Lisa Mohebati

Policy options for responding to the growing challenge from obesity in the United Kingdom

The aim of this study was to map and analyse how key stakeholders evaluated options for dealing with the rising incidence of obesity in the UK, as part of a wider cross‐national study in nine European countries. Multi‐criteria mapping was used to capture the ways in which different policy options were evaluated by a variety of key stakeholders. ‘Positive societal benefits’ was among the criteria most often selected by participants to assess the options and was generally considered more important than costs. Of the seven pre‐defined options that all participants appraised, those related to increasing opportunities for physical activity received the highest rankings, and fiscal measures the lowest. Educational measures fared best among the remaining 13 discretionary options while technological measures performed poorly. No one option, or group of options, was considered sufficient to address the obesity problem. Rather, a general consensus was evident in support of mutually reinforcing measures related to education, information, healthier food and physical activity. Although obesity policies are currently emerging in these different areas in the UK, there is a need for them to be better coordinated, and for improved surveillance to estimate their effectiveness in reversing the trend in obesity.

What factors are important in smoking cessation and relapse in women from deprived communities? A qualitative study in Southeast England.

OBJECTIVES Women are relatively more susceptible to smoking-related diseases and find it more difficult to quit; however, little research exists on factors associated with smoking cessation and relapse in women. We examined attitudes towards and perceptions of factors associated with smoking cessation and relapse in women from deprived communities. STUDY DESIGN Qualitative interview study. METHODS Participants included eleven women, smokers and ex-smokers, from disadvantaged communities in East Sussex, England, who had used the National Health Service (NHS) stop smoking service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis. RESULTS Participants opined that it is more difficult for women to quit smoking than men. Women felt that postcessation weight gain was inevitable and acted as a barrier to quitting. Hormonal fluctuations during the menstrual cycle and greater levels of stress were perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited effects of smoking on physical appearance, oral hygiene and guilt about exposing children to passive smoke as powerful motivators to quit; and highlighted the impact of public health campaigns that focused on these factors. Views diverged on whether quitting with someone close to you is a help or hindrance. Other themes including alcohol intake, daily routine and being in the presence of smokers emerged as situational triggers of relapse. CONCLUSIONS Interventions that address womens concerns related to postcessation weight gain, hormonal fluctuations during the menstrual cycle and stress may aid with smoking cessation and reduce relapse. Public health campaigns should consider the impact of smoking on physical appearance and the effect of passive smoke on children.

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England

Objective In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. Design and setting Qualitative study in Southeast England. Participants 26 adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. Results Participants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers. Conclusions People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.

Opinions of women from deprived communities on national tobacco control measures in England

Abstract Objective: To ascertain the perceptions of women from deprived communities on national tobacco control measures in England. Methods: A qualitative study of 11 women, smokers and ex-smokers, from disadvantaged areas, who had used the National Health Service (NHS) Stop Smoking Service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis. Results: The ban on smoking in confined public places was perceived as an effective measure for tobacco control. Methods to restrict accessibility – including removing point-of-sale displays, raising the price, and preventing sales in certain places – were perceived as effective techniques to deter smoking initiation and prevent triggering temptation to smoke for someone motivated to quit, but not helpful to change attitudes or behaviors among current smokers. Women felt desensitized to health warnings used on tobacco products. Public health campaigns with gain-framed messages were more likely to engage smokers to want to quit. Of the loss-framed messages, participants felt that focusing on personal appearance and children was effective. Conclusions: Strategies that are tailored to attitudes and beliefs among women smokers should consider gain-framed messages and messages that focused on the effects to appearance and children to promote cessation and prevent relapse.

Perceived barriers to accessing mental health services among black and minority ethnic communities: a qualitative study in southeast England

Abstract Background In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in health care. Methods In this qualitative study in southeast England, 26 adults (13 men, 13 women; aged >18 years) from black and minority ethnic backgrounds were recruited to two focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings, and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. Findings Participants identified two broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health, and financial factors. Second, factors affecting the relationship between service user and health-care provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity, and discrimination towards the needs of black and minority ethnic service users, and lack of awareness of different services among service users and providers. Interpretation People from black and minority ethnic backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Health-care providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from black and minority ethnic backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access. Funding Public Health Directorate NHS Brighton and Hove, Sussex Partnership NHS Foundation Trust, Black and Minority Ethnic Community Partnership, Brighton and Sussex Medical School.

How much does your baby cry?: Expectations, patterns and perceptions of infant crying in Mexico

BACKGROUND A limited number of studies have examined infant crying patterns in less affluent societies, but none of them have been longitudinal in nature. The aim of this study was to describe reported infant crying patterns in a cohort of Mexican infants and examine how these are associated with crying-related maternal expectations, general perceptions and help-seeking behavior. METHODS Observational cohort study, 204 primiparous mothers and their infants, recruited at birth and visited in their homes at nine different time points from 1 to 24 weeks of infant age. RESULTS Mothers reported that their infants cried less than infants in other more affluent societies, although not less frequently. A previously reported evening clustering of crying was present, with a subtle 24-h crying peak emerging around 2 to 4 weeks. Having an expectation of an infant who will be difficult to soothe and/or an increased report of crying frequency were associated with perceptions of maternal anguish, which was associated with maternal concern and help-seeking behaviors related to crying. CONCLUSIONS Similarities and differences were found in the crying patterns reported by mothers of Mexican infants and others previously studied. Expectations and reports of crying behavior were associated with maternal perceptions, which may have a role in reducing crying-related anguish and demand on health services.

PP75 What Factors are Important in Smoking Cessation and Relapse in Women from Deprived Communities? – A Qualitative Study

Background It is well established that women start to smoke earlier, are more susceptible to smoking-related disease and find it harder to quit than men. However, little research exists on factors associated with smoking cessation and relapse in women, particularly those from deprived communities. We conducted a qualitative study in South East England to examine these factors. Methods Eleven women who had used the NHS Stop Smoking Service in East Sussex were engaged in focus group discussions. Data were subjected to manual and NVIVO software-based thematic analysis. Results Women confirmed that it is harder for them to quit smoking than men. A number of gender-specific themes were identified for this perceived difference. Women felt that post cessation weight gain was inevitable and acted as a barrier to quitting. Menstrual fluctuations and greater levels of stress were perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited the effects of smoking on appearance, and guilt about exposing young children to passive smoking as powerful motivators to stop and highlighted the force of public health campaigns that focused on these factors. Whilst participants agreed that female smoking is still stigmatised it was not clear if this motivates cessation. The study exposed divergent views on whether quitting with someone close to you is a help or hindrance. Other non-gender specific themes including alcohol intake, daily routine and being in the presence of smokers all emerged as situational triggers of relapse. Discussion These findings support consideration of issues around weight gain, menstrual fluctuations, stress, appearance, stigma and guilt about exposure of young children to passive smoking in the design of public health campaigns and interventions. Female-specific policy/programmes have been shown to facilitate cessation in women, and more research is needed on how to limit the impact and perception of post-cessation weight gain, stress and menstrual fluctuations on cessation attempts and relapses. This study and previous research suggest that national campaigns focusing on appearance and the effect of passive smoke on children may alter behaviour. However, more research is needed to understand how altered appearance can be made more relevant to younger women, and whether mass media specifically targeted at women is more effective at changing female smoking behaviour. Low socioeconomic status and deprivation are the strongest predictors of smoking in women, and more research is needed into how services and interventions can be best designed to impact on women living in deprived communities.

OP02 Women’s Views on Smoking Cessation Services and National Tobacco Control Measures

Background A large proportion of public health resource is dedicated to smoking cessation services and national campaigns to control tobacco. Although it is well established that women start to smoke earlier, are more susceptible to smoking-related disease and find it harder to quit smoking than men, little research has been done to understand the perception of women regarding smoking cessation services and national tobacco control measures. Methods Eleven women who had used the NHS Stop Smoking Service in East Sussex were engaged in focus group discussions. Data were subjected to manual and NVIVO software-based thematic analysis. Results Women felt that tailoring of services to their needs would improve cessation rates. They expect the smoking cessation counsellors to be non-judgmental and to offer a psychological insight into addiction, however they shared differing opinions on the need for counsellors to be female or ex-smokers. They praised the continuity of care, capacity for peer support, flexibility of time and location and free cessation aids offered. Conversely, they felt the service was poorly advertised, that access was not universally good and that women would be more likely to access and engage with services if female-only groups and drop-in clinics were available. Use of social networking and integration of services into schools were highlighted as ways to engage young women. Opinion varied on the effect that removing cigarettes from view, limiting availability and increasing price would have on initiation and cessation. Campaigns focusing on appearance and consequences of passive smoke inhalation in children were praised, whilst most shock tactics were felt to be ineffective, with a more positive message being favoured. Discussion Women value service flexibility in terms of group size, location and timing. Improved advertising, more universal access and more female-centred options such as female only groups may help to better meet women’s needs. Women’s suggestions of services, such as drop-in groups, which already exist is evidence that service promotion should be improved. Women are engaged by national campaigns focusing on appearance and effects of passive smoking on children; however more research is needed on whether positive messaging can have a greater impact on female cessation than shock tactics, and on how the effects of smoke on appearance can be made more relevant to younger women. More research is needed on the importance of counsellor characteristics, the effectiveness of group interventions, and whether social networking and support and accessing schools can alter smoking behaviour in younger women.