During the COVID-19 pandemic, international migrant workers were often at risk of increased hardships due to disrupted employment, insecure residency status, and stringent government pandemic policies. Migrant domestic workers (MDW) who are typically required to live in the home of their employer, away from social support networks, may face additional stressors and vulnerabilities. This study seeks to understand the impact of the COVID-19 pandemic on female MDWs in Hong Kong. Semi-structured, one-on-one interviews were conducted from June 2021 to May 2022 with 20 female MDWs currently employed in Hong Kong. The study explored the impact of the COVID-19 pandemic on the MDWs: employment conditions, economic situation, family and social networks, and personal health. Thematic analysis, informed by the Employment Conditions and Health Inequalities Framework, was conducted on the interview data. Participants reported negative changes to employment conditions including new job duties, longer working hours, and not receiving statutory days off. Participants also felt that government COVID-19 policies unfairly targeted MDWs. Although MDWs often reported tolerating the negative work-related impacts of the pandemic to provide for left-behind family, MDWs would commonly seek other employment to cope with their employer-related difficulties. Additional stressors faced by MDWs during the COVID-19 pandemic were largely attributable to existing regulations and pandemic-related MDW policies that limited their autonomy. Improving the well-being of MDWs, particularly during public health crises, necessitates regulatory reforms that include MDW mental health as a priority area.

International migrant workers often face discrimination and poor work conditions that may negatively affect their mental health. Female migrant domestic workers (MDW), who often must reside in their place of work, may face additional daily stressors and discrimination compared with other international migrant workers. To address the stresses from discrimination and other challenges faced by MDWs, use of social support networks are often encouraged to improve mental well-being. This study seeks to examine the mediating effect of stress between perceived discrimination and self-reported mental health and the moderating role of perceived social support. An online cross-sectional survey was conducted during August 2020 – August 2021 among female MDWs in Hong Kong, China ( n = 1965). In addition to assessing the association between perceived discrimination with anxiety (GAD-7) and depression (PHQ-9), a moderated mediation analysis examined the mediating role of stress and moderating role of perceived social support. Of respondents, 60.4% experienced at least occasional discrimination. Higher levels of perceived discrimination were significantly directly associated with both increased anxiety and depression ( p < 0.05). Stress significantly mediated this association. Perceived social support significantly moderated the mediation pathway but did not moderate the direct effect of perceived discrimination on mental health. Increasing social support channels may alleviate the effects of increased stress from perceived discrimination on MDWs’ mental health. Policy-level campaigns to reduce discrimination against migrant workers should be considered.

OBJECTIVES:Female migrant domestic workers (MDW), often unemployed in their home country, are household workers that migrate abroad for better wages. Although poor employment conditions have shown detrimental effects on MDWs health, the mental health effect of perceived discrimination remains understudied among MDWs. This mixed-methods study seeks to (a) assess the association between perceived discrimination and mental health among female MDWs and (b) explore in-depth the common ways MDWs experience discrimination. METHOD:A cross-sectional self-administered survey (n = 1965) was conducted among Filipino and Indonesian MDWs from August 2020 to August 2021 in Hong Kong. A multivariable logistic regression model, controlling for background characteristics, assessed associations between perceived discrimination with anxiety and depression. Qualitative semistructured interviews were then conducted (n = 20) to provide in-depth information about perceived discrimination. Thematic analysis was used to identify the contexts and types of discrimination experienced. RESULTS:Among survey respondents, 60.4% reported ever experiencing discrimination, and 10.5% reported often/always feeling discriminated against. Of MDWs, 18.1% and 31.5% were classified with anxiety and depression, respectively. MDWs reporting higher frequency of discrimination were at increased risk of anxiety (ORadj: 2.30-6.60) and depression (ORadj: 2.06-5.91). In-depth interviews revealed that perceived discrimination inside the workplace (from overwork, lack of autonomy, and employer-imposed restrictions) and outside the workplace (from MDW policies) had strong effects on MDWs' mental health. CONCLUSIONS:Increased availability to mental health services should be considered. To improve MDW mental health, policymakers may also regulate maximum weekly working hours and ensure minimum standards for living environments. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

