School-based smoking cessation programs: Do youth smokers want to participate in these programs?

Abstract:

The purpose of the present study was to examine characteristics that predict interest in school-based cessation programs among 3136 youth smokers with intentions to quit smoking. The majority of youth smokers report that they would not join a school-based smoking cessation program. However, improving awareness of these types of programs among students is important as sub-populations of youth smokers were more likely to be interested in school-based cessation initiatives when aware that such programs exist. Future school-based cessation intervention outcomes might be improved if programs are targeted to the youth that are most likely to use them, if more youth can be made aware of existing programs, and if the benefits of participating in such programs can be more adequately conveyed to youth smokers.

My opinion:

This journal proves that school students most likely won't be interested in joining smoking cessation programs, any program it is. Though it is still accepted that if there are a lot of people joining, students will tend to be interested in a program. Other means to increase efficacy of smoking cessation clinic is through good publication and promotion of such smoking cessation classes.

From this new point of view, I will adapt advertisement (banners, pamphlets), and promotion of health warnings to increase the efficacy of smoking cessation and smoke free school that I devised.

Reference of journal:

Leatherdale, Scott T. "School-Based Smoking Cessation Programs: Do Youth Smokers Want To Participate In These Programs?". Addictive Behaviors 31.8 (2006): 1449-1453. Web.

School-Based Interventions Going Beyond Health Education to Promote Adolescent Health: Systematic Review of Reviews

Abstract:

Purpose - Health education in school classrooms can be effective in promoting sexual health and preventing violence and substance use but effects are patchy and often short term. Classroom education is also challenging because of schools' increasing focus on academic-performance metrics. Other school-based approaches are possible, such as healthy school policies, improving how schools respond to bullying, and parent outreach, which go beyond health education to address broader health determinants. Existing systematic reviews include such interventions but often alongside traditional health education. There is scope for a systematic review of reviews to assess and synthesize evidence across existing reviews to develop an overview of the potential of alternative school-based approaches.

Methods - We searched 12 databases to identify reviews published after 1980. Data were reviewed by two researchers. Quality was assessed using a modified Assessing the Methodological Quality of Systematic Reviews checklist and results were synthesized narratively.

Results - We screened 7,544 unique references and included 22 reviews. Our syntheses suggest that multicomponent school-based interventions, for example, including school policy changes, parent involvement, and work with local communities, are effective for promoting sexual health and preventing bullying and smoking. There is less evidence that such intervention can reduce alcohol and drug use. Economic incentives to keep girls in school can reduce teenage pregnancies. School clinics can promote smoking cessation. There is little evidence that, on their own, sexual-health clinics, antismoking policies, and various approaches targeting at-risk students are effective.

Conclusions - There is good evidence that various whole-school health interventions are effective in preventing teenage pregnancy, smoking, and bullying.

My opinion:

My program only encompass smoking cessation classes (with several methods of recruitment) and smoke free school policy (with fine if violated). This journal shows that several various whole school interventions are effective in preventing smoking. Other methods used in this journal are: parents involvement, local communities volunteering, and school games activities.

While I agree that these methods will be effective if applied, these programs are still not used in my programs because of cost needed, minimal staffs to apply and no prior programs were applied at the school. These methods still not yet included in my programs are very interesting and by logic will help improves effectiveness ratio of the program. After 1 year of application of my program, evaluation will then performed and discussed whether another methods should be applied on next year program.

Reference of journal:

Shackleton, Nichola et al. "School-Based Interventions Going Beyond Health Education To Promote Adolescent Health: Systematic Review Of Reviews". Journal of Adolescent Health 58.4 (2016): 382-396. Web.

Changes in teachers' smoking behaviour following enforcement of a total smoke-free school policy

Abstract:

Tobacco smoking among workers remains a major public health issue. One effective approach to encourage smokers to quit or reduce smoking is to make workplaces smoke-free.1 The Health Promotion Law of Japan, which came into force in 2002, put the managers of public facilities – including restaurants, cafes, public transportation, schools and offices – under the obligation to control secondhand smoke. In accordance with this legislation, the Nara City Government implemented a total smoke-free school policy in all municipal schools in April 2007. Taking this opportunity, questionnaire surveys were conducted for all teachers working in the municipal schools in Nara City before and after implementation of the policy. The authors have previously reported baseline smoking behaviour and attitudes towards the smoke-free school policy,2 and changes in the health-related quality of life among teachers following enforcement of the policy.3 The aim of the present study was to investigate the changes in smoking behaviour of teachers who smoke following enforcement of the smoke-free policy.

