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Background: Early sexual initiation and inadequate contraceptive use can place adolescents at increased risk of unplanned pregnancy and sexually transmitted infections. These behaviours are patterned by gender and may be linked to social inequalities. This paper examines trends in sexual initiation and contraceptive use by gender and family affluence for Scottish adolescents. Methods: Cross-sectional data from four nationally representative survey cycles (2002, 2004, 2010, 2014) (n =8895) (mean age= 15.57) were analysed. Logistic regressions examined the impact of survey year on sexual initiation, condom use and birth control pill (BCP) use at last sex; as well as any changes over time in association between family affluence and the three sexual behaviours. Analyses were stratified by gender. Results: Between 2002 and 2014, adolescent males and females became less likely to report having had sex. Low family affluence females were more likely to have had sex than high family affluence females, and this relationship did not change over time. Condom use at last sex was reported less by males since 2002, and by females since 2006. Low family affluence males and females were less likely to use condoms than high family affluence participants, and these relationships did not change over time. There were no effects of time or family affluence for BCP use. Conclusion: There has been a reduction in the proportion of 15-year olds in Scotland who have ever had sex, but also a decrease in condom use for this group. Economic inequalities persist for sexual initiation and condom use. [ABSTRACT FROM AUTHOR]

Background Colorectal cancer (CRC) screening using faecal tests reduces disease-specific mortality. To investigate mortality and its association with sex, rates in women and men, and in different age ranges, were examined, before and after screening began in Scotland. Methods From 1990–99, no structured screening existed. Three pilots ran from 2000 to 2007 and subsequent full roll-out completed in 2009. Crude mortality rates for 1990–2020 were calculated relative to Scottish population estimates, and age–sex standardized rates calculated for all, pre-screening (<50 years), screening (5–74 years) and post-screening (>74 years) age ranges. Results CRC mortality declined from 1990 to 2020, but not linearly, and differed between sexes. In women, 1990–99 showed a steady decline [average annual percentage change (AAPC): −2.1%, 95% confidence interval (CI): −2.8% to −1.4%], but a less marked decline after 2000 (AAPC: −0.7%, 95% CI: −0.9% to −0.4%). In men, no clear decline was seen from 1990 to 1999 (AAPC: −0.4%, 95% CI: −1.1% to 0.4%), but mortality declined from 2000 to 2020 (AAPC: −1.7%, 95% CI: −1.9% to −1.5%). This pattern was exaggerated in the screening age ranges. For 2000–20, the overall reduction in mortality was less in women and in the screening age range. In the post-screening age range, reductions were smaller, but an increase was seen in the pre-screening age range, greater in women. Conclusions CRC mortality fell during 1990–2020, but the decline differed markedly between sexes, indicating a larger beneficial effect of screening on CRC mortality in men compared to women: use of different thresholds for the sexes might lead to equality. [ABSTRACT FROM AUTHOR]

The article offers information on public health research, specifically on the inequalities and regional differences in health. One study explored the differences in morbidity and mortality within various Protestant denominations in Northern Ireland. Another paper focused on the contribution of causes of death to inequalities in mortality in Scotland, taking into consideration the impact at different ages for men and women.

Background: Regular participation in physical activity can have significant health gains in terms of physical and psychological wellbeing but there is evidence to suggest that many young people are not sufficiently active to benefit their health. This paper examines the socio-demographic patterning of leisure-time vigorous physical activity among Scottish schoolchildren between 1990 and 2002. Methods: The Health Behaviour in School-Aged Children survey of 11-, 13- and 15-year-old schoolchildren has been carried out in Scotland since 1990 at four-yearly intervals. Levels of vigorous physical activity were measured in relation to gender, age and socio-economic status (SES). Results: Girls reported lower levels of vigorous physical activity than boys and this gender difference persisted throughout the four survey years, irrespective of changes in overall levels of physical activity. Vigorous physical activity was also consistently lower among lower SES groups and older adolescents. The effect of gender was greatest, with high-SES girls reporting lower levels of vigorous activity than low-SES boys, and low-SES girls being the least active overall. Conclusion: Scottish adolescent females, especially those from low SES groups, may be at particular risk of the adverse health effects associated with low levels of physical activity. Health promotion programmes to promote physical activity need to address these persistent gender and socio-economic inequalities. [ABSTRACT FROM AUTHOR]

