Using different physical activity measurements in eight European countries. Results of the European Physical Activity Surveillance System (EUPASS) time series survey.

OBJECTIVES: The European Physical Activity Surveillance System (EUPASS) research project compared several physical activity (PA) measures (including the International Physical Activity Questionnaire (IPAQ)) in a time series survey in eight countries of the European Union. The present paper describes first results provided by the different instruments regarding PA participation, frequency and duration, both at the European and national levels. The purpose of the present study is to explore and compare the specific quality and usefulness of different indicators rather than to provide valid and reliable prevalence data. Thus, the main focus is on discussion of the methodological implications of the results presented. METHODS: A time series survey based on computer-aided telephone interviewing (CATI) was carried out in eight European countries over a six-month period. The study provided for about 100 realised interviews per month in each country (i.e. approximately 600 per country). Descriptive statistical analysis was used to: (1) report IPAQ results on vigorous, moderate and light PA and sitting, as well as on the overall measure of calories expenditure (MET min-1), in the different countries; (2) compare these results with national PA indicators tested in EUPASS; and (3) compare IPAQ results with other European studies. RESULTS: First, the scores for the different PA categories as well as for the overall measure of calories expenditure provided by the IPAQ appeared rather high compared with previous studies and public health recommendations. Second, the different PA measurements used in EUPASS provided completely different results. For example, national indicators used in Germany and The Netherlands to date neither corresponded in absolute values (e.g. means of PA or sitting) nor correlated with the IPAQ in any significant way. Third, comparing EU countries, the ranking for vigorous, moderate and light activities by use of the IPAQ differed from that of other European studies. For example, in the present analysis, German respondents generally showed higher scores for PA than the Finns and the Dutch, while, in contrast, findings from other studies ranked Finland before The Netherlands and Germany. CONCLUSIONS: The present analysis highlights some methodological implications of the IPAQ instrument. Among other things, differences in overall scores for PA as well as in the ranking of nations between the present results using IPAQ and other measures and studies may partly be due to the concepts of PA behind the measurements. Further analysis should investigate if the range of PA-related categories provided by the IPAQ is fully appropriate to measure all relevant daily activities; it may also consider the public health implications of mixing up different contexts of PA (e.g. work, leisure-time, transportation) in the IPAQ short version.

Physical activity monitoring in Europe. The European Physical Activity Surveillance System (EUPASS) approach and indicator testing.

OBJECTIVES: The main objective of this paper is to describe the approach and specific findings of the European Physical Activity Surveillance System (EUPASS) research project. In particular, the analysis presented aims at testing the reliability, comparability and predictive power of different sets of physical activity (PA) indicators. DESIGN: First, a panel study based on computer-aided telephone interview (CATI) was designed to report PA data of a representative, selected group of about 100 persons per country at three points in time. Second, a CATI time series survey was carried out with the goal of realising about 100 interviews per month over six consecutive months. SETTING: The project was carried out in eight European countries to support the development of the European Union's (EU) Health Monitoring Programme. SUBJECTS: Random population samples (subjects aged 18 years and older) were drawn from each participating country. RESULTS: While many PA indicators used in EU countries to date as well as the psychosocial and environmental measures tested in the present study had acceptable to good reliability coefficients, the test-retest reliability scores of the International Physical Activity Questionnaire (IPAQ) version tested (the short (last 7 days) telephone interview IPAQ; IPAQ-S7T) were rather low. The comparability between extant national PA items and the IPAQ-S7T was low for all countries. The strongest predictors of perceived health were the psychosocial and environmental PA indicators. CONCLUSIONS: According to the results of the present study, more research is needed to further investigate and improve the quality of the IPAQ. In addition, the specific predictive power of the tested psychosocial and environmental PA indicators on perceived health should be of particular interest for designing health surveillance activities in the future.

The missing relative: the home help service in England and Wales 1918-1974 part 2.

Although recent work in social policy has illustrated how the work of home helps means that they straddle the health-social services boundary, there has been relatively little work on the earlier history of this service. In this the second of two articles, the author attempts to remedy this neglect, and considers the development of the home help service in England and Wales between 1918 and 1974, examining the overall evolution of this service. In the second article (to be published in the next issue of the journal), three themes are discussed in greater detail: the issue of training, regional variations in provision, and what home helps actually did for their clients. Although the focus is on England and Wales as a whole, in this second part the author illustrates particular themes through a case study of the Midlands city of Leicester, a local authority in which the home help service was particularly highly developed. Part one was published in the last issue of the International History of Nursing Journal (volume 5, number 1, Winter 1999 issue).

The missing relative: the home help service in England and Wales 1918-1974 part I.

Although recent work in social policy has illustrated how the work of home helps means that they straddle the health-social services boundary, there has been relatively little work on the earlier history of this service. In this the first of two articles, the author attempts to remedy this neglect, and considers the development of the home help service in England and Wales between 1918 and 1974, examining the overall evolution of the service. In the second article (to be published in the next issue of the journal), three themes are discussed in greater detail: the issue of training, regional variations in provision, and what home helps actually did for their clients. Although the focus is on England and Wales as a whole, in the second part the author illustrates particular themes through a case study of the Midlands city of Leicester, a local authority in which the home help service was particularly highly developed.

Family visitors or social workers? Health visiting and public health in England and Wales 1890-1974.

This article examines health visiting from its origins in the late 19th century to the 1974 National Health Service reorganisation. It looks at the successes and failures of health visiting in England and Wales as a whole, and compares this with a case study of provision in the Midlands city of Leicester.

