Hannah Farrimond

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS).

BACKGROUND This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents. METHODS BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each students area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances. RESULTS Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship. CONCLUSIONS This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Beyond the caveman: Rethinking masculinity in relation to men’s help-seeking

Statistically, men make less use of health-care services than women. This has been interpreted as the result of the ‘hegemonic’ masculine code in which ‘real’ men are understood to be physically fit, uninterested in their health and self-reliant. However, less attention has been paid to understanding how hegemonic masculinity intersects with the wider western socio-cultural contexts of men’s help-seeking, particularly the valorization of health as a form of social achievement. This article presents the results of interviews with 14 higher socio-economic status (SES) men to uncover their ‘interpretive repertoires’ in relation to health and illness, help-seeking and masculinity. Although many interviewees drew on the stereotype of the ‘Neanderthal Man’ who avoids the doctors to explain help-seeking by men ‘in general’, they constructed their own experiences of help-seeking in terms of being responsible, problem-solving and in control. It is argued that the framing of help-seeking in terms of ‘taking action’ chimes with an increasingly pro-active ‘expert patient’ approach within western health-care. This conceptual reconstruction of the dominant masculine code in relation to help-seeking, from ‘Neanderthal Man’ to ‘Action Man’, may lead to greater gender equality in terms of accessing health-care. However, it has the potential to exacerbate social inequalities between men from different SES groups.

Non-Invasive Prenatal Genetic Testing: A Study of Public Attitudes

Background/Objectives: Non-invasive prenatal genetic diagnostic (NIPD) tests are being developed using cell-free fetal DNA in the maternal circulation. NIPD tests avoid or reduce the need for invasive diagnostic procedures for conditions like Down syndrome. Discussion of ethical and social implications of these techniques is increasing. We report findings from a study of public attitudes relevant to the introduction of NIPD. A key aim was to examine the range of attitudes relevant to NIPD within a diverse sample. Methods: Qualitative analysis of written free text ‘first responses’ to a written neutral description of NIPD as part of a Q-methodology study conducted with a purposive sample of the UK population (n = 71). Results: The majority (63%) of respondents described their first response as positive. However, respondents displayed ambivalence, expressing positive views of individual/medical rationale for NIPD and unease concerning public health rationale and societal implications. Unease related to eugenic reasoning underlying existing prenatal testing, ‘too much control’ in reproduction, commercial provision, information and support requirements for expanded testing, and limiting the use of testing. Conclusions: These findings suggest that regulating and monitoring commercial provision of NIPD services, and monitoring introduction and clinical use, are a public preference.

Public viewpoints on new non-invasive prenatal genetic tests:

Prenatal screening programmes have been critiqued for their routine implementation according to clinical rationale without public debate. A new approach, non-invasive prenatal diagnosis (NIPD), promises diagnosis of fetal genetic disorders from a sample of maternal blood without the miscarriage risk of current invasive prenatal tests (e.g. amniocentesis). Little research has investigated the attitudes of wider publics to NIPD. This study used Q-methodology, which combines factor analysis with qualitative comments, to identify four distinct “viewpoints” amongst 71 UK men and women: 1. NIPD as a new tool in the ongoing societal discrimination against the disabled; 2. NIPD as a positive clinical application offering peace of mind in pregnancy; 3. NIPD as a medical option justified for severe disorders only; and 4. NIPD as a valid expansion of personal choice. Concerns included the “trivialisation of testing” and the implications of commercial/direct-to-consumer tests. Q-methodology has considerable potential to identify viewpoints and frame public debate about new technologies.

Making sense of being at ‘high risk’ of coronary heart disease within primary prevention

Current National Health Service policy advocates screening to identify individuals at ‘high risk’ of cardio-vascular disease (CHD) in primary care. This article utilizes the work of Radley to explore how ‘high risk’ of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. ‘Discovery’ interviews were conducted with ‘high risk’ participants (n = 38, mean age = 55) two weeks after intervention and thematically analysed. In response to perceived threat, many participants sought to both ‘minimize’ and ‘normalize’ their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower socio-economic status participants. Such perceptions and intentions were contextualized within the life-course of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at ‘high risk’ of CHD in later middle-age.

A Q-methodological study of smoking identities

In contrast to the psychological literature on adolescent smoking, little research has investigated the social identities of adult smokers. This study aimed to identify shared ‘smoking identities’ amongst a sample of 64 British smokers from different socio-economic groups using Q-methodology. Participants were asked to sort 70 items concerning smoking and smokers according to their agreement/disagreement with them. The 64 Q-sorts were then subjected to a by-person factor analysis yielding six factors, with the first four interpretable factors being presented here. Each factor is understood to represent a distinct ‘identity position’. The first two, the ‘addicted’ smoker, and the ‘in control’ smoker, oriented around a biomedical model of smoking as an addictive health risk. The final two, the ‘no big deal’ smoker and the ‘proud’ smoker reflected alternative understandings and values. The identity positions also differed in the extent to which smoking was considered a core part of self-identity. Unpacking the ‘smoking identities’ of current smokers offers the opportunity to devise targeted health promotion.

The impact of breathalysers on violence and attitudes in the night-time economy:

The current study evaluates the efficacy and acceptability of a month-long pilot breathalyser scheme for pubs and clubs implemented in the UK. During the initiative 818 people were breathalysed. The number of violent crimes (excluding domestic abuse) decreased by almost 40 percent compared with the previous year, while violent incidents increased in a comparison location. The Assault Related Injuries Database (ARID) of admissions to Accident and Emergency showed there were fewer alcohol-related injuries during the initiative. Over 75 percent of respondents to an online survey (n = 310) supported the breathalyser scheme. Results suggest the breathalysers may promote moderate drinking and result in less violence. However, the number of crimes is small and fluctuates over time, so more research is needed to demonstrate whether this initiative is effective.

Active ageing, emotional care and the threat of stigma: Identity management in older adults using sleeping medication long-term:

Amid fears about the medicalisation of old age, the high prevalence of sleeping medication use in older cohorts is a significant public health concern. Long-term use is associated with a plethora of negative effects, such as cognitive impairment and risk of addiction. However, little is known about the lived experience of older adults using sleeping medication longer term. Episodic interviews lasting approximately 90 minutes were conducted with 15 independently living adults, aged 65–88 years, who were using sedative-hypnotic or tricyclic sleeping medication for more than 11 years on average. Thematic analysis shows that participants divided their rationale for use into two temporal periods: (1) to ensure physical ability in the daytime and (2) to ensure emotional stability at night. Long-term sleeping medication was thus characterised as a form of ‘emotional self-management’ of the negative emotions associated with later life, blotting out feelings of loss and loneliness by inducing sleep. Participants feared loss of access to their medication ‘supply’, employing strategies to ensure its continuity, while expressing shame about their dependence. However, identity management, in the form of explanations, minimisations and social comparisons, functioned to downplay their addiction. Through this, long-term sleeping medication users were able to elude the spoiled identities and multiple stigmas of both the ‘out of control’ addict and the unsuccessful older adult by asserting a positive identity; that of the ‘new’ older adult, actively medicating for success both day and night.

Making Sense of Evidence: Using Research Training to Promote Organisational Change

Abstract Many have argued that the development of evidence-based policing (EBP) depends on those in law enforcement agencies receiving appropriate training in research methodologies and data analysis. Despite this, there are few detailed accounts of such training and its delivery. This paper describes and evaluates the contribution of training workshops for police officers and staff in driving forward EBP. The workshops, developed based on a model used in healthcare, sought to provide attendees with the knowledge, skills, and confidence to engage with research evidence during their work, and sat within a wider plan for organisational change within one force in England. We outline the development and delivery of the workshops, which were undertaken using an action research approach, and assess their impact including subsequent changes to practice. Finally, we consider the role these workshops played within organisational change, and reflect on how EBP can be promoted within academic-police collaborations.