Tag: children

From Bristol City to Mexico City: New challenges for obesity research

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In this blog, Simon Sebire from the Centre for Exercise, Nutrition & Health Sciences and three PhD students reflect on new avenues of research into childhood physical activity and obesity in Low and Middle Income Countries and the opportunities and challenges this work presents.

New ideas emerge in the least likely places. As I listened to Professor Andy Gouldson present his research to the School for Policy Studies in spring 2014, I was inspired to sketch connections between some of Andy’s concepts (economic development and environmental issues) and my own (the psychology of motivating people to adopt healthy behaviours like being physically active). After the talk, I shared my scribbles with my colleague Prof. Russ Jago, only to find that he had an almost identical set.

Our thoughts had independently been transported from Bristol to Mexico and musings about the potential associations of urban development and rural-urban migration on the lifestyle behaviours of children and their families. This international perspective is not something either of us had previously pursued is but clearly had prompted some scribbling! The Mexico connection was inspired by three CONACyT-funded students, from Mexico, who at the time were studying our MSc in Nutrition, Physical Activity and Public Health and were considering PhDs.

Nearly 1 year on the three students (Ana Ortega Avila, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron) are now PhD students in the School for Policy Studies Centre for Exercise, Nutrition and Health Sciences supervised by Prof. Russ Jago, Dr Angeliki Papadaki and I. They secured further funding from CONACyT to pursue their programme of research to study how various social, psychological and environmental factors might be related to physical activity and nutrition behaviours in children adolescents and their families in Mexico.

The causes of and response to increasing levels of obesity in low and middle income countries have been the focus of a recent Guardian Global Development Podcast. The podcast draws on the experiences of children, families, health practitioners and campaigners from South Africa and Mexico. In Mexico 73% of men, 69% of women and approximately 35% of adolescents are obese or overweight which is higher than in the USA. It is clear that there is much to be done to both treat those who are already overweight and prevent the development of obesity in young people. However, extrapolating our existing research and knowledge of what we think drives obesogenic behaviours in places like Bristol to the context of people’s lives in Mexico presents a number of challenges.

Ana, Maria and Nadia have a wealth of experience from previously working in Mexico as nutritionists or within the food industry, so I asked them to listen to the podcast and share their insider’s view of the challenges ahead:

Maria referred to the potentially damaging effects of families in Mexico aspiring to an American lifestyle dominated by unhealthy foods and sedentary behaviour:

The blog says that processed foods and junk food are one of the main causes of overweight and obesity increasing in Mexico, which is partially true, but I think it has to do a little bit more with what I call “junk behaviours”. For example, how mums from rural areas prefer to give their children processed foods instead of home-made meals because they heard somewhere that people from USA consumed them, and because Americans always choose right (at least that’s the belief in some parts of Mexico); junk food and processed foods are the way to go for feeding their children.

Ana suggested that this influence may be strongest in regions closest to America and highlighted the broader problems associated with researching an issue which is geographically diverse:

Mexico is among the largest countries in the world geographically and demographically (118 million people); where differences in dietary pattern exist between rural and urban areas or between north, central and south regions.I have always lived in the northwest and the influence of the U.S.A. is visible in a lot of aspects in our life compared to the centre or south of the country. Our dietary patterns are based on American food choices and less on the Mexican traditional diet.

Ana, Maria and Nadia all added that the potential mismatch between perceptions of wealth and health may be making being overweight an aspiration:

Ana: In my experience as a nutritionist there are a number of cultural misconceptions among population when it comes to healthy nutrition. For example, being a little overweight still means you are healthy and well-nourished whereas being thin means you are unhealthy or sick. People don’t see overweight as a problem, on the contrary, they see it as something normal.

Nadia suggested that such perceptions may prevent parents from identifying obesity as a potential health problem in their children:

I think the healthy body image is distorted as family, friends or in the streets, the most common thing is to see someone obese; and that is really concerning because how will they do something to improve their health if they don’t even think there’s a problem. 

