Document Sample
ADOLESCENTS Powered By Docstoc
					                        Health Scotland Library
                     e-Bulletin No 366 August 2009


Subjects covered:-

Adolescents ................................. 3       Older People .............................. 26

Alcohol ......................................... 4   Physical Activity ......................... 26

Children ....................................... 7    Physical Disabilities ................... 29

Dental/Oral Health ....................... 8          Pregnancy.................................. 30

Ethnic and Minority Groups .......... 8               Public Health.............................. 30

Health Improvement/Health                             Research and Evaluation ........... 32
Promotion .................................... 9

HIV Infection/AIDS ..................... 11           School Health ............................ 34

Immunisation.............................. 14         Sexual Health and Well-Being ... 35

Learning and Development ........ 15                  Sexuality .................................... 37

Learning Disabilities ................... 16          Sexually Transmitted Infections . 38

Mental Health ............................. 17        Smoking ..................................... 39

Nutrition ..................................... 21    Women‟s Health ........................ 44

Obesity ....................................... 24    Workplace/Occupational Health. 45

                                                      New books ................................ 47

Health Scotland Library                                                                             1
                                 Library News
Library closure

We will be closed for two weeks during August (10th-21st) in order to undertake our
annual weeding of library stock. We are focusing on the journals collection this year
and, as we have decided to shift to electronic only storage for the bulk of our journal
subscriptions, we will be clearing a large number of print volumes from the library
shelves during these two weeks. Our apologies for any inconvenience this closure
may cause. We will re-open for normal service on Monday 24 August 2009.

E-library replacement

If you‟re a regular user of the NHS Scotland e-library ( then you
need to know about the new and improved version which will be replacing the current
e-library towards the end of this year. The site - a test format is available at – offers a completely new design and is being described
as an “NHS Google” providing a more powerful search function and easy-to-use
features. It will provide customisable features such as news feeds and quick links
and will offer greater access to e-learning resources. Please take time to try the new
test site and provide us with feedback – we will happily pass your comments to our
colleagues at NHS Education who are working hard to deliver this new resource.

Comments and suggestions

Below are a selection of the comments and suggestions recently received by the
library. Suggestions for how the library service can be improved are always welcome.

Thanks again for the induction, it was very useful, I have been navigating my
way through the ejournals with ease!

Many thanks for this, as you say it shows what needs to be done and so is spot
on. Once again you have bailed me out at my 11th hour! [Literature search
undertaken at short notice]

Can I say thank you for your faithful sending of the bulletin. It is getting better
and easier to use over time and an invaluable source of information.

Could I ask who I would make a request to for a new alert topic? I’m wanting to
ask if you would do one on health inequalities ie socio-economic deprivation
causing ill-health and papers which look at how to stop that.

         Response sent: We do cover this topic in our library bulletin and it does
         get looked at in some of our topic-specific alerts as well…

                                                                   Sharon Jamieson
                                                           Library Services Manager

Health Scotland Library                                                              2
                                 Journal Articles

The following articles are a selection taken from our library catalogue. If you
are interested in further articles please contact us for a literature search.
Alternatively browse our website at


Please try your local libraries first. They may stock the relevant journal or staff
may be able to obtain a copy on your behalf from the British Library.

However, if you wish the Library to obtain the article for you, please note that
there is a charge of 50p for each article photocopied except for NHSScotland
employees. To comply with photocopy regulations, only one article from any
one issue of a journal can be supplied. NHSScotland employees may request
two articles from any one issue of a journal.

Please make cheques/postal orders payable to NHS Health Scotland.

If you order photocopied material from this library please note that the
Copyright, Designs and Patents Act requires libraries to obtain signed and
completed declaration forms for each item requested before the order can be
fulfilled. If you are unable to photocopy the declaration form on the inside of
the back cover of this bulletin, the library staff will be happy to send you
copies of this form.

All abstracts contained in this Bulletin are taken from journal head-notes


ADAMS, Alison and D'SOUZA, Rachel. Teenage contraception. General
Practice Update Volume 2, Issue 6 - June 2009: 36-39
  Abstract: Despite the 1998 government target to halve teenage pregnancies
by 2010, the UK teenage pregnancy rate remains high. It is acknowledged
that improving contraception use by teenagers plays a key role in reducing
pregnancies. In this article, we look at the challenges in prescribing to this
group, the specific issues involved and the use of long-acting reversible
contraceptive methods for young women. We also discuss the government's
Teenage Pregnancy Strategy, which aims to employ a multidisciplinary
approach to try and tackle the problem.

LEACH, Liana S and RICKWOOD, Debra J. The impact of school bullying
on adolescents' psychosocial resources and help-seeking intentions.
Advances in School Mental Health Promotion Vol 2, No 2 - April 2009: 30-39
  Abstract: School bullying has been recognized as having a major impact on
mental health. Bullied students are often encouraged to seek help from
others, but research indicates that adolescents experiencing problems tend
not to ask for help. This study examines whether being bullied depletes
psychological and social resources such that those who are bullied have lower
intentions to seek help with this problem. Students (169 females, 153 males)
from a large public high school in Australia completed a questionnaire
assessing bullying prevalence, help-seeking and associated psychosocial

Health Scotland Library                                                         3
                                 Journal Articles

factors. The results showed that being bullied was associated with poorer
psychological health, fewer social resources and lower help-seeking intentions
from informal sources (friends and family). The association between being
bullied and low help-seeking intentions was explained principally by fewer
social resources. All students indicated they were unlikely to seek help from
formal sources (teachers, mental health workers etc). Anti-bullying
interventions should account for the negative psychological and social
consequences of bullying, and the reluctance to seek help from formal

WEN, Ming and VAN DUKER, Heather and others. Social contexts of
regular smoking in adolescence: towards a multidimensional ecological
model. Journal of Adolescence Vol 32, No 3 - June 2009: 671-692
  Abstract: Using data from the Add Health, this study examined multilevel
factors of adolescent smoking after controlling for the baseline smoking
behavior and individual characteristics. Results showed that peer, family and
school were all important life domains contextually influencing subsequent
smoking behavior among adolescents. Time spent with peers, best friend
smoking and household member smoking were associated with higher risk.
Parent-child closeness, parental control, attending a private school and having
a higher percentage of Hispanic students at school were protective factors.
Significant interaction effects were found between parental control and
household member smoking and between parent-child closeness and
communication. None of the neighborhood- and state-level factors were
significant in the final full model but they were significant in reduced models.
More proximate social contexts appear to play a more direct and immediate
role in adolescent smoking than macro-level factors. An ecological model
incorporating multiple social systems seems more fruitful than single-system
models to reveal etiology of adolescent smoking.


ANDERSON, Peter and CHISHOLM, Dan and others. Effectiveness and
cost-effectiveness of policies and programmes to reduce the harm
caused by alcohol. Lancet 27 June 2009: 2234-2246
  Abstract: This paper reviews the evidence for the effectiveness and cost-
effectiveness of policies and programmes to reduce the harm caused by
alcohol, in the areas of education and information, the health sector,
community action, driving while under the influence of alcohol (drink-driving),
availability, marketing, pricing, harm reduction, and illegally and informally
produced alcohol. Systematic reviews and meta-analyses show that policies
regulating the environment in which alcohol is marketed (particularly its price
and availability) are effective in reducing alcohol-related harm. Enforced
legislative measures to reduce drink-driving and individually directed
interventions to already at-risk drinkers are also effective. However, school-
based education does not reduce alcohol-related harm, although public
information and education-type programmes have a role in providing
information and in increasing attention and acceptance of alcohol on political
and public agendas. Making alcohol more expensive and less available, and

Health Scotland Library                                                       4
                                 Journal Articles

banning alcohol advertising, are highly cost-effective strategies to reduce
harm. In settings with high amounts of unrecorded production and
consumption, increasing the proportion of alcohol that is taxed could be a
more effective pricing policy than a simple increase in tax.

CASSWELL, Sally and THAMARANGSI, Thaksaphon. Reducing harm from
alcohol: call to action. Lancet 27 June 2009: 2247-2257
  Abstract: Despite clear evidence of the major contribution alcohol makes to
the global burden of disease and to substantial economic costs, focus on
alcohol control is inadequate internationally and in most countries. Expansion
of industrial production and marketing of alcohol is driving alcohol use to rise,
both in emerging markets and in young people in mature alcohol markets.
Cost-effective and affordable interventions to restrict harm exist, and are in
urgent need of scaling up. Most countries do not have adequate policies in
place. Factors impeding progress include a failure of political will, unhelpful
participation of the alcohol industry in the policy process, and increasing
difficulty in free-trade environments to respond adequately at a national level.
An effective national and international response will need not only
governments, but also non-governmental organisations to support and hold
government agencies to account. International health policy, in the form of a
Framework Convention on Alcohol Control, is needed to counterbalance the
global conditions promoting alcohol-related harm and to support and
encourage national action.

MASON, W Alex and KOSTERMAN, Rick and others. Gender moderation
and social developmental mediation of the effect of a family-focused
substance use preventive intervention on young adult alcohol abuse.
Addictive Behaviors Vol 34, No 6-7 - June/July 2009: 599-605
  Abstract: This study examined the long-term impact of Preparing for the
Drug Free Years (PDFY) on young adult alcohol abuse disorder, addressing
theory-based questions about how, and for whom, the program had its effects
on the outcomes. Participants were 429 families of 6th graders enrolled in 33
rural schools located in the Midwestern United States. Schools were randomly
assigned to conditions. Target adolescents (52% female) were interviewed
periodically from age 11 to age 22; throughout adolescence, information was
collected also from the youths' parents. Moderation and mediation analyses
were conducted using regression analysis and structural equation modeling
with covariates measured at baseline (age 11), mediators measured at
posttest (age 12), and the outcome measured at the young adult follow-up
(age 22). Results showed that PDFY reduced the rate of alcohol abuse
among target young women, with evidence that this effect was mediated by
increased prosocial skills. The rate of alcohol abuse among PDFY group men
was not significantly different from that of control group men. Findings have
implications for reducing the public health burden of alcohol abuse among
young women.

RATHFELDER, Martin. Getting it right about alcohol. Health Matters Issue
76 Summer 2009: 26-28

Health Scotland Library                                                        5
                                 Journal Articles

  Abstract: Martin Rathfelder describes the evidence given by Socialist Health
Association to the House of Commons' Health Committee Enquiry into

REHM, Jurgen and MATHERS, Colin and others. Global burden of disease
and injury and economic cost attributable to alcohol use and alcohol-
use disorders. Lancet 27 June 2009: 2223-2233
  Abstract: Alcohol consumption has been identified as an important risk
factor for chronic disease and injury. In the first paper in this Series, we
quantify the burden of mortality and disease attributable to alcohol, both
globally and for ten large countries. We assess alcohol exposure and
prevalence of alcohol-use disorders on the basis of reviews of published work.
After identification of other major disease categories causally linked to alcohol,
we estimate attributable fractions by sex, age, and WHO region. Additionally,
we compare social costs of alcohol in selected countries. The net effect of
alcohol consumption on health is detrimental, with an estimated 3·8% of all
global deaths and 4·6% of global disability-adjusted life-years attributable to
alcohol. Disease burden is closely related to average volume of alcohol
consumption, and, for every unit of exposure, is strongest in poor people and
in those who are marginalised from society. The costs associated with alcohol
amount to more than 1% of the gross national product in high-income and
middle-income countries, with the costs of social harm constituting a major
proportion in addition to health costs. Overall, we conclude that alcohol
consumption is one of the major avoidable risk factors, and actions to reduce
burden and costs associated with alcohol should be urgently increased.

STREPPEL, M L and OCKE, M C and others. Long-term wine consumption
is related to cardiovascular mortality and life expectancy independently
of moderate alcohol intake: the Zutphen Study. Journal of Epidemiology
and Community Health Vol 63, No 7 - July 2009: 534-540
  Abstract: Background: Light to moderate alcohol intake lowers the risk of
cardiovascular mortality, but whether this protective effect can be attributed to
a specific type of beverage remains unclear. Moreover, little is known about
the effects of long-term alcohol intake on life expectancy. Methods: The
impact of long-term alcohol intake and types of alcoholic beverages
consumed on cardiovascular mortality and life expectancy at age 50 was
investigated in the Zutphen Study, a cohort of 1373 men born between 1900
and 1920 and examined repeatedly between 1960 and 2000. Hazard ratios
(HRs) for total alcohol intake and alcohol from wine, beer and spirits were
obtained from time-dependent Cox regression models. Life expectancy at age
50 was calculated from areas under survival curves. Results: Long-term light
alcohol intake, that is 20 g per day, compared with no alcohol, was strongly
and inversely associated with cerebrovascular (HR 0.43, 95% CI 0.26 to
0.70), total cardiovascular (HR 0.70, 95% CI 0.55 to 0.89) and all-cause
mortality (HR 0.75, 95% CI 0.63 to 0.91). Independent of total alcohol intake,
long-term wine consumption of, on average, less than half a glass per day
was strongly and inversely associated with coronary heart disease (HR 0.61,
95% CI 0.41 to 0.89), total cardiovascular (HR 0.68, 95% CI 0.53 to 0.86) and
all-cause mortality (HR 0.73, 95% CI 0.62 to 0.87). These results could not be
explained by differences in socioeconomic status. Life expectancy was about

Health Scotland Library                                                        6
                                 Journal Articles

5 years longer in men who consumed wine compared with those who did not
use alcoholic beverages. Conclusion: Long-term light alcohol intake lowered
cardiovascular and all-cause mortality risk and increased life expectancy.
Light wine consumption was associated with 5 years longer life expectancy;
however, more studies are needed to verify this result.

VAN HOOF, Joris J and DE JONG, Menno D T and others. There's alcohol
in my soap: portrayal and effects of alcohol use in a popular television
series. Health Education Research Vol 24, No 3 - June 2009: 421-429
  Abstract: Two studies are reported addressing the media influences on
adolescents' alcohol-related attitudes and behaviours. A content analysis was
conducted to investigate the prevalence of alcohol portrayal in a Dutch soap
series. The coding scheme covered the alcohol consumption per soap
character, drinking situations and drinking times. Inter-coder reliability was
satisfactory. The results showed that alcohol portrayal was prominent and that
many instances of alcohol use reflected undesirable behaviours. To assess
the influence of such alcohol cues on adolescents, a 2 × 2 experiment was
conducted focusing on the separate and combined effects of alcohol portrayal
in the soap series and surrounding alcohol commercials. Whereas the alcohol
commercials had the expected effects on adolescents' attitudes, the alcohol-
related soap content only appeared to have unexpected effects. Adolescents
who were exposed to the alcohol portrayal in the soap series had a less
positive attitude towards alcohol and lower drinking intentions. Implications of
these findings for health policy and future research are discussed.


