Hyperplastic polyps arising in autoimmune metaplastic atrophic gastritis patients: is this a distinct clinicopathological entity?

OBJECTIVES: Gastric hyperplastic polyp (GHP) commonly arises in the abnormal surrounding mucosa, including autoimmune metaplastic atrophic gastritis (AMAG). We aimed to compare clinicopathological features in patients with GHPs associated with AMAG with those in patients with GHPs associated with non-AMAG. PATIENTS AND METHODS: A total of 1170 patients with GHP(s) were enrolled, and their clinical and pathological data were analyzed, retrospectively. RESULTS: The GHP patients were divided into 181 A-GHP (type A GHP, AMAG-associated GHP) participants, 312 B-GHP (type B GHP, Helicobacter pylori infection-associated GHP) participants, and 677 other GHP participants (non-A-GHP and non-B-GHP) based on pathological status of the surrounding non-polypoid mucosa. The A-GHP patients were older and predominantly female (p < .05). Gastroscopically, A-GHPs showed less distal and more multiple-region distribution in the stomach (p < .001). In addition, the A-GHPs were observed to be usually numerous (55.8%), larger (mean maximum diameter 12.3 mm), and more pedunculated or sub-pedunculated (45.3%) (p < .001). Histopathologically, the intestinal metaplasia, intraepithelial neoplasia, and carcinomatous transformation within GHPs were present in 24.3%, 9.9%, and 2.8% of AMAG patients, respectively, which were significantly higher than those in the B-GHPs and other GHPs (p < .05). However, the differences of intraepithelial neoplasia and adenocarcinoma in surrounding non-polypoid mucosa did not reach statistical significance (p > .05). CONCLUSIONS: The GHP(s) arising in AMAG patients is a distinct subgroup of GHP(s) and was an important precancerous lesion. The biopsy from surrounding non-polypoid mucosa was essential to evaluate the underlying etiology of the GHPs, and endoscopists should pay attention to these.

Cancer information seekers in china: a preliminary profile.

Cancer is now the leading cause of death in China. Effective communication about cancer risk and prevention is an important component of cancer control. Yet, research in this area is very limited in China. This study used probability sample survey data from 2 Chinese cities (Beijing and Hefei, Anhui Province) to investigate potential predictors of self-initiated cancer information seeking. Analysis showed that cancer information seekers in China were likely to be married, relatively educated, earning modest incomes, living in rural areas, smoking occasionally, having a family cancer history, relatively trusting of the media for health information, somewhat knowledgeable about cancer, having nonfatalistic attitudes about cancer, and seeing a personal need for more cancer information. The pattern of results, particularly the lack of influence of personal health and risk perception factors, highlights the possibility that seeking for others might be more prevalent than seeking for self in China. Overall, findings suggest that emphasizing family need and mobilizing family support might be a productive approach to cancer communication interventions in China.

Absolute and comparative cancer risk perceptions among smokers in two cities in China.

INTRODUCTION: Knowledge about health effects of smoking motivates quit attempts and sustained abstinence among smokers and also predicts greater acceptance of tobacco control efforts such as cigarette taxes and public smoking bans. We examined whether smokers in China, the world's largest consumer of cigarettes, recognized their heightened personal risk of cancer relative to nonsmokers. METHODS: A sample of Chinese people (N = 2,517; 555 current smokers) from 2 cities (Beijing and Hefei) estimated their personal risk of developing cancer, both in absolute terms (overall likelihood) and in comparative terms (relative to similarly aged people). RESULTS: Controlling for demographics, smokers judged themselves to be at significantly lower risk of cancer than did nonsmokers on the comparative measure. No significant difference emerged between smokers and nonsmokers in absolute estimates. CONCLUSIONS: Smokers in China did not recognize their heightened personal risk of cancer, possibly reflecting ineffective warning labels on cigarette packs, a positive affective climate associated with smoking in China, and beliefs that downplay personal vulnerability among smokers (e.g., I don't smoke enough to increase my cancer risk; I smoke high-quality cigarettes that won't cause cancer).

[A study on health information literacy among urban and suburban residents in six provinces in China].

