Series Of National Surveys Research Articles

Summary of the Centers for Disease Control and Prevention's Self-reported Traumatic Brain Injury Survey Efforts.

Surveillance of traumatic brain injury (TBI), including concussion, in the United States has historically relied on healthcare administrative datasets, but these methods likely underestimate the true burden of TBI. The Centers for Disease Control and Prevention (CDC) has recently added TBI prevalence questions to several national surveys. The objective of this article is to summarize their recent efforts and report TBI prevalence estimates. Surveys. Adult and youth respondents to a series of national surveys. Recent nationally representative surveys with either 12-month or lifetime TBI prevalence questions were identified. For each data source, survey methodology, TBI definition, question wording, and prevalence estimates were examined. TBI prevalence varied depending on the question wording and data source. Overall 12-month prevalence of concussion/TBI among adults ranged from 2% to 12% while overall lifetime prevalence of concussion or TBI ranged from 19% to 29%. Overall 12-month prevalence of concussion/TBI among children and adolescents was 10% while 12-month prevalence of sports- and recreation-related concussion for youth ranged from 7% to 15%. Overall lifetime prevalence of TBI among youth ranged from 6% to 14%. Survey data based on self-reported concussions and TBIs resulted in larger prevalence estimates than would be expected based on traditional surveillance methods. Analyses of the various surveys shows that how the questions are asked and what terminology is used can notably affect the estimates observed. Efforts can be made to optimize and standardize data collection approaches to ensure consistent measurement across settings and populations.

Native American agriculture and food systems: Challenges and opportunities presented by the COVID-19 pandemic

The COVID-19 pandemic has unveiled deep and systemic weaknesses and gross inequalities in U.S. food and farming systems, compounding the effects of an already unjust food and agricultural system. Emergent studies reveal disproportionate effects of the pandemic on minority farmers and vulnerable communities, as well as inequitable access to critical relief programs. Less is under­stood about the experiences and responses of Native American producers, tribal governments, and tribal-led organizations to the COVID-19 cri­sis. As the nation’s primary Native American agri­culture and natural resources organization, serving 574 Federally Recognized Tribal communities throughout the United States, the Intertribal Agri­culture Council (IAC) received a resounding increase in inquiries during the pandemic pertain­ing to a number of challenges that tribal producers and governments face. In response, IAC launched a series of national surveys to assess the impacts and needs of Native American producers, tribal governments, and grocery stores in and near tribal communities, with the goal of identifying effective strategies to address tribal priorities in policy and programming. As we continue to learn about the causes and consequences of food system ruptures during the COVID-19 pandemic, it has become abundantly clear that increased investment in and sovereignty over decentralized regional food and farming systems’ infrastructure and markets are needed to strengthen the economic viability and resilience of Native American agriculture and food systems.

Public acceptance of evolution in the United States, 1985-2020.

The public acceptance of evolution in the United States is a long-standing problem. Using data from a series of national surveys collected over the last 35 years, we find that the level of public acceptance of evolution has increased in the last decade after at least two decades in which the public was nearly evenly divided on the issue. A structural equation model indicates that increasing enrollment in baccalaureate-level programs, exposure to college-level science courses, a declining level of religious fundamentalism, and a rising level of civic scientific literacy are responsible for the increased level of public acceptance.

Trends and Disparities of Energy Intake and Macronutrient Composition in China: A Series of National Surveys, 1982-2012.