HOLSEN, Ingrid and IVERSEN, Anette Christine and others. Universal social
competence promotion programme in school: does it work for children
with low socio-economic background? Advances in School Mental Health
Promotion Vol 2, No 2 - April 2009: 51-60
  Abstract: The purpose of this study on which this paper reports was to
examine the effects of a universal social competence promotion programme
on children from families characterised by low socio-economic status (SES).
The study employed an age cohort design. The sample consisted of 1,153
students in fifth to seventh grade from 11 schools in Norway. Data were
collected by questionnaires at baseline (2004) and after one year of
programme implementation (2005). The programme resulted in significantly
greater gains for low SES students on some but not all of the outcomes
measured. Low SES students showed greater improvement in social
competence, school performance and satisfaction with life than their medium
to high SES peers. The finding that a universal programme has beneficial
effects for children who report low socio-economic status is promising, since
those children show a cluster of psychosocial disadvantages.

Health Scotland Library                                                       7
                                 Journal Articles


CLARKE, Wendy and PERIAM, Catherine and others. Oral health promotion
for linguistically and culturally diverse populations: understanding the
local non-English-speaking population. Health Education Journal Vol 68,
No 2 - June 2009: 119-129
  Abstract: Changes in the prevalence of oral diseases and the funding of
National Health Service Dentistry in the United Kingdom have combined to
emphasize the role of the dental team in the prevention of disease. As part of
this, oral health promotion plays a vital role in local communities and
educational settings. Like many other inner-city London boroughs, Lambeth,
Southwark and Lewisham have linguistically and culturally diverse
populations, accompanied in recent years by an increasing demand and need
for oral health promotion for non English speakers and those with low English
language proficiency. Using the population of Lambeth, Southwark and
Lewisham as an example, this paper will highlight the complexity of
developing oral health promotion resources for non-English-speaking
populations, where language is a barrier to accessing information and
services. Practical strategies for delivering health promotion in the community
will also be considered.


FISCHBACHER, C M and BHOPAL, R and others. Is there equity of service
delivery and intermediate outcomes in South Asians with type 2
diabetes? Analysis of DARTS database and summary of UK
publications. Journal of Public Health Vol 31, No 2 - June 2009: 239-249
  Abstract: Background: There are doubts whether diabetes care is equitable
across UK ethnic groups. We examined processes and outcomes in South
Asians with diabetes and reviewed the UK literature. Methods: We used
name search methods to identify South Asians in a regional diabetes
database. We compared prevalence rates, processes and outcomes of care
between November 2003 and December 2004. We used standard literature
search techniques. Results: The prevalence of diabetes in South Asians was
3-4 times higher than non-South Asians. South Asians were 1.11 times (95%
confidence interval 1.06, 1.16) more likely to have a structured review. South
Asian women were 1.10 times more likely to have a record of body mass
index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00,
1.06) among South Asians, retinopathy 1.36 times more common (95% CI
1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87).
Conclusions: We found evidence of equity in many aspects of diabetes care
for South Asians in Tayside. The finding of higher HbA1c and more
retinopathy among South Asians needs explanation and a service response.
These findings from a region with a small non-White population largely
support the recent findings from other parts of the UK.

Health Scotland Library                                                     8
                                 Journal Articles

NAZROO, James. Ethnicity and health. Health Matters Issue 76 Summer
2009: 16-18
  Abstract: James Nazroo argues that the significance of social and economic
inequalities should not be forgotten in any discussion about ethnicity and


ALLEGRANTE, John P and BARRY, Margaret M and others. Toward
international collaboration on credentialing in health promotion and
health education: the Galway Consensus Conference. Health Education
and Behavior Vol 36, No 3 - June 2009: 427-438
  Abstract: The interest in competencies, standards, and quality assurance in
the professional preparation of public health professionals whose work
involves health promotion and health education dates back several decades.
In Australia, Europe, and North America, where the interest in credentialing
has gained momentum, there have been rapidly evolving efforts to codify
competencies and standards of practice as well as the processes by which
quality and accountability can be ensured in academic professional
preparation programs. The Galway Consensus Conference was conceived as
a first step in an effort to explore the development of an international
consensus regarding the core competencies of health education specialists
and professionals in health promotion and the commonalities and differences
in establishing uniform standards for the accreditation of academic
professional preparation programs around the world. This article describes the
purposes, objectives, and process of the Galway Consensus Conference and
the background to the meeting that was convened.

BRADFORD, C and HILL, A and others. English health profiles - did they
do what was expected? An evaluation of Health Profiles 2006. Public
Health Vol 123, No 4 - April 2009: 311-315
  Abstract: Objectives: To assess the impact of Health Profiles 2006 by
English local authorities, and to determine what changes need to be made to
the profiles to have an impact on their target audience. Study design:
A telephone- and web-based survey of a sample of the health profiles' target
audience was conducted, along with an analysis of web statistics. Methods:
In total, 285 telephone interviews were undertaken. Fifty-three percent of the
respondents were National Health Service employees. An evaluation form
was also available through the Health Profiles website, which elicited 117
responses (19 scrutiny officers and 83 members of the public). Results:
There was a positive response to the content and format of Health Profiles
2006. The majority of respondents felt that the profiles provided a unique
summary of local-authority-based health and health inequality information that
was both accessible and understandable. Conclusions: A number of
recommendations are made to improve health profile production as a tool for
information for health improvement. These include simplifying graphics,
greater local input into commentary, and a more interactive website so that
the data can be accessed and explored. However, the recommendations for
change must be viewed alongside the number of comments specifically

Health Scotland Library                                                     9
                                 Journal Articles

relating to the English health profiles that nothing should be changed other
than updating the data and filling in the gaps.

JOHANSSON, Agneta and ERIKSSON, Lina S and others. Participation,
resource mobilization and financial incentives in community-based
health promotion: an economic evaluation perspective from Sweden.
Health Promotion International Vol 24, No 2 - June 2009: 177-184
  Abstract: Local community participation is an important objective for many
health promotion interventions, but it hinges on the incentives for local
organizations to participate. Both aspects might be explored with information
obtained from economic evaluations, illustrated in this study with data from a
cost-effectiveness analysis of an elderly safety promotion programme
implemented in Sweden. Previously, resource mobilization has been used as
a process indicator for successful community participation. We propose that
resource mobilization can be measured as the proportion of total intervention
costs paid by collaborators. In the case presented here, local collaborators
contributed 50 per cent of the total intervention costs (SEK 6.45 million, in
Swedish krona 2004; 1 USD = 7.35 SEK), while participants, i.e. the elderly in
the intervention area, contributed 13 per cent and the remainder, 37 per cent,
was paid by project funds. In a subsector financial analysis, the distribution of
costs and financial benefits from interventions among different sectors in
society is described. The estimated financial benefits in the case were divided
between the health-care system (SEK 2.5 million), the local authority (SEK 3.7
million) and the elderly and their relatives (SEK 0.3 million). The only net
beneficiary was the local authority. In the case presented here, the health
promotion objective of local community participation was achieved as half of
the total costs was mobilized from local collaborators. The local community
participation objective was supported by financial incentives for at least one
key collaborator.

RAYNOR, Geof. Obesity: a question of arts and minds. Health Matters
Issue 76 Summer 2009: 13-15
  Abstract: Geof Raynor argues that the focus on individual choice and
partnerships with the food industry limit what can be achieved in addressing

TAUB, Alyson and ALLEGRANTE, John P and others. Perspectives on
terminology and conceptual and professional issues in health education
and health promotion credentialing. Health Education and Behavior Vol 36,
No 3 - June 2009: 439-450
  Abstract: This article was prepared to inform the deliberations of the Galway
Consensus Conference by providing a common and global reference point for
the discussion of terminology and key conceptual and professional issues in
the credentialing of health education and health promotion specialists. The
article provides a review of the terminology that is currently employed across
different countries in defining health education and health promotion as well
as health educator and health promotion specialist. The terminology used to
describe concepts in professional credentialing of health education and health
promotion specialists and the scope of professional responsibilities of such
specialists, including the terms professional competencies, professional

Health Scotland Library                                                        10
                                 Journal Articles

standards, and accreditation, are also reviewed. Finally, key unresolved
issues are identified and discussed from a global perspective. The article
concludes that despite differences in terminology in the definitions of roles and
responsibilities, health education and health promotion are conceptually more
similar than different across countries.

TOUNTAS, Yannis. The historical origins of the basic concepts of health
promotion and education: the role of ancient Greek philosophy and
medicine. Health Promotion International Vol 24, No 2 - June 2009: 185-192
  Abstract: Although it is commonly accepted that the basic concepts of
'Health Promotion' have been developed in the last two decades, they have
their roots in ancient civilizations and in particular in Greek antiquity. As
evident from medical and philosophical documents of the sixth to fourth
centuries B.C., the ancient Greeks were the first to break with the
supernatural conceptions of health and disease that had so far dominated
human societies. The ancient Greeks developed the physiocratic school of
thought, realizing that maintaining good health and fighting illness depend on
natural causes and that health and disease cannot be dissociated from
particular physical and social environments nor from human behavior. In this
context, they defined health as a state of dynamic equilibrium between the
internal and the external environment, they took under consideration the
physical and social determinants of health, they empowered individuals and
communities through new democratic and participatory institutions, they gave
emphasis in health education and skill development, they recognized the
importance of supportive environments and of healthy public policy and they
re-oriented medicine toward a more naturalistic and humanistic perspective.
The aim of the present study is to highlight such core concepts from these
early times that helped establishing the foundations for health promotion and
education in the modern era according to the Ottawa Charter.


CAMERON, Ailsa and LLOYD, Liz and others. Working across boundaries
to improve health outcomes: a case study of a housing support and
outreach service for homeless people living with HIV. Health and Social
Care in the Community Vol 17, No 4 - July 2009: 388-395
  Abstract: This paper reports the findings of an evaluation of the 'Housing
Support, Outreach and Referral' service developed to support people living
with HIV who were homeless or at risk of homelessness. The service was set
up as part of the Supporting People Health Pilot programme established to
demonstrate the policy links between housing support services and health and
social care services by encouraging the development of integrated services.
The paper considers the role of housing support in improving people's health,
and considers the challenges of working across housing, health and social
care boundaries. The evaluation of the health pilot employed two main
sources of data collection: quarterly project evaluation reports, which collected
process data as well as reporting progress against aims and objectives, and
semi-structured interviews with professionals from all key stakeholder groups
and agencies, and with people who used services. Over the course of 15

Health Scotland Library                                                       11
                                 Journal Articles

months, 56 referrals were received of which 27 were accepted. Fifteen people
received tenancy support of whom 12 were helped to access temporary
accommodation. At the end of the 15 months, all of the tenancies had been
maintained. In addition, 18 people registered with a general practitioner and
13 registered with an HIV clinic. Interviews with professionals emphasised the
importance of the local joint working context, the involvement of the voluntary
sector and the role of the support workers as factors that accounted for these
outcomes. Those using services placed most emphasis on the flexibility of the
support worker role. Importantly, interviews with professionals and those using
services suggest that the role of support worker incorporates two dimensions -
those of networker/navigator as well as advocate - and that both dimensions
are important in determining the effectiveness of the service.

GALBRAITH, Jennifer S and STANTON, Bonita and others. Exploring
implementation and fidelity of evidence-based behavioral interventions
for HIV prevention: lessons learned from the Focus on Kids Diffusion
Study. Health Education and Behavior Vol 36, No 3 - June 2009: 532-549
  Abstract: Evidence-based interventions (EBIs) are used in public health to
prevent HIV infection among youth and other groups. EBIs include core
elements, features that are thought to be responsible for the efficacy of
interventions. The authors evaluate experiences of organizations that adopted
an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity to the
intervention's eight core elements. A cross-sectional telephone survey was
administered to 34 staff members from organizations that had previously
implemented FOK. Questions assessed how the organization adhered to,
adapted, dropped, or altered the intervention. None of the organizations
implemented all eight core elements. This study underscores the importance
for HIV intervention researchers to clearly identify and describe core
elements. More effort is needed to reflect the constraints practitioners face in
nonresearch settings. To ensure intervention effectiveness, additional
research and technical assistance are needed to help organizations
implement HIV prevention EBIs with fidelity.

GRAFFIGNA, Guendalina and OLSON, Karin. The ineffable disease:
exploring young people's discourses about HIV/AIDS in Alberta, Canada.
Qualitative Health Research Vol 19, No 6 - June 2009: 790-801
   Abstract: The ongoing epidemic of HIV/AIDS in Western societies (in
particular in North America), where most of the population knows about the
disease and how it is transmitted, suggests that providing information is not
enough to change unsafe conduct. More complex psychosocial processes,
mainly still unexplored, seem to underlie the translation of health knowledge
about the disease and the infection into safe practices. In this article we
explore the discourse of young people in Alberta about HIV/AIDS and discuss
ways in which this information might be used to shape preventive strategies.
We conducted eight focus groups with young people 18 to 25 years of age
living in Edmonton, Alberta, Canada, and analyzed the data using
psychosocial discourse analysis. The results confirm the role of young
people's interpersonal exchanges in determining HIV/AIDS preventive
conduct and show the importance of social discourses about HIV/AIDS in

Health Scotland Library                                                       12
                                 Journal Articles

mediating the impact of preventive campaigns on young people's attitudes
and beliefs.

KIMBROUGH, Lisa W and FISHER, Holly E and others. Accessing social
networks with high rates of undiagnosed HIV infection: the social
networks demonstration project. American Journal of Public Health Vol 99,
No 6 - June 2009: 1093-1099
   Abstract: Objectives: We evaluated the use of social networks to reach
persons with undiagnosed HIV infection in ethnic minority communities and
link them to medical care and HIV prevention services. Methods: Nine
community-based organizations in 7 cities received funding from the Centers
for Disease Control and Prevention to enlist HIV-positive persons to refer
others from their social, sexual, or drug-using networks for HIV testing; to
provide HIV counseling, testing, and referral services; and to link HIV-positive
and high-risk HIV-negative persons to appropriate medical care and
prevention services. Results: From October 1, 2003, to December 31, 2005,
422 recruiters referred 3172 of their peers for HIV services, of whom 177 were
determined to be HIV positive; 63% of those who were HIV-positive were
successfully linked to medical care and prevention services. The HIV
prevalence of 5.6% among those recruited in this project was significantly
higher than the approximately 1% identified in other counseling, testing, and
referral sites funded by the Centers for Disease Control and Prevention.
Conclusions: This peer-driven approach is highly effective and can help
programs identify persons with undiagnosed HIV infection in high-risk

MUKOMA, Wanjiru and FLISHER, Alan J and others. Process evaluation of
a school-based HIV/AIDS intervention in South Africa. Scandinavian
Journal of Public Health Vol 37, Supplement 2 - June 2009: 37-47
   Abstract: Aims: This paper presents a process evaluation that assessed the
fidelity and quality of implementation, as well as the acceptability and
subjective evaluations of a HIV/AIDS intervention among students and
teachers. Methods: The process evaluation was conducted as part of a cluster
randomized controlled trial of a theory- and evidence-based school HIV/AIDS
intervention in Cape Town. The intervention was designed for grade 8 high
school students and delivered by teachers over a six-month period. Twenty-
six schools participated in the trial, 13 in the intervention group and 13 in the
control group. Results: The success of implementation was varied within and
across the schools, with some teachers implementing the intervention with
more fidelity than others. This was influenced by a combination of individual
characteristics and institutional factors. The factors that aided implementation
included compliance with the current outcomes-based education approach;
provision of teacher training; provision of teacher manuals with detailed
information and instructions about the lessons and activities; continued
monitoring and support for teachers; and student enthusiasm for the lessons.
Proper implementation was hindered by large class sizes; too many activities
in the intervention; teacher resistance to and inexperience in using
participatory methods; teacher turnover; the low status of life orientation
compared to other subjects; and a general disregard for life orientation among
students. Conclusions: These findings are important for improving the

Health Scotland Library                                                       13
                                 Journal Articles

intervention and contextualizing the results of the outcome evaluation; and to
better plan for further large scale dissemination of school-based HIV/AIDS
intervention programmes.


