Junjie Huang

Background and Aims: Pneumococcal disease (PD) poses a substantial burden among older adults and individuals with chronic conditions, yet pneumococcal vaccination uptake remains suboptimal in Hong Kong. Understanding the psychological, social, and contextual determinants of pneumococcal vaccination decision‑making is essential for strengthening adult vaccination strategies. Methods: A qualitative study was conducted among 24 adults from pneumococcal vaccination target groups. Semi‑structured interviews explored perceptions, motivations, and barriers related to PD and pneumococcal vaccination. Data were analysed using thematic analysis informed by the Theoretical Domains Framework (TDF). The TDF synthesizes constructs from behaviour change theories into 14 domains, enabling systematic examination of psychological, social, and contextual determinants of health behaviours. Results: Over half of participants (13/24) expressed willingness to receive pneumococcal vaccination, though decisions were shaped by complex multi‑level influences. Trust in healthcare professionals and confidence in government recommendations, reflecting Social influences, emerged as commonly reported facilitators of vaccination. Financial support, such as subsidies or free vaccination, served as an important Reinforcement mechanism. The predominant barriers were limited understanding of pneumococcal vaccination and the vaccination programme (Knowledge), strong reliance on personal judgement in vaccination decision‐making (Social influences), and limited knowledge of PD (Knowledge). Participants also reported concerns about potential adverse effects (Beliefs about consequences), low perceived urgency (Intentions), and practical constraints, including limited accessibility of vaccination sites and appointment difficulties (Environmental context and resources), which were reported as additional barriers to vaccination. Conclusions: Pneumococcal vaccination decision‐making among high‑risk adults was influenced by a combination of informational, psychological, social, and structural influences. Strengthening vaccine communication by healthcare professionals, improving awareness of and access to existing free or subsidised vaccination services, improving service accessibility, and delivering sustained public education may help address misconceptions, elevate perceived need, and improve pneumococcal vaccination coverage in Hong Kong.

Objective: This study aimed to explore perceptions of the potential implementation of osteoporosis screening among stakeholders, including service recipients, physicians, and policymakers, in Hong Kong. Methods: This qualitative study involved one-on-one, in-depth interviews with key stakeholders relevant to osteoporosis screening in Hong Kong. Interviews explored perceptions of the feasibility and implementation of osteoporosis screening. The updated Consolidated Framework for Implementation Research (CFIR) was employed to guide the development of the interview guide and data analysis, focusing on five domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process. Results: A total of 35 participants were included, comprising 12 service recipients, 19 physicians, and 4 policymakers. Within the Innovation domain, the relative advantages of osteoporosis screening were widely recognized by service recipients and physicians, its evidence-based nature was emphasized by physicians. However, policymakers and some physicians raised concerns about the absence of local evidence. In the Outer Setting, financial concerns were consistently identified across stakeholder groups, whereas subsidies and affordable access were viewed as key facilitators of implementation. Within the Inner Setting, service recipients and policymakers reported insufficient dissemination of information, while physicians highlighted the primary barriers related to resource constraints within the clinical setting. At the Individual level, risk awareness and motivation for disease management facilitated participation among service recipients, while policymakers highlighted insufficient awareness about screening and the disease as a barrier. In the Implementation Process domain, service recipients emphasized community-based promotion, physicians highlighted the importance of multi-stakeholder collaboration and professional education, and policymakers identified limited coordination, unclear referral pathways, and difficulties in reaching vulnerable populations as barriers. Conclusion: This study identified perceived facilitators and barriers to implementing osteoporosis screening in Hong Kong, with the absence of local evidence, financial concerns, resource constraints, and low public awareness as major challenges despite recognized benefits. Overcoming these requires coordinated efforts across sectors, including policy support, public–private partnerships, and culturally tailored education to enhance access and participation. Future research should build on these findings to develop context-specific implementation strategies for osteoporosis screening in Hong Kong. Trial Registration: Not applicable.

