Internationalization of teaching and learning in public health

Due to the increased interconnectedness in the world, healthcare workers and policy makers now widely recognize that health transcends national boundaries, with global political and economic impact. Unfortunately, existing evidence suggests that the current global public health workforce is unprepared to confront the challenges posed by globalization. There is growing recognition of the need for the internationalization of curriculum (IoC), and the development of educational programmes that adequately prepare the public health workforce to deal with global health issues. The present literature review aims to examine the current perspectives, pedagogical approaches, theoretical or policy issues and debates related to (and explores different ways of improving) IoC in public health. A systematic search of literature up to 22 January 2018 was undertaken in the following databases in addition to google scholar: MEDLINE; EMBASE and PsycInFo. Data analysis involved writing annotated summaries of each paper and classifying the papers according to which of the questions they address, displaying the data, comparing the themes across papers, and drawing inferences and conclusions. The results suggest that internationalization of the public health curriculum, overall, can enable universities and individuals to meet both local and global social accountabilities and responsibilities. However, the way that IoC is defined, along with the internationalization model and pedagogical approach taken, have an impact on the benefits that can be realised

Reducing substance misuse and related problems: How can unhealthy alcohol users and problem drug users be effectively intervened with in general hospital settings?

Background: There is a high prevalence of unhealthy alcohol use and problem drug use among patients presenting to general hospital settings. However, many unhealthy alcohol users and problem drug users in these settings are not even aware, or do not acknowledge that they have such problems. Their presentation to hospital for the treatment of other conditions offers an opportunity to engage with them. However, there is uncertainty over how best to identify, assess and intervene with this population. Aim: To investigate how unhealthy alcohol users or problem drug users can be effectively identified, assessed and intervened with when they present to general hospital settings for the treatment of other conditions. Methods: This thesis is based on six published papers that used systematic review, meta-regression and Delphi methods. Main findings: To date, research on interventions for unhealthy alcohol use in general hospital settings has focused on brief interventions (BIs). Multiple session BIs are likely to be beneficial for unhealthy alcohol use in these settings. Where targeted screening and intervention is the strategy of choice, a focus on gastroenterology and emergency medicine is a promising way to target resources for unhealthy alcohol use. There is lack of evidence on how to effectively identify and intervene with problem drug users. The available evidence favours the ASSIST as the problem drug use screening instrument of choice. There is also lack of evidence to inform which comprehensive substance misuse assessment package to use in these settings. Conclusions: There is still need for robustly designed research on how to effectively identify, assess and intervene with unhealthy alcohol users and problem drug users within general hospital settings. It is to be hoped that the body of work presented in this thesis will, effectively, contribute to the development stage for other primary research in the future

The effects of price and non-price policies on cigarette consumption in South Africa

The health consequences of smoking are serious and have been frequently detailed. A reduction in tobacco-related mortality hinges upon the ability to reduce tobacco usage. There is overwhelming evidence that higher cigarette prices reduce cigarettes demand, but little is known about the combined e⁄ect of price and non-price policies. This paper extends the analysis of price elasticities by estimating the e⁄ect of changes in price and non-price legislations in South Africa. Annual time-series data from 1961 to 2016 are used, with a policy index constructed to capture the instances of non-price tobacco legislation. The combined impact is estimated using a vector error correction model and a two-stage least squares (2SLS) model. The long-run own-price elasticities lie between -0.55 and -0.72, while the income elasticities lie between 0.39 and 0.49. The coefcients of the changing tobacco policies and changing market structure show that they contribute to a modest reduction in cigarette consumption. The short-run deviations from the steady state are presented using the error correction term. Cigarette demand is responsive to prices and non-pricing policies but failure to control for non-pricing policies overstates the price e⁄ect. This suggests that both prices and non-pricing legislation are e⁄ective in reducing cigarette consumption

A situational analysis of tobacco control in Ghana: progress, opportunities and challenges