Background: China’s diet transition might offer guidance to undeveloped countries on the way to prosperity. This report describes the trends and disparities in energy and macronutrient composition among Chinese adults, and between subpopulations. Methods: Data for the current study were obtained from the 1982, 1992, 2002, and 2010–2012 China National Nutrition Survey (CNNS) rounds, which were nationally representative cross-sectional surveys. We applied 24-h dietary recall and food weighing to assess dietary intake. Results: There were 204,877 participants aged 20 years or older included in the current analysis. From 1982 to 2012, the estimated energy intake declined from 2614.7 kcal to 2063.9 kcal. The trend in the estimated percentage of energy intake from fat showed a spike. It increased from 16.3% to 33.1% (1992 vs. 1982 difference, 7.6%; 95% CI 7.4% to 7.7%; 2002 vs. 1992 difference, 7.7%; 95% CI 7.6% to 7.9%; 2012 vs. 2002 difference, 1.6%; 95% CI 1.4% to 1.7%; p < 0.01 for trend). The trends coincided in all the subgroups (all p < 0.01 for trend) except for the subgroup of those educated over 15 years, whose percentage of energy intake from fat declined from 37.4% to 36.6% (2012 vs. 2002 difference, −0.8%; 95% CI −1.6% to 0.0%). The estimated percentage of energy intake from carbohydrates declined from 74.0% to 55.0%. The ranges of the estimated percentage of energy intake from fat, within population subgroups stratified by education level, area and Gross national product (GNP) level, were narrowed. Conclusions: Quick improvements in society and the economy effectively curbed undernutrition, but easily triggered overnutrition. Disparities persistently existed between different subpopulations, while the gaps would narrow if comprehensive efforts were made. Education might be a promising way to prevent overnutrition during prosperous progress. The low-social profile populations require specific interventions so as to avoid further disease burdens.

Race, Education Attainment, and Happiness in the United States.

As suggests by the Minorities' Diminished Returns (MDR) theory, education attainment and other socioeconomic status (SES) indicators have a smaller impact on the health and well-being of non-White than White Americans. To test whether MDR also applies to happiness, in the present study, Blacks and Whites were compared in terms of the effect of education attainment on the level of happiness among American adults. General Social Survey (1972-2016) is a series of national surveys that are performed in the United States. The current analysis included 54,785 adults (46,724 Whites and 8,061 Blacks). The years of schooling (i.e., education attainment) and happiness were the main independent variable and the main dependent variable of interest, respectively. In addition, other parameters such as gender, age, employment status, marital status, and the year of the survey were the covariates and race was the focal effect modifier. Finally, the logistic regression model was used to analyze the data. Based on the results, high education attainment was associated with higher odds of happiness in the pooled sample. Further, a significant interaction was found between race and education attainment on the odds of happiness, showing a larger gain for Whites compared to Blacks. Race-specific models also confirmed this finding (i.e., a larger magnitude of the effect of education for Whites compared to Blacks). Overall, the MDR theory also applies to the effect of education attainment on happiness. Blacks' disadvantage in comparison to the Whites in gaining happiness from their education may be due to the structural, institutional, and interpersonal racism and discrimination in the US. Therefore, there is a need for economic and public policies that can minimize the Blacks' diminished returns of education attainment and other SES resources.

Underemployment of highly qualified labour in advanced capitalism: trends and prospects

ABSTRACT ‘Employers know that they can hire worldwide now … so, there is limitless supply of people … who can do the job … . they’re all qualified, most of them are actually over-qualified … . I’m a wage slave basically, I don’t think we have very much social status … . we are replaceable workers … I mean, the employer holds all the cards really. We are salaried employees … no different from any other worker.’ (Owen, automation engineer 2017)(Respondent to CWKE interview with engineers) Post-secondary graduates and professional employees in particular are widely regarded as highly qualified strategic resources in advanced capitalist ‘knowledge economies.’ However, there is mounting evidence that these ‘knowledge workers’ are experiencing increasing underemployment as well as diminishing involvement in continuing learning and some decline in job satisfaction. Trends in these factors are documented primarily on the bases of a series of national surveys of the labour force in Canada between 1982 and 2016. Prospects for more critical attitudes to working conditions as well as shifts in theorising and policy-making regarding relations between employment reforms and educational reforms are considered.

