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Preview: Journal of Public Health - current issue

Journal of Public Health Current Issue





Published: Mon, 12 Jun 2017 00:00:00 GMT

Last Build Date: Mon, 12 Jun 2017 11:45:41 GMT

 









Differing patterns in intentional and unintentional poisonings among young people in England, 1998–2014: a population-based cohort study

2016-08-13

Abstract
Background
Accurate and up to date data on changes in poisoning incidence among young people are lacking. Recent linkage of UK primary care, hospital and mortality data allows these to be quantified to inform service delivery.
Methods
An open cohort study of 1 736 527 young people aged 10–24 between 1998 and 2014 was conducted using linked data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics deaths. Incidence rates (IRs) by poisoning intent were calculated by age, sex, deprivation and year.
Results
Total poisoning IRs increased by 25% from 1998/99 to 2013/14 [adjusted incidence rate ratio (aIRR) 1.25, 95% CI: 1.20–1.30]. Patterns differed markedly by intent. Intentional poisoning rates increased by 52% while unintentional rates remained unchanged. Intentional rates increased almost exclusively among females, gradually between 1998/99 and 2013/14 among 16–18 (88% increase) and 19–24 (36% increase) year olds but only increased among 10–15 year olds in the last 2 years (79% increase). A 2-fold increased risk of poisoning for the most compared to least deprived quintile existed (aIRR 2.21, 95% CI: 2.02–2.23) and remained over time.
Conclusions
Commissioning of primary and secondary prevention services needs to address the growing problem of intentional poisonings among young people.



Listening to doctors on patients’ use of healthcare during the crisis: uncovering a different picture and drawing lessons from Portugal

2016-08-13

Abstract
Background
The consequences of financial crises on patients’ use of healthcare have been widely discussed. This paper seeks to ascertain whether the position of key players, i.e. doctors, may reveal realities other than those officially reported about the 2008 financial crisis.
Methods
In 2013–14, a national survey of doctors was conducted in Portugal, which received international assistance in the wake of the financial crisis. An exploratory model comprising descriptive statistics, regression and independence analyses focused on doctors’ experience of patients’ use of medications, consultations, exams and treatment services, and whether they stopped treatments.
Results
According to doctors, an unspecified number of patients experienced difficulties using healthcare as more patients requested prescriptions for cheaper medications or simply stopped treatments. Significant variations were found according to speciality, years of practice and sector of activity.
Conclusions
Cost-containment mechanisms are regarded as necessary. However, the evidence indicated a side effect, i.e. a decrease in patients’ ability to use healthcare, including in the National Health Service (NHS). It also highlighted the need to listen to health professionals as key informants on patient's behaviour and the daily functioning of health services.



A process evaluation of the UK-wide Antibiotic Guardian campaign: developing engagement on antimicrobial resistance

2016-07-22

Abstract
Background
Public Health England developed and led a new UK-wide pledge campaign aiming to improve behaviours around the prudent use and prescription of antibiotics. This paper presents a process evaluation for the first season of the campaign to determine the impact of the campaign and inform future campaigns.
Methods
Data were collected from AntibioticGuardian.com and Google analytics between August 2014 and January 2015. The primary outcome was the decision to pledge and was assessed according to target audience, location, source and route of referral to the website.
Results
There were 47 158 unique visits to the website and 12 509 visitors made a pledge (26.5%) to become Antibiotic Guardians (AGs); 69% were healthcare professionals. Social media directed the most traffic to the website (24% of the public that signed up cited social media as how they discovered the campaign), other acquisition routes such as self-directed, email or website referral, were more effective at encouraging visitors to pledge.
Conclusions
The campaign completed its goal of 10 000 AGs in the first year. Further work is required to improve engagement with target audiences and determine whether this campaign has an impact on antibiotic consumption and prescribing behaviour among the public and healthcare professionals.



Microfinance participation and contraceptive use: does control over resources matter?

