141. Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996–2002: prevention failure? - Hart, G.; Williamson, L.
Objective: To investigate trends in homosexual men’s sexual risk behaviour for HIV infection in Scotland. Methods: Cross sectional surveys in 1996, 1999, and 2002 were carried out in "gay" bars in Glasgow and Edinburgh, Scotland. 6508 men—2276 (79% response rate) in 1996, 2498 (78%) in 1999, and 1734 (62%) in 2002. Results: In 1996, 10.7% of men surveyed and in 1999, 11.2% reported unprotected anal intercourse (UAI) with casual partners, compared with 18.6% in 2002 (p<0.001). There was also a significant increase in men reporting that they "knew" their casual partners’ HIV status, despite no increase in HIV testing among men...

142. Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty-07 study - Adamson, J.; Ebrahim, S.; Dieppe, P.; Hunt, K.
Objective: To examine the association between three modifiable risk factors (obesity, smoking, and alcohol consumption) and reported joint pain. Methods: Cross sectional data were collected on 858 people aged 58 years living in the West of Scotland and on the same individuals four years later, aged 62 years. Results: There was a positive relation between obesity and reported pain in the hips, knees, ankles, and feet. The strongest relation was with knee pain (odds ratio = 2.42 (95% confidence interval, 1.65 to 3.56)). There were no strong consistent associations between smoking habits and pain in any joint after adjusting for...

143. Evaluating health effects of transport interventions: methodologic case study - Ogilvie, D.; Mitchell, R.; Mutrie, N.; Petticrew, M.; Platt, S.
Background: There is little evidence about the effects of environmental interventions on population levels of physical activity. Major transport projects may promote or discourage physical activity in the form of walking and cycling, but researching the health effects of such “natural experiments” in transport policy or infrastructure is challenging. Methods: Case study of attempts in 2004–2005 to evaluate the effects of two major transport projects in Scotland: an urban congestion charging scheme in Edinburgh, and a new urban motorway (freeway) in Glasgow. Results: These interventions are typical of many major transport projects. They are unique to their context. They cannot easily be...

144. Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection - Senok, A.; Wilson, P.; Reid, M.; Scoular, A.; Craig, N.; McConnachie, A.; Fitzpatrick, B.; MacDonald, A.
STUDY OBJECTIVE: To assess whether opportunistic and postal screening strategies for Chlamydia trachomatis can be compared with usual care in a randomised trial in general practice DESIGN: Feasibility study for a randomised controlled trial. SETTING: Three West of Scotland general medical practices: one rural, one urban/deprived and one urban/affluent. PARTICIPANTS: 600 women aged 16-30 years, 200 from each of three participating practices selected at random from a sample of West of Scotland practices that had expressed interest in the study. The women could opt out of the study. Those who did not were randomly assigned to one of three groups: postal screening, opportunistic...

145. Early discharge of low-risk women from cervical screening - Ogilvie, D.
Background: The Scottish Cervical Screening Programme currently offers three-yearly screening to all women between the ages of 20 and 60. However, previous studies have indicated that well-screened women over the age of 50 are likely to be at low risk of cervical neoplasia. This study aimed to explore the implications of discharging these women from screening in a typical area of Scotland. Methods: A case–control study of the screening histories of women with and without screen-detected cervical neoplasia between ages 50 and 59 in Lanarkshire was carried out, as well as a cross-sectional study of the prevalence of adequate screening histories...

146. Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? - Ogilvie, D.; Egan, M.; Hamilton, V.; Petticrew, M.
Study objective: There is little guidance on how to select the best available evidence of health effects of social interventions. The aim of this paper was to assess the implications of setting particular inclusion criteria for evidence synthesis. Design: Analysis of all relevant studies for one systematic review, followed by sensitivity analysis of the effects of selecting studies based on a two dimensional hierarchy of study design and study population. Setting: Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling. Main results: The distribution of available...

147. Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go? - Ogilvie, D.; Hamilton, V.; Egan, M.; Petticrew, M.
Study objective: There is little guidance on how to identify useful evidence about the health effects of social interventions. The aim of this study was to assess the value of different ways of finding this type of information. Design: Retrospective analysis of the sources of studies for one systematic review. Setting: Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling. Main results: Only four of the 69 relevant studies were found in a "first-line" health database such as Medline. About half of all relevant studies were...

148. Young people's access to tobacco, alcohol, and other drugs - Ogilvie, D.; Gruer, L.; Haw, S.
Young people in the UK can easily obtain cigarettes and alcoholic drinks from a range of social and illicit commercial sources before they reach the legal minimum purchase age; many also report having access to illicit drugs. Prices of alcoholic drinks and most illicit drugs, but not cigarettes, have been falling in real terms. Increasing the price of tobacco and alcohol is likely to reduce young people’s demand for them. Enforcing or raising minimum purchase ages can reduce under-age sales of tobacco and alcohol, and has also been shown to reduce young peope’s hazardous use of alcohol. Unenforced voluntary agreements...

149. Giving urban policy its 'medical': assessing the place of health in area-based regeneration - Atkinson, R.; Thomson, H.; Kearns, A.; Petticrew, M.
How does regeneration affect health and how have successive urban policy evaluations sought to measure such impacts? This article draws on a systematic review of national-level evaluation documentation relating to government-funded, area-based regeneration initiatives in the UK since 1980. The review examined whether health impacts had been intended and, if so, how they had been measured. The process and difficulties of conducting the review raise significant questions about policy formulation and evaluation. Is evidence-based policy possible where evaluations are not stored centrally? In short, a model policy development as 'enlightened' or incremental is hard to sustain where a lack of...

150. The validation of self-reported smoking status by analysing Cotinine levels in stimulated and unstimulated saliva, serum and urine - Binnie, V.; McHugh, S.; Macpherson, L.; Borland, B.; Moir, K.; Malik, K.
Objectives: Cotinine, a nicotine metabolite, can be used to measure exposure to tobacco smoke. The aim of this study was to compare cotinine levels in different biological fluids collected from both smokers and non-smokers and to relate the findings to self-reported smoking status. Data were also collected concerning the acceptability of the differing methods of sample collection. Material and method: Patients recruited to the study were asked to provide samples of urine, blood and saliva (both stimulated and unstimulated). Data collected from patients by questionnaire included information on smoking behaviour such as daily number of cigarettes and environmental exposure to smoke....

151. The Gay Men's Task Force: the impact of peer education on the sexual health behaviour of homosexual men in Glasgow - Williamson, L.; Hart, G.; Flowers, P.; Frankis, J.; Der, G.
Objective: To assess the impact of a peer education intervention, based in the "gay" bars of Glasgow, which sought to reduce sexual risk behaviours for HIV infection and increase use of a dedicated homosexual men's sexual health service, and in particular increase the uptake of hepatitis B vaccination. Design: Self completed questionnaires administered to men who have sex with men (MSM) in Glasgow's gay bars. Subjects: 1442 men completed questionnaires in January 1999, 7 months after the end of the 9 month sexual health intervention. Main outcome measures: Self reported contact with the peer education intervention, reported behaviour change, and...

152. Is use of antiretroviral therapy among gay men associated with increased risk of transmission of HIV infection? - Stephenson, J.M.; Imrie, J.; Davis, M.M.; Mercer, C.; Black, S.; Copas, A.J.; Hart, G.; Davidson, O.R.; Williams, I.G.
Background/objective: There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission. Methods: A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases. Results: Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of...

153. Asking semi-literate adolescents about sexual behaviour: The validity of assisted self-completion questionnaire (ASCQ) data in rural Tanzania - Plummer, M.; Wight, D.; Ross, D.; Balira, R.; Anemona, A.; Todd, J.; Salamba, Z.; Obasi, A.; Grosskurth, H.; Changalucha, J.; Hayes, R.
To develop and test a sexual behaviour survey method for semi-literate populations, combining the privacy of a self-completion questionnaire (SCQ) with the clarity of a face-to-face questionnaire (FFQ). In 1998, 6079 Tanzanian primary school students (mean age 15.1 years) were surveyed using an innovative assisted self-completion questionnaire (ASCQ). The format of the questionnaire was simple, all responses were closed, and conceptually complex questions such as those involving ranking or multiple answers were avoided. The ASCQ was administered to groups of 20 by a research assistant who read questions and answers aloud in two languages so pupils could tick or write responses...

154. 'A bit more truthful': The validity of adolescent sexual behaviour data collected in rurual northern Tanzania using five methods - Plummer, M.; Ross, D.; Wight, D.; Changalucha, J.; Mshana, G.; Wamoyi, J.; Tood, J.; Anemona, A.; Mosha, F.; Obasi, A.; Hayes, R.
Objective: To assess the validity of sexual behaviour data collected from African adolescents using five methods. Methods: 9280 Tanzanian adolescents participated in a biological marker and face to face questionnaire survey and 6079 in an assisted self-completion questionnaire survey; 74 participated in in-depth interviews and 56 person weeks of participant observation were conducted. Results: 38% of males and 59% of females reporting sexual activity did so in only one of the two 1998 questionnaires. Only 58% of males and 29% of females with biological markers consistently reported sexual activity in both questionnaires. Nine of 11 (82%) in-depth interview respondents who had...

155. Fruit, vegetables and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort - Maynard, M.; Gunnell, D.; Emmett, P.; Frankel, S.; Davey-Smith, G.
Study objective: To examine associations between food and nutrient intake, measured in childhood, and adult cancer in a cohort with over 60 years follow up. Design and setting: The study is based on the Boyd Orr cohort. Intake of fruit and vegetables, energy, vitamins C and E, carotene, and retinol was assessed from seven day household food inventories carried out during a study of family diet and health in 16 rural and urban areas of England and Scotland in 1937–39. Participants: 4999 men and women, from largely working class backgrounds, who had been children in the households participating in the...

156. Socio-economic differences in CVD and physical activity: stereotypes and reality - Macintyre, S.; Mutrie, N.
Cardiovascular disease (CVD) is patterned by socio-economic status, being more common in lower social classes. Since physical inactivity is a risk factor for CVD it might be assumed that it is more common in lower social classes. We examine major recent UK population surveys and show that this assumption is incorrect; although higher social class adults engage in more formal sports activities, they are less likely to engage in other (e.g. occupational) activities. Lower social class children are more likely to engage in sports and active play. We also show that although Scotland has higher rates of CVD than England,...

157. Multilevel modelling and public health policy - Leyland, A.H.; Groenewegan, P.P.
Background: Multilevel modelling is a statistical technique that extends ordinary regression analysis to the situation where the data are hierarchical. Such data form an increasingly common evidence base for public health policy, and as such it is important that policy makers should be aware of this methodology. Method: This paper therefore lays out the a basic description of multilevel modelling, discusses the problems of alternative approaches, and details the relevance for public health policy before describing which levels are relevant and illustrating the different kinds of hypotheses that can be tested using multilevel modelling. A series of examples is used...

158. Empirical Bayes methods for disease mapping - Leyland, A.H.; Davies, C.A.
This paper reviews empirical Bayes methods for disease mapping. A distinction is made between spatial models (which take into account the geographical distribution of disease) and nonspatial models. Several estimators are presented, and methods of estimation are described. Empirical Bayes methods are compared with full Bayes methods, and we argue that both have their place.

159. Assessing the impact of mobility on health: implications for life course epidemiology (Editorial) - Leyland, A.H.
The need to use multilevel models when analysing hierarchical data—to take account of the correlation in the data when estimating regression coefficients—is widely recognised in health research.1,2 The advantages afforded by multilevel models—including the ability to partition variation to determine the relative importance of different levels of the hierarchy, to test hypotheses about variation, and to attempt to separate the influences of context and composition—are also well reported.3 The complexity of the real world means that our data are not always drawn from strict hierarchies.4 In this issue of the journal Chandola et al consider a multiple membership model—a situation...

160. Is sport for all? Exercise and physical activity patterns in early and late middle age in the West of Scotland - Hunt, K.; Ford, G.; Mutrie, N.
Recent evidence shows that any form of physical activity, not just aerobic activity to improve cardiovascular fitness, can have significant health benefits. However, physical inactivity is increasingly widespread. Recent health promotion has emphasised the value of integrating activity into daily life, yet popular attention continues to focus on sporting excellence and team sports. Data from people in early and late middle age in the West of Scotland demonstrate that sporting and team activities are rarely undertaken throughout adult life, especially amongst women and people from more disadvantaged circumstances. The activities that are most commonly taken up and sustained throughout later...

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