An Online Survey of the Dietary Practices of Saudi Students in the UK: A Quantitative Study

There has been an abundance of research on the dietary practices of international university students in the United Kingdom (UK), as they comprise a significant proportion of the country’s undergraduate population. However, there is a paucity in the literature with regard to the dietary practices, or other health behaviours, of Saudi students studying in the UK. Therefore, this empirical study sought to provide new insights to address this gap. This study contribution to investigate the dietary practices of Saudi students in the UK. The data was collected from a sample of 212 university students and encompassed an age range from 18 to 31+ years. A quantitative methodology was adopted in the form of an exploratory survey questionnaire. The sample was recruited through voluntary and snowball sampling techniques. Questionnaire data was analysed using Microsoft Excel and SPSS for Windows, version 26. The results demonstrated that various intrapersonal, interpersonal, and environmental factors play a significant role in developing eating behaviours and dietary choices. Some favourable changes in dietary practices were observed among Saudi students in the UK as opposed to Saudi Arabia, including a higher intake of fruit and vegetables, along with a lower intake of soft drinks, sugary and fatty foods. However, there was a notable reduction in consumption of all types of meat and fish as well as the total number of daily meals. Additionally, around a third of participants regularly consumed ready-to-eat food and takeaways 2-6 times a week. Interventions should therefore consider individual, societal and environmental factors

An evidence-based socioecological framework to understand men’s use of anabolic androgenic steroids and inform interventions in this area

Research into men’s use of anabolic androgenic steroids (AAS) over the past three decades has identified many factors that contribute to decision making in this area. However there are limited theoretical frameworks to synthesize this research and guide practice, such as interventions to prevent use or reduce health risks. To address this gap a socioecological framework is presented based upon the international literature examining AAS use. Socioecological models recognize that individuals and behaviors exist within complex physical and social systems and are useful tools for guiding interventions to ensure consideration is given to multiple influential factors. This framework proposes that use of AAS is the result of the interaction of a range of factors at the individual, social network, institutional, community and societal levels that are likely to change over time and with experience. Viewed through this framework it becomes clear that AAS use can be a complex behavior with many influential environments and relationships impacting on a diverse population in different ways and at different times. The implications of findings for engaging with people who use AAS and delivering interventions are discussed, such as the identification of important transition times and influencing norms within social groups and communities

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.

We examined intervention effectiveness of strategies to prevent image- and performance-enhancing drug use. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow-up times. However, studies with components in addition to information provision may be more promising. Interventions outside of sport settings are required to reflect the transition of this form of substance use to the general population

Looking beyond the provision of injecting equipment to people who use anabolic androgenic steroids: Harm reduction and behaviour change goals for UK policy.

Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioural outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the need for a range of interventions to reduce harm and risk in those that choose to use AAS, to prevent initiation, to motivate and support cessation, and to prevent relapse. Study findings indicate that while providing sterile injecting equipment remains essential, it should be considered a bare minimum. The challenge is to develop and deliver a range of harm reduction interventions that look beyond BBV prevention to provide appropriate support to who choose to use AAS at all points in their cycles of use and ultimately for those choosing the temporary or permanent cessation of use

Looking beyond the provision of injecting equipment to people who use anabolic androgenic steroids: harm reduction and behavior change goals for UK policy.

Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the need for a range of interventions to reduce harm and risk in those that choose to use AAS, to prevent initiation, to motivate and support cessation, and to prevent relapse. Study findings indicate that while providing sterile injecting equipment remains essential, it should be considered a bare minimum. The challenge is to develop and deliver a range of harm reduction interventions that look beyond BBV prevention to provide appropriate support to who choose to use AAS at all points in their cycles of use and ultimately for those choosing the temporary or permanent cessation of use

Welcome

Welcome to the second issue of the Public Health Institute Journal (PHIJ). In this edition we present the abstracts of dissertation projects undertaken by our MSc Public Health, International Public Health, Public Health Addictions and Public Health Nutrition students. They are to be commended for producing high calibre, innovative and thought provoking work - all done during the COVID-19 pandemic. National restrictions, to stem the spread of the coronavirus, necessitated changes to how research was conducted. It also sparked interest in new topics and for some, mastery of online methods of data collection. Not surprisingly many students investigated the impact of COVID-19, covering mental health and well-being in the student population, physical activity levels among  BAME students, eating behaviour and take away food consumption and the use of a weight management app during lockdown. Vaccination uptake amongst university students was also examined, as were social distancing and testing decisions, and adverse COVID outcomes for BAME groups. Whilst COVID-19 based research projects predominated, more traditional public health issues were not neglected and there is some excellent research around risky health behaviours, including substance misuse projects on SPICE amongst the homeless, skin infections and injuries among men who inject image-and performance enhancing drugs, the impact of national changes in public health policy on local drug treatment service delivery, and a review of the UK’s 12 Step Groups for those seeking recovery from substance dependency. Childhood obesity, stigma and veganism, menstrual hygiene in the British army, parental experiences of free school meals, electronic cigarette use in pregnancy and the attitudes of gay men to physical activity are just a few of the other timely public health topics that were tackled this year.   The impact of Euro 2020 on domestic violence was examined through the print media and a gender-based violence and bystander intervention programme was evaluated. Prevention was the focus of several reviews, including infection prevention in the ambulance sector and preventing adolescent pregnancy in low and middle income countries. Social media continues to generate interest; there were projects on the influence of Instagram on perceived body image and weight management and the online sports betting behaviours of UK men.  Sub-Saharan Africa (SSA) was the context for a cluster of reviews that looked at maternal mortality, CVD risk prevention in HIV patients, climate change and childhood diarrhoea. Tuberculosis in different countries was systematically reviewed, as was the consumption of processed meats and chronic diseases in Middle Eastern and North African countries. These abstracts provide a rich tapestry of the many contemporary public health issues affecting the world today that our MSc students consider important and relevant. Further they demonstrate our students’ ability to apply in practice key public health concepts - prevention, protection and promotion - and a passion for and commitment to improving the public’s health.   Finally, the cover image chosen for this issue showcases one of two beautiful cathedrals in Liverpool. The Liverpool Anglican Cathedral has been home to Liverpool John Moores University graduations for many years and marks a period of celebration and achievement. Whilst graduations have been postponed recently due to COVID-19, we are pleased to see them rescheduled for early 2022 and look forward to celebrating our students' success with them, their friends and family. We congratulate our MSc students on their excellent work and wish them much success as they embark on the next stage of their careers in public health.   Lorna, Conan, Jen and Jan

