Gary Raine

A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons

BackgroundPrisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.MethodsA mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012.Study selection criteria were:Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs).Intervention: Peer-based interventions.Comparators: Review questions 3 and 4 compared peer and professionally led approaches.Outcomes: Prisoner health or determinants of health; organisational/process outcomes; views of prison populations.Study designs: Quantitative, qualitative and mixed method evaluations.ResultsFifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions.ConclusionsThere is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.Systematic review registrationPROSPERO ref: CRD42012002349.

An examination of the association between premature mortality and life expectancy among men in Europe.

BACKGROUND A feature of the health of men across Europe is their higher rates of premature mortality and shorter life expectancy at birth than women. Following the publication of the first State of Mens Health in Europe report, we sought to explore possible reasons. METHOD We analyzed trends in life expectancy at birth in 19 European Union member states (EU19) between 1999 and 2008 using mortality data obtained from Eurostat. We then used Pollards decomposition method to identify the contribution of deaths from different causes and at different age groups to differences in life expectancy. RESULTS Between 1999 and 2008, life expectancy at birth in the EU19 increased by 2.74 years for men and by 2.09 years for women. Most of these improvements were due to reductions in mortality at ages >60, with cardiovascular disease accounting for approximately half these improvements for men. In 2008, life expectancy of men in the EU19 was 5.92 years lower than that of women. Deaths from all major groups of causes, and at all ages, contributed to this gap, with external causes contributing 0.96 years, cardiovascular disease 1.80 years and neoplasms 1.61 years. CONCLUSION Improvements in the life expectancy at birth of men and women have mostly occurred at older ages. There has been little improvement in the high rate of premature death in younger men, suggesting a need for interventions to tackle their high death rate.

Commercial activities in primary schools: a quantitative study

The commercialisation of schools is a controversial issue, but very little is known about the actual situation in UK schools. The aim of this study was to investigate, with particular reference to health education and health promotion, commercial activities and their regulation in primary schools in the Yorkshire and Humber region of the UK. A questionnaire was sent to a random sample of 650 headteachers with respondents being asked whether a range of commercial activities had been present in their school during the previous 20 months. They also indicated whether the school had any policies on the types of activity covered by the questionnaire. The results showed that four types of commercial activity had been present in over 50% of responding schools. These were voucher/token collection schemes, business linked competitions/contests, business linked sports coaching and sponsorship. Voucher/token collection schemes were found to be the most common form of activity, with 85% of schools having participated in at least one of these initiatives. Only 4% of schools had any policies on the types of activity covered in the questionnaire. Further research in the UK on commercial activities in schools is recommended.

Commercial Activities and the Promotion of Health in Schools

Many companies nowadays consider schools to be an important setting for marketing to children. However, important concerns can be raised from a health promotion perspective about the potential negative impact of commercial activities on the health and well-being of pupils. As this discussion paper will demonstrate, some commercial activities raise concerns in relation to physical health and obesity, not only by potentially undermining formal curriculum messages, but also through the active promotion of specific products, particularly those high in fat, sugar or salt. Nonetheless, the issues raised by commercial activities are not solely limited to effects on physical health. By allowing commercial activities, schools risk instilling in pupils consumer-orientated values. This is significant as such values have been linked to the development of poor health and well-being. Furthermore, the presence in schools of commercial activities will also militate against informed decision-making and be disempowering. There is also evidence that business-sponsored teaching materials can contain biased and misleading information. The potential negative impacts of commercial activities are inconsistent with goals in relation to the promotion of health and the principles of health-promoting schools.

Doing and rethinking. Building resilience with men

Purpose – The purpose of this paper is to present findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of activities within a multi-dimensional men’s mental health programme, and exploring interactions between social context factors and models of change. Design/methodology/approach – The paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning activities, social support and coping strategies, and to situate these within wider environments. Findings – The programme significantly raised the perceived resilience of participants. Activities were engaging for men, while the complex intersection between activities, social networking, and coping strategies course provided opportunities for men to develop resilience in contexts resonant with their male identities. Research limitations/implicat...

Peer support as a resilience building practice with men

Purpose – The purpose of this paper is to present findings from an evaluation of a community mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of facilitated peer support within a multi-dimensional men’s mental health programme, and exploring implications for resilience building delivery approaches for men. Design/methodology/approach – The paper draws on a mixed methodology design involving before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning peer support, and to situate these within wider community environments. Findings – The programme significantly raised the perceived resilience of participants. Project activities promoted trusting informal social connections, gains in social capital arose through trusting relations and skill-sharing, and peer-peer action-focused talk and planning enhanced men’s resilience. Research limi...

Extending the Comfort Zone: Building Resilience in Older People With Long-Term Conditions

This article examines how a 6-week mental health resilience course for people with long-term conditions (LTCs; diabetes, heart disease, and arthritis) increased perceived resilience of older participants. This article examines how peer support assisted participants to develop resilience, considers gender issues, examines the importance of course activities, and explores how resilience enhances quality of life. A mixed methods approach was used. A before-and-after questionnaire was administered 3 times, including 3-month follow-up. Interviews were held with 24 program participants, aged 45 to 80 years. Diaries were kept by participants over 3 months. Survey findings showed significant gains in perceived resilience, at the end of the course, with no significant drop-off after 3 months. Interview and diary narratives highlighted positive experiences around well-being, condition management, and social engagement. Peer support was key to effective processes. Challenges concern ongoing support in communities, and considering age and gender variables when researching what improved resilience means to older people with LTCs.