Association Between Stress and Social Support Among Young Adult Pacific Islander Smokers.

Recent studies have found high levels of stress among Americans, particularly amongst young adults and ethnic minority groups. The purpose of this secondary data analysis was to explore the association between stress and social support among a sample of 276 young adult smokers of Pacific Islander ancestry, specifically Samoans and Tongans with an average age of 25.3 years. Previous research had documented the protective role of social support on stress, and thus it is hypothesized that young adult Pacific Islander smokers who perceived higher levels of social support will have less perceived stress. Social support was assessed using a 12-item scale which measured participant's perceived social support from family, friends, and significant others. Perceived stress was measured using a 10-item scale with 2 subscales - self efficacy and helplessness. Standardized parameter estimates from structural equation modeling indicated a statistically significant inverse relationship between perceived social support from family and perceived stress related to helplessness. More specifically, young adult Samoans and Tongans who report higher levels of social support from family do not feel as much stress stemming from being helpless. The results highlight the importance of family social support on stress management among this population. Most importantly, these findings add to the limited research around mental health within Pacific Islander (Samoan and Tongan) communities in the US.

Coping strategies and stress among resettled Bhutanese adults in Massachusetts.

Stress associated with attempts to integrate into a new culture is directly linked to mental health outcomes among refugees. However, there is a paucity of literature on how refugees cope to reduce their stress. This study assessed the association between coping strategies and perceived stress among resettled Bhutanese adults in Western Massachusetts. A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 years residing in Massachusetts. Coping was measured with the 32-item Tobin Coping-Strategies Inventory-Short Form (CSI-SF). The 32-item CSI-SF includes 8 subscales: problem-solving, cognitive-structuring, express-emotions, social-contact, problem-avoidance, wishful thinking, self-criticism, and social-withdrawal, each with 4 items. Four composite constructs were created from subscales, namely, problem-focused engagement (problem solving + cognitive structuring), emotion-focused engagement (express emotions + social contact), problem-focused disengagement (problem avoidance + wishful thinking), and emotion-focused disengagement (self-criticism + social withdrawal). Perceived stress was measured with the 10-item Cohen Perceived Stress Scale. Associations of coping scores with perceived stress score (PSS) were assessed using multiple linear-regression analyses adjusting for sociodemographic, and lifestyle factors. The coping scores of 4 subscales were inversely associated with PSS including problem solving (ß = -0.430, p ≤ .0001), cognitive structuring (ß = -0.416, p = .0002), express emotions (ß = -0.292, p = .004), and social contact (ß = -0.448, p ≤ .0001). Two composite constructs of subscales, namely, problem-focused (ß = -0.236, p ≤ .0001) and emotion-focused (ß = -0.199, p = .0003) engagement coping strategies were inversely associated with PSS. Greater use of problem- or emotion-focused engagement coping strategies was associated with reduced PSS among Bhutanese, suggesting that problem-focused or emotion-focused stress management interventions hold promise for stress reduction among resettled Bhutanese. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sociocultural Perceptions and Enablers to Seeking Mental Health Support Among Bhutanese Refugees in Western Massachusetts.

This qualitative study aimed to identify cultural influences on seeking mental health support among Bhutanese refugees resettled in Western Massachusetts. Bhutanese refugees aged 18 years or older were recruited for eight focus group discussions, organized by age and gender ( N = 67, 49.3% female, mean age = 38, SD = 15.9). The PEN-3 cultural model was used as the theoretical framework to examine the roles of cultural perceptions that influence mental health-seeking behaviors. Focus group discussions were audio taped to facilitate the thematic-analysis. Younger participants (<35 years) reported experiencing stressors relating to economic hardships and difficulties in developing academic and social skills as they juggle breadwinner and care-giving responsibilities for their families. Older participants reported frustration with the difficulties in learning English and increased dependence on their children. Family members provided the initial frontline support to persons with mental health problems. If family support did not work, they consulted with their relatives and trustworthy community members for further assistance. Psychological factors such as fears of emotions, social norms, beliefs, and self-esteem associated with cultural norms and values influenced seeking mental health support. All participants expressed the need to have a culturally tailored intervention to develop acquired skills to improve their self-esteem and self-efficacy in order to integrate into their new social and cultural environment. Because family members make important decisions about seeking mental health support, involving family members in developing and delivering culturally appropriate skill development interventions could be a potential strategy to reduce their stress and increase resilience in this refugee community.

Serum albumin levels and depression in people living with Human Immunodeficiency Virus infection: a cross-sectional study.

