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Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework. Tob Control 2023; 32:589-598. [PMID: 35017262 PMCID: PMC10447402 DOI: 10.1136/tobaccocontrol-2021-056825] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.
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Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Tobacco Control Policy Simulation Models: Protocol for a Systematic Methodological Review. JMIR Res Protoc 2021; 10:e26854. [PMID: 34309577 PMCID: PMC8367099 DOI: 10.2196/26854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tobacco control models are mathematical models predicting tobacco-related outcomes in defined populations. The policy simulation model is considered as a subcategory of tobacco control models simulating the potential outcomes of tobacco control policy options. However, we could not identify any existing tool specifically designed to assess the quality of tobacco control models. Objective The aims of this systematic methodology review are to: (1) identify best modeling practices, (2) highlight common pitfalls, and (3) develop recommendations to assess the quality of tobacco control policy simulation models. Crucially, these recommendations can empower model users to assess the quality of current and future modeling studies, potentially leading to better tobacco policy decision-making for the public. This protocol describes the planned systematic review stages, paper inclusion and exclusion criteria, data extraction, and analysis. Methods Two reviewers searched five databases (Embase, EconLit, PsycINFO, PubMed, and CINAHL Plus) to identify eligible studies published between July 2013 and August 2019. We included papers projecting tobacco-related outcomes with a focus on tobacco control policies in any population and setting. Eligible papers were independently screened by two reviewers. The data extraction form was designed and piloted to extract model structure, data sources, transparency, validation, and other qualities. We will use a narrative synthesis to present the results by summarizing model trends, analyzing model approaches, and reporting data input and result quality. We will propose recommendations to assess the quality of tobacco control policy simulation models using the findings from this review and related literature. Results Data collection is in progress. Results are expected to be completed and submitted for publication by April 2021. Conclusions This systematic methodological review will summarize the best practices and pitfalls existing among tobacco control policy simulation models and present a recommendation list of a high-quality tobacco control simulation model. A more standardized and quality-assured tobacco control policy simulation model will benefit modelers, policymakers, and the public on both model building and decision making. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020178146; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178146 International Registered Report Identifier (IRRID) DERR1-10.2196/26854
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Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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Mohammed HT, Hyseni L, Bui V, Gerritsen B, Fuller K, Sung J, Alarakhia M. Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use. PLoS One 2021; 16:e0253665. [PMID: 34166441 PMCID: PMC8224904 DOI: 10.1371/journal.pone.0253665] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has rapidly transformed how healthcare is delivered to limit the transmission of the virus. This descriptive cross-sectional study explored the current use of virtual visits in providing care among primary care providers in southwestern Ontario during the first wave of the COVID-19 pandemic and the anticipated level of utilization post-pandemic. It also explored clinicians’ perceptions of the available support tools and resources and challenges to incorporating virtual visits within primary care practices. Methods Primary care physicians and nurse practitioners currently practicing in the southwestern part of Ontario were invited to participate in an online survey. The survey invite was distributed via email, different social media platforms, and newsletters. The survey questions gathered clinicians’ demographic information and assessed their experience with virtual visits, including the proportion of visits conducted virtually (before, during the pandemic, and expected volume post-pandemic), overall satisfaction and comfort level with offering virtual visits using modalities, challenges experienced, as well as useful resources and tools to support them in using virtual visits in their practice. Results We received 207 responses, with 96.6% of respondents offering virtual visits in their practice. Participants used different modalities to conduct virtual visits, with the vast majority offering visits via phone calls (99.5%). Since the COVID-19 pandemic, clinicians who offered virtual visits have conducted an average of 66.4% of their visits virtually, compared to an average of 6.5% pre-pandemic. Participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients’ limited access to technology, 55% about patients’ knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection. There were significant differences in perception of some challenges between clinicians in urban vs, rural areas. Clinicians in rural areas were more likely to consider the inconsistent Wi-Fi and limited connectivity as barriers to incorporating virtual visits within the practice setting (58.8% vs. 40.2%, P = 0.030). In comparison, clinicians in urban areas were significantly more concerned about patients overusing virtual care services (39.4% vs. 21.6%, P = 0.024). As for support tools, 47% of clinicians advocated for virtual care standards outlined by their profession’s college. About 32% identified change management support and technical training as supportive tools. Moreover, 39% and 28% thought local colleagues and in-house organizational support are helpful resources, respectively. Conclusion Our study shows that the adoption of virtual visits has exponentially increased during the pandemic, with a significant interest in continuing to use virtual care options in the delivery of primary care post-pandemic. The study sheds light on tools and resources that could enhance operational efficiencies in adopting virtual visits in primary care settings and highlights challenges that, when addressed, can expand the health system capacity and sustained use of virtual care.
