Quantifying Alcohol-Related Mortality: Should Alcohol-Related Contributory Causes of Death be Included?

Aims: The aim of the study was to assess whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death. Methods: A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death. Results: Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcohol-related contributory causes of deaths would increase the male-female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcohol-related deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident. Conclusions: Using only underlying cause of death undoubtedly underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men.

Targeting social need in a divided society: an evaluation of a community-based adult education initiative

This article examines the impact of a community-based adult education initiative designed to target social need in Northern Ireland. Set against a backdrop of extreme civil unrest and disadvantageous socio-economic conditions a cohort of adults was identified to participate in a personal and social development programme. The initiative was funded from Peace and Reconciliation resources made available to Northern Ireland by the European Union. High levels of unemployment and negativity about previous learning experiences were characteristic features among participants. An evaluation of the effectiveness of the programme was carried out and a follow-up qualitative survey ensued 6 months after the completion of the training. Results indicate that the learner-centred methodology was effective in providing a gateway to further education and training and enhancing participants' self-esteem, confidence, motivation, tolerance, social skills, community involvement and

Distribution, extent of inter-annual variability and diet of the bloom-forming jellyfish Rhizostoma in European waters

Jellyfish (Cnidaria: Scyphozoa) are increasingly thought to play a number of important ecosystem roles, but often fundamental knowledge of their distribution, seasonality and inter-annual variability is lacking. Bloom forming species, due to their high densities, can have particularly intense trophic and socio-economic impacts. In northern Europe it is known that one particularly large (up to 30 kg wet weight) bloom forming jellyfish is Rhizostoma spp. Given the potential importance, we set out to review all known records from peer-reviewed and broader public literature of the jellyfish R. octopus (Linnaeus) and R. pulmo (Macri) (Scyphozoa: Rhizostomae) across western Europe. These data revealed distinct hotspots where regular Rhizostoma spp. aggregations appeared to form, with other sites characterized by occasional abundances and a widespread distribution of infrequent observations. Surveys of known R. octopus hotspots around the Irish Sea also revealed marked inter-annual variation with particularly high abundances forming during 2003. The location of such consistent aggregations and inter-annual variances are discussed in relation to physical, climatic and dietary variations.

Are caregiving responsibilities associated with non-attendance at breast screening?

Background: Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities.

The Politics of Actually Existing Unsustainability:Human Flourishing in a Climate-Changed, Carbon-Constrained World

Going against both the naive techno-optimist of ‘greening business as usual’ and a resurgent ‘catastrophism’ within green thinking and politics, The Politics of Actually Existing Unsustainability offers an analysis of the causes of unsustainability and diminished human flourishing. The books locates the causes of unsustainability in dominant capitalist modes of production, debt-based consumer culture, the imperative for orthodox economic growth and the dominant ideology of neoclassical economics. It suggests that valuable insights into the causes of and alternatives to unsustainability can be found in a critical embracing of human vulnerability and dependency as both constitutive and ineliminable aspects of what it means to be human. The book defends resilience, the ability to ‘cope with’ rather than somehow ‘solve’ vulnerability. The book offers a trenchant critique of the dominant neoclassical economic ‘groupthink’, viewing it not as some value-neutral form of ‘expert knowledge’, but as a thoroughly ideological ‘common sense’. Outlining a green political economic alternative replacing economic growth with economic security, it argues economic growth has done its work in the minority, affluent world, which should now focus on improving human flourishing, lowering socio-economic equality and fostering solidarity as part of a new re-orientation of public policy. Complementing this, a, ‘green republicanism’ is developed as an innovative and original contribution to contemporary debates on a ‘post-growth’ economy and society. The Politics of Actually Existing Unsustainability draws widely from a range of disciplines and thinkers, from cultural critic Susan Sontag to the critical theory of the Frankfurt School, contemporary debates in green political thinking, and the latest thinking in heterodox and green economics, to produce a highly relevant, timely, and provocatively original statement on the human predicament in the twenty-first century.

Residential segregation and health in Northern Ireland

Patterns of residential segregation in Northern Ireland reflect historic sectarian conflict as well as current animosities. A number of indices of segregation are examined in this paper and their relative merits in capturing localised societal divisions are discussed.The implications of such divisions on health as mediated through conflict-related stress are then considered. Costed datasets of hospital, community and anxiety/depression prescribing data havebeen assembled and attributed to local geographies.The association between geographical variations in these costs and levels of segregation was modelled using regression analysis.It was found that the level of segregation does not help to explain variations in costed utilisation of acute and elderly services but does explain variations in the costs of prescribing for anxiety and depression with controls for socio-economic deprivation included. Results in this paper would indicate that strategies to promote good relations in Northern Ireland have positive implications for mental health.

Is dieting behaviour decreasing in young adolescents?

Abstract Objective: To report trends in underweight, overweight and obesity in 12–15-year-old adolescents and examine changes in dieting behaviour, which have been less well documented. Design: Comparison of two independent representative cross-sectional surveys. Setting: Northern Ireland. Subjects: Weight and height were objectively measured in 1324 boys and 1160 girls in 1996 and 1274 boys and 1374 girls in 2007. Participants reported whether they were following any particular diet including a self-proposed or prescribed weight-reduction diet. Results: Overweight and obesity increased in girls from 15% to 23% and 2% to 6%, respectively. Increases were more modest in boys with overweight increasing from 13% to 18% and obesity from 3% to 6%. The proportion of underweight adolescents decreased from 9% to 6% in girls and 8% to 5% in boys. Evidence of social disparity was observed in girls from a manual socio-economic background, with overweight/obesity prevalence rates increasing from 21% to 36% compared with 15% to 26% in girls from a non-manual background. Despite these trends fewer adolescents, in particular girls, reported following weight-reduction diets (14% of overweight/obese girls in 2007 v. 21% in 1996; 8% of boys in 2007 v. 13% in 1996). Of these girls, the proportion from a manual background following weight-reduction diets decreased from 25% to 11%. Conclusions: Overweight and obesity are continuing to increase in adolescents despite government and media awareness strategies. There also appears to be reduced dieting behaviour, despite increasing body weight, particularly in girls from manual socio-economic backgrounds.

Alcohol and the affluence paradox: A secondary analysis exploring the health disparities surrounding adolescent alcohol use and alcohol related harm in adulthood

Several studies have shown social differences in alcohol consumption, and social inequalities of harm related to alcohol use and abuse. However, relationships between the position in the socio-economic spectrum, alcohol use, and alcohol-related health problems are not clear cut. While there is some evidence of social gradients or associations between indicators of deprivation and some adolescence outcomes (e.g. externalising behaviour), the evidence regarding associations between socio-economic status and alcohol-related problems in adolescence is more conflicting. A major problem in studying socio-economic inequalities in adolescent health is related to the paucity of measures of socio-economic status in adolescence that are both conceptually and methodologically sound.
The aims of this study were to investigate socio-economic differences in pathways from onset to establishment of drinking patterns in adolescence, assess the consequences of these pathways in terms of alcohol related harm, and to consider the causal mechanisms that may contribute to socio-economic differences in drinking pathways and outcomes

Policing in an Age of Austerity: A postcolonial perspective

Policing in an Age of Austerity uniquely examines the effects on one key public service: the state police of England and Wales. Focusing on the major cut-backs in its resources, both in material and in labour, it details the extent and effects of that drastic reduction in provision together with related matters in Scotland and Northern Ireland. This book also investigates the knock-on effect on other public agencies of diminished police contribution to public well-being.

The book argues that such a dramatic reduction in police services has occurred in an almost totally uncoordinated way, both between provincial police services, and also with regard to other public agencies. While there may have been marginal improvements in effectiveness in certain contexts, the British police have dramatically failed to seize the opportunity to modernize a police service that has never been reformed to suit modern exigencies since its date of origin in 1829. British policing remains a relic of the past despite the mythology by which it increasingly exports its practices and officers to (especially) transitional societies.

Operating at both historical and contemporary levels, this book furnishes a mine of current information. Critically, it also emphasizes the extent to which British policing has traditionally concentrated on the lowest socio-economic stratum of society, to the neglect of the policing of the more powerful. Policing in an Age of Austerity will be of interest to academics and professionals working in the fields of criminal justice, development studies, and transitional and conflicted societies, as well as those with an interest in the social schisms caused by the current financial crisis.

Work-place social capital and smoking cessation: The Finnish Public Sector Study

AIMS:
To examine whether high social capital at work is associated with an increased likelihood of smoking cessation in baseline smokers.
DESIGN:
Prospective cohort study.
SETTING:
Finland.
PARTICIPANTS:
A total of 4853 employees who reported to be smokers in the baseline survey in 2000-2002 (response rate 68%) and responded to a follow-up survey on smoking status in 2004-2005 (response rate 77%).
MEASUREMENTS:
Work-place social capital was assessed using a validated and psychometrically tested eight-item measure. Control variables included sex, age, socio-economic position, marital status, place of work, heavy drinking, physical activity, body mass index and physician-diagnosed depression.
FINDINGS:
In multi-level logistic regression models adjusted for all the covariates, the odds for being a non-smoker at follow-up were 1.26 [95% confidence interval (CI)=1.03-1.55] times higher for baseline smokers who reported high individual-level social capital than for their counterparts with low social capital. In an analysis stratified by socio-economic position, a significant association between individual-level social capital and smoking cessation was observed in the high socio-economic group [odds ratio (OR) (95% CI)=1.63 (1.01-2.63)], but not in intermediate [(OR=1.10 (0.83-1.47)] or low socio-economic groups [(OR=1.28 (0.86-1.91)]. Work unit-level social capital was not associated with smoking cessation.
CONCLUSIONS:
If the observed associations are causal, these findings suggest that high perceived social capital at work may facilitate smoking cessation among smokers in higher-status jobs.

Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health. (c) 2007 Elsevier Ltd. All rights reserved.

Uptake of breast screening is influenced by current religion and religion of upbringing

Research has shown that individuals with a current religious affiliation are more likely to use preventive health services. The aim of this study was to determine whether breast screening uptake in Northern Ireland is higher amongst women with a current affiliation to an organised religion and, for those with no current affiliation, to examine whether their religion of upbringing is associated with uptake of breast screening. The Northern Ireland Longitudinal Study (NILS) was used to link Census and national breast screening data for 37,211 women invited for routine breast screening between 2001 and 2004. Current religious affiliation, religion of upbringing and other demographic and socio-economic characteristics were as defined on the Census form. Multivariate logistic regression was used to determine the relationship between religion affiliation and attendance. Uptake of breast screening is about 25% lower for those without a current religious affiliation. There are modest differences between Catholics and Protestants, with the latter about 11% more likely to attend for screening. For those with no current religion, the religion of upbringing appears to positively influence attendance rates. These differences remain after adjustment for all of the socio-demographic and socio-economic factors that have been shown to influence uptake rates of breast screening in the UK to date. Record linkage is an efficient way to examine equity across demographic characteristics that are not routinely available. The lower uptake amongst those with no religious affiliation may mean that screening services may find it difficult to maintain or improve uptake rate in an increasingly secularised society.

Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

Climate change adaptation : a decision support framework to encourage environmentally responsible behaviour

Structured Abstract:
Purpose: Very few studies investigate environmentally responsible behaviour (ERB). This paper presents a new 'Awareness Behaviour Intervention Action' (ABIA) Decision Support Framework to sustain ERB.

Design/methodology/approach: Previous ERB programmes have failed to deliver lasting results; they have not appropriately understood and provided systems to address ERB (Costanzo et al., 1986). These programmes were based on assumptions (Moloney et al., 2010), which this paper addresses. The ABIA Framework has been developed through a case study of social housing tenants waiting for low or zero carbon homes.

Findings: The ABIA Framework enables a better understanding of current attitudes to environmental issues and provides support for ERB alongside technological interventions employed to promote and sustain carbon reduction.

Research limitations/implications: The ABIA Framework should be tested on individuals and communities in a variety of socio-economic, political and cultural contexts. This will help unpack how it can impact on the behaviours of individuals and communities including stakeholders.

Practical implications: This type of research and the ABIA Framework developed from it are crucial if the UK pledge to become the first country in the World where all new homes from 2016 are to be zero carbon.

Social implications: The Framework encourages both individual and community discussion and solving of sustainability issues.

Originality/value: There are few, if any, studies that have developed a framework which can be used to support behavioural change for adaptation to sustainable living in low or zero carbon homes.

Understanding material deprivation: A comparative European analysis

In this paper, taking advantage of the inclusion of a special module on material deprivation in EU-SILC 2009. we provide a comparative analysis of patterns of deprivation. Our analysis identifies six relatively distinct dimensions of deprivation with generally satisfactory overall levels of reliability and mean levels of reliability across countries. Multi-level analysis based on 28 European countries reveals systematic variation in the importance of within and between country variation for a range of deprivation dimensions. The basic deprivation dimension is the sole dimension to display a graduated pattern of variation across countries. It also reveals the highest correlations with national and household income, the remaining deprivation dimensions and economic stress. It comes closest to capturing an underlying dimension of generalized deprivation that can provide the basis for a comparative European analysis of exclusion from customary standards of living. A multilevel analysis revealed that a range of household characteristics and household reference person socio-economic factors were related to basic deprivation and controlling for contextual differences in such factors allowed us to account for substantial proportions of both within and between country variance. The addition of macro-economic factors relating to average levels of disposable income and income inequality contributed relatively little further in the way of explanatory power. Further analysis revealed the existence of a set of significant interactions between micro socioeconomic attributes and country level gross national disposable income per capita. The impact of socio-economic differentiation was significantly greater where average income levels were lower. Or, in other words, the impact of the latter was greater for more disadvantaged socio-economic groups. Our analysis supports the suggestion that an emphasis on the primary role of income inequality to the neglect of differences in absolute levels of income may be misleading in important respects. (C) 2012 International Sociological Association Research Committee 28 on Social Stratification and Mobility. Published by Elsevier Ltd. All rights reserved.