OBJECTIVE: To understand the status and its influencing factors of health information literacy among urban and suburban residents in China, and to explore the method for improving the health information literacy. METHODS: From March to May in 2013, residents aged 18-60 years in six provinces in China were investigated with Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China about self-reported health information literacy. The results of the survey were standardized by the 6th national census data. Logistic regression analysis was used to explore influencing factors of health information literacy. RESULTS: A total of 4 416 residents were surveyed, and 4 282 (97.0%) valid questionnaires were collected. After weight adjustments, 30.1% of the residents aged 18-60 years had adequate health information literacy in China, and the 95%CI of the rate was 28.5% - 31.6%. Totally, 70.8% of the residents ever actively searched for health information, 43.7% of the residents could easily retrieve the health information, 49.1% of the residents could easily understand the health information, 41.8% of the residents could confidently differentiate the quality of the health information and 51.1% of the residents ever searched health information on the internet. The results of multi-logistic regression showed that the rural residents, the males, those with lower levels of education, those with poor health had a lower health information literacy. The most trusted health information source was from doctors, and the trust rate reached 97.0%, followed by family members, friends or colleagues. The residents trusted the interpersonal communication more than the mass media and the new media. CONCLUSION: The level of health information literacy of the residents was generally low in China. To improve the health information literacy, high-quality health information services should be delivered to the residents, and the health education on the internet provided by the medical professionals should also be explored.

[A study on risk factors and perceptions of diabetes among urban and suburban residents from six provinces in China].

OBJECTIVE: To study the epidemiological status of diabetes' risk factors among urban and suburban residents and their perceptions of their own health status and risk of diabetes. METHODS: Stratified multi-stage sampling method was used to conduct the survey among 18-60 years old residents from Zhejiang, Jiangsu, Shanxi, Henan, Yunnan, and Qinghai provinces in China from March to May in 2013. The Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China was used to conduct the survey, and then the data were analyzed. The main contents of the questionnaire included diabetes mellitus knowledge, diabetes mellitus risk factors and diabetes mellitus risk self-assessment. The results of the survey were standardized by the 6(th) national census data. RESULTS: A total of 4 416 respondents were surveyed, and 4 282 valid questionnaires were successfully collected during the survey and the response rate was 97.0%. After weighted adjustment, the overweight and obesity rate of the residents in 6 provinces was 35.3%, abdominal obesity rate was 54.7%. 77.8% of the residents without diabetes had more than one risk factor, but only 8.5% thought they might got diabetes. The residents with high risk behavior possessing rates of diabetes were in eastern areas (79.7%), urban areas (80.7%), men (84.1%), aged from 45 to 60(100.0%), below primary school education level (83.4%) and enterprise personnel (79.7%). The residents with high risk consciousness of getting diabetes were in eastern areas (11.0%), urban areas (9.7%), men (9.7%), aged from 45 to 60 (12.3%), over college education level (12.7%) and the offices (14.7%). The results of logistic regression showed that residents in the middle areas (OR = 2.148, 95% CI: 1.633-2.920), urban residents (OR = 2.100, 95% CI: 1.611-2.738), male (OR = 2.488, 95% CI: 1.962-3.154), the older (OR = 1.102, 95% CI: 1.090-1.115) had a higher risk behavior rate of diabetes mellitus. Urban residents (OR = 2.784, 95% CI: 1.497-5.175), male (OR = 1.522, 95% CI: 1.152-2.011), the older (OR = 1.022, 95% CI: 1.009-1.035), college educational level (OR = 1.685, 95% CI: 1.033-2.749), with a higher score of health awareness(OR = 1.090, 95% CI: 1.061-1.120)had a higher risk consciousness to being diabetes mellitus. CONCLUSION: The urban and suburban residents in China had a high risk behavior possessing rates of diabetes, and a low risk consciousness of being diabetes.

[An analysis of health literacy about diabetes prevention and control and its influencing factors among the residents in six provinces in China].

