Abstracts for presentation
PLENARY
Zoe Ward (presented by Professor Peter Vickerman)
University of Bristol
The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK.
Zoe Ward, Senior Research Associate in Infectious Disease Modelling, University of Bristol
Linda Campbell, Research Associate, University of Bristol
Julian Surey, Research Nurse, Find & Treat, NHS London
Steven Platts, Chief Executive, Groundswell, London
Rachel Glass, HIV/STI Prevention and Surveillance Scientist, Public Health England
Matthew Hickman, Professor of Epidemiology, University of Bristol
Alastair Story, Clinical Lead of Find & Treat, University College London
Peter Vickerman, Professor of Infectious Disease Modelling, University of Bristol
Background: Hepatitis C virus (HCV) disproportionately affects marginalised communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilising HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care.
Aim: Assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared to standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).
Methodology: Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact, parameterised using London specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 200 were identified as HCV RNA positive, 198 attended secondary care and 99 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50-year time horizon.
Results: For a £20,000 per quality adjusted life year (QALY) gained willingness-to-pay threshold, the HepFriend initiative was cost-effective, mean ICER of £8,880/QALY, and would become cost-saving at 45% (£17,536 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions.
Conclusions: New models of care that undertake active case-finding with enhanced peer-support to improve testing and treatment uptake amongst marginalised and vulnerable groups could be highly cost-effective and possibly cost-saving.
Anna Bornioli (presented by Paul Pilkington)
University of West of England
Public health evaluation of the 20mph speed limit policy in Bristol, UK.
Anna Bornioli, Research Fellow and Lecturer in Public Health, Centre for Public Health and Wellbeing, University of the West of England, Bristol; Isabelle Bray, Centre for Public Health and Wellbeing, University of the West of England, Bristol; Paul Pilkington, Centre for Public Health and Wellbeing, University of the West of England, Bristol; Emma Bird, Centre for Public Health and Wellbeing, University of the West of England, Bristol
Aim: This paper presents the findings from the public health evaluation of the 20 mph sign-only city-wide intervention in Bristol, UK, on vehicle speeds and collision data.
Background: Twenty mph (32.2 km/h) speed limits across urban areas are becoming a widespread tool for public health and road danger reduction globally. Determining the effectiveness of these interventions is a crucial first step in any logic model that seeks to associate 20 mph speed limits to improved health and wellbeing outcomes.
Methodology: Speed analysis was conducted with a quasi-stepped wedge design. Speeds of 36,973,090 single vehicles, recorded by Automatic Traffic Counts before and after the 20 mph intervention, were analysed. Generalized linear mixed models were used to control for confounding variables. Changes in collisions were analysed with Poisson regression.
Results: Results showed an unadjusted speed reduction of 4.7 mph (7.56 km/h) and an adjusted speed reduction of 2.66 mph (4.28 km/h) over two to three years. Some variability due to time variables was detected. The roads that did not receive the 20 mph intervention also saw a small reduction in speed (0.03 mph). A preliminary descriptive analysis of collision data shows a lower number of collisions in the post-intervention period (4.5 fatal injuries less per year city wide).
Conclusions: The findings indicate that the sign-only 20 mph intervention was successful in lowering individual vehicle speeds, and highlight potential public health benefits in terms of reduced casualties. Policy makers are encouraged to implement a careful monitoring of the effects of 20 mph speed limit interventions on vehicle speeds in order to enable a meaningful evaluation of potential public health benefits.
Abstracts for parallel presentation
A1
Joanna Kesten
University of Bristol
Evaluating health and wellbeing outcomes following the South Gloucestershire Pain Review Pilot for patients on long-term opioids for chronic non-cancer pain
Dr Jo Kesten, Senior Research Associate, NIHR CLAHRC West at Universty Hospitals Bristol NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom and NIHR HPRU in Evaluation of Interventions, University of Bristol
Ms Lauren Scott, Senior Research Associate, NIHR CLAHRC West at Universty Hospitals Bristol NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
Mr Kevin Bache, Project worker, Developing Health & Independence, Warmley, South Gloucestershire
Ms Rosie Closs, Programme Lead for Drugs and Alcohol within South Gloucestershire Public Health and Wellbeing Division, South Gloucestershire Council, Bristol
Dr Sabi Redwood, Deputy Director CLAHRC West, NIHR CLAHRC West at Universty Hospitals Bristol NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol
Dr Kyla Thomas, Consultant Senior Lecturer in Public Health Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
Aim: To evaluate the health and well-being outcomes and perceived impact of the South Gloucestershire Pain Review pilot service to inform future service development.
Background: The South Gloucestershire Pain Review pilot is an individually-tailored service to help primary care patients on long-term (>3 months) treatment with opioid painkillers for chronic non-cancer pain understand their relationship with opioids and support alternative non-drug-based pain management strategies. The pilot was based in two GP practices in South Gloucestershire.
Methods: Quantitative data were collected for all enrolled patients on demographics; opioid use, misuse and dose (measured as average daily morphine equivalent); and pre-post intervention changes in health, well-being, quality of life (QoL), pain intensity/relief and interference with life measures. Twenty-five semi-structured interviews (18 service users and 7 service providers) explored experiences of the pilot including perceived impacts and benefits.
Results/findings: Fifty-nine patients were invited to use the service and 34 (58%) enrolled. The median prescribed opioid dose had reduced from 90mg (Interquartile range [IQR] 60 to 240) at baseline to 72mg (IQR 30 to 160) at follow-up (p<0.001). On average, service users showed improvement on all health, well-being and QoL outcomes except pain relief.
Service users and providers received the service positively. Perceived benefits of the service related to well-being and QoL (e.g. improved confidence and self-esteem), use of pain management strategies (e.g. pacing), changes in medication use and changes in primary care use.