BackgroundMetabolic health status and levels of adiposity are prone to change over time. Mixed results have been reported regarding the extent by which changes in metabolic health and weight affect cardiometabolic risks. This systematic review and meta-analysis aims to examine the association between transitions in metabolic health and adiposity status on risk of incident type 2 diabetes (T2DM) and cardiovascular disease (CVD) events.MethodsA systematic literature search was conducted on MEDLINE and EMBASE through August 2022 for prospective cohort studies examining transitions in metabolic health and adiposity status and risk of incident T2DM and CVDs without restrictions on language or publication status. Meta-analysis was performed to summarize hazard ratios for T2DM and composite CVD events separately using random-effects model.ResultsA total of 17 studies were included. Compared to stable metabolically healthy status, transition to metabolically unhealthy status significantly increased the risk of incident T2DM and composite CVD events among individuals with normal weight and individuals with overweight/obesity. Compared to stable metabolically unhealthy status, transition to metabolically healthy status significantly lowered the risk among individuals with normal weight and individuals with overweight/obesity. When metabolic health status remained unchanged, progression from normal weight to overweight/obesity significantly increased risk of CVDs but not risk of T2DM.ConclusionThe impact of change in metabolic health on the risks of T2DM and CVD is more prominent than that of change to body mass index category. Obesity treatment should consider prioritizing improvement in metabolic health parameters over focusing on the extent of weight loss only.

Background Female migrant domestic workers (MDW), approximately 8.5 million globally, often live in their employer’s home under vulnerable conditions. In Hong Kong, MDWs currently comprise 5% of the population. This study was conducted to assess the association between employment conditions and mental health, and the mediating roles stress and job satisfaction have, among female MDWs in Hong Kong. Methods Participants completed an online cross-sectional survey. A total of 1,965 survey were collected between August 2020 and August 2021. Questions in the survey were related to MDWs background information, employment conditions, stress, job satisfaction, and two mental health outcomes: anxiety and depression. An employment conditions score was created to assess the cumulative effect poor employment conditions had on mental health. A multicategorical parallel mediation analysis was used to assess the direct effect employment conditions have on mental health and the indirect effects through stress and job satisfaction. Results Overall, 17.7% of MDWs were reported to be suffering from anxiety and 30.8% from depression. An increase in poor employment conditions was statistically associated with an increase in both outcomes, while stress levels and job satisfaction mediated this association. Conclusions The findings call for increased scrutiny of employment conditions and mental well-being of MDWs.

To counter the harms of excessive alcohol use, the World Health Organization (WHO) outlined a series of alcohol policy recommendations, including the most cost-effective "Best Buys". This study aims to obtain key stakeholder views on feasibility of implementing various publicly endorsed alcohol policies in Hong Kong, a relatively low alcohol consumption region with few extant alcohol regulations. Between 2019 and 2021, we conducted semistructured interviews with stakeholders involved in alcohol policy adoption and implementation. Interviewees included hospitality/alcohol sales workers (n = 13) and government officers (n = 4). The stakeholders noted that although WHO advocacy facilitated local policy considerations, the adoption of stringent measures was challenged by low political priority due to the low visibility of harms. For implementing strategies, the stakeholders cited alignment with social norms as a major facilitator, whereas law enforcement difficulties and resistance from industry/business sectors were viewed as major obstacles. There was a general belief that population-level alcohol policies would be effective for certain groups of drinkers but would also harm the local economy and detract from Hong Kong's image as a "world city". Hong Kong may not be ready to adopt a wide range of highly restrictive population-level alcohol policies. Local governments should carefully consider contextual factors when following international recommendations.

