International Festival of Public Health

LT3 - Health Promotion and Improvement Abstracts

Betting, borrowing and obesity: providing robust public health advice to urban planners

Ben Cave, Ryngan Pyper

Urban planning has a pivotal role in enhancing the social determinants of health and in addressing health inequalities. Despite this urban planners and Public Health specialists struggle to articulate and implement policies to improve health and wellbeing. Public health recommendations to urban planners can be aspirational or poorly framed and thus are often found to be inadmissible. This presentation describes work with two London boroughs each of which demonstrate high levels of childhood obesity, poor mental health, socioeconomic deprivation and debt.

The planning teams were seeking to control the proliferation of hot food outlets, betting shops and high street money-lenders. These premises are controlled by planning law and can be linked to the adverse health outcomes described above. Access to, and use of, these outlets has a disproportionate adverse effect on people with low incomes. The request was to identify how Public Health can support planning decisions to refuse applications where densities of these outlets are already high.We demonstrate that public health can be a 'material planning consideration' and we identify ways of structuring information to ensure it is recognised as a robust argument by planning inspectors.

This approach advances our understanding of ways in which urban planners and Public Health can support each other. It is a contribution towards local strategies to manage market forces which undermine efforts to improve mental health, to reduce obesity and reduce health inequalities.

Help-seeking for possible cancer symptoms following a previous 'all clear' diagnosis

Cristina Renzi, Jane Wardle

Aim: This literature review examined research into the impact of a previous 'all clear' or non-cancer diagnosis following symptomatic presentation (here called a false alarm) on patient attitudes and help-seeking for new or recurrent potential cancer symptoms.

Methods: Bibliographic databases and reference lists were searched to identify quantitative and qualitative studies addressing the topic.

Results: A total of 1198 papers were screened, of which102 were retrieved for full-text evaluation. Among them, 17 papers reported information on patients with a previous false alarm and considered the impact on help-seeking for subsequent potential cancer symptoms using qualitative (n=10), quantitative (n=5) and mixed data collection methods (n=2). Breast (n=8 studies) and colorectal cancer (n=3) were the most frequently studied. A delay in cancer diagnosis was reported for some patients with a previous false alarm, but studies were limited by small sample size, retrospective design, or lack of control group. Delay in help-seeking for a subsequent symptom was explained by some patients in terms of reassurance from the previous benign diagnosis. However, other patients reported a negative previous healthcare experience, with their symptoms dismissed as un-important, or felt they had wasted the doctor's time on the previous occasion, or were concerned about appearing hypochondriacal.

Conclusion: Limited information is available on the impact of a false alarm on subsequent help-seeking; but what there is, suggests that patients may be either 'over-reassured' or 'under-supported'. Information needs and concerns following a false alarm should be addressed to reduce delay in help-seeking for subsequent symptoms.This work is supported by CRUK [C48748/A16867]

Licensing - a Public Health opportunity

Frances Carbery

April 2012 saw a change in licensing legislation that enabled public health to be a responsible authority. This meant that Directors of Public Health could make licensing representations and ask for reviews of existing licences.For many Public Health departments, licensing was a new concept to which there had been little or no public health contribution. Bury Public Health saw the change in legislation as an opportunity to influence the granting of premise licences for alcohol outlets. With the pressures on hospitals and other services from alcohol related admissions and A&E attendances, the cost of alcohol to society both financially and otherwise is a great burden.

Bury Council's Public Health team has embraced the challenge of its new role as a responsible authority, and working with colleagues in other departments and organisations has demonstrated the added value that Public Health can provide to the licensing process.Using Public Health intelligence combined with information from the police, hospital data, research and local knowledge, Bury Public Health has contributed on a number of occasions to the licensing process and at licensing reviews. Outcomes have varied, and often the issues that Bury Public Health faces are shared with other Public Health teams, such as the lack of premise-specific public health intelligence and the fact that public health is not a licensing objective.The commitment to reducing health inequalities and improving years of life remains consistent however, and Public Health is truly embedded in the licensing process for Bury Council.

