18 research outputs found
Is the "Glasgow effect" of cigarette smoking explained by socio-economic status?: A multilevel analysis
Background: The Glasgow area has elevated levels of deprivation and is known for its poor health and associated negative health-related behaviours, which are socially patterned. Of interest is whether high smoking rates are explained by the area's socio-economic profile.<p></p>
Methods: Data on age, sex, current/previous smoking status, area deprivation, social class, education, economic activity, postcode sector, and health board region were available from Scottish Health Surveys conducted in 1995, 1998 and 2003. Multilevel logistic regression models were applied by sex, unadjusted and adjusted for age, survey year, and socio-economic factors, accounting for geographical hierarchy and missing data.<p></p>
Results: Compared with the rest of Scotland, men living in Greater Glasgow were 30% and women 43% more likely to smoke [odds ratio (OR) = 1.30, (95% CI = 1.08–1.56) and (OR = 1.43, CI = 1.22–1.68), respectively] before adjustment. In adjusted results, the association between living in Greater Glasgow and current smoking was attenuated [OR = 0.92, CI = 0.78–1.09 for men, and OR = 1.08, CI = 0.94–1.23 for women; results based on multiply imputed data to account for missing values remained borderline significant for women]. Accounting for individuals who had been told to give up smoking by a medical person/excluding ex-smokers did not alter results.<p></p>
Conclusion: High levels of smoking in Greater Glasgow were attributable to its poorer socio-economic position and the strong social patterning of smoking. Tackling Glasgow's, and indeed Scotland's, poor health must involve policies to alleviate problems associated with poverty.<p></p>
Factors associated with breastfeeding cessation in nursing mothers in a peer support programme in Eastern Lancashire
<p>Abstract</p> <p>Background</p> <p>The UK has one of the lowest breastfeeding rates worldwide and in recent years the Government has made breastfeeding promotion one of its priorities. The UNICEF UK Baby Friendly Initiative is likely to increase breastfeeding initiation but not duration. Other strategies which involve provision of support for breastfeeding mothers in the early weeks after birth are therefore required to encourage UK mothers to breastfeed for the recommended duration. This paper examines the effects of maternal socio-demographic factors, maternal obstetric factors, and in-hospital infant feeding practices on breastfeeding cessation in a peer support setting.</p> <p>Methods</p> <p>Data on mothers from Blackburn with Darwen (BwD) and Hyndburn in Eastern Lancashire who gave birth at the Royal Blackburn Hospital and initiated breastfeeding while in hospital were linked to the Index of Multiple Deprivation (IMD). The data were analysed to describe infant feeding methods up to 6 months and the association between breastfeeding cessation, and maternal factors and in-hospital infant feeding practices.</p> <p>Results</p> <p>The mean breastfeeding duration was 21.6 weeks (95% CI 20.86 to 22.37 weeks) and the median duration was 27 weeks (95% CI 25.6 to 28.30 weeks). White mothers were 69% more likely to stop breastfeeding compared with non-White mothers (HR: 0.59; 95% CI, 0.52 to 0.67 [White mothers were the reference group]). Breastfeeding cessation was also independently associated with parity and infant feeding practices in hospital. There were no significant associations between breastfeeding cessation and marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation.</p> <p>Conclusion</p> <p>In this study ethnicity, parity and in-hospital infant feeding practices remained independent predictors of breastfeeding cessation in this peer support setting. However other recognised predictors such as marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation were not found to be associated with breastfeeding cessation.</p
Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes
Aims/hypothesis
We investigated whether objectively measured sedentary time and interruptions in sedentary time are associated with metabolic factors in people with type 2 diabetes.
Methods
We studied 528 adults (30–80 years) with newly diagnosed type 2 diabetes, who were participants in a diet and physical activity intervention. Waist circumference (WC), fasting HDL-cholesterol, insulin and glucose levels, HOMA of insulin resistance (HOMA-IR) and physical activity (accelerometer) were measured at baseline and at 6 months follow-up. Linear regression models were used to investigate cross-sectional and longitudinal associations of accelerometer-derived sedentary time and breaks in sedentary time (BST) with metabolic variables.
Results
In cross-sectional analyses each hour of sedentary time was associated with larger WC (unstandardised regression coefficient [B] [95% CI] 1.89 cm [0.94, 2.83]; p < 0.001), higher insulin (B = 8.22 pmol/l [2.80, 13.65]; p = 0.003) and HOMA-IR (B = 0.42 [0.14, 0.70]; p = 0.004), and lower HDL-cholesterol (B = −0.04 mmol/l [−0.06, −0.01]; p = 0.005). Adjustment for WC attenuated all associations. Each BST was associated with lower WC (B = −0.15 cm [− 0.24, −0.05]; p = 0.003) and there was evidence of a weak linear association with HDL-cholesterol, but no association with insulin levels or HOMA-IR. Volume of sedentary time at baseline predicted HDL-cholesterol (B = −0.05 mmol/l [−0.08, −0.01]; p = 0.007), insulin levels (B = 8.14 pmol/l [0.1.51, 14.78]; p = 0.016) and HOMA-IR (B = 0.49 [0.08, 0.90]; p = 0.020) at 6 months, though not WC. Baseline BST did not substantially predict any metabolic variables at follow-up. No change was seen in sedentary time or BST between baseline and 6 months follow-up.
