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Background: School-based green space activities have been found to be beneficial to the physical activity level and lifestyle habits of adolescent students. However, their effects on green space use and satisfaction, mental health, and dietary behaviors required further investigation. This study aimed to investigate the effects of school-based hydroponic planting integrated with health promotion activities in improving green space use, competence and satisfaction, healthy lifestyle, mental health, and health-related quality of life (QoL) among early adolescent students in secondary schools. Methods: This study adopted a three-group comparison design (one control and two intervention groups). Secondary school students (N = 553) of grades 7-9 participated in either (1) hydroponic planting (two times per week for 8 months) integrated with health promotion activities; (2) only health promotion activities (one time per week for 6 weeks); or (3) control group. Outcomes assessed by questionnaire included green space use and satisfaction, life happiness, lifestyle, depressive symptoms, and health-related QoL. Results: After adjusting for sex and school grade, the scores in "green space distance and use" and "green space activity and competence" were significantly better in the intervention groups than in the control group. Hydroponic planting integrated with health promotion activities was also associated with better scores in dietary habits and resistance to substance use. Intervention groups had a higher score in "Green space sense and satisfaction" and life happiness when compared with the control group. Conclusions: Our study shows that the school-based hydroponic planting integrated with health promotion activities were feasible and, to a certain extent, useful to improve green space use and competence, dietary habits, and resistance to substance use among early adolescent students in secondary schools in urban areas. Future studies should address the limitations identified, for example, designing a randomized controlled trial that could fit school schedules to generate new evidence for physical and mental health in adolescent communities.

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OBJECTIVE: This study evaluated the validity of self-reported smartphone usage data against objectively-measured smartphone usage data by directly tracking the activities in the participants' smartphone among Chinese adolescents and young adults in Hong Kong. METHODS: A total of 187 participants were recruited (mean age 19.4, 71.7% female) between 2017 and 2018. A smartphone usage tracking app was installed on all participants' smartphone for 7 consecutive days. After the 7-day monitoring period, they completed a selfadministered questionnaire on smartphone usage habits. RESULTS: Although the correlation between self-reported and objectively-measured total smartphone usage time was insignificant (ρ=-0.10, p=0.18), in three out of the four usage domains were positively and significantly correlated, namely social network (ρ=0.21, p=0.005), instant messaging (ρ=0.27, p<0.001), and games (ρ=0.64, p<0.001). Participants' self-report of the total time spent on smartphones exceeded the objective data by around 760 min per week (self-reported 1,930.3 min/wk vs. objectively-measured 1,170.7 min/wk, p<0.001). Most of the over-reporting was contributed by the web browsing domain (self-reported 447.8 min/wk vs. objectively-measured 33.3 min/wk, p<0.001). CONCLUSION: Our results showed large discrepancies between self-reported smartphone and objectively-measured smartphone usage except for self-reported usage on game apps.

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We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11-25 years (n = 357, 67% female). We installed an app that tracked the subjects' smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p = .043, 95% confidence interval [CI]: -0.14, -0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p = .02, 95% CI: -0.52, -0.04) min and 0.18 min (p = .01, 95% CI: -0.32, -0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p = .001, 95% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.

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The prevalence rate of substance misuse is high among people with mental illnesses. This study adopted an individualized structured relapse prevention program (SRPP) by using an integrative motivational interviewing (MI) and cognitive behavioral therapy (CBT) approach for people with dual diagnosis, i.e., substance use disorder (SUD) comorbid with mental illnesses, in a Chinese population. This study assessed the feasibility of the SRPP and its preliminary effects to provide directions for future wide-scale trials. The program consisted of eight one-to-one interviews conducted weekly. Each interview lasted 1 h. MI was scheduled in the first session, followed by six sessions of CBT and a final session for concluding remarks. The high recruitment and retention rates of the participants indicated that the SRPP was feasible in Hong Kong. Preliminary results reflected a significant increase in self-efficacy to abstain from substance misuse and a decrease in the psychiatric symptoms among the participants with SUD. These effects were sustained 3 months after the intervention. A large sample size and the inclusion of a control group are warranted in future trials to determine the causal relationship between treatment and effect.