2016-07-15

Abstract
Background
The purpose of the present study was to assess the association between microfinance and contraceptive use. A secondary purpose of the study was to assess the role of control over resources between microfinance participation and contraceptive use.
Method
Using secondary data from Bangladesh Demographic and Health Survey 2011 the present study conducted logistic regression analysis to estimate the interaction effect of microfinance participation and control over resources on reported contraceptive use.
Results
Findings indicate that microfinance participants are 1.69 times more likely to use contraceptive (P < 0.001), and women with control over resources are 4.28 times more likely to use contraceptive (P < 0.001). However, the interaction effect of microfinance participation and control over resources suggest that microfinance participants with control over resources are less likely to use contraceptive, but that finding is not significant.
Conclusion
While control over resources matter the most in terms of women's use of contraceptive, this does not hold true for microfinance participants with control over resources.



Interactions between individual and perceived environmental factors on Latinas’ physical activity

2016-07-13

Abstract
Background
Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas’ PA.
Methods
We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA.
Results
Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women.
Conclusions
Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas’ PA.



Intensity of physical activity and subjective well-being: an empirical analysis of the WHO recommendations

2016-07-13

Abstract
Background
This study examined the effect of different intensities of physical activity and the recommendations of the World Health Organization (WHO) on the subjective well-being (SWB) of adults in two age groups (18–64; 65+).
Methods
Cross-sectional survey data from 28 European countries were used for the analysis (n = 21 008). Participation intensity was measured with the number of days and minutes of light (walking), moderate and vigorous activity. Another three dummy variables reflected how the WHO guidelines were met. Two-stage least square models were estimated with life satisfaction (measuring SWB) as the dependent variable.
Results
For 18- to 64-year-olds, walking (minutes and days/week) and vigorous activity (minutes/week) significantly added to SWB, while moderate activity (minutes/week) had a negative effect. Individuals in both age groups meeting the guidelines only for moderate activity and those meeting the guidelines for both moderate and vigorous activity or using a combination of both reported significantly higher well-being levels compared with those not meeting the guidelines.
Conclusions
Physical activity recommendations aiming at improving individuals’ mental health should reconsider the inclusion of light-intensity activity, the interchangeability of moderate and vigorous activity, and the fact that more physical activity does not lead to better outcomes for all intensities and age groups.



The impact of an HIV/AIDS adult integrated health program on leaving hospital against medical advice among HIV-positive people who use illicit drugs

2016-07-13

Abstract
Background
Leaving hospital against medical advice (AMA) is a major source of avoidable morbidity, mortality and healthcare expenditure. The objective of this study was to assess the impact of an innovative HIV/AIDS adult integrated health program on leaving hospital AMA among HIV-positive people who use illicit drugs (PWUD).
Methods
Using generalized estimating equations, we examined the relationship between being a participant of the Dr. Peter Centre (DPC), a specialty HIV/AIDS-focused adult integrated health program, and leaving hospital AMA among a cohort of HIV-positive PWUD patients.
Results
Between July 2005 and July 2011, 181 HIV-positive PWUD who experienced ≥1 hospitalization were recruited into the study. Of the 406 hospital admissions among these individuals, 73 (39.9%) participants left the hospital AMA. In a multivariable model adjusted for confounders, being a participant of the DPC was independently associated with lower odds of leaving hospital AMA (adjusted odds ratio = 0.42; 95% confidence interval: 0.19–0.89).
Conclusions
Our findings suggest that the provision of a broad range of clinical, harm reduction and support services through an innovative HIV/AIDS-focused adult integrated health program operating in proximity to a hospital may curb the rate at which individuals leave hospital prematurely.



Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort

2016-07-13

Abstract
Background
The ‘Five Year Forward View’ (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to general practice (GP) provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers.
Method
Data from the Born in Bradford cohort (around 12 000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision.
Results
Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is ‘explained’ by the nature of GP provision. Women in practices with a low GP to patient ratio had around 09 fewer consultations over the six year period compared to women in practices with the highest ratio.
Conclusions
Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need.



The Public Health Responsibility Deal: making the workplace healthier?

