2e Health and Social Behaviour Flashcards
1
Q
What is the role of public health in nutrition?
A
Public health nutrition involves studying the relationship between dietary intake and disease (nutritional epidemiology) and applying the knowledge gained to help prevent disease in the population (nutrition intervention).
Dietetics is the application of nutritional knowledge particularly tailored to individual needs. It generally involves the use of diet in the treatment and management of disease.
2
Q
What is the The Eatwell Plate?
A
Designed by the Food Standards Agency to make healthy eating choices easier to understand for individuals (http://www.food.gov.uk).
The plate is a visual representation of the five types and proportions of food people need to maintain a healthy and balanced diet. The five types are broken down into the following categories:
Fruit and vegetables
Bread, rice, pasta, potatoes, and any other starchy foods
Milk and dairy foods
Meat, fish, eggs, beans, and any other non-dairy sources of protein
Foods and drinks high in fat and/or sugar.
Food that represent the largest groups/proportions in the Eatwell Plate should be eaten most often, and food from the smallest groups/proportions should be eaten least often.
3
Q
What is national surveillance in relation to nutrition?
A
Nutritional surveillance involves the routine collection and collation of data which inform us about the nature and causes of nutritionally related diseases.
Initially, these were diseases arising from nutritional deficiencies (e.g. anaemia, rickets, and osteoporosis) but they now include a whole range of conditions (e.g. obesity, hypertension, cancers, coronary heart disease, and dental caries).
4
Q
How is national surveillance for nutrition done in the UK?
A
National food productions, household expenditure on food, household studies of food purchases and consumption and occasionally studies of individual
consumption contribute to the Food and Agriculture Organisation’s data on national food balance sheets.
This is a surveillance system that links dietary and health surveillance (using indices of health such as weight, blood pressure, serum
cholesterol and anaemia) allows more effective evaluation of the dietary contributors to diseases such as obesity, diabetes, hypertension and cardiovascular disease.
5
Q
How is national surveillance for nutrition done in the UK?
A
National food productions, household expenditure on food, household studies of food purchases and consumption and occasionally studies of individual
consumption contribute to the Food and Agriculture Organisation’s data on national food balance sheets.
This is a surveillance system that links dietary and health surveillance (using indices of health such as weight, blood pressure, serum cholesterol and anaemia) and allows evaluation of the dietary contributors to diseases such as obesity, diabetes, hypertension and cardiovascular disease.
In the UK, the National Diet and Nutrition Survey (see Markers of nutritional status, nutrition and food) links diet with indices of health. It was established to compare current intakes of nutrients with the various Dietary Reference Values (DRVs) to assess where problems exist in the population (e.g. high salt intake and low consumption of fruit and vegetables) and to assist with informing government policy.
6
Q
What are the short and long term markers that can be used for nutritional intake?
A
Short:
High intake of sugary foods – Increased dental caries
High intake of salt – increased blood pressure
Long Term:
Lack of fruit and vegetable intake – colon cancer
High and prolonged intake of alcohol – colon cancer
Lack of breastfeeding – breast cancer
Central obesity – type 2 diabetes
Lack of dietary calcium – osteoporosis
7
Q
What is malnutrition?
A
A lack of proper nutrition is caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat. Note it can include overeating as well as undereating.
8
Q
What are the risks of over-nutrition?
A
Obesity
Heart disease
Diabetes
Hypertension.
Excess of certain nutrients (e.g. vitamins and minerals) can result in toxicity over prolonged time periods.
9
Q
What are the risks of undernutrition?
A
Loss of weight
Loss of muscle
Increasedq risk of infection
Symptoms - Skin rash, depression, hair loss, tiredness, brittle bones and bleeding gums.
10
Q
What are the risks of maternal undernutrition?
A
Intrauterine growth restriction
11
Q
What are the causes of Intrauterine growth restriction
A
Maternal undernutrition
Maternal anaemia
Maternal smoking
Maternal infections (especially malaria).
11
Q
What are the consequences of Intrauterine growth restriction?
A
Infant mortality and Morbidity
Increases susceptibility to severe malnutrition in childhood
Poor cognitive, mental and physical development.
Increases the risk of chronic diseases in adulthood, Perpetuates an intergenerational cycle of malnutrition, poverty and disease.
12
Q
What is is the most common nutritional deficiency in the world?