OBJECTIVE: To investigate the health literacy about diabetes prevention and control and its influencing factors among the public in China. METHODS: A multistage stratified random sampling method was applied to investigate urban and rural residents aged 18-60 years among six provinces in China during March and May, 2013. The Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China was used to conduct the survey. The influencing factors of health literacy about diabetes prevention and control were analyzed by logistic regression. The results of the survey were standardized by the 6(th) national census data. RESULTS: A total of 4 416 persons were interviewed. A total of 4 282 valid questionnaires including 1 986 males (46.4%) and 2 296 females (53.6%) were obtained. The efficiency rate was 97.0%. The level of health literacy about diabetes prevention and control among the public in China was 32.7% (1 036/2 399). And this rate was 40.5%, 36.5% and 15.4% in east, middle and west of China, respectively. Take the west region as reference, the health literacy about diabetes prevention and control in east China was high (OR = 2.510, 95% CI: 1.931-3.263), central China was in the second place (OR = 2.083, 95% CI: 1.579-2.749). The health literacy about diabetes prevention and control among males was lower than that in females (OR = 0.488, 95% CI: 0.402-0.593). The higher education level the respondents had, the higher the health lireracy level about diabetes prevention and control. Taking the primary school and below education level as reference, the health lireracy level about diabetes prevention and control of respondents with a secondary education was higher (OR = 1.103, 95% CI: 0.812-1.499), and that of college or above degree was the highest (OR = 2.029, 95% CI: 0.460-0.870). The health literacy about diabetes prevention and control among civil servants and institution staff was high, the enterprise personnel was in the second place (OR = 0.632, 95% CI: 0.460-0.870), the literacy level among the rural residents was very low (OR = 0.339, 95% CI: 0.234-0.491). The health literacy about diabetes prevention and control among people who have a family history of diabetes was relatively higher (OR = 1.570, 95% CI: 1.222-2.018 ). The health literacy about diabetes prevention and control among people who considered that they have diabetes risk was higher than that among people who considered they didn't (OR = 1.821, 95% CI: 1.317-2.517). CONCLUSION: The east region, females, a high educational level, civil servants and public officers, having a family history of diabetes, self-assessed risk of getting diabetes were protective factors of health literacy about diabetes prevention and control.

[The study of diabetes-related behavior status and affecting factors among urban and suburban residents in six provinces in China].

OBJECTIVE: To explore the status of diabetes-related behaviors and affecting factors among urban and suburban residents in China. METHODS: A sample of 18-60 years old residents from Zhejiang, Jiangsu, Shanxi, Henan, Yunnan and Qinghai provinces was investigated by using stratified cluster random sampling method from March to May in 2013, and 4 282 residents were recruited. The Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China was used to conduct the survey. χ(2) test was used to compare the different risk behavior characteristics of diabetes. The results of the survey were standardized by the 6th national census data. Multiple regression analysis was used to understand the affecting factors to related behaviors. RESULTS: After data standardization, 14.3% sat more than 6 hours every day, 57.6% exercised less than 3 times every week, 21.3% had no regularly daily diet, 58.7% paid no attention to diet control, 15.7% and 7.8% residents preferred salty and oily diet, 51.4% had physical examination less than 1 time every year, 29.7% were smokers, and 9.2% often drank. Urban residents spent much more time on sitting (18.2%) than rural residents (8.4%) (P < 0.05), and the rates of lack of physical exercise(52.7%), irregular diet (17.2%), paying no attention to diet control (51.9%), smokers (23.6%) among urban residents were lower than rural residents (60.1%, 21.4%, 62.5% and 32.1% respectively) (P < 0.05). The rates of irregular diet (24.6%), paying no attention to diet control (63.5%), high-salt and high-fat diet (30.1%), smokers (57.7%), drinking (18.7%) among men were higher than those in females (15.5%, 52.1%, 23.2%, 2.2%, and 0.8% respectively) (P < 0.05); regions, genders, educational levels, occupations were related to relative behaviors of diabetes, residents in rural areas (t = 7.829, P < 0.01), males (t = -21.760, P < 0.01), lower education level (t = 0.771, P < 0.01), as well as institution personnel (t = -4.240, P < 0.01) had lower behavior scores, which meant they had more risk behaviors related to diabetes. CONCLUSION: There were diabetes-related risk behaviors among both urban and suburban residents in China, such as insufficient physical exercise, no diet control and regular medical examinations. These risk behaviors happened more in rural areas than in urban areas, men than women, older age group than lower age group.

