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For Peer Review Only BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from Should iodised and non-iodised salt both be made available in Chinese cities? A cross-sectional survey ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2014-005397 Article Type: Research Date Submitted by the Author: 04-Apr-2014 Complete List of Authors: yu, JUN; Institute for Iodine Deficiency Disorders, Center for endemic disease control, Chines CDC, Harbin medical university LIU, Peng; Institute for Iodine Deficiency Disorders, Center for endemic disease control, Chines CDC, Harbin medical university LIU, YING; Institute for Iodine Deficiency Disorders, Center for endemic disease control, Chines CDC, Harbin medical university LIU, SHOUJUN; Institute for Iodine Deficiency Disorders, Center for endemic disease control, Chines CDC, Harbin medical university SUN, DIANJUN; Center for endemic disease control, Chines CDC, Harbin medical university <b>Primary Subject Health policy Heading</b>: http://bmjopen.bmj.com/ Secondary Subject Heading: Epidemiology, Health policy, Public health telephone interview, iodized salt, non-iodized salt, knowledge-attitude- Keywords: practice, iodine deficiency disorders Note: The following files were submitted by the author for peer review, but cannot be converted to PDF. You must view these files (e.g. movies) online. on September 30, 2021 by guest. Protected copyright. STROBE_checklist_BMJ-Open_cross-sectional-studies.doc For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 26 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from 1 2 3 Title page 4 5 Should iodised and non-iodised salt both be made available in 6 7 Chinese cities? A cross-sectional survey 8 9 10 † † 11 Jun Y , Peng L , Ying L, Shou-jun L, Dian-jun S* 12 13 Corresponding author 14 15 Name: Dian-junFor SUNpeer review only 16 17 Degree: M.D. 18 19 Position: Chief of Center for Endemic Disease Control 20 Affiliation: Center for Endemic Disease Control, Chinese Center for 21 22 Disease Control and Prevention, Harbin Medical University, Harbin 23 24 150081, People’s Republic of China 25 26 Full address: No.157 Baojian Road, Nan’gang District, Center for 27 28 Endemic Disease Control, Harbin Medical University, Harbin, China 29 30 Postal code: 150081 31 32 Telephone: 86-451-86675814 33 http://bmjopen.bmj.com/ 34 Fax: 86-451-86657674 35 36 Email: [email protected] 37 38 39 40 First Author 41 † † on September 30, 2021 by guest. Protected copyright. 42 Name: Jun YU , Peng LIU 43 † 44 have made the same contribution 45 46 Other Author Name:Ying LIU, Shou-jun LIU 47 48 Affiliation: Center for Endemic Disease Control, Chinese Center for 49 50 Disease Control and Prevention, Harbin Medical University, Harbin 51 52 150081, People’s Republic of China 53 54 Keywords: telephone interview, iodized salt, non-iodized salt, 55 knowledge-attitude-practice, iodine deficiency disorders 56 57 Word count: 3054 words 58 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 26 BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from 1 2 3 Shall we supply iodized or non-iodized salt simultaneously? 4 5 Chinese National telephone interview survey 6 7 ABSTRACT 8 9 Objective: To contribute evidence relevant to the policy of supplying 10 11 iodised salt (IS), non Iodised salt NIS) or both, in Chinese cities. 12 13 14 15 Design:For National telephonepeer interview review survey. only 16 17 18 19 Setting: 17 capital cities and 6 coastal cities of 17 iodine deficiency 20 21 disorder (IDD)-eliminated provinces (municipalities) in China. 22 23 24 25 Participants: 24 557 numbers were dialled. Telephone numbers were 26 27 randomly selected by random digit dialing and Mitofsky-Waksberg two 28 29 stages sampling method used. 30 31 32 Results: Among 4833 citizens who accepted the telephone interview, 33 http://bmjopen.bmj.com/ 34 35 3738 (77.3%) citizens chose IS, 481 (10.0%) citizens chose NIS, others 36 37 chose both IS and NIS. Citizens’ awareness rate of IDD and IDD 38 preventive measures were 68.7% and 62.5%, respectively. 39 40 41 on September 30, 2021 by guest. Protected copyright. 42 Conclusions: It was not a suitable time to supply IS and NIS 43 44 simultaneously in the developed cities of China, whereas a pilot project 45 46 may be carried out in the cities where IDD has been sustainably 47 48 eliminated, there is strong awareness of IDD and the population can 49 50 choose IS accurately. IDD health education should be further 51 52 strengthened, especially on its IQ damage. 