Abstract
BackgroundHow advances in knowledge lead via behaviour change to better health is not well understood. Here we report two case studies: a rapid reduction in HIV transmission in homosexual men and a decline in Sudden Infant Death Syndrome (SIDS) that took place in the period before the relevant national education programmes commenced, respectively, in 1986 and 1991. The role of newspapers in transferring knowledge relevant to reducing the risk of AIDS and SIDS is assessed.MethodsHIVSearches were made of The Times (1981–1985), Gay News (1981–1984) and, for the key period of April to June 1983, of eight newspapers with the highest readership. Information on transmission route and educational messages were abstracted and analysed.SIDSSearches were made of The Times and the Guardian (1985–1991), The Sun (selected periods only, 1988–1991) and selected nursing journals published in England and Wales. Information on sleeping position and educational messages were abstracted and analysed.ResultsHIVForty-five out of 50 articles identified in newspapers described homosexuals as an at risk group. Sexual transmission of AIDS was, however, covered poorly, with only 7 (14%) articles referring explicitly to sexual transmission. Only seven articles (14%) associated risk with promiscuity. None of the articles were specific about changes in behaviour that could be expected to reduce risk. Gay periodicals did not include specific advice on reducing the number of partners until early 1984.SIDSOut of 165 relevant articles in The Times and 84 in the Guardian, 7 were published before 1991 and associated risk with sleeping position. The reviewed nursing journals reflected a pervasive sense of uncertainty about the link between SIDS and sleeping position.ConclusionPresumptively receptive audiences responded rapidly to new knowledge on how changes in personal behaviour might reduce risk, even though the 'signals' were not strong and were transmitted, at least partly, through informal and 'horizontal' channels. Advances in knowledge with the potential to prevent disease by behaviour change may thus yield substantial health benefits even without the mediation of formal education campaigns ('interventions'). Formal campaigns, when they came, did make important additional contributions, especially in the case of SIDS.
Highlights
How advances in knowledge lead via behaviour change to better health is not well understood
Sexual transmission of AIDS was, covered poorly, with only 7 (14%) articles referring explicitly to sexual transmission
We consider changes away from two high risk behaviours that took place in Britain, mainly during the 1980s – movements away from sexual practices associated with human immunodeficiency virus (HIV) transmission and away from putting babies to sleep on their fronts, a practice known to increase risk of sudden infant death (SIDS)
Summary
How advances in knowledge lead via behaviour change to better health is not well understood. The advance of knowledge is the most important distal (or 'wider') determinant of health improvement, the means by which new knowledge produces its beneficial effects on health are often far from clear This is especially true when these beneficial effects depend on informed behaviour change by the public. One interpretation of how the advance of knowledge leads via behaviour change to better health emphasises the formal 'top down' pathway. In the case of sleeping position and SIDS, 'top-down' sequences of this kind have been documented across several European countries by McKee and others [1] Such interpretations emphasise the role of the formal education programmes instituted from above Such interpretations emphasise the role of the formal education programmes instituted from above (i.e. 'interventions') in putting the new knowledge to work for preventive purposes
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