杭州市社区医疗机构职工开展生活方式健康促进的效果评价

目的 了解杭州市社区医疗机构医务人员健康促进生活方式的干预现况,评估干预措施效果.方法 采用问卷方式调查杭州市3个代表性城区(下城区、拱墅区和西湖区)社区医务人员,内容包括职工日常饮食习惯、生活方式,工作场所开展吸烟、饮食和体力活动干预措施及同事间健康促进影响情况.采用x2检验及logistic回归法评估工作场所健康促进活动的干预效果.结果 工作场所吸烟干预措施中,讲座、戒烟规定及个体戒烟咨询均无显著效果；在饮食干预中参加平衡膳食、合理营养讲座课程与经常吃蔬菜、水果间存在关联,其经常吃蔬菜、水果的频率是未参与者的1.74倍(OR=1.74,95％CI:1.22～2.47)；体力活动干预措施中,同伴效应效果显著,和同事-起参与体力活动的职工进行有规律的高、中度体力活动频率是非干预措施组的1.62倍(OR=1.62,95％CI:1.15～2.29).干预措施的联合效应分析表明,无论是饮食干预还是体力活动干预,多干预措施联合作用可显著提高职工健康饮食和规律运动的行为习惯.结论 在工作场所开展饮食和体力活动干预,可显著改进职工的健康促进行为.     

杭州市社区医务人员慢性病防治技能干预效果评价

目的 评价牛津健康联盟-社区健康干预(Community Interventions for Health, CIH)项目是否有利于提高杭州市社区医务人员对慢性病防治相关技能的掌握及操作情况。方法 选取杭州市下城、拱墅和西湖区3个城区,采用平行对照、非随机分组的类实验设计设置干预区与对照区。在干预区开展为期2年的有关慢性病干预及管理技能的综合性干预,并对干预效果进行评价。基线调查获得有效问卷985份,随访调查获得有效问卷870份。结果 经过2年干预后,干预区医务人员对接诊或服务患者进行血胆固醇、血压、空腹血糖检测的比例高于干预前,差异有统计学意义(χ²=7.97,P=0.05; χ²=27.21,P=0.00; χ²=21.32,P=0.00),对照区的血糖测量比例(31.19%)高于基线调查时比例(25.37%),差异有统计学意义(χ²=15.29,P=0.00)。在干预区,平衡膳食、合理营养重要性的医患交流高于干预前,差异有统计学意义(χ²=8.64,P=0.03),如何增加体力活动、如何戒烟的交流无论干预区还是对照区干预前后均无统计学变化。多因素logistic回归分析显示,筛查常见慢性病的技能培训、管理慢性病患者的技能培训均与血胆固醇、血压和空腹血糖的检测相关联。慢性病咨询、建议的培训也在一定程度上影响着医患慢性病危险因素的交流。结论 对社区医务人员实施一系列慢性病防治知识、技能的培训,能够在一定程度上推动医务人员慢性病相关检测的开展,并促进慢性病防治知识、技能的医患交流。     

苏州市社区建成环境与居民体力活动的关联分析

目的 了解苏州市居民体力活动水平,探索社区建成环境与居民体力活动的关联。方法 2017年采用多阶段整群随机抽样方法抽取苏州市25~64岁常住人群进行面对面调查,采用国际体力活动量表长卷（IPAQ-L）评估居民体力活动水平,采用居民环境步行量表简表（NEWS-A）评价社区建成环境主观感知。结果 苏州市居民过去1周总体力活动水平M=3 610.42 MET-min/w,以工作相关体力活动水平为主,交通、家务及休闲相关体力活动水平较低。控制社会人口学因素后,公共服务可及性与社区居民的总体力活动水平呈负相关（OR=0.522,95%CI：0.329~0.830）,场所设施多样性与工作相关体力活动水平呈负相关（OR=0.701,95%CI：0.492~0.999）,步行和自行车道设施与工作相关体力活动水平呈正相关（OR=1.603,95%CI：1.004~2.559）;交通安全与交通相关体力活动水平呈负相关（OR=0.642,95%CI：0.416~0.990）;住宅密度与休闲相关体力活动水平呈正相关（OR=1.001,95%CI：1.000~1.002）;此外,社区美观与舒适的主观感知程度越高,工作、交通、家务及总体力活动水平越高（OR=1.889,95%CI：1.176~3.033;OR=1.671,95%CI：1.120~2.495;OR=1.775,95%CI：1.143~2.756;OR=1.593,95%CI：1.079~2.350）。结论 完善步行道和自行车道设施、提高社区的美观和舒适程度对于增加居民体力活动有重要作用。     