Conclusions/Recommendations: The pilot has shown promising results. The service was viewed as acceptable to service users and providers and health and wellbeing outcomes suggest a benefit. Following further development of the service, a randomised controlled trial is needed to formally test the effects of this type of care-pathway on pain management and reducing long-term opioid use.
A2
Una Geary
Swindon Borough Council
Translation of the evidence for the Scottish Football Fans In Training (FFIT) weight loss programme for men into practice in Swindon, and evaluation of its long-term effectiveness
Authors: Penny Marno, Consultant in Public Health, Swindon Borough Council
Una Geary, Public Health Coordinator & Analyst, Swindon Borough Council
Fiona Dickens, Public Health Programme Manager, Swindon Borough Council
Aim: Using data from 210 participants, the evaluation aims were:
To investigate whether FFIT participants lose a significant amount of weight following completion of the programme, i.e. at 12 weeks from baseline
To investigate whether FFIT participants maintain significant weight loss in the long-term following completion of the programme
Background: Following publication by the Lancet (2014) of evidence of effectiveness of the Scottish FFIT weight-loss programme, Swindon Borough Council (SBC) and Swindon Town Football Club launched FFIT, aimed at men agedbetween 35-65, with a BMI of 28 (kg/m2) or higher, in January 2015. To date, seven 12-week courses with 30 participants each have been delivered. As the first place in England to deliver FFIT, Swindon now has the longest-term follow-up data to evaluate whether weight-loss achieved by programme completion is sustained.
Methodology: Linear regression analysis was used to investigate the relationship between weight at baseline and post-intervention, adjusting for length of follow-up.Measurements were available at baseline, at the 12 week programme completion point and at follow-up intervals ranging from 6 to 18 months post-baseline.
Results: Average weight-loss between baseline and programme completion was 7.93 kg (95% confidence interval (CI) = 7.33-8.53 kg), which was highly statistically significant (n = 196, t(195) = 26.01, p<0.001).
Linear regression analysis found that, on average, participants maintained a statistically significant reduction of 14.5% of their baseline weight at long-term follow-up (n = 125, mean follow-up = 13.35 months, 95% CI = 0.776-0.933, p<0.001). Average long time weight loss was 8.22 kg.
Conclusions: The FFIT programme was effective in Swindon in supporting men to lose a clinically important amount of weight. Results were sustained long term. Swindon is contributing to the long-term evaluation by Scottish academics, and also piloting courses for female football fans and non-football fans using the same model.
References: Hunt K, Wyke S, Gray C.M, Anderson A.S, Brady A, et al. A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial. Lancet. 2014; 383(9924): 1211–1221.
A3
Harriet Fisher
University of Bristol
Barriers and enablers to adolescent self-consent for vaccination: A mixed-methods evidence synthesis
Dr Harriet Fisher1, Senior Research Associate in Public Health
Dr Sarah Harding1, ResearchAssociate in Public Health
Professor Matthew Hickman1, Professor in Public Health and Epidemiology
Professor John Macleod1, Professor in Clinical Epidemiology and Primary Care
Dr Suzanne Audrey1, Senior Research Fellow in Public Health
1 Population Health Sciences, Bristol Medical School, University of Bristol.
Aim: We aimed to review systematically the associated barriers and enablers to implementation of adolescent self-consent procedures.
Background: The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against infectious diseases and improve their health. Although the legal framework in many countries permits young people to consent for vaccinations if competent, lack of written parental consent can still prevent uptake.
Methods: A comprehensive search strategy of ten databases from inception to June 2018 was undertaken to identify relevant qualitative and quantitative studies. Titles, abstracts and full texts were assessed for eligibility, and the methodological quality of eligible primary studies evaluated. Thematic synthesis methods were used to interpret and combine qualitative data, and to identify overarching themes as well as similarities and differences within themes. Quantitative data were summarised and, because the data were sufficiently similar in focus, were integrated within the qualitative framework.
Results: Twenty-five publications related to23 studies were included. Three themes were identified which related to the policy framework, protection, and self-determination. Despite supportive national policy frameworks, implementation of adolescent self-consent procedures can be prevented by local policies, professionals’ misunderstandings of the legal framework and the context in which the vaccination programme is delivered. Motivation to protect young people’s health increased acceptability of adolescent self-consent, but implementation might be prevented to protect the reputation of professionals or relationships with parents. Further, maintaining the role of parents as decision-makers for their child’s healthcare was frequently prioritised over enabling young people’s autonomy to consent.
Conclusions: Barriers to the implementation of adolescent self-consent procedures have implications for young people’s health and uptake of vaccination programmes. There is a need to clarify the policy framework and challenge the primacy of parental consent.
A4
Kathryn Hamilton
Specialty Registrar
A systematic review of active case finding strategies for tuberculosis in homeless populations
Authors:
Dr Kathryn Hamilton BMBCh BA (Oxon) MRCP
Public Health Specialty Registrar
South West Public Health Training Programme
Mr Robert Tolfree MSc
Public Health Specialty Registrar
South West Public Health Training Programme
Dr Julie Mytton MBBS, PhD, FFPH
Associate Professor in Child Health
University of the West of England, Bristol.
Aim: To determine the effectiveness of ACF for TB control, and identify strategies to improve uptake of screening and the diagnostic pathway, in homeless populations, in low and medium-burden settings. Secondary objectives included assessing yield of screening, and participant characteristics.
Background: Tuberculosis (TB) is prevalent in the homeless population, creating health inequalities and challenging eradication. Evidence-based approaches to active case finding (ACF) are needed.
Methods: A systematic search of electronic databases and grey literature sources identified ACF studies that reported population measures (prevalence or incidence) of TB control, and/or uptake and/or yield of screening for latent TB infection (LTBI) or active TB affecting any site. Studies are described using narrative synthesis.
