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Controlling the spread of an infectious disease depends critically on the general public's adoption of preventive measures. Theories of health behavior suggest that risk perceptions motivate preventive behavior. The supporting evidence for this causal link is, however, of questionable validity. The COVID-19 pandemic provides a rare opportunity to examine how risk perceptions, preventive behavior, and the link between them develop in a fast-changing risky environment. In a 4-wave longitudinal study conducted in the United States and China, we found that for Chinese participants, there was little relationship between risk perceptions and preventive behavior. This may be a result of the Chinese government's strict control and containment policies and a collectivistic culture that encourages conforming to norms-both of which limit individuals' nonconformist behavior. For U.S. participants, risk perceptions did motivate preventive behavior in the early stage of the pandemic; however, as time went by and the risk of COVID-19 persisted, preventive behavior also led to perception of higher infection risk, which in turn further motivated preventive behavior. Thus, instead of the presumed unidirectional influence from perception to behavior, our results indicate that the two could mutually reinforce each other. Overall, our findings suggest that risk perceptions-at least in the context of a dynamic health hazard-may only motivate preventive behavior at specific stages and under specific conditions. They also highlight the importance of early interventions in promoting preventive behavior.

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Background: Knee osteoarthritis (KOA) provides many challenges on the healthcare system. However, few studies have reported the epidemiology, particularly in a large population. Our study aimed to estimate the prevalence, incidence, trends, and patterns of diagnosed KOA in China. Methods: This was a longitudinal study. We used health insurance claims of 17.7 million adults from 2008–2017 to identify people with KOA. Trends in prevalence and incidence were analyzed using joinpoint regression. Results: We identified 2,447,990 people with KOA in Beijing, 60% of which were women. The 10-year average age-standardized prevalence and incidence of KOA was, respectively, 4.6% and 25.2 per 1000 person-years. Prevalence increased with age, surging after 55 years old. The average crude prevalence was 13.2% for people over 55 years old. The prevalence showed an increasing trend from 2008 to 2017, including a period of rapid rise from 2008 to 2011 (p < 0.05); the increase in prevalence was greatest in people under 35 years old (p < 0.05). Conclusion: Our analyses showed that the annual prevalence rate of KOA increased significantly from 2008 to 2017 in China. We need to increase our attention to women and the elderly over 55 years old, and also be alert to the younger trend of incidence of KOA.

Aims To describe secular trends in diagnosed type 2 diabetes prevalence and incidence in Beijing, China. Methods Using health insurance claims for 17.7 million adults ≥20 years in 2008–2017, we identified people with diabetes using hospital diagnoses and drug prescriptions. Results were age‐standardised using data for Beijing from China's 2010 census. Trends in prevalence and incidence were analysed using Joinpoint regression analysis. Results From 2008 to 2017, we identified 2,104,159 people diagnosed with type 2 diabetes. Type 2 diabetes prevalence increased from 3.7% [95% CI: (3.6, 3.8)] to 6.6% (6.4, 6.7), but the annual rate of increase slowed from 18.1% (14.4, 22.0) to 1.5% (0.8, 2.2) before and after 2011 respectively. Women had a higher diabetes prevalence than men, for all years. The yearly increase in prevalence was greater in people younger than 40 years, with an average annual percentage change of 13.6% (10.7, 16.5) compared to 6.5% (5.6, 7.4) in those over 40 years. Over the 10 years, the overall incidence decreased from 24.3 (24.2, 24.4) to 11.5 (11.5, 11.6) per 1000 person‐years, but it increased in people younger than 40 years. The average age at diabetes diagnosis dropped from 62 to 56 years (p < 0.001). Among incident cases of diabetes, the percentage of people under 40 years increased from 3.0% to 10.9% (p < 0.001). Conclusions The prevalence of diagnosed type 2 diabetes in Beijing increased continuously over the 10 years, the incidence decreased, except in people under 40 years. Continuous efforts are needed to prevent diabetes in China.

ObjectiveTo evaluate a comprehensive tobacco control policy package on hospital admissions for acute myocardial infarction (AMI) and stroke in a global city.DesignInterrupted time series study.SettingBeijing, China.Population31 707 AMI and 128 116 stroke hospital admissions recorded by the Beijing Medical Claim Data for Employees in 17.7 million residents from January 2013 to June 2017.InterventionThe policy package including all components of MPOWER has been implemented since June 2015.Main outcome measuresThe immediate change of AMI and stroke hospital admissions and the annual change in the secular trend.ResultsThere was a secular increase trend for the crude hospital admission rates of AMI and stroke during the observational period. After implementation of the policy, immediate reductions were observed in the hospital admissions for both AMI (−5.4%, 95% CI −10.0% to −0.5%) and stroke (−5.6%, 95% CI −7.8% to −3.3%). In addition, the secular increase trend for stroke was slowed down by −15.3% (95% CI −16.7% to −13.9%) annually. Compared with the hypothetical scenario where the policy had not taken place, an estimated 18 137 (26.7%) stroke hospital admissions had been averted during the 25 months of postpolicy period.ConclusionsThe results indicated significant health benefits on cardiovascular morbidity after the Beijing tobacco control policy package, which highlighted the importance for a comprehensive tobacco control policy at the national level in China. Similar tobacco control policy which consists of all components of MPOWER is urgently needed in other areas, especially in settings with high tobacco consumption, to achieve greater public health gains.

BackgroundCoronary heart disease (CHD) is a major cause of morbidity and mortality, and cardiac rehabilitation (CR) is still not well developed in mainland China. The objective of this study is to investigate the barriers associated with those seeking cardiac rehabilitation (CR) and to explore appropriate secondary prevention modalities tailored to the needs of Chinese patients with coronary heart disease (CHD).MethodsA consecutive series of eligible patients was recruited from the cardiac department of a teaching hospital in Nanjing, located in southeast China. Structured face-to-face interviews were conducted with 328 patients prior to hospital discharge. Patient preferences for seeking an outpatient CR program or an alternative outpatient self-choice, minimal-cost educational program were evaluated. Socio-demographic characteristics and clinical data were assessed. Additionally, patients were asked to provide the reasons affecting their choice.ResultsOverall, only 14.3% patients preferred the standard CR program. Factors associated with non-participating were female gender (odds ratios [ORs], 6.05, 95% CI, 1.30-28.19), older age (ORs, 1.11, 95% CI, 1.04-1.19, per year), less education (ORs, 8.13, 95% CI, 2.83-23.38), low income (ORs, 3.26, 95% CI, 1.24-8.54), and having either basic medical care or a lack of health insurance (ORs, 10.01, 95% CI, 3.90-25.68). The most common reason for refusing to participate in CR was that patients could not afford it. Of the remaining patients, 65.8% patients chose self-choice educational programs, especially for female (ORs, 5.84, 95% CI, 2.67-12.79), older (ORs, 1.06, 95% CI, 1.02-1.11, per year), and low income (ORs, 2.14, 95% CI, 1.12-4.10) patients. The main reasons for their preferences were their desires for more information about disease and risk factors, the low cost, feasibility, and saving time.ConclusionsMultiple barriers, which may occur at the patient, health system, and societal levels, have prevented eligible patients from participating in CR programs. Self-choice educational programs, an alternative model incorporating more information, would strongly meet the needs of most patients. A feasible delivery format for secondary prevention should be provided for all CHD patients.