International Festival of Public Health

LT 4 - Health Promotion and Improvement Abstracts

The Anaesthetic Room - The Good, The Bad and The Ugly

Michael Bourke, Elias Delis

It is common practice in the UK to anaesthetise patients in an anaesthetic room, but many other countries, such as the USA, Australia and Canada, have abandoned this practice and now anaesthetise patients in the operating theatre. The first reference of an anaesthetic room within the UK literature if from 1860 and still remains large in British literature, however, through 50s and 60s there was a decline in the use of anaethetic rooms in America, until it eventually disappeared during the 1970s. This presentation reviews the literature on anaesthetic room, presenting the advantages (the good), the disadvantages (the bad) and the consequences when things go wrong (the ugly).

White cider; trade down at what cost?

Jan Gill, Jonathan Chick, Heather Black, Cheryl Rees, Fiona O, Robert Rush, Barbara McPake

Aims: to:1.Provide descriptors of the alcohol intake of heavy drinkers who consume white cider in two Scottish cities.2.Contrast these findings with those of heavy drinkers not consuming white cider but recruited simultaneously at the same city sites.3.Compare this data with that of heavy drinkers, also consumers of white cider, but recruited at similar settings four years earlier.Design: Cross sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012 and with data collected within Edinburgh during 2008-09.

Setting: NHS hospital clinics (in- and out- patient settings).Participants: 639 patients with serious health problems linked to alcohol, 345 in Glasgow, 294 in Edinburgh.

Results: White cider drinkers drank significantly more alcohol than other heavy drinkers. Typical weekly consumption was 249 UK units per week, paying a median unit price of 17 pence per UK unit. White cider drinkers were younger and more likely to be male, when compared to those heavy drinkers not consuming white cider. Comparison with data collected in 2008 suggested that drinkers had maintained consumption levels in the intervening period.

Conclusions: The continued availability of cheap off-sale drinks enables many heavy drinkers to 'trade down' and maintain their high consumption with little increase in expenditure despite population-wide reductions in affordability partly due to increases in the average price of alcohol. Several factors relating to the consumption of this drink may compound the potential detrimental impact on the consumer.

Making Every Contact Count (MECC):Increasing Public Health Capacity of frontline workers in Tameside

Karan Thomas, Kate Benson, Val Andrews

Aim: We have completed Year 1 of an ambitious three year MECC programme.The aim is to equip all front line workers with the skills, resources and crucially the confidence to raise the issue of healthier lifestyles consistently with all the customers/clients they have contact with.

Design: The MECC programme was designed to build on the assets of local people, to expand community cohesion and resilience and increase self-care and independence.•A calendar of training was established and 10 TMBC departments self-selected to lead the initiative - staff were trained using a variety of training models to suit service delivery; Training supported by the production of high quality public and professional resources; Key strategic Health and Wellbeing Board partners engaged through briefings and high profile launches; Elected members engaged with bespoke training

Settings: Year 1 TMBC focused: Customer Care and Advocacy, Neighbourhood Services, People and Workforce Development, Adult Services, Operations and Greenspace, Waste Services, Early Years, Education and Training. Voluntary Sector, Social landlords, probation. Results Year 1 •Over 400 staff trained from 13 organisations. Public and professional resources were collaboratively developed and market tested. •21 MECC Trainers were trained and fully equipped to deliver MECC sessions in house; MECC Champions were trained. •MECC short film developed for use in public spaces highlighting local success stories•Impact evaluation found a 60% increase in number of 'health conversations'.

Conclusion: Enormous appetite for involvement in positive health promotion campaigns across all sectors; Detailed evaluation and managerial support crucial; Establish support network; Engage large volunteer workforce

Evaluation of a public information campaign aimed at raising awareness of obesity

Karen Beattie, Gillian Gilmore

Background: The most recent Northern Ireland strategy, 'A Fitter Future For All', aims to reduce obesity levels by 4% in the next decade1. Subsequently, the Public Health Agency developed 'Choose To Live Better', a public information campaign to raise awareness of what constitutes being overweight/obese, personal weight status and lifestyle.

