Perspectives in Public Health

Published by SAGE Publications
Online ISSN: 1757-9147
Publications
Article
The London borough of Newham is ethnically diverse and is one of the poorest regions in the UK. Rates of teenage pregnancy, sexually transmitted infections (STIs) and HIV are high compared to the rest of the country. One strand of the local school-based HIV-prevention programme for young people utilizes performance arts as a tool for HIV education and prevention. This study evaluated HIV knowledge, confidence and intention to use a condom in two groups of 13- 16-year-olds who had participated in performance-based events. Group 1 (n = 14) participated in a six-week programme of performance arts-based HIV education and prevention workshops, which culminated in a theatre-based performance. Group 2 (n = 65) were audience members who attended the performance. Participants completed a short questionnaire containing both qualitative and quantitative items. Qualitative data suggested that the participants had learned about condoms and their efficacy in preventing acquisition of HIV and sexually transmitted diseases. Quantitative results indicated that after participation in the events, respondents had more information about HIV and condom use; were more confident that they could insist on condom use with partners; and planned to use condoms in the future. There was a statistically significant difference between Groups 1 and 2 but because of the small numbers in Group 1 this result should be interpreted cautiously. Performance-based HIV-prevention activities may be a useful way to deliver HIV-prevention messages to young people. This evaluation will form the basis of a more systematic and robust evaluation of future events.
 
Article
To investigate changes in mean body mass index (BMI) and prevalence of obesity between 1998 and 2006 in annual cohorts of 9-10-year-old Liverpool schoolchildren. Stature and body mass data collected at the Liverpool SportsLinx project's fitness testing sessions were available on 26,782 (n = 13,637 boys, 13,145 girls) participants. BMI was calculated from these data. BMI z-score increased over time (p < 0.01) in both boys (z-score range = -0.22-0.14) and girls (z-score range = -0.2-0.16), with all years showing significantly higher BMI values in comparison to the first two years of the project (p < 0.01). There were no significant differences between the most recent three years of data in boys and girls. Prevalence of obesity, and obesity plus overweight increased over time. However a 'levelling off' in prevalence was observed in the most recent three years of data (2003-2006). A substantial number of Liverpool schoolchildren are at risk of obesity-related illness and disease. However the most recent three cohorts' data (2003-2006) suggest that the increasing prevalence of obesity may have slowed; a positive step towards meeting the partnership agreement to halt the year-on-year increase in obesity by 2010.
 
Article
Social marketing is a highly systematic approach to health improvement that sets out unambiguous success criteria focused on behaviour change. This paper reviews the key concepts and principles of social marketing and its recent rapid development across government in England in the public health field. This paper outlines the role of the National Social Marketing Centre and concludes with a discussion of the probable future impact of social marketing on public health practice. The paper argues that there is a close ideological match between social marketing and liberal democratic imperatives. Social marketing's focus on outcome, return on investment and its emphasis on developing interventions that can respond to diverse needs, means it is probable that social marketing will increasingly be required by governments as a standard part of public health programmes.
 
Article
Gina Mohajer from the Development Team at the RSPH, highlights the need for innovative thinking as organizations cope with challenging economic times
 
Article
Aiming to make the most of the Olympic legacy, Sarah Prest and Rachel Partridge, from NHS Dorset, explain how one county is encouraging lifestyle change
 
Article
There is no evidence that previous Olympic Games have raised physical activity levels in adult populations. However, it may be premature to assume that this lack of previous evidence for an inherent effect is an indication that there is no potential to proactively harness the Games to generate a physical activity or sport legacy. Given that the political goal of achieving a physical activity legacy had already been set, the policy-led aim of this systematic review was to examine the processes by which the London 2012 Olympic and Paralympic Games might deliver a physical activity (as opposed to sport) legacy. Searches were conducted on five databases: SPORTS DISCUS, CINAHL, PsychLNFO, MEDLINE and Web of Knowledge. There are two key findings: first, that communities that are not positively engaged with hosting the 2012 Games in London are likely to be beyond the reach of any initiatives seeking to harness the Games to develop legacies in any area; second, major events such as London 2012 can, if promoted in the right way, generate a 'festival effect' that may have the potential to be harnessed to promote physical activity among the least active. The 'festival effect' derives from the promotion of the 2012 Games as a national festival that is bigger than and beyond sport, but that is also rooted in the lives of local and cultural communities, thus creating a strong desire to participate in some way in an event that is both nationally significant and locally or culturally relevant. Physical activity policy makers and professionals should seek to satisfy this desire to participate through providing physical activity (rather than sport) opportunities presented as fun community events or programmes. The key to generating a physical activity legacy among the least active adults through this process is to de-emphasise the sporting element of the 2012 Games and promote the festival element.
 
