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Community Interventions for Health(CIH)

Sponsored by the PepsiCo Foundation

Confronting the Epidemic of Chronic Disease

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Background

• Non-communicable diseases (NCDs) account for 60% of all deaths globally, with 80% occurring in low and middle income countries

• Four NCDs are largely responsible; cardiovascular disease, chronic respiratory disease, cancer and diabetes

• These diseases are preventable. Approximately 80% could be prevented by addressing the main risk factors

• The three main risk factors are tobacco use, unhealthy diet and physical inactivity

2008-2013 Action Plan, WHO 2010


Individual or Community Interventions?

• Traditionally, medical research investigating risk of NCD targets the at-risk individual

• Randomised controlled trail are conducted, comparing an intervention group with a control group

• Effective interventions at the individual level are identified

• These individual-level behaviour change interventions are often unsuccessful at community or population level

• The challenge is to find a way to change the environment to promote health and reduce risk of disease


Community Interventions for Health (CIH)

• CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken

• The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors

• CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities


CIH sites and target population

Leicester, UK150,00

Kerala, India150.00

Hangzhou, China300,000

Mexico City150,00


Study design

• In each study area, an intervention and control site has been selected for comparison

• Baseline data have been collected from all sites and comprise:

- Questionnaires from a sample of the population

- Biometrics from a sub-sample

- Environmental scans

• Interventions have been implemented

• Final data collection for comparison with baseline will be collected at the end of 2011

Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use

Process system for CIH

Inputs for change

Locus of change

Assessment of change

Health education

Social marketing

Community mobilization

Structural change

Strategies for change

Individual Family Community Society

QuestionnairesEnvironmental scan Policy reviews

CIH management board

International

National

Local

China India Mexico UK

NeighborhoodsHealth Centers

Workplaces Schools


Workplaces Schools


Workplaces Schools


Workplaces Schools

Organisation of CIH


Evaluation: Research Study Sample

Survey sample per country site

Neighbourhood Schoolchildren

Workplaces (including industry, health centres, and schools)

Health care providers(doctors and nurses)

TOTAL

Intervention site 1,000 2,000 2,700(1,000, 1000, 700)

400 6,100

Control site 1,000 2,000 2,700(1,000, 1000, 700)

400 6,100

SAMPLE AGGREGATE

2,000 4,000 5,400 800 12,200

400m (0.25m)

Information

Streets Stores and kiosks

Cigarette vending

Street vending

Restaurants and food services

Parks and gardens

Recreationalfacilities

School

Evaluation: Environmental scanning for CIH


Examples of baseline data

• Tobacco use in China

• Overweight and obesity among schoolchildren in Mexico

• Physical activity among schoolchildren in India

• BMI of study population in all sites

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Tobacco Use - China

Current smoking tobaccoMen: 42.9%Women: 1.4%


Childhood obesity - Mexico

BMI – adjusted for age and gender

%(N = 4,082)

<25 62.7

25 – 29.9 28.9

>30 8.4


Frequency of Physical Activity in Indian Schoolchildren


Rates of overweight and obesity (BMI>25)

Site Adult BMI >25 (%)

Child BMI >25 (%)

Hangzhou, China 26.5 16.6

Kerala, India 21.1 4.1

Mexico City 62.6 37.3

Leicester, UK 46.1 no data


Interventions – tobacco control in China

• Extensive health education programme

• Smoking banned in worksites and public places


Interventions – improving diets to reduce obesity in Mexican school children

• School meals are not routinely provided in Mexican schools

• Many children eat snacks and fast food from vendors

• Parents in some schools have begun to cook and provide healthy meals


Interventions – increasing physical activity in girls in India

• Culturally, girls in India are not encouraged to take exercise

• CIH provides bicycles for school girls and organises cycling lessons


Summary – achievements to date

Community Interventions for Health has:

• Been operating since 2008

• Involved 750,000 people in 4 countries

• Been established as the largest global trial of community intervention so far

• Generated much world-wide interest

• Published a methodology paper 1

• Agreed publication of a manual with Oxford University Press

1. O’Connor Duffany et al. Community Interventions for Health (CIH): a novel approach to tackling the worldwide epidemic of chronic diseases. CVD Prevention and Control (2011) 6: 47-56


Challenges ahead

• Data collection is due to be completed by the end of 2011

• Analysis of the data will involve:

– organisation and collation

– support for the statistical team

– one year’s duration (2012) to allow reports from each country individually and then to combine data to give overview results and messages

– papers to be prepared for publication


Thanks from the team

Documents

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