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Descriptors:
Psychopathology; Risk; Public Health; Diagnostic Tests; Attention Deficit Hyperactivity Disorder; Genetics; Pervasive Developmental Disorders; Body Weight; Siblings; Prenatal Influences; Environmental Influences; Correlation; Attribution Theory; Molecular Structure; Autism; Hazardous Materials; Disadvantaged Environment; Intervention; Drug Therapy

Abstract:
Background: Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors. Method: This review (focussing on literature published since 1997, selected from a search of PubMed) critically considers putative risk factors with a focus on genetics and selected environmental risks, examines their relationships with ADHD and discusses the likelihood that these risks are causal as well as some of the main implications. Results: No single risk factor explains ADHD. Both inherited and noninherited factors contribute and their effects are interdependent. ADHD is familial and heritable. Research into the inherited and molecular genetic contributions to ADHD suggest an important overlap with other neurodevelopmental problems, notably, autism spectrum disorders. Having a biological relative with ADHD, large, rare copy number variants, some small effect size candidate gene variants, extreme early adversity, pre and postnatal exposure to lead and low birth weight/prematurity have been most consistently found as risk factors, but none are yet known to be definitely causal. There is a large literature documenting associations between ADHD and a wide variety of putative environmental risks that can, at present, only be regarded as correlates. Findings from research designs that go beyond simply testing for association are beginning to contest the robustness of some environmental exposures previously thought to be ADHD risk factors. Conclusions: The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history. There is a need to consider the possibility of parents and siblings being similarly affected and how this might impact on engagement with families, influence interventions and require integration with adult services. Genetic contributions to disorder do not necessarily mean that medications are the treatment of choice. We also consider how findings might influence the conceptualisation of ADHD, public health policy implications and why it is unhelpful and incorrect to dichotomise genetic/biological and environmental explanations. It is essential that practitioners can interpret genetic and aetiological research findings and impart informed explanations to families. (Contains 2 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Indigenous Populations; Addictive Behavior; Sociocultural Patterns; Influences; Public Health; Risk; Prevention; Literature Reviews

Abstract:
The prevention of gambling-related problems amongst Aboriginal communities has been neglected by most public health strategies which concentrate on mainstream populations. Research indicates that rates of problem gambling are higher for Aboriginal groups than the general population. Specific cultural, familial, and social patterns influence gambling by Aboriginal groups, which are individually different, making it difficult to implement a cohesive strategy to address gambling-related harms. Because of this complexity, a thorough literature review is necessary to identify gaps in policy and research. This paper uses a public health framework to consider multi-dimensional influences (personal, environmental, economic, cultural and social) that affect gambling uptake. Such analysis is also important for identifying risk factors which facilitate the development and maintenance of problem gambling and potentially for underpinning protection, prevention and treatment programs. It is advised that strategies be developed in consultation with Aboriginal peoples to guide public health policy and research to minimise any gambling-related harms. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Information Needs; Public Health; Guidelines; Foreign Countries; Nutrition; Infants; Mothers; Decision Making; Information Sources; Parent Attitudes; Health Behavior

Abstract:
The majority of mothers in Ireland provide formula milk to their infants during the initial weeks postpartum; however, data are lacking on their formula feeding practices and support needs. This prospective Dublin-based observational study, which included 450 eligible mother-term infant pairs recruited and followed up to six months postpartum, aimed to advance our understanding of maternal formula feeding practices, their reasons for deciding to formula feed, sources of feeding information and perceived support needs; insights into infant formula milk consumption patterns in relation to current feeding guidelines are also provided. In summary, the vast majority of infants at six weeks were provided with formula milk (n =368; 81.8%). Positive maternal perceptions of formula feeding were among the most frequently reported reasons underlying mothers' decisions to formula feed (e.g. convenience, 17.3%). Potential public health concerns over the large formula milk volumes consumed by infants (mean 205 ml/kg/day) relative to infant feeding guidelines (150 ml/kg/day) were raised from this study. Some mothers continue to add solid foods to infant bottle feeds at six weeks (3.8%) and six months (6%), a non-recommended feeding practice posing a choking risk for infants. Crucially, this study highlights the need to provide greater support and information to mothers who decide to formula feed postpartum, including practical information on sterilisation and formula reconstitution. While breastfeeding promotion and research continues to be a public health priority in Ireland, addressing the support and information needs of mothers who formula feed, an under-represented and understudied population in the literature, also needs to be considered to ensure optimal health and safety for their infants. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Higher Education; Public Health; Governance; Neoliberalism; Foreign Countries; Educational Change; Public Policy; State Action; Commercialization; Case Studies; Labor Force Development; Knowledge Economy; Global Approach; Criticism