Background To counter the harms caused by alcohol use, the World Health Organization (WHO) outlined a series of evidence-based recommendations, including the highly cost-effective “Best Buys” recommendations. While many Western countries have been actively introducing alcohol harms reduction strategies, it is unclear whether these cost-effective policies would be publicly acceptable in Asian regions with traditionally low alcohol consumption. This study examines the public acceptability of WHO-recommended alcohol harms reduction strategies in an Asian city with few extant alcohol regulations. Methods A cross-sectional telephone survey of Hong Kong Chinese residents aged 18–74 ( n = 4,000) was conducted from January to August 2018. Respondents were asked about their perceptions of various WHO-recommended strategies and consequences of their implementation. After reducing the strategies into several policy categories by principal component analysis, multivariable linear regression was performed to identify factors associated with endorsement of the various policies. Results Among the “Best Buys”, introduction of moderate beer/wine taxes (68.7%) and shortened alcohol retail hours (51.9%) were the most supported while bans on event sponsorships (19.5%) and public drinking events (17.7%) were the least popular. Strategies targeting young drinkers were particularly highly supported. Males, younger adults, Non-abstainers, and those who believed in drinking's social benefits were less likely to endorse stringent control measures ( p < 0.05). Adults with higher household income were less supportive, partially due to concerns about infringements on local economy, lifestyles, and economic freedom. Women and older people were generally more supportive, partially because they perceived these policies would lower alcohol-related harms. Conclusion In order to reduce barriers to implementing WHO-recommended strategies in the region, it is imperative to increase awareness of alcohol-related harms and to strengthen beliefs in the effectiveness of these countermeasures, especially among men, young adults, and drinkers.

Globally, minority groups and non-citizens may not be sufficiently included in the COVID-19 vaccine coverage. This study seeks to understand determinants of vaccine uptake among female foreign domestic workers (FDWs) in Hong Kong. We conducted a cross-sectional study of female FDWs (n = 581) from June to August 2021. Respondents completed an online survey obtaining sociodemographic, employment, and health status information. Based upon the socio-ecological model, we obtained individual, interpersonal, and socio-structural factors that may be associated with COVID-19 vaccine uptake. Multivariable logistic regression analysis was used to examine factors associated with having received at least one dose of a COVID-19 vaccine. At the individual level, agreeing that taking COVID-19 vaccines can contribute to COVID-19 control in Hong Kong (OR 6.11, 95% CI 2.27–16.43) was associated with increased vaccine uptake, while being worried of severe side-effects from vaccination (OR 0.29, 95% CI 0.16–0.55) was associated with decreased uptake. At the interpersonal level, those being encouraged by their employer (OR 2.05, 95% CI 1.06–3.95) and family members (OR 2.27, 95% CI 1.17–4.38) were more likely to be vaccinated, while at the socio-structural level, believing vaccination would violate religious beliefs (OR 0.19, 95% CI 0.06–0.65) was associated with decreased uptake. The government can formulate a multi-level approach according to our findings to target the remaining unvaccinated FDW population.

Background Improving health-related quality of life (HRQOL) is becoming a major focus of old age care and social policy. Researchers have been increasingly examining subjective social status (SSS), one’s self-perceived social position, as a predictor of various health conditions. SSS encompasses not only concrete socio-economic (SES) factors but also intangible aspects of status. This study’s main objective was to examine the association between SSS and long-term change in HRQOL in older Chinese adults. Methods A longitudinal Hong Kong study recruited 2934 community-dwelling adults (age > 65 years). Participants completed SF-12 physical health (PCS) and mental health (MCS) HRQOL scales. This study analyzed baseline SSS-Society (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one’s own social network) as predictors of long-term HRQOL decline. After stratifying for sex, multiple-linear-regression was performed on 4-year follow-up SF-12 PCS and MCS scores after adjusting for baseline SF-12 scores, traditional SES indicators, demographic variables, clinical conditions, and lifestyle variables. Results In the multivariable analyses, lower SSS-Society was associated with declines in MCS in males (β standardized = 0.08, p = 0.001) and declines in PCS (β standardized = 0.07, p = 0.006) and MCS (β standardized = 0.12, p < 0.001) in females. SSS-Community was associated with declines in PCS in males (β standardized = 0.07, p = 0.005) and MCS in females (β standardized = 0.14, p < 0.001). Conclusions SSS may be a useful supplementary tool for predicting risk of long-term HRQOL decline in older Chinese adults. Strategies to reduce perceived social inequalities may improve HRQOL in older adults.

