Symptom awareness and cancer prevention: Exploratory findings from an at-risk population

Purpose: Secondary prevention programmes have traditionally employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies involving public education and self-referral may prove more cost-effective with low risk populations for cancers with symptomatic presentation. This study, which was commissioned to inform the development of a cancer awareness campaign, examines public perceptions of the early detection of cancer, the psycho-social barriers to self-referral amongst a key at-risk population and the implications for patient education. Methodology: An exploratory study using qualitative focus groups with an at-risk population of older people living in deprived communities in west-central Scotland. Findings: The findings reveal broad support for initiatives designed to raise symptom awareness. However fear of cancer can lead to apparently irrational responses to symptoms and subsequent delay , particularly amongst men who are less likely to seek support from lay networks. Implications: Early detection messages need to take account tone and symptom description to allay fears and ensure appropriate presentation. Consideration also needs to be given to the role played by lay and professional opinion formers to informing and supporting patients decision to present with suspicious symptoms, particularly when targeting harder to reach patients of men, older people, and people living in deprived communities

Making hospital shops healthier:evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Background The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. Methods The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n=17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines, and) (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n=32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. Results All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS’s impact, managers identified some opportunities in the scheme and positive changes in the supply chain. Conclusions Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings

"What are you meant to do when you see it everywhere?": Young people, alcohol packaging and digital media

The consumption of alcohol plays an important part in the way in which people create identities and live their social lives. Alcohol brands become embedded in everyday life through marketing practices, and this is amplified by an increase in new technologies that facilitate the transference of marketing messages. This research explores how alcohol brands use social networking sites (SNS) and packaging as part of their repertoire of marketing activities, and how users respond to these activities

"I Wouldn't Be Friends with Someone If They Were Liking Too Much Rubbish": A Qualitative Study of Alcohol Brands, Youth Identity and Social Media

The consumption of alcohol by young people remains a major public health concern at both the national and international level. Levels of drinking among 15‐year olds in the United Kingdom (UK) remain significantly higher than the European average. This study explored how alcohol brands are used by young people to develop their desired identities and how these acts of consumption extend to young people's profiles on social media. It also deepens understanding of how alcohol brands are connected to young peoples' concerns about image and peer group dynamics. This involved qualitative focus groups with young people aged 14-7 in Central Scotland. Certain alcohol brands were approved and viewed as socially acceptable by young people, while others were rejected. Children as young as 14 were selecting products to portray a drinking identity that was appropriately aligned to their gender and sexuality. Participants displayed a desire to associate themselves with the mature drinking culture personified by some brands, whilst simultaneously distancing themselves from immature drinking practices associated with others. Publicly associating with alcohol brands on social media carried with it potential risks to peer group acceptance. Understanding how young people perceive alcohol brands, the importance of social media in communicating that identity to their peers and the role that alcohol brands play in adolescent identity formation is an important first step to reforming alcohol marketing regulations

Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom

Aims To explore how the concept of lay epidemiology can enhance understandings of how drinkers make sense of current UK drinking guidelines. Methods Qualitative study using 12 focus groups in four sites in northern England and four sites in central Scotland. Participants were 66 male and female drinkers, aged between 19 and 65 years, of different socio-economic backgrounds. Data were analysed thematically using a conceptual framework of lay epidemiology. Results Current drinking guidelines were perceived as having little relevance to participants' drinking behaviours and were generally disregarded. Daily guidelines were seen as irrelevant by drinkers whose drinking patterns comprised heavy weekend drinking. The amounts given in the guidelines were seen as unrealistic for those motivated to drink for intoxication, and participants measured alcohol intake in numbers of drinks or containers rather than units. Participants reported moderating their drinking, but this was out of a desire to fulfil work and family responsibilities, rather than concerns for their own health. The current Australian and Canadian guidelines were preferred to UK guidelines, as they were seen to address many of the above problems. Conclusions Drinking guidelines derived from, and framed within, solely epidemiological paradigms lack relevance for adult drinkers who monitor and moderate their alcohol intake according to their own knowledge and risk perceptions derived primarily from experience. Insights from lay epidemiology into how drinkers regulate and monitor their drinking should be used in the construction of drinking guidelines to enhance their credibility and efficacy

Rapid literature review of smoking cessation and tobacco control issues across criminal justice system settings

This review was undertaken to inform the development of the Regional Criminal Justice Coordinator role in the North West Region. It was conducted by the Institute for Social Marketing at the University of Stirling and involved a rapid review of literature on smoking cessation and tobacco control issues across criminal justice system (CJS) settings, namely prisons, probation services, police and courts