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Affiliation(s)
| | - Lirije Hyseni
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
| | - Victoria Bui
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | - Beth Gerritsen
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | - Katherine Fuller
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jihyun Sung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mohamed Alarakhia
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Lloyd-Williams F, Hyseni L, Guzman-Castillo M, Kypridemos C, Collins B, Capewell S, Schwaller E, O'Flaherty M. Evaluating stakeholder involvement in building a decision support tool for NHS health checks: co-producing the WorkHORSE study. BMC Med Inform Decis Mak 2020; 20:182. [PMID: 32778087 PMCID: PMC7418313 DOI: 10.1186/s12911-020-01205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Stakeholder engagement is being increasingly recognised as an important way to achieving impact in public health. The WorkHORSE (Working Health Outcomes Research Simulation Environment) project was designed to continuously engage with stakeholders to inform the development of an open access modelling tool to enable commissioners to quantify the potential cost-effectiveness and equity of the NHS Health Check Programme. An objective of the project was to evaluate the involvement of stakeholders in co-producing the WorkHORSE computer modelling tool and examine how they perceived their involvement in the model building process and ultimately contributed to the strengthening and relevance of the modelling tool. Methods We identified stakeholders using our extensive networks and snowballing techniques. Iterative development of the decision support modelling tool was informed through engaging with stakeholders during four workshops. We used detailed scripts facilitating open discussion and opportunities for stakeholders to provide additional feedback subsequently. At the end of each workshop, stakeholders and the research team completed questionnaires to explore their views and experiences throughout the process. Results 30 stakeholders participated, of which 15 attended two or more workshops. They spanned local (NHS commissioners, GPs, local authorities and academics), third sector and national organisations including Public Health England. Stakeholders felt valued, and commended the involvement of practitioners in the iterative process. Major reasons for attending included: being able to influence development, and having insight and understanding of what the tool could include, and how it would work in practice. Researchers saw the process as an opportunity for developing a common language and trust in the end product, and ensuring the support tool was transparent. The workshops acted as a reality check ensuring model scenarios and outputs were relevant and fit for purpose. Conclusions Computational modellers rarely consult with end users when developing tools to inform decision-making. The added value of co-production (continuing collaboration and iteration with stakeholders) enabled modellers to produce a “real-world” operational tool. Likewise, stakeholders had increased confidence in the decision support tool’s development and applicability in practice.
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Affiliation(s)
- Ffion Lloyd-Williams
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Lirije Hyseni
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Maria Guzman-Castillo
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.,Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Chris Kypridemos
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Brendan Collins
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Simon Capewell
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ellen Schwaller
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.
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Lloyd-Williams F, Masters R, Hyseni L, Denny ES, O'Flaherty M, Capewell S. The QUEST for Effective and Equitable Policies to Prevent Non-communicable Diseases: Co-Production Lessons From Stakeholder Workshops. Int J Health Policy Manag 2020; 10:638-646. [PMID: 32610821 PMCID: PMC9278532 DOI: 10.34172/ijhpm.2020.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities. METHODS We developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach. RESULTS We engaged with 43 diverse stakeholders. They identified 'healthy environment' as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/ policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of 'elite actors' (ministers, public sector leaders) was seen as key to the success of NCD prevention policies. CONCLUSIONS NCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theorybased co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.
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Affiliation(s)
- Ffion Lloyd-Williams
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Rebecca Masters
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Emily St Denny
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Hyseni L, Guzman-Castillo M, Kypridemos C, Collins B, Schwaller E, Capewell S, Boland A, Dickson R, O'Flaherty M, Gallacher K, Hale P, Lloyd-Williams F. Engaging with stakeholders to inform the development of a decision-support tool for the NHS health check programme: qualitative study. BMC Health Serv Res 2020; 20:394. [PMID: 32393313 PMCID: PMC7212552 DOI: 10.1186/s12913-020-05268-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The NHS Health Check Programme is a risk-reduction programme offered to all adults in England aged 40-74 years. Previous studies mainly focused on patient perspectives and programme delivery; however, delivery varies, and costs are substantial. We were therefore working with key stakeholders to develop and co-produce an NHS Health Check Programme modelling tool (workHORSE) for commissioners to quantify local effectiveness, cost-effectiveness, and equity. Here we report on Workshop 1, which specifically aimed to facilitate engagement with stakeholders; develop a shared understanding of current Health Check implementation; identify what is working well, less well, and future hopes; and explore features to include in the tool. METHODS This qualitative study identified key stakeholders across the UK via networking and snowball techniques. The stakeholders spanned local organisations (NHS commissioners, GPs, and academics), third sector and national organisations (Public Health England and The National Institute for Health and Care Excellence). We used the validated Hovmand "group model building" approach to engage stakeholders in a series of pre-piloted, structured, small group exercises. We then used Framework Analysis to analyse responses. RESULTS Fifteen stakeholders participated in workshop 1. Stakeholders identified continued financial and political support for the NHS Health Check Programme. However, many stakeholders highlighted issues concerning lack of data on processes and outcomes, variability in quality of delivery, and suboptimal public engagement. Stakeholders' hopes included maximising coverage, uptake, and referrals, and producing additional evidence on population health, equity, and economic impacts. Key model suggestions focused on developing good-practice template scenarios, analysis of broader prevention activities at local level, accessible local data, broader economic perspectives, and fit-for-purpose outputs. CONCLUSIONS A shared understanding of current implementations of the NHS Health Check Programme was developed. Stakeholders demonstrated their commitment to the NHS Health Check Programme whilst highlighting the perceived requirements for enhancing the service and discussed how the modelling tool could be instrumental in this process. These suggestions for improvement informed subsequent workshops and model development.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK.
| | - Maria Guzman-Castillo
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Brendan Collins
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Ellen Schwaller
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Angela Boland
- Department of Health Services Research, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rumona Dickson
- Department of Health Services Research, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Kay Gallacher
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Peter Hale
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
| | - Ffion Lloyd-Williams
- Department of Public Health & Policy, University of Liverpool, 3rd floor Whelan Building, Room 3.09, Liverpool, L69 3GB, UK
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Kypridemos C, Puzzolo E, Aamaas B, Hyseni L, Shupler M, Aunan K, Pope D. Health and Climate Impacts of Scaling Adoption of Liquefied Petroleum Gas (LPG) for Clean Household Cooking in Cameroon: A Modeling Study. Environ Health Perspect 2020; 128:47001. [PMID: 32233878 PMCID: PMC7228103 DOI: 10.1289/ehp4899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The Cameroon government has set a target that, by 2030, 58% of the population will be using Liquefied Petroleum Gas (LPG) as a cooking fuel, in comparison with less than 20% in 2014. The National LPG Master Plan (Master Plan) was developed for scaling up the LPG sector to achieve this target. OBJECTIVES This study aimed to estimate the potential impacts of this planned LPG expansion (the Master Plan) on population health and climate change mitigation, assuming primary, sustained use of LPG for daily cooking. METHODS We applied existing and developed new mathematical models to calculate the health and climate impacts of expanding LPG primary adoption for household cooking in Cameroon over two periods: a) short-term (2017-2030): Comparing the Master Plan 58% target with a counterfactual LPG adoption of 32% in 2030, in line with current trends; and b) long-term (2031-2100, climate modeling only), assuming Cameroon will become a mature and saturated LPG market by 2100 (73% adoption, based on Latin American countries). We compared this with a counterfactual adoption of 41% by 2100, in line with current trends. RESULTS By 2030, successful implementation of the Master Plan was estimated to avert about 28,000 (minimum = 22,000 , maximum = 35,000 ) deaths and 770,000 (minimum = 580,000 maximum = 1 million ) disability-adjusted life years. For the same period, we estimated reductions in pollutant emissions of more than a third in comparison with the counterfactual, leading to a global cooling of - 0.1 milli ° C in 2030. For 2100, a cooling impact from the Master Plan leading to market saturation (73%) was estimated to be - 0.70 milli ° C in comparison with to the counterfactual, with a range of - 0.64 to - 0.93 milli ° C based on different fractions of nonrenewable biomass. DISCUSSION Successful implementation of the Master Plan could have significant positive impacts on population health in Cameroon with no adverse impacts on climate. https://doi.org/10.1289/EHP4899.
