Influencing factors on the voluntary premarital medical examination among Chinese population / 中华流行病学杂志

Objective To explore the factors influencing the premarital medical examination in Chinese population and to discuss the related possible intervention strategies.Methods Data were collected through self-designed questionnaires on 2572 newly married respondents,selected under a stratified randomized sampling method,at Marriage Registration Office in 12 counties in Zhejiang province.Predictive factors were derived from the integrating complementary constructs of Health Belief Model,Theory of Reasoned Action as well as individual demographic characteristics.Multiple logistic multilevel analyses was used as the main statistical method,with individuals as the ' low' and counties as the 'high' levels.Results Behaviors on premarital medical examination showed a clustering trait at the county level (P=0.018) and variance partition coefficients (VPC) of each variables was between 15.40％ and 17.58％.There were no statistical significances found in the rates of premarital medical examination among gender,age,residence of Household Registration,education,income,health insurance and history of premarital medical examination.However,significant correlation was seen on occupation of the respondents.The rate of premarital medical examination among the respondents who had not attended medical examination during the last six moths was 1.31times (95％ confidence intervals,1.05 -1.65 ) more than those who had,with OR (odds ratio) as 1.51 (95％CI:1.14-2.00) for the pregnant respondents in their first marriage and 0.35 (95％CI:0.23-0.51 )for remarried respondents,compared with women at first marriage but remained unpregnant.Regarding premarital medical examination,the respondents reported greater benefits,less barriers,greater positive behavioral attitudes and normative beliefs to it,with an ORs as 2.32 (95％ CI:1.18-4.60),0.71 (95％CI:0.57-0.90),1.69 (95％CI:1.10-2.58) and 1.72 (95％CI:1.34-2.20)respectively,but with no significant association with perceived susceptibility,perceived severity and motivation to comply.Conclusion Factors such as individual perceived benefits,barriers,attitudes and normative beliefs etc.,were determinants of premarital medical examination accompanied by minor (16％) influence coming from the geographical environment.

Perceived stress in general public during prevalence of severe acute respiratory syndrome and its impact on health behavior / 中华预防医学杂志

<p><b>OBJECTIVE</b>To find out the perceived stress in general public during prevalence of severe acute respiratory syndrome (SARS) and its impact on health behavior.</p><p><b>METHODS</b>A retrospective survey was conducted in Guangzhou, Hangzhou, and Taiyuan according to the epidemic situations of SARS, and 2532 subjects were randomly selected from constructive industry, school, and commercial business and residents in urban and rural areas. The perceive stress was measured by Chinese perceived stress scale (CPSS), and health related behavior during SARS was tested by uniform and self-made questionnaire. EpiData 2.0 was used for data management and CPSS value was calculated according to answer to 14 questions contained in the scale. Health risk stress among different population group and health related behavior among low, medium and high stress state were analyzed by SPSS 11.5.</p><p><b>RESULTS</b>2424 subjects were involved in the survey. The CPSS value was measured from 0 - 49 (22.7 +/- 6.8), M = 24.0. 39.3% (953/2379) subjects were under the health risk stress. The health related behaviors such as washing hands, opening the window for air, keeping away from others when cough and sneeze, doing exercises etc were reduced with the stress increased. Logistic regression indicated that compared with the persons with the thoughts of nothing serious of SARS, without any dread of SARS, and knowing nothing about prevention of SARS, the perceived stress was significantly related with perceiving of the thread to certain extent (beta = 0.41, Wald chi(2) = 4.84, P = 0.03), worrying little about the epidemic (beta = 0.50, Wald chi(2) = 6.69, P = 0.01), worrying about it to certain extent (beta = 1.39, Wald chi(2) = 48.59, P = 0.00) and scared so much (beta = 1.77, Wald chi(2) = 53.59, P = 0.00), and knowing little about the prevention (beta = 0.74, Wald chi(2) = 4.48, P = 0.03), knowing something about prevention (beta = -0.98, Wald chi(2) = 8.29, P = 0.00) and knowing the prevention very well (beta = -1.18, Wald chi(2) = 10.66, P = 0.00).</p><p><b>CONCLUSION</b>The adoption of health related behaviors declined with increase of perceived stress. Opening connection to authority and government, enhancing the awareness of outburst affairs among general public and providing positive social support may be effective ways to reduce the population perceived stress.</p>

