School-based education programme to reduce salt: Scaling-up in China (EduSaltS)

高盐摄入会增加患高血压、中风、心脏病和其他一些慢性疾病（如胃癌）的风险。中国人的盐摄入量非常高，平均每天12-14克，是世界卫生组织建议的每天5克的两倍多。与英国和其他发达国家不同，中国人饮食中75%-80%的盐是消费者在烹饪或酱汁中添加的。一个有效的策略来减少家庭烹饪中的盐是非常紧迫和重要的，不仅对中国，而且对许多其他发展中国家。然而，对于个人来说，改变他们的饮食习惯是非常困难的。我们提出的研究将建立在一项成功测试的试点研究的基础上，该研究名为“以学校为基础的减盐教育计划”（school - edusalt），在中国，小学生在他们通常的健康教育课程中接受有关盐对健康的影响以及如何减少盐摄入量的教育。然后，孩子们指示他们的家人在家里准备食物时减少盐的使用量。这项初步研究的结果表明，以学校为基础的教育在减少儿童和成人的盐摄入量方面非常有效。这项试点研究在中国北方的长治市进行。我们现在提议进行一项研究，以测试我们是否可以在多种环境中扩大一项改进的学校-教育盐计划，以减少中国更多人口的盐摄入，包括生活在偏远和农村地区的最贫困人口。这项扩大规模的研究将在中国的三个地区进行，包括北京（中国首都）、石家庄（北部）和镇江（南部），覆盖100多万学龄儿童和220万成年人。这项研究将涉及一些重要的利益攸关方，包括政府组织以及三个地区的卫生和教育当局。根据世卫组织的“扩大规模概念框架”，我们将与这些利益攸关方合作，制定、实施和评估可行的扩大规模一揽子计划，将其纳入现有的学校卫生教育系统，以确保可持续的扩大规模。将从三个方面对扩大计划进行评估：有效性、过程和卫生经济学。我们将评估该教育计划是否能改善参与者在减盐方面的知识、态度和做法。此外，我们将评估教育计划能否持续减少盐摄入量，这将通过24小时尿液收集的黄金标准方法来衡量。我们的最终目标是将完善的教育方案纳入国家学校课程，以便中国所有的学校都能效仿。在全国范围内实施将对减少人口盐摄入量产生巨大影响。在整个人口中减少盐的摄入量，即使只是一点点，也会降低人口的血压，每年预防成千上万的中风、心脏病发作和心力衰竭，并为个人、他们的家庭和卫生服务节省大量费用。

High salt intake increases the risk of high blood pressure, strokes, heart disease, and several other chronic diseases such as stomach cancer. Salt intake in China is very high with an average of 12-14 gram per day, more than double the WHO recommended level of 5 gram per day. Unlike the UK and other developed countries, 75%-80% of the salt in the Chinese diet is added by the consumers during cooking or in sauces. An effective strategy to reduce salt from home cooking is of great urgency and importance, not only for China, but also for many other developing countries. However, it is very difficult for individuals to change their eating habits. Our proposed research will build upon a successfully-tested pilot study entitled "School-based education programme to reduce Salt" (School-EduSalt) in China, in which primary school children were educated, during their usual health education lessons, about the effects of salt on health and how to reduce salt intake. Children then instructed their family members to reduce the amount of salt used during food preparations at home. The results of this pilot study have shown that the school-based education is very effective in reducing salt intake in children and adults. The pilot study was carried out in one city called Changzhi, in northern China.We now propose to do a study to test whether we can scale up a refined School-EduSalt programme in multiple settings, to reduce salt in larger populations in China, including the poorest population living in the remote and rural areas. This scale-up study will be carried out in three regions of China including Beijing (capital of China), Shijiazhuang (in the north) and Zhenjiang (in the south), covering a population of over 1 million school children and 2.2 million adults. The study will involve a number of important stakeholders, including governmental organisations, and the health and education authorities of the three regions. Based on WHO's Conceptual Framework for Scaling up, we will work with these stakeholders to develop, implement and evaluate a feasible scale-up package, which will be integrated into the existing school health education system to ensure sustainable scaling-up.The scale-up package will be evaluated in three aspects: effectiveness, process and health economics. We will assess whether the education programme can improve the participants' knowledge, attitudes and practices towards salt reduction. Additionally, we will assess whether the education programme can achieve a sustainable reduction in salt intake which will be measured by the gold standard method of 24-hour urine collection.Our ultimate aim is to incorporate the refined education programme into the national school curriculum, so that all schools in China will follow. A nation-wide implementation will have an enormous impact on reducing population salt intake. A reduction in salt intake across the whole population, even by a small amount, will lower population blood pressure and prevent hundreds of thousands of strokes, heart attacks and heart failure each year, and also lead to major cost-savings to individuals, their families and the health service.