OBJECTIVE:Subjective social status (SSS), one's self-perceived social position, encompasses not only concrete socio-economic (SES) factors (e.g., income) but also intangible aspects of status (e.g., social capital). In recent years, there has been increasing research interest in SSS as a predictor of a vast array of health outcomes but very few studies examining effects on cognitive functioning. This study's main objective was to examine the association between SSS and long-term cognitive decline in older Chinese adults. DESIGN:A 4-year longitudinal study. SETTING:Hong Kong, China. PARTICIPANTS:Chinese adults (aged ≥65) (n = 3,153). MEASUREMENTS:This study analyzed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term cognitive decline. Multiple-linear-regression was performed on 4-year follow-up Mini-Mental-Status-Examination (MMSE) cognitive function score (score range: 0-30) after adjusting for baseline MMSE scores, traditional SES indicators (e.g., education), demographic variables (e.g., sex), clinical conditions (e.g., stroke history, depression), and lifestyle variables (e.g., physical activity levels). RESULTS:Lower SSS-Community but not SSS-Hong Kong was associated with greater cognitive decline (unstandardized coefficient (95% CI) = 0.13 (0.07, 0.19) standardized β-coefficient = 0.08, after adjusting for objective SES measures and other background and clinical factors. The standardized β-coefficients for the SSS-Community variable were similar in magnitude to those for depression and diabetes. CONCLUSION:Cognitive decline is influenced by self-perceived rank in proximal reference groups rather than socioeconomic comparison with society at-large. SSS-Community is a useful, single-item supplementary instrument to improve prediction of cognitive decline in elderly Chinese.

INTRODUCTION:Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol-related harms. This study examines the alcohol-related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation.METHODS:A cross-sectional telephone survey was conducted in 2019 on Chinese adults aged 18-74 (n = 3200). Respondents were asked about various past-year first-hand drinking harms (after one's own drinking), second-hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation.RESULTS:Of drinkers, 21.1% reported first-hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger-aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first-hand harms. Of the sample, 18.2% experienced past-year second-hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past-year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second-hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first-hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second-hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies.DISCUSSION AND CONCLUSIONS:Although high levels of alcohol-related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking-related harms.

Abstract Background Although dormitory residents have been identified as a high-risk group for alcohol misuse in Chinese university settings, the factors associated with their drinking behaviors has not be characterized. Methods A cross-sectional study was conducted among hostel residents in two Hong Kong universities (n = 1455) using self-administered, anonymous surveys. In addition to examining the knowledge levels and drinking-related attitudes, we examined the factors associated with binge drinking in this population using multivariable regression analysis. Results Among university dormitory residents, the prevalence of past-month binge drinking was 26.8% among males and 12.8% among females. It was noted that although respondents demonstrated attitudes conducive towards alcohol-free socialization, they exhibited low levels of alcohol-related knowledge (mean knowledge score: 3.3/ 10, SD = 2.0). While about 59% were aware that alcohol is a carcinogen and that some medications should not be taken with alcohol, only 10.4% were familiar with symptoms of alcohol poisoning and only 23% were familiar with relative amounts of alcohol in different beverage categories. Of the respondents the factors independently associated with past-month binge drinking were: male sex, older age, full-time hostel residence, drinking roommates, drinking romantic partner, participation in drinking games, and having pro-alcohol attitudes (OR ranging from 1.33-3.69). Alcohol-related knowledge was not associated with binge drinking. Conclusions Although southern China is a low alcohol consumption area, binge drinking is common among university residents and requires multi-prong interventions. Heavy drinking is a neglected health problem among urban Chinese university students. Interventions targeting binge drinkers need to counteract pro-alcohol attitudes and peer effects. Increasing alcohol knowledge may additionally help to reduce alcohol-related harms in this age group. Key messages Urban Chinese university dormitory residents demonstrate low levels of alcohol knowledge. Pro-alcohol attitudes and peers effects need to be addressed in university anti-binge drinking interventions.

Background Subjective social status (SSS), one’s self-perceived social status, has been gaining interest among researchers as a risk/protective factor of many health outcomes. SSS encompasses both socio-economic factors (eg, income) and intangible aspects of status (eg, esteem from peers). This study’s main objective was to examine the association between SSS and future risk of depression in elderly Chinese. Methods Using data from the ongoing Mr/Mrs Os study, a longitudinal study of Hong Kong Chinese elderly, this study analysed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one’s own social network) as predictors of Geriatric Depression Scale (GDS) score at year 4 (n=3153). The models adjusted for baseline depression scores, socio-economic status indicators, demographic variables, clinical conditions and functional status variables. Results Higher depression scores at follow-up were independently associated with lower SSS-Hong Kong (standardised β-coefficient= −0.040, p=0.017), lower SSS-Community (standardised β-coefficient= −0.057, p=0.001), in addition to older age, female gender and stroke history. After stratifying by dementia status, higher baseline SSS was associated with less depressive symptoms only in the non-dementia group. In the multivariable models that included both SSS variables, only SSS-Community was significantly associated with year 4 GDS score. However, both SSS variables were independently associated with year 4 depression status in the logistic regression analysis. Conclusion In Chinese elderly, SSS captures aspects of social status that are not captured by traditional socio-economic indicators. SSS can be a useful supplementary tool for assessing future risk of developing mental health conditions.