A
Iron Deficiency Anaemia
13
Q
Who is most affected by iron deficiency anaemia?
A
Infants, children, teens and women of childbearing age.
More prevalent in developing countries than in developed countries.
14
Q
What are the consequences of iron deficiency anaemia during pregnancy?
A
Increased risk of maternal mortality and morbidity,
Increases risk of foetal morbidity, mortality
Increased risk of low birth weight
15
Q
What methods can be used to reduce iron deficiency anaemia at a population level?
A
Iron supplementation (especially in pregnant women);
Iron fortification of certain foods (UK, USA)
Dietary modification to increase the bioavailability of iron.
16
Q
What are the consequences of iodine deficiency?
A
Adult Life:
Hypothyroidism
Maternal iodine deficiency:
Cretinism
Stillbirth
Worse infant morbidity and mortality
Postnatal:
Impaired mental development
17
Q
Who is most affected by iodine deficiency?
A
Developing countries
18
Q
What interventions can be used to reduce iodine deficiency?
A
Iodization of salt (UK)
Iodized oil injections
Iodized oil by mouth.
19
Q
What are the consequences of Vitamin A deficiency?
A
Postnatal/Adulthood
Xerophthalmia (a severe drying of the eye surface caused by a malfunction of the tear glands)
Blindness
Maternal:
Night blindness
Increased risk of maternal mortality
20
Q
In which ways can you reduce vitamin A deficiency at a population level?
A
Vitamin A supplementation in deficient populations
Dietary changes - Yellow and orange fruit and vegetables
Food fortification, for example, sugar in Guatemala,
Promoting breastfeeding prevents vitamin A deficiency in babies.
21
Q
In which way can severe protein deficiency present in children?
A
Kwashiorkor and Marasmus are the two main types. Kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats.
Kwashiorkor
Higher mortality rate
Emaciated appearance except for oedema in ankles, feet, and abdomen.
Can occur in an epidemic form following a measles outbreak.
Marasmus:
Lower mortality rate
Wrinkled and shrunken appearance
Marasmic kwashiorkor:
This may occur if a Marasmic child is overfed with a diet too high in sodium, which causes oedema.
22
Q
How may undernutrition present in a child?
A
Severe:
Kwashiorkor
Marasmus
Less severe:
Vitamin Deficiency
Growth failure (body weight and height less than the ideal for their age)
Poor development (deficits in intellectual, cognitive and social behaviour).
23
Q
How is undernutrition assessed in children?
A
Weight for age
Height for age
Weight for height
24
How can individual nutrition status be assessed?
Anthropometry is the means by which body composition can be assessed in living people, method include:
Bodyweight
BMI
Growth charts
Skin fold thickness
Waist circumference
Biochemical and Haematological considerations
25
How is BMI calculated?
BMI = Weight (kg)/Height squared (meters)
26
How is BMI interpreted?
<18.5 = underweight
18.5 - 24.9 = healthy weight
25 - 29.9 = overweight
30+= Obese
27
What are the problems with using BMI?
Does not take into account muscle mass
Not appropriate for children
28
What are growth charts and how are they interpreted?
The single most important measurement of nutritional status in those under 5 years old. The 3 types of chart include:
* Weight for age
* Height for age
* Weight for height
To be classified with wasting, underweight or stunting, the child must be 2 SD (or more) below the standards compared to internationally accepted reference standards (f international reference populations.
29
What are the three types of growth chart and what do they each indivudally measure?
Height for Age - Shows linear growth, and can be used to measure for long term growth faltering or stunting.
Weight for Height - Shows proper body proportions and harmony of growth. It is sensitive to acute growth disturbances and detects wasting.
Weight for Age - Used to diagnose underweight children.
30
What are the limitations of using haematological and biochemical markers for assessing nutrition status?
Change on a daily basis
Compensated for by homeostatic mechanisms
Affected by concurrent disease
Only show depleted levels if there is a severe deficiency
31
What are the methods for assessing an individual's diet?
Prospective methods:
Food Frequency and Amount Questionnaires (FAQs)
Food diary
* Household measures
* Weighted inventory
Duplicate Diet Method
Food Checklists
Retrospective methods:
24 hour recall
Diet history
32
What is the Food Frequency and Amount Questionnaires (FAQs) method of assessing dietary intake and what are its advantages and disadvantages?
Pre-printed lists of foods, which subjects are asked to fill in, indicating the typical frequency of consumption of foods and the average amount.
Advantage
Good for large epidemiological studies
Disadvantages
Questionnaires take a long time to develop
Assess food groups rather than
individual foods (so subjects must know how to classify foods).
33
What is the food diary method of assessing dietary intake, what are the different types and what are the advantages/disadvantages of each?
There are 2 kinds of food diary – the weighed inventory and the household measures technique:
Weighed inventory:
The most widely used technique.
Subjects keep a record of all food and drink consumed, all weighed prior to consumption.
Advantage:
High accuracy
Disadvantage:
There could be under-reporting.
The household measures technique:
Subjects record their portion sizes in household measures (e.g. cup, bowl, spoonful, etc) instead of weighing foods
Aids (e.g. models or photos) may
improve portion size estimates.
Advantage:
Simplifies the recording process
Disadvantage:
Less precise and thus may lead to misclassification of individuals
34
What is the duplicate diet method of assessing dietary intake and what are its advantages and disadvantages?
The subject has to weigh and record food consumed, but also weigh and set aside exactly the same portions again. These portions are collected and chemically analysed.
Advantage
Independent of errors associated with food composition tables
Disadvantages:
Expensive
Subjects may fail to set aside exact duplicates.
35
What is the food checklist method of assessing dietary intake and what are its advantages and disadvantages?
Subjects are given lists of foods commonly consumed by the population under study. The subject then ticks the foods which they have consumed each day, and record the approximate amounts in household measures.
Advantage:
Reduces the amount of recording required
Reduces the amount of time spent processing data.
Disadvantage:
Subjects may fail to record foods not listed (there is a section to add other foods)
36
What is the 24-hour recall method of assessing dietary intake and what are its advantages and disadvantages?
A trained interviewer asks subjects to recall and describe every item of food and drink consumed over exactly 24 hours. It involves a systematic repetition of open-ended questions, asking subjects to describe amounts in household measures.
Advantages
Quick process to administer (10-15 minutes)
Good compliance
Disadvantage:
A single 24-hour recall can’t classify a subject (it is used for estimating the average intake of groups).
37
What is the diet history method of assessing dietary intake and what are its advantages and disadvantages?
A diet history is used to assess the usual diet over the recent past. It begins with a 24-hour recall followed by a 2-hour interview to elaborate on this. A trained interviewer asks about the variety and frequency of foods that subjects are likely to eat, assessing differences between weekdays and weekends, and seasonal variation.
Advantage
Highly informative
Special attention can be paid to specific food
Disadvantage
Dependent on the skill of the interviewer
Social bias may lead to over/under-reporting
38
What are the advantages and disadvantages of retrospective methods of dietary intake assessment?
Advantages:
Less labour intensive.
Quick
Cheap
Less selection bias (easier to do)
Can assess historical diet
Disadvantages:
Recall issues (particularly in young or elderly subjects)
Subjects skill dependant (if asking for food portion size).
Social/Recall biases
Daily variation is less readily assessed
Subjects with irregular eating habits may not be suitably assessed
39
What are the advantages and disadvantages of prospective methods of dietary intake assessment?
Advantages:
Directly measure current diet.
Can be carried out for varying lengths of time
Disadvantages:
Labour-intensive
Require good literacy and numeracy
Data may be inaccurate due to inaccurate subject recording
Data may not reflect the actual diet (subjects may alter answers for ease of recording or because they felt their diet was being scrutinised).
40
What are the methods of assessing dietary intake at a local and national level?
Indirect measurements of food intake:
Derived from sources providing data on the amount of food available for consumption (food supply data), the volume of food traded at the wholesale or retail level (food disappearance data) or the amount of food
purchased at a household level (household budget or expenditure data)
Household Food Surveys:
‘Household expenditure’ or ‘Household budget’ surveys assess the amount of money spent on food over a
given period. Sometimes quantities of food purchased may be collected (however these are rarely analysed).
Food Mapping exercises:
The process of finding out where people can buy and eat food, and identifying the food needs of local people. It is a type of needs assessment, aiming to identify the geographical areas or communities that have the greatest needs in terms of food access.
Monitoring surrogate markers:
Disease levels e.g. obesity, coronary heart disease, stroke, Iron Deficiency Anaemia, Low Birth Weight
41
What are the advantages and disadvantages of the "household food survey" method of assessing community or national-level dietary intake?
Advantages
Conducted at regular intervals on representative samples of households
Information can be classified by socio-demographic characteristics, geographical location and season.
Disadvantages
Information collected differs from country to country,
Expenditure on food consumed outside of the house (e.g. restaurants) or data on domestic wastage (how much is thrown away or given to pets) is rarely monitored.
Food is reported at the food group level, not individual foods (limiting assessment of nutrition).
Difficult to compare data between countries due to different food codes.
42
What is the main household food survey conducted in the UK?
The Office of National Statistics conducts the Family Expenditure Survey (FES)
43
What are the advantages and disadvantages of the "food mapping" method of assessing community or national-level dietary intake?
Advantages:
Adaptable
Gives a whole picture view
Disadvantages:
Expensive
Time-consuming
44
What is a food desert?
An ‘area of relative exclusion where people experience physical and economic barriers to accessing healthy food’.
They often include areas of inner cities where cheap nutritious food is virtually unobtainable. Car-less or disabled residents are unable to reach out-of-town
supermarkets and thus depend on corner shops where prices are high, products are processed, and fresh fruit and vegetables are poor or non-existent.
45
What are the main national surveys assessing dietary intake in the UK?
National Diet and Nutrition Survey of Adults (19-64)
National Diet and Nutrition Survey of young people (4-19)
Low-Income Diet and Nutrition Survey
46
Give an example of a government campaign that looks to improve nutrition at a population level.
5 A Day
The Government recommends an intake of at least 5 different portions of fruit and vegetables. This recommendation comes from a number of studies which concluded that 400g (around 5 portions) of fruit and vegetables each day helps to reduce the risk of some cancers, heart disease and many other chronic diseases. This is a large campaign and includes initiatives such as the school fruit and vegetable scheme.
Food labelling
The food standards agency has implemented a ‘traffic light’ labelling system, which supermarkets such as Waitrose and Sainsburys are using.
Healthy Weight, Healthy Lives – A Cross Government Strategy for England (2008)
A 2008 strategy following the foresight report aimed to support people to maintain a healthy weight. The first focus was on reducing childhood obesity levels by 2020.
47
What are the different types of national-level nutritional interventions?
Education campaigns e.g. 5 a day campaign and Traffic Light food labelling.
Supplementation and food fortification e.g. fortification of salt with iodine and bread/flour with folate.
Collaboration with food manufacturers to reduce the salt, sugar or fat content of foods.
National Healthy Schools Programme (NHSP) - more than 95% of schools nationally are now involved in the programme and over 60% of schools have achieved National Healthy Schools Status
48
What are the different types of local-level nutritional interventions?
Workplace initiatives e.g. ‘healthy’ canteen, replacing vending machines with ‘healthy vending’ machines.
Skills training to allow previously uneaten foods to be consumed e.g. cooking, planning meals, managing a budget, shopping tours.
49
What are the different types of individual-level nutritional interventions?
Individual counselling - usually occurs in primary care or a health centre setting and is generally addressing a particular health problem (e.g. obesity, hypertension). Dietary advice is provided and tailored to the individual.
50
What are the ways in which you can assess a nutritional intervention?
Measure the impact on physical growth e.g. using anthropometry (such as BMI, growth charts etc).
Measure the impact on biomarkers using laboratory methodologies
Measure clinical, morbidity, and mortality data
Measure dietary assessments
Measure the impact on physical activity and physical fitness
Monitor behavioural change and psychological indicators
51
What are the key determinants of diet choice?
Biological determinants:
Hunger
Appetite
Taste
Economic determinants:
Cost
Income
Physical determinants:
Accessibility and availability
Education, knowledge and skills
Time constraints
Social determinants:
Socioeconomic class
Cultural differences
Social context
Psychological determinants:
Mood e.g. Guilt
Stress
Other:
Attitudes & beliefs - E.g. Trying to eat healthily, Qualitly or freshness of food
Optimistic bias - People think their diet is healthy so feel they don't need to change it.
52
What are the main types of dietary recommendations that can be made by public health teams?
Dietary allowances (DRVs) - Quantitative guidelines for the essential macro- and micro-nutrients that prevent nutritional deficiencies. They are aimed at different population subgroups.