Results: 20 studies met with the inclusion criteria. Studies were heterogeneous across multiple elements including programme design, which likely contributed to variability in outcomes. ACF was associated with reductions in TB rates in three time-trend analyses. The strongest evidence for improving uptake of screening is for incentives, with mixed evidence for peer educators. Observationally, professional support and mandatory screening may also improve uptake, and additional community support enhances completion of the diagnostic pathway. Those most likely to be diagnosed with TB appeared less likely to accept screening. Yield of screening was 1.5-57% (41,684 participants) for LTBI, and 0-3.1% (91,771 participants) for active TB.
Conclusion: Though the evidence is weak, ACF appears effective. Strategies to improve screening uptake are identified. Variability in uptake and yield necessitates programmes tailored to local populations, and areas for further research are identified.
B1
Emma Bird
University of West of England
Implementation of ‘CLICK into Activity’ in South Somerset: Social prescribing through general practice referral of ‘at risk’ populations to community leisure services
Bird, E.L.1, Kok, M.S.Y.2, Powell, J.E.3
1Senior Lecturer in Public Health, UWE Bristol
2Research Associate in Public Health, UWE Bristol
3Professor of Public Health Economics, UWE Bristol
Aim: This study used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the impact of CLICK into Activity, a 12-week community-based physical activity programme for inactive adults with (or at risk of) long-term conditions.
Background: In the UK, inactivity is more prevalent among those with long-term conditions. General Practice (GP) referral to community-based physical activity has increased in recent years, however, the effectiveness of such programmes is inconclusive and evidence is limited on the wider contextual and individual factors facilitating delivery.
Methodology: A mixed methods evaluation was conducted with data obtained from a range of sources: questionnaires, qualitative interviews, and programme-related documentation, including cost data. Triangulation methods were used to analyse data, with findings synthesised across each dimension of the RE-AIM framework.
Results: The programme was adopted bynine GP surgeries, with a total of 602 eligible participants. Programme reach was 30.2% of the target population. A range of individual-, social-, and environmental-level factors were associated with programme participation. Improvements in physical activity outcomes were identified, although no differences were observed when comparing responses from participants that attended the programme with those that did not. Follow-up response rates were low, limiting our understanding of long-term programme impacts. Implementation facilitators included programme deliverer characteristics and tailoring content to target population needs, while barriers included a lack of GP staff engagement and scepticism about the value of physical activity. Implementing CLICK into Activity cost £175,000 over three years, with an average cost per person attending at least one programme session of £535.
Conclusions: Overall, CLICK into Activity was successfully implemented, with positive results attributed to participation, and contextual factors which may facilitate successful delivery identified. Findings highlight strategies to be explored in future development and implementation of community-based physical activity programmes targeting inactive adults with (or at risk of) long-term conditions.
B2
Samuel Coleborn
South Gloucestershire Council
Understanding weight status trajectories of South Gloucestershire children and the impact of obesity on measurement opt-out: An NCMP cohort matching study
Coleborn, S
Public Health Analyst
Aim: This study used National Child Measurement Programme (NCMP) data to understand child weight status trajectories in South Gloucestershire, and how these were influenced by deprivation and gender. We also aimed to understand how weight status at age 4-5 impacted measurement opt-out at age 10-11.
Background: The NCMP was established to improve our understanding of the prevalence and trends in childhood obesity across England and to inform the planning and delivery of children’s services. Local analysis is completed annually to explore the distribution of childhood obesity by deprivation and observe trends over time.
Methodology: Matching took a two-stage approach based on name, date of birth and gender. These were cleansed to ensure records met inclusion criteria (i.e. if surnames did not match, a consistent postcode was required). Analysis was completed in Excel using cross tabulation to plot the weight status trajectories of children aged 4-5 and 10-11.
Results: Boys displaying excess weight in reception were more often able to attain a healthy weight by Year 6 than girls. The higher the weight category in reception, the worse the outcomes at Year 6. 70% (n=323) of those reported as obese or severely obese at age 10-11 were from healthy (43%, n=201) or overweight (26%, n=122) categories at age 4-5. Healthy weight 4-5 year olds experiencing higher levels of deprivation reported higher levels of obesity at year 6 than those experiencing lower levels of deprivation. Children who were obese at ages 4-5 were much more likely to be opted out of 10-11 measurement, mostly by parent(s).
Conclusions: Support before ages 4-5 should be explored to reduce life course burden of obesity. Services need to target both treatment and prevention of obesity at age 4-5, as healthy weight children comprise a large portion of obese 10-11 year-olds. The attainment of a healthy weight throughout primary school and reductions in levels of obesity are subject to health inequalities. Measurements at 10-11 are skewed by increased parental opt-out of those obese at 4-5, possibly indicating a need to review communication of reception age results.
B3
Suzanne Audrey
University of Bristol
Acceptability of new adolescent consent procedures for the HPV vaccination programme
Dr Suzanne Audrey, Senior Research Fellow in Public Health, University of Bristol
Dr Harriet Fisher, Senior Research Associate, University of Bristol
Background: The legal framework in England and Wales allows young people to consent for medical treatment without parental consent provided they are deemed Gillick competent. However, there is reticence about vaccinating young people without written parental consent, and this has been shown to be a barrier to uptake for some groups. This study examines the acceptability of new consent procedures for the HPV vaccine in Bristol and South Gloucestershire.
Methods: The new procedures include parental verbal consent and adolescent self-consent. A mixed methods approach to data collection was used comprising questionnaires, observations and audio-recorded interviews with young women, immunisation nurses, school staff and parents. Quantitative data were analysed descriptively. Qualitative data were analysed using thematic analysis and the Framework method for data management.
Results: Although schools received information detailing the new consent procedures, nearly half were unaware of the changes. Observations of vaccination sessions showed, for those young women without written parental consent, verbal consent (telephone) could usually be obtained from parents. Adolescent self-consent occurred less frequently. The acceptability of adolescent self-consent procedures varied, with adult respondents showing a stronger preference to seek parental consent (written or verbal). Barriers to adolescent self-consent included perceptions of the decision-making capacity of adolescents, especially in some alternative educational settings. Professionals suggested students from more disadvantaged backgrounds, and some minority ethnic groups, may benefit from the policy change as their parents may be less likely to return the written consent form.