Two self-reported questionnaire surveys were conducted in January 2007 and September 2007, 3 months before and 5 months after enforcement of the total smoke-free public school policy in Nara City, respectively. The questionnaires were sent to all teachers affiliated with the public elementary, junior high and senior high schools in Nara City for each survey (70 schools; n = 1748). As eight schools had already adopted the smoke-free school policy of their own accord before the first survey, the 214 teachers assigned to these schools were excluded. The remaining 1534 teachers were enrolled in the study. In the baseline survey, in addition to smoking status, sex, age, school type, managerial position, attitude towards the smoke-free school, age at smoking initiation, number of cigarettes consumed per day, and score on the Fagerstrom Test of Nicotine Dependence (FTND), 4 experience of quit attempts, intention to quit and existence of smoking peers were examined. In the follow-up survey, smoking status, attempts to quit during the follow-up period, time of quitting, time of relapse and reasons for quitting were examined as the outcome measures.

Of the 1534 teachers enrolled in the study, those who smoked at baseline, answered both the baseline and follow-up questionnaires, and had no missing values in the required questionnaire items were eligible for the following analyses. Changes in smoking status and changes in number of cigarettes smoked per day between the baseline and follow-up surveys were evaluated using McNemar's Chi-squared test and Wilcoxon's signed-rank test, respectively. In addition, the relationship between each baseline variable and subsequent smoking cessation was evaluated using Fisher's exact test. The level of significance was set at 5%. In addition, factors for attempting to quit and success in quitting were examined separately using logistic regression analyses with forward selection methods. All analyses were conducted using Statistical Package for the Social Sciences Version 15.0 (SPSS Inc., Chicago, IL, USA).

In total, 1153 of the 1534 teachers completed the baseline questionnaire with no missing data. Following exclusion of teachers who did not answer the follow-up questionnaire and had missing data in the follow-up survey, 844 teachers (377 males and 467 females) were eligible for the analyses. No significant difference was observed in the baseline characteristics between the eligible and the ineligible teachers. Among the eligible participants, 111 (13%) were smokers at baseline. The majority (94%) of the smokers were males, and their mean age was 47 (standard deviation 9) years. Eighty-nine smokers (80%) expressed an interest in smoking cessation. During the 9-month follow-up period, 35 of 111 (32%) teachers made a quit attempt. Nineteen (54%) of these teachers relapsed into smoking thereafter, but 16 (46%) teachers had not smoked for at least 1 month at the time of the follow-up survey. Since no new smokers were found, the overall smoking rate of the participants decreased from 13% to 11% (P < 0.01). Eight of 16 quitters (50%) ascribed their cessation to the total smoke-free policy. Other reasons for smoking cessation included ‘health concerns’ (n = 4), ‘own illnesses’ (n = 2), ‘marriage’ (n = 1) and ‘pregnancy’ (n = 1). Among the persistent smokers (n = 95), the number of cigarettes smoked per day decreased significantly following enforcement of the smoke-free policy (P < 0.01). The number of heavy smokers (smoking ≥ 20 cigarettes per day) decreased from 21 (22%) to 15 (16%), while the number of light smokers (smoking ≤ 10 cigarettes per day) increased from 17 (18%) to 25 (26%). Table 1 shows the relationship of the baseline characteristics with quit attempts and successful quitting. High intention to quit [odds ratio (OR) 3.8; 95% confidence interval (CI) 1.1–14.1] and lack of smoking peers [OR 3.6; 95% CI 1.5–8.6)] were found to be significantly associated with quit attempts. A low score on the FTND (OR 4.8; 95% CI 1.0–25.1) and previous attempts to quit smoking were significantly associated with successful quitting (OR 6.3; 95% CI 1.3–30.7).

My opinion:

It's stated that in general, no significant smoking cessation happened to teachers after the application of smoke free policy at schools, but according to this research, most teachers agrees that stopping smoking for several hours while at school is understandable and will promote healthier environment for the students. Stopping smoking for several hours while at school is not changing or affecting daily activities or daily number of cigarette smoking.

Using this model, it's proven that the application of smoke free regulation school is mandatory for healthier school and prevent student's exposure to indirect smoking advertisement and secondhand smoking. Applying this regulation at my program is a suitable step to take.

Reference of journal:

Kiyohara, K. et al. "Changes In Teachers' Smoking Behaviour Following Enforcement Of A Total Smoke-Free School Policy". Public Health 126.8 (2012): 678-681. Web.

