The China Seven Cities Study (CSCS) consortium: adapting evidence-based prevention science from west to east

Abstract

Chronic, noncommunicable diseases (NCDs) have surpassed infectious diseases as the primary cause of death and disability in most developing nations. Nowhere is this more evident than in China where NCDs account for 80% of all deaths and skyrocketing medical costs. Driving the escalation of NCDs are high rates of tobacco use, longer life spans, and changes in the traditional Chinese diet and lifestyle bolstered by unprecedented economic growth and the new global culture. Despite the epidemic of NCDs, few evidencebased interventions either to prevent or retard their progression exist in China. We present a case for the development and adoption of such strategies as effective tools to combat China's greatest health threat. Finally, we offer an example of a collaborative network linking Chinese public health and academic institutions with US researchers to promote the translation of western evidence-based interventions that fully incorporate local knowledge, culture, and capacity. KeywordsNoncommunicable disease, Tobacco control, China, Evidence-based As low-and middle-income countries industrialize, urbanize, and integrate features of western culture with their traditional lifestyle, rates of noncommunicable diseases (NCDs) rise and portend alarming trends for the future. Globally, 35 million deaths annually are attributable to cardiovascular diseases (CVDs), chronic respiratory diseases, diabetes, and cancer with 80% of these occurring in developing nations [1]. In resource-poor developing nations where healthcare systems are often woefully underfunded, understaffed, and in flux, population-based approaches to combating NCDs may produce the greatest and most cost-effective results. The value of incorporating evidence-based, prevention-focused strategies that can be rolled out into communities has been demonstrated in developed nations [2]. To date, however, very few evidence-based approaches for health risk behavior modification have been utilized in economically developing nations [3].

Smoking intention among Chinese youth and implications for health interventions

“…Research in China describes increasing rates of smoking acquisition among young people, and tobacco-caused diseases will assume greater prominence if this trend continues (Niu, Yang, & Chen, 1998;Palmer et al, 2011;Weiss, Palmer, Chou, Mouttapa, & Johnson, 2008). Chinese youth are at greatest risk of smoking experimentation and initiation, but limited research about their smoking intention hampers the development of effective smoking prevention strategies (Hesketh, Ding, & Tomkins, 2002;Palmer et al, 2011;Unger, Li, et al, 2001;Unger, Yan, et al, 2001;Weiss et al, 2008;Yang et al, 2004;Zhang, Wang, Zhao, & Vartiainen, 2000).…”

“…Chinese youth are at greatest risk of smoking experimentation and initiation, but limited research about their smoking intention hampers the development of effective smoking prevention strategies (Hesketh, Ding, & Tomkins, 2002;Palmer et al, 2011;Unger, Li, et al, 2001;Unger, Yan, et al, 2001;Weiss et al, 2008;Yang et al, 2004;Zhang, Wang, Zhao, & Vartiainen, 2000).…”

“…Guo et al (2007) conducted an insightful evaluation of the applicability of the TPB and Theory of Reasoned Action (TRA) to smoking behaviour in a sample of 14,434 school students, and both models successfully predicted smoking intention and behaviour, and the TPB accounted for significantly more variance than TRA. However, Guo et al (2007) analysed secondary data from a project designed to examine changing economic and social factors, and thus measurement of TPB variables could have been improved (Palmer et al, 2011). For example, the scale items formulated to assess the attitude construct of the TPB did not measure direct and personal effects of smoking, and they were based on student's perceptions of addiction and enforcement of antitobacco policies.…”

A Theory-Based Smoking Intervention for Chinese High School Students: Development, Implementation, and Evaluation

“…E. Hill et al, 1997). The team members had developed a friendly and collaborative relationship which is essential for the consensus process and international collaboration, since each member can feel free to express his/her opinions (C. E. Palmer et al, 2011).…”

“…Since most of the previous smoking interventions were developed in the West, languages, values, and other factors are likely to influence their effectiveness (Palmer et al, 2011). Thus, the intervention in the present research is not simply a translation of a Western programme.…”