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Bunce A, Hashemi L, Clark C, Stansfeld S, Myers CA, McManus S. Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey. BMC Public Health 2024; 24:1147. [PMID: 38658961 PMCID: PMC11044501 DOI: 10.1186/s12889-024-18614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Evidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health. METHODS Data were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16-70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220-299). RESULTS One in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02-3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46-0.72) and closeness to others (aOR 0.57, 0.46-0.72). Patterns of association between WBH and mental health were similar in men and women. CONCLUSIONS These findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.
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Affiliation(s)
- Annie Bunce
- Violence and Society Centre, City, University of London, Rhind Building, Northampton Square, London, EC1V 0HB, UK.
| | - Ladan Hashemi
- Violence and Society Centre, City, University of London, Rhind Building, Northampton Square, London, EC1V 0HB, UK
| | - Charlotte Clark
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, UK
| | - Stephen Stansfeld
- Centre for Psychiatry and Mental Health, Barts & the London School of Medicine, Queen Mary University of London, London, UK
| | - Carrie-Anne Myers
- Department of Sociology and Criminology, School of Policy and Global Affairs, City, University of London, London, EC1V 0HB, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, Rhind Building, Northampton Square, London, EC1V 0HB, UK
- National Centre for Social Research, 35 Northampton Square, London, EC1V 0AX, UK
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Kock L, Cox S, Shahab L, Roberts A, Sharman S, Buss V, Brown J. Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022. BMJ Open 2024; 14:e079633. [PMID: 38604639 PMCID: PMC11015260 DOI: 10.1136/bmjopen-2023-079633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain. DESIGN A nationally representative cross-sectional survey in October 2022. SETTING Great Britain. PARTICIPANTS A weighted total of 2398 adults (18+ years). OUTCOME MEASURES We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling. RESULTS Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling. CONCLUSIONS Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.
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Affiliation(s)
- Loren Kock
- Department of Behavioral Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Sharon Cox
- Department of Behavioral Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Lion Shahab
- Department of Behavioral Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Amanda Roberts
- School of Psychology, University of Lincoln, Lincoln, UK
| | - Steve Sharman
- National Addiction Centre, King's College London, London, UK
| | - Vera Buss
- Department of Behavioral Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioral Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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Firman N, Wilk M, Marszalek M, Griffiths L, Harper G, Dezateux C. Is obesity more likely among children sharing a household with an older child with obesity? Cross-sectional study of linked National Child Measurement Programme data and electronic health records. BMJ Paediatr Open 2024; 8:e002533. [PMID: 38599801 PMCID: PMC11015308 DOI: 10.1136/bmjpo-2024-002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES We identified household members from electronic health records linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of obesity among children living with an older child with obesity. METHODS We included 126 829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property Reference Numbers for 115 466 (91.0%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household children (underweight/healthy weight <91st, ≥91st overweight <98th, obesity ≥98th centile) and estimated adjusted ORs and 95% CIs of obesity in the youngest child by the oldest child's weight status, adjusting for number of household children (2, 3 or ≥4), youngest child's sex, ethnicity and school year of NCMP participation. RESULTS We identified 19 702 households shared by two or more NCMP participants (% male; median age, range (years)-youngest children: 51.2%; 5.2, 4.1-11.8; oldest children: 50.6%; 10.6, 4.1-11.8). One-third of youngest children with obesity shared a household with another child with obesity (33.2%; 95% CI: 31.2, 35.2), compared with 9.2% (8.8, 9.7) of youngest children with a healthy weight. Youngest children living with an older child considered overweight (OR: 2.33; 95% CI: 2.06, 2.64) or obese (4.59; 4.10, 5.14) were more likely to be living with obesity. CONCLUSIONS Identifying children sharing households by linking primary care and school records provides novel insights into the shared weight status of children sharing a household. Qualitative research is needed to understand how food practices vary by household characteristics to increase understanding of how the home environment influences childhood obesity.
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Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Marta Wilk
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Milena Marszalek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Lucy Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Cybulski L, Chilman N, Jewell A, Dewey M, Hildersley R, Morgan C, Huck R, Hotopf M, Stewart R, Pritchard M, Wuerth M, Das-Munshi J. Improving our understanding of the social determinants of mental health: a data linkage study of mental health records and the 2011 UK census. BMJ Open 2024; 14:e073582. [PMID: 38286672 PMCID: PMC10826590 DOI: 10.1136/bmjopen-2023-073582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES To address the lack of individual-level socioeconomic information in electronic healthcare records, we linked the 2011 census of England and Wales to patient records from a large mental healthcare provider. This paper describes the linkage process and methods for mitigating bias due to non-matching. SETTING South London and Maudsley NHS Foundation Trust (SLaM), a mental healthcare provider in Southeast London. DESIGN Clinical records from SLaM were supplied to the Office of National Statistics for linkage to the census through a deterministic matching algorithm. We examined clinical (International Classification of Disease-10 diagnosis, history of hospitalisation, frequency of service contact) and socio-demographic (age, gender, ethnicity, deprivation) information recorded in Clinical Record Interactive Search (CRIS) as predictors of linkage success with the 2011 census. To assess and adjust for potential biases caused by non-matching, we evaluated inverse probability weighting for mortality associations. PARTICIPANTS Individuals of all ages in contact with SLaM up until December 2019 (N=459 374). OUTCOME MEASURES Likelihood of mental health records' linkage to census. RESULTS 220 864 (50.4%) records from CRIS linked to the 2011 census. Young adults (prevalence ratio (PR) 0.80, 95% CI 0.80 to 0.81), individuals living in more deprived areas (PR 0.78, 95% CI 0.78 to 0.79) and minority ethnic groups (eg, Black African, PR 0.67, 0.66 to 0.68) were less likely to match to census. After implementing inverse probability weighting, we observed little change in the strength of association between clinical/demographic characteristics and mortality (eg, presence of any psychiatric disorder: unweighted PR 2.66, 95% CI 2.52 to 2.80; weighted PR 2.70, 95% CI 2.56 to 2.84). CONCLUSIONS Lower response rates to the 2011 census among people with psychiatric disorders may have contributed to lower match rates, a potential concern as the census informs service planning and allocation of resources. Due to its size and unique characteristics, the linked data set will enable novel investigations into the relationship between socioeconomic factors and psychiatric disorders.
