Patterns of health care utilization and health behaviors among street sex workers in Hong Kong

OBJECTIVE: To describe the current use of health services by the street-based female sex workers (FSWs) and to explore beliefs behind these health behaviors. STUDY SETTING: Community outreach approach in a few red-light districts in Hong Kong. STUDY DESIGN: A 30 min face-to-face interview was carried out in 89 women by direct approach and snowballing, followed by a focus group discussion drawn from the participants of the questionnaire. RESULTS: While these FSWs' perception of personal health was good, a considerable proportion suffered from illnesses but the consultation rate was a third of the mean rate of the general population in Hong Kong. Many street workers experienced difficulty in utilizing health service in Hong Kong and even when they did, it was mainly for acute problems. Affordable access to health public services was excluded and many found private services unaffordable due to the high price charged by the practitioners. It was common for these women to self-medicate, delay in seeking medical help, or travel back to China for treatment. CONCLUSION: The current empirical understanding of the health and health service utilization by sex workers is unbalanced. In order to reduce sexually transmitted infections (STIs) and HIV among the street sex workers, it is essential to address the fundamental issue of health care access.     

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.     

The mental health status and long term care needs of the Chinese elderly in Hong Kong

This paper examines the mental health status of 945 Chinese older people who are in need of long term care services in Hong Kong. It was found that for those aged respondents who are already waiting for admission to infirmary, over 59.3% were already living in private aged homes, and only as few as 17.8% of these applicants were still living in their own homes. Besides, it was found that the mean SPMSQ score was lowest amongst those living in medical infirmary (1.52) and highest for those living in their own residences (5.99). Analysis of the relationship between GDS scores and residential types reveals that there were higher proportion of respondents residing in their own residences that fell into the highly depressed category. There is a need for the overall revamp of the planning, provision and financing for long term care and psychogeriatric services for Chinese older people in Hong Kong.     

Filipino domestic workers in Hong Kong: health related behaviors, health locus of control and social support

A total of 290 female Filipino domestic helpers residing in Hong Kong completed a concurrent cross sectional survey designed to provide an initial report of basic data which measured mental health symptoms, health-related behaviors, health locus of control and social support. The four top ranking symptoms of mental distress reported included waking in the early hours, loneliness, worry and taking a long time to get to sleep. In general, the level of health related behaviors was high, with a satisfactory diet and low rates of alcohol, nicotine and coffee consumption. However, few women surveyed had previously had a Pap smear. There were also low scores for other preventive health practices. Reinforcement for health behaviors was seen as either a matter of chance or being influenced by powerful others for two thirds of the women. The conclusion highlights the intersection between gender, immigration and social class by drawing attention to issues of acceptance and accessibility of healthcare services for immigrant within host countries. In addition, cultural directions for immigrant health education are outlined.     

Using the PRECEDE model to plan men's health programs in a managed care setting

Managed care organizations represent an important venue for delivering health promotion programs. However, most health plans do not employ public health strategies that match peoples' needs and preferences to effective behavior change techniques. This article focuses on the planning efforts by Blue Cross and Blue Shield of North Carolina (BCBSNC) to address the problem of underutilization of preventive health care services among adult male members--an issue that has received comparatively little attention in the health behavior arena. BCBSNC planners used the PRECEDE planning process to define issues relevant to the target population and determine appropriate intervention strategies. Increasing perceived susceptibility and severity to disease, perceived benefits of screening, physician recommendation for screening, and health knowledge/awareness emerged as intervention priorities. The PRECEDE planning process yielded important evidence-based information and strategies to address men's underuse of preventive services and led BCBSNC to adopt new systems for planning interventions to promote the health of its members.     

Quality of life of mental health consumers in Hong Kong: Analysis of service perceptions

Objectives Successful psychiatric rehabilitation entails fostering overall quality of life of individuals recovering from severe mental illnesses. Understanding how service-related perceptions may be related to quality of life can be useful in improving the effectiveness of community-based care. This study investigated the quality of life of mental health consumers using a service-oriented paradigm. Methods 162 mental health consumers from community-based psychiatric rehabilitation centers were interviewed. Analyses were conducted to investigate the relationships between service perceptions (perceived treatment coercion, rehabilitation needs, and continuity of care) and quality of life. Results Physical health quality was negatively related to rehabilitation needs. Mental health quality was negatively related to both rehabilitation needs and poorer continuity of service. Life satisfaction was negatively related to poorer continuity of service and higher perceived treatment coercion. Conclusions This study highlighted the significance of service perceptions in the well-being of individuals with severe mental illness.     

