Publications by authors named "Huwen Wang"

15 Publications

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Longitudinal predictors for incidence of internet gaming disorder among adolescents: The roles of time spent on gaming and depressive symptoms.

J Adolesc 2021 Jul 7;92:1-9. Epub 2021 Jul 7.

School of Public Health, Shanghai Jiao Tong University School of Medicine, No 227 S Chongqing Road, Shanghai, 200025, China. Electronic address:

Introduction: Internet gaming disorder (IGD) was popular among adolescents worldwide, but whether some associated factors could contribute to the development of IGD was unclear. This longitudinal study explored the temporal stability of IGD over one year and determined the predictors for IGD incidence.

Methods: Participants were 1121 adolescents from six junior high schools in Shanghai, China (50.6% males; median age = 13.0 years). The baseline and follow-up questionnaire survey measured IGD, time spent on gaming, depressive symptoms, insomnia condition, substance use and background variables from 7th to 8th grade. Multivariate logistic regression analysis was conducted to test the associations between other factors and IGD incidence.

Results: IGD incidence was 7.7% at one-year follow-up. Gender, family financial condition, parental educational level, time spent on gaming, insomnia condition and depressive symptoms were associated with IGD incidence in univariate analysis, whereas only gender, family financial condition, time spent on gaming and depressive symptoms were associated with IGD incidence in multivariate logistic regression.

Conclusions: IGD might persist for years during adolescence. After controlling for sociodemographic factors, time spent on gaming and depressive symptoms were independent predictors for IGD incidence.
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http://dx.doi.org/10.1016/j.adolescence.2021.06.008DOI Listing
July 2021

Evaluating the validity and reliability of the Chinese entrapment scale and the relationship to depression among men who have sex with men in Shanghai, China.

BMC Psychiatry 2021 07 2;21(1):328. Epub 2021 Jul 2.

School of Public Health, Shanghai Jiao Tong University School of Medicine, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.

Background: Perception of entrapment can emerge when someone feels trapped in an aversive situation and incapable of escape. Depression is closely related to the construct of entrapment. In China, men who have sex with men (MSM) have a high prevalence of depression; therefore, a tool to evaluate entrapment in this population is needed. We evaluated the validity and reliability of the Chinese version of the entrapment scale (ES) and the relationship to depression among MSM in Shanghai, China.

Methods: We recruited 304 MSM from four districts in Shanghai, China. Participants completed health behavior questionnaires that included baseline information and psychological measurements such as the ES and Patient Health Questionnaire (PHQ-9). The sample was randomly divided into two groups for exploratory factor analysis (n = 143) and confirmatory factor analysis (n = 161). Criterion validity was tested to explore the correlation between the ES and PHQ-9 scores. The reliability of the ES was evaluated with internal consistency reliability (Cronbach's α coefficient) and split-half reliability (Spearman-Brown coefficient). We performed hierarchical regression analysis to determine the variance explained of entrapment to predicting depressive symptoms after adjusting for sociodemographic factors. Finally, receiver operator characteristic curve analysis was performed to measure the optimal ES cut-off value for predicting depression.

Results: Factor analysis showed the ES had one principal component, and one-dimensional scale had more acceptable model fit indices than two-dimensional model. The correlation coefficient between the ES and PHQ-9 scores was 0.756 (P < 0.01). The Cronbach's α coefficient was 0.970 and the Spearman-Brown coefficient was 0.976. ES scores significantly predicted an additional 45.1% of depressive symptoms after controlling for sociodemographic characteristics in the MSM population (β = 0.689, P < 0.001). The optimum cut-off value was 23, which had a sensitivity of 70% and a specificity of 85.4%.

Conclusions: The Chinese version of the ES has good validity and reliability in the MSM population in Shanghai, and can be used to evaluate perception of entrapment among MSM. The findings confirmed an association between entrapment and depression.
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http://dx.doi.org/10.1186/s12888-021-03333-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254295PMC
July 2021

Limited role for meteorological factors on the variability in COVID-19 incidence: A retrospective study of 102 Chinese cities.

PLoS Negl Trop Dis 2021 02 24;15(2):e0009056. Epub 2021 Feb 24.

