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This paper explores FGM-safeguarding in the UK through a decolonial lens. Based on an analysis of the development of law and policy relating to 'Female Genital Mutilation' in the UK alongside data collected in focus groups with people of ethnic Somali heritage living in Bristol, we argue that the current legislation and policies, as well as their delivery, are steeped in colonial Othering. We demonstrate that legislative and policy approaches operate through a gendered and generational binary in which non-White mothers are othered as migrants (regardless of citizenship status) for whom anachronistic culture is deemed determinative, whilst their daughters are claimed as British. In this construction, 'FGM' operates as the symbolic marker that designates un/belonging: the uncircumcised girl is rescuable and claimed as 'one of us', whilst the circumcised mother is considered a mutilated political subject for whom belonging is foreclosed. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. Methods and findings: Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. Conclusions: In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services. In a meta-ethnography, Dr Narinder Bansal and colleagues report insights into ethnic inequalities in mental healthcare in the UK. Author summary: Why was this study done?: People from ethnic minority groups in the UK have poorer mental health and access to mental healthcare, and more negative experiences and outcomes compared to the majority white British group. These inequalities have been reported for over 50 years. There remains some debate regarding their causes and the interventions required to tackle these. In order to develop effective interventions, we need to consider a wide range of perspectives from communities, service users, carers, and mental health professionals in a way that allows interrogation of commonalities and variations in experience across a diverse range of ethnic and lay/professional backgrounds. What did the researchers do and find?: We conducted a comprehensive literature search and identified 66 relevant studies that explored the experiences and perspectives of people in different ethnic minority groups and mental health professionals in relation to access to and experience of mental healthcare. We identified key themes across papers and explored similarities and differences in experiences across ethnic groups and between communities and mental health professionals. We found that current statutory approaches to the assessment and treatment of mental illness are experienced as a major barrier to the delivery of appropriate and person-centred care to those in ethnic minority groups. These are perceived to exclude the everyday realities of people's lives including racism, migration stress, complex trauma, and spirituality and the ways in which these may contribute to (or mitigate) mental illness. The lack of progress in tackling ethnic inequalities is attributed to superficial attempts at coproduction and inadequate adoption of existing community recommendations within services. What do these findings mean?: The delivery of safe and equitable person-centred care requires a model of mental healthcare that recognises, and is responsive to, the lived experiences of people in ethnic minority groups. This includes paying attention to how experiences of racism and migration affect mental health during assessment and treatment and tackling institutional racism in mental healthcare. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of existing barriers and obstacles to authentic and meaningful inclusion of people with lived experience from ethnic minority groups in the development and delivery of mental healthcare services. [ABSTRACT FROM AUTHOR]

The UN has stated its aim to eliminate 'Female Genital Mutilation' by 2030. In adherence to this, many countries have introduced or enhanced legislative and policy measures aimed at prevention through surveillance and punishment. In the European context, while protecting young girls from harm is the notional purpose of such measures, political and media debates have often been framed within nation-building rhetoric: across Europe 'FGM' has become the de rigour signifier of the vilified migrant/Muslim Other. This paper explores the impact of FGM-safeguarding measures in relation to citizenship and belonging for people of Somali heritage living in Bristol, England. It contributes to the incipient critical scholarship concerned with the powerful but blinkered hegemonic narrative pedalled by the UN and the policy turn within Europe towards prevention-through-criminalisation. Further, it advances debates on the conundrum of inclusive citizenship considering how a policy intervention which was initiated with widespread support among affected groups and undertaken on an anti-racist platform, resulted in stigmatisation and racism. Using Anderson's (Us and Them? The Dangerous Politics of Immigration Control. Oxford: OUP) framework of citizenship as a 'community of value', the paper also contributes to the growing body of work on how citizenship is experienced and the symbiotic and interdependent relationship between status, rights and identity. [ABSTRACT FROM AUTHOR]