The Medical Officer of Health in England and Wales, 1900-1974: watchdog or lapdog?

The recent revival of interest in the potential of preventive medicine, reflected in its re-emergence as a medical specialism and in monitoring and campaigning activity at the local level, has been accompanied by growing interest in the history of public health. In particular, the work of the Medical Officers of Health (MOsH), the doctors appointed by many local authorities after 1850, has come under closer scrutiny. However, whereas historians have acknowledged that the MOsH played a key role in tackling environmental health and infectious disease in the second half of the nineteenth century, judgements have been less favourable for the period since 1900. It is alleged that the MOsH produced repetitive and complacent reports, delayed the introduction of immunization, and were seduced away from public health by hospital administration. Both they and their counterparts in the School Medical Service ignored wider threats to health such as malnutrition and unemployment, and campaigning on these issues was left to other individuals and pressure groups. Furthermore, it is argued that after the establishment of the National Health Service in 1948, MOsH failed to exploit the potential of health education, lagged behind thinking on social work, and were slow to develop services for 'community care'. According to this analysis, the demise of the MOH in the 1974 health service reorganization represented the logical culmination of trends in the previous 75 years. This paper examines the strengths and weaknesses of this interpretation, partly through a case-study based on the Midlands city of Leicester. It argues that, although some MOsH were complacent, all operated within the limitations of important local and national constraints, and that, given these restrictions on their room for manoeuvre, many were remarkably innovative and imaginative. The paper concludes that, until further research is undertaken, the charges levelled against these doctors remain largely unproven.

The issue of never-married motherhood in Britain, 1920-70.

This article examines shifts in attitudes and changes in provision with regard to never-married mothers within three broad chronological periods. The first section considers attitudes towards these mothers in the period 1918-45, when the issue was conceptualized as one of public health and moral welfare. Second, the article examines the period between 1945 and 1970, when the dominant professional view of never-married mothers focused on identifying individual pathology, but when significant continuities in treatment can nevertheless be found. Third, the article looks briefly at the substantial change in policy and provision for what were then called 'one-parent families' during the 1970s. In conclusion it argues that while there were substantial changes in terms of the way in which unmarried motherhood was defined, from the point of view of the unmarried mothers themselves the continuities have been more striking. Unmarried mothers have been persistently singled out and labelled a social problem and, in all but a brief period during the late 1960s and 1970s, also as a moral problem.

In search of the 'problem family': public health and social work in England and Wales 1940-70.

Recent attempts to explain the decline of public health in England and Wales after 1948 have suggested that services had developed steadily but haphazardly in the interwar period, and that the lack of an underlying philosophy left Medical Officers of Health and their empires vulnerable to a range of forces that included the decline of infectious disease, the rise of hospital medicine, the growth of general practice, and the increasing professionalism of social work. Yet the argument that public health practitioners lagged behind contemporary thinking on social work in the 1950s deserves closer examination, and this article uses the rise and decline of the concept of the 'problem family' to examine the changing relationship between the two professional groups. It traces the emergence of the concept of the 'social problem group' in the 1930s, and considers why and how Medical Officers of Health and the Eugenics Society took up the idea of the 'problem family' after the Second world War. It charts how the Ministry of Health encouraged local authorities to use home helps and health visitors to tackle the 'problem family', and contrasts this medical approach with the casework methods developed by voluntary organizations and subsequently adopted by the social work profession. The article concludes that in revealing how Medical Officers of Health were out of touch with contemporary research and practice in social work, the issue of the 'problem family' helps to explain the decline of public health under the early National Health Service.

Images of youth: the issue of juvenile smoking, 1880-1914.

Despite its enormous social and medical significance, smoking has attracted little interest from historians. This article examines the issue of juvenile smoking in Britain between 1880 and 1914, and it locates this theme in the context of wider debates about urbanization, fears of 'physical deterioration' and attempts to inculcate citizenship. First it uses the Lancet to trace continuities and changes in medical opinion about the dangers of smoking for both adults and children. Secondly, the article examines the place of juvenile smoking in debates about 'physical deterioration' and considers the history of one anti-smoking organization, the International Anti-Cigarette League. Thirdly it traces attempts to legislate on the question of juvenile smoking, and it notes that while the Children's Act of 1908 prohibited the sale of tobacco to children, smoking continued to have an important place in the stereotype of working-class youth. The article concludes that in the period 1880-1914, smoking linked both physical and moral concerns about working-class children and adolescents, and suggests that citizenship continued to be an important theme in health education.

Physical education and the School Medical Service in England and Wales, 1907-1939.

Historians who have examined physical education (PE) have rarely related PE to its wider social context. This article considers the development of PE in elementary schools in England and Wales between 1907 and 1939, and locates PE within the wider history of the School Medical Service. From 1907, local authorities appointed specialist staff, acquired playing fields, and sent their teachers on short vacation courses, while at a policy level the Chief Medical Officer, Sir George Newman, came to regard PE as a component of preventive medicine. In the interwar period, PE was greatly influenced by voluntary organizations, and by the physical training schemes set up by the continental dictatorships, and this culminated in the Physical Training and Recreation Act of 1937. However PE also illustrated many of the weaknesses of the School Medical Service, including striking regional variations in its provisions, and in the 1930s the emphasis on PE contrasted with the relative neglect of malnutrition. The article concludes by suggesting that the contrast between Sir George Newman's ambitious plans for PE as a branch of preventive medicine, and provision in most local authorities, illustrated the great gulf that could exist between rhetoric and reality.