Loneliness in Old Age: Interventions to Curb Loneliness in Long-Term Care Facilities

Presently there is little analytical research examining practical interventions to address loneliness in long-term aged care. Thus, a review of the literature was conducted to identify and examine the usefulness of current interventions. A broad range of activities were found to benefit lonely residents. Animal-assisted therapy was the most widely implemented strategy and was both appropriate and effective for cognitively impaired and non-impaired residents. Collaborative group approaches to improve cognitive aging were highly beneficial to residents as was indoor gardening, group use of game consoles and increased social contact with family or friends mediated via videoconferencing. Continued innovation and adaptation of practices to provide stimulation and increase social connectedness are needed, in conjunction with rigorous research methodologies, to determine effectiveness and appropriateness of those interventions to reduce loneliness for residents in long-term care facilities.     

Selection of priority groups for obesity prevention: current approaches and development of an evidence‐informed framework

Resources for obesity prevention interventions are inevitably limited, necessitating the selection of priority groups to ensure effective and equitable use of funds. This paper aims to review published approaches to selection of priority groups (‘target populations’) for obesity prevention, and to present the development of a new systematic framework for organizing and assessing evidence for selecting priority groups. A review was conducted of the process and justification described for selecting priority groups in a sample of obesity prevention publications. Using the results of this review and adaptation of theory and frameworks in both the obesity prevention and health promotion priority‐setting literature, a framework was developed for assessment of potential priority groups for obesity prevention. The published literature lacks discussion of and explicit processes for selection of priority groups for obesity prevention intervention. The new framework describes specific types of evidence that should be considered in the assessment of a potential priority group for obesity prevention and has applications for funding and implementing community‐based or settings‐level obesity prevention interventions and research. Application of this framework has the potential to enhance the effective use of limited obesity prevention resources and to identify areas in need of additional research evidence.     

Global perspective on tobacco control. Part II. The future of tobacco control: making smoking history?

Serious efforts to reduce the harm caused by tobacco use throughout populations require implementation policies and interventions capable of reaching all smokers and potential smokers. While the Framework Convention on Tobacco Control promises to accelerate the adoption of comprehensive tobacco control policies throughout the world, its extensive 'optional' language provides considerable latitude for governments unwilling to implement rigorous controls. This paper examines four broad areas in which important debates and policy advances will be necessary to ensure population-wide impact of tobacco control: harm reduction; demand reduction strategies involving particularly the use of news generation in increasing the coverage of tobacco and health issues; denormalisation of tobacco use, especially among health workers in nations where use remains high; and further efforts to regulate the tobacco industry, particularly in regard to plain packaging, under-the-counter retail sales and the regulation of tobacco products.     

Susceptibility of youth to tobacco: a social ecological framework for prevention

For most smokers, tobacco dependence begins in childhood or adolescence. This review summarizes the state of social science with respect to the prevention of tobacco use. Social ecology is introduced as a theoretical framework useful for organizing prevention approaches. In recent years, the field has shifted from approaches directed at individuals, towards appreciation of additional, more comprehensive social and environmental influences on initiation. These range from intra-individual factors (including physiological responses to nicotine and the psychology of use) to individual, interpersonal, organizational, community, and population factors affecting access and demand. This review highlights prevention approaches that address social and societal influences, from school programs that attempt to change susceptibility of individual youth to tobacco, to community projects, media campaigns, restrictive policies, and tobacco pricing. The most promising approaches are those designed with input based on extensive formative research including studies with youth, directed at multiple levels of the social ecology, and sustained over time with significant resources and ongoing, multi-sector inputs.     