Welcome

oai:openjournals.ljmu.ac.uk:article/533Welcome, we are excited to present the first issue of the Public Health Institute Journal (PHIJ) showcasing the dissertations produced by our students on the BSc Environmental Health and BSc Public Health programmes.  COVID-19 has dominated the horizon this year and our students have shown great resilience in adapting to new ways of learning and the demands of collecting their empirical data wholly online in line with university policy.  Despite these challenges, the work published here is an extremely high standard, broad in its scope, thought provoking and innovative. Not surprisingly, a number of students chose to focus on the pandemic and there are timely studies on the impact of COVID-19 on international students; on people with food allergies; on diet more generally (where it appears some of us made improvements, eating more home cooked meals and fewer processed foods than before!); on the joys and pitfalls of dog ownership during lockdown; and the difficulty of using PPE in the workplace.  There are also ‘big picture’ dissertations on how pandemics exaggerate health inequalities, polarise communities and stigmatise  groups, not only in the UK, but around the world and throughout history.  Even during a global pandemic, other problems don’t go away and this is reflected in students’ other choices, including health and safety, pollution, cannabis use, loneliness, social media, alcohol, disabilities, cosmetic procedures, food labelling, food borne illnesses, food poverty, and poor housing.  Browsing these abstracts provides a rich overview of the contemporary public and environmental health issues deemed important by our students and it reassures us that they have their eyes wide open and are informed about the challenges ahead.  Public and Environmental health has never been more of a priority and as they go on to further study and employment, we are enthused by their passion, intelligence and commitment to these issues. We are confident that these important disciplines are in safe hands and we want to congratulate the students on their excellent work and wish them the very best for the future.  Finally, a note on the cover image for this issue: when it came to finding something apt, we found it a challenge to sum up the last year in public health. But in the end we chose an image which will probably be familiar to all of our students after living and working in Liverpool. Antony Gormley’s iron men on Crosby beach stand at perfect social distance as an apt metaphor for our experiences over the last year (local people have even put facemasks on them). They have been weathered by change, but are still standing, looking out to the horizon and ready to face whatever challenge comes next. We have every confidence that our students are ready to do the same.&nbsp

Sex tourism in an era of globalisation, harm reduction and disease migration: a new conceptual model

Purpose: This paper aims to contribute to sex tourism literature by placing it into a contemporary context of globalisation, harm reduction and disease migration. Design/methodology/approach: The paper takes a public health and social science approach to map sex tourism, drawing on sex worker and tourist situations alongside global forces including technology, human rights, law enforcement and health. Findings: A new, holistic conceptual model is presented, containing interacting, multi level associations. Whilst the separate micro, contextual, meso and macro levels are versatile, decision makers and practitioners will be equipped to understand sex tourism in its entirety. Originality/value: The paper’s originality is found in the proposed conceptual model

Antenatal screening for haemoglobinopathies in primary care - a whole system participatory action research project

BACKGROUND: The usual system for antenatal screening for haemoglobinopathies permits termination only late in the second trimester of pregnancy. AIM: To evaluate a system where pregnant women are screened in general practice, and to develop a model of care pathway or whole system research able to bring into view unexpected effects of health service innovation. DESIGN OF STUDY: A whole system participatory action research approach was used. Six purposefully chosen general practices screened women who attended with a new pregnancy. Data of gestational age of screening were compared with two control groups. Qualitative data were gathered through workshops, interviews and feedback to the project steering group. At facilitated annual workshops participants from all parts of the care pathway produced a consensus about the meaning of the data as a whole. SETTING: Six general practices in north London. METHOD: A whole system participatory action research approach allowed stakeholders from throughout the care pathway to pilot the innovation and reflect on the meaning and significance of quantitative and qualitative data. RESULTS: The gestational age of screening in general practice was 4.1 weeks earlier (95% confidence interval (CI) = 3.41 to 4.68) than in hospital clinics (P<0.001), and 2.9 weeks earlier (95% CI = 2.07 to 3.65) than in community midwife clinics (P<0.001). However, only 35% of pregnant women in the study were screened in the practices. Changes required throughout the whole care pathway make wider implementation more difficult than at first realised. The cost within general practice is greater than initially appreciated owing to a perceived need to provide counselling about other issues at the same time. Practitioners considered that other ways of early screening should be explored, including preconceptual screening. The research approach was able to bring into view unexpected effects of the innovation, but health workers were unfamiliar with the participatory processes. CONCLUSION: Antenatal screening for haemoglobinopathies in general practice lowers the gestational age at which an at-risk pregnancy can be identified. However, widespread implementation of such screening may be too difficult