BACKGROUND: Lower serum albumin levels and depression are common among HIV-infected persons. High serum albumin levels may provide protection against depression through its defensive role in inflammation and infection. We tested the hypothesis of an independent relationship between serum albumin levels and depressive symptoms in a cohort of HIV-infected persons. METHODS: A cross-sectional survey was conducted among 310 HIV-infected persons (176 men and 134 women) aged 20-60years residing in the Kathmandu Valley, Nepal. The bromocresol green method was used to measure serum albumin levels and the Beck Depression Inventory method was used to measure depressive symptoms, with a cut off score of 20 or higher indicating likely depression. The relationship between serum albumin levels and depressive symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for sociodemographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors. RESULTS: Serum albumin levels were inversely associated with depressive symptoms scores (beta for 1 unit change in serum albumin levels: ß=-3.91; p=0.001) for the total participant sample. This inverse association was significant in both men (ß=-3.93; p=0.009) and women (ß=-4.47; p=0.03). A significantly decreased risk of depression was observed among participants with the highest serum albumin levels, with odds ratio and 95% CI for those with >5.0g/dL versus <4.0g/dL of 0.22 (0.06-0.80) (p=0.01). CONCLUSION: Serum albumin levels were inversely associated with depressive symptoms scores in HIV-infected persons.

Coinfection of Sexually Transmitted Infections among HIV-Positive Individuals: Cross-Sectional Results of a Community-Based Positive Living with HIV (POLH) Study in Nepal.

In Asian concentrated HIV epidemics, data on coinfection of sexually transmitted infections (STIs) among HIV-positive individuals are limited. The authors measured the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and syphilis, and their correlates among 319 HIV-positive individuals in Kathmandu, Nepal. The authors tested blood samples for syphilis and urine samples for CT and NG. Overall, 17 (5.3%) participants had at least 1 STI (CT: 1.3%, NG: 2.8%, and syphilis: 1.2%). Of 226 participants who had sex in past 6 months, 51.3% did not always use condoms. Older (aged 35-60 years) participants were more likely (adjusted odds ratio [AOR] = 3.83; 95% confidence interval [CI] = 1.19-12.33; P = .024) and those who were currently married (AOR = 0.30; 95% CI = 0.09-0.97; P = .046) or on antiretroviral therapy (AOR = 0.21; 95% CI = 0.06-0.71; P = .012) were less likely to have at least 1 STI. Our results suggest the need to strengthen the efforts to screen and treat STIs and to promote safer sexual practices among Nepalese HIV-positive individuals.

Associations between psychological characteristics and indicators of metabolic syndrome among Chinese adults.

Current knowledge about the relationship between psychological characteristics and metabolic syndrome (MetS) components is limited in Asian populations. The purpose of this study is to investigate linkages between physiological markers of MetS and life satisfaction, hostility, and depression in Chinese adults. Secondary analyses were conducted using cross-sectional data from parents of randomly selected middle school students participating in a pilot study in Qingdao, China. Among 440 parents who consented to participate (237 women, 203 men), 368 provided valid responses in all three categories of psychological characteristics, and only those subjects were included in these analyses. General linear models and logistic regressions were run separately by gender, controlling for covariates. Among women, life satisfaction was inversely associated with triglyceride levels (p = .04), LDL-C (p < .01), risk of hypertriglyceridemia (OR[.53], p < .01), HDL-C (OR[.78], p = .03), and MetS (OR[.52], p = .03). No associations were found between life satisfaction and any psychological characteristics among men. Among women, hostility was positively associated with triglyceride level (p = .04) and risk of hypertriglyceridemia (OR[2.12], p < .05). Among men, hostility was positively associated with waist circumference (p = .04), waist-hip ratio (p < .05), and fasting plasma insulin (p < .01). Depression was not associated with any physiological measurement in either gender. These findings indicate that relationships exist between certain psychological characteristics and physiological indicators of MetS among Chinese adults, although there may be important differences between genders.

Serum zinc concentrations and depression in persons with Human Immunodeficiency Virus infection: The positive living with HIV (POLH) study.

