International Festival of Public Health

LT 1 - Health Promotion and Improvement

Impact of healthcare professionals' (HP) input during pregnancy on positive health behaviour changes

Presenter: Aalaa Jawad, North Central Deanery

Other author(s): None

Abstract Text:

Main objective: We aimed to determine whether HP input during pregnancy has an impact on the following three positive health behaviours: consuming folic acids and vitamins, stopping smoking and stopping alcohol.

Methods: We conducted a cross-sectional health behaviour survey of 1173 pregnant women attending three maternity services in London. We conducted adjusted binary logistic regression models to determine the relationship between our outcome measures and HPs' input during pregnancy.

Main results: Approximately two thirds of women (n=770, 65.6%) reported consuming vitamins and folic acid, 73.2% of ever smokers (n=142) stopping smoking, and the majority of women (n=577, 85.5%) stopped drinking alcohol during pregnancy. Compared to those who had not received HP input during pregnancy, those who had were at significantly higher odds of consuming vitamins and folic acid during pregnancy (60% with no HP input vs. 68% with HP input; AOR 1.78, 95% CI 1.17-2.69), but at lower odds to have stopped smoking during pregnancy (80% with no HP input vs. 69% with HP input; AOR 0.33, 95% CI 0.91-1.21) and significantly lower odds of stopping alcohol during pregnancy (90% with no HP input vs. 79% with HP input; AOR 0.53, 95% CI 0.28-1.00).

Significance of the findings:HP input during pregnancy may be beneficial for the consumption of vitamins and folic acid during pregnancy. The detrimental effect of HP input with regards to stopping smoking and stopping alcohol during pregnancy may be confounded by higher smoking and drinking intensity in this group as well as recall bias.

A qualitative study of new parents' and midwives' views on alcohol advice during pregnancy in England and Sweden

Presenter: Lisa Schölin, Liverpool John Moores University

Other author(s): Lorna Porcellato, Prof Karen Hughes, Prof Mark Bellis, Prof Charli Eriksson

Abstract Text: The lack of conclusive evidence on the risks of consuming small amounts of alcohol during pregnancy has led to disparities in recommendations to pregnant women in Europe. Many countries, such as Sweden, advise complete abstinence. However, in the UK women are advised to abstain or to limit themselves to small amounts if they choose to drink. Previous research has indicated such a dual message causes confusion and creates difficulties for women to make an informed decision. The aim of this study was to compare how alcohol advice is disseminated and perceived in antenatal care in two European countries with disparate guidance. Semi-structured interviews were conducted with 44 new parents and 16 midwives in Merseyside, UK and Örebro County, Sweden and were analysed using thematic analysis. Emerging themes included the importance of the relationship between the midwife and woman; issues of trust and receiving tailored advice based on how pregnant women presented themselves. Both parents and midwives in Sweden consistently reported promotion of abstinence. Yet some English parents experienced conflicting advice, despite midwives stating they provided only the abstinence message. Midwives were perceived to be in a good position to provide verbal advice, although the message was further emphasised for Swedish parents through a leaflet specifically informing about alcohol and pregnancy. The results indicate that further clarity in the advice could be promoted in England and that targeted health education material on alcohol may help to further emphasise the risks with drinking during pregnancy.

Exclusive breastfeeding: exploring the complexities of a global issue, with a focus on the UK

Presenter: Rosie Conroy, HCRI, University of Manchester

Other author(s): Dr Maura Duffy

Abstract Text: Breastfeeding has many health-benefits for the infants and exclusive-breastfeeding for 6-months is recommended as the 'optimal' form and duration of infant-feeding by the WHO and UNICEF. Nevertheless, current rates of exclusive-breastfeeding in the UK remain very low. Based on extensive desk-based research undertaken during 2014 as part of my thesis for the Intercalated BSc in Global Health at HCRI, University of Manchester, this paper explores the reasons for these low rates. It emphasizes how in developed contexts, including the UK, there are six key barriers to women achieving exclusive-breastfeeding: employment, a mother's demographics, milk-substitute advertising, knowledge and attitudes, gender roles in infant feeding and personal choices. This paper also examines the Baby-Friendly Initiative, which is the recommended breastfeeding support intervention for developed countries. I argue that its strategy for implementation in the UK is not being translated into practice and that it fails to address many of the key barriers to exclusive-breastfeeding. In particular I highlight how the content and timing of breastfeeding support does not meet the needs of families in the UK. The paper concludes that for exclusive-breastfeeding rates in the UK to improve, increased post-natal family-centered breastfeeding support needs to be provided, laws on milk-substitute advertising need to be more rigorously enforced, and more 'breastfeeding-friendly' facilities in the workplaces need to be available. I also call for further research to identify the factors that enable some women in the UK to achieve exclusive breastfeeding for six months, and why some women choose not to breastfeed at all.

Supporting the physical needs of people with mental illness with a focus on healthy weight and smoking cessation

Presenter: Simon Nugent, University of Lincoln

Other author(s): Isobel Duckworth, North East Lincolnshire Council

Abstract Text:

The aim was to review with the local mental health provider how people with mental illness were being supported with their physical health needs – with a focus on healthy weight and smoking cessation. The national strategy 'No Health without mental health' states, recognises the importance of physical health so 'more people with mental health problems will have good physical health' (DH, 2011a). There is a range of NICE (www.nice.org.uk) guidance to support mental health service providers in general and specifically on topics of smoking and weight management . A review of the literature on physical health inequalities associated with mental illness was undertaken with particular reference to healthy weight and smoking cessations as these are key factors affecting mortality and morbidly in people with mental illness. Discussions were undertaken with the mental health provider and stop smoking and weight management services to understand how needs were being met locally. The review found that: 1. Mental health services need to provide planned and evaluated interventions for smoking cessation and healthy weight management. 2. People with mental illness who undertake smoking cessation and healthy weight interventions need careful management, and in the case of smoking cessation will require review of their psychotropic medication. This work highlighted that more focus and support needed to be given to people with mental illness to improve physical and mental health outcomes . This review was helpful to inform local commissioners and providers. Reference : Department of Health (DH) (2011a) No health without mental health six shared objectives: A cross-government mental health outcomes strategy for people of all ages. London: DH.