Background A comprehensive smokefree prison policy (SFPP) was introduced in Scottish prisons from November 2018, reflecting concern about inequalities in occupational exposures to second-hand smoke (SHS) and tobacco-related harms among people in custody (PiC). We aimed to address a gap, whereby few studies have sought to understand SFPP from the perspectives of people living and working in prisons. Methods As part of a comprehensive evaluation, focus groups and interviews with staff (n = 99) and interviews with PiC (n = 23) were conducted 6–9 months post-implementation of SFPP in Scotland. Data were analysed using the framework approach. Results Our study found that new restrictions on smoking had been widely accepted by PiC, after a period of adjustment which was less troublesome than participants had anticipated. Benefits of the SFPP for the safety and comfort of staff and PiC who were no longer exposed to SHS, and additionally for the health of PiC who were now smoking-abstinent, were widely acknowledged. Drawbacks of the SFPP, such as difficulties managing without tobacco and use of alternatives (e.g. e-cigarettes and changes in use of illegal drugs), were also reported. Contraband tobacco was not reported to be a major problem following prisons becoming smokefree. Conclusions The findings strengthen evidence that SFPPs can be implemented without causing major disruption and highlight the need for removal of tobacco to be underpinned by careful planning, partnership working and ensuring the availability of support for smokers. Experiences from Scotland may be of interest and some comfort, internationally for jurisdictions considering smoke-free rules in prisons. [ABSTRACT FROM AUTHOR]

Background Different configurations of family adversity affect children's socio-emotional development differently; however, we lack knowledge of moderators amenable to policy intervention. This study explored whether early childhood centre-based childcare moderated the impact of family adversity configurations on socio-emotional development. Methods Data were from the Growing Up in Scotland first birth cohort, born 2004–05. Latent class analysis of 19 early childhood family adversity indicators identified four classes: 'Low Risk' (68%), 'Poor Maternal Health' (16.5%), 'Economic Hardship' (10.0%) and 'Multiple Adversities' (5.5%). Latent growth models of externalizing and internalizing symptom trajectories (age 46–152 months, n  = 3561) by family adversity controlled for confounding. Moderation by centre-based childcare use was examined through stratification. Results Compared to 'Low Risk', high-risk classes had more externalizing and internalizing symptoms and internalizing symptoms increased at a faster rate, with 'Multiple Adversities' faring worst. The effects of 'Economic Hardship' on change in externalizing symptoms over time varied by childcare (P  =   0.035): relative to the Low Risk group, symptoms increased (+0.04 points/year) among those not using childcare, and decreased (–0.09 points/year) among those who did. The effect of 'Multiple Adversities' on internalizing symptoms also varied (P  =   0.034): +0.12 without centre-based childcare; +0.33 with centre-based childcare (patterns were similar for externalizing symptoms but with wide confidence intervals). No moderation was found by 'Poor Maternal Health'. Conclusions Centre-based childcare may alleviate disadvantages in socio-emotional wellbeing for children experiencing mainly economic hardship, but may exacerbate them for those experiencing multiple adversities. A better understanding of how early years' services can support families with complex needs is required. [ABSTRACT FROM AUTHOR]

Background International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. Methods Records from a sample of the Scottish Longitudinal Study (N =86 500) were linked to monthly primary care antidepressant prescriptions (2009–15). Regional economic trends were characterized by annual full-time employment data (2004–14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010–15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. Results Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08–1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7–61%) of this association was explained by the impact of welfare benefit reforms on average incomes. Conclusions Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants. [ABSTRACT FROM AUTHOR]

