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Biomedical subjects

P Aveyard

Publications and source records attributed to P Aveyard.

18 recordsLinked to original sources
PubMed2003

The importance of social sources of cigarettes to school students.

OBJECTIVE: To discover the importance of social sources of tobacco to young people as opposed to commercial sources; to describe the peer market for cigarettes in schools and the consequences for young people of their involvement in it. STUDY DESIGN: Cross sectional questionnaire survey, one-to-one interviews, and focus groups. SETTING: Seven schools in Birmingham, UK. SUBJECTS: All students in two randomly selected classes from each school completed the questionnaire, and never smokers, occasional smokers, and regular smokers were interviewed. RESULTS: Two thirds of occasional smokers and one quarter of regular smokers obtained cigarettes socially, mostly for free. A few smokers regularly bought their cigarettes from others. Among friendship groups, both smokers and non-smokers were involved in the exchange of cigarettes, often for money, which is a common activity. A few young people use the selling of cigarettes to fund their own smoking. Some young people, smokers and non-smokers, are involved in semi-commercial selling of cigarettes. All school students are aware of where to purchase cigarettes from non-friends, which is only used "in emergency" because of the high price. One school had a strong punishment policy for students caught with cigarettes. In this school, more people bought singles from the peer market and the price was higher. CONCLUSIONS: The passing and selling of cigarettes in school is a common activity, which from the young persons perspective, ensures that all share cross counter purchases. A few people are prepared to use the peer market for monetary gain and it appears to be responsive to external conditions. The peer market might mean that efforts to control illegal sales of cigarettes are not as effective as hoped.

Adolescent↗
PubMed2003

A cluster randomised controlled trial of smoking cessation in pregnant women comparing interventions based on the transtheoretical (stages of change) model to standard care.

OBJECTIVES: To evaluate the effectiveness in helping pregnant women stop smoking of two interventions (Pro-Change for a healthy pregnancy) based on the transtheoretical model of behaviour change (TTM) compared to current standard care. DESIGN: Cluster randomised trial. SETTING: Antenatal clinics in West Midlands, UK general practices. PARTICIPANTS: 918 pregnant smokers INTERVENTIONS: 100 general practices were randomised into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM based self help manuals), and C (TTM based self help manuals plus sessions with an interactive computer program giving individualised smoking cessation advice). MAIN OUTCOME MEASURES: Biochemically confirmed smoking cessation for 10 weeks previously, and point prevalence abstinence, both measured at 30 weeks of pregnancy and 10 days after delivery. RESULTS: There were small differences between the TTM arms. Combining the two arms, the odds ratios at 30 weeks were 2.09 (95% confidence interval (CI) 0.90 to 4.85) for 10 week sustained abstinence and 2.92 (95% CI 1.42 to 6.03) for point prevalence abstinence relative to controls. At 10 days after delivery, the odds ratios were 2.81 (95% CI 1.11 to 7.13) and 1.85 (95% CI 1.00 to 3.41) for 10 week and point prevalence abstinence respectively. CONCLUSIONS: While there is a small borderline significant increase in quitting in the combined intervention arms compared with the controls, the effect of the intervention is small. At 30 weeks gestation and at 10 days postnatal, only about 3% of the intervention groups achieved sustained cessation, with numbers needed to treat of 67 (30 weeks of gestation) and 53 (10 weeks postnatal) for one additional woman to achieve sustained confirmed cessation. Given also that the intervention was resource intensive, it is of doubtful benefit.

Adolescent↗
PubMed2002

The relationship between mean birth weight and poverty using the Townsend deprivation score and the Super Profile classification system.

Super Profiles have been used as alternative methods of characterising the deprivation of an area. Some reports suggest that Super Profiles are as accurate as established indices such as the Townsend score (TS). This was a test of this assertion.A total of 138 696 live born singleton births to Birmingham residents born between 1986 and 1996 (inclusive) were allocated to enumeration districts (EDs) by linkage from the postcode. We allocated the TS of the individual's ED. We allocated a Lifestyle and Target Market (TM) from Super Profiles by linkage to the ED. We examined the gradient between mean birth weight and the 10 Super Profile Lifestyles and compared this to the gradient between 10 Townsend groups and mean birth weight. We repeated this approach using the 40 TMs and 40 Townsend groups. We used both the median income and a census-derived deprivation measure to rank Lifestyles and TMs. The gradient between mean birth weight and area deprivation was linear for Townsend groups but not linear using either Lifestyles or TMs whichever method of ranking Lifestyles or TMs was used. Where Lifestyles or TMs were out of line with their neighbours, the TS of that group mostly explained this. As Super Profiles are generated using nationally representative data, applying the affluence ranking to small areas can lead to inaccuracies, as shown in this data. We conclude that Super Profiles are probably unsuitable as measures of deprivation of small areas.

Birth Certificates↗
PubMed2002

Does smoking status influence the prognosis of bladder cancer? A systematic review.

