Latent Heterogeneity of Online Sexual Experiences and Associations With Sexual Risk Behaviors and Behavioral Health Outcomes in Chinese Young Adults: Cross-Sectional Study.

BACKGROUND: Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. OBJECTIVE: This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. METHODS: The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs was analyzed via latent class analysis with substantive checking of the class profiles. Structural equation modeling was used to examine the direct and indirect associations between the OSE class and behavioral health outcomes via sexual risk behaviors and PHQ-4 scores. RESULTS: The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. CONCLUSIONS: This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.

Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys.

BACKGROUND: The global population of women of menopausal age is quickly increasing. The COVID-19 pandemic has led to an accelerated increase in the use of telehealth services, especially technological solutions targeting women's health. Understanding the factors behind midlife women's help-seeking behaviors amidst the pandemic will assist in the development of person-centered holistic telehealth solutions targeting menopausal and postreproductive health. OBJECTIVE: This study aimed to compare the factors underlying help-seeking for menopausal distress among midlife women in the United States and China. METHODS: We conducted 2 web-based panel surveys in the United States using Amazon Mechanical Turk and in China using Credamo between July and October 2022. A total of 1002 American and 860 Chinese women aged between 40 and 65 years took part in the survey. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID-19- and non-COVID-19-related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the data using full information maximum likelihood to manage missing data. RESULTS: Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity but positively related to COVID-19-related barriers; in turn, higher perceived severity, benefits, COVID-19-related barriers, and self-efficacy and lower non-COVID-19-related barriers were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity, susceptibility, benefits, barriers (COVID-19- and non-COVID-19-related), and self-efficacy; in turn, higher self-efficacy, COVID-19-related barriers, and benefits were associated with more help-seeking motivation. The factors explained 53% and 45.3% of the variance of help-seeking motivation among the American and Chinese participants, respectively. CONCLUSIONS: This study revealed disparate pathways between knowledge, health beliefs, and the motivation for help-seeking among American and Chinese midlife women with respect to menopausal distress. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID-19 infection was related to higher help-seeking motivation in both samples. Hence, our findings recommend the further development of telehealth services to (1) develop content beyond health education and symptom management that serves to enhance the perceived benefits of addressing women's multidimensional menopausal health needs, (2) facilitate patient-care provider communication with a focus on self-efficacy and a propensity to engage in help-seeking behaviors, and (3) target women who have greater midlife health concerns in the postpandemic era.

Global impacts of COVID-19 pandemic on sexual and reproductive health services: An international comparative study on primary care from the INTRePID Consortium.

OBJECTIVE: To understand how the COVID-19 pandemic has impacted sexual and reproductive health (SRH) visits. DESIGN: An ecological study comparing SRH services volume in different countries before and after the onset of the COVID-19 pandemic. SETTING: Seven countries from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) across four continents. POPULATION: Over 3.8 million SRH visits to primary care physicians in Australia, China, Canada, Norway, Singapore, Sweden and the USA. METHODS: Difference in average SRH monthly visits before and during the pandemic, with negative binomial regression modelling to compare predicted and observed number of visits during the pandemic for SRH visits. MAIN OUTCOME MEASURES: Monthly number of visits to primary care physicians from 2018 to 2021. RESULTS: During the pandemic, the average volume of monthly SRH visits increased in Canada (15.6%, 99% CI 8.1-23.0%) where virtual care was pronounced. China, Singapore, Sweden and the USA experienced a decline (-56.5%, 99% CI -74.5 to -38.5%; -22.7%, 99% CI -38.8 to -6.5%; -19.4%, 99% CI -28.3 to -10.6%; and -22.7%, 99% CI -38.8 to -6.5%, respectively); while Australia and Norway showed insignificant changes (6.5%, 99% CI -0.7 to -13.8% and 1.7%, 99% CI -6.4 to -9.8%). The countries that maintained (Australia, Norway) or surpassed (Canada) pre-pandemic visit rates had the greatest use of virtual care. CONCLUSIONS: In-person SRH visits to primary care decreased during the pandemic. Virtual care seemed to counterbalance that decline. Although cervical cancer screening appeared insensitive to virtual care, strategies such as incorporating self-collected samples for HPV testing may provide a solution in a future pandemic.

Online social media poses opportunities and risks in autistic youth: implications for services from a qualitative study.