Dietary goals - Quantitative national targets for selected macronutrients and micronutrients aimed at preventing long-term chronic disease e.g. coronary heart disease. They are usually aimed at the national population level
rather than the individual level
Dietary guidelines - Broad targets aimed at the individual to promote nutritional well-being. Can be expressed as quantitative targets (e.g. five servings of fruit and vegetables/day) or as qualitative guidelines (e.g. eat more fruit and vegetables).
53
What are the four dietary reference values (DRV's) set in the UK?
Estimated Average Requirements (EARs):
An estimate of the average requirement of energy or a nutrient needed by a group of people i.e. approximately 50% of people will require less, and 50% will require more.
Reference Nutrient Intakes (RNIs):
The amount of a nutrient that is enough to ensure that the needs of nearly all a group (97.5%) are being met i.e. the majority will need less.
Lower Reference Nutrient Intakes (LRNIs):
The amount of a nutrient that is enough for only a small number of people in a group who have low requirements (2.5%) i.e. the majority need more.
Safe Intake:
Where there is insufficient evidence to set an EAR, RNI or LRNI. The safe intake is the amount judged to be enough for almost everyone, but below a level that could have undesirable effects.
54
What are the general patterns of nutritional requirements over the life course?
Birth to 18: Dietary requirements for calories, micronutrients and macronutrients gradually increase.
Adult life: Lower requirement for certain micronutrients (such as calcium and phosphorous) and calories than in adolescence.
Pregnancy: Increased requirements for some nutrients (for example folic acid)
Lactation: Increased caloric, micro and macronutrient requirements.
50+: Gradual reduction in energy needs but vitamins and minerals requirements remain unchanged.
55
Where does the evidence for the UK dietary recommendations come from?
1991, COMA report on energy and nutrients provided evidence for the dietary recommendations for total fat, saturated fat, total carbohydrate, sugars, and dietary fibre.
1994, COMA recommended reducing the average salt intake of the population to 6g a day based on evidence of a link between high salt intake and high blood pressure.
In 2003, the SACN reviewed the evidence (e.g. Intersalt study and Dietary Approaches to Stop Hypertension (DASH) sodium trial) since 1994 and concluded the strength for the association between high salt intake and hypertension had increased. High blood pressure increases the risk of stroke and cardiovascular disease.
SACN confirmed that reducing salt intake to 6g per day would benefit the whole population.
Evidence for increasing the consumption of fruit and vegetables to 5 a day is provided by a number of sources including the Department of Health.
56
What are the main different cultural diets and what are the differences?
Good for health:
Japanese - High in soy. Low rates of heart disease, osteoporosis and some cancers, and reduces menopausal symptoms.
Mediterranean- High unsaturated fat, fruit, veg and low levels of meat, with moderate alcohol. High adult life expectancy and low rates of chronic diseases
Bad for health:
Western - High in total energy, high saturated fat, low fibre and high salt. High rates of obesity, breast
cancer, colorectal cancer, hypertension and stroke.
South Asian - High total dietary fat leads to high rates of T2DM, obesity and cardiovascular disease.
57
What is the state of physical activity in the UK?
Physical activity is low in adults and there is concern regarding children, such as teenage girls.
In England in 2004, only 35 per cent of men and 24 per cent of women reported achieving the physical activity recommendations for adults.
In 2002, only 70 per cent of boys and 61 per cent of girls met current physical activity guidelines for children.
Over the last 20-30 years there has been a decrease in physical activity as part of daily routines but an increase in the proportion of people taking physical activity for leisure.
58
What are the health benefits of physical activity and what are their aims?
Reduced risk of cardiovascular disease
Prevents obesity
Reduced risk of type 2 diabetes
Reddcued levels of certain cancer (e.g. Colon and breast)
Improved bone mineral density/Lower rates of osteoporosis
Improved mental health
Reduced long-term social and economic discrimination
59
What is Sport England and what is their strategy?
Aims to get more people playing and enjoying sports and help those with talent succeed.
More people doing sports, fewer teenagers dropping out of sports, improved talent systems, increased satisfaction in sports, getting kids to reach their target exercise each week.
60
What interventions have been trialled to increase physical activity in the UK?
Brief intervneiton in primary care – opportunistic advice, discussion and encouragement.
Exercise referral schemes – Assessment, tailored physical activity programme, monitoring and follow-up.
Pedometers – Used to increase the amount of physical activity undertaken
Community-based exercise programmes for walking and cycling
Initiatives promoting and creating environments that encourage physical activity – e.g.cycle lanes, green open spaces and public paths.