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Affiliation(s)
- Lukasz Cybulski
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Natasha Chilman
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Amelia Jewell
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Michael Dewey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosanna Hildersley
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Megan Pritchard
- University of East Anglia Norwich Medical School, Norwich, UK
| | - Milena Wuerth
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Stewart E, Such E. Evaluating participant experiences of Community Panels to scrutinise policy modelling for health inequalities: the SIPHER Consortium. Res Involv Engagem 2024; 10:4. [PMID: 38191500 PMCID: PMC10775539 DOI: 10.1186/s40900-023-00521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
Data-intensive research, including policy modelling, poses some distinctive challenges for efforts to mainstream public involvement into health research. There is a need for learning about how to design and deliver involvement for these types of research which are highly technical, and where researchers are at a distance from the people whose lives data depicts. This article describes our experiences involving members of the public in the SIPHER Consortium, a data-intensive policy modelling programme with researchers and policymakers working together over five years to try to address health inequalities. We focus on evaluating people's experiences as part of Community Panels for SIPHER. Key issues familiar from general public involvement efforts include practical details, careful facilitation of meetings, and payment for participants. We also describe some of the more particular learning around how to communicate technical research to non-academic audiences, in order to enable public scrutiny of research decisions. We conclude that public involvement in policy modelling can be meaningful and enjoyable, but that it needs to be carefully organised, and properly resourced.
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Kock L, Shahab L, Garnett C, Oldham M, Tattan-Birch H, Angus C, Brose L, Brown J. Brief interventions for smoking and alcohol associated with the COVID-19 pandemic: a population survey in England. BMC Public Health 2024; 24:76. [PMID: 38172788 PMCID: PMC10763226 DOI: 10.1186/s12889-023-17559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Following the onset of the COVID-19 pandemic, in March 2020 health care delivery underwent considerable changes. It is unclear how this may have affected the delivery of Brief Interventions (BIs) for smoking and alcohol. We examined the impact of the COVID-19 pandemic on the receipt of BIs for smoking and alcohol in primary care in England and whether certain priority groups (e.g., less advantaged socioeconomic positions, or a history of a mental health condition) were differentially affected. METHODS We used nationally representative data from a monthly cross-sectional survey in England between 03/2014 and 06/2022. Monthly trends in the receipt of BIs for smoking and alcohol were examined using generalised additive models among adults who smoked in the past-year (weighted N = 31,390) and those using alcohol at increasing and higher risk levels (AUDIT score 38, weighted N = 22,386), respectively. Interactions were tested between social grade and the change in slope after the onset of the COVID-19 pandemic, and results reported stratified by social grade. Further logistic regression models assessed whether changes in the of receipt of BIs for smoking and alcohol, respectively, from 12/2016 to 01/2017 and 10/2020 to 06/2022 (or 03/2022 in the case of BIs for alcohol), depended on history of a mental health condition. RESULTS The receipt of smoking BIs declined from an average prevalence of 31.8% (95%CI 29.4-35.0) pre-March 2020 to 24.4% (95%CI 23.5-25.4) post-March 2020. The best-fitting model found that after March 2020 there was a 12-month decline before stabilising by June 2022 in social grade ABC1 at a lower level (~ 20%) and rebounding among social grade C2DE (~ 27%). Receipt of BIs for alcohol was low (overall: 4.1%, 95%CI 3.9-4.4) and the prevalence was similar pre- and post-March 2020. CONCLUSIONS The receipt of BIs for smoking declined following March 2020 but rebounded among priority socioeconomic groups of people who smoked. BIs for alcohol among those who use alcohol at increasing and higher risk levels were low and there was no appreciable change over time. Maintaining higher BI delivery among socioeconomic and mental health priority groups of smokers and increasing and higher risk alcohol users is important to support reductions in smoking and alcohol related inequalities.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- SPECTRUM Research Consortium, Edinburgh, UK.