Preventing sexually transmitted infections among adolescents: 'the glass is half full'

PURPOSE OF REVIEW: Given the disproportionate burden of sexually transmitted infections for adolescents, there is an urgent need to identify effective prevention programs. RECENT FINDINGS: This review documents the efficacy of recent sexually transmitted infection-prevention programs. Overall, the review identified few sexually transmitted infection-prevention trials published since 2000. Moreover, considerable variability in program efficacy was observed across studies. Some studies observed changes in sexually transmitted infection-associated risk behaviors, while only a few identified reductions in biologically confirmed sexually transmitted infections. In general, few programs demonstrated consistency of effects and a significant magnitude of effects across a broad range of outcomes. SUMMARY: New and innovative approaches are needed to amplify sexually transmitted infection intervention effects. Program development and evaluation needs to continue in a coordinated, scientifically rigorous fashion to optimize impact and, as important, to sustain effects over protracted periods. Furthermore, for interventions with demonstrated efficacy, a critical challenge is to translate them into sustainable programs that are widely disseminated. Ultimately, preventing sexually transmitted infections in adolescents does not only depend on the development of effective interventions alone, but on how effectively these interventions can be translated and integrated into self-sustaining components of clinic, school or community programs, particularly in those areas and among adolescent populations most adversely impacted by the epidemic of sexually transmitted infection.     

Women and tobacco

Smoking prevalence is lower among women than men in most countries, yet there are about 200 million women in the world who smoke, and in addition, there are millions more who chew tobacco. Approximately 22% of women in developed countries and 9% of women in developing countries smoke, but because most women live in developing countries, there are numerically more women smokers in developing countries. Unless effective, comprehensive and sustained initiatives are implemented to reduce smoking uptake among young women and increase cessation rates among women, the prevalence of female smoking in developed and developing countries is likely to rise to 20% by 2025. This would mean that by 2025 there could be 532 million women smokers. Even if prevalence levels do not rise, the number of women who smoke will increase because the population of women in the world is predicted to rise from the current 3.1 billion to 4.2 billion by 2025. Thus, while the epidemic of tobacco use among men is in slow decline, the epidemic among women will not reach its peak until well into the 21st century. This will have enormous consequences not only for women's health and economic wellbeing but also for that of their families. The health effects of smoking for women are more serious than for men. In addition to the general health problems common to both genders, women face additional hazards in pregnancy, female-specific cancers such as cancer of the cervix, and exposure to passive smoking. In Asia, although there are currently lower levels of tobacco use among women, smoking among girls is already on the rise in some areas. The spending power of girls and women is increasing so that cigarettes are becoming more affordable. The social and cultural constraints that previously prevented many women from smoking are weakening; and women-specific health education and quitting programmes are rare. Furthermore, evidence suggests that women find it harder to quit smoking. The tobacco companies are targeting women by marketing light, mild, and menthol cigarettes, and introducing advertising directed at women. The greatest challenge and opportunity in primary preventive health in Asia and in other developing areas is to avert the predicted rise in smoking among women.     

Management of NCD in Low- and Middle-Income Countries

Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified “best buys” it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases.     

What works? A review of evaluated alcohol misuse interventions among Aboriginal Australians

Aims. To identify which intervention strategies have been effective in reducing excessive consumption of alcohol, and related harm, among some segments of Australia's Aboriginal population. Design. Items dealing with 'alcohol' and 'evaluation' (27) were identified from the comprehensive electronic data base on Aboriginal alcohol and other drug issues, maintained by Australia's National Centre for Research into the Prevention of Drug Abuse. From these were selected all reports (14) dealing specifically with evaluation of particular intervention projects. These were grouped and systematically reviewed under the broad categories of treatment, health promotion education, acute interventions and supply reduction. Findings. A broad range of intervention strategies has been employed. However, few systematic evaluations have been undertaken and the methodologies employed have been generally insufficient to allow robust generalization. The impact of most interventions appears limited but, in part, this may be a function of inadequate resourcing and programme support. Conclusions. Despite the limitations of the evaluation reports, several conclusions can be tentatively drawn. It appears there is a need to employ a broader range of treatment models and complementary intervention strategies. Interventions are generally inadequately resourced. There is a suggestion that supply reduction interventions may be effective. Most importantly, there is a pressing need for more rigorous evaluation studies in cooperation with Aboriginal community organizations.     

Suboptimal prescribing in older inpatients and outpatients

Investigators searched Medline and HealthSTAR databases from January 1, 1985 through June 30, 1999 to identify articles on suboptimal prescribing in those age 65 years and older. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. The definitions for various types of suboptimal prescribing (polypharmacy, inappropriate, and underutilization) are numerous, and measurement varies from study to study. The literature suggests that suboptimal prescribing is common in older outpatients and inpatients. Moreover, there is significant morbidity and mortality associated with suboptimal prescribing for these older patients. Evidence from well-controlled studies suggests that multidisciplinary teams and clinical pharmacy interventions can modify suboptimal drug use in older people. Future research is necessary to measure and test other methods for tackling this major public health problem facing older people.     