Ana, Maria and Nadia reflected on the challenges of applying our physical activity and nutrition research findings which are largely based on evidence from developed countries such as the UK or USA to the context of middle income countries such as Mexico. A good example is parents’ perceptions of safety when letting their children play outside of the home. In UK research, including some in Bristol by my ENHS colleagues, we tend to focus attention on the presence of traffic or children’s risk of injury while unsupervised. In contrast, perceptions of safety in Mexico are measured nationally with questions including those related to the risk of kidnap, existence of violent gangs in the neighbourhood, armed robbery and frequency of firearms shootings. 73.3% of the participants in the 2014 National Survey on Victimization and Perception of Public Safety (ENVIPE) in Mexico reported not feeling safe in their local areas. In addition to the safety implications of conducting research in this context, it is clear that current measures of parents’ perceptions of their child’s safety to be active outside the home will not be sufficient and Nadia has plans to develop a new tool.

In addition, the political landscape challenges us to consider different ways in which our research may be best able to impact on health policy:

Ana: The political context in Mexico is complex, the government is dealing with high levels of insecurity and corruption, events that prevent the government from focusing on other matters such as the implementation of new health policies.

Maria believes that more is needed to be done to educate policy makers in addition to the public: There is a huge educational barrier, both governmental and individual, which makes difficult to take seriously the obesity and overweight problem.

Nadia: All those factors are completely different to high-income countries, and makes the context a complex matter to understand when almost all the research has developed in a completely different contexts with a wider range of opportunities to change or create policies that have a real impact in the population’s health. 

In summary, over the last year or so, I have been transported from Bristol city to Mexico City thanks to a fortuitous combination of research daydreaming and inspiring MSc (now PhD) students.  As a supervisor, my initial conversations with our new students has forced me out of my research comfort zone, an experience which has been echoed and reported by researchers in the International Physical Activity and the Environment Network in Latin America. Undoubtedly, our success in co-producing research which could have international impact will require us to work together to combine our collective knowledge to understand the context and key drivers of obesity-related behaviour change in Mexico.

Thanks to Ana Avila Ortega, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron for their contributions.

  • Ana’s PhD focusses on the development of a social media intervention to reduce consumption of sugar-sweetened beverages in  Mexican older adolescents
  • Maria is studying the associations between urbanicity in Mexico and lifestyle behaviours and the influence of the rural urban transition on family health.
  • Nadia’s PhD focusses on the environmental and social correlates of physical activity in children in Mexico City.

Dr Simon Sebire is Lecturer in Physical Activity & Exercise Psychology in the Centre for Exercise, Nutrition & Health Sciences (ENHS) in the School for Policy Studies.The results of the 2014 Research Excellence Framework (REF) confirm the Centre’s international reputation for research excellence within the field of physical activity, nutrition and health. ENHS was rated 1st overall in the UK.

 

Emma Williamson, Senior Research Fellow in the School for Policy Studies, discusses gendered violence

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010-savile

People around the World are currently engaged in 16 days of activism against gendered violence.  Communities across different nations are challenging the inequality which some men interpret as an excuse to violate and oppress those, predominately women and children, who are more vulnerable than themselves.

This image is being used with permission from J.Fleming

This is a global phenomenon which has landed in the middle of our city of Bristol. I drove past the Premier Inn on my way to work this morning.  The same hotel where last week it was revealed that a young, vulnerable, girl of 13 had been raped and sexually abused by a group of men who had been grooming her for sexual exploitation.  That building used to house Bristol Social Services.

It is possible that I have met this young woman, or someone like her, during the course of our research on the needs of homeless women or in the recent evaluation of a nearby Child Sexual Exploitation project.

She could be Jasmine, not her real name, who we first met when she was 19.

