Inequalities in dental health: An ecological analysis of the interaction between the effects of water fluoridation and social deprivation on tooth decay in children living in England

Oral health in England has improved considerably in recent years but continues to show a strong inequalities gradient. This study was aimed at investigating variations in dental decay and elation to social deprivation and local water fluoridation. An ecological analysis using the 2007 and 2008 National Dental Epidemiology Programme survey of 5 year old children in England. Postcode of residence was mapped to census lower super output area (LSOA). LSOAs were assigned a national deprivation quintile and a fluoridation category based upon therapeutic level of 1 mg/L. Multiple logistic regression was applied to determine independent influences on tooth decay. Analysis of covariance (ANCOVA) was used to investigate interactions between fluoridation and deprivation on the mean levels of dental caries. Analysis is based on 142,030 clinical dental examinations, representing 25% of estimated population of 5 year olds in England. Overall, 31% of children had at least one decayed missing or filled tooth (dmft). Multiple logistic regression showed that children living in the most deprived areas were three times more likely to experience tooth decay than those living in affluent areas; whereas children living in fluoridated areas were 1.5 times less likely to have dmft than those living in non-fluoridated areas. Therefore, although both are independently significant, living in the most deprived quintile of social deprivation doubled the impact on the likelihood of dental decay compared to non-fluoridation. ANCOVA showed a strong gradient of increasing mean dmft with increasing social deprivation in both water-fluoridated and non-fluoridated areas, with 3 times more dental decay in more deprived areas than in more affluent areas. In all deprivation quintiles, children living in fluoridated areas have significantly (p < 0.001) lower mean dmft than those living in equivalent deprivation with no water fluoridation. Fluoridated drinking water may moderate dental caries; however, socioeconomic deprivation has a stronger influence on dental decay than local fluoridation of water

The impact of partial smokefree legislation on health inequalities: Evidence from a survey of 1150 pubs in North West England

BACKGROUND: The UK government claims that between 10 and 30% of pubs and bars will be exempt from proposed legislation to achieve smokefree enclosed public places across England. This arises from the contentious inclusion that pubs and bars that do not prepare and serve food and private members clubs, will be able to allow smoking. We aimed to survey pubs and bars across the North West of England to assess smoking policies and the proportion and variations by deprivation level of venues preparing and serving food. METHODS: We carried out a telephone survey of 1150 pubs and bars in 14 local authorities across the North West of England. The main data items were current smoking policy, food preparation and serving status, and intention to change food serving and smoking status in the event of implementation of the proposed English partial smokefree legislation. RESULTS: 29 pubs and bars (2.5%) were totally smoke-free, 500 (44%) had partial smoking restrictions, and 615 (54%) allowed smoking throughout. Venues situated in the most deprived quintiles (4 and 5) of deprivation were more likely to allow unrestricted smoking (62% vs 33% for venues in quintiles 1 and 2). The proportion of pubs and bars not preparing and serving food on the premises was 44% (95% CI 42 to 46%), and ranged from 21% in pubs and bars in deprivation quintile 1 to 63% in quintile 5. CONCLUSION: The proportion of pubs and bars which do not serve food was far higher than the 10–30% suggested by the UK government. The proportion of pubs allowing unrestricted smoking and of non-food venues was higher in more disadvantaged areas, suggesting that the proposed UK government policy of exempting pubs in England which do not serve food from smokefree legislation will exacerbate inequalities in smoking and health

Authors

We would like to thank staff at the North West Public Health Observatory for their help and support, in particular Steve Rogers and Neil Potter for the maintenance of the online tool, Dan Dedman and Karen Murphy for HES data analysis, Alyson Jones for comments on the report, and Joy Spalding for contributions to proofreading.

