Pet ownership: A sign of superior socioeconomic position? Evidences from six cities in China.

The aim of this study was to assess the prevalence of pet ownership and the relationship between pet ownership and people's socioeconomic positions examined at the individual, household, and regional levels among a large representative sample of residents in China. A cross-sectional study was conducted among six cities in China, incorporating a total of 5782 male residents along with their families in the analysis. The multilevel logistic regression models were employed to determine associations between socioeconomic deprivation and pet ownership prevalence. Pet-keeping is common in China as about 21.6% (95% C.I. 18.4%-24.0%) of households in China owned pets. Male participants aged over 55 years (OR: 0.78, 95%C.I.0.66-0.98) and those who are married (OR: 0.79, 95%C.I. 0.65-0.97) exhibit a reduced likelihood of pet ownership when contrasted with individuals younger than 25 years and those who have never married. Participants originating from medium or large urban centers demonstrate a significantly elevated likelihood of pet ownership, with an odds ratio of 1.98 (95%C.I. 1.71-2.30), when compared to their rural counterparts. Households residing in areas with medium population density have a 1.73 (95%C.I. 1.21-2.19) times higher likelihood to own a pet compared to those in regions of low population density. Elevated levels of socioeconomic deprivation, both at home and regionally, are associated with a substantially reduced probability of pet ownership. This study provides concrete evidence to the prevalence of pet ownership and its demographic distribution in China. These findings suggest that keeping pets might be more available to people with higher socioeconomic status.

Association between secondhand smoke exposure among women and the implementation of tobacco control measures on campus: A cross-sectional study in 50 universities across China.

INTRODUCTION: Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China. METHODS: 7,469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policy reported the implementation of smoke-free policy on campus measured by (1) no evidence of smoking and (2) display of smoke-free signs at public places. Multivariate logistic regression models were applied using weighted survey data. RESULTS: SHS exposure among participants was 50.5% (95% CI: 44.2%-56.9%). The adoption of smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI: 0.71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI:0.47-0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI: 1.42, 3.82; OR: 1.52; 95% CI: 1.15, 2.02, respectively). CONCLUSIONS: Exposure to SHS is prevalent among female college students in China. Successful implementation of smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China. IMPLICATIONS: Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with a higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.

Behavioral and Mental Health Problems in Children.

The stimulus, stress, and behavioral and mental response (SSB) model proposes that various stimuli induce stress and behavioral responses, which may, in turn, lead to health problems [...].

Real-world, anti-tobacco environmental impact upon price-induced smoking reduction among urban Chinese men: Evidence from China's 2015 cigarette tax increase.

INTRODUCTION: Raising the price of cigarettes via taxation has been promoted by the World Health Organization as an important tobacco control strategy. Price elasticity of cigarettes is not uniform and is dependent upon individual and environmental determinants. Many studies have examined the determinants of price-induced smoking, taking into account sociodemographic characteristics and consumption patterns. Little research has been conducted on the association between anti-smoking environments and price-induced smoking behavior. This study addresses the deficit within the Chinese context. METHODS: Participants were 2852 male smokers identified through a multi-stage survey sampling process encompassing 6 cities in China between July and December 2016. A standardized questionnaire tapped price-induced smoking reduction and related information. Both unadjusted and adjusted logistic regression methods were applied in the analyses. RESULTS: In all, 25.5% (95% CI: 22.5-27.9) of smokers in this study decreased their smoking expenditures following the 2015 excise tax increase. The adjusted logistic regression analysis showed that increased exposures to an anti-smoking information environment (AOR=1.39; 95% CI: 1.10-1.79), restricted smoking in their home (AOR=1.67; 95% CI: 1.32-2.08) and workplace (AOR=1.43; 95% CI: 1.09-1.85) were more likely to report diminished cigarette smoking following the tax increases. CONCLUSIONS: This study adds to understanding price-induced smoking behavior among urban male Chinese smokers. Strengthening of excise tax policies needs to intensify environmental smoking restrictions and public education campaigns to increase the sensitivity of cigarette price changes among smokers.

Temporal changes in mental response and prevention patterns, and their impact from uncertainty stress during the transition in China from the COVID-19 epidemic to sporadic infection.