Abstract:
Market forces are being introduced in public spheres such as higher education and public health, which hitherto were closed to such forces. Ironically, it is the state that is responsible for this process of marketisation. Some see this state action as leading to a growing influence of the state in public policy while others see an attenuation of its role. Critiquing this market-state incompatibility thesis from a geo-spatial perspective on globalisation, this paper calls for an articulation of state-market relations that emphasises their interpenetration. Using Botswana as a case study, the paper argues that although on-going tertiary education reforms in the country are characterised by the state's promotion of market forces this does not mean that the state is retreating, leaving the sub-sector to the vagaries of the market. Contrarily, the state is employing marketisation to reform the sub-sector so that it is responsive to labour and skills demands of an economy aspiring to be knowledge-based. (Contains 6 notes.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Outcomes of Education; Health Education; Public Health; Action Research; Professional Education; Transformative Learning; Health Personnel; Foreign Countries; Interdisciplinary Approach; Social Change; Nursing Education; Nutrition; Dietetics; Occupational Therapy; Interviews; Focus Groups; Allied Health Occupations Education; Relevance (Education); Health; Cultural Differences

Abstract:
Transformative learning aims to awaken students to issues of injustice, and to promote their critical analysis of assumptions, beliefs and values that lead to and sustain social inequities, so that they may become agents of social change. This paper introduces the Sensitise Take Action and Reflection (STAR) framework, which encapsulates transformative learning principles, as a tool for educators to enhance student health professionals' capacity and preparedness to address health inequities they are likely to encounter in their future practice. Using an action research methodology within a three-cycle process, STAR was trialled and evaluated by an interdisciplinary team of health educators (n = 25) in an Australian university. Disciplines included: nursing, nutrition and dietetics, public health, occupational therapy and paramedic science. Data were gathered via individual interviews, focus group discussions and field notes, and were analysed inductively, with member-checking of emerging themes to ensure interpretive rigour. The results of this research suggest that STAR is easily understood by users, has relevance for health professional education, and holds promise for producing desired educational outcomes within and across health disciplines. Furthermore, this project could be considered a model for fostering inter-professional collaboration in health education, research and practice. (Contains 3 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Program Evaluation; Youth; State Programs; Adolescents; Advertising; Regression (Statistics); At Risk Persons; Prevention; Smoking; Telephone Surveys; Health Promotion; Health Behavior; Health Education; Public Health; Adolescent Attitudes; Program Effectiveness; Mass Media Effects; Mass Media Role

Abstract:
In 2003, the state of North Carolina (NC) implemented a multi-component initiative focused on teenage tobacco use prevention and cessation. One component of this initiative is "Tobacco.Reality.Unfiltered." ("TRU"), a tobacco prevention media campaign, aimed at NC youth aged 11-17 years. This research evaluates the first 5 years of the TRU media campaign, from 2004 to 2009, using telephone surveys of NC youth. Overall, TRU campaign awareness was moderate among youth in its first year, with awareness significantly increasing over time. The majority of youth who saw the advertisements reported that they were convincing, attention grabbing and gave good reasons not to smoke. In 2009, logistic regression models revealed awareness of the TRU advertisements was associated with decreased odds of current smoking and experimenting with cigarettes for at-risk NC youth. Results from this research may help other states to define, evaluate and modify their own media campaigns, especially within financially or politically constraining environments. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Foreign Countries; Smoking; Family Environment; Risk; Educational Attainment; Socioeconomic Status; Low Income Groups; Health Promotion; Prevention; Health Behavior; Public Health; Program Effectiveness; Questionnaires; Predictor Variables; Statistical Analysis

