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NHS Library and Information Service North Staffordshire

Health Inequalities Bulletin

ISSUE No: 20 – July - August 2009
About this Bulletin:

ƒ Aims to draw attention to some of the key documents and reviews of research
in health inequalities that have been published in the two previous months.

ƒ Where possible, links to the full text documents are included. If the article is in
a journal, you can contact the Health Library for a copy.
Link to request form:
[A charge of £2 per request is payable for most copies]

ƒ If you need further assistance in obtaining any of the resources listed in the
bulletin or have other information needs, please contact the Outreach
Librarians or the Health Library, details below.

ƒ The bulletin can be e-mailed to colleagues who may also find it useful.

ƒ A list of websites that are checked in the production of this bulletin are listed
on the first page. Please suggest others that may be useful.

ƒ Feedback is welcomed to inform future issues of the bulletin.

Topics reviewed
Black and Ethnic Minorities
Contact information Breastfeeding
Children and Young People
NHS Outreach Librarians Immunisation/Vaccination
Tel: 07834 115958 [please leave a message] Inequalities
E-mail: Lifestyles
Men’s Health
Mental Health
Health Library Nutrition
Tel: 01782 556565 Obesity
Fax: 01782 556582 Older People
E-mail: Oral Health
Physical Activity
Public Health
Sexual Health
Substance Misuse

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Sources checked for this bulletin

Please suggest further sites that should be monitored in the production of this bulletin

ARIF – Aggressive Research Intelligence Facility:

Association of Public Health Observatories:
Audit Commission - regeneration^576^SUBJECT^408
Audit Commission - health^574
British Nutrition foundation:
Centre for Analysis of Social Exclusion:
DOH bulletins [Chief exec, GP, Dental social care]
Every Child Matters [govt website]:
Health Inequalities page -DoH
Health Protection Agency
Home Office
Housing and Homelessness
IDeA – Healthier Communities section - including Health inequalities briefing papers: http://www.idea-
Joseph Rowntree
King’s Fund
Monitoring Poverty and Social Exclusion [JRF and New Policy Institute]:
Neighbourhood Renewal unit
NICE - health inequalities pages:
NICE – Centre for Public Health Excellence
Screening specialist library -
Social Exclusion Unit
Sure Start
UNICEF – Baby Friendly Initiative – breast feeding news and research
West Midlands Public Health Observatory:

List of other Public Health and Primary Care update services published in Staffordshire
Title Focus Contact & Tel Email and website
Daily Health Bulletin Daily e-mail update on Sheffield Health 0114 271 1167
new publications from Informatics Service
the DH and NHS Or contact Jayne
Hickton to be added to
circulation list
Clinical Effectiveness Bi Monthly update of Jayne Hickton – NHS 07834 115958
Bulletin reviews of evidence on Outreach Library
clinical effectiveness Service North Staffs

HP Source Monthly news and Health Improvement 01782 298193 Issues of HP Source are published on
update on health Library the Health Promotion website:
promotion issues with
emphasis on evidence resources/index.htm
based information
Health Management Weekly update of news Kelly Danks-Hyden 01889 571730 kelly.danks-
Bulletin and information relating South Staffs Health
to health management Management Library

Public Health Bulletin Weekly update of news Kelly Danks-Hyden 01889 571730 kelly.danks-
and information relating South Staffs Health
to public health issues Management Library

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Black and Ethnic Minorities

Cancer Incidence and Survival By Major Ethnic Group, England, 2002 – 2006
National Cancer Intelligence Network (NCIN) and Cancer Research UK
According to the report, black people were nearly twice as likely as white people to get
stomach cancer. And black men were up to three times more likely than white men to get
prostate cancer. The report will help to shape policy on targeting relevant public health
messages to the ethnic communities around the signs and symptoms of cancer.

Engaging black and minority ethnic (BME) groups with sexual health services: a youth
participation project summary and recommendations
10 point guide for health professionals aimed at improving access of young people from BME
groups to services.

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Developing a breastfeeding strategy
UNICEF UK Baby Friendly Initiative
This guide is aimed at all those who are tasked with, or who wish to drive forward, the
creation of a breastfeeding strategy.