Background: Autistic people are vulnerable to developing mental health problems due to their difficulties in managing social situations and interpersonal relationships. The popular online social media (OSM) can be a potential solution to these concerns for their social lives as it allows non-face-to-face social interactions, however it remained unclear how this group is using these online platforms. This study explored their experiences of using online social media, and their perceived benefits and risks associated with this use. Method: Qualitative data was collected through in-depth face to face interviews. We recruited 13 autistic young adults who were with normal intelligence from two community centers in Hong Kong. Interviews were conducted in a semi-structured format by experienced clinical psychologist and social workers. Results: Four themes were identified from the data, namely: (1) Paradox of using OSM to supplement social needs; (2) Unpleasant social interactions in the online environment; (3) Restricted and repetitive pattern of interest leading to troubles in OSM use, and; (4) Privacy and personal safety issues. The results suggested that while OSM could be a useful tool for our participants to connect with existing friends and to meet new ones, their limitations, such as difficulties in understanding languages and social interaction as well as restricted patterns of interests could potentially put them at risk, including interpersonal conflicts, cyber-bullying, financial scams, as well as unwanted sexual experiences. These experiences not only paradoxically increased their sense of loneliness and their distance from others, but also resulted in a negative impact on their mood and functioning. Conclusion: This qualitative study provided some insights into the OSM use among autistic young adults. OSM could be a useful tool to overcome potential limitations in social interactions, but at the same time it could potentially bring detrimental consequences. In order to maximize the benefits of online social networking, there is a need for timely guidance and support to use OSM among autists, and for psychoeducation to promote awareness, and enable adequate skills and behaviors attainment associated with safe OSM use.

Impacts of electronic device use on adolescents' sexual knowledge, attitude and perception during the COVID-19 pandemic: A representative sexuality survey.

Background: COVID-19 pandemic has led to school closure and social distancing measures for infection control. Many young people thus spent more time on electronic devices and the Internet. This study aimed to determine if and how sexual knowledge, perception and behavior as well as sexuality among Hong Kong adolescents were affected as a result. Methods: Youth Sexuality Study conducted by The Family Planning Association of Hong Kong (FPAHK) evaluated the sexual knowledge, attitudes and behaviors and sexual health of youth every 5 years since 1981 with adaptations made to the changing environment. We analyzed this cross-sectional data on sexual knowledge, attitude, and experiences as well as the impacts of COVID-19 on daily life, health and relationships. Univariate analysis was conducted to investigate the relationships between the time spent on electronic devices and sexuality, while mediation analyses using the PROCESS procedure were performed to further explore differences in time spent on electronic devices. Results: During the COVID-19 pandemic, the majority of our participants spent more time on social media and browsing the Internet on electronic devices with less time for extracurricular activities and learning. Nonetheless, there was better overall sexual knowledge and a lower degree of sexual stigma with a higher overall acceptance of sexual minorities. The mediation analyses found that sexual content [Conditional effect = 0.024 (95% CI 0.008, 0.043)] and engagement online [Conditional effect = 0.036 (CI 0.021, 0.053)] could indirectly influence the effect of screen time on the frequency of sexual practices. Conclusion: Policymakers and frontline professionals should re-examine the pedagogy of the present sex education and consider online sex education as the key mode of delivery while guiding the proper use of electronic devices in the learning and exploration of sexual knowledge.

Web-Based Harm Reduction Intervention for Chemsex in Men Who Have Sex With Men: Randomized Controlled Trial.