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Melissa Oldham
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Colin Angus
- SPECTRUM Research Consortium, Edinburgh, UK
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Leonie Brose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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Wood ML, Gunning L, Relins S, Sohal K, Wright J, Mon-Williams M, Atkinson AL. Potential for England's statutory school entry assessment to identify special educational needs and reveal structural inequalities: a population-based study. Arch Dis Child 2023; 109:52-57. [PMID: 37827813 PMCID: PMC10804042 DOI: 10.1136/archdischild-2023-325590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate at a population level whether England's universal assessment of 'school readiness' is associated with later identification of special educational needs (SEN). Also, whether ethnic differences exist in SEN identification (white British versus ethnic minority) and whether this varies as a function of school readiness. METHOD Analysis included 53 229 individuals aged 5-12 years from the Connected Bradford Database (2012/2013-2019/2020). Logistic regression analyses examined: (1) whether reaching a 'good level of development' on England's 'school readiness' assessment was associated with later SEN identification; and (2) whether interactions exist between school readiness and ethnicity. RESULTS 32 515 of 53 229 children reached a good level of development, of which 3036 (9.3%) were identified as having SEN. In contrast, 10 171 of 20 714 (49.1%) of children who did not reach a good level of development were later identified as having SEN. Children not reaching a good level of development had increased odds of being later identified as having SEN after controlling for covariates (OR: 8.50, 95% CI: 8.10 to 8.91). In children who did not reach a good level of development, white British children had higher odds of being identified as having SEN compared with ethnic minority peers (OR: 1.22, 95% CI: 1.11 to 1.34). No ethnic differences of having SEN were observed in children reaching a good level of development (OR: 1.04, 95% CI: 0.93 to 1.16). CONCLUSIONS School readiness assessments are associated with later SEN identification. Structural inequalities may exist in SEN identification in children not entering formal education 'school ready'. Such assessments could facilitate earlier identification of SEN and reduce structural inequalities in its identification.
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Affiliation(s)
- Megan L Wood
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Lydia Gunning
- Bradford Institute for Health Research, Bradford, UK
| | - Sam Relins
- Bradford Institute for Health Research, Bradford, UK
| | - Kuldeep Sohal
- Bradford Institute for Health Research, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford, UK
| | - Mark Mon-Williams
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Amy L Atkinson
- Department of Psychology, Lancaster University, Lancaster, UK
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Jana Neto FC, Martimbianco ALC, de Medeiros DV, Felix FC, Mesquita-Ferrari RA, Bussadori SK, Duran CCG, Motta LJ, Barbosa EC, Fernandes KPS. Cost analysis of photobiomodulation in tibia fracture in the Brazilian public health system. PLoS One 2023; 18:e0294290. [PMID: 38064443 PMCID: PMC10707925 DOI: 10.1371/journal.pone.0294290] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
Managing tibial fractures requires substantial health resources, which costs the health system. This study aimed to describe the costs of photobiomodulation (PBM) with LEDs in the healing process of soft tissue lesions associated with tibial fracture compared to a placebo. Economic analysis was performed based on a randomized controlled clinical trial, with a simulation of the cost-effectiveness and incremental cost model. Adults (n = 27) hospitalized with tibia fracture awaiting definitive surgery were randomized into two distinct groups: the PBM Group (n = 13) and the Control Group with simulated phototherapy (n = 14). To simulate the cost-effectiveness and incremental cost model, the outcome was the evolution of wound resolution by the BATES-JENSEN scale and time of wound resolution in days. The total cost of treatment for the Control group was R$21,164.56, and a difference of R$7,527.10 more was observed when compared to the treatment of the PBM group. The proposed intervention did not present incremental cost since the difference in the costs to reduce measures between the groups was smaller for the PBM group. When analyzing the ICER (Incremental cost-effectiveness ratio), it would be possible to save R$3,500.98 with PBM and decrease by 2.15 points in the daily average on the BATES-JENSEN scale. It is concluded, therefore, that PBM can be a supportive therapy of clinical and economic interest in a hospital setting.
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Affiliation(s)
- Frederico Carlos Jana Neto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Orthopedics and Traumatology Group Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil
- Medicine School Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment. Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
- Health Technology Assessment Center, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil
| | | | | | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Cinthya Cosme Gutierrez Duran
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Estela Capelas Barbosa
- Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
| | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Carlisle S, Bunce A, Prina M, McManus S, Barbosa E, Feder G, Lewis NV. How effective are UK-based support interventions and services targeted at adults who have experienced domestic and sexual violence and abuse at improving their safety and wellbeing? A systematic review protocol. PLoS One 2023; 18:e0289192. [PMID: 38060529 PMCID: PMC10703258 DOI: 10.1371/journal.pone.0289192] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Domestic and sexual violence and abuse (DSVA) is prevalent in the UK, with wide-ranging impacts both on individuals and society. However, to date, there has been no systematic synthesis of the evidence for the effectiveness of UK-based support interventions and services for victim-survivors of DSVA. This review will aim to systematically collate, synthesise and quality assess the evidence regarding the effectiveness of UK support interventions and services targeted at those who have experienced DSVA. The review will use findings of a preliminary scoping review, as well as input from stakeholders representing domestic and sexual violence third sector organisations to identify and prioritise the most relevant outcomes to focus on. METHODS We will undertake a systematic search for peer-reviewed literature in MEDLINE, EMBASE, PsycINFO, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), International Bibliography of the Social Sciences (IBSS), Sociological abstracts and SSCI. Grey literature will be identified by searching grey literature databases, circulating a call for evidence to local and national DSVA charities and organisations, and targeted website searching. Two reviewers will independently perform study selection and quality appraisal, with data extraction undertaken by one reviewer and checked for accuracy by a second reviewer. Narrative synthesis will be conducted, with meta-analysis if possible. DISCUSSION Existing individual studies and evaluations have reported positive impacts of support interventions and services for those who have experienced DSVA. Thus, it is expected that this review and synthesis will provide robust and conclusive evidence of these effects. It will also allow comparisons to be made between different types of support interventions and services, to inform policy makers and funders regarding the most effective ways of reducing domestic and sexual violence and abuse and its impacts.