Child nutrition to new stage in China: evidence from a series of national surveys, 1985\u20132015

BackgroundBoth child under- and over-nutrition are major global public health challenges. We aimed to examine thirty-year trends in physical growth, under- and over-nutrition in Chinese urban and suburban children between 1985 and 2015, and discuss implications for child health programmes.MethodsA total of 610,785 urban and suburban children from birth to 7 years of age were collected from a series of large-scale national surveys in China. Height, weight and body mass index (BMI) Z-scores and prevalence of stunting, underweight, wasted and possible risk of overweight, overweight and obesity were calculated according to the World Health Organization (WHO) 2006 growth standards. The trends in the prevalence were tested across different survey years by Cochran-Armitage trend test.ResultsRapid secular growth trend was observed in China over the past 30 years, but the trend showed a slowing sign in urban children in recent 10 years. The growth level of Chinese urban and suburban children surpassed the WHO 2006 growth standards in 2015. Between 1985 and 2015 the stunting, underweight and wasted prevalence decreased from 12.21, 4.44, 1.68 to 0.97%, 0.59, 0.87% for children under 5 years and from 12.69, 10.02, 3.41 to 0.42%, 0.67, 2.17% for children aged 5- < 7 respectively; the possible risk of overweight prevalence increased from 6.51 to 12.57%, overweight from 0.70 to 3.48% and obesity from 0.17 to 0.86% for children aged 2- < 7 and the increasing rates of overweight and obesity prevalence in suburban children first outnumbered urban children in recent 10 years. The overweight prevalence overtook the wasted or underweight in children aged 2- < 7 in 2005 and onward.ConclusionSlowing secular height trend and overweight prevalence overtaking the wasted or underweight suggested child nutrition and health strategies should adjust swiftly and deliberately from primarily reducing under-nutrition prevalence to controlling rapid weight gain and promoting integrated early development.

Impact of updated standard tables of food composition on nutrient intakes in Japan

This study aimed to identify the influence of revisions to the food composition database in Japan, on nutrient intake estimates using one-day food intake data from 26,133 participants of the National Health and Nutrition Survey, 2016. The nutrient profiles of food intakes were developed using two editions of the Japanese Standard Food Composition Tables (2010 and 2015 editions), and differences resulting from their revision were examined. The difference in the mean daily energy intake value (2015 edition – 2010 edition) was 80 kJ (19 kcal)/person. Of the 1604 food items reported in the survey, 591 displayed differences in terms of the nutrient values at the population level. Regarding food groups, meat was the most substantial contributor to differences in the energy intake values, producing a difference of 70 kJ (17 kcal)/day/person. For the 29 nutrients reported in the survey, the differences in the nutrient intake values between the two databases ranged from −5.3% (vitamin D) to +10.5% (magnesium). The influence of the revisions to the food composition database differed by each nutrient, predominantly because of the sources. To evaluate nutrient intake trends in the national survey series, future longitudinal studies are needed.

Proletarianization of Professional Employees and Underemployment of General Intellect in a “Knowledge Economy”

Proletarianization refers to the subordination of hired labour to the owners of capital. This inquiry assesses the extent of proletarianization of professional employees on the basis of a distinctive series of national surveys of the general labour force in Canada between 1982 and 2016. Non-managerial professional employees are distinguished from professionals in other class positions (i.e. professional employers, self-employed professionals, and professional managers) with whom they have been conflated in much of the prior research. The findings suggest increasing proletarianization of professional employees during this period in terms of declining job autonomy and decreasing participation in organizational decision-making, as well as increasing underemployment and more critical political attitudes. But there is also evidence of increasing qualifications and development of “general intellect” among more traditional working-class employees, as well as even more extensive underemployment. Implications of convergence between the proletarianization of professional employees, as a “new working class,” and the qualifications and perceived working conditions of other non-managerial hired labour in emergent “knowledge economies” are discussed. More careful distinctions between non-managerial professional employees and professionals in other class positions in future studies are recommended.&#x0D; &#x0D; La prolétarisation fait référence à la subordination de la main-d’œuvre salariée aux propriétaires du capital. Cette enquête évalue l’ampleur de la prolétarisation des employés professionnels sur la base d’une série distincte d’enquêtes nationales sur la population active en général au Canada entre 1982 et 2016. Les employés professionnels non-cadres sont distingués des professionnels occupant d’autres postes (par ex. employeurs professionnels, travailleurs indépendants et gestionnaires professionnels) avec lesquels ils ont été confondus dans la plupart des recherches antérieures. Les résultats suggèrent une prolétarisation croissante des employés professionnels au cours de cette période en termes de perte d’autonomie professionnelle et de participation à la prise de décision organisationnelle, ainsi que d’augmentation du sous-emploi et d’attitudes politiques plus critiques. Mais il existe également des preuves d’une augmentation des qualifications et du développement de « l’intellect général » chez les employés plus traditionnels de la classe ouvrière, ainsi que d’un sous-emploi encore plus étendu. Les implications de la convergence entre la prolétarisation des employés professionnels, en tant que « nouvelle classe ouvrière », et les qualifications et les conditions de travail perçues des autres travailleurs salariés non-cadres dans les « économies du savoir » émergentes sont discutées. Des distinctions plus soigneuses entre les employés professionnels non-cadres et les professionnels occupant d’autres postes de la classe dans les études éventuelles sont recommandées.