53 54 55 Keywords: telephone interview, iodized salt, non-iodized salt, 56 57 knowledge-attitude-practice, iodine deficiency disorders 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 26 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from 1 2 3 4 5 6 7 8 9 10 11 Strengths and limitations of this study 12 13 14 The 77.3% population of China developed cities chose iodized rather 15 For peer review only 16 than non-iodized salt. 17 18 19 The 68.7% population of China developed cities knew IDD and 20 21 65.2% knew the preventive measure. 22 23 24 It was not a suitable time to supply IS and NIS simultaneously in the 25 26 developed cities of China, whereas a pilot project may be carried out 27 28 29 in some cities. 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 on September 30, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 3 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 26 BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from 1 2 3 1 Shall we supply iodized or non-iodized salt simultaneously? 4 5 2 Chinese National telephone interview survey 6 7 3 INTRODUCTION 8 9 4 China has about 20% population of the world, and is one of the most 10 11 5 severe iodine deficiency (external environment) countries. The Iodine 12 13 6 Deficiency Disorders (IDD) was once widespread and caused great 14 15 7 damages.For As an effectivepeer measure, review the Universal Saltonly Iodization(USI) has 16 17 8 been adopted for IDD prevention and control and has made great 18 19 9 achievement since 1994. By 2000, 17 provinces (municipalities) of China 20 21 10 had reached the goal of IDD elimination, and by far, have sustained for 22 [1] 23 11 10 years according to IDD eliminating criteria by WHO. 24 25 12 However, along with the discovering of iodine excess and its 26 [2-4] 27 13 side-effects, the increasing rate of thyroid disease, the raising of 28 29 14 residents’ health awareness, the debate of informed choices on choosing 30 31 15 IS or NIS became acute in China, ad hoc in coastal areas. As we know, 32 16 some developed European countries such as Belgium, Finland, France, 33 http://bmjopen.bmj.com/ 34 35 17 Germany, Greece, Ireland, Italy and Netherlands, etc. supply IS and NIS 36 [5] 18 37 simultaneously in the market. Their residents can purchase IS or NIS 38 19 voluntarily. As regards to China, for developed cities in IDD sustainable 39 40 20 eliminated provinces, is it the right time for supplying IS and NIS 41 on September 30, 2021 by guest. Protected copyright. 42 21 simultaneously? If so, can their residents still be free of IDD? And is 43 44 22 there a proper method to demarcate cities of supplying IS and NIS 45 46 23 simultaneously or only supplying IS? To answer these questions, the 47 48 24 status of residents’ subjective preference on choosing IS or NIS and 49 50 25 relevant influencing factors should be made clear first. 51 52 26 Door-to-door interview is usually used to conduct such investigations. 53 54 27 Considering the expenditure of time and money, a cross-sectional 55 56 28 telephone interview is a feasible alternative，it is a widespread method 57 58 59 60 4 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 26 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005397 on 11 July 2014. Downloaded from 1 2 [6] 3 29 adopted rather earlier and used by different countries all over the world. 4 5 30 Successful cases in the past in China were KAP surveys on influenza, 6 [7-10] 7 31 smoke and pollinosis, etc. Its application bases on conditions of high 8 9 32 social economic level and telephone popularization rate. 10 11 33 In China, by the end of 2009, the national average Urban Per Capita 12 13 34 Disposable Income was 17,175 RMBY, and some developed cities 14 15 35 (municipalities)For inpeer the IDD eliminatedreview provinces only were all near even 16 [11] 17 36 beyond this(table 1). Besides, the national fixed line penetration had 18 19 37 increased to 314 million (23.5 telephones/100 persons), and in cities, 212 20 21 38 million (34.1 telephones/100 persons). Facts above made the telephone 22 23 39 interview a good representative and feasible way to research on residents’ 24 25 40 KAP on IDD.
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