Article
Emphasis is laid on the desirability of careful investigation in consultation with local interests before deciding on a site and on the nature of the facilities to be provided. Suggestions are made on how to assess the extent of the facilities required. A sharp contrast is drawn between planning for line as opposed to booth dressing, and the importance of adequate cooling facilities for carcases and offals is stressed. Distinction is drawn between administrative management and management of slaughtering and dressing operations, and attention is drawn to the repercussion single v. multiple control of operations may have on planning.
 
Article
Aims: Accident and Emergency attendances continue to rise. Infants are disproportionately represented. This study examines the clinical reasons infants attend UK Accident and Emergency departments. Methods: A retrospective review of 6,667 infants aged less than one year attending Accident and Emergency at two district general hospitals in London from 1(st) April 2009 to 30(th) March 2010. All infants had been assigned to a diagnostic category by the medical coding department according to National Health Service (NHS) data guidelines, based on the clinical diagnoses stated in the medical records. The Accident and Emergency case notes of a random subsample of 10% of infants in each of the top five recorded diagnostic categories (n = 535) were reviewed in detail and audited against the standard national NHS data set. Results: The top 5 clinical diagnoses were 'infectious diseases', 'gastrointestinal', 'respiratory', 'unclassifiable' and 'no abnormality detected' (NAD). A third of infants were originally given a diagnosis of unclassifiable (21.5%) or NAD (11.5%). After detailed case-note review, we were able to reduce this to 9.7% (95% confidence interval (CI): 9.0, 10.4) and 8.8% (95% CI: 8.1, 9.5), respectively. Conclusion: This study demonstrates the importance of providing a clear clinical diagnosis and coding system for Accident and Emergency attendances and understanding that system fully. This would allow for better informed health service evaluation, planning and research as each of these relies on the interpretation of routine health-care data. Furthermore, the relatively high proportion (10%) of infants attending with no discernible underlying medical abnormality suggests the health needs of a significant proportion of infants attending Accident and Emergency departments may be better addressed by alternative service provision and/or improved education and support to parents.
 
Article
Objectives: This study investigates the perceptions of individuals with body piercings in relation to health behaviours and values specifically taking into account piercing location. Methods: A qualitative study that employed a series of in-depth, semi-structured individual interviews using thematic analysis to analyse data. Nine individuals with a range of piercings were recruited and semi-structured interviews were carried out in a West Midlands piercing studio. Results: The analysis identified themes relating to the presence of body piercings that included a range of health-related outcomes such as physical appearance, health behaviours, addiction and impressions. A possible relationship between oral piercings and 'crash dieting' was also identified. Conclusions: The results suggest that from the comments made the presence of body piercings is not related to any particular health concern, which is instead comparable to the general population. These results contradict previous studies citing a relationship with high-risk health behaviours. Further large-scale studies examining these findings are warranted.
 
