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www.oxha.org. Confronting the Epidemic of Chronic Disease. Community Interventions for Health (CIH ) Sponsored by the PepsiCo Foundation. The Oxford Health Alliance. The Oxford Health Alliance. Background. - PowerPoint PPT PresentationTRANSCRIPT
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Community Interventions for Health(CIH)
Sponsored by the PepsiCo Foundation
Confronting the Epidemic of Chronic Disease
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Background
• Non-communicable diseases (NCDs) account for 60% of all deaths globally, with 80% occurring in low and middle income countries
• Four NCDs are largely responsible; cardiovascular disease, chronic respiratory disease, cancer and diabetes
• These diseases are preventable. Approximately 80% could be prevented by addressing the main risk factors
• The three main risk factors are tobacco use, unhealthy diet and physical inactivity
2008-2013 Action Plan, WHO 2010
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Individual or Community Interventions?
• Traditionally, medical research investigating risk of NCD targets the at-risk individual
• Randomised controlled trail are conducted, comparing an intervention group with a control group
• Effective interventions at the individual level are identified
• These individual-level behaviour change interventions are often unsuccessful at community or population level
• The challenge is to find a way to change the environment to promote health and reduce risk of disease
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Community Interventions for Health (CIH)
• CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken
• The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors
• CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities
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CIH sites and target population
Leicester, UK150,00
Kerala, India150.00
Hangzhou, China300,000
Mexico City150,00
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Study design
• In each study area, an intervention and control site has been selected for comparison
• Baseline data have been collected from all sites and comprise:
- Questionnaires from a sample of the population
- Biometrics from a sub-sample
- Environmental scans
• Interventions have been implemented
• Final data collection for comparison with baseline will be collected at the end of 2011
Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use
Process system for CIH
Inputs for change
Locus of change
Assessment of change
Health education
Social marketing
Community mobilization
Structural change
Strategies for change
Individual Family Community Society
QuestionnairesEnvironmental scan Policy reviews
CIH management board
International
National
Local
China India Mexico UK
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
Organisation of CIH
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Evaluation: Research Study Sample
Survey sample per country site
Neighbourhood Schoolchildren
Workplaces (including industry, health centres, and schools)
Health care providers(doctors and nurses)
TOTAL
Intervention site 1,000 2,000 2,700(1,000, 1000, 700)
400 6,100
Control site 1,000 2,000 2,700(1,000, 1000, 700)
400 6,100
SAMPLE AGGREGATE
2,000 4,000 5,400 800 12,200
400m (0.25m)
Information
Streets Stores and kiosks
Cigarette vending
Street vending
Restaurants and food services
Parks and gardens
Recreationalfacilities
School
Evaluation: Environmental scanning for CIH
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Examples of baseline data
• Tobacco use in China
• Overweight and obesity among schoolchildren in Mexico
• Physical activity among schoolchildren in India
• BMI of study population in all sites
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Tobacco Use - China
Current smoking tobaccoMen: 42.9%Women: 1.4%
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Childhood obesity - Mexico
BMI – adjusted for age and gender
%(N = 4,082)
<25 62.7
25 – 29.9 28.9
>30 8.4
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Frequency of Physical Activity in Indian Schoolchildren
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Rates of overweight and obesity (BMI>25)
Site Adult BMI >25 (%)
Child BMI >25 (%)
Hangzhou, China 26.5 16.6
Kerala, India 21.1 4.1
Mexico City 62.6 37.3
Leicester, UK 46.1 no data
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Interventions – tobacco control in China
• Extensive health education programme
• Smoking banned in worksites and public places
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Interventions – improving diets to reduce obesity in Mexican school children
• School meals are not routinely provided in Mexican schools
• Many children eat snacks and fast food from vendors
• Parents in some schools have begun to cook and provide healthy meals
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Interventions – increasing physical activity in girls in India
• Culturally, girls in India are not encouraged to take exercise
• CIH provides bicycles for school girls and organises cycling lessons
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Summary – achievements to date
Community Interventions for Health has:
• Been operating since 2008
• Involved 750,000 people in 4 countries
• Been established as the largest global trial of community intervention so far
• Generated much world-wide interest
• Published a methodology paper 1
• Agreed publication of a manual with Oxford University Press
1. O’Connor Duffany et al. Community Interventions for Health (CIH): a novel approach to tackling the worldwide epidemic of chronic diseases. CVD Prevention and Control (2011) 6: 47-56
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Challenges ahead
• Data collection is due to be completed by the end of 2011
• Analysis of the data will involve:
– organisation and collation
– support for the statistical team
– one year’s duration (2012) to allow reports from each country individually and then to combine data to give overview results and messages
– papers to be prepared for publication
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Thanks from the team