Changes in, and factors associated with family functioning: results of four cross-sectional household surveys from 2011 to 2017 in Hong Kong.

BACKGROUND: Previous research has well-documented that family functioning is an important predictor of individuals' physical and mental health. However, relatively little research has explored family functioning at the family and population levels, such as changes in family functioning across years and whether predictors of family functioning differ across different family structures. Understanding of the changes in family functioning across years and factors promoting family functioning will inform the development of preventive measures to enhance family health and resilience. Objectives of the study were: (1) to examine the changes in family functioning across a 6-year study period and (2) to study protective factors associated with family functioning and the extent to which the factors are the same or different across different family structures. METHOD: The study involved secondary data analysis of the biannual Family Survey carried out by the Family Council, an advisory body to the Hong Kong government. A series of ANOVA and regression analyses were conducted using data of four population-based cross-sectional household surveys conducted in Hong Kong in 2011, 2013, 2015, and 2017. RESULTS: There were some fluctuations in overall family functioning scores across the study period, but no significant difference was found between the scores in 2011 and 2017. Different predictors of family functioning were found for different family types, and frequent family communication was a common protective factor for most family types, including never married, married/cohabiting with children, and married/cohabiting with no children. CONCLUSION: The study is among the first to examine changes in family functioning at the population level. Monitoring and addressing family functioning may help tackle various social problems and future public health crises. Interventions to promote family functioning should address both common and different protective factors of different family types.

Intimate Partner Violence Against Women Before, During, and After Pregnancy: A Meta-Analysis.

Intimate partner violence (IPV) against pregnant women negatively impacts women's and infants' health. Yet inconsistent results have been found regarding whether pregnancy increases or decreases the risk of IPV. To answer this question, we systematically searched for studies that provided data on IPV against women before pregnancy, during pregnancy, and after childbirth. Nineteen studies met our selection criteria. We meta-analyzed the nineteen studies for the pooled prevalence of IPV across the three periods and examined study characteristics that moderate the prevalence. Results showed the pooled prevalence estimates of IPV were 21.2% before pregnancy, 12.8% during pregnancy and 14.7% after childbirth. Although these findings suggest a reduction in IPV during pregnancy, our closer evaluation of the prevalence of IPV after childbirth revealed that the reduction does not appear to persist. The prevalence of IPV increased from 12.8% within the first year after childbirth to 24.0% beyond the first year. Taken together, we should not assume pregnancy protects women from IPV, as IPV tends to persist across a longer-term period. Future studies are needed to investigate if IPV transits into other less obvious types of violence during pregnancy. Moderator analyses showed the prevalence estimates significantly varied across countries by income levels and regions.

Aggressive parenting behavior among grandparents providing childcare for grandchildren: A case study of Shenzhen, China.

BACKGROUND: Grandparents play an essential role in childrearing and fill the parenting gap for dual-earner Chinese families. Many Chinese grandparents engage heavily in childcare, which may increase the risk of child abuse. OBJECTIVE: This study aimed to examine grandparental use of psychological and physical aggression toward children and explore its associated risk factors. PARTICIPANTS AND SETTING: This was a cross-sectional study which involved purposive sampling of 278 grandparents (204 females and 74 males) taking care of at least one grandchild below 18 years old in Shenzhen, China. METHODS: Information on childcare was collected, including grandparents' use of psychological and physical aggression and their involvement in childcare in terms of intensity and activity. RESULTS: An alarming percentage (57.1 %) of grandparents had used psychological aggression, while 26.5 % had used corporal punishment, in the past year. The average use of psychological aggression and corporal punishment was 16.10 times and 10.08 times per year, respectively. Grandparents taking care of two or more grandchildren were more likely to use psychological aggression and corporal punishment compared to those taking care of only one grandchild. Higher mental and physical health summary scores were associated with lower likelihood of psychological and physical aggression of grandparents. CONCLUSIONS: This study advances our understanding of negative grandparenting behavior in childcare. As grandparents play a significant role in childcare, we need to improve their grandparenting skills, provide more formal childcare services to ease their childcare burden, and support their physical and mental well-being to reduce the risk of child abuse.

Effectiveness of Digital Health Interventions in Reducing Bullying and Cyberbullying: A Meta-Analysis.