Predictors of risky alcohol consumption in schoolchildren and their implications for preventing alcohol-related harm

BACKGROUND: While alcohol-related health and social problems amongst youths are increasing internationally, both consumption and associated harms are particularly high in British youth. Youth drinking patterns, including bingeing, frequent drinking and drinking in public spaces, are associated with increased risks of acute (e.g. violence) and long-term (e.g. alcohol-dependence) health problems. Here we examine economic, behavioural and demographic factors that predict these risky drinking behaviours among 15-16 year old schoolchildren who consume alcohol. A cross-sectional survey was conducted among schoolchildren in North West England (n = 10,271) using an anonymous questionnaire delivered in school settings. Analysis utilised logistic regression to identify independent predictors of risky drinking behaviour. RESULTS: Of all respondents, 87.9% drank alcohol. Of drinkers, 38.0% usually binged when drinking, 24.4% were frequent drinkers and 49.8% drank in public spaces. Binge, frequent and public drinking were strongly related to expendable income and to individuals buying their own alcohol. Obtaining alcohol from friends, older siblings and adults outside shops were also predictors of risky drinking amongst drinkers. However, being bought alcohol by parents was associated with both lower bingeing and drinking in public places. Membership of youth groups/teams was in general protective despite some association with bingeing. CONCLUSION: Although previous studies have examined predictors of risky drinking, our analyses of access to alcohol and youth income have highlighted eradicating underage alcohol sales and increased understanding of children's spending as key considerations in reducing risky alcohol use. Parental provision of alcohol to children in a family environment may also be important in establishing child-parent dialogues on alcohol and moderating youth consumption. However, this will require supporting parents to ensure they develop only moderate drinking behaviours in their children and only when appropriate

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

Gold OABackground: Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject. Methods A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated. Results 43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice. Conclusions This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended

The European survey of probation staff’s knowledge of, and attitudes to, mental illness

From Crossref journal articles via Jisc Publications RouterHistory: epub 2023-03-01, issued 2023-03-01Publication status: PublishedFunder: Confederation of European ProbationThere is a high prevalence of mental health disorders on probation staffs' caseloads. Approximately 40% of all clients will have a mental health disorder often compounded by drug or alcohol problems. It is therefore important that a probation officer can recognise mental illness and refer to the appropriate local agency. It is therefore important to know how much probation staff understand about mental illness. The Mental Health Literacy Scale (MHLS) was distributed to probation staff in all countries registered as members of the Confederation of Europe. In this paper, overall average scores for the MHLS for each country are presented. Factors which help to explain the variation in scores are also examined such a caseload size and gender of staff member. The results are discussed within the context of a possible European curriculum for probation training. Probation (CEP) organisation

Can Weight Watchers (WW) Help Address Maternal Obesity? An Audit of Weight Change in Women of Childbearing Age and Mothers-To-Be, Referred into a Commercial Slimming Programme.

From PubMed via Jisc Publications RouterHistory: accepted 2021-08-07Publication status: aheadofprintThe scale of overweight and obesity amongst women of childbearing age or mothers to be, living in Wales, places a considerable burden on the NHS and public health. High BMI (over 30) during pregnancy increases the health risks for mother and baby. Policy advice recommends weight management services are available to help women lose weight before and whilst planning pregnancy. In parts of Wales, NHS partnerships with commercial companies provide weight management services for women considering or planning pregnancy. This study evaluates whether an established referral Weight Watchers (WW) programme, known to be effective in adults in England, can help mothers-to-be living in North Wales lose weight. Analysis used routine data from 82 referrals to WW between June 2013 and January 2015. Participants received a referral letter inviting them to attend face-to-face group workshops combined with a digital experience. The programme encompassed healthy eating, physical activity and positive mind-set. Trained WW staff measured bodyweight before, during and at 12 weeks. On entry to the course, participants had a median age of 31.4 years (interquartile range (IQR) 28-34) with a median BMI of 36.8 kg/m (IQR 33.3-43.7). Women completing the course (n = 34) had a median weight loss of 5.65 kg (IQR 0.45-10.85), equating to 5.7% (SD 3.46) of initial body weight. Intention-to-treat analysis (last observation carried forward), which included lapsed courses n = 66, showed a median weight loss of 3.6 kg (IQR - 2.53 to 9.73), equating to 3.7% (SD 3.62) of initial body weight. Overall, there was significant weight loss during the WW programme (Wilcoxon signed rank test Z = - 6.16; p < 0.001). Weight loss was significantly correlated with the number of workshops attended (Spearman correlation coefficient 0.61 p < 0.001). The proportion of all 82 participants (intention to treat, baseline observation carried forward) that achieved a weight loss of ≥ 5% initial weight was 30.5%. Referral of obese mothers-to-be into WW can successfully achieve short-term weight loss, at or above 5%, in approximately one third of participants. The dose-response effect supports a causal inference. Successful weight loss at this critical life stage may provide women with the necessary motivation to initiate weight loss for healthy pregnancy, however further research is required. [Abstract copyright: © 2021. The Author(s).