Respiratory syncytial virus (RSV) poses a significant health risk to pregnant women, infants, and older adults, yet vaccine uptake remains suboptimal globally. This study aimed to explore the barriers and facilitators influencing RSV vaccine acceptance among pregnant women and older adults in Hong Kong. A qualitative design was employed, involving semi-structured interviews with pregnant women and older adults in Hong Kong. The interview guide was informed by the Theoretical Domains Framework (TDF) to capture behavioural determinants across 14 domains. Data were analyzed using thematic analysis, combining deductive coding based on TDF domains with inductive identification of emergent themes. Barriers and facilitators were further categorized to facilitate interpretation. Of the 24 participants included in this study, 9 expressed willingness to receive RSV vaccination, while 15 expressed unwillingness. Commonly reported barriers included financial concerns, worries about potential side effects, and limited knowledge about RSV and its vaccines. Trust in healthcare professionals and government authorities was commonly recognized as a facilitator. Additional facilitators included the availability of fee waivers or subsidies, access to more comprehensive vaccine information, and influence from community members, family, and friends. Knowledge gaps, safety concerns, financial considerations, and social influence were recurring themes in RSV vaccination decision-making, while trust in healthcare providers and government authorities was a salient facilitator. Future research should apply behavioural frameworks to design and evaluate targeted interventions that can be scaled within Hong Kong’s healthcare system.

Esophageal cancer is a major contributor to the global cancer burden, yet comprehensive global assessments of its burden across subtypes are lacking. This study examines the incidence, risk factors, and trends of esophageal cancer by histological and anatomical subtypes, with stratification by sex and age across different countries, using GLOBOCAN 2022 estimates, Cancer Incidence in Five Continents data, and country-level socioeconomic, lifestyle, and metabolic risk-factor indicators. Here we show that Eastern Asia has the highest age-standardized rate (ASR) of incidence of esophageal squamous cell carcinoma (ESCC) (7.2 per 100,000 population) and upper- and middle-third esophageal cancer (6.0), whereas Northern Europe exhibits the highest ASR of incidence of esophageal adenocarcinoma (EAC) (3.2) and lower‑third esophageal cancer (3.6). EAC and lower‑third esophageal cancer generally share risk factors and exhibit increasing trends; in contrast, ESCC and the upper- and middle-third esophageal cancer share a different risk profile and show an overall decreasing trend. In developed regions, EAC and lower‑third esophageal cancer are more common, whereas in developing regions, ESCC and upper- and middle-third esophageal cancer predominate. Our findings may assist the development of tailored prevention strategies based on locally emerging patterns of esophageal cancer subtypes and relevant risk factors.

Background: Lung cancer is a leading cause of cancer‐related mortality, and its prognosis is often affected by comorbidities such as type 2 diabetes mellitus (T2DM). This study aimed to identify survival risk factors for lung cancer patients with T2DM, evaluate the predictive models, and develop a risk score system for survival prediction. Study Design and Methods: We analyzed data from 5491 lung cancer patients with T2DM from the Hong Kong Hospital Authority Data Collaboration Laboratory (HADCL) (2000–2020). Prognostic factors were evaluated using Cox proportional hazards regression. Four algorithms were used to construct survival analysis models: Cox proportional hazards regression, LASSO Cox regression, survival tree, and random survival forests (RSF). An interpretable risk scoring system was subsequently derived using the selected predictors. Results: Older age at cancer diagnosis, male sex, longer duration between T2DM diagnosis and lung cancer diagnosis (T2DM duration), smoking, alcohol consumption, history of stroke, and higher HbA1c were associated with increased mortality risk, whereas hypertension, coronary heart disease, insulin usage, anti‐lipid usage, and anti‐diabetic usage were associated with reduced mortality risk. Among the evaluated models, the RSF model demonstrated the best predictive performance, as indicated by the C‐index (0.71) and time‐dependent AUC (0.883). The developed risk score system included the following criteria: age at cancer diagnosis; T2DM duration; smoking status; HbA1c; HDL‐C; serum potassium (K) levels; LDL‐C. A score ≥ 75 classified 47.33% of patients as high‐risk, with a corresponding five‐year survival probability of 5.51%. Conclusions: Among the evaluated models, the RSF model demonstrated the best predictive performance. The developed risk scoring system may support risk stratification and identification of high‐risk patient subgroups, potentially facilitating personalized prognostic assessment and clinical management.

