Successful up-scaled population interventions to reduce risk factors for non-communicable disease in adults: results from the International Community Interventions for Health (CIH) Project in China, India and Mexico

PLoS One. 2015 Apr 13;10(4):e0120941. doi: 10.1371/journal.pone.0120941. eCollection 2015.

Abstract

Background: Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC.

Methods: The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up.

Results: A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥ 5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014).

Conclusions: Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • China / epidemiology
  • Cross-Sectional Studies
  • Diet / adverse effects
  • Eating
  • Feeding Behavior
  • Female
  • Fruit / metabolism
  • Humans
  • India / epidemiology
  • Male
  • Mexico / epidemiology
  • Middle Aged
  • Motor Activity
  • Obesity / epidemiology
  • Obesity / prevention & control
  • Overweight / epidemiology*
  • Overweight / prevention & control
  • Risk Factors
  • Salts / metabolism
  • Tobacco Use / adverse effects
  • Vegetables / metabolism

Substances

  • Salts

Grants and funding

This work was supported by the Oxford Health Alliance, the PepsiCo Foundation, Novo Nordisk A/S and the National Institute for Health Research. The authors are indebted to all the staff in the Community Interventions for Health sites and particularly Qingmin Liu, Yanjun Ren, and all leaders and staff working in the Bureaus of Health and Centers for Disease Control and Prevention in the city and districts of Xiacheng, Gongshu, Xihu in Hangzhou in China, Ravi Prasad Varma, Rekha M. Ravindran, N. S. Rajeev, Elezebeth Mathews, the staff of schools, industries, health centres, and the elected representatives of the local self Governments of Athiyannoor and Chirayinkeezh block Panchayat in Kerala in India, María Teresa Fernández Ramos, Adriana Vianey Cortés Alejo, Diana Gómez López, Samantha Nayeli De la Rosa, Marlene Medina Hernández, Armando Ahued and Gabriela Capo in Mexico, and Javier Valenzuela at the InterAmerican Heart Foundation. None of the major sponsors, namely the National Institute of Health Research, Novo Nordisk A/S and the PepsiCo Foundation had a role in the design or conduct of the study, in the collection, management, interpretation and analysis of the data or in the preparation, review or approval of the manuscript, nor have the data been released to the funding bodies in advance of the publication. The Oxford Health Alliance was responsible for the management and reporting of the study.