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John Kemm

Publications and source records attributed to John Kemm.

5 recordsLinked to original sources
PubMed2006

The limitations of 'evidence-based' public health.

This paper examines how the concept of the 'evidence-based' approach has transferred from clinical medicine to public health and has been applied to health promotion and policy making. In policy making evidence has always been interpreted broadly to cover all types of reasoned enquiry and after some debate the same is now true for health promotion. Taking communities rather than individuals as the unit of intervention and the importance of context means that frequently randomized controlled trials are not appropriate for study of public health interventions. Further, the notion of a 'best solution' ignores the complexity of the decision making process. Evidence 'enlightens' policy makers shaping how policy problems are framed rather than providing the answer to any particular problem. There are lessons from the way that evidence-based policy is being applied in public health that could usefully be taken back into medicine.

Decision Making↗
PubMed2003

A model to predict the results of changes in smoking behaviour on smoking prevalence.

BACKGROUND: Data are available on the prevalence of smoking states (never, current and ex). However, data on behaviour change rates (starting - never to current, quitting - current to ex and lapsing - ex to current) are not readily available and cannot be simply derived from or related to prevalence data. METHOD: A model was constructed to relate prevalence of smoking states to behaviour change rates. It was populated with prevalence of smoking status taken from the General Household Survey together with population structure, age- and sex-specific death rates, and birth rates for England and Wales. This model could be used to calculate past behaviour change given observed prevalence of smoking states or future prevalence of smoking given predicted rates of behaviour change. RESULTS: To fit data it was necessary to assume that as they age some ex smokers reclassify themselves as never smokers. In the age band 16-19 years about 9 percent of never smokers start smoking, and about 5 percent of current smokers quit. In the age band 20-24 years the corresponding figures for starting are about 4 percent in males and 2 percent in females, and for quitting about 2 percent in both. In older age bands the percentages starting are zero or less than zero (indicating reclassifying), and the percentage quitting rises with age. Net lapsing (shift from ex to current) occurred very infrequently and is quantitatively unimportant. If the current starting, quitting and lapsing rates are maintained the Smoking kills target will not be met. Future prevalence of smoking under different scenarios is examined. CONCLUSION: The model is useful in calculating the proportions changing smoking state from serial cross-sectional data on prevalence and for predicting future prevalence.

Adolescent↗
PubMedDate not supplied

An analysis by birth cohort of alcohol consumption by adults in Great Britain 1978-1998.

AIMS AND METHODS: The General Household Survey for Great Britain has, since 1978, in even numbered years, included questions on alcohol consumption. A cohort analysis was applied to these sequential cross-sectional data. RESULTS AND CONCLUSIONS: Analysis confirms that, after about age 20 years, both men and women, as they grow older, become more likely to be non- or very light drinkers. Men are also less likely to be heavy drinkers as they grow older, but for women the picture is less clear-cut. Cohort effects can also be discerned, but are much less obvious than for smoking. There is a general trend for members of later cohorts at any age to be less likely to be non- or very light drinkers and more likely to be heavy drinkers, than members of earlier cohorts. However, for men, this trend seems to have ended with those born from about 1927 to 1931, while for women the trend has continued and possibly become stronger in cohorts born after 1927-1931.

Adult↗