Differing results on the impact of dummy use

Baby Friendly Initiative
A multicentre, randomized controlled trial with 1,021 mothers was carried out to establish
whether the recommendation to offer a pacifier once lactation is well established reduces the
prevalence or duration of breastfeeding. A second study was carried out to investigate how
breastfeeding technique and pacifier use were related to breastfeeding problems and duration
of breastfeeding. The study was a randomized trial in which trained health visitors followed up
mothers (n=570) for six months after childbirth. Both studies reported differing results.

Confident commitment is a key factor for sustained breastfeeding

A Avery, K Zimmermann, PW Underwood, and JH Magnus
Birth, June 1, 2009; 36(2): 141-8
A study was carried out to identify the processes contributing to breastfeeding decisions
among Caucasian and African American women in three major US cities. It emerged that
those mothers who were more likely to breastfeed successfully had confidence in the process
of breastfeeding, confidence in their ability to breastfeed, and commitment to making
breastfeeding work despite obstacles. Antenatal preparation appears to be crucial to the
process, as if mothers achieved a level of "confident commitment" before the birth, they were
able to withstand lack of support by significant others and the common challenges that
occurred as they initiated breastfeeding.
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Children and Young People

The impact of integrated services on children and their families in Sure Start children’s

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This report evaluates the impact of integrated services on children, parents and families in 20
children’s centres. The effective integration of services is having a positive impact in terms of
support for children and parents in over half of the centres visited. Three centres were judged
as making an outstanding difference. Challenges remain with onward links with primary
schools, in reaching the most vulnerable families and in developing data on outcomes for
parents and children. The least effective partnership working seen was between the children’s
centres and Jobcentre Plus.

Your child, your schools, our future: building a 21st century schools system
Department for Children, Schools and Families
The document outlines the challenges and changes that schools now face, and describe
reforms that have been made to meet these. These reforms build on the progress of the last
decade and mean that the Government can now take the historic step of setting out new Pupil
and Parent Guarantees. The Pupil Guarantee sets out new entitlements to personalised
support for every child, and the Parent Guarantee for every parent. The White Paper sets out
plans for securing those guarantees across the country, outlining changes to the curriculum,
school partnerships, leadership and responsibilities.

NHS Baby LifeCheck

NHS Choices
This interactive website aims to help parents and carers keep their babies aged five to eight
months, healthy, happy and safe. It guides parents and carers through a set of simple multiple
choice questions, then offers advice and reassurance on making the best decisions for their
child. It covers topics including: development, talking and playing, feeding, healthy teeth,
safety, sleep routine, immunisations and being a parent.

Safeguarding children: a review of arrangements in the NHS for safeguarding children

Care Quality Commission
Based on a detailed survey of 392 NHS trusts, the findings indicate that a majority of
organisations had the right people and systems to help protect children. However, they also
highlight worrying shortfalls in the numbers of staff up to date with mandatory training,
designed to help them identify and respond to concerns. This was true for staff across the
NHS, as well as those dealing with children routinely, such as GPs and those in A&E,
paediatric and sexual health services.

The Team Around the Child and the Lead Professional: A guide for managers
Department for Children, Schools and Families
This guidance has been updated in order to reflect policy developments and include revisions
identified in consultation with practitioners and managers across the children and young
people’s workforce.

Attitudinal Barriers to Engaging Young People in Positive Activities: Literature and

communications review
Department for Children, Schools and Families
This research project looked at providing an overview of physical and attitudinal barriers and
motivators to participation in positive activities for young people and identifying
communications to promote activities and examples of good practice.

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Assessments of parenting and parenting support need

Joseph Rowntree Foundation
How health, education and family practitioners assess what support parents might need.

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Swine flu vaccination programme
Department of Health
The priority groups who will be first in line for vaccination against swine flu will include
pregnant women, frontline health and social care workers, and everyone in at-risk groups
aged over six months.

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Wellbeing and health inequalities
Health Services Management Centre
HSMC was commissioned by the Department of Health to undertake rapid reviews of the
literature in six clinical areas to provide the evidence base for the Department’s recently
published Transforming Community Service Clinical Guides. The aim of this review was to
identify good practice in these areas which is not already widely implemented in the NHS and
to assess the nature of the available research.