Purpose: Nasopharyngeal, oropharyngeal, and hypopharyngeal cancers are the three types of pharyngeal malignancies that vary in prognosis. This study aims to evaluate the global disease incidence, risk factors, and trends of pharyngeal cancer by anatomical sites. Methods: The Global Cancer Observatory, Global Burden of Disease, and Cancer Incidence in Five Continents Plus , were accessed to investigate the disease burden and related risk factors by anatomical site. Average Annual Percentage Changes were computed using Joinpoint regression to assess trends in age‐standardized rates (ASR) of incidence of pharyngeal cancer. Results: An estimated total of 316,020 (ASR=3.5) pharyngeal cancer cases were reported in 2020, with nasopharyngeal cancer being the most prevalent subtype (1.7), followed by oropharyngeal (1.1) and hypopharyngeal cancer (0.91). Nasopharyngeal, oropharyngeal, and hypopharyngeal cancers were most common in South‐Eastern Asia (ASR = 5.0), Western Europe (ASR = 2.8), and South‐Central Asia (ASR = 2.1), respectively. Higher Human Development Index (HDI), smoking, alcohol drinking, unhealthy dietary habits, hypertension, and lipid disorders were associated with higher pharyngeal cancer incidence. The results indicated a declining or constant trend in hypopharyngeal and nasopharyngeal cancers and a notable rise in oropharyngeal cancer. Conclusion: The incidence of pharyngeal cancer subtypes demonstrates significant geographical heterogeneity. While hypopharyngeal and nasopharyngeal cancers are declining or stable, oropharyngeal cancer is on a clear upward trajectory. Given the prolonged latency between risk factor exposure and clinical onset, the oropharyngeal cancer burden is projected to rise further.

Respiratory syncytial virus (RSV) represents a significant global health burden, particularly for high-risk groups such as children and older adults. This study aimed to assess the willingness of the public in Hong Kong to receive a fully funded RSV vaccine and identify associated factors. An online survey was conducted in August 2024 across Hong Kong to gather territory-wide data on sociodemographic characteristics, constructs of the health belief model (HBM), knowledge about RSV, and the willingness to receive a fully funded RSV vaccine. A total of 2,099 respondents participated, with 1,356(64.6%) expressing a willingness to receive the fully funded RSV vaccine. Factors associated with a higher likelihood of vaccine willingness included higher perceived susceptibility, higher perceived severity, higher perceived benefits, higher cues to action, higher self-efficacy, lower perceived barriers, and did not receiving government subsidies. Parallel mediation analysis revealed that knowledge about RSV was significantly associated with vaccine willingness, with HBM constructs mediating 77.8% of this association. All HBM constructs showed positive mediation effects, except for perceived barriers, which demonstrated a negative effect. Promoting knowledge about RSV may enhance acceptability of RSV vaccine. Multivariable regression revealed that government subsidy recipients were less likely to accept vaccination, while higher perceived barriers were associated with reduced willingness. The findings highlight the urgent need for targeted public health interventions and policies to enhance awareness and correct misconceptions about RSV, particularly its lack of specific antiviral treatments and the critical role of vaccination in prevention.

Background: Neglected tropical diseases (NTDs) remain a major yet unevenly addressed public health challenge in Southeast Asia, where persistent transmission is closely linked to poverty, environmental vulnerability, and health-system constraints. Understanding the evolution of the regional research landscape is essential for informing integrated disease control strategies and strengthening evidence-based policy responses. This study investigated the scientific landscape of NTD research in Southeast Asia, examining temporal trends, thematic trajectories, and patterns of collaboration using a scientometric approach. Methods: A retrospective scientometric analysis was conducted using Scopus-indexed publications (1906–2024). Eligible records included English-language original research and review articles with at least one Southeast Asian institutional affiliation. Bibliometric performance indicators and science mapping techniques were applied using Bibliometrix (R) and VOSviewer. Analyses included publication trends, citation impact, collaboration networks, keyword co-occurrence, thematic mapping, and conceptual structure modeling. Results: A total of 12,119 publications were identified, demonstrating sustained growth (AGR: 5.48%), with marked acceleration after 2000. Research productivity was concentrated in Thailand, Indonesia, and Malaysia, while several lower-income ASEAN member states exhibited minimal indexed output. International collaboration networks were dense but asymmetrical, with strong linkages to the United States, United Kingdom, Japan, and Australia, and comparatively limited intra-ASEAN integration. Thematic analyses identified dengue as the dominant motor theme, supported by strong vector biology and molecular epidemiology clusters. Helminthic and zoonotic diseases occupied more peripheral positions. Emerging domains included spatial epidemiology, genomic surveillance, and climate-linked modeling, though One Health integration remained structurally underdeveloped. Conclusion: Findings delineate a maturing yet structurally bifurcated NTD research ecosystem in Southeast Asia. Strengthening intra-regional scientific networks, diversifying funding architectures, and promoting cross-disciplinary integration will be critical to aligning research production with regional disease burdens and advancing equitable progress toward the WHO 2030 NTD Roadmap. Clinical trial registration: Not applicable.