An epidemic of a highly lethal disease can overwhelm people emotionally and physically. Little is known about how public mental and preventive patterns changed during the transition from the COVID-19 epidemic to sporadic infection. This study examined changing trends of metal response and behavioral variables, and their impact from uncertainty stress in this process in China. A prospective longitudinal observation design was utilized. There were 7 waves of surveys from COVID-19 epidemic status to the sporadic infection period. Sixty-two participants completed all observation points and were included in the study. The Mann-Kendall Test was used to assess changing trends across the seven observation points. The nonparametric linear mixed effects model was used to examine the association between uncertainty stress and mental and behavioral responses. The mean uncertainty stress did not change significantly over the observation period (Z: -0.911, p > 0.05). This trend was also true for perceived risk, perceived severity, self-efficacy for prevention, and prevention behavior. There was a statistically significant downward trend in irrational beliefs about prevention (Z: -4.993, p < 0.01), sleep (Z: -2.499, p < 0.05), emotions (Z: -5.650, p < 0.01), and lifestyle (Z: -5.978, p < 0.01). The results showed that uncertainty stress was positively associated with irrational beliefs (ß: 0.16298, p < 0.01), their sleep (ß: 0.02070, p < 0.05), emotions (ß: 0.03462, p < 0.01), and lifestyle (ß: 0.02056, p < 0.05). High levels of uncertainty stress were negatively associated with self-efficacy for prevention and prevention behavior, ß was -1.33210 (p < 0.01) and -0.82742 (p < 0.01). These results may have important policy and disease prevention in post-epidemic times.

Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study.

BACKGROUND: Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China. METHODS: Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH. RESULTS: The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65). DISCUSSION: Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China.

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

Validation of the 4-Item and 10-Item Uncertainty Stress Scale in a Community-Based Sample of Chinese Adults.

Purpose: The objectives of this study were to examine the psychometric properties of the Uncertainty Stress Scale (USS) and to compare the usefulness of two versions of the scale (USS-4 and USS-10) among a large community-based sample of Chinese adults. Participants and Methods: The Uncertainty Stress Scale was validated in 904 community residents (mean age: 32.71 ± 10.99; male: 41.7%) through an online survey conducted in February 2020. Psychometric properties of reliability (Cronbach's alpha), construct validity (confirmatory factor analysis), and criterion validity (correlation and ROC curve analyses) were evaluated using established benchmarks. To validate the USS, we used the Chinese version of the Perceived Stress Scale (CPSS). In addition, sensitivity, specificity, and suitable cutoff values of the two versions of USS were determined. Results: Both versions of the USS had high internal consistency (USS-10: 0.941; USS-4: 0.851). Confirmatory factor analyses supported a one-factor structure for both measures. Both USS-4 and USS-10 scores were significantly positively correlated with CPSS scores, indicating acceptable criterion validity. Conclusion: The findings of the current study confirmed that the psychometric properties of two Chinese versions of USS are acceptable. Furthermore, the 4-item USS was as effective as the 10-item USS for the measurement of uncertainty stress in our community-based sample of Chinese adults suggesting that the USS-4 is a time-efficient alternative to the USS-10 which can be used when the circumstances require a time-efficient instrument (eg, in epidemiological studies with a large test battery).

Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China-A Qualitative Study.

(1) Background: It is well recognised that a focus on changing behaviour remains a dominant and often appealing approach to develop health policies. This study provides a sociological insight into young adults' knowledge of the health effects of smoking cigarettes. We also examine the challenges in tobacco control and criticize the implementation policies in Chinese context. (2) Methods: The study applies both a micro-sociological and a macro-sociological approach using semi-structured interviews and documents as the primary research methodology. Fieldwork was conducted from July to September 2016 and December 2016 to March 2017. The qualitative study involved 45 semi-structured interviews with young adults aged 16-24 years (15 females and 30 males) in Tianjin, China. A grounded theory approach was used for a thematic analysis. (3) Results: The participants knew cigarettes are harmful, although they lacked a comprehensive understanding of the health risks of smoking. Because the health consequences usually emerge after a long period of smoking, young smokers decide to take the health risk. All participants have a general understanding of China's tobacco control policies and think that the implementation is ineffective. (4) Conclusions: Changing in smoking is a process embedded in complex social environments and cultures. Smoking behaviour is not only a personal choice, but also related to personal connections with peers and identity in Chinese society. The Chinese government has made significant achievements in tobacco control since joining the WHO framework convention on tobacco control in 2005. However, implementation needs to be stricter in order to achieve international levels of control, especially in taxes on tobacco product and the price of cigarettes. There is an urgent need for the regulation of e-cigarettes in China.

