-efficacy, and response costs, were significantly correlated with the willingness to receive the COVID-19 vaccine, and response efficacy was the strongest influencing factor (adjusted OR = 2.93, 95% CI: 2.42-3.54). In conclusion, the coping appraisals for vaccination, instead of threat appraisals regarding the pandemic itself, mainly influenced people's willingness to get vaccinated after the emergency use authorization of the COVID-19 vaccine in China. These findings are helpful for developing education and interventions to promote vaccination willingness and enhance public health outcomes during a pandemic.

Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study.

BACKGROUND: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. OBJECTIVE: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. METHODS: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. RESULTS: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=-0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=-0.45, P<.001) via vaccine hesitancy (SSC=-0.32, P<.001). CONCLUSIONS: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function.

How can the uptake of preventive behaviour during the COVID-19 outbreak be improved? An online survey of 4827 Chinese residents.

OBJECTIVES: The aims of this study were to assess the uptake of preventive behaviour during the COVID-19 outbreak and to investigate the factors influencing the uptake of preventive behaviour based on the theory of planned behaviour (TPB）. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional online survey was conducted among Chinese residents aged ≥18 years and 4827 participants from 31 provinces and autonomous regions were included in the current study. Uptake of preventive behaviour, attitude towards the spread of COVID-19 and preventive behaviour, subjective norms, perceived behavioural control, demographic characteristics and the information attention and processing mode were measured. Multivariate logistic regressions were used to identify associations between the potential influencing factors and uptake of preventive behaviour. RESULTS: There were 2393 (52.8%) respondents reported high uptake of preventive behaviour. Multivariate analyses demonstrated that attitude towards the behaviour, subjective norms and perceived behavioural control were significantly correlated with uptake of preventive behaviour, and perceived behavioural control was the strongest influencing factor (OR=4.09, 95% CI 3.57 to 4.69). Furthermore, systematic information processing mode was positively associated with high uptake of preventive behaviour compared with heuristic information processing mode (OR=2.16, 95% CI 1.67 to 2.81). CONCLUSIONS: These findings are helpful for developing education and interventions to promote high uptake of preventive behaviour and enhance public health outcomes during pandemic.

Untargeted Urinary Metabolomics and Children's Exposure to Secondhand Smoke: The Influence of Individual Differences.

Children's exposure to secondhand smoke (SHS) is a severe public health problem. There is still a lack of evidence regarding panoramic changes in children's urinary metabolites induced by their involuntary exposure to SHS, and few studies have considered individual differences. This study aims to clarify the SHS-induced changes in urinary metabolites in preschool children by using cross-sectional and longitudinal metabolomics analyses. Urinary metabolites were quantified by using untargeted ultra high-performance liquid chromatography-mass spectrometry (UPLC(c)-MS/MS). Urine cotinine-measured SHS exposure was examined to determine the exposure level. A cross-sectional study including 17 children in a low-exposure group, 17 in a medium-exposure group, and 17 in a high-exposure group was first conducted. Then, a before-after study in the cohort of children was carried out before and two months after smoking-cessation intervention for family smokers. A total of 43 metabolites were discovered to be related to SHS exposure in children in the cross-sectional analysis (false discovery rate (FDR) corrected p < 0.05, variable importance in the projection (VIP) > 1.0). Only three metabolites were confirmed to be positively associated with children's exposure to SHS (FDR corrected p < 0.05) in a follow-up longitudinal analysis, including kynurenine, tyrosyl-tryptophan, and 1-(3-pyridinyl)-1,4-butanediol, the latter of which belongs to carbonyl compounds, peptides, and pyridines. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis indicated that 1-(3-pyridinyl)-1,4-butanediol and kynurenine were significantly enriched in xenobiotic metabolism by cytochrome P450 (p = 0.040) and tryptophan metabolism (p = 0.030), respectively. These findings provide new insights into the pathophysiological mechanism of SHS and indicate the influence of individual differences in SHS-induced changes in urinary metabolites in children.

Investigating HPV- and HPV Vaccine-Related Knowledge, Perceptions, and Information Sources among Health Care Providers in Three Big Cities in China.

The limited access to vaccination and vaccine hesitancy are prevalent even among health care providers in less developed countries. This study assessed the relationships between (i) health care providers' knowledge on human papillomavirus (HPV) and vaccination for HPV and (ii) their perceptions, demographic characteristics, and the use of information sources. In this large-scale online survey, participants (n = 1394) were recruited from hospitals of three big cities in China (Shanghai, Guangzhou, and Shenzhen). Descriptive analysis, the chi-square test, and logistic regression analysis were used to answer different research questions. Health care providers' overall knowledge scores are consistent with their perceptions about HPV and HPV vaccine. Occupation, specialty, the type of hospitals, and the frequency of participants' search for information using professional informational sources are the most significant characteristics that are closely associated with their knowledge of HPV and its vaccine. Targeted educational interventions are needed to improve health care providers' engagement in the promotion of the HPV vaccine. Such interventions, besides increasing knowledge, should also emphasize the importance of appropriate information sources to acquire information.

Mental health problems and social media exposure during COVID-19 outbreak.

Huge citizens expose to social media during a novel coronavirus disease (COVID-19) outbroke in Wuhan, China. We assess the prevalence of mental health problems and examine their association with social media exposure. A cross-sectional study among Chinese citizens aged≥18 years old was conducted during Jan 31 to Feb 2, 2020. Online survey was used to do rapid assessment. Total of 4872 participants from 31 provinces and autonomous regions were involved in the current study. Besides demographics and social media exposure (SME), depression was assessed by The Chinese version of WHO-Five Well-Being Index (WHO-5) and anxiety was assessed by Chinese version of generalized anxiety disorder scale (GAD-7). multivariable logistic regressions were used to identify associations between social media exposure with mental health problems after controlling for covariates. The prevalence of depression, anxiety and combination of depression and anxiety (CDA) was 48.3% (95%CI: 46.9%-49.7%), 22.6% (95%CI: 21.4%-23.8%) and 19.4% (95%CI: 18.3%-20.6%) during COVID-19 outbroke in Wuhan, China. More than 80% (95%CI:80.9%-83.1%) of participants reported frequently exposed to social media. After controlling for covariates, frequently SME was positively associated with high odds of anxiety (OR = 1.72, 95%CI: 1.31-2.26) and CDA (OR = 1.91, 95%CI: 1.52-2.41) compared with less SME. Our findings show there are high prevalence of mental health problems, which positively associated with frequently SME during the COVID-19 outbreak. These findings implicated the government need pay more attention to mental health problems, especially depression and anxiety among general population and combating with "infodemic" while combating during public health emergency.