Reducing risk in smokers

PURPOSE OF REVIEW: Tobacco smoking is a leading cause of lung cancer and chronic obstructive pulmonary disease. For smokers who want to quit, nicotine replacement therapy and bupropion are frequently recommended. Currently, disagreement surrounds the extent of risk reduction from quitting, the consequences of the change of nicotine replacement therapy to over-the-counter status, and the safety and efficacy of new tobacco products being marketed by tobacco companies. This article reviews the current evidence relevant to these and other developments in smoking interventions and describes the most effective strategies that smokers can use to reduce their risk. RECENT FINDINGS: Although it may take approximately 10 to 30 years of abstinence for former smokers' risk of lung cancer to reach that of never smokers, quitting at any time is substantially less risky than continuing to smoke. Quitting after diagnosis also prolongs survival. Bupropion and nicotine replacement therapy are effective pharmacotherapies, doubling quit rates compared with self-quitting. However, many users of over-the-counter nicotine replacement therapy are using it inappropriately. More research is needed to determine the long-term health effects of modified tobacco products and their efficacy in helping smokers quit. Switching to "low tar" filter cigarettes to reduce lung cancer risk, however, is clearly ineffective. The most effective interventions for quitting continue to be a combination of behavioral and pharmacologic approaches. SUMMARY: Health care practitioners should encourage all smokers to attempt cessation and emphasize pharmacotherapy as an important aid to quitting. Professionals who educate patients on the appropriate use of pharmacotherapy and follow-up on smokers' attempts to quit will help reduce the societal burden and personal risks of smoking.     

Cigarette smoking among adolescent females in Pakistan.

SETTING: Tobacco use among adolescent females is gaining importance as they take up smoking in increasing numbers. Recent studies show that sex differences in tobacco use are disappearing and that tobacco companies are agressively targeting females in developing countries. OBJECTIVE: To determine the factors influencing the use of cigarettes among female high-school students in Karachi, Pakistan, and hence to identify areas for future intervention. METHOD: A two-stage cluster sample of 644 females was drawn from government and private schools in a locality in Karachi. A self-administered questionnaire was used for data collection. RESULTS: The mean age was 15.29 years. The prevalence of ever-smokers was found to be 16.3%. Univariate analysis indicated that private school attendance, underage sale of tobacco at shops, tobacco use by family members and exposure to cigarette advertisements predicted smoking among girls. Knowledge assessment of the subjects showed that most girls had good knowledge about the hazards of smoking. CONCLUSION: Our study has identified several risk factors for smoking among young girls. Appropriate interventions are needed in the form of public education programmes, effective anti-tobacco laws and stricter enforcement of existing laws to restrict the number of young female smokers.     

Drug prevention programmes for young people: where have we been and where should we be going?

Aim Substance use by young people has long been a concern of western society, but opinion is mixed as to which prevention approach offers the greatest benefit, and whether indeed there is any benefit at all. This paper reviews the nature of prevention programmes, the research evidence that underpins these programmes and the prevention objectives against which effectiveness is measured. The aim of this is to create better understanding of the elements that maximize programme effectiveness, what can be achieved by prevention programmes and how programmes can be improved. Findings There is a range of prevention approaches for which there is evidence of effectiveness. Some are classroom‐based; some focus upon parenting; some have substantial whole‐of‐school and community elements; and some target risk and protective factors in early childhood. All, however, are based substantially on the social influence model. In an attempt to improve practice lists of effective programmes have been developed, but there are concerns about the science behind selection. On balance, there is consistent evidence that social influence prevention programmes do have a small, positive effect on drug use, but this then raises the question as to whether harm, rather than use, would be the more worthwhile target for prevention. Prevention that seeks to reduce harm has been demonstrably effective, but has found little support in some jurisdictions. Conclusion Research has created a progressively better understanding of how to optimize programme effectiveness and what can be achieved realistically by even the most effective programmes. However, further research is required to identify which, if any, particular approach offers greater promise. The effectiveness of harm reduction should be compared with more traditional abstinence and the additional effects of whole of school, parent and community elements need to be measured more accurately. Contemporary social influence prevention programmes are flawed, but the approach is still the best way of influencing drug use behaviour in young people as a whole. Evidence‐based refinement is the best option for greater benefit.     