Tackling health inequalities by addressing social determinants of health

In 2008, the WHO Global Commission on the Social Determinants of Health published a
report ‘Closing the Gap in a Generation’. Subsequently the Secretary of State for Health
commissioned the ‘Post-2010 Strategic Review of Health Inequalities (Marmot Review)’.
These have raised the profile of the social determinants of health and of the importance of
addressing the conditions of everyday life that lead to inequities in health.

Health inequalities intervention tool

Association of Public Health Observatories has published a new version of the Spearhead
health inequalities intervention tool which has been updated with 2005-2007 data to provide
an update on the gaps in life expectancy between spearhead areas and England as a whole.
This tool supports planning and commissioning to achieve the national target to reduce
inequalities in life expectancy. It provides: the life expectancy gap between each Spearhead
local authority and England as a whole, broken down by cause of death and age group; and
the same breakdown between the Spearhead Group as a whole, and England.

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A guide to involving patients and members of the public in staying healthy

NHS Centre for Involvement
This guide will assist people and organisations with the process of involving patients and the
public in Staying Healthy services. It is organised around a wheel of involvement made up of
eight spokes which together make up the end-to-end process of patient and public

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involvement. Examples from the field of Staying Healthy are provided to illustrate each part of
the process.

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Men’s Health

Man Made: Men, masculinities and equality in public policy

Coalition on Men and Boys
The report provides a unique, in-depth picture of the circumstances and needs of men and
boys in England and Wales, and the issues they currently face. Focusing on the key themes
of work, fatherhood, health, education and violence, ‘Man Made’ analyses how public policy
can support and engage with men and boys effectively, and outlines practical proposals for

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Mental Health

Guide to providing mental health care support to asylum seekers in primary care
Royal College of General Practitioners
Guidance for primary health care staff involved in the delivery and the development of mental
health care provision to asylum seekers in the UK.

Moving on up
Mental Health Foundation
This report reveals the barriers that are preventing patients with mild or moderate depression
from accessing exercise on prescription. They include funding constraints within local
government and PCTs, and that many GPs aren't aware that exercise schemes are available
in their area.

People with mental health conditions and Pathways to Work

Department for Work and Pensions
This report presents findings from a qualitative research project carried out as part of a wider
evaluation of Jobcentre Plus Pathways to Work. The study was conducted in 2008 and 2009
to explore how Jobcentre Plus Pathways to Work may better meet the needs of the
heterogeneous mental health client group.

Working together to provide age-appropriate environments and services for mental

health patients aged under 18
National Mental Health Development Unit
This briefing has been written to support commissioners of both adult mental health services
and child and adolescent mental health services to prepare to meet the requirements of a
new duty within the Mental Health Act 2007, amending the 1983 Act, to admit and treat
patients aged under 18 into an environment in hospital which is suitable having regard to their
age. The Government has committed to commencing this duty in April 2010, with the purpose
of preventing the inappropriate admission of children and young people to adult psychiatric

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Happiness matters
St Mungo’s
Despite the many improvements to mental health services in the past decades, St Mungo's
believes that still, even now, homeless people with mental health problems do not get the
services they need. This report looks at access and barriers to services and support for
mental health, the impact of drink and drugs, and emotional wellbeing.

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Evaluation of the Phase 2 Snack Right Social Marketing Project – Final Report
Lyn Winters, Liverpool Public Health Observatory
The aims of this project were threefold: to improve the nutritional quality of snacks given to
pre-school children in deprived areas of Cheshire and Merseyside and to gain experience and
build capacity in social marketing throughout Cheshire and Merseyside; to put marketing
theory into practice on a Cheshire and Merseyside footprint; and to disseminate the learning
in social marketing.

Comparison of Putative Health Effects of Organically and Conventionally Produced

Foodstuffs: A systematic review
Food Standards Agency
This report reviews the evidence of differences in putative health effects of organically
compared with conventionally produced foodstuffs.

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Effectiveness of weight management programs in children and adolescents

Whitlock E P et al
Database of Abstracts of Reviews of Effects (Published May 2009)
CRD Summary: This review concluded that behavioural interventions have modest beneficial
effects on weight in the short to medium term (6-12 months). Behavioural interventions are
more effective when combined with pharmacological interventions. Surgical interventions for
morbidly obese adolescents are associated with greater weight loss, but also more adverse
effects. The review was well conducted and the conclusions are likely to be reliable.

