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A supply of high-quality cultural tourism products effectively promotes people’s happiness. This study takes the coupling and coordination relationship between cultural tourism (CT) and objective well-being (OWB) in western China as the research object and constructs an index evaluation system for the development levels of cultural tourism and objective welfare, which are divided into three development stages of dysfunctional, transitional, and coordinated development and 10 coordination levels, including high-quality coordination. The entropy weight method, coupled coordination model, Thiel index, standard deviation, and coefficient of variation were used to calculate the comprehensive development index and coupling coordination degree of the CT and OWB systems in western China from 2007 to 2020, and then their evolution characteristics were analyzed from the perspectives of time and space. The results show the following: (1) The comprehensive development capacity of the CT and OWB systems in the western region shows a relatively consistent growth trend except for 2020, the overall development capacity of objective welfare was relatively high, and the development capacity of cultural tourism was relatively low. (2) The CT and OWB systems were in a state of transition from high coupling and low coordination to high coupling and high coordination, which were divided into three development stages: imbalanced stage (2007–2008), transitional stage (2009–2011), and coordinated development (2012–2020). The coordination degree has developed steadily from moderate misalignment to good coordination over time, and the diversified characteristics of coupling coordination levels are obvious. (3) The spatial equilibrium of the CT and OWB systems is obvious, and the spatial difference in the western region is getting smaller, but the relative gap is widening significantly. (4) The comprehensive development capacity of the cultural tourism system should be enhanced, the spiritual needs of residents based on objective well-being should be met, and the sustainable development of the CT and OWB systems.

(1) Background: Men who have sex with other men (MSMs) are at high risk of being infected by the human immunodeficiency virus (HIV) in western China. Pre-exposure prophylaxis (PrEP) is an efficient way to prevent HIV transmission. However, adherence is the most vital determinant factor affecting PrEP effectiveness. We conducted a study based on the Health Belief Model to explore factors that predict adherence to PrEP among a cohort of 689 MSMs in western China. (2) Methods: We assessed perceived susceptibility, severity, benefits, barriers, self-efficacy, cues to action, and HIV-preventive behavior through a cross-sectional survey. (3) Results: PrEP self-efficacy was directly associated with PrEP behaviors (β = 0.221, p < 0.001), cues to action were directly associated with PrEP behaviors (β = 0.112, p < 0.001), perceived benefits were directly associated with PrEP behaviors (β = 0.101, p < 0.001), and perceived susceptibility was directly associated with PrEP behaviors (β = 0.117, p = 0.043). (4) Conclusion: Medication self-efficacy, perceived susceptibility, and cue to action structures are predictors of the MSMs’ HIV-preventive behavior in western China. These results will provide theoretical plans for promoting PrEP adherence in MSMs.

Rapid urbanization of China has brought lifestyle changes resulting in a continuous decline in children’s physical fitness (PF) and out-of-school physical activity (PA). To date, studies have been focused on correlates of PF and out-of-school PA, and patterns and trends based on geographic diversity and urban-rural contrasts. Western China, with a large rural population, has substantial urban-rural differences, but little work has been done to compare its children’s physical fitness (PF) and out-of-school physical activity (PA) at a county level. A total of 715 primary school students (grades 3–6) were surveyed from one urban school (n = 438) and four rural schools (n = 277) in a county-level administrative unit, Yangling District, Shaanxi, in western China. Physical fitness index (PFI) was measured and calculated based on the revised Chinese Student Physical Fitness Standards. Out-of-school PA and other variables of demographics, behavior and perception were collected using questionnaires. Statistical analyses explored urban-rural differences and correlates of PFI and out-of-school PA. We found that the PFI (72.86 vs. 79.67) and weekly moderate-to-vigorous physical activity (MVPA) duration (167.57 vs. 220.08) of urban students were significantly lower than those of rural students. Weekly MVPA duration had the largest positive impact on PFI. Perceived availability of PA spaces was positively associated with both the urban and rural students’ PF and PA, while screen time was negatively associated with PF and PA, especially for rural students. Facilitators of PA frequency include the perceived availability of PA time and parental educational level. Parents’ PA habits had a positive impact on urban students’ PA. No association between active school commuting and PF or PA was found. Our findings revealed that PF and out-of-school PA of urban students were clearly lower than among rural students. The health of rural children at the county level in western China should be paid much more attention during the process of rapid urbanization.