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

While many studies have focused on identifying the association between meteorological factors and the activity of COVID-19, we argue that the contribution of meteorological factors to a reduction of the risk of COVID-19 was minimal when the effects of control measures were taken into account. In this study, we assessed how much variability in COVID-19 activity is attributable to city-level socio-demographic characteristics, meteorological factors, and the control measures imposed. We obtained the daily incidence of COVID-19, city-level characteristics, and meteorological data from a total of 102 cities situated in 27 provinces/municipalities outside Hubei province in China from 1 January 2020 to 8 March 2020, which largely covers almost the first wave of the epidemic. Generalized linear mixed effect models were employed to examine the variance in the incidence of COVID-19 explained by different combinations of variables. According to the results, including the control measure effects in a model substantially raised the explained variance to 45%, which increased by >40% compared to the null model that did not include any covariates. On top of that, including temperature and relative humidity in the model could only result in < 1% increase in the explained variance even though the meteorological factors showed a statistically significant association with the incidence rate of COVID-19. In conclusion, we showed that very limited variability of the COVID-19 incidence was attributable to meteorological factors. Instead, the control measures could explain a larger proportion of variance.
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http://dx.doi.org/10.1371/journal.pntd.0009056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904227PMC
February 2021

Limited role for meteorological factors on the variability in COVID-19 incidence: A retrospective study of 102 Chinese cities.

PLoS Negl Trop Dis 2021 02 24;15(2):e0009056. Epub 2021 Feb 24.

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

While many studies have focused on identifying the association between meteorological factors and the activity of COVID-19, we argue that the contribution of meteorological factors to a reduction of the risk of COVID-19 was minimal when the effects of control measures were taken into account. In this study, we assessed how much variability in COVID-19 activity is attributable to city-level socio-demographic characteristics, meteorological factors, and the control measures imposed. We obtained the daily incidence of COVID-19, city-level characteristics, and meteorological data from a total of 102 cities situated in 27 provinces/municipalities outside Hubei province in China from 1 January 2020 to 8 March 2020, which largely covers almost the first wave of the epidemic. Generalized linear mixed effect models were employed to examine the variance in the incidence of COVID-19 explained by different combinations of variables. According to the results, including the control measure effects in a model substantially raised the explained variance to 45%, which increased by >40% compared to the null model that did not include any covariates. On top of that, including temperature and relative humidity in the model could only result in < 1% increase in the explained variance even though the meteorological factors showed a statistically significant association with the incidence rate of COVID-19. In conclusion, we showed that very limited variability of the COVID-19 incidence was attributable to meteorological factors. Instead, the control measures could explain a larger proportion of variance.
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http://dx.doi.org/10.1371/journal.pntd.0009056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904227PMC
February 2021

Limited role for meteorological factors on the variability in COVID-19 incidence: A retrospective study of 102 Chinese cities.

PLoS Negl Trop Dis 2021 02 24;15(2):e0009056. Epub 2021 Feb 24.

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

While many studies have focused on identifying the association between meteorological factors and the activity of COVID-19, we argue that the contribution of meteorological factors to a reduction of the risk of COVID-19 was minimal when the effects of control measures were taken into account. In this study, we assessed how much variability in COVID-19 activity is attributable to city-level socio-demographic characteristics, meteorological factors, and the control measures imposed. We obtained the daily incidence of COVID-19, city-level characteristics, and meteorological data from a total of 102 cities situated in 27 provinces/municipalities outside Hubei province in China from 1 January 2020 to 8 March 2020, which largely covers almost the first wave of the epidemic. Generalized linear mixed effect models were employed to examine the variance in the incidence of COVID-19 explained by different combinations of variables. According to the results, including the control measure effects in a model substantially raised the explained variance to 45%, which increased by >40% compared to the null model that did not include any covariates. On top of that, including temperature and relative humidity in the model could only result in < 1% increase in the explained variance even though the meteorological factors showed a statistically significant association with the incidence rate of COVID-19. In conclusion, we showed that very limited variability of the COVID-19 incidence was attributable to meteorological factors. Instead, the control measures could explain a larger proportion of variance.
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http://dx.doi.org/10.1371/journal.pntd.0009056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904227PMC
February 2021

Estimation of reproduction numbers of COVID-19 in typical countries and epidemic trends under different prevention and control scenarios.

Front Med 2020 Oct 28;14(5):613-622. Epub 2020 May 28.