Aim: The evaluation aimed to determine campaign impact on knowledge of obesity related issues, and lifestyle changes.

Methodology: Following implementation of Choose To Live Better, a face-to-face household survey was conducted in 2013 with 1019 people, representative of the Northern Ireland population (with quotas for gender, age, social class and geographical area).

Results: 21% of those exposed to Choose To Live Better correctly identified maximum recommended waist sizes, compared to 2% of respondents who had not seen campaign materials (p<.001). Exposed individuals were also more aware of overweight/ obesity prevalence, compared to those unaware of the campaign (31% and 22% respectively; p<.001). Moreover, campaign exposure was linked to weight loss attempts, with those who had seen the campaign twice as likely to have tried to slim down as those who hadn't (41% and 19.5% respectively; p<.001).

Conclusions: In order to reduce obesity levels (as stipulated in A Fitter Future) 1, the public need to be better informed as to how to recognize weight status correctly, and supported to make necessary lifestyle changes. These results suggest that a public health campaign can communicate these messages effectively, raising public awareness of obesity issues, and facilitating small lifestyle changes to enable weight loss. References 1. Department of Health and Social Services and Public Safety (DHSSPSNI). A Fitter Future for All. Consultation report. Obesity prevention framework for Northern Ireland. 2011-2021. Belfast, DHSSPSNI, 2010.

Weighing and measuring children in Early Years day-care settings: an opportunity to identify overweight and obesity before Reception-age

Katrina Stephens, Amy Ashton, Gillian Maudsley

Aim: To investigate current weighing and measuring practice in local authority day-care settings, to inform weighing and measuring practice in Early Years day-care settings.Design: Mixed methods study design, complementing quantitative analysis of height and weight data with semi-structured interviews involving day-care staff.

Setting: The study focused on quantitative data collected by staff from day-care settings in an urban local authority (Manchester, North West England) and interviewed them. Method: Descriptive and paired data analysis explored the quality of weight and height data from 20 day-care settings. Nine semi-structured interviews involved staff from five settings.

Results: Quantitative data suggested high prevalence of overweight and obesity in children (81/271, 29.9%), but day-care staff did not process, interpret, or act on the data. Day-care settings faced challenges in measuring young children accurately, due to unsuitable equipment and inconsistencies in practice between staff. A multi-agency group developed a protocol for weighing and measuring children in day-care settings; 19 day-care settings implemented this protocol (January 2013). Training and equipment were provided to settings adopting the protocol. Of children weighed and measured in March 2013, 89/546 (16.3%) were above the 91st centile, with 56/89 (62.9%) referred to weight management services or health visitor (none having previously accessed weight management support).

Conclusions: Early Years day-care settings can play an important role in promoting healthy lifestyles, and identifying early the children who are not a healthy weight is crucial. With provision of suitable equipment and training, it is feasible to weigh/measure children meaningfully in this setting.

Addressing cancer fear and fatalism

Lanne Crook, Gwen Kaplan, Gillian Kilgour

Every year in the UK, over 300 000 people are diagnosed with cancer. Yet more people are surviving the disease nowadays. Survival rates have doubled in the past 40 years and half of people diagnosed with cancer now survive at least ten years. Through our seven years experience of talking to the public, we know some believe cancer is still a death sentence and don't want to know if they have it. We also hear echoes of this belief from some working in the health profession, who have a remit to encourage people to adopt healthier lifestyles and seek help early if worried about a symptom.Fear and fatalism around cancer has been associated with a variety of negative beliefs about cancer outcomes and with avoidance of cancer information. This can stop people from making changes towards a healthier lifestyle and from seeking help if they notice possible signs or symptoms.

Cancer Research UK's Talk Cancer workshops equip front-line health staff to promote cancer awareness messages. The aim is to challenge negative perceptions, address myths and share our experience of talking to the public about cancer. Those who attend Talk Cancer are working in the community, for example pharmacists, nurses, HCAs and healthy lifestyle advocates, including those working in deprived groups.Pre and post training, trainees are asked to write down the first word that comes into their head when they hear the word 'cancer'. Results show the most common initial responses are related to 'death' or 'fear'. Post-training we see a shift in attitudes with the most common responses being related to 'hope' or 'survival'.