Bullying and cyberbullying bring adverse physical and psychological impacts on individuals and an economic burden for society. Scholars have developed anti-bullying intervention programs to combat these problems. This meta-analysis aims to examine and compare the effectiveness of digital health interventions (DHIs) in reducing bullying and cyberbullying. A comprehensive search was conducted using databases (PsycINFO, Social Service Abstracts, Sociological Abstracts, MEDLINE, ERIC, and EMBASE). Quasi-experimental and randomized controlled trials (RCTs) published before 31 January 2021 that reported the effects of DHIs in reducing bullying or cyberbullying were included. The 16 studies included in the synthesis reported overall random effect sizes (Cohen's d) for bullying and cyberbullying reduction were 0.41 and 0.19, respectively. The results provide evidence on the effectiveness of DHIs, comparable to that of face-to-face interventions. The subgroup analysis revealed that the critical components of effective DHIs include training on bystander and bully-victim dual roles, coping skills, and interactive serious games. It highlights the promising effects of digital health approaches in bullying and cyberbullying interventions. Our review identifies avenues for future research on the development of more effective DHIs to reduce bullying and cyberbullying.

The Occurrence and Co-Occurrence of Harsh Parenting and Family Conflict in Hong Kong.

The violation of children's right to a safe home environment is a major public health problem in need of serious attention. Evidence has been limited about the family characteristics that go with the co-occurrence of harsh parenting and family conflict. By using a representative community sample of Hong Kong families, this study aims to examine the prevalence and risk factors of harsh parenting and family conflict. This study was conducted using a secondary analysis obtained from the 2017 Hong Kong Family Survey with a sample size of 1926 respondents who have children. Results showed that participants' ages are negatively related to the occurrence and co-occurrence of harsh parenting and/or family conflict. Married mothers reported less family conflict. Fathers with lower education levels reported more experiences of family violence. Mothers reporting a higher level of family satisfaction were less associated with harsh parenting. This study provides insights into the unique and shared familial elements that prevent harsh parenting and family conflict and help facilitate the development of effective intervention strategies for family violence co-occurrence. Family-based prevention for family violence may screen for the presence of harsh parenting and family conflict and take into consideration these signals to better support families in need.

Associating sleep quality, quality of life and child poly-victimization.

BACKGROUND: The role of sleep deprivation in the relationship between child poly-victimization and pediatric quality of life (PedsQL) has received little attention. OBJECTIVE: This study aims to provide a profile of the association between child victimization and poly-victimization and PedsQL among children, examining the role of sleep quality patterns in these relationships. PARTICIPANTS AND SETTING: We conducted a cross-sectional school survey study of family structure and child victimization among families in Hong Kong in 2016-17 with two-stage stratified sampling. The final sample consisted of 5, 567 students recruited from a representative sample of 107 kindergartens, primary schools, and secondary schools in all districts of Hong Kong. METHODS: Multi-phase regression analysis and simple slope analysis were conducted to examine the moderating effects of sleep quality between child victimization and PedsQL. RESULTS: The findings showed that children who experienced four or more types of victimization were more likely to show parasomnia and daytime dysfunction symptoms than those experiencing one to three types of victimization and non-victims. It also revealed significant relationships between child poly-victimization and lower levels of PedsQL, which were moderated by parasomnia and daytime dysfunction. CONCLUSIONS: This study has implications for clinicians in targeting the pattern of sleep changes combined with holistic screening in outpatient services for early detection of child poly-victims.

Attitudes toward Grandparental Involvement in Hong Kong: A Trend Analysis.

This article examines individuals' attitudes toward the involvement of grandparents in family issues in Hong Kong. While existing studies have largely focused on the nature and types of grandparents' involvement in childcare, it is worth conducting a quantitative investigation of the attitudes in the general population about grandparental involvement. Drawing on the 2011, 2013, 2015, and 2017 waves of the Family Surveys, the study examined the trend in attitudes toward grandparental involvement with 8932 HK residents. Multivariate linear regression analyses were performed to assess individual and family relationship factors associated with the attitudes toward grandparental involvement. Results show that although most people held positive attitudes toward grandparental involvement, there was a significant drop in the agreement with grandparental involvement in 2017 across all age groups. The findings imply that intergenerational support tends to be weakened in HK in recent years. Involving grandparents in family issues in HK was more likely to be need-driven rather than value-driven, as parent respondents had relatively more positive attitudes toward grandparental involvement compared with non-parents. Positive family and intergenerational relationships were significantly associated with the positive attitudes toward grandparental involvement. Policymakers and service providers should recognize the changes in people's attitudes toward family lives and provide appropriate support such as family counselling, (grand)parenting programs and childcare support to promote the wellbeing of families and older adults.

