Measles in Vietnamese refugee children in Hong Kong.

From September 1991-January 1992, there was a measles epidemic in an established refugee camp for 7000 Vietnamese 'Boat People' living in Hong Kong. This 16 week outbreak occurred against a backdrop of poor uptake of measles vaccination and overcrowded living conditions. Two hundred and sixty-two children were affected (155 boys, 107 girls); 235 children (89.7 %) were < 2 years old, age range 5-39 months. Children age 6-11 months had the highest crude attack rate (AR) of 54.3%. The highest age specific crude AR was 83.8% in children aged 14 months. Measles complications affected 234 (89.3%) children. Sixty-six children (25.2%) were admitted to hospital. There were two deaths from pneumonia, giving a case fatality rate of 0.76%. Measles control in refugee camps continues to be a public health challenge.     

Oral health status and behaviours of preschool children in Hong Kong

ABSTRACT: BACKGROUND: Dental caries is a major public health problem in many countries. Since the last territority-wide dental survey of Hong Kong preschool children was conducted in 2001, a survey to update the information is necessary. This study aimed to describe the dental caries experience of preschool children in Hong Kong and factors affecting their dental caries status. METHODS: A stratified random sample of children from seven kindergartens in Hong Kong was surveyed in 2009. Ethical approval from IRB and parental consent was obtained. Clinical examinations of the children were performed by two calibrated examiners using disposable dental mirrors, an intra-oral LED light and ball-ended periodontal probes. A questionnaire to investigate possible explanatory factors for caries status was completed by the children's parents. Caries experience was recorded using the dmft index. Multifactor-ANOVA was used to study the relationship between dental caries experience, and the background and oral health-related behaviours of the children. RESULTS: Seven hundred children (53% boys), mean age 5.3 +/- 0.7 years were examined. The mean dmft score of the surveyed children was 2.2 and 51% of them had no caries experience (dmft = 0). Most (>95%) of the decayed teeth were untreated. Statistically significant correlations were found between dental caries experience of the children and their oral health-related habits, family income, parental education level and parental dental knowledge. CONCLUSIONS: Early childhood dental caries was prevalent among the preschool children in Hong Kong. Their caries experience was associated with their oral health-related behaviours, socio-economic background, and parental education and dental knowledge.     

Meaning of family reunification as interpreted by young Chinese immigrants

This paper is a narrative analysis of young Chinese immigrants' subjective interpretation of their family reunification in Hong Kong. The major objectives of the study were to understand what family reunification actually meant to them and how it affected their subsequent adjustment. It also tried to examine the similarities and differences in the experience and interpretation of family reunification among young immigrants who had different levels of adjustment. Participants in this study included 45 immigrants, aged between 12 and 17. Research findings show that family reunification was their long-cherished wish and the main reason for their migration. It was not only their primary concern before coming to Hong Kong but also the stance from which separation with close relatives in their native place and the subsequent hardships as a new comer in the competitive host society were justified. Reunification of the family and harmonious and caring relationship among family members had been the source of comfort and support for those who had successful adjustment. However, for those who did not experience warmth and concern from family members, the disillusionment with a happy family reunification and the experience of distant or even conflictive family relationship had not only created in them a sense of alienation but also resulted in poor adjustment in the new environment.     

Traumatic experience and sleep disturbance in refugee children from the Middle East

BACKGROUND: Sleep disturbance is frequently reported in children after traumatic experiences associated with organised violence. The aim of this study was to identify specific traumatic risk indicators and modifying factors for sleep disturbance among recently arrived refugee children from the Middle East. METHODS: The study group comprises 311, 3-15 year old refugee children from the Middle East. On arrival in Denmark, their parents participated in a structured interview about their childrens' health and history of exile and eventual exposure to war, organised violence and human rights violation. RESULTS: A family history of violence (grandparent's violent death before the birth of the child or parental exposure to torture) as well as a stressful present family situation (father scolds the child more than previously) were the strongest predictors of prevalent sleep disturbance in the children. Arriving in Denmark with both parents rather than one was a modifying factor, so the effect of traumatic experience on sleep patterns later in childhood was mediated through parental presence and behaviour. CONCLUSION: This study indicates that the family environment is of primary importance for childhood sleep disturbance following traumatic experiences connected with war and other organised violence.     