Changes of feeding patterns in Chinese city children under 2years from 1985 to 2015: results from a series of national cross-sectional surveys.

In China, as the social transformation and economic development from 1985 to 2015, children's feeding pattern has undergone some changes. So we aimed to analyze the secular trend on feeding patterns of city children in China. All data were from a series of national survey which implemented once every 10years in China from 1985 to 2015. We use same indexes to evaluate the feeding pattern of children in these four surveys. From 1985 to 2005, the exclusive breastfeeding rates in infants under 6months of age decreased, especially in suburban areas decreased by 17.7%; the continuous breastfeeding rate of 1-year-old children in suburbanarea decreased from 60.1 to 27.6%. However, from 2005 to 2015, the exclusive breastfeeding rates under 6months of age increased by16.0% in urban areas and 5.9% in suburban areas; the continuous breastfeeding rate of 1-year-old children in urban increased from 17.0 to 36.0%. The overall feeding rate of complementary food in infants under 6months of age declined from 1985 to 2015; the average age at introduction ofall complementary foods was around 6months of age in 2015. There is an obvious trend on feeding pattern of Chinese children. From 1985 to 2005, the breastfeeding rate decreased, the duration time of breastfeeding was shortened and the age at introduction ofcomplementary food was advanced. From 2005 to 2015, the breastfeeding rate increased, the duration time of breastfeeding wasprolonged, and the age at introduction of complementary food was postponed.

Trends in Adult Alcohol Use and Binge Drinking in the Early 21st-Century United States: A Meta-Analysis of 6 National Survey Series.

Recent trends in alcoholic liver disease, alcohol-related emergency room admissions, and alcohol use disorder prevalence as measured by general-population surveys have raised concerns about rising alcohol-related morbidity and mortality in the United States. In contrast, upward trends in per capita alcohol consumption have been comparatively modest. To resolve these discordant observations, we sought to examine trends in the prevalence of alcohol use and binge drinking from 6 regularly or periodically administered national surveys using a meta-analytic approach. Annual or periodic prevalence estimates for past-12-month or past-30-day alcohol use and binge drinking were estimated for available time points between the years 2000 and 2016. Estimates were combined in a random-effects regression model in which prevalence was modeled as a log-linear function of time to obtain meta-analytic trend estimates for the full population and by sex, race, age, and educational attainment. Meta-analysis-derived estimates of average annual percentage increase in the prevalence of alcohol use and binge drinking were 0.30% per year (95% CI: 0.22%, 0.38%) and 0.72% per year (95% CI: 0.46%, 0.98%), respectively. There was substantial between-survey heterogeneity among trend estimates, although there was notable consistency in the degree to which trends have impacted various demographic groups. For example, most surveys found that the changes in prevalence for alcohol use and binge drinking were large and positive for ages 50 to 64 and 65 and up, and smaller, negative, or nonsignificant for ages 18 to 29. Significant increases in the prevalence of alcohol use and of binge drinking over the past 10 to 15years were observed, but not for all demographic groups. However, the increase in binge drinking among middle-aged and older adults is substantial and may be driving increasing rates of alcohol-related morbidity and mortality.

Land cover and vegetation data from an ecological survey of &amp;quot;key habitat&amp;quot; landscapes in England, 1992–1993

Abstract. Since 1978, a series of national surveys (Countryside Survey, CS) have been carried out by the Centre for Ecology and Hydrology (CEH) (formerly the Institute of Terrestrial Ecology, ITE) to gather data on the natural environment in Great Britain (GB). As the sampling framework for these surveys is not optimised to yield data on rarer or more localised habitats, a survey was commissioned by the then Department of the Environment (DOE, now the Department for Environment, Food and Rural Affairs, DEFRA) in the 1990s to carry out additional survey work in English landscapes which contained semi-natural habitats that were perceived to be under threat, or which represented areas of concern to the ministry. The landscapes were lowland heath, chalk and limestone (calcareous) grasslands, coasts and uplands. The information recorded allowed an assessment of the extent and quality of a range of habitats defined during the project, which can now be translated into standard UK broad and priority habitat classes. The survey, known as the "Key Habitat Survey", followed a design which was a series of gridded, stratified, randomly selected 1 km squares taken as representative of each of the four landscape types in England, determined from statistical land classification and geological data ("spatial masks"). The definitions of the landscapes are given in the descriptions of the spatial masks, along with definitions of the surveyed habitats. A total of 213 of the 1 km2 square sample sites were surveyed in the summers of 1992 and 1993, with information being collected on vegetation species, land cover, landscape features and land use, applying standardised repeatable methods. The database contributes additional information and value to the long-term monitoring data gathered by the Countryside Survey and provides a valuable baseline against which future ecological changes may be compared, offering the potential for a repeat survey. The data were analysed and described in a series of contract reports and are summarised in the present paper, showing for example that valuable habitats were restricted in all landscapes, with the majority located within protected areas of countryside according to different UK designations. The dataset provides major potential for analyses, beyond those already published, for example in relation to climate change, agri-environment policies and land management. Precise locations of the plots are restricted, largely for reasons of landowner confidentiality. However, the representative nature of the dataset makes it highly valuable for evaluating the status of ecological elements within the associated landscapes surveyed. Both land cover data and vegetation plot data were collected during the surveys in 1992 and 1993 and are available via the following DOI: https://doi.org/10.5285/7aefe6aa-0760-4b6d-9473-fad8b960abd4. The spatial masks are also available from https://doi.org/10.5285/dc583be3-3649-4df6-b67e-b0f40b4ec895.

The orthodontic condition of children in England, Wales and Northern Ireland 2013.

Background The 2013 Children's Dental Health Survey is the fifth in a series of national surveys.Aims This paper reports the orthodontic condition of 12- and 15-year-olds and how they and their parents feel about the appearance of their teeth.Methodology A representative sample of children (5y, 8y, 12y, 15y) in England, Wales and Northern Ireland were invited to participate in dental examinations. A modified Index of Orthodontic Treatment Need (IOTN) was used as a measure of orthodontic treatment need for 12- and 15-year-olds. Children and parents were invited to complete a questionnaire about oral health behaviour and attitudes.Results Nine percent of 12-year-olds and 18% of 15-year-olds were undergoing orthodontic treatment at the time of the survey. Forty-four percent of 12-year-olds and 29% of 15-year-olds expressed a desire for straighter teeth, however over half of this group would not qualify for NHS treatment. Unmet treatment need was higher in children eligible for free school meals (P <0.05 at 15y).Conclusions Provision of and demand for orthodontic treatment is increasing, with a significant proportion of children who desire orthodontic care not eligible to receive it. Children from deprived backgrounds have greater unmet orthodontic treatment need.

Changing the balance of social care for older people: simulating scenarios under demographic ageing in New Zealand.

The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.

