General Practitioners' views on the provision of nicotine replacement therapy and bupropion.

BACKGROUND: Nicotine replacement therapies (NRT) and a new drug, bupropion, are licensed in several countries as aids to smoking cessation. General practitioners (GPs) play a crucial role in recommending or prescribing these medications. In the UK there has been discussion about whether the medications should be reimbursable by the National Health Service (NHS). This study assessed English GPs' attitudes towards reimbursement of NRT and bupropion. METHODS: Postal survey of a randomly selected national sample of GPs; 376 GPs completed the questionnaire after one reminder; effective response rate: 53%. There was no difference between the responses of GPs who responded to the initial request and those who responded only after a reminder suggesting minimal bias due to non-response. RESULTS: Attitudes of GPs were remarkably divided on most issues relating to the medications. Forty-three percent thought that bupropion should not be on NHS prescription while 42% thought that it should be (15% did not know); Fifty percent thought that NRT should not be on NHS prescription while 42% thought it should be (8% did not know). Requiring that smokers attend behavioural support programmes to be eligible to receive the medications on NHS prescription made no appreciable difference to the GPs' views. GPs were similarly divided on whether having the medications reimbursable would add unacceptably to their workload or offer a welcome opportunity to discuss smoking with their patients. A principal components analysis of responses to the individual questions on NRT and bupropion revealed that GPs' attitudes could be understood in terms of a single 'pro-con' dimension accounting for 53% of the total variance which made no distinction between the two medications. CONCLUSIONS: GPs in England appear to be divided in their attitudes to medications to aid smoking cessation and appear not to discriminate in their views between different types of medication or different aspects of their use. This suggests that their attitudes are generated by quite fundamental values. Addressing these values may be important in encouraging GPs to adhere more closely to national and international guidelines

Watch out for the Aunties! Young British Asians' accounts of identity and substance use

This paper considers how young people able to trace their origins from Pakistan or India (henceforth 'Asians'), discuss their use of, or abstention from, alcohol and tobacco in terms of religious and cultural tradition. The role of religion, ethnicity, gender and generation in the uptake or avoidance of alcohol and tobacco was explored in 19 qualitative group and individual interviews with 47 Asians aged 16–26 years and analysed in terms of pioneering and conservative forms of tradition. Religious proscriptions on alcohol and tobacco were reported to be formally gender blind, but concerns about reputation and future marriage chances, sanctioned by gossip, meant that women's behaviour was consistently more constrained than men's. Muslims' abstinence from alcohol was tightly linked with an Islamic identity in that drinking jeopardised one's claim to being a Muslim, whereas cigarette smoking was tolerated among young men. Sikhs' and Hindus' avoidance of tobacco was strongly sanctioned, but smoking did not strongly jeopardise a religious identity. Sikh men's abstention indicated manly strength central to a devout identity. Some experimentation was possible out of view of the older generation, especially the aunties, but the risk of gossip damaging young women's reputations was keenly felt. While damage to women's reputations was hard to undo, men's reputations tarnished by substance use, could be compensated for by their parents' honourable status. Discussion of tradition as innovation was rare and met with resistance. Tradition was largely experienced as a constraint to be circumvented

A study of HIV/AIDS education within the secondary schools of a Local Education Authority, 1990–1993

This study, partly commissioned by Leicestershire Local Education Authority, provides a detailed account of HIV/AIDS education in Leicestershire secondary schools in 1990. Information and views about HIV/AIDS education were collected by means of questionnaires to all head teachers and all teachers in charge of teaching HIV/AIDS education. The purpose was to inform future strategies adopted by the LEA and the Leicestershire Health Authority to support the development of HIV/AIDS education. [Continues.]</p

Performance indicators and health promition targets

This paper discusses the usefulness of performance indicators in health promotion. Health promotion and target-setting in health have both risen to the fore in the light of the Health of the Nation White Paper. This coupled with increasing pressure on all sectors of health care to demonstrate their “value-for-money” have meant that health promotion activities are being scrutinised as never before. Performance indicators have been one suggested means of ensuring movement towards Health of the Nation targets and value-for-money in health promotion. The paper outlines the uses to which performance indicators have been put elsewhere in the NHS and argues that they are unlikely to be directly transferrable to health promotion. Criteria for successful performance indicators in health promotion are outlined. However, it is doubtful whether these criteria will be fulfilled to any useful extent at present. The theory of health promotion is characterised by many different views of what is an appropriate outcome measure of any health promotion intervention and therefore what will be an appropriate performance indicator. Consensus in theory is needed before any consensus on what is most suitable to measure is reached. In addition, any outcomes from health promotion, by its very nature, are likely to become apparent only over long periods of time, if at all. This reduces the likelihood of attribution and the feasibility of assigning responsibility for meeting targets. Nonetheless, there is some scope for performance indicators in health promotion and their use as an internal management tool and as mechanisms for reaching external micro and macro level health-related targets is discussed. A collection of suggested macro performance indicators from the Health Education Authority are evaluated according to the criteria developed earlier. It is argued that at present these do not qualify as performance indicators, although they are certainly useful as monitoring tools. The paper concludes with priorities for further research in this area. Despite the emphasis on target-setting brought about by the Health of the Nation, knowledge and expertise in performance indicators for health promotion is lacking. This is a matter of urgent concern. There are many complex conceptual and practical problems which will influence the future role and choice of performance indicators in health promotion. These range from the fundamental, differing views about the definition of health education and health promotion, to the practical, a lack of knowledge at the community level about how to start looking for indicators, and the technical, a lack of clear responsibility for meeting macro-level targets.performance indicators, targets

