Barriers and facilitators to physical activity in second-generation British Indian women:a qualitative study

Aim To understand the barriers to and motivations for physical activity among second-generation British Indian women. Subject Approximately 50% of British South Asians are UK-born, and this group is increasing as the second-generation also have children. Previous research into the barriers to and facilitators for physical activity has focused on migrant, first-generation populations. Qualitative research is needed to understand a) how we might further reduce the gap in physical activity levels between White British women and British Indian women and b) the different approaches that may be required for different generations. Methods Applying a socioecological model to take into account the wider social and physical contexts, we conducted semi-structured interviews with 28 Indian women living in Manchester, England. Interviews with first-generation British Indian women were also included to provide a comparator. Interviews were audio-recorded, transcribed, thematically coded and analysed using a grounded theory approach. Results Ways of socialising, concerns over appearance while being physically active, safety concerns and prioritising educational attainment in adolescence were all described as barriers to physical activity in second-generation British Indian women. Facilitators for physical activity included acknowledging the importance of taking time out for oneself; religious beliefs and religious groups promoting activity; being prompted by family illness; positive messages in both the media and while at school, and having local facilities to use. Conclusions Barriers to physical activity in second-generation Indian women were very similar to those already reported for White British women. Public health measures aimed at women in the general population may also positively affect second-generation Indian women. First-generation Indian women, second-generation children and Muslim women may respond better to culturally tailored interventions

The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review

<p>Abstract</p> <p>Background</p> <p>There is considerable geographic variation in stroke mortality around the United Kingdom (UK). Whether this is due to geographical differences in incidence or case-fatality is unclear. We conducted a systematic review of high-quality studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the UK. We aimed to study geographic and temporal trends in relation to equivalent mortality trends.</p> <p>Methods</p> <p>MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted. All rates were standardised to the European Standard Population for those over 45, and between 45 and 74 years. Stroke mortality rates for the included areas were then calculated to produce rate ratios of stroke mortality to incidence for each location.</p> <p>Results</p> <p>Five papers were included in this review. Geographic variation was narrow but incidence appeared to largely mirror mortality rates for all stroke. For men over 45, incidence (and confidence intervals) per 100,000 ranged from 124 (109-141) in South London, to 185 (164-208) in Scotland. For men, premature (45-74 years) stroke incidence per 100,000 ranged from 79 (67-94) in the North West, to 112 (95-132) in Scotland. Stroke subtype data was more geographically restricted, but did suggest there is no sizeable variation in incidence by subtype around the country. Only one paper, based in South London, had data on temporal trends. This showed that there has been a decline in stroke incidence since the mid 1990 s. This could not be compared to any other locations in this review.</p> <p>Conclusions</p> <p>Geographic variations in stroke incidence appear to mirror variations in mortality rates. This suggests policies to reduce inequalities in stroke mortality should be directed at risk factor profiles rather than treatment after a first incident event. More high quality stroke incidence data from around the UK are needed before this can be confirmed.</p

Intergenerational differences in the physical activity of UK South Asians

This thesis examines intergenerational change in prevalence of and attitudes to physical activity by comparing first and second-generation South Asians in Britain. British South Asians have poorer health outcomes including a higher prevalence of cardiovascular disease (CVD) and diabetes than White British people. Physical inactivity is one of the risk factors for CVD and diabetes. Physical activity levels are lower among British South Asians than the White British population, for reasons that include cultural factors related to being South Asian, the low socioeconomic status of some South Asian groups, and living in deprived neighbourhoods. However, existing literature on physical activity levels does not clearly distinguish between first and second-generations. Understanding generational differences in the influences on physical activity among South Asians is important for developing appropriate interventions. First, I review the existing quantitative and qualitative literature on physical activity in second-generation South Asians. There is some evidence that second-generation South Asians are more physically active than the first-generation. Despite this, second-generation South Asians remain less active than White British people. Neither the quantitative nor the qualitative literature has adequately explored the reasons for these findings. I then use data from the Health Survey for England to explore the ways that adult Indians, Pakistanis and Bangladeshis are physically active. When analysed by age and sex, all South Asians and the White British group were physically active in different ways to each other. However, there was little difference between younger Indians and younger White British people in the contribution of walking to total activity. Finally, I present a qualitative analysis of how ethnicity influences physical activity in second-generation South Asians. I interviewed 28 Indian women living in Manchester, England. I found that a British schooling and messages from the media had strongly influenced second-generation Indian women's attitudes to physical activity. Consequently, their motivations and barriers to physical activity were generally very similar to those reported for White British women. Second-generation Indian women had mostly adopted Western gender roles, with Indian gender expectations having a limited impact on their physical activity. In contrast, the traditional roles of Indian women constrained the leisure-time physical activity of the first-generation Indian women. There was no generational difference in how the local neighbourhood influenced physical activity. This thesis demonstrates clear differences in physical activity prevalence and attitudes between first and second-generation South Asian women in the UK. Interventions aimed at improving local environments for physical activity are likely to help all people living in deprived areas, regardless of ethnic background. Changing generic Western social norms around femininity and being physically active may be more important than tailored interventions for second-generation Indian women.</p