Identifying credible attribution sources for cigarette health warning labels in China: results from a cross-sectional survey of Chinese adults.

OBJECTIVE: The Framework Convention on Tobacco Control recommends health warning labels (HWLs) include an attribution source. Little is known regarding the perceived credibility and effectiveness of different message sources. This study examined perceptions of four HWL attribution sources among adults in China - the world's largest consumer of cigarettes. DESIGN: Cross-sectional experimental survey design. PARTICIPANTS: Data were collected in 2017 from a convenience sample of 1999 adults across four cities in China; 80% of the sample were current smokers. MAIN OUTCOME MEASURES: Participants viewed four versions of the same HWL, each with a different attribution source: the China Center for Disease Control (ref. group); the regulatory arm of China's domestic tobacco company (STMA); Liyuan Peng, China's first lady; and the WHO. Respondents indicated which HWL was the most: (1) credible, (2) effective at making people quit and (3) effective at preventing youth initiation. RESULTS: Multinomial logistic regression models estimated adjusted relative risk ratios (aRRRs) of the three outcomes. Controlling for demographics and smoking status, HWLs attributed to STMA and Liyuan Peng, respectively, were perceived as significantly less credible (aRRR=0.81, p<0.001; aRRR=0.31, p<0.001), less effective at making people quit (aRRR=0.46, p<0.001; aRRR=0.24, p<0.001) and less effective at preventing young smoking (aRRR=0.52, p<0.001; aRRR=0.39, p<0.001) than the China CDC HWL. There were no significant differences in perceived effectiveness of between the WHO and China CDC HWLs. Participants viewed the WHO HWL as significantly more credible (aRRR=1.21, p<0.001) than the China CDC HWL. CONCLUSION: Results suggest the unique role of health organisations in conveying smoking-related messages that appear credible and effective at motivating others to quit smoking or never start smoking in China. Findings can inform global recommendations regarding HWL attribution sources.

Regional Internet Access and Mental Stress Among University Students: A Representative Nationwide Study of China.

Background: The Internet changed the lives of average citizens in the early part of the twenty-first century, and it has now become an essential part of daily life. Many studies reported that accessibility of Internet use is associated with mental health. However, previous studies examining this association were confined to local and community subpopulations and limited at the individual level, which increases the potential bias from the selection effect at a different level. Regional variables would be a stable estimate of people's socioeconomic and cultural environments and how these variables affect mental health needed to be studied. The objective of this study was to evaluate the association between regional Internet access, and mental stress among university students. Methods: Participants were 11,954 students, who were identified through a multistage survey sampling process conducted in 50 Chinese universities. Regional Internet access was retrieved from a national database, and mental stress was measured using the Perceived Stress Scale (Chinese Version) (CPSS). Both unadjusted and adjusted methods were considered in the analyses. Results: More than one-third 36.9% (95% CI: 24.4-49.5%) of university students in this study suffered from severe mental stress (SMR). The multilevel logistic regression model found that university students studied in low-level universities had 2.52 (95% C.I. 1.17 to 6.37) times the prevalence of SMR than those in high-level universities. Compared with small cities, students in a large city had a lower prevalence of SMR (OR 0.25; 95%C.I. 0.06 to 0.77). Most importantly, regional Internet access was negatively associated with students' SMR (OR 0.25; 95%C.I. 0.08 to 0.76). Conclusions: This study indicated that regional Internet access and other environmental factors including city size and type of universities contribute to students' mental health. The findings underscore that efforts to control excessive mental stress among students in China should pay greater attention to environmental determinants of stress and particularly to improve internet access.

