Does the current economic crisis require the deep cuts in public spending announced in the June 2010 emergency budget, with potential implications for public health? The arguments for and against such cuts in response to economic recession are complex, but if public health professionals are to engage in debates about future public spending, they should be informed by relevant evidence. In this perspective, we note that opinions among politicians and economists about how to respond to economic downturns are divided, while other EU countries, many with greater levels of debt than the UK, are protecting public expenditure unless required to do so by the International Monetary Fund. Current UK debt may in fact be viewed as sustainable given current information about interest rates, inflation and economic growth. Before accepting large cuts in public spending, it is important to contrast the lack of evidence for such short-term fixes with potentially dire repercussions for population health and welfare.

To describe the characteristics of a population with high-risk sexual behaviours and associations between sexual intercourse, high-risk sexual behaviours and socio-demographic characteristics among Chinese urban adolescents.

In 2005, 109 754 students in grades 10–12 and 33 653 college students were anonymously surveyed using a Chinese Youth Risk Behaviour Survey. Demographic variables and indicators of forced sex, condom use and unintended pregnancy were analysed with multiple logistic regressions.

Of students surveyed, median age was 17.6 (range 14–24 years) and 76 233 were female (53.2%); 4.8% of high school students reported had experienced sexual intercourse; of these, 32.8% reported had forced sex; 11.3% of college students reported had experienced sexual intercourse and of these, the prevalence of forced sex, condom use and unintended pregnancy were 23.5, 49.7 and 24.2%, respectively. School type and socioeconomic status were found to be independently associated with sexual intercourse and forced sex for high school students. For college students, educational level, school type, family structure, maternal education and socioeconomic status were independently associated with high-risk sexual behaviours.

This study highlights the association between high-risk sexual behaviours and school type and socioeconomic status. These results strongly suggest the importance of providing sex education in high schools and lower socioeconomic areas.

Drug users engaged in survival sex work are at heightened risk for drug- and sexual-related harms. We examined factors associated with survival sex work among street-involved youth in Vancouver, Canada.

From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14–26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging sex for money, drugs etc. with those who did not.

The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival sex work. Factors associated with survival sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) = 3.45, 95% confidence interval (CI): 1.75–6.78], female gender (AOR = 3.02, 95% CI: 1.66–5.46), Aboriginal ethnicity (AOR = 2.35, 95% CI: 1.28–4.29) and crystal methamphetamine use (AOR = 2.02, 95% CI: 1.13–3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival sex work.

This study demonstrates a positive interactive effect of dual stimulant use in elevating the odds of survival sex work among street youth who use drugs. Novel approaches to reduce the harms associated with survival sex work among street youth who use stimulants are needed.

In the UK, needle and syringe programmes (NSP) are delivered via community pharmacies or substance misuse services (SMSNSP). Understanding the profile of drug injectors primarily using different sources of injecting equipment can help service design.

Blood spot samples and behavioural data were collected from drug injectors and tested for antibodies to hepatitis C and hepatitis B. Data were analysed in relation to NSP use by multivariate logistic regression.

Of 700 eligible individuals interviewed, 657 provided information on their main source of equipment; 26% reported pharmacy NSP, 56% SMSNSP and 18% secondary distribution. In the adjusted analysis, individuals whose main source was SMSNSP were more likely to report markers of increased risk (homelessness, groin injection, having injected >16 days/month) and had a higher hepatitis B antibody prevalence than individuals primarily using pharmacy NSP. Individuals whose main source was secondary distribution had a different profile (e.g. they were younger, more likely to be recent onset injectors than main source SMSNSP users and less likely to report being in drug treatment).

Differences exist in the populations primarily accessing different NSP and commissioning of services must reflect these differences. Injecting drug users relying on secondary exchange should be targeted to improve health service contact.

Hepatitis C virus (HCV) prevalence is high among injection drug users (IDUs) in Afghanistan. Duration of injection and young age at first injection are common risk factors for HCV in IDU populations. The association of HCV with these time factors was analyzed.

Socio-demographic and drug use behavior information were collected. Participants had rapid testing for HCV with recombinant immunoblot assay confirmation. Modeling of non-linear associations was performed using fractional polynomial logistic regression.

Among 459 male IDUs, age at first injection had a constant HCV risk (odds ratio (OR): 1.01 per year; 95% confidence interval (CI): 0.98–1.03), while each additional year of injection drug use had a significantly increased risk (OR: 4.72 per year, 95% CI: 2.92–7.66). HCV risk increased significantly with each additional year of injecting drug use by groups of injectors: young (≤22 years, OR: 1.97; 95% CI: 1.27–3.07), middle (23–28 years, OR: 1.76; 95% CI: 1.28–2.43) and older (≥29 years, OR: 7.56; 95% CI: 3.15–18.14).