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BACKGROUND: The adequate fit of an N95 respirator is important for health care workers to reduce the transmission of airborne infectious diseases in the clinical setting. This study aimed to evaluate whether adequately sealed N95 respirators may provide consistent protection for the wearer while performing nursing procedures. METHODS: Participants were a group of nursing students (N = 120). The best fitting respirator for these participants was identified from the 3 common models, 1860, 1860S, and 1870+ (3M), using the quantitative fit test (QNFT) method. Participants performed nursing procedures for 10-minute periods while wearing a backpack containing the portable aerosol spectrometers throughout the assessment to detect air particles inside the respirator. RESULTS: The average fit factor of the best fitting respirator worn by the participants dropped significantly after nursing procedures (184.85 vs 134.71) as detected by the QNFT. In addition, significant differences in particle concentration of different sizes (>0.3, >0.4, >1.0, and >4.0 µm) inside the respirator were detected by the portable aerosol spectrometers before, during, and after nursing procedures. CONCLUSIONS: Body movements during nursing procedures may increase the risk of face seal leakage. Further research, including the development of prototype devices for better respirator fit, is necessary to improve respiratory protection of users.

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Aim It is the aim of this study to explore the characteristics of influential peers identified by schoolmates, and the mechanism by which they exert their influence on their peers. BACKGROUND: Adolescent crowds are a salient influence on the health-risk behaviors of peers, contributing to adolescent substance use such as drinking alcohol, smoking cigarettes, and taking drugs. METHODS: A mixed method study. Three schools granted us access to students and those who had been nominated as influential by their peers. The students were asked to nominate and indicated the characteristics of peers whom they considered influential in a quantitative study. Those peers whom they considered influential were invited to take part in focus group interviews. A total of six focus group interviews were conducted, comprised of two groups from each school, with an average of seven participants in each group. Findings Students considered caring and friendliness (91.0%), being a buddy (88.5%), and entertaining/humor (86.8%) as the top three characteristics of influential peers. The interviews revealed that the students believed that they are influential because of their cheerfulness and humor, considerateness, ability to communicate, popularity and sociability, sincerity and trustworthiness, and because they possess the characteristics of a leader. They also believed that their power to influence came about through their helpfulness, accommodation, and the closeness of their relationships. Their influence was manifested in both positive and negative ways on the academic pursuits and health-risk behaviors of their peers. In order to engage at-risk students in health promotion programs, it is important to identify their influential peers, and to understand how adolescent friends may help one another to resist behaviors that pose a risk to their health.

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BACKGROUND: Substance use among adolescents has caused worldwide public health concern in recent years. Overseas studies have demonstrated an association between adolescent self-esteem and substance use, but studies within a Chinese context are limited. A study was therefore initiated to: (1) explore the 30 days prevalence of substance use (smoking, drinking, and drugs) among male and female adolescents in Hong Kong; (2) identify the significant associations between multidimensional self-esteem and gender; and (3) examine the relationship between multi-dimensional self-esteem and substance use. METHODS: A self-esteem scale and the Chinese version of the global school-based student health survey were adopted. A total of 1,223 students were recruited from two mixed-gender schools and one boys' school. RESULTS: Among females, there was a lower 30-day prevalence of cigarette, alcohol, and drug use. They also had significantly higher peer and family self-esteem but lower sport-related self-esteem. Body image self-esteem was a predictor of alcohol use among females, while peer and school self-esteem were predictors of drug use among males. CONCLUSIONS: In summary, the findings demonstrated the influence of self-esteem to the overall well-being of adolescents. Schools could play a role in promoting physical fitness and positive relationships between adolescents and their peers, family, and schools to fulfill their physical and psychological self-esteem needs.