Facebook recruitment of young adult smokers for a cessation trial: Methods, metrics, and lessons learned

Abstract:

Further understanding is needed of the functionalities and efficiency of social media for health intervention research recruitment. Facebook was examined as a mechanism to recruit young adults for a smoking cessation intervention. An ad campaign targeting young adult smokers tested specific messaging based on market theory and successful strategies used to recruit smokers in previous clinical trials (i.e. informative, call to action, scarcity, social norms), previously successful ads, and general messaging. Images were selected to target smokers (e.g., lit cigarette), appeal to the target age, vary demographically, and vary graphically (cartoon, photo, logo). Facebook's Ads Manager was used over 7 weeks (6/10/13–7/29/13), targeted by age (18–25), location (U.S.), and language (English), and employed multiple ad types (newsfeed, standard, promoted posts, sponsored stories) and keywords. Ads linked to the online screening survey or study Facebook page. The 36 different ads generated 3,198,373 impressions, 5895 unique clicks, at an overall cost of $2024 ($0.34/click). Images of smoking and newsfeed ads had the greatest reach and clicks at the lowest cost. Of 5895 unique clicks, 586 (10%) were study eligible and 230 (39%) consented. Advertising costs averaged $8.80 per eligible, consented participant. The final study sample (n = 79) was largely Caucasian (77%) and male (69%), averaging 11 cigarettes/day (SD = 8.3) and 2.7 years smoking (SD = 0.7). Facebook is a useful, cost-effective recruitment source for young adult smokers. Ads posted via newsfeed posts were particularly successful, likely because they were viewable via mobile phone. Efforts to engage more ethnic minorities, young women, and smokers motivated to quit are needed.

My opinion:

Social media advertising for smoking cessation clinic client recruitment is deemed effective according to this research. This proves that there are still many people that actually in need of smoking cessation clinic, but are too shy too actually search cessation clinic themselves or reaching out to colleagues to search for help. Social media anonymity of searches and browses leads people that previously don't know where to look for help to quit smoking into easily accessed smoking cessation program.

While this is understandably easy to implement and will effective if applied anywhere social media is actively used, it's not really well suited for school campaign on smoking cessation programs. Social media is designed to reach more people, while several ads can be directed to a targeted audience, social media programming cannot target member of certain school members for ads, as their target is countrywide clients to generate pay per click for the ads.

Social media used as advertising method is very good and will be very effective if applied in larger scale than school, especially if nationwide. This method should not be used on school program of smoking cessation, as the ads target won't be fitting and large cost maintenance to be calculated.

Reference of journal:

Ramo, Danielle E. et al. "Facebook Recruitment Of Young Adult Smokers For A Cessation Trial: Methods, Metrics, And Lessons Learned". Internet Interventions 1.2 (2014): 58-64. Web.

GENDER EQUITY IN HEALTH CARE: THE CASE OF SWEDISH DIABETES CARE

Abstract:

To explore the issue of gender equity in diabetes care in Sweden and to develop strategies for monitoring gender equity in health care, population-based studies and statistics published since 1990 were reviewed that contained gender-specific data on health care utilization, glycemic control, patient satisfaction, health-related quality of life, and mortality from diabetes. The review shows that diabetic women in Sweden report more frequent outpatient contacts, less patient satisfaction, and a lower health-related quality of life than diabetic men. No gender differences were found in the level of glycemic control. Young and middle-aged men with diabetes have a high excess all-cause mortality as compared with nondiabetic men. A trend toward stronger social gradient in mortality among women than men with diabetes was observed in a large nationwide study. The reasons for the observed gender differences are uncertain but may constitute a combination of medical, psychological, and social factors. Monitoring the impact of gender should become an integrated part of quality management in diabetes care. As long as the relationship between use and outcomes of care is not fully understood, analyses of gender equity should address both health care utilization and outcomes of care.

My Opinion:

Gender equity is still very misunderstood for even gender equality and inequality raises a lot of queries and causes never ending debates all around the world. Emma Watson quoted that "...we all see gender as a spectrum instead of two sets of opposing ideals." The world still has not quite had the grasp of understanding this spectrum. If anything at all is happening is that this spectrum that Watson speaks of is getting murkier everyday. In such a chaotic, gender segregated world, equity among genders has not caught the limelight.

In Sweden however, the issue has been researched upon in correlation to diabetes care. It is stated that a combination of medical, psychological and social factors are needed if equity in diabetes care must be achieved.

In Asia, gender equity is not achieved and seems very far fetched at the moment with men holding higher grounds in most cases. We need to identify and address the gender inequity in seeking medical care and attention, especially for diabetes and work towards better outcomes. Health care must be utilized by specifying the needs of male and female separately rather than just being general or biased to just one gender. Analysis is required to identify the inequity gap that is faced by both genders and its causes. With the help of public health experts and psychologists, I am sure a solution can be conjured up to aid doctors in managing diabetes holistically. 

Reference:

http://www.tandfonline.com/doi/pdf/10.1080/07399330050082245?needAccess=true

Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes

Abstract:

Background - The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain.

Methods - We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene.

Results - The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group.

Conclusions - Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications, with the exception of progression of albuminuria (P = 0.01).

My Opinion:

This article mainly speaks on the relationship between vascular complications and intensive glucose control. Maximal and standard doses of an oral agent or insulin therapy. The reason veterans were selected in my opinion is because, after strict rigorous regime and diet plans, most of them tend to loosen up once they return to the comfort of their homes. In order to preoccupy themselves, they would socialize more with family and friends and catch up on what they have missed out on while they were in training or for some, while at the battlefield. Most of the time, this socializing lead to lots of "good" food. Food becomes a "go to drug" for these ex-soldiers to de-stress themselves.

