Int. J. Epidemiol. Advance Access published January 29, 2015 International Journal of Epidemiology, 2015, 1–13 doi: 10.1093/ije/dyu257 Cohort Profile
Cohort Profile
Cohort Profile: FAMILY Cohort Downloaded from http://ije.oxfordjournals.org/ at University of Texas at San Antonio on November 17, 2015
Gabriel M Leung,1 Michael Y Ni1,* Paul TK Wong,1,2 Paul H Lee,1,3 Brandford HY Chan,1 Sunita M Stewart,4 C Mary Schooling,1,5 Janice M Johnston,1 Wendy WT Lam,1 Sophia SC Chan,6 Ian McDowell,7 and Tai Hing Lam1 1
School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Early Psychosis Foundation (EPISO), Hong Kong, 3School of Nursing, Hong Kong Polytechnic University, Hong Kong, 4Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 5School of Public Health, Hunter College and CUNY, New York, NY, 6School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong and 7Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON 2
*Corresponding author. School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, 7 Sassoon Road, Hong Kong SAR, People’s Republic of China. E-mail: [email protected] Accepted 2 December 2014
Summary The FAMILY Cohort is a longitudinal study of health, happiness and family harmony (the ‘3Hs’) at individual, household and neighbourhood levels in Hong Kong. Using a family living in the same household as the sampling unit, the study (n ¼ 20 279 households and 46 001 participants) consists of a composite sample from several sources, including: a population-representative random core sample (n ¼ 8115 households and 19 533 participants); the first-degree relatives of this sample (n ¼ 4658 households and 11 063 participants); and oversampling in three new towns (n ¼ 2891 households and 7645 participants) and in three population subgroups with anticipated changes in family dynamics (n ¼ 909 households and 2160 participants). Two household visits and five telephone- or web-based follow-ups were conducted over 2009–14. Data collected include socio-demographics, anthropometrics, lifestyle and behavioural factors, measures of social capital, and standardized instruments assessing the 3Hs. We also intend to collect biomaterials in future. The analytical plan includes multilevel inter-relations of the 3Hs for individuals, households, extended families and neighbourhoods. With Hong Kong’s recent history of socioeconomic development, the FAMILY Cohort is therefore relevant to global urban populations currently experiencing similarly rapid economic growth. The FAMILY Cohort is currently set up as a supported access resource.
C The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association V
1
2
International Journal of Epidemiology, 2015, Vol. 0, No. 0
Key Messages • The FAMILY Cohort includes all eligible members in a family, which may involve multiple households, and thus en-
ables the study of the family as a complex system. • This cohort aims to track the dynamics of health and well-being in Hong Kong longitudinally through the study of
households as a unit of analysis, given the territory’s unique blend of a Confucian heritage and a colonial past in the postmodern present as the most Westernized and urbanized city of China. • A triaxial organizing conceptual framework of health, happiness and harmony underpins the design of the cohort
study. • The cohort developed standardized scales to measure family harmony as a factor potentially influencing health
status.
The FAMILY Project, supported by the Hong Kong Jockey Club Charities Trust through a grant to the University of Hong Kong’s School of Public Health, was conceived in 2007 as the first large-scale programme to assess and promote family health, happiness and harmony (the ‘3Hs’) in Hong Kong. The Project was established in part to respond to important changes in the dynamics and distribution of social and individual well-being in Hong Kong. These followed a period of significant social change that included: a declining fertility rate;1 the Asian financial crisis of the late 1990s; an increasing Gini coefficient;2 changing patterns of social disparities in chronic diseases3 and mortality4 with economic development; the repatriation of Hong Kong to China in 1997; and the severe acute respiratory syndrome (SARS) epidemic in 2003. The unemployment rate in Hong Kong reached a historical high of 7.9% in 2003, and suicide incidence rose to 18.6 per 100 000, a 50% increase over the 1997 figure.5 Yet Hong Kong continues to have one of the longest life expectancies in the world, a remarkable feat given that the population experienced socioeconomic development from pre- to post-industrial conditions within just one lifetime. Determinants of health in Hong Kong are therefore of great relevance to global populations currently experiencing similarly rapid economic growth. As the cohort is based in a recently transitioned population, differences in life course influences such as: behaviours; family patterns and dynamics; socioeconomic environment; and genetic variants6 can be leveraged to test novel hypotheses to further our understanding of the 3Hs. Moreover, by comparing associations observed in populations where confounding structures differ, we can explore residual confounding and improve causal inference.7 In sum, Hong Kong is a ‘social laboratory’ that could act as an epidemiological sentinel for other rapidly developing regions around the world but particularly in China and Asia. A Social Development Index used to track social change and the resulting strains in 14 different social sectors of
Hong Kong8 has demonstrated progress in almost all sectors between 1998 and 2008, with the exception of the Family Solidarity Index. The Family Solidarity Index, a composite score covering family tension, divorce and violence, showed a large decline from 1998 to 2008.9 In this context, the overall goal of the FAMILY Project was to guide upstream interventions, based on a public health approach, that would improve individual and family 3Hs.10 To design such interventions, we needed to better understand how the family environment affects the health of individuals and of the family as a whole. The first step was to develop a cohort study of local families (where 93.6% of the population are ethnic Chinese).11 Family can impact on the individual’s health by shaping the biological and environmental influences across the life course.6 Although family functioning has been extensively studied in European and North American literature, research on this topic in a Chinese context is limited.12 The groups of individuals who identify themselves as Chinese are by no means homogeneous; they live in contexts that are diverse with regard to political and economic outlook and many aspects of daily culture. Yet Chinese around the world also share a rich cultural and traditional heritage and have systems of values, beliefs and principles recognizably distinct from individualistic and many other collective cultures.13,14 However, few of these value systems have received the attention they deserve in culture-specific or cross-cultural research.15 It was these shared values that guided our focus on the core of the family. The three dominant schools of thought in the Chinese tradition—Confucian, Buddhist and Taoist—all centre around the essence of a holistic being, completed by achieving harmony among individuals and harmony between Man and Nature.16 Accordingly, in a traditional Chinese society, personal desires may be suppressed in the interests of maintaining social harmony and order; and it is more important to maintain harmony in the family and
Downloaded from http://ije.oxfordjournals.org/ at University of Texas at San Antonio on November 17, 2015
Why was the cohort set up?
International Journal of Epidemiology, 2015, Vol. 0, No. 0