Workplace initiatives – Health checks by qualified practitioner, policies to encourage employees to walk or cycle (e.g. bike loan schemes).
General Practitioner Physical Activity Questionnaire (GPPAQ) – questionnaire intended for use in adults (16-74 yrs) in routine general practice to provide a 4-level Physical Activity Index reflecting an individual’s current physical activity.
Physical activity care pathway.
61
What are the three types of drinking?
Sensible drinking - Drinking in a way that is unlikely to cause yourself or others significant risk or harm.
Harmful drinking - Drinking at levels that lead to significant harm to physical and mental health and at levels that may cause substantial harm to others.
Binge drinking - Drinking too much alcohol over short period of time e.g. over the course of an evening (typically drinking that leads to drunkenness). It has immediate and short-term risks to the drinker and
to those around them.
62
What are the risks of binge drinking?
More likely to be involved in an accident or assault
Increased rates of criminal offence
Increased irks of sexually transmitted disease and unplanned pregnancy.
63
What are the criteria for binge drinking?
Adult Women - Drinking over 6 units a day
Adult men - Drinking over 8 units a day
64
What are the criteria for harmful drinking?
Adult Women - Regularly drink over 6 units a day (or over 35 units a week)
Adult men - Regularly drink over 8 units a day (or over 50 units a week)
Drinking while pregnant or trying to conceive (as a woman)
65
What are the criteria for sensible drinking?
Adult Women- Should not regularly drink more than 2-3 units of alcohol a day
Adult men - Should not regularly drink more than 4-5 units of alcohol a day
Pregnant women or women trying to conceive - Should avoid drinking alcohol.
66
What are the general trends of drinking in the UK?
Since reaching a peak in the mid-2000s, consumption has been falling steadily.
The incidence of alcohol-related deaths and diseases has increased.
More alcohol is being bought from off-licenses and consumed at home rather than in pubs.
The UK now has among the highest incidences of youth drunkenness. Underage drinking and drinking by young adults is perceived as a real problem by the public.
Drinking over the sensible drinking guidelines is more common in:
Men than women
young people aged 16-24 than people in other age groups
Areas of high deprivation
67
What are the negative health effects of harmful drinking?
Acute admission - alcoholic liver disease, mental and behavioural disorders due to alcohol, and toxic effects of alcohol.
Chronic disease - Liver disease (e.g. Cirrhosis), Linked to hypertension, cardiovascular disease, pancreatitis
Death - Alcoholic liver disease (cirrhosis and fibrosis) and alcohol cardiomyopathy
68
What are the risks of drinking during pregnancy?
Miscarriage
Fetal alcohol syndrome
Small for gestational age
69
What is the general trend in drinking driving in the UK?
There has been a huge reduction in the annual number of drink-driving deaths in Great Britain (1,600 at the end of the 1970s to 560 in 2005) but the rate of decline in the past 10 years has slowed significantly.
70
What are the risks of harmful drinking to young people?
Injuries whilst under the influence of alcohol (binge drinking)
Youth offending
Teenage pregnancy
School failure, truancy and exclusion
Illegal drug misuse
Medical complications
71
What different interventions have been trialled in the UK to reduce harmful drinking?
Education:
‘Know your limits’ (2006) binge drinking campaign to target 18-24 year old binge drinkers.
‘THINK!’ drink driving campaign developed by the Department of Transport.
Restriction on alcohol advertising by Ofcom.
Code of Practice by the Portman Group on the naming, packaging and promotion of alcoholic drinks.
Health services:
Trailblazer research projects to identify and advise people whose drinking habits are likely to lead to ill health in the future.
National Alcohol Needs Assessment Research Project (ANARP) identifies services for those requiring treatment for alcohol disorders.
‘Alcohol Misuse Interventions: guidance on developing a local programme of improvement’ (2005) was published to assist local health organisations, local authorities and other organisations working with the NHS to tackle
alcohol misuse.
‘Models of Care for Alcohol Misuse’ (2006) was produced by DH and the National Treatment Agency to provide a framework for commissioning and providing interventions
The Review of the Effectiveness of Treatment for the Alcohol Problems (2006) by the National Treatment Agency provides a comprehensive review of the effectiveness and cost effectiveness of alcohol treatment.
Combating crime:
New powers under the Licensing Act 2003 implemented in 2005 to regulate the sale of alcohol at the point of sale
New powers under the Violent Crime Reduction Act 2006 to tackle irresponsible individual licensed premises.