[The status of diabetes prevention awareness among Chinese residents in six provinces].

OBJECTIVE: To explore the status of diabetes prevention awareness among Chinese residents in order to provide the scientific basis for making intervention strategy. METHODS: A sample of 18-60 years old residents in six provinces was investigated from March to April in 2013. RESULTS: Totally, 17.8% of respondents answered all questions correctly about the awareness of diabetes. As for "Diabetes is a common chronic disease" got highest recognition rate (86.2%), and "Diabetes can be cured" got the lowest rate, 48.3%. 50.6% of respondents answered all questions correctly about the diabetes symptoms; and "thirsty, drink more water" got the highest recognition rate (75.3%). 17.8% of respondents answered all questions correctly about the complications of diabetes; and "causes of diabetes ketoacidosis" got the lowest rate of 31.6%. 12.3% of respondents answered all questions correctly about the diabetes high-risk group; the correct recognition rate for "family history" was the highest (75.1%); and the "macrosomia" got the lowest rate of 20.4%. 74.2% of respondents answered all questions correctly about the diabetes preventive measure;the correct cognition rate of a reasonable diet was the highest (92.0%), and the weight control was the lowest (81.5%). In addition, there are significant differences of knowledge score between different areas and genders. City residents' knowledge score about diabetes related views (6.2 ± 1.8), typical symptoms (2.9 ± 1.4), complication (4.1 ± 2.3), high-risk groups (3.4 ± 1.7), prevention measures (3.7 ± 0.9) were higher than rural residents (respectively 5.2 ± 2.2, 2.7 ± 1.5, 3.2 ± 2.3, 2.9 ± 1.8, 3.3 ± 1.2) (P < 0.05). Female residents' knowledge score about diabetes related views (5.7 ± 2), typical symptoms (2.9 ± 1.4), complication (3.8 ± 2.3), high-risk groups (3.1 ± 1.8), prevention measures (3.5 ± 1) were higher than male residents (respectively 5.5 ± 2.1, 2.7 ± 1.5, 3.5 ± 2.4, 3.1 ± 1.8, 3.4 ± 1.2, 18.1 ± 6.8) (P < 0.05). CONCLUSION: The public is lack of diabetes prevention awareness, and city residents' knowledge score is higher than rural residents', females are higher than males.

An mHealth-based school health education system designed to scale up salt reduction in China (EduSaltS): A development and preliminary implementation study.

Background: High-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system. Methods: The EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO's conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China. Results: EduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users' smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%. Conclusion: As an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing.

[Status quo of lifestyle among women of five occupations in six provinces of China].

OBJECTIVE: To learn the status quo of lifestyle among women of five occupations in six provinces of China. METHODS: A questionnaire was administered among 7416 women from five occupations (civil servants, teachers of elementary and high schools, technical staff, enterprise managers and physical laborers) in Beijing, Hebei, Jilin, Hubei, Ningxia and Gansu of China. The sample was selected by multi-stage stratified cluster random sampling method from December 2009 to June 2010. The questionnaire information included demographic characteristics, diet, sleep habit, smoking, physical exercise. The χ(2) test was used to analyze the different in life style of different occupations. RESULTS: There were 7416 valid questionnaires received, and the valid rate of the questionnaires was 97.58% (7416/7682). About 38.00% (2818/7416) respondents preferred to bland diet and 28.44% (2109/7416) preferred to salty and oily food and 33.56% (2489/7416) had no preference. The proportion of sleep time between seven and eight hours per day was highest (accounting for 56.23%, 4154/7416), 25.27% (1867/7416) with sleep time less than seven hours. Among the population who had the sleep time less seven hours, teacher that had the highest rate accounted for 33.19% (531/1607) and technical staff had the lowest rate accounted for 21.05% (301/1401) (P < 0.01). Most of respondents were non-smokers, accounting for 93.10% (6869/7416). 22.73% (1671/7416) respondents passively smoked. The proportion of always passive smoking was highest among civil servants and lowest among teachers, accounting for 26.60% (404/1531) and 18.71% (298/1607), respectively. The proportion of having no physical exercises was highest, accounting for 62.87% (4637/7416). The proportion of having three times physical exercises per week was 12.68% (935/7416). The proportion of having no physical exercises among physical laborers (66.42%, 912/1386), enterprise managers (66.64%, 987/1491) and teachers (62.40%, 999/1607) were higher than others and the proportion of having physical exercises per week among technical staff was 40.83% (569/1401), higher than others (P < 0.01). The proportion of person who worked in sitting quietly beyond six hours per day was 42.62% (3146/7416). The technical staff had the higher rate than other occupational populations (P < 0.01), accounting for 57.83% (809/1401). CONCLUSION: The female occupational population had some unhealthy lifestyles, such as taking in high salt food, lacking of sleep, smoking and passive smoking, lacking of physical exercises and working in sitting quietly. Different occupational populations had different unhealthy lifestyles.