A multilevel analysis on the association between socioeconomic status and psychiatric disorders / 中华流行病学杂志

Objective To explore the association between psychiatric disorders and socioeconomic status such as education,income,employment and area of community settings in Zhejiang province.Methods Data were from the epidemiological survey of mental illnesses aged 15 and older in 2001(n=14 632).Psychiatric disorders were measured by GHQ-12 with a cut-point 4.Logistic multilevel analysis was the main statistical method being used.Results The overall prevalence of psychiatric disorders was 18.5%(95% confidence intervals,17.9% to 19.1%),higher than the data from Hebei province(u=4.39,P＜0.001).Annual household income and employment were strongly associated with psychiatric disorders especially for those with low income(odds ratio 3.45,95%CI:1.72-6.67)and unemployment(odds ratio 2.03,95%CI:1.73-2.40).Factors as regional effect and education level showed weak or inconsistent association with psychiatric disorders after controlling on other indicators.Conclusion Inverse gradient relation between psychiatric disorders and SES seemed as the main result of low SES individual characteristics and some minor effects at the county level.

A multilevel cross-sectional study of mental disorder in community settings in Zhejiang Province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of mental disorder through the 12-item general health questionnaire (GHQ-12) survey and its related factors in community settings in Zhejiang Province.</p><p><b>METHODS</b>A muti-level model was analyzed using data of 14,632 respondents nested in counties (cities), townships (urban districts), villages (urban neighborhoods) from the epidemiological survey of mental illnesses above 15 years old.</p><p><b>RESULTS</b>The mean score measured by GHQ-12 was (1.54 +/- 2.15), which was lower than that of samples from four cities of Guangzhou, Chongqing, Taiyuan and Hangzhou (U = 11.08, P < 0.01). The mental disorder clustered within county (city) level, which represented 4.3% (chi(2) = 3.94, P < 0.05) of the total variance including four levels. After controlling for the county level, the mental disorder was associated with age, marital status, residency patterns, education, occupation and household incoming. In particular, it was reported that higher household incoming was significantly associated with better mental disorder among population in community settings.</p><p><b>CONCLUSION</b>The prevalence of mental disorder clustered at the county (city) level is relatively lower with vulnerable groups including divorced, widowed, unemployed, retired, lower-income ones in community settings in Zhejiang Province.</p>

Cognitive and behavioral strategies of stress management among Chinese urban residents / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify the effective stress management strategies among the Chinese.</p><p><b>METHODS</b>The sample was selected from Hangzhou, Guangzhou, Chongqing and Taiyuan by using a multi-stage sampling procedure, including 3679 subjects. The data were collected using the household interviewing survey method. The Chinese perceived stress scales (CPSS) measured stress. Stress management strategies included the cognitive and behavioral ones, the former were further divided into positive, neutral and negative ones and the latter were divided into three kinds, i.e. looking for support, liberating and displacing, and relaxing and detracting. The frequency of their usage and their perceived effectiveness were assessed. Multivariable analysis was used to examine the association between various stress management strategies and stress.</p><p><b>RESULTS</b>The prevalence of health risk stress (HRS) was 44.54% (95% CI: 42.90% - 46.12%). Among the cognitive strategies, all the positive strategies and one of neutral strategies ("Suiyuan") were associated with lower HRS, and the rest of them had no effects. Among the behavioral strategies, all were associated with lower HRS except that of looking for support.</p><p><b>CONCLUSION</b>The effective stress management strategies identified in this study might be used to develop a stress management program.</p>

The change of health related behavior during and after severe acute respiratory syndrome prevalence / 中华预防医学杂志