四城市成年人主观感知建成环境与休闲性体力活动的相关性研究

目的 探讨4城市社区成年居民主观感知的建成环境与休闲性体力活动之间的相关性。方法 2017年6月至2018年7月采用多阶段整群随机抽样方法抽取杭州、苏州、成都和青岛市25～64岁成年人,使用社区环境步行适宜性量表简版和国际体力活动问卷长版评估建成环境和休闲性体力活动水平,采用广义线性混合模型分析主观感知的建成环境与休闲性体力活动的相关性。结果 共纳入有效样本3 789份。调整可能的混杂因素后,公共服务可及性（OR=1.34,95% CI：1.02～1.75）和美观度（OR=1.37,95% CI：1.09～1.73）与居民自报过去一周有休闲性体力活动的可能性呈正相关;类似地,居民进行休闲性步行的可能性与这2个维度也呈正相关。街道连通性与居民休闲性步行水平呈正相关［exp（β）=1.09,95% CI：1.00～1.19］;居住密度［exp（β）=1.000 4,95% CI：1.000 0～1.000 8］越高、体力活动场所可及性［exp（β）=1.09,95% CI：1.00～1.19］越好,美观度［exp（β）=1.11,95% CI：1.00～1.22］越好,居民休闲性体力活动水平越高,达标的可能性也越高。结论 改善社区某些建成环境维度,有望增加居民进行休闲性体力活动的可能性及相应的水平。     

社区综合干预对杭州城区初中生体力活动的短期影响

目的评价社区综合干预对杭州城区初中生体力活动的短期影响。方法采用平行对照、非随机分组的类实验设计,在下城、拱墅区的社区、工作单位、学校和医疗机构开展2年社区综合干预,对居民进行健康教育的同时营造支持性环境,同期西湖区为对照区,通过比较干预前后两次横断面调查结果进行评价。结果干预区和对照区体力活动累积时间干预后高于干预前,差异有统计学意义(均为P0.001)。干预区周末总静坐行为(除做作业以外)时间达到2 h/d及以上比例干预后(58.3%)低于干预前(67.2%),差异有统计学意义(P0.001),对照区差异无统计学意义(P0.064)。结论社区综合干预可以影响干预区初中生在一定程度上减少周末总静坐行为(除做作业以外)时间,但未见显著提高体力活动时间,需考虑持续干预进行远期追踪评估。     

杭州市城区不同特征人群对体力活动相关建成环境的主观感知评价

目的 了解杭州市城区不同特征人群的体力活动相关建成环境主观感知情况。方法 采用多阶段分层随机抽样方法在杭州市城区抽取25~59岁常住居民开展面对面问卷调查。社区步行环境量表简版(NEWS-A)用于评价居民对社区内住宅密度、场所设施多样性、公共服务可及性、街道连通性、步行道和自行车道适宜性、美观舒适度、交通安全、治安8个建成环境维度的主观感知。采用两水平logistic回归模型分析社会人口学特征和BMI等个体因素对居民建成环境主观感知的影响。结果 共纳入1 362例常住居民,性别、婚姻状况、是否有工作与建成环境主观感知各维度得分关联均无统计学意义。调整其他因素影响后,年龄45~59岁与街道连通性感知得分呈正相关(OR=2.02,95%CI:1.30~3.15)。大专及以上文化程度与人口密度感知得分存在正相关(OR=1.97,95%CI:1.29~3.00),与场所设施多样性感知得分呈负相关(OR=0.65,95%CI:0.43~0.97)。超重肥胖与步行道/自行车道(OR=0.67,95%CI:0.48~0.95)和社区治安得分(OR=0.75,95%CI:0.57~0.99)均呈负相关。相对于Ⅰ类区域,Ⅲ类区域居民对场所设施多样性(OR=0.11,95%CI:0.04~0.30)、公共服务可及性(OR=0.33,95%CI:0.11~0.95)、街道连通性(OR=0.30,95%CI:0.11~0.86)、交通安全(OR=0.39,95%CI:0.17~0.91)的主观感知得分更低。结论 杭州市城区居民对体力活动相关的建成环境主观感知与年龄、文化程度、BMI和居住区域存在相关性,开展人群体力活动的环境干预时需要考虑个体特征。     

