International Festival of Public Health

S 3 - Transdisciplinarity Abstracts

Working for Health Equity: The Role of Health Professionals

Matilda Allen, Jessica Allen

Those in the health sector regularly bear witness to, and must deal with the effects of the social determinants of health on patients, their families, and wider communities. This presentation will demonstrate that (non-public health) health professionals have an important and otften under-utilised role in reducing health inequalities through action on the social determinants of health. The health workforce are, after all, well placed to initiate and develop services that take into account, and attempt to improve, the wider social context for patients and staff.

The presentation will be based on the 2013 publication 'Working for Health Equity' (http://www.instituteofhealthequity.org/projects/working-for-health-equity-the-role-of-health-professionals), which was produced in collaboration with over 19 Royal Colleges and other professional organisations. The subsequent work of the UCL Institute of Health Equity will be described, particularly in the area of education and training. Examples of successful interventions and case studies will be presented, alongside recommendations for future action. These recommendations are based on professional involvement and a large scale literature review, and cover the areas of:

1. Workforce Education and Training

2. Working with Individuals and Communities

3. NHS Organisations

4. Working in Partnership

5. Workforce as advocates

6. The Health System: Challenges and Opportunities

Dose-response relationship between alcohol consumption, major coronary disease, and all-cause mortality; does adiposity make a difference?

Aleksandra Herbec, Steven Bell, Eric Brunner

Background: Moderate alcohol consumption may not be cardioprotective among all individuals. We assessed whether adiposity moderated the relationship between alcohol consumption, coronary heart disease (CHD) and all-cause mortality (ACM).

Methods: A prospective study (Whitehall II study) with median follow-up of 17 and 19 years for major CHD and ACM, respectively. The analysis was based on 6797 (30.5% female) participants who at baseline (1991-1994) were aged 39-63 and free from cardiovascular disease, diabetes and cancer. Adiposity was assessed through body mass index (BMI; high BMI≥25) and waist-to-height ratio (WTHR; high WTHR≥0.5). Participants were divided into never, infrequent, moderate, and heavy drinkers. The data were modeled using survival analysis.

Results: There were 286 major CHD and 624 ACM events. Alcohol and adiposity were independently predictive of events, and there was an indication of adiposity moderating the alcohol-event relationship. Among those with low adiposity (BMI<25) never and infrequent drinkers had increased risks of CHD (HR=2.93, 95% CI=1.37-6.27; HR=1.82; 95% CI=1.15-2.87, respectively), and heavy drinkers of ACM (HR=1.45, 95% CI=1.06-1.99) in comparison to moderate drinkers. However, among those with high adiposity levels only infrequent drinkers in BMI models had increased risk of CHD (HR=1.58; 95% CI=1.06-2.37). The other alcohol groups in BMI and WTHR models did not have significantly greater risks of major CHD or ACM than moderate drinkers.

Conclusions: Adiposity is more strongly associated with health outcomes than alcohol consumption, and the cardioprotective effects of moderate alcohol consumption are not evident among overweight individuals. Adiposity should be considered in the future alcohol guidelines.

Job strain as a predictor of retirement transitions and intentions: initial results from five waves of ELSA

Ewan Carr

Aim: To examine whether job strain (high demands, low control) is associated with either (i) retirement transitions or (ii) retirement intentions.

Design: Panel data for 6,163 male and 6,638 female employees aged 40-80 drawn from a representative English sample (the English Longitudinal Study of Ageing; baseline in 2002, biennial follow-ups till 2010). Only respondents employed in at least one wave are considered. Retirement transitions refer to moves from employment to retirement, where the latter is defined by self-reported economic activity, working hours and income (analysed using event history analysis). Retirement intentions are derived from employees' preferred retirement age and their age at interview (analysed using multilevel regression).

Main results: Job demands were associated with an increased likelihood of becoming retired and with preferences for earlier retirement. Adjusting for demographic variables and health status, the odds of retirement were 1.25 (95% CI 1.10 to 1.42) times higher for employees agreeing with the statement I have to work very fast , compared to those who disagreed. Workers reporting constant time pressure preferred to work 0.39 (95% CI 0.15 to 0.62) years less than those not reporting pressure. Job control was associated with preferences for later retirement, but not retirement transitions. Notably, these relationships were strongly dependent on age. Working conditions were much more important (as a determinant of retirement) among older workers than younger ones.