[Study on lifestyle and self-rated health among 5 kinds of occupational populations in 6 provinces in China].

OBJECTIVE: To know about the status of self-rated health and life style among 5 kinds of occupational populations in 6 provinces in China and to explore the influencing factors related with health of the occupational population. METHODS: From May to August 2009, a total of 13 492 persons aged 18 - 60 years including civil servants, scientific and technical personnel, administrative staff, teachers and physical workers were selected by multi-stage stratified sampling from Beijing city, Ningxia Hui autonomous region, Liaoning, Zhejiang, Hubei and Qinghai provinces to undergo surveys on the Lifestyle of Occupational Population in Urban in China and Self-rated Health Measurement Scale Version 1.0 (SRHMS V1.0). The effects of lifestyles on health scores were analyzed by logistic linear regression. RESULTS: Overall, 13 073 valid questionnaires of the Lifestyle of Occupational Population in Urban in China and 13 177 valid questionnaires of SRHMS V1.0 were collected. The valid rate was 96.9% and 97.7% respectively. Among the respondents, 46.9% (6136/13073) ate timely in a day, 50.9% (6658/13 073) ate breakfast every day, 27.8% (3635/13 073) worked over 8 hours per day, 31.0% (4057/13 073) didn't do any exercises, 14.6% (1906/13073) sat for over 4 hours in spare time, 39.3% (5137/13 073) were drinking and 24.8% (3230/13 073) were current smokers. The average score of SRHMS of all respondents was 73.34 +/- 11.86, of which the civil servant had the highest score (74.83 +/- 11.89) while the teacher had the lowest score (71.65 +/- 11.44, P < 0.05). The results of multiple linear regression showed that females (b = -0.945, b' = -0.041), the elderly (b = -0.098, b' = -0.087), teachers (b = - 2.151, b' = -0.074), the divorced (b = -1.607, b' = -0.021), the widowed (b = -2.926, b' = -0.019), and smokers (b = -1.198, b' = -0.045) were with worse condition. Respondents with higher education (b = 0.588, b' = 0.037), eating timely (b = 2.301, b' = 0.141), eating breakfast every day (b = 1.503, b' = 0.096), paying more attention on diet (b = 0.499, b' = 0.021) and doing more exercises (b = 1.820, b' = 0.058) had better condition. CONCLUSION: Eating irregularly, working long hours, lack of exercise, sitting for long hours, smoking and drinking were common among occupational population. The self-rated physical health status was associated with gender, age, education level, occupation, diet and exercise.

[Status of knowledge and behavior of drug use among residents in 5 provinces in China in 2011].