‘Alcohol Misusing Offenders – A strategy for delivery’ (2006) by the National Probation Service provides a coherent framework for those tackling alcohol misuse in offenders.
National Alcohol Misuse Enforcement Campaigns (AMECs) between 2004 and 2006 involved police and trading standards targeting irresponsible drinkers who were causing violence and disorder, and premises that were breaking the law by selling to under-18s.
‘Challenge 21’ policy
Tackling Violent Crime Programme (TVCP) was launched in November 2004. It involved the Home Office working with practitioners in a small number of local areas with high levels of more serious violent crime.
The Children Act 2004 places responsibility on directors of children’s services to protect children and young people from harm (this includes parents with substance misuse problems who can place their children at risk).
Working with the alcohol industry:
Health information on bottles including the Government’s sensible drinking message and the alcohol unit content of containers and of standard glasses.
Social Responsibility Standards for the Production and Sale of Alcohol Drinks in the UK (2005). The standards were compiled jointly by the Government and alcohol industry.
Local partnership schemes e.g. Best Bar None. This is based on partnership working between police and local retailers to promote responsible management of on-license premises and to reduce incidents of alcohol-related crime and disorder.
72
What is drug misuse?
The use of illegal drugs or the misuse of prescribed drugs and substances
73
What are the trends of drug use in the UK?
Rates of drug-related deaths and blood-borne viruses are rising.
For Class A drugs the highest use in England is in London.
Cannabis was the drug most commonly taken in young people
The UK has one of the highest rates of cannabis use among 15 and 16-year-olds in Europe.
The number of people who are in contact with structured drug treatment services is increasing.
More men access treatment services than women.
Overall heroine is the main drug for which people receive treatment, whereas in the under 18 age group, it was cannabis.
74
Which groups are more prone to drug misuse?
Young people
Prisoners
Socially deprived groups
Homeless
Men are more likely than women
75
What are the health effects of drug misuse?
Psychological effects:
Addiction
Schizophrenia
Depression
Anxiety
Memory loss
Lack of control and lack of interactions in society, leading to decreased social capital.
Physical effects
Accidental death from drug misuse
Suicide
Blood-borne virus infections (hepatitis and HIV)
Poor nutrition
Associated with alcohol misuse and tobacco use
Societal effects
Increased antisocial behaviour and crime.
76
Add section on current government strategies and interventions for nutrition, alcohol, exercise, sun exposure, drugs etc
To be done
77
Give an example of a previous drug misuse intervention.
The Frank Campaign:
The Department of Health’s campaign, the FRANK campaign, provides information and support for young people to ensure they understand the risks and dangers of drugs and their use and that they know where to go for help and advice. FRANK also aims to give parents the confidence and knowledge to talk to their children about drugs. FRANK is jointly delivered by the Department of Health, the Home Office and the Department for Children, Schools and Families.
Since launching in 2003, FRANK has established itself as an informed and trusted source of help and information. FRANK has received over 739,000 telephone calls, responded to over 48,000 emails and received over 5.7 million hits to talktofrank.com.
83% of young people are aware of FRANK. The number of 15-18 year olds agreeing that smoking cannabis can damage the mind went up from 45% to 61% as a result of this campaign.
78
What are the smoking trends in the UK?
Smoking rates have been declining significantly in England since the 1960s. Prevalence peaked in the 30s and has been declining since.
Scotland has higher rates than England.
More males smoke than females, except for in teenagers, where females have a higher prevalence of smoking. There is a higher prevalence of smoking in lower socio-economic groups.
There is a high proportion of smoking in some occupations e.g. publicans, soldiers and manual workers.
There is also a strong association with smoking and high alcohol intake.
79
What are the health effects of smoking?
The principle cause of premature death in the UK
Coronary heart disease
Cerebrovascular disease
Cancer
Emphysema/COPD
Addiction side effects
80
What are the consequences of smoking during pregnancy?
Smoking while pregnant causes increased risk of miscarriage, low birth weight, and inhibited child development.
Smoking by parents following the birth is linked to sudden infant death syndrome, and higher rates of infant respiratory illness.
81
What are the health consequences of second-hand smoking?
Increased risk of childhood lung disease e.g. Asthma
Increased risk of COPD
Increased risk of lung cancer.
