Health Education Authority Research Articles

Smoking cessation and the dental hygiene and dental therapy curriculum

As part of a needs assessment exercise on behalf of the Health Education Authority (HEA), a telephone survey of senior tutors from dental hygiene schools in England, Wales and Northern Ireland was conducted. The aim was to examine the status of smoking cessation in dental hygiene and dental therapy curricula and to develop appropriate teaching resources in this area. Questions concerned how and if smoking cessation was taught; barriers and facilitators to teaching smoking cessation techniques and to using them in practice; beliefs regarding the effectiveness of smoking cessation advice and its perceived relevance to the role of dental professionals.Interviews were obtained with 11 of the 14 schools contacted (giving a response rate of 79%). While all tutors agreed on the importance of smoking cessation in the curriculum and in practice, there was a wide variation in the extent to which it was covered, dependent mostly on the availability of suitably qualified staff, resources and space in the timetable. Just under half of the schools interviewed said they did not normally cover smoking cessation directly in their curricula but some other schools offered extensive and continuous tuition in this area. All respondents were interested in obtaining additional practical resources (including further training) to aid smoking cessation teaching.The vast majority of tutors considered smoking cessation advice relevant to the role of dental hygienists and therapists but most felt its effectiveness was variable or difficult to assess. A number of barriers to both teaching and practising smoking cessation were raised.The results of the study have implications for the development of dental hygiene and therapy curricula and highlight the need for increased training and resource provision in the area of smoking cessation.

Continuing low uptake of periconceptional folate warrants increased food fortification

Objective To assess whether the Health Education Authority’s recent promotion of periconceptional folic acid has been successful in increasing uptake sufficient to prevent neural tube defects. Design A retrospective questionnaire, completed by 162 patients in the early pregnancy clinic in Doncaster Royal Infirmary, an average-sized UK district general hospital. The study ran in February and March 1999. Methods and main outcome measures Data were collected on: supplementation and dietary intake of folic acid, both preconceptionally and after confirmation of pregnancy; awareness of the benefits of folic acid; source of information on folic acid; the reasons for not taking folic acid (if this was so); planned or unplanned pregnancy; previous pregnancies; previous neural tube defect in a pregnancy; smoking habit; and age. Results Eighty-one per cent of women were aware of the benefits of folic acid, but only 27% took it preconceptionally. Sixty-eight per cent took it after confirmation of pregnancy. A quarter of patients made an attempt to increase dietary folate. Unplanned pregnancy was a significant bar to uptake, with significant differences in awareness and consumption. Number of pregnancies had no effect. Older women were more likely to take postconceptional folate, but awareness and preconceptional use were the same as younger women. Conclusion Despite an extensive campaign commissioned by the Department of Health and run by the Health Education Authority, use of periconceptional folate will probably only prevent one-sixth of affected pregnancies. The adverse effects of fortification discussed in the body of this paper are small. It is now time for increased fortification of all cereal-grain products to be instituted in the UK in a similar manner to the United States.

What contribution can health economics make to health promotion?

Health promotion is an area that has been relatively neglected by health economists. There are a variety of reasons for this including lack of demand by health promotion specialists misunderstanding of what health economics has to offer the discipline of health promotion misunderstanding of what health promotion is trying to do on the part of health economists and perceived difficulties in applying standard economic appraisal techniques to health promotion programmes. Health Promotion Wales was the first UK Health Promotion Agency to employ a health economist. In February 1998 at a meeting of the research departments of the four territorial agencies at the time (Health Promotion Wales Health Education Authority England Health Promotion Authority for Northern Ireland and the Health Education Board for Scotland) it was decided that a position paper on health economics and health promotion would be useful. A meeting involving seven health economists from six universities and six health promotion researchers representing the then four UK agencies was held to inform this paper. Three broad areas were discussed illustrating the potential role for health economics in health promotion; these were economic evaluation the role of economics in explaining and predicting individual behaviour and economic policy and health promotion policy. This paper summarizes the main discussion points from the meeting. (authors)

Smoking cessation: an evidence-based approach

Smoking remains the largest single cause of preventable morbidity and mortality in Europe. Successful strategies for smoking cessation will have clear health benefits. Even brief advice from health professionals can increase smoking cessation and such an approach should be actively promoted. The Health Education Authority (see note) in England recently developed comprehensive, evidence-based, professionally endorsed guidelines on smoking cessation. These guidelines are presented here as specific recommendations for each of the main target audiences. Although the guidelines were commissioned by the Health Education Authority (note) which had a remit for England, it is anticipated that they will prove relevant and adaptable to other countries and healthcare systems across Europe.

Can anti-smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England's anti-smoking TV campaign

OBJECTIVESTo evaluate the effectiveness of the Health Education Authority for England's anti-smoking television advertising campaign in motivating smokers to give up and preventing relapse in those who had already given...