CHAO, Chun and SLEZAK, Jeff M and others. Papanicolaou screening
behavior in mothers and human papillomavirus vaccine uptake in
adolescent girls. American Journal of Public Health Vol 99, No 6 - June
2009: 1137-1142
   Abstract: Objectives: We investigated whether maternal attitude toward
prevention, as indicated by history of seeking Papanicolaou (Pap) tests and
contracting sexually transmitted infections, influenced human papillomavirus
(HPV) vaccine uptake among their adolescent daughters. Methods: We
linked the electronic health records of girls aged 9 to 17 years with their
mothers at Kaiser Permanente Southern California (n = 148 350 mother-
daughter pairs). Personal identifying information was removed from the data
set after the matching of daughters and mothers was completed. We used
logistic regression models to detect associations between mothers' history of
Pap tests and abnormal results, genital or anal warts, and other sexually
transmitted infections and daughters' HPV vaccine initiation and 3-dose
regimen completion. Results: Mothers' testing history was associated with
daughters' likelihood for vaccination across ethnic and neighborhood
socioeconomic strata (overall odds ratio [OR] = 1.47; 95% confidence interval
[CI] = 1.43, 1.52). Mothers' history of sexually transmitted infections was only
modestly associated with daughters' vaccination. Mothers' testing history was
positively associated with daughters' regimen completion (overall OR = 1.42;
95% CI = 1.31, 1.54). Conclusions: Mothers' attitude toward prevention may
influence HPV vaccine uptake among adolescent girls. The impacts of
targeting mothers should be considered by HPV vaccination programs and
investigated by further research.

HOWLETT, Roberta I and MILLER, Anthony B and others. Defining a
strategy to evaluate cervical cancer prevention and early detection in the
era of HPV vaccination. Preventive Medicine Vol 48, No 5 - May 2009: 432-
  Abstract: Objective: The purpose of this paper is to outline the short-,
medium- and long-term requirements of a strategy to evaluate the impact of
HPV immunization and to define a framework to facilitate planning and
evaluation. Method: This strategy was developed in Ontario from January to
August 2008. Literature review was completed to assess existing material
relevant to vaccine evaluation, and HPV vaccine specifically. Scientists and
epidemiologists within our organization attended meetings to brainstorm and
identify key requirements for vaccine evaluation. Other selected internal and
external experts were consulted to review preliminary lists of potential
indicators and questions for inclusion in an evaluation strategy. Results:
Results are reported in three sections - literature review, proposed evaluation
framework and data requirements. Conclusion: The first vaccine evaluation
strategy that integrates primary and secondary prevention of cervical cancer is

Health Scotland Library                                                       14
                                 Journal Articles

presented. Among women who are neither screened nor immunized,
customized interventions will be required to ensure that they are aware of
potential risks and benefits. This evaluation strategy may serve as a useful
outline for jurisdictions in Canada and elsewhere. This new paradigm of
combined primary and secondary intervention will encourage cooperation for
effective evaluation of an integrated approach for control of cervical cancer
and other HPV-related disease.

PORTA, Miquel. The improbable plunge. What facts refute reasons to
expect that the effectiveness of HPV vaccination programs to prevent
cervical cancer could be low? Preventive Medicine Vol 48, No 5 - May
2009: 407-410

ZIARNOWSKI, Karen L and BREWER, Noel T and others. Present choices,
future outcomes: anticipated regret and HPV vaccination. Preventive
Medicine Vol 48, No 5 - May 2009: 411-414
   Abstract: Objective: The study examined the role of anticipated regret in
human papillomavirus (HPV) vaccination decisions as well as potential
antecedents of anticipated regret. Method: In 2007, we interviewed 889
caregivers for girls aged 10-18 in areas of North Carolina with high rates of
cervical cancer. The survey assessed vaccination regret (anticipated regret if
daughter became more sexually active after vaccination) and inaction regret
(anticipated regret if an unvaccinated daughter developed an HPV infection
that could lead to cervical cancer). Main outcomes were self-reported
vaccination behavior and intentions to vaccinate. Analyses controlled for
perceived risk and caregiver and child characteristics. Results: Caregivers
who reported higher vaccination regret were less likely to have gotten their
adolescent daughters the HPV vaccine (OR = .60, p < .001). Among those
who had not yet vaccinated their daughters, higher intentions to vaccinate
were associated with higher anticipated inaction regret (ß = .45, p < .001) and
lower vaccination regret (ß = -.22, p < .001). Decision urgency was a
significant correlate of both types of regret. Conclusion: Anticipated regret
appears to play an important role in caregivers' decisions to vaccinate
adolescent girls against HPV, above and beyond the role played by perceived


KELLY, Fiona and PAPADOPOULOS, Irena. Enhancing the cultural
competence of healthcare professionals through an online course.
Diversity in Health and Social Care Vol 6, No 2 - 2009: 77-84
  Abstract: With the marked growth of in-migration to many Western countries
over the past few decades, health services face the challenge of providing
care to increasingly diverse populations. Minority ethnic groups encounter
cultural, linguistic and institutional barriers in accessing health services and in
the quality and continuity of their care. A key step in developing culturally
sensitive services is the training of health and social care professionals in
cultural competence. This article describes an online course on cultural
competence for health and social care professionals as an example of good

Health Scotland Library                                                          15
                                 Journal Articles

practice. This 8-week course aims to enhance knowledge and skills in cultural
competence through an interactive online learning environment. The paper
begins with a general introduction to the concept of cultural competence in
healthcare and the rationale behind it. It then examines the advantages and
disadvantages of online learning as opposed to traditional classroom learning.
The many advantages of online learning are discussed, including the flexibility
for the learner to fit the course around their work and family commitments.
The advantages and disadvantages of the course are subsequently examined
from the viewpoint of the students through the course evaluation. This
evaluation showed that the three critical elements for running a successful
online course were present, namely content, learner support and learning
activities. All received positive evaluations from the students. In conclusion, it
is clear that online courses on cultural competence can be successful, so long
as they are well designed and supported.


have sex tonight?' - people with learning difficulties pursuing privacy in
residential group settings. British Journal of Learning Disabilities Vol 37, No
2 - June 2009: 91-97
  Abstract: Many residential group settings for people with learning difficulties
do not provide individuals with the private space in which they can explore
their sexual relationships in a safe and dignified manner. Lack of agreed
private spaces seriously infringes the individual's human rights. Many people
with learning difficulties who lack privacy have no other option but to escape
to isolated public or semi-private spaces to be sexually active. This places
individuals at risk. It is suggested that self-advocacy driven policy guidance
must be developed which must require residential services to review their
practice to ensure that they accommodate residents' need for privacy, whilst
supporting them to lead safe sexual relationships.

KAEHNE, Axel and BEYER, Stephen. 'Views of professionals on aims and
outcomes of transition for young people with learning disabilities'. British
Journal of Learning Disabilities Vol 37, No 2 - June 2009: 138-144
  Abstract: The paper reports the findings of a study of professionals in
strategic and operational positions who were involved in transition planning for
young people with learning disabilities. Respondents were asked to comment
on what they regarded as the optimal aim and outcome of transition from
school to post-school placements. The results illustrate the problems and
advantages of inter-agency partnerships in delivering meaningful post-school
destinations for young people leaving school.

REDLEY, Marcus. Understanding the social exclusion and stalled welfare
of citizens with learning disabilities. Disability and Society Vol 24, No 4 -
June 2009: 489-501
  Abstract: Despite the UK's recent history of promoting the social inclusion
and equality of men and women with learning disabilities they remain a
significantly disadvantaged group. Compared with their non-disabled peers

Health Scotland Library                                                         16
                                  Journal Articles

they are more likely to be unemployed, less likely to own their own homes and
are at a significantly greater risk of physical and mental ill health. The first part
of this paper discusses the welfare rights of citizens with learning disabilities in
terms of New Labour's welfare to work policies. The second part discusses
the UK's mixed welfare economy and its impact upon services for men and
women with learning disabilities. The paper concludes by considering whether
the social inclusion of men and women with learning disabilities can be
promoted solely through policies that emphasise inclusion through work and
the personalisation of welfare services.

WEBB, Jenny and STANTON, Melanie. Better access to primary
healthcare for adults with learning disabilities: evaluation of a group
programme to improve knowledge and skills. British Journal of Learning
Disabilities Vol 37, No 2 - June 2009: 116-122
  Abstract: The health of people with learning disabilities is poor when
compared with the general population but this difference is not reflected in
higher rates of access to primary healthcare. * This paper will report on a
study undertaken to run and evaluate a 12-week programme to enable people
with learning disabilities to better access primary healthcare. * The importance
of this research lies in the successful outcomes achieved, and in the
distinctive properties of the programme, which used practice-based groups,
and focussed on the development of health skills as well as health knowledge.


ANNOR, Samuel and ALLEN, Pauline. Why is it difficult to promote public
mental health? A study of policy implementation at local level. Journal of
Public Mental Health Vol 7, No 4 - December 2008: 17-29
   Abstract: The promotion of public mental health is a challenging endeavour
for policy actors and stakeholders. In particular, the implementation of public
mental health initiatives highlighted in Standard One of the National Service
Framework for Mental Health has been poor and patchy (Department of
Health, 2004a). This paper attempts to illuminate the complex process of
public mental health policy implementation at local level through the
exploration of stakeholders' actions. An exploratory case study design was
selected, focusing on one local health and social care community within inner
London. A conceptual framework about policy implementation and the
concept of partnership working are used to shape the analysis of the empirical
findings. This paper addresses the challenges associated with the promotion
of public mental health initiatives within one local NHS health and social care
community. It attempts to increase the understanding and insights into public
mental health policy and practice at local level from a policy implementation
standpoint. Using an empirical case study of public mental health in an
English locality, some of the key issues explored in this paper are about
perceptions of public mental health concepts among key policy actors and
also stakeholders' behaviour in Local Implementation Team (LIT)
partnerships. Furthermore, the authors address the issue of how local policy
actors engage the local community in supporting the needs of vulnerable
groups such as service users and black and minority ethnic (BME) groups.

Health Scotland Library                                                           17
                                 Journal Articles

Although functional partnership are essential for the promotion of public
mental health initiatives, the interdependencies of the stakeholders,
competition for resources, power dynamics and the difficulty of engaging a
diverse range of voices have a significant limiting effect on achieving
successful policy implementation on the ground.

ARTHUR, Belinda and KNIFTON, Lee and others. 'Cutting the dash' -
experiences of mental health and employment. Journal of Public Mental
Health Vol 7, No 4 - December 2008: 51-59
   Abstract: People who have used mental health services in Scotland have
the lowest employment rates of all working ages, despite a national
programme for mental health and well-being that provides significant
investment in anti-stigma initiatives and employment support services. This
paper qualitatively identifies barriers to employment from the perspectives of
people who have experienced mental health issues by conducting in-depth
focus groups with 20 people who have experienced mental health issues
undertaken through collaborative research involving people who have
experienced mental health issues alongside practitioners and academics.
Researchers who have experienced mental health issues instigated and
determined the direction, execution and dissemination of the study. The
findings add to the growing evidence base outlining the complex and
interlinked barriers to employment which include previous experience of
workplace discrimination, financial uncertainty, disclosure concerns, quality of
jobs available and the potential of work at times to worsen mental health
conditions. Despite this, most participants expressed hopefulness and
resilience. Many wanted paid work and outlined practical steps that employers
can take in terms of recruitment and retention. However, participants also
stressed the equal importance of voluntary work and not just as a step to paid
employment. A multi-perspectives approach provides important insights into
the complex and sensitive policy area of mental health and employment.
Meaningful involvement of people who have used mental health services
should be a central aspect of further research that aims to understand and
address these barriers. This study has shaped the development of a national
service user research consortium in Scotland.

MAUNDER, Lesley and CAMERON, Lorna and others. Effectiveness of self-
help materials for anxiety adapted for use in prison - a pilot study.
Journal of Mental Health Vol 18, No 3 - June 2009: 262-271
  Abstract: Background: Self-help materials can be effective for anxiety and
depression in community settings, but there is little research on their use in
prisons. Aim: A pilot study to investigate the effectiveness of self-help
materials for the treatment of anxiety and depression in an adult male prison
population. Method: Participants were assigned to the depression or anxiety
group depending on their symptom profile. Within these groups they were
randomly assigned to the intervention (received self-help immediately) or
waiting list control group (received self-help after 4 weeks). Participants
completed self-report outcome measures at baseline, 4 weeks and 8 weeks.
Results: For most of the prisoners referred into the study, anxiety, not
depression, was their predominant symptom. The study suggests that
prisoners can receive at least short-term benefits in anxiety reduction through

Health Scotland Library                                                      18
                                 Journal Articles

a self-help booklet delivered in a healthcare setting. The effect size of the
anxiety booklet intervention was large. Conclusions: Self-help materials are a
promising approach for people with anxiety problems in a custodial setting.
Further studies are necessary to expand upon these pilot data.

OMSTEAD, Darlene and CANALES, Claudia and others. Learning from
turbulent, real-world practice: insights from a whole school mental
health promotion project. Advances in School Mental Health Promotion Vol
2, No 2 - April 2009: 5-16
  Abstract: Mental health promotion in schools has a growing literature on
best practice, but there is insufficient exploration of whole-school change,
particularly in every-day settings. We investigated the transfer of a high-
profile, successful, whole-school mental health promotion demonstration
project into a different context, a cluster of schools in a low-income area with
fewer resources than the prototype model available to implement the project.
Our study involved interviews with teachers, staff and parents. Despite the
fact that significant features of the model program were not followed (for
example any particular classroom-level, or extensive teacher training) the
central organizational development process still led many participants to
report a qualitative improvement in school climate. Internalizing the project as
a mindset seemed to be the strongest way in which the project 'existed'.
Recommendations for strengthening practice in challenging contexts are
outlined, in particular the use of informal and incidental learning theory to
encourage language that amplifies organizational change approaches.