<p><b>OBJECTIVE</b>To describe the changes of health related behavior and influencing factor during and after the prevalence of severe acute respiratory syndrome (SARS), as to providing evidence for inducing public health related behavior to cope with the emergent infectious public health hazards.</p><p><b>METHODS</b>According to the epidemic strength of SARS, Guangzhou, Taiyuan, Hangzhou were selected to be the research areas, and convenience sampling was used to identify 200 city residents, 200 country residents and 400 occupational populations from each area. The uniform and self-made questionnaire was carried out by about 2400 residents.</p><p><b>RESULTS</b>All 2424 subjects completed the questionnaire. The correlation coefficient of scores of health related behavior during and after SARS was 0.782 (P < 0.01). And 39.3% subjects were considered as under the health risked stress by CPSS. Multiple linear regression indicated that the scores of health related behavior were significantly related to the perceived stress, demographic characteristics and recognition of SARS.</p><p><b>CONCLUSIONS</b>The public health related behavior should be developing in the SARS, and part of health related behavior had been kept after SARS and part been decreased. Behavior change should depends on the prevalence of the disease, cultural heritage and behavior variability. More attention should be paid to induce the public psychology and behavior and enhance the degree of recognition on related knowledge through health education as to relieving the stress in populations when we conduct to cope with the emergent public health hazards.</p>

Study on the dissemination of human immunodeficiency virus risk behaviors in a floating workers coming from the countryside in China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the pattern of transmission of human immunodeficiency virus through risky sexual behaviors (RSB) in floating workers coming from the countryside to the cities.</p><p><b>METHODS</b>Data were collected anonymously through a structured questionnaire survey in 1595 men from Hangzhou and Guangzhou cities, using a multi-stage sampling method. Data from both preliminary analyses and multivariate regression analysis would show the cumulative adoption of RSB over time and the identification of factors associated with the adoption in this population from the two areas.</p><p><b>RESULTS</b>57.9% - 88.1% of the study samples with the pre-stage RSB (receiving shampoo, massage or leisure-seeking activities from "sexual workers") and 79.9% of those with commercial RSB were initiated during the period when they were working away from their home-towns. The highest adoption rate (15.2% - 26.8%) was happened in the third month after moving to the urban areas for pre-stage RSB, while the highest rate (14.4%) was noticed in the sixth month for the commercial ones. The transition interval between the two behaviors was around 3 months. The cumulative rate was peaked from 57.3% to 70.4% for pre-stage RSB and 48.9% for commercial RSB. The cumulative adoption curves showed that the robust increment was more pronounced in the pre-stage than in the commercial RSB. Most of the early adopters were married and holding higher hedonistic beliefs for the commercial RSB. Communication of sex information and behavioral adoption of RSB was associated with the perceived stress and hedonistic beliefs.</p><p><b>CONCLUSION</b>RSB epidemics seemed to be social and group phenomena, suggesting that related social strategies should be developed in order to control the RSB in this population.</p>

The application of structural equation model approach in epidemiological research / 中华流行病学杂志

<p><b>OBJECTIVE</b>To discuss application of structural equation model (SEM) approach in epidemiological research.</p><p><b>METHODS</b>A brief overview on major components of SEM, statistical assumptions underlying the use of SEM, and current software available to users and how SEM can be used were discussed through a practical epidemiological research project.</p><p><b>RESULTS</b>Advantages of SEM comparing with conventional epidemiological approach were shown. SEM, having the nature of comprehensive thinking and analytic approach, not only exploring the association between factors and diseases but also among factors. It also served a confirmatory, rather than exploratory approach on data modeling, as well as having the capability of correcting estimates by separating measurement error from the equations, to provide modeling the latent variables.</p><p><b>CONCLUSION</b>SEM approach could be used in epidemiological research as having some advantages comparing with conventional epidemiological approaches.</p>

