title: Successful up-scaled population interventions to reduce risk factors for non-communicable disease in adults: results from the International Community Interventions for Health (CIH) Project in China, India and Mexico.
abstract: BACKGROUND
  Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC.
  
  
  METHODS
  The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up.
  
  
  RESULTS
  A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥ 5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014).
  
  
  CONCLUSIONS
  Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity.
authors: University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, OX3 7LJ, United Kingdom.
authors: Pamela A
authors: PA
authors: Dyson
authors: University of Oxford, Harris Manchester College, Mansfield Road, Oxford, OX1 3DT, United Kingdom.
authors: Denis
authors: D
authors: Anthony
authors: MATRIX Public Health Solutions Inc, 794 Edgewood Avenue, New Haven, Connecticut, 06515, United States of America.
authors: Brenda
authors: B
authors: Fenton
authors: MATRIX Public Health Solutions Inc, 794 Edgewood Avenue, New Haven, Connecticut, 06515, United States of America.
authors: Denise E
authors: DE
authors: Stevens
authors: InterAmerican Heart Foundation Inc, 7272 Greenville Avenue, Dallas, Texas, 75231-4596, United States of America.
authors: Beatriz
authors: B
authors: Champagne
authors: School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
authors: Li-Ming
authors: LM
authors: Li
authors: School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
authors: Jun
authors: J
authors: Lv
authors: InterAmerican Heart Foundation Inc, 7272 Greenville Avenue, Dallas, Texas, 75231-4596, United States of America; National Autonomous University of Mexico, Insurgentes Cuicuilco, Coyoacán, 04530, Mexico City, Mexico.
authors: Jorge
authors: J
authors: Ramírez Hernández
authors: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
authors: K R
authors: KR
authors: Thankappan
authors: University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, OX3 7LJ, United Kingdom; University of Oxford, Harris Manchester College, Mansfield Road, Oxford, OX1 3DT, United Kingdom; Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom.
authors: David R
authors: DR
authors: Matthews
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D005638:Fruit / Q000378:metabolism; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D050177:Overweight / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D012492:Salts / Q000378:metabolism; D064424:Tobacco Use / Q000009:adverse effects; D014675:Vegetables / Q000378:metabolism
chemical_list: D012492:Salts