Selling second best: how infant formula marketing works

Background: Despite the clear policy intent to contain it, the marketing of formula milk remains widespread, powerful and successful. This paper examines how it works. Methods: The study comprised a mix of secondary analysis of business databases and qualitative interviews with marketing practitioners, some of whom had previously worked in formula marketing. Results: The World Health Assembly Code aims to shield parents from unfair commercial pressures by stopping the inappropriate promotion of infant formula. In reality marketing remains widespread because some countries (e.g. the USA) have not adopted the Code, and elsewhere industry has developed follow-on and specialist milks with which they promote formula by proxy. The World Health Assembly has tried to close these loopholes by extending its Code to these products; but the marketing continues. The campaigns use emotional appeals to reach out to and build relationships with parents and especially mothers. Evocative brands give these approaches a human face. The advent of social media has made it easier to pose as the friend and supporter of parents; it is also providing companies with a rich stream of personal data with which they hone and target their campaigns. The formula industry is dominated by a small number of extremely powerful multinational corporations with the resources to buy the best global marketing expertise. Like all corporations they are governed by the fiduciary imperative which puts the pursuit of profits ahead of all other concerns. This mix of fiscal power, sophisticated marketing, and single-mindedness is causing great harm to public health. Conclusions: Formula marketing is widespread and using powerful emotional techniques to sell parents a product that is vastly inferior to breast milk. There is an urgent need to update and strengthen regulation

Learning from the implementation of Universal Free School Meals in Scotland using Normalisation Process Theory:Lessons for policymakers to engage multiple stakeholders

In 2014/15, Universal Free School Meals (UFSM) were introduced in Scotland and England for children in their first three years of primary school. This study examined the implementation of UFSM in Scotland using Noramlisation Process Theory (NPT), a middle-range theory of implementation, to identify areas of learning for policymakers wishing to introduce or extend similar policies. NPT is predominantly used to evaluate interventions or new technologies in healthcare settings. Qualitative data were collected across Scotland using a case study approach shortly after implementation (n = 29 school-level stakeholders) and in the following school year (n = 18 school-level stakeholders and n = 19 local authority-level stakeholders). Observations of lunchtime in each school were conducted at both timepoints. Data were analysed using a thematic framework approach using NPT constructs and sub-constructs. Results suggested education and catering stakeholders experiences of implementation diverged most around the NPT concepts of coherence, cognitive participation, and reflexive monitoring. Lack of coherence around the purpose and long-term benefits of UFSM appeared to reduce education stakeholders’ willingness to engage with the policy beyond operational issues. In contrast, catering stakeholders identified a direct benefit to their everyday work and described receiving additional resources to deliver the policy. Overall, participants described an absence of monitoring data around the areas of greatest salience for education stakeholders. This study successfully used NPT to identify policy learning around school meals. Policymakers must increase the salience of such intersectoral policies for all relevant stakeholders involved before policy implementation, and plan adequate monitoring to evaluate potential long-term benefits

The Response of Retailers in Scotland to the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive

Introduction With most marketing channels prohibited, the retail environment has assumed greater importance for tobacco companies, even in markets with a ban on the open display of tobacco products. Research has yet to qualitatively explore how retailers respond to standardized packaging in a country where this has been introduced. Methods As part of the DISPLAY study, face-to-face interviews were conducted with 24 small retailers in Scotland between May 23 and June 26, 2017; the interviews were conducted after The Standardised Packaging of Tobacco Products Regulations and the Tobacco Products Directive were fully implemented. Results We found high retailer compliance with the legislation. With price-marked packs and packs containing less than 20 cigarettes and 30 g of rolling tobacco banned, retailers stated that this helped simplify ordering and stock management. The removal of price-marked packs also allowed them some flexibility to set their own prices, but many chose to stick closely to recommended retail price in order to remain competitive and avoid complaints from customers. In contrast to one of the tobacco industry’s arguments against standardized packaging, most retailers suggested that transaction times had not increased, even though the changes had only recently come into force. Conclusions This study challenges some of the arguments used against standardized packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs. Implications This study explores the response of the retailers to the introduction of standardized tobacco packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs. It explores the importance of the retailer in tobacco companies’ desire to maintain tobacco sales and challenges some of the arguments used against standardized packaging, such as an increase in transaction times. Countries seeking to introduce standardized packaging should monitor the experiences of retailers, preferably from preimplementation through to post implementation, to help understand how retailers respond to this policy and to inform compliance

Evaluated interventions to reduce alcohol-related harm among young people

First paragraph: The European Alcohol and Health Forum (EAHF) Task Force on youth-specific aspects of alcohol recommended the development of a database resource that could be used to share information on good practice projects intended to reduce alcohol-related harms among young people. The working title for the initiative during the preparation of this report is the Resource on Alcohol and Youth Projects (RAYPRO)