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Purba AK, Henderson M, Baxter A, Pearce A, Katikireddi SV. The Relationship Between Time Spent on Social Media and Adolescent Cigarette, E-cigarette, and Dual Use: A Longitudinal Analysis of the UK Millennium Cohort Study. Nicotine Tob Res 2024:ntae057. [PMID: 38569613 DOI: 10.1093/ntr/ntae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION To estimate the effect of social media use in 14 year olds on risk of and inequalities in cigarette, e-cigarette, and dual use at 17 years, using the UK-representative Millennium Cohort Study (born 2000-2002). AIMS AND METHODS The relationship of time spent on social media (using questionnaires [n = 8987] and time-use-diaries [n = 2520]) with cigarette, e-cigarette, and dual use was estimated using adjusted odds ratios (AORs) or relative risk ratios (ARRRs). Effect modification was examined (using parental education as an indicator for socioeconomic circumstances) by comparing adjusted risk differences within low and high-parental education groups. Analyses accounted for prespecified confounders (identified via directed acyclic graphs), baseline outcome measures (to address reverse causality), sample design, attrition, and item-missingness (through multiple imputation). RESULTS Time spent on social media was associated with increased risk of cigarette, e-cigarette, and dual use in a dose-response manner. Social media use for ≥2 hours/day (vs. 1-<30 minutes) was associated with increased cigarette (AOR 2.76 [95% confidence interval 2.19 to 3.48]), e-cigarette (3.24 [2.59 to 4.05]), and dual use (ARRR 4.11 [2.77 to 6.08]). The risk of cigarette use among 30 minutes-<1 hour/day users (vs. non-users) were smaller in those with high versus low parental education (ARDs 1.4% vs. 12.4%). Similar findings were observed across the higher time categories. Analyses using time-use-diaries, in complete case samples, and with additional adjustment for baseline outcome measures generally revealed similar findings. CONCLUSIONS After accounting for observed confounders and potential reverse causality, findings suggest social media use increases the risk of cigarette, e-cigarette, and dual use in a dose-response manner. Guidance addressing adolescent online safety should be prioritized. IMPLICATIONS This study's identification of a dose-response relationship and differential effects across socioeconomic groups, could assist in the development of guidance on time spent on social media. The adverse effects of social media use on adolescent cigarette, e-cigarette, and dual use supports legislation aimed at promoting adolescent online safety. Study findings strengthen calls to prohibit social media marketing of nicotine-related products and importantly highlight the need to increase awareness and understanding of the underlying algorithms which drive adolescent exposure to nicotine-related content on social media to ensure they are functioning in a way that best serves the adolescent population.
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Affiliation(s)
- Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Andrew Baxter
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Purba AK, Pearce A, Henderson M, McKee M, Katikireddi SV. Social media as a determinant of health. Eur J Public Health 2024:ckae029. [PMID: 38402522 DOI: 10.1093/eurpub/ckae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024] Open
Affiliation(s)
- Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marion Henderson
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Purba AK, Henderson M, Baxter A, Katikireddi SV, Pearce A. The relationship between time spent on social media and adolescent alcohol use: a longitudinal analysis of the UK Millennium Cohort Study. Eur J Public Health 2023; 33:1043-1051. [PMID: 37699850 PMCID: PMC10710344 DOI: 10.1093/eurpub/ckad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND To estimate the effect of social media use in 14 year olds on risk of and inequalities in alcohol use and binge drinking at 17 years. METHODS Using the UK-representative Millennium Cohort Study, the relationship between time spent on social media (assessed using questionnaires [n = 8987] and time-use-diaries [n = 2520]) with frequency of alcohol use in the past month and binge drinking was estimated using adjusted odds ratios (AORs) or adjusted relative risk ratios (ARRRs). Associations within low and high parental education groups were compared to examine effect modification. Analyses accounted for pre-specified confounders, baseline outcome measures (to address reverse causality), sample design, attrition and item-missingness (through multiple imputation). RESULTS Questionnaire-reported time spent on social media was associated with increased risk of alcohol use and binge drinking in a dose-response manner. Compared to 1-< 30 min/day social media users, 30 min-<1 h/day users were more likely to report alcohol use ≥6 times/month (ARRR 1.62 [95% confidence interval 1.20 to 2.20]) and binge drinking (AOR 1.51 [1.22 to 1.87]), as were 1-<2 h/day users (ARRR 2.61 [1.90 to 3.58]; AOR 2.06 [1.69 to 2.52]) and ≥2 h/day users (ARRR 4.80 [3.65 to 6.32]; AOR 3.07 [2.54 to 3.70]). Social media measured by time-use-diary was associated with higher risks, although not always demonstrating a dose-response relationship. The effect of social media use (vs no-use) on binge drinking was larger in the higher (vs lower) parental education groups. Analyses repeated in complete case samples, and with adjustment for baseline outcome measures revealed consistent findings. CONCLUSIONS Findings suggest social media use may increase risk of alcohol use and binge drinking. Regulatory action protecting adolescents from harmful alcohol-related social media content is necessary.