Discussion: The new consent procedures appear generally acceptable, although there is a clear preference for obtaining parental verbal consent with adolescent self-consent as a last resort. The impact on inequalities and uptake of the HPV vaccination programme will be investigated through future statistical analyses of routine data.
Please note: Additional data collection and analyses are currently being undertaken and the final abstract and presentation will reflect these additional findings.
B4
Nabaa Agha
University of West of England
Analysis of national UK newspapers’ coverage of the problem of Antimicrobial Resistance AMR in 2017
Agha, N and Grey, S
Aim: To evaluate newspaper messages regarding antimicrobial resistance (AMR)to explore what information lay audiences receive about knowledge, attitude and behaviour in respect of AMR.
Background: AMR is a significant public health threat, and a focus solely on physicians and health organisations alone is not sufficient to tackle the problem. The pubic have a considerable role in tackling the AMR issue, so evaluating the messages that they receive about AMR that may inform their knowledge and attitude is important. This study aimed to explore the coverage of AMR as an issue through examining one source of information, that being provided by national newspapers.
Method: An online Lexis Nexis data base was used to collect the national UK newspapers articles reported on AMR in 2017. Frame analysis was then applied to analyse the collected newspapers articles with regards their national strategy coverage, keywords, key players and key concepts.
Findings: 113 articles were found to report on AMR by 13 national newspapers in 2017. 6 newspapers were tabloid-type newspapers, and 7 were broadsheet-type newspapers. Both newspaper classes focused on optimising antibiotic prescribing and developing new drugs more than other parts of the strategy. Both newspaper genres showed healthcare workers and scientists as being the major players, with a very limited discussion on the role of the public. Alarmist words and metaphors were very common in the messages of all newspapers. Their storylines were mainly a reflection of research on progress or the research findings. However, they focused on biological research or those who aimed to develop new drugs rather than those dealing with the social factors of the problem.
Conclusion: It is clear that the public in the UK reading newspapers, both tabloid and broadsheet and thus of various socioeconomic status in 2017 received incomplete and sometimes inappropriate messages about AMR. Specifically, they were exposed to problem framing which definitely affects their knowledge and behaviour regarding antimicrobial resistance and is unlikely to facilitate positive behaviour change with respect to antibiotic use.
C1
Joanna McLaughlin
Specialty Registrar
Establishing the feasibility of evaluating the impact of a CCG pre-surgical health optimisation policy
Joanna McLaughlin, Public Health Specialty Registrar, Bath and North East Somerset Council
Lucie Owens, Commissioning Manager for Planned Care, NHS Bath and North East Somerset Clinical Commissioning Group
Becky Reynolds, Public Health Consultant, Bath and North East Somerset Council
Ruth Kipping, Consultant Senior Lecturer in Public Health, Honorary Consultant in Public Health, University of Bristol
Amanda Owen-Smith, Lecturer, Population Health Sciences, University of Bristol
Penny Whiting, Senior Research Fellow, NIHR CLAHRC West
Sabi Redwood, Senior Research Fellow in Ethnography/ Qualitative Social Science, Bristol Medical School, Deputy Director and Ethnography Team Lead, NIHR CLAHRC West
University Hospital Bristol NHS Foundation Trust
Lauren Scott, Senior Research Associate, NIHR CLAHRC West, Population Health Sciences, University of Bristol
Jenny Donovan, Professor of Social Medicine, University of Bristol,Director, NIHR CLAHRC West
Aim: To determine the feasibility of evaluating a pre-surgical health optimisation policy and to provide a descriptive analysis of the effect of the policy in its first phase of implementation.
Background: In 2017, B&NES Clinical Commissioning Group (CCG) introduced a health optimisation policy whereby smokers or those with a body mass index (BMI) ≥30kg/m2 are supported to lose weight or stop smoking in a 3-month window before their elective surgical referral. A lack of published evidence and concerns over potential exacerbations of health inequalities resulted in a need to rigorously evaluate the impact of the policy.
Methodology: A working group outlined the intended flow of patients, available data, data governance and evaluation questions. A feasibility study was developed using 6 months of data from the first phase of implementation. Descriptive summary statistics on the characteristics and activity of patients eligible or ineligible for health optimisation were reported.
Results: 855 patients were referred to the hip and knee pathway from February to July 2018. Of these, 262 (31%) were eligible for health optimisation: 237 (90%) for BMI ≥30kg/m2, 23 (9%) for smoking status and 2 (1%) for both. By March 2019, comparative data will be available on age, gender, ethnicity, deprivation score, surgical outcomes and length of hospital stay. Data on BMI, smoking status and Oxford Hip or Knee Score will be available from initial GP consultations, through health optimisation, and at ≥6-months follow-up.
Conclusions: The impact of health optimisation policies is poorly evidenced at present, yet policies are in place in many CCGs. Evaluation is challenging due to the number of organisations and data sources involved. This feasibility study provides valuable insight into an initial cohort impacted by the policy and the necessary considerations for a future research study to evaluate the impact on health inequalities and outcomes.
C2
Tamsin Newlove-Delgado
University of Exeter
The impact of the Exeter Sugar Smart campaign on the local food environment
Dr Tamsin Newlove-Delgado,Clinical Lecturer, University of Exeter & Honorary Consultant in Public Health, Devon County Council
Ruby Entwistle, Advanced Public Health Practitioner, Devon County Council
Dr Jane R Smith, Senior Lecturer, University of Exeter
Dr Jenny Lloyd, Senior Research Fellow, University of Exeter
Dr Samantha van Beurden, Postdoctoral Research Associate, University of Exeter
James Gould, Undergraduate Student, University of Exeter
Thomas Reed, Undergraduate Student, University of Exeter
Daisy Pearce, Undergraduate Student, University of the West of England
Dr Natalia Lawrence, Associate Professor, University of Exeter
Aim: To assess the impact of Exeter’s Sugar Smart campaign on the local food environment.