Article
Aims: Given a North-South divide in mortality in England, we aimed to assess the extent of a North-South divide in risk factors for cardiovascular disease (CVD), controlling for markers of socio-economic position (SEP). Methods: We undertook cross-sectional analyses using respondents from the 2006 Health Survey for England. We assessed mean systolic blood pressure, total cholesterol, body mass index (BMI) and smoking prevalence in the two regions. We built nested regression models adding demographic factors, SEP indicators, behavioural risk factors, vascular disease status and CVD preventive medications stepwise into each model. We examined interactions between region, age and gender. Results: Controlling for demographic variables, we found a northern excess in systolic blood pressure (+1.95mmHg (SE = 0.40)), BMI (0.40kgm(-2) (SE = 0.12)) and smoking prevalence (5.6% (SE = 1.1)). The difference in smoking prevalence was entirely abolished by markers of SEP. Systolic blood pressure and BMI differences were attenuated by SEP, behavioural and disease indicators, but remained (+1.63mmHg (SE = 0.41) and 0.25kgm(-2) (SE = 0.12), respectively). However, they were lost after adjustment for preventive medication. The North-South divide in systolic blood pressure was attributed to differences in men and younger-to-middle-aged groups. Northern respondents were more physically active, especially younger men. Conclusions: English North-South differences in smoking can be explained through adverse, cross-sectional SEP. Northern excesses in blood pressure and BMI may be associated with differential clinical management. Risk factor differences may, in part, explain a previously found North-South divide in mortality. Further exploration of geographic inequalities, concentrating on the impact of healthcare, may be warranted.
 
Article
Dr Ann Hemingway and Dr Paul Steven from the Centre for Wellbeing and Quality of Life at Bournemouth University look at the importance of creating a supportive environment to encourage people to have the confidence to take risks and move out of their comfort zone.
 
Article
Project Manager Stefanie Radford from the Association for Nutrition, and her colleague Amy Hall, offer an insight into the development of a unique quality assurance framework in nutrition and the rapid progress being made.
 
Article
Aim: Government policy has highlighted the need for inclusive education for people with long-term mental health needs. As a starting point, the aim of this study was to assess the extent to which further education (FE) colleges in the south east of England provide supported education for people with mental health needs, and the extent to which these organizations collaborate with local NHS primary care trusts (PCTs). Also, to assess the potential numbers of people who might benefit from fully inclusive educational provision needs assessment, together with the potential healthcare cost savings. Method: A survey was conducted of 33 multi-faculty FE colleges and 49 PCTs via structured telephone interviews with nominated representatives, in order to collect quantitative and qualitative data of the provision of supported education provision for people with mental health needs. The FE survey enquired whether they had provision for people with mental health needs, and if so, the details. The PCT survey gathered data on their caseload of standard and enhanced clients for the population covered, and the extent to which they were aware of the benefits of learning on mental health. Results: Only 15 FE colleges (45%) had some form of provision for students with long-term mental health needs, and only six PCTs (12%) provided an educational link co-ordinator. FE colleges with existing provision averaged 70 students per college, against an attainable potential target of 130 students per college. Encouragingly, cohorts of students with mental health needs were reported to have levels of 'retention', 'achievement' and 'success' rates that were comparable with students from the general population on mainstream courses--e.g. expected rates of around 85% retention, 75% achievement (of those retained), 65% success (overall from enrolled to achieving), with some 5% progressing to university and 12% into employment. On present levels of FE recruitment, there is a potential net saving to the taxpayer of 13 million sterling pounds in mental healthcare costs (around 50%) and if recruitment increased to projected levels, then the potential net saving to the taxpayer would be 26 million sterling pounds. The substantial estimated savings to the health budget not only shows that supported education provision in FE is effective in promoting mental health, it also indicates the high level of its cost-effectiveness. Conclusion: This research has implications for budget holders, health promotion staff and mental health teams working within a social model of health, and the collaborative use of resources to assist people recovering from or managing mental health difficulties in moving forward in their lives.
 
Article
Background: Meningococcal infection is fatal in 10% of cases, and age-specific attack rates are highest in infancy. A nursery outbreak was declared just before a bank holiday weekend in August 2010, when two children attending the same nursery were confirmed to have meningococcal infection. Although such outbreaks are rare, they generate considerable public alarm and are challenging to manage and control. This report describes the investigation and public health response to the outbreak. Results: Both cases had relatively mild disease and were confirmed as having serogroup B infection. Chemoprophylaxis and advice were given to most of the 146 children and 30 staff at the nursery. Within 28 hours of declaring the outbreak, over 95% of parents received information, advice and prescriptions for their children. GPs were also given information and the after-hours service provided continuity over the weekend. No further cases were identified and the outbreak was closed four weeks after being declared. Conclusions: Considerable logistical challenges were involved in providing timely advice and chemoprophylaxis to the entire nursery and staff one day before a bank holiday weekend. The speed of the public health response and implementation of preventive measures was crucial in providing assurance to parents and staff, and reducing their anxiety. The decision to provide on-site prescribing at the nursery (coupled with information sessions and individual counselling) proved to be a key implementation-success factor. Effective coordination and management by the outbreak control team was able to rapidly provide leadership, delegate tasks, identify gaps, allocate resources and ensure a proactive media response. A number of useful lessons were learnt and recommendations were made for future local practice.
 