Abstract:
Our objective was to assess how exposure to secondhand tobacco smoke occurs in Hungarian homes, particularly among non-smokers, and to examine the effectiveness of home smoking bans in eliminating exposure to secondhand smoke at home. In 2009, 2286 non-smokers and smokers aged 16-70 years, who were selected randomly from a nationally representative sample of 48 Hungarian settlements, completed paper-and-pencil self-administered questionnaires addressing tobacco-related attitudes, opinions and behaviors. Chi-square tests, one-way analysis of variance and multivariate logistic regression models were used to assess the effect of demographics, socio-economic characteristics and home smoking policies on the risk of exposure to secondhand tobacco smoke at home. Significantly higher risk of exposure was found among younger, lower educated and poorer people and among those having no or partial home smoking restrictions. There was a significant interaction between education level and home smoking policies: the effect of a smoking ban on exposure to secondhand tobacco smoke was stronger for the lower educated group than the higher educated group. The results suggest that Hungarians are making good progress in implementing home smoking bans, and that in the majority of population these bans are working. More can be done to promote the uptake of home smoking bans among poorer and less educated subpopulations. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Foreign Countries; Behavior Change; Qualitative Research; Mothers; Children; Pollution; Smoking; Intervention; Outcome Measures; Barriers; Family Environment; Health Promotion; Health Behavior; Public Health; Child Health; Parent Attitudes; Program Effectiveness; Comparative Analysis; Statistical Analysis; Case Studies

Abstract:
This article explores mothers' narratives of changing home smoking behaviours after participating in an intervention (Reducing Families' Exposure to Smoking in the Home [REFRESH]) aimed at reducing families' exposure to secondhand smoke (SHS) in homes in Scotland. An analysis of qualitative findings illuminates quantitative changes in levels of SHS exposure. Prospective quantitative and qualitative data were drawn from 21 smoking mothers with at least one child under 6 years. Quantitative change was measured by home air quality, i.e. fine particulate matter less than 2.5 micrograms (PM[subscript 2.5]). These measurements guided the organization of mothers into categories of change (smoke-free home at baseline [SFB], smoke-free home at final, some change and no change [NC]). Qualitative data from 17 mothers with non-SFB were analysed thematically within and across these categories. Three comparative case studies illustrate the varying changes made, barriers to change and how mothers valued such changes. The outcomes varied post-intervention, with homes smoke-free, partially smoke-free or making NC. The changes in home smoking behaviour were incremental, yet beneficial to reducing SHS exposure, and related to the nature of the restrictions and personal circumstances in the home pre-intervention. Across all change categories, mothers valued the changes they had made and expressed an intention to increase the changes. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Foreign Countries; Indigenous Populations; Stakeholders; Smoking; Health Personnel; Concept Mapping; Focus Groups; Cultural Relevance; Workshops; Brainstorming; Health Promotion; Prevention; Health Behavior; Behavior Change; Public Health; Community Health Services; Program Development; Interviews; Multivariate Analysis

Abstract:
Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Evidence; Risk; Smoking; Intervention; Behavior Modification; Depression (Psychology); Low Income Groups; Socioeconomic Status; Counseling; Counseling Effectiveness; Drug Therapy; Health Promotion; Prevention; Health Behavior; Behavior Change; Health Education; Public Health; Community Health Services; Health Personnel; Program Implementation; Program Effectiveness; Outcomes of Treatment; Correlation

Abstract:
Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for greater than 7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P = 0.026) or have attempted quitting (85.0 versus 47.4%, P = 0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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