积极心理学促进护士心理健康的应用进展

国内外有大量研究表明,积极心理对于促进人们的心理健康、疾病康复、幸福感提升具有重要意义。但国内对积极心理学与护理学的交叉研究较晚,相关文献自2005年才逐渐增加。多项研究显示,积极心理学为改善心理健康状况带来了新的有效方法,它可以改变人的认知态度,以更积极、乐观的角度看待问题,不产生埋怨、悲观的消极情绪。这也更加坚定了运用积极心理学对护士进行心理干预,努力确保护士们身心健康,并提高护理质量。本文通过检索国内外相关文献,了解和分析将积极心理学应用于临床护理管理中来促进护士心理健康的现状,以探讨其临床价值及意义。     

Community health and reform in Hong Kong

In this paper I argue that the health crisis in the underdeveloped world today is not primarily one of shortages of services, but is a result of lack of power and control over economic, political and social institutions by the majority of the population. Hong Kong is presented as a case study in which a plural medical system is dominated by a political economy that shapes patterns of both sickness and health care. As an advanced capitalist colony, a financial center for the Pacific Basin, and a neutral area for China's foreign negotiations, social policies in Hong Kong aim at promoting business growth, often at the expense of the health of the population. Further, government and voluntary agencies attempts at reforming the health system have done little more than further solidify biomedicine and its social relations. Finally an attempt is made to define potential vehicles for change.     

Physicians' beliefs about the importance of 25 health promoting behaviors.

A mail survey of 1,040 primary care physicians in Maryland examined their beliefs about the importance of 25 behaviors for promoting the health of the average person. Physician consensus existed across specialties in rating most health behaviors as very important and few as very unimportant. Eliminating smoking was most important and taking vitamin supplements least important.     

The ecology of health care in Hong Kong

To better understand the distribution of resources and health care consumption patterns in different geo-ethnic and socio-economic settings, we sought to describe the patterns of illness, care-seeking behavior and health services utilization in Hong Kong compared to the US and UK. Data were derived from the 2002 Hong Kong Thematic Household Survey covering 31,762 non-institutional and institutional residents, representing 6,504,255 persons after applying population weights. Of 1000 individuals during a 1-month period, 567 reported symptoms, 512 of whom considered seeking health care. Four hundred and forty persons visited western allopathic medical practitioners, with 372 (84.5%) in primary care and 68 (15.5%) in specialty care. There were 54 visits to traditional Chinese medical practitioners and 16 emergency room episodes. Seven individuals were hospitalized in community hospitals and on average one in 1000 were admitted to a tertiary medical center. Ninety out of the 567 who experienced symptoms undertook self-management strategies, which included over-the-counter western allopathic medications (n=54) or traditional Chinese remedies (n=14) or both (n=2), dietary modification (n=1) and rest (n=15). We have mapped the ecology of health care in Hong Kong. Monthly prevalence estimates were remarkably similar to US figures for hospital-based events, whereas there was evidence of apparent, substantial "over-consumption" of ambulatory, community-based care. Our results also indicate that the local community's care-seeking orientation still very much favors western allopathic medicine over traditional Chinese therapy, at least for acute illness episodes.     

Respiratory health of bus drivers in Hong Kong

Objective: We conducted a cross-sectional study to evaluate the lung function and respiratory symptoms of Hong Kong bus and tram drivers exposed to air pollutants. Methods: Demographic information, vital signs, pulmonary function, respiratory symptoms and blood lead levels in 358 male drivers of air-conditioned buses (ACB) were compared with 129 male drivers of non-air-conditioned buses and trams (NACB). Particulate matter (PM₁₀), carbon dioxide (CO₂) and carbon monoxide (CO) levels were measured in 16 air-conditioned and 15 non-air-conditioned trams along the same route. Results: Forced vital capacity, forced expiratory volume in 1 s and maximal voluntary ventilation were lower but blood lead levels were higher in the NACB drivers compared with ACB drivers. More NACB drivers compared to ACB drivers reported frequent productive cough, dry cough, as well as sore throat. The measured lung function parameters in the NACB drivers were lower than a cohort of personnel working in an academic environment. The work-year duration was longer and scheduled days off per month were shorter for NACB (13.4±8.8 years and 4.3±1.3 days) compared to ACB drivers (11.5±9 years and 5.4±0.8 days), respectively (P<0.001). The PM₁₀ and CO₂ levels were higher in ACB (265±83 μg/m³ and 2,114±69.6 ppm) compared to non-air-conditioned trams (161±103 μg/m³ and 500 ppm, respectively) (P<0.005). Conclusion: We hypothesise that prolonged exposure to air pollutants adversely affects lung function in our NACB drivers but air recirculation could result in higher blood lead levels in ACB drivers.     

Byssinosis in Hong Kong.

