Starting young? children’s experiences of trying smoking during pre-adolescence

Although the risks smoking poses to health are now well known, many young people continue to take up the habit. While numerous crosssectional studies of adolescents have identified correlates of smoking initiation, much less prospective, longitudinal research has been conducted with young children to gather their accounts of early experiences of smoking, and this study fills that significant gap. Quantitative and qualitative data, collected using questionnaires, interviews and focus groups, are presented from the pre-adolescent phase of the Liverpool Longitudinal Study of Smoking. By age 11, 27% of the cohort had tried smoking, 13% had smoked repeatedly and 3% were smoking regularly. Rates of experimentation increased over time. Qualitative data revealed that curiosity and the role of peers were central to children’s accounts of early smoking. By preadolescence, children are at different stages in their smoking careers, therefore interventionsmust be targeted to their varied experiences. Current prevention strategies often focus on restricting access to cigarettes, but a broad range of intervention measures is required which take account of the multifactorial nature of smoking onset. To be effective, policies that aim to prevent smoking must be grounded in children’s lived experiences

Evidence of improved uptake of health checks : rapid review

Summary of findings:Seven papers (five studies) met the inclusion criteria regarding reporting information around uptake or increasing uptake within CVD screening/Health Checks. All of these were studies from England. There is limited evidence of the demographic and health factors that impact on NHS Health Check uptake and from a systems perspective those GP practices that are most successful at attracting people to take up the Health Check were small. From this review a number of recommendations can be made (see page 18-19) around potential ways of increasing uptake of NHS Health Checks in Salford. However, it is also suggested more qualitative research is needed to understand the views of those invited to and who have had Health Checks in relation to some of the issues raised through this review

Challenges in designing, conducting, and reporting oral health behavioral intervention studies in primary school age children : methodological issues

Often within oral health, clinical outcome measures dominate trial design rather than behavioral outcome measures, and often there is a reliance on proxy self-reporting of children’s behavior with no corroboration through triangulation of measures. The complexity of the interventions involved in oral health intervention is often overlooked in trial design, and more flexible pragmatic designs that take account of the research context may be more appropriate. Some of the limitations in oral health behavioral intervention studies (trials) in primary school age children were reported in a recently published Cochrane review. This paper aims to critically discuss the findings of a recent Cochrane review in terms of the methodological implications that arise for future design, development, measurement, and reporting of oral health trials in primary school age children. Key components of the UK Medical Research Council’s framework for the design and evaluation of complex interventions are discussed in relation to using taxonomies of behavior change. This paper is not designed to be a definitive guide but aims to bring learning from other areas of public health and health promotion into dental public health. Ultimately, the aim is to aid the design of more successful interventions that produce long-term behavioral changes in children in relation to toothbrushing and nighttime sugar snacking

Distinguishing factors that influence attendance and behaviour change in family‐based treatment of childhood obesity: a qualitative study

ObjectivesFor the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)).DesignFocus groups with children and parents/carers as part of a broader mixed-methods evaluation.MethodsEighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change.ResultsInitial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others.ConclusionsFactors that influence attendance and behaviour change are distinct and may be important at different stages of the family’s change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention

Football and Health: Getting Strategic

Community foundations and charities operating within professional football clubs are being championed as a vehicle to deliver on the Public Health agenda. This personal commentary from the authors offers insight into the context of football for health drawing on the relevant research literature and their experiences working within the football industry in England. The football and health examples highlight under-resourced and under-evaluated interventions, whilst highlighting the importance of partnership working. The authors hope to support those in football and health in getting strategic through their interventions, evaluations and partnerships, in order to capitalize the potential of football in supporting the objectives of Public Health England

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT) -based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n=7) or to the SDT-based intervention (n=6). Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833

Applied public health research - falling through the cracks?

<p>Abstract</p> <p>Background</p> <p>There is a degree of dissonance between the types of evaluative research required by organisations providing or commissioning health care, those recommended by organisations developing evidence-based guidance, and those which research funding bodies are prepared to support.</p> <p>Methods</p> <p>We present a case study of efforts to establish a pragmatic but robust evaluation of local exercise referral schemes. We considered the epidemiological, ethical and practical advantages and disadvantages of a number of study designs and applied for research funding based on an uncontrolled design, outlining the difficulties of carrying out a randomised controlled trial to evaluate an existing service.</p> <p>Results</p> <p>Our proposal was praised for its relevance and clear patient outcomes, but the application was twice rejected because both funders and reviewers insisted on a randomised controlled trial design, which we had found to be impractical, unacceptable to service users and potentially unethical.</p> <p>Conclusion</p> <p>The case study highlights continuing challenges for applied public health research in the current funding climate.</p

Factors influencing participation in outdoor physical activity promotion schemes: The case of South Staffordshire, England

Policy exhortations for promoting outdoor physical activity have increased considerably in England and Wales over the past 20 years. Despite a considerable number of schemes developing during this period to encourage physical activity and exercise, marked population-level changes in outdoor physical activity behaviour have not been seen. The paper explores the triggers to this participation using a five-fold classification: physical infrastructure; information infrastructure; administrative infrastructure; participant constraints and participant preferences. Through a series of interviews in a case study 'healthy exercise' scheme in South Staffordshire, a district local authority in England, these triggers to participation are identified and explored. It is concluded that whilst the infrastructure triggers can be manipulated by scheme providers in an attempt to improve scheme participation, participant triggers fall largely beyond the control of scheme providers. Research suggests, too, that participant triggers tend to be stronger than infrastructure ones. Because of this, where there is a lack of healthy exercise scheme success, this cannot necessarily be attributed to scheme providers as it might be as a result of user triggers. For the same reason, it might be beyond the influence of scheme providers to turn 'failing' exercise schemes into successful ones. © 2012 Copyright Taylor and Francis Group, LLC