Purpose: Psychotic disorders, which are associated with substantially increased morbidity and mortality, are up to five times more common in some ethnic minority groups compared with the white majority in Western countries. This long-standing and well-replicated public mental health disparity has hitherto largely eluded adequate explanation. We argue that this might have arisen in part due to the lack of attention given to theoretical work characterising the complex and multidimensional social nature of ethnicity by those epidemiological investigations that have dominated the literature. Methods: To bridge this gap, we draw on theoretical and empirical literature from across the social sciences considering the ontological significance of ethnicity (as biology, migration, racialised structures and identity) and its relationships with psychotic disorders to illuminate probable drivers of excess psychosis risk. Results: The largest gains in our theoretical understanding of excess psychosis risk among ethnic minority groups are to be made by considering ethnicity in relation to disempowerment resulting from structural and identity-based exclusion. The former is readily studied through the social gradient in health: socioeconomic disadvantage clusters in some ethnic minorities and increases the risk of poor health outcomes, including psychosis. Furthermore, limitations on identity acquisition and expression imposed by the ethnic majority can further contribute to alienate ethnic minorities and increase psychosocial disempowerment (a lack of control over one's life). Conclusion: We theorise that structural and identity-based exclusion act as the primary drivers shaping variation in rates of psychotic disorder by ethnic minority status. [ABSTRACT FROM AUTHOR]

This study uses data from consecutive England and Wales censuses to examine the intragenerational economic mobility of individuals with different ethnicities, religions and genders between 1971 and 2011, over time and across cohorts. The findings suggest more downward and less upward mobility among Black Caribbean, Indian Sikh and Muslim people with Bangladeshi, Indian and Pakistani ethnicities, relative to white British groups, and more positive relative progress among Indian Hindu people, but also some variation in the experiences of social mobility between individuals even in the same ethnic groups. For some groups, those becoming adults or migrating to the UK since 1971 occupy an improved position compared with older or longer resident people, but this is not universal. Findings suggest that these persistent inequalities will only be effectively addressed with attention to the structural factors which disadvantage particular ethnic and religious groups, and the specific ways in which these affect women. [ABSTRACT FROM AUTHOR]

Negative rhetoric and policy regarding Muslims has been justified according to a perceived lack of integration into British society. However, this lack of integration has not been empirically established and remains poorly described. This paper explores whether there are variations in levels of 'Britishness' and perceptions of the compatibility between Britishness and other cultural/religious identities among different minoritized groups in England and Wales. It examines the impact of racialization and other forms of social and economic exclusion on ideas of Britishness, focusing on similarities and differences in a sense of access to forms of Britishness among migrant groups. Descriptive and multivariate analyses of Citizenship Survey data showed that 90 per cent of Muslims, Hindus, Sikhs and Christians felt part of Britain. Muslims were more likely than Caribbean Christians to report a strong British identification and (along with Hindus and Sikhs) to recognize potential compatibility between this and other aspects of national identity. The strength of this feeling was associated with age, gender, generation and, importantly, risk of racist victimization. Greater recognition must be given to the impact of social exclusion on the ability of ethnic and religious minority groups to feel part of British society, and also to the strong claim to Britishness made by Muslim people in England. [ABSTRACT FROM AUTHOR]

The role of victimization in the generation of ethnic inequalities is increasingly acknowledged yet its impact on the lives of people with different religious affiliations remains underexplored. This is despite evidence of the importance of religion for forms of group identification and social mobilization. An exploration of the particular impact of religion as a focus for experiences of victimization may be particularly pertinent given the increasingly negative treatment of Muslim people since the riots in Britain of 2001, the terrorist incidents of 2001, 2004 and 2005 and the political and military responses to them. Cross-sectional analyses of data collected in 2000 and 2008/2009 explore whether there is evidence that the ethnic/religious patterning of reports of different forms of victimization have varied over time, after adjusting for the impact of age, gender, migration and socioeconomic differences between the groups. In 2000 Muslim people with different ethnic backgrounds were less likely, but by 2008/2009 were more likely, to report experiences of victimization than Caribbean Christians. However, the ethnic/religious patterning of perceptions of Britain as a ‘racist society’ were more consistent over time. This may suggest that, despite their increased exposure to victimization over the period, Muslim people in the United Kingdom have yet to experience the racialization characteristic of the treatment of Caribbean Christians, which requires a more prolonged exposure to racist negative attitudes. But this may be only a matter of time. The persistent expectation of poor treatment described by Caribbean Christians is testament to the difficulties of addressing these negative perceptions once racialized identities are embedded. Immediate action must be taken to prevent this occurring among other ethnic/religious minorities. [ABSTRACT FROM PUBLISHER]