Who is in the cohort? The sampling unit was a family living in the same household, operationally defined as all individuals who live at the same address and identify each other as family members. The Hong Kong census defines a household in terms of a group of persons who live together, need not be related but make common provision for essentials for living. Household composition in Hong Kong includes 66.3% nuclear family households, 14.5% relative households (couple and at least one of their parents), 17.1% single-person households, and 2.1% non-relative households (comprising unrelated persons).11 Domestic helpers (7.9% of Hong Kong households had at least one foreign domestic helper in 2006, who was required to lodge within the household)17 were not included in the study. All family members aged 10 years or older were eligible and invited to participate. Those aged 15 years or above completed the main questionnaire, whereas 10 to 14-year-olds completed a modified survey designed for adolescents. A household was enrolled in the cohort when all eligible members agreed to participate in the baseline survey. As the study aimed to examine family cultures specific to Hong Kong Chinese and 89.5% of the local population speak the Chinese dialect of Cantonese,11 only those who could
understand and respond to the survey interview in Cantonese were eligible. The cohort was compiled as a composite sample from several sources to cover about 20 000 households, or just under 1% of Hong Kong’s 2 368 796 households. First, the random core sample was obtained using stratified random sampling, where residential addresses were randomly sampled in all 18 districts in Hong Kong with sample sizes proportionate to each of the district populations. Compared with Hong Kong census statistics from 2011, households living in public housing and households with low monthly household income were over-represented in the random core sample. Therefore for subsequent analyses, we weighted the random core sample by housing type and monthly household income. Table 1 compares the weighted random core sample with the census statistics from 2011. Most of the characteristics show small Cohen’s w effect sizes (chi*
0.99 (0.92-1.07) 1.15 (1.08-1.23) 0.92 (0.86-0.98) 0.93 (0.86-1.00) 1.30 (1.22-1.38) 0.95 (0.89-1.02)
0.80
Cohort Profile
Cohort Profile: FAMILY Cohort Downloaded from http://ije.oxfordjournals.org/ at University of Texas at San Antonio on November 17, 2015
Gabriel M Leung,1 Michael Y Ni1,* Paul TK Wong,1,2 Paul H Lee,1,3 Brandford HY Chan,1 Sunita M Stewart,4 C Mary Schooling,1,5 Janice M Johnston,1 Wendy WT Lam,1 Sophia SC Chan,6 Ian McDowell,7 and Tai Hing Lam1 1
School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Early Psychosis Foundation (EPISO), Hong Kong, 3School of Nursing, Hong Kong Polytechnic University, Hong Kong, 4Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 5School of Public Health, Hunter College and CUNY, New York, NY, 6School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong and 7Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON 2
*Corresponding author. School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, 7 Sassoon Road, Hong Kong SAR, People’s Republic of China. E-mail: [email protected] Accepted 2 December 2014
Summary The FAMILY Cohort is a longitudinal study of health, happiness and family harmony (the ‘3Hs’) at individual, household and neighbourhood levels in Hong Kong. Using a family living in the same household as the sampling unit, the study (n ¼ 20 279 households and 46 001 participants) consists of a composite sample from several sources, including: a population-representative random core sample (n ¼ 8115 households and 19 533 participants); the first-degree relatives of this sample (n ¼ 4658 households and 11 063 participants); and oversampling in three new towns (n ¼ 2891 households and 7645 participants) and in three population subgroups with anticipated changes in family dynamics (n ¼ 909 households and 2160 participants). Two household visits and five telephone- or web-based follow-ups were conducted over 2009–14. Data collected include socio-demographics, anthropometrics, lifestyle and behavioural factors, measures of social capital, and standardized instruments assessing the 3Hs. We also intend to collect biomaterials in future. The analytical plan includes multilevel inter-relations of the 3Hs for individuals, households, extended families and neighbourhoods. With Hong Kong’s recent history of socioeconomic development, the FAMILY Cohort is therefore relevant to global urban populations currently experiencing similarly rapid economic growth. The FAMILY Cohort is currently set up as a supported access resource.
C The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association V
1
2
International Journal of Epidemiology, 2015, Vol. 0, No. 0
Key Messages • The FAMILY Cohort includes all eligible members in a family, which may involve multiple households, and thus en-
ables the study of the family as a complex system. • This cohort aims to track the dynamics of health and well-being in Hong Kong longitudinally through the study of
households as a unit of analysis, given the territory’s unique blend of a Confucian heritage and a colonial past in the postmodern present as the most Westernized and urbanized city of China. • A triaxial organizing conceptual framework of health, happiness and harmony underpins the design of the cohort
study. • The cohort developed standardized scales to measure family harmony as a factor potentially influencing health
status.