But when I got kicked out the last time, that was the only person who I could go to … but he’s on like a paedophile thing, he’s on the sex offenders for life … and he’s just not right in the head. […] Not … he never done nothing to me … or that I know about … cos he could have done it when I was asleep … but I never felt safe there. It was just horrible. (Jasmine, age 19)

When we spoke to her again, she told us

When I think back to that I do get very paranoid thinking he might have put stuff in my drink and … cos I just would not put it past him.  And … but I try not to think of it, cos I’d never find out now. (Jasmine, age 19)

When Jasmine told us about this she did so with a resignation and matter of fact honesty.  She genuinely does not know, on that occasion, if she was sexually assaulted or not.  The rest of Jasmine’s story has an inevitability about it, for example she told us about both her current and ex- ‘boyfriend’:

One time my ex-boyfriend, he hit me before … this was like proper punches to the head … never got the police involved when I should have.  But this one’s a bit different – although he’s physical, he’s like in your head.  That’s what he’s more like – he tries brainwashing you. (Jasmine, age 19)

And about how she coped with alcohol and drugs:

I know it sounds stupid, but I was just thinking a bit religiously and thinking it’s not natural, this is not what God like wanted you to do – take drugs and drink all the time. There’s got to be more to life than that (Jasmine, age 19).

Speaking with older homeless women, the vast majority of whom had experienced domestic or sexual violence throughout their lives and used alcohol and drugs as a coping strategy, demonstrates how the abuse of vulnerable girls and women continues overtime with immeasurable personal costs.

Blossom was 52 when we spoke to her:

[…] this person I’d known from last year, […] he harassed me going along the road, he wouldn’t leave me alone … he said “I need to talk to you” … and the outcome was I was assaulted […] And you see the thing is I knew him when I had nowhere to live, and I stayed there for a night.  And people don’t realise how vulnerable you are when you have nowhere to go. […] you’re vulnerable to all sorts of people.  And believe me I’ve met people that are not nice, and they take advantage of the situation. (Blossom, age 52)

Or Daisy and Ginger who spoke to us about staying in a mixed homeless hostel:

[…] the mixed [shelter], it ain’t safe in there because being women, sometimes I’d get a lot of attention from men, you know?  […] you don’t like waking up in the night getting touched or things going that shouldn’t be going on, you know what I mean?   (Daisy, age 30)

Yeah it’s mostly men, there’s only four women there.  It can be a bit agitating, cos the men there think they can just grab you when they’re drunk and do what they like, you know, but they can’t really can they? (Ginger, age 49)

The Bristol case yet again highlights the abuse and exploitation of vulnerable girls but it also challenges us all, as a society to reconsider how we respond to victims and how we all contribute to the reality in which abusive behaviours, across the continuum from wolf whistling to rape, are experienced and understood.

Whilst the media is rightly abhorred by the rape and sexual exploitation of young vulnerable girls, it doesn’t ask about the wider dynamics of gender and power which contribute to such abuse taking place.  When exploited girls talk about perpetrators as their ‘boyfriends’ it is in a context where society teaches young women to judge their self-worth on the basis of women’s objectification in the eyes of men.  Where they are bombarded by objectifying images on a daily basis in our newspapers, on TV, and on the cover of magazines.  Where senior executives from one of our national TV stations think it is ok to represent the harassment and abuse of women as tongue in cheek comedy entertainment.

In Bristol we have a council that sanctions licenses for sexual entertainment venues – whilst simultaneously seeking to educate young people in the city about respectful relationships. What we need to realise is that the violence and abuse experienced by women and children is inextricably linked to gender and inequality.  If we fail to challenge the latter, we fail to address the root causes of abuse and let victims and survivors down.

Dr Emma Williamson

Anyone who wishes to donate to a local Bristol charity which works with vulnerable women in relation to sexual exploitation might wish to donate to:

http://one25.org.uk/

http://www.sarsas.org.uk/

 

Understanding Gender Based Violence within national and international contexts

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GG NANadia Aghtaie and Geetanjali Gangoli from the Centre for Gender and Violence Research in the School for Policy Studies introduce their new book

The endemic, universal and multifaceted nature of gender based violence is what drives the work of the Centre for Gender and Violence Research (CGVR), at the School for Policy Studies, University of Bristol. Through our recent book (Aghtaie, N. and Gangoli, G. eds (2014) Understanding Gender Based Violence. National and international contexts. Routledge), we aim not only to contribute to scholarly debates on gender and violence,  but also to showcase some of the pioneering and original research conducted by members of the CGVR.  All the chapters in this book have contributions from current and former members of staff or post graduate research students attached to the CGVR.

