Bruce Bolam

Mediation and the Construction of Contemporary Understandings of Health and Lifestyle

The practice of using media to promote the benefits of diet and exercise has been associated with the rise in prominence of a sense of personal obligation for one’s own health. This article contributes to recent critiques of the emphasis being placed on individual responsibility for health. We argue that if health psychologists are to develop an adequately social understanding of our role in promoting health, then we must begin to examine the influence of our practices and agendas on public understandings. Extracts from research accounts are used to illustrate the pervasiveness of media health messages in everyday life and the prominence of a sense of individual responsibility.

'Just do it': An analysis of accounts of control over health amongst lower socioeconomic status groups

Recent interest in health inequalities research has focused upon psychosocial factors such as a sense of control. Previous work has sought to measure or describe personal beliefs about control over health without addressing the contradictory and rhetorical dimensions of such accounts. These issues are explored through an analysis of interviews with 30 lower socioeconomic status (SES) participants drawn from two qualitative studies of health inequalities. Key findings concern the rhetorical construction and interweaving of two contrasting positions regarding control over health: fatalism and positive thought. Fatalistic talk provided a means by which participants acknowledged their limited control over health, although not in an exclusively negative manner. Talk about thinking positively enabled participants to present themselves as having agency in the face of adversity. The creative interweaving of these two positions in accounts of control over health enabled participants to navigate the moral imperative of responsibility for health in the context of adverse and capricious circumstance. By foregrounding the social character of accounts of control the significance of moral and ethical dimensions for health inequalities research and practice are highlighted.

Does smoking cessation cause depression and anxiety? Findings from the ATTEMPT cohort.

INTRODUCTION The impact of long-term smoking abstinence upon symptoms of depression and anxiety has not been adequately studied. The ATTEMPT cohort is the largest longitudinal study of smoking cessation currently available with sufficiently frequent follow-up to be able to address this question. METHODS A cohort of quitters free from symptoms of depression (n = 1,027) and anxiety (n = 936) at baseline were followed up over 9 months using an established Internet panel. RESULTS The age- and sex-adjusted odds ratios for incident symptoms of depression or anxiety associated with 6- to 9-month smoking abstinence compared with continued smoking were 1.03 (95% CI 0.41 to 2.56) and 1.05 (95% CI 0.39 to 2.82), respectively. CONCLUSIONS Stopping smoking does not appear to increase the risk of symptoms of depression and anxiety in those free from symptoms when they quit.

Place-identity and geographical inequalities in health: A qualitative study

Psychological research on health inequalities has yet to consider the geographical dimension to these injustices. The study reported here is aimed to describe accounts of health, well-being and place-identity associated with two inner-city locales within a southern English city, distinct in terms of the health of their populations, to advance psychosocial explanations of geographical inequalities in health. Thirty participants, sampled using a combination of purposive and theoretical strategies, completed semi-structured interviews which were subsequently analysed using discourse analysis. The three key themes of pollution, space and community elucidate the material, psychological and social domains of place-identity in accounts of health, well-being and inequality. By centring upon the locatedness of human subjectivity, analysis of place-identity may be a useful tool in explicating how multiple dimensions of stratification interact within local contexts to reproduce geographical inequalities in health and social (dis)identification with place, without losing sight of the objective structural and material context of space.

Using New Media to Build Social Capital for Health A Qualitative Process Evaluation Study of Participation in the CityNet Project

The present article presents an exploratory qualitative process evaluation study of ‘Ambassador’ participation in CityNet, an innovative informationcommunication technology-based (ICT) project that aims to build aspects of social capital and improve access to information and services among disadvantaged groups in Nottingham, UK. A purposive sample of 40 ‘Ambassadors’ interviewees was gathered in three waves of data collection. The two emergent analytic themes highlighted how improvements in confidence, self-esteem and social networks produced via participation were mitigated by structural problems in devolving power within the project. This illustrates how concepts of power are important for understanding the process of health promotion interventions using new media.

Review of behaviour change interventions to reduce population salt intake.

BackgroundExcess salt intake is a major cause of raised blood pressure—the leading risk factor for death and disability worldwide. Although behaviour change interventions such as awareness campaigns and health education programs are implemented to reduce salt intake, their effectiveness is unclear. This global systematic review investigates the impact of population-level behaviour change interventions that aim to reduce salt intake.MethodsA search for published and grey literature was conducted using PubMed, Cochrane Library, Embase, Web of Science, Sage, Scopus, OpenGrey, Google Scholar and other relevant organizations’ websites. Studies were included if 1) published between 2005 and 2015; 2) the education or awareness-raising interventions were aimed at the population or sub-population and 3) salt intake and/or salt-related behaviours were outcome measures. Study and intervention characteristics were extracted for the descriptive synthesis and study quality was assessed.ResultsTwenty two studies involving 41,448 participants were included. Most were conducted in high income countries (n = 16), targeting adults (n = 21) in the general population (n = 16). Behaviour change interventions were categorised as health education interventions (n = 14), public awareness campaigns (n = 4) and multi-component interventions (including both health education and awareness campaigns, n = 4). 19 of the 22 studies demonstrated significant reductions in estimated salt intake and/or improvement in salt-related behaviours. All studies showed high risk of bias in one or more domains. Of the 10 higher quality studies, 5 found a significant effect on salt intake or salt behaviours based on the more objective outcome assessment method.ConclusionBased on moderate quality of evidence, population-level behaviour change interventions can improve salt-related behaviours and/or reduce salt intake. However, closer analysis of higher quality studies show inconsistent evidence of the effectiveness and limited effect sizes suggest the implementation of education and awareness-raising interventions alone are unlikely to be adequate in reducing population salt intake to the recommended levels. A framework which guides rigorous research and evaluation of population-level interventions in real-world settings would help understand and support more effective implementation of interventions to reduce salt intake.

Professionalization and Reflexivity in Critical Health Psychology Practice

W E S U P P O RT the arguments advanced by Prilleltensky and Prilleltensky (this issue) regarding the development of a critical health psychology practice. We draw attention to the key issues their article raises for debate about the professionalization of health psychology, and argue that a critical approach to practice counters current drives towards professionalization and the unproblematic adoption of a scientist-practitoner model within health psychology. We maintain that reflexivity must occupy a central place in the development of critical health psychology practice.

Salt reduction in Australia: from advocacy to action

BACKGROUND As part of its endorsement of the World Health Organizations Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action. METHODS A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies. RESULTS A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the governments Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015. CONCLUSIONS In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.

State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact

Background High-salt diets are linked to elevated blood pressure, a major risk factor for cardiovascular diseases, particularly stroke. State and community salt reduction strategies may complement nationally led initiatives and contribute to achieving global salt reduction targets. We aim to systematically review such interventions and document reported impact where programmes have been evaluated. Methods Electronic databases were searched up to June 2015 using terms ‘salt’ or ‘sodium’ and ‘state’ and ‘community’ in combination with ‘campaign’, ‘initiative’, ‘project’, ‘strategy’, ‘intervention’ or ‘programme’. Data from evaluated and unevaluated interventions were included. Studies were analysed in relation to intervention components and outcome measures and appraised for quality using a Cochrane Risk-of-Bias Tool. Results 39 state and community programmes were identified. Settings varied from whole communities (n=23), state-owned buildings (n=5), schools (n=7), workplaces (n=3) and correctional facilities (n=1). Strategies included nutrition education programmes, public education campaigns, changes to the food environment, other ‘novel’ approaches and multifaceted approaches. Of the 28 studies that evaluated intervention effectiveness, significant reductions were observed in terms of salt intake from dietary assessment (n=7), urinary sodium excretion (n=8), blood pressure (n=11) and sodium in foods (n=9). Six studies reported positive changes in consumer knowledge, attitudes and behaviours. All but two studies had some methodological limitations. Conclusions State and community salt reduction programmes may be effective in a range of settings but more robust evaluation methods are needed. Scaling up these efforts in coordination with national initiatives could provide the most effective and sustainable approach to reducing population salt intake.

Knowledge and Attitudes Are Related to Selected Salt-Specific Behaviours among Australian Parents

Salt intake in adults and children exceeds recommended levels. Salt-related knowledge, attitudes, and behaviours (KABs) may influence the amount of salt consumed. The aims of this study were to assess salt-related KABs among parents, and investigate whether salt-related knowledge and attitudes are associated with salt-specific behaviours. Parents with children <18 years were recruited from four shopping centers across Victoria, Australia; Facebook; and an online consumer research panel; they then completed an online questionnaire assessing salt-related KABs and salt use in children. Eight hundred and thirty-seven parents (mean age 41.0 (10.0) (SD) years) provided valid responses. Most (77%) parents were aware that eating too much salt damages children’s health and that reducing the amount of salt in their children’s diet was important (70%), and 46% reported adding salt to food prepared for their children. Parents who were aware that eating too much salt damages children’s health were less likely to report that their child added salt at the table (OR = 0.51, p < 0.001), and that they added salt to food prepared for the child (OR = 0.46, p < 0.001). Educational messages that highlight the adverse health effects of salt during childhood are likely to be useful in reducing discretionary salt use in the home environment.