OBJECTIVE: To summarize, in a systematic review, the evidence for the effect of stopping smoking on recurrence, cancer-specific and all cause-mortality among smokers with newly diagnosed bladder cancer. MATERIALS AND METHODS: Two electronic databases and the reference lists of identified primary studies and reviews were searched. Studies were included if a hazard ratio and its confidence intervals could be extracted. A predefined set of study characteristics was extracted which defined whether studies were giving valid prognostic data on the effects of smoking in reasonably homogenous cohorts. The results of studies were synthesized qualitatively. RESULTS: Fifteen relevant studies were identified; former and current smokers were combined in many studies. Many studies produced information on prognosis that was confounded by the mixing of incident and prevalent cases. Only three studies examined the influence of smoking on prognosis in only incident cases, most of whom had superficial disease. Of these, only one was of high quality. These three studies and the other 12 showed suggestive evidence that continued smoking or a lifetime of smoking constitutes a moderate risk factor for recurrence and death, and that stopping smoking could favourably change this. However, the evidence base for this is weak because of the methodological shortcomings and because most studies' results were not statistically significant. A life-table model showed that if stopping smoking altered the prognosis, the size of the benefit would be clinically worthwhile. CONCLUSION: There is suggestive evidence that stopping smoking might favourably alter the course of bladder cancer, but this is insufficient for clinicians to inform patients that doing so will improve their prognosis, and for providing specialized services to assist in stopping smoking to patients with bladder cancer.

Adult↗
PubMed2001

The change-in-stage and updated smoking status results from a cluster-randomized trial of smoking prevention and cessation using the transtheoretical model among British adolescents.

BACKGROUND: The transtheoretical model (TTM) and computer technology are promising technologies for changing health behavior, but there is little evidence of their effectiveness among adolescents. METHOD: Four thousand two hundred twenty-seven Year 9 (ages 13-14) pupils in 26 schools were randomly allocated to control and 4,125 in 26 schools were allocated to TTM intervention. TTM pupils received three whole class lessons and three sessions with an interactive computer program. Control pupils received no special intervention. Positive change in stage and smoking status was assessed from a questionnaire completed at baseline, 1 year, and 2 years. Random effects logistic regression was used to compare the change in stage and smoking status between the arms. RESULTS: Eighty-nine percent of the TTM group and 89.3% of the control group were present at 1-year and 86.0 and 83.1%, respectively, were present at 2-year follow-up. The adjusted odds ratio (95% confidence interval) for positive stage movement in the TTM relative to control was 1.13 (0.91-1.41) at 1 year and 1.25 (0.95-1.64) at 2 years and for regular smoking was 1.14 (0.93-1.39) at 1 year and 1.06 (0.86-1.31) at 2 years. Subgroup analysis by initial smoking status revealed no benefit for prevention or cessation. CONCLUSIONS: The intervention was ineffective.

Adolescent↗
PubMed2001

The cost effectiveness of including pencils and erasers with self-completion epidemiological questionnaires.

It is cheap to process epidemiological data from optical mark read (OMR) questionnaires. Respondents should use a pencil to complete OMR questionnaires, but many will not unless these are supplied. Sending pencils and erasers is expensive. Does sending pencils and erasers increase the response rate as cost-effectively as sending reminders, or does this decrease the error rate and offset data checking costs? We mailed 300 smokers and half were randomised to receive pencils and erasers. The relative risk (95% confidence intervals) for the response rate for the pencil group relative to the non-pencil group was 0.77 (0.46-1.29) and for the error rate was 1.31 (0.78-2.21). Sending pencils and erasers was not cost-effective in sensitivity analysis with any response rate or using the confidence intervals. Including pencils with mailed epidemiological questionnaires probably has no benefit and any plausible benefit does not offset the costs of sending pencils and erasers.

Cost Allocation↗
PubMed2000

Does the multidimensional nature of Super Profiles help district health authorities understand the way social capital affects health?

BACKGROUND: Social capital describes the notion that the social processes in an area can lead to benefits in health. As Super Profiles describe the social character of an area and they are easy for health authorities to use, they could provide a simple method for local assessment of how social organization affects health. METHODS: We calculated the expected mean birthweight for the enumeration districts of Birmingham based upon marital status, registration details of the child, year of birth, the mother's country of birth, fetal sex and deprivation as judged by the Townsend score using data from 138,696 live-born singleton births for the years 1986-1996 inclusive. We classified enumeration districts into Target Markets, derived from Super Profiles. For each Target Market, we calculated the observed mean birthweight and the difference and 95 per cent confidence interval between the observed and expected birthweights. We used information in Super Profiles to speculate about the social processes that led to some Target Markets having mean birthweights that were significantly different from those expected. RESULTS: Fifteen of the 40 Target Markets had significant differences between predicted and observed mean birthweight, but these differences were less than 50 g. There were no common characteristics of Target Markets that were consistently advantageous for birthweight and none that were disadvantageous. CONCLUSION: The information in the Super Profiles does not illuminate the way that social processes affect health, and the variation in mean birthweight between areas explained by social processes as measured by Super Profiles is small.