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

The coronavirus disease 2019 (COVID-19) has become a life-threatening pandemic. The epidemic trends in different countries vary considerably due to different policy-making and resources mobilization. We calculated basic reproduction number (R) and the time-varying estimate of the effective reproductive number (R) of COVID-19 by using the maximum likelihood method and the sequential Bayesian method, respectively. European and North American countries possessed higher R and unsteady R fluctuations, whereas some heavily affected Asian countries showed relatively low R and declining R now. The numbers of patients in Africa and Latin America are still low, but the potential risk of huge outbreaks cannot be ignored. Three scenarios were then simulated, generating distinct outcomes by using SEIR (susceptible, exposed, infectious, and removed) model. First, evidence-based prompt responses yield lower transmission rate followed by decreasing R. Second, implementation of effective control policies at a relatively late stage, in spite of huge casualties at early phase, can still achieve containment and mitigation. Third, wisely taking advantage of the time-window for developing countries in Africa and Latin America to adopt adequate measures can save more people's life. Our mathematical modeling provides evidence for international communities to develop sound design of containment and mitigation policies for COVID-19.
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http://dx.doi.org/10.1007/s11684-020-0787-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255828PMC
October 2020

Phase- and epidemic region-adjusted estimation of the number of coronavirus disease 2019 cases in China.

Front Med 2020 Apr 31;14(2):199-209. Epub 2020 Mar 31.

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

The outbreak of the coronavirus disease 2019 was first reported in Wuhan in December 2019 and gradually spread to other areas in China. After implementation of prevention and control measures, the estimation of the epidemic trend is needed. A phase- and region-adjusted SEIR model was applied for modeling and predicting the number of cases in Wuhan, Hubei Province and regions outside Hubei Province in China. The estimated number of infections could reach its peak in late February 2020 in Wuhan and Hubei Province, which is 55 303-84 520 and 83 944-129 312, respectively, while the epidemic peaks in regions outside Hubei Province in China could appear on February 13, 2020 with the estimated 13 035-19 108 cases. According to the estimation, the outbreak would abate in March and April all over China. Current estimation provided evidence for planned work resumption under stringent prevention and control in China to further support the fight against the epidemic. Nevertheless, there is still possibility of the second outbreak brought by the work resumption and population migration, especially from Hubei Province and high intensity cities outside Hubei Province. Strict prevention and control measures still need to be considered in the regions with high intensity of epidemic and densely-populated cities.
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http://dx.doi.org/10.1007/s11684-020-0768-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148426PMC
April 2020

Phase- and epidemic region-adjusted estimation of the number of coronavirus disease 2019 cases in China.

Front Med 2020 Apr 31;14(2):199-209. Epub 2020 Mar 31.

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

The outbreak of the coronavirus disease 2019 was first reported in Wuhan in December 2019 and gradually spread to other areas in China. After implementation of prevention and control measures, the estimation of the epidemic trend is needed. A phase- and region-adjusted SEIR model was applied for modeling and predicting the number of cases in Wuhan, Hubei Province and regions outside Hubei Province in China. The estimated number of infections could reach its peak in late February 2020 in Wuhan and Hubei Province, which is 55 303-84 520 and 83 944-129 312, respectively, while the epidemic peaks in regions outside Hubei Province in China could appear on February 13, 2020 with the estimated 13 035-19 108 cases. According to the estimation, the outbreak would abate in March and April all over China. Current estimation provided evidence for planned work resumption under stringent prevention and control in China to further support the fight against the epidemic. Nevertheless, there is still possibility of the second outbreak brought by the work resumption and population migration, especially from Hubei Province and high intensity cities outside Hubei Province. Strict prevention and control measures still need to be considered in the regions with high intensity of epidemic and densely-populated cities.
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http://dx.doi.org/10.1007/s11684-020-0768-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148426PMC
April 2020

COVID-19 containment: China provides important lessons for global response.

Front Med 2020 Apr 25;14(2):215-219. Epub 2020 Mar 25.

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

The world must act fast to contain wider international spread of the epidemic of COVID-19 now. The unprecedented public health efforts in China have contained the spread of this new virus. Measures taken in China are currently proven to reduce human-to-human transmission successfully. We summarized the effective intervention and prevention measures in the fields of public health response, clinical management, and research development in China, which may provide vital lessons for the global response. It is really important to take collaborative actions now to save more lives from the pandemic of COVID-19.
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http://dx.doi.org/10.1007/s11684-020-0766-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095399PMC
April 2020

Phase-adjusted estimation of the number of Coronavirus Disease 2019 cases in Wuhan, China.

