bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP42 The Influence of Parental Monitoring and School Environment on Adolescent Alcohol Use
Authors: McCann M , Higgins K , Perra O , McCartan C , McLaughlin A 
Published: September 2013

BackgroundThe importance of social determinants of adolescent health behaviour such as alcohol use has stimulated interest in family and school environments that may act as risk or protective factors. This study looked at characteristics of schools and parents, and how they influence young people’s alcohol use.MethodsThe Belfast Youth Development Study began in 2000. It surveyed secondary school children annually for five years of compulsory schooling, and two further years (age 16/17 & 21/22). This study is based on data from the first five data sweeps. We used the Stattin & Kerr parental monitoring measures, and alcohol use coded as: rarely/never, infrequently, monthly or less, weekly or more.Phase 1: Cross-lagged structural equation models assessed bi-directional associations between parental monitoring and subsequent alcohol use.Phase 2: Multilevel regression models assessed between-school variation in alcohol use frequency and the effect of parental monitoring.Phase 3: Structural equation models assessed the effect of parental attachment and parental monitoring, and how these two factors interacted to influence alcohol use.ResultsAnalysis was based on 4,775 respondents attending 38 schools, the proportions drinking weekly or more frequently in each of the five years of the study were 4%, 11%, 21%, 27% and 34%.Phase 1: Parental monitoring was protective against frequent alcohol use (OR = 0.76, p < 0.01). More frequent alcohol use was also associated with lower parental monitoring to a lesser extent (b = -0.04 p < 0.05).Phase 2: Around 6% of the variation in alcohol use was attributable to differences between schools. The effect of parental monitoring on alcohol use varied widely between schools (OR 0.70 [95% coverage interval 0.52, 0.93]).Phase 3: Higher parental monitoring, and better parental attachment were protective against alcohol use. Better parental attachment was also associated with lower levels of parental monitoring; this meant better parental attachment was indirectly associated with higher frequency of drinking due to its effect to reduce monitoring. The combination of these two opposing influences led to parental attachment having zero overall influence on alcohol use.ConclusionSchool and home environment play an important role in shaping young people’s health risk behaviours. What these findings show is that the school environment may influence the extent to which parental behaviours can successfully reduce risk behaviour. While parent-child attachment may provide an important role for overall social functioning, improving monitoring behaviour may have a greater influence on alcohol use than improving attachment.
OP14 Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Syria
Authors: Wilcox M , Mason H , Fouad F M , Rastam S , Ali R Al , Capwell S , O’Flaherty M , Page T F , Maziak W 
Published: September 2013

BackgroundCoronary heart disease (CHD) and stroke account for approximately half of all-deaths in Syria. The country’s CHD mortality rate has escalated by nearly two-thirds between 1996 and 2006, partly reflecting substantial increases in systolic blood pressure (SBP). In high income countries, reduction of dietary salt intake represents a cost effective means of decreasing CHD events via reduced SBP levels. This study aims to assess the potential costs and benefits of implementing contrasting salt reduction policies in Syria, with particular emphasis on the feasibility of policies within the country’s socioeconomic and political realities.MethodsA projected 10-year period cost-effectiveness analysis of salt reduction policies was conducted comparing three different approaches: health promotion campaign about salt reduction, labelling of salt content on packaged foods, reformulation of salt content within packaged foods, or a comprehensive strategy involving all three approaches. The incremental cost of a policy was calculated as the sum of CHD-related savings in healthcare costs and the costs of implementing and monitoring the policy, with costs presented in international dollars using 2010 purchasing power parity (PPP) exchange rates. Benefits were defined as life years gained (LYG) due to fewer CHD events. Data sources included existing national resources, international literature, and interviews with local food producers, manufacturers, and government agencies. The effect of salt reduction on SBP was based on review of the literature. Health care costs, LYG and expected CHD events were calculated using the IMPACT CHD model. Sensitivity analyses were conducted to account for the uncertainty in the reduction of salt intake.ResultsAll policy combinations resulted in LYG when compared to no policy. Health promotion and labelling of salt content were both associated with low private sector costs and large healthcare savings. This resulted in cost savings for both policies alone and the comprehensive approach combining all three policies. Reformulation alone, reformulation plus health promotion, and reformulation plus labelling were not cost saving due to high private sector costs associated with reformulation (+PPP $96,000,000). However, the three policy approaches were very cost-effective with incremental costs of $5453 PPP, $2125 PPP, and $2201 PPP per LYG, respectively (well below the region’s established cost effectiveness threshold of PPP$12,250).ConclusionAll salt reduction policies analysed resulted in a reduction of CHD deaths and were either cost-effective or even cost saving. This paper will provide further details concerning the feasibility of such policies in the context of a developing country.
PP43 Feasibility and Acceptability of a Brief Intervention to Reduce Alcohol Consumption in Sexual Health Clinic Attendees
Authors: Dimitrov B D , Sundaram S , Roderick P , Frater A , Leydon G , Sheron N , Dewhirst S , Tucker L , Maskell J , Chatwin J , Harindra V 
Published: September 2013