Conclusions/interpretation
Higher sedentary time is associated with a poorer metabolic profile in people with type 2 diabetes
Practice characteristics and prescribing of cardiovascular drugs in areas with higher risk of CHD in Scotland: cross-sectional study
Background We examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics.
Methods Propensity score matching was used to identify two groups of practices in Scotland. The cases were in areas with 5% or more of the population in South Asian ethnic groups. The controls were in areas with less than 1% of the population in South Asian ethnic groups and were matched for other population characteristics.
Results The 39 case practices have lower prescribing rates than the matched controls for all heart disease drugs Significant different are found for six drugs (statins, ace Inhibitors, clopidogrel, thiazides, warfarin and digoxin. The differences range from 12.8% less for amlodipine to 43.9% for clopidogrel. The case practices also have lower prescribing costs than the unmatched group with the exception of ace inhibitors and aspirin. The highest prescribing costs for all drugs are found in the matched control group. The case practices are smaller than the controls, and have fewer GPs per 1,000 patients. Case practices have fewer quality markers and receive less in total resources, but have higher sums reimbursed to cover their employed staff costs.
Conclusion Patients with higher risk of CHD tend to live in areas served by practices with lower prescribing rates and poorer structural characteristics. The scale of the differences in prescribing suggests that health care system factors rather than individual treatment decisions cause inequity in care. Identifying whether South Asian individuals are less likely to receive heart disease drugs than non South Asians requires individual-level prescribing data, which is currently not available in the UK
Modifying Alcohol Consumption to Reduce Obesity (MACRO): development and feasibility trial of a complex community-based intervention for men
BackgroundObese men who consume alcohol are at a greatly increased risk of liver disease; those who drink > 14 units of alcohol per week have a 19-fold increased risk of dying from liver disease.ObjectivesTo develop an intervention to reduce alcohol consumption in obese men and to assess the feasibility of a randomised controlled trial (RCT) to investigate its effectiveness.Design of the interventionThe intervention was developed using formative research, public involvement and behaviour change theory. It was organised in two phases, comprising a face-to-face session with trained laypeople (study co-ordinators) followed by a series of text messages. Participants explored how alcohol consumption contributed to weight gain, both through direct calorie consumption and through its effect on increasing food consumption, particularly of high-calorie foodstuffs. Men were encouraged to set goals to reduce their alcohol consumption and to make specific plans to do so. The comparator group received an active control in the form of a conventional alcohol brief intervention. Randomisation was carried out using the secure remote web-based system provided by the Tayside Clinical Trials Unit. Randomisation was stratified by the recruitment method and restricted using block sizes of randomly varying lengths. Members of the public were involved in the development of all study methods.SettingMen were recruited from the community, from primary care registers and by time–space sampling (TSS). The intervention was delivered in community settings such as the participant’s home, community centres and libraries.ParticipantsMen aged 35–64 years who had a body mass index (BMI) of > 30 kg/m2 and who drank > 21 units of alcohol per week.ResultsThe screening methods successfully identified participants meeting the entry criteria. Trial recruitment was successful, with 69 men (36 from 419 approached in primary care, and 33 from 470 approached via TSS) recruited and randomised in 3 months. Of the 69 men randomised, 35 were allocated to the intervention group and 34 to the control group. The analysis was conducted on 31 participants from the intervention group and 30 from the control group. The participants covered a wide range of ages and socioeconomic statuses. The average alcohol consumption of the men recruited was 47.2 units per week, more than twice that of the entry criterion (> 21 units per week). Most (78%) engaged in binge drinking (> 8 units in a session) at least weekly. Almost all (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease (BMI of > 30 kg/m2 and > 14 units of alcohol per week). Despite this, they believed that they were at low risk of harm from alcohol, possibly because they seldom suffered acute harms (e.g. hangovers) and made few visits to a general practitioner or hospital.InterventionThe intervention was delivered with high fidelity. A high follow-up rate was achieved (98%) and the outcomes for the full RCT were measured. A process evaluation showed that participants engaged with the main components of the intervention. The acceptability of the study methods was high.ConclusionsThis feasibility study developed a novel intervention and evaluated all of the stages of a RCT that would test the effectiveness of the intervention. The main stages of a trial were completed successfully: recruitment, randomisation, intervention delivery, follow-up and measurement of study outcomes. Most of the men recruited drank very heavily and were also obese. This places them at a very high risk of liver disease, making them a priority for intervention
Scottish indices of deprivation 2003 Summary report
SIGLEAvailable from British Library Document Supply Centre- DSC:m03/17073 / BLDSC - British Library Document Supply CentreGBUnited Kingdo
Claiming matters Changing patterns of benefit receipt across Wales, 1995 to 2000
Includes bibliographical references. Title from cover. - Added title in Welsh: Hanfod hawlio : y newid ym mhatrymau derbyn budd-daliadau ledled Cymru, 1995 i 2000. Parallel text in English and Welsh, printed tete-becheAvailable from British Library Document Supply Centre- DSC:m03/37982 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo
Housing-related data at sub-district level in England A feasibility study
SIGLEAvailable from British Library Document Supply Centre- DSC:m03/32407 / BLDSC - British Library Document Supply CentreGBUnited Kingdo