Seeking asylum in Denmark: refugee children's mental health and exposure to violence

AIMS: The aim of this study was to compare profiles of present mental health and previous exposure to violence among refugee children from the Middle East, whose asylum seeking families either did or did not obtain permission to stay in Denmark. METHODS: Shortly after arrival in Denmark, the parents of 311 Middle-Eastern children answered a structured interview on their children's exposure to organized violence and their mental health. The families were followed-up as concerns receipt of a residence permit. RESULTS: At arrival in Denmark, the children's patterns of previous exposure to violence and present mental health was generally similar irrespective of the family getting a residence permit, as was the case for 90 families (60.4%) with 190 children (61.1%). In both groups an overwhelming majority, eight to nine out of 10 children, had been exposed to conditions of war and had stayed in a refugee camp, and seven out of 10 had witnessed violence. Half of the children had a tortured parent. Considerably more children of families who did not get a residence permit had lost a parent (30.6% versus 13.7%; P<0.001). In both groups about two-thirds suffered from anxiety and about 30% from sleep problems, and children whose families did not later on get a residence permit more often appeared sad or miserable (43.8% versus 27.9%; P<0.005). CONCLUSIONS: The asylum-granting decision process seems to have divided the children into two groups with only superficial disparity as concerns their previous exposure to violence and their present mental health. There seems to be good reason to systematically integrate evidence on the children of refugee families in the treatment of applications for permission to stay.     

Barriers to Accessing Health Care Services for West African Refugee Women Living in Western Australia

Help-seeking pathways and barriers to accessing health care services were surveyed in 51 West African refugee women who had settled recently in Perth, Western Australia, and in 100 Australian women. Shame or fear of what family and friends might think, fear of being judged by the treatment provider, fear of hospitalization, and logistical difficulties were significant impediments to accessing health care services for the refugee women. Surprisingly, barriers often were greater for the more-educated refugee women and strengthened with years of residence in Australia. Strategies to help at-risk women overcome these barriers need to be implemented to ensure appropriate access to health care services.     

Barriers to accessing health care services for West African refugee women living in Western Australia

Help-seeking pathways and barriers to accessing health care services were surveyed in 51 West African refugee women who had settled recently in Perth, Western Australia, and in 100 Australian women. Shame or fear of what family and friends might think, fear of being judged by the treatment provider, fear of hospitalization, and logistical difficulties were significant impediments to accessing health care services for the refugee women. Surprisingly, barriers often were greater for the more-educated refugee women and strengthened with years of residence in Australia. Strategies to help at-risk women overcome these barriers need to be implemented to ensure appropriate access to health care services.     

The impact of acculturation on smoking in Asian American homes

This study examined the relationship between acculturation and smoking in Asian American homes and the factors that predict whether Asian Americans have family members or visitors smoking in the home. A sample of 1,374 participants was selected using a stratified-cluster proportional sampling technique. Overall, 38.3% were exposed to secondhand smoke in their home and 33.7% allowed smoking by visitors. Vietnamese had the significantly highest rates of smoking in the home (44.9%), followed by Cambodians (43.8%), Koreans (42.0%), and Chinese (29.7%). The independent variables that predicted smoking in the home were living in the United States five or fewer years, less acculturation, being female, being foreign born, having a family size of four or more, being Korean, Vietnamese, or Cambodian, and being smokers. The same variables predicted allowing visitors to smoke in the home, excluding being female. Protective factors included being more educated, being older, and having children under 18 at home.     

A comprehensive study of smoking in primary school children in Hong Kong: implications for prevention.

STUDY OBJECTIVE: To identify factors associated with smoking behaviour in primary school children in Hong Kong. DESIGN: A cross sectional survey in which both children and parents completed questionnaires. The main outcome measure was the smoking status of the children; and risk factors (knowledge of and attitude to smoking and demographic and socioeconomic background) were identified as predictors of ever/never smoking. SETTING AND SUBJECTS: Altogether 9598 primary school children, aged 8-13 years, and attending 27 schools from two districts in Hong Kong participated. MAIN RESULTS: The prevalence of ever-smoking was 12% (1119)-15% (760) in boys and 7% (359) in girls. It ranged from 3% in 8 year old girls to 52% in 13 year old boys. The factors associated with ever-smoking included the following: being a boy (adjusted odds ratio 2.21; 95% confidence interval 1.89, 2.59), increasing age per year (1.48; 1.40, 1.57), living in Kwai Tsing district (1.29; 1.10, 1.50), having one or more smokers at home (2.07; 1.78, 2.39), and having a father who was not working (1.41; 1.19, 1.67). Children who were ever-smokers had both seen and approved of their friends' smoking (8.79; 5.33, 14.50), had a more positive attitude towards smoking (3.35; 2.21, 5.09), and were more successful in recognising cigarette brand names and logos (1.67; 1.42, 1.96), but they lacked confidence (1.78; 1.32, 2.39). CONCLUSIONS: The influences on child smoking are multifactorial and programmes in Hong Kong are falling to curb them. The control of these risk factors must be incorporated in the smoking prevention policy of Hong Kong and supported by future enforced legislation.     