Stress in Balancing Work and Family among Working Parents in Hong Kong.

Work-life imbalance might lead to detrimental outcomes, including family dissatisfaction, poor performance in the workplace, and poor mental and physical health. This population-based study aims to explore the situation and trends in regard to work-life balance among working men and women in 2017, with a special focus on the stress experienced in work and personal lives. Descriptive analysis and multiphase regression are used to explore the associations of work-life imbalance with individual and family factors. Males' satisfaction with the amount of time spent at work was most significantly related to the level of work-life stress. Both males' and females' satisfaction with work life, family life, and the amount of time spent at work and with family were all negatively related to the level of work-life stress. Participants who were not in marital or cohabiting status reported significantly higher levels of work-life stress. Participants who had childcare support reported higher levels of work-life stress than those who looked after their children by themselves or their partners. A similar pattern was found among participants involved in elderly care. This study provides insight into family policy that could promote balance in professional and personal life and relationships.

Modifiable Factors for the Trajectory of Health-Related Quality of Life among Youth Growing Up in Poverty: A Prospective Cohort Study.

Poverty is a decisive risk factor for poor health and well-being, and its negative consequences could be more severe and substantial among children. Understanding the factors associated with improvement in well-being is vital to design interventions. This is a prospective cohort study of 546 youth growing up in families in poverty in Hong Kong. All participants were assessed twice, in 2016 and 2019, in regard to their physical and mental health, as well as for different economic, social, and psychological variables. The results show that approximately 41% experienced an improvement in their health-related quality of life (HRQoL). Findings from the logistic regression analyses suggest that the health and development of youth in poverty may be restored by promoting social support, a sense of hope, future orientation, job stability, and money management practices, such as savings, during childhood and adolescence. The findings shed light on future policy making and forms of service development that could help to end the vicious cycle of poverty and hampered health.

Associations Between Child Maltreatment and Adolescents' Health-Related Quality of Life and Emotional and Social Problems in Low-Income Families, and the Moderating Role of Social Support.

This study aimed to examine the associations between different types of child maltreatment and health-related quality of life (HRQoL) and emotional and social problems in adolescents, and to examine the moderating effect of social support on those associations. A cross-sectional survey was conducted between January and June 2016 in Hong Kong. The sample comprised 351 parent and adolescent dyads from low-income families. The parents reported on child maltreatment (physical abuse, psychological aggression, and neglect), and the adolescents reported on their HRQoL, emotional problems, and social problems. The adolescents' perceived social support was included as a potential moderator. Results of the study show that child physical abuse was strongly associated with emotional and social problems (B = 0.91-1.45, p < .05). Lower overall HRQoL was associated with psychological aggression (B = -3.96, p < .05) and neglect (B = -4.14, p < .05). Physical functioning was affected by psychological aggression (B = -3.16, p < .05), and emotional functioning was affected by neglect (B = -4.82, p < .05). Social functioning was impacted by all three types of maltreatment (B = -9.16 to -5.26, p < .05). This study extends previous literature by showing the varying effects of different types of child maltreatment on children's health in the context of low-income families. The findings of this study also support that peer social support may buffer the effects of child physical abuse on adolescents' emotional and social problems.

A Child Development Fund Program, Emotional Development, and Poverty Reduction.

OBJECTIVES: We aim to examine the effects of the Child Development Fund (CDF) program on the long-term psychological, health, social, and financial development of children in poverty. METHODS: The current study was a 4-year follow-up survey study (the follow-up study) of a nonrandomized controlled trial (the first study), conducted in 2019 and 2015, respectively, in Hong Kong. Subjects were 902 young adults who were from families living in poverty and receiving financial assistance from the government and who had completed the first study. Approximately 61% of the subjects (N = 546) completed the current follow-up study. RESULTS: Of the 546 subjects (46% male), 335 (61%; CDF participants) completed the CDF program between 2011 and 2015, and 211 (39%; CDF nonparticipants) were matched controls in the first study. The mean age was 20.64 years (SD = 2.72). After adjustments of covariates, the CDF participants reported fewer behavioral problems, higher levels of study motivation, higher levels of hope, and more positive attitudes toward their future education. The CDF participants also perceived greater social support from significant others and reported greater amounts of money saved every month. After further adjustments, CDF participants showed greater improvements in health-related quality of life related to emotional functioning. A considerable number of families of the CDF participants who were working for a living were no longer reliant on financial assistance from the government. CONCLUSIONS: The positive effects of the CDF program on children in poverty could be sustained throughout adolescence to young adulthood. Findings warrant the promotion of the program to reach more children.

