Tobacco use amongst out of school adolescents in a Local Government Area in Nigeria

Abstract Introduction Out-of-school adolescents are often neglected when planning for tobacco prevention programmes whereas they are more vulnerable. Few studies exist in Nigeria about their pattern of tobacco use to serve as the basis for effective policy formulation. Method A sub sample of 215 out of school adolescents was analyzed from a descriptive cross sectional study on psychoactive substance use amongst youths in two communities in a Local Government Area in Nigeria which used a multi-stage sampling technique. Results Males were 53% and females 47%. Only 20.5% had ever used tobacco while 11.6% were current users. Males accounted for 60% of current users compared to 40% amongst females. Of current users, 84% believed that tobacco is not harmful to health. In addition, the two important sources of introduction to tobacco use were friends 72% and relatives 20%. Use of tobacco amongst significant others were: friends 27%, fathers 8.0%, relatives 4.2% and mothers 0.5%. The most common sources of supply were motor parks 52% and friends 16%. Conclusion The study showed that peer influence is an important source of introduction to tobacco use while selling of tobacco to adolescents in youth aggregation areas is common. We advocate for a theory based approach to designing an appropriate health education intervention targeted at assisting adolescents in appreciating the harmful nature of tobacco use in this locality. A point-of-sale restriction to prevent adolescent access to tobacco in youth aggregation areas within the context of a comprehensive tobacco control policy is also suggested. However, more research would be needed for an in-depth understanding of the tobacco use vulnerability of this group of adolescents.Peer Reviewe

The search for a proportionate care law by formula funding in the English NHS

Although the National Health Service was created to achieve equity of access to health care in 1948, over twenty years later an ‘inverse care law’ was seen to operate. The 1976 Report of the Resource Allocation Working Party laid the principles of formula funding to achieve an equitable distribution of resources, to move, over time, towards the operation of a proportionate care law. These principles have been applied ever since in England. This paper describes the context, governance and subsequent development of formulas and three persistent problems: accounting for populations, their needs and variations in the unavoidable costs of providers. The paper concludes by outlining continuing problems from the past and new challenges of formula funding in England to reduce ‘avoidable’ inequalities in health

The evaluation of complex health policy: lessons from the UK total purchasing experiment

© 2001, SAGE Publications (London, Thousand Oaks and New Delhi). The last five years have witnessed the increasing use of evaluated pilot programmes as a way of developing health services policy in the UK. Total purchasing was the first major quasi-market development in the National Health Service to be independently evaluated from the outset. The initiative allowed local, volunteer pilots considerable freedom to implement extensions to existing arrangements for general practitioner budget holding for specialist services in the National Health Service. The experience indicates that future evaluations of similarly complex innovations should give attention to developing explanatory frameworks (i.e. theories), which include consideration of the impact of the context in which interventions are introduced on their potential outcomes. Such an approach should help in ensuring the generalizability of evaluations through theory building and thus increase their relevance for policy development. In addition, evaluations must be designed to be capable of accommodating the needs of changing policy imperatives if they are to have long-term usefulness