OBJECTIVE: To understand the status of knowledge and behavior of drug use among urban and rural residents in 5 provinces in China to suggest priority intervention strategies and measures for drug use health education. METHODS: From March to May of 2011, 6159 urban and rural residents were selected from Beijing, Liaoning, Zhejiang, Yunnan, Shaanxi provinces by the multistage stratified sampling method and were investigated by the questionnaires on drug use knowledge and behavior. RESULTS: The residents' average awareness rate for 11 pieces of basic drug use information was 48.3% (32,750/67,749). The residents' average awareness rate in the rural (40.3%, 9189/22 792) was lower than that in metropolitan (51.9%, 11 483/22 110) and small and middle-sized cities (52.9%, 12,078/22,847) and the differences had statistical significance (χ2=889.30, P<0.01). Overall, 77.0% (4742/6159) of residents purchased drug according to the doctors' prescription; 36.9% (2271/6159) of residents bought by their experiences; 33.3% (2049/6159) of residents did not know whether they had bought faked drugs; 32.7% (2016/6159) of residents did not read instructions carefully before using drug; 83.4% (5134/6159) of residents stored drugs in their house and only 29.2% (1798/6159) of residents would check up expired drugs regularly; 59.6% (3673/6159) of residents changed drug by themselves after suspected adverse reaction of drugs. CONCLUSION: Chinese urban and rural residents' knowledge level of drug use is inadequate and drug use behaviors are not optimistic. Drug use health education should be enhanced among urban and rural residents.

Salt-Related Knowledge, Attitudes, and Behaviors and Their Relationship with 24-Hour Urinary Sodium Excretion in Chinese Adults.

Salt intake in China is very high, which increases the risk of hypertension and cardiovascular disease. This study aimed to assess the levels of salt-related knowledge, attitudes, and behaviors (KABs) and the factors that influence them and to explore the relationship between the scores of salt-related KAB and 24-h urinary sodium excretion. In 2018, we collected data from 5453 individuals aged 18-75 years from six provinces in China. A face-to-face survey was carried out, focusing on the KAB related to salt reduction. All participants were asked to collect one 24-h urine sample. Of the 5453 participants, 5352 completed urine collection. The mean score for overall KAB was 31.27 (SD = 9.18), which was composed of three elements: knowledge 4.80 (SD = 5.14), attitude 9.33 (SD = 3.93), and behavior 17.14 (SD = 4.43). The average 24-h urinary sodium excretion was 187.70 (SD = 77.48) mmol, which was equivalent to a urinary sodium excretion of 4.32 (SD = 1.78) g/d. We found that salt-related knowledge, attitude, behavior, and overall KAB scores were all inversely associated with 24-h urinary sodium excretion. For every one-point increase in the KAB score, the 24-h urinary sodium excretion decreased by 0.851 mmol (95% CI: -1.095, -0.602). We also found that location (rural/urban), sex, age, and education are associated with salt-related KAB scores. These results suggest that large-scale health education is needed to reduce salt intake in the Chinese population. In particular, efforts should be focused on reaching those who live in rural areas with low educational levels and older people.

Prevalence of tobacco dependence and associated factors in China: Findings from nationwide China Health Literacy Survey during 2018-19.

Background: Tobacco dependence is the key barrier to successful smoking cessation. However, little is known about its prevalence, sociodemographic characteristics and determinants. We aimed to estimate the prevalence, associated factors and burden of tobacco dependence in China. Methods: During 2018-2019, the nationally representative 2018 China Health Literacy Survey (2018 CHLS) invited 87,708 participants to participate using a multistage stratified sampling method from 31 provinces (or equivalent) in mainland China, and 84,839 participants aged 20-69 with valid data were included in the analysis. We diagnosed tobacco dependence based on international criteria (ICD-10, DSM-4) and tailored to Chinese population according to China Clinical Guideline for Tobacco Cessation (2015 version). The prevalence of tobacco dependence was estimated overall and by sociodemographic factors. The Logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CIs) for tobacco dependence and success of smoking cessation (being ex-smokers), with different levels of adjustment. These were used to estimate the total number of adults who were tobacco dependent in China. Findings: In China, the estimated prevalence of current smoking was 25.1%, significantly higher in men than in women (47.6% vs 1.9%). The prevalence of current smoking varied approximately 3-fold (12.9% to 37.9%) across 31 provinces of China. Among general population aged 20-69 years, the prevalence of tobacco dependence was 13.1% (95% CI:12.2-14.1). Among current smokers, the prevalence of tobacco dependence was 49.7% (46.5-52.9%), with no difference between men and women (49.7% vs 50.8%). The prevalence of tobacco dependence was associated significantly with smoking intensity, defined by pack-years (1.62 [1.54-1.70] per 10 pack-years), cigarettes smoked per day (2.01 [1.78, 2.27] per 10 cigarettes), and smoking starting age (0.93 [0.90, 0.97] per 5 years). Given smoking intensity, the prevalence of tobacco dependence also varied by age, gender, certain socioeconomic status and regions. Compared with those without tobacco dependence, ever smokers with tobacco dependence were less likely to be ex-smokers (2.88, 2.59-3.21). In China, 183.5 (170.4-197.4) million adults (177.5 million were men) were tobacco dependent in 2018. Interpretation: In China, tobacco dependence is highly prevalent, with approximately half of current smokers being addictive, highlighting the need for coordinated effort to improve awareness, diagnosis and treatment of tobacco dependence. Funding: Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), National Key R&D Program of China (grant no 2017YFC1309400), and National Natural Science Foundation of China (grant no 81720108001). Note: Chinese translation of abstract is available in appendix section.