杭州市城区成年居民步行时间与建成环境主观感知的关联分析

目的 了解杭州市城区成年居民步行与建成环境主观感知之间的关系。方法 2012年采用多阶段分层随机抽样方法选取杭州市城区25~59岁居民开展面对面问卷调查。采用国际体力活动量表长版(IPAQ-L)和社区步行环境量表简版(NEWS-A)评价居民过去1周交通出行相关步行时间、休闲性步行时间以及建成环境主观感知。利用多因素logistic回归法分析步行与建成环境主观感知得分的关联性。结果 杭州市城区成年居民过去1周总体力活动得分M=2 766 met·min^-1·week^-1,平均1周休闲相关步行时间为90 min,平均1周交通相关步行时间则为100 min。控制年龄、BMI、婚姻状况、工作状态、文化程度、居住社区类型、总体力活动水平后,男性(OR=0.764,95%CI:0.588~0.992)和女性(OR=0.633,95%CI:0.481~0.833)的休闲性步行时间均与场所设施可及性维度得分呈负相关,女性休闲性步行时间还与住宅密度维度得分呈负相关(OR=0.997,95%CI:0.996~0.999),女性交通出行相关步行时间则与步行道/自行车道维度得分呈正相关(OR=1.537,95%CI:1.138~2.075)。男性交通出行相关步行时间与建成环境主观感知各维度得分的关联均无统计学意义。结论 可通过改善步行道/自行车道等建成环境促进成年居民的交通相关步行时间,开展成年人步行的环境干预时需要考虑性别差异。     

综合干预对杭州市社区医务人员提供戒烟咨询的效果及影响因素分析

目的 评价综合干预对社区医务人员提供戒烟咨询的短期效果及影响因素.方法 以杭州市下城区和拱墅区作干预区,开展为期2年的综合吸烟干预,西湖区为对照区,干预前后采用问卷调查戒烟资源、准备情况及实际行动,评价干预效果.采用logistic回归分析戒烟干预的影响因素.结果 干预区299人,对照区141人,吸烟率均约5％.(1)戒烟资源:干预前后,干预区获取种类分别为2、3种,利用种类分别为1、3种,干预前后差异有统计学意义(均P＜0.001),对照区获取及利用种类均呈下降趋势.(2)准备情况:干预区准备好戒烟咨询的比例在干预前后分别为35.5％、52.0％,干预前后差异有统计学意义(P＜0.001),对照区前后分别为28.1％、39.3％,干预前后无统计学意义(P=0.162).(3)实际行动,干预区能对≥90％的患者提供戒烟咨询的医务人员比例呈小幅上升趋势,而对照区呈下降趋势,差异均无统计学意义.准备情况的改善有助于提高医务人员询问患者吸烟状况的比例(调整OR=1.43,P=0.007).结论 综合干预可一定程度增加社区医务人员戒烟培训及戒烟资源的获取机会和利用水平,改善其提供咨询的准备心态,但并不能显著改善其提供戒烟咨询服务的行为,需考虑建立配套机制,切实促进行为改善.     

杭州市城区初中教职工体力活动水平的影响因素分析

目的 了解杭州市城区初中教职工体力活动水平及其影响因素。方法 2009年对杭州市3个城区的所有初中教职工进行横断面问卷调查。利用国际体力活动量表评价体力活动水平,采用Kruskal-Wallis秩和检验和多分类logistic回归法分析教职工体力活动水平的影响因素。结果 1 497名教职工达到低、中、高水平体力活动的比例分别为40.8%、40.6%和18.6%。与低水平体力活动的教职工相比较,年龄≥45岁（OR＝1.576,95%CI：1.128～2.201）和感到有一些压力（OR＝1.490,95%CI：1.141～1.946）的教职工达到中等水平体力活动的概率高。体力活动得分高（OR＝1.070,95%CI：1.002～1.143）、男性（OR＝3.088,95%CI：2.162～4.409）、同事经常/总是一起参加运动（OR＝2.903,95%CI：1.587～5.312）、同事有时一起参加运动（OR＝1.900,95%CI：1.160～3.110）和家附近有步行可达的地方（OR＝1.657,95%CI：1.022～2.688）达到高水平体力活动的概率高。婚姻状况、社会经济水平、工作年数、BMI、学历、同事鼓励参加运动与教职工增加体力活动水平的关联则无统计学意义。结论 杭州市城区初中教职工的体力活动水平有待加强,开展体力活动促进需要考虑年龄、性别、工作压力和支持性的工作及居住环境等因素影响。     

