2002-12-31-世界卫生组织-2003-2004_STEPS_Country_Report_Cook_Islands_108页_4mb

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Cook Islands NCD STEPS Report Summary

Location and Background

• Country: Cook Islands - 15 small islands in the South Pacific Ocean.
• Population: ~6,594 adults (25-64 years) surveyed in 9 islands.
• Objective: To quantify the prevalence of major NCD risk factors (smoking, alcohol, poor diet, physical inactivity, hypertension, high BMI, high blood glucose, high cholesterol) and their relationship with gender and age. This was the first national survey on NCD risk factors.

Methodology

• Approach: Used the standardized WHO STEPwise approach to surveillance (STEPS).
• Sample: A representative random sample of 2,036 individuals (response rate ~90%) aged 25-64 years.
• Survey Structure: Three-step process.
  1. Step 1: Self-reported questionnaires on tobacco use, alcohol, diet, physical activity, medical history.
  2. Step 2: Physical measurements (height, weight, waist circumference, blood pressure).
  3. Step 3: Biochemical measurements (Fasting blood glucose, total cholesterol).
• Investigating Partner: Ministry of Health (Cook Islands), WHO, University of Sydney.

Key Findings by Risk Factor

1. Tobacco Use

• Prevalence: 43.9% of the population (46.6% men, 41.1% women) were current smokers.
• Daily Smoking: 33.3% were daily smokers (37.5% men, 28.8% women). Highest prevalence in the youngest age group (25-34 years).
• Duration: Mean duration for current smokers was 17.5 years, higher for men (18.8 years) compared to women (15.7 years) in some age groups.

2. Alcohol Consumption

• Current Drinkers: 62.9% (74.4% men, 50.6% women) consumed alcohol in the past 12 months.
• Binge Drinking (≥5 drinks/day on drinking day): Extremely high, with 74.7% of men reporting it, while 51.6% of women did.
• Heavy Drinking (>20 drinks/week): 33.8% of men drinkers reported drinking >20 drinks in the last 7 days.

3. Diet

• Fruit & Vegetable Intake: Only ~6 servings/day (target is ~5 combined servings). 81.8% consumed fewer than 5 combined servings. Mean fruit: 1.5 servings/day, vegetables: 1.5 servings/day. Fresh fish consumption was common (~3 days/week).
• Fats/Oils: Most used vegetable oil for cooking.
• Low Nutritious Food Availability/Promotion: Seen as needing improvement in public health programs.

4. Physical Activity

• Low Activity Level: A staggering 75.3% of the population was classified as having low total physical activity (average <600 MET-minutes/week).
• Domains: Work was the main contributor, followed by transport; recreational activity contributed little.
• Intensive Activity: Relatively low percentage engaged in high-intensity activity (14.1% men vs. 9.6% women).

5. Overweight and Obesity

• Huge Prevalence: 88.5% were overweight (BMI ≥ 25 kg/m²); 61.4% were obese (BMI ≥ 30 kg/m²) — the highest obesity rates in the region reported.
• Gender Disparity: Slightly higher in women than in men.

6. Blood Pressure

• High Prevalence: 33.2% had raised blood pressure (SBP ≥140 or DBP ≥90 or on medication). Slightly higher in men.
• Central Obesity: Men had higher mean waist circumference.

7. Blood Glucose and Diabetes

• Diabetes Rate: 23.6% had diabetes based on fasting glucose (61.8% had impaired fasting glucose).
• Cardiovascular Risks: High prevalence of cardiovascular disease risk factors (high blood pressure, high cholesterol, diabetes, high BMI).

8. Blood Cholesterol

• High Pct: 75.2% had raised total blood cholesterol (≥5.0 mmol/L).
• Component: Significantly higher levels in older women.

Overall NCD Risk Profile

• Combined Risk Factors: Using 5 risk factors (smoking, <5 fruit/veg, low activity, overweight, high BP or high cholesterol), only 0.3% of the population had no risk factors, 23.1% were at moderate risk, and 76.6% were at high risk.
• Vulnerability: Over half of the population (54.9%) had at least 3 risk factors, indicating very high NCD vulnerability.

Recommendations & Actions

1. Prioritize NCD Prevention: National development agenda.
2. Tobacco Control: Implement and enforce the WHO Framework Convention on Tobacco Control.
3. Healthy Diets: Promote local foods, improve availability of fruits/vegetables, reduce harmful fats/oils.
4. Physical Activity: Establish supportive environments for walking/cycling, promote culturally appropriate activity.
5. Hypertension/Cholesterol/Diabetes: Increase public awareness, strengthen healthcare capacity for early detection and management.
6. Surveillance: Plan for a rigorous follow-up STEPS survey to monitor trends.
7. Implementation: Strengthen health infrastructure, partnerships, and integrate NCD prevention into governmental strategies.
8. Reducing Alcohol: Especially binge drinking.

The STEPS survey provided an unprecedented wealth of scientific data on the major NCD risk factors in the Cook Islands, highlighting an urgent need for comprehensive actions across multiple sectors to address this significant public health threat.