The experience of tobacco withdrawal symptoms among current smokers and ex-smokers in the general population: Findings from nationwide China Health Literacy Survey during 2018-19.

Objective: To clarify the extent to which smokers in the general population experience tobacco withdrawal symptoms and whether such experience differs in those who continue to smoke and those who stopped smoking. Methods: We included relevant questions in the nationally-representative China Health Literacy Survey (CHLS) conducted in 2018-2019. Among 87,028 participants, there were 22,115 ever-smokers aged 20-69 years who provided information on their smoking history and their experience of tobacco withdrawal symptoms. Multivariate logistic regressions were conducted to explore the association between withdrawal symptoms and other variables. Results: Among ever-smokers, there were 19,643 (88.8%) current smokers and 2,472 (11.2%) ex-smokers. Among current smokers, 61.3% reported having tried to quit smoking in the past. Overall, 61.1% of current smokers reported experiencing withdrawal symptoms: 69.9% of those who tried to quit smoking in the past and 47.5% of those who did not. A lower proportion of ex-smokers experienced withdrawal symptoms (46.3%) and the difference remained significant after controlling for demographic characteristics (OR = 1.76, 95% CI 1.62-1.93, P < 0.001). The most commonly reported withdrawal symptoms in both current smokers and ex-smokers were craving, restlessness and anxiety. In the multivariable-adjusted analyses, those who experienced withdrawal symptoms when they tried to quit smoking (OR: 2.05, 95% CI: 1.86-2.27) were less likely to successfully quit. Conclusions: The clinical picture of the tobacco withdrawal syndrome is the same in current smokers and in ex-smokers, but ex-smokers are less likely to have experienced it. The experience of discomfort when unable to smoke is common and seems likely to be a major factor contributing to maintaining smoking behavior not just among individuals seeking help with quitting smoking, but among smokers generally.

The Association Between Health Literacy and Self-rated Health Among Residents of China Aged 15-69 Years.

INTRODUCTION: Health literacy is a critical determinant of health. However, the association between health literacy and outcomes among Chinese residents has not been studied using nationally representative data. This study examines the association between health literacy and self-rated health among Chinese residents based on the 2017 China Health Literacy Survey. METHODS: The 2017 China Health Literacy Survey was conducted among non-institutionalized residents aged 15-69 years from 31 provinces in China. Self-rated health was measured using a single question with a 1-5 scale. Health literacy was assessed using the Chinese Health Literacy Scale. Multilevel linear regression models examined the association between health literacy and self-rated health. Data were collected in 2017 and analyzed between 2018 and 2019. RESULTS: The final sample size was 85,384. The overall weighted mean of the self-rated health score was 4.02 (95% CI=4.00, 4.03). After adjusting for individual-, county-, and province-level covariates, Chinese residents with higher levels of health literacy were more likely to have better self-rated health (ß=0.0007, SE=0.0002, p<0.001). Of 6 dimensions of health literacy, 4 (i.e., infectious diseases literacy, chronic diseases literacy, medical care literacy, and health information literacy) were associated with self-rated health. Additionally, self-rated health was associated with gender, age, education, occupation, annual household income, and chronic conditions. CONCLUSIONS: Using nationally representative data collected in 2017, this study found that self-rated health is associated with health literacy among Chinese residents aged 15-69 years. The promotion of health literacy should be an important component of health education, patient management, and health promotion.