Background Average life expectancy has stopped increasing for many countries. This has been attributed to causes such as influenza, austerity policies and deaths of despair (drugs, alcohol and suicide). Less is known on the inequality of life expectancy over time using reliable, whole population, data. This work examines all-cause and cause-specific mortality rates in Scotland to assess the patterning of relative and absolute inequalities across three decades. Methods Using routinely collected Scottish mortality and population records we calculate directly age-standardized mortality rates by age group, sex and deprivation fifths for all-cause and cause-specific deaths around each census 1981–2011. Results All-cause mortality rates in the most deprived areas in 2011 (472 per 100 000 population) remained higher than in the least deprived in 1981 (422 per 100 000 population). For those aged 0–64, deaths from circulatory causes more than halved between 1981 and 2011 and cancer mortality decreased by a third (with greater relative declines in the least deprived areas). Over the same period, alcohol- and drug-related causes and male suicide increased (with greater absolute and relative increases in more deprived areas). There was also a significant increase in deaths from dementia and Alzheimer's disease for those aged 75+. Conclusions Despite reductions in mortality, relative (but not absolute) inequalities widened between 1981 and 2011 for all-cause mortality and for several causes of death. Reducing relative inequalities in Scotland requires faster mortality declines in deprived areas while countering increases in mortality from causes such as drug- and alcohol-related harm and male suicide. [ABSTRACT FROM AUTHOR]

Background Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. Methods We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). Results Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. Conclusions (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is most commonly encountered in Africa and the Middle East, with migration from FGM-practicing countries meaning it is increasingly seen in Europe. Addressing FGM requires accurate information on who is affected but ascertainment is notoriously difficult. This study estimated FGM prevalence in women presenting for maternity care in the Lothian region of Scotland and compared this with that expected by extrapolation of survey data from women’s country of birth. Methods Electronic clinical records were linked to birth registration data to estimate FGM in the obstetric patients in Lothian from 2010 to 2013. Results Among all, 107 women affected by FGM were detected, at a rate of 2.8/1000 pregnancies. Of 487 women from UNICEF-recognized FGM-practicing countries who accessed care, 87 (18%) had documented evidence of FGM (three quarters of whom came from Nigeria, Sudan or The Gambia). The prevalence was 54% of the level expected from the extrapolation method. Country of birth had a sensitivity of 81% for FGM. Conclusion Women from FGM-practicing countries commonly access maternity care in Lothian. This confirms the need for ongoing training and investment in identifying and managing FGM. Matching electronic clinical records with birth registration data was a useful methodology in estimating the level of FGM in the maternity population. In a European country like Scotland with modest migrant numbers, asking country of birth during pregnancy and making sensitive enquiries could detect 81% of women with FGM. Extrapolation from maternal country of birth surveys grossly overestimates the true prevalence. [ABSTRACT FROM AUTHOR]

Background: Comparisons of outcomes of health care in different systems can be used to inform health policy. The EuroHOPE (European Healthcare Outcomes, Performance and Efficiency) project investigated the feasibility of comparing routine data on selected conditions including breast cancer across participating European countries. Methods: Routine data on incidence, treatment and mortality by age and clinical characteristics for breast cancer in women over 24years of age were obtained (for a calendar year) from linked hospital discharge records, cancer and death registers from Finland, the Turin metropolitan area, Scotland and Sweden (all 2005), Hungary (2006) and Norway (2009). Age-adjusted breast cancer incidence and 1-year survival were estimated for each country/region. Results: In total, 24576 invasive breast cancer cases were identified from cancer registries from over 13 million women. Age-adjusted incidence ranged from 151.1 (95%CI 147.2-155.0) in Hungary to 234.7 (95%CI 227.4-242.0)/100 000 in Scotland. One-year survival ranged from 94.1% (95%CI 93.5-94.7%) in Scotland to 97.1% (95%CI 96.298.1%) in Italy. Scotland had the highest proportions of poor prognostic factors in terms of tumour size, nodal status and metastases. Significant variations in data completeness for prognostic factors prevented adjustment for case mix. Conclusion: Incidence of and survival from breast cancer showed large differences between countries. Substantial improvements in the use of internationally recognised common terminology, standardised data coding and data completeness for prognostic indicators are required before international comparisons of routine data can be used to inform health policy. [ABSTRACT FROM AUTHOR]