BACKGROUND: Men who have sex with men (MSM) who practice chemsex have a higher likelihood of engaging in risky sexual behaviors and higher rates of HIV infection and other sexually transmitted infections (STIs) than those who do not. OBJECTIVE: This trial aimed to evaluate the effectiveness of a web-based intervention in reducing the sexual harms of chemsex among MSM. METHODS: The study was a 2-arm, assessor-blinded, randomized, parallel-group trial with a 3-month follow-up period. The study was conducted in the year 2021 in Hong Kong. Underpinned by the theory of planned behaviors and a harm reduction approach, the intervention consisted of interactive components and knowledge-based information about chemsex. Participants in the control group received brief information and content about sexual violence. The primary outcome was self-efficacy in refusing risky sexual behaviors and chemsex, as measured by the Condom Self-Efficacy Scale (CSES), Self-Efficacy for Sexual Safety (SESS) instrument, and Drug Avoidance Self-Efficacy Scale (DASES). The secondary outcomes included intentions to have chemsex, actual engagement in chemsex, HIV and other STI testing, and condom use in the last 3 months. All outcomes were self-reported. An online structured questionnaire was used to collect data. RESULTS: In total, 316 MSM enrolled in the study. The intervention group demonstrated a significantly larger improvement in condom-use self-efficacy (as measured by CSES scores; time-by-group interaction: ß=4.52, 95% CI 2.03-7.02; P<.001), self-efficacy for sexual safety (as measured by SESS scores; time-by-group interaction: ß=2.11, 95% CI 0.66-3.56; P=.004), and drug avoidance self-efficacy (as measured by DASES scores; time-by-group interaction: ß=6.98, 95% CI 1.75-12.22; P=.009). Regarding the secondary outcomes, participants in the intervention group demonstrated a significantly larger reduction in the likelihood of having engaged in chemsex in the last 3 months (time-by-group interaction: odds ratio [OR]=0.23, 95% CI 0.10-0.53; P=.001) and likelihood of having had the intention to engage in chemsex in the last 3 months (time-by-group interaction: OR=0.37, 95% CI 0.18-0.78; P=.009). Participants in the intervention group also showed a significantly larger increase in the likelihood of having undergone HIV testing in the last 3 months (time-by-group interaction: OR=3.08, 95% CI 1.72-5.54; P<.001). CONCLUSIONS: This study suggests that a web-based intervention with a harm reduction approach can enhance the self-efficacy of MSM in refusing risky sexual behaviors and chemsex and improve the uptake of HIV testing. We also provide initial evidence that such interventions can reduce both the intention of MSM to engage in chemsex and their actual engagement in chemsex. TRIAL REGISTRATION: ISRCTN Registry ISRCTN20134522; https://www.isrctn.com/ISRCTN20134522. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-021-10742-8.

Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong.

AIM: This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong. DESIGN: The study adopted a qualitative descriptive design with thematic analysis. METHODS: Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach. RESULTS: Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence - 'it has nothing to do with me' and (4) dilemma towards sexual violence prevention. CONCLUSION: The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence. IMPACTS: This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.

Effectiveness of Using Mobile Technology to Improve Cognitive and Social Skills Among Individuals With Autism Spectrum Disorder: Systematic Literature Review.

BACKGROUND: Mobile technology has become a necessity in the lives of people in many countries. Its characteristics and advantages also make it a potential medium of intervention for people with autism spectrum disorder (ASD). OBJECTIVE: The objective of this review was to evaluate previous evidence, obtained in randomized controlled trials (RCTs), on the effectiveness of using mobile devices as the medium of intervention targeting social and cognitive skills among individuals with ASD. METHODS: Literature search was conducted on electronic databases including Medline, PsycInfo, PsycArticles, Education Resources Information Centre, and Social Science Citation Index. Only RCTs published in English and after year 2000 were included for this review. Data extraction was carried out by 2 independent reviewers using constant comparative methods. RESULTS: Totally 10 RCTs were identified. Most of the findings indicated that mobile devices could be an effective medium of intervention for people with ASD, among which 6 indicated significant intervention effects and 2 showed mixed findings. Effective intervention was more likely to be achieved in the studies that recruited older participants (aged over 9 years), targeting practical skills that could be readily applied in real life, or using pictures or materials that were highly relevant in daily life in the apps or mobile devices. Furthermore, the use of mobile devices was also reported to promote participation in the intervention among individuals with ASD. CONCLUSIONS: The results suggested that mobile devices could be a promising means for the delivery of interventions targeting people with ASD. Although including a small number of studies was a limitation of this review, the results provided useful implications for designing effective mobile technology-assisted interventions for the ASD population in future studies.

Preparing genomic revolution: Attitudes, clinical practice, and training needs in delivering genetic counseling in primary care in Hong Kong and Shenzhen, China.

PURPOSE: The aim was to evaluate knowledge, attitudes, and clinical practice concerning medical genetics, genetic testing, and counseling among primary care physicians (PCPs) in Hong Kong and Shenzhen, China. METHODS: The University of Hong Kong (HKU), HKU-Shenzhen Hospital, and Shenzhen Health Capacity Building and Continuing Education Center invited PCPs from Hong Kong and Shenzhen to participate in an online survey. RESULTS: The survey was completed by 151 PCPs and 258 PCPs from Hong Kong and Shenzhen, respectively. The majority agreed it was important to keep current with genetics (91%) and that personalized medicine was the future of healthcare (86%), yet only 10% reported that they had postgraduate training in genomic medicine. Seventeen percent of Hong Kong and 40% of Shenzhen's PCPs encountered genetic-related cases in the past 6 months, and they identified insufficient knowledge, few training opportunities, and self-rated low confidence in their skillsets as main barriers. CONCLUSIONS: Our survey shows that Hong Kong and Shenzhen's PCPs are not yet fully utilizing potential benefits of genomic medicine in their clinical practice, which could be addressed with a combination of easily accessible educational resources, clear referral pathways and guidelines on genetic diseases, and cross-specialty collaboration between healthcare systems and professional bodies.