STRENG, Isabelle. Using therapeutic board games to promote child
mental health. Journal of Public Mental Health Vol 7, No 4 - December 2008:
  Abstract: This article focuses on group work with children using a board
game format. Combining the principles of group work and board games helps
to engage and motivate children and adolescents to address and work
through their difficulties. Lifegames are a series of six therapeutic board
games developed for group work with children and adolescents who
encounter adversity in their life as a consequence of bereavement, family
break up, poor relationships, bullying, chronic illness or obesity. The games
facilitate the understanding and disclosure of the complex feelings
experienced by children and young people when they are confronted with
traumatic life events. The games encourage and assist the participants to
obtain and maintain behavioural change. Lifegames are a means to assist
professionals in their group work with children and adolescents.

TOMLINSON, Mark and RUDAN, Igor and others. Setting priorities for
global mental health research. Bulletin of the World Health Organization Vol
87, No 6 - June 2009: 438-446
  Abstract: Objective: To set investment priorities in global mental health
research and to propose a more rational use of funds in this under-resourced
and under-investigated area. Methods: Members of the Lancet Mental Health
Group systematically listed and scored research investment options on four
broad classes of disorders: schizophrenia and other major psychotic
disorders, major depressive disorder and other common mental disorders,

Health Scotland Library                                                       19
                                 Journal Articles

alcohol abuse and other substance abuse disorders, and the broad class of
child and adolescent mental disorders. Using the priority-setting approach of
the Child Health and Nutrition Research Initiative, the group listed various
research questions and evaluated them using the criteria of answerability,
effectiveness, deliverability, equity and potential impact on persisting burden
of mental health disorders. Scores were then weighted according to the
system of values expressed by a larger group of stakeholders. Findings: The
research questions that scored highest were related to health policy and
systems research, where and how to deliver existing cost-effective
interventions in a low-resource context, and epidemiological research on the
broad categories of child and adolescent mental disorders or those pertaining
to alcohol and drug abuse questions. The questions that scored lowest related
to the development of new interventions and new drugs or pharmacological
agents, vaccines or other technologies. Conclusion: In the context of global
mental health and with a time frame of the next 10 years, it would be best to
fill critical knowledge gaps by investing in research into health policy and
systems, epidemiology and improved delivery of cost-effective interventions.

WHITE, Karen and KENDRICK, Tony and others. Change in self-esteem,
self-efficacy and the mood dimensions of depression as potential
mediators of the physical activity and depression relationship: exploring
the temporal relation of change. Mental Health and Physical Activity
Volume 2, Issue 1 - June 2009: 44-52
  Abstract: Objectives: Physical activity has been found to alleviate
depression, but little is known about the mechanisms of change. This study
assessed whether depression and hypothesised mechanisms - self-esteem,
physical self-perceptions, self-efficacy, positive affect (PA) and negative affect
(NA) - changed over time among depressed individuals who increased their
physical activity. It also assessed the temporal relation of change. Design:
Longitudinal, within-subjects design. Method: Thirty-nine individuals with
elevated symptoms of depression increased their physical activity for an eight-
week period. Measures of depression and the hypothesised mechanisms
were taken at baseline, week one, week three and week eight. Results:
There were statistically significant improvements in depression and all the
potential mechanisms between baseline and week eight. An initial reduction in
depression was observed at week one, with most of the reduction occurring
by week three. Initial improvement in PA, NA and self-efficacy also occurred
at week one, while initial improvement in self-esteem and self-perceptions
occurred at week three. Further improvement in self-esteem and some of the
self-perception variables was observed after there was no further significant
change in depression. There were larger changes in PA than the other
measured mechanisms at weeks one and three. Conclusions: Change in PA,
NA and self-efficacy present stronger candidate mechanisms than change in
self-esteem and self-perceptions for mediating change in depression, at least
in the early stages of increased activity. An increase in PA may be especially
important. However, a causal role for the potential mechanisms cannot be
determined from this study.

Health Scotland Library                                                        20
                                 Journal Articles


CLIFFORD, Dawn and ANDERSON, Jennifer and others. Good Grubbin':
impact of a TV cooking show for college students living off campus.
Journal of Nutrition Education and Behavior Vol 41, No 3 - May/June 2009:
  Abstract: Objective: To determine if a series of 4 15-minute, theory-driven
(Social Cognitive Theory) cooking programs aimed at college students living
off campus improved cooking self-efficacy, knowledge, attitudes, and
behaviors regarding fruit and vegetable intake. Design: A randomized
controlled trial with pre-, post- and follow-up tests. Setting: University
campus. Participants: Students (n = 101) from upper-level nonhealth courses
(n = 37 male and n = 94 living off campus). Intervention: The intervention
group (n = 50) watched 4 weekly episodes of the cooking show, Good
Grubbin'. The control group (n = 51) watched 4 weekly episodes on sleep
disorders. Main Outcome Measures: Demographic information; knowledge,
self-efficacy, motivations, barriers of eating fruits and vegetables; self-efficacy,
motivations, barriers and behaviors of cooking; fruit and vegetable intake food
frequency questionnaire. Analysis: Repeated-measure analysis of variance
and chi-square analyses were used to compare outcome variables. Results:
There were significant improvements in knowledge of fruit and vegetable
recommendations in the intervention group compared to the control group
postintervention and at 4-month follow-up (P < .05). There were no significant
changes in fruit and vegetable motivators, barriers, self-efficacy or intake.
Conclusions and Implications: A television show on nutrition and cooking may
be influential in changing students' knowledge, but it seems to have little
impact on dietary behaviors. With a recent increase in popularity of cooking
shows, future research should investigate the impact an extended cooking
and nutrition show series might have on young adult viewers.

HUSBY, Ida and HEITMANN, Berit Lilienthal and others. Meals and snacks
from the child's perspective: the contribution of qualitative methods to
the development of dietary interventions. Public Health Nutrition Vol 12,
No 6 - June 2009: 739-747
   Abstract: Objective: To explore the everyday consumption of meals and
snacks from the child's perspective, among those with healthier v . less
healthy dietary habits. Design: The sample in this qualitative study
comprised two groups of Danish schoolchildren aged 10 to 11 years, one with
a healthier diet ( n 9) and the other with a less healthy diet ( n 8). Both groups
were recruited from respondents to a dietary survey. Semi-structured
interviews took their starting point in photographs of their meals and snacks
taken by the children themselves. Results: Both subgroups of children had a
meal pattern with three main meals and two to four snacks. We found a
connection between the nutritional quality of the diet and the social contexts of
consumption, especially with regard to snacks. Among children with healthier
eating habits, both snacks and meals tended to be shared social events and
items of poor nutritional quality functioned as markers of a special social
occasion. This was not the case among children with less healthy eating
habits. All children described particular rules governing food consumption
within their families. Although only some of them had participated in the

Health Scotland Library                                                          21
                                 Journal Articles

development of these rules, and despite the fact that rules were different and
were perceived as having been developed for different reasons, children from
both subgroups tended to accept them. Conclusions: The results of the study
suggest that dietary interventions designed to promote children's health
should focus more on the different social contexts of consumption and more
on the role of parents.

MORGAN, Maria and FAIRCHILD, Ruth and others. A content analysis of
children's television advertising: focus on food and oral health. Public
Health Nutrition Vol 12, No 6 - June 2009: 748-755
  Abstract: Objectives: To analyse the nature and content of advertising
during children's popular television viewing times with the specific aims of (i)
identifying the proportion of advertising time devoted to confectionery and
potentially cariogenic products (those which readily give rise to dental caries,
more commonly known as tooth decay); and (ii) determining whether there is
a variation in the advertisement of confectionery and other high-sugar
products within children's school holiday time v . outside holiday time.
Method: In five separate one-week periods, the output of the four most
popular British children's commercial television channels was video-recorded
during the most popular viewing times for children. In total, 503 h of television
were recorded and analysed. Results: Analysis of the recordings revealed
that 16·4 % of advertising time was devoted to food products; 6·3 % of all
advertising time was devoted to potentially cariogenic products. Sugared
cereals were the most commonly advertised high-sugar product, followed by
sweetened dairy products and confectionery ( [chi] 2 = 6524·8, df = 4, P <
0·001). The advertisement of confectionery and high-sugar foods appeared to
be influenced by school holidays. Conclusions: Health-care professionals
should be aware of the shift away from the advertisement of confectionery
towards the promotion of foods that might be considered healthier but contain
large amounts of hidden sugar.

PARMER, Sondra M and SALISBURY-GLENNON, Jill and others. School
gardens: an experiential learning approach for a nutrition education
program to increase fruit and vegetable knowledge, preference, and
consumption among second-grade students. Journal of Nutrition
Education and Behavior Vol 41, No 3 - May/June 2009: 212-217
  Abstract: Objective: To examine the effects of a school garden on children's
fruit and vegetable knowledge, preference, and consumption. Design: Self-
report questionnaires, interview-style taste and rate items, lunchroom
observations. Setting: An elementary school. Participants: Second-grade
students (n = 115). Intervention: Participants were assigned to one of 3
groups: (1) nutrition education and gardening (NE+G) treatment group, (2)
nutrition education only (NE) treatment group, or (3) control group (CG). Both
treatment groups received classroom instruction, and the NE+G group also
received a school gardening experience. Main Outcome Measures: Fruit and
vegetable knowledge, preference, and consumption. Analysis: Analyses of
variance (? = .05). Results: Participants in the NE+G and NE treatment
groups exhibited significantly greater improvements in nutrition knowledge
and taste ratings than did participants in the CG. Moreover, the NE+G group
was more likely to choose and consume vegetables in a lunchroom setting at

Health Scotland Library                                                        22
                                 Journal Articles

post-assessment than either the NE or CG groups. Conclusions and
Implications: School gardens as a component of nutrition education can
increase fruit and vegetable knowledge and cause behavior change among
children. These findings suggest that school administrators, classroom
teachers, and nutrition educators should implement school gardens as a way
to positively influence dietary habits at an early age.

POLLARD, Christina M and NICOLSON, Clemency and others. Translating
government policy into recipes for success! Nutrition criteria promoting
fruits and vegetables. Journal of Nutrition Education and Behavior Vol 41,
No 3 - May/June 2009: 218-226
   Abstract: Objective: To develop nutrition criteria consistent with Australian
dietary guidelines encouraging fruit and vegetable consumption for branding
recipes with the Go for 2&5 campaign message. Design: Dietary policies,
guidelines, food selection guides, nutrient targets, existing consumer
education programs' nutrition criteria, food habits, and eating styles were
reviewed to develop nutrition criteria, which were then used to assess 128
recipes. Setting: Perth, Australia. Analysis: Recipes were analyzed then
assessed against criteria for fat, sodium, fiber, energy, added sugar, fruit,
vegetables, cereal, and dairy content/per serving. Results: Recipe nutrition
criteria were devised, and 128 contemporary industry recipes were evaluated
according to developed nutrition criteria. Recipe categories included main
meals; light meals (includes breakfast); soups; salads; side dishes; snacks
(includes drinks); desserts; bakery; and basic ingredients (eg, stocks, dips,
and sauces). Nearly three quarters failed. Excess fat (45%) and sodium (30%)
and inadequate cereal (24%) were the main reasons. Only minor
modifications were required to meet criteria. Conclusions and Implications:
„Healthful‟ recipes promoting fruits and vegetables were often high in fat and
sodium and low in cereal content. Nutrition criteria developed for this study
provided a practical way of assessing specific meals and snacks according to
the dietary guidelines, making them suitable for nutrition promotions.

SMITH, Chery and MORTON, Lois W. Rural food deserts: low-income
perspectives on food access in Minnesota and Iowa. Journal of Nutrition
Education and Behavior Vol 41, No 3 - May/June 2009: 176-187
  Abstract: Objective: To investigate how low-income rural residents living in
food deserts access the normal food system and food safety net services
within their communities, and explore how social, personal, and environment
drives food access and food choice. Design: Seven focus groups (90
minutes each) were conducted with 2 moderators present and were
audiotaped. Setting: Food deserts in rural Minnesota and Iowa.
Participants: Fifty-seven residents (Minnesota: 13 females and 8 males; Iowa:
24 females and 12 males). Most participants were white and had not
completed high school or higher education. Phenomenon of Interest: Food
choice and food access among rural residents. Analysis: Transcripts were
evaluated for consistency and coded for themes and subthemes. Results:
Three dominant themes influence food access and choice and were identified
as: (a) personal and household determinants of food; (b) social and cultural
environment; and (c) structure of place or the external environment.
Conclusions and Implications: Personal, environmental, and dietary

Health Scotland Library                                                      23
                                 Journal Articles

behavioral factors are all interconnected; each plays a major role in
influencing dietary behavior and the resulting health outcomes in rural
Minnesotans and Iowans living in food deserts. However, although personal
factors impact eating behavior for rural people, it is the physical and social
environments that place constraints on food access, even in civically engaged
communities. Food access may be improved in communities where civic
engagement is strong, and where local organizations join in providing
solutions to decrease barriers of food access by increasing access to the
normal and food safety net systems and by creating informal alternatives,
such as community gardens and informal transportation networks, or
enhancing federal programs through greater volunteer involvement.


ASHWELL, Margaret. Obesity risk: importance of the waist-to-height
ratio. Nursing Standard Vol 23, No 41 - 17 June 2009: 49-54
  Abstract: This article reviews the benefits and limitations of some of the
different anthropometric measures to assess the health risks of obesity.
Those covered are the body mass index, the waist-to-hip ratio, waist
circumference and the waist-to-height ratio. The latter has the potential to be
globally applicable to different ethnic populations and to children and adults.
The suggested boundary values of 0.5 and 0.6 are used in a shape chart and
shape calculator, described here, to indicate different levels of health risk in
adults and children. A simple message from this work is 'keep your waist
circumference to less than half your height'.

JONES, A R and HYLAND, R M and others. Developing a focus group
approach for exploring parents' perspectives on childhood overweight.
Nutrition Bulletin Vol 34, No 2 - June 2009: 214-219
  Abstract: Numerous public health initiatives have been proposed in an
attempt to reduce the number of overweight and obese children nationally.
The success of such strategies is heavily reliant upon families recognising and
becoming engaged with the issue. It is therefore important to understand
parents' perceptions of excess weight in children and which preventive
strategies would be most acceptable to them. The present paper describes
the development of a focus group approach designed to explore these
important research questions and illustrates techniques that can be readily
implemented and replicated to explore complex and sensitive issues. Some of
the potential difficulties of focus group research are also detailed, together
with suggestions for successfully overcoming these obstacles. It is also
demonstrated that both quantitative and qualitative methods can work in
partnership, informing each other, and a combination of these approaches is
necessary for future research if public health messages are to be successfully
and effectively communicated.