The probability of HCV infection increased markedly by duration of injection drug use and varied according to age at first injection. Drug counseling and educational efforts should be directed to older drug users who have not yet initiated injecting and to young IDUs to avert infection and reduce risky drug use behaviors.

Treatment for drug addiction is effective in reducing the harms of injection drug use, including infection with HIV and/or hepatitis C. We sought to examine the prevalence and correlates of being unable to access addiction treatment in a representative sample of injection drug users randomly recruited from a supervised injection facility.

Using generalized estimating equations, we determined the prevalence and factors associated with being unable to access addiction treatment.

Between 1 July 2004 and 30 June 2006, 889 individuals completed at least one interview and were included in this analysis. At each interview, ~20% of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months. Being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. In a secondary question, the majority of individuals reported waiting lists were the reason for being unable to access treatment.

Given the independent association between inability to access addiction treatment and elevated HIV risk behavior, these results suggest expanding addiction treatment may contribute significantly to HIV prevention efforts in this population.

Existing systematic reviews have concluded that psycho-educational interventions for smoking relapse prevention were ineffective. Our objective was to conduct an exploratory meta-analysis, guided by mechanisms of these complex interventions for preventing smoking relapse.

Relevant trials were identified from a Cochrane review and by an updated search of MEDLINE and PsycINFO (up to August 2009). We examined theories or mechanisms underlying relapse prevention interventions, and process variables reported in trials. Odds ratios (ORs) for the rate of smoking abstinence at the longest follow-up were pooled in meta-analysis.

Forty-nine trials were included, and interventions were at least partly based on the cognitive-behavioural approach to coping skills training in 41 trials. Only a few trials reported data on process variables. Coping skills training for smoking relapse prevention was effective for community quitters (OR 1.27, 95% CI: 1.08–1.49), and particularly for those who stopped smoking for at least 1 week at baseline (OR 1.52, 95% CI: 1.20–1.93). These findings were interpretable with mechanisms of coping skills training for relapse prevention.

On the basis of post hoc subgroup analyses, coping skills training for smoking relapse prevention is effective for motivated community quitters. This finding has important public health implications and needs to be confirmed by further trials.

Behavioral theories suggest that a past quit attempt influences psycho-social determinants to predict smokers' intention to quit, although no study has tested the hypothesis among youth smokers.

A sample of 1561 Chinese secondary students, who were current smokers, were collected in a cross-sectional school-based survey in Hong Kong.

For the 943 students with past quit attempts, those with lower daily cigarette consumption; who perceived smoking would not elicit positive social responses from others; who had one parent/teacher who prohibited them to smoke; who were aware of the health hazards of smoking and being male smokers, were more likely to have an intention to quit smoking. For the 618 students without a past quit attempt, those who did not perceive any benefit from smoking; who had parents and teachers to prohibit them to smoke and who received social support to quit, were more likely to have an intention to quit smoking.

Strengthening the prohibition of smoking and providing social support may help initiate the intention to quit among youth smokers without a past quit attempt, while de-normalizing social images of smoking, providing information about the health hazards of smoking and relieving nicotine addiction may sustain quitting intentions among youth smokers with past quit attempts.

The carcinogenicity of chewing tobacco is well established. It is predominantly used by the South Asian community in England. Little is known about the accessibility of the products available for use in England.

Wards with high proportions or numbers of residents from the South Asian community were identified using 2001 Census data. Within each ward product purchasers identified retail outlets and purchased chewing tobacco products from them.

Chewing tobacco products were found in a broad variety of premises in all but one ward, and were easily accessible. Ninety-eight products were identified and purchased with a mean price of £1.82. Of the ninety four pre-packaged products purchased only 15% (95% CI: 8%, 22%) complied with legal health warning requirements.

The study indicates the need to improve compliance with legal controls and enforcement to protect the South Asian community from health risks associated with chewing tobacco products.

Since resources are limited, selecting the most promising targets for obesity interventions is critical. We examined the relative associations of physical activity, fruit and vegetable consumption and ‘junk food’ consumption with BMI and the prevalence of relevant policies in school, work, food outlets and health-care settings.

We conducted intercept surveys in three low-income, high-minority California communities to assess fruit, vegetable, candy, cookie, salty snacks and sugar-sweetened beverage consumption and self-reported height, weight and physical activity. We also assessed relevant policies in selected worksites, schools and health-care settings through key informant interviews.

Data were collected from 1826 respondents, 21 schools, 40 worksites, 14 health-care settings and 29 food outlets. The average intake of salty snacks, candy, cookies and sugar-sweetened beverages was estimated at 2226 kJ (532 kcal) daily, 88% higher than the US Department of Agriculture/Department of Health and Human Services guidelines recommend. Energy from these sources was more strongly related to BMI than reported physical activity, fruit or vegetable consumption. Policies to promote healthy eating and physical activity were limited in worksites. Fruits and vegetables were less salient than junk food in community food outlets.

