title: Measuring and valuing health-related quality of life among children and adolescents in mainland China--a pilot study.
abstract: BACKGROUND
  The Child Health Utility 9D (CHU9D), a new generic preference-based health-related quality of life (HRQoL) instrument, has been validated for use in young people in both the UK and Australia. The main objectives of this study were to examine the feasibility of using a Chinese version of the CHU9D (CHU9D-CHN) to assess HRQoL and to investigate the association of physical activity, homework hours and sleep duration with HRQoL in children and adolescents in Mainland China.
  
  
  METHODS
  Data were collected using a multi-stage sampling method from grades 4-12 students in May 2013 in Nanjing, China. Consenting participants (N = 815) completed a self-administered questionnaire including the CHU9D-CHN instrument and information on physical activity, homework and sleep duration, self-reported health status, and socio-demographic characteristics. Descriptive and multivariate linear regression analyses were undertaken. CHU9D-CHN utility scores were generated by employing two scoring algorithms currently available for the instrument, the first derived from UK adults utilising the standard gamble (SG) valuation method and the second derived from Australian adolescents utilising the best-worst scaling (BWS) method.
  
  
  RESULTS
  It was found that CHU9D utility scores discriminated well in relation to self-reported health status and that better health status was significantly associated with higher utility scores regardless of which scoring algorithm was employed (both p<0.001). The adjusted mean utilities were significantly higher for physically active than inactive students (0.023 by SG, 0.029 by BWS scoring methods, p<0.05). An additional hour of doing homework and sleep duration were, separately, associated with mean utilities of -0.019 and 0.032 based on SG, and -0.021 and 0.040 according to BWS scoring algorithms (p<0.01).
  
  
  CONCLUSIONS
  The CHU9D-CHN shows promise for measuring and valuing the HRQoL of children and adolescents in China. Levels of self-reported physical activity, homework and sleep time were important influencers of utility scores.
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China ; The School of Public Health, Nanjing Medical University, Nanjing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xu
authors.affiliation: Flinders Health Economics Group, Flinders University, Adelaide, Australia.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.affiliation: Health Economics and Decision Science, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Katherine
authors.initials: K
authors.lastname: Stevens
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: HaiRong
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: ShengXiang
authors.initials: S
authors.lastname: Qi
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: ZhiYong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hong
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: XuPeng
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: HuaFeng
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: ChenChen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Flinders Health Economics Group, Flinders University, Adelaide, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D002648:Child; D002652:Child Behavior; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D055815:Young Adult