2016-06-14

Abstract
Background
The Public Health Responsibility Deal (RD) in England is a public–private partnership which aims to improve public health by addressing issues such as health at work. This paper analyses the RD health at work pledges in terms of their likely effectiveness and added value.
Methods
A review of evidence on the effectiveness of the RD ‘health at work’ pledges to improve health in the workplace; analysis of publically available data on signatory organizations' plans and progress towards achieving the pledges; and assessment of the likelihood that workplace activities pledged by signatories were brought about by participating in the RD.
Results
The ‘health at work’ pledges mostly consist of information sharing activities, and could be more effective if made part of integrated environmental change at the workplace. The evaluation of organizations' plans and progress suggests that very few actions (7%) were motivated by participation in the RD, with most organizations likely (57%) or probably (36%) already engaged in the activities they listed before joining the RD.
Conclusions
The RD's ‘health at work’ pledges are likely to contribute little to improving workplace health as they stand but could contribute more if they were incorporated into broader, coherent workplace health strategies.



An audit of tuberculosis health services in prisons and immigration removal centres

2016-05-30

Abstract
Background
Tuberculosis (TB) is the second leading cause of death worldwide due to a single infectious agent. Rates of active TB in places of prescribed detention (PPD), which include Prisons, Young Offender Institutions and Immigration Removal Centres, are high compared with the general population. PPD therefore present an opportunity to develop targeted health programmes for TB control. This audit aims to assess current service provisions and identify barriers to achieving best practice standards in PPD across London.
Methods
Twelve healthcare teams within PPD commissioned by NHS England (London Region) were included in the audit. Services were evaluated against the National Institute for Health and Care Excellence standards for TB best practice.
Results
None of the health providers with a digital X-ray machine were conducting active case finding in new prisoners and no health providers routinely conduct Latent TB infection testing and preventative treatment. Barriers to implementing standards include the lack of staff skills and staff skills mix, structural and technical barriers, and demands of custodial and health services.
Conclusions
This audit restates the importance of national public health TB strategies to consider healthcare provisions across PPD.






Poverty and health-related quality of life of people living in Hong Kong: comparison of individuals from low-income families and the general population

2016-05-24

Abstract
Background
To assess health-related quality of life (HRQOL) among Chinese adults from low-income households in Hong Kong, and to explore any threshold of household income that impaired HRQOL.
Methods
A cross-sectional analysis was conducted on 298 adults from low-income families when they enrolled into a cohort study between 2012 and 2014. HRQOL was measured by the 12-item Short-Form Health Survey-version 2 (SF-12v2). Their mean SF-12v2 subscale and summary scores were compared with those of 596 age–sex-matched subjects randomly selected from a database of 2763 adults from the Hong Kong general population (ratio = 1:2). Multiple linear regressions were conducted to determine any association between monthly household income and HRQOL.
Results
Subjects from low-income households had significantly lower SF-12v2 bodily pain, general health, vitality and physical component summary (PCS) scores than the age–sex matched subjects from the general population. Subgroup analysis showed that a household income <50% of the median monthly household income in Hong Kong (HK$10 000 ≈ US$1290, i.e. poverty line in Hong Kong) was independently associated with poorer PCS and mental component summary (MCS) scores after adjustment for socio-demographics and co-morbidities.
Conclusion
Chinese adults from low-income households had poorer HRQOL, and <50% of the median monthly household income seems to be the threshold for impairment of both physical and mental HRQOL. The findings support the current definition of the poverty line.



Retrospective case series analysis of characteristics and trends in unintentional pharmaceutical drug poisoning by methadone, opioid analgesics, antidepressants and benzodiazepines in Clark County, NV 2009–13

2016-05-24

Abstract
Background
Poisoning has become the leading cause of injury death in the USA—with opioid analgesic involved in more fatal poisonings than any other drug, including cocaine and heroin. The epidemic of prescription drug poisonings is a public health concern. This study aimed to define potential high-risk groups for unintentional prescription drug poisoning by methadone, opioid analgesics, antidepressants or benzodiazepines.
Methods
A hospital-based retrospective case series analysis of admissions related to prescription drug poisonings associated with methadone, opioid analgesics, antidepressants or benzodiazepines for hospitals in Clark County, Nevada between 2009 and 2013 was employed.
Results
There were 7414 admissions with a primary diagnosis of an unintentional poisoning due to methadone, opioid analgesics, antidepressants or benzodiazepines. Women had the highest rate of admissions particularly in the 45–54 age group. Higher rates of admissions were also found among non-Hispanic whites, single and uninsured populations. There were concerning increases in admissions among 65+ and Native American/Alaskan Native subgroups in 2013. Benzodiazepines and opioid analgesics were the most prevalent drug categories for prescription drug poisoning admissions.
Conclusion
Public health professionals can utilize hospital data to identify populations at risk and in need of targeted interventions.