Delivering Large Scale Alcohol IBA Training in Liverpool

Karan Thomas, Val Andrews

Delivering Large Scale Alcohol IBA Training in Liverpool The aim of the public health intervention was to contribute to a reduction in alcohol related harm in the population of Liverpool. In 2010 Liverpool had the highest number of alcohol-related hospital admissions in the UK. A large scale training programme was introduced to equip all frontline workers in Liverpool to be able to conduct an IBA (Identification and Brief Advice) to their client population.

The training was offered in a 3 hour format with general training and bespoke courses being provided in a comprehensive training calendar. During a 30 month period 1,400 frontline workers were trained.Liverpool's approach was to offer the training to a wide variety of organisations and services and as a result 94 organisations were involved in some way. In 2011 a further training project was undertaken specifically for staff of primary care and by March, 2013 all 97 GP practices in Liverpool had received alcohol training/briefings and specially designed resource kits.

A celebratory conference was held in March, 2013 which attracted over 100 trained frontline workers. The conference was opened by the Mayor of Liverpool and celebrated the efforts of frontline workers to contribute to alcohol harm reduction. Liverpool has now dropped to fifth in the hospital admissions table.The conference was used to highlight the on-going support required to maximise the trained and resources available to 1,400 frontline workers. Training is set to continue in 2013/14.

Promoting Responsible Alcohol Retailing: City Centre 'Reduce the Strength' pilots

Liz Burns

To reduce alcohol-related problems in an anti-social behaviour hotspot, a 'Reduce the Strength' initiative was piloted as part of a partnership approach to promoting responsible alcohol retailing by local authority, police and public health officers. Off-licences were invited to voluntarily stop selling high strength beers, lagers and ciders at 6.5% abv or above and 'Responsible Alcohol Sales' training provided free of charge.The DPPO was also reinforced both at point of sale as well as in the community with high visibility joint patrols.

At 6-12 month follow-up, retailers were revisited to thank them for their engagement, monitor participation and capture feedback. The project setting was a defined area of Manchester city centre with a total of 23 off-licensed premises eligible to participate. At 6 months, 70% (n=16) of off-licences were contributing to the pilot. This included premises who had partially or fully removed relevant products as well as those who were not selling at baseline.

Overall alcohol-related crime and incidents reduced by 41% when compared to the same six months in the previous year. This reduction was over 2.5 times more than the rest of the city centre. Results suggest that alcohol-related problems may have reduced as a result of the specific factors operating in the area: removal of high strength beers, lagers and ciders; proactive engagement with retailers; reinforcing the DPPO; and follow-up monitoring. The project highlights the value of Integrated Neighbourhood Teams working with public health to deliver multi-component programmes to reduce harm in and around licensed premises.

The role of GP brief intervention in known patients using excessive alcohol

Sadhia Khan, Rebecca Connell

Background: It is well known that excessive alcohol consumption is associated with serious adverse health outcomes. General Practise (GP) is suggested to be a suitable place to identify these patients. The World Health organisation (WHO) developed the Alcohol Use Disorders Identification Test (AUDIT) over a period of two decades as a simple method of screening and to assist in brief assessment.

Aim: The aim of this audit is to identify those patients who drink alcohol excessively and evaluate the effect a brief GP intervention has on consumption.

Method: This audit was carried out at Partington Health Centre. Patients who had discussed excessive alcohol use between: March 2013 and March 2014 were identified on the surgeries EMIS software. If available the following was noted from their two most recent consultations when the AUDIT questionnaire was undertaken: date as to when the consultations occurred; AUDIT scores; intervention used; units of alcohol consumed per week.

Results: of the 86 patients identified 51 were included. AUDIT scores were affected by brief intervention as follows: 6 patients' scores did not change; 28 patients' scores decreased and 16 patients' scores increased. Units of alcohol consumed changed as follows: 3 patients' consumption remained same; 11 patients' consumption increased and 27 patients' consumption decreased.

Conclusion: This audit documents that the use of brief intervention is more likely to change patients' drinking habits in a beneficial manner. It has also highlighted areas of implementation which can be improved.