BACKGROUND:Accumulating evidence suggested that long-term antibiotic use may alter the gut microbiome, which has, in turn, been linked to type 2 diabetes. We undertook this study to investigate whether antibiotic use was associated with increased risk of type 2 diabetes. METHODS:This prospective cohort study included women free of diabetes, cardiovascular disease and cancer in the Nurses' Health Study (NHS 2008-2014) and NHS II (2009-2017). We evaluated the overall duration of antibiotics use in the past 4 years and subsequent diabetes risk with Cox proportional-hazards regression adjusting for demography, family history of diabetes and lifestyle factors. RESULTS:Pooled analyses of NHS and NHS II (2837 cases, 703 934 person-years) revealed that a longer duration of antibiotic use in the past 4 years was associated with higher risk of diabetes [Trend-coefficient = 0.09, 95% confidence interval (CI) 0.04 to 0.13]. Participants who received antibiotics treatment for a medium duration of 15 days to 2 months [hazard ratio (HR) 1.23, 95% CI 1.10 to 1.39] or long duration of >2 months (HR 1.20, 95% CI 1.02 to 1.38) had higher risk of type 2 diabetes as compared with non-users. Subgroup analyses suggested that the associations were unlikely to be modified by age, family history of diabetes, obesity, smoking, alcohol drinking, physical activity and overall diet quality. CONCLUSIONS:A longer duration of antibiotic use in recent years was associated with increased risk of type 2 diabetes in women. Physicians should exercise caution when prescribing antibiotics, particularly for long-term use.

Abstract Background Although advances in medical technologies now allow greater reproductive options, the social acceptance of assisted reproductive technologies (ART) has not been examined in East Asian countries which currently have the lowest fertility rates in the world and highly prohibitive regulations. Methods A cross-sectional telephone surveys interviewed 990 among Hong Kong Chinese adults (>18 years of age) in 2015 who were asked about their knowledge and attitudes towards various ART and their inclination to use ART. A focus group was conducted (n = 30) on physicians to examine the perceived barriers and benefits of integrating ART as routine offerings. Results Although nearly all adults (>92.0%) were familiar with ART procedures such as in vitro fertilization, sperm banking, and gestational surrogacy, attitudes supporting the use of these services and the inclination to use these services varied widely by socio-demographic attributes. Nearly one-third (31.5%) of women said that they would consider cryopreservation of their oocytes or embryos if they could afford it and 21.9% would encourage their female family members to do so. Although respondents considered sperm donation and embryo preservation to be well-accepted practices, support for these services was noticeably lower than in Western countries for unmarried individuals and homosexuals. Also, the vast majority of respondents were much more disinclined to use anonymous donor gametes than in Western countries. Among medical practitioners, the primary barriers to routine offering of these services to their clients was the perceived lack of cultural acceptance of these types of services. Conclusions Public support of assisted reproductive services for genetic offspring is well-accepted for heterosexual couples. Main Messages: Asian countries with sub-replacement fertility levels may consider integrating ART into their mainstream health services and updating their regulatory frameworks. Key messages Public support for assisted reproductive technologies is high for married couples only in Hong Kong. Given the sub-replacement fertility levels, cities in East Asia should consider updating regulatory frameworks to allow expansion of ART services.