Article
Kirsty Beck, Science and Policy Project Manager, and Dr Rachel Thompson, Science Programme Manager (Nutrition), at the World Kirsty Beck, Science and Policy Project Manager, and Dr Rachel Thompson, Science Programme Manager (Nutrition), at the World Cancer Research Fund International, highlight the importance of addressing health inequalities in the fight against cancer
 
Article
This study aimed to develop a practical toolkit to support non-government organizations (NGOs) in tackling health inequalities in the UK and to highlight the challenges and lessons learned. A mixed qualitative methodology within an action research framework was conducted. Semi-structured questionnaires, focus group interviews and discussions with an expert reference group aimed to identify the important themes and produce the toolkit content. A practical guide of information materials for NGOs working on addressing health inequalities was subsequently developed and successfully piloted. The experience of using participatory action research revealed a number of lessons and challenges. The key challenges were lack of training and experience in conducting action research, costs and insufficient resources, slow and time-consuming process, lack of commitment from marginalized groups, and differences in emphasis of goals and vision among participants. The main lessons learned were importance of effective leadership and project management skills, importance of integrating researchers and the researched as equal partners, creation and nurturing of trust, importance of evaluating and piloting processes, importance of engaging with marginalized groups, and use of evidence base in decision making. The lessons and challenges enumerating herein are of value to researchers aiming to implement participatory action research in developing checklists, tools, practical guidance and frameworks, and they offer important areas to consider before starting such projects. In addition, this offers an insight into how the dynamics of participatory action research methodology evolved in the development of the toolkit. Future research and initiatives in this area should focus on ways to improve the toolkit and make it more relevant to a wider community, and methods for evaluating the impact of the toolkit on practice.
 
Article
There is a long history of people expressing concern about the health, lifestyle and well-being of our population--and of proposals for action to address the inequitable experiences between groups within this population. Over time, our understanding of both the problem and its causal connections has changed considerably. This is reflected within an increasingly explicit articulation of the issues and a progressively more sophisticated and determined cross-sectoral approach to tackling health inequalities. This paper reflects on the progress we have made in England in addressing this challenge, suggesting that we need to engage more proactively with our population and with our international partners, taking a systematic partnership approach to inform policy, practice and delivery on the ground.
 
Article
Aims: Health-promoting strategies need to be culturally appropriate to encourage healthy behaviours and lifestyle choices in children and young people. This rapid review explores the effects of participating in creative activities on the health and well-being of children aged between 11 and 18 years. Methods: Building on an earlier systematic review undertaken by Daykin and colleagues(1) a rapid review of the literature published between 2004 and 2011 was undertaken. The search was conducted systematically and included research on music, dance, singing, drama and visual arts, taking place in community settings or as extracurricular activities in mainstream schools. Therapies such as art, drama and music were excluded from the review. Results: Following rigorous application of inclusion and exclusion criteria, 20 papers were included in the review: six quantitative, eight qualitative and six mixed-method approaches. The interventions used in the studies were diverse and the research was heterogeneous, therefore overall synthesis of the results was inappropriate. The review is therefore organised into the following headings: sexual health, obesity, mental health and emotional well-being. Despite the methodological weakness and limitations of the majority of the studies there were some consistencies in their findings. It was found that participating in creative activities can have a positive effect on behavioural changes, self-confidence, self-esteem, levels of knowledge and physical activity. Conclusions: Although the research evidence is generally weak there is some evidence that using creative activities as part of a health-promoting strategy may be a useful method of increasing knowledge and positive behaviours in children and young people.
 