Late bedtime, uncertainty stress among Chinese college students: impact on academic performance and self-rated health.

This study aims to examine the relationship between uncertainty stress and late bedtime behaviour, and to explore their associations with self-rated health and self-reported academic performance. The participants were 11,954 students from 50 universities in China from a cross-sectional survey. College students' bedtime, sleep duration, health status, and academic performance were assessed with a self-reported questionnaire. Uncertainty stress and general life stress were also measured by standard stress questionnaires. The logistic regression models and the path analysis were applied to explore the network relationships among these variables. Late bedtime prevalence among college students was 17.2% (95% C.I. 16.5%-17.9%). Gender, grade, monthly expenditure, and sleep duration were found to be related to the prevalence of late bedtime. Uncertainty stress was more influential on late bedtime and academic performance than general life stress. Students with higher uncertainty stress were 1.41 times more likely to experience late bedtime than those with lower uncertainty stress. Late bedtime was associated with involvement in adverse outcomes including worse self-rated health status and poor academic performance. Many college students were at risk for late bedtime, and those at risk may perceive high uncertainty stress and be at risk for academic failure and health problems. These findings underscore the significance of evaluating and monitoring bedtime in college students and the importance of intervention strategies that target bedtimes and uncertainty stress in an effort to reduce associated self-rated health outcomes and improve academic performance.

Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China.

The primary aims of this study are to examine the associations between two key environmental factors-regional cigarette tobacco production and tobacco retail outlet density-and secondhand smoke (SHS) exposure in urban China and to explore the possible mechanisms that explain this association. METHODS: A cross-sectional multistage sampling design was used to collect individual information in 21 cities in China. Environmental variables were retrieved from national databases. Multilevel logistic regression analysis was conducted to examine the associations between regional cigarette tobacco production, tobacco retail outlet density and SHS exposure. Structural equation modelling was employed to determine possible mechanisms. RESULTS: SHS exposure prevalence defined as daily exposure to SHS for at least 15 min/day at the time of the survey was found to be 28.1% among non-smokers (95% CI 27.1 to 29.0) across the 21 cities. The multilevel logistic regressions showed that province-level per capital cigarette production (OR: 2.72 (95% CI 1.56 to 4.76)and per GDP cigarette production(OR:1.69(95% CI 1,42,2.01), and city-level tobacco retail outlet density (OR: 2.66 (95% CI 1.63 to 4.38)) were significantly associated with SHS exposure. Moreover, results showed that these associations may be explained by the level of tobacco advertisement, which influences social norms, including attitudes and behaviours toward SHS exposure. CONCLUSIONS: Findings shed light on the role of cigarette manufacturers and retailers in producing environmental SHS pollution. To address the health and economic burden associated with SHS in China, it will be critical for the Chinese government to enact tobacco control measures consistent with the Framework Convention for Tobacco Control. Efforts should also focus on restricting the permitted density of tobacco retail outlets, and tobacco production in China.

Association of Excessive WeChat Use with Mental Disorders: A Representative Nationwide Study in China.

OBJECTIVES: We examined associations between excessive WeChat use and mental disorders at the individual and contextual level. METHODS: We conducted a representative nationwide survey sampling process of 11,283 medical students from 30 universities in China. Mental health status was measured by the Chinese Health Questionnaire. Both unadjusted and adjusted methods were considered in the analyses. RESULTS: High frequency and long-time use prevalence was 19.1% and 31.2% respectively among WeChat users. The multilevel logistic regression model found that individual-level high frequency (OR = 1.26) and long-time use (OR = 1.24) were significantly associated with mental health disorders. University-level excessive WeChat use also was associated with the mental disorders (OR = 1.33 [high frequency use]; OR = 1.17 [long-time use]). Structural equation analysis showed that individual- and university-level high frequency and individual-level and university-level long-time WeChat use have a direct influence on poor mental health. The above variables, except individual-level long-time use, have an indirect influence on poor mental health through mental stress. CONCLUSIONS: This study provides new evidence that excessive WeChat use is associated with mental disorders. These findings underscore the importance of alerting people to the possible health risks of excessive social media use.