Exposure to suicide and suicidal behaviors among Hong Kong adolescents

Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.     

Declines in tobacco brand recognition and ever-smoking rates among young children following restrictions on tobacco advertisements in Hong Kong

BACKGROUND: We compared the recognition of tobacco brands and ever-smoking rates in young children before (1991) and after (2001) the implementation of cigarette advertising restrictions in Hong Kong and identified continuing sources of tobacco promotion exposure. METHODS: A cross-sectional survey of 824 primary school children aged from 8 to 11 (Primary classes 3-4) living in two Hong Kong districts was carried out using self-completed questionnaires examining smoking behaviour and recognition of names and logos from 18 tobacco, food, drink and other brands common in Hong Kong. RESULTS: Ever-smoking prevalence in 2001 was 3.8 per cent (1991, 7.8 per cent). Tobacco brand recognition rates ranged from 5.3 per cent (Viceroy name) to 72.8 per cent (Viceroy logo). Compared with 1991, in 2001 never-smoker children recognized fewer tobacco brand names and logos: Marlboro logo recognition rate fell by 55.3 per cent. Similar declines were also seen in ever-smoker children, with recognition of the Marlboro logo decreasing 48 per cent. Recognition rates declined amongst both boys and girls. Children from non-smoking families constituted 51 per cent (426) of the sample, whereas 34.5 per cent (284), 8.5 per cent (70), 1.7 per cent (14) and 4.4 per cent (36) of the children had one, two, three or more than three smoking family members at home, respectively. Tobacco brand recognition rates and ever-smoking prevalence were significantly higher among children with smoking family members compared with those without. Among 12 possible sources of exposure to cigarette brand names and logos, retail stalls (75.5 per cent; 622), indirect advertisements (71.5 per cent; 589) and magazines (65.3 per cent; 538) were ranked the most common. CONCLUSION: Advertising restrictions in Hong Kong have effectively decreased primary-age children's recognition of tobacco branding. However, these children remain vulnerable to branding, mostly through exposure from family smokers, point-of-sale tobacco advertisement and occasional promotions. Action to curb these is now required.     

Parent Refugee Status, Immigration Stressors, and Southeast Asian Youth Violence

Purpose: To assess the effects of parents’ experience of traumatic events on violence among Southeast Asian and Chinese youth. The study examines independent effects of parents’ refugee camp experiences and immigration stress on serious or family/partner violence among youth. Findings contribute evidence on the intergenerational effects of community-level trauma that can help policy makers better integrate family and community strategies to reduce youth violence. Methods: Obtained cross-sectional, face-to-face interview data including peer delinquency, parental engagement, parental discipline, serious violence, and family/partner violence from a sample of 329 Chinese and Southeast Asian adolescents. Measures of socioeconomic status, refugee status, and immigration stressors were collected from their respective parents. Data were analyzed using LISREL 8.54 for structural equation modeling. Results: Findings show that parents’ refugee status facilitated serious violence, and was fully mediated by peer delinquency and parental engagement, but for Vietnamese only. Parents’ refugee status was also significantly related to family/partner violence, and mediated by peer delinquency. This relationship was not observed among the other Asian ethnic groups. The immigration stress variable had no significant effects on either serious violence or family/partner violence. Conclusions: Refugee communities may not transform easily into stereotypical immigrant Asian communities characterized by little youth violence. Results suggest that the refugee process, as experienced second-hand through the children of refugees, has a strong effect on externally oriented violence (serious violence) and on family/partner violence for particular subgroups. Therefore, community-oriented policy makers should join social workers in developing programs to address youth violence in Southeast Asian families and communities. Findings have implications for other forms of community trauma such as natural disasters.     