After a report in 1980 of the first three diagnosed locally cases and a preliminary epidemiological investigation that found little evidence of the disease, a survey was aimed at determining the prevalence of byssinosis in Hong Kong. Some 1776 workers in six cotton mills were studied using the standard MRC questionnaire and portable spirometers. Only 48 (2.7%) of the mill workers had symptoms acceptable for a diagnosis of byssinosis. The pattern of relation to dust exposure levels was similar to findings in other countries: blowing and carding process operatives had twice the prevalence rate of the spinners. Another 178 workers (10%) had symptoms of chest tightness or breathlessness or both that were not related to the first exposure after a break and therefore did not fit the standard diagnosis. Some 257 workers (14.5%) had chronic obstructive airflow disease but only 12 (4.7%) had chronic bronchitis. Job mobility had self selection of sensitive cases out of cotton dust exposure seem the most likely explanations for the low prevalence. The significance of non-specific lung ailments needs further assessment to elucidate the possible connection with cotton dust exposure.     

Prevalence and correlates of problem behaviors among adolescents in Hong Kong

The aims of this study were to examine the frequency and correlates of problem behaviors among Hong Kong adolescents. It is a cross-sectional survey targeting secondary forms 1 to 3 (equivalent to grades 7-9 in the United States) students (N = 1029). A self-administered questionnaire was used as the measurement tool. The study found that there are intercorrelations of problem behaviors in adolescence, such as tobacco use, alcohol use, drug abuse, and having connections with triad society. Given the intercorrelations among problem behaviors, identification of a single type of problem behavior in adolescents can help discover the likelihood of the occurrence of other problem behaviors. It can facilitate identification and intervention at an early stage. The results provide some insights for the concerned authorities to develop a syndrome approach addressing problem behaviors.     

Smoking and perceived health in Hong Kong Chinese

This population-based cross-sectional study examined the associations between smoking and perceived health in Hong Kong. 6117 healthy Chinese (3053 men, 3064 women), aged 25-74 years, were randomly selected for telephone interviews in Hong Kong in 1994-96. Adjusted odds ratios (ORs) of having poor or very poor perceived health (against good or very good) were calculated. In men, the ORs (and 95 percent confidence intervals) for current smokers in young (25-39) and middle age (40-59) were close to unity, but that of 1.97 (1.01, 3.85) in old age (60-74) was significantly raised. The adjusted ORs for male quitters were 1.98 (0.43, 9.14), 1.70 (0.75, 3.81) and 2.59 (1.23, 3.33) for young, middle and old age, respectively. Compared with current smokers, the adjusted ORs for quitters was 2.30 (1.07, 4.92) for those who had quit for less than 5 years, 2.02 (0.80, 5.11) for 5-9 years and 1.14 (0.47, 2.75) for 10 years or more. Among former smokers, each year of quitting was associated with 7 percent reduction in reporting poor or very poor perceived health with OR of 0.93 (0.85, 1.01). In women, the ORs were 1.95 (1.15, 3.28) for current and 1.54 (0.60, 3.94) for former smokers. In both genders combined, the overall ORs were 1.41 (1.04, 1.92) for current and 1.94 (1.27, 2.97) for former smokers. In conclusion, former smokers apparently had the worst perceived health but long-term quitting was beneficial. Overall, current smokers had worse perceived health than never smokers, but in men the excess risk was mainly observed in old age. The perceived health of smokers may have implications for the approaches used in smoking cessation.     

Impacts of SARS on health-seeking behaviors in general population in Hong Kong

BACKGROUND: The severe acute respiratory syndrome (SARS) epidemic that occurred in Hong Kong in 2003 caused serious public health consequences. Its impacts on health-seeking behaviors of the general public have not been assessed. METHODS: Two cross-sectional, random telephone surveys interviewed 1603 Hong Kong adult residents in the post-SARS epidemic period, June and September 2003 to investigate changes in the post-SARS period. RESULTS: Noteworthy percentages of the respondents self-reported increased frequencies of practicing favorable health-seeking behaviors in June 2003, as compared with the pre-SARS period. Few respondents reported the opposite. This was observed in different dimensions: health services seeking, adoption of healthier lifestyle, spending more resources on health, adoption of good personal hygiene, mask use when ill with influenza, and avoidance of risk behaviors. The frequencies of practicing most of these health-seeking behaviors, as measured in June and September 2003, were comparable. Further increases in healthy diet and weight control, etc., were observed during that period. Those who worried about contracting SARS were more likely to have improved health-seeking behaviors. CONCLUSIONS: The community in Hong Kong responded to the SARS epidemic by practicing more favorable health-seeking behaviors. Public health workers should utilize these opportunities to foster favorable changes.