82
What is the WHO's Framework Convention on Tobacco Control?
The WHO FCTC is the world’s first global public health treaty. The FCTC requires parties to adopt a range of measures designed to reduce the health and economic impacts of tobacco.
The Framework Convention Alliance (FCA) was founded in 1999 and is now made up of more than 350 organisations from more than 100 countries.
83
In what ways can tobacco use be reduced?
Reducing exposure to second hand smoke
Smoking cessation
Media and education campaigns
Reducing availability of tobacco products
Reducing tobacco advertising and legislation
Tobacco regulation
84
Give an example of an intervention that aimed to reduce smoking in the UK?
Banning indoor smoking.
This has the effect of denormalising smoking and helping create a
non-smoking culture, as well as preventing the health impacts of secondhand smoke.
85
What is sexual health?
Sexual health is defined by the WHO as
Enjoyment of sexual relation without exploitation, oppression or abuse.
Safe pregnancy and childbirth, and avoidance of unintended pregnancies.
Absence and avoidance of sexually transmitted infections, including HIV.
Unhealthy sexual behaviour can lead to deviance from any of these three points.
86
What are the general UK trends in sexual health?
There is a clear relationship between sexual ill health, poverty and social exclusion. There is also an unequal impact of STI infection on gay men and certain minority ethnic groups.
There have been large increases in many STIs including Chlamydia , gonorrhoea and HIV.
People are having sex for the first time at a younger age, a greater proportion of people have multiple partners, and a greater proportion of men report having had a same-sex partner.
Co-infection is common
The most common conditions in England are now Chlamydia, non-specific urethritis, and wart virus infections.
GUM clinic visits are increasing
87
What are the health effects of poor sexual health?
Unintended pregnancies
STIs including HIV
Hepatitis B and C
Cervical and other genital cancers (through HPV)
Pregnancy complications - Ecoptic, Premature pregnancy, miscarriage
Impact on relationships
The stigma associated with the above conditions
Psychological consequences such as coercion and abuse.
88
Give an example of an intervention aimed at improving sexual health in the UK?
HPV vaccine programme
Chlamydia screening programme
89
What are the general trends of dangerous sun exposure in the UK?
Sun exposure is the main cause of melanoma and non-melanoma skin cancers.
Over time, the incidence of malignant melanoma has increased more than for any other major cancer in the UK.
Melanoma is the third most common cancer amongst 15 to 39 year olds.
90
Who is most affected by skin cancer?
Skin cancer is generally more common with increasing age, but melanoma is disproportionately high in younger people.
Melanoma is more than twice as common in young women as in young men, however, more men die from it.
Melanoma rates are higher in people living in more affluent areas.
91
What are the negative health effects of sun exposure?
Melanoma, basal cell carcinoma, squamous cell carcinoma
Wrinkles/aged skin
Cataracts
Inflammatory eye conditions (acute)
Cold Sores (through reactivation of herpes simplex)
92
What is the public health advice related to sun exposure?
Take sensible precautions to avoid sunburn (e.g. wear hats, sunglasses and clothing, seek shade particularly around the four hours around midday).
Apply sunscreens (but this should not be used to intentionally prolong exposure).
Take particular care with children.
Discourage use of sunbeds and sunlamps for cosmetic tanning.
Health professionals and manufacturers to warn patients and the general public about the interactions between UV rays and some prescribed medicines, drugs, foods and cosmetics that can cause sensitisation of the skin and eyes i.e. make an individual more sensitive to sunlight.
93
Give an example of an intervention to reduce sun exposure in the UK.
SunSmart, the UK’s national skin cancer prevention campaign is run by Cancer Research UK. SunSmart’s key messages are listed below:
SMART:
Spend time in the shade between 11 and 3
Make sure you never burn
Aim to cover up with a t-shirt, hat and sunglasses
Remember to take extra care with children
Then use factor 15+ sunscreen
Also report mole changes or unusual skin growths promptly to your doctor.
93
Give an example of an intervention to reduce sun exposure in the UK.
SunSmart, the UK’s national skin cancer prevention campaign is run by Cancer Research UK. SunSmart’s key messages are listed below:
SMART:
Spend time in the shade between 11 and 3
Make sure you never burn
Aim to cover up with a t-shirt, hat and sunglasses
Remember to take extra care with children
Then use factor 15+ sunscreen
Also report mole changes or unusual skin growths promptly to your doctor.