Summary Background Proton pump inhibitors (PPIs) have a significant impact on the gut microbiome, which in turn, might increase the risk of rheumatoid arthritis (RA). Aim To evaluate regular use of PPIs and risk of RA. Methods This is a prospective analysis of the US nurses who reported PPI use data, and were free of RA from the Nurses’ Health Study (NHS 2002‐2014) and NHS II (2003‐2015). The exposure was regular use of PPI in the past 2 years, which was repeatedly evaluated in biennial surveys. RA was confirmed by the 1987 or 2010 American College of Rheumatology criteria. We estimated the hazard ratios (HRs) and confidence interval (CIs) with time‐dependent Cox regression adjusting for potential confounders. Results We documented 421 cases of RA over 1 753 879 person‐years of follow‐up. Regular PPI users had a 44% higher risk of RA as compared with non‐regular users (adjusted HR = 1.44; 95%CI, 1.10‐1.89). The risk of RA increased with the total duration of PPI use ( P ‐trend = 0.008). Compared with non‐regular users, the adjusted HRs were 1.22 (95%CI, 0.93‐1.62) for women with >0 to 4 years’ use and 1.73 (95% CI, 1.14 to 2.61) for >4 years’ use. Conclusions Regular use of PPI was associated with increased risk of RA in women, with a higher risk observed in individuals with a longer duration of PPI use. Due to the observational study design, large prospective trials are still required to confirm our finding.

Abstract Background Although second-harms alcohol harms, harms caused by the drinking of others, may contribute significantly to the public health burden of alcohol, these harms are an understudied area of public health research. This study aims to examine second-hand alcohol harms in among urban Chinese university students residing on campus who are were previously identified as a high risk group for alcohol misuse. Methods A cross-sectional study was conducted among hostel residents in two Hong Kong universities (n = 1455) using self-administered, anonymous surveys. We examined the prevalance and the factors associated with second-hand alcohol harms this population using multivariable regression analysis. Results Approximately 2/3 of the university residents experienced at least one second-hand drinking harm in the past year while 1/5 experienced 4 or more harms. The harms reported were: 1) inconveniences/disturbances (46.2%), psychological distress/anxiety/depression (32.9%), home arguments (28.3%), conflicts/arguments/insults in public (25.3%), worsened productivity/academics (22.2%), property damage/monetary loss (13.2%), accidents/injury/assault (11.7%) and having to deal with authorities/law enforcement (11.5%). Only 9.1% reported these harms to authorities. Participation in drinking games (OR = 1.44), having drinking roomates (OR = 1.37) or drinking romantic partner (OR = 1.89) were independently associated with likelihood of second-hand alcohol harms (p < 0.05). Conclusions Although southern China is a low alcohol consumption region, there is a high prevalence of second-hand alcohol harms among university dorm residents. Universities in the region should rectify the near absence of alcohol-related topics in university health promotion. Key messages Harms from the drinking of others is a commonplace but underappreciated phenomenon among university campus residents. University health promotion in the region should include alcohol harms reduction topics.

OBJECTIVE:This study aimed to assess the knowledge, attitudes and factors associated with promotion of umbilical cord blood (CB) donation by Chinese midwives to expectant mothers. DESIGN:An anonymous cross-sectional survey using self-administered questionnaires. SETTING:Hong Kong, China. PARTICIPANTS:One-hundred-and-forty-seven registered Chinese midwives were recruited by convenience sampling from government obstetric clinics and public and private hospitals. MEASUREMENTS AND FINDINGS:In addition to collecting demographic background information, the study examined the midwives' cord blood-related knowledge and perceptions as well as past-year practices and future intention of giving cord blood advice. Hong Kong midwives generally showed high levels of knowledge about the medical uses of cord blood but they were not as familiar with the administrative, legal and financial aspects of donation and storage. Only about 10% had received formal cord blood training and the majority felt that it should be integrated into midwifery program curricula. Although the midwives showed strong positive attitudes towards cord blood donation, only 10.9% consistently gave information and 7.5% consistently advised cord blood donation to expectant mothers in the preceding year while slightly higher percentages planned to do so in the future. In the multivariable models, higher educational attainment and hospital employment were the most consistent predictors of past-year practices of giving cord blood information and future intention to provide advice. Higher score in cord blood-related attitudes was significantly associated with giving past-year cord-blood advice, future intention to provide advice and future intention to recommend donation in the multivariable models. Key barriers to advising expectant mothers were the lack of a formal work protocol, lack of time in the clinic routine and fear of criticism by peers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:Increasing education, improving perceptions and changing workplace protocols will likely increase cord blood advising by Hong Kong midwives to their patients.