Background: Despite global efforts to control human immunodeficiency virus (HIV) among adolescents, the number of new infections among adolescents continues to increase. The increasingly widespread HIV epidemic among Chinese college students indicates an urgent need for more effective services in this context. To meet this need, we conducted a survey that aimed to produce a clear understanding of knowledge and sexual behavior concerning acquired immunodeficiency syndrome (AIDS) among college students. This study can serve as a reference for policy-makers and university administrators seeking to implement more targeted measures in this context. Methods: In November 2024, a cross-sectional internet questionnaire survey was distributed at 13 universities in Guangzhou, China. The chi-square test was performed to examine the differences among respondents who exhibited different characteristics. A multivariate logistic regression analysis was conducted to explore the main influences on college students' AIDS knowledge. Confidence intervals that did not contain zero or p values < 0.05 were considered to indicate statistical significance. Results: A total of 12,632 valid questionnaires were collected. On this basis, a total of 11,587 (91.73%) students were determined to possess AIDS knowledge. The main influences on college students' AIDS knowledge were age, school classification, major, accommodation method, place of origin and average monthly living expenses. The proportion of students who reported a history of sexual behavior increased alongside students' grade. The relevant values were as follows: freshmen (5.16%), sophomores (11.9%), fourth-year and fifth-year students (15.59%), master's students (29.27%) and doctoral students (55.22%). A total of 6.63% of the respondents who had engaged in sexual behaviors reported that they had engaged in noncommercial sex with causal sexual partners. During the past year, the percentages of respondents who did not insist on using condoms during sexual activities with their casual sexual partners, male same-sex sexual partners, or commercial sexual partners were 30.58, 51.81, and 81.25%, respectively. The percentages of students who possessed AIDS knowledge and insisted on using condoms during sexual activities with "casual sexual partners (72.16%)" or "male same-sex sexual partners (48.19%)" were greater than the corresponding percentages of students who did not possess such knowledge (p < 0.01). Individuals who did not possess AIDS knowledge reported that they did not insist on using condoms during sexual activities with male same-sex sexual partners. "Did not buy a condom" was identified as the main reason for the failure to use condoms during sexual activities with casual sexual partners (26.43%) and commercial sexual partners on the basis of monetary transactions (48.00%). The main reason for failing to use condoms during same-sex sexual activities was "I did not think that it was necessary to use it" (41.67%). The percentage of college students included in the survey who reported that they had acquired AIDS knowledge from social software was the highest (76.96%). A total of 30.90% of the respondents reported that their favorite way of acquiring AIDS knowledge was through their school courses. Conclusion: The level of AIDS knowledge exhibited by college students is affected by various factors. Improvements in AIDS knowledge can help raise awareness of the need for self-protection during high-risk sexual activities among college students. The risk of contracting AIDS and other sexually transmitted diseases can be reduced through the use of condoms. Social networks are the main source by which college students acquire AIDS knowledge, although such students typically hope to acquire AIDS knowledge from their school courses.

Introduction: Although the adverse health effects of PM2.5 exposure has been well documented, evidence of its adverse effect on overall outpatient visits was still limited. Besides, the adverse health effects of PM2.5 exposure get complicated due to various components within the particles. So far, little is known about the relationship between PM2.5 components and overall outpatient visits. Objectives: This study aims to evaluate the causal relationships between long-term exposure to primary chemical components of PM2.5 and outpatient visits, while estimating the mixture effect and relative contribution of the components. Methods: Based on nationwide provincial-level surveillance data of outpatient visits in China and well-validated simulations of PM2.5 components concentration, we employed the Difference-In-Differences (DID) approach to evaluate the causal relationships between long-term exposure to primary chemical components of PM2.5 and outpatient visits, and used a Bayesian Weighted Quantile Sum (BWQS) regression to assess the mixture effect of the components. Results: We found a 20.44% increase in the risk (IR%) of outpatient visits following each InterQuartile Range (IQR) increment in PM2.5 concentration. Our estimation further suggested a 17.07%, 15.91%, and 14.04% increase in the risk of outpatient visits for organic matter, sulfate, and nitrate, but non-significant increases for other components. However, when considering the inter-components correlation, sulfate and black carbon contributed most (42.3% and 28.1%, respectively) to the overall mixture effect of PM2.5 which was indicated by a 4.84% increase (95%CI: 1.92%, 7.83%) in the risk of outpatient visits following every unit increase in the overall BWQS index. Additionally, stratified analyses showed a stronger association among aged provinces and provinces with lower education rates. Conclusion: Our findings would improve understanding of the individual and mixture impact of major chemical components of PM2.5 and may contribute to more targeted and optimized environmental programs for pollution control.