Exploring the Acceptability of a Tax on Sugar-sweetened Drinks

Hannah Timpson, Rachel Lavin, Lisa Hughes

Aims: Recent research has predicted that a 20% tax on sugar-sweetened beverages (SSBs) could reduce obesity in the UK by 1.3%. Our research explored consumer attitudes and perceptions towards this public health measure, and whether behaviour would change as a result.

Design: Qualitative methods were used to collect data from the biggest SSB consumer groups in the UK; children, young people and families. Data were collected in the North West of England. Specific areas for inclusion were selected on the basis of obesity and deprivation, two of the key determinants of SSB intake.

Results: Participants generally found the notion of a tax on SSBs acceptable, but felt a 20% price increase would not be enough to impact on consumption. Adults described the influence of price as affecting decisions about consumption, and described purchasing cheaper SSBs from discount stores, as part of a meal deal or supermarket offer. Children and young people had less concept of these issues and described buying SSBs, regardless of price. Many participants (regardless of age) did not recognise all the drinks that are classed as SSBs. Participants viewed sugary drinks as a source of energy but very few linked this to excess calories and weight gain; the majority knew of the negative effect on dental health.

Conclusion: Varying prices and consumer behaviours suggests that a 20% increase in the price of SSBs may not be enough to influence consumption. Advertising and education would be important considerations in highlighting the health implications of SSBs, beyond dental health.

Electronic cigarettes in Great Britain: A gateway to smoking or an exit door away from it?

Hazel Cheeseman, Rory Morrison

Introduction: Electronic cigarettes ('e-cigarettes') are battery powered devices that vaporise a solution (often containing nicotine and flavourings) then inhaled by the user. They are believed to confer considerably less risk to health than smoked tobacco, but their resemblance to conventional cigarettes and marketing approaches have caused significant debate in the public health community.

Methods: An analysis of survey data from representative population surveys in Great Britain conducted online in 2010 to 2014.

Results and conclusions: E-cigarette awareness and use amongst adult smokers and ex-smokers has risen rapidly over time. From 3% smokers currently using e-cigarettes in Q1 2010 to 18% in Q1 2014. There has been a small increase in e-cigarette experimentation among adult never smokers, however it remains very low and current use among never smokers is negligible or zero. Most smoker and ex-smokers report using e-cigarettes to quit or reduce smoking and e-cigarette using smokers are more motivated to quit smoking than non-e-cig users. Results will be discussed in context of other domestic and international research. In Britain, e-cigarettes may be contributing to less, rather than more, tobacco smoking.

Do Children Overestimate the Extent of Smoking among their Peers? A Feasibility Study of the Social Norms Approach to Prevent Smoking

Helen Elsey, Elizabeth Owiredu, Heather Thomson, Gemma Mann, Rashesh Mehta, Kamran Siddiqi

Social norms approaches (SNA) are based on the premise that we frequently overestimate risk behaviours among our peers. By conducting campaigns to reduce this dissonance, SNAs aim to reduce risk behaviours. This study examines the extent to which 12 to 13 year old pupils overestimate smoking among their peers and explores the appropriateness of using SNA in secondary schools to prevent smoking uptake.

Methods: The extent of overestimation of smoking among peers was assessed through anon-line SNA questionnaire in five schools (n=595). Based on questionnaire results, pupils developed SNA campaigns in each school.Qualitative methods of focus groups (7), interviews (7) and observation were used to explore in-depth, from the perspective of staff and pupils, the appropriateness and feasibility of the SNA to prevent smoking uptake in secondary schools.

Results: A quarter of pupils, 25.9% (95% CI 25.6% to 26.1%) believed that most of their peers smoked, however, only 3% (95% CI 2.8% to 3.3%) reported that they actually did; a dissonance of 22.9% (95% CI 19.1% to 26.6%). Self-reported smoking was not significantly different between schools (p=0.064), however, perceptions of year group smoking was significantly different across schools (p<0.001). Qualitative analysis identified full school engagement, minimal teacher time requirements, pupils' belief in questionnaire results and understanding wider context, as key in optimising implementation.