Urban Air Pollution and Mental Stress: A Nationwide Study of University Students in China.

Background: Studies exploring the relationship between air pollution levels and mental stress have rarely been done, and no studies have been done comparing university student mental stress levels based on regional air pollution levels. Objectives: The objective of this study was to evaluate the association between air pollution and mental stress among university students. Methods: Participants were 11,942 students, who were identified through a multistage survey sampling process conducted in 50 universities. Regional air pollution levels were retrieved from a national database, and mental stress was measured using a perceived stress scale. Both unadjusted and adjusted methods were utilized in the data analyses. Results: Mental stress prevalence was 36.9% (95% Confidence Interval: 24.4-49.5%). The final model indicated that regional air pollution levels were positively associated with students' mental stress. Conclusions: This study provided new and direct evidence of the health hazards of air pollution. The findings underscore the need to develop and implement stringent environmental protection policies, while simultaneously raising public awareness of environmental protection.

COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak.

BACKGROUND: The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. METHODS: A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. RESULTS: The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (ß = 0.015, 95%C.I. = 0.009-0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (ß = 0.009, 95%C.I. = - 0.002-0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (ß = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. CONCLUSIONS: These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.

Uncertainty Stress, and Its Impact on Disease Fear and Prevention Behavior during the COVID-19 Epidemic in China: A Panel Study.

Objectives: We examined changing trends of uncertainty stress, and its impact on disease fear and prevention behaviors during the Chinese COVID-19 epidemic, using a prospective observational study. Methods: We employed a longitudinal design. We recruited participants for an online panel survey from chat groups on social media platforms. There were 5 waves of interviews. Information on uncertainty stress and related variables were collected via the online survey. Descriptive statistics and the GIM program were used for data analysis. Results: Participants numbered 150 for the linkable baseline survey and 102 (68%) for the final survey. Uncertainty stress (ß = -.047, SE = .118, p > .05) did not show a statistically significant temporal change trend over the observation period. Disease fear manifested a statistically significant downwards trend (ß = -.342, SE = .157, p < .05), and prevention behaviors indicated an upwards trend (ß = .048, SE = .021, p < .05) during the observation period. Uncertainty stress was positively associated with disease fear (ß = .45046, SE = .05964, p < .001), and negatively associated with self-efficacy (ß = -.6698, SE = .01035, p < .001), and prevention behaviors (ß = -.02029, SE = .00876, p =.021). Conclusion: This study yielded new information about uncertainty stress among Chinese people during the COVID-19 epidemic. Policy changes and public education are essential for minimizing the negative effects of uncertainty stress in disease prevention.

Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

PURPOSE: To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. DESIGN: A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. SETTING: This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. PARTICIPANTS: A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. MEASURES: The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. ANALYSIS: Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. RESULTS: Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (ß=-0.119**) and sanitization practices (ß=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. CONCLUSION: Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.

Social deprivation and secondhand smoke exposure among urban male residents: A nationwide study in China.

INTRODUCTION: Social deprivation is a known determinant of health and related behaviors. Many studies have linked socioeconomic factors to secondhand smoke (SHS) exposure. However, no studies have examined the relationship between social deprivation and SHS exposure. This study examined whether contextual social deprivation - variously based on living in a house without a car, that was overcrowded, or had an unemployed member (s) - had an independent association with SHS exposure at both individual and regional levels among Chinese residents. METHODS: A cross-sectional multistage sampling design was utilized to interview subjects from 6 selected cities in China. A standardized questionnaire selected sociodemographic characteristics, contextual social deprivation and SHS exposure. Multilevel logistic regression models were used to assess the association between social deprivation and SHS exposure. RESULTS: A total of 5782 valid questionnaires were collected in this study. Among 2930 non-smokers, the SHS exposure prevalence was 21.9% (95% CI: 19.5- 24.30). Multilevel logistic regression showed a negative association between household income, regional GDP, and SHS exposure, respectively, and positive associations between contextual social deprivation and SHS exposure. CONCLUSIONS: Findings support the central proposition that contextual social deprivation must be factored into SHS exposure messages. Our research underscores the importance of reducing health inequality in controlling SHS exposure.