Tobacco use is the leading cause of preventable deaths in the world, with most of these deaths now occurring in low and middle-income countries (LMICs). Sub-Saharan Africa (SSA) is at an early stage of a tobacco epidemic and is, therefore, particularly vulnerable to rapid growth in tobacco consumption. More than a decade into the implementation of the World Health Organization's Framework Convention on Tobacco Control (FCTC), State Parties in several countries in SSA, such as Ghana, have yet to fully fulfill their obligations. Despite early ratification of the FCTC in 2004, progress in implementing tobacco control measures in Ghana has been slow and much work remains to be done. The aim of this paper is to critically reflect on tobacco control implementation in Ghana, identify significant research priorities and make recommendations for future action to support tobacco control implementation. We emphasize the need for stronger implementation of the FCTC and its MPOWER policy package, particularly in the area of tobacco taxes, illicit trade and industry interference

HIV health care providers’ perspectives on smoking behavior among PLHIV and smoking cessation service provision in HIV clinics in Uganda

Introduction: Integration of smoking cessation interventions into HIV care can play a crucial role in reducing the growing burden of disease due to smoking among people living with HIV (PLHIV). However, there is a dearth of information on HIV care providers’ perspectives towards integrating smoking cessation interventions into HIV care programs. We explored HIV health care providers’ perceptions on the smoking behaviour among PLHIV, and the provision of smoking cessation services to PLHIV who smoke within HIV care services in Uganda. Methods: Semi structured face-to-face qualitative interviews were conducted with 12 HIV care providers between October and November 2019. Data were collected on perceptions on smoking among HIV-positive patients enrolled in HIV care, support provided to PLHIV who smoke to quit and integrating smoking cessation services into HIV care programs. Data were analysed deductively following a thematic framework approach. Results: Findings show that: a); HIV care providers in HIV clinics had low knowledge on the prevalence and magnitude of smoking among PLHIV who attended the clinics b) HIV care providers did not routinely screen HIV-positive patients for smoking and offered sub-optimal smoking cessation services; c) HIV care providers had a positive attitude towards integration of tobacco smoking cessation services into HIV care programs but called for support in form of guidelines, capacity building and strengthening of data collection and use as part of the integration process. Conclusion: Our study shows that HIV care providers did not routinely screen for tobacco use among PLHIV and offered suboptimal cessation support to smoking patients but they have a positive attitude towards the integration of tobacco smoking into HIV care programs. These findings suggest a favourable ground for integrating tobacco smoking cessation interventions to into HIV care programmes

Exposure to second-hand smoke in public places and barriers to the implementation of smoke free regulations in the Gambia : a population-based survey

Introduction. Second-hand smoke is associated with more than 1.2 million deaths per year among non-smokers. Smoking in public places is prohibited in The Gambia but there is no information on the level of exposure to second-hand smoke among adolescents and adults 15-64 years. The aim of this study was to assess the level and predictors of exposure to second-hand smoke in public places and compliance with smoke free regulations in The Gambia. Methods. A population-based survey was conducted in an established Health and Demographic Surveillance System (HDSS). A total of 4547 participants (15-64 years)from households within the Farafenni HDSS were interviewed at their homes but only 3533 were included in our analysis. Factors associated with exposure to second-hand smoke in public places were assessed by three different multivariable regression models. Results. Exposure to tobacco smoke in public places was high (66.1%, ), and higher in men (79.9%) than women (58.7%). Besides being male, less education, lower household income, urban residence and not aware of smoke free regulations were strongly associated with exposure to second-hand smoke. Conclusion. Despite existing smoke-free regulations, reported exposure to second-hand smoke remains high in public places in The Gambia. The Ministry of Health should continue to strengthen their advocacy and sensitization programs to ensure smoke free regulations are fully implemented. Some population subgroups are at a higher risk of exposure and could be targeted by interventions; and settings where these subgroups are exposed should be targeted by enforcement efforts

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASSII): a combined evidence and theory-based plus partnership intervention development approach.

Introduction: Deaths from second-hand smoke (SHS) exposure are increasing but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making while developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages. Methods: The development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka; identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF); user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF. Results: It was judged inappropriate to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated. Conclusion: The potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory, and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts