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BackgroundThe COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. ObjectiveThis study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. MethodsA large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. ResultsOf the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). ConclusionsBoth mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic.

BackgroundMobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. ObjectiveWe explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. MethodsThe cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. ResultsIn total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P

BackgroundApp-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined. ObjectiveThis study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers. MethodsA 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers’ self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted. ResultsIn total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51). ConclusionsThe app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers’ safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly. Trial RegistrationChinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84) International Registered Report Identifier (IRRID)RR2-10.1186/s12889-018-5790-1

BackgroundWith the growing popularity of mobile health technology, app-based interventions delivered by smartphone have become an increasingly important strategy toward injury prevention. ObjectiveThis study aimed to develop a framework supporting the design of an app-based intervention to prevent unintentional injury, targeted for caregivers of Chinese children aged 0 to 6 years. MethodsA theory-based mixed-method study, including focus groups and Web-based quantitative survey, was performed. Adult caregivers who care for children aged 0 to 6 years and own a smartphone were recruited into 2 sequential stages of research. First, focus groups were conducted among the caregivers at community health care centers and preschools from December 2015 to March 2016. Focus groups (8-10 participants per group) explored awareness, experiences, and opinions of caregivers toward using an app to prevent unintentional injury among children. Second, based on the focus groups findings, a Web-based quantitative survey was designed and distributed to caregivers in November 2016; it collected information on specific needs for the app-based intervention. Thematic analysis and quantitative descriptive analyses were performed. ResultsIn total, 12 focus groups were completed, involving 108 caregivers. Most participants expressed a strong desire to learn knowledge and skills about unintentional child injury prevention and held positive attitudes toward app-based interventions. Participants expressed multiple preferences concerning the app-based intervention, including their contents, functions, interactive styles, installation and registration logistics, and privacy protection and information security. Following the focus groups, 1505 caregivers completed a WeChat-based quantitative survey, which generated roughly similar results to those of focus groups and added numerical metrics concerning participants’ preferences on what to learn, when to learn it, and how to learn it. A detailed framework was established involving 5 components: (1) content design, (2) functional design, (3) interactive style, (4) installation and registration logistics, and (5) privacy protection and information security, and 15 specific requirements. ConclusionsWe developed a framework that can be used as a guide to design app-based interventions for parents and caregivers, specifically for unintentional injury prevention of children aged 0 to 6 years.