Background: Non-invasive prenatal testing (NIPT) for Down’s syndrome (DS) using cell free fetal DNA in maternal blood has the potential to dramatically alter the way prenatal screening and diagnosis is delivered. Before NIPT can be implemented into routine practice, information is required on its costs and benefits. We investigated the costs and outcomes of NIPT for DS as contingent testing and as first-line testing compared with the current DS screening programme in the UK National Health Service. Methods: We used a pre-existing model to evaluate the costs and outcomes associated with NIPT compared with the current DS screening programme. The analysis was based on a hypothetical screening population of 10,000 pregnant women. Model inputs were taken from published sources. The main outcome measures were number of DS cases detected, number of procedure-related miscarriages and total cost. Results: At a screening risk cut-off of 1∶150 NIPT as contingent testing detects slightly fewer DS cases, has fewer procedure-related miscarriages, and costs the same as current DS screening (around UK£280,000) at a cost of £500 per NIPT. As first-line testing NIPT detects more DS cases, has fewer procedure-related miscarriages, and is more expensive than current screening at a cost of £50 per NIPT. When NIPT uptake increases, NIPT detects more DS cases with a small increase in procedure-related miscarriages and costs. Conclusions: NIPT is currently available in the private sector in the UK at a price of £400-£900. If the NHS cost was at the lower end of this range then at a screening risk cut-off of 1∶150 NIPT as contingent testing would be cost neutral or cost saving compared with current DS screening. As first-line testing NIPT is likely to produce more favourable outcomes but at greater cost. Further research is needed to evaluate NIPT under real world conditions. [ABSTRACT FROM AUTHOR]

Muslims in Europe are increasingly constructed as problematic and insular. This article examines whether this construction may be justified and the impact this has had on the attitudes of Muslims living in different countries in Europe. Over 70 percent of Bangladeshi, Turkish and Moroccan Muslims living in Britain, Germany and Spain, respectively, felt ‘at home’ in their country of residence. This sense of being at home, and whether the events of 11 September 2001 or 11 March 2004 affected this was associated with citizenship of or birth in Europe, experiences of victimization and perceived local social support. Citizenship, experiences of discrimination and strength of religious identities were associated with reporting British, German or Spanish identities. Rather than providing evidence of self-segregation, these findings emphasize the impact of the political and social marginalization faced by Muslim groups in Europe, which significantly affects their ability to feel themselves at home there. [ABSTRACT FROM PUBLISHER]

To investigate variations in explanations given for disparities in health care use between migrant and non-migrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five 'migrant' health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: 'Communication issues', 'Cultural differences in approaches to medical consultations' and 'Effects of perceptions of inequalities in care quality and discrimination'. Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of 'migrant' clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and 'migrant' patients encourages a sense of powerlessness and mistreatment among patients. [ABSTRACT FROM AUTHOR]

Community severance occurs where road traffic (speed or volume) inhibits access to goods, services, or people. Appleyard and Lintell's seminal study of residents of three urban streets in San Francisco found an inverse relationship between traffic and social contacts. The extent of social networks predicts unhealthy behaviors, poor health, and mortality; high rather than low social integration is associated with reduced mortality, with an effect size of similar magnitude to stopping smoking. Although community severance diminishes social contacts, the implications of community severance for morbidity and mortality have not been empirically established. Based on a systematic literature search, we discuss what is actually known about community severance. There is empirical evidence that traffic speed and volume reduces physical activity, social contacts, children's play, and access to goods and services. However, no studies have investigated mental or physical health outcomes in relation to community severance. While not designed specifically to do so, recent developments in road design may also ameliorate community severance. [ABSTRACT FROM AUTHOR]