Perceived barriers towards healthy eating and their association with fruit and vegetable consumption

2016-05-24

Abstract
Background
Improving dietary intakes is a key public health target. Perceived barriers to healthy eating (PBHE) are an important component of the Health Belief Model which aims to understand why individuals do not adopt preventive health measures. This study investigates the relationship between PBHE and reported fruit and vegetable (F&V) consumption.
Methods
Data from the Scottish Health Survey 2008–11 (n = 8319) for PBHE and self-reported F&V consumption were used in Probit regression models to test the association between meeting the 400 g per day F&V recommendation and PBHE.
Results
Regression models show women who reported a lack of cooking skills were 10.4% less likely to meet the F&V recommendations (P = 0.001). Not liking the taste of healthy foods or finding them too boring (10.2%, P = 0.022), preparation time (5.6%, P = 0.020) or willpower (3.0%, P = 0.021) were also significant. For men, reporting not liking the taste of healthy foods or finding them too boring (6.8%, P = 0.02) was the only significant result. Price, a commonly reported PBHE, was not significantly associated with F&V consumption.
Conclusions
Not all commonly reported perceived barriers to healthy eating are significantly associated with meeting the recommended F&V intake.



Perceived barriers to partner notification among sexually transmitted infection clinic patients, Cape Town, South Africa

2016-05-24

Abstract
Background
Public health approaches to sexually transmitted infection (STI) prevention in resource-limited countries rely on patients to self-notify sex partners of their STI. However, a majority of partners go uninformed and remain untreated and infectious.
Methods
Anonymous surveys collected from 776 men and women receiving STI clinic services in Cape Town, South Africa.
Results
Half of patients surveyed intended to inform their partners, while half did not intend to notify partners. Women were more likely than men to intend to notify their partners. Patients who completed formal education were also more likely to indicate intentions to notify partners. There were no associations between numbers of partners patients had or partner types with intentions to notify partners. Among both men and women, concerns about adverse partner reactions were associated with intentions not to notify partners. Multivariable analyses stratified by gender and controlling for confounds showed that intentions to notify partners were significantly related to men's concerns that their partner could react violently against them and women's concerns that their partner may leave them and refuse to see them again.
Conclusions
Interventions that assist patients to develop strategies to safely inform their partners are needed to increase patient-initiated partner notification.






Food pantry selection solutions: a randomized controlled trial in client-choice food pantries to nudge clients to targeted foods

2016-05-12

Abstract
Background
Food pantries and food banks are interested in cost-effective methods to encourage the selection of targeted foods without restricting choices. Thus, this study evaluates the effectiveness of nudges toward targeted foods.
Methods
In October/November 2014, we manipulated the display of a targeted product in a New York State food pantry. We evaluated the binary choice of the targeted good when we placed it in the front or the back of the category line (placement order) and when we presented the product in its original box or unboxed (packaging).
Results
The average uptake proportion for the back treatment was 0.231, 95% CI = 0.179, 0.29, n = 205, and for the front treatment, the proportion was 0.337, 95% CI = 0.272, 0.406, n = 238 with an odds ratio of 1.688, 95% CI = 1.088, 2.523. The average uptake for the unboxed treatment was 0.224, 95% CI = 0.174, 0.280, n = 255, and for the boxed intervention, the proportion was 0.356, 95% CI = 0.288, 0.429, n = 188 with an odds ratio of 1.923, 95% CI = 1.237, 2.991.
Conclusions
Nudges increased uptake of the targeted food. The findings also hold when we control for a potential confounder. Low cost and unobtrusive nudges can be effective tools for food pantry organizers to encourage the selection of targeted foods.
Trial Registration Number:
NCT02403882.