Towards a new model of evidence for public health

BackgroundWe are faced with a growing crisis of non-communicable diseases driven by factors such as unhealthy diets, physical inactivity, tobacco use, and alcohol consumption, compounded by major inequalities in health. Over recent decades, biomedical research methods have helped to answer many important questions about treatment and prevention, but the kinds of tools that can tell us which intervention to choose over another are not invariably the most appropriate to address complex challenges such as designing healthier cities, or creating healthier, more sustainable food systems. The aim of this project was to identify the main obstacles to obtaining valid and appropriate evidence to guide public health decision making, and propose a set of solutions to address these problems.MethodsWe conducted a series of case studies to illustrate some of the problems with the current dominance of the biomedical approach to the generation and use of evidence for complex public health problems, including an analysis of the types of projects funded by the National Institute for Health Research (NIHR) Public Health Research (PHR) Programme since 2009. We held a workshop on Sept 12–13, 2016, for several internationally recognised experts on complex systems approaches to public health evidence to produce a consensus statement.FindingsThe NIHR case study showed that funding from the PHR Programme has predominantly gone to the evaluation of downstream, individual-level interventions, with only a small proportion devoted to assessment of upstream policy actions (>75% of the 110 funded proposals examined downstream or midstream interventions). The key conclusions from the meeting are that current approaches to research and policy in major public health problems such as obesity have reached an impasse. Breaking this impasse will require a move beyond linear models of cause and effect to embrace complex systems approaches to both the generation and use of evidence. Achieving a solution will require many changes, ranging from strategic shifts in the way research is funded to new conceptual models for tackling public health problems at system level.InterpretationThere is a pressing need to change the focus of research and action to tackle complex public health problems. Research funding must address the challenges of evaluating not only complex interventions, but also simple interventions within complex systems. The tools required to do this are still in the early stages of development, but we need to rebalance our approach to public health research to encompass complex systems science and methods in addition to more traditional biomedical approaches. The expert group will publish its views in a consensus paper towards the end of 2016.FundingThis work is supported by a grant from The Health Foundation.     

Global research neglect of population-based approaches to smoking cessation: time for a more rigorous science of population health interventions

It has been argued that the preponderance of studies into individual smoking cessation therapies seems grossly out of proportion to the number of people who use these therapies to quit smoking, and that this imbalance is due to factors such as the role of the pharmaceutical industry in funding research and a general bias towards individual- rather than population-based approaches to medical and health problems. We believe that there are other significant factors that affect the balance of research in smoking cessation, such as the higher standards of evidence required to justify the implementation of individual medical therapies compared with population-based interventions. We argue that research practitioners in the area of population tobacco control are well placed to address this imbalance by setting more rigorous standards of evidence for population health interventions. This could be achieved by setting aside a small proportion of funds from population health and advocacy activities to invest in studying their effectiveness. We believe that this would potentially return information of sufficient value to justify increasing overall population investment beyond the cost of the additional research component. Additional benefits would be gained from increased research in this area, such as better understanding of how to translate tobacco control initiatives to developing countries with high smoking rates, and how to target disadvantaged and marginalized populations more effectively in developed countries that continue to have high rates of smoking and low rates of smoking cessation, despite the existence of broad population-based strategies.     

Challenges and opportunities for cardiovascular disease prevention

Cardiovascular diseases are highly preventable, yet they remain the most common cause of death in the world. The epidemic is receding in industrialized countries; however, many low-income and middle-income countries have experienced an increase in cardiovascular diseases and 80% of all cardiovascular diseases deaths occur there. In the last 20 years, the epidemiology and surveillance of cardiovascular diseases have laid the foundations for public health interventions that may reduce the burden of disease. Relevant population-specific local data are therefore needed to describe the trends and pattern of risk for atherosclerotic diseases. Once the basis for surveillance and epidemiological research has been laid, cardiovascular disease prevention will require approaches adapted for each individual and population. The existence of effective preventive interventions justifies the assertion that coronary heart disease and stroke could be virtually prevented and controlled. Our goal in this review is to summarize the current challenges and opportunities for cardiovascular medicine, focusing on the need for high-quality local surveillance systems that provide the appropriate data needed to develop sound national cardiovascular disease preventive policies.     