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Affiliation(s)
- Sophie Carlisle
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Annie Bunce
- Violence and Society Centre, City, University of London, London, United Kingdom
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Sally McManus
- Violence and Society Centre, City, University of London, London, United Kingdom
- National Centre for Social Research, London, United Kingdom
| | - Estela Barbosa
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Natalia V. Lewis
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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10
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Santana de Lima E, Preece C, Potter K, Goddard E, Edbrooke-Childs J, Hobbs T, Fonagy P. A community-based approach to identifying and prioritising young people's mental health needs in their local communities. Res Involv Engagem 2023; 9:104. [PMID: 37996912 PMCID: PMC10666450 DOI: 10.1186/s40900-023-00510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Identifying locally relevant and agreed-upon priorities for improving young people's mental health, aligned with social and environmental factors, is essential for benefiting target communities. This paper describes a participatory approach to engage young people and professionals in identifying such priorities, whilst considering the social determinants related to them. METHODS We utilised a community-based participatory approach to support young people and professionals in identifying, reviewing, refining, and prioritising, locally relevant opportunity areas that are crucial for understanding and addressing social determinants of young people's mental health. We adopted a flexible five-stage process, which enabled greater reflection and adaptation in response to young people's and professionals' feedback and reflections. RESULTS Over seven months, we engaged with young people and professionals in Northern Devon, (a rural area in southwest England), involving over 290 individuals to identify locally relevant priorities for supporting young people's mental health. Three priorities were identified for subsequent exploration using co-design approaches: (1) identity and belonging; (2) mental health awareness and literacy; and (3) diverse opportunities (for education, employment and leisure). The engagements suggested that designing initiatives and strategies in these areas could contribute to improvements in young people's mental health. CONCLUSION Young people in Northern Devon prioritised three themes for the next phase of the Kailo Programme-mental health literacy, access to diverse careers and employment opportunities, and identity and belonging within their communities. Rural communities face unique barriers associated with these issues, related to less diverse populations, lack of access to reliable and affordable transport and local industries, and seasonal working. The perceived neglect by authorities towards rural young people has resulted in a lack of activities and opportunities catering to their specific needs, compared to urban areas. Although the government has recognised the need to address these disparities, community members suggest that there is still more work to be done.
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Affiliation(s)
- Ediane Santana de Lima
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Bristol, UK
| | - Cristina Preece
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Hereford, UK
| | - Katie Potter
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Stoke Gabriel, UK
| | - Ellen Goddard
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Bangor, UK
| | | | - Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Totnes, UK
| | - Peter Fonagy
- University College London (UCL), London, UK
- Division of Psychology and Language Sciences at University College London (UCL), London, UK
- Anna Freud National Centre for Children and Families, London, UK
- Child and Family Programme at the Menninger Department of Psychiatry and Behavioural Sciences at Baylor College of Medicine, London, UK
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11
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Höhn A, Stokes J, Pollack R, Boyd J, Chueca Del Cerro C, Elsenbroich C, Heppenstall A, Hjelmskog A, Inyang E, Kopasker D, Sonthalia S, Thomson RM, Zia K, Katikireddi SV, Meier P. Systems science methods in public health: what can they contribute to our understanding of and response to the cost-of-living crisis? J Epidemiol Community Health 2023; 77:610-616. [PMID: 37328262 PMCID: PMC10423532 DOI: 10.1136/jech-2023-220435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many complex public health evidence gaps cannot be fully resolved using only conventional public health methods. We aim to familiarise public health researchers with selected systems science methods that may contribute to a better understanding of complex phenomena and lead to more impactful interventions. As a case study, we choose the current cost-of-living crisis, which affects disposable income as a key structural determinant of health. METHODS We first outline the potential role of systems science methods for public health research more generally, then provide an overview of the complexity of the cost-of-living crisis as a specific case study. We propose how four systems science methods (soft systems, microsimulation, agent-based and system dynamics models) could be applied to provide more in-depth understanding. For each method, we illustrate its unique knowledge contributions, and set out one or more options for studies that could help inform policy and practice responses. RESULTS Due to its fundamental impact on the determinants of health, while limiting resources for population-level interventions, the cost-of-living crisis presents a complex public health challenge. When confronted with complexity, non-linearity, feedback loops and adaptation processes, systems methods allow a deeper understanding and forecasting of the interactions and spill-over effects common with real-world interventions and policies. CONCLUSIONS Systems science methods provide a rich methodological toolbox that complements our traditional public health methods. This toolbox may be particularly useful in early stages of the current cost-of-living crisis: for understanding the situation, developing solutions and sandboxing potential responses to improve population health.
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Affiliation(s)
- Andreas Höhn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Roxana Pollack
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jennifer Boyd
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Corinna Elsenbroich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison Heppenstall
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Annika Hjelmskog
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elizabeth Inyang
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shreya Sonthalia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kashif Zia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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12
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Yorganci E, Sleeman KE, Sampson EL, Stewart R. Survival and critical care use among people with dementia in a large English cohort. Age Ageing 2023; 52:afad157. [PMID: 37678881 PMCID: PMC10484725 DOI: 10.1093/ageing/afad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Admitting people with dementia to critical care units may not always lead to a clear survival benefit. Critical care admissions of people with dementia vary across countries. Little is known about the use and trends of critical care admissions of people with dementia in England. OBJECTIVE To investigate critical care use and survival among people with dementia in a large London catchment area. METHODS A retrospective cohort study using data from dementia assessment services in south London, UK (2007-20) linked with national hospitalisation data to ascertain critical care admissions. Outcomes included age-sex-standardised critical care use and 1-year post-critical care admission survival by dementia severity (binary: mild versus moderate/severe). We used logistic regression and Kaplan-Meier survival plots for investigating 1-year survival following a critical care admission and linear regressions for time trends. RESULTS Of 19,787 people diagnosed with dementia, 726 (3.7%) had ≥1 critical care admission at any time after receiving their dementia diagnosis. The overall 1-year survival of people with dementia, who had a CCA, was 47.5% (n = 345). Dementia severity was not associated with 1-year survival following a critical care admission (mild dementia versus moderate-severe dementia odds of 1-year mortality OR: 0.90, 95% CI [0.66-1.22]). Over the 12-year period from 2008 to 2019, overall critical care use decreased (β = -0.05; 95% CI = -0.01, -0.0003; P = 0.03), while critical care admissions occurring during the last year of life increased (β = 0.11, 95% CI = 0.01, 0.20, P = 0.03). CONCLUSIONS In this cohort, while critical care use among people with dementia declined overall, its use increased among those in their last year of life. Survival remains comparable to that observed in general older populations.