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Older People

Prevention Package for Older People

Department of Health
The prevention package raises the focus on prevention as a means of ensuring good health,
well-being and independence in later life by promoting and encouraging uptake of
comprehensive health and social care services for older people. The prevention package,
brings together information on existing health ‘entitlements’ including sight tests, flu
vaccination and cancer screening, promotes best practice around falls prevention and
effective fracture management, introduces measures to improve access to affordable footcare
services, updates national intermediate care guidance and summarises existing progress on
audiology and telecare.

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Oral Health
Dental commissioning statistics
Department of Health
This data shows the number of Units of Dental Activity (UDAs) commissioned as at 30th June
2009. Key findings are: all 152 Commissioners (PCTs and Care Trusts) returned data, 84.5
million UDAs have been commissioned as at 30th June 2009 and this represents an increase
of 1.1 million (1.4 %) on the UDAs commissioned as at 31st March 2009.

Local self-assessment audit for assessing implementation of HTM 01-05:

decontamination in primary care dental practices and related infection prevention and
control issues
Department of Health
This audit tool has been produced jointly by the Department and the Infection Prevention
Society, to allow practices to assess their level of compliance with the HTM 01-05:
decontamination in primary care dental practices. It will allow practices to identify areas where
they need to improve the quality of the decontamination process to achieve essential quality
requirements and best practice, as identified in the guidance document.
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Reaching out: community engagement and health
IdeA and NICE
This report explores the importance of engaging communities in health promotion and health
services, and the health benefits that this can bring. It reflects on the government
commitments to engaging the public further in democratic and decision-making processes
and builds on the NICE guidance on community engagement and health.

New routes to better outcomes

This is a new publication from the IDeA's Partnerships team. It comes in two parts:
Part 1: Improving public services through local partnership
Part 2: A practitioners' handbook

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Physical Activity
Children and Young People’s Participation in Organised Sport: Omnibus survey
Department for Children, Schools and Families
This research measured current levels of participation in organised sport among children and
young people aged 5 to 19 in England.

Exercise and Physical Activity for Older Adults’ Position Stand

American College of Sports Medicine
The ACSM has updated the Position Stand, initially launched in 1999. This is in response to
the accumulation of a significant amount of new evidence regarding the benefits of regular
exercise for older adults over the past decade. The ACSM Position Stand is divided into three

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main sections: Section 1 briefly reviews some of the structural and functional changes that
characterise human ageing, section 2 considers the extent to which exercise/physical activity
can influence the ageing process and section 3 summarises the benefits of both long-term
exercise and physical activity and shorter-duration exercise programmes on health and
functional capacity.

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Public Health
Informing healthier choices
Informing Healthier Choices is a Department of Health programme to make public health
intelligence more accessible, useful and timely, and to give people the tools, skills and
knowledge to use it.

We’re all in this together: improving the long-term health of the nation
Public Health Commission
This report is the culmination of the work of the Public Health Commission which was
established in 2008 following a request to review a Responsibility Deal to improve public

Building Britain’s future

HM Government
This paper outlines the action that the UK Government is taking to move the UK from
recession to recovery and forge a new model of economic growth; restore trust and
accountability to the political system; and modernise public services and national
infrastructure. Chapter four covers the rebuilding of public services, including health services.

The public health effect of economic crises and alternative policy responses in Europe:
an empirical analysis
David Stuckler et al
The Lancet, Volume 374, Issue 9686, Pages 315 - 323, 25 July 2009
There is widespread concern that the present economic crisis, particularly its effect on
unemployment, will adversely affect population health. This research investigates how
economic changes have affected mortality rates over the past three decades and identified
how governments might reduce adverse effects.
(Article available from the Health Library)

Intelligent commissioning: better information, better decisions, better health

Association of Public Health Observatories
This report gives examples of the work of the Association, Public Health and Themed
Observatories to support commissioning and looks at the way forward.

Health protection regulations: a consultation

Department of Health
This is a consultation on draft health protection regulations to be made under the amended
Public Health (Control of Disease) Act 1984, to continue the process of modernising health
protection legislation in England. The regulations cover requirements for notification of
disease caused by infection or contamination by chemicals or radiation, to allow prompt
investigation and response; evidential requirements and safeguards for people who might be

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subject to a JP order under the amended Act; and updated local authority powers to protect
public health. Responses are invited by 30 September 2009.

