Why We All Need to Work Togehter to Prioritize Breastfeeding

Amakobe Sande^1,#

1. UNICEF Representative to China, United Nations Children's Fund (UNICEF) Office for China, Beijing, China.

^# Corresponding author: Amakobe Sande, asande@unicef.org.

The first week of August marks World Breastfeeding Week. It provides a valuable opportunity to review progress in breastfeeding initiatives, analyze the enabling environment for breastfeeding support, and propose targeted actions to protect, promote, and advance breastfeeding practices. As of April 2025, 48% of infants under six months are exclusively breastfed worldwide, approaching the World Health Assembly's target of 50% by 2025. However, reaching the more ambitious global target of 60% by 2030 will require sustained investment in evidence-based programs and policies, strong political commitment, robust accountability mechanisms, and strengthened health systems to protect, promote, and support breastfeeding practices. The 2024 Global Breastfeeding Scorecard reveals that only 30% of countries have implemented all four policy actions recommended by the Global Breastfeeding Collective. China has undertaken significant measures to promote breastfeeding nationwide. In 2021, fifteen government ministries issued the National Action Plan for Promoting Breastfeeding (2021–2025). Concurrently, China has implemented concrete national-level actions, including nationwide promotion of infant and young child feeding counseling services, improvements in family-friendly workplace policies, and strengthening of Baby-Friendly Hospital Initiatives. Achieving breastfeeding targets requires sustained, multisectoral efforts across all levels of society. Key recommendations for action include enacting and enforcing legally binding Code of Marketing of Breastmilk Substitutes, implementing comprehensive family-friendly workplace policies, strengthening community support networks, integrating breastfeeding counseling and support into routine maternal and child health services, implementing the Ten Steps to Successful Breastfeeding in all maternity facilities, and establishing routine monitoring and evaluation systems. Through these coordinated measures, mothers will receive the comprehensive support they need to breastfeed exclusively, providing their babies with the healthiest possible foundation for life.

为何促进母乳喂养需要全社会共同投入

桑爱玲^1,#

1. 联合国儿童基金会驻华代表，联合国儿童基金会驻华办事处，北京，中国。

^# 通信作者: 桑爱玲 （Amakobe Sande)，asande@unicef.org。

每年八月的第一周是世界母乳喂养周，也是用于回顾母乳喂养工作的进展，分析支持母乳喂养的支持性环境，并提出保护、促进和支持母乳喂养的行动建议的宝贵机会。截至2025年4月，全球六个月以下婴儿的纯母乳喂养率是48%，接近世界卫生大会设定的2025年50%的目标。然而，要实现2030年全球60%的更高目标，需要持续投资于循证项目和政策、强有力的政治意愿、健全的问责机制以及强化的卫生系统，以保护、促进和支持母乳喂养。中国在促进母乳喂养方面采取了重要措施。2021年，15个政府部门联合发布了《促进母乳喂养行动计划（2021–2025年）》，旨在建立一个由政府主导、部门协同、全社会支持的母乳喂养促进机制。同时中国也在全国层面实施了具体行动，包括在全国范围内推广婴幼儿喂养咨询服务、改善家庭友好型工作场所政策，以及加强"爱婴医院"倡议等。实现母乳喂养目标需要持续的、多部门的努力。关键行动建议包括，制定并执行具有法律约束力的《母乳代用品营销守则》，实施家庭友好型工作场所政策，加强社区支持， 将母乳喂养咨询与支持纳入常规的妇幼保健服务，在所有产科机构实施"成功母乳喂养十步法"， 建立常规的监测与评估系统。通过采取这些措施，母亲将获得母乳喂养所需的支持，为婴儿的健康人生打下坚实基础。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.171

Association Between Family Upbringing Environment and Mobile Phone Dependence Syndrome in Middle School Students — Guangzhou City, Guangdong Province, China, 2023

Runquan Zhang¹, Haiyuan Zhu¹; Qiqi Wu¹; Rong Lin²; Hui Liu²; Minying Sun²; Weiquan Lin²; Wenhao Li³; Bing Huang⁴; Jierong Zhao⁴; Yingyu Yang⁵; Ying Li⁵; Xiaomei Dong^1,#; Chang Wang^2,#

1. Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, China;

2. Guangzhou Center for Disease Control and Prevention (Guangzhou Health Supervision Institute), Guangzhou City, Guangdong Province, China;

3. The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, Guangdong Province, China;

4. Guangzhou Liwan District Center for Disease Control and Prevention, Guangzhou City, Guangdong Province, China;

5. Guangzhou Nansha District Center for Disease Control and Prevention, Guangzhou City, Guangdong Province, China.

^# Corresponding author: Xiaomei Dong, tdongxm@jnu.edu.cn; Chang Wang, gzcdc_wangc@gz.gov.cn.