MUSINGARIMI, Primrose. Obesity in the UK: a review and comparative
analysis of policies within the devolved administrations. Health Policy Vol
91, No 1 - June 2009: 10-16

Health Scotland Library                                                       24
                                 Journal Articles

  Abstract: In the United Kingdom obesity is a significant public problem and
the formulation and implementation of policies to address it are primarily the
responsibility of the devolved administrations. Containing populations which
are broadly similar, albeit with regional differences, devolution allows for the
exploration of the obesity policy directions the different UK countries have
taken; thus providing opportunities for policy learning and comparison. A
review and analysis of policy responses in the devolved administrations
reveals differences in the strategic approaches to tackling obesity with
England having recently introduced a population-wide strategy in contrast to
the other countries. Further, policies to address obesity in England and
Northern Ireland are being target driven in contrast to Scotland and Wales. In
all the countries, the focus on obesity has been on addressing childhood
obesity with Scotland having taken the lead on setting nutritional standards for
school meals and the other countries subsequently following. While devolution
has provided scope for the variation in responses to address the obesity
epidemic in the UK, it is still too early to determine the impact of the different
strategic approaches being used to tackling it.

NEUMARK-SZTAINER, Dianne and HAINES, Jess and others. 'Ready. Set.
ACTION!' A theater-based obesity prevention program for children: a
feasibility study. Health Education Research Vol 24, No 3 - June 2009: 407-
  Abstract: This study examined the feasibility of implementing an innovative
theater-based after-school program, 'Ready. Set. ACTION!', to reach
ethnically diverse and low-income children and their parents with obesity
prevention messages. The study population included 96 children and 61
parents. Children were in fourth to sixth grade and 41% were overweight at
baseline. Program impact was evaluated with a pre/post-randomized
controlled study design, but a major focus was placed on the process
evaluation conducted in the intervention schools. Intervention children and
parents reported high program satisfaction and that they had made changes
or intended to make positive changes in their behaviors due to program
participation. However, few meaningful differences between the intervention
and control conditions were found at follow-up. Thus, the combined process
and impact evaluation results suggest that the intervention was effective in
leading to increased awareness of the need for behavioral change, but was
not powerful enough on its own to lead to behavioral change. From this
feasibility study, we concluded that Ready. Set. ACTION! offers promise as a
creative intervention strategy. The next research step may be to incorporate
theater-based programs into more comprehensive school-based interventions,
with both educational and environmental components, and evaluate program

Effectiveness of a school-based obesity prevention program.
International Journal of Health Promotion and Education Vol 47, No 2 - 2009:
  Abstract: Introduction: A school-based obesity prevention program was
designed using the community-based participatory approach to promote
health-related behavioral changes. Methods: All physical education students

Health Scotland Library                                                        25
                                 Journal Articles

in the middle school (6th, 7th, 8th graders) received the curriculum in a 9-
week period as part of the normal class curriculum. A large subset of these
students (pre-testing n = 226 and post-testing n = 214) agreed to participate in
the research project evaluating its effectiveness. All subjects enrolled in the
study were assessed on height, weight, nutritional knowledge, nutritional
behaviors, physical activity behaviors, parental and peer support of nutrition
and physical activity changes. A feedback questionnaire was completed by
parents and students. Results: The program successfully impacted nutritional
intake and physical activity as well as having a positive impact on both peer
and parent support of behavioral change. Discussion: The positive results
found in the present study are discussed in detail, along with limitations in this
study and directions for future research to clarify effects.


GADALLA, Tahany M. Sense of mastery, social support, and health in
elderly Canadians. Journal of Aging and Health Vol 21, No 4 - August 2009:
  Abstract: Objective: This study aims to examine the structural relationships
among sense of mastery (SOM), income level, social support, physical health,
and stress in older Canadians, while controlling for demographic
characteristics. Method: This research uses data collected in the National
Population Health Survey on Canadians aged 65 years and older (N = 1,399).
Results: Higher income predicts better health and more social support, which,
in turn, predicts higher SOM. The relationship between physical health and
stress is fully mediated through SOM for both genders. The SOM fully
mediates the relationship between social support and stress for men and
partially mediates this relationship for women. Discussion: Findings confirm
the importance of a network of social services targeting older persons with low
income, diminished physical health, and/or those living alone .


BALL, Kylie and CLELAND, Verity J and others. Socioeconomic position
and children's physical activity and sedentary behaviors: longitudinal
findings from the CLAN study. Journal of Physical Activity and Health Vol 6,
No 3 - May 2009: 289-298
  Abstract: Background: This study aimed to examine cross-sectional and
longitudinal associations between socioeconomic position (SEP) and physical
activity and sedentary behaviors amongst children and adolescents. Methods:
Maternal education was reported by parents of 184 5-6 year-old and 358 10-
12 year-old children in 2001. In 2001 and 2004, physical activity was
assessed by accelerometry. Older children self-reported and parents of
younger children proxy-reported physical activity and television (TV) viewing
behaviors. Linear regression was used to predict physical activity and
sedentary behaviors, and changes in these behaviors, from maternal
education. Results: Among all children, accelerometer-determined and
self/parent-reported moderate and vigorous physical activity declined over

Health Scotland Library                                                        26
                                 Journal Articles

three years. Girls of higher SEP demonstrated greater decreases in TV
viewing behaviours than those of low SEP. In general, no prospective
associations were evident between SEP and objectively-assessed physical
activity. A small number of prospective associations were noted between SEP
and self-reported physical activity, but these were generally weak and
inconsistent in direction. Conclusions: This study did not find strong evidence
that maternal education was cross-sectionally or longitudinally predictive of
children's physical activity or sedentary behaviors. Given the well-documented
inverse relationship of SEP with physical activity levels in adult samples,
findings suggest that such disparities may emerge after adolescence.

HOHEPA, Maea and SCRAGG, Robert and others. Associations between
after-school physical activity, television use, and parental strategies in a
sample of New Zealand adolescents. Journal of Physical Activity and Health
Vol 6, No 3 - May 2009: 299-305
  Abstract: Background: Youth display suboptimal levels of[1] physical activity
and sedentary behaviors. Few studies have examined the existence of the
'displacement hypothesis' or the effect of parental strategies on activity
behaviors during the after-school period. Methods: A total of 3471 students
(12-18 years old) completed a self-report survey that assessed after-school
physical activity and television (TV) use and perceived parental strategies (ie,
encouragement to be active, TV-viewing rules). Participants were grouped
into 4 activity groups: high TV/low active, high TV/active, low TV/low active, or
low TV/active. Descriptive statistics and nominal logistic-regression analyses
were conducted. Results: Compared with students who watched less than 1 h
of TV, participants who watched =4 h of TV were half as likely to be active
after school (=4 h; adjusted odds ratio 0.51, 95% CI .40-.65). Compared with
the low TV/active group, the other activity groups were at least 1.28 times
more likely to have parents that provided only 1 parental strategy
(encouragement for activity or TV rules) and up to 4.7 times more likely to
have parents that provided neither strategy. Discussion: Sedentary behaviors
are associated with displacement of active pursuits. Parental strategies exert
a strong influence on after-school behaviors of high school students.

KNOWLES, Ann-Marie and NIVEN, Ailsa G and others. A longitudinal
examination of the influence of maturation on physical self-perceptions
and the relationship with physical activity in early adolescent girls.
Journal of Adolescence Vol 32, No 3 - June 2009: 555-566
  Abstract: This longitudinal study investigated the influence of maturation on
physical self-perceptions and the relationship with physical activity in early
adolescent girls (N=150; mean age=12.79±0.31). Physical characteristics
were measured and participants completed the Physical Activity
Questionnaire for Children, the Children and Youth Physical Self-Perception
Profile and the Pubertal Development Scale on two occasions 12 months
apart. The results demonstrated a decrease in overall physical activity levels
over 12 months which was not influenced by maturational status or physical
characteristics. Additional analysis indicated that physical self-perceptions
partially accounted for the explained variance in physical activity change, with
physical condition being an important individual predictor of physical activity.
Further analysis indicated that body mass was an important individual

Health Scotland Library                                                       27
                                 Journal Articles

predictor of changes in perceptions of body attractiveness and physical self-
worth. At this age maturation has a limited influence on the physical activity
behaviours of early adolescent girls and although the variance in physical
activity was partly accounted for by physical self-perceptions, this was a
relatively small contribution and other factors related to this drop in physical
activity need to be considered longitudinally.

NICHOL, Marianne E and PICKETT, William and others. Associations
between school recreational environments and physical activity. Journal
of School Health Vol 79, No 6 - June 2009: 247-254
  Abstract: Background: School environments may promote or hinder physical
activity in young people. The purpose of this research was to examine
relationships between school recreational environments and adolescent
physical activity. Methods: Using multilevel logistic regression, data from
7638 grade 6 to 10 students from 154 schools who participated in the 2005/06
Canadian Health Behaviour in School-Aged Children Survey were analyzed.
Individual and cumulative effects of school policies, varsity and intramural
athletics, presence and condition of fields, and condition of gymnasiums on
students' self-reported physical activity (=2 h/wk vs <2 h/wk) were examined.
Results: Moderate gradients in physical activity were observed according to
number of recreational features and opportunities. Overall, students at
schools with more recreational features and opportunities reported higher
rates of class-time and free-time physical activity; this was strongest among
high school students. Boys' rates of class-time physical activity were 1.53
(95% confidence interval (CI) = 1.12-1.80) times as high at high schools with
the most recreational features as at schools with the fewest. Similarly, girls'
rates of free-time physical activity at school were 1.62 (95% CI: 0.96-2.21)
times as high at high schools with the most opportunities and facilities as
compared to schools with the fewest. Modest associations were observed
between individual school characteristics and class-time and free-time
physical activity. Conclusions: Taken together, the cumulative effect of
school recreational features may be more important than any one
characteristic individually.

PESCE, Caterina and CROVA, Claudia and others. Physical activity and
mental performance in preadolescents: effects of acute exercise on free-
recall memory. Mental Health and Physical Activity Volume 2, Issue 1 - June
2009: 16-22
   Abstract: The purpose of this study was to investigate the effects of physical
activity on memory performance in preadolescents. Fifty-two students aged
11-12 years performed a test involving free-recall of items from a 20-item
word list during three separate testing sessions at school. Two sessions
directly followed physical education lessons (aerobic circuit training or team
games) characterized by similar exercise intensities, but different cognitive
and social interaction demands. A third, baseline session was not preceded
by any lesson. For each session, the number of items recalled from the whole
list and from its primacy and recency portions was recorded twice under
conditions of immediate and delayed recall. Immediate recall scores in both
primacy and recency portions were higher following the team games than in
the baseline session, whereas delayed recall scores in the recency portion

Health Scotland Library                                                            28
                                 Journal Articles

were higher after both team game and aerobic training. Results suggest that
an acute bout of submaximal exercise, as performed by students during
physical education class, may facilitate memory storage. The differential
effects of qualitatively unique types of exercise on immediate and delayed
recall suggest that memory storage processes may be facilitated not only by
exercise-induced increases in physiological arousal, but also by the cognitive
activation induced by cognitive exercise demands. Results are discussed
highlighting the importance of relationships between acute exercise and
memory storage for mental health promotion.

VAUGHN, Amber E and BALL, Sarah C and others. Promotion of walking
for transportation: a report from the walk to school day registry. Journal
of Physical Activity and Health Vol 6, No 3 - May 2009: 281-288
  Abstract: Background: In the US, promoting active transportation to school
has received increased attention as a means of encouraging physical activity
and preventing obesity among youth. However, little systematic evaluation of
existing programs, such as Walk to School (WTS), has occurred. Methods:
WTS coordinators from across the US were surveyed (via web, mail, and
telephone) about program activities, school and environmental characteristics,
and perceived changes in children walking to school. As an exploratory aim,
logistic regression analyses were used to examine program characteristics
associated with perceived increases in children walking. Results: From a
database of 783 coordinators, 493 usable surveys were returned. Almost all
respondents (98.2%) participated in a one-day WTS event. Other common
activities included promotional activities (72.7%), safety trainings (49.6%),
walkability audits (48.5%), and designated safe walking routes (46.5%). As
part of their WTS efforts, 24.4% made policy changes and 38.4% made
changes to the physical environment. Logistic regression analyses showed
that policy changes, physical environment improvements, and number of
activities were associated with the largest perceived increased in children
walking to school. Conclusions: These findings help address the gap in
knowledge about schools‟ participation in WTS programs, and suggest
strategies to increase active transportation to school.


GONZALEZ, Maria Lopez. Getting to know reality and breaking
stereotypes: the experience of two generations of working disabled
women. Disability and Society Vol 24, No 4 - June 2009: 447-459
  Abstract: This paper sets out the results of a Spanish study of the
experience and meaning of work among disabled women of two generations,
with three types of disability (physical, visual and hearing). Performing a
socially recognised activity such as a job is a source of emotional welfare and
self-esteem. Moreover, it confers a certain social status. For the participants in
this study the kind of work involved, whether productive, paid and 'extra-
domestic' or 'reproductive', unpaid and done at home, acquires different
meanings, since for disabled women, sexist stereotypes - already more or
less accentuated in the culture - social attitudes towards disability and
personal factors introduce relevant differences, while leading to conflicts and

Health Scotland Library                                                        29
                                 Journal Articles

dilemmas that these women have to solve. At any rate, their sense of
responsibility in performing all types of work should be emphasised as
evidence of their sense of independence and personal competence, forming a
keystone in their construction of a sense of identity and social integration.


ABAYOMI, J C and WATKINSON, H and others. Identification of ‘hot spots'
of obesity and being underweight in early pregnancy in Liverpool.
Journal of Human Nutrition and Dietetics Vol 22, No 3 - June 2009: 246-254
  Abstract: Background: Obesity and being underweight in pregnancy are
related to an increased risk of maternal and foetal morbidity, yet their
prevalence is often unknown. The present study aimed to identify
neighbourhoods with a higher than average prevalence or 'hot spots' of
obesity and/or being underweight among first trimester pregnant women.
Methods: A database was compiled consisting of postcode, height and weight
for 7981 women who had booked-in for antenatal care between July 2004 and
June 2005 at Liverpool Women's Hospital. Body mass index (BMI) was
calculated and women were categorised accordingly. Postcodes for 6865
cases across Merseyside were converted to geolocations (pin-points on a
map) using conversion software ( Results:
There was a very high prevalence of being overweight (27%) and obesity
(17%); 3.8% of women were underweight and probably malnourished (BMI <
18.5 kg m-2); and a further 10.7% of women were possibly malnourished (BMI
< 20.0 kg m-2. Deriving case density from the geolocations allowed
visualisation and identification of six neighbourhoods with above average
levels of obesity and three neighbourhoods had marked concentrations of
both being underweight and obesity. Conclusions: These neighbourhoods,
particularly those identified as 'hot spots' for both being underweight and
obesity, include some of the most deprived wards in the UK. As dietetic
intervention may help to promote optimal weight gain during pregnancy and
improve dietary intake for pregnant women and their families, primary health
care providers should target these localities with a high prevalence of low and
high BMI as a priority.