Objective To evaluate the precision and dependability of road traffic mortality data recorded in the World Health Organization Mortality Database and investigate how uncorrected data influence vital mortality statistics used in traffic safety programmes worldwide. Methods We assessed country and territory-specific data quality from 2015 to 2020 by calculating the proportions of five types of nonspecific cause of death codes related to road traffic mortality. We compared age-adjusted road traffic mortality and changes in the average annual mortality rate before and after correcting the deaths with nonspecific codes. We generated road traffic mortality projections with both corrected and uncorrected codes, and redistributed the data using the proportionate method. Findings We analysed data from 124 countries and territories with at least one year of mortality data from 2015 to 2020. The number of countries and territories reporting more than 20% of deaths with ill-defined or unknown cause was 2; countries reporting injury deaths with undetermined intent was 3; countries reporting unspecified unintentional injury deaths was 21; countries reporting unspecified transport crash deaths was 3; and countries reporting unspecified unintentional road traffic deaths was 30. After redistributing deaths with nonspecific codes, road traffic mortality changed by greater than 50% in 7% (5/73) to 18% (9/51) of countries and territories. Conclusion Nonspecific codes led to inaccurate mortality estimates in many countries. We recommend that injury researchers and policymakers acknowledge the potential pitfalls of relying on raw or uncorrected road traffic mortality data and instead use corrected data to ensure more accurate estimates when improving road traffic safety programmes. Objectif Determiner le niveau de precision et de fiabilite des informations concernant le nombre de deces lies aux accidents de la route enregistrees dans la base de donnees de l'Organisation mondiale de la Sante sur la mortalite, mais aussi etudier l'influence des donnees non corrigees sur les statistiques de mortalite, qui jouent un role essentiel dans les programmes de securite routiere a travers le monde. Methodes Nous avons evalue la qualite des donnees propres a chaque pays et territoire entre 2015 et 2020 en calculant la proportion que representent cinq types de codes non specifiques relatifs aux causes de deces dans des accidents de la route. Nous avons compare la mortalite routiere selon l'age et l'evolution du taux de mortalite annuel moyen avant et apres avoir corrige les deces portant des codes non specifiques. Pour terminer, nous avons genere des projections en matiere de mortalite routiere a l'aide des codes corriges et non corriges, puis redistribue les donnees par integration proportionnelle. Resultats Nous avons analyse les donnees issues de 124 pays et territoires, avec au moins un an de donnees de mortalite entre 2015 et 2020. Deux pays et territoires mentionnaient plus de 20% de deces imputables a des causes inconnues ou mal definies ; trois pays signalaient des deces dus a des blessures non intentionnelles ; 21 faisaient etat de blessures mortelles non intentionnelles et non specifiees ; trois ne precisaient pas le type de vehicule implique dans les collisions mortelles ; et enfin, 30 pays rapportaient des accidents de la route mortels, indetermines et involontaires. Apres redistribution des deces munis de codes non specifiques, le taux de mortalite routiere a change de plus de 50% dans 7% (5/73) a 18% (9/51) des pays et territoires. Conclusion L'emploi de codes non specifiques a entraine une mauvaise estimation de la mortalite dans de nombreux pays. Nous recommandons aux responsables politiques et chercheurs actifs dans le domaine des traumatismes de tenir compte des eventuels pieges que recele l'usage de donnees brutes ou non corrigees sur la mortalite routiere, et leur conseillons de se fonder sur des donnees corrigees afin d'obtenir des estimations plus precises pour l'amelioration des programmes de securite routiere. Objetivo Evaluar la precision y la fiabilidad de los datos sobre mortalidad por accidentes de trafico registrados en la Base de datos sobre mortalidad de la Organizacion Mundial de la Salud. Asimismo, investigar como los datos incorrectos influyen en las estadisticas vitales sobre mortalidad utilizadas en programas de seguridad vial a nivel mundial. Metodos Evaluamos la calidad de los datos en funcion del pais y del territorio desde 2015 a 2020 calculando los porcentajes de cinco tipos de codigos de fallecimientos sin causa especifica relacionados con la mortalidad por accidentes de trafico. Comparamos la mortalidad por accidentes de trafico en funcion de la edad, asi como los cambios en el indice medio anual de mortalidad antes y despues de corregir los fallecimientos con codigos no especificos. Generamos las proyecciones de mortalidad por accidentes de trafico con codigos corregidos y sin corregir, y distribuimos de nuevo los datos utilizando el metodo proporcional. Resultados Analizamos los datos correspondientes a 124 paises y territorios que contaban con datos sobre mortalidad de al menos un ano, del periodo comprendido entre 2015 y 2020. El numero de paises y territorios que notificaron mas de un 20% de fallecimientos por causas imprecisas o desconocidas fue de 2; los paises que notificaron fallecimientos por lesiones con intencionalidad indeterminada fueron 3; los paises que notificaron fallecimientos por lesiones no intencionadas y no especificadas fueron 21; los paises que notificaron fallecimientos no especificados en accidentes de transporte fueron 3; y los paises que notificaron fallecimientos no especificados y no intencionados en accidentes de trafico fueron 30. Tras redistribuir los fallecimientos con codigos no especificos, la mortalidad por accidentes de trafico cambio en mas de un 50% en un intervalo del 7% (5/73) al 18% (9/51) de los paises y territorios. Conclusion Los codigos no especificos dieron lugar a estimaciones imprecisas sobre mortalidad en numerosos paises. Instamos a que los investigadores y los responsables de politicas de lesiones reconozcan las potenciales deficiencias que supone el hecho de basarse en datos no tratados ni corregidos, y a que, en lugar de eso, utilicen datos corregidos con el fin de garantizar estimaciones mas precisas a la hora de mejorar los programas sobre seguridad vial. [phrase omitted], Introduction Globally, road traffic crashes cause approximately 1.3 million preventable deaths and 50 million injuries each year. (1) In 2021, the United Nations (UN) General Assembly resolution 74/299 committed to [...]