Maternal fear associated with pregnancy and childbirth in Hong Kong Chinese women

BACKGROUND: Women's fear toward pregnancy and childbirth is a common and important health concern. This study examined the objects, causes, and manifestations of maternal fears and their associated demographic factors in a sample of Hong Kong Chinese pregnant women. METHODS: Three hundred Chinese pregnant women were recruited in an obstetric unit in Hong Kong in 2003. Data were collected using a 73-item questionnaire. Principal components factor analysis was applied to identify the objects, causes, and manifestations of fear toward pregnancy and childbirth. RESULTS: The mean maternal age was 30 (SD 5.6) years. All participants reported some degree of fear. The main objects of fear were "fear of childbirth" and "child's and mother's wellbeing." The first factor identified for causes of fear was "negative stories," followed by "negative attitude or mood." Regarding the various manifestations of fear, "stress symptoms" and "wish to avoid pregnancy and childbirth" ranked highest. Twenty-two percent of participants had considered requesting an elective cesarean section due to fear of childbirth. CONCLUSIONS: Even in a group of low-risk pregnant women, fear toward pregnancy and childbirth was frequently experienced. Better strategies to address women's psychological needs during pregnancy are warranted.     

Fears about treatment among young drug abusers in Hong Kong

This study examined fears about drug treatment among 300 young male heroin abusers in Hong Kong (172 newcomers and 128 repeaters) recruited from non-government treatment agencies. An indigenous 35-item Fears about Treatment Scale (Fears Scale) was developed to measure fears about treatment among the participants. Results showed that four factors (fear of failure, fear of labeling or disclosure, fear of maladaptation and fear of withdrawal) were abstracted from the scale. Reliability analyses showed that subscales based on these four factors and the total scale were internally consistent. The findings showed that treatment failure was the major fear in the respondents. The present findings suggest that drug treatment and rehabilitation services should help clients, particularly young substance abusers, mitigate their treatment fears.     

Coping with patients suffering from overactive bladder: experiences of family caregivers in Hong Kong

This article examines the experiences of family caregivers working with patients affected by overactive bladder (OAB) in Hong Kong. Chronic diseases create physical and emotional burdens not only for patients but also for family caregivers, who often experience physical and emotional burnout and social impairment. Extensive literature has pertained to caregiver experiences in western and non‐western settings; however, few studies have addressed the livelihoods and experiences of family caregivers of patients with OAB in ethnic Chinese communities. Because of the increasing prevalence of OAB worldwide, this study investigated the experiences of such caregivers in Hong Kong, examining their emotional and social needs. A qualitative research design with individual semistructured interviews was adopted, and snowball sampling was used to recruit 35 family caregivers who were referred by patients with OAB. The participants were interviewed individually from May to August 2013. A phenomenological approach was adopted in the data analysis. The data revealed that all participants had unpleasant experiences in caring for family members with OAB. A sense of powerlessness, helplessness, confusion and guilt, as well as grievances and social withdrawal, was prevalent, causing great physical and emotional suffering and subsequent physical and emotional burnout. These negative experiences were often caused by confusion regarding caretaking duties. The negative emotions of the participants and their family members also caused a lack of communication and mutual understanding about the disease, causing care‐giving to be even more confusing and difficult. Furthermore, because of traditional Chinese cultural values and gender expectations, male participants experienced the triple burden of employment, domestic duties and care‐giving. More holistic social and healthcare support services should be provided for care‐giving family members of patients with OAB patients, empowering such caregivers to attend to family members and care for their own emotional well‐being.     

Fear and anxiety about COVID-19 among local and overseas Chinese university students

This study aimed to establish a new COVID-19 Fear (Higher Education) scale to investigate the relationship between fear and generalised anxiety symptoms among Chinese students in mainland China, Hong Kong, and other countries. 219 Chinese university students studying in universities in mainland China (n = 76, 34.7%), Hong Kong (n = 66, 30.1%), and overseas (i.e., outside of China as international students, n = 77, 35.2%) participated in an online study from March 31, 2020 to April 4. Participants completed a newly developed COVID-19 Fear (Higher Education) scale to measure three domains of fear including fear of infection, fear of instability and fear of insecurity related to the COVID-19 pandemic. They also completed the Generalized Anxiety Disorder 7-item scale (GAD-7) on the severity of anxiety symptoms. About 9.6% of the participants could be classified as exhibiting high anxiety level according to the GAD-7. More students studying overseas (about 15%) were classified into the high GAD group when compared to students studying in both mainland China (6.6%) and Hong Kong (6.1%). MANOVA results showed that students studying in Hong Kong and overseas had more concerns related to preventive measures related to COVID-19 than their mainland counterparts did. We concluded that international students studying away from their home country would have higher risk to develop anxiety problems during a collective trauma such as the COVID-19 pandemic. Education institutions should provide support services including online support groups, social media groups for mutual support to alleviate the fear and anxiety of international students.     

