Releases Saturday 3 March 2001
No 7285 Volume 322

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(1) MORE AWARENESS OF AND INVOLVEMENT WITH
TOBACCO MARKETING ENCOURAGES TEENAGE
SMOKING

(2) ADVERSE EVENTS IN HOSPITALS MAY COST NHS £1
BILLION A YEAR

(3) MORE INFORMATION NEEDED TO IMPROVE
WOMEN'S UNDERSTANDING OF SMEAR RESULTS

(4) CLIENT VIOLENCE TOWARDS PROSTITUTES MUST
BE ADDRESSED



(1) MORE AWARENESS OF AND INVOLVEMENT WITH
TOBACCO MARKETING ENCOURAGES TEENAGE
SMOKING

(Cross sectional study of young people's awareness of and
involvement with tobacco marketing)
http://bmj.com/cgi/content/full/322/7285/513

Teenagers are aware of, and are participating in, many forms of
tobacco marketing, and this phenomenon is consistently
associated with being a smoker, finds a study in this week's
BMJ. These findings confirm the need for statutory controls on
tobacco marketing to protect young people.

A random sample of 629 young people aged 15 and 16 years
completed a questionnaire about their awareness of and
involvement with different types of tobacco marketing. Around
95% were aware of advertising and all had seen some form of
advertising at point of sale. Awareness of and involvement with
tobacco marketing were both significantly associated with being
a smoker: for example, 30% of smokers had received free gifts
through coupons in cigarette packs, compared with 11% of
non-smokers.

When other factors known to be linked with teenage smoking
were held constant, awareness of coupon schemes, brand
stretching (the attachment of tobacco brands to non-tobacco
products) and tobacco marketing in general were all
independently associated with current smoking.

This suggests that the current voluntary regulations designed to
protect young people from smoking are clearly not working.
Comprehensive statutory regulations, which outlaw all forms of
tobacco marketing, and are rigorously monitored and policed,
are required, say the authors.

They conclude: "The findings of the study clearly show that the
current (voluntary) codes are being easily circumvented; we
need to ensure that the same thing doesn't happen when the
Government's new Tobacco Advertising and Promotion Bill
becomes law."

Contacts:

Lynn MacFadyen, Research Officer or Gerard Hastings,
Director, Centre for Tobacco Control Research, University of
Strathclyde, Glasgow, UK
Email: l.macfadyen@csm.market.strath.ac.uk

(2) ADVERSE EVENTS IN HOSPITALS MAY COST NHS £1
BILLION A YEAR

(Adverse events in British hospitals: preliminary retrospective
record review)
http://bmj.com/cgi/content/full/322/7285/517

(Editorial: Medical errors: a common problem?)
http://bmj.com/cgi/content/full/322/7285/501

(Personal View: How the Atlantic barons learnt teamwork)
http://bmj.com/cgi/content/full/322/7285/563

Ten per cent of patients admitted to British hospitals experience
an adverse event, about half of which are preventable,
according to preliminary findings from a pilot study in this
week's BMJ. These events could cost the NHS around £1bn a
year in extra bed days alone.

A review of 1,014 medical and nursing records was carried out
at two acute hospitals in the London area. In all, 110 (10.8%)
patients experienced an adverse event, with an overall 11.7%
rate of adverse events when multiple adverse events were
included. About half of these events were judged preventable
with ordinary standards of care. A third of these events led to
moderate or greater disability or death.

Some adverse events are serious and are traumatic for both
staff and patients. Others are frequent, minor events that go
unnoticed in routine clinical care and yet together have massive
economic consequences, explain the authors. These results
suggest that adverse events are a serious source of harm to
patients and could cost the NHS around £1bn a year in 3
million extra bed days, they conclude.

The need to put in place a national system for recording adverse
events is highlighted by Professor George Alberti, President of
the Royal College of Physicians in an accompanying editorial.
"Only then will we really learn and improve our practice to the
ultimate benefit of the public," he writes.

Finally, in a personal view, David Johnson, senior route check
captain with British Airways, discusses how the experience of
the aviation industry can help the NHS address the problems of
safety.

Contacts:

[Paper]: Charles Vincent, Professor of Psychology, Clinical
Risk Unit, University College London, UK.
Email: c.vincent@ucl.ac.uk

[Editorial]: George Alberti, President, Royal College of
Physicians, London, UK.

(3) MORE INFORMATION NEEDED TO IMPROVE
WOMEN'S UNDERSTANDING OF SMEAR RESULTS

(Women's understanding of a "normal smear test result":
experimental questionnaire based study)
http://bmj.com/cgi/content/full/322/7285/526

Only about half of women understand that the term "normal
smear result" means there is a low risk of having or developing
cervical cancer in the next five years, finds a study in this week's
BMJ. These findings suggest that NHS policy for reporting
normal smears needs to change.

A total of 1027 women, aged 20-64, were asked to imagine
that they had received a normal smear result. The meaning of
this result was then presented using different combinations of
verbal and numerical explanations.

When informed only that their smear result was normal, just
52% correctly understood that this entailed a residual risk of
cervical cancer, compared with 70% given an additional
statement explaining that a normal test result means there is a
low risk of cervical cancer. However, understanding was not
improved further by the use of a numerical absolute (1 in 5000)
or a relative probability (five times lower).

In light of these findings, the reporting of a "normal smear result"
should be accompanied by a sentence stating that this means a
low risk for having or developing cervical cancer in the next five
years, say the authors.

They conclude: "Adopting our recommendation has the potential
to avoid as many as half a million women a year being falsely
reassured."

Contact:

Theresa Marteau, Professor of Health Psychology, King's
College London, UK
Email: theresa.marteau@kcl.ac.uk

(4) CLIENT VIOLENCE TOWARDS PROSTITUTES MUST
BE ADDRESSED

(Violence by clients toward female prostitutes in different work
settings: questionnaire survey)
http://bmj.com/cgi/content/full/322/7285/524

Half of prostitutes working outdoors and over a quarter of those
working indoors routinely experience some form of violence by
clients, according to a study in this week's BMJ. These levels of
violence need to be addressed and reported attacks responded
to more effectively, say the authors.

Researchers at Glasgow University contacted 240 female
prostitutes; 115 worked outdoors and 125 worked indoors in
saunas or flats in three British cities. They found that prostitutes
working outdoors were younger, involved in prostitution at an
earlier age, reported more illegal drug use, and experienced
significantly more violence from their clients than those working
indoors. Only 34% of prostitutes reported violence by clients to
the police, and this was reported more often by prostitutes
working outdoors than indoors.

Violence by clients towards prostitutes has seldom been the
focus of public and academic interest, yet it is a major health
issue, say the authors. Health services for prostitutes is an area
that should be urgently addressed if levels of injury and death
from violence by clients is to be reduced, they conclude.

Contact:

Dr Marina Barnard, Centre for Drug Misuse Research,
University of Glasgow, Scotland, UK
Email: M.A.Barnard@socsci.gla.ac.uk


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