Background: Dietary behaviors during adolescence greatly influence lifelong health habits, with patterns and nutritional deficiencies at this stage potentially carrying into adulthood and affecting long-term health. This study examined associations between sociodemographic characteristics, health literacy, mental toughness, and unhealthy dietary behaviors among Hong Kong adolescents. Methods: A cross-sectional survey was conducted between September and November 2024 with secondary school students (Grades 1–4) from 20 schools in Hong Kong. Participants completed a self-administered questionnaire assessing sociodemographic variables, socioeconomic status, dietary behaviors, physical activity, health literacy, and mental toughness. Descriptive analysis of the factors was conducted to illustrate the frequency and percentage distributions. Both crude prevalence and weighted prevalence of unhealthy dietary behaviors were calculated. An survey-weighted logistic regression model was employed to examine the factors associated with unhealthy dietary habits. Results: A total of 1,423 secondary students were included in this study, comprising 802 females (56.4%) and 621 males (43.6%). The mean age of participants is 13.56 (standard deviation [SD]: ±1.39). Over half (51.0%) of adolescents skipped breakfast daily, while 86.1% and 83.8% reported inadequate vegetable and fruit consumption, respectively. In multivariable regression analysis, breakfast skipping was positively associated with excessive social media use (aOR = 1.668, 95% CI: 1.279–2.176, p < 0.001), and inversely related to sufficient sleep (aOR = 0.579, 95% CI: 0.447–0.751, p < 0.001), higher mental toughness(aOR = 0.692, 95% CI: 0.531–0.901, p = 0.006), and a higher level of health literacy(aOR = 0.659, 95% CI: 0.507–0.857, p = 0.002). Inadequate fruit intake was linked to older age groups (aOR _{aged 13−14} = 1.497, 95%CI: 1.035–2.166, p = 0.032; aOR _aged>14 = 1.486, 95%CI:1.024–2.156, p = 0.037) and excessive screen time on game (aOR = 1.435, 95%CI:1.015–2.028, p = 0.041), while high socioeconomic status (aOR = 0.371, 95%CI: 0.213–0.643, p < 0.001) and higher level of health literacy (aOR = 0.674, 95% CI: 0.479–0.950, p = 0.024) reduced this risk. However, no significant association was found between factors and insufficient vegetable intake in the multivariable regression analysis. Conclusion: Unhealthy dietary behaviors are widespread among Hong Kong adolescents and are associated with modifiable behavioral, psychological, and sociodemographic factors. Targeted multi-level interventions focusing on health literacy, physical activity, and screen time regulation are recommended.

Background: The Hong Kong Government developed the Reference Framework for Preventive Care for Older Adults (RF) to provide evidence-based recommendations for preventive care in the primary care setting. However, no study has systematically evaluated the adoption and awareness of this framework among primary care physicians (PCPs). Objective: This study aimed to explore PCPs' perceptions of the RF and identify barriers and facilitators to its adoption in primary care settings. Methods: This cross-sectional qualitative study involved interviews with 40 PCPs in Hong Kong to assess their views on the RF’s adoption and implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis, focusing on five domains: intervention characteristics, outer setting, inner setting, individual characteristics, and implementation process. Results: Relative advantage (65%, n = 26), innovation design (45%, n = 18), and access to knowledge and information (70%, n = 28) were the facilitators that mostly discussed by interviewee. By contrast, interviewees also raised concerns regarding policy and legal (n=29, 73%) and availability of resources (n=29, 73%) in the implementation of the RF. In general, participants acknowledged the RF's evidence-based foundation and comprehensive design, appreciating its potential to improve care for older adults. However, barriers included the complexity and limited personalization of the RF, competing clinical priorities, time constraints, and resource limitations. Government support and policy initiatives facilitated engagement, but clearer integration into existing workflows and stronger promotion were needed. Tailored updates, user feedback, and technological enhancements were seen as essential for improving the RF’s usability and ensuring its relevance in clinical practice. Conclusions: This study highlights that while the RF has potential to improve preventive care in Hong Kong’s primary care setting, its adoption is constrained by systemic, organizational, and individual barriers. To ensure its successful integration, flexible implementation, institutional support, tailored incentives, and enhanced clinician and patient engagement are essential. These findings offer practical implications for policymakers and healthcare practitioners to refine and promote the RF in routine consultations, and underscore the need for future research to test theory-informed implementation strategies. Furthermore, this study offered novel contributions to the CFIR literatures in systematically investigate physician perspectives on RF for the older adult population within the distinct socio-cultural and structural context of Hong Kong, COVID-19 pandemic impact to the current healthcare system and actionable implementation strategies for Asian populations. Applying the findings from this study, the CFIR-ERIC Matching Tool could be used to address the specific barriers identified in this study and improving implementation outcomes across various healthcare settings.