Article
Many companies nowadays consider schools to be an important setting for marketing to children. However, important concerns can be raised from a health promotion perspective about the potential negative impact of commercial activities on the health and well-being of pupils. As this discussion paper will demonstrate, some commercial activities raise concerns in relation to physical health and obesity, not only by potentially undermining formal curriculum messages, but also through the active promotion of specific products, particularly those high in fat, sugar or salt. Nonetheless, the issues raised by commercial activities are not solely limited to effects on physical health. By allowing commercial activities, schools risk instilling in pupils consumer-orientated values. This is significant as such values have been linked to the development of poor health and well-being. Furthermore, the presence in schools of commercial activities will also militate against informed decision-making and be disempowering. There is also evidence that business-sponsored teaching materials can contain biased and misleading information. The potential negative impacts of commercial activities are inconsistent with goals in relation to the promotion of health and the principles of health-promoting schools.
 
Article
Although there has been a substantial decline in its prevalence during the last twenty years, acute rheumatism remains one of the most important diseases of the rheumatic group. Infection with hæmolytic streptococci of Group A is at present the only factor in the aetiology of acute rheumatism which can be identified with confidence. Until other aetiological factors, which almost certainly exist, have been defined the prevention of acute rheumatism rests upon general measures such as diminution of overcrowding which will control the frequency, weight and variety of upper respiratory tract infections among children and young adults. Prompt detection of acute rheumatism, especially of the forms which have an insidious onset, rest in bed during the stages of acute illness and convalescence, together with special clinical arrangements for after-care extending over many years remain the only satisfactory measures for the prevention and limitation of the chronic heart disease caused by acute rheumatism. The chief responsibility for this now lies with the hospital and specialist section of the National Health Service. Research at present in progress may serve to uncover some of the hitherto unknown factors in the aetiology of acute rheumatism and hence lead to better methods for its prevention. The use of penicillin to control upper respiratory infections in rheumatic individuals and of hormones in the treatment of the initial illness which are now being investigated may prove to be valuable in the prevention of chronic rheumatic heart disease.
 
Article
Aims: The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England. Methods: Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture. Results: Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level. Conclusion: Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.
 
Article
Jane Thomas, Head of Insight and Social Marketing at Liverpool PCT, describes how the obesity epidemic is being tackled in a city heavily affected
 
Article
Background: Children's health suffers disproportionately from the effects of poverty. The inverse care law states that those who need care the most are the least likely to receive it. Community paediatricians are well placed to address health inequalities in children. Aims: To explore, using routinely collected data, whether we address health inequalities and the inverse care law, particularly for certain conditions targeted by our specialty. Methods: Five years of data were analysed, during which health equity audits have led to service changes in order to tackle inequities. The data include postcodes, allowing each child to be assigned to a deprivation quintile, and a range of diagnoses, including five sentinel conditions: attention deficit hyperactivity disorder (ADHD) on medication, autistic spectrum disorder (ASD), epilepsy, cerebral palsy and Down's syndrome. This allowed analysis of the caseload by deprivation index for these conditions, comparison with the background population and exploration of time trends. Results: The number of children on the caseload and their distribution across the quintiles remained stable. The proportion of deprived children (i.e. in the lowest two quintiles) on the caseload over the last five years taken together is 56%, compared to 44% in the background population. The numbers of children with ADHD on medication has almost quadrupled in deprived quintiles and doubled in the least deprived quintile, while the numbers of children with this diagnosis in the most deprived is four times that in the least deprived. Numbers of children with ASD have also increased in each quintile. In contrast, the number of children with epilepsy and cerebral palsy did not show much variation, but those from deprived quintiles made up a greater proportion of the caseload. Conclusions: Routine data collection demonstrates that inequalities are addressed using all four quality domains of service provision and sentinel conditions more likely to affect deprived children are targeted. We believe it is possible for all services to collect and analyse data thus with minimal effort, thereby providing a foundation from which to address the inverse care law.
 