Some veterans would not be able to give up their disciplined lifestyle. Others however may succumb to the temptations around them and it is with them that metabolic diseases such as diabetes develops. This can be applied to veterans in an Asian setting and the older generation in our communities face a similar problem as well. Most old people cannot hold their tiring jobs after a certain age and become home bound with a very sedentary lifestyle. Lack of activity and high intake of carbohydrates and fats can lead to type 2 diabetes.

Intensive glucose control may sound like the best way to solve this problem but according to this article it proved to have no significant effect on reducing mainly vascular complications. However, if started at an early stage this could prove effective. For this to happen, people should be educated on detecting early signs and symptoms of diabetes. Early intervention must be made available for such patients. Hospitals and clinics should be equipped to be able to administer to these patients from developing a more serious case of type 2 diabetes mellitus.

If prevention fails, we can still hope that early intensive intervention when detected can save the day.

References:

http://www.nejm.org/doi/full/10.1056/NEJMoa0808431#t=article

Knowledgeable Neighbors: A Mobile Clinic Model for Disease Prevention and Screening in Underserved Communities

The Family Van mobile health clinic uses a “Knowledgeable

Neighbor” model to deliver cost-effective screening and prevention

activities in underserved neighborhoods in Boston, MA. We

have described the Knowledgeable Neighbor model and used

operational data collected from 2006 to 2009 to evaluate the

service. The Family Van successfully reached mainly minority

low-income men and women. Of the clients screened, 60% had

previously undetected elevated blood pressure, 14% had previously

undetected elevated blood glucose, and 38% had previously

undetected elevated total cholesterol. This represents an

important model for reaching underserved communities to deliver

proven cost-effective prevention activities, both to help control

health care costs and to reduce health disparities.

Opini:

Artikel ini dibuat untuk menilai program mobile vlinic yang dijalankan di Boston. Mobile clinic tersebut digunakan untuk skrining penyakit, khususnya penyakit kronik.

The Family Van merupakan mobile clinic yang didirakan oleh Harvard Medical School. Program ini dijalankan melalui beberapa pendekatan, yaitu:

KNOWLEDGEABLE NEIGHBOR MODEL

STEP 1: Reaching Clients Through Creating a Community Hub of Wellness

A. Building trust on the Family Van

1.  Service is led by health educators, dietitians, and HIV counselors, many of whom are from the community.

2.  Inclusive relationships are created through interpersonal informality in a safe, nonhierarchical, nontraditional health care environment.

3.  Clients control the encounter, deciding when to come, what screenings to receive, and when and how to act on the information they receive.

4.  Staff receives cultural competence training to ensure that they have the skills to learn each client’s unique social and economic context, cultural beliefs, and behaviors.

B. Building trust in the community

1. Long-term weekly presence in neighborhoods (established 1992)

2.  Strong collaborations with community health centers, hospitals, churches, and others

3.  Continual outreach through participation in community events and street outreach

C. Reducing financial barriers: no charge to clients

D.  Reducing logistical barriers: drop-in service in the neighborhood (no appointments, no waiting, no eligibility requirements, no distance to travel)

STEP 2: Empowering Clients to Access Care and Improve Their Health

1.  Screening for several chronic conditions, including hypertension, diabetes, and hypercholesterolemia, so that clients can learn about their health

2.  Culturally competent health literacy and motivational interviewing: to educate clients about their health and help them develop appropriate wellness strategies

3.  Creating a bridge into care: through referral to community neighborhood health centers and social services, with additional advocacy and navigational support

Selama 2006-2009, sebanyak 13272 klien, 1% usia dibawah 18 tahun dan 50% usia 35-64 tahun, datang mengunjungi The Family Van mobile clinic. Program ini sukses meningkatkan kepedulian masyarakat terhadap penyakit kronik yang diawali dengan melakukan skrining terhadap tekanan darah, gula darah, dan total kolesterol. Dari skrining tersebut didapatkan 60% pasien memiliki tekanan darah tinggi yang tidak diketahui sebelumnya, 14%  pasien baru mengetahui bahwa dirinya memiliki gula darah yang tinggi, dan 38% pasien dengan peningkatan total kolesterol.

Menurut saya program ini dapat dijadikan sebagai salah satu contoh program yang dapat diterapakan untuk menjangkau kesehatan masyarakat yang kurang peduli terhadap kesehatannya. Program ini juga dinilai dapat mengurangi kesenjangan kesehatan antar masyarakat serta menurunkan anggaran untuk kesehatan.

Referensi:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487671/pdf/AJPH.2011.300472.pdf