Low levels of serum zinc concentrations and depression are common in persons infected with Human Immunodeficiency Virus (HIV). Low levels of serum zinc concentrations may increase risk of depression in general population. However, research on the role of zinc in depression among HIV- infected person is limited. We assessed the association between serum zinc concentrations and depression in HIV-infected persons. A cross-sectional survey was conducted among 311 HIV-positive people (177 men and 134 women) aged 18-60 years residing in Kathmandu, Nepal. The atomic absorption method was used to measure serum zinc concentrations and the Beck Depression Inventory (BDI)-Ia method was used to measure depression, with cut off score 20 or higher consistent with clinically significant depression. Relationships were assessed using multiple linear and logistic regression analyses. Serum zinc concentrations were significantly inversely associated with depression in all participants and in men but not in women. Participants with the highest tertile of serum zinc concentrations had a significantly decreased risk of depression in men but not in women. Serum zinc concentrations were inversely associated with depressive symptoms scores in HIV-infected men. Further prospective studies are needed to confirm the role of zinc in depression among persons infected with HIV.

Overweight Perception: Associations with Weight Control Goals, Attempts, and Practices among Chinese Female College Students.

BACKGROUND: Concurrent with the dramatic cultural and economic shifts occurring as mainland China becomes increasingly "Westernized," the weight perceptions, ideal body weight, and weight management goals and practices of Chinese females have also undergone significant changes. OBJECTIVE: To investigate relationships between overweight status, weight perception patterns, and weight management goals and practices in Chinese female college students. DESIGN/PARTICIPANTS/SETTING: A cross-sectional analysis was conducted with data from 902 female subjects aged 18 to 25 years participating in the China Seven Cities Study, a health promotion and smoking prevention study conducted in mainland China in 2003. MAIN OUTCOME MEASURES/STATISTICAL ANALYSES: Logistic regression models were used to explore associations between overweight status, weight perception, specific weight management goals and practices, and current levels of vigorous-intensity physical activity and food consumption. RESULTS: Based on World Health Organization standards for Asian adults, 16.7% of college females were overweight or obese, although 50.8% considered themselves to be "too heavy." Among participants perceiving themselves as overweight (n=458), 69.2% (n=371) were inaccurate and did not meet criteria for overweight or obese. The percentage of participants attempting weight loss was 48.2%, and 33.1% wanted to maintain their current weight. Attempts to lose or maintain weight were related to actual and perceived weight status, but not to increased vigorous-intensity physical activity or fruit and vegetable intake, nor to decreased consumption of sweets, soda, Western fast foods, and fried foods. Only 21.5% of participants desiring weight loss or maintenance reported using a combination of vigorous-intensity physical activity and a reduced-fat and -calorie diet, whereas 20.2% tried extreme methods such as fasting, using diet pills, vomiting, or smoking. CONCLUSIONS: Our findings underscore the need to promote healthy weight management practices among Chinese female college students, with an emphasis on diet and physical activity strategies that encourage balance rather than extremes.

Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults.

OBJECTIVES: According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS). METHODS: Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking. RESULTS: After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05). CONCLUSIONS: Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.

A Longitudinal Analysis of the Effects of Socioeconomic Factors, Foreign Media, and Attitude toward Appearance on General and Central Adiposity in Chinese Adolescents.

OBJECTIVE: This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents. METHOD: A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status. RESULTS: Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (ß=-0.06, p=0.01 for middle school girls; ß=-0.06, p=0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR=0.86, p<0.01). Among boys, parental education was significantly positively associated with general adiposity (ß=0.62, p<0.01 for middle school boys; ß=0.37, p=0.02 for high school boys) and associated with greater odds of being overweight (OR=1.55, p<0.01 for middle school boys; OR=1.26, p=0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time. CONCLUSION: Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.

The Association between Family Structure and Adolescent Smoking among Multicultural Students in Hawaii.

OBJECTIVE: The purpose of this study was to examine whether the prevalence of smoking was associated with family structure among multicultural adolescents and whether there was gender disparity on the association. METHODS: Data were collected from a sample of 7th graders in Hawaii who completed in-class questionnaires in 2004. The final sample included 821 multicultural students from different family structures. Descriptive analyses, Chi-square tests and logistic regression were performed to examine the prevalence of smoking and the association between family structure and smoking prevalence. RESULTS: This sample contained students who lived in intact (61.7%), single-parent (16.5%), step-parent (15.6%), and no-parent (6.2%) families. The overall prevalence of ever/lifetime smoking was 24.0%, and was not significantly different between genders in each family structure (p>0.05). Compared with living in intact families, living in single-parent, step-parent, or no-parent families was significantly associated with higher odds of ever/lifetime smoking among all students (p<0.05) and living in single-parent and stepparent families was significantly associated with higher odds of ever/lifetime smoking among females (p<0.05) and among males (p<0.05) respectively, after adjusting for covariates. CONCLUSIONS: These findings suggest that family structure is a risk factor for smoking among multicultural students. Anti-smoking programs should consider this factor.

Tobacco smoking among school children in Colombo district, Sri Lanka.

Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs.

C-reactive protein and depression in persons with Human Immunodeficiency Virus infection: the Positive Living with HIV (POLH) Study.

BACKGROUND: Human Immunodeficiency Virus (HIV) infection has been frequently associated with chronic inflammation as well as depression. C-reactive protein (CRP) is positively associated with depression in people without HIV infection. We tested the hypothesis of an independent relationship between CRP and depression in a cohort of HIV-positive people. METHODS: A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 18-60years residing in the Kathmandu Valley, Nepal. The latex agglutination turbidimetric method was used to measure serum CRP concentrations and the Beck Depression Inventory (BDI)-I method was used to measure depression, with a cut off of ⩾20 indicating likely depression. The relationship between CRP concentrations and depression symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for potential socio-demographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors. RESULTS: Twenty-six percent participants (men: 23%; women: 29%) met criteria for depression. In multiple regression analysis, the authors observed a linear relation between serum CRP concentrations and BDI score (beta for 1 unit change in ln(CRP)=1.13, p=0.001) in HIV-positive participants. In a logistic regression analysis, participants with serum CRP levels>3mg/L had a 2.3-fold higher odds of depression symptoms compared to those with serum CRP level⩽3mg/L (p=0.005). In analyses stratified by sex, associations were stronger in men than in women. For example, CRP>3mg/L was associated with a 3.6-fold higher odds of depression in men (p=0.002), while in women the odds ratio was 1.7 (p=0.33). CONCLUSION: We found a linear relationship between serum CRP concentrations and depression symptoms score in HIV-positive people, and evidence that risk of depression is elevated among HIV-positive men with a high level of inflammation (CRP>3mg/L). Further prospective study to confirm the role of inflammation in depression among HIV-positive people is warranted.

Use of a community-based participatory research approach to assess knowledge, attitudes, and beliefs on biospecimen research among Pacific Islanders.

Objectives. The purpose of this article is to describe a community-based participatory research pilot project conducted to investigate the knowledge, attitudes, and beliefs that Pacific Islanders (PIs) hold toward biospecimen collection, use, and banking, all of which will help drive higher PI participation rates in both medical and behavioral research studies. Method. Academic and community partners worked side by side to develop a conceptual model, study measures, and study protocols. PI community partners screened, recruited, and conducted data collection, which consisted of a paper-and-pencil survey and a 1-hour semistructured interview administered by trained community workers. Results. A total of 60 PI adults representing various PI ethnic groups completed the surveys and interviews. Results showed a general support for biospecimen studies that would benefit the community, and many are willing to provide their biospecimen samples if asked. Conclusion. Due to the established level of trust, community partners were able to successfully recruit and collect data for the study. Many of those interviewed also called for more outreach and education about the importance of biospecimen research in their communities.

Coinfection with hepatitis C virus among HIV-positive people in the Kathmandu Valley, Nepal.

BACKGROUND: Previous research has studied the rate of hepatitis C virus (HCV) coinfection among HIV-positive people regardless of their antiretroviral therapy (ART) status. Our objectives were to measure the seroprevalence of HCV both in HIV-positive people receiving ART and in those not receiving ART and to describe the characteristics of coinfected people in the Kathmandu Valley, Nepal. METHODS: We conducted a cross-sectional survey of 319 HIV-positive people residing in the Kathmandu Valley, Nepal. We screened the participants' serum samples for HCV antibodies using the Latex Photometric Immunoassay based on third-generation assay. RESULTS: A total of 138 (43.3%) participants were HCV positive. The prevalence of HCV coinfection was 96.2% (125 of 130) among participants with lifetime injection drug use (IDU). Among participants not receiving ART, the coinfection rate was 58.1% (50 of 86) compared with 37.8% (88 of 233) among those receiving ART. In multivariable analysis, participants who reported lifetime IDU and were current smokers were more likely to have HCV coinfection. The adjusted odds ratio (AOR) of HCV coinfection for ART was decreased, although it was not statistically significant (AOR = 0.45; 95% confidence interval = 0.13-1.48). CONCLUSION: The high prevalence of HCV coinfection among both individuals receiving ART and those not receiving ART suggests that screening for HCV among HIV-positive people would be useful, in particular, for those with lifetime IDU and soon after their HIV diagnosis.

The role of cognitive attributions for smoking in subsequent smoking progression and regression among adolescents in China.

Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking. Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders. Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression. This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.