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Affiliation(s)
- Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Andrew Baxter
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Purba AK, Thomson RM, Henery PM, Pearce A, Henderson M, Katikireddi SV. Social media use and health risk behaviours in young people: systematic review and meta-analysis. BMJ 2023; 383:e073552. [PMID: 38030217 PMCID: PMC10685288 DOI: 10.1136/bmj-2022-073552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years). DESIGN Systematic review and meta-analysis. DATA SOURCES EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022). METHODS Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent (v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media (v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day (v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes. CONCLUSIONS Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful. STUDY REGISTRATION PROSPERO, CRD42020179766.
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Affiliation(s)
- Amrit Kaur Purba
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Rachel M Thomson
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Paul M Henery
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Anna Pearce
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Marion Henderson
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - S Vittal Katikireddi
- 1 Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- 2Public Health Scotland, Edinburgh, UK
- 3School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
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Purba AK, Henderson M, Baxter A, Pearce A, Katikireddi SV. To what extent does time spent on social media influence adolescent use of cigarettes and e-cigarettes: a longitudinal analysis of the UK Millennium Cohort Study. Lancet 2022; 400 Suppl 1:S73. [PMID: 36930021 DOI: 10.1016/s0140-6736(22)02283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We estimated the effect of social media use on adolescents aged 14 years and risk of cigarette, e-cigarette, and dual use when aged 17 years. Data was from the UK Millennium Cohort Study, which followed up approximately 19 000 children born between 2000 and 2002. METHODS Representative longitudinal data were collected at ages 14 years and 17 years. Directed acyclic graphs identified confounders (eg, demographics, mental health, in-person interactions, cognitive ability, risk-taking, antisocial behaviour, previous or current parental cigarette or e-cigarette use, and socioeconomic circumstances). The relationship between self-reported social media use per weekday (reference category: from 1 min to under 30 mins) and cigarette, e-cigarette, and dual use was examined using longitudinal analysis to estimate adjusted odds ratios (OR) or relative risk ratios (RRRs). A complete case sample was used; weights accounted for sample design and attrition. This study was a secondary data analysis of the UK Millennium Cohort Study (prospective longitudinal study). Ethical approval was received from a Research Ethics Committee at each study sweep. FINDINGS In total, 6234 individuals (168 314 observations) were included. 5778 (92·7%) reported social media use, 1730 (27·8%) cigarette use, 1389 (22·3%) e-cigarette use, and 479 (7·68%) dual use. Social media use was associated with all outcomes in a dose-response manner. For cigarette use, ORs increased from 1·67 (95% CI 1·26-2·21) for 30 mins to 1 h, to 3·09 (2·43-3·91) for 2 h or longer of social media use. For e-cigarette use, ORs increased from 1·90 (1·41-2·55) for 30 mins to 1 h, to 3·34 (2·60-4·28) for 2 h or longer of social media use. For dual use, RRRs increased from 1·91 (1·16-3·15) for 30 mins to 1 h, to 4·26 (2·81-6·46) for 2 h or longer of social media use. For e-cigarette and dual use, associations were stronger for males than for females; the opposite was found for cigarette use. INTERPRETATION After accounting for observed confounders and reverse causality, our findings suggest social media use, although only measured at one point in time, is associated with increased risk of cigarette, e-cigarette, and dual use. The greatest risk was observed in those who used social media for 2 h or longer. Given the potential health harms of social media use, guidance for parents and caregivers about safe social media use and regulation on time spent on social media is required. FUNDING Medical Research Council, Chief Scientist Office, Wellcome Trust.