Article
The problems of sanitary administration associated with the incursions of large numbers of visitors into holiday resorts is briefly discussed. Common deficiencies in catering establishments are reviewed and the need for compulsory registration of premises is stressed. The difficulties facing the health educator in holiday catering trades are discussed and brief suggestions made for overcoming them. The manufacture and distribution of ice-cream is briefly dealt with and the value of sampling is discussed ; sample results are quoted. Attention is drawn to the need for sterilization of ice-cream servers and the result of a simple test on the use of a quaternary ammonium disinfectant is given. A local code of standard for ice-cream vehicles is quoted. The provision of sanitary accommodation in places of public entertainment is briefly referred to and a local interpretation of section 89 of the Public Health Act is included. The sterilization of beer glasses is discussed and details are given of tests on an automatic washer. Defects in powers of control of boarding houses are enumerated and some remedial suggestions are made, including the introduction of compulsory registration. The author concludes by stressing the need for additional staff in holiday resorts in order that the increased difficulties of sanitary administration can be overcome.
 
Article
Cervical cancer is the third most common female cancer worldwide. It remains the highest ranking preventable cancer affecting women in developing countries. Cervical cancer is caused by sexual transmission of human papillomavirus (HPV). It is estimated that more than 80% of sexually active women will be infected with HPV in their lifetime, usually in their mid to late teens, 20s and early 30s. Persistence of high-risk oncogenic subtypes can lead to the development of precancerous change (cervical intraepithelial neoplasia (CIN)), which can ultimately lead to cervical cancer. Progression from CIN to cancer is slow in most cases, and it is believed that progression from CIN 3 to cancer at 10, 20 and 30 years is 16%, 25% and 31.3%, respectively. The cervical screening programme has been successful in reducing the incidence of cervical cancer by recognising early precancerous changes and treating them. A promising advance in women's health has been the development of a vaccine targeting high-risk oncogenic subtypes 16 and 18, which are responsible for 70% of all cervical cancers. Two HPV vaccines are available: Merck & Co.'s Gardasil(®) and GlaxoSmithKline's Cervarix(®). The aim of this programme is to provide three doses prior to sexual debut with the hope that it will reduce the rates of cervical cancer in the future. Women who are already sexually active can still be vaccinated, but, the vaccine has been shown to be less effective in them. Uptake remains a challenge for public health, and efforts should focus on educating parents about the association between HPV and cervical cancer. Routine vaccination of young men is a debatable issue and has been found to be less cost-effective, as the burden of disease such as anal and penile cancers in males is less than cervical cancers in women. Current evidence suggests that the HPV vaccination programme should focus on increasing and maintaining high coverage of vaccination in girls. There may, however, be some benefit in vaccinating young men in areas where the uptake of vaccination in women in less than 70%. A school-based vaccination programme has been shown to be effective, with an uptake rate in England of 76% for 2009/2010, but this has implications for the role of school nurses in the delivery of other services. This article explores the health benefits of the HPV vaccine, the impact of attitudes, cost-effectiveness and the involvement of school nurses in programme delivery.
 
Article
Aims: In 2010, the English Department of Health launched a radical new public health strategy, which sees individual factors, such as self-esteem, as the key to improving all aspects of young people's health. This article compares the strength of association between key adolescent health outcomes and a range of individual and social factors Methods: All participants aged 12-15 in the nationally representative 2008 Healthy Foundations survey were included. Six individual factors related to self-esteem, confidence and personal responsibility, and seven social factors related to family, peers, school and local area were investigated. Single-factor and multivariable logistic regression models were used to calculate the association between these factors and seven health outcomes (self-reported general health, physical activity, healthy eating, weight, smoking, alcohol intake, illicit drug use). Odds ratios were adjusted for gender, age and deprivation. Results: Individual factors such as self-esteem were associated with general health, physical activity and healthy eating. However, the influence of family, peers, school and local community appear to be equally important for these outcomes and more important for smoking, drug use and healthy weight. Conclusion: Self-esteem interventions alone are unlikely to be successful in improving adolescent health, particularly in tackling obesity and reducing substance misuse.
 