Cell Discov 2020 24;6:10. Epub 2020 Feb 24.

1School of Public Health, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China.

An outbreak of clusters of viral pneumonia due to a novel coronavirus (2019-nCoV/SARS-CoV-2) happened in Wuhan, Hubei Province in China in December 2019. Since the outbreak, several groups reported estimated of Coronavirus Disease 2019 (COVID-19) and generated valuable prediction for the early phase of this outbreak. After implementation of strict prevention and control measures in China, new estimation is needed. An infectious disease dynamics SEIR (Susceptible, Exposed, Infectious, and Removed) model was applied to estimate the epidemic trend in Wuhan, China under two assumptions of . In the first assumption, was assumed to maintain over 1. The estimated number of infections would continue to increase throughout February without any indication of dropping with  = 1.9, 2.6, or 3.1. The number of infections would reach 11,044, 70,258, and 227,989, respectively, by 29 February 2020. In the second assumption, was assumed to gradually decrease at different phases from high level of transmission (  = 3.1, 2.6, and 1.9) to below 1 (  = 0.9 or 0.5) owing to increasingly implemented public health intervention. Several phases were divided by the dates when various levels of prevention and control measures were taken in effect in Wuhan. The estimated number of infections would reach the peak in late February, which is 58,077-84,520 or 55,869-81,393. Whether or not the peak of the number of infections would occur in February 2020 may be an important index for evaluating the sufficiency of the current measures taken in China. Regardless of the occurrence of the peak, the currently strict measures in Wuhan should be continuously implemented and necessary strict public health measures should be applied in other locations in China with high number of COVID-19 cases, in order to reduce to an ideal level and control the infection.
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http://dx.doi.org/10.1038/s41421-020-0148-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039910PMC
February 2020

Applying the information-motivation-behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients.

BMC Public Health 2020 Feb 6;20(1):198. Epub 2020 Feb 6.

Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China.

Background: The prevalence of osteoporosis (OP) is rapidly increasing. Healthy behaviors are crucial for the management of OP. Application of the information-motivation-behavioral skills (IMB) model has been verified in various chronic diseases, but this model has not been investigated for behavioral interventions among people with OP. This study aimed to examine factors influencing OP self-management behavior and their interaction paths based on the IMB model.

Methods: We conducted a cross-sectional study using a convenience sampling method in 20 community health service centers in Shanghai, China. Predictive relationships between IMB model variables and self-management behaviors were evaluated using an anonymous questionnaire. Structural equation modeling was used to test the IMB model.

Results: In total, 571 participants completed the questionnaire, of which 461 (80.7%) were female. Participants' mean age was 68.8 ± 10.1 years. Only 101 (17.7%) participants were classified as having better OP self-management behaviors. The model demonstrated the data had an acceptable fit. Paths from information to self-efficacy (β = 0.156, P < 0.001) and self-management behaviors (β = 0.236, P < 0.001), from health beliefs to self-efficacy (β = 0.266, P < 0.001), from medical system support to self-efficacy (β = 0.326, P < 0.001) and self-management behaviors (β = 0.230, P < 0.001), and from self-efficacy to self-management behaviors (β = 0.376, P < 0.001) were all significant and in the predicted direction.

Conclusion: This study validated the utility of the IMB model for OP self-management behaviors in this population. Middle-aged and older adult patients with OP have poor self-management behaviors. Enhanced knowledge about OP and is important for improving self-management behaviors.
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http://dx.doi.org/10.1186/s12889-020-8292-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006415PMC
February 2020

How involuntary subordination and social support influence the association between self-esteem and depression: a moderated mediation model.

BMC Psychiatry 2019 12 11;19(1):390. Epub 2019 Dec 11.

School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.

Background: In China, young migrants are at elevated risk of mental health problems, such as depression. The influence of self-esteem on depression is well acknowledged. We examined correlates of depression and their mediating and moderating role in the association between self-esteem and depression to promote a better understanding of depression prevention among young migrants.

Methods: We conducted a cross-sectional study among young Chinese migrants. A moderated mediation model was used to test the combined effect of involuntary subordination and social support on the association between self-esteem and depression. The Johnson-Neyman method was used to identify the range of scores for which social support acted as a moderator.