糖尿病社区干预对居民肥胖及相关因素的影响

目的　评价糖尿病社区干预对城市居民肥胖状况及相关因素的影响 ,为制定社区干预对策与措施提供科学依据。方法　按照实验流行病学方法 ,选取山东省 2个城市社区分别作为干预社区与对照社区。 1997年 ,收集基线资料 ,同时开始在干预社区实施糖尿病综合干预措施。 2 0 0 1年 ,再次以相同的方法收集 2个社区相关资料 ,通过2个社区基线与 4年后资料的比较 ,分析干预措施对社区健康人群体重指数 (BMI)、腰臀比 (WHR)、业余体力活动强度和膳食结构的影响。结果　干预前后 ,干预社区人群BMI均值与WHR均值无显著性差异 ,对照社区人群 4年后BMI均值与WHR均值均上升 (P <0 0 5)。干预社区人群在干预前后超重与肥胖率无显著性差异 ,但对照社区人群超重者增加了 12 1% ,肥胖者增加了 5 6% (P <0 0 1)。干预社区干预前后业余体力活动程度构成无显著性差异 ,而对照社区人群中度活动组比例从 47 6%下降为 14 2 % (P <0 0 1)。 4年后 ,干预社区喜荤食的比例下降了 4 8% (P<0 0 5) ,而对照社区相应比例上升了 1 6% (P <0 0 1)。结论　社区水平的糖尿病干预项目对城市居民肥胖及其相关因素 ,体力活动强度 ,膳食结构均有显著影响 ,提示社区居民对糖尿病和相关危险因素的干预有较好的依从性     

“Do you see what I see?” – Correlates of multidimensional measures of neighborhood types and perceived physical activity–related neighborhood barriers and facilitators for urban youth

ObjectivesTo classify types of neighborhood environment and to examine the gender-specific cross-sectional associations between these neighborhood types and adolescents' perceptions of physical activity–related neighborhood barriers and facilitators.MethodsThis cross-sectional study was conducted with a sample of 350 high school students in Baltimore, Maryland, in 2006. Participants completed the Neighborhood Environment Walkability Scale (NEWS). Objectively GIS-measured attributes of urban form came from various sources. Classification of built environment/neighborhood types was achieved by factor analysis and cluster analysis.ResultsFour neighborhood types were identified: (1) arterial development; (2) inner-city area; (3) suburban residential; and (4) central business district. Girls who lived in suburban residential areas were less likely than their central business district counterparts to perceive the protective effects of crosswalks and pedestrian traffic signals. Girls living in inner-city neighborhoods were more likely than their central business district counterparts to perceive the traffic as being slow. Boys' perceptions of their neighborhood did not vary by neighborhood pattern.ConclusionsGirls appear to be more sensitive to their environment and perceive more physical activity–related built environment barriers compared to boys. Efforts to overcome physical activity barriers salient for adolescent girls should be tailored to the type of neighborhood.     

Association between perceived urban built environment attributes and leisure-time physical activity among adults in Hangzhou,China

BackgroundNeighborhood built environment may influence residents' physical activity, which in turn, affects their health. This study aimed to determine the associations between perceived built environment and leisure-time physical activity in Hangzhou, China.Methods1440 participants aged 25–59 were randomly selected from 30 neighborhoods in three types of administrative planning units in Hangzhou. International Physical Activity Questionnaire long form and NEWS-A were used to obtain individual-level data. The China Urban Built Environment Scan Tool was used to objectively assess the neighborhood-level built environment. Multi-level regression was used to explore the relationship between perceived built environment variables and leisure-time physical activities. Data was collected in Hangzhou from June to December in 2012, and was analyzed in May 2013.ResultsSignificant difference between neighborhood random variations in physical activity was identified (P = 0.0134); neighborhood-level differences accounted for 3.0% of the variability in leisure-time physical activity. Male residents who perceived higher scores on access to physical activity destinations reported more involvement in leisure-time physical activity. Higher scores on perception of esthetic quality, and lower on residential density were associated with more time in leisure-time walking in women.ConclusionsThe present study demonstrated that perceived urban built environment attributes significantly correlate with leisure-time physical activity in Hangzhou, China.     