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Affiliation(s)
- Emel Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London SE5 9PJ, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London SE5 9PJ, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Liaison Psychiatry, Royal London Hospital, East London NHS Foundation Trust, London E1 1FR, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK
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13
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Li L, Neubauer L, Stewart R, Roberts A. Characterizing the Differences in Descriptions of Violence on Reddit During the COVID-19 Pandemic. J Interpers Violence 2023; 38:9290-9314. [PMID: 36987388 PMCID: PMC10064198 DOI: 10.1177/08862605231163885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Concerns have been raised over the experiences of violence such as domestic violence (DV) and intimate partner violence (IPV) during the COVID-19 pandemic. Social media such as Reddit represent an alternative outlet for reporting experiences of violence where healthcare access has been limited. This study analyzed seven violence-related subreddits to investigate the trends of different violence patterns from January 2018 to February 2022 to enhance the health-service providers' existing service or provide some new perspective for existing violence research. Specifically, we collected violence-related texts from Reddit using keyword searching and identified six major types with supervised machine learning classifiers: DV, IPV, physical violence, sexual violence, emotional violence, and nonspecific violence or others. The increase rate (IR) of each violence type was calculated and temporally compared in five phases of the pandemic. The phases include one pre-pandemic phase (Phase 0, the date before February 26, 2020) and four pandemic phases (Phases 1-4) with separation dates of June 17, 2020, September 7, 2020, and June 4, 2021. We found that the number of IPV-related posts increased most in the earliest phase; however, that for COVID-citing IPV was highest in the mid-pandemic phase. IRs for DV, IPV, and emotional violence also showed increases across all pandemic phases, with IRs of 26.9%, 58.8%, and 28.8%, respectively, from the pre-pandemic to the first pandemic phase. In the other three pandemic phases, all the IRs for these three types of violence were positive, though lower than the IRs in the first pandemic phase. The findings highlight the importance of identifying and providing help to those who suffer from such violent experiences and support the role of social media site monitoring as a means of informative surveillance for help-providing authorities and violence research groups.
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Affiliation(s)
| | | | - Robert Stewart
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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14
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Garrett JK, Rowney FM, White MP, Lovell R, Fry RJ, Akbari A, Geary R, Lyons RA, Mizen A, Nieuwenhuijsen M, Parker C, Song J, Stratton G, Thompson DA, Watkins A, White J, Williams SA, Rodgers SE, Wheeler BW. Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales. Sci Rep 2023; 13:9684. [PMID: 37322030 PMCID: PMC10272170 DOI: 10.1038/s41598-023-35427-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β = - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.
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Affiliation(s)
- Joanne K Garrett
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.
| | - Francis M Rowney
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
- School of Geography, Earth and Environmental Sciences, University of Plymouth, Plymouth, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
- Cognitive Science HUB, University of Vienna, Vienna, Austria
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Rich J Fry
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ashley Akbari
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Rebecca Geary
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ronan A Lyons
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Amy Mizen
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Chrissie Parker
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Gareth Stratton
- Faculty of Science and Engineering, ASTEM Research Centre, Swansea University, Swansea, UK
| | - Daniel A Thompson
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Alan Watkins
- Department of Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Sarah E Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
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15
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Mansukoski L, Lockyer B, Creaser A, Sheringham J, Sheard L, Garnett P, Yang T, Cookson R, Albert A, Islam S, Shore R, Khan A, Twite S, Dawson T, Iqbal H, Skarda I, Villadsen A, Asaria M, West J, Sheldon T, Wright J, Bryant M. Meta-evaluation of a whole systems programme, ActEarly: A study protocol. PLoS One 2023; 18:e0280696. [PMID: 37262082 PMCID: PMC10234514 DOI: 10.1371/journal.pone.0280696] [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] [Received: 01/06/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. METHODS The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. DISCUSSION This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.
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Affiliation(s)
- Liina Mansukoski
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Bridget Lockyer
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Amy Creaser
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Laura Sheard
- Department of Health Sciences, University of York, York, United Kingdom
| | - Philip Garnett
- The School for Business and Society, University of York, York, United Kingdom
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, York, United Kingdom
| | | | - Shahid Islam
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Robert Shore
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Aiysha Khan
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Simon Twite
- Public Health Division, London Borough of Tower Hamlets, London, United Kingdom
| | - Tania Dawson
- The School for Business and Society, University of York, York, United Kingdom
| | - Halima Iqbal
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, United Kingdom
| | - Aase Villadsen
- Centre for Longitudinal Studies, University College London, London, United Kingdom
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jane West
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Trevor Sheldon
- Centre for Public Health & Policy, Queen Mary University of London, London, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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16
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Co M, Moreno-Agostino D, Wu YT, Couch E, Posarac A, Wi T, Sadana R, Carlisle S, Prina M. Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review. PLoS One 2023; 18:e0284324. [PMID: 37224103 PMCID: PMC10208510 DOI: 10.1371/journal.pone.0284324] [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] [Received: 01/27/2021] [Accepted: 03/28/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults. METHODS We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed. RESULTS Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies. CONCLUSIONS Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.