Background: Patterns of adverse birth outcomes vary spatially and there is evidence that this may relate to features of the physical environment such as air pollution. However, other social characteristics of the environment such as levels of crime are relatively understudied. This study examines the association between crime rates and birth weight and prematurity. Methods: Maternity inpatient data recorded at birth, including residential postcode, was linked to a representative 5% sample of Scottish Census data and small area crime rates from Scottish Police forces. Coefficients associated with crime were reported from crude and confounder adjusted models predicting low birth weight (<2500g), mean birthweight, small for gestational age and prematurity for all singleton live births. Results: Total crime rates were associated with strong and significant reductions in mean birth weight and increases in the risks of both a small for gestational age baby and premature birth. These effects, with the exception of prematurity, were robust to adjustment for individual characteristics including smoking, ethnicity and other socio-economic variables as well as area based confounders including air pollution. Mean birth weight was robust to additional adjustment for neighbourhood income deprivation. Conclusion: The level of crime in a mother's area of residence, which may be a proxy for the degree of threat felt and therefore stress experienced, appears to be an important determinant of the risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal (GI) diseases are common, but there is a paucity of data describing variations by ethnic group and so a lack of understanding of potential health inequalities. We studied the incidence of specific upper GI hospitalization and death by ethnicity in Scotland. Methods: Using the Scottish Health and Ethnicity Linkage Study, linking NHS hospitalizations and mortality to the Scottish Census 2001, we explored ethnic differences in incidence (2001-10) of oesophagitis, peptic ulcer disease, gallstone disease and pancreatitis. Relative Risks (RRs) and 95% confidence intervals were calculated using Poisson regression, multiplied by 100, stratified by sex and adjusted for age, country of birth (COB) and socio-economic position. The White Scottish population (100) was the reference population. Results: Ethnic variations varied by outcome and sex, e.g. adjusted RRs (95% confidence intervals) for oesophagitis were comparatively higher in Bangladeshi women (209; 124-352) and lower in Chinese men (65; 51-84) and women (69; 55-88). For peptic ulcer disease, RRs were higher in Chinese men (171; 131-223). Pakistani women had higher RRs for gallstone disease (129; 112-148) and pancreatitis (147; 109-199). The risks of upper GI diseases were lower in Other White British and Other White [e.g. for peptic ulcer disease in men, respectively (74; 64-85) and (81; 69-94)]. Conclusion: Risks of common upper GI diseases were comparatively lower in most White ethnic groups in Scotland. In non-White groups, however, risk varied by disease and ethnic group. These results require consideration in health policy, service planning and future research. [ABSTRACT FROM AUTHOR]

Background: Substantial investments in promoting breastfeeding have taken place in the past 10 years in Scotland. This study assesses whether there were significant changes in breastfeeding initiation and mixed breastfeeding duration between 2004–2005 and 2010–2011. Methods: This study uses data from two nationally representative cohorts of babies in Scotland born between June 2004–May 2005 (N = 5030) and March 2010–February 2011 (N = 5838). Multivariate logistic regression for breastfeeding initiation and multivariate survival analysis for breastfeeding duration using cross-sectional data based on maternal recall were performed. Results: An increase in breastfeeding initiation from 60 to 63% was not significant (P = 0.125), and controlling for covariates, there was no significant cohort effect when comparing breastfeeding initiation between cohorts [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.91–1.13]. For breastfeeding duration of up to 1 month, the 2010–11 cohort was more likely to give up breastfeeding sooner (HR 1.23, 95%CI 1.12–1.34). However, for breastfeeding durations of >1–6 months, or ≥6 months, the 2010–11 cohort was significantly less likely to give up breastfeeding sooner (HR 0.79, 95%CI 0.70–0.88 and HR 0.79, 95%CI 0.68–0.92, respectively). Breastfeeding duration increased the most among mothers with fewer educational qualifications, and mothers with no qualifications in 2010–11 were far less likely to stop breastfeeding early compared with their counterparts in 2004–05 (HR 0.32, 95%CI 0.17–0.58). Conclusion: After the 1 month mark, babies born in 2010–11 were more likely to be breastfed for longer compared with those born in 2004–05, and this effect was particularly pronounced among more disadvantaged families. The potential causal role of health policy is discussed. [ABSTRACT FROM AUTHOR]

Background: Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. Methods: We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35–74 years old men and women. Results: South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37–1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05–1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64–0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Conclusions: Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe’s multiethnic populations. [ABSTRACT FROM PUBLISHER]