Long-term Student Outcomes of the Integrated Nutrition and Physical Activity Program

ObjectiveTo examine the long-term effects of the Integrated Nutrition and Physical Activity Program (INPAP), a school-based nutrition education program.DesignQuasi-experimental design comparing intervention and comparison cohorts at 3–6 years after delivery of the INPAP intervention on nutrition- and physical activity–related outcomes.SettingThis study was conducted in 1 school district in a low-income rural county of ～15,000 residents in south-central Colorado.ParticipantsIn second grade, intervention and comparison cohorts included 173 (fall 2000) and 190 (fall 1999) students, respectively. Approximately 60% of these students completed assessments in eighth grade.InterventionsINPAP is an experiential school-based nutrition education program, grounded in social cognitive theory and Piaget's cognitive development theory and adapted for use in a rural setting.OutcomesNutrition and physical activity knowledge, self-efficacy, attitudes and behaviors, body mass index.AnalysisWilcoxon signed rank test, chi-square test for proportions, and t test for means.ResultsLong-term effects were observed in nutrition-related knowledge and attitudes but not self-efficacy or behavior change. The effects that did occur were attenuated over time.Conclusion and ImplicationsThis study found that INPAP implemented in elementary school had limited lasting effects by the end of middle school, a time when students have increased autonomy to make food choices.     

中国慢性病前瞻性研究: 10 个项目地区成人体力活动和休闲静坐时间特征差异的分析

目的 描述中国慢性病前瞻性研究(CKB)10个项目点健康人群体力活动和静坐行为特征的地区差异。方法 剔除自报患有冠心病、卒中和肿瘤等慢性疾病的个体后, 研究分析10个项目地区中486 514名30~79岁队列成员体力活动和每周休闲静坐时间的基线信息, 重点描述地区差异。结果 男性总体力活动水平(22.9 MET-h/d)高于女性(20.6 MET-h/d), 休闲静坐时间(3.1 h/d)多于女性(2.9 h/d)。浙江项目点个体每天总体力活动水平最高(男31.3 MET-h/d, 女 30.2 MET-h/d)且静坐时间最少(男2.0 h/d, 女 1.6 h/d)。工作相关活动所占比例, 男性以浙江(86.5%)和河南(85.2%)项目点最高, 海口(69.4%)最低;女性以浙江(74.8%)最高, 河南(40.9%)最低。甘肃项目点(男17.8%, 女18.1%)交通活动所占比例明显高于其他地区。家务活动所占比例, 男性以湖南项目点(18.0%)最高, 女性以河南(54.0%)和湖南(39.1%)最高。城市项目点的休闲相关活动所占比例高于农村, 其中柳州(男9.5%, 女10.4%)最高。甘肃(男36.8%, 女29.8%)、四川(男34.1%, 女33.8%)和浙江(男20.0%, 女19.2%)3个农村项目点的高强度活动所占比例明显高于其他项目点。结论 CKB 10个项目地区的研究人群在总体力活动水平、活动类型、活动强度和休闲静坐时间等特征上存在明显的地区差异。     

中国人群成年期体重变化现况分析

目的 描述中国慢性病前瞻性研究（CKB）队列人群的成年期体重变化状况及其地区和人群差异。方法 采用自行设计的电子问卷进行面对面基线调查，收集调查对象25岁体重以及社会人口学特征、生活方式等信息，并测量调查对象当前体重。本研究剔除基线自报患有慢性病、重要变量缺失、年龄<35岁或者>70岁的个体，最终纳入360 903名研究对象。成年期体重变化定义为当前体重与25岁时体重的差值。结果 研究对象成年期平均增重4.9 kg。城市地区人群增重高于农村地区，北方地区高于南方地区。10个项目点中，青岛项目点成年期平均增重量最大（9.3 kg），甘肃项目点最低（1.5 kg）。出生年代越早者，25岁BMI较高。成年期增重量在45～50岁组最高。在调整了年龄和地区后，不同文化程度、职业、家庭年收入、体力活动水平、吸烟情况人群的成年期体重变化的分布差异有统计学意义（P<0.001）。25岁时BMI水平越高者，成年期增重量越小；当前BMI水平越高者，成年期增重量越大（趋势P<0.001）。结论 CKB项目10个地区研究人群成年期体重变化存在明显的地区和人群差异。     

Walkability indices and children's walking behavior in rural vs. urban areas

PurposeThis study described associations between selected walk indices (WI) and walking and physical activity behaviors in rural and urban children.FindingsWI were higher in urban environments, yet children from rural areas walked for transportation more than children from urban areas. There was a negative correlation between National WI scores and walking for transportation in urban areas, and between the Frank WI scores and walking for exercise in rural areas.ConclusionsIndices of walkability are not associated with objectively measured physical activity or self-reported walking behavior in children living in rural and urban settings.     