A cross-sectional analysis examining the association between dieting behaviours and alcohol use among secondary school students in the COMPASS study

2016-05-10

Abstract
Background
Unhealthy weight-control methods and problematic alcohol use appear linked, with individuals engaging in both behaviours at greater risk of adverse consequences. Most studies have been conducted among females and young adults, yet both dieting and binge drinking emerge at earlier stages of development. Moreover, gender differences are likely due to contrasting body ideals. This study investigated the co-occurrence of dieting and alcohol use among youth, focusing on varying weight goals in males and females, and meal skipping, as a form of food restriction.
Methods
Cross-sectional analyses were conducted in sample of 44 861 Grade 9–12 students from Year 2 (2013–14) of the COMPASS study.
Results and conclusions
The majority of females were trying to lose weight, while males tended to report efforts to gain and these two groups demonstrated the highest odds of alcohol use and binge drinking. Breakfast and lunch skipping predicted binge drinking and alcohol use in females, but only the former was related to drinking behaviour in males. Breakfast skipping rarely occurred for weight loss purposes, although more females reported this reason for missing meals than males. Results support hypothesized gender variations in weight goals and meal skipping, and differing associations with drinking behaviour.



Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel

2016-05-10

Abstract
Background
An organization-wide inequity-reduction quality improvement (QI) initiative was implemented in primary care clinics serving disadvantaged Arab and Jewish populations. Using the Chronic Care Model (CCM), this study investigated the types of interventions associated with success in inequity reduction.
Methods
Semi-structured interviews were conducted with 80 staff members from 26 target clinics, and information about intervention types was coded by CCM and clinical domains (e.g. diabetes, hypertension and lipid control; performance of mammography tests). Relationships between type and number of interventions implemented and inequity reduction were assessed.
Results
Target clinics implemented 454 different interventions, on average 17.5 interventions per clinic. Interventions focused on Decision support and Community linkages were positively correlated with improvement in the composite quality score (P < 0.05). Conversely, focusing on a specific clinical domain was not correlated with a higher quality score.
Conclusions
Focusing on training team members in selected QI topics and/or tailoring interventions to meet community needs was key to the interventions' success. Such findings, especially in light of the lack of association between QI and a focus on a specific clinical domain, support other calls for adopting a systems approach to achieving wide-scale inequity reduction.



Wider horizons, wiser choices: horizon scanning for public health protection and improvement

2016-05-08

Abstract
Background
Systematic continuous thinking about the future helps organizations, professions and communities to both prepare for, and shape, the future. This becomes ever more critical given the accelerating rate at which new data emerge, and in some cases uncertainties around their reliability and interpretation. Businesses with the capability to filter and analyse vast volumes of data to create knowledge and insights requiring action have a competitive advantage. Similarly Government and the public sector, including public health can be more effective and efficient through the early identification of emerging issues (both threats and opportunities).
Methods
Horizon scanning approaches, and the use of resulting intelligence related to health protection and improvement were reviewed.
Results
Public health horizon scanning systems have to date focussed on health technologies and infectious diseases. While these have been successful there is a major gap in terms of non-infectious hazards and health improvement.
Conclusion
Any system to meet this need must recognize the changed environment for delivering front line public health services and the critical role of local authorities and the local democratic process. This presents opportunities and challenges and this paper explores those dynamics describing an existing environment and health horizon scanning system which could readily and rapidly be re-engineered to provide a national service.



Psychosocial stressors and lung function in youth ages 10–17: an examination by stressor, age and gender

2016-05-08

Abstract
Background
Research on the impact of psychosocial stressors on child and adolescent lung function is uncommon, and has primarily relied either on parents' own stress measures or parent-reported stressors the child experienced, which may be a poor proxy for perceived stress in older children and adolescents.
Methods
We performed multivariate linear regression of spirometry measures (FVC, FEV1 and FEF25–75) and psychosocial stressors in 584 adolescents in the Los Angeles Family and Neighborhood Survey. We examined family conflict, unsafe neighborhood or school, and the absence of a father in models stratified by gender, adjusting for PM2.5 and potential confounders.
Results
We observed reductions in lung function in males related to the absence of a father in the house (FEV1: −176.2 ml, 95% CI −322.7, −29.7) and family conflict (FEV1: −156.2 ml, 95% CI −327.8, 15.5); associations were stronger in older males ages 15–17 years for each stressor (P for interaction of age and sex was 0.009 and 0.06, respectively).
Conclusions
This research informs a very small literature on psychosocial stressors and lung function in adolescents. Our finding of differential vulnerability by age and gender warrants further exploration of adolescent psychosocial stressor response on lung function.



