[Knowledge, attitude and practice of salt reduction among residents in four counties of Shandong and Jiangsu Provinces in 2013].

OBJECTIVE: To explore current status of knowledge, attitude and practice of salt reduction among adults in four counties of Shandong and Jiangsu Provinces, and analyze the relevant influencing factors. METHODS: In 2013, multi-stage cluster sampling was used to select the adults(aged 18-69) in Gaomi City of Weifang City and Fushan Distract of Yantai City, Shandong Province, and Xinyi City of Xuzhou City and Ganyu County of Lianyungang City, Jiangsu Province. A total of 9573 subjects were included. Knowledge, attitude and practice of anti-hypertension by low salt was collected using questionnaire and physical examination was conducted. Then the level of knowledge, attitude and practice of salt reduction was calculated, and multivariate Logistic regression model was used to analyze the influencing factors. RESULTS: A total of 3214 people had hypertension(33.57%), and the proportion of overweight and obesity was 36.20% and 19.48%, respectively. The awareness rate of salt reduction knowledge was between 22.50% and 51.35%; the attitude of salt reduction was between 82.24% and 93.01%, and the rate of salt reduction was between 10.86% and 46.16%. According to Logistic analysis, the degree of education had the greatest impact on knowledge(junior high school vs. elementary school and below: OR=2.30, 95%CI 2.06-2.57, high school and above vs. elementary school and below: OR=5.00, 95%CI 4.35-5.76). The knowledge level had the greatest impact on attitude(OR=3.10, 95%CI 2.80-3.43) and practice(OR=4.66, 95%CI 4.29-5.07). Those aged 45-69 years old had lower knowledge level(OR=0.64, 95%CI 0.58-0.71) but higher practice(OR=1.18, 95%CI 1.09-1.29). The knowledge(OR=3.66, 95%CI 3.34-4.01) and attitude(OR=1.84, 95%CI 1.69-2.02) of salt reduction among residents in Shandong were higher than those in Jiangsu. CONCLUSION: The awareness rate of knowledge is lower, the attitude support rate is higher, and the practice rate is lower among residents in Shandong and Jiangsu Provinces. More attention should be paid to the practical application of salt reduction.

Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016.

Importance: High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. Objective: To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. Design, Setting, and Participants: This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. Interventions: Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. Main Outcomes and Measures: The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. Results: Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. Conclusions and Relevance: The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.