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Affiliation(s)
- Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Elisa Puzzolo
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
- Global LPG Partnership (GLPGP), New York, USA
| | - Borgar Aamaas
- CICERO Center for International Climate Research, Oslo, Norway
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Matthew Shupler
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Kristin Aunan
- CICERO Center for International Climate Research, Oslo, Norway
| | - Daniel Pope
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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Stanistreet D, Hyseni L, Puzzolo E, Higgerson J, Ronzi S, Anderson de Cuevas R, Adekoje O, Bruce N, Mbatchou Ngahane B, Pope D. Barriers and Facilitators to the Adoption and Sustained Use of Cleaner Fuels in Southwest Cameroon: Situating 'Lay' Knowledge within Evidence-Based Policy and Practice. Int J Environ Res Public Health 2019; 16:E4702. [PMID: 31779156 PMCID: PMC6926764 DOI: 10.3390/ijerph16234702] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
Approximately four million people die each year in low- and middle-income countries from household air pollution (HAP) due to inefficient cooking with solid fuels. Liquid Petroleum Gas (LPG) offers a clean energy option in the transition towards renewable energy. This qualitative study explored lay knowledge of barriers and facilitators to scaling up clean fuels in Cameroon, informed by Quinn et al.'s Logic Model. The model has five domains and we focused on the user and community needs domain, reporting the findings of 28 semi-structured interviews (SSIs) and four focus group discussions (FGDs) that explored the reasons behind fuel use choices. The findings suggest that affordability, safety, convenience, and awareness of health issues are all important influences on decision making to the adoption and sustained use of LPG, with affordability being the most critical issue. We also found the ability of clean fuels to meet cooking needs to be central to decision-making, rather than an aspect of convenience, as the logic model suggests. Local communities provide important insights into the barriers and facilitators to using clean fuels. We adapt Quinn et al.'s logic model accordingly, giving more weight to lay knowledge so that it is better positioned to inform policy development.
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Affiliation(s)
- Debbi Stanistreet
- Department of Epidemiology and Public Health, Royal College Surgeons Ireland, Dublin D02 YN77, Ireland;
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - James Higgerson
- Department of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK;
| | - Sara Ronzi
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Rachel Anderson de Cuevas
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Oluwakorede Adekoje
- Department of Epidemiology and Public Health, Royal College Surgeons Ireland, Dublin D02 YN77, Ireland;
| | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | | | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
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Hyseni L, Maden M, Boland A, Kypridemos C, Collins B, O’Flaherty M. Umbrella review of strategies to improve uptake of screening programmes. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
High participation rates in screening programmes targeting non-communicable diseases are instrumental in achieving full screening benefits; however, screening programmes remain underused, especially among vulnerable populations. We conducted an umbrella review to assess the type of approaches screening programmes use to maximise uptake, the effectiveness of the approaches and the impact on equity.
Methods
Electronic databases were searched (1999-2019) for systematic reviews on approaches aimed at improving uptake of screening programmes for adults in middle- and high-income countries, with participation rate as the primary outcome. A narrative synthesis was undertaken to present the results by strategy, screening programme and strength of evidence. This study was registered in PROSPERO [CRD42019132087].
Results
In total, 3,059 records were identified, and 82 systematic reviews were included. Preliminary findings suggest contradictory evidence, and effectiveness appears to depend on the disease screened for and specific program implementation. Invitation methods including letters and direct reminders seem to work universally. However, combined approaches using access-enhancing, individual- and system-directed strategies seem to be more effective than single approaches such as invitation methods alone. Few studies evaluated the impact on equity.
Conclusions
Strategies to improve uptake of screening programmes have the potential to be effective. However, there are many components within the system, either at individual, health care professional or health care system level that can influence uptake of screening programmes. Within each screening programme, it is likely that a range of interventions is needed to improve the uptake as opposed to a single intervention.
Key messages
Improving uptake of screening programmes is a complex issue with many factors influencing the process. A range of interventions is favoured over single interventions.
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Affiliation(s)
- L Hyseni
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | - M Maden
- Health Services Research, University of Liverpool, Liverpool, UK
| | - A Boland
- Health Services Research, University of Liverpool, Liverpool, UK
| | - C Kypridemos
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | - B Collins
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | - M O’Flaherty
- Public Health and Policy, University of Liverpool, Liverpool, UK
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Ronzi S, Puzzolo E, Hyseni L, Higgerson J, Stanistreet D, Hugo MBNB, Bruce N, Pope D. Using photovoice methods as a community-based participatory research tool to advance uptake of clean cooking and improve health: The LPG adoption in Cameroon evaluation studies. Soc Sci Med 2019; 228:30-40. [PMID: 30875542 DOI: 10.1016/j.socscimed.2019.02.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/07/2018] [Accepted: 02/24/2019] [Indexed: 11/19/2022]
Abstract
Each year up to 2.6 million people die prematurely from household air pollution (HAP) due to cooking with polluting fuels such as wood and charcoal, particularly in low and middle-income countries (LMICs). The World Health Organisation recommends scaling the adoption of clean fuels to improve maternal and child health. Liquefied Petroleum Gas (LPG) represents a scalable clean fuel that provides health and environmental benefits when used for household energy in LMICs. In Cameroon, over 70% of people rely on biomass for cooking, and the Government aims to increase LPG use from <20% to 58% by 2030. Supporting households make this transition requires involvement of multiple stakeholders and an understanding of perspectives from the community's perspective. We used visual participatory methods 'Photovoice' to explore households' perceptions of factors influencing the uptake of LPG for cooking in South-West Cameroon. Two groups of participants from rural (n = 7) and peri-urban (n = 8) areas photographed subjects they identified as preventing and facilitating LPG uptake in their communities. Subsequently, individual interviews (n = 15) and group discussions (n = 5) explored participants' reflections on the photographs. Thematic analysis was conducted using NVivo 10 software. The main barriers identified included difficulty in affording the initial LPG equipment and ongoing refills, scarcity of LPG retail shops and refills, and safety concerns. Facilitators included (i) increasing awareness of the benefits of LPG (e.g. health), (ii) increasing retail outlet density in rural areas, (iii) addressing safety concerns (e.g. replacing damaged cylinders), and (iv) reducing the price of LPG refills. Participants presented their photos at a public exhibition, which generated discussions with key stakeholders (e.g. government ministries) about how best to assist communities in this transition. Photovoice was found to be an innovative and effective approach for exploring how to advance equitable access to LPG from a community perspective and successfully engage with key stakeholders.
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Affiliation(s)
- Sara Ronzi
- Department of Public Health and Policy, University of Liverpool, UK.
| | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, UK; Global LPG Partnership, New York, USA.
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, UK.
| | - James Higgerson
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Debbi Stanistreet
- Royal College of Surgeons in Ireland, Epidemiology & Public Health Medicine, Dublin, Ireland.
| | | | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, UK.
| | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, UK.
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Buckton CH, Patterson C, Hyseni L, Katikireddi SV, Lloyd-Williams F, Elliott-Green A, Capewell S, Hilton S. The palatability of sugar-sweetened beverage taxation: A content analysis of newspaper coverage of the UK sugar debate. PLoS One 2018; 13:e0207576. [PMID: 30517133 PMCID: PMC6281206 DOI: 10.1371/journal.pone.0207576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/02/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Excess sugar consumption, including sugar-sweetened beverages (SSBs), contributes to a variety of negative health outcomes, particularly for young people. The mass media play a powerful role in influencing public and policy-makers' perceptions of public health issues and their solutions. We analysed how sugar and SSB policy debates were presented in UK newspapers at a time of heightened awareness and following the announcement of the UK Government's soft drinks industry levy (SDIL), to inform future public health advocacy. METHODS & FINDINGS We carried out quantitative content analysis of articles discussing the issues of sugar and SSB consumption published in 11 national newspapers from April 2015 to November 2016. 684 newspaper articles were analysed using a structured coding frame. Coverage peaked in line with evidence publication, campaigner activities and policy events. Articles predominantly supportive of SSB taxation (23.5%) outnumbered those that were predominantly oppositional (14.2%). However, oppositional articles outnumbered supportive ones in the month of the announcement of the SDIL. Sugar and SSB consumption were presented as health risks, particularly affecting young people, with the actions of industry often identified as the cause of the public health problem. Responsibility for addressing sugar overconsumption was primarily assigned to government intervention. CONCLUSION Our results suggest that the policy landscape favouring fiscal solutions to curb sugar and SSB consumption has benefited from media coverage characterising the issue as an industry-driven problem. Media coverage may drive greater public acceptance of the SDIL and any future taxation of products containing sugar. However, future advocacy efforts should note the surge in opposition coinciding with the announcement of the SDIL, which echoes similar patterns of opposition observed in tobacco control debates.
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Affiliation(s)
- Christina H. Buckton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - S. Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Alex Elliott-Green
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, United Kingdom
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Pope D, Bruce N, Higgerson J, Hyseni L, Ronzi S, Stanistreet D, MBatchou B, Puzzolo E. Household Determinants of Liquified Petroleum Gas (LPG) as a Cooking Fuel in South West Cameroon. Ecohealth 2018; 15:729-743. [PMID: 30276494 PMCID: PMC6267519 DOI: 10.1007/s10393-018-1367-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 05/05/2023]
Abstract
Currently 70% of the population in Cameroon are reliant on solid fuel for cooking (90% in rural communities) and the associated household air pollution contributes to significant mortality and morbidity in the country. To address the problems of energy security, deforestation and pollution the government has developed a strategy (Masterplan) to increase use of liquified petroleum gas (LPG) as a cooking fuel from 12% to 58% by 2030. As a clean fuel scaled adoption of LPG has the potential to make significant positive impacts on population health. The LPG Adoption in Cameroon Evaluation (LACE) studies are assessing in the community (i) barriers and enablers for and (ii) local interventions to support, adoption and sustained use of LPG. A census survey conducted for LACE in rural and peri-urban regions of SW Cameroon provided an opportunity to investigate current fuel use patterns and factors associated with primary and exclusive use of LPG. A cross-sectional survey of 1577 households (1334 peri-urban and 243 rural) was conducted in March 2016 using standardised fuel use and household socio-demographic questions, administered by trained fieldworkers. Wood (40.7%) and LPG (51.1%) were the most frequently reported fuels, although the dominant fuels in rural and peri-urban communities were wood (81%) and LPG (58%) respectively. Fuel stacking was observed for the majority of LPG using households (91% of peri-urban and 99% of rural households). In rural homes, a higher level of education, access to sanitation and piped water and household wealth (income and asset ownership) were all significantly associated with LPG use (p < 0.05). In peri-urban homes, younger age, access to sanitation and piped water and increasing education were significantly associated with both any and exclusive use of LPG (p < 0.05). However, whilst household wealth was related to any LPG use, there was no relationship with exclusive use. Results from this census survey of a relatively well-established LPG market with lower levels of poverty and high levels of education than Cameroon as a whole, find LPG usage well below target levels set by the Cameroon government (58% by 2030). Fuel stacking is an issue for the majority of LPG using households. Whilst, as observed here, education, household wealth and socio-economic status are well recognised predictors of adoption and sustained use of clean modern fuels, it is important to consider factors across the whole LPG eco-system when developing policies to support their scaled expansion. A comprehensive approach is therefore required to ensure implementation of the Cameroon LPG Masterplan achieves its aspirational adoption target within its stated timeframe.
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Affiliation(s)
- Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK.
| | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - James Higgerson
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | | | - Debbi Stanistreet
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | | | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
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Pope D, Bruce N, Higgerson J, Hyseni L, Ronzi S, Stanistreet D, MBatchou B, Puzzolo E. Correction to: Household Determinants of Liquified Petroleum Gas (LPG) as a Cooking Fuel in South West Cameroon. Ecohealth 2018; 15:744. [PMID: 30315509 PMCID: PMC6828085 DOI: 10.1007/s10393-018-1378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Household Determinants of Liquified Petroleum Gas (LPG) as a Cooking Fuel in South West Cameroon.
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Affiliation(s)
- Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK.
| | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - James Higgerson
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - Sara Ronzi
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | - Debbi Stanistreet
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
| | | | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK
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Hyseni L, Bromley H, Kypridemos C, O’Flaherty M, Lloyd-Williams F, Guzman-Castillo M, Pearson-Stuttard J, Capewell S. Systematic review of dietary trans-fat reduction interventions. Bull World Health Organ 2017; 95:821-830G. [PMID: 29200523 PMCID: PMC5710076 DOI: 10.2471/blt.16.189795] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). METHODS We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes. RESULTS After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day. CONCLUSION Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Helen Bromley
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Chris Kypridemos
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Martin O’Flaherty
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | | | - Simon Capewell
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
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Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, Orton L, Bromley H, Cappuccio FP, Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One 2017; 12:e0177535. [PMID: 28542317 PMCID: PMC5436672 DOI: 10.1371/journal.pone.0177535] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. METHODS We searched six electronic databases (CDSR, CRD, MEDLINE, SCI, SCOPUS and the Campbell Library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream": dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. RESULTS After screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in Finland and Japan, 3g/day in Turkey and 1.3g/day recently in the UK. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. CONCLUSIONS Comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future NCD prevention strategies.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Alex Elliot-Green
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Francesco P. Cappuccio
- University of Warwick, WHO Collaborating Centre, Warwick Medical School, Coventry, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Kypridemos C, Guzman-Castillo M, Hyseni L, Hickey GL, Bandosz P, Buchan I, Capewell S, O'Flaherty M. Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study. BMJ Open 2017; 7:e013791. [PMID: 28119387 PMCID: PMC5278253 DOI: 10.1136/bmjopen-2016-013791] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England. DESIGN A microsimulation study of a close-to-reality synthetic population. In the first period, 2003-2015, we compared the impact of current policy against a counterfactual 'no intervention' scenario, which assumed salt consumption persisted at 2003 levels. For 2016-2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. SETTING Synthetic population with similar characteristics to the non-institutionalised population of England. PARTICIPANTS Synthetic individuals with traits informed by the Health Survey for England. MAIN MEASURE CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation. RESULTS Since 2003, current salt policies have prevented or postponed ∼52 000 CVD cases (IQR: 34 000-76 000) and 10 000 CVD deaths (IQR: 3000-17 000). In addition, the current policies have prevented ∼5000 new cases of GCa (IQR: 2000-7000) resulting in about 2000 fewer deaths (IQR: 0-4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone ∼19 000 CVD cases (IQR: 8000-30 000) and 3600 deaths by 2030 (IQR: -400-8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: -200-3000) and 700 deaths (IQR: -900-2300) could be prevented or postponed with a neutral impact on inequalities. CONCLUSIONS Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits.
