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BMJ Open. 2019 Jun 14;9(6):e028126. doi: 10.1136/bmjopen-2018-028126.

Social support, social network and salt-reduction behaviours in children: a substudy of the School-EduSalt trial.

Author information

1
Peking University Health Science Centre, Department of Epidemiology and Biostatistics, Beijing, China.
2
Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA.
3
Department of Preventive Medicine, Changzhi Medical College, Changzhi, China.
4
Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China.
5
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
6
The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
7
Peking University Clinical Research Institute, Beijing, China.
8
Department of Probability and Statistics, Peking University School of Mathematical Sciences, Beijing, China.

Abstract

OBJECTIVES:

Healthy behaviour changes, such as reducing salt intake, are important to prevent lifestyle-related diseases. Social environment is a major challenge to achieve such behaviours, but the explicit mechanisms remain largely unknown. We investigated whether social networks of children were associated with their behaviours to reduce salt intake.

DESIGN:

An ancillary study of a school-based cluster randomised controlled trial to reduce salt intake in children and their families (School-EduSalt), in which salt intake of children was significantly reduced by 25%.

SETTING:

14 primary schools in urban Changzhi, northern China.

PARTICIPANTS:

603 children aged 10-12 years in the intervention arm.

PRIMARY AND SECONDARY OUTCOME MEASURES:

We developed a score assessing salt-reduction behaviours (SRB score) of children based on self-administered questionnaires. The SRB score was validated by the changes in salt intake measured by 24-hour urine collection in a random sample of 135 children. A 1-unit increase in SRB score was associated with a 0.31 g/day greater reduction in salt intake during the trial (95% CI 0.06 to 0.57, p=0.016).

RESULTS:

Children from families with more family members not supporting salt reduction had significantly lower SRB scores (p<0.0001). Children from a class with a smaller size and from a class with more friendship connections, as well as children having more friends within the class all showed higher SRB scores (all p<0.05). Children whose school teachers attended the intervention programme more frequently also had higher SRB scores (p=0.043).

CONCLUSION:

Social networks were associated with the behaviours to reduce salt intake in children. Future salt-reduction programmes may benefit from strategies that actively engage families and teachers, and strategies that enhance interconnectivity among peers.

TRIAL REGISTRATION NUMBER:

NCT01821144; post-results.

KEYWORDS:

behaviour change; hypertension; salt reduction; social networks; social support

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