'Get it on' in the millennium.

Over the Christmas and New Year period the Health Education Authority launched a sexual health promotion campaign aimed at increasing the awareness of and reducing the incidence of sexually transmitted infections (STIs) and unwanted pregnancy. We undertook a study to assess the effect of this campaign locally in 2 genitourinary medicine (GUM) clinics. From our study we concluded the following: (1) Although rarely performed, it is possible to assess the effectiveness of health promotion campaigns. (2) Genitourinary medicine clinics provide a good forum for the assessment of such campaigns. (3) The information obtained from such assessments can be valuable for effective targeting of future campaigns.

A Randomized Control Trial of New Tailored Walking Campaigns in an Employee Sample

Public health groups use mass media communications to address the problem of sedentary behaviour . However , these campaigns are poorly evaluated and lack tailoring . Campaigns and questionnaires were developed based on existing theoreti cal , cross - sectional , and qualitative data regarding how to promote walking with people who are not regularly active . Subjects were volunteer white - collar employees (n = 181 ) randomly allocated by quota to the campaigns , or control , for one week . One - hundred - thirty - eight subjects ( 76 . 2 %) completed pre - and postcampaign ques tionnaires . T his study successfully ( 1 ) developed four new tailored campaigns to promote walking according to a formalized process that health promoters can adapt and refine , ( 2 ) developed a complimentary measure of outcomes , and ( 3 ) compared the new campaigns with the English Health Education Authority ( HEA ) '' Active for L ife '' campaign ( control ).

Impact of a telephone helpline for smokers who called during a mass media campaign

OBJECTIVETo evaluate the impact of a telephone helpline (Quitline) with additional support (written information) on callers who use the service during a mass media campaign.DESIGNTelephone recall surveys of callers to...

‘Dirty looks’ and ‘trampy places’ in young people's accounts of community and neighbourhood: Implications for health inequalities

This paper draws on preliminary data collected in an ongoing school-based research project for the Health Education Authority (HEA) which is exploring Putnam's (1993) concept of 'social capital' in relation to children and young people's well-being and health. Putnam's conceptualization of social capital consists of the following features: trust, reciprocal support, civic engagement, community identity, and social networks; and the premise is that levels of social capital in a community have an important effect on people's well-being. A range of qualitative methods have been used to elicit 12-15 year olds' views of friendship networks and neighbourhoods: (1) written accounts of out-of-school activities, who is important, definitions of 'friend', future aspirations and social networks (2) visual methods including map drawing and photography by the participants and (3) group discussions exploring use of and perceptions of neighbourhoods, and community and institutional participation. The paper presents data, which suggest that young people face many paradoxes and contradictions in their environments that on the one hand support them and on the other hand exclude them. They often seem to develop their own 'communities' in the face of a strongly felt hostility from the adults around them. The paper concludes firstly that age is an important structuring principle which needs to be taken into account when considering entitlements to use of public space within neighbourhoods, and secondly that how young people use and experience communal areas is likely to have an important effect on their sense of community identity and ultimately their well-being.

Tackling health inequalities through partnership working: Learning from a realistic evaluation

UK government health policy now strongly supports local partnership working as a key mechanism for tackling health inequalities. There is, however, still a lack of evidence based operational guidance for the development of local partnerships in tackling inequalities in health, as well as continuing evidence of the deep-rooted political, organizational and cultural barriers to partnership working. This paper reports on the evaluation of a two year Health Education Authority programme of demonstration projects designed to test five different models of partnership working in tackling health inequalities. The evaluation drew on Pettigrew et al.'s (1992) concepts of receptive and non-receptive contexts for change as well as the 'realistic evaluation' of Pawson & Tilley (1997). Data were collected using a range of qualitative methods including semi-structured interviews with key stakeholders and non-participant observation. Six key themes were identified from the case studies: shared strategic vision, leadership and management, relations and local ownership, accountability, organizational readiness and responsiveness to a changing environment. The importance of understanding how project mechanisms worked in the context of national and local policy change is emphasized, and lessons are identified for UK Health Improvement Programmes, Health Action Zones and Primary Care Groups.

Aerobic capacity, weight gain and psychotropic medication.

The relationship between physical health and psychological wellbeing is a complex one, with each impacting upon the other to one degree or another. Psychiatric patients are often reported to be not as physically healthy as their counterparts in the general population, with reports of increased weight gain and decreased activity. This study of two classifications of psychiatric patients in a high security psychiatric establishment was an attempt to ascertain if such a relationship existed between physical fitness, psychopathology, weight gain and medication levels. Using standardized tests to assess two parameters of health-related fitness--Harpenden skinfold callipers to estimate percentage body fat (BF), and a submaximal cycle ergometer ride for aerobic capacity (VO2 max)--results were compared with the general population using the Allied Dunbar National Fitness Survey (Sports Council and Health Education Authority, 1992) as a reference. The results indicate significant differences in aerobic fitness between the two groups (P < 0.01) and such differences could be a cause for concern and may constitute a threat to both physiological and mental wellbeing.

