Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey.

OBJECTIVES: We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. METHODS: Data on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. RESULTS: Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. CONCLUSIONS: Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

Health care and female survivors of childhood sexual abuse: health professionals' perspectives.

The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model-transition to ethical practice-emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.

Working sensitively with child sexual abuse survivors: what female child sexual abuse survivors want from health professionals.

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22-65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.

Health professionals' responses to disclosure of child sexual abuse history: female child sexual abuse survivors' experiences.

This study reports on a postal questionnaire, conducted in 2004, with female survivors of historic child sexual abuse. The questionnaire explored their experiences of health professionals' responsiveness to disclosure of child sexual abuse history. Of 61 participants, aged between 22 and 65, 69% had disclosed to health professionals. Those who had not disclosed reported that they would have liked to but were not asked about child sexual abuse. Thirty-five percent of participants suggested routine questioning about child sexual abuse. Most participants related a fear of common medical examination procedures to their experience of child sexual abuse, and 64% said this stopped them from attending regular health checks. The current study suggests the development of guidelines for dealing with possible child sexual abuse survivors would be useful for health professionals.

Parental and retail supply of tobacco to minors: findings from a community-based social supply intervention study.

AIM: We report on findings from a quasi-experimental community trial of a complex intervention aimed at reducing social and commercial supply of cigarettes to young people. MATERIALS AND METHODS: The intervention comprised a package of school, community and home-based smokefree strategies implemented over three years from 2007 to 2009 in a low-income area of Auckland, New Zealand, with another area serving as the control population. The main outcome measures were relative change in parental and retailer behaviour and in attitudes to the provision of tobacco to youth. We analysed baseline and follow-up data from questionnaires administered to parents and children living in the intervention and control areas using PASW Statistics 18. RESULTS: No difference was found between groups in parents' permissiveness of smoking and in retailer compliance to the tobacco sale legislation over the course of the study, either because our intervention had no or only a limited effect, or alternatively because limitations in the study design diluted any effect. CONCLUSIONS: Nevertheless, a key finding was that parents and retailers persisted as important sources of cigarettes for young people. Further study is required to identify effective interventions to address this issue.

Smokefree prisons in New Zealand: maximising the health gain.

A total smoking ban in prisons comes into effect from July 2011. The ban, introduced by the Corrections Minister, Judith Collins, aims to provide a healthier environment for prison staff and inmates through the elimination of secondhand smoke. Overseas experience has shown that simply banning smoking will not necessarily result in prisoners giving up, nor will it result in the maintenance of abstinence by those who do stop smoking during incarceration. In order to reap maximum health gains from the total smoking ban in prison policy, comprehensive cessation support for all inmates needs to be provided to ensure that they quit during incarceration and continue to abstain from smoking upon release.