Fighting against COVID-19: preparedness and implications on clinical practice in primary care in Shenzhen, China.

BACKGROUND: The new coronavirus pneumonia (NCP) caused by COVID-19 has affected more than 46 million people worldwide. In China, primary care has played a vital role during the COVID-19 outbreak, and it is important to examine the challenges faced by general practitioners (GPs). This study investigated the roles, preparedness and training needs of GPs in China in managing the NCP outbreak. Based on the outcomes of the study, we hope to take lessons and identify how GPs could be supported in delivering their gatekeeping roles and clinical duties in times of infectious disease outbreak. METHODS: An online survey on the official website of Shenzhen Continuing Education Center. It included questions on GPs' demographics, their awareness of COVID-19 and their preparedness in managing suspected cases of NCP, as well as referrals and their training needs. Conditional multi-variate logistic models were used to investigate the relationships between GPs' preparedness, situational confidence and anxiety. RESULTS: GPs' clinical practice was significantly affected. GPs endeavoured to answer a flood of COVID-19-related enquiries, while undertaking community preventive tasks. In addition to in-person consultations, GP promoted COVID-19 awareness and education through telephone consultations, physical posters and social media. Overall GPs in Shenzhen felt well supported with adequate Personal Protective Equipment (PPE) and resources from secondary care services. Higher levels of self-perceived preparedness (OR = 2.19; 95%CI, 1.04-4.61), lower level of anxiety (OR = 0.56; 95%CI, 0.29-1.09) and fewer perceived family worries (OR = 0.37; 95%CI, 0.12-1.12) were associated with better confidence in coping at work. CONCLUSIONS: Training and supporting GPs while reducing their (and their families') anxiety increase their confidence in delivering the important roles of gatekeeping in face of major disease outbreaks.

Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study.

BACKGROUND: Smartphone-based dating apps are rapidly transforming how people seek potential sexual and romantic partners. However, they can also increase the risk of unsafe sexual behaviors, harassment, and infringement of personal privacy. Current research on interventions for safer dating app use remains insufficient. OBJECTIVE: The goal of this study was to describe the development of an intervention for safer dating app usage using crowdsourcing and peer-led approaches. METHODS: This paper describes the development of an intervention program designed to promote safer dating app use among college students. Crowdsourcing and peer-led approaches were adopted during key stages of the development process. Focus group discussions were held to assess the experience and needs of dating app users. A crowdsourcing contest then solicited ideas for performance objectives for the intervention. These objectives were grouped to further identify practical strategies. A one-day intensive workshop was subsequently held with peer mentors to brainstorm ideas for the production of creative interventional materials. The intervention programs were produced and tested in a pilot study. The app's effectiveness will be evaluated in a cluster randomized controlled trial. RESULTS: The intervention program consists of a risk assessment tool, a first-person scenario game, and four short videos. The risk assessment tool, comprised of 14 questions, will give the participant a score to determine their level of risk of adverse events when using dating apps. The scenario game is a first-person simulation game where the players are presented with choices when faced with different scenarios. The short videos each last 2-4 minutes, with points of discussion aimed at addressing the risks of using dating apps. The programs were piloted and were found to be relatable and helpful when further modifications were made. CONCLUSIONS: Potential challenges identified during the development process included data management and analysis, sustaining peer mentors' interests and participation, and balancing between providing more information and perpetuating social stigma around dating app use. By integrating new approaches, such as crowdsourcing and the peer-led approach, in developing an intervention for safer dating app use, our development process provides a viable model for developing future interventions to address the risks associated with dating app use.

Impact of household composition and satisfaction with family life on self-reported sexual health outcomes of high-school students in Hong Kong.