BackgroundAlcohol misuse and poor sexual health are closely related Hazardous drinking is more prevalent in sexual health clinic (SHC) attendees than in the general population leading to risky sexual behaviours. Little data exists on the feasibility of integrating a Brief Intervention (BI) into the sexual health consultation.MethodsThe aim was to assess the feasibility and acceptability of a brief intervention to SHC attendees. SHC attendees (≥ 16 years) were screened using the short Alcohol Use Disorders Identification Test (AUDIT) - Consumption (C) questionnaire (AUDIT-C). Males scoring ≥ 5 and females scoring ≥ 4 were randomised to either receive BI or usual care (UC) which included a standard alcohol leaflet. Clinical staff members were randomised to receive BI training. Patients saw only trained staff in BI arm and non-trained staff in UC arm. Patients completed full AUDIT questionnaire, alcohol diary and questions on sexual behaviour at baseline and follow-up. Follow-up at 6 weeks and 6 months was largely by phone interviews. A sample of consultations was audio-recorded for intervention fidelity check. Patients with AUDIT score >15 were initially excluded; this was subsequently relaxed to a score > 20.ResultsOut of total 664 patients screened, 215 were eligible for randomisation and 207 were included in the final analysis - 103 (BI) and 104 (UC). Mean age was 25 years, 66% were female, most were white, nearly 50% were employed fulltime and 27% were students. Follow-up sample at 6 weeks and 6 months was 54% and 47%, respectively, being slightly higher in the UC group, although not statistically significant at either time. Both groups reduced their alcohol consumption significantly, but the total alcohol units/week fell more sharply in UC (p < 0.05). There was no significant difference in sexual behaviour between the groups though an evidence of decrease over time in the frequency of partners was seen in both groups. The fidelity check showed that BI was delivered as intended and increased consultation time by an average of 5 minutes. The staff found it acceptable and appropriate for the SHC setting.ConclusionThe brief intervention for alcohol misuse is feasible and acceptable in a SHC. The study was not powered to detect outcome differences. Screening alone was sufficient to influence drinking and sexual behaviour in both groups. Further research to optimise this intervention is needed in those drinking most heavily.
PP45a Use it, Don’t Lose it! The Role of Lifestyle Behaviours on 20-year Cognitive Decline
Authors: Cadar D , Pikhart H , Mishra G , Stephen A , Richards M 
Published: September 2013

BackgroundCognitive decline represents a major public health impact on individuals and governments around the world. There is a well-established relationship between specific lifestyle behaviours and cognitive decline, but extremely limited research on the role of combined behaviours. The aim of these analyses was to examine the role of lifestyle behaviours (smoking, physical activity and dietary choice) separately and in combination on 20-year cognitive decline from from age 43 years to 60–64 (60+) years in a prospective longitudinal population-based study.MethodsParticipants were 1018 study members from the UK MRC National Survey of Health and Development regularly followed up since birth in 1946. Cognitive functioning was measured at age 43 years and 60+ years using tests of verbal memory (maximum words recalled 45) and timed visual search (maximum letter searched 600). Lifestyle behaviours were examined at 36 & 43 years and overall early-midlife scores were calculated. Smoking was classified as non-smoker, moderate or heavy smoker (20+ cigarettes per day). Physical activity was classified as inactive, moderate or mostly active (> 5+ activities/month). Dietary choice was classified as high/low quality diet based on breakfast consumption, type of milk & bread, daily portions of fruit and vegetables and energy derived from fat. The covariates included in these analyses were social class of origin, childhood cognition, education, adult social class and depression.ResultsKey findings were that high quality dietary choices made in early-midlife were associated with slower memory decline β = 0.64 (95% CI 0.05 to 1.24) as compared to low quality dietary choices, and most active levels of physical activity were associated with a slower visual search speed decline β = 13.45 (2.43 to 24.47) compared to those who were inactive. Heavy smoking was marginally associated with faster decline in visual search speed compared to non-smokers, but not with memory decline. These associations were independent from each other in terms of lifestyle behaviours as well as from the selected covariates.ConclusionThe current results suggest that physical activity and healthy dietary choice are protective of cognitive decline, and that smoking is harmful in this respect. Public health interventions based on modifiable lifestyle behaviours across the life course represent high level priorities and should be regarded as an important line of defence against cognitive decline and dementia.
PP46 Screening and Alcohol Brief Intervention in Antenatal Care: A Realist Evaluation
Authors: Doi L , Jepson R , Cheyne H 
Published: September 2013