Article
Aims: To compare levels of health engagement between adolescents, young adults and older adults and to investigate the association between health engagement and key health outcomes at different ages. Methods: Using the Healthy Foundations study (2008), the responses to three previously validated questions on health engagement were analysed by age group; adolescents (12-15 years; N=452), young adults (16-24 years; N=785) and older adults (25-74 years; N=4136). Logistic regression was used to calculate the odds ratio of poor health outcomes among participants with low versus high health engagement. Results: Feeling in control of one's own health decreased from adolescence (mean score 79.3 (95% CI 77.6,81.0)), through young adulthood (74.6 (73.1,76.1)) into older adulthood (72.2 (71.5,72.9)). In contrast, perceived involvement in health showed a U-shaped trajectory: (adolescents 72.0 (70.2,73.7), young adults 68.6 (67.1,70.1), older adults 73.8(73.1,74.5)), as did perceived importance of health (adolescents 75.0 (73.1,76.9), young adults 62.9 (61.0,64.8), older adults 77.1 (76.4,77.8)). Not feeling involved in health was more strongly associated with poor general health among adolescents (OR 1.81 (1.41,2.32)) than older adults (OR 1.19 (1.11,1.28)). Not feeling in control of health was only associated with poorer general health among young adults (OR 2.33 (1.93,2.83)) and older adults (OR 2.26 (2.10,2.44)). In contrast, lack of control over health was most strongly associated with physical inactivity among adolescents (OR 1.99 (1.49,2.66)) but this was also significant in young adults (OR 1.25 (1.06,1.48)) and older adults (OR 1.11 (1.04,1.19)). Conclusion: Young adults feel less involved in their health and rate health a less important priority than adolescents and older adults. Involvement is more strongly linked to key health behaviours among under 25s than older adults.
 
Article
Alcohol misuse by young people causes significant health and social harm, including death and disability. Therefore, prevention of youth alcohol misuse is a policy aim in many countries. Our aim was to examine the effectiveness of (1) school-based, (2) family-based and (3) multi-component universal alcohol misuse prevention programmes in children and adolescents. Three Cochrane systematic reviews were performed: searches in MEDLINE, EMBASE, PsycINFO, Project CORK and the Cochrane Register of Controlled Trials up to July 2010, including randomised trials evaluating universal alcohol misuse prevention programmes in school, family or multiple settings in youths aged 18 years or younger. Two independent reviewers identified eligible studies and any discrepancies were resolved via discussion. A total of 85 trials were included in the reviews of school (n = 53), family (n = 12) and multi-component (n = 20) programmes. Meta-analysis was not performed due to study heterogeneity. Most studies were conducted in North America. Risk of bias assessment revealed problems related to inappropriate unit of analysis, moderate to high attrition, selective outcome reporting and potential confounding. Certain generic psychosocial and life skills school-based programmes were effective in reducing alcohol use in youth. Most family-based programmes were effective. There was insufficient evidence to conclude that multiple interventions provided additional benefit over single interventions. In these Cochrane reviews, some school, family or multi-component prevention programmes were shown to be effective in reducing alcohol misuse in youths. However, these results warrant a cautious interpretation, since bias and/or contextual factors may have affected the trial results. Further research should replicate the most promising studies identified in these reviews and pay particular attention to content and context factors through rigorous evaluation.
 
Article
Vaccinations and disease-screening services occupy an important position within the constellation of interventions designed to prevent, forestall or mitigate illness: they straddle the worlds of clinical medicine and public health. This paper focuses on a set of clinical preventive services that are recommended in the USA for adults aged 65 and older, based on their age and gender. These services include immunisations against influenza and pneumococcal disease, and screening for colorectal and breast cancers. We explore opportunities and challenges to enhance the delivery of these interventions, and describe some recently developed models for integrating prevention efforts based in clinician offices and in communities. We also report on a state-level surveillance measure that assesses whether older adults are 'up to date' on this subset of preventive services. To better protect the health of older Americans and change the projected trajectory of medical costs, expanded delivery of recommended vaccinations and disease screenings is likely to remain a focus for both US medicine and public health.
 
Article
The aim was to extend the body of knowledge through a systematic review that combines the strengths and partly fills the gaps from earlier reviews. The aim is to review randomized controlled trials of the long-term effectiveness of physical exercise/activity with or without diet and/or behaviour modification therapy in terms of training effect, weight loss and improvement of body composition in overweight and obese, healthy adults. Data for systematic review was collected via a search of databases for literature published between 1995 and 2006. The search yielded 12 articles. The studies showed that training intensity should be moderate. The treatment of overweight and obese individuals with training alone cannot be expected to result in any substantial weight loss but should be combined with diet and behaviour modification therapy. However training can be an important factor in preventing further weight gain, or in helping individuals maintain a lowered body weight. According to this systematic review of randomized controlled trials, the treatment that produced the best weight loss results included a combination of training, behaviour therapy and diet.
 
