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Research shows that school environment impacts significantly on students' mental health, future aspirations and feelings of school connectedness, which in turn can improve academic outcomes. The UK has seen rising numbers of academy schools in recent years which have been scrutinised for academic performance but overlooked in terms of important aspects of school environment. This study compares outcomes for mental health, school connectedness and future aspirations in low-socioeconomic status adolescents attending academy and non-academy schools. Data came from 1284 11-16yr olds attending 1 of 67 academy or non-academy schools from areas of deprivation in London. A total of 639 complete cases were analysed. Self-reported measures of school connectedness, future aspirations and mental health, including self-esteem, were analysed and compared using linear regression clustered at school level, adjusting for the effects of gender, ethnicity, school year and affluence. Adolescents attending academies were found to have significantly higher levels of school connectedness than those at non-academy schools. No direct effect of academies on mental health or aspirations was found, however school connectedness had a significant, mediating effect on pro-social mental health scores. Academies in this sample can therefore be said to indirectly increase levels of mental health by increasing levels of school connectedness. These findings highlight the importance of school connectedness for adolescent wellbeing and suggest that academies can be more successful in promoting levels of school connectedness which can then impact positively on individual mental health. More work needs to be done on identifying the structures and processes at work.

Achieving adequate levels of physical activity (PA) is important to maintain health and prevent chronic disease. The costs of inadequate physical activity to the NHS have been estimated at over a billion pounds annually. While socio-demographic characteristics such as age, sex and ethnicity have been reported to be associated with different levels of PA, there is evidence that people's social environments may also be important in encouraging a physically active lifestyle. The objective of this paper is to describe associations between the social environment and physical activity among the poorer communities in an outer London Borough, when other socio-demographic factors are controlled for. A household survey was carried out in six poorer neighbourhoods in Redbridge in 2008 as part of a wider health needs assessment. The questionnaire included questions allowing estimation of levels of physical activity as well as extent of social environment [social network score (SNS) and social support score (SSS)]. A random sample of households was taken and a total of 799 completed responses from over 16 year old were obtained. The association between physical activity and the social environment controlling for socio-demographic characteristics was estimated using a logistic nested model. Higher SNS was significantly associated with younger age, Black ethnicity, higher education level, higher household income and higher levels of PA in bivariate analyses. Higher SSS was positively associated with Indian ethnicity, higher household income and area of residence. In multivariate analyses higher levels of PA were significantly associated with wider social networks and stronger social support, educational level and marital status. Despite its limitations, our findings confirm that the relationship between low physical activity and weak social networks and low social support, observed in general population studies, also occurs in deprived communities in London. The relationship merits further exploration given the limited evidence on the effectiveness of interventions to promote physical activity.

Objective: To investigate the attitudes of the main stakeholders towards the introduction of sex education in schools in Russia. Design: Qualitative semi-structured interview study. Setting: Altai Krai, Volgograd Oblast, Moscow, Russian Federation. Participants: One hundred and fifty-three interviews with Intersectoral HIV/AIDS Committee members, government officials responsible for HIV policies and interventions, non-governmental organisation and private-sector representatives. Main outcome measures: Perception of and attitudes towards the introduction of sex education in schools. Results: Ninety-one per cent of stakeholders welcomed the introduction of sex education in schools and emphasised its importance for a child's personal development, public health, sexually transmitted diseases and HIV/AIDS control, and pregnancy planning. The majority of respondents suggested providing different information for each age and grade. Despite the claimed support of interviewed policy-makers and main HIV stakeholders, there has been no action to introduce sex education. The majority of respondents were of the view that wider positive support through propaganda about health, sex and healthy lifestyle should be gained prior to introducing sex education in schools by addressing the stigma surrounding sexual issues. Conclusions: There was little opposition to the introduction of sex education in Russian schools expressed in our survey, but there are uncertainties regarding curriculum quality, teaching methods and the starting grade of teaching about sex, and there is a need to cover local sensitivities in the territories. These concerns could and should be addressed during curriculum design, development and programme implementation by the federal and local authorities. Wider involvement of educational specialists, peer-adults, health workers, celebrities and religious representatives in discussion of the curriculum could help prevent opposition to its implementation. Contribution to knowledge: Discussion of sex-related topics has been taboo in Russia and there has been little research into opinions on issues related to sex education. The contribution of this research is in gaining theoretical in-depth understanding of the attitudes of the interviewed stakeholders in Russia about the introduction of sex education in schools. (Contains 2 tables.)

Objectives. We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work. Methods. We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored. Results. Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily. Conclusions. Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users. doi:10.2105/AJPH.2005.069732

We undertook a qualitative study to explore the micro-environment of drug injecting, risk reduction and syringe exchange practices among injecting drug users (IDUs) in Togliatti City, Russia. Semi-structured qualitative interviews (n = 57) were undertaken with current IDUs in May 2001. Findings highlight a recent transition away from hanka (a home-produced liquid opiate derived from opium poppy) towards the injection of heroin powder, and a drug use culture in which injecting predominates. Findings emphasise that risk reduction practices may be influenced less by availability of injecting equipment than by an interplay of situational and micro-environmental factors. Principal among these is a reported fear of police detainment or arrest among IDUs which encourages a reluctance to carry needles and syringes, and which in turn, is associated with needle and syringe sharing at the point of drug sale. We note the role of policing practices in influencing risk reduction and the potential role of policing agencies in supporting HIV prevention initiatives among IDUs. Keywords: HIV prevention; Injection drug use; Russia; Police; Risk environment

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions. Keywords: HIV/AIDS; Community care; Hospital care; Service costs; Equality; Equity

Abstract Background The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here. Methods The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. Results There were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012. Trial registration Current Controlled Trials ISRCTN68175121

Abstract Background Exercise referral schemes are one of the most popular forms of physical activity intervention in primary care in the UK and present an opportunity to better understand the factors related to exercise adherence. But standard schemes tend to be delivered over a short period and so provide information about the factors associated with short-term adherence. This retrospective register-based study of a longer-duration scheme allowed investigation of longer-term adherence. Methods Social, physiological and anthropometric data were extracted from records of a cohort of ERS participants who had enrolled between 01 January and 31 December 2007 (n = 701). Characteristics of adherers and non-adherers were compared and potential predictors of longer-term adherence examined using binomial logistic regression. Results Significant adjusted odds ratios predicting longer-term adherence were found for age and medical condition. For every 10 year increase in age, the odds of people continuing exercise increased by 21.8% (OR = 1.02; CI = 1.00 to 1.04; p = 0.03). Participants referred with orthopaedic (OR = 0.25; CI = 0.07-0.94; p = 0.04), cardiovascular (OR = 0.18; CI = 0.05-0.70; p = 0.01) and other (OR = 0.20; CI = 0.04-0.93; p = 0.04) problems had significantly lower odds of adhering than those with metabolic conditions. Conclusion Improved understanding of the factors that influence adherence to exercise referral schemes will enable providers develop better referral guidance and tailor schemes to better meet participants’ needs. Longer-term schemes offer the opportunity to understand participants’ likelihood of maintaining adherence to exercise.