Background: Sugar Smart Exeter aims to alter the food environment (choice architecture) to encourage lower-sugar choices or lower-frequency sugar choices, principally by supporting local organisations in making specific pledges that are actionable and measureable (e.g. reducing sugary products at checkouts).
Methods: We collected quantitative data to describe the food environment and the pledges made by local organisations. Data collection on the food environment in Exeter involved foot audits at baseline chosen to include campaign ‘target organisations’ such as leisure centres and hospitals, and food retailers (n=44; Jan – June 2017) using a Sugar Smart audit tool. Follow-up audits (12-months post baseline) included both organisations who had made Sugar Smart pledges and those that had not. We used pledge data collected from the national campaign website to analyse the type and distribution of pledges made by Exeter based organisations.
Findings: Baseline audits indicated prominent advertising, placement at checkouts and price promotions on sugary products and limited healthier alternatives. At follow-up there had been little change in the audited organisations, including some of those that had pledged. As of September 2018, 39 organisations in Exeter including leisure centres, children’s centres and hospital trusts, had pledged, with the most common pledges being: promoting water (n=9), banning price promotions on high-sugar products (n=6) and setting sugar smart challenges (n=5).
Conclusions: There is scope for improvement in Exeter’s food environment. Although some organisations made specific pledges, our data has shown that not all have yet been implemented. Moreover, organisations were more likely to make simple and low cost pledges that did not involve reducing prices or availability of high-sugar products. Our current ongoing qualitative work aims to investigate challenges and barriers organisations face when implementing actionable changes surrounding sugar.
C3
Andrew Salmon
University of Exeter
Cost effectiveness analysis of targeted vs opportunistic screening for viral hepatitis within UK immigrant communities.
Andrew Salmon, Associate Research Fellow, College of Medicine and health, University of Exeter
Simon Briscoe, Information Specialist, Exeter HS&DR Evidence Synthesis Centre, College of Medicine and Health, University of Exeter.
Martin Pitt, Associate Professor, College of Medicine and Health, University of Exeter.
Graham Foster. Professor, Barts’ Liver Centre, The Blizard Institute, QMUL, London E1 4AT, UK
Aim: To explore whether offering incentives to GPs to screen for hepatitis caused by hepatitis B or C virus is cost-effective.
Background: Immigrant communities in the UK potentially contain large numbers of undiagnosed cases of viral hepatitis due to high prevalence in some countries of origin. Targeted screening methods such as in the recent HepFree study, a cluster randomised trial of incentives vs usual care, promote patient engagement and may be cost effective. We report on this possibility, taking a UK NHS and professional social services perspective.
Methods: We used a decision tree and Markov simulation model to represent cohorts of patients over a lifetime horizon. To parameterise the model, we used a combination of data collected from the recent HepFree trial, and long term follow up data sourced from the literature. We report the deterministic incremental cost effectiveness ratio (ICER), one way sensitivity and probabilistic sensitivity analysis, based on the whole cohort and important subgroups
Results: Whole cohort screening was cost effective at willingness to pay thresholds exceeding £8,540 per Quality adjusted life year (QALY) based on the patients recruited and treated. Screening of over 40s was cost-effective at £15,696 per QALY and patients of Pakistani ethnicity at £9,523 per QALY. These results are highly cost-effective relative to NICE (National Institute for Health and Care Excellence) range of £20-30,000 per incremental QALY. Threshold analysis indicates that screening is unlikely to be cost-effective where the mean cohort age exceeds 56 years. PSA results suggest that the intervention was highly likely (99%) to be cost-effective at NICE willingness to pay thresholds based on 5,000 Monte Carlo simulations.
Conclusion: Targeted screening by invitation letter is highly likely to be cost effective compared to usual care in populations with mean age of ~56 and with (joint) prevalence >= 2 %
C4
Georgina Angel
Specialty Registrar
An audit of the public health management of meningococcal disease in the South West, May 2016 – April 2017
Angel, G, Specialty Registrar in Public Health, PHE
Dr Toyin Ejidokun, Consultant in Communicable Disease Control, PHE
Sharon Hilton, Health Protection Practitioner, PHE
Jonathan Plumb, Health Protection Practitioner, PHE
Aim: This audit examined the public health management of meningococcal disease in the South West over a period of 12 months to identify areas for improvements across the wider healthcare system.
Background: National guidance outlines the key role of public health following the notification of suspected cases of meningococcal disease.
Method: The audit criteria and standards were developed using national guidance and the Centre’s local Standard Operating Procedure (SOP). A total of 161 cases of possible, probable and confirmed meningococcal disease notified to the South West PHE centre between 1st May 2016 and 31st May 2017 were included. An electronic data collection tool was used and the data analysed using Excel.
Results: Sample demographics and disease epidemiology were consistent with the national picture. Early notification, i.e. within 24 hours, occurred in 61% of cases. 10% of cases were notified more than 3 days late, up to 10 days in a few cases. The audit identified specific hospitals where delayed notification was a concern. Actions relating to laboratory investigation of cases were well completed. Chemoprophylaxis was arranged for contacts within 24 hours in 89% of cases along with information on signs and symptoms. The audit also identified a number of contacts who had not received vaccinations where indicated, and these were followed up. Incomplete documentation of HPZone records was also identified as a concern, particularly with regards to pre-admission antibiotics and vaccination status.
Recommendations: Ten recommendations were proposed which have led to actions across the system. Electronic reminders regarding notification and investigations have been implemented in various trusts. Clinical leads have committed to continuously raising awareness, particularly amongst junior staff, of the responsibility to notify. This together with importance of early notification and investigation, and awareness of unusual presentations has also been raised at a strategic level. Internally, the HPT have implemented changes to improve and standardise documentation.
