Correction to: The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka.

It was highlighted that in the original article [1] the selection process was not described clearly enough to avoid confusion under the heading of the Target of Outcomes in the Methods section.

The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka.

BACKGROUND: Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. METHODS: A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. RESULTS: Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group. CONCLUSIONS: An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. TRIAL REGISTRATION: Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.

School-based intervention to enable school children to act as change agents on weight, physical activity and diet of their mothers: a cluster randomized controlled trial.

BACKGROUND: School health promotion has been shown to improve the lifestyle of students, but it remains unclear whether school-based programs can influence family health. We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers. The objective of this study was to examine the effect of the child-initiated intervention on weight, physical activity and dietary habit of their mothers. METHODS: A 12-month cluster randomized trial was conducted, with school as a cluster. Participants were mothers with grade 8 students, aged around 13 years, of 20 schools in Homagama, Sri Lanka. Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them, whereas those of the comparison group received no intervention. Body weight, step count and lifestyle of their mothers were assessed at baseline and post-intervention. Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes, respectively. RESULTS: Of 308 study participants, 261 completed the final assessment at 12 month. There was a significantly greater decrease of weight and increase of physical activity in the intervention group. The mean (95% confidence interval) difference comparing the intervention group with the control group was -2.49 (-3.38 to -1.60) kg for weight and -0.99 (-1.40 to -0.58) kg/m(2) for body mass index. The intervention group had a 3.25 (95% confidence interval 1.87-5.62) times higher odds of engaging in adequate physical activity than the control group, and the former showed a greater number of steps than the latter after intervention. The intervention group showed a greater reduction of household purchase of biscuits and ice cream. CONCLUSIONS: A program to motivate students to act as change agents of family's lifestyle was effective in decreasing weight and increasing physical activity of their mothers. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry SLCTR/2013/011 .

Students' perception of school environment and life satisfaction at Sinhala-medium secondary schools in the Colombo District, Sri Lanka.

The objective of this study was to examine the associations between students' perception of physical and psychosocial school environment and satisfaction with life among secondary school students in Colombo District, Sri Lanka. Data were collected from 20 Sinhala-medium secondary schools between January and February in 2010. A questionnaire-based survey was conducted with students in grade seven (n = 342) and grade ten (n = 446). Multivariate logistic regression analysis, adjusted for confounding variables, was used to assess the associations between students'satisfaction with life measured by Cantril ladders, and scores of perceived physical and psychosocial school environment that focused on school cleanliness and attractiveness, relations with teachers and peers, satisfaction with school and bullying. Students in the highest quartile of school environment score were significantly more likely to have high life satisfaction, compared to those in the lowest quartile (adjusted odds ratio 2.32; 95% confidence interval 1.35-3.99). Odds ratio of high life satisfaction increased with increasing school environment scores (p for trend<0.001). In conclusion, students who perceived positive school environment were significantly more likely to have high life satisfaction. Positive changes in the focused areas of school environment have the potential to lead to improved life satisfaction of students.

Healthy lifestyle index and its association with hypertension among community adults in Sri Lanka: A cross-sectional study.

OBJECTIVES: To investigate the association between a healthy lifestyle index (HLI) (i.e., a composite score comprising multiple lifestyle factors) and hypertension among community adults living in Sri Lanka. METHODS: The present study used baseline information of a cluster randomized controlled trial among 456 adults aged 27-65 years in a semi-urban community in Colombo, Sri Lanka. The HLI was constructed by summing a number of low-risk lifestyle factors: low body mass index, sufficient physical activity, non-smoking, low alcohol consumption, and sufficient fruit and vegetable consumption. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of antihypertensive medication. A logistic regression model was used to investigate the association between the HLI (low: 0-2; middle: 3; high: 4-5) and hypertension. RESULTS: A total of 178 (39%) participants were hypertensive. Compared with the low HLI group, multivariate-adjusted odds ratios (95% confidence intervals) of hypertension were 0.72 (0.44-1.19) and 0.28 (0.15-0.54) for the middle and high HLI groups, respectively (p-trend <0.001). CONCLUSIONS: The present study provides essential evidence on an inverse association between adherence to healthy lifestyles and hypertension.

Disaster management: lessons from immediate responses to the tsunami.

There are many lessons learnt from the immediate reactions of people in the aftermath of the vast destruction from the giant waves that hit Sri Lanka. Reactions of victims fell between extremes of resilience and helplessness. Responses of those not directly harmed illustrated the two extremes--selflessness and depravity. These responses offer insight into how we live and how we react to situations, and also to an extent how we should be reacting. Among these is that helpers should respect and involve, from the inception, the resources within the group or community affected by the disaster. Control of the relief effort to the maximum feasible extent, should be in the hands of those at whom it is directed.

Association between concurrent alcohol and tobacco use and poverty.

INTRODUCTION AND AIMS: The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. DESIGN AND METHODS: A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. RESULTS: Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use. DISCUSSION AND CONCLUSIONS: The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.

Different disasters, different needs.

Different kinds of disaster create dissimilar conditions for survivors, and the specific realities associated with each must guide our helping responses. This in no way negates the importance of having general principles to follow in responding to major disasters (Sphere Project, 2004; van Ommeren et al, 2005).