The FAMILY Project, supported by the Hong Kong Jockey Club Charities Trust through a grant to the University of Hong Kong’s School of Public Health, was conceived in 2007 as the first large-scale programme to assess and promote family health, happiness and harmony (the ‘3Hs’) in Hong Kong. The Project was established in part to respond to important changes in the dynamics and distribution of social and individual well-being in Hong Kong. These followed a period of significant social change that included: a declining fertility rate;1 the Asian financial crisis of the late 1990s; an increasing Gini coefficient;2 changing patterns of social disparities in chronic diseases3 and mortality4 with economic development; the repatriation of Hong Kong to China in 1997; and the severe acute respiratory syndrome (SARS) epidemic in 2003. The unemployment rate in Hong Kong reached a historical high of 7.9% in 2003, and suicide incidence rose to 18.6 per 100 000, a 50% increase over the 1997 figure.5 Yet Hong Kong continues to have one of the longest life expectancies in the world, a remarkable feat given that the population experienced socioeconomic development from pre- to post-industrial conditions within just one lifetime. Determinants of health in Hong Kong are therefore of great relevance to global populations currently experiencing similarly rapid economic growth. As the cohort is based in a recently transitioned population, differences in life course influences such as: behaviours; family patterns and dynamics; socioeconomic environment; and genetic variants6 can be leveraged to test novel hypotheses to further our understanding of the 3Hs. Moreover, by comparing associations observed in populations where confounding structures differ, we can explore residual confounding and improve causal inference.7 In sum, Hong Kong is a ‘social laboratory’ that could act as an epidemiological sentinel for other rapidly developing regions around the world but particularly in China and Asia. A Social Development Index used to track social change and the resulting strains in 14 different social sectors of
Hong Kong8 has demonstrated progress in almost all sectors between 1998 and 2008, with the exception of the Family Solidarity Index. The Family Solidarity Index, a composite score covering family tension, divorce and violence, showed a large decline from 1998 to 2008.9 In this context, the overall goal of the FAMILY Project was to guide upstream interventions, based on a public health approach, that would improve individual and family 3Hs.10 To design such interventions, we needed to better understand how the family environment affects the health of individuals and of the family as a whole. The first step was to develop a cohort study of local families (where 93.6% of the population are ethnic Chinese).11 Family can impact on the individual’s health by shaping the biological and environmental influences across the life course.6 Although family functioning has been extensively studied in European and North American literature, research on this topic in a Chinese context is limited.12 The groups of individuals who identify themselves as Chinese are by no means homogeneous; they live in contexts that are diverse with regard to political and economic outlook and many aspects of daily culture. Yet Chinese around the world also share a rich cultural and traditional heritage and have systems of values, beliefs and principles recognizably distinct from individualistic and many other collective cultures.13,14 However, few of these value systems have received the attention they deserve in culture-specific or cross-cultural research.15 It was these shared values that guided our focus on the core of the family. The three dominant schools of thought in the Chinese tradition—Confucian, Buddhist and Taoist—all centre around the essence of a holistic being, completed by achieving harmony among individuals and harmony between Man and Nature.16 Accordingly, in a traditional Chinese society, personal desires may be suppressed in the interests of maintaining social harmony and order; and it is more important to maintain harmony in the family and
Downloaded from http://ije.oxfordjournals.org/ at University of Texas at San Antonio on November 17, 2015
Why was the cohort set up?
International Journal of Epidemiology, 2015, Vol. 0, No. 0
Who is in the cohort? The sampling unit was a family living in the same household, operationally defined as all individuals who live at the same address and identify each other as family members. The Hong Kong census defines a household in terms of a group of persons who live together, need not be related but make common provision for essentials for living. Household composition in Hong Kong includes 66.3% nuclear family households, 14.5% relative households (couple and at least one of their parents), 17.1% single-person households, and 2.1% non-relative households (comprising unrelated persons).11 Domestic helpers (7.9% of Hong Kong households had at least one foreign domestic helper in 2006, who was required to lodge within the household)17 were not included in the study. All family members aged 10 years or older were eligible and invited to participate. Those aged 15 years or above completed the main questionnaire, whereas 10 to 14-year-olds completed a modified survey designed for adolescents. A household was enrolled in the cohort when all eligible members agreed to participate in the baseline survey. As the study aimed to examine family cultures specific to Hong Kong Chinese and 89.5% of the local population speak the Chinese dialect of Cantonese,11 only those who could
understand and respond to the survey interview in Cantonese were eligible. The cohort was compiled as a composite sample from several sources to cover about 20 000 households, or just under 1% of Hong Kong’s 2 368 796 households. First, the random core sample was obtained using stratified random sampling, where residential addresses were randomly sampled in all 18 districts in Hong Kong with sample sizes proportionate to each of the district populations. Compared with Hong Kong census statistics from 2011, households living in public housing and households with low monthly household income were over-represented in the random core sample. Therefore for subsequent analyses, we weighted the random core sample by housing type and monthly household income. Table 1 compares the weighted random core sample with the census statistics from 2011. Most of the characteristics show small Cohen’s w effect sizes (chi*
0.99 (0.92-1.07) 1.15 (1.08-1.23) 0.92 (0.86-0.98) 0.93 (0.86-1.00) 1.30 (1.22-1.38) 0.95 (0.89-1.02)
0.80
