International Festival of Public Health

S 1 - Health Promotion and Improvement Abstracts

Sexual orientation identity and symptoms of common mental disorder: Individual Participant Meta-Analysis of 6,474 cases among 31,474 individuals pooled data from nine UK health surveys

Joanna Semlyen, Gareth Hagger-Johnson

Aims. To determine the association between sexual orientation identity and risk of common mental disorder symptoms such as anxiety/depression, among adults in the UK.Design. Individual Participant Meta-Analysis of 31,474 individuals with 6,474 cases (21.0%).

Setting. Pooled data from nine UK health surveys (Health Survey for England 2011, 2012, Scottish Health Survey 2008 to 2012, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12).

Participants. Participants were classified as lesbian/gay (n = 319), bisexual (n = 341), 'other' (n = 238) or heterosexual (n = 30,576).Results. Adjusting for age and sex and allowing for between-study variance, adults identifying as lesbian/gay (OR = 1.95, 95% CI 1.45, 2.35), bisexual (OR = 2.33, 95% CI 1.87, 2.92) or 'other' (OR = 1.40, 95% CI 1.04, 1.90) were at increased risk of disordered symptoms compared to heterosexuals. Further adjustment for ethnic minority status, educational attainment, smoking, alcohol use and longstanding illness/disability removed the association for the 'other' group (OR = 1.30, 95% CI 0.96, 1.77) but the association for lesbian/gay (OR = 1.77, 95% CI 1.38, 2.27) and bisexual (OR = 2.20, 95% CI 1.75, 2.77) identities remained.

Conclusions. LGB adults, and particularly bisexual adults, are at increased risk for common mental disorder symptoms. We will examine whether effects differ for men/women, ethnic minorities and different age groups. Sexual orientation identity should be monitored routinely in population health surveys and clinical settings, to allow us to gain knowledge about health inequalities and thus comply with equal opportunities legislation.

The new vision for Public Health -using the Three Horizons model to identify the emergent practice that will address the social determinants of health

Paula Wheeler, Wendy Meredith, Alison Giles, Gill Sadler, Jude Stansfield

A group of pioneering public health practitioners in the North West of England, together with the International Futures Forum (IFF), has been looking for ways to respond effectively and positively to today's public health challenges. The main impetus for the work was the Marmot review of health inequalities Fair Society Healthy Lives.

The group was concerned that Marmot's goals would not be achieved by a society that was focused on economic growth and by a health system dominated by the medical model. What should the public health practice of the future look like to address the social determinants of health and create balance between economic, environmental and wellbeing outcomes? The group used the IFF's Three Horizon thinking to frame its discussions. This approach encourages reflection on public health approaches that are reaching the end of their lifetime, recognition of those approaches that are gaining momentum and shaping the 'now', and identification of emergent ideas that, if championed, will become the public health practice of the future.

We called the story that emerged from our work the 'New New Public Health' or N2PH for short, a reference to the seminal work of Ashton and Seymour in the 1980's on The New Public Health. We have produced a workbook to support reflective practice on the social determinants among public health practitioners and the story has also been released as an animation, narrated by Professor Lord Robert Winston. Both outputs will be available to delegates during the conference.

Do UK television alcohol advertisements abide by the Code of Broadcast Advertising rules regarding the portrayal of alcohol?

Rebecca Searle

Aims: The aim of the study was to assess the extent to which members of the UK general public perceive television alcohol advertisements to comply with the regulatory code governing these: the Advertising Standards Authority Code of Broadcast Advertising (BCAP Code). The Code provides a general principle and 16 rules to prevent such adverts implying, condoning or encouraging immoderate, irresponsible or anti-social drinking.

Methods: Quota sample of 373 adults, representative of the UK population aged 18–74 years in terms of age and gender, were recruited at Manchester Piccadilly train station. Participants were shown one of seven advertisements that had been broadcast in the previous month on the two leading commercial television channels, and then completed a questionnaire with 40 statements representing the BCAP Code rules.

Results: Overall, 75% of the participants rated the advertisements as breaching at least one rule from the BCAP Code. Breaches were observed for all the seven advertisements, ranging from 49 to 91% non-compliant. Rules regarding alcohol being presented as contributing to popularity or confidence, and implying that alcohol is capable of changing mood, physical condition, behaviour, or as nourishment, were seen as being breached by over 50% of participants.

Conclusions: A clear majority of the UK general public perceive alcohol advertisements to breach the BCAP Code, suggesting that the current regulatory system for UK television alcohol advertisements is inadequate.

To What Extent Can Primary Care Teams Play a Role in the Prevention and Management of Childhood Obesity?

Rhiannon George-Carey

Background. Childhood obesity is a major public health problem, which is predicted to affect 25% of under-16 year olds by 2050. Levels in Stockport are below the average but still affect 8% and 17% of Reception and Year 6 children, respectively. Childhood obesity causes serious immediate and longer-term health problems, and the financial implications are substantial.

Discussion. It is not recognised as a priority in primary care teams (PCTs) despite the advantages of prevention and treatment in this setting. Awareness of the problem and a positive attitude towards tackling it are critical for effective management. Therefore, appropriate training is key. PCTs should signpost to and collaborate with initiatives in the community as GP backing encourages participation. Treatment needs to be multi-disciplinary, family-based and tailored to each patient, and long-term support should be given. Recognition of high-risk children is vital for prevention, and women need to be educated about certain behaviours during pregnancy that can affect the child's future risk of obesity.

Conclusion. Although there are barriers to effective management in PCTs, such as time limitations and lack of parental motivation, primary care can play an integral role in addressing the childhood obesity epidemic through: (i) raising awareness; (ii) collaboration with local resources; (iii) tailoring interventions; and (iv) educating women in pregnancy. However, insufficient training and apathetic attitude mean that it is often viewed as a lesser priority among PCTs. Education is therefore critical in improving its management in primary care.

Are we HIV doctors or GPs? How we worked together to improve safety and equity for HIV+ people accessing HIV care and primary care in Greater Manchester

Sarah Stephenson, Margaret Kingston, Penny Cook

Nearly 5,000 people diagnosed with HIV live in Greater Manchester, and there is an approximate annual 10% increase in HIV cases. The Greater Manchester Sexual Health Network (GMSHN) brings together commissioners, clinicians and non-statutory organisations involved in patient care. As the move from hospital collected to home delivery of HV medication was undertaken in 2008, it was noted by the GMSHN that significant numbers of HIV patients were obtaining medications more appropriately prescribed in primary care from their HIV physicians. In most cases this was due to patient's familiarity with the HIV centre, convenience for them, and to manage drug interactions. However, this was leading to lack of engagement with primary care, and prescribing of drugs outside the expertise of the treating physician. In additional, as HIV infection has moved from a severely life limiting to a long term chronic condition, engagement of HIV positive patients with their GPs is crucial.

We introduced a shared care model with GPs, with these goals:

• Reduce inappropriate prescribing in HIV clinics, e.g. Benzodiazepines
• Manage the risk of drug interactions
• Increase GPs’ knowledge to promote HIV testing and increase early diagnosis
• Encourage patients to register with a GP and disclose their HIV status

Resources produced to support this change include:

• List of ‘do not prescribe’ drugs
• Statin interaction flowchart
• Trouble-shooting telephone directory
• Patient information, coaching and feedback sessions
• ‘How to register with a GP’ leaflet

Partnership working to deliver this change has been essential and the synergistic working relationships fostered by the GMSHN helped achieved this. Patient engagement and involvement was also crucial, and this was taken forward by George House Trust (GHT), a local patient support agency, GPs and GU consultants to produce resources and champion the change.

A list of agreed HIV related medications was produced for treating clinicians to adhere to, and it was introduced to the clinics at the start of 2009. The effectiveness of this intervention was evaluated by comparing the proportion of drugs prescribed by HIV clinicians not on the agreed list before and after its adoption. At Manchester Royal Infirmary, one of the largest HIV centres in the region, this was 4.3% in 2007/08 and 0.5% in 2011/12, demonstrating a significant change in prescribing practice.