While the Centre was formally created in 2009, members of the Centre have a long history of researching gender based violence at a local, national and international level, and feeding this into policy and practice. The CGVR grew organically from the Violence Against Women Research Group (2003) that emerged from the Domestic Violence Research Group (1990).All the members of the CGVR identify as feminist, and have a personal passion to end GBV, and our research has always originated from this desire.018

The CGVR works on all forms of GBV and interventions challenging it, and explores how violence, gender and power operate within intimate partner, interpersonal and structural violence, for example in the context of domestic abuse, prostitution and trafficking for sexual exploitation of women and girls, rape and sexual violence, domestic violence and disabled women and gender based violence for BME communities, young people’s experiences of intimate partner violence, online and offline,  same sex domestic violence and abuse, and international and comparative research on gender based violence, in a variety of contexts.

Based on the varied research conducted by members of the CGVR, the book aims to highlight the continuing, pervasive and varied nature of gender based violence in a range of countries and contexts, such as the UK, India, Iran, Rwanda and China. The chapters in the book focus on the importance of context and structure both nationally and internally The book both builds on, and expands on existing research, theories and methodologies on the issue; as well as, enters into some under researched geographical areas; and issues, such as children’s and young people’s experiences and attitudes to gender based violence and disability and domestic violence.

The book gives a taste of the many projects, studies, international reach and contributions to theories and practice of the CGVR. The Centre is now one of the largest research centre on gender based violence in Europe. Ultimately we believe and hope that the work done by the Centre does and will contribute to a more egalitarian society, where women, men and children, are free of the pressures to ‘do gender’ and are free of violence and abuse. This is, in our view, the core of feminist research.

The book will be launched on the 3rd December 2014 at the Common Room, 8 Priory Road, Bristol.  All welcome – book here!

 

Child Sexual Exploitation: Groundhog day

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Emma Williamson and Natasha Mulvihill, Centre for Gender and Violence Research

The report into the abuse and sexual exploitation of children and young people in Rotherham[i] whilst shocking, is not a surprise. The report comes in a long line of reports, inquiries, research, and reviews which are consistent in their findings. That victims have been ignored or not believed; that busy professionals have been unable (for a variety of reasons) to respond appropriately; that officials have not adequately prioritised the work of those on the front line; and that existing legislation is not being used even in cases where it could be, to tackle the sexual exploitation of children and young people.

As British actor Samantha Morton made clear in her recent interview, every incident of child sexual abuse is a life sentence for that individual, their families, and those around them.

As calls for yet another inquiry are made, maybe this is the time to take a different approach. A recent Parliamentary Select Committee Report, published in April 2014, concluded that there was no evidence to suggest that in terms of child sexual exploitation “justice cannot currently be served due to the lack of a specific offence”. The recommendation of this report was that “existing offences could be used more effectively”.  Sheila Taylor, CEO of NWG Network, in recent news interviews and her own press release, highlighted how their organisation had compiled the recommendations from 16 recent relevant reports which resulted in up to 400 recommendations. The result, she suggests is that practitioners are overwhelmed, frustrated, and struggle to implement the findings from a report before a new one comes out. Ms Taylor suggests, and we would wholeheartedly agree with her, that maybe that money would be better spent on dedicated, ring fenced, services to implement the recommendations we already have and provide the much needed victim-focused services which are clearly needed.

Too often the response to inquiries, reviews, and reports by the time they come out, however damning, are that lessons have been learnt and changes made. The scandal which we need to face is why this keeps happening if lessons have been learnt? What happens in these areas when the glare of the media spotlight disappears and victims once again become the target of perpetrators whose behaviour society allows to go unchallenged?