Mini-Oral presentations – sessions D1-D4 – please see Mini-Oral list
E1
Michael Dalili
University of Bristol
A systematic review and network meta-analysis of the safety and effectiveness of smoking cessation medicines and electronic cigarettes
Dalili, M.N.1, López-López, J.A.2, Keeney, E.3, Caldwell, D.M.4, Munafò, M.R.5, Stevenson, M.6, Welton, N.J.7, Thomas, K.H.8
1. Senior Research Associate, Population Health Science, Bristol Medical School, University of Bristol
2. Research Fellow, Population Health Science, Bristol Medical School, University of Bristol
3. Senior Research Associate, Population Health Science, Bristol Medical School, University of Bristol
4. Senior Lecturer in Public Health, Population Health Science, Bristol Medical School, University of Bristol
5. Professor of Biological Psychology, MRC Integrative Epidemiology Unit and UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol
6.Professor of Health Technology Assessment, School of Health and Related Research, University of Sheffield
7. Professor in Statistical and Health Economic Modelling, Population Health Science, Bristol Medical School, University of Bristol
8.Consultant Senior Lecturer in Public Health Medicine, Population Health Science, Bristol Medical School, University of Bristol
Aim: To assess the comparative safety and effectiveness of smoking cessation medicines.
Background: Cigarette smoking is one of the leading causes of early death. Of UK-licensed stop smoking medicines (Varenicline [Champix], Bupropion [Zyban], Nicotine Replacement Therapy [NRT]), Varenicline has been shown to be the most effective monotherapy for long-term smoking abstinence. However, there is ongoing debate regarding the neuropsychiatric safety of these medicines and of the newly licensed electronic cigarettes (E-Cigarettes).
Methodology: We conducted systematic reviews and network meta-analyses of randomised controlled trials (RCTs) of medicines delivered as monotherapy and in combination treatment (e.g. Varenicline+NRT) with control groups. Studies published before March 2017 were identified from 8 databases. The primary composite safety outcome was serious adverse events (SAEs) and secondary composite outcomes were major adverse neuropsychiatric events (MANEs) and major adverse cardiovascular events (MACEs). The primary effectiveness outcome was sustained smoking cessation abstinence (≥ 6 months, biochemically validated).
Results: We screened 10,779 records and analysed 334 and 346 RCTs for safety and effectiveness outcomes, respectively. We found evidence that Bupropion at standard dose increased the odds of SAEs (OR=1.31, 95% CI 1.06-1.60) but reduced the odds of MANEs (0.62, 0.42-0.87) compared to placebo, whereas E-Cigarette users had higher odds of SAEs compared to those who received placebo (2.34, 1.09-5.16). No treatment increased the odds of MACEs compared to placebo. Regarding effectiveness, smokers randomised to standard doses of Bupropion (1.65, 1.39-1.95), Varenicline (2.75, 2.29 to 3.29), Varenicline+NRT (5.58, 2.25-14.0) or Varenicline+Bupropion (2.80, 1.15-6.96), alongside those using any E-Cigarette (2.75, 1.26-6.11), were more likely to achieve sustained abstinence than smokers treated with placebo.
Conclusions: Combination treatment with varenicline and NRT (currently unlicensed in the UK) is most likely to be effective at achieving sustained abstinence from smoking. E-cigarettes for smoking cessation showed promise, but also increased odds for a SAE based on few studies.
E2
Rachel Hayes
University of Exeter
The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: results of the STARS cluster randomised controlled trial
Dr Rachel Hayes (STARS Trial Manager) and Professor Tamsin Ford (Professor of Child and Adolescent Psychiatry) University of Exeter Medical School
Aim: The Incredible Years® (IY) Teacher Classroom Management (TCM) course has been identified by a recent systematic review of interventions aiming to improve children’s mental health through training teachers as the school-based programme with the most evidence (see panel). We evaluated whether TCM improved children’s mental health (primary outcome), enjoyment of school and behaviour, and if so, whether any impact was sustained and whether TCM was cost-effective.
Background: There is a growing policy focus on the role that schools play in children’s mental health. We evaluated the effectiveness and cost-effectiveness of the Incredible Years® (IY) Teacher Classroom Management (TCM) programme on children’s mental health.
Methodology: A two-arm, pragmatic, parallel group, superiority, cluster randomised controlled trial recruited three cohorts of schools (clusters) between 2012 and 2014, randomising them to TCM (intervention) or Teaching As Usual (TAU–control). TCM was delivered to teachers in six whole-day sessions, spread over six months. The primary outcome was teacher-reported Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-TD).
Results: Eighty schools (2075 children) were enrolled; 40 (1037 children) to TCM and 40 (1038 children) to TAU. Outcome data were collected at 9, 18 and 30-months follow-up for 96%, 89% and 85% of children, respectively. The intervention reduced the SDQ-TD score at 9 months (mean (SD): 5·5 (5·4) in TCM versus 6·2 (6·2) in TAU; adjusted mean difference (AMD)=-1·0; 95% CI: -1·9 to -0·1; p=0·03) but this did not persist. TCM may be cost-effective compared to TAU at 30-months. Planned subgroup analyses suggested that TCM is more effective for children with poor mental health.
Conclusions: In conclusion, our findings provide tentative evidence that TCM may be an effective and cost-effective child mental health intervention in the short term, particularly for primary school children who teachers identify as struggling. Future research should explore TCM as a whole school approach.