BACKGROUND: The study aimed to examine the impact of household composition and satisfaction with family life on sexual behaviours among high school male and female students (aged 11-22 years) in Hong Kong. METHOD: High schools were randomly selected, and the final sample comprised 25 schools. Students were divided into two groups ('living with both biological parents' vs 'not living with both biological parents'). Students were asked to rate their satisfaction with family life on a five-point Likert scale in a self-administered questionnaire. Dependent variables were sexual experience, sexual harassment, sexting and nude chats. Multiple logistic regression was used to analyse the results. RESULTS: 3907 students were included in the analysis. 202 students (5.2%) were sexually active. 505 students had ever (13.0%) sexually harassed others and 303 students (7.8%) had ever been sexually harassed by others. 58 students (1.5%) had ever had nude chats. 1005 students (25.8%) had sexted in the last 12 months. Students who lived with both biological parents were less like to be sexually active, to sext and to have nude chats than those who did not. Students who had higher family life satisfaction were less likely to be sexually active, to sexually harass others, to be sexually harassed by others, to sext and to have nude chats than students who had lower satisfaction with their family life. CONCLUSIONS: Sexual health programmes and interventions should consider family functioning. Students who have low family satisfaction and those who do not live with both their biological parents should be targeted for sexual health interventions.

A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing.

Chlamydia trachomatis is the most common bacterial sexually transmitted infection, causing significant morbidity and economic burden. Strategies like national screening programs or home-testing kits were introduced in some developed countries, yet their effectiveness remains controversial. In this systematic review, we examined reviews of chlamydia screening interventions to assess their effectiveness and the elements that contribute to their success to guide public policy and future research. We assessed English material published after 2000 in PubMed, the Cochrane Library, the British Nursing Index, Medical Database, and Sociological Abstracts, in addition to World Health Organization Global Health Sector Strategies, the European Center for Disease Prevention and Control guidelines, and the Prospective Register of Systematic Reviews. Systematic reviews that focused on chlamydia screening interventions were included. Using the socioecological model, we examined the levels of interventions that may affect the uptake of chlamydia screening. A total of 19 systematic reviews were included. Self-collection in home-testing kits significantly increased screening among girls and women 14-50 years of age. At the organizational level, using electronic health records and not creating additional costs facilitated testing. At the community level, outreach interventions in community and parent centers and homeless shelters achieved high screening rates. At the policy level, interventions with educational and advisory elements could result in significant improvements in screening rates.

Evaluation and mechanism analysis of HIV prevention programme using resilience framework among female sex workers: A randomised controlled trial.

BACKGROUND: Evidence shows traditional sexual harm reduction for female sex workers (FSW) based on health behaviour theories is effective but short-lived. This study aimed to evaluate and understand the effectiveness of a resilience-promoting programme in improving psychological health and, ultimately, safe sex practice. METHODS: A randomised controlled trial was conducted at three Hong Kong-based non-governmental organisations. 127 sex workers were recruited and randomly assigned to the intervention or control groups. The former received a six-session resilience-promoting programme designed to improve self-esteem, self-efficacy and coping skills, whereas the latter had the usual care. Between-group differences in psychological outcomes and condom use were tested using the intention-to-treat, with ANOVA and chi-square tests, measured at baseline, post-intervention and 3-month follow-ups. Multiple mediation analysis was used to examine how the intervention worked through resilience factors. RESULTS: Significant between-group improvements in adaptive coping (F 1,119 = 5.82, p < .05) and reduction in psychological distress (F 1,118 = 5.00, p < .05) were seen at post-intervention and 3-month follow-ups, with significant time × group interaction changes suggesting the changes occurred at different rates between the two groups. Condom use during the last transactions had increased in the intervention group and the rate of consistent condom use during transactions improved in the intervention group at follow-ups (χ 2 = 4.35, p < .05). Self-esteem and resilience significantly mediated the effect of intervention at reducing psychological distress. CONCLUSIONS: These findings suggest that resilience improves the psychological health and general wellbeing of Chinese FSWs.

Study protocol for a peer-led web-based intervention to promote safe usage of dating applications among young adults: a cluster randomized controlled trial.