Contributions of alcohol use to teenage pregnancy: an initial examination of geographical and evidence based associations.

1. Key points and recommendations • From the data analyses: a. Alcohol-related hospital admissions in young people (aged 15-17 years) have been used here as a proxy measure of alcohol misuse in these age groups1, and have been compared with teenage conceptions (in females aged under 182). b. At both lower tier local authority and ward levels there is a significant positive relationship between teenage conceptions and alcohol-related hospital admissions in young people. This relationship is independent of deprivation. c. After taking deprivation3 at ward level into account, the teenage conception rate was 34 per 1000 females (aged 15-17 years) in wards with the lowest levels of alcohol-related hospital admissions, compared with 41 per 1000 females in wards with the highest levels of alcoholrelated hospital admissions. d. Local authorities that have seen increases in teenage conceptions between 2006 and 2007 have also seen disproportionate annual increases in teenage alcohol-related hospital admissions. e. While England as a whole saw a 0.8% increase in alcohol-related hospital admissions in young people, local authorities which documented increases in teenage conceptions saw a five-fold greater increase (5.2%). • From the evidence review: a. A rapid evidence review, although not a full structured systematic review, was conducted to provide an overview of some of the key studies examining associations between alcohol consumption and sexual behaviours. b. Early regular alcohol consumption is associated with early onset of sexual activity. c. Any amount of current drinking by teenagers is associated with being sexually active, especially binge drinking and drinking in greater quantities. d. Alcohol use at first sex is associated with lower levels of condom use at first intercourse. e. Beginning to drink alcohol at an early age is strongly associated with having a higher (or multiple) number of sexual partners. Those drinking more and at higher frequencies are at greater risk of having multiple partners. f. Evidence of a routine association between non-condom use and alcohol consumption is equivocal. However, there is better evidence to support higher levels of non-condom use in those who binge drink or have alcohol problems. g. In young people there is some evidence of an association between the misuse of alcohol and sex without any contraception. However, the relationship between risk and increasing levels of consumption is unclear. h. Alcohol consumption, and especially binge drinking and drinking greater quantities, is associated with an increased risk of becoming pregnant in females and getting someone pregnant in males. i. There is good evidence to suggest that alcohol consumption in young people contributes to levels of regretted sex and that increasing consumption is associated with a greater probability of having experienced regretted sex. j. There is good evidence to suggest an association between drinking in young people, especially binge drinking, and increased risk of forced sex. • Suggested further steps a. Better intelligence on the relationships between alcohol and teenage pregnancy could be developed from existing data sets. Comprehensive analyses of the relationships between alcohol-related hospital admissions and teenage conceptions should be undertaken once new data are available.4 b. Additional data sets are likely to provide a more comprehensive picture of the relationships between alcohol consumption, teenage conceptions, and also other key sexual health issues. Use of the National Drug Treatment Monitoring Data5 may improve understanding of links. For some parts of the country, accident and emergency department data relating to alcohol can also be utilised. Such analyses should examine relationships with alcohol and levels of terminations, and with sexually transmitted infections (including Chlamydia) as well as with teenage conceptions. c. We would suggest that this combination of data sets (on sexual heath and substance use such as alcohol and drugs) is used to create a model of youth (i.e. under 18 year olds) behaviour at ward, local authority and NHS/primary care trust levels across England. Unlike typical analyses on single issues this could help inform strategies for delivering holistic support for young people. d. A model using sexual health, alcohol and drugs data could also be used to examine the match of service need to service provision for young people at local levels. e. Research studies on the relationships between alcohol and sexual health issues in England are relatively few and far between. High quality research on understanding how these issues are linked in England is urgently needed. f. Adequate evidence is already available to suggest strong links between alcohol, teenage conceptions and other sexual health issues. Future developments in both alcohol and sexual health services should examine how prevention messages and initiatives can be delivered to address both issues together. g. Services dealing with sexual health or substance misuse should be encouraged to provide seamless support for young people who may present with either a sexual health or an alcohol problem, recognising they will often have problems with both