E3
Abigail Russell
University of Bristol
Pathways between early life adversity and adolescent self-harm: the mediating role of inflammation: a longitudinal cohort study
Abigail Russell1 and Becky Mars2
1 Senior Research Associate in Epidemiology, Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School
2Research Fellow in Epidemiology, Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School and NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
Aim. We set out to investigate whether systemic inflammation mediates the association between adverse childhood experiences (ACEs) and adolescent self-harm using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort study of UK children. We specifically aimed to explore whether levels of interleukin 6 (IL-6) and c-reactive protein (CRP) at age 9.5 mediate the association between ACEs experienced from ages 0-9 and self-harm at age 16.
Background. ACEs such as physical, sexual and emotional abuse are strongly associated with self-harm, but mechanisms underlying this association are unclear. Inflammation has been linked to both the experience of ACEs and self-harm or suicide in prior studies. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self-harm.
Methods. Data from ALSPAC (N=4308) were used. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0-9 years, levels of inflammatory markers IL-6 and CRP measured at 9.5 years, and self-harm reported at 16 years. Two sample Mendelian Randomisation (MR) was also conducted to explore whether this association was causal.
Results. The mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self-harm at 16 (direct effect Relative Risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p<0.001). We did not find evidence of an indirect effect of ACEs on self-harm via inflammation (RR 1.00, 95% CI 0.998, 1.005, p=0.40).
Conclusions. The association between ACEs and self-harm does not appear to be mediated by an inflammatory process in childhood, as indexed by peripheral levels of circulating inflammatory markers. Those exposed to ACEs are a group at high risk of self-harm. MR results and their implications will be discussed.
E4
Anna Bornioli
University of West of England
Adolescent body dissatisfaction as public health issue: effects on later risky health behaviour
Anna Bornioli, Research Fellow and Lecturer in Public Health, Centre for Public Health and Wellbeing, University of the West of England, Bristol; Helena Lewis-Smith, Centre for Appearance Research, University of the West of England, Bristol; Andrew Smith, Applied Statistics Group, University of the West of England, Bristol; Amy Slater, Centre for Appearance Research, University of the West of England, Bristol; Isabelle Bray, Centre for Public Health and Wellbeing, University of the West of England, Bristol
Aim: Body dissatisfaction is prevalent among teenagers, and may influence the uptake of risky health behaviours. The study assessed the influence of body dissatisfaction on smoking, cannabis use, drug use, self-harm, gambling, and drinking and the mediating role of disordered eating in a population-based sample of British adolescents.
Background: Previous studies found that body dissatisfaction is a risk factor for disordered eating, and that disordered eating predicts risky health behaviours.
Methodology: Participants were 2,634 females and 1,684 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of risky health behaviours at 21 years old. Mediation analysis tested the mediating role of disordered eating at 16 years old on each risky health behaviour.
Results: Among females, body dissatisfaction predicted smoking (OR=1.40, 95% CI = 1.14 – 1.71), cannabis use (OR=1.22, 95% CI = 1.03 – 1.45), drug use (OR=1.54, 95% CI = 1.21 – 1.94), self-harm (OR=1.45, 95% CI = 1.37 – 1.86) and high-risk drinking (OR=1.44, 95% CI = 1.12 – 1.85). Disordered eating symptoms had mediating effects on some behaviours. Among males, body dissatisfaction predicted smoking (OR=1.43, 95% CI = 1.14 – 1.80) and no effect of disordered eating was found on any risky health behaviour.
Conclusions: This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of several risky health behaviours, and elucidates the mediating role of disordered eating. The findings highlight that body dissatisfaction is a public health concern. Early interventions to promote body satisfaction may reduce the prevalence of later risky health behaviours.
F1
Georgie MacArthur
Specialty Registrar
A qualitative exploration of parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among adolescent offspring
Dr GJ MacArthur, Specialty Registrar in Public Health, Bristol City Council & Honorary Lecturer, Department of Population Health Sciences, University of Bristol
Dr Siobhan Mitchell, Research Associate, Department of Population Health Sciences, University of Bristol
Professor Rona Campbell, Professor of Public Health Research, Department of Population Health Sciences, University of Bristol
Aim: We conducted a qualitative study to explore the perspectives of parents/caregivers regarding offspring alcohol use to inform the optimisation of interventions to prevent excessive alcohol use during adolescence.
Background: Parent/caregiver behaviours such as alcohol consumption, provision, poor parental monitoring and positive motivations influence alcohol use among adolescent offspring. However, relatively little is known about perspectives of parents from qualitative studies in the UK.
Methodology: Twenty-three one-to-one interviews (21 F; 2 M) were conducted with parents of children aged 13-18 years in the West of England. Participants were recruited via schools, workplaces and community centres using letters, leaflets, workplace bulletins and snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis in NVivo 11.
Results: Preliminary findings indicate that parents viewed adolescent alcohol use as an inevitable practice, driven by peer influence, cultural norms and a desire for fun and rebellion, but they also reported clear concerns around safety, vulnerability and risks to health. Most parents described navigating such duality via an accepting approach, which strove for balance between support for sociability, and avoidance of rebellion and intoxication via supervised introductions to alcohol, boundaried alcohol provision, parental monitoring and strategized communication regarding harm reduction. Only a minority of parents reported use of abstinence-based approaches. Parents also sought to foster a responsible approach by maintaining bonds, trust and dialogue, while minimising secrecy and enhancing safety and support. Notably, many participants reported disapproval around excessive alcohol use and permissive actions of other parents, suggesting a spectrum of approaches that extended to active support for adolescent consumption.
Conclusions: Preliminary findings suggest that public health messages may need to stress risks associated with early introductions to alcohol use and parental provision to address cultural norms among parents and reduce the prevalence of alcohol-related harm during adolescence.
F2
Judi Kidger
University of Bristol
Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: A mixed-methods implementation study of the WISE intervention
Fisher, H (Senior Research Associate), Kidger, J (Lecturer in Public Health)
University of Bristol, Population Health Sciences
Background: The Wellbeing in Secondary Education (WISE) study is a cluster randomised controlled trial that aims to improve the emotional wellbeing of secondary school teachers. The intervention comprised delivery of a Mental Health First Aid (MHFA) training package and a staff peer support service. This presentation reports the extent to which the intervention was implemented successfully. The impact of the intervention on teachers’ emotional wellbeing will be reported elsewhere.