Serum 25-hydroxyvitamin d levels and C-reactive protein in persons with human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection has frequently been associated with vitamin D deficiency as well as chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D [25(OH)D] and high-sensitivity C-reactive protein (CRP) in a cohort of HIV-positive people. A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 16 to 60 years residing in the Kathmandu Valley, Nepal. Serum high-sensitivity CRP concentrations and serum 25(OH)D levels were measured by the latex agglutination nephelometry method and the competitive protein-binding assay, respectively. The relationship between serum CRP concentrations and 25(OH)D serum level was assessed using multiple logistic regression analysis with adjustment of potential cardiovascular and HIV-related factors. The proportions of participants with 25(OH)D serum levels <20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were 83.2%, 15.5%, and 1.3%, respectively. The mean 25(OH)D serum levels in men and women were 15.3 ng/ml and 14.4 ng/ml, respectively. Participants with a 25(OH)D serum level of <20 ng/ml had a 3.2-fold higher odds of high CRP (>3 mg/liter) compared to those with a 25(OH)D serum level of ≥20 ng/ml (p=0.005). Men and women with a 25(OH)D serum level of <20 ng/ml had 3.2- and 2.7-fold higher odds of high CRP (>3 mg/liter), respectively, compared to those with a 25(OH)D serum level of ≥20 ng/ml. The relationships remained significant only in men (p =0.02) but not in women (p=0.28). The risk of having a high level of inflammation (CRP>3 mg/liter) may be high among HIV-positive men and women with a 25(OH)D serum level of <20 ng/ml.

Exposure to violence in relation to depressive symptoms among male and female adolescent students in Cambodia.

PURPOSE: In spite of the apparent increases in family and community violence, research into its effects on adolescent mental health has received limited attention in Cambodia. This study examines the association between exposure to violence and depressive symptoms among adolescents controlling for the effects of several factors in family and school domains. METHODS: We randomly selected 993 male and 950 female students proportionally from 11 junior high schools and high schools in Battembang provincial city. Students were questioned about the violence to which they were subjected and which they witnessed in their family and community. The Asian adolescent depression scale was used to measure depressive symptoms. RESULTS: In this study, 27.9% of male students and 21.5% of female students had been victimized in at least one case of family violence, while 18.0% of male and 5.8% of female students had been victimized in at least one case of community violence. After adjustment, increased levels of depressive symptoms were significantly associated with being the victim of or witnessing family or community violence among both male and female students. However, the positive association between the levels of depressive symptoms and being a witness to community violence was found only in female students. CONCLUSIONS: Efforts to prevent depression in adolescent students should focus on reducing family and community violence; such efforts should also consider gender differences.

Tobacco smoking, quitting, and relapsing among adult males in Mainland China: the China Seven Cities Study.

INTRODUCTION: Despite an estimated 1 million tobacco-related deaths annually in China, public health officials face overwhelming barriers to implementing effective tobacco control policies and programs. Models of effective tobacco control can be adapted for Chinese tobacco use and culture based on reliable and valid data regarding predictors of smoking and abstaining. METHODS: As part of the China Seven Cities Study to assess the role of rapid social, economic, and cultural change on tobacco use and related health practices and outcomes, 4,072 adult male smokers provided data in 3 annual waves. Measures included current smoking, nicotine dependence, readiness for quitting, perceived stress, hostility, depressive symptoms, as well as covariates (e.g., age, marital status, educational attainment, and family income). RESULTS: Odds of being abstinent at Wave 3 were increased by: lower nicotine dependence at Wave 1 and becoming less dependent between Waves 1 and 3; progressing beyond the contemplation stage between Waves 1 and 3; perceiving less stress, whether initially at Wave 1 or over time from Wave 1 to Wave 3; and lower hostility scores at Wave 1 and decreased hostility from Wave 1 to Wave 3. Among those who quit, odds of remaining abstinent rather than relapsing by Wave 3 were higher among those who were less dependent at Wave 1 and who became less dependent from Wave 1 to Wave 3; and those who showed decreases in hostility from Wave 1 to Wave 3. CONCLUSIONS: The public health challenge posed by very high prevalence of male smoking in China can be met by policies and programs that lead to successful long-term cessation. This can only be done successfully by designing interventions based on knowledge of the country's smokers and the current study suggests several elements.

Sibling care, school performance, and depression among adolescent caretakers in Cambodia.

In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ(2) test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p<0.001), as well as poor school performance (p=0.001) and perceived likelihood of dropping out of school in the near future (p=0.002). Among girls, increased levels of depressive symptoms retained their significant association with sibling caretaking (p<0.001); also poor school performance (p<0.001). Sibling care responsibility might have negative impact on school performance and the mental health condition of adolescent caretakers.