This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role &ldquo, 0&rdquo, MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role &ldquo, 1&rdquo, MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role &ldquo, 0.5&rdquo, MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role &ldquo, /&rdquo, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role &ldquo, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role &ldquo, MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.

Historical grassland cover change is vital for global and regional environmental change modeling, however, in China, estimates of this are rare, and therefore, we propose a method to reconstruct grassland cover over the past 300 years. By synthesizing remote sensing-derived Chinese land use and land cover change (LULCC) data (1980&ndash, 2015) and potential natural vegetation data simulated by the relationship between vegetation and environment, we first determined the potential extent of natural grassland vegetation (PENG) in the absence of human activities. Then we reconstructed grassland cover across western China between 1661 and 1996 at 10 km resolution by overlaying the Chinese historical cropland dataset (CHCD) over the PENG. As this land cover type has been significantly influenced by anthropogenic factors, the data show that the proportion of grassland in western China continuously decreased from 304.84 &times, 106 ha in 1661 to 277.69 &times, 106 ha in 1996. This reduction can be divided into four phases, comprising a rapid decrease between 1661 and 1724, a slow decrease between 1724 and 1873, a sharp decrease between 1873 and 1980, and a gradual increase since 1980. These reductions correspond to annual loss rates of 7.32 &times, 104 ha, 2.90 &times, 104 ha, 17.04 &times, 104 ha, and &minus, 2.37 &times, 104 ha, respectively. The data reconstructed here show that the decrease in grassland area between 1661 and 1724 was mainly limited to the Gan-Ning region (Gansu and Ningxia) and was driven by the early agricultural development policies of the Qing Dynasty. Grassland was extensively cultivated in northeastern China (Heilongjiang, Jilin, and Liaoning) and in the Xinjiang region between 1724 and 1980, a process which resulted from an exponential increase in immigrants to these provinces. The reconstruction results enable provide crucial data that can be used for modeling long-term climate change and carbon emissions.

The study aimed to reveal the risk factors and predict the prevalence of human cystic echinococcosis (CE) in Western China. To do this, we analyzed county-wide data relating to the prevalence of human CE in seven provinces of Western China, along with associated human, natural geographical environmental data. We then used spatial analysis and multiple regression analysis to investigate the correlation between the prevalence of human CE and associated environmental factors and to create a risk map of the disease in the seven provinces. Our analysis showed that grassland area ratio and Tibetan population ratio were independent variables positively correlated with the prevalence of human CE and that gross domestic product (GDP) and land surface temperature (LST, Spring) were negative independent variables. We also created a predictive risk map of human CE that revealed that the high-risk areas were mainly located in the south of Qinghai, the Northwest of Sichuan and most of the Tibet Autonomous Region. Knowledge of the spatial distribution and risk factors associated with human CE could help to prevent and control echinococcosis in China.