Population Centered Segmentation

Sue Cumming, Joy Wyche

Understanding people is paramount in being able to provide solutions and services that people will be receptive to and take action from and therefore reduce health inequalities. A key point that should be noted is that populations are not homogenous and one size does not fit all. Therefore we also need to understand subgroups of the population and focus resources where they are most needed and the biggest differences can be made.Public Health Liverpool has adopted the DoH's Healthy Foundations segmentation model since 2011. The model explores the relationship between health outcomes, environment and personal motivation and identifies five segments within the population. The most challenging segment, 'Unconfident Fatalists' has higher prevalence of smoking and obesity and is the most likely to have mental health issues. This group lacks motivation and has largely given up on life. These are the people who would most benefit from lifestyle change. However change will almost certainly require more help and support than information alone can provide. In Liverpool, Healthy Foundations has been used to develop behavior change strategies, market services more effectively and to improve service design. For example we are looking at self-care pathways, for a number of long term conditions. This approach has allowed commissioners to understand the differing needs of each segment, and what interventions are most likely to influence them to better self-manage their condition and lead healthier lifestyles. Behaviour change success using the model includes increasing early presentation of the signs and symptoms of Bowel cancer by 19%.

An Introduction to Brook's Integrated Health and Wellbeing Approach

Helen Corteen, Geoff Holliday

Brook delivered a Pilot project within Blackburn to identify ways in which our core offer to young people can be effectively extended to address a wider range of health and wellbeing issues focussing on mental/emotional health and wellbeing. Investing in Resource Based Therapies, Brook has developed and delivered an evidenced based brief intervention approach 'Love Life' aimed at supporting young people to make choices and set goals around managing risk, contraception, STI's and relationships.We have delivered a series of 3 session programmes to 5 tutor groups within Blackburn College as part of their personal development tutorial programme with approximately 100 young people aged between 18 and 20.

Following the discussions about what it means to be healthy well and happy, three quarters of the young people were immediately able to identify an area of their lives which they would like to improve, with 80% of those able to identify an action they could take to improve things. Using Motivational and Goal Focussed Coaching techniques engages young people extremely well and is a good fit with our existing needs led rights based approach and will be integrated across all service areas within Brook. This approach elicits no resistance from young people; they actively enjoy it and if applied rigorously, supports young people to arrive at their own goals which care for themselves without this being imposed by adults assessing young people's care needs. In addition to the expected health behaviour outcomes we are starting to see improvements in attendance and educational attainment; these are the elements this presentation will focus on.

Inactivity and the Urban Environment, Structuring our Cities to encourage Physical Activity through Active Travel

Eleanor Roaf, Vincent Goodwin

Lack of physical activity, obesity and poor air quality are major health issues this century. Most adults do not meet the weekly recommended levels of physical activity. Cycling or walking as part of every day journeys represent ideal opportunities to incorporate regular physical activity into every day lives bringing population benefits in increased physical and mental well being.However, all too often our cities and infrastructure impede active travel rather than facilitate this. How can we create an urban landscape that encourages physical activity throughout active travel?

This short oral presentation will look at the issues driving choices in travel behaviour and look at ways of introducing measures to encourage active travel. If we could redesign urban environments with people rather than cars at the centre of planning then the benefits will be huge. The health benefits of regular physical activity are well documented but there are other wider benefits to reduction in car use in urban areas such as better air quality, economic regeneration and better social cohesion, which all have positive impacts on public health. Cyclists are also the happiest commuters.Yet despite this we have not got there yet. How do we create a vision and political will that will create change and improve the urban environment, making active travel the preferred choice? We will discuss our local work developing 'Sustrans' Pocket Places', a project that is delivering change through community consultation and direct action through temporary street design.

Heroin and Hepatitis?

Jo Baxter

Treatment options for hepatitis C are improving and expanding rapidly. They are set to offer an unprecedented increase in cure rates to in excess of 90% when approved for public use. Cost will be the biggest obstacle for widespread provision of these new therapies. The largest burden of HCV infection in the UK and globally is found in the injecting drug using population. Treatment uptake in this group remains low for many reasons, linked both to the physicians and the patients.

This review of the literature looks to examine potential barriers to treatment in the injecting drug users, justification for offering treatment to this group and touches on whether elimination of HCV may be possible.