Mortgaging the American Dream: The Misplaced Role of Accreditation in the Federal Student Loan System

In 2013, outstanding student loan balances in the United States exceeded $994 billion. This growing volume of student debt has had far–reaching consequences for both individual borrowers and society as a whole. In many ways, the federal student loan program, available to students under the Higher Education Act (HEA), has achieved its goal of making higher education more accessible. Undergraduate college enrollment increased from 10.5 million students in 1980 to 17.6 million students in 2009. Despite the benefit of increased enrollment, however, the federal loan program has been criticized for increasing student loan debt and contributing to the “student loan crisis.” This student loan crisis threatens to undermine the purpose of the HEA by making higher education less accessible to Americans. Higher education institutions must be accredited to be eligible for Title IV federal funding under the HEA. The federal government relies on accreditation to assess the academic quality of the institutions and programs to which it provides federal funding. This federal funding–accreditation relationship, riddled with conflicts of interest, has been ineffective in regulating student loans, contributing to the mounting student loan debt. This Note examines the relationship between the federal student loan system and accrediting bodies through economic theory, ultimately arguing that the HEA be amended to decouple accreditation and federal student loans

Subprime Education: For-Profit Colleges and the Problem with Title IV Federal Student Aid

Federal student-aid policy is designed with the goal of expanding access to higher education for all students. It has been enormously successful in achieving that goal. Yet, for many students, federal student aid has served only to burden them with oppressive student-debt obligations. These obligations are a particular problem with respect to the for-profit higher-education sector, which receives a large and ever-growing proportion of federal aid. This Note examines the interaction between federal student-aid policy and for-profit institutions, arguing that the noble goals of modern federal student-aid policy enable the very practices that lead to negative outcomes for many students by creating a lucrative market for subprime education. This Note analyzes a continuum of approaches to reducing the negative student outcomes caused by many for-profit institutions, concluding that the blame lies not with for-profit institutions but with federal student-aid policy. Ultimately, the modern federal student-aid regime requires regulators to choose between abetting negative student outcomes and reducing access to higher education. This dilemma can be avoided only by deemphasizing the student-oriented aid model in favor of an institution-centered model that is focused on reducing the price of education

Access to healthy foods: Part I. Barriers to accessing healthy foods: Differentials by gender, social class, income and mode of transport

This paper examines the issues of access to food and the influences people face when shopping for a healthy food basket. It uses data from the Health Edu cation Authority's 1993 Health and Lifestyles Survey to examine the barriers people face in accessing a healthy diet. The main findings are that access to food is primarily determined by income, and this is in turn closely related to physical resources available to access healthy food. There is an associated class bias over access to sources of healthy food. The poor have less access to a car, find it harder to get to out-of-town shopping centres and thus are less able to carry and transport food in bulk. The majority of people shop in supermarkets as they report that local shops do not provide the services people demand and that food choice and quality are limited. In tackling food poverty and pro moting healthy eating, health promotion practice needs to address these struc tural issues as opposed to relying on psycho-social models of education based on the provision of information and choice

Institutional Mergers in Ireland

The importance of knowledge as a driver of social and economic growth and prosperity, and the increasingly competitive “global race for knowledge and talent” (Hazelkorn, Higher Educ Manage Policy 21(1):55–76, 2009) have combined to transform the higher education landscape, forcing national governments and higher education institutions (HEIs) to pursue new ways of addressing the challenges of a multi-polar world order. Rising demand for higher education (HE), as part of the broader shift from elite to mass to universal participation, has led to the emergence of new models of provision. At the same time, many governments face restrictions on public resources due to high levels of public and private debt; accordingly, system-level and institutional restructuring has been contemplated as a way to enhance quality, performance and efficiency

Goodbye to Projects? - Review of development interventions and livelihoods approaches in Uganda

Approaches to projects and development have undergone considerable change in the last decade with significant policy shifts on governance, gender, poverty eradication, and environmental issues. Most recently this has led to the adoption and promotion of the sustainable livelihood (SL) approach. The adoption of the SL approach presents challenges to development interventions including: the future of projects and programmes, and sector wide approaches (SWAPs) and direct budgetary support. This paper `Review of development interventions and livelihood approaches in Uganda¿ is the fourth in the series of the project working papers. This is the output of a literature review and series of interviews on development interventions in Uganda.Department for International Developmen