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In public health, as in other fields, there has been much discussion about the type of evidence we need for decision making. In particular, there has been much debate about how the production of trials can be increased. However, this is not the only challenge and perhaps not even the main one. A better understanding is needed of why trials are not conducted, and what sort of evidence is used in their place. More generally, researchers need a better understanding of the ways in which other forms of evidence than trials are informative to decision makers.

Cripes, said Bunter, what will the government do next? Mark Petticrew investigates. © 2008, BMJ Publishing Group Ltd. All rights reserved.

BACKGROUND: Despite the Government acting quickly to reassure parents about MMR safety following the publication of the 1998 paper by Wakefield and colleagues, MMR uptake declined. One of the reasons suggested for this decline is a loss of public trust in politicians and health professionals. The purpose of this analysis was to examine parents' views on the role the media, politicians and health professionals have played in providing credible evidence about MMR safety. METHODS: A qualitative focus group study conducted with parents living in Central Scotland. Eighteen focus groups were conducted with 72 parents (64 mothers and 8 fathers) between November 2002 and March 2003. Purposive sampling was used to ensure maximum variation among parents. RESULTS: In the period after the MMR controversy, parents found it difficult to know who to trust to offer balanced and accurate information. The general consensus was that politicians were untrustworthy in matters of health. The motives of primary health care providers were suspected by some parents, who saw them as having a range of vested interests (including financial incentives). Among the sources of evidence seen by some parents as more credible were other parents, and Andrew Wakefield who was viewed as an important whistle-blower and champion of ordinary parents. CONCLUSION: The provision of accurate information is only one aspect of helping parents make immunisation decisions. Establishing and maintaining trust in the information provided is also important. The MMR controversy may provide useful lessons for health professionals about trust and credibility that may be generalisable to future health controversies.

Abstract Background Despite the Government acting quickly to reassure parents about MMR safety following the publication of the 1998 paper by Wakefield and colleagues, MMR uptake declined. One of the reasons suggested for this decline is a loss of public trust in politicians and health professionals. The purpose of this analysis was to examine parents' views on the role the media, politicians and health professionals have played in providing credible evidence about MMR safety. Methods A qualitative focus group study conducted with parents living in Central Scotland. Eighteen focus groups were conducted with 72 parents (64 mothers and 8 fathers) between November 2002 and March 2003. Purposive sampling was used to ensure maximum variation among parents. Results In the period after the MMR controversy, parents found it difficult to know who to trust to offer balanced and accurate information. The general consensus was that politicians were untrustworthy in matters of health. The motives of primary health care providers were suspected by some parents, who saw them as having a range of vested interests (including financial incentives). Among the sources of evidence seen by some parents as more credible were other parents, and Andrew Wakefield who was viewed as an important whistle-blower and champion of ordinary parents. Conclusion The provision of accurate information is only one aspect of helping parents make immunisation decisions. Establishing and maintaining trust in the information provided is also important. The MMR controversy may provide useful lessons for health professionals about trust and credibility that may be generalisable to future health controversies.

BACKGROUND: The provision of commercialised gambling products and services has changed radically in recent decades. Gambling is now provided in many places by multi-national corporations, with important implications for public health and policymaking. The United Kingdom is one of the most liberalised gambling markets globally, however there are few empirical analyses of gambling policy from a public health perspective. This study aims to provide a critical analysis of a core element of UK gambling policy, the provision of industry-funded youth gambling education programmes. METHODS: Adopting a commercial determinants of health lens, a discourse theoretical analysis was conducted using the logics of critical explanation. The data comprised resources provided by three gambling industry-funded charities (GambleAware, GamCare and the Young Gamers and Gamblers Education Trust) and their partners. RESULTS: The resources present a gambling education discourse that serves to reproduce the 'responsible gambling' agenda, while problematising children and young people. While the resources appear to offer educational content and opportunities for debate, the dominant focus is on teaching about personal responsibility and on the normalisation of gambling and gaming and their industries, while constraining the concept of agency. The resources encourage young people to act as individuals to control their impulses, and to correct what are portrayed as faulty cognitions with the aim of becoming responsible consumers. Our findings demonstrate how the gambling education discourse aligns with wider industry interests, serving to deflect from the harmful nature of the products and services they market while shifting responsibility for harm onto children, youth and their families. CONCLUSIONS: Despite being delivered in the name of public health, the resources construct a discourse favourable to corporate interests. Educators, parents, policymakers, and others need to be empowered to address the conflicts of interest that exist in ...

Background: The provision of commercialised gambling products and services has changed radically in recent decades. Gambling is now provided in many places by multi-national corporations, with important implications for public health and policymaking. The United Kingdom is one of the most liberalised gambling markets globally, however there are few empirical analyses of gambling policy from a public health perspective. This study aims to provide a critical analysis of a core element of UK gambling policy, the provision of industry-funded youth gambling education programmes. Methods: Adopting a commercial determinants of health lens, a discourse theoretical analysis was conducted using the logics of critical explanation. The data comprised resources provided by three gambling industry-funded charities (GambleAware, GamCare and the Young Gamers and Gamblers Education Trust) and their partners. Results: The resources present a gambling education discourse that serves to reproduce the 'responsible gambling' agenda, while problematising children and young people. While the resources appear to offer educational content and opportunities for debate, the dominant focus is on teaching about personal responsibility and on the normalisation of gambling and gaming and their industries, while constraining the concept of agency. The resources encourage young people to act as individuals to control their impulses, and to correct what are portrayed as faulty cognitions with the aim of becoming responsible consumers. Our findings demonstrate how the gambling education discourse aligns with wider industry interests, serving to deflect from the harmful nature of the products and services they market while shifting responsibility for harm onto children, youth and their families. Conclusions: Despite being delivered in the name of public health, the resources construct a discourse favourable to corporate interests. Educators, parents, policymakers, and others need to be empowered to address the conflicts of interest that exist in ...