Background: Ethnic-minority health is a public health priority in Europe. This study compares strategies for tackling ethnic inequalities in health from two countries, Scotland and Belgium. Methods: We compared the countries using the Whitehead framework. Official policy documents were retrieved and reviewed and two databases related to immigrant health policies were also used. Ethnic inequalities in health were compared using the UK and Belgian Censuses of 2001. We analysed the recognition of the problem, the policies and the services and described ethnic health inequalities. Results: Scotland has recognized the problem of ethnic inequalities in health, thanks to better data and the Scottish Government has come up with a bold strategy. Belgium is a later starter, unable to properly monitor ethnic inequalities. In addition, there is no clear government commitment to tackling either health inequalities or ethnic inequalities in health. Both countries provide health-care services to ethnic minority groups through the mainstream services, although ethnic minority groups have more choice in Belgium than in Scotland. Overall, ethnic heath inequalities are lower in Scotland than in Belgium. Conclusion: Scotland has provided a more advanced and comprehensive response to tackling ethnic inequalities in health than Belgium. It has acknowledged that discrimination exists and that ethnic minority groups may have different needs. Belgium still assumes non-discrimination in health care and effectively denies the need for policy to tailor services to meet these needs. In Scotland, public organizations have been made accountable for promoting equality in health. This is an important contribution to European health policy. [ABSTRACT FROM AUTHOR]

Previous research suggests there are significant differences between soclo-economic groups in prevalence and amount of decayed missing and filled primary teeth (d[sub3]mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d[sub3]mft and deprivation in Scotland. Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. Deprivation is positively and significantly associated with having d[sub3]mft; the odds of a child in DepCat 7 (most deprived) having d[sub3]mft in 1993 were 7.49 (5.03-11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d[sub3]mft have reduced and in 2003 the odds of a child in DepCat 7 having d[sub3]mft were 4.60 (3.47-6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d[sub3]mft for those with d[sub3]mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. Conclusion: While socio-economic inequalities in prevalence of children with d[sub3]mft have decreased in recent years, socio-economic inequalities in the amount of d[sub3]mft for those with d[sub3]mft persist. This suggests that improvements are only seen for those children with the potential for low d[sub3]mft. High d[sub3]mft persists among children from more deprived areas. The national target conceals this apparent inconsistency. [ABSTRACT FROM AUTHOR]

Background: To evaluate how Scotland's smokefree law impacted self-reported secondhand smoke (SHS) exposure in hospitality venues, workplaces and in people's homes. In addition, we examine changes in support for the law, pub and restaurant patronage, smoking cessation indicators and whether any observed changes varied by socioeconomic status. Methods: A quasi-experimental longitudinal telephone survey of nationally representative samples of smokers and non-smokers interviewed before the Scottish law (February to March 2006) and 1 year later after the law (March 2007) in Scotland (n=705 smokers and n=417 non-smokers) and the rest of the UK (n=1027 smokers and n=447 non-smokers) where smoking in public places was not regulated at the time. Results: Dramatic declines in the observance of smoking in pubs, restaurants and workplaces were found in Scotland relative to the rest of the UK. The change in the percent of smokers reporting a smokefree home and number of cigarettes smoked inside the home in the evening was comparable in Scotland and the rest of the UK. Support for smokefree policies increased to a greater extent in Scotland than in the rest of the UK. Self-reported frequency of going to pubs and restaurants was generally comparable between Scotland and the rest of the UK; however, non-smokers in Scotland were more likely to frequent pubs more often. No differences in smoking cessation indicators were observed between countries. Conclusion: The Scottish smokefree law has been successful in decreasing secondhand smoke exposure while causing none of the hypothesized negative outcomes. [ABSTRACT FROM AUTHOR]

Background: As part of the independent evaluation of Healthy Respect (a national demonstration project to improve teenage sexual health in Scotland) this study examined the effect of the school-based sexual health education intervention comprising multiprofessional classroom delivery and alongside drop-in clinics on teenage sexual behaviour outcomes. Methods: Before-and-after cross-sectional surveys of secondary school pupils (average age 14 years and 6 months) were used in 10 Healthy Respect intervention %schools in Lothian region and 5 comparison schools without intervention in Grampian region (2001 and 2003). Results: By 2003, the proportion of pupils in Lothian feeling confident about getting condoms and using condoms properly significantly increased, more Lothian pupils (particularly boys) showed improved knowledge about condoms being protective against sexually transmitted infections. No further evidence of improved knowledge, attitudes, or intentions was evident after the intervention. Pupils in Lothian remained more likely to think using a condom would be embarrassing (especially girls), would reduce sexual enjoyment (especially boys), and intentions about condom use (as closer predictors of actual behaviour change) showed no significant improvement. More Lothian (∼24%) than Grampian (∼19%) pupils report having had sexual intercourse at age <16 years, both before and after the intervention, with no evidence of a significant reduction in Lothian by 2003. Overall differences in attitudes to condom use by gender were noted. Findings remain consistent in both unadjusted and adjusted comparisons. Conclusion: These findings demonstrate limited impact on sexual health behaviour outcomes, and raise questions about the likely and achievable sexual health gains for teenagers from school-based interventions. [ABSTRACT FROM AUTHOR]

Background: Housing conditions are recognised as an important determinant of health. In the UK, interventions to improve domestic heating are in place with the expectation that they will improve health. As a component of evaluating such policies, this study assesses whether specific health outcomes are significantly associated with the extent and duration of domestic heating use, either directly or via a possible mediating effect of internal environmental conditions. Methods: Baseline data from a prospective controlled study evaluating the health effects of a publicly-funded programme of heating improvements in Scotland were used to assess associations among heating use, internal conditions, and three specific health outcomes. Results: There were significant associations (P < 0.01) between measures of heating use and the presence of environmental problems in the home, such as mould and condensation. The presence of such problems was, in turn, found to be significantly predictive of two health outcomes derived from the SF-36 (P < 0.01) and of adult wheezing (P < 0.05). The direction of significant associations was highly consistent: greater levels of heating were associated with reduced likelihood of environmental problems, and the presence of environmental problems was linked to poorer health status. Heating use was not directly associated with the health outcomes considered. Conclusions: The study findings are consistent with a conceptual model in which health may be influenced by usage patterns of domestic heating, via the mediating effect of poor internal environmental conditions. Since these findings are based on cross-sectional data, interpretation must he carried out cautiously. However, if confirmed by planned future work they have important implications for policy initiatives relating to domestic heating and fuel poverty. [ABSTRACT FROM AUTHOR]

Features a study that determined the relationship between household income and measures of health at different points in the life course. Analysis of second-wave data collected in a 1990 to 1991 longitudinal study of three age cohorts in the West of Scotland; Possible models of the relationship; Results and discussion.

Presents a study on measuring performance of health care in European hospitals. Disadvantage of using summary measures in evaluating performance; Importance of distinguishing between influences that can be attributed to the hospitals and those which arise from differences in the patients they treat; Variations in the length of hospital stay of gynecology patients in Scotland.

The article offers updates related to the European Public Health Association (EUPHA). The two most important features of the EUPHA are highlighted. The day-to-day activities of the EUPHA, which varied and can range from writing press releases to assisting section presidents in travel arrangements to go represent EUPHA all over Europe are also tackled.

The article provides updates related to public health services in Europe in 2014. It highlights the European Public Health Conference which focuses on patient involvement and the integrated approach for chronic conditions. It also highlights the establishment of the Expert Panel on Health of the European Commission and the 2014-2020 strategy of the European Public Health Association.

Background: In March 2004, Ireland implemented comprehensive smoke-free regulations. Some were concerned this would cause pub patrons to move their smoking and drinking from inside pubs to inside homes. This article aims to assess whether nationwide smoke-free policies are associated with more smoking or drinking inside the home. Methods: Participants were 1917 adult smokers (>18-years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), which did not have smoke-free laws at the time of the interview, who completed a random digit-dialed telephone survey in February to March 2006. The percentage of alcoholic drinks consumed in the home versus pubs was compared by country as well as the percentage of daily cigarette consumption occurring in the home after work. Results: Irish respondents reported a significantly lower percentage of alcoholic drinks consumed in the home compared to Scotland and the rest of the United Kingdom, and cigarette consumption in the home was comparable in all three regions. Conclusions: Smoking and drinking in the home was not greater in smoke-free Ireland than in the United Kingdom, where there was not a smoke-free law at the time of the survey. These findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control. [ABSTRACT FROM AUTHOR]

The author discusses how the rather bizarre aspect of Scottish culture and diet is responsible for a rise in mortality among Scottish individuals. He comments on the tradition of deep frying Mars bars and eating them as a snack. However; it is the neoliberalism resulting in a higher prevalence of unhealthy eating habits leading to a rise in Scottish mortality as seen in an article by McCartney and colleagues. He highlights the variations in health between Scotland and Great Britain.