BRADFORD, C and HILL, A and others. English health profiles - did they
do what was expected? An evaluation of Health Profiles 2006. Public Health
Vol 123, No 4 - April 2009: 311-315
  Abstract: Objectives: To assess the impact of Health Profiles 2006 by
English local authorities, and to determine what changes need to be made to
the profiles to have an impact on their target audience. Study design:
A telephone- and web-based survey of a sample of the health profiles' target
audience was conducted, along with an analysis of web statistics. Methods:
In total, 285 telephone interviews were undertaken. Fifty-three percent of the
respondents were National Health Service employees. An evaluation form

Health Scotland Library                                                     30
                                 Journal Articles

was also available through the Health Profiles website, which elicited 117
responses (19 scrutiny officers and 83 members of the public). Results:
There was a positive response to the content and format of Health Profiles
2006. The majority of respondents felt that the profiles provided a unique
summary of local-authority-based health and health inequality information that
was both accessible and understandable. Conclusions: A number of
recommendations are made to improve health profile production as a tool for
information for health improvement. These include simplifying graphics,
greater local input into commentary, and a more interactive website so that
the data can be accessed and explored. However, the recommendations for
change must be viewed alongside the number of comments specifically
relating to the English health profiles that nothing should be changed other
than updating the data and filling in the gaps.

METCALFE, O and HIGGINS, C. Healthy public policy - is health impact
assessment the cornerstone? Public Health Vol 123, No 4 - April 2009: 296-
  Abstract: The 8th International Health Impact Assessment Conference,
entitled 'Healthy public policy - is health impact assessment the cornerstone?',
was hosted by the Institute of Public Health in Ireland (IPH). At the event, IPH
sponsored a keynote speech to set the context of the conference and outline
the importance of healthy public policy. This article presents an overview of
healthy public policy and the barriers to its adoption in policy-making. Health
impact assessment is one such tool to overcome the barriers, and the authors
recommend the methodology as the cornerstone to healthy public policy.

SMITH , K E and BAMBRA, C and others. Partners in health? A systematic
review of the impact of organizational partnerships on public health
outcomes in England between 1997 and 2008. Journal of Public Health Vol
31, No 2 - June 2009: 210-221
  Abstract: Objective: To systematically review the available evidence on the
impact of organizational partnerships on public health outcomes (health
improvement and/or a reduction in health inequalities) in England between
1997 and 2008. Design: Systematic review of quantitative (longitudinal before
and after) and qualitative studies (1997-2008) reporting on the health (and
health inequalities) effects of public health partnerships in England. Data
sources: Eighteen electronic databases (medical, social science and
economic), websites, bibliographies and expert contacts. Results: Only 15
studies, relating to six different interventions, met the review criteria and most
of these studies were not designed specifically to assess the impact of
partnership working on public health outcomes. Of the studies reviewed, only
four included a quantitative element and they produced a mixed picture in
terms of the impacts of partnership working. Qualitative studies suggested
that some partnerships increased the profile of health inequalities on local
policy agendas. Both the design of partnership interventions and of the
studies evaluating them meant it was difficult to assess the extent to which
identifiable successes and failures were attributable to partnership working.
Conclusion: This systematic review suggests that there is not yet any clear
evidence of the effects of public health partnerships on health outcomes. More

Health Scotland Library                                                        31
                                 Journal Articles

appropriately designed and timed studies are required to establish whether,
and how, partnerships are effective.


ARNEY, Fiona M and BROMFIELD, Leah M and others. Integrating
strategies for delivering evidence-informed practice. Evidence and Policy:
a journal of research, debate and practice Vol 5, No 2 - May 2009: 179-191
  Abstract: The need for policy and practice to be informed by a high-quality
evidence base has been widely recognised. However, there are many barriers
to overcome in order to realise this goal. This article describes a conceptual
framework for understanding the drivers of policy and practice in the child and
family welfare sectors, and profiles strategies being employed across
Australia to facilitate evidence-informed practice.

CANAVAN, John and GILLEN, Aisling and others. Measuring research
impact: developing practical and cost-effective approaches. Evidence
and Policy: a journal of research, debate and practice Vol 5, No 2 - May 2009:
  Abstract: This article discusses the theoretical context of the measurement
of research impact within thinking on research dissemination and utilisation.
Then, using their experience in a university-based research centre in Ireland,
the authors discuss six propositions for successful research impact
measurement and illustrate their application in a case study of research on
services for people with learning disabilities. The article concludes by
examining the implications for research centres in building partnerships with
policy and practice communities.

ECCLES, Colleen. Effective delivery of evidence-informed practice.
Evidence and Policy: a journal of research, debate and practice Vol 5, No 2 -
May 2009: 193-206
  Abstract: There is much support from the UK government for the
development and implementation of policy and practice that is based on
evidence. For over a decade, Research in Practice (RiP) has developed a
web of interconnected strategies for delivering evidence-informed practice to
professionals at all levels in children's services. This article examines why the
RiP model has proved sustainable and has grown in size and influence over
the past 12 years. The article starts with a brief outline and illustrative
examples of RiP's mechanisms of delivery. Delivery is then explored in
relation to the concepts of the individual, the champion, the agency and the
network to enable analysis of need and impact at these levels.
Cross-cutting this framework is the argument that an essential factor in RiP's
success has been a move away from traditional evidence-based practice
towards the adoption of a pluralistic notion of 'evidence' (Blewett, 2007).
Furthermore, the use of the term 'informed' deliberately places human agency
at the heart of decision making. In RiP's approach, research is a key but not
sole determinant of decision making and evidence is inclusive of practice
wisdom and service user views. In particular, the development of RiP's

Health Scotland Library                                                        32
                                 Journal Articles

Change Project method is described as a response to deepening engagement
with practice. It is argued that engagement with research as a process, rather
than the pure transfer of research knowledge, is essential in delivering
effective methods of evidence-informed practice.

O'CONNELL, E and HURLEY, F. A review of the strengths and
weaknesses of quantitative methods used in health impact assessment.
Public Health Vol 123, No 4 - April 2009: 306-310
   Abstract: Objectives: To explore some of the strengths and weaknesses of
purely quantitative approaches used in health impact assessment (HIA) and
the implication of this for policy making. Study design: The studies presented
generally used a variety of quantitative risk assessment (QRA)
methodologies. Methods: For each population, concentration-response (CR)
or exposure-response (ER) functions, typically expressed as percentage
change in health effect per unit change in concentration or exposure, were
applied to estimates of population exposure and background rates of
morbidity and mortality in order to calculate the attributable health impact or
burden. In some cases, this burden was then costed according to standard
economic models. Results: In most of the studies discussed, where a reliable
CR or ER relationship was available, it was possible to quantify the impact(s)
of the relevant environmental stressors on health, and to estimate the
associated uncertainties. Conclusions: QRA has an important role in
producing estimates for the health impacts of those risk factors where there is
a sufficient base of research to quantify relationships between population
exposure and health, and to predict the effects of policies on population
exposure. However, quantified HIA is not an infallible process and can give an
illusion of certainty that belies the complexity of the interactions involved,
particularly where multiple determinants of health are likely to be affected. It is
important that any uncertainties associated with that which has been
quantified, as well as the likely impacts of that which cannot be quantified, are
assessed and represented comprehensively. A simplistic application of QRA
estimates is an inadequate HIA, as it may encourage policy makers and
others to attach more importance to those impacts that are easier to quantify
but which do not necessarily have the greatest associated burden.

THOMPSON, Jill and BARBER, Rosemary and others. Health researchers'
attitudes towards public involvement in health research. Health
Expectations Vol 12, No 2 - June 2009: 209-220
  Abstract: Objective: To investigate health researchers' attitudes to involving
the public in research. Background: Public involvement in research is
encouraged by the Department of Health in the UK. Despite this, the number
of health researchers actively involving the public in research appears to be
limited. There is little research specifically addressing the attitudes of health
researchers towards involving the public: how they interpret the policy, what
motivates and de-motivates them and what their experiences have been to
date. Design: A qualitative research design, using semi-structured telephone
interviews. Setting and participants: Fifteen purposively sampled UK-based
University health researchers were the participants. Interviews were
conducted over the telephone. Findings: The participants suggested varying
constructions of public involvement in research. Arguments based on moral

Health Scotland Library                                                         33
                                 Journal Articles

and political principles and consequentialist arguments for involving the public
in research were offered and most participants highlighted the potential
benefits of involving the public. However, feelings of apprehension expressed
by some participants imply that a number of researchers may still be
uncomfortable with involving the public, as it presents a different way of


BUCKLEY, L and SHEEHAN, M. A process evaluation of an injury
prevention school-based programme for adolescents. Health Education
Research Vol 24, No 3 - June 2009: 507-519
  Abstract: A process evaluation provides critical information that can inform
the design and implementation of a programme. This study sought to provide
examples of how to operationalize a process evaluation of an effective
programme (Skills for Preventing Injury in Youth). A comprehensive definition
of process evaluation was used which included assessing dose, adherence,
quality of process, participant responsiveness and programme differentiation.
Dose was assessed through teacher and student ratings as well as
independent observations. Reports from an observer were used to assess
adherence to programme objectives, the quality of process including
interactive delivery and programme differentiation. Participant responsiveness
was assessed quantitatively and qualitatively with students providing greater
depth to the findings. Findings regarding dose varied and suggested different
sources of reports provided supplementary information. The findings also
suggested that independent observations are an important tool for process
evaluation and identified challenges for programme designers regarding
interactive material. Overall, the research indicated that a comprehensive
definition of process evaluation could be operationalized and provided an
understanding of an application of a process evaluation to an injury prevention
programme. Continued development of process evaluations will enable a
better understanding of the conduct of interventions and maximize the likely
effect of such interventions.

SLOBODA, Zili and STEPHENS, Peggy and others. Implementation fidelity:
the experience of the Adolescent Substance Abuse Prevention Study.
Health Education Research Vol 24, No 3 - June 2009: 394-406
  Abstract: While researchers have developed more effective programs and
strategies to prevent the initiation of substance use and increasingly
communities are delivering these interventions, determining the degree to
which they are delivered as they were designed remains a significant research
challenge. In the past several years, more attention has been given to
implementation issues during the various stages of program development and
diffusion. This paper presents the findings from a substudy of an evaluation of
a newly designed middle and high school substance abuse prevention
program, Take Charge of Your Life delivered by local Drug Abuse Resistance
Education officer instructors. A key aspect of the study was to determine the
extent to which implementation fidelity, using the measures of content
coverage and appropriate instructional strategy, was associated with

Health Scotland Library                                                       34
                                 Journal Articles

improvement in the program mediators of realistic normative beliefs,
understanding the harmful effects of substance use and the acquisition of
decision-making and resistance skills. Although it was found that higher
fidelity was associated with better scores on some of the mediators, this was
not a consistent finding. The mixed results are discussed within the context of
the lesson activities themselves.


CAMPBELL, Tomas and BEER, Hannah and others. "Sex, love and one-
night stands: getting the relationship you want": evaluation of a sexual
health workshop for HIV+ young people. Education and Health Vol 27, No
2 - 2009: 23-27

JEROME, Sally and HICKS, Carolyn and others. Designing sexual health
services for young people: a methodology for capturing the user voice.
Health and Social Care in the Community Vol 17, No 4 - July 2009: 350-357
  Abstract: The aim of the study was to assess the suitability of the Thurstone
paired comparison method for capturing the user voice, through a survey of
young people's views on the most salient priorities for a sexual health service.
A convenience sample of 161 12-24 year olds was used. A psychometrically
robust questionnaire was developed from a review of the relevant literature
and from the information provided by three focus groups. The data derived
from both stages were distilled into seven themes, and adapted to a
Thurstone paired comparison format, in which each theme was paired with
every other theme, with an 8-point scale between each pairing (21 pairings in
total). Respondents were required to indicate their preference for one theme
over the other in each pairing. The questionnaire was completed by 161
young people between April and July 2007, and the results were analysed
using the Kendall coefficient of concordance to establish the degree of within-
group agreement. The results suggested that there was significant agreement
as to the essential desirable features of a sexual health service, both within
the whole sample as well as within sub-samples (i.e. gender, age group and
previous sexual health service use). The priorities were privacy, and a
dedicated service close to home, with a drop-in facility and male and female
staff being next most important, and an informal service and young staff being
lowest priorities. The feedback from the pilot study, the 40% return and
absence of spoiled questionnaires together indicated that the respondents
found the method acceptable, while the actual findings corroborated those
from other studies. Taken together, these results suggest that the Thurstone
method offers a quick and simple method of capturing the user voice, with the
results having sufficient validity to inform the planning of a local sexual health

MARTINO, Steven C and COLLINS, Rebecca L and others. It's better on TV:
does television set teenagers up for regret following sexual initiation?
Perspectives on Sexual and Reproductive Health Vol 41, No 2 - June 2009:

Health Scotland Library                                                         35
                                 Journal Articles

   Abstract: Context: Two-thirds of sexually experienced teenagers in the
United States say they wish they had waited longer to have intercourse for the
first time. Little is known about why such a large proportion of teenagers
express disappointment about the timing of their initial experience with sex.
Methods: Data on television viewing, on regret about the timing of first
intercourse and on potentially relevant covariates were obtained from a
national, three-year (2001-2004) longitudinal survey of adolescents aged 12-
17 at baseline. Logistic regression and path analysis were used to examine
the association between exposure to sex on television and the likelihood of
regret following sexual initiation, the extent to which shifts in expectations
about the positive consequences of sex mediate this association and whether
these relationships differ by gender. Results: Sixty-one percent of females
and 39% of males who had sex for the first time during the study period
reported that they wished they had waited to have sex. Exposure to sexual
content on television was positively associated with the likelihood of regret
following sexual initiation among males (coefficient, 0.34) but not females. The
association among males was partly explained by a downward shift in males'
sex-related outcome expectancies following sexual initiation. Conclusions:
Interventions that limit teenagers' exposure to televised sexual content, that
provide a more accurate portrayal of sexuality than typically depicted on
television or that help adolescents think critically about televised sexual
content may help teenagers make more carefully considered decisions about
sexual debut.