Large-scale epidemiological studies on the association of blood lead levels with blood pressure and hypertension prevalence are still limited, particularly among lead-exposed workers. The evidence is even more scarce on the interaction of blood lead levels with occupational variables and ambient air pollution levels. We developed mixed-effect models based on a large group of lead-exposed workers (N = 22,002). The results were also stratified by multiple groupings. Compared to participants with blood lead < 20 μg/L, those with levels > 20 μg/L had a 26–37% higher prevalence of hypertension, as well as a 0.65–13.7 mmHg higher systolic and diastolic blood pressure. Workers exposed to high PM10 levels had a 21–28% higher risk. Workers exposed to high temperatures had a 0.41–2.46 mmHg greater increase in blood pressure, and those not exposed to dust had a 1.29–1.65 mmHg greater blood pressure increase. Our findings suggested the negative impact of blood lead on blood pressure and the prevalence of hypertension, with workers exposed to high PM10 concentrations, those exposed to occupational high temperature, and those without dust exposure being more vulnerable.

Background Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. Methods A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. Results A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year. Conclusions Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China.

Factory workers make up a large proportion of China’s internal migrants and may be highly susceptible to job and adaptation stress, negative affective states (e.g., depression and anxiety), and Internet gaming disorder (IGD). This cross-sectional study investigated the relationships between job stress, psychological adaptation, negative affective states and IGD among 1,805 factory workers recruited by stratified multi-stage sampling between October and December 2019. Structural equation modeling (SEM) was conducted to test the proposed mediation model. Among the participants, 67.3% were male and 71.7% were aged 35 years old or below. The prevalence of probable depression, probable anxiety, and IGD was 39.3, 28.7, and 7.5%. Being male, younger age, and shorter duration of living in Shenzhen were associated with higher IGD scores. Job stress was significantly associated with IGD (β = 0.11, p = 0.01) but not with negative affective states (β = 0.01, p = 0.77). Psychological adaptation was significantly associated with negative affective states (β = −0.37, p < 0.001) but not with IGD (β = 0.09, p > 0.05). Negative affective states were positively associated with IGD (β = 0.27, p < 0.001). The indirect effect of psychological adaptation (β = −0.10, p = 0.004) but not job stress (β = 0.003, p = 0.77) on IGD through negative affective states was statistically significant. The observed psychological correlates and mechanisms are modifiable, and can inform the design of evidence-based prevention programs for depression, anxiety, and IGD in this population.

Background: People undergoing mass home- and community-based quarantine are vulnerable to mental health disorders during outbreaks of coronavirus disease (COVID-19), but few studies have evaluated the associated psychosocial factors. Objective: This study aimed to estimate the prevalence of anxiety and depressive symptoms and identify associated demographic and psychosocial factors in the general Chinese population during the COVID-19 pandemic quarantine period. Methods: Participants aged 18 years or above were recruited in a cross-sectional online survey using snowball sampling from February 26-29, 2020. The survey included questions on demographics, family relationships, chronic diseases, quarantine conditions, lifestyle, COVID-19 infection, and anxiety and depressive symptoms. Logistic regression analyses were conducted to identify factors associated with elevated anxiety or depressive symptoms. Results: Out of 2331 participants, 762 (32.7%) experienced elevated anxiety or depressive symptoms. Nine risk factors associated with anxiety or depressive symptoms included younger age, reduced income, having cancer or other chronic diseases, having family members living with cancer, concerns related to COVID-19 infection for themselves or family members, living alone, having family conflicts, having <3 or >8 hours of sedentary time per day, and worsened sleep quality. Conclusions: The findings highlight an urgent need for psychological support for populations at high risk for elevated anxiety or depressive symptoms during the COVID-19 pandemic.

Background Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. Objective The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. Methods Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. Results The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=–2.184, P=.048) and a greater frequency of items completed (β at 3 months=–0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. Conclusions This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5693-1

BACKGROUND:Under the circumstance of global population aging, the issue on how to facilitate the quality of life (QOL) for older people brings us grand challenge. On the way to solve this problem, it is inextricable to measure QOL for older people accurately at onset. This study is aimed at evaluating the reliability and validity of the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD).METHODS:We received 1005 valid WHOQOL-OLD questionnaires from 1050 respondents who were 60 and older by quota sampling method. To calculate the test-retest correlation coefficient we re-interviewed 101 participants from the community. Psychometric properties were evaluated from the aspect of feasibility, internal consistency reliability, test-retest reliability, content validity, construct validity and discriminant validity.RESULTS:Missing item responses took up 0.0%-2.7% in the scale. The WHOQOL-OLD showed satisfactory reliability with Cronbach's Alpha coefficients ranging from 0.711 (Social participation) to 0.842 (Sensory ability) for each domain. The intra-class correlation coefficients (ICC) presenting test-retest reliability were all over 0.7. In Confirmatory Factor Analysis (CFA), Root Mean Square Error of Approximation (RMSEA) was 0.084 (a little more than 0.08) and comparative fit index (CFI) 0.95 (>0.90) which meant acceptable construct validity. There were higher correlation coefficients between items and their hypothesized domains than other domains (P < 0.001), indicating good content validity. The results of t-test showed good discriminant validity of the WHOQOL-OLD between the healthy group and the unhealthy group (P < 0.0083).CONCLUSION:The Chinese version of WHOQOL-OLD showed good feasibility, reliability and validity in this study. However, before it can be used national-widely, further research should be conducted in other areas of China.