BackgroundIn an effort to protect the health and safety of the unborn child, the Scottish Government in collaboration with National Health Services (NHS) Health Scotland implemented screening and alcohol brief interventions (ABIs) in a range of health care settings, including antenatal care setting. Yet while there is strong evidence of the benefits of screening and ABIs in reducing hazardous and harmful drinking among primary care population, evidence of their effectiveness with the antenatal care population is limited. Further, the few studies evaluating screening and ABIs in antenatal care settings have tended to rely on randomised controlled trials which often produce inconsistent findings regarding their effectiveness. Moreover, they do not give adequate account of why the intervention worked or not. Realist evaluation focuses on which aspects of the intervention work for whom, how and under what circumstances. In this study we aimed to use realist evaluation design to increase understanding of the factors likely to influence the effectiveness of the recently implemented screening and ABIs in Scottish antenatal setting, delivered at the first antenatal visit.MethodsThe study employed a realist evaluation methodology, where a priori program theories were first identified through systematic reviews and face-to-face policy implementers’ interviews data. The program theories were tested and later refined using interviews and focus group data with pregnant women and midwives. The qualitative data was analysed by thematic content analysis.ResultsTraining and resources provided to midwives improved their skills and confidence. However, as many of the women reported to have reduced or abstained from alcohol in pregnancy, most of the midwives had not subsequently employed the motivational interviewing skills acquired from training. Midwives’ confidence therefore decreased leading to missed opportunities to appropriately deliver ABIs to eligible women. Further, it negatively affected midwives’ attitudes as they then accorded ABIs low priority in their workload. Lack of adequate rapport at the first antenatal interview also led to women providing socially desirable responses to alcohol consumption questions.ConclusionAs trust-based relationships are essential to effective screening and ABI delivery, delivering them at the first antenatal visit when they are likely to make the most impact, may be particularly challenging and may require adequate motivational interviewing skills. However, the limited number of ABI delivered in antenatal care require that midwives may need on-going support to sustain their motivation and skills in order to ensure benefits for the few pregnant women who are drinking at hazardous and harmful levels.
PP47 The Cost of Overweight and Obesity on the Island of Ireland
Authors: Dee A P , Perry I J , O’Neill C , Doherty E , Callan A , Kearns K , O’Dwyer V , Staines A , McVeigh T , Sweeney M R , Sharp L , Balanda K , Hughes J , Kee F 
Published: September 2013

BackgroundOverweight and obesity are increasing in prevalence worldwide In Ireland, their prevalence makes up over 60% of the population. The incidence of many chronic diseases, and some cancers, is increased in those who are overweight and obese. This places pressure on the health service, financially and otherwise. There is also a cost on society in terms of productivity loss. Many countries have studied the costs involved, but as each country has a unique profile of risk prevalence and health service, the costs are country specific. In order to inform prevention policies and ignite political will in the public health battle against obesity, the measurement of direct and indirect costs of overweight and obesity is a useful exercise. This study was a collaborative effort to enumerate these costs for the island of Ireland.MethodsA comprehensive literature review was performed examining the international evidence on cost of overweight and obesity. Regression analyses of data from SLAN and TILDA in the Republic of Ireland, and The 2010/11 Health Survey for Northern Ireland were performed to give estimates of direct health care costs in both jurisdictions, and of indirect costs due to absenteeism. In addition, Population Attributable Fractions were applied to hospital activity, drug reimbursement, social welfare and mortality data for both jurisdictions to give additional information where no survey data were available, and to triangulate results. Adjustments were made for inflation and purchasing power parity to allow for the production of an estimate in one currency for a single year.ResultsThe literature review yielded 45 studies and showed heterogeneity of methodology between studies. However, in almost all cases there was a positive correlation between obesity and increased healthcare costs, and indirect costs were in all cases greater than direct costs. The cost of overweight and obesity for the Republic of Ireland was estimated to be €1,166,050,482 and for Northern Ireland it was €510,323,754 for the year 2009. Direct healthcare costs represented 38% of the total, and 2.9% of total healthcare spend in the Republic of Ireland and, in Northern Ireland, 25% of the total and 2.8% of total healthcare spend.ConclusionUrgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity. The cost of associated chronic disease is substantial, and if prevalence rates continue to rise, will cause unsustainable health service cost escalation, and productivity losses to the wider economy.
PP53 Predictive Risk Modelling of Childhood Overweight or Obesity at age 10-11 years: An Epidemiological Analysis of National Child Measurement Programme and Birth Notification Data
Authors: Gilchrist K , Memon A 
Published: September 2013