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Effectiveness of cervical screening with age: population based case-control study of
prospectively recorded data
Peter Sasieni
BMJ 2009;339:b2968 (Published 28 July 2009)
Conclusions: Cervical screening in women aged 20-24 has little or no impact on rates of
invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on
advanced stage tumours in women under age 30. By contrast, screening older women leads
to a substantial reduction in incidence of and mortality from cervical cancer. These data
should help policy makers balance the impact of screening on cancer rates against its harms,
such as overtreatment of lesions with little invasive potential.
(Full text article available with Athens)

Inequalities in reported use of breast and cervical screening in Great Britain: analysis
of cross sectional survey data
Moser K et al
BMJ 2009;338:b2025 (Published 16 June 2009)
CONCLUSIONS: Most (84%) eligible women report having had both breast and cervical
screening, but 3% report never having had either. Some inequalities exist in the reported use
of screening, which differ by screening type; indicators of wealth were important for breast
screening and ethnicity for cervical screening. The routine collection within general practice of
additional sociodemographic information would aid monitoring of inequalities in screening
coverage and inform policies to correct them.
(Full text article available with Athens)

Screening and prostate-cancer mortality in a randomised European study

Schröder FH, Hugosson J, Roobol MJ, et al, for the ERSPC investigators
N Engl J Med 2009;360:1320–8
Conclusions: PSA-based screening reduced the rate of death from prostate cancer by 20%
but was associated with a high risk of overdiagnosis.
(Full text article available with Athens)

Tailored information about cancer risk and screening: A systematic review

Albada A,, Ausems MG, Bensing JM, van Dulmen S
Patient Education and Counseling 2009 Apr 17. [Epub ahead of print]
CONCLUSION: Information that was tailored based on behavior change variables increased
realistic perception of cancer risks and knowledge of cancer compared to generic information.
Also, information tailored to individuals' risk factors increased realistic risk perception
compared to generic information.
(Article available from Health Library)

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Sexual Health
STI statistics
Health Protection Agency

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Latest figures on sexually transmitted infections (STIs) show an 11% decrease in the total
number of new gonorrhoea infections diagnosed in the UK last year from 18,649 infections in
2007 to 16,629 in 2008 - the lowest number of new infections recorded since 1999. Syphilis
also showed a 4% decrease from 2,633 new cases recorded in 2007 to 2,524 new cases in
2008. Syphilis remains a relatively uncommon infection in the UK, although levels are still
considerably higher than 10 years ago. The greatest burden of STIs continues to fall among
young people (aged 16 to 24 years), who are disproportionately affected by STIs. While just
12% of the population are aged 16 to 24 years old, this age group accounts for more than half
of all new STIs diagnosed in the UK.

Access to GUM services

Department of Health
This data shows the number of first attendances to a GUM clinic for each clinic provider, how
many of these attendances were offered an appointment within 48 hours and how many were
seen within 48 hours. Some findings are: the percentage of appointments offered within 48
hours was 99.9% for June 2009, an increase of 0.1% from May and the percentage of
attendances seen within 48 hours as a proportion of the total number of attendances was
88.7% for June 2009, an increase of 1.5% from May.

Disturbing symptoms
British Association for Sexual Health and HIV
This report is based on the analysis of responses from commissioners and specialist
clinicians to two short surveys distributed in early 2009. The surveys aim to build a picture of
the impact of national health policies on sexual health and HIV services.

Moving forward: progress and priorities - working together for high quality sexual
health: Government response to the Independent Advisory Group’s review of the
Sexual Health and HIV Strategy
Department of Health
This Government response outlines the progress made in improving sexual health since 2001
and responds to each of the national level recommendations put forward by the Independent
Advisory Group.