Effect of smoking on multiple sclerosis: a meta-analysis

2016-05-08

Abstract
Background
Despite our awareness of the significant effect of smoking on multiple sclerosis (MS), there was a serious lack of information about the effect of different types of smoking habit on MS as well as the dose–response relationship between smoking and MS, but this gap was addressed by this meta-analysis.
Methods
Major electronic databases, including PubMed, Web of Science and Scopus were searched until July 2015. Epidemiological studies addressing the association between smoking and MS were enrolled. The heterogeneity across studies was investigated by Q-test and I2 statistic. The probability of publication bias was explored using Begg's and Egger's tests. The results were expressed as odds ratio (OR) with 95% confidence intervals (CI) using a random effects model.
Results
We identified a total of 10 687 references and included 34 studies involving 623 852 participants. Compared with nonsmokers, the OR estimate of MS was 1.46 (1.33, 1.59) among ever smokers, 1.57 (1.34, 1.80) among current smokers, 1.36 (1.27, 1.46) among ex-smokers and 1.12 (0.87, 1.36) among passive smokers. In addition, analyzing the effect of cigarette pack-year on MS indicated that the OR estimate of MS was 1.34 (1.06, 1.61) for 1–5 cigarette pack-years, 1.56 (1.15, 1.97) for 6–10 cigarette pack-years, 1.74 (1.16, 2.33) for 11–15 cigarette pack-years and 1.46 (0.49, 2.43) for more than 15 cigarette pack-years.
Conclusions
Smoking habits are significantly associated with MS, although the association is not very strong. However, there is a dose–response relationship between the smoking habits and MS.



The role of parental smoking on adolescent smoking and its social patterning: a cross-sectional survey in six European cities

2016-05-08

Abstract
Background
Several studies have observed socio-economic (SE) inequalities in smoking among adolescents, but its causes are not fully understood. This study investigates the association between parental and adolescent smoking, and whether this association is socially patterned.
Methods
We used data from a survey administered in 2013 to students aged 14–17 years old of six European cities (n = 10 526). Using multilevel mixed-effects logistic regression, we modelled the probability of being a daily smoker as a function of parental smoking and SE status. We tested whether the smoking association differed across social strata.
Results
The prevalence of parental smoking was higher in low SE status adolescents. Boys and girls were more likely to smoke if they have a father [boys: adjusted odds ratio (AOR) = 1.90, 95% CI = 1.47–2.46; girls: AOR = 1.42, 95% CI = 1.09–1.86] and mother (boys: AOR = 1.77, 95% CI = 1.35–2.31; girls: AOR = 3.36, 95% CI = 2.56–4.40) who smoked. Among boys, the odds of smoking when having a smoking parent were higher in lower SE classes. However, this was not statistically significant, nor was it observed among girls.
Conclusions
Adolescents are more likely to smoke when their father and mother smoke. Although the susceptibility to parental smoking was similar across social classes, SE differences in parental smoking contribute to the transmission of SE inequalities in smoking.



The sedentary profile of primary care patients

2016-05-08

Abstract
Background
Primary care is one of the key environments in which to target public health and sedentary behaviours are increasing being linked to several adverse health outcomes. The aim of this study was to determine the prevalence and correlates of sedentary behaviour in an adult primary care population.
Methods
The International Physical Activity Questionnaire was used to collect data on the weekday sitting of participants. Stratified random sampling based on urban/rural location and deprivation was used to identify three primary care centres from which the sample was drawn.
Results
Data were collected from 885 participants (96.7% response rate) of whom 64% (n = 565) were female and 36% (n = 320) were male. The mean age was 42 (SD 14.2). Overall 48% (n = 418) of participants sat for >4 h daily with a median sitting time of 240 min (IQR 150–480). Attendance at the urban non-deprived primary care centre (B = 0.237, P < 0.001), male gender (B = 0.284, P < 0.001), overweight/obesity (B = 0.081, P = 0.048) and having a disability or injury limiting physical activity (B = 0.093, P = 0.028) were associated with higher sitting times.
Conclusion
This study established the factors that influence sedentary behaviours in the primary care population which can help inform the development and targeting of promotional strategies.