A Qualitative Study of Practitioners' Views on Family Involvement in Treatment Process of Adolescent Internet Addiction.

Despite emerging evidence of the effectiveness of a family-focused approach as an Internet addiction (IA) treatment modality for adolescents, little research has been done to explore family involvement in the treatment process from the clinician's perspective. This study employed a qualitative design to examine practitioners' views pertaining to the roles and challenges of family participation in IA intervention. In total, 10 practitioners working with adolescents with IA were interviewed. Thematic analysis was used to analyze the transcribed interviews. Three overreaching themes were synthesized: That family involvement in IA intervention is challenging yet important; shifting the focus from the adolescent to the relationship; and provision of individualized services and intervention to address the heterogeneous nature of cases. The findings show that family participation in IA treatment is successful in enhancing positive outcomes. The needs of adolescents with IA and family members are addressed through individual counseling and psychoeducation, respectively. Conjoint therapy sessions foster effective communication, improve family interactions and functioning, and restore relationships. However, caution regarding family dynamics is required when considering whether family involvement is appropriate. Practitioners need to establish therapeutic alliances and be flexible when working with family members in terms of the degree and arrangement of participation.

Linking Healthcare and Social Service Databases to Study the Epidemiology of Child Maltreatment and Associated Health Problems: Hong Kong's Experience.

OBJECTIVE: To examine the incidence and trend of child maltreatment and its associated health problems in Hong Kong by linking healthcare and social service databases. STUDY DESIGN: Data on 4816 children under the age of 18 years registered with the Child Protection Registry and matching health records in public hospitals in Hong Kong from 2003 to 2010 were extracted. Associations were examined between different types of child maltreatment and child's medical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes including suicidal attempt (X60-X84), nonchild maltreatment related injuries (S00-S99; T00-T98, excluding T74 and T76 that are maltreatment related injuries), mental health problems (F00-F99), and congenital malformations/chromosomal abnormalities (Q00-Q99). RESULTS: Significant rising trends were found for child physical abuse, neglect, and sexual abuse during the period from 2003 to 2010. Psychological abuse remained stable. Risk of suicide attempt was higher among children suffering from sexual abuse, psychological abuse, and children experiencing multiple abuses; mental health diagnoses were more common in victims of psychological and multiple abuses. Congenital malformations and chromosomal abnormalities were more commonly found among neglected children. CONCLUSIONS: In contrast to the decreasing trend observed in the West during the study period, there has been an escalating trend in child maltreatment in Hong Kong and child maltreatment is strongly associated with major health problems. This is one of the first studies to demonstrate the power of linking healthcare and social service databases, which allows for both a better understanding of the impact of child maltreatment and as a guide future policy and service planning.

The Longer-Term Psychosocial Development of Adolescents: Child Development Accounts and the Role of Mentoring.

Objective: To examine the long-term development of adolescents who participated in the Child Development Fund (CDF), which was a community intervention that consisted of Child Development Accounts (CDAs) and mentorship components. Design: This was an evaluative study of the CDF community intervention and was conducted between January and June 2016 in Hong Kong. Participants: A total of 902 adolescents from low socioeconomic backgrounds participated in this study (552 in the CDF and 350 in the comparison group). All CDF participants completed the 3-year CDF program between 2011 and 2015. Main outcome measures: We assessed different developmental aspects of the adolescents, including health in terms of health-related quality of life; behavioral problems; attitude in terms of hope; cognitive capacity in terms of schooling; and social aspects in terms of social support. Results: Compared to the non-participants, the CDF participants appeared to have fewer behavioral problems, higher levels of perceived social support, higher levels of hope, better understanding of academic subjects, higher levels of motivation to study, fewer school withdrawal behaviors, and better quality of life related to social functioning. The male gender moderated the program's effect on hope. Results also show that higher levels of mentorship quality moderated the program's effect on social support, hope, self-perceived understanding of academic subjects, and motivation to study. Conclusion: Adolescents who participated in the CDF program appeared to perform better than the non-participants in regard to behavioral, academic, attitudinal, and social aspects. Good quality of mentorship had a positive influence on the program's effects. The CDF appears to be a promising program offering long-term and multi-dimensional benefits to participants.