Results: A total of 572 participants completed questionnaires. The median depression score was 19 (interquartile range: 14). Self-esteem had a negative effect on involuntary subordination (β = - 2.1440, p < 0.001). Involuntary subordination (β = 0.2406, p < 0.001), self-esteem (β = - 0.3870, p < 0.01), and social support (β = - 0.1221, p < 0.01) all had significant effects on depression. The effect of involuntary subordination on depression was moderated by social support (β = - 0.0041, p < 0.05), and the effect decreased as social support scores increased.

Conclusions: Our results indicated a mediating role of involuntary subordination and a moderating role of social support in the association between self-esteem and depression among young Chinese migrants. Future intervention strategies should focus on these factors to reduce depressive symptoms.
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http://dx.doi.org/10.1186/s12888-019-2330-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907199PMC
December 2019

Feelings of Entrapment and Defeat Mediate the Association Between Self-Esteem and Depression Among Transgender Women Sex Workers in China.

Front Psychol 2019 4;10:2241. Epub 2019 Oct 4.

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Transgender women sex workers have a high prevalence of depression. Low self-esteem and subsequent involuntary subordination (characterized by feelings of defeat and entrapment) are well-documented risk factors for depression. The object of the present study was to investigate the mediating effect of feelings of entrapment and defeat on the relationship between self-esteem and depression among transgender women sex workers in China.

Methods: A cross-sectional study was conducted in Shenyang and Guangzhou in 2017. Participants were 198 transgender women sex workers who completed a structured questionnaire assessing background characteristics, self-esteem, feelings of entrapment and defeat, and depression. Linear regression was used to test the mediation hypotheses.

Results: Of participants, 25.25% exhibited high levels of depression. Self-esteem scores were negatively correlated with depression scores ( = -0.54, < 0.05, = 0.23), defeat scores ( = -1.68, < 0.05, = 0.31), and entrapment scores ( = -1.67, < 0.05, = 0.25). In the mediation hypothesis model, entrapment ( = 0.21, < 0.05) and defeat ( = 0.08, < 0.05) had a complete mediating effect on the relationship between self-esteem (Spearman's = -0.06, = 0.36) and depression ( = 0.61).

Conclusion: Feelings of entrapment and defeat mediated the association between self-esteem and depression. More focus is needed on monitoring feelings of defeat and entrapment among transgender women sex workers to mitigate the risk of depression.
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http://dx.doi.org/10.3389/fpsyg.2019.02241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788383PMC
October 2019

Exploring effects of self-management on glycemic control using a modified information-motivation-behavioral skills model in type 2 diabetes mellitus patients in Shanghai, China: A cross-sectional study.

J Diabetes 2018 Sep 23;10(9):734-743. Epub 2018 Mar 23.

Department of Community Health and Behavioral Medicine, School of Public Health, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Background: The original information-motivation-behavioral skills (IMB) model has been verified in type 2 diabetes mellitus (T2DM) patients, but the effects of the model on glycemic control remain unclear. The aim of this study was to modify the IMB model to explore the effects of self-management on glycemic control in T2DM patients in Shanghai, China.

Methods: A cross-sectional study was conducted on participants recruited using a convenience sampling method between June and August 2015 in three tertiary hospitals and four community health service centers; 796 participants meeting the inclusion criteria (age ≥18 years and a diagnosis of T2DM) completed a questionnaire and blood test for glycemic control. Structural equation models were used to test the IMB framework.

Results: The modified model demonstrated an acceptable fit of the data. Paths from information to self-management behaviors (β = 0.119, P = 0.001) and HbA1c (β = -0.140, P < 0.001), from motivation to behavioral skills (β = 0.670, P < 0.001), from behavioral skills to self-management behaviors (β = 0.562, P < 0.001), and from self-management behaviors to HbA1c (β = -0.343, P < 0.001) were all significant and in the predicted direction. Information and motivation varied with each other (r = 0.350, P < 0.001).

Conclusions: Glycemic control can be incorporated into the IMB model. The utility of the modified model in the study population is validated. Type 2 diabetes mellitus patients with poor control of glucose levels may be a better target population for application of the modified IMB model.
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http://dx.doi.org/10.1111/1753-0407.12655DOI Listing
September 2018
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