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PURPOSE: The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China. METHODS: Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes. RESULTS: The indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors. CONCLUSION: This indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.

Tingting Li, 1–3 Yong Fang, 4 Dewei Zeng, 5 Zumin Shi, 6 Manoj Sharma, 7–9 Huan Zeng, 1–3 Yong Zhao 1 3, 10 1School of Public Health and Management, Chongqing Medical University, Chongqing 400016, People's Republic of China; 2Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, People's Republic of China; 3The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, People's Republic of China; 4Nan'an District Health Center for Woman and Children, Chongqing 400067, People's Republic of China; 5Nan'an District Center for Disease Control and Prevention, Chongqing 400067, People's Republic of China; 6Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha, Qatar; 7Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA; 8Health for All, Omaha, NE 68124, USA; 9Health Sciences, Walden University, Minneapolis, MN 55401, USA; 10Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing 400014, People's Republic of ChinaCorrespondence: Yong Zhao; Huan ZengSchool of Public Health and Management, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, People's Republic of ChinaTel +86-138-8346-0842Fax +86 023 6848 5008Email zhaoyong@cqmu.edu.cn; huanzeng@cqmu.edu.cnPurpose: The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China.Methods: Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes.Results: The indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors.Conclusion: This indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.Keywords: healthy city, urban health, indicator system, health in all policy, public health, healthy China

Nutrition literacy plays an important role in children's dietary habits and nutrition. This study aimed to analyse the status of nutrition literacy and its influencing factors amongst middle school students in Chongqing, China. "Nutrition literacy scale for middle school students in Chongqing" was used in 29 districts of Chongqing in September 2020. The scores of nutrition literacy and its' three sub-domains (functional, interactive and critical nutrition literacy) were divided into low and high groups based on their median scores. Binary logistic regression was used to measure the influencing factors of nutrition literacy. A total of 18,660 middle school students were included in this study. The median of nutrition literacy of middle school students was 61.68 (IQR = 14.37). Interactive nutrition literacy had the highest score (median = 70.00, IQR = 20.00), followed by functional nutrition literacy (median = 68.69, IQR = 14.14) and critical nutrition literacy (median = 45.83, IQR = 25.00). Students who were the minority (OR = 0.71, 95% CI = 0.637–0.785), in senior high school (OR = 0.51, 95% CI = 0.477–0.548), in rural areas (OR = 0.85, 95% CI = 0.790–0.911), receiving school meal support from the government (OR = 0.63, 95% CI = 0.591–0.664), with other caregivers' parenting (OR = 0.86, 95% CI = 0.805–0.914), with parents having a low level of education and with an abnormal BMI [thin (OR = 0.91, 95% CI = 0.837–0.990), overweight (OR = 0.87, 95% CI = 0.785–0.968), and obese (OR = 0.83, 95% CI = 0.767–0.902)] presented less probability of being a high level of nutrition literacy. Our results could assist public health authorities in developing strategies of nutrition literacy promotion for references and theoretical foundations.

Abstract Background Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented. Methods Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling. Results Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status. Conclusions Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.