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Affiliation(s)
- Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Marion Henderson
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Andrew Baxter
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Thomson RM, Igelström E, Purba AK, Shimonovich M, Thomson H, McCartney G, Reeves A, Leyland A, Pearce A, Katikireddi SV. How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis. Lancet Public Health 2022; 7:e515-e528. [PMID: 35660213 PMCID: PMC7614874 DOI: 10.1016/s2468-2667(22)00058-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years). METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379. FINDINGS Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I2=79-87%). GRADE certainty was low or very low. INTERPRETATION Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged. FUNDING Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.
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Affiliation(s)
- Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michal Shimonovich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK; Public Health Scotland, Edinburgh, UK
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Herdman MT, Cordery R, Karo B, Purba AK, Begum L, Lamagni T, Kee C, Balasegaram S, Sriskandan S. Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019. BMJ Open 2021; 11:e057772. [PMID: 34952887 PMCID: PMC9066343 DOI: 10.1136/bmjopen-2021-057772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis. DESIGN AND SETTING Cross-sectional community-based study of children with scarlet fever notified to London's three Health Protection Teams, 2018-2019. PARTICIPANTS From 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity. OUTCOME MEASURES Preplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox's regression), and qualitative analysis of free text comments were added. RESULTS Rash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities. CONCLUSIONS Scarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.
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Affiliation(s)
- Michael Trent Herdman
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
- UK Field Epidemiology Training Programme, Public Health England (now UK Health Security Agency), London, UK
| | - Rebecca Cordery
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Basel Karo
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Amrit Kaur Purba
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Lipi Begum
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Chuin Kee
- Oak Lodge Medical Centre, Barnet, North Central London CCG, London, UK
| | - Sooria Balasegaram
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated infection and AMR, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
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Tweed EJ, Thomson RM, Lewer D, Sumpter C, Kirolos A, Southworth PM, Purba AK, Aldridge RW, Hayward A, Story A, Hwang SW, Katikireddi SV. Health of people experiencing co-occurring homelessness, imprisonment, substance use, sex work and/or severe mental illness in high-income countries: a systematic review and meta-analysis. J Epidemiol Community Health 2021; 75:1010-1018. [PMID: 33893182 PMCID: PMC8458085 DOI: 10.1136/jech-2020-215975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND People affected by homelessness, imprisonment, substance use, sex work or severe mental illness experience substantial excess ill health and premature death. Though these experiences often co-occur, health outcomes associated with their overlap have not previously been reviewed. We synthesised existing evidence on mortality, morbidity, self-rated health and quality of life among people affected by more than one of these experiences. METHODS In this systematic review and meta-analysis, we searched Medline, Embase, and PsycINFO for peer-reviewed English-language observational studies from high-income countries published between 1 January 1998 and 11 June 2018. Two authors undertook independent screening, with risk of bias assessed using a modified Newcastle-Ottawa Scale. Findings were summarised by narrative synthesis and random-effect meta-analysis. RESULTS From 15 976 citations, 2517 studies underwent full-text screening, and 444 were included. The most common exposure combinations were imprisonment/substance use (31% of data points) and severe mental illness/substance use (27%); only 1% reported outcomes associated with more than two exposures. Infections were the most common outcomes studied, with blood-borne viruses accounting for 31% of all data points. Multiple exposures were associated with poorer outcomes in 80% of data points included (sign test for effect direction, p<0.001). Meta-analysis suggested increased all-cause mortality among people with multiple versus fewer exposures (HR: 1.57 and 95% CI: 1.38 to 1.77), though heterogeneity was high. CONCLUSION People affected by multiple exclusionary processes experience profound health inequalities, though there are important gaps in the research landscape. Addressing the health needs of these populations is likely to require co-ordinated action across multiple sectors, such as healthcare, criminal justice, drug treatment, housing and social security. PROSPERO REGISTRATION NUMBER CRD42018097189.
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Affiliation(s)
- Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Dan Lewer
- Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Colin Sumpter
- Department of Public Health, NHS Forth Valley, Stirling, UK
| | - Amir Kirolos
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Paul M Southworth
- Department of Public Health, NHS Dumfries and Galloway, Dumfries, UK
| | - Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Alistair Story
- Find and Treat Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
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