scholarly journals Increasing boys’ and girls’ intentions to avoid teenage pregnancy: a cluster randomised controlled feasibility trial of an interactive video drama-based intervention in post-primary schools in Northern Ireland

2017 ◽  
Vol 5 (1) ◽  
pp. 1-344 ◽  
Author(s):  
Maria Lohan ◽  
Áine Aventin ◽  
Lisa Maguire ◽  
Rhonda Curran ◽  
Clíona McDowell ◽  
...  
Keyword(s):  
Public Health ◽  
Sexual Intercourse ◽  
Teenage Pregnancy ◽  
Primary Schools ◽  
Interactive Video ◽  
Public Health Research ◽  
Phase Iii ◽  
Feasibility Trial ◽  
Effectiveness Trial ◽  
Survey Instruments

BackgroundAdolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions.ObjectivesTo determine the value and feasibility of conducting an effectiveness trial of theIf I Were JackRelationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness.DesignCluster randomised Phase II feasibility trial with an embedded process and economic evaluation.InterventionA teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships.Main outcome measuresAbstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions.ResultsThe intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of deliveringIf I Were Jack(mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness.ConclusionTrial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted.Future workProgression to a Phase III effectiveness trial.Trial registrationCurrent Controlled Trials ISRCTN99459996.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information.

scholarly journals Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

2015 ◽  
Vol 3 (15) ◽  
pp. 1-188 ◽  
Author(s):  
Jeremy Segrott ◽  
Heather Rothwell ◽  
Gillian Hewitt ◽  
Rebecca Playle ◽  
Chao Huang ◽  
...  
Keyword(s):  
Public Health ◽  
Secondary Schools ◽  
Outcome Measures ◽  
Health Research ◽  
Primary Schools ◽  
Alcohol Misuse ◽  
Public Health Research ◽  
Effectiveness Trial ◽  
Intermediate Outcomes

BackgroundInvolvement of parents/carers may increase the effectiveness of primary school-based alcohol-misuse prevention projects. However, few interventions have been designed for pre-adolescent children, or specifically involve parents/carers. The Kids, Adults Together (KAT) programme in primary schools aimed to reduce alcohol misuse through such an approach.ObjectiveTo determine the value and feasibility of conducting an effectiveness trial of KAT.DesignParallel-group cluster randomised exploratory trial with an embedded process evaluation. Schools were the unit of randomisation.SettingPrimary schools (n = 9) in south Wales, UK.ParticipantsPupils in Year 5/6 (aged 9–11 years) and their parents/carers; school staff.InterventionThe Kids, Adults Together programme consisted of (1) classwork addressing the effects of alcohol; (2) a family event for children and parents/carers; and (3) a ‘goody bag’ containing fun items, including a digital versatile disc (DVD) for families to watch together. The intervention comprised KAT plus existing alcohol-related activities and lessons. Control-group schools continued with existing alcohol-related lessons and activities.Main outcome measuresKey outcomes related to the progression criteria for a potential future effectiveness trial. These included the acceptability, participation equity, feasibility and implementation of KAT; the recruitment and retention of research participants; and the acceptability and feasibility of research processes, including data collection methods and outcome measures.ResultsNine schools (free school meal entitlement ranging from 1% to 37.2%) participated. Two of five intervention schools withdrew but all four control schools were retained, and these seven schools facilitated all research data collections. Programme acceptability and participation rates were high in all three intervention schools (parent/carer participation rates ranged from 45.1% to 65.7%), although implementation quality varied. At baseline, approximately 75% of eligible children (n = 418) provided data, of whom 257 also provided data at follow-up. Only 27 parents/carers (estimated response rate 6.5%) completed interviews. Most children were willing to complete questionnaires but measures were not appropriate for this age group. Measures of alcohol consumption produced inconsistent responses. Intermediate outcomes on family communication showed no evidence of intervention effectiveness.ConclusionsIn the three schools that received the KAT intervention, it was found to be acceptable to schools and pupils and there were good levels of participation from parents/carers from across a range of socioeconomic groups. However, two intervention schools withdrew from the trial. Findings from intermediate outcomes on family communication did not support programme theory. In addition, the study highlighted challenges in identifying suitable outcome measures for children aged 9–11 years and the feasibility of long-term follow-up via secondary schools.Future workIt would not be appropriate to proceed to an effectiveness trial of KAT. There are doubts/uncertainties about the potential effects of KAT; suitability of measures; the large number of schools which would be required for an effectiveness trial of KAT, and the cost of this; feasibility of follow-up in secondary schools; and programme implementation and theory. There is a need to develop and validate measures for children aged 9–11 years; to test the feasibility of follow-up data collection methods in secondary schools; and to further consider sample size requirements and feasibility.Trial registrationCurrent Controlled Trials ISRCTN80672127.FundingThe exploratory trial of this project was funded by the National Institute for Health Research Public Health Research programme and the process evaluation was funded by the Economic and Social Research Council. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. This project will be published in full inPublic Health Research; Vol. 3, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