With the widespread adoption of smartphones, Mobile Phone Dependence Syndrome (MPDS) has emerged as a significant public health concern. However, the relationship between family upbringing environment and MPDS among middle school students remains unclear. We employed a multi-stage cluster random sampling method to conduct questionnaire and scale assessments among 1,928 students from eight middle schools in Guangzhou during April and May 2023. Propensity score matching was performed to control for confounding variables, including sex, grade, boarding status, and place of residence. We used multivariate logistic regression models to examine the associations between parental educational attainment, parenting styles, care levels, family economic conditions, and middle school students' MPDS. After adjusting for covariates, this study revealed that middle school students whose fathers had educational attainment levels of junior high school [odds ratio (OR)=0.39, 95% confidence interval (95% CI): 0.17–0.90], senior high school, junior college, technical secondary school, or vocational university (OR=0.28, 95% CI: 0.12–0.67), or a bachelor's degree and above (OR=0.34, 95%  CI:0.12–0.92) demonstrated significantly lower odds of MPDS compared to those whose fathers had only elementary school education or below. Additionally, students whose fathers employed an authoritarian parenting style (OR=1.98, 95%  CI:1.22–3.21) showed significantly higher odds of MPDS compared to those whose fathers embraced a democratic parenting approach. Promoting democratic parenting styles among fathers and enhancing fathers' educational levels may be beneficial in reducing adolescents' MPDS risk. This study provides valuable insights for developing scientifically informed strategies aimed at promoting adolescents' physical and mental well-being.

基于倾向性得分匹配研究家庭教养环境与中学生手机依赖综合征的关联 — 广州市，广东省，中国，2023年

张润权¹；朱海源¹；吴绮琦¹；林蓉²；刘慧²；孙敏英²；林伟权²；李文浩³；黄冰⁴；赵洁荣⁴；杨莹钰⁵；李瑛⁵；董晓梅^1,#；王畅^2,#

1. 公共卫生与预防医学系，医学院，暨南大学，广州市，广东省，中国；

2. 广州市疾病预防控制中心（广州市卫生监督所），广州市，广东省，中国；

3. 暨南大学附属广东省第二人民医院，广州市，广东省，中国；

4. 广州市荔湾区疾病预防控制中心，广州市，广东省，中国；

5. 广州市南沙区疾病预防控制中心，广州市，广东省，中国。

^# 通信作者：董晓梅，tdongxm@jnu.edu.cn；王畅，gzcdc_wangc@gz.gov.cn。

随着智能手机的广泛普及，手机依赖综合征（MPDS）已成为重要的公共卫生问题。然而，中学生家庭教养环境与 MPDS 之间的关系尚不明确。本研究于2023 年 4-5 月，采用多阶段整群随机抽样方法对广州市8所中学共1928名学生进行了问卷和量表评估。通过倾向得分匹配控制混杂变量，包括性别、年级、寄宿情况和居住地。采用多因素逻辑回归模型来研究父母教育程度、教养方式、关爱程度、家庭经济状况与中学生 MPDS 之间的关系。经调整协变量的多因素logistic回归分析显示，与父亲教育程度为小学及以下的中学生相比，父亲教育程度为初中（OR=0.39，95% CI: 0.17–0.90）、高中/中专/大专/职业大学（OR=0.28，95%  CI: 0.12–0.67）及本科及以上（OR=0.34，95%  CI: 0.12–0.92）的中学生，手机依赖的风险更低。父亲为专制型教养方式的中学生（OR=1.98，95%  CI: 1.22–3.21）患MPDS的风险显著高于父亲为民主型教养方式的中学生。培养父亲对孩子的民主型教养方式和提高父亲的教育程度有利于降低青少年MPDS风险。本研究为科学制定促进青少年身心健康发展的策略和措施具有重要的借鉴和指导意义。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.173