Our recent evaluation of a specialist service working with young people at risk of sexual exploitation[ii] is that lessons haven’t been learnt. Austerity is impacting on the ability of statutory services, the police, social services, and youth services, to deal with the cases that fall onto their desks, let alone going out and finding what are hidden and difficult cases to deal with. Too often the services for those in need, as opposed to those where there is a statutory responsibility to intervene, are restricted, where they exist, to short term interventions. It beggars belief that commissioners think that someone being groomed for sexual exploitation would be identified, supported to recognise the abuse, and disclose that abuse in the 6 week support packages currently written into so many service contracts. Those being exploited need specialist support, over a long period of time, and for there to be coordinated responses between the police and support workers. All of that costs money which is increasingly difficult for local authorities and voluntary services to find.

Given the difficulties faced by service providers with ever increasing workloads and limited specialist service providers where they can send clients, it is not surprising that victims end up falling through the net. The vulnerabilities which perpetrators target victims for, are the same that allow agencies under pressure to perceive these victims as difficult and un-credible.

Rather than waste yet more money on an inquiry, the responses to which we have heard before, maybe the government and all political parties should commit to 10 years of ring fenced funding for the establishment of a national response. This should include specialist sexual exploitation workers to support victims in every area of the country and specialist dedicated police officers in those areas to use every law at their disposal to target perpetrators so it is their behaviour under the spotlight and not that of the victim.  Where this has happened in local areas, real progress has been made.  We need the same concerted effort nationally to tackle this problem.

The authors can be contacted at nm8543@bris.ac.uk and e.williamson@bris.ac.uk 

This blog was originally posted on the PolicyBristol blog. 

[i] Jay, A. (2014) Independent Inquiry into Child Sexual Exploitation in Rotherham 1997 – 2013. Rotherham Metropolitan Borough Council.

[ii] Mulvihill, N. and Williamson, E. (2014) An Evaluation of the GDVSAP Trafficking and Grooming Project, Gloucester, UK.  Bristol: Centre for Gender and Violence Research, University of Bristol.

 

Patricia Lucas explains why the School for Policy Studies is researching dental decay

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Lucas

Data released by Public Health England on 30 September 2014 has shown what many interested in health in the early years know already.  Over 80,000 3-year-old children in England – about 12% – suffer from a completely preventable disease.  Dental decay is painful, the treatments are unpleasant, and decayed, missing and filled teeth affect appearance.  Oral disease can have very serious consequences: in Bristol alone 721 children aged 0-19 years (of whom 155 were under 5) were admitted hospital for extraction of decayed teeth in a one year period (2012/13).

Tooth decay is of importance for us in the School for Policy Studies because while rates have reduced dramatically since the 1970s, there remain important and significant inequalities.  Closer examination of

data suggests geographical and social disparities in oral health.  Children from more disadvantaged backgrounds are significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic.  In Bristol, while the rate of child dental decay was on a par with the UK average in 2008, the DMFT (decayed, missing, filled, in teeth) index for children in South Bristol, an area of high deprivation, is currently twice the city average.  Ashley and Lawrence Hill wards experience nearly three times as many dental fillings in under 5 years old, compared to neighbouring Bishopston and Redland wards.

The Public Health England (PHE) report points out that the most important cause of dental decay is sugar in diet, and the most important preventive action is fluoride (in toothpaste or water).  The response from PHE focuses on the former, but it is important not to ignore the latter, and to understand the policy context for this.  Despite clear evidence that very small amounts of fluoride in water supplies reduces dental decay, few water supplies are fluoridated in the UK.  Water supplies are a shared resource, and public and legislative barriers mean addition of fluoride seldom happens.  In the absence of this, use of fluoridated toothpaste and fluoride varnishes by dentists are the next line of defence.

One difficulty for local policy makers is that we don’t have good enough data on oral health in childhood.  The new PHE Survey is important, but sampled just 211 3 year olds in Bristol.  We need better local data to really understand what is happening to have a reliable estimate of the local rate, including how this varies between areas.

Our study, which is part of the BoNEE project, will improve our understanding of oral health inequalities among children in Bristol.  We will do this by looking at dental hospital records of who is attending for dental extractions, by understanding better what happens when children do visit the dentist, and by gathering parents views and experiences of oral health services in Bristol.

This project is in collaboration with colleagues at University Hospitals Bristol NHS Foundation Trust, the University of Bristol’s School of Oral and Dental Sciences, and Bristol City Council.