Objectives. To examine the role of religion in the patterning of health inequities, and how this is related to ethnicity and socioeconomic status. Design. Multivariate analyses using nationally representative data on self-assessed fair or poor health, longstanding limiting illness, diagnosed diabetes, diagnosed hypertension, waist-hip ratio, body mass index, current tobacco use and participating in no regular physical activity from 14,924 Christians, 4337 Muslims, 656 Sikhs, 1197 Hindus and 2682 people reporting not identifying with any religion with different ethnic backgrounds, who were interviewed as part of the Health Survey for England in either 1999 or 2004, adjusted for age, gender and socioeconomic status and periodicity. Results. Odds ratios for general health, hypertension, diabetes, waist-hip ratio, tobacco use and physical activity speak to the importance of ethnicity in the patterning of health inequalities. But there is also evidence of an important, independent role for religion, with risks for the different health indicators varying between people with the same ethnic, but different religious, identifications. Adjusting for socioeconomic status attenuated the ethnic/religious patterning of, particularly, self-assessed health, longstanding activity-limiting illness, waist-hip ratio, body mass index and tobacco use. Conclusions. This evidence enables greater understanding of the complexities of the relationship between ethnicity, religion and health, recognising the need to understand the heterogeneity underlying both ethnic and religious group membership and the processes producing the structural disadvantage facing certain religious and ethnic groups in the mediation of the relationship between health and ethnicity/religion. [ABSTRACT FROM AUTHOR]

This paper reports results from a national survey in 1999 of voluntary hospice services in the UK. It focuses on volunteer and staff views of the purposes of hospice care, and on current debates within palliative care. Twenty-five hospice services, stratified by region, services provided (inpatient care, day care and/or home care) and number of beds were randomly sampled from amongst 175 voluntary hospices in the UK. Nineteen participated. Seventy per cent of a random sample of professional and voluntary staff within these hospices returned a postal questionnaire. Both volunteers and professionals considered care of the whole person, pain and symptom control, quality of life and dying peacefully to be important aspects of hospice care. Most doctors chose care of the whole person as the most important aspect, and they were more likely to choose this option than other staff. Hospice volunteers were less positive than hospice staff (particularly doctors and nurses) in their attitudes to extending hospice care to noncancer patients (where many volunteers held no strong view), to restricting care to patients with specialist palliative care needs, and less negative about euthanasia. These findings illustrate the importance of including hospice volunteers and the general public, as well as hospice staff, in debates about the future of hospice and palliative care in the UK. Further research is needed into lay and professional views of the role of hospices and palliative care services. [ABSTRACT FROM AUTHOR]

In this paper we report findings of a 1999 nationally representative survey of independent hospices in the UK, focusing on hospice staff and volunteers' experiences of working in hospices. Nineteen of 25 sampled services participated, and these differed little in terms of service provision, size and region from the total sample of 175 services. A response rate of 70% for randomly sampled hospice staff and volunteers was achieved (n = 504). There were significant intergroup differences (doctors, nurses, nursing auxiliaries, other staff and volunteers) in participants' reported experience of working in the hospice with, for example, doctors being more likely than other groups to feel appreciated and to report receiving adequate support from hospice management. Overall, 31% of respondents wanted more support from management. Half had considered leaving the hospice (65% nurses, 60% other staff, 55% nursing auxiliaries, 40% doctors and 37% volunteers). Nurses who had considered leaving were less satisfied than other nurses with, for example, support from hospice management, and less likely to feel valued by the hospice. These results raise questions about the quality of the relationship between hospice trustees, managers and staff, and about the realities of enhancing multiprofessional teamwork in organizations where there are significant differences between staff groups in perception of, and satisfaction with, the working environment. Voluntary hospice trustees and managers face a difficult task in managing and supporting staff whilst also negotiating relationships with the NHS at a time of rapid change, and ensuring hospices' financial viability. Access to high quality leadership programmes may play an important role in ensuring voluntary hospices are characterized by effective, supportive working relationships. [ABSTRACT FROM AUTHOR]