Association Between Early-life Malnutrition and Lifestyle Behaviors in Later Life Among Rural Elderly with Hypertension — Jia County, Pingdingshan City, Henan Province, China, 2023

Jian Wu¹; Saiyi Wang¹; Yudong Miao¹; Zichen Zhou¹; Yifei Feng¹; Lipei Zhao¹; Weijia Zhao¹; Clifford Silver¹; Yaru Duan²; Ronghai Bie^1,#

1. Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou City, Henan Province, China;

2. Henan University of Chinese Medicine, Zhengzhou City, Henan Province, China.

^# Corresponding author: Ronghai Bie, brongh@zzu.edu.cn.

Early-life malnutrition plays a critical role in human development; however, its long-term impact on lifestyle behaviors remains poorly understood. This study investigated the association between early-life malnutrition and lifestyle behaviors among elderly hypertensive populations. A total of 17,871 elderly hypertensive populations were surveyed from July 11 to August 31, 2023, in Jia County, Pingdingshan City, Henan Province, China. Early-life malnutrition exposure was defined based on natural disasters occurring between 1959 and 1961, with participants categorized by age at exposure as follows: infant and toddler exposed group (1956–1958), preschooler exposed group (1953–1955), school-aged exposed group (1947–1952), adolescent exposed group (1942–1946), and adult exposed group (before 1942). Outcome measures included four lifestyle behaviors: smoking, alcohol consumption, healthy body mass index (BMI), and healthy waist circumference (WC). Multivariable logistic regression models were used to evaluate associations with sex-stratified subgroups, and sensitivity analyses were performed to ensure robustness. The mean age of the participants was 73.4 years, and 57.9% were women. Compared to the adult exposed group, individuals exposed to malnutrition during infancy, preschool, school-aged, and adolescence had significantly higher risks of smoking and alcohol consumption. Additionally, those with early-life malnutrition exposure showed a lower likelihood of maintaining healthy BMI and WC, with odds ratios (ORs) demonstrating significant trends as age at exposure increased (P _{for trend}<0.001). Subgroup analysis revealed that these associations were significant in males, whereas no statistically significant associations were observed between smoking and alcohol consumption in females. Sensitivity analyses, excluding individuals with diabetes or coronary heart disease, confirmed the robustness of the findings. Early-life malnutrition, particularly during infancy, childhood, and adolescence, was significantly associated with unhealthy lifestyle behaviors, including increased smoking, alcohol consumption, and obesity among elderly individuals with hypertension. These findings provide valuable insights for countries and regions facing natural disasters. Furthermore, they can help public health professionals design targeted interventions for vulnerable populations.

农村老年高血压人群早期营养不良与晚年生活方式行为的关系 — 郏县，平顶山市，河南省，中国，2023年

吴建¹；王赛怡¹；苗豫东¹；周子琛¹；冯宜飞¹；赵丽培¹；赵蔚嘉¹；Clifford Silver¹；段亚茹²；别荣海^1,#

1. 卫生管理系，公共卫生学院，郑州大学，郑州市，河南省，中国；

2. 河南中医药大学，郑州市，河南省，中国。

^# 通信作者：别荣海，brongh@zzu.edu.cn。

早期营养不良经历在个体成长过程中起着关键作用。但其对老年期生活方式行为的影响仍不明确。本研究旨在探讨早期营养不良经历与老年高血压患者生活方式行为之间的关联。本研究共纳入2023年7月11日至8月31日期间在河南省郏县调查的17,871名老年高血压患者。早期营养不良经历指1959年至1961年间因自然灾害导致的大范围食物短缺和营养不良。按早期营养不良经历暴露时的年龄，将研究对象分为五组：婴幼儿期（1956–1958年出生的个体）、学前期（1953–1955年出生的个体）、学龄期（1947–1952年出生的个体）、青春期（1942–1946年出生的个体）及成年期（1942年以前出生）。研究的结局变量包括吸烟、饮酒、健康体质指数（BMI）和腰围（WC）四种生活方式行为。采用多因素logistic回归分析评估早期营养不良经历与各结局变量之间的关联，并进行性别分层分析及敏感性分析以验证结果稳健性。研究对象平均年龄为73.4岁，其中57.9%为女性。与成年期暴露组相比，婴幼儿期、学前期、学龄期和青春期暴露组的吸烟和饮酒风险显著增加，早期营养不良暴露者维持正常体重和非中心性肥胖的风险较低，趋势性检验结果具有统计学意义（P_趋势<0.001）。亚组分析发现，这些关联在男性群体中具有统计学意义，而在女性群体中，吸烟和饮酒未观察到显著关联。敏感性分析（排除糖尿病和冠心病患者）进一步验证了研究结果的稳健性。早期营养不良经历，特别是婴幼儿期、学前期、学龄期和青少年期的营养不良，与老年高血压人群的生活方式行为密切相关，包括吸烟、饮酒和肥胖的增加。本研究结果为面临自然灾害的国家和地区提供了重要的公共卫生参考，帮助公共卫生工作者针对脆弱人群制定有针对性的干预措施。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.174

Estimating Hospitalization Expenditures Associated with Chronic Diseases and Multimorbidity for Older Adults: Evidence Based on Hospital Discharge Database — Guangzhou City, Guangdong Province, 2017–2019

Fei Zhao¹; Yang Li¹; Xuyan Lou¹; Molin Li¹; Chao Ma²; Wei Xu³; Yangdong Fan⁴; Yang Jiao⁵; Yihan Wu²; Zhuo Chen^1,6,#

1. School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo City, Zhejiang Province, China;

2. School of Economics and Management, Southeast University, Nanjing City, Jiangsu Province, China;

3. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China;

4. School of Health Management, Guangzhou Medical University, Guangzhou City, Guangdong Province, China

5. Department of Accounting, Economics, and Finance, Texas A&M University-Texarkana, Texarkana, TX, USA;

6. Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.

^# Corresponding authors: Zhuo Chen, zhuo.chen@nottingham.edu.cn.

Chronic diseases and multimorbidity are increasingly prevalent among older adults in China, contributing substantially to hospitalization burden. However, real-world evidence on their direct medical expenditures remains limited. This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019, and adopted generalized linear models (GLMs) to estimate hospitalization expenditures across chronic disease and multimorbidity patterns. Older adults with multimorbidity had nearly double the median annual hospitalization costs compared to those with single conditions. Schizophrenia incurred the highest cost among single diseases, while cancer+CVD+heart disease combinations led among multimorbidity patterns. Over half of disease combinations showed super-additive spending. This provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity. The findings underscore the need for integrated care model, evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.

估算老年人慢病与共病相关的住院花费 — 广州市，广东省，中国，2017–2019年

赵 飞¹；李 杨¹；楼旭妍¹；李沫林¹；马 超²；徐 伟³；范阳东⁴；焦 阳⁵；吴依含²；陈 茁^1,6,#

1. 人文社科学院经济系，宁波诺丁汉大学，宁波市，浙江省，中国；

2. 经济管理学院，东南大学，南京市，江苏省，中国；

3. 国际医药商学院，中国药科大学，南京市，江苏省，中国；

4. 健康管理学院，广州医科大学，广州市，广东省，中国；

5. 会计、经济与金融系，德克萨斯农工大学德克萨卡纳分校，德克萨卡纳市，德克萨斯州，美国；

6. 卫生政策与管理系，公共卫生学院，佐治亚大学，雅典市，佐治亚州，美国。

^# 通信作者：陈茁，zhuo.chen@nottingham.edu.cn。

慢性病与多病共存在中国老年人群中日益普遍，显著增加了住院负担，但基于真实世界的针对慢病和共病的直接医疗花费证据仍较有限。本研究分析了2017–2019年度广州市住院病案首页数据，采用广义线性模型（GLMs）评估不同慢病及共病模式下的住院支出。多病共存患者的年住院中位费用几乎是单种慢病患者的两倍。精神分裂症在单种慢病中住院费用最高，而癌症+脑血管+心脏病的慢病组合在共病模式中住院费用支出最高。此外，约57.1%的共病组合呈现超加性支出。本研究揭示了老年人慢性病及其共病的住院医疗经济负担，强调应推动全面的慢病预防、循证干预、支付优化和照护整合等策略，以优化资源配置并改善健康结局。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.175