AIDS, risk and social governance

This paper considers the discursive properties of public health literature produced around AIDS in the 1980s and early 1990s. Attention is focused upon the role of health promotion in the UK government's response to the epidemic and on the language used in the educational campaigns conducted by the Health Education Council and its replacement the Health Education Authority. Using an analytical approach influenced by the work of Michel Foucault, the paper argues that the knowledges of AIDS produced by these various public health institutions constructed discursive boundaries between the idea of ‘normal’ and ‘abnormal’ behavioural practices. The notion of risk, produced as it is from epidemiological knowledge, is a central mechanism in this process. It is through the production, articulation and normalisation of ‘at risk’ groups that society is fragmented and hence subject to the governance strategies of late-modern liberal economies.

Perceptions of Barriers to Healthy Physical Activity among Asian Communities

There is clear evidence of inequalities in the health status of minority ethnic groups in Britain. This includes a number of conditions which may be alleviated or prevented through increased levels of physical exercise. Other research has shown lower levels of activity and raised body mass among Asian groups. There remains some scope for argument about the reasons for these differences. It is, for example, suggested that health education materials are poorly targeted at South Asian communities, or that certain cultures discourage involvement in recreational physical activities. It is known that both motivation and self-image are important to physical activity behaviour, from school age upwards. A lifestyle survey sponsored by the Health Education Authority, and qualitative research, provide an opportunity to examine the degree to which there are distinctive 'ethnic' barriers to exercise or other healthy physical activity amongst communities of South Asian origin living in England. While there are many similarities with the reasons given by members of the white population for 'not exercising', there are some subtle differences between communities, and a number of issues which appear to be specific to the minority populations. Some are particular to a religion, gender or generation. Attention to these, including questions of modesty, gender segregation, and safety, would improve the accessibility of recreational activities to this target group. At the same time, it is clear that individuals from these communities are well informed and well motivated, and do take advantage of local facilities when they can. The question of both institutional and personal racism cannot be excluded from a strategy for promoting healthy physical activity; equally, it is important to pay attention to the characteristics of particular communities to gain their confidence. A 'colour-blind' or homogenous approach may be counterproductive.

Use of qualitative techniques to measure work based stressors

This paper describes the development of a model for the use of qualitative techniques for measuring work based stressors. The model is based on the concepts of organisational stress that have been developed by the Health Education Authority as part of their ‘Positive Stress at Work’ training. The model has been piloted in one organisation as the first part of an intervention to tackle workplace stressors. The aim of the audit in this context was to provide practical management based information that could guide the development of these interventions. This paper focuses on the development of research techniques within settings based health promotion, suggesting how qualitative techniques could be adapted to gain insight into organisational stress.

How effective was the Health Education Authority's folic acid campaign?

The Health Education Authority's campaign, encouraging the use of periconceptional folic acid in the prevention of neural tube defects, started in February 1996 and is ongoing. Its effectiveness was assessed using a questionnaire, answered by patients not exposed to the campaign and by those that were. The study population was comprised of 337 women in approximately their 20th week of pregnancy, attending antenatal clinic for a routine fetal anatomy ultrasound scan. Data were collected on aspects of folate awareness, intake and sources of advice, before and after the campaign's start. Significant increases in preconceptional and total folate consumption, awareness of folate's benefits, and GP prescription were seen as the study went on. Unplanned pregnancy prevented compliance with periconceptional folate guidelines. We conclude that whilst the promotional campaign seemed to work in York, fortification of foodstuffs may need to be used to increase folate consumption in those with unplanned pregnancy.

Chamydial infections in men

Chlamydia infection is now considered to be the most common sexually transmitted disease (STD) in Great Britain and the United States. Statistics obtained from clinics (Department of Health, 1998) show that just over 30000 cases per year of chlamydia are diagnosed, but the true figure is estimated to be as much as 10 times higher. Despite being more common than other well-publicised conditions such as HIV, herpes and gonorrhoea, relatively few people seem to know very much about it. The Health Education Authority (1998) carried out a poll last year and found that only 27% of those adults who were surveyed actually knew what chlamydia was.