Changes in the sexual health behaviours of New Zealand secondary school students, 2001–2012: findings from a national survey series

ObjectiveTo describe trends in self‐reported sexual and reproductive health behaviours among New Zealand secondary school students. MethodsNationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012. Results‘Ever had sex’ (−6.9%, p<0.001); ‘currently sexually active’ (− 2.3%, p<0.001); ‘always use condoms’ (−3.3%, p=0.006); ‘condoms at last sex’ (−7.0, p=0.002); ‘contraception at last sex’ (−5.8%, p<0.001) and sexually transmitted infections (−0.3%, p=0.001) have reduced over time. ‘Always use contraception’ did not change significantly (−1.4%, p=0.514) over time. Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception. ConclusionsStudents in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11‐year period suggests that current strategies are inadequate, particularly for Māori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.

National survey of nurse prescribing in mental health services; a follow-up 6years on.

Introduction This paper reports the latest in a series of national surveys of nurse prescribing in mental health organizations in England. Aim To describe and understand changes and trends in the use of nurse prescribing nationally. Methods Postal survey to all 53 National Health Service Mental Health Trusts (publicly funded provider organizations); 75% responded (n=40). Results Numbers of nurse prescribers (NPs) have grown significantly in the last 6years, although remain a small percentage of the total Mental Health Nursing workforce. Most NPs are in community services, particularly community mental health teams and drug/alcohol services. Independent prescribing has now become the most common form of NP, replacing supplementary prescribing. Discussion Overall growth in numbers of NPs has continued, but remains marked by large variance in numbers between organizations. The study evidences that the particular form of nurse prescribing will influence its applicability in different clinical settings and that sustained increase over time in NP numbers is feasible at a national level, even with local variation in uptake. Implications for practice Nurse prescribing has become well embedded in many organizations although large-scale adoption may be hindered by the lack of a definitive evidence base as to outcomes compared with those from medical prescribing.

Reconnecting class and production relations in an advanced capitalist ‘knowledge economy’: Changing class structure and class consciousness

Recent approaches to class analysis in advanced capitalism have been largely disconnected from the capitalist labour process. This paper has three basic goals. First, we suggest a composite Marxist model of current class structure grounded in ownership, managerial authority, specialized knowledge and value relations in the capitalist labour process. Secondly, this model is used for an empirical assessment of continuity and change in class structure, based on a series of national surveys in Canada in the period 1982–2010. Thirdly, using the same series of surveys, we use this model of class structure to evaluate the extent to which employment class positions are relevant for understanding shifting expressions of class consciousness. Within the employed labour force in this particular advanced capitalist country, we find a generally declining conventional working class and expanding proportions of managerial and professional employees. Connections between employment class positions and class consciousness can involve complex mediations. Evidence for the persistence of strong hegemonic consciousness among corporate capitalists is provided by an additional unique series of surveys. This persistence contrasts with declining working class identity and increasingly mixed class consciousness among most other employment class positions. However, pro-labour oppositional consciousness is found to dominate among unionized industrial workers and professional employees in the private goods-producing sector, who may be among the most directly exploited workers in value terms in an emergent ‘knowledge economy’. The findings suggest the continuing relevance of pursuing class analyses based on production relations in advanced capitalist economies.

BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000–14

Obesity, physical inactivity, and reduced physical fitness contribute to the rising burden of chronic diseases in China. We investigated these factors in Chinese adults over a 14-year period (2000-14) using data from randomised national surveys. We did four national surveys in 2000, 2005, 2010, and 2014 among Chinese adults aged 20-59 years. We used BMI to assess underweight (<18·5 kg/m(2)), overweight (≥23·0 to <27·5 kg/m(2)), and obesity (≥27·5 kg/m(2)). Central obesity was defined as a waist circumference greater than 90 cm in men and greater than 85 cm in women. We assessed leisure-time physical activity (LTPA) by whether or not participants had completed the recommended minimum 150 min of moderate or 75 min of vigorous exercise per week. Indices for assessment of physical fitness were forced vital capacity, resting heart rate, hand grip strength, sit and reach distance, and time standing on one leg. 151 656 (78%) of 193 440 adults responded to the survey in 2000, 163 386 (84%) in 2005, 154 931 (80%) in 2010, and 146 703 (76%) in 2014. The prevalence of obesity increased from 8·6% in 2000, to 10·3% in 2005, 12·2% in 2010, and 12·9% in 2014 (estimated increase 0·32% per year, 95% CI 0·30-0·33; p<0·0001). The equivalent estimates were 37·4%, 39·2%, 40·7%, and 41·2% for overweight (estimated increase 0·27% per year, 95% CI 0·25-0·30; p<0·0001) and 13·9%, 18·3%, 22·1%, and 24·9% for central obesity (estimated increase 0·78% per year, 0·76-0·80; p<0·0001). The prevalence of overweight, obesity, and central obesity increased with age (all p<0·0001) and was higher in men than in women (all p<0·0001). We noted a simultaneous decrease in the prevalence of underweight (estimated decrease of 0·06% per year, 95% CI 0·04-0·07; p<0·0001). The proportion of adults meeting the minimum LTPA recommendation increased over time (17·2% in 2000, 18·1% in 2005, and 22·8% in 2014), with the estimated prevalence change per year being 0·33% (95% CI 0·24-0·42; p<0·0001) for underweight people, 0·50% (0·47-0·53; p<0·0001) for normal-weight people, 0·37% (0·34-0·40; p<0·0001) for overweight people, and 0·06% (0·00-0·13; p=0·044) for obese people. We noted deteriorations over time in all measures of physical fitness in normal-weight adults (all p<0·0001), apart from resting heart rate (p=0·69). Despite increased participation in LTPA, we noted increases in overweight or obesity and a decrease in physical fitness in Chinese adults. Continued nationwide interventions are needed to promote physical activity and other healthy lifestyle behaviours in China. National Physical Fitness Surveillance Center and Ministry of Science and Technology of the People's Republic of China.

Body Mass Index of Young Men in China: Results From Four National Surveys Conducted Between 1955 and 2012.

To analyze the characteristics and trends of body mass index (BMI) among young men in China using data from a series of national surveys conducted between 1955 and 2012, and to provide evidence for policy making and disease control and prevention.BMI-related data were collected by routine medical examination from young men, most aged 18 to 20 years, in 4 national surveys (1955, 1974, 2001, and 2012) using a stratified cluster sampling method in 31 provinces, autonomous regions, and municipalities in China. The characteristics and trends of BMI during this period were analyzed by region, year, age, and economic level.Totals of 266,791, 118,092, 69,776, and 57,969 participants were included in the 4 national surveys, respectively. Between 1955 and 2012, height, weight, and BMI showed increasing trends in men aged 18 to 20 years at the national level and in each of the 6 areas of China. BMI also differed among geographical regions. Data from the 2012 national survey showed that age (17–22 years) was correlated positively with the prevalence of overweight and negatively with the prevalence of underweight (both P < 0.05). Gross domestic product was correlated negatively with the prevalence of underweight (r = –0.25) and positively with the prevalence of overweight and obesity (r = 0.45 and 0.240, respectively; all P < 0.001).BMI increased with economic development among young men from 1955 to 2012, with distinct variation among geographic areas in China. Although underweight remains prevalent in young men, especially in urban and northern regions, overweight and obesity are increasingly prevalent and warrant public health attention.

China’s Dormant and Active Social Volcanoes

China’s leaders often claim that the rising tide of mass protests in recent years is primarily driven by popular anger over the widening gap between rich and poor. However, in a series of national surveys that I helped direct, it becomes clear the average Chinese citizen is less angry about current income gaps than citizens in many other societies. There also is no clear increase in such anger over time (despite a sustained rise in income inequality). The primary drivers of popular anger lie elsewhere—primarily in power inequalities, manifested in abuses of power, official corruption, bureaucrats who fail to protect the public from harm, mistreatment by those in authority, and inability to obtain redress when mistreated. China’s leaders have done an impressive job in recent years of addressing poverty and material inequality, thus keeping the distributive injustice social volcano dormant. However, they have so far been unwilling or unable to make fundamental reforms to address procedural injustices. Unless they can provide Chinese citizens with more effective protections from the arbitrariness and abuses of entrenched power, a shared sense of injustice will persist, and this active volcano will continue to smolder, with the potential to erupt and threaten Party rule.