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Affiliation(s)
- Melissa Co
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Darío Moreno-Agostino
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Yu-Tzu Wu
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elyse Couch
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI, United States of America
| | - Ana Posarac
- Ageing and Health Unit, Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organisation, Geneva, Switzerland
| | - Teodora Wi
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Ritu Sadana
- Ageing and Health Unit, Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organisation, Geneva, Switzerland
- World Health Organization Secretariat, Council on the Economics of Health for All, Geneva, Switzerland
| | - Sophie Carlisle
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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17
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Bellis MA, Hughes K, Cresswell K, Ford K. Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales. BMJ Open 2023; 13:e072916. [PMID: 37068903 PMCID: PMC10111913 DOI: 10.1136/bmjopen-2023-072916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms. DESIGN Secondary analysis of combined data from eight cross-sectional general population ACE surveys. SETTING Households in England and Wales. PARTICIPANTS 20 556 residents aged 18-69 years. MEASURES Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure. RESULTS Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined. CONCLUSION Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.
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Affiliation(s)
- Mark A Bellis
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
| | - Karen Hughes
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Katie Cresswell
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
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18
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Montel L. The social determinants of health, law, and urban development: using human rights to address structural health inequalities in our cities. Med Law Rev 2022; 30:680-704. [PMID: 36399065 PMCID: PMC9732648 DOI: 10.1093/medlaw/fwac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic exacerbated profound inequalities in the conditions in which people live, work, and age. Law plays a critical role in shaping these structural health inequalities, which have existed for decades. This dynamic can be observed at the local level, with cities operating as environments unequally distributing the risks of non-communicable diseases between population groups. This article first focuses on urban development to explore the conceptual links between health inequalities and the role of law. I expand this observation and I posit that the social determinants of health are about human rights. With that in mind, I argue that human rights are necessary to address the issue of unequally unhealthy urban environments, hence recognising that people are entitled to a minimum essential level of the conditions in which they live, work, and age, which the State is responsible to fulfil. By way of strengthening my argument, I lay out how a human rights framework can improve these conditions and ameliorate unfair inequalities. Finally, I recognise and respond to the limits of a human rights approach.
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van Schalkwyk MCI, Zenone M, Maani N, Petticrew M, McKee M. Back to our roots or sowing new seeds: thinking anew on the paradigms of health, harm and disease. J Public Health (Oxf) 2022; 44:i28-i33. [PMID: 36465052 PMCID: PMC9720360 DOI: 10.1093/pubmed/fdac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Health, harms and disease are intimately linked, and their promotion and distribution are determined by the social, political and physical worlds in which people live. Yet, the popular narrative on health is still dominated by a biological model that focuses on a disease-causing 'pathogen' or 'agent' that leads to pathology which is diagnosable and amenable to intervention at the individual level via measures delivered through the health care and public health systems. This model generally rests on understanding populations as a collection of individuals, with the pattern of disease seen as the sum of a series of risk factors acting on each of them. Too little attention is paid to the ways in which health, harm, disease, causation and risk are conceptualized and used as guiding concepts in research, policy debates and other fora. We often overlook the distribution of health and the regulatory regimes, norms, values and rights that promote or undermine health. By challenging our ways of thinking about health, harms and disease, we can start to appreciate with greater depth the ways in which health can be threatened and what should be seen as harmful, and conversely, opportunities for moving our systems towards promoting and protecting health.
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Affiliation(s)
- May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Gostoli U, Silverman E. An agent-based model of social care provision during the early stages of Covid-19. Sci Rep 2022; 12:16534. [PMID: 36192471 PMCID: PMC9528879 DOI: 10.1038/s41598-022-20846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/29/2021] [Accepted: 09/20/2022] [Indexed: 01/28/2023] Open
Abstract
Social care is a frequent topic in UK policy debates, with widespread concern that the country will be unable to face the challenges posed by the increase in demand for social care. While this is a societal problem whose dynamics depends on long-term trends, such as the increase of human lifespans and the drop of birth-rates, a short-term crisis, such as a pandemic, can affect the need and supply of social care to a considerable, although temporary, extent. Building on previous modelling effort of social care provision, we present an agent-based computational model to investigate social care provision in the context of a pandemic (using as an example, the early stages of the Covid-19 pandemic), and related mitigation policies, on social care demand and supply, using a proof-of-concept agent-based model (ABM). We show how policy solutions aimed at controlling the pandemic may have substantial effects on the level of unmet social care need and propose that such models may help policymakers to compare alternative containment policies, taking into account their side effects on the social care provision process.
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Affiliation(s)
- Umberto Gostoli
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK
| | - Eric Silverman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK.