WILLIAMSON, Lisa M and BUSTON, Katie and others. Young women and
limits to the normalisation of condom use: a qualitative study. AIDS Care
Vol 21, No 5 - May 2009: 561-566
  Abstract: Encouraging condom use among young women is a major focus of
HIV/STI prevention efforts but the degree to which they see themselves as
being at risk limits their use of the method. In this paper, we examine the
extent to which condom use has become normalised among young women.
In-depth interviews were conducted with 20 year old women from eastern
Scotland (N=20). Purposive sampling was used to select a heterogeneous
group with different levels of sexual experience and from different social
backgrounds. All of the interviewees had used (male) condoms but only three
reported consistent use. The rest had changed to other methods, most often
the pill, though they typically went back to using condoms occasionally.
Condoms were talked about as the most readily available contraceptive
method, and were most often the first contraceptive method used. The young
women had ingrained expectations of use, but for most, these norms centred
only on their new or casual partners, with whom not using condoms was
thought to be irresponsible. Many reported negative experiences with
condoms, and condom dislike and failure were common, lessening trust in the
method. Although the sexually transmitted infection (STI) prevention provided
by condoms was important, this was seen as additional, and secondary, to
pregnancy prevention. As the perceived risks of STIs lessened in relationships
with boyfriends, so did condom use. The promotion of condoms for STI
prevention alone fails to consider the wider influences of partners and young
women's negative experiences of the method. Focusing on the development
of condom negotiation skills alone will not address these issues. Interventions

Health Scotland Library                                                      36
                                 Journal Articles

to counter dislike, method failure, and the limits of the normalisation of
condom use should be included in STI prevention efforts.


AIRTON, Liz. From sexuality (gender) to gender (sexuality): the aims of
anti-homophobia education. Sex Education Vol 9, No 2 - May 2009: 129-
  Abstract: The tradition of anti-homophobia education is often characterized
by the conflation of gender and sexuality in which oppression arising from
gender non-normativity is subsumed within the sexuality-based concepts of
homophobia and heterosexism. This paper presents the view that oppression
arising from stringent gender normativity should instead be attributed to a
gender-based form of oppression: genderism. Through critically interrogating
the envisioned aims of anti-homophobia and anti-genderism as gender-based
educational projects, it is argued that - given the ways in which gender non-
normativity is routinely read as non-heterosexuality - anti-genderism is a more
transparent and broadly applicable platform on which to elaborate measures
toward safeguarding of all students against hegemonic processes of sexuality
and gender normalization, regardless of each student's sexual orientation or
gender identity.

CULLEN, Fin and SANDY, Laura. Lesbian Cinderella and other stories:
telling tales and researching sexualities equalities in primary school.
Sex Education Vol 9, No 2 - May 2009: 141-154
  Abstract: This article provides a critical account of a selection of approaches
that were used in the 26-month No Outsiders participatory action research
project in education settings. The paper questions what challenges are
presented to educators in critically exploring and challenging heteronormative
sex-gender discourses. We revisit some of the tensions in undertaking a
project of this kind, by exploring data episodes as vignettes to highlight the
recuperative nature of heteronormativity. The paper's title originates in one of
the author's dramatic persona of Cindy, a Lesbian Cinderella. We critically
reflect on this creation, acknowledge Cindy's potential, and query the
characters' capacity to even briefly 'trouble' heteronormative discourses in
action within the classroom. Finally, we argue that pupils' multiple and shifting
subjectivities, and understandings of these discourses offered by such
pedagogic interventions, provides an arena for children to resist, reappropriate
and challenge such figures that move beyond bounds of heteronormative sex-
gender discourses.

JIMENEZ, Karleen Pendleton. Queering classrooms, curricula, and care:
stories from those who dare. Sex Education Vol 9, No 2 - May 2009: 169-
  Abstract: This article explores the potential of students and teachers to
disrupt heterosexist schooling practices with queer interventions. Through a
critical investigation of four vignettes, taken from the collection 'Unleashing the
unpopular': Talking about sexual orientation and gender diversity in education,
a progression of possibilities for queering elementary education is articulated.

Health Scotland Library                                                         37
                                 Journal Articles

In particular, I examine how student and teacher decisions and interactions
can alter the course of the curriculum. Examples of strategic practices and
institutional locations for queer innovation are provided. The subjects act
amidst a tradition of queer repression that saturates school systems and
punishes the queers. Finally, I offer the possibility of subverting and claiming
'care,' a core value of the teaching profession, for queer education.


AL-TAYYIB, A A and MCFARLANE, M and others. Finding sex partners on
the internet: what is the risk for sexually transmitted infections? Sexually
Transmitted Infections Vol 85, No 3 - June 2009: 216-220
  Abstract: Objective: To assess the association between sexual encounters
with internet partners and current Chlamydia trachomatis (Ct) and Neisseria
gonorrhoeae (GC) infections. Methods: Between August 2006 and March
2008, patients at the Denver Metro Health Clinic were routinely asked about
sexual encounters with internet partners. This retrospective case-control study
was limited to patients who tested for Ct/GC at their visit. Analyses were
stratified by sexual orientation to account for differences in baseline risk
behaviours. Results: Of 14 955 patients with a valid Ct/GC test result, 2802
(19%) were infected with Ct/GC. Stratified by sexual orientation, the
prevalence of Ct/GC infection was 17% for men who have sex with men
(MSM), 21% for men who have sex with women (MSW) and 16% for women.
A total of 339 (23%) MSM, 192 (3%) MSW and 98 (2%) women reported
having a sexual encounter with a person they met on the internet in the past 4
months. The estimates of the association between recent internet sex partner
and current Ct/GC infection were not significant for MSM (risk ratio (RR): 1.12,
95% confidence interval (CI): 0.84 to 1.49) and women (RR: 0.81, 95% CI
0.45 to 1.48). However, the association appeared to be significantly protective
among MSW (RR: 0.66, 95% CI 0.44 to 0.98). Conclusions: Sexual
encounters with internet partners did not appear to be associated with
increased risk of current Ct/GC infection among people seeking care at a
sexual health clinic. Seeking sexual partners on the internet is a complex
behaviour and its implications for STI/HIV infection are not fully understood.

BASTA, M S T and HANDY, P and others. Do asymptomatic patients
attending genitourinary medicine clinics for a sexual health screen want
to be examined? A pilot study. International Journal of Health Promotion
and Education Vol 47, No 2 - 2009: 40-43
  Abstract: Background: Screening for sexually transmitted infections (STI)
traditionally involves genital examination in addition to obtaining genital swabs
and blood tests. Another type of screening is evolving as a result of the ever-
increasing demand on genitourinary medicine (GUM) clinics. The latter
screening includes testing the urine or self-collected genital swabs of
asymptomatic patients in the community without genital examination.
(Department of Health, choosing health document, 2004; Cohen and
Kanouse, 2005; Department of Health, our health, our care, our say, 2006).
Objectives: To investigate the preference of asymptomatic patients with
regard to routine genital examination when they attend for sexually

Health Scotland Library                                                        38
                                 Journal Articles

transmitted infections screening. Design: An anonymous questionnaire was
used to explore the preference of two hundred asymptomatic patients (100
men and 100 women) attending the genitourinary medicine clinic with regard
to routine genital examination. Setting: The genitourinary medicine (GUM)
clinic at the Newcastle General Hospital. Methods: In January 2006, two
hundred asymptomatic patients attending the Newcastle GUM clinic for
routine screening (100 men and 100 women) completed an anonymous
questionnaire to explore their acceptability of routine genital examination.
Results: The questionnaire showed that 98 (98%) and 91 (91%) of women
and men respectively preferred to be examined when they attend for routine
STI screening. Conclusion: This study showed that the majority of
asymptomatic patients prefer to be examined when they attend the GUM clinic
for routine screening. Future modernisation of GUM services aiming at
screening asymptomatic patients without genital examination will need to
educate patients and provide them with clear information on when an
examination may be necessary so that patients will ask for the appropriate
type of screening.

LORIMER, K and REID, M E and others. "It has to speak to people's
everyday life...": qualitative study of men and women's willingness to
participate in a non-medical approach to Chlamydia trachomatis
screening. Sexually Transmitted Infections Vol 85, No 3 - June 2009: 201-
  Abstract: Objective: To explore the factors associated with men and
women's willingness to provide a urine sample for Chlamydia trachomatis
screening in various non-medical settings. Methods: Men and women aged
16-24 years attending non-medical settings were invited to participate in urine-
based screening and later to participate in a follow-up in-depth interview.
Participant observation techniques were also used to collect data on young
people's response to the offer of screening. Results: The views of 24 men
and women revealed three themes in relation to willingness to participate,
particularly among men: their raised awareness of chlamydia, particularly its
asymptomatic nature; the convenience of the offer; and the "non-medical"
nature of the screening. In contrast, women more often felt the public nature
of the settings inhibited them from agreeing to take the test and, thus, acted
as a barrier to their willingness to participate in screening. Conclusions: The
gender difference in willingness to participate in non-medical screening
suggests that extending the reach of screening could certainly assist in
bringing more young men into screening but may not necessarily destigmatise
screening for women. As such, the potential benefits to men must be
considered in the context of the potential psychosocial harms to women.


ALBERS, A B and BIENER, L and others. Impact of parental home
smoking policies on policy choices of independently living young
adults. Tobacco Control Vol 18, No 3 - June 2009: 245-248
  Abstract: Objective: To determine whether adolescents living in parental
homes where smoking is banned are more likely to move into smoke-free

Health Scotland Library                                                      39
                                 Journal Articles

living quarters when they leave home. Methods: We analysed data on 693
youths from a 4-year, three-wave prospective study of a representative
sample of Massachusetts adolescents (aged 12-17). All youths resided in
independent living quarters at follow-up. The primary outcome was presence
of a smoking ban in the living quarters at follow-up. The primary predictor was
presence of a household smoking ban in the parental home, assessed 2 years
before the outcome. Generalised linear mixed effects models examined the
effect of a parental household smoking ban on the odds of moving into
smoke-free living quarters at follow-up overall and stratified by smoking status
at follow-up. Results: Youths leaving home had much higher odds of moving
to smoke-free living quarters if their parental household had had a smoking
ban (odds ratio (OR) = 12.70, 95% CI, 6.19 to 26.04). Other independent
predictors included moving into a school or college residence (OR = 3.88,
95% CI 1.87 to 8.05), and not living with smokers at follow-up (OR = 3.91,
95% CI 1.93 to 7.92). Conclusions: A household smoking ban in the parental
home appears to lead youths to prefer smoke-free living quarters once they
leave home.

APOLLONIO, D E and MALONE, R E. Turning negative into positive:
public health mass media campaigns and negative advertising. Health
Education Research Vol 24, No 3 - June 2009: 483-495
   Abstract: Literature suggests that 'negative advertising' is an effective way to
encourage behavioral changes, but it has enjoyed limited use in public health
media campaigns. However, as public health increasingly focuses on non-
communicable disease prevention, negative advertising could be more widely
applied. This analysis considers an illustrative case from tobacco control.
Relying on internal tobacco industry documents, surveys and experimental
data and drawing from political advocacy literature, we describe tobacco
industry and public health research on the American Legacy Foundation's
"truth" campaign, an example of effective negative advertising in the service of
public health. The tobacco industry determined that the most effective
advertisements run by Legacy's "truth" campaign were negative
advertisements. Although the tobacco industry's own research suggested that
these negative ads identified and effectively reframed the cigarette as a
harmful consumer product rather than focusing solely on tobacco companies,
Philip Morris accused Legacy of 'vilifying' it. Public health researchers have
demonstrated the effectiveness of the "truth" campaign in reducing smoking
initiation. Research on political advocacy demonstrating the value of negative
advertising has rarely been used in the development of public health media
campaigns, but negative advertising can effectively communicate certain
public health messages and serve to counter corporate disease promotion.

BOWLES, Hannah and MAHER, Alison and others. Helping teenagers stop
smoking: comparative observations across youth settings in Cardiff.
Health Education Journal Vol 68, No 2 - June 2009: 111-118
  Abstract: Objective This paper presents comparative observations between
schools/colleges, youth centres, and specialist youth provision, in relation to
delivery of the 2tuff2puff six-week smoking cessation and awareness
programme to young people in Cardiff. Design: A six-week smoking
cessation programme was delivered to 12-23 year olds in various youth

Health Scotland Library                                                         40
                                 Journal Articles

venues, using weekly records of attendance and compulsory questionnaires
delivered by the group facilitator at week one and week six. Setting: Twenty-
two groups were delivered in 14 youth settings across Cardiff. These settings
were categorized into three types: schools/ colleges; youth centres; and
specialist youth provisions. Method: Data collected from 179 young people at
week one and 84 young people at week six were used to measure changes in
weekly smoking behaviour, weekly expenditure on cigarettes, knowledge
about smoking and smoking cessation, attitudes toward smoking, motivation
to quit/ cut down, and attrition. These were compared across the three
different setting types. Youth Health Development Officers rated the three
setting types on five factors (ease of access/communication with venue;
suitability for sessions/acceptability to young people; supportiveness of
environment for making a quit attempt; recruitment of young people; and data
collection and evaluation) to reflect their practical experiences of delivering the
six-week smoking cessation programme across the different youth settings.
Results: Schools/colleges and specialist youth provision had the highest
levels of attendance, and positive change in attitude toward quitting was
greatest in specialist youth settings (79 per cent of attendees were more
determined to quit). Conclusion: Overall, when both practical delivery issues
and young peoples' outcome measures were considered, specialist youth
provisions were the most effective settings for delivery of this programme.
Delivery of smoking awareness as part of a wider health curriculum for groups
of excluded young people is also recommended.

CARTER, O B J and MILLS, B W and others. The effect of retail cigarette
pack displays on unplanned purchases: results from immediate
postpurchase interviews. Tobacco Control Vol 18, No 3 - June 2009: 218-
  Abstract: Objective: To assess the influence of point-of-sale (POS) cigarette
displays on unplanned purchases. Methods: Intercept interviews were
conducted with customers observed purchasing cigarettes from retail outlets
featuring POS cigarette displays. Measures included intention to purchase
cigarettes prior to entering the store, unprompted and prompted salience of
POS tobacco displays, urge to buy cigarettes as a result of seeing the POS
display, brand switching and support for a ban on POS cigarette displays.
Results: In total, 206 daily smokers aged 18-76 years (90 male, 116 female)
were interviewed. Unplanned cigarette purchases were made by 22% of
participants. POS displays influenced nearly four times as many unplanned
purchases as planned purchases (47% vs 12%, p<0.01). Brand switching was
reported among 5% of participants, half of whom were influenced by POS
displays. Four times as many smokers were supportive of a ban on POS
tobacco displays than unsupportive (49% vs 12%), and 28% agreed that such
a ban would make it easier to quit. Conclusions: POS tobacco displays act
as a form of advertising even in the absence of advertising materials. They
stimulate unplanned cigarette purchases, play an important role in brand
selection and tempt smokers trying to quit. This justifies removing POS
tobacco displays from line of sight-something that very few smokers in our
sample would object to.