Actively seeking health services lies at the core of effective models of chronic disease self-management and contributes to promoting the utilization of allied health services (AHS). However, the use of AHS by ethnic minority Chinese, especially the elderly living in rural areas, has not received much attention. This study, therefore, aims to explore the association between personal characteristics and the activeness of ethnic minority patients with chronic diseases in rural areas of western China seeking AHS. A cross-sectional study was conducted to collect data on the socio-demographic and economic characteristics, health knowledge level and health communication channels of the sampled patients. A logistic regression model was used to examine the association of these predictors with the activeness of the surveyed patients in seeking AHS. A total of 1078 ethnic minorities over 45 years old who had chronic conditions were randomly selected from three western provinces in China and were interviewed in 2014. It is found that the New Cooperative Medical Scheme (NCMS) is the most salient predictor affecting the activeness of Chinese ethnic minorities in seeking AHS. The probability is 8.51 times greater for those insured with NCMS to actively seek AHS than those without (95% Confidence Interval (CI) 4.76–15.21, p &lt, 0.001). Moreover, participants between 60 and 70 years old and those who have five to six household members are more likely to seek AHS compared with other social groups (Odds Ratio (OR) = 1.64, 95% CI 1.28–2.97, p = 0.007, OR = 1.95, 95% CI 1.15–2.36, p = 0.002). However, the activeness of patients seeking AHS is lower for those who have better household economic conditions. Besides socio-demographic predictors, the Chinese ethnic minorities’ activeness in seeking AHS is clearly associated with the communication channels used for receiving health information, which include direct communication with doctors (OR = 5.18, 95% CI 3.58–7.50, p &lt, 0.001) and dissemination of elementary public health knowledge posted on bulletin boards (OR = 2.30, 95% CI 1.61–3.27, p &lt, 0.001) and traditional mass media (OR = 1.74, 95% CI 1.22–2.48, p = 0.002). First, the government should further improve the coverage of NCMS to households suffering from chronic diseases and satisfy the requirements of social groups at different income levels and various ages in their health care to improve their activeness in AHS utilization. Second, doctors’ advice, bulletin boards and traditional media are common health communication channels for those seeking AHS and thus should be continuously employed in rural western China. Third, specified healthcare services should be designed to meet the needs of different patient segmentations.

Tobacco use is one of the behavioral risk factors for chronic diseases. The aim of the study was to investigate smoking prevalence in chronically ill residents and their smoking behavior in western rural China, to identify factors associated with success in quitting smoking, and to provide appropriate intervention strategies for tobacco control. Cross-sectional survey data from patients with chronic diseases from rural western China were analyzed. Among the 906 chronically ill patients, the current smoking prevalence was 26.2%. About 64.3% of smokers with chronic diseases attempted to quit smoking, 21.0% of which successfully quitted. The odds ratio (OR) of smokers with only one chronic disease to quit smoking successfully was higher than that of those who have other diseases (OR = 2.037, 95% confidence interval (CI) = 1.060-3.912; p < 0.05). The smokers who were always restricted to smoking in public places were more likely to quit smoking successfully than those who were free to smoke (OR = 2.188, 95% CI = 1.116–4.291; p < 0.05). This study suggests that health literacy, comorbidity of diseases, and psychological counseling should be considered when developing targeted tobacco prevention strategies. Strengthening tobacco control measures in public places such as rural medical institutions will be effective.

Purpose: China’s Ministry of Health has enacted Rural Primary Health Care Program (2001–2010) (HCP) guidelines to improve the quality of people’s health. However, the program’s success in Western China remains unevaluated. Thus, this study aims to begin to fill that gap by analyzing the provision and utilization of Rural Primary Health Care (RPHC) in Western China. Methods: A cross-sectional study was conducted to collect secondary data on the socio-economic characteristics, system construction, services use and implementation of RPHC, and the residents’ health status of the sampled areas. Four hundred counties from 31 provinces in China were selected via stratified random sampling, including 171 counties from 12 Western provinces. Twenty-seven analysis indicators, covering system construction, services use and implementation of RPHC were chosen to assess Western China’s primary health quality. Analysis of Variance (ANOVA) and Least Significant Difference (LSD) methods were used to measure the RPHC disparities between Western and Eastern and Central China. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used to rank Western, Eastern and Central internal provinces regarding quality of their RPHC. Results: Of the 27 indicators, 13 (48.15%) were below the standard in Western China. These focused on rural health service system construction, Chinese medicine services, and public health. In the comparison between Western, Central and Eastern China, 12 indicators had statistical significance (p &lt, 0.05), and using LSD to compare between Western and Eastern China, all indicators were statistically significant (p &lt, 0.05), demonstrating regional disparities. Xinjiang Province’s RPHC ranked highest overall, and Yunnan Province ranked the lowest, indicating the internal differences within the 12 Western provinces, and Western provinces’ Ci value was lower than that of Eastern and Central China overall. Conclusion: Western China’s RPHC has proceeded well, but remains weaker than that of Eastern and Central China. Differences within Western internal provinces threaten the successful implementation of RPHC.