Islamic countries are of key importance to transnational tobacco companies as growing markets with increasing smoking rates. We analyzed internal tobacco industry documents to assess the industry's response to rising concerns about tobacco use within Islamic countries.

Abstract Background "Smoke-Free" legislation prohibiting smoking in all enclosed public places was introduced in March 2006. This qualitative study presents insights from bar workers about their observations of the changing social bar environment, changing patrons' behaviours and challenges bar workers have faced in managing smoke-free legislation. Methods Twelve in-depth interviews were conducted between November 2006 and January 2007 with a purposively-selected sample of bar workers, identified from a larger quantitative study evaluating the impact of the legislation in Scotland [the Bar Workers' Health and Environmental Tobacco Smoke Exposure project (BHETSE)]. Results Bar workers all spoke of the improvements the legislation had brought to their working lives and the greater comfort it appeared to offer patrons. Bar workers reported that patrons were generally quick to accept and comply with the new law, and that families had become a greater feature of pub life since the legislation. However, they expressed concerns that older men seemed to have had most difficulty adjusting to the legislation and lack of knowledge about the best practices they should adopt in order to reduce the risks of unattended drinks being spiked and of anti-social behaviour associated with patrons moving outside to smoke. Conclusion Smoke-free legislation is changing the social context of smoking in Scotland. Further research to assess the impact the legislation is having on older male smokers and on the incidence of drink spiking would be useful. More specifically, bar workers would benefit from guidance on how to manage issues arising from patrons moving outside to smoke.

BACKGROUND: "Smoke-Free" legislation prohibiting smoking in all enclosed public places was introduced in March 2006. This qualitative study presents insights from bar workers about their observations of the changing social bar environment, changing patrons' behaviours and challenges bar workers have faced in managing smoke-free legislation. METHODS: Twelve in-depth interviews were conducted between November 2006 and January 2007 with a purposively-selected sample of bar workers, identified from a larger quantitative study evaluating the impact of the legislation in Scotland [the Bar Workers' Health and Environmental Tobacco Smoke Exposure project (BHETSE)]. RESULTS: Bar workers all spoke of the improvements the legislation had brought to their working lives and the greater comfort it appeared to offer patrons. Bar workers reported that patrons were generally quick to accept and comply with the new law, and that families had become a greater feature of pub life since the legislation. However, they expressed concerns that older men seemed to have had most difficulty adjusting to the legislation and lack of knowledge about the best practices they should adopt in order to reduce the risks of unattended drinks being spiked and of anti-social behaviour associated with patrons moving outside to smoke. CONCLUSION: Smoke-free legislation is changing the social context of smoking in Scotland. Further research to assess the impact the legislation is having on older male smokers and on the incidence of drink spiking would be useful. More specifically, bar workers would benefit from guidance on how to manage issues arising from patrons moving outside to smoke.

Background: "Smoke-Free" legislation prohibiting smoking in all enclosed public places was introduced in March 2006. This qualitative study presents insights from bar workers about their observations of the changing social bar environment, changing patrons' behaviours and challenges bar workers have faced in managing smoke-free legislation. Methods: Twelve in-depth interviews were conducted between November 2006 and January 2007 with a purposively-selected sample of bar workers, identified from a larger quantitative study evaluating the impact of the legislation in Scotland [the Bar Workers' Health and Environmental Tobacco Smoke Exposure project (BHETSE)]. Results: Bar workers all spoke of the improvements the legislation had brought to their working lives and the greater comfort it appeared to offer patrons. Bar workers reported that patrons were generally quick to accept and comply with the new law, and that families had become a greater feature of pub life since the legislation. However, they expressed concerns that older men seemed to have had most difficulty adjusting to the legislation and lack of knowledge about the best practices they should adopt in order to reduce the risks of unattended drinks being spiked and of anti-social behaviour associated with patrons moving outside to smoke. Conclusion: Smoke-free legislation is changing the social context of smoking in Scotland. Further research to assess the impact the legislation is having on older male smokers and on the incidence of drink spiking would be useful. More specifically, bar workers would benefit from guidance on how to manage issues arising from patrons moving outside to smoke.

English
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 nationallevel 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 systematic storage of data means that researchers, policy makers and practitioners may struggle to produce clear answers to important policy questions.

First paragraph: Ensuring communities have good access to healthy affordable food is one of the government's joined up strategies to improve public health and reduce health inequalities. Policy solutions for deprived communities without good access - food deserts - have focused on improving provision of food retail as part of a wider suite of recommendations for population dietary change focused around awareness, affordability, and acceptability. However, the evidence for the widespread existence of food deserts and their impact on population health has been contested. This has meant that although retail based policy recommendations to reduce diet related health inequalities now exist, the evidence to inform how, when, and where to reduce these inequalities is only now emerging. ; Output Type: Editorial