Influenza vaccination of adults with and without high-risk health conditions in China

2016-05-08

Abstract
Background
The World Health Organization recommends the elderly and persons with certain chronic diseases to receive an annual influenza vaccine and to be prioritized for immunization against pandemic influenza, because they are at greater risk for health complications. This paper aims to compare influenza vaccination coverage between adults in China with and without high-risk health conditions.
Methods
Data were from the cross-sectional China General Social Survey, 2010. Adults were interviewed about their health, including whether they had been vaccinated against either seasonal or pandemic influenza within the past year. A multivariable logistic regression model estimated the adjusted odds of any influenza vaccination in high-risk groups compared with low-risk groups.
Results
Only 10.5% (372/3592) of Chinese adults were vaccinated against influenza. In a multivariable regression model, there was no significant difference in influenza vaccine uptake between those with and without high-risk health conditions. However, healthcare attitudes and behaviours were significantly associated with vaccine uptake.
Conclusions
Influenza vaccination coverage is extremely low in Chinese adults who are elderly and have chronic diseases. These two groups are at greatest risk for influenza-related morbidity and mortality and should be targets of programmes to increase positive attitudes towards vaccination and decrease barriers to uptake.



Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey

2016-04-26

Abstract
Background
Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men.
Methods
Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London).
Results
Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partner and living in London were protective of mental health.
Conclusion
Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes.






Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA

2016-04-15

Abstract
Background
Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks.
Methods
In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between people's awareness to prior pandemics and their awareness of and knowledge about MERS.
Results
Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified.
Conclusions
Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.



Black box towards glass box: ‘Mapaloguing’ a typology of public health CPD activities in UK in 2011/12

2016-04-15

Abstract
Background
The 1996 Faculty of Public Health study of specialists continuing professional development (CPD) diaries indicated forward-looking approaches. There has been little substantive research on public health CPD records since.
Methods
Mixed methods research assessed 795 CPD records/reflective notes from 2011/12. The quantitative methods aimed to analyse types of new learning; a qualitative sub-sample analysis of reflective standards will be reported elsewhere. Many current CPD categories were non-specific and situational, including conferences/workshops and learning as part of the job. These were later classified to a new CPD typology of 13 learning-orientated categories with sub-types.
Results
Most (572 = 71.9%) activities fell into current FPH CPD categories that did not identify the learning topic. The new categorization identified four most common CPD learning types: about health protection topics, key specialist knowledge/skills, experiences handling new public health systems and educator/trainer requirements.
Conclusions
This new typology illustrates wide-ranging CPD activities, including work-based opportunities from shifts in organizations and policies. A CPD ‘Mapalogue’ is proposed, with ‘Mapaloguing’ as an analytical research process, combining mapping of influences and direction of CPD alongside cataloguing actual CPD undertaken. This could inform individual professionals' choice menu for CPD and personal development and increase the profession's transparency and understanding of long-term trends.



Physical health inequalities among gay and bisexual men in England: a large community-based cross-sectional survey

2016-04-13

Abstract
Background
Gay and bisexual men experience a disproportionate burden of ill health compared with the general male population. However, little is known regarding health inequalities that exist within this group. We describe five key physical health indicators and their variation across common axes of inequality.
Methods
Community-based opportunistic sampling recruited 5799 gay and bisexual men to a self-completion Internet survey. Respondents provided data relating to their height, weight, physical activity and substance use (tobacco, alcohol, illicit drugs). Responses were compared across seven demographic characteristics.
Results
Indicators of problematic health behaviour were concentrated within different groups and inequalities were rarely observed in the same direction. Older men were more likely to be overweight and drink alcohol frequently but less likely to smoke or use illicit drugs. Men of Asian ethnicity were more likely to exercise infrequently but less likely to smoke. Men living in London were more likely to smoke and use illicit drugs but less likely to be overweight. However, lower education was associated with being overweight, frequent alcohol, low exercise and smoking.
Conclusion
There is evidence of significant demographic variation in physical health-related behaviours among gay and bisexual men, and men with lower levels of education are consistently in greater need.



