Neil Spencer

Adolescent multiple risk behaviour: an asset approach to the role of family, school and community

BACKGROUND Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young peoples lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. METHODS A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. RESULTS Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. CONCLUSIONS Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.

The management of antenatal venous thromboembolism in the UK and Ireland : a prospective multicentre observational survey

This prospective observational study reports on 126 women from 25 UK centres with image‐proven antenatal venous thromboembolism (VTE), 62% deep vein thrombosis and 38% pulmonary embolism. Thrombophilia screening was of limited benefit except to identify antithrombin deficiency. Sixteen (13%) patients had previous VTE, all but one was related to previous pregnancy or combined oral contraceptive and 12 received no thromboprophylaxis in the index pregnancy, the other four thus received inadequate low molecular weight heparin (LMWH) doses. Treatment was with dalteparin in 25%, enoxaparin in 47%, tinzaparin in 25% and unfractionated heparin alone in 3%. 66% of patients received once‐daily LMWH. Anti‐activated factor X (anti‐Xa) monitoring was performed at 90% of centres, with a wide range of target values. Thus current management of antenatal VTE, despite widely diverse clinical practice, appeared effective and safe, for there were no recurrent events and postpartum haemorrhage was not increased when compared to known rates. Larger studies are required to confirm this. The need for twice as opposed to once daily LMWH and for anti‐Xa monitoring is questioned by this study. The importance of clinical risk assessment and adherence to the Royal College of Obstetricians and Gynaecologists guidelines on antenatal thromboprophylaxis, with adequate LMWH dosing is confirmed.

Sustaining a positive body image in adolescence: an assets-based analysis

The increasing impetus to provide an effective response to childhood obesity has generated a corresponding concern that weight management interventions may lead to emotional problems among young people, notably in relation to the development of a negative body image. However, currently the processes and factors that contribute to the acquisition of body image among young people is poorly understood. Drawing on salutogenic theory, this paper employs an assets-based approach that focuses on health promoting and protective factors to identify how young people may create or sustain positive body images. Secondary data analysis was undertaken from the WHO Health Behaviour in School Aged Children Study. During the spring term of 2002, information was collected from 6425 English adolescents aged 11-15 using a self-administered questionnaire. The data were analysed using stepwise multinomial logistic regression to determine which factors were associated with positive body image; a total of 2898 students were included in the final analysis. Adolescents who self-identified as having a positive body image were more likely to report ease of talking with a father figure, feeling intelligent, perceiving that their family were well off and a belief that their teachers were interested in them as people. Body Mass Index, age, gender and living within a household containing a father were also significant predictors of body image. The discussion provides an exploration of how the construction of young peoples emotional health is in part linked with the attainment of a secure and positive body image. The implications for health promotion and educational programmes are then examined. By considering the assets, which support or sustain a positive body image during adolescence, obesity prevention programmes could be better tailored to meet the needs of young people. In the future, a salutogenic curriculum might provide an alternative to unsustainable levels of deficit led, targeted programmes.

Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: a manikin study

Six different supraglottic airway devices: Combitube™, laryngeal mask airway, intubating laryngeal mask airway (Fastrach™), i‐gel™, Laryngeal Tube™ and Pro‐Seal™ laryngeal mask airway were assessed by 58 paramedic students for speed and ease of insertion in a manikin, whilst wearing either chemical, biological, radiation, nuclear‐personal protective equipment (CBRN‐PPE) or a standard uniform. All devices took significantly longer to insert when wearing CBRN‐PPE compared with standard uniform (p < 0.001). In standard uniform, insertion time was shorter than 45 s in 90% of attempts for all devices except the Combitube, for which 90% of attempts were completed by 53 s. Whilst wearing CBRN‐PPE the i‐gel was the fastest device to insert with a mean (SD (95% CI)) insertion time of 19 (8 (17–21))s, p < 0.001, with the Combitube the slowest with mean (65 (23 (59–71))s. Wearing of CBRN‐PPE has a negative impact on supraglottic airway insertion time.

Video gaming in adolescence: factors associated with leisure time use

The geographies of the current generation of young people are markedly distinct from previous generations by virtue of their access to a virtual playground. The vast majority of young people now engage in video gaming as a leisure activity. Drawing on findings from the 2009/2010 WHO Health Behaviour in School-aged Children study this paper set out to investigate the factors that might be associated with higher levels of video gaming. Information was collected from 4404 school students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Higher usage was defined as game play exceeding two hours a day. Separate analyses were conducted for boys and girls. For both genders higher levels of game playing was associated with early adolescence, opposite sex friends and minimal parental mediation. Bullying and going to bed hungry were associated with higher usage for boys only, while life satisfaction and family activities were linked to girls’ game playing only. Parents were identified as effective mediators of young people’s video game usage. The study identified gendered motivations for higher levels of game play, suggesting different interventions for boys and girls may be required in order for young people to create a balanced approach to video gaming.

Combining modelling strategies to analyse teaching styles data

This paper combines two estimation procedures: Iterative Generalized Least Squares as used in the software MLwiN; Gibbs Sampling as employed in thesoftware BUGS to produce a modelling strategy that respects the hierarchical natureof the Teaching Styles data and also allows for the endogeneity problems encountered when examining pupil progress.

Investigating data with Andrews plots

Most data that are collected are multivariate in nature, and much of them can be regarded as continuous. In the initial stages of analysis, graphic displays can be used to explore the data, but for multivariate data, traditional histograms or two- or three-dimensional scatter plots may miss complex relationships that exist in the data set. A number of methods for graphically displaying multivariate data have been suggested. However, these are not generally available in major statistical packages and are thus largely not used by researchers. One of the most appealing methods is that of Andrews Plots. This article discusses the potential uses of Andrews Plots and makes them accessible to users through the production of a freely available add-in for Microsoft Excel. The use of Andrews Plots is demonstrated by using data from the 2001 Parliamentary General Election in the United Kingdom.

Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?

Objective. Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration. Design. A randomized control trial examining the ability of rescuers to draw up drugs from four different drug presentations (a Minijet prefilled syringe, an Aurum prefilled syringe, and glass and plastic ampoules with needle and syringe) was undertaken with participants wearing and not wearing the National Health Service (NHS) CBRN-PPE. Each participant underwent the procedure once in “normal clothes” and twice while wearing the CBRN-PPE. The speed and accuracy of each participant were measured as well as the participants perceived risk of suit damage associated with the four different drug presentations. Participants. The participants constituted a non-homogenous group of emergency nurses, nurse lecturers, paramedic lecturers, and student paramedics. A total of 81 participants were recruited; one participant withdrew due to claustrophobia. All participants had used all four drug preparations prior to being enrolled into the study. Results. Wearing the CBRN-PPE had a negative effect on drawing up drugs in the first attempt while wearing the CBRN-PPE, typically taking 63.8% longer time than without (95% confidence interval: 55.3–72.9%). Improvements were noted on second attempts. The choice of drug presentation had an effect on the time taken to draw up the drugs, with Aurum being overall the fastest and glass ampoules the slowest (p-values < 0.001). All participants rated the prefilled syringes as the easiest and the safest to use, and the glass ampoules with needles and syringes as the most difficult to use and the ones most likely to puncture the CBRN-PPE. During the drawing-up process, varying amounts of “drug” were lost, although in two-thirds of the attempts all 10 mL was drawn up. The lowest volume was lost from the prefilled syringes and the maximum volume of fluid was lost from the glass ampoules. Conclusions. The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.

Association Between Experiencing Relational Bullying and Adolescent Health Related Quality of Life

BACKGROUND Bullying is a public health concern for the school-aged population, however, the health outcomes associated with the subtype of relational bullying are less understood. The purpose of this study was to examine the association between relational bullying and health-related quality of life (HRQL) among young people. METHODS This study utilized data from 5335 students aged 11-15 years, collected as part of the 2014 Health Behavior in School-aged Children (HBSC) study conducted in England. Data were collected through self-completed surveys. Multilevel analysis modeled the relationship between relational bullying and HRQL. Demographic variables (sex, age, ethnicity, socioeconomic status) and other forms of bullying were controlled for. RESULTS Experiencing relational bullying had a significant negative association with HRQL whilst controlling for other forms of bullying. Weekly relational bullying resulted in an estimated 5.352 (95% confidence interval (CI), -4.178, -6.526) decrease in KIDSCREEN-10 score compared with those not experiencing relational bullying. CONCLUSION Experiencing relational bullying is associated with poorer HRQL. The findings question the perception of relational bullying as being a predominantly female problem. Girls were more likely to report experiencing relational bullying, but the negative association with HRQL was equal for boys and girls.

Normal enough? Tools to aid decision making

Abstract When undertaking quantitative hypothesis testing, social researchers need to decide whether the data with which they are working is suitable for parametric analyses to be used. When considering the relevant assumptions they can examine graphs and summary statistics but the decision making process is subjective and must also take into account the robustness of the proposed tests to deviations from the assumptions. We review the contemporary advice on this issue available to researchers and look back to the roots of hypothesis testing and associated work undertaken by eminent statisticians since the 1930s. From this we create a set of flow charts to give researchers tools they can use to make decisions in a more objective manner.