A systematic review of lesbian, gay, bisexual and transgender health in the West
Midlands region of the UK compared to published UK research
West Midlands Health Technology Assessment Collaboration
This systematic review presents all available research conducted in the West Midlands on
LGBT health since 2000. Local health research is compared to UK national, peer reviewed
and published LGBT health research in order to determine whether the local results are
unusual compared to national LGBT data, and to routinely collected data on the UK
population, where appropriate, in order to determine whether and where the LGBT population
differ from the general population. Only UK research has been included because there was
no previous UK specific systematic review so it was unclear how generalisable foreign
research would be to the UK.

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NHS Stop Smoking Services: England, April 2008 to March 2009
NHS Information Centre

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This annual report presents final results from the monitoring of the NHS Stop Smoking
Services (NHS SSS) in England during the period April 2008 to March 2009. This report
includes information on the number of people setting a quit date and the number who
successfully quit at the 4 week follow-up. It also presents in depth analyses of the key
measures of the service including pregnant women, breakdowns by ethnic groups and type of
pharmacotherapy received and regional analyses at Strategic Health Authority (SHA) and
Primary Care Trust (PCT) levels.

Pharmacy-based stop smoking services: optimising commissioning

NHS Employers
Guidance aimed at senior NHS managers who are responsible for commissioning
pharmaceutical services, public health professionals and commissioners of stop smoking
services. It will also be of interest to community pharmacies providing these services and
other providers of core NHS stop smoking services.

'Cut down to quit' with nicotine replacement therapies in smoking cessation: a

systematic review of effectiveness and economic analysis
Wang D, Connock M, Barton P, Fry-Smith A, Aveyard P, Moore D
Database of Abstracts of Reviews of Effects (Published May 2009)
CRD Summary: This review evaluated the effectiveness of nicotine replacement therapy
(NRT) in achieving smoking abstinence for smokers unwilling or unable to quit abruptly. The
authors concluded that NRT was an effective intervention in achieving smoking abstinence for
smokers who were unwilling or unable to attempt an abrupt quit. The authors' conclusions
reflected the evidence presented and were likely to be reliable.

Effects of Web- and computer-based smoking cessation programs

Myung S K, McDonnell D D, Kazinets G, Seo H G, Moskowitz J M
Database of Abstracts of Reviews of Effects (Published June 2009)
CRD Summary: This review concluded that Web-based and computer-based interventions
(with or without other interventions) improve smoking cessation in adults and the evidence is
strong enough to support their use in practice. The review had some reporting limitations but
the conclusions about effectiveness are in line with the evidence presented and likely to be

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Substance misuse
Smoking, drinking and drug use among young people in England in 2008 full report
NHS Information Centre
This report contains results from an annual survey of secondary school pupils in years 7 to 11
(mostly aged 11 to 15). 7,798 pupils in 264 schools in England completed questionnaires in
the autumn term of 2008. The survey report presents information on the percentage of pupils
who have ever smoked, tried alcohol or taken drugs. The report explores the attitudes and
beliefs of school children towards smoking and drinking and where children obtain cigarettes
and alcohol. Relationships between smoking, drinking and drug use are explored along with
the links between smoking, drinking and drug use with other factors such as age, gender,
ethnicity, previous truancy or exclusion, and school policies in these areas.

Reducing Alcohol Harm: health services in England for alcohol misuse

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House of Commons Public Accounts Committee

The report states that alcohol misuse is a significant and growing problem in England, with
more than 10 million people now regularly drinking above the guidelines set by the
Government. The report adds that alcohol misuse places a considerable burden on the
National Health Service (NHS), costing an estimated £2.7 billion per year.

Young People and Alcohol Guidance: Consultation response

Department for Children, Schools and Families
This is the Government's response to a consultation on alcohol guidance, advice and
information for parents, children and young people.

Towards successful treatment completion: a good practice guide

National Treatment Agency (NTA) for Substance Misuse
This is a good practice guide to help reduce the number of unplanned discharges and
increase successful treatment completions.

Clinical governance in drug treatment: a good practice guide for providers and
National Treatment Agency (NTA) for Substance Misuse
Guidance aiming to improve clinical governance in the commissioning and delivery of drug
misuse treatment.

Deaths related to drug poisoning, England and Wales

National Statistics

Home Office Statistical Bulletin 12/09: Drug misuse declared - Findings from the 2008-
09 British Crime Survey - England and Wales
Home Office
These statistics cover self-reported drug use for adults and young people in England and
Wales from the 2008-09 British Crime Survey.

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