Objectives. The definitions of ethnic status currently employed in, particularly, epidemiological research, tend to focus on skin colour or on perceived historical or ancestral links with certain geographical locations. Neither of these classificatory systems stem from any widely supported theoretical standpoint and their usefulness in terms of explaining any ethnic variation is therefore questionable. In order to enable more informative exploration of ethnicity and its relationship with health and other indicators, a clearer understanding of the processes involved in ethnic identification is required. This paper sets out to explore underlying dimensions which could constitute an ethnic identity across different ethnic groups in England. Design. Principal components factor analyses on the different ethnic groups included in the Ethnic Minority Psychiatric Illness Rates in the Community study: Bangladeshi, Caribbean, Indian, Irish and Pakistani people and a 'white majority' group. Results. In each ethnically specific model, three dimensions of ethnic identity were determined; related to multiculturalism, or the sustenance of ethnic difference, racialisation and community participation. In the ethnic minority group models the 'multiculturalism' dimension formed two factors: one related to the presentation of oneself as a member of a particular ethnic group and one exploring attitudes towards cultural assimilation. The findings suggested that the processes of ethnic identification are similar across the different ethnic (minority and majority) groups explored, but that there may be important differences within any particular group. Conclusion. The recognition of these dimensions of ethnic affiliation provide us with an opportunity to improve our indicators of ethnic status. Each of these dimensions would appear to be important to the lives of people from different ethnic groups in England. These findings also highlight the important role that external attitudes play in the understanding of what it means to be a member of any ethnic group. This aspect of ethnic affiliation has been ignored by current definitions of ethnicity and this imbalance should be redressed. [ABSTRACT FROM AUTHOR]

We set out to explore the influence of environment on ethnic inequalities in health. Studies exploring the relationship between environment and health have tended to ignore the role of ethnicity, and the health impact of the residential concentration of ethnic minority groups in disadvantaged areas. Those that have explored the role of ethnicity tend to focus on the way in which residential concentration may promote a sense of community among ethnic minority groups, and, consequently, may be protective of health (the `ethnic density effect'). Again, they have tended to ignore the health impact of the concentration of ethnic minority groups in areas of social and economic disadvantage. We undertook a factor analysis to determine aspects of perception of `quality' of the local environment, followed by multi-level analyses to explore the relationship between self-reported fair or poor health and individual- and ward-level characteristics among four ethnic groups (Caribbean, Indian, Pakistani and Bangladeshi, and white) in the UK. Results of the factor analysis suggested three underlying dimensions of perception of quality of the local area, related to the quality of the local environment, the provision of local amenities and local problems of crime and nuisance. These factors were entered into the multi-level models at level 2, along with indicators of ward-level ethnic density and Townsend's deprivation score, with age, gender and household social class entered at level 1. In general, there was a residual random ward-level effect suggesting an area influence on self-assessed health. However, on the whole, none of the ward-level indicators showed any statistically significant association with self-assessed health, making it difficult to precisely determine the mechanisms operating. These findings suggest, though, that there is no ethnic density effect on self-assessed health for ethnic minority groups. [ABSTRACT FROM AUTHOR]

Objectives. This study explored associations between racism, social class, and health among ethnic minority people in England and Wales. Methods. We conducted a series of regression analyses on cross-sectional data from the Fourth National Survey of Ethnic Minorities to explore the relation between different indicators of racism and health and household occupational class. Results. Marked independent associations existed between reported experience of racism and perceptions of Britain as a "racist society," household social class, age, sex, and various mental and physical health indicators. These associations showed reasonable consistency across the different ethnic groups. Conclusions. The different ways in which racism may manifest itself (as interpersonal violence, institutional discrimination, or socioeconomic disadvantage) all have independent detrimental effects on health, regardless of the health indicator used. (Am J Public Health. 2002;92:624-631) [ABSTRACT FROM AUTHOR]

Explores ethnic variations in drug, tobacco and alcohol use. Correlation with other factors which operate through peer, familial and religious influences; Need for health education initiatives; Promotion of personal decision-making skills within the context of the young people's individual culture.

Findings from the Health Surveys for England indicate that Bangladeshi and Black Caribbean men report higher current smoking rates than other men, while white and Black Caribbean women smoke more frequently than other women. Deprivation explains differences in current smoking rates between Bangladeshi and Black Caribbean, and white English men. The smoking rates of Pakistani men and Black Caribbean women were significantly lower than those of white English people after adjusting for socio-economic status. The smoking rates of white English, Black Caribbean and Pakistani men and Black Caribbean women appear more stable over time than those of other groups. [ABSTRACT FROM AUTHOR]

This article presents information about a study which analyzes the effects of racism on health. The findings of this study suggest that, independent of the effects of gender, age, and household social class, being worried about being a victim of racial harassment could have an important impact on one's health experience. The measures adopted here are comparatively crude; there may be better ways to measure both aspects of racism and socioeconomic status and the cross sectional nature of the data means that it is impossible to determine the direction of any causality. But these findings provide further evidence that there is an association that requires further exploration.