BACKGROUND: Dating applications are a popular platform to meet new people. At the same time, they have been associated with risks such as unsafe sexual behavior and privacy concerns in young adults. This paper presents a study protocol of a cluster randomized controlled trial (RCT) to evaluate the effectiveness of a peer-led web-based intervention to promote its safe usage in young adults. METHODS: The study design is an open-labeled cluster RCT with an intervention and a placebo control arm. The intervention group will receive a web-based intervention developed through focus group discussions, a crowdsourcing contest, and a Peer-Vetted Creative Production (PVCP) workshop. The control group will receive a web-based resource on health and exercise. We aim to recruit approximately 338 young adults aged 17-27 years from three tertiary educational institutions in Hong Kong with the class as the cluster unit. Based on the Information, Motivation, and Behavioral Skills (IMB) model, the primary outcome of this study is self-efficacy in using dating applications measured by the General Self Efficacy Scale. Secondary outcomes include change in risk perception measured by the Risk Propensity Scale and a Risk Assessment Tool. Questionnaires will be administered before the intervention, after the intervention, and at one-month follow-up. Intention-to-treat analysis and multilevel regression modeling will be used to evaluate differences in outcomes between groups and the factors affecting these outcomes, respectively. DISCUSSION: Dating application usage presents opportunities as well as challenges to young adults meeting new friends. Innovative and relatable interventions are needed to promote the safe usage of dating applications to this population. Practical knowledge gained from the development process may be helpful for future intervention utilizing the peer-led approach. If effective, the intervention will be disseminated to non-governmental organizations and educational institutions to be used as a teaching resource. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03685643 . Registered on 26 September 2018. University of Hong Kong Clinical Trials Registry, HKUCTR-2512.

Contextual factors associated with consistent condom use and condom self-efficacy amongst African asylum seekers and refugees in Hong Kong.

BACKGROUND: Hong Kong has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This study explores the sexual health behaviours and social inequities amongst African ASRs in Hong Kong. METHODS: A cross-sectional survey of African ASRs was conducted through three local non-governmental organizations in 2013. A logistic model was used to test the interactions and relationship between the respondents' consistent condom use and contextual antecedents, socio-demographic factors, psychosocial factors and condom self-efficacy (CSE) score. RESULTS: 371 adult African ASRs were recruited. In the previous month, 35% and 38% of participants consistently had used condoms with regular and casual sexual partners respectively. However, less than 50% perceived no risk of HIV/STIs and less than 60% reported not knowing how to access sexual health screening. Consistent condom use was less likely among African ASRs who were married (adjusted odds ratio (aOR) = 0.10), used recreational drugs (aOR = 0.11) or were unsure of their sexual orientation (aOR = 0.05) and was positively associated with higher CSE scores (aOR = 1.09) Pre-migration determinants and lifestyle determinants accounted for most of the variance in the model. CONCLUSION: The inconsistent condom use makes African ASRs vulnerable to HIV/STIs. Tailored interventions are needed to address the associated determinants and inequities amongst African ASRs living in Hong Kong.

Correction: Prevalence and risk factors of chlamydia infection in Hong Kong: A population-based geospatial household survey and testing.

[This corrects the article DOI: 10.1371/journal.pone.0172561.].

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries.

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges' g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges' g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.

A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial.

BACKGROUND: The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population. OBJECTIVE: The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong. METHODS: A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated. RESULTS: Of 196 eligible participants-100 in the control group and 96 in the intervention group-who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04). CONCLUSIONS: A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16009495; http://www.chictr.org.cn/showprojen.aspx?proj=16234 (Archived by WebCite at http://www.webcitation.org/6s0Fc2L9T).

Mental health of African asylum-seekers and refugees in Hong Kong: using the social determinants of health framework.

BACKGROUND: Hong Kong is non-signatory to the 1951 Refugee Convention and its 1967 Protocol, and has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This creates a tenuous setting for African ASRs there. This study explored how mapped social determinates of health has impacted the mental health and wellbeing of African ASR's in Hong Kong. METHODS: A cross-sectional survey was carried out with 374 African ASRs. The survey comprised of: (a) socio-demographics; (b) health status; (c) health behaviours; and, (d) social experiences. Associations between social determinants of health and depression screen were explored and multivariable regression analysis was conducted. RESULTS: Majority of participants were 18-37 years old (79.7%), male (77.2%), single (66.4%) and educated (60.9% high school and above). Over a third (36.1%) screened positive for depression. Analyses revealed that living with family reduced the odds of a positive depression screen (OR = 0.25, 95%CI = 0.07-0.88). Those perceiving their health to be "Poor" were 5.78 times as likely to be screened for depression. Additionally, those with higher scores on the discrimination scale were more likely to have positive depression screen (OR = 1.17, 95%CI = 1.10-1.24). CONCLUSION: A significant proportion of African ASRs in Hong Kong exhibits depressive symptoms. A complex interaction combining both social and perceptions of health and discrimination in the host society is likely exacerbated by their ASR status. The use of community support groups or even re-examination of the family reunification laws could improve the mental health and wellbeing of African ASRs in Hong Kong.