Health Scotland Library                                                         41
                                 Journal Articles

HASSANDRA, Mary and THEODORAKIS, Yiannis and others. I do not
smoke - I exercise: a pilot study of a new educational resource for
secondary education students. Scandinavian Journal of Public Health Vol
37, No 4 - June 2009: 372-379
  Abstract: Aims: The aim of this study was to examine the applicability of a
smoking prevention educational resource for secondary education students
named 'I do not smoke, I exercise'. The main focus of this program was the
promotion of exercise as an alternative behaviour to smoking. Methods: The
applicability of the intervention was assessed through questionnaires
regarding: (a) attitudes towards smoking, (b) interest in information about
smoking, and (c) knowledge about health consequences of smoking.
Moreover, interviews were taken from the educators and the school principals.
The questionnaires were completed from 210 students (101 boys and 109
girls) before the beginning, at the end of the program, and 12 months after the
completion of the programme. One-way repeated measure ANOVA was
performed to examine the differences between the pre-, post-, and the follow-
up measures. Results: Results showed that the program succeeded in
changing the students' attitudes, but the follow-up measures, 12 months later,
showed that attitudes towards smoking and interest in information were
relapsed to the pre-intervention levels. The only effect that was sustained was
that for knowledge. The interviews also revealed positive comments about the
program implementation and pointed some shortcomings. Conclusions: The
program needs some modifications in order to overcome its weaknesses,
have more lasting effects and to improve its applicability.

MILLER, C L and HILL, D J and others. Impact on the Australian Quitline of
new graphic cigarette pack warnings including the Quitline number.
Tobacco Control Vol 18, No 3 - June 2009: 235-237
  Abstract: Background: In March 2006, Australia introduced graphic pictorial
warnings on cigarette packets. For the first time, packs include the Quitline
number. Objective: To measure the combined effect of graphic cigarette
pack warnings and printing the Quitline number on packs on calls to the
Australian Quitline service. Methods: Calls to the Australian Quitline were
monitored over 4 years, 2 years before and after the new packets were
introduced. Results: There were twice as many calls to the Quitline in 2006
(the year of introduction), as there were in each of the preceding 2 years. The
observed increase in calls exceeds that explained by the accompanying
television advertising alone. While call volume tapered back in 2007, it
remained at a level higher than before the introduction of new packets. No
change was observed in the proportion of first time callers. Conclusion:
Introducing graphic cigarette packet warnings and the Quitline number on
cigarette packets boosts demand for Quitline services, with likely flow on
effects to cessation.

MURRAY, Rachael L and BAULD, Linda and others. Improving access to
smoking cessation services for disadvantaged groups: a systematic
review. Journal of Public Health Vol 31, No 2 - June 2009: 258-277
  Abstract: Background: Smoking is a main contributor to health inequalities.
Identifying strategies to find and support smokers from disadvantaged groups
is, therefore, of key importance. Methods: A systematic review was carried

Health Scotland Library                                                     42
                                 Journal Articles

out of studies identifying and supporting smokers from disadvantaged groups
for smoking cessation, and providing and improving their access to smoking-
cessation services. A wide range of electronic databases were searched and
unpublished reports were identified from the national research register and
key experts. Results: Over 7500 studies were screened and 48 were
included. Some papers were of poor quality, most were observational studies
and many did not report findings for disadvantaged smokers. Nevertheless,
several methods of recruiting smokers, including proactively targeting patients
on General Physician's registers, routine screening or other hospital
appointments, were identified. Barriers to service use for disadvantaged
groups were identified and providing cessation services in different settings
appeared to improve access. We found preliminary evidence of the
effectiveness of some interventions in increasing quitting behaviour in
disadvantaged groups. Conclusions: There is limited evidence on effective
strategies to increase access to cessation services for disadvantaged
smokers. While many studies collected socioeconomic data, very few
analysed its contribution to the results. However, some potentially promising
interventions were identified which merit further research.

RICHMOND, R. Tobacco in prisons: a focus group study. Tobacco Control
Vol 18, No 3 - June 2009: 176-182
  Abstract: Objective: To examine the role of tobacco use in prison and
possible influences of the prison environment on smoking among inmates in
the context of developing inmate smoking cessation programmes. Method:
Qualitative study based on seven focus groups with prisoners and ex-
prisoners. Settings: A maximum security prison in rural New South Wales
(NSW), Australia, and a community justice restorative centre and
accommodation service for ex-prisoners in Sydney, NSW, Australia.
Participants: 40 participants (28 men and 12 women) comprising nine
prisoners (including four Indigenous inmates) and 31 ex-prisoners. Results:
Prisoners reported that tobacco serves as a de facto currency in correctional
settings and can be exchanged for goods, used to pay debts and for
gambling. Smoking helps manage the stressful situations such as transfers,
court appearances and prison visits. Inmate smoking cessation programmes
need to address the enmeshment of tobacco in prison life, improve availability
of pharmacotherapies (for example, nicotine patches, bupropion) and the
quitline (a free telephone helpline providing information on stopping smoking),
provide non-smoking cells and areas within prisons, encourage physical
activity for inmates and maintain monitoring of smoking cessation status after
release. Conclusions: Tobacco is integrally bound up in the prison "culture".
Our findings are relevant to inform prison health authorities concerned with
improving the health of prisoners, and for support organisations attempting to
facilitate smoking cessation both in prison and after release. Smoking
cessation programmes in prisons should be tailored to the unique stresses of
the prison environment. Programmes need to acknowledge the difficulties of
quitting smoking in prison arising from the stresses posed by this setting.

SMITH, P B and MACQUARRIE, C R and others. Beyond 'reach':
evaluating a smoke-free homes social marketing campaign. International
Journal of Health Promotion and Education Vol 47, No 2 - 2009: 57-62

Health Scotland Library                                                      43
                                 Journal Articles

   Abstract: Environmental tobacco smoke (ETS) is an important public health
risk, with children especially vulnerable to its adverse effects. This study
evaluates an evidence-based social marketing and community engagement
campaign designed to address children's exposure to ETS in the home. A pre-
and post-intervention quasi-experimental non-equivalent control group design
was utilized. The intervention targeted households in which having a smoke-
free home within the next six months was not even contemplated.
Respondents from 1135 households in which both a smoker and a child lived
participated in a pre-intervention telephone survey, with 1044 participating one
year later, following the intervention. Outcome measures were awareness of
the campaign in the intervention and control sites, and movement along
Prochaska's stages of change model toward smoke-free home status.
Respondents in the intervention site were more likely to recall particulars of
the social marketing campaign at post-test than were those from the control
site (65% vs. 10%) (chi2 (1, N = 1042) = 323.724, p<.001). The proportion of
pre-contemplation households in the intervention site dropped substantially
between pre-intervention and post-intervention surveys (chi2 (1, N = 1107) =
37.950, p<.001), but the same was true in the control site (chi2 (1, N = 1068)
= 36.627 p<.001). The magnitude of change toward smoke-free homes did not
differ between intervention and control sites. Caution is urged in respect to
strategies often used to evaluate social marketing campaigns, such as focus
on campaign reach, attention to knowledge and attitudes but not behaviour,
and failure to utilize control sites.

VERKOOIJEN, Kirsten Thecla and DE VRIES, Nanne and others. Youth
crowds and cigarette smoking: a prospective study. Addiction Research
and Theory Vol 17, No 3 - June 2009: 333-342
  Abstract: This study examined the prospective relationship between crowd
affiliation and smoking behavior among a national sample of 16-22 year old
Danes (N = 952). Self-reported data were collected by means of a postal
questionnaire at baseline and at 18 months follow-up. The sample included
participants, who at baseline reported to identify with a crowd with either a
low-smoking norm (n = 705) or a high-smoking norm (n = 247). The results
showed that participants, who at baseline identified with a crowd with a high-
smoking norm were compared to those, who identified with a low-smoking
norm crowd, more likely to have started smoking at time of the follow-up (OR
= 2.15). Further, discordance between one's behavior and the norm of the
crowd resulted more often in a change in smoking behavior (OR = 2.00) and
crowd identification (OR = 2.15) than the absence of such discordance. The
results confirm the importance of crowds in smoking initiation and call for
more attention to this issue in smoking prevention.


MOSER, Kath and PATNICK, Julietta and others. Inequalities in reported
use of breast and cervical screening in Great Britain: analysis of cross
sectional survey data. British Medical Journal 20 June 2009: 1480-1484
  Abstract: Objective: To investigate the relation between women's reported
use of breast and cervical screening and sociodemographic characteristics.

Health Scotland Library                                                       44
                                 Journal Articles

Design: Cross sectional multipurpose survey. Setting: Private households,
Great Britain. Population: 3185 women aged 40-74 interviewed in the
National Statistics Omnibus Survey 2005-7. Main outcome measures Ever
had a mammogram, ever had a cervical smear, and, for each, timing of most
recent screen. Results 91% (95% confidence interval 90% to 92%) of women
aged 40-74 years reported ever having had a cervical smear, and 93% (92%
to 94%) of those aged 53-74 years reported ever having had a mammogram;
3% (2% to 4%) of women aged 53-74 years had never had either breast or
cervical screening. Women were significantly more likely to have had a
mammogram if they lived in households with cars (compared with no car: one
car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars,
odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with
rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own
outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by
ethnicity, education, occupation, or region were found. For cervical screening,
ethnicity was the most important predictor; white British women were
significantly more likely to have had a cervical smear than were women of
other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening
was greater among more educated women but was not significantly
associated with cars, housing tenure, or region. Conclusions Most (84%)
eligible women report having had both breast and cervical screening, but 3%
report never having had either. Some inequalities exist in the reported use of
screening, which differ by screening type; indicators of wealth were important
for breast screening and ethnicity for cervical screening. The routine collection
within general practice of additional sociodemographic information would aid
monitoring of inequalities in screening coverage and inform policies to correct


KNIFTON, Lee and WALKER, Alice and others. Workplace interventions
can reduce stigma. Journal of Public Mental Health Vol 7, No 4 - December
2008: 40-50
  Abstract: Stigma and discrimination towards people with mental health
problems is a global issue, imposing a considerable public health burden in
terms of social isolation, limited life chances, delayed help-seeking behaviour
and stress. While numerous initiatives have been undertaken to address
these issues, an evidence base for what works is still emerging. This paper
explores the impact of 15 population-level awareness workshops delivered
over a five-month period to 137 participants. These were employees drawn
from workplaces identified as being important in the day-to-day lives of people
with mental health problems. Evaluation approaches maximised specificity,
sensitivity and anonymity and they assessed participant knowledge, attitude
and behaviour. The workshops significantly improved participant knowledge.
Attitude change was more complex with an overall significant improvement in
attitudes, particularly in relation to unpredictability and recovery, but not
dangerousness, which had more positive baseline attitudes. Social distance, a
proxy for behavioural intent, had significant improvements in relation to
'moderate' social contact only. Qualitative feedback indicated that complex,

Health Scotland Library                                                       45
                                 Journal Articles

unanticipated and positive messages had been absorbed by participants and
influenced beliefs and behavioural intent. Service user narratives focusing on
recovery were identified as the most valuable component of the intervention.

SILCOX, Sarah. Health promotion international evidence review.
Occupational Health Vol 61, No 6 - June 2009: 31-32
  Abstract: The author reports on an international review of the scientific
review of the strategic evidence for the effectiveness of a range of health
promotion and workplace health interventions.

YAMAMOTO, Shelby and LOERBROKS, Adrian and others. Measuring the
effect of workplace health promotion interventions on "presenteeism": a
potential role for biomarkers. Preventive Medicine Vol 48, No 5 - May
2009: 471-472
  Abstract: Health promotion activities to improve employee health to reduce
health care costs and increase productivity are of particular importance for
organizations and society. The evaluation of employee health and health
promotion programs has typically focused on absenteeism, disability and
increasingly, "presenteeism", which refers to an employee's presence at work
with reduced performance due to illness. Existing psychometric measures of
presenteeism may be subject to the effects of recall bias as they typically rely
on questionnaires. Biomarkers such as heart rate variability and salivary
cortisol can provide additional objective measures of illness and stress.
Combining such physiologic measures of stress with assessments of
presenteeism may offer a more comprehensive way to assess workplace
productivity when developing health promotion programs.

Health Scotland Library                                                       46
                                 Selected New Books

The following list is a selection of new books added to the Library during the
previous two months. Most of the books may be borrowed either by post or
through visiting the Library. If the shelf mark ends with the letters REF or
STAT, this means that the item is held in the Library for reference only and
may not be borrowed. However, the Library staff will be happy to supply you
with further information for ordering from your local library or book shop.


GRANT, Ian and SPRINGBETT, Anthea and others (2009). Alcohol
attributable mortality and morbidity: alcohol population attributable
fractions for Scotland.
Edinburgh: ISD Publications
Shelf Mark: ScotPHO


LAWRENCE, Andrew (2008). Better together: a guide for people in the
health service on how you can help to build more cohesive
Coventry: Institute of Community Cohesion
Shelf Mark: F362.0 LAW


JELPHS, Kim and DICKINSON, Helen (2008). Working in teams.
Bristol: Policy Press. ISBN 9781847420336
Shelf Mark: 65 JEL

LAWRENCE, Andrew (2008). Better together: a guide for people in the
health service on how you can help to build more cohesive
Coventry: Institute of Community Cohesion
Shelf Mark: F362.0 LAW


CARPENTER, John and DICKINSON, Helen (2008). Interprofessional
education and training.
Bristol: Policy Press. ISBN 9781847420329
Shelf Mark: 37 CAR

Health Scotland Library                                                      47
                                 Selected New Books


DAVIES, Teifion and CRAIG, Tom (2008). ABC of mental health.
London: Wiley Blackwell. ISBN 9780727916396
Shelf Mark: 616.89 DAV


SCOTTISH GOVERNMENT (2009). Food and drink in Scotland: key facts
Edinburgh: Scottish Government. ISBN 9780755980727
Shelf Mark: 613.2 SCO STAT

SCOTTISH GOVERNMENT (2009). Leadership forum report:
development of the national food and drink policy.
Edinburgh: Scottish Government. ISBN 9780755981045
Shelf Mark: 613.2 SCO REF

SCOTTISH GOVERNMENT (2009). Recipe for success: Scotland's
national food and drink policy.
Edinburgh: Scottish Government. ISBN 9780755980840
Shelf Mark: 613.2 SCO REF


CATTO, Sonnda and GIBBS, Diane and others (2009). Are people in
becoming more active? Combined results from Scotland's routine
national surveys.
Glasgow: NHS Health Scotland. ISBN 9781844854622
Shelf Mark: FS 371.7 CAT REF


GRANT, Ian and SPRINGBETT, Anthea and others (2009). Alcohol
attributable mortality and morbidity : alcohol population attributable
fractions for Scotland. Edinburgh: ISD Publications
Shelf Mark: ScotPHO

Health Scotland Library                                                  48