BackgroundAlthough childhood overweight and obesity rates have been falling in England in recent years, they remain an important public health concern because of the association between adolescent obesity and increased ill health risks in adult life including an increased risk of mortality from all causes independent of adult weight. Early intervention is important since behaviours contributing to obesity, higher energy diet and increased sedentary behaviour, are also prevalent during early childhood. We have conducted an epidemiological analysis of routine data collected at birth to examine the factors associated with overweight and obesity in children aged 10-11 years.MethodsAdministrative records of children in aged 10-11 years, measured between September 2006 and July 2010, as part of the National Child Measurement Programme in a large area on the South East coast of England were examined. Of the 19,924 children in the study with a valid height and weight measurement, 29% were overweight/obese. Factors identified from the literature as potential predictors of childhood overweight or obesity were extracted, where recorded. These are age; birth weight; gender; maternal smoking; previous live births; multiple birth; mother’s age; and Index of Multiple Deprivation quintile.ResultsFactors independently associated with an increased risk of overweight or obesity included deprivation (OR 1.6 [95% CI 1.4, 1.9]) (children born in most deprived areas compared with least deprived), regular maternal smoking during pregnancy (1.3 [1.2, 1.4]) and high brith weight (1.5 [1.2, 1.9]). Low birth weight (0.8 [0.7, 0.9]), being female (0.8 [0.8, 0.9]) and maternal age <20 years (0.7 [0.6, 0.9]) were independently associated with a reduced risk of childhood overweight/obesity. There was a significant participation bias by gender, with girls less likely to be measured which may explain the apparent protective effect for girls. This finding could impact on the results of the NCMP nationally if also found elsewhere. The predictive model, whilst significant, did not discriminate well at the population level. The limited set of data recorded before 2003 restricted the factors which could be included in the model. With better recording of factors such as breastfeeding and ethnicity there is potential to enhance the model in the future.ConclusionFactors associated with childhood overweight and obesity at age 10-11 were neighbourhood deprivation, regular maternal smoking during pregnancy and high birth weight. Potential protective factors include low birth weight and young maternal age. Early intervention in tackling inequalities and maternal smoking in pregnancy are important strategies to help reduce childhood overweight and obesity.
PP58 Prevention of Stroke following a TIA – who Receives Care? A descriptive study of Patients Referred to TIA Clinics between 2007-2010 in a NHS Foundation Trust
Authors: Campbell F , Croot E , Read J , Ryan T , Venables G 
Published: September 2013

BackgroundA TIA can offer a vital warning to the risk of a disabling or fatal stroke. Appropriate help seeking behaviour, followed by referral to TIA services allows diagnosis and treatment of conditions that are major risk factors for stroke such as hypertension, as well as opportunities to alter behavioural risk factors. The incidence, and prevalence of stroke and the risk of mortality following stroke is substantially higher in patients from lower socioeconomic groups. This study sought to explore access to TIA prevention services following a TIA, in order to understand the profile of patients both represented and underrepresented and also the patterns of referral that enable patients to access prevention services.MethodsRoutine hospital data was collected and anonymised. Analysis was performed using Microsoft excel and SPSS software. Collected data included patient’s age, ethnic origin, sex and socioeconomic status as measured by Index of Multiple Deprivation. It also included source of referral and the time between referral and being seen in clinic.ResultsOver the three years, 3069 patients attended TIA clinics, including patients who were later found to have alternative diagnosis but had suffered symptoms suggestive of a TIA. More women (n = 1613) were seen than men (n = 1456). Risk of stroke is higher in men, and this disparity is seen both nationally and locally. Our data suggests that men are not help seeking following symptoms of a TIA as responsively as women. The mean age of patients was 69.6 years. The majority were ‘British white’ (97%), only 3% described themselves as members of minority ethnic groups. The proportion of the population in Sheffield from ethnic minority groups is 7.2%. Again this would suggest that members of these groups are not responding to TIA symptoms and seeking help, enabling appropriate referral or alternatively not being appropriately referred after seeking help. Rates of referral from more deprived areas were also lower than projected figures would predict. The majority of referrals to secondary care following a TIA came from general practitioners (60%), suggesting that most patients do not see their symptoms as an emergency ((7%) were referred via emergency services).ConclusionOur research suggests that targeted work addressing help seeking behaviour amongst groups less well represented at TIA clinics might serve to address some inequalities in stroke. However, these differences in access of prevention services are not sufficient to explain the extent of the socioeconomic disparity in disease burden caused by stroke.