Methods: A mixed methods approach for data collection comprised researcher observations of training delivery, training attendee evaluation forms, focus groups with training attendees, interviews with trainers, peer supporter feedback meetings, and logs of support provided. Qualitative and free text questionnaire data were coded and analysed thematically. Quantitative data were used to generate indicators of extent of implementation.
Results: In the 12 schools assigned to the intervention arm, 113 staff completed the two-day standard MHFA training as preparation for the role of peer supporter, and 146 staff completed the one-day MHFA for Schools and Colleges training to better equip them to support student mental health. Delivery of the MHFA training package was achieved with high levels of fidelity and participant-rated quality across schools. However, effective delivery could be constrained by the school timetable and competing demands of school staff. All schools established the peer support service following training. Peer supporters usually provided face-to-face support, on an ad-hoc basis. Barriers to delivery included time constraints of peer supporters and concerns related to confidentiality of information within the workplace.
Conclusion: Findings suggest that the MHFA training package was delivered largely as intended, and the staff peer support service was established in each school. However, consideration is needed as to how to address barriers within the school setting that may impede effective delivery of MHFA training and staff peer support.
F3
Sarah Bell
University of Bristol
The relationship between physical activity, mental wellbeing and risk of mental health disorder in adolescents: a cohort study
Sarah Louise Bell, Senior Research Associate in Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
Suzanne Audrey, Senior Research Fellow, Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS, UK
David Gunnell, Professor of Epidemiology, Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS, UK
Ashley Cooper, Professor of Physical Activity and Public Health, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BS8 1TZ, UK
Rona Campbell, Professor of Public Health Research, Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS, UK
Background: In the UK, there is a high prevalence of mental illness and poor mental wellbeing among young people. The aim of this study was to investigate whether physical activity is associated with better mental wellbeing and reduced risk of mental health disorder in adolescents.
Methodology: A cohort of 928 12-13 year olds from six secondary schools in England, who participated in the AHEAD trial ‘Activity and Healthy Eating in Adolescence,’ was followed up three years later. At baseline, physical activity was measured using accelerometers. At follow-up, mental wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and risk of mental health disorder using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression analyses were used to investigate associations.
Results: 794 of the eligible 928 young people (86%) provided valid accelerometer physical activity data at baseline. At follow-up, 668 (72%) provided mental wellbeing data and 673 (73%) provided risk of mental health disorder data. There was no evidence of an association between physical activity (volume or Moderate to Vigorous Physical Activity (MVPA)) and mental wellbeing (WEMWBS overall score) or overall risk of mental health disorder (SDQ Total Difficulties Score). However, higher levels of physical activity volume at age 12-13 years were associated with lower scores on the emotional problems subscale of the SDQ at age 15-16.
Conclusions: This cohort study provided no strong evidence that physical activity is associated with better mental wellbeing or a reduced risk of overall mental health disorder in adolescents. However, a protective association was found between physical activity volume and the emotional problems subscale of the SDQ. These findings infer that physical activity has the potential to reduce the risk of emotional symptoms in adolescents. Future cohort study designs should allow for repeated measures to fully explore the temporal nature of any relationship.
F4
Jo Williams
University of Bristol
Do Early Years Settings engage with a broad child health improvement programme and what changes do they make?
Micky Willmott1, Jo Williams2, Russ Jago3, Chris Metcalfe4, Julie Mytton5, Rona Campbell6, Ruth Kipping7.
1 Senior Research Associate, Bristol Medical School, University of Bristol
2 Consultant Senior Lecturer in Public Health, Bristol Medical School, University of Bristol
3 Professor of Paediatric Physical Activity and Public Health, School for Policy Studies, University of Bristol
4 Professor of Medical Statistics, Bristol Medical School, University of Bristol
5 Professor of Child Health, Department of Nursing and Midwifery, University of the West of England
6 Professor of Public Health Research, Bristol Medical School, University of Bristol
7 Consultant Senior Lecturer in Public Health, Bristol Medical School, University of Bristol
Aim: To evaluate the pilot Bristol Standard for Health (BSH), including acceptability, changes in practice, and feasibility of future research.
Background: Bristol City Council developed the BSH to improve ten health priorities in Early Years Settings (EYS) and invited 15 settings to each pilot two topics. No known EYS intervention covers this range: physical activity, domestic violence, oral health, immunisations, nutrition, emotional health, injury, smoking, supporting young parents, and risk behaviours.
Methodology: Ten of the EYS were invited to participate in the research; nine consented. When EYS set health improvement targets (June 2017), data were collected using observation (n=16), semi-structured interviews (n=16), one focus group and documentary analysis (n=8). Nine months later, 9 settings participated in a follow-up study with observation; semi-structured interviews (n=6); and documentary analysis (n=9). Interviews and focus group were audio-recorded, transcribed and anonymised; observations were recorded on standard templates. Data were analysed in NVivo11 using a framework based on thematic analysis. Documentary analysis of targets set by EYS were dual coded using the framework of the Nuffield ladder of interventions .
Results: The BSH is feasible, acceptable and the focus on health was welcomed by EYS with benefits in staff knowledge and confidence. Domestic violence and emotional health were the most frequently selected topics and smoking, the least. Sixty-five targets were set and 36 achieved, of which 24 were ‘monitoring’ or ‘providing information’, 10 ‘enabling choice’; and 2 ‘guiding choice’.
Conclusions: Whilst EYS engaged in a broad range of health topics through the BSH, to improve impact on child health the programme should be strengthened through training and support to implement evidence-based interventions. The heterogeneity of the changes and outcomes makes it unsuitable for an RCT study but further evaluation is important.