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About the Authors:
Tingzhong Yang
* E-mail: [email protected]
Affiliation: Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Dan Wu
Affiliation: Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Weifang Zhang
Affiliation: Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Randall R. Cottrell
Affiliation: Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, Ohio, United States of America
Ian R. H. Rockett
Affiliation: Injury Control Research Center and Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
Introduction
Since 1978, China has been transitioning from a centralized to a market-based economy. A concomitant is massive social change [1]–[3]. This socioeconomic transition has promised higher living standards, and markedly improved individual choice in education, health, consumer goods and services, and employment. It simultaneously has generated many challenges, including an imbalance between urban and rural development, rampant corruption, and a chasm between rich and poor [4], [5]. Studies suggest that people exposed to such conditions endure high stress [6]–[8]. For example, one study reported that 64% of urban residents manifested moderate or high levels of stress, and 22% suffered from mental disorders [7].
Stress is now a major public health problem in China, with an estimated 173 million Chinese adults having a mental disorder [6]. Many studies show escalation of stress-related health problems [6], [7]. The World Health Organization (WHO) estimated that neuropsychiatric conditions and suicide collectively comprised over 20% of the total illness burden of China in 2004 [9]. Given the huge population, even a conservative estimate gives China the largest number of reported suicides in the world [10]. Chinese suicides account for between 25% and 33% of the official global total, with at least 600–800 people committing suicide daily. In recent decades, there has been a striking increase in alcohol consumption and related problems in China [11], [12]. However, most Chinese stress studies have been based on a single cross-sectional survey that was confined to local subpopulations [13]–[15]. There is a crucial need to collect national population-based, longitudinal data on stress in urban communities with multiple time points, in order to inform health policy, plan prevention strategies, and design...