Birth Certificates↗
PubMed1999

Cluster randomised controlled trial of expert system based on the transtheoretical ("stages of change") model for smoking prevention and cessation in schools.

OBJECTIVES: To examine whether a year long programme based on the transtheoretical model of behaviour change, incorporating three sessions using an expert system computer program and three class lessons, could reduce the prevalence of teenage smoking. DESIGN: Cluster randomised trial comparing the intervention to a control group exposed only to health education as part of the English national curriculum. SETTING: 52 schools in the West Midlands region. PARTICIPANTS: 8352 students in year 9 (age 13-14 years) at those schools. MAIN OUTCOME MEASURES: Prevalence of teenage smoking 12 months after the start of the intervention. RESULTS: Of the 8352 students recruited, 7444 (89.1%) were followed up at 12 months. The intention to treat odds ratio for smoking in the intervention group relative to control was 1.08 (95% confidence interval 0.89 to 1.33). Sensitivity analysis for loss to follow up and adjustment for potential confounders did not alter these findings. CONCLUSIONS: The smoking prevention and cessation intervention based on the transtheoretical model, as delivered in this trial, is ineffective in schoolchildren aged 13-14.

Adolescent↗
PubMed1998

A fresh look at proportional mortality ratios.

This is a review of the use of proportional mortality ratios (PMRs). District health authorities rarely concern themselves with searching for unknown causes of disease but do need to monitor the health of a population. PMRs are a good way to do this. Textbooks of epidemiology tend to see PMRs as biased measures of risk and give them little attention. This review shows that the bias is small and of no practical importance. PMR studies can be seen as case-control studies and the major bias in these studies as analogous to Berkson's fallacy. We can then use the same techniques to reduce bias in PMR studies that are used in case-control studies. These are the use of several controls, the use of positive and negative controls, and the use of only one type of death in the denominator, rather than all causes of death. This article reviews these means of minimising bias using examples to show that careful selection of controls can overcome many of the supposed problems of PMR studies. It also shows how PMRs can control confounding in a way that SMRs cannot. PMR studies should be more widely used to monitor the health of the population.

Bias↗
PubMed1997

Evidence-based medicine and public health.

Much of the everyday work of public health professionals is concerned with the implementation of evidence-based medicine (EBM). Is this likely to improve the quality of the health service that patients' receive? In this paper, I argue that EBM is unlikely, by itself, to improve the dimensions of quality as defined by Maxwell (1994). This is because EBM relies on the individual doctor doing the right thing all of the time. Open systems theory is a way of looking at the influences of the environment on individual clinical behaviour. Using this perspective, it is easy to see why EBM will fail to improve patient care dramatically. The environment in which we work is a much bigger influence on us than we care to admit. I use some published examples to look at the way that the environment affects clinical behaviour to the detriment of the overall service quality. As public health professionals, we should be more concerned with the outcome of the service than with the specifics of a particular consultation. In this context, EBM is likely not to be a very useful tool for public health professionals.

Evidence-Based Medicine↗
PubMed1997

Monitoring the performance of general practices.

Performance indicators for general practice which reduce complex processes to simple counts can have little validity. Additionally, performance indicators are often statistically unreliable in small populations like general practices. Instead, it is possible to combine these measures of performance by using multiple regression to predict the outcome from a set of processes. This allows one to adjust the outcome for differences in the practice populations. It also improves the statistical reliability, because data from all practices are used to predict the outcome. This approach has statistical problems, because it is an ecological analysis, and does not pick out the poor performers ('bad apples'). The regression approach is similar to the concepts of continuous quality improvement (CQI). It is arguable that using CQI to improve quality is more likely to lead to cooperation from general practices than trying to pick out the poor performers.

Cooperative Behavior↗
PubMed1997

Assessing the performance of general practices caring for patients with asthma.

BACKGROUND: General practitioners (GPs) have had to record information about chronic disease management and send this to the health authorities since the introduction of the new contract in 1990. AIM: To discover the relationship between practice emergency admission rates for asthma and the characteristics of the practice's patients and chronic disease management programme. METHOD: This was an ecological study comparing practice emergency admission rates of asthma by general practice with the practice's performance in measuring the prevalence, peak flow, and number of patients on regular prophylaxis. In addition, prescribing analysis and costing (PACT) data and census linkage were used to assign social class to patients and, when aggregated, to practices. The practice admission rate was correlated against each of these variables and then the relationships were explored in multiple linear regressions. RESULTS: A high rate of admission in practices was correlated with deprivation of the patients, in the form of a practice Townsend score (r = 0.33, P = 0.003), and also with poorer prescribing, measured by the preventer-reliever ratio (r = -0.38, P = 0.001). Regression analysis showed that the relationship between good prescribing and low admission rates was not explained by confounding variables. Only 32% of the variation in admission rates between practices was explained by the regression equation. None of the variables recorded in the annual report were significantly related to admission rates. CONCLUSION: Annual reports from the practice to the health authority are unhelpful in monitoring general practice performance, but prescribing, as measured by the preventer-reliever ratio, and hospital admission rates have limited usefulness.

Asthma↗