A cross-sectional study on the changes in dietary behavior stages in resident / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the possibility of applying the concept of various stages of dietary behavior changes in Hangzhou residents.</p><p><b>METHODS</b>The dietary behavior was surveyed and analyzed in 1 388 Hangzhou residents with 18 year-old and older using the various dietary behavior change model model and stages of change.</p><p><b>RESULTS</b>The proportion of Hangzhou residents with unhealthy dietary behavior was high and associated with gender and education level. The changes of dietary behavior could be divided into 5 stages, i.e. preintention, intention, preparation, action and maintenance. These stages of change happen consecutively. The changes of unhealthy dietary behavior do not match the improvement of health knowledge. Although a significant proportion of the residents understand that it is unhealthy to eat too much fat, pickles and high salt food, there are only a few of them really take action to reduce the consumption of these foods and to consume more milk, fruit and vegetable.</p><p><b>CONCLUSIONS</b>There are multiple factors that affect the changes of dietary behavior in people. The changes of dietary behavior occur in various consecutive stages. Different intervention measures should be applied to people in different dietary behavior changes.</p>

An epidemiological study on stress among urban residents in social transition period / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the stress related problems and risk factors among urban residents in the social transition period.</p><p><b>METHODS</b>Samples including 3 666 subjects came from Hangzhou, Guangzhou, Chongqing and Taiyuan under multi-stage sampling procedure. Data were collected through a household interviewing survey. Stress was measured by the Chinese Perceived Stress Scales (CPSS). Distribution of health risk stress (HRS), high level stress were described along the demographic dimension. Multivariate logistic analysis was used to identify the predictors of HRS.</p><p><b>RESULTS</b>CPSS was found to have good validity and reliability among this study sample. The mean score for the total sample was 24.22 +/- 5.81 and the overall prevalence of HRS was 44.54% (95% CI: 42.90 - 46.12). The difference between male (42.95%) and female (46.30%) was statistically significant (P < 0.05). The rate of HRS decreased with age, with the highest rate (59.29%) among those less than 21 years old. The rate of HRS also decreased as educational level increased and differed significantly by occupation. High school students, people who had never been employed and those who had lost their jobs had the highest rates of HRS. The rate of HRS was also related to marriage status, household's economic level, and the level of the social engagement of the subjects.</p><p><b>CONCLUSION</b>Stress experienced by the urban residents became a serious health problem which requires special attention to be paid to certain subgroups in the population.</p>

The application of Chinese health questionnaire for mental disorder screening in community settings in mainland China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the applicability of Chinese Health Questionnaire (Taiwan version) (CHQ) originated from General Health Questionnaire (GHQ) for mental disorder screening in community settings in mainland China.</p><p><b>METHODS</b>A pilot study was conducted in Hangzhou (n = 377). Three thousand seven hundred and seven subjects were recruited from four cities to validate the results of the pilot study. Validation of the Screening Questionnaire was analyzed, using Relative Operating Characteristic (ROC) method.</p><p><b>RESULTS</b>Cronbach's alpha coefficients were calculated to be 0.79 for the 12-items and 0.89 for 30-items to CHQ version in the first sample, and 0.74 in the second sample (12-items). Four factors were extracted from the CHQ-30, including somatic symptoms, anxiety and worry, social dysfunction, poor family relationship, and depression. CHQ-12 could be explained by a single factor in both samples. The areas under ROC were 0.80 (95% CI: 0.70 - 0.89) for 12 items and 0.72 (95% CI: 0.62 - 0.82) for 30 items. The sensitivities of CHQ-12 and CHQ-30 were found to be 76.9% and 71.8%, and the specificities were 73.8% and 67.9% with Kappa value 0.44 (P = 0.00) and 0.38 (P = 0.00), respectively. The estimated rates of mental disorder were 18.13% (95% CI: 14.16 - 22.10) by CHQ-12, and 22.80% (95% CI: 18.19 - 27.11) by CHQ-30 in the first sample and the rates were 21.72% (95% CI: 20.39 - 23.05) by CHQ-12 in the second sample.</p><p><b>CONCLUSION</b>CHQ, especially CHQ-12 through slight language modification, could be used for epidemiological studies and on community health care to screen for mental disorder in the mainland of China.</p>