Objective To evaluate the effectiveness of a 2020 nationwide helmet promotion campaign, in terms of helmet wearing and correct helmet wearing, aimed at electric bike riders and motorcyclists in China. Methods We obtained 192 hours of film of traffic before (2019) and after (2021) implementation of the campaign at eight road intersections in Changsha, recording cyclist (traditional and electric) and motorcyclist helmet-wearing behaviour during both weekdays and the weekend, and peak and off-peak traffic. We extracted data on rider characteristics and helmet-wearing behaviour. We applied a logistic regression to obtain estimates of helmet wearing and correct helmet wearing, and calculated odds ratios adjusted for rider variables. Findings We filmed 11 525 cyclists and motorcyclists, 5256 (45.6%) before and 6269 (54.4%) after the campaign. We estimated a substantial increase in the overall percentage of helmet wearing from 8.8% (95% confidence interval, CI: 8.0-9.6) to 62.0% (95% CI: 60.8-63.2). After controlling for covariates, we noted that helmet wearing increased in all groups. However, we observed a decrease in the overall percentage of correct helmet wearing from 91.9% (95% CI: 89.4-94.3) to 83.5% (95% CI: 82.3-84.7). Post-campaign, we estimated the highest percentage of helmet wearing for delivery riders (88.8%) and lowest for traditional cyclists (3.8%); we estimated the lowest percentage of correct helmet wearing for three-wheeled motorcyclists (58.8%). Conclusion To increase helmet wearing and correct helmet wearing, we recommend amending the campaign to include traditional cyclists as well as education and legislation on the correct fastening of helmet chinstraps. Objectif Mesurer l'efficacite d'une campagne nationale organisee en 2020 afin de promouvoir l'adoption et le port adequat du casque pour les motocyclistes et les cyclistes utilisant un velo electrique en Chine. Methodes Nous avons obtenu 192 heures de videos provenant de cameras de surveillance routiere placees sur huit carrefours a Changsha, avant (2019) et apres (2021) la mise en oeuvre de la campagne. Ces cameras ont filme le comportement des motocyclistes ainsi que des cyclistes (sur velo traditionnel et electrique) vis-a-vis du casque, en semaine et durant le week-end, mais aussi pendant les heures de pointe et les heures creuses. Nous y avons trouve des informations sur les caracteristiques de ces usagers et leur attitude par rapport au casque. Enfin, nous avons applique un modele de regression logistique en vue de formuler des estimations sur l'adoption et le port adequat du casque, puis nous avons calcule l'odds ratio ajuste pour les variables relatives a ces usagers. Resultats Nous avons filme 11 525 cyclistes et motocyclistes, 5256 (45,6%) avant et 6269 (54,4%) apres la campagne. Nous avons observe une importante augmentation du pourcentage total d'usagers portant un casque, de 8,8% (intervalle de confiance de 95%, IC: 8,0-9,6) a 62,0% (IC de 95%: 60,8-63,2). Apres avoir pris en compte les covariables, nous avons remarque que le port du casque avait augmente dans toutes les categories. Neanmoins, nous avons constate une baisse du pourcentage total d'usagers portant correctement leur casque, de 91,9% (IC de 95%: 89,4-94,3) a 83,5% (IC de 95%: 82,3-84,7). A l'issue de la campagne, la categorie d'usagers enregistrant le pourcentage le plus eleve de port du casque etait celle des coursiers a velo (88,8%), tandis que celle des cyclistes traditionnels affichait le plus faible pourcentage (3,8%). Nous avons egalement note que les motocyclistes a trois roues constituaient la categorie la moins bien representee en matiere de port adequat (58,8%). Conclusion Afin d'ameliorer l'adoption et le port adequat du casque, nous recommandons de modifier la campagne et d'y inclure les cyclistes traditionnels, mais aussi d'adapter la legislation et l'education pour apprendre aux usagers a attacher correctement la mentonniere de leur casque. Objetivo Evaluar la eficacia de una campana de promocion del uso del casco a nivel nacional en 2020, en lo que respecta al uso del casco y a su correcta utilizacion, cuyo grupo objetivo son los conductores de bicicletas electricas y motociclistas en China. Metodos Se obtuvieron 192 horas de filmacion del trafico antes (2019) y despues (2021) de la aplicacion de la campana en ocho intersecciones viales de Changsha, en las que se registro el comportamiento de los ciclistas (con bicicletas tradicionales y electricas) y de los motociclistas en relacion con el uso del casco, tanto en dias laborables como en fin de semana, y en horas pico y no pico de trafico. Se extrajeron datos sobre las caracteristicas de los ciclistas y el uso del casco. Se aplico una regresion logistica para obtener estimaciones del uso del casco y de su correcto uso, y se calcularon las razones de posibilidades ajustadas a las variables de los conductores. Resultados Se filmaron a 11 525 ciclistas y motociclistas, 5256 (45,6 %) antes y 6269 (54,4 %) despues de la campana. Se estimo un aumento sustancial del porcentaje global de uso del casco, que paso del 8,8 % (intervalo de confianza del 95 %, IC: 8,0-9,6) al 62,0 % (IC del 95 %: 60,8-63,2). Tras controlar las covariables, se observo que el uso del casco aumento en todos los grupos. No obstante, se observo una reduccion en el porcentaje global de uso correcto del casco del 91,9 % (IC del 95 %: 89,4-94,3) al 83,5 % (IC del 95 %: 82,3-84,7). Despues de la campana, se estimo que el porcentaje mas alto de uso del casco correspondia a los repartidores (88,8 %) y el mas bajo a los ciclistas que utilizan bicicletas tradicionales (3,8 %); se estimo que el porcentaje mas bajo de uso correcto del casco correspondia a los motociclistas con vehiculos de tres ruedas (58,8 %). Conclusion Para aumentar el uso del casco y su correcta utilizacion, se sugiere modificar la campana para incluir a los ciclistas con bicicletas tradicionales, asi como la educacion y la legislacion sobre la correcta sujecion de las correas de la barbilla del casco. [phrase omitted], Introduction Cyclists and motorcyclists are vulnerable road users; of the 1 198 289 global road traffic deaths in 2019, cyclists and motorcyclists accounted for 64 693 (5.4%) and 222 357 [...]