Patricia is Head of the Centre for Research in Health and Social Care in the School for Policy Studies at the University of Bristol.

 

Progress on the FAB kids outreach project

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FAB1Mark Edwards, Active7 Trial Manager in the School for Policy Studies, reflects on the first term of delivering the FAB Kids outreach workshop in schools. Mark previously blogged on this project here

It’s been a busy term. Aside from their full-time jobs, Exercise, Nutrition and Health Sciences (ENHS) staff and students have worked hard to get the FAB (Food, Activity, and Bodies) Kids project up and running in schools. Taking the workshop from drawing board to school hall has been an arduous task, but seeing the children (and teachers) learn from and enjoy the workshop activities makes the efforts worthwhile. It has been a rewarding process for FAB staff; going into schools and being in dialogue with small groups of children, learning from them and hearing their stories (sometimes fascinating, other times bizarre), and quickly(!) getting to grips with controlling groups of over-excited children.

Between May and early July, 13 staff and student volunteers have delivered the FAB workshop to 355 children. Workshops have been delivered in 8 mainstream primaries, one Special Educational Needs school, and one fee paying school. We’ve also taken FAB to the Big Bang (Cirencester) and Bridgwater Science Festivals.

What has been the impact?

FAB2

So what have the children learnt? At the end of each workshop we ask them just this question. As you’d expect (or hope) from a health-focused workshop, lots of children came away with the message that they should ‘always keep healthy and fit and drink what’s right for you’.  Many took away messages they can use in their day-to-day lives, such as ‘some drinks that appear to be healthy have a lot of added sugar’ and the ‘more you exercise the less likely you are going to have heart problems’. Others memorised interesting snippets  such as ‘Diet Coke contains an ingredient that is in fireworks’, ‘there are over 600 muscles in your body’ and ‘the average heart rate for children is 70-100 beats per minute’. One child was simply speechless (or ironic beyond his years); ‘Absolutely epic! I can’t get any of it out of my head because I learnt so much!’ Whilst most were more conservative in their comments, we hope and think that all children have taken something – however little – from the workshop that may help them to improve their lifestyle.

What did the teachers think?

School staff provide more formal evaluation of the workshop. The three individual workshop activities and the workshop overall (separate questions) were rated ‘very good’ by all teachers. It was interesting to see how teachers engaged with the workshop, with some using it as a way to develop their own knowledge, and experimenting with props and asking questions as if they themselves were participants. The qualitative feedback they provided is testament to the enthusiasm of the staff delivering the workshop. Comments from teachers include:

‘A perfect morning’s learning where the children enjoyed themselves! They loved learning the new facts. All brilliant, staff energetic and formed great relationships with children.’

‘All interactivity was brilliant! Children really enjoy learning in a different way with various approaches.’

‘All the activities were interactive, stimulating and fun for the children. They were enthusiastic and engaged throughout and certainly enjoyed what they were doing.’

FAB3

‘Really loved the jigsaw/children very engaged. Children liked the booklets and enjoyed all the activities.’

‘All members of the team had a lovely manner with children and quickly established a positive rapport. Not always easy! The resources were all well organised, interesting and engaging.’

Where next?

Although we are delighted with this term’s progress, we are not complacent and have identified several areas for improvement (which will be made over the summer). In September, MSc students will be invited to assist with the delivery of the workshop. As such, we will be designing training sessions and delivery manuals over the next few months. The plan is to allow trained MSc students to deliver the workshop, giving some supervisory roles, and gradually reducing the hands-on involvement of ENHS staff. In September we will begin to book in more schools to receive the workshop.

FAB_team

If you would like any further information on the FAB Kids workshop please visit www.fab-kids.org or email fab-kids@bristol.ac.uk.

FAB team members: Bethan Baker Williams, Rachael Pound (MSc student), Mark Edwards, Laura Pool, Kate Banfield, Byron Tibbitts, Jo Kesten and Sarah Harding.

ENHS is a research centre in the School for Policy Studies. Staff work on a variety of projects focusing on physical activity and nutrition, and their associations with health across the life course. Much research in ENHS is conducted with children in local schools.