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Abstract
In this proof-of-concept work, we evaluate the performance of multiple machine-learning methods as surrogate models for use in the analysis of agent-based models (ABMs). Analysing agent-based modelling outputs can be challenging, as the relationships between input parameters can be non-linear or even chaotic even in relatively simple models, and each model run can require significant CPU time. Surrogate modelling, in which a statistical model of the ABM is constructed to facilitate detailed model analyses, has been proposed as an alternative to computationally costly Monte Carlo methods. Here we compare multiple machine-learning methods for ABM surrogate modelling in order to determine the approaches best suited as a surrogate for modelling the complex behaviour of ABMs. Our results suggest that, in most scenarios, artificial neural networks (ANNs) and gradient-boosted trees outperform Gaussian process surrogates, currently the most commonly used method for the surrogate modelling of complex computational models. ANNs produced the most accurate model replications in scenarios with high numbers of model runs, although training times were longer than the other methods. We propose that agent-based modelling would benefit from using machine-learning methods for surrogate modelling, as this can facilitate more robust sensitivity analyses for the models while also reducing CPU time consumption when calibrating and analysing the simulation.
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Affiliation(s)
- Claudio Angione
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, United Kingdom
- Healthcare Innovation Centre, Teesside University, Middlesbrough, United Kingdom
- National Horizons Centre, Teesside University, Darlington, United Kingdom
- Centre for Digital Innovation, Teesside University, Middlesbrough, United Kingdom
| | - Eric Silverman
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elisabeth Yaneske
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, United Kingdom
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Branston JR, Hiscock R, Silver K, Arnott D, Gilmore AB. Cigarette-like cigarillo introduced to bypass taxation, standardised packaging, minimum pack sizes, and menthol ban in the UK. Tob Control 2021; 30:708-711. [PMID: 32848080 PMCID: PMC8543195 DOI: 10.1136/tobaccocontrol-2020-055700] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Affiliation(s)
- J Robert Branston
- School of Management, University of Bath, Bath, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Rosemary Hiscock
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Karin Silver
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | | | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
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Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, Petticrew M. The need for a conceptual understanding of the macro and meso commercial determinants of health inequalities. Eur J Public Health 2021; 31:674-675. [PMID: 34137840 PMCID: PMC8505001 DOI: 10.1093/eurpub/ckab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
| | - Jeff Collin
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Sharon Friel
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, Australia
| | - Anna B Gilmore
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lindsay Robertson
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
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Lauber K, Hunt D, Gilmore AB, Rutter H. Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study. PLoS Med 2021; 18:e1003695. [PMID: 34473694 PMCID: PMC8412307 DOI: 10.1371/journal.pmed.1003695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diets with high proportions of foods high in fat, sugar, and/or salt (HFSS) contribute to malnutrition and rising rates of childhood obesity, with effects throughout the life course. Given compelling evidence on the detrimental impact HFSS advertising has on children's diets, the World Health Organization unequivocally supports the adoption of restrictions on HFSS marketing and advertising. In February 2019, the Greater London Authority introduced novel restrictions on HFSS advertising across Transport for London (TfL), one of the most valuable out-of-home advertising estates. In this study, we examined whether and how commercial actors attempted to influence the development of these advertising restrictions. METHODS AND FINDINGS Using requests under the Freedom of Information Act, we obtained industry responses to the London Food Strategy consultation, correspondence between officials and key industry actors, and information on meetings. We used an existing model of corporate political activity, the Policy Dystopia Model, to systematically analyse arguments and activities used to counter the policy. The majority of food and advertising industry consultation respondents opposed the proposed advertising restrictions, many promoting voluntary approaches instead. Industry actors who supported the policy were predominantly smaller businesses. To oppose the policy, industry respondents deployed a range of strategies. They exaggerated potential costs and underplayed potential benefits of the policy, for instance, warning of negative economic consequences and questioning the evidence underlying the proposal. Despite challenging the evidence for the policy, they offered little evidence in support of their own claims. Commercial actors had significant access to the policy process and officials through the consultation and numerous meetings, yet attempted to increase access, for example, in applying to join the London Child Obesity Taskforce and inviting its members to events. They also employed coalition management, engaging directly and through business associations to amplify their arguments. Some advertising industry actors also raised the potential of legal challenges. The key limitation of this study is that our data focused on industry-policymaker interactions; thus, our findings are unable to present a comprehensive picture of political activity. CONCLUSIONS In this study, we identified substantial opposition from food and advertising industry actors to the TfL advertising restrictions. We mapped arguments and activities used to oppose the policy, which might help other public authorities anticipate industry efforts to prevent similar restrictions in HFSS advertising. Given the potential consequences of commercial influence in these kinds of policy spaces, public bodies should consider how they engage with industry actors.
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Affiliation(s)
- Kathrin Lauber
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
- * E-mail:
| | - Daniel Hunt
- Independent Researcher and Freelance Health Policy Consultant, Bath, United Kingdom
| | - Anna B. Gilmore
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
| | - Harry Rutter
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, United Kingdom
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
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Barker AB, Bal J, Murray RL. A Content Analysis and Population Exposure Estimate Of Guinness Branded Alcohol Marketing During the 2019 Guinness Six Nations. Alcohol Alcohol 2021; 56:617-620. [PMID: 34080614 PMCID: PMC8521759 DOI: 10.1093/alcalc/agab039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS To quantify Guinness-related branding in the 2019 Guinness Six Nations Championship. METHODS Content analysis of Guinness-related branding ('Guinness' and the alibi brand 'Greatness') was shown during active play throughout all 15 games of the 2019 Guinness Six Nations Championship. The duration of each appearance was timed to the nearest second to provide information on the amount of time that Guinness-related branding was shown on screen. Census data and viewing figures were used to estimate gross and per capita alcohol impressions. RESULTS Our coding identified a total of 3719 appearances of two logos of which 3415 (92%) were for 'Guinness' and 304 (8%) were for 'Greatness'. 'Guinness' imagery was present for 13,640 s (227.3 min or 3.8 h, 16% of total active play time), 'Greatness' was present for 944 s (15.7 min, 1% of total active play time), with a combined total of 14,584 s across all games (243 min or 4.05 h, 17% of active play time). The 15 games delivered an estimated 122.4 billion Guinness-related branded impressions to the UK population, including 758 million to children aged under 16. CONCLUSIONS Alcohol marketing was highly prevalent during the 2019 Guinness Six Nations Championship and was a significant source of exposure to alcohol marketing and advertising for children, likely influencing youth alcohol experimentation and uptake.