Conclusions: Job demands and control were associated with retirement transitions and preferences, particularly for older workers. This highlights the importance of good working conditions to extend working life.

'Workplace health in small medium enterprises (SME). What public health support do SMEs really want?'

Maxine Holt, Susan Powell

Background: Research into small, medium sized enterprises (SMEs) workplace health is limited. The issue of concern regarding SMEs access to appropriate health and wellbeing services is highlighted (Black 2008). North West England has discernible health inequalities attributed to levels of economic activity and sickness absence in the region, is amongst the highest in the country (Sedgley & Dooris 2007). This illustrates, the specific challenges that the North West faces and why work is an important issue for the public health workforce in the region. The purpose of the study was to explore:•The main health and wellbeing needs of a cohort of SMEs in Greater Manchester

Method & Analysis: This commissioned qualitative study was carried out with 97 SMEs across Greater Manchester. The aim was to assess the main health and wellbeing needs of SMEs in Greater Manchester. Telephone interviews were used to gather data and thematic analysis used to analyse interviews.

Findings: Employees will present at work with acute illness that requires rest, is easily transmitted to other employees, will take longer to recover from as cross infection and re-infection occur. Public health preventative services such as the provision of flu vaccines in the workplace may be one way of supporting SMEs with acute seasonal episodes of illness.

References: Black C (2008) Review of the health of Britain's working age population. Working for a Healthier Tomorrow. Department for Working Pensions. London HMSO. Sedgley L & Dooris M (2007) North West Regional Workplace Health Strategy. University of Central Lancashire: Preston.

Health Promotion Training for staff prompts self health evaluation

Gary Bickerstaffe

There have been calls for all frontline health staff to be trained to deliver brief advice. This is meant to capitalise on an opportunity to assess if a patient can be given some simple advice, signposted somewhere else or referred to another service. This has concentrated on lifestyle issues such as smoking, alcohol use, weight, diet and physical activity. At the same time there have been calls to improve employee health and to use the workplace as an opportunity to engage staff in evaluating their own health needs and potentially challenge behaviours that are considered to be harmful to health.It is difficult to direct specific information or advice at staff themselves within a workplace setting. However we have found that by implementing training for staff to deliver brief advice they are being indirectly prompted to evaluate their own health needs.

We looked at this response by asking over 400 staff who attended Health Promotion Brief Advice training if they felt that it had made them think about their own health? A significant majority 74% reported that it had; 11% were Not Sure and 15% said No. The issues staff say they would like to change in prioritised order are: Exercise Weight Diet alcohol mental well being and smoking. Staff often made multiple choices when indicating the lifestyle they consider to need some attention. The most common multiple responses were for Diet, Weight, & ExerciseWhilst overall mental wellbeing has not scored as highly it has increased over recent months.

This potentially offers a win-win situation for healthcare employers when staff are 'skilled-up' to help patients think about lifestyle. Staff are prompted to evaluate their own health against specific lifestyle guidance.Presentation of the data may offer the chance to discuss the potential benefit of wide scale implementation of this type of training.

A content analysis that investigates how shisha pipe smoking is portrayed on YouTube.

Liz Johnston

Shisha pipe smoking, although an ancient cultural tradition in the East, has in recent years experienced growing popularity in the Western world. It has become a growing concern for public health departments as emerging evidence sheds light on how harmful it is. The focus of this research is to find out how shisha pipe smoking is portrayed on YouTube in terms of how popular the videos are, what types of videos they are, identify the most common messages about shisha pipe smoking in these videos and look for any evidence that these videos are being used to market shisha tobacco brands.

This study is important in order for public health departments to formulate responses to this growing concern. The research approach adopted in this dissertation was content analysis and a sample of one hundred and twenty six videos were analysed. The findings from this research provide evidence that the videos are popular (judged by the number of views they have), they are in the majority positive about shisha pipe smoking (portrayed as attractive, fun, powerful, pleasurable, relaxing or sexy) and that they not only advertise tobacco products, but numerous other shisha related products too. This dissertation recommends that public health departments use YouTube videos in health campaigns, that Governments around the World start to think about how websites like YouTube can be regulated for tobacco content and that YouTube itself reviews its own policies with regard to tobacco content allowed.

keywords: Shisha, hookah, YouTube, smoking, internet.

Legislation and regulation of the waterpipe tobacco industry: a global analysis

Mohammed Jawad

Introduction: Waterpipe tobacco smoking (known in the UK as shisha ) has grown in worldwide prevalence since the mid-1990s. In contrast to the cigarette industry, little attention has been given to waterpipe industry regulation and legislation. This study aimed to summarise worldwide waterpipe tobacco legislation and regulation in comparison to cigarettes.

Methods: In April 2014, the following sources of information were searched: peer-reviewed literature, grey literature and tobacco control law websites. There were no search restrictions.

Results: In the UK, waterpipe tobacco smoking is not exempt from tobacco control laws, although in some US states and regions of Canada there are smokefree law exemptions. In the EU and US, waterpipe tobacco is exempt from bans on flavoured tobacco. In the US, waterpipe tobacco is taxed at a lower rate than cigarette tobacco. The US Food and Drug Administration (FDA) has recently decided to regulate watepipe tobacco in terms of its chemical content and application of health warnings. In the Middle East, minimum distance laws exist between waterpipe cafes and educational establishments. In parts of Pakistan and India, legislation has banned public waterpipe cafes due to health risks. In Malaysia, there is a religious edict branding waterpipe tobacco smoking sinful. These, and others, will be discussed in more detail within the context of an evidence base.Conclusion: Wide variation exists in national- and regional-level legislation in the waterpipe tobacco industry. It appears broadly exempt from cigarette tobacco control laws in most countries. This is a public health concern that should be addressed.

A Multilevel analysis of Individual and Contextual socioeconomic correlates of cigarette smoking among women in Nigeria.

Tolulope Odeyemi, Olatunde Aremu

Background: Currently there is an upsurge in the number of non-communicable related disease and deaths in most low and middle income countries. Cigarette smoking is one of the known risk factors for non communicable diseases. Male and female alike may be at increased risk of exposure to tobacco use via cigarette smoking. Several factors such as occupation and education have been associated with cigarette use among women in high income countries. However, the presence of widespread poverty which is pervasive in most low-and-middle income countries masks the socioeconomic gradients in cigarette smoking among women in LMICs.

Objectives: To assess socioeconomic correlates of tobacco smoking among women in Nigeria from a multilevel perspective.Methods. A multilevel analysis was conducted using the data from a nationally representative sample of 15,350 women aged 15-49 years from across Nigeria based on the most recent Demographic and Health Survey.

Results: Of the 15,350 women included in the analysis, about 19% are active cigarette smokers. Cigarette smoking is associated with several measures of socioeconomic status at both individual and community levels. Having a full time occupation, high educational attainment, belonging to a richer household wealth and residence in a economically deprived community are strong determinants of cigarette smoking among women. .

Conclusion: The prevalence of cigarette smoking which is associated with socioeconomic status is very high among Nigerian women of reproductive age. Any initiatives aimed at control illicit cigarette smoking should aim at reducing economic hardship among the women and the communities where they reside.

The Burden of Hospital-Acquired Pneumonia (HAP) in South-East, Nigeria

Oli Angus N, Ekejindu CC, Oli AH, Ejiofor SO, Ibeh CC

Background and aims: Nosocomial pneumonia occurs in several different patient groups and most important are patients on ventilators in intensive care unit where rate of pneumonia may be as high as 3% per day. This study was undertaken to ascertain the prevalence of HAP in South-East, Nigeria.

Methods: Structured questionnaires totaling 660 were administered personally to healthcare workers consisting of 96 doctors, 170 nurses, 24 pharmacists and 40 medical laboratory scientists from randomly selected government hospitals and 90 doctors, 180 nurses, 30 pharmacists and 30 medical laboratory scientists from randomly selected private hospitals. Study was approved by the ethics committees of Nnamdi Azikiwe University Teaching Hospital, Nnewi and Anambra State University Teaching Hospital, Awka.