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Affiliation(s)
- Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Graeme L Hickey
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland
| | - Iain Buchan
- Farr Institute @ HeRC, University of Manchester, Manchester, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Hyseni L, Elliot Green A, Lloyd-Williams F, O’Flaherty M, Kypridemos C, McGill R, Orton L, Bromley H, Cappuccio F, Capewell S. P48 Systematic review of dietary salt reduction policies: evidence for an “effectiveness hierarchy”? J Epidemiol Community Health 2016. [DOI: 10.1136/jech-2016-208064.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kypridemos C, Guzman-Castillo M, Hyseni L, Hickey GL, Bandosz P, Buchan I, Capewell S, O’Flaherty M. P46 Potential changes in cardiovascular and gastric cancer disease burdens under different salt policies in England: an IMPACT NCDmicrosimulation study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Elliott-Green A, Hyseni L, Lloyd-Williams F, Bromley H, Capewell S. OP75 Sugar Sweetened Beverages Coverage in the British Media – An Analysis of Public Health Advocacy versus Pro-Industry Messaging. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Elliott-Green A, Hyseni L, Lloyd-Williams F, Bromley H, Capewell S. Sugar-sweetened beverages coverage in the British media: an analysis of public health advocacy versus pro-industry messaging. BMJ Open 2016; 6:e011295. [PMID: 27436666 PMCID: PMC4964256 DOI: 10.1136/bmjopen-2016-011295] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the extent of media-based public health advocacy versus pro-industry messaging regarding sugar-sweetened beverages (SSBs). DESIGN We conducted a systematic analysis to identify and examine all articles regarding SSBs published in all mainstream British print newspapers and their online news websites from 1 January 2014 to 31 December 2014. We initially conducted a brief literature search to develop appropriate search terms and categorisations for grouping and analysing the articles. Articles were then coded according to the publishing newspaper, article type, topic, prominence and slant (pro-SSB or anti-SSB). A contextual analysis was undertaken to examine key messages in the articles. RESULTS We identified 374 articles published during 2014. The majority of articles (81%) suggested that SSBs are unhealthy. Messaging from experts, campaign groups and health organisations was fairly consistent about the detrimental effects of SSB on health. However, relatively few articles assessed any approaches or solutions to potentially combat the problems associated with SSBs. Only one-quarter (24%) suggested any policy change. Meanwhile, articles concerning the food industry produced consistent messages emphasising consumer choice and individual responsibility for making choices regarding SSB consumption, and promoting and advertising their products. The food industry thus often managed to avoid association with the negative press that their products were receiving. CONCLUSIONS SSBs were frequently published in mainstream British print newspapers and their online news websites during 2014. Public health media advocacy was prominent throughout, with a growing consensus that sugary drinks are bad for people's health. However, the challenge for public health will be to mobilise supportive public opinion to help implement effective regulatory policies. Only then will our population's excess consumption of SSBs come under control.
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Allen K, Kypridemos C, Hyseni L, Gilmore AB, Diggle P, Whitehead M, Capewell S, O'Flaherty M. The effects of maximising the UK's tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study. BMC Public Health 2016; 16:292. [PMID: 27036296 PMCID: PMC4818400 DOI: 10.1186/s12889-016-2962-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. However, room remains for improvement in tobacco control policies. Our aim was to evaluate the cumulative effect on smoking prevalence of improving all TCS components in England, stratified by socioeconomic circumstance. Methods Effect sizes and socioeconomic gradients for all six types of smoking policy in the UK setting were adapted from systematic reviews, or if not available, from primary studies. We used the IMPACT Policy Model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2025 were stratified by quintiles of socioeconomic circumstance. Results The model estimated that improving all smoking policies to achieve a maximum score on the TCS might reduce smoking prevalence in England by 3 % (95 % Confidence Interval (CI): 1–4 %), from 20 to 17 % in absolute terms, or by 15 % in relative terms (95 % CI: 7–21 %). The most deprived quintile would benefit more, with absolute reductions from 31 to 25 %, or a 6 % reduction (95 % CI: 2–7 %). There would be some 3300 (95 % CI: 2200–4700) fewer premature CHD deaths between 2015–2025, a 2 % (95 % CI: 1.4–2.9 %) reduction. The most disadvantaged quintile would benefit more, reducing absolute inequality of CHD mortality by about 4 % (95 % CI: 3–9 %). Conclusions Further, feasible improvements in tobacco control policy could substantially improve population health, and reduce health-related inequalities in England. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2962-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirk Allen
- Lancaster Medical School, Lancaster University, Lancaster, UK.,Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Peter Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O'Flaherty M, Taylor-Robinson D, Guzman-Castillo M, Gillespie D, Moreira P, Allen K, Hyseni L, Calder N, Petticrew M, White M, Whitehead M, Capewell S. Erratum to: Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 2015; 15:894. [PMID: 26373840 PMCID: PMC4571134 DOI: 10.1186/s12889-015-2162-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rory McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lois Orton
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Helen Bromley
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | | | - Duncan Gillespie