Article
Aims: Examining the co-occurrence patterns of modifiable biobehavioral risk factors for deadly chronic diseases (e.g. cancer, cardiovascular disease, diabetes) can elucidate the etiology of risk factors and guide disease-prevention programming. The aims of this study were to (1) identify latent classes based on the clustering of five key biobehavioral risk factors among US adults who reported at least one risk factor and (2) explore the demographic correlates of the identified latent classes. Methods: Participants were respondents of the National Epidemiologic Survey of Alcohol and Related Conditions (2004-2005) with at least one of the following disease risk factors in the past year (N = 22,789), which were also the latent class indicators: (1) alcohol abuse/dependence, (2) drug abuse/dependence, (3) nicotine dependence, (4) obesity, and (5) physical inactivity. Housing sample units were selected to match the US National Census in location and demographic characteristics, with young adults oversampled. Participants were administered surveys by trained interviewers. Results: Five latent classes were yielded: 'obese, active non-substance abusers' (23%); 'nicotine-dependent, active, and non-obese' (19%); 'active, non-obese alcohol abusers' (6%); 'inactive, non-substance abusers' (50%); and 'active, polysubstance abusers' (3.7%). Four classes were characterized by a 100% likelihood of having one risk factor coupled with a low or moderate likelihood of having the other four risk factors. The five classes exhibited unique demographic profiles. Conclusions: Risk factors may cluster together in a non-monotonic fashion, with the majority of the at-risk population of US adults expected to have a high likelihood of endorsing only one of these five risk factors.
 
Article
Aims: Domestic radon gas concentrations in parts of the UK are sufficiently high to increase lung cancer risk among residents, and recent studies have confirmed that the risk of smokers developing lung cancer is significantly enhanced by the presence of radon. Despite campaigns encouraging residents of radon-affected areas (RAEs) to test and remediate their homes, public response to the risks posed by radon remains relatively modest, particularly among smokers and young families, limiting the health benefits and cost-effectiveness achievable by remediation. The observation that smokers, who are most at risk from radon, are not explicitly targeted by current radon remediation campaigns prompted an assessment of the value of smoking-cessation initiatives in reducing radon-induced lung cancers by reaching at-risk subgroups of the population hitherto uninfluenced by radon-awareness programmes. This study addresses the motivation of current quitters in a designated RAE using a postal questionnaire administered around one year after the cessation attempt. Methods: Residents of the Northamptonshire RAE who had joined the smoking-cessation programme between July and September 2006 and who remained verifiably tobacco free at four weeks, were subsequently invited to participate in a questionnaire-based investigation into factors affecting their decision to cease smoking. From an initial population of 445 eligible individuals, 205 of those contacted by telephone after 12 months agreed to complete postal questionnaires, and unsolicited questionnaires were sent to a further 112 participants for whom telephone contact had proved impossible. One hundred and three completed questionnaires were returned and analysed, the principal tools being χ(2) , Mann-Whitney and Kruskal-Wallis tests. Results: Individuals decide to quit smoking from self-interest, principally on health grounds, and regard the effects of their smoke on others, particularly children and unborn babies, as less significant. The risk of developing respiratory, coronary/cardiac or cancerous conditions provides the greatest motivation to the decision to quit, with knowledge of radon among the lowest-ranked influences. Conclusions: This study confirms that quitters place risks to their personal health as the highest factors influencing their decision to quit, and health professionals should be aware of this when designing smoking-cessation initiatives. As radon risk is ranked very low by quitters, there would appear to be the potential to raise radon awareness through smoking-cessation programmes, with the objective of increasing the uptake and success rate of such programmes and encouraging participation in radon-remediation programmes.
 
Top-cited authors
Rajarshi Dey
  • University of South Alabama
Federico J.A. Perez-Cueto
  • University of Copenhagen
Laurits Rohden Skov
Holly Blake
  • University of Nottingham
Mark E Batt
  • Nottingham Spire Hospital