Results: The study shows that the prevalence of nosocomial infection in the hospitals surveyed is in the following descending order: urinary tract infection (34.9%), Staphylococcus aureus (31.0%), Gastroenteritis (27.1%), Hospital acquired pneumonia (20.3%), Candida albicans/Aspergillus spp (10.8%), Pseudomonas aeruginosa (10.5%), Tuberculosis (9.0%), Clostridium difficile (3.9%), ventilator associated pneumonia (3.6%), Methicillin and vancomycin resistant bacteria (1.5%). The study also showed that the frequency of occurrence of HAP is higher in government than private hospitals. This can be attributed to the higher population of patients leading to overcrowding. The modes of transmission of hospital acquired pneumonia was observed to follow this order airborne > contact with blood and body fluids > contaminated instruments > contaminated hands > needle sticks.

Discussion/Conclusions: The burden of HAP in this part of the world is still very high. Efforts are needed to reduce the incidence of nosocomial infections generally and HAP in particular, improve the quality of life of patients and healthcare workers and improve healthcare delivery.

Smoking and depression among urban adolescents in Bangladesh

Afroza Begum, Farzana Islam Khan

Aim: The study aims to assess the relationship between depression and smoking among urban adolescent.

Setting: Urban school and college Participants: Students of class ix to xi aged 15 to 19 years.

Design : Cross-sectional survey. The analysis was carried out using descriptive statistics and chi-square tests.

Results: Out of 165 around 49% of the respondant's age was 18 years and rest were below 18 years. Most of them were Muslim(97%). About 79% were lived in nuclear family. This study shows 49.1% respondents were depressed, 50.9% respondents were normal and 66.1% were smoker, 33.9% were nonsmoker. Among smoker 82.7% were depressed and among nonsmoker 17.3% were depressed. The relationship between depression and smoking was statistically significant ( p=<0.001). Most of the respondents started smoking around the age of 14.3 yrs. Study shows 62.5% respondents were depressed whose parents were smoker, on the other hand 59.4% were normal whose parents were non smoker ( p=.006). 54.1% respondents were influenced about smoking by their friends. Others factors are also associated with depression like domestic violence (p= <0.001), familial disharmony ( p=0.001), stressful events in the life (p= <0.001), failure in love (p=0.002).

Conclusions: Parents smoking and peer smoking play an important role to start smoking among adolescent. Increasing awareness about hazards of smoking and depression among adolescent and their parents will help to mitigate the problem. The findings of this study will help for smoking control prevention strategies in Bangladesh.

A Common Monitoring & Evaluation Framework Guided by the Collective Impact Model: Recommendations to Enhance the Tobacco Control Effort in Sub-Saharan Africa

Meenu Anand

Objective: To identify opportunities to improve the systematic operations/capacity of global partners collaborating to prevent the tobacco epidemic in SSA

Background: Management of tobacco use is a wicked problem. In SSA, the use of tobacco is generally low and region is viewed in early stages of the four stage tobacco epidemic model. This offers public health community an extraordinary opportunity – not only is the epidemic predicted far in advance, there is knowledge on how to prevent it.

Methods: First, the secondary data was sorted using a comparative, thematic approach to detect themes related to monitoring and evaluation (M&E) practices at individual (organizational) level and at the group (collective) level. Second, the sorted data analyzed using hypothesized content analysis for alignment of perceptions across the five components of collective impact model (CIM)- shared agenda, shared measurements, mutually reinforcing activities, on-going communications, and support organization

Results: Current practices of M&E are perceived as sub-optimal both at individual and group levels. Even though the secondary data focused primarily on shared measurements, mapping of perceptions indicated that the other four components of CIM were organically addressed in the discussions in varied depths. Analysis indicated general willingness to adopt a common M&E framework

Conclusions: A common M&E framework, a missing component of the collaborative effort, is needed to learn from past successes and challenges and to inform strategy of current and future initiatives. This framework must be conceptualized within the context of a common agenda, and supported by processes and structure to facilitate mutually reinforcing activities and continuous communication among collaborators.

Implications: The recommendations have the potential to increase the likelihood of seizing the unprecedented public health opportunity to prevent death and suffering from tobacco use in SSA.