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AIMS: To examine the lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong. BACKGROUND: The establishment of healthy lifestyle habits and maintenance of psychosocial well-being during early adolescence can prevent the morbidity and mortality caused by unhealthy practices. DESIGN: A cross-sectional study. METHODS: A questionnaire was used to solicit information on primary school students' lifestyle behaviours and psychosocial well-being using the Chinese version of the Adolescent Lifestyle Questionnaire (C-ALQ). RESULTS: Out of 249 primary school students, 241 returned their questionnaires (a response rate of 96.8%). Results on the lifestyle behaviours of students indicated that nearly half of them 'play sports at least three times a week' (n = 111, 46.1%), 'try not to eat foods high in fats/salt' (n = 112, 46.5%), 'report unusual bodily changes to nurses, parents, friends or physician' (n = 136, 56.4%) and 'avoid doing drugs' (n = 186, 77.2%). Results for the psychosocial well-being of students showed that nearly half 'use helpful strategies to deal with stress' (n = 104, 43.2%), are 'confident about [their] own beliefs and values in life' (n = 143, 59.3%) and 'enjoy spending time with friends' (n = 169, 70.1%). Male students were found less likely than females to demonstrate 'health awareness' (t = 4.87, p = 0.028) and 'social support'(t = 4.17, p = 0.042) and to have better overall psychosocial well-being (t = 5.43, p = 0.021). CONCLUSIONS: Primary school students have various health education needs related to lifestyle behavioural choices and the maintenance of psychosocial well-being. Lifestyle choices are formed in early adolescence; therefore, health education must begin as early as possible to influence healthy behaviours. RELEVANCE TO CLINICAL PRACTICE: School nurses should assess health needs across the school-age population and develop programmes to address these overall needs. School nurses are needed to cater for the needs of students, particularly boys, to establish health programmes for lifelong healthy lifestyles and psychosocial well-being and to monitor their health status.

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A collaborative endeavor was initiated between a Hong Kong school of nursing and a school of health in Guangzhou to develop a prevention-focused community nursing educational program. The collaboration aims were to increase the ability and confidence of Guangzhou nurses in performing their community healthcare roles and to train local community health nursing trainers in Guangzhou. The collaborating parties participated in a series of review for planning the teaching team, the taught subjects in the curriculum, the education approach, the student assessment and the train the trainer scheme for the program. The program was developed after the review, planning and implementation phases. This collaboration provided the groundwork for the education of community nurses in Guangzhou and developed local trainers in community health nursing; it enhanced understanding of the present status of community health nursing for both the school of health and the students; and it provided a reference for others that may collaborate with institutions in the People's Republic of China to initiate or strengthen educational programs to build up community health nursing.

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BACKGROUND: An integrated adolescent curriculum on health and development (ADH) was implemented in a pre-service nursing programme in a university. AIM: This study examined the efficacy of an ADH curricular framework in improving the competency variables of student nurses in delivering ADH services. METHOD: The design of the study was quasi-experimental with the systematically designed ADH training curriculum as an intervention. Pre- and post-tests incorporating an experimental group and a control group for a sample of 101 student nurses were used. FINDINGS: Reports from 50 student nurses in the experimental group indicated that there was a significant increase from the pre-test to the post-test phase in the total score for the variables in the ADH Competency Checklist (Z=-5.71, p<0.001) and its four subscales: the professional development subscale (Z=-5.37, p<0.001), the psychosocial and physical well-being subscale (Z=-5.66, p<0.001), the health behaviours and lifestyles subscale (Z=-5.07, p<0.001), and the identity and reproductive health subscale (Z=-4.86, p<0.001). Significant changes were detected in the ADH competency variables for the control group in the post-test phase. CONCLUSION: The findings reveal that the systematic integration of ADH in the nursing curriculum had the positive impact of increasing the competency of student nurses for the examined variables.

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