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Affiliation(s)
- Alexander B Barker
- Division of Epidemiology and Public Health,
University of Nottingham, Clinical Sciences
Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- SPECTRUM Consortium, UK
| | - Jaspreet Bal
- Division of Epidemiology and Public Health,
University of Nottingham, Clinical Sciences
Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- SPECTRUM Consortium, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health,
University of Nottingham, Clinical Sciences
Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- SPECTRUM Consortium, UK
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Silverman E, Gostoli U, Picascia S, Almagor J, McCann M, Shaw R, Angione C. Situating agent-based modelling in population health research. Emerg Themes Epidemiol 2021; 18:10. [PMID: 34330302 PMCID: PMC8325181 DOI: 10.1186/s12982-021-00102-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Today's most troublesome population health challenges are often driven by social and environmental determinants, which are difficult to model using traditional epidemiological methods. We agree with those who have argued for the wider adoption of agent-based modelling (ABM) in taking on these challenges. However, while ABM has been used occasionally in population health, we argue that for ABM to be most effective in the field it should be used as a means for answering questions normally inaccessible to the traditional epidemiological toolkit. In an effort to clearly illustrate the utility of ABM for population health research, and to clear up persistent misunderstandings regarding the method's conceptual underpinnings, we offer a detailed presentation of the core concepts of complex systems theory, and summarise why simulations are essential to the study of complex systems. We then examine the current state of the art in ABM for population health, and propose they are well-suited for the study of the 'wicked' problems in population health, and could make significant contributions to theory and intervention development in these areas.
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Affiliation(s)
- Eric Silverman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Umberto Gostoli
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Stefano Picascia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Jonatan Almagor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Mark McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Richard Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Claudio Angione
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, TS1 3BX UK
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27
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Lauber K, Rutter H, Gilmore AB. Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Glob Health 2021; 6:e005216. [PMID: 34117011 PMCID: PMC8202098 DOI: 10.1136/bmjgh-2021-005216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/08/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an urgent need for effective action to address the over 10 million annual deaths attributable to unhealthy diets. Food industry interference with policies aimed at reducing non-communicable diseases (NCDs) is widely documented at the national level but remains under-researched at the global level. Thus, this study explores how ultra-processed food industry actors have attempted to influence NCD policy at WHO. METHODS A combination of inductive and deductive thematic coding of internal industry documents, academic literature and interviews with key informants from international organisations and global civil society was used to identify action-based strategies ultra-processed food industry actors employ to influence global-level policy. RESULTS Ultra-processed food industry actors have attempted to influence WHO and its policies through three main action-based strategies: coalition management, involvement in policy formulation, and information management. Coalition management includes the creation and use of overt alliances between corporations-business associations-and more covert science-focused and policy-focused intermediaries, the hiring of former WHO staff and attempted co-option of civil society organisations. Industry involvement in policy formulation is operationalised largely through the lobbying of Member States to support industry positions, and business associations gaining access to WHO through formal consultations and hearings. Information management involves funding and disseminating research favourable to commercial interests, and challenging unfavourable evidence. CONCLUSION We provide novel insights into how ultra-processed food industry actors shape global-level NCD policy and identify a clear need to guard against commercial interference to advance NCD policy. In their approach, the political behaviour of multinational food corporations bears similarities to that of the tobacco industry. Increased awareness of, and safeguarding against, commercial interference at the national as well as the global level have the potential to strengthen the crucial work of WHO.
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Affiliation(s)
- Kathrin Lauber
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
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Lauber K, Ralston R, Mialon M, Carriedo A, Gilmore AB. Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations. Global Health 2020; 16:76. [PMID: 32847604 PMCID: PMC7448499 DOI: 10.1186/s12992-020-00611-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The UN system's shift towards multistakeholder governance, now embedded in the Sustainable Development Goals (SDGs), invites a broad range of actors, including the private sector, to the policymaking table. Although the tobacco industry is formally excluded from engagement, this approach provides opportunities for other unhealthy commodity industries to influence the World Health Organization's (WHO's) non-communicable disease (NCD) agenda. Focusing on the food industry, this research maps which actors engaged with WHO consultations, and critically examines actors' policy and governance preferences as well as the framing they employ to promote these preferences in the global context. METHODS All written responses from food industry actors to publicly available NCD-relevant WHO consultations held between September 2015 and September 2018 were identified, totalling forty-five responses across five consultations. A qualitative frame analysis was conducted to identify policy positions expressed by respondents, as well as arguments and frames used to do so. RESULTS Though no individual companies responded to the consultations, the majority of participating business associations had some of the largest multinational food corporations as members. Respondents overarchingly promoted non-statutory approaches and opposed statutory regulation and conflict of interest safeguards. To this purpose, they framed the food industry as a legitimate and necessary partