Attitudes, beliefs and behaviour regarding the use of sunbeds amongst healthcare workers in Bradford.

Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs and behaviour regarding the use of sunbeds. We sought to determine the frequency of sunbeds use in a select sample and to assess the knowledge and beliefs regarding this behaviour. A self-administered anonymous questionnaire was distributed to a sample of 648 employees work for Bradford Hospitals NHS Trust. The questionnaire explored demographic information (including hair and skin type, family history with skin cancer), frequency of sunbeds use, knowledge about the risks of UV exposure and motivations for practising this behaviour. Four hundred and eighteen women and 52 men completed the questionnaire, making a response rate of 73%. Nearly half of respondents (207; 44%) reported using sunbeds to some extent; of those 12% reported frequent use. Appearance ('to look better') was the most popular reason given by respondents for using sunbeds, followed by 'feel healthy'. Frequency of using sunbeds was found to be negatively correlated with the age of respondents and the existence of family experience with skin cancer, and strongly associated with the opinion that it is safer to use a sunbed than subathing outdoors, the female sex and smoking. It is clear from this study that the psychological factors that influence sunbeds use are complex and that so far public education campaigns have had little impact on it. This study highlights some of these psychological factors.

'Not too much, not too little, but just enough?': observations on continuing professional development in Public Health in the north of England.

Three inquiries about Public Health continuing professional development were undertaken in the Northern and Yorkshire Region of the National Health Service during 1995-96. Public Health Physicians were asked about their experience of continuing education and for their views on a regional policy for continuing professional development. Health Authority Chief Executives were asked about their reactions to Public Health Physicians continuing educational needs. The overall response rates for the Public Health Physicians were very disappointing. Most of the Chief Executives (a much smaller group) responded to the inquiry. A large minority of Public Health Physicians believed that their continuing education in the preceding two years had been adequate. Most wished their future continuing education activities to be multi-disciplinary. One finding with considerable significance for those managing Public Health education, both specialist and continuing, was that many of those with teaching responsibilities had not been trained to teach. Despite apparent concordance between the views of Chief Executives and those of Public Health Physicians; on some important points there were inconsistencies in the comments of Chief Executives, which suggested lack of understanding of both the roles of their professional colleagues and the need for their continuing education. The inquiries gave rise to a sense of apathy and under-confidence, manifested in some reluctance to accept policing of continuing education. There is a need to experiment with learning and teaching approaches in order to progress from the current traditional educational methods.

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93.

The objectives were: to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breast cancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has helped to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a diseases or health service provision. Community development approaches often produce outcomes that had not been predicted. There is a need to conduct a definitive study in this area of health promotion for minority ethnic populations with emphasis on evaluation, cost-benefit analysis and opportunity costs.

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93

The objectives were to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included the health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer and breast across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breastcancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has help to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a disease/s or health service provision. Community development approaches often produce outcomes that had not been predicted. (AU)

Survey of the variation in ultraviolet outputs from ultraviolet A sunbeds in Bradford.

Concerns have been expressed for some time regarding the growth of the cosmetic suntanning industry and the potential harmful effects resulting from these exposures. Recently published work has appeared to confirm a link between sunbed use and skin cancer. A previous survey in Oxford some years ago demonstrated significant output variations, and we have attempted to extend and update that work. Ultraviolet A, UVB and blue-light output measurements were made on 50 sunbeds using a radiometer fitted with broad-band filters and detectors. A number of irradiance measurements were made on each sunbed within each waveband so that the uniformity of the output could also be assessed. UVA outputs varied by a factor of 3, with a mean of 13.5 mW/cm2; UVB outputs varied by a factor of 60, with a mean of 19.2 microW/cm2; and blue-light outputs varied by a factor of 2.5, with a mean of 2.5 mW/cm2. Outputs fall on average to 80% of the central value at either end of the sunbed. Facial units in sunbeds ranged in output between 18 and 45 mW/cm2. Output uniformity shows wide variation, with 16% of the sunbeds having an axial coefficient of variation > 10%. UVB output is highly tube-specific. Eyewear used in sunbeds should also protect against blue light.

Ethnic differences in risk markers for heart disease in Bradford and implications for preventive strategies.

OBJECTIVES: To assess and compare the prevalence of established risk markers for ischaemic heart disease in a sample of Asian and non-Asian men and to relate these observations to preventive strategies. SETTING: Two factories in the textile industry in Bradford, West Yorkshire, UK. Subjects--288 male manual workers aged 20 to 65 years. DESIGN: Cross sectional study within one occupational/social class stratum. MEASUREMENTS AND MAIN RESULTS: Age, body mass index, plasma lipids, fibrinogen and serum insulin values, blood pressure, smoking habits, alcohol consumption, and exercise routines were recorded. Plasma total cholesterol concentrations were significantly lower in Asian than non-Asian men (5.3 mmol/l v 5.8 mmol/l respectively, p < 0.0001), as were low density lipoprotein cholesterol concentrations (3.4 mmol/l v 3.7 mmol/l, p = 0.0150), and high density lipoprotein (HDL) cholesterol (1.1 mmol/l v 1.3 mmol/l, p < 0.0001). Hypercholesterolaemia (concentration > 6.5mM) was present in nearly one quarter of non-Asians but less than one eighth of Asian men. Triglyceride values were not significantly higher in Asians. Smoking rates were high in non-Asians (43.8%) and only slightly lower in Asians (39.1%). Asian smokers smoked fewer cigarettes per day on average (9.3 v 16.1, p = 0.0001). Almost a quarter of non-Asian men (23.1%) and 26.6% of Asian men had raised blood pressure. Systolic pressures were higher in non-Asian men (138.3 mmHg v 133.0 mmHg, p = 0.0070), but diastolic pressures showed no ethnic differences. Diabetes was more prevalent in Asian men (10.9% v 4.4% p < 0.05), who also showed higher serum insulin concentrations after glucose loading (22.3 mU/l v 10.2 mU/l, p < 0.0001). Plasma fibrinogen values were higher in non-Asian men (2.9 g/l v 2.6 g/l, p < 0.0001) and these were associated with smoking. Nearly all non-Asians (92.5%) consumed alcohol at some time whereas 62.5% of Asians habitually abstained from alcohol consumption. Among the drinkers, non-Asian men consumed on average, 23.9 units per week and Asian men 18.4 units per week (p = 0.083). The mean body mass index for Asian men was 24.5 kg/m2 which was not significantly different to the mean in non-Asian men (25.2 kg/m2). The frequency of exercise in leisure time was low in both groups with 44.4% of non-Asian and 21.1% of Asian men taking moderate exercise weekly, and even fewer, regular strenuous exercise (16.3% and 8.6% respectively). CONCLUSIONS: The plasma cholesterol and fibrinogen concentrations, prevalence of hypertension, smoking habits, alcohol intakes, and infrequency of exercise in leisure time in these non-Asian men in Bradford were consistent with an increased risk of heart disease. The pattern of risk markers was clearly different in Asian men. Only their lower HDL cholesterol concentrations, marginally higher triglyceride values, higher prevalence of diabetes, and very low frequency of exercise in leisure time would be consistent with a higher risk of heart disease compared with non-Asians. The implications of these observations for heart disease preventive strategies are discussed.

Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian in Bradford.

OBJECTIVE: To examine the hypothesis, in a community not studied before, that insulin resistance associated with centralised adiposity is the mechanism underlying the predisposition of Asian immigrant communities to both ischaemic heart disease and diabetes mellitus. DESIGN: Cross sectional study within one socioeconomic stratum. SETTING: Two factories in the textile sector in Bradford, West Yorkshire. SUBJECTS: Male manual workers of Asian (110) and non-Asian origin (156) aged 20-65 years. RESULTS: Diabetes was almost three times more prevalent in the Asian group. Two hours after an oral glucose load Asian men had double the serum insulin concentrations of non-Asian men (p < 0.0001). Asian men also had significantly lower concentrations of plasma total cholesterol (p < 0.03), high density lipoprotein cholesterol (HDL) (HDL2, p < 0.0001; HDL3, p < 0.0001), and apolipoprotein AI (p < 0.0001). Fasting plasma triglyceride concentrations were slightly higher (p = 0.072) in the Asian men; thus the ratio of triglyceride cholesterol was higher (p = 0.006). The inter-relation between serum insulin and plasma lipid concentrations indicated metabolic differences between the ethnic groups. Insulin concentrations were associated with cholesterol concentrations in the Asian men only and there was a lack of association between triglyceride, low density lipoprotein cholesterol, and HDL cholesterol in this group. The risk marker profile in the Asian men was therefore quite different to that of their non-Asian counterparts and was associated with a greater tendency to centralised adiposity. CONCLUSION: These data support the insulin resistance hypothesis and thus have important implications for strategies for the prevention of heart disease in Asian communities in the United Kingdom.

Patients' choice of general practitioner: importance of patients' and doctors' sex and ethnicity.

The relative importance of sex and ethnicity in patients' choice of doctor is not known. A total of 1633 consultations at a health centre in Bradford, with a mixed ethnic list, were examined over a four week period to test the relative importance of these variables. Patients had the choice to consult any one of: a male Asian, a male white or a female white doctor. Asian patients, irrespective of sex, were significantly (P less than 0.001) more likely to consult the Asian doctor then either of the other two doctors, though a greater proportion of Asian women than men consulted the female white doctor. Although the sex of the doctor was important in patients' choice, for Asian patients the doctor's culture and language were more important.

General practitioners' perceptions of Asian and non-Asian patients.

The literature on the health of the population of Asian origin contains little on their interaction with primary care services. This paper reports results of a postal survey of GPs' attitudes towards Asian and Non-Asian patients. The response rate was 78%-141 of the 182 GPs replied. Compared with non-Asian patients, GPs held less positive attitudes towards Asian origin patients who were thought to require longer for consultations, be less compliant, and make excessive and inappropriate use of health services. These perceptions have implications for patient care and the GP workload.

Cross-cultural use of socio-medical indicators with British Asians.

Socio-medical measures of health are increasingly being used as adjuncts to traditional clinical and epidemiological investigations. Such instruments can potentially make a significant contribution to research on inequalities in health between different ethnic groups and in planning health service delivery. However, care must be taken to ensure that the cross-cultural adaptation has conceptual, semantic and linguistic equivalence with the original and cultural differences in the meanings of health and illness must be closely considered. The use of some such instruments with Britain's Asian populations is reviewed and issues in adapting the Nottingham Health Profile for use with these populations, and some preliminary results are discussed.

Influence of ethnicity and unemployment on the perceived health of a sample of general practice attenders.

Published research shows people of Asian origin to be less healthy than the white population. Most of the studies have not taken account of differences in employment between populations of white and Asian origin. Also, little research has been carried out on the patients' perceived health. This study, based on 215 patients from an inner-city general practice in Bradford, looks at the influence of ethnicity and unemployment on the perceived health of the sample. The Nottingham Health Profile was used as the measure of perceived health. In the study population, twice as many Asians as white people were unemployed, and significant differences in perceived health were observed between the employed and the unemployed. After controlling for employment, Asian males had significantly better perceived health than white males in the 16-34 age group. Perceived health of Asian and white females was similar on most morbidity dimensions.

Patients' choice of general practitioner: influence of patients' fluency in English and the ethnicity and sex of the doctor.

Asian patients' use of general practitioner services and, in particular, their interaction with doctors is not well researched. However, difficulty in communication and in the case of women, reluctance to be examined by a male doctor has been reported. This study, based on interviews with 241 Caucasian, Pakistani and Indian patients attending a general practice in Bradford, examined the relationship between choice of general practitioner and the patient's fluency in English and the general practitioner's ethnicity and sex. Both Pakistani and Indian patients, particularly women, had poor fluency in English and the use of interpreters was confined to women (11% of Pakistani women and 4% of Indian women). The linguistic and broad cultural concordance between the patient and the general practitioner was more important in the choice of doctor than the sex of the general practitioner. It was also found that while 62% of Pakistani women objected to being examined by a male doctor, this was true for only 21% of Indian women.

Health of British Asians; a research review.

About 2.5 per cent of United Kingdom residents are of Asian (or Indian subcontinent) origin though the term 'Asian' hides their internal diversities of languages, religions and national origins. The research on the health of these populations is heavily concentrated in areas of rickets and osteomalacia, tuberculosis, maternal and child health, and mental health, and is mainly dependent on analysis of routinely available morbidity and mortality data. Little has been published on the use of primary care services, racism in health service delivery, quality of care and doctor-patient communication. Also, few of the studies have attempted to interpret their findings against the disadvantaged background of Asian communities. It is implied that differences in health status are due to linguistic and cultural factors alone. The research literature on the health of Asian populations is critically reviewed.