Conclusion: This study shows significant dissonance between self-reported and perceived smoking among peers in secondary schools, thus supporting a key premise of social norms theory. Implementing SNAs and studying effects is feasible within secondary schools.

Drinking in later life, health and social transitions: findings from the ELSA study

Hynek Pikhart, Clare Holdsworth, Martin Frisher, Marina Mendonsa, Nicola Shelton, Cesar Oliveira

Background: The contribution of alcohol consumption to inequalities in health is paradoxical, particularly among older drinkers for whom there is a significant relationship between drinking and good health, as well as between drinking and wealth. This relationship is challenging for recent public health campaigns that have identified drinking in later life as a cause for concern and called for lower recommended weekly limits for older people. In this paper we present the findings of an ESRC-funded longitudinal study of drinking in later life, using the English Longitudinal Study of Ageing, to establish the relationship between drinking in later life, life course transitions, socio-economic characteristics and health.

Methods: The analysis is based on data from 3653 men and women aged 50-99 years participating in English Longitudinal Study of Ageing (ELSA) with valid longitudinal data between waves 0 and 5. We constructed health-, work- and marital transitions for each individual and assessed their role in changes in drinking habits during first five waves of ELSA using multilevel regression modelling.

Results: Our findings show that alcohol consumption decreases with age, and it decreases more among those with high levels of consumption at the beginning of the period of observation. Both marital and retirement transitions influence magnitude of alcohol consumption decline over the years of the study. Preliminary results also suggest that gender might be an important effect modifier as the factors associated with changes in alcohol consumption in later life are different for men and women and we consider the reasons for these gender differences.

Discussion: Our analysis argues for the importance of a life course approach to drinking, that to understand drinking in later life it is important to put this into the context of life course experiences and transitions rather to focus on age-specific interventions.

Understating high rates of smoking in pregnancy in one quarter - an audit through maternity

Isobel Duckworth, Trevor Parkin, David Hardy

Our local area has one of the highest rates of smoking in pregnancy in England. Quarter 2 (2013/14 ) data showed that 26.2% of mothers were smoking at time of delivery compared to 13.7% in the neighbouring authority/hospital site serviced by the same midwifery and stop smoking service. Therefore we needed to understand the local situation in more detail.

Aim: The aim of the audit was to identify if the smoking status of pregnant mothers is being accurately recorded at the time of delivery and to identify what improvements could be made to the assessment and recording of smoking status.Design Public health paid for some time of a midwife to undertake an audit of notes for that period checking data with the stop smoking service where necessary.

Setting: The audit was carried out during March 2014 in one maternity unit in England. Results Of those identified as a smoker at time of antenatal booking some women had to be removed as they were out of area - leaving 142 notes. Of these only Only one of the 142 women identified as a smoker at booking in was identified as a non smoker at delivery in midwifery records. This was inconsistent with that information provided by the stop smoking services who identified at least 9 women had quit during that time. Other inconsistences were shown when cross referencing data between handheld records, CMIS and postnatal records.

Conclusion: The audit identified a number of areas for improvement and an action plan to address these points was developed by the head of midwifery with public health.

NW Directors of Public Health - Public Health Manifesto

Matthew Ashton

Over the next 12 months, running up to the May 2015 general election, the country's political parties will develop their manifestos, setting out their intentions for the next 5 years. The North West Directors of Public Health would like to challenge all politicians to have clear objectives and statements, and in particular within their manifestos, in support of creating good health and well-being for people living in all parts of the UK. The directors of public health in the north west have been working on collaboratively developing and agreeing their own manifesto which will be used to influence cross party political agendas, and hopefully be included in future plans.

The development has been led by the DsPH and has included views and comments from the wider public health system. The content includes 'unfinished' or 'on-going' business, such as Minimum Unit Price and Active Travel - subjects on which the public health family have campaigned and advocated for many years; where the evidence base is clear but political will and support is needed for implementation. Also included are ideas which are much more future focussed and the directors, as system leaders, fighting for good health within their local communities, are providing a steer and direction for healthy policies, both at national and local level.The North West Directors of Public Health's Manifesto sets out 10 priority areas and actions that should be taken to address the issue.