Targeting consumption of salty snacks, candy cookies and sugar-sweetened beverages appeared more promising than alternative approaches.

To determine the accuracy of patient self-reports of specific cardiovascular diagnoses and to identify individual patient characteristics that influence the accuracy.

This investigation was conducted as a part of the randomized controlled ORBITAL study. Patients with hypercholesterolemia were enrolled in 1961 primary-care centers all over Germany. Self-reported questionnaire data of 7640 patients were compared with patients' case report forms (CRFs) and medical records on cardiovascular diseases, using statistics and binomial logit models.

values ranged from 0.89 for diabetes to 0.04 for angina. The percentage of overreporting varied from 1% for diabetes to 17% for angina, whereas the percentage of underreporting varied from 8.0% for myocardial infarction to 57% for heart failure. Individual characteristics such as choice of individual general practitioner, male gender and age were associated with the accuracy of self-report data.

Since the agreement between patient self-report and CRFs/medical records varies with specific cardiovascular diagnoses in patients with hypercholesterolemia, the adequacy of this tool seems to be limited. However, the authors recommend additional data validation for certain patient groups and consideration of individual patient characteristics associated with over- and underreporting.

Colorectal cancer is one of the most common cancers in men and women. Participation rates in faecal occult blood testing (FOBT) screening activities are, however, relatively low. In terms of lowering the colorectal cancer mortality, high participation rates are essential, and therefore it is important to understand the barriers to FOBT screening.

We undertook a systematic search through PUBMED, Medline, EMBASE and PsycINFO in order to identify studies that provide information on socio-demographic determinants of participation in FOBT screening.

FOBT participation varied considerably across countries, but they have rarely been above 60%. The use of other health-care services was in most studies a strong determinant for participation in screening with FOBT. There was a tendency to higher participation among women than among men and among married as opposed to not married, but determinants varied across countries and test settings. There was no systematic variation in participation across age groups.

The participation pattern depends in part on local circumstances, which makes it difficult to point to a general strategy for increasing the uptake in FOBT screening. This stresses the need for monitoring of individual screening programmes and developing information strategies targeted to the local participation pattern.

Within the decentralization framework of Government, the Ministry of Health (MoH) Nepal initiated the decentralization of primary care services closer to citizens. This paper aims to examine and understand the effect of decentralization at the district health service from the perspectives of service users and providers.

Using non-probability purposive sampling, we conducted a series of in-depth interviews and focus group discussions in four primary health care institutions with service users, providers and other stakeholders. QSR©NVivo7 software was used to analyse and categorize the data under emerging themes.

Decentralization was positively associated with increased service access and utilization and improved service delivery. The study also revealed areas of concern and possible improvement and identified the barriers to implementing these improvements. Problems described included three main areas: functions, functionaries and funding.

Both service users and providers convey a generally positive message about the health sector decentralization. The active involvement of service users, providers, policy-makers in the process of decentralization and clear national and local policy agendas may bring positive changes in district health services.

There has been a philosophical commitment to participation in public health since the 1970s. UK policy rhetoric on participation in public health has been particularly marked since 1997. It is less clear that participatory approaches have been pursued by UK public health units in practice.

A systematic review was undertaken of all studies using any recognized research methodology from 1974 to 2007 reporting on health and social outcomes of participatory approaches by UK public health units. Seventeen electronic databases were searched and inclusion/exclusion criteria and quality appraisal criteria applied.

Five thousand and four hundred and fifty-one references were identified, reduced to 2155 once duplicates were removed. Only eight papers covering seven studies were relevant and included in the analysis. Only two studies met more than half of the relevant quality appraisal criteria. The studies fell into two distinct groups: four used qualitative methods to illustrate the complexities of effective community participation; three claimed success for their participative initiative without providing adequate evidence to substantiate such claims.

This systematic review demonstrates that there is very little evidence in the peer-reviewed literature of participatory approaches by UK public health units or of such approaches having any noteworthy impact on health and social outcomes.

US Department of Health and Human Services reported that the lack of English language proficiency and the shortage of providers who possessed appropriate language skills were identified as major barriers to mental health service use for approximately half of the population of Asians and Pacific Islanders. The aim of this study was to examine the predictors of lifetime mental health service use in relation to English language proficiency among Asian Americans.

Data from 2095 Asian participants from the National Latino and Asian American Study were analyzed using logistic regression.

Respondents with better English language proficiency and with a mental health diagnosis were more inclined to use mental health services. Participants who were born in the USA, who were widowed, separated or divorced, who sought comfort from religion, who reported worse physical and mental health self-ratings were more likely to use mental health services. The lack of health insurance coverage was not a significant predictor.

The public health implications for behavioral health include the need to educate health-care providers working with Asian Americans regarding the benefits derived from seeking services and making interpreter services available in a culturally sensitive environment.