Child health, development and psychosocial well-being in Hong Kong : determinants and evidence-based interventions

Abstract

This thesis focuses on the different dimensions of environmental determinants of health, development, and psychosocial well-being of children in Hong Kong and the effectiveness of evidence-based interventions. Early detection and intervention of health or health-related issues is critical so that timely support is provided to children and their families in critical stages and many serious health and developmental problems developing later in life can be prevented. Awareness of the public and the government would aid in the formulation of relevant policies so that equitable health opportunities are available for every child. After the introduction of the thesis and its study design in Chapter One, Chapter Two focuses on our original scientific studies relating to environmental exposure, both physical and social, as determinants of a child’s health and well-being. Environmental risks that children are particularly vulnerable to start at the embryonic stage and continue through adolescence. Community, school and family environment could contribute to weight and weight-related disorders in children to different extents. Chapter Three addresses the role of the family environment in various aspects of child development including psychosocial development, school readiness and behavioural problems. Family socioeconomic status, digital technology environment, parenting factors, and maternal substance misuse are key environmental factors considered. Chapter Four deals with the risk factors, burden and consequences of child maltreatment which are closely related to the studies and discussions in Chapter Two and Chapter Three. Seasonal trend in child maltreatment and its prevalence in Hong Kong, possibly related to examination and parental stress, is identified. Factors such as family socioeconomic status and structure, parenting style, and maternal age/parity/gravidity are associated with child maltreatment. This leads to further studies on ADHD in Chapter Five, which is an outcome and important risk factor interlinked with child maltreatment and the early adversities and family environment studied in the previous 3 chapters. Chapter Five outlines risk factors for Attention-Deficit/Hyperactivity Disorder (ADHD) and the variation in treatment trends across world regions. A temporal pattern for the occurrence of neurological adverse events following ADHD medication initiation and its potential interaction with other concurrent medications in neurological outcomes is presented. ADHD and ADHD medication prescribing prevalence in Hong Kong and its association with child maltreatment is also studied. Chapter Six presents innovative and evidence-based child and adolescent health and health-related intervention programs in Hong Kong in order to address the needs identified in our studies in the first few chapters and to generate innovative evidence-based intervention models to bridge the gap in child health, development and psychosocial wellbeing. Improvement in physical and mental health, poverty alleviation, promotion of a smoke-free environment, and alteration in risk-taking behaviour of substance-abusing mothers was discernible. The effectiveness of one of the first clinical trials on multi-component parenting intervention to improve the social-emotional development of children in low-income families was also examined. Each of the studies conducted in this MD thesis offers professionals, stakeholders and policymakers evidence-based recommendations for developing effective interventions in a Chinese cultural context to attain the ultimate goal of enhancing child health, development and wellbeing in Hong Kong and in other Chinese communities.