A comparison of urban and rural kindergarten teachers’ perceptions of school safety for young children: implications for quality teacher education

Although a quality preschool supports young children's health and safety, ‘quality' has been defined diversely enough that its delivery has been varied among kindergarten teachers. The current study was the first to examine and compare perceptions of school safety between urban and rural kindergarten teachers. Sixty-seven Hong Kong teachers (from an urban region of China) and 111 Yunnan teachers (from a rural region of China) rated their perceived knowledge and attitudes regarding child safety and perceived school safety for young children. The results showed that although Yunnan teachers rated their schools’ safety less favourably than did Hong Kong teachers, they rated themselves as having better knowledge and stronger attitudes about child safety. Hong Kong teachers’ age and total teaching experience and Yunnan teachers’ perceived knowledge significantly predicted their perceived school safety for young children. The implications for ‘quality' as a multi-level construct in relation to quality teacher education are discussed.     

中国出生队列研究进展

出生队列研究历经100余年发展,在探讨孕前及孕期环境暴露对婴儿、儿童、青少年、成年人及老年人健康的影响中发挥了巨大的作用。我国出生队列研究起步较晚,但发展迅速。近年来,中国大陆以及香港地区、台湾地区先后建立起一批大型出生队列研究。本文将针对中国目前已开展的出生队列研究进行简要综述。     

Use of the Pyramid Model for supporting preschool refugees

Response to intervention is being applied to early childhood settings for the support of positive behavioural and social development through the Pyramid Model [Fox, L., Carta, J., Strain, P.S., Dunlap, G., & Hemmeter, M.L. (2010). Response to intervention and the pyramid model. Infants and Young Children, 23(1), 3–13]. This qualitative study assessed the use of the Pyramid Model for preschool-aged refugee children living in a refugee resettlement community. Many young refugee children have experienced trauma [George, M. (2010). A theoretical understanding of refugee trauma. Clinical Social Work Journal, 38, 379–387], and some experience behavioural and social challenges [Almqvist, K., & Brandell-Forsberg, M. (1997). Refugee children in Sweden: Post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Child Abuse and Neglect, 21(4), 351–366]. Twenty-five preschool service providers were interviewed about their use of the Pyramid Model for the support of preschool refugee students. Themes to be shared include how early childhood educators are implementing the practices outlined in the Pyramid Model along with strategies for adapting recommended practices to meet the needs of refugee families.     

Understanding family involvement in body donation in Hong Kong: A qualitative study of registered donors and bereaved family members

Encouraging the public to donate their bodies after death is crucial for anatomy teaching in medical education. In Hong Kong, success may be affected if family members override the registered donors' wish after death, and thus the role of family in body donation is worth more attention. This study aims to examine how family is involved in the process of body donation. A qualitative study was conducted in Hong Kong. Registered donors and bereaved family members were recruited from a body donation scheme organised by a medical school. In‐depth interviews were done and thematic analysis was conducted. Five themes were found: (a) decision‐making: individual versus family; (b) family conflicts: avoidance versus confrontation; (c) trust in family members: discuss versus do not discuss; (d) family members' struggles in implementation; (e) informed end‐of‐life planning. Findings revealed that donors may not necessarily discuss their decisions about body donation with family members directly. Instead, it was found that family was involved in the body donation process in different ways and to different extents. For example, donors considered family members' views about body donation, but they chose not to involve them in the discussions if they expected objections, in order to avoid conflicts. Bereaved family members considered understanding family members' body donation decisions prior to death important, and they shared the implications of body donation for funeral arrangements and the grieving process. Findings help to understand the role of the family in body donation, especially in the Hong Kong Chinese context, and may give insights into how the body donation scheme could be enhanced to facilitate better communication between registered donors and family members as well as to support bereaved family members in implementing the decision to donate.