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Patricia Moreira
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Kirk Allen
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Nicola Calder
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Mark Petticrew
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Liverpool, UK
| | - Martin White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Allen K, Kypridemos C, Hyseni L, Diggle P, Whitehead M, Capewell S, O’Flaherty M. OP11 The effects of maximising the UK’s tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hyseni L, Atkinson M, Bromley H, Orton LC, Lloyd-Williams F, McGill R, Capewell S. PP57 Effectiveness of policy actions to improve population dietary patterns and prevent diet related non-communicable diseases: scoping review. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O'Flaherty M, Taylor-Robinson D, Guzman-Castillo M, Gillespie D, Moreira P, Allen K, Hyseni L, Calder N, Petticrew M, White M, Whitehead M, Capewell S. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 2015; 15:457. [PMID: 25934496 PMCID: PMC4423493 DOI: 10.1186/s12889-015-1781-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/22/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP). METHODS We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person". RESULTS Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen inequalities. CONCLUSIONS Interventions categorised by a "6 Ps" framework show differential effects on healthy eating outcomes by SEP. "Upstream" interventions categorised as "Price" appeared to decrease inequalities, and "downstream" "Person" interventions, especially dietary counselling seemed to increase inequalities. However the vast majority of studies identified did not explore differential effects by SEP. Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact.
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Affiliation(s)
- Rory McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Lois Orton
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Helen Bromley
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | | | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | | | | | - Duncan Gillespie
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Patricia Moreira
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Kirk Allen
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Nicola Calder
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Mark Petticrew
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Liverpool, UK.
| | - Martin White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK.
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
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Stanistreet D, Hyseni L, Bashin M, Sadumah I, Pope D, Sage M, Bruce N. The role of mixed methods in improved cookstove research. J Health Commun 2015; 20 Suppl 1:84-93. [PMID: 25839206 DOI: 10.1080/10810730.2014.999896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The challenge of promoting access to clean and efficient household energy for cooking and heating is a critical issue facing low- and middle-income countries today. Along with clean fuels, improved cookstoves (ICSs) continue to play an important part in efforts to reduce the 4 million annual premature deaths attributed to household air pollution. Although a range of ICSs are available, there is little empirical evidence on appropriate behavior change approaches to inform adoption and sustained used at scale. Specifically, evaluations using either quantitative or qualitative methods provide an incomplete picture of the challenges in facilitating ICS adoption. This article examines how studies that use the strengths of both these approaches can offer important insights into behavior change in relation to ICS uptake and scale-up. Epistemological approaches, study design frameworks, methods of data collection, analytical approaches, and issues of validity and reliability in the context of mixed methods ICS research are examined, and the article presents an example study design from an evaluation study in Kenya incorporating a nested approach and a convergent case oriented design. The authors discuss the benefits and methodological challenges of mixed-methods approaches in the context of researching behavior change and ICS use recognizing that such methods represent relatively uncharted territory. The authors propose that more published examples are needed to provide frameworks for other researchers seeking to apply mixed methods in this context and suggest a comprehensive research agenda is required that incorporates integrated mixed-methods approaches, to provide best evidence for future scale-up.
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Affiliation(s)
- Debbi Stanistreet
- a Department of Public Health and Policy, Institute of Psychology, Health and Society , University of Liverpool , Liverpool , United Kingdom
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Lloyd-Williams F, Bromley H, Orton L, Hawkes C, Taylor-Robinson D, O'Flaherty M, McGill R, Anwar E, Hyseni L, Moonan M, Rayner M, Capewell S. Smorgasbord or symphony? Assessing public health nutrition policies across 30 European countries using a novel framework. BMC Public Health 2014; 14:1195. [PMID: 25413832 PMCID: PMC4251675 DOI: 10.1186/1471-2458-14-1195] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/10/2014] [Indexed: 11/12/2022] Open
Abstract
Background Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods We created a public health nutrition policy database for 30 European countries . National nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies. Results Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging. Conclusions Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1195) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ffion Lloyd-Williams
- Department of Public Health & Policy, Institute of Psychology, Health & SocietyUniversity of Liverpool, Whelan Building, Quadrangle, L69 3GB Liverpool, Merseyside, UK.
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