Evaluation of a city-wide school-located influenza vaccination program in Oakland,California with respect to race and ethnicity: A matched cohort study

BackgroundIncreasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018.MethodsWe used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data.ResultsDifferences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017–18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [?2.2%, 14.0%]), and multiracial (6.3% [?1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017–18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016–17 (DID ?25.14 per 100,000 [95% CI: ?40.14, ?10.14]) and 2017–18 (?36.6 per 100,000 [?52.7, ?20.5]) and Black older adults in 2017–18 (?282.2 per 100,000 (?508.4, ?56.1]), but not in other groups.ConclusionsSLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable influenza outcomes.     

Likelihood of meeting physical activity guidelines in rural and urban adults: cross-sectional analysis of the Canadian Community Health Survey

ObjectivesThe goal of this study was to compare the odds of meeting physical activity (PA) guidelines among adults living in rural and urban areas of Canada.MethodsData from the 2017 cycle of the Canadian Community Health Survey were analyzed using binomial logistic regression with a sample of 47,266 adults representing a survey-weighted total of 25,669,018. The odds of meeting PA guidelines were determined based on self-reported moderate-to-vigorous PA (<150 min per week or ≥150 min per week). Communities were categorized as urban or rural based on population size and density. Individual-level correlates included in the model were self-identified sex, age, body mass index, highest level of education, household income, perceived health, and sense of belonging to community.ResultsApproximately 56.6% of rural and 59.3% of urban adults reported meeting recommended PA levels when location was examined as a sole predictor. The best-fit model adjusted for all individual-level factors showed a significant sex × location interaction. Males in rural communities were more likely to report meeting PA guidelines (odds = 0.90 or 47.4%) than males in urban areas (odds = 0.78 or 43.8%), whereas females living in rural communities (odds = 0.58 or 36.7%) were less likely to report meeting PA guidelines than females in urban areas (odds = 0.65 or 39.4%).ConclusionThe association between rural-urban residence and meeting PA guidelines appears to be contingent on self-identified sex differences. Future work should explore how gender- and location-related variables interact to influence self-reported PA engagement.     

Field challenges to measles elimination in the Democratic Republic of the Congo

BackgroundDuring a measles epidemic, the Ministry of Public Health (MOH) of the Democratic Republic of the Congo conducted supplementary immunization activities (2016-SIA) from August 28-September 3, 2016 throughout Maniema Province. From October 29-November 4, 2016, Médecins Sans Frontières and the MOH conducted a reactive measles vaccination campaign (2016-RVC) targeting children six months to 14 years old in seven health areas with heavy ongoing transmission despite inclusion in the 2016-SIA, and a post-vaccination survey. We report the measles vaccine coverage (VC) and effectiveness (VE) of the 2016-SIA and VC of the 2016-RVC.MethodsA cross-sectional VC cluster survey stratified by semi-urban/rural health area and age was conducted. A retrospective cohort analysis of measles reported by the parent/guardian allowed calculation of the cumulative measles incidence according to vaccination status after the 2016-SIA for an estimation of crude and adjusted VE.ResultsIn November 2016, 1145 children (6–59 months old) in the semi-urban and 1158 in the rural areas were surveyed. Post-2016-SIA VC (documentation/declaration) was 81.6% (95%CI: 76.5–85.7) in the semi-urban and 91.0% (95%CI: 84.9–94.7) in the rural areas. The reported measles incidence in October among children less than 5 years old was 5.0% for 2016-SIA-vaccinated and 11.2% for 2016-SIA-non-vaccinated in the semi-urban area, and 0.7% for 2016-SIA-vaccinated and 4.0% for 2016-SIA-non-vaccinated in the rural area. Post-2016-SIA VE (adjusted for age, sex) was 53.9% (95%CI: 2.9–78.8) in the semi-urban and 78.7% (95%CI: 0–97.1) in the rural areas. Post 2016-RVC VC (documentation/declaration) was 99.1% (95%CI: 98.2–99.6) in the semi-urban and 98.8% (95%CI: 96.5–99.6) in the rural areas.ConclusionsAlthough our VE estimates could be underestimated due to misclassification of measles status, the VC and VE point estimates of the 2016-SIA in the semi-urban area appear suboptimal, and in combination, could not limit the epidemic. Further research is needed on vaccination strategies adapted to urban contexts.