The tobacco industry in Mexico

Smoking is presently one of the most important public health problems worldwide. Even though smoking is a preventable cause of morbidity and mortality, it still contributes importantly to the burden of disease. In Mexico, contrary to what is happening in other parts of the world, the smoking epidemic is in an early phase, as evidenced by the low number of lung cancer cases or deaths, and by the minimal public health efforts to control tobacco consumption. One of the most important advances is its recognition as a priority public health problem by public health workers and society in general. Effective interventions to reduce tobacco consumption have been launched to render the country free of tobacco. These public health interventions are being countered by the tobacco industry and the market forces that strive to preserve smoking as a life style of the population. The present work reviews the production means of the Mexican tobacco industry, particularly those of cigarettes, the market structure, and the product expansion in the Mexican population. This information should be useful to frame effective preventive measures, in the short and long term, to control this epidemic.     

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review

Aims To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. Methods A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. Conclusions There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid‐childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.     

Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs)

The global epidemic of cardiovascular diseases (CVDs) is spiraling upwards primarily due to a sharp rise in the low and middle income countries (LMICs) which are experiencing rapid health transition driven by socioeconomic, technological and lifestyle changes. LMICs currently face a double burden of communicable and non-communicable diseases, leading to competing claims of health conditions that vie for policy makers’ attention as public health priorities in a setting of limited resources, substantially high out-of-pocket expenditure and weak systems of healthcare delivery. Evidence from high income countries suggests that most CVDs are largely preventable as the major CVD risk behaviours including tobacco use, physical inactivity, unhealthy diet, harmful use of alcohol, are avoidable and modifiable. Effective and sustainable behaviour change strategies for LMICs would require low cost, affordable and scalable interventions. There is limited evidence from LMICs on effective interventions to prevent, control and manage CVDs in LMICs. The global guidelines and framework for addressing CVD calls for an urgent need to identify and assess contextually relevant and resource sensitive health care interventions augmented by policy actions. A combination of population based and high risk individual based strategies which are evidence based, cost-effective, feasible as well as scalable would reduce CVD mortality and its devastating impact in LMICs.     

The tobacco use research program at Oregon Research Institute

The research program at ORI deals with both adolescent and adult tobacco use and is guided by a behavioral framework which emphasizes the role of the social context in tobacco use onset, maintenance and cessation. Growing appreciation of the importance of social context variables, combined with an emerging recognition of the need for a public health rather than clinical perspective on tobacco use, have led to a focus on interventions in larger social systems such as schools, worksites, health care plans, and communities. This research requires attention to the science of behavior change at both the individual and organizational levels.     

Rapid HIV testing: issues in implementation

With the approval of rapid HIV testing and the expected broader use of this technology, community-based organizations incorporating its use face both opportunities and challenges. The primary advantage of rapid testing is the ability to dramatically increase the number of individuals who become aware of their HIV status. Individuals will be able to test for HIV and learn their results in the same session. Many challenges exist, however, for those agencies considering offering rapid HIV testing. For example, given the potential for an increase in the number of individuals seeking rapid testing, there will be a need to ensure that the individuals who are at highest risk for HIV are being tested. In addition, given that rapid testing will be done in a single session, it will be necessary to consider how to effectively address a client's behaviors and attitudes concerning high-risk activities. New types of referrals may also need to be developed, such as for individuals who receive a preliminary positive HIV test result and who will need to return for a confirmatory result. In addition, those receiving confirmatory positive results will require immediate linkages to a variety of services, including medical, mental health, and social services. Also, counselors providing immediate test results may need additional skills and support to address the stress associated with implementing this new technology. Community agencies will need to utilize this technology in a way that maximizes its potential to identify cases of HIV and links individuals as quickly as possible to needed services.