Intergenerational differences in the physical activity of UK South Asians

This thesis examines intergenerational change in prevalence of and attitudes to physical activity by comparing first and second-generation South Asians in Britain. British South Asians have poorer health outcomes including a higher prevalence of cardiovascular disease (CVD) and diabetes than White British people. Physical inactivity is one of the risk factors for CVD and diabetes. Physical activity levels are lower among British South Asians than the White British population, for reasons that include cultural factors related to being South Asian, the low socioeconomic status of some South Asian groups, and living in deprived neighbourhoods. However, existing literature on physical activity levels does not clearly distinguish between first and second-generations. Understanding generational differences in the influences on physical activity among South Asians is important for developing appropriate interventions. First, I review the existing quantitative and qualitative literature on physical activity in second-generation South Asians. There is some evidence that second-generation South Asians are more physically active than the first-generation. Despite this, second-generation South Asians remain less active than White British people. Neither the quantitative nor the qualitative literature has adequately explored the reasons for these findings. I then use data from the Health Survey for England to explore the ways that adult Indians, Pakistanis and Bangladeshis are physically active. When analysed by age and sex, all South Asians and the White British group were physically active in different ways to each other. However, there was little difference between younger Indians and younger White British people in the contribution of walking to total activity. Finally, I present a qualitative analysis of how ethnicity influences physical activity in second-generation South Asians. I interviewed 28 Indian women living in Manchester, England. I found that a British schooling and messages from the media had strongly influenced second-generation Indian women's attitudes to physical activity. Consequently, their motivations and barriers to physical activity were generally very similar to those reported for White British women. Second-generation Indian women had mostly adopted Western gender roles, with Indian gender expectations having a limited impact on their physical activity. In contrast, the traditional roles of Indian women constrained the leisure-time physical activity of the first-generation Indian women. There was no generational difference in how the local neighbourhood influenced physical activity. This thesis demonstrates clear differences in physical activity prevalence and attitudes between first and second-generation South Asian women in the UK. Interventions aimed at improving local environments for physical activity are likely to help all people living in deprived areas, regardless of ethnic background. Changing generic Western social norms around femininity and being physically active may be more important than tailored interventions for second-generation Indian women.This thesis is not currently available on ORA

Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983–2013: joinpoint regression analysis

Abstract Background We aimed to study the time trends underlying a change from cardiovascular disease (CVD) to cancer as the most common cause of age-standardized mortality in the UK between 1983 and 2013. Methods A retrospective trend analysis of the World Health Organization mortality database for mortality from all cancers, all CVDs, and their three most common types, by sex and age. Age-standardized mortality rates were adjusted to the 2013 European Standard Population and analyzed using joinpoint regression analysis for annual percent changes. Results The difference in mortality rate between total CVD and cancer narrowed over the study period as age-standardized mortality from CVD decreased more steeply than cancer in both sexes. We observed higher overall rates for both diseases in men compared to women, with high mortality rates from ischemic heart disease and lung cancer in men. Joinpoint regression analysis indicated that trends of decreasing rates of CVD have increased over time while decreasing trends in cancer mortality rates have slowed down since the 1990s. The lowest improvements in mortality rates were for cancer in those over 75 years of age and lung cancer in women. Conclusions In 2011, the age-standardized mortality rate for cancer exceeded that of CVD in both sexes in the UK. These changing trends in mortality may support evidence for changes in policy and resource allocation in the UK

The physical activity profiles of South Asian ethnic groups in England.

BACKGROUND: To identify what types of activity contribute to overall physical activity in South Asian ethnic groups and how these vary according to sex and age. We used the White British ethnic group as a comparison. METHODS: Self-reported physical activity was measured in the Health Survey for England 1999 and 2004, a nationally representative, cross-sectional survey that boosted ethnic minority samples in these years. We merged the two survey years and analysed data from 19 476 adults. The proportions of total physical activity achieved through walking, housework, sports and DIY activity were calculated. We stratified by sex and age group and used analysis of variances to examine differences between ethnic groups, adjusted for the socioeconomic status. RESULTS: There was a significant difference between ethnic groups for the contributions of all physical activity domains for those aged below 55 years, with the exception of walking. In women aged 16–34 years, there was no significant difference in the contribution of walking to total physical activity (p=0.38). In the 35–54 age group, Bangladeshi males have the highest proportion of total activity from walking (30%). In those aged over 55 years, the proportion of activity from sports was the lowest in all South Asian ethnic groups for both sexes. CONCLUSIONS: UK South Asians are more active in some ways that differ, by age and sex, from White British, but are similarly active in other ways. These results can be used to develop targeted population level interventions for increasing physical activity levels in adult UK South Asian populations

The epidemiology of cardiovascular disease in the UK 2014

Cardiovascular disease (CVD) presents a significant burden to the UK. This review presents data from nationally representative datasets to provide up-to-date statistics on mortality, prevalence, treatment and costs. Data focus on CVD as a whole, coronary heart disease (International Classification of Diseases (ICD):I20–25) and cerebrovascular disease (ICD:I60–69); however, where available, other cardiovascular conditions are also presented. In 2012, CVD was the most common cause of death in the UK for women (28% of all female deaths), but not for men, where cancer is now the most common cause of death (32% of all male deaths). Mortality from CVD varies widely throughout the UK, with the highest age-standardised CVD death rates in Scotland (347/100 000) and the North of England (320/100 000 in the North West). Prevalence of coronary heart disease is also highest in the North of England (4.5% in the North East) and Scotland (4.3%). Overall, around three times as many men have had a myocardial infarction compared with women. Treatment for CVD is increasing over time, with prescriptions and operations for CVD having substantially increased over the last two decades. The National Health Service in England spent around £6.8 billion on CVD in 2012/2013, the majority of which came from spending on secondary care. Despite significant declines in mortality in the UK, CVD remains a considerable burden, both in terms of health and costs. Both primary and secondary prevention measures are necessary to reduce both the burden of CVD and inequalities in CVD mortality and prevalence