Presents results of a survey of the palliative care needs of hospital patients with advanced disease in London, England. Similarity with the findings of a survey conducted in a French hospital; Definition of advanced disease; Major concerns and complaints of patients.

Background: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children's well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0-10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.Methods/design: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3-18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.Discussion: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.Trial Registration: Prospectively registered Randomised Controlled Trial ISRCTN15194500 . [ABSTRACT FROM AUTHOR]

Background Small-scale evaluations suggest that the provision of feedback to parents about their child's weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. Methods We conducted a pre-post survey of 1,844 parents of children aged 4-5 and 10-11 years who received weight feedback as part of the 2010-2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differences in the pre-post proportions of parents reporting each outcome were assessed using a McNemar's test. Results General knowledge about child overweight as a health issue was high at baseline and increased further after weight feedback. After feedback, the proportion of parents that correctly recognised their child was overweight increased from 21.9% to 37.7%, and more than a third of parents of overweight children sought further information regarding their child's weight. However, parent-reported changes in lifestyle behaviours among children were minimal, and limited to increases in physical activity in the obese children only. There was some suggestion that weight feedback had a greater impact upon changing parental recognition of the health risks associated with child overweight in non-white ethnic groups. Conclusions In this population-based sample of parents of children participating in the National Child Measurement Programme, provision of weight feedback increased recognition of child overweight and encouraged some parents to seek help, without causing obvious unfavourable effects. The impact of weight feedback on behaviour change was limited; suggesting that further work is needed to identify ways to more effectively communicate health information to parents and to identify what information and support may encourage parents in making and maintaining lifestyle changes for their child. [ABSTRACT FROM AUTHOR]

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12–18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health. [ABSTRACT FROM AUTHOR]

Background: There is substantial evidence that health and health-care experiences vary along ethnic lines and the need to understand and tackle ethnic health inequalities has repeatedly been highlighted. Research into ethnicity and health raises ethical, theoretical and methodological issues and, as the volume of research in this area grows, so too do concerns regarding its scientific rigour and reporting, and its contribution to reducing inequalities. Guidance may be helpful in encouraging researchers to adopt standard practices in the design, conduct and reporting of research. However, past efforts at introducing such guidance have had limited impact on research practice, and the diversity of disciplinary perspectives on the key challenges and solutions may undermine attempts to derive and promote guiding principles. Methods: A consensus building Delphi exercise—the first of its kind in this area of research practice—was undertaken with leading academics, practitioners and policymakers from a broad range of disciplinary backgrounds to assess whether consensus on key principles could be achieved. Results: Ten key principles for conducting research on ethnicity and health emerged, covering: the aims of research in this field; how such research should be framed and focused; key design-related considerations; and the direction of future research. Despite some areas of dispute, participants were united by a common concern that the generation and application of research evidence should contribute to better health-care experiences and health outcomes for minority ethnic people. Conclusion: The principles provide a strong foundation to guide future ethnicity-related research and build a broader international consensus. [ABSTRACT FROM PUBLISHER]

Community severance occurs where road traffic (speed or volume) inhibits access to goods, services, or people. Appleyard and Lintell's seminal study of residents of three urban streets in San Francisco found an inverse relationship between traffic and social contacts. The extent of social networks predicts unhealthy behaviors, poor health, and mortality; high rather than low social integration is associated with reduced mortality, with an effect size of similar magnitude to stopping smoking. Although community severance diminishes social contacts, the implications of community severance for morbidity and mortality have not been empirically established. Based on a systematic literature search, we discuss what is actually known about community severance. There is empirical evidence that traffic speed and volume reduces physical activity, social contacts, children's play, and access to goods and services. However, no studies have investigated mental or physical health outcomes in relation to community severance. While not designed specifically to do so, recent developments in road design may also ameliorate community severance. [ABSTRACT FROM AUTHOR]

Abstract: Accumulating research suggests that racism may be a major determinant of health. Here we report associations between self-reported experience of racial discrimination and health in New Zealand. Data from the 2002/2003 New Zealand Health Survey, a cross-sectional survey involving face-to-face interviews with 12,500 people, were analysed. Five items were included to capture racial discrimination in two dimensions: experience of ethnically motivated attack (physical or verbal), or unfair treatment because of ethnicity (by a health professional, in work or when gaining housing). Ethnicity was classified using self-identification to one of four ethnic groups: Māori, Pacific, Asian and European/Other peoples. Logistic regression, accounting for the survey design, age, sex, ethnicity and deprivation, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Māori reported the highest prevalence of “ever” experiencing any of the forms of racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific peoples (25%). Māori were almost 10 times more likely to experience multiple types of discrimination compared to European/Others (4.5% vs. 0.5%). Reported experience of racial discrimination was associated with each of the measures of health examined. Experience of any one of the five types of discrimination was significantly associated with poor or fair self-rated health; lower physical functioning; lower mental health; smoking; and cardiovascular disease. There was strong evidence of a dose–response relationship between the number of reported types of discrimination and each health measure. These results highlight the need for racism to be considered in efforts to eliminate ethnic inequalities in health. [Copyright &y& Elsevier]

Summary Background Inequalities in health between different ethnic groups in New Zealand are most pronounced between Māori and Europeans. Our aim was to assess the effect of self-reported racial discrimination and deprivation on health inequalities in these two ethnic groups. Methods We used data from the 2002/03 New Zealand Health Survey to assess prevalence of experiences of self-reported racial discrimination in Māori (n=4108) and Europeans (n=6269) by analysing the responses to five questions about: verbal attacks, physical attacks, and unfair treatment by a health professional, at work, or when buying or renting housing. We did logistic regression analyses to assess the effect of adjustment for experience of racial discrimination and deprivation on ethnic inequalities for various health outcomes. Findings Māori were more likely to report experiences of self-reported racial discrimination in all instances assessed, and were almost ten times more likely to experience discrimination in three or more settings than were Europeans (4·5% [95% CI 3·2-5·8] vs 0·5% [0·3-0·7]). After adjustment for discrimination and deprivation, odds ratios (95% CI) comparing Māori and European ethnic groups were reduced from 1·67 (1·35-2·08) to 1·18 (0·92-1·50) for poor or fair self-rated health, 1·70 (1·42-2·02) to 1·21 (1·00-1·47) for low physical functioning, 1·30 (1·11-1·54) to 1·02 (0·85-1·22) for low mental health, and 1·46 (1·12-1·91) to 1·11 (0·82-1·51) for cardiovascular disease. Interpretation Racism, both interpersonal and institutional, contributes to Māori health losses and leads to inequalities in health between Māori and Europeans in New Zealand. Interventions and policies to improve Māori health and address these inequalities should take into account the health effects of racism. [ABSTRACT FROM AUTHOR]

Background: The Social Functioning Questionnaire (SFQ), an eight-item self-report scale (score range 0-24), was developed from the Social Functioning Schedule (SFS), a semi-structured interview which has been used primarily with non-psychotic patients and has good test-retest and inter-rater reliability as well as construct validity. The SFQ was developed following the need for a quick assessment of perceived social function. Aims: To give further details of old and new data sets from studies involving over 4000 subjects assessed with the SFQ illustrating its epidemiological and clinical associations. Method: New data were analysed from a national epidemiological study, a comparison of key-worker and subject versions of the SFQ, and reanalysis of data from three earlier clinical studies, of psychiatric emergencies, general practice psychiatric patients and those with recurrent psychotic illnesses. These data were examined further to determine their range, their relationship to other clinical measures, and change over time in clinical trials. Results: The population mean score in 4164 subjects was 4.6 and the data from all studies suggested that a score of 10 or more indicated poor social functioning. Those presenting as psychiatric emergencies had the poorest social function (mean 11.4) and psychiatric patients from general practice the best function (mean 7.7) of the clinical populations. The eight item scores had a normal distribution in psychiatric populations and a skewed one in a normal population; scores were relatively stable over the short (weeks) and long-term (months), and were high in the presence of acute mental health disturbance and personality disorder, giving support to the validity of the scale. The results from a UK sample of a randomly selected population specifically weighted for ethnic minorities showed similar social function across groups. [ABSTRACT FROM AUTHOR]

Background: There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin.Aims: The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms.Method: Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ).Results: There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association.Conclusion: Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans. [ABSTRACT FROM AUTHOR]

Objectives. We measured perceived discrimination and its association with common mental disorders among workers in the United Kingdom. Methods. We conducted a secondary analysis of a national sample of 6 ethnic groups (n=2054). Discrimination was measured as reports of insults; unfair treatment at work; or job denial stemming from race, religion, or language. The outcome assessed was presence of common mental disorders. Results. The risk of mental disorders was highest among ethnic minority individuals reporting unfair treatment (odds ratio [OR]=2.0; 95% confidence interval [CI]= 1.2, 3.2) and racial insults (OR =2.3; 95% CI = 1.4, 3.6). The overall greatest risks were observed among Black Caribbeans exposed to unfair treatment at work (OR=2.9; 95% CI=1.2, 7.3) and Indian (OR=3.1; 95% CI=1.4, 7.2), Bangladeshi (OR=32.9; 95% CI=2.5, 436.0), and Irish (OR=2.9; 95% CI=1.1, 7.6) individuals reporting insults. Conclusions. Racial/ethnic discrimination shows strong associations with common mental disorders. (Am J Public Health. 2005;95:496-501.). [ABSTRACT FROM AUTHOR]

Background. There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. Method. Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p =0.02] and Pakistani (adjusted RR 2.38, 95% CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation. [ABSTRACT FROM AUTHOR]

This article sets out to examine ethnic differences in the key influences on quality of life for older people in the context of the increasing health and wealth of British older people generally and the ageing of the post-1945 migrants. It is based on secondary multivariate analysis of the Fourth National Survey of Ethnic Minorities of England and Wales. Respondents aged 45–74 years belonging to four ethnic groups (1,068 white, 514 Caribbean, 581 Indian and East African Asian, and 199 Pakistani) were included in the analysis, which focuses on differences between ethnic groups by age and gender, using the white population as the reference group. Four dimensions (incorporating seven factors) that influence the quality of life were determined among this age group: quality of neighbourhood (availability of local amenities, and problems with crime and the physical environment); social networks and community participation (strength of family networks, and community participation); material conditions (income, wealth and housing conditions) and health. The relative position of the four ethnic groups on the seven factors illustrated two contrasting patterns. For the factors based on conventional indicators of social inequalities such as material circumstances, health, participation in formal social networks, and quality of the physical environment - the white group ranked highest, the Pakistanis lowest, and the Indian and Caribbean groups ranked second and third. But factors that capture more immediate and subjective elements, such as frequency of family contact and the desirability of the residential neighbourhood, displayed a diametrically opposite rank-order, with the Pakistani group ranked first and the white group fourth. The study highlights the value of examining separately the various influences on quality of life. Contradictory patterns are revealed in key influences that are hidden by global measures. The study also reveals the difficulty of identifying culturally-neutral measures of quality of locality, with ethnic minority groups having a more positive perception of their area than rated by conventional measures of area deprivation such as the Index of Deprivation. [ABSTRACT FROM AUTHOR]

Background: Small-scale evaluations suggest that the provision of feedback to parents about their child's weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England.Methods: We conducted a pre-post survey of 1,844 parents of children aged 4-5 and 10-11 years who received weight feedback as part of the 2010-2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differences in the pre-post proportions of parents reporting each outcome were assessed using a McNemar's test.Results: General knowledge about child overweight as a health issue was high at baseline and increased further after weight feedback. After feedback, the proportion of parents that correctly recognised their child was overweight increased from 21.9% to 37.7%, and more than a third of parents of overweight children sought further information regarding their child's weight. However, parent-reported changes in lifestyle behaviours among children were minimal, and limited to increases in physical activity in the obese children only. There was some suggestion that weight feedback had a greater impact upon changing parental recognition of the health risks associated with child overweight in non-white ethnic groups.Conclusions: In this population-based sample of parents of children participating in the National Child Measurement Programme, provision of weight feedback increased recognition of child overweight and encouraged some parents to seek help, without causing obvious unfavourable effects. The impact of weight feedback on behaviour change was limited; suggesting that further work is needed to identify ways to more effectively communicate health information to parents and to identify what information and support may encourage parents in making and maintaining lifestyle changes for their child. [ABSTRACT FROM AUTHOR]

Presents a correction to an article that was published in a previous issue of the periodical "Social Psychiatry and Psychiatric Epidemiology."