Conceptualising Social Capital in Relation to the Well-Being of Children and Young People: A Critical Review

This exploratory article forms the background for an empirical study for the Health Education Authority on children, young people, health, well-being and social capital. In terms of morbidity, children tend not to exhibit clear health problems, but obviously engage in activities that have important implications for their health and well-being (West &amp; Sweeting, 1996), and these activities may be influenced by, as well as impact upon, children's social capital. Social capital is an elusive concept and has been defined in various ways, and refers to sociability, social networks and social support, trust, reciprocity, and community and civic engagement. The paper contrasts three interpretations of the concept, by Coleman (1988, 1990), Putnam (1993, 1995) and Bourdieu (1986). It concludes that the concept is currently poorly specified as it relates to children, and that the use of the term is inherently problematic, and needs to be carefully critiqued and empirically grounded before it can usefully be applied in social policy formulations. One possible way forward might be to conceptualise social capital not so much as a measurable ‘thing’, rather as a set of processes and practices that are integral to the acquisition of other forms of ‘capital’ such as human capital and cultural capital (ie qualifications, skills, group memberships, etc).

Promoting participation for children and young people: Some key questions for health and social welfare organisations

This article draws on research carried out by Barnardo's on behalf of the Health Education Authority. It analyses different meanings of 'participation' and identifies different processes in which it is currently deemed valuable to ensure children's participation. Although the article concludes by summarising some of the advantages of participation-for individuals, for organisations and for society-it challenges the reader to be clear about the nature and purpose of attempts to involve children

An alarming lack of public awareness towards oral cancer.

To determine public awareness and knowledge of oral cancer in Great Britain. The respondents were selected according to a systematic probability sample designed to be representative of all adults in Great Britain (GB). The overall design was similar to previous omnibus surveys carried out by National Opinion Poll (NOP). The survey was carried out in ten regions of GB in September 1995 and was commissioned by the Health Education Authority (HEA). A random sample of 1,894 members of the public over the age of 16 years were asked in face-to-face interviews their knowledge relating to cancer, with particular reference to oral cancer, its causes and those at high risk and general attitudes to cancer. Oral cancer was one of the least heard of cancers by the public with only 56% of the participants being aware, whereas 96% had heard of skin cancer, 97% lung cancer and 86% cervical cancer. There was a 76% awareness of the link between smoking and oral cancer but only 19% were aware of its association with alcohol misuse. Whereas 94% agreed that early detection can improve the treatment outcome, a disheartening 43% believed that whether a person developed a cancer or not was a matter of chance and therefore was unavoidable. This survey highlights a general lack of awareness among the public about mouth cancer and a lack of knowledge about its causation especially the excess risk associated with alcohol. There is a clear need to inform and educate the public in matters relating to the known risk factors associated with oral cancer. A media campaign informing the public about oral cancer is clearly required. The need for the reduction in the incidence of oral cancer should be included in 'Our healthier nation' targets. An overall health promotion strategy to reduce cancers should include oral cancer as a priority. In addition the European Code against Cancer which aims to improve prevention, the early detection of oral cancer and the necessity for fast track referral should be made more widely known. Recognition of oral cancer in local strategies for oral health should be encouraged.

Educating medical students for work in culturally diverse societies.

Recent attention has focused on whether government health service institutions, particularly in the United Kingdom, reflect cultural sensitivity and competence and whether medical students receive proper guidance in this area. To systematically identify educational programs for medical students on cultural diversity, in particular, racial and ethnic diversity. The following databases were searched: MEDLINE (1963-August 1998); Bath International Data Service (BIDS) Institute for Scientific Information science and social science citation indexes (1981-August 1998); BIDS International Bibliography for the Social Sciences (1981-August 1998); and the Educational Resources Information Centre (1981-August 1998). In addition, the following online data sets were searched: Kings Fund; Centre for Ethnic Relations, University of Warwick; Health Education Authority; European Research Centre on Migration and Ethnic Relations, University of Utrecht; International Centre for Intercultural Studies, University of London; the Refugee Studies Programme, University of Oxford. Medical education and academic medicine journals (1994-1998) were searched manually and experts in medical education were contacted. Studies included in the analysis were articles published in English before August 1998 that described specific programs for medical students on racial and ethnic diversity. Of 1456 studies identified by the literature search, 17 met the criteria. Two of the authors performed the study selection independently. The following data were extracted: publication year, program setting, student year, whether a program was required or optional, the teaching staff and involvement of minority racial and ethnic communities, program length, content and teaching methods, student assessment, and nature of program evaluation. Of the 17 selected programs, 13 were conducted in North America. Eleven programs were exclusively for students in years 1 or 2. Fewer than half (n = 7) the programs were part of core teaching. Only 1 required program reported that the students were assessed on the session in cultural diversity. Our study suggests that there is limited information available on an increasingly important subject in medical education. Further research is needed to identify effective components of educational programs on cultural diversity and valid methods of student assessment and program evaluation.