Association between built environment and moderate to vigorous physical activity in Korean adults: a multilevel analysis

2016-03-29

Abstract
Background
Research on the association between the built environment and moderate and vigorous physical activities (MVPA) is still evolving. Therefore, more evidence is needed. This study examines the relationship between built environment and MVPA in Korean adults.
Methods
A large sample of 204 324 adults from the 2012 Korean Community Health Survey (KCHS) was analyzed. MVPA was assessed by the International Physical Activity Questionnaire. Individual correlates from the KCHS and community built environment data from the Korean government were collected. A multilevel logistic regression was performed using the GLIMMIX procedure.
Results
Residents in cities (OR = 0.75, 95% CI 0.60–0.93) and districts (OR = 0.70, 95% CI 0.52–0.94) were less likely to engage in MVPA than residents in counties. While residents in communities with the least amount of physical equipment were less likely to participate in MVPA (OR = 0.72, 95% CI 0.57–0.90), residents in communities with the second smallest area of open space for PA were more likely to be active (OR = 1.37, 95% CI 1.07–1.77). The effect of built environment on MVPA was significant but relatively weak in comparison to the influence of individual correlates.
Conclusions
To improve MVPA in adults, a community built environment should be considered along with individual correlates.



The portrayal of infant feeding in British women's magazines: a qualitative and quantitative content analysis

2016-03-21

Abstract
Background
Exclusive breastfeeding is the best start an infant can receive. However, in many high-income countries breastfeeding rates are low and this may be a reflection of social norms which in turn may be influenced by the media. This study therefore explored the portrayal of infant feeding in women's general interest magazines.
Methods
The five top selling women's weekly magazines in Britain and Ireland for 2013 over a 4-month period were included. A quantitative and qualitative content analysis was conducted for both written and visual content.
Results
In 58 magazines, there were 90 references to infant feeding with an average of 1.5 (range: 0–5) per magazine. Breastfeeding and formula feeding references were present in equal number and both were predominantly portrayed positively. There was only 1 visual representation of breast feeding compared with 11 of bottle feeding. Potential drivers for breastfeeding included its role in post-pregnancy weight loss and celebrity endorsement while family routine, the role of males in the house and concerns about adverse health effects were identified as barriers to breastfeeding.
Conclusion
An improvement in visual representations of breast feeding and factual information in women's weekly magazines may be helpful in re-defining social norms regarding infant feeding.Keywords: food and nutrition, health promotion, public health



Syndromic surveillance for influenza in Tianjin, China: 2013–14

2016-03-10

Abstract
Background
Diverse sources of syndromic surveillance including over-the-counter (OTC) drug sales, hospital and school-based influenza-like illness (ILI) and Baidu search queries estimate influenza activity in Tianjin, China. The purpose of this study was to determine which syndromic surveillance systems had the strongest correlation with laboratory-confirmed influenza activity.
Methods
Data were obtained from sentinel hospitals and laboratories; sentinel hospitals also reported percentage of ILI. OTC sales and school-based ILI absentee data were provided by public pharmacies and schools. Baidu search queries for influenza surveillance were analyzed. Spearman correlation analysis examined correlations of syndromic systems with laboratory-confirmed data.
Results
Syndromic data for hospital ILI%, OTC sales and school-based ILI correlated well with laboratory data (r = 0.732, 0.490 and 0.693, respectively; P < 0.05). Baidu, the predominant Chinese Internet service, searches for ‘influenza’, ‘cough’ and ‘fever’ correlated best with laboratory-confirmed activity; queries for ‘fever’ were strongest (r = 0.924, P < 0.001). Correlations between school-based ILI and laboratory-confirmed influenza increased from 0.693 to 0.795 after a 1-week lag (P < 0.05).
Conclusions
A Baidu query of ‘fever’ provided the strongest correlation to laboratory surveillance. School-based ILI absence reporting detected influenza virus activity 1 week earlier than laboratory confirmation. Use of diverse syndromic surveillance systems in conjunction with traditional surveillance systems can improve influenza surveillance.