2021 ◽  
Vol 9 (9) ◽  
pp. 1-116
Author(s):  
Esther MF van Sluijs ◽  
Helen E Brown ◽  
Emma Coombes ◽  
Claire Hughes ◽  
Andrew P Jones ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Health Research ◽  
Delphi Study ◽  
Family Members ◽  
Public Health Research ◽  
Feasibility Trial ◽  
Recruitment Strategies ◽  
Family Based

Background Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking. Objectives To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies. Design The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study. Setting Norfolk/Suffolk counties, UK. Participants Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate. Interventions The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm. Main outcome measures Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation. Data sources review Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS). Review methods Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies. Inclusion criteria Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults. Results The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies. Limitations Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited. Conclusions This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach. Future work Further refinements to intervention delivery and recruitment methods should be investigated. Study registration Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

scholarly journals The PATHS curriculum for promoting social and emotional well-being among children aged 7–9 years: a cluster RCT

2018 ◽  
Vol 6 (10) ◽  
pp. 1-116 ◽  
Author(s):  
Neil Humphrey ◽  
Alexandra Hennessey ◽  
Ann Lendrum ◽  
Michael Wigelsworth ◽  
Alexander Turner ◽  
...  
Keyword(s):  
Public Health ◽  
Social Skills ◽  
Health Research ◽  
Primary Schools ◽  
Well Being ◽  
Public Health Research ◽  
Psychological Well Being ◽  
Social And Emotional ◽  
The Social ◽  
Children's Social Skills

BackgroundUniversal social and emotional learning interventions can produce significant practical improvements in children’s social skills and other outcomes. However, the UK evidence base remains limited.ObjectivesTo investigate the implementation, impact and cost-effectiveness of the Promoting Alternative THinking Strategies (PATHS) curriculum.DesignCluster randomised controlled trial. Primary schools (n = 45) were randomly assigned to implement PATHS or to continue with their usual provision for 2 years.SettingPrimary schools in seven local authorities in Greater Manchester.ParticipantsChildren (n = 5218) in Years 3–5 (aged 7–9 years) attending participating schools.InterventionPATHS aims to promote children’s social skills via a taught curriculum, which is delivered by the class teacher, generalisation activities and techniques, and supplementary materials for parents. Schools in the usual provision group delivered the Social and Emotional Aspects of Learning programme and related interventions.Main outcome measuresChildren’s social skills (primary outcome, assessed by the Social Skills Improvement System); pro-social behaviour and mental health difficulties (Strengths and Difficulties Questionnaire); psychological well-being, perceptions of peer and social support, and school environment (Kidscreen-27); exclusions, attendance and attainment (National Pupil Database records); and quality-adjusted life-years (QALYs) (Child Health Utility 9 Dimensions). A comprehensive implementation and process evaluation was undertaken, involving usual provision surveys, structured observations of PATHS lessons, interviews with school staff and parents, and focus groups with children.ResultsThere was tentative evidence (at ap-value of  < 0.10) that PATHS led to very small improvements in children’s social skills, perceptions of peer and social support, and reductions in exclusions immediately following implementation. A very small but statistically significant improvement in children’s psychological well-being [d = 0.12, 95% confidence interval (CI) –0.02 to 0.25;p < 0.05) was also found. No lasting improvements in any outcomes were observed at 12- or 24-month post-intervention follow-up. PATHS was implemented well, but not at the recommended frequency; our qualitative analysis revealed that this was primarily due to competing priorities and pressure to focus on the core academic curriculum. Higher levels of implementation quality and participant responsiveness were associated with significant improvements in psychological well-being. Finally, the mean incremental cost of PATHS compared with usual provision was determined to be £29.93 per child. Mean incremental QALYs were positive and statistically significant (adjusted mean 0.0019, 95% CI 0.0009 to 0.0029;p < 0.05), and the incremental net benefit of introducing PATHS was determined to be £7.64. The probability of cost-effectiveness in our base-case scenario was 88%.LimitationsModerate attrition through the course of the main trial, and significant attrition thereafter (although this was mitigated by the use of multiple imputation of missing data); suboptimal frequency of delivery of PATHS lessons.ConclusionsThe impact of PATHS was modest and limited, although that which was observed may still represent value for money. Future work should examine the possibility of further modifications to the intervention to improve goodness of fit with the English school context without compromising its efficacy, and identify whether or not particular subgroups benefit differentially from PATHS.Trial registrationCurrent Controlled Trials ISRCTN85087674 (the study protocol can be found at:www.journalslibrary.nihr.ac.uk/programmes/phr/10300601/#/).FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol 6, No. 10. See the NIHR Journals Library website for further project information.

The Rise of Anchor Institutions and the Threat to Community Health: Protecting Community Wealth, Building Community Power

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Lawrence T. Brown ◽  
Ashley Bachelder ◽  
Marisela B. Gomez ◽  
Alicia Sherrell ◽  
Imani Bryan
Keyword(s):  
Public Health ◽  
Economic Development ◽  
Local Governments ◽  
The United States ◽  
Public Health Research ◽  
Ethical Implications ◽  
Anchor Institutions ◽  
Health Related Research ◽  
Research Parks ◽  
Wealth Building

Academic institutions are increasingly playing pivotal roles in economic development and community redevelopment in cities around the United States. Many are functioning in the role of anchor institutions and building technology, biotechnology, or research parks to facilitate biomedical research. In the process, universities often partner with local governments, implementing policies that displace entire communities and families, thereby inducing a type of trauma that researcher Mindy Thompson Fullilove has termed “root shock.” We argue that displacement is a threat to public health and explore the ethical implications of university-led displacement on public health research, especially the inclusion of vulnerable populations into health-related research. We further explicate how the legal system has sanctioned the exercise of eminent domain by private entities such as universities and developers.Strategies that communities have employed in order to counter such threats are highlighted and recommended for communities that may be under the threat of university-led displacement. We also offer a critical look at the three dominant assumptions underlying university-sponsored development: that research parks are engines of economic development, that deconcentrating poverty via displacement is effective, and that poverty is simply the lack of economic or financial means. Understanding these fallacies will help communities under the threat of university-sponsored displacement to protect community wealth, build power, and improve health.

Trends in the incidence and mortality of oral cancer in Nevada (Preprint)

2020 ◽  
Author(s):  
Kevin Foote ◽  
Karl Kingsley
Keyword(s):  
Public Health ◽  
Oral Cancer ◽  
Cancer Incidence ◽  
Cancer Control ◽  
Cancer Registries ◽  
Public Health Research ◽  
Chi Square ◽  
Incidence And Mortality ◽  
The Us ◽  
Chi Square Analysis

BACKGROUND Reviews of national and state-specific cancer registries have revealed differences in rates of oral cancer incidence and mortality that have implications for public health research and policy. Many significant associations between head and neck (oral) cancers and major risk factors, such as cigarette usage, may be influenced by public health policy such as smoking restrictions and bans – including the Nevada Clean Indoor Act of 2006 (and subsequent modification in 2011). OBJECTIVE Although evaluation of general and regional advances in public policy have been previously evaluated, no recent studies have focused specifically on the changes to the epidemiology of oral cancer incidence and mortality in Nevada. METHODS Cancer incidence and mortality rate data were obtained from the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS) Surveillance, Epidemiology and End Results (SEER) program. Most recently available rate changes in cancer incidence and mortality for Nevada included the years 2012 – 2016 and are age-adjusted to the year 2000 standard US population. Comparisons of any differences between Nevada and the overall US population were evaluated using Chi square analysis. RESULTS This analysis revealed that the overall rates of incidence and mortality from oral cancer in Nevada differs from that observed in the overall US population. For example, although the incidence of oral cancer among Caucasians is increasing in Nevada and the US overall, it is increasing at nearly twice that rate in Nevada, P=0.0002. In addition, although oral cancer incidence among Minorities in the US is declining, it is increasing in Nevada , P=0.0001. Analysis of reported mortality causes revealed that mortality from oral cancer increased in the US overall but declined in Nevada during the same period (2012-2016). More specifically, mortality among both Males and Females in the US is increasing, but is declining in Nevada, P=0.0027. CONCLUSIONS Analysis of the epidemiologic data from Nevada compared with the overall US revealed significant differences in rates of oral cancer incidence and mortality. More specifically, oral cancer incidence increased in Nevada between 2012-2016 among all groups analyzed (Males, Females, White, Minority), while decreases were observed nationally among Females and Minorities. Although mortality in Nevada decreased over this same time period (in contrast to the national trends), the lag time between diagnosis (incidence) and mortality suggests that these trends will change in the near future. CLINICALTRIAL Not applicable

The Perils of Partnership

2019 ◽  
Author(s):  
Jonathan H. Marks
Keyword(s):  
Public Health ◽  
Multinational Corporations ◽  
Separation Of Powers ◽  
Public Health Research ◽  
Noncommunicable Diseases ◽  
New Paradigm ◽  
Public Health Agencies ◽  
Ethical Implications ◽  
Health Agencies ◽  
Public Bodies

Collaboration with industry has become the paradigm in public health. Governments commonly develop close relationships with companies that are creating or exacerbating the very problems public health agencies are trying to solve. Nowhere is this more evident than in partnerships with food and soda companies to address obesity and diet-related noncommunicable diseases. The author argues that public-private partnerships and multistakeholder initiatives create webs of influence that undermine the integrity of public health agencies; distort public health research and policy; and reinforce the framing of public health problems and their solutions in ways that are least threatening to the commercial interests of corporate “partners.” We should expect multinational corporations to develop strategies of influence. But public bodies need to develop counter-strategies to insulate themselves from corporate influence in all its forms. The author reviews the ways in which we regulate public-public interactions (separation of powers) and private-private interactions (antitrust and competition laws), and argues for an analogous set of norms to govern public-private interactions. The book also offers a novel framework that is designed to help public bodies identify the systemic ethical implications of their existing or proposed relationships with industry actors. The book makes a compelling case that, in public health, the paradigm public-private interaction should be at arm’s length: separation, not collaboration. The author calls for a new paradigm to protect and promote public health while avoiding the ethical perils of partnership with industry.

Navigating the Ethics of Big Data in Public Health

2019 ◽  
pp. 353-367
Author(s):  
Effy Vayena ◽  
Lawrence Madoff
Keyword(s):  
Public Health ◽  
Big Data ◽  
Credit Card ◽  
Health Sector ◽  
Public Health Research ◽  
Ethical Challenges ◽  
The Public ◽  
Health Community ◽  
Digital Disease Detection ◽  
The Public Sphere

“Big data,” which encompasses massive amounts of information from both within the health sector (such as electronic health records) and outside the health sector (social media, search queries, cell phone metadata, credit card expenditures), is increasingly envisioned as a rich source to inform public health research and practice. This chapter examines the enormous range of sources, the highly varied nature of these data, and the differing motivations for their collection, which together challenge the public health community in ethically mining and exploiting big data. Ethical challenges revolve around the blurring of three previously clearer boundaries: between personal health data and nonhealth data; between the private and the public sphere in the online world; and, finally, between the powers and responsibilities of state and nonstate actors in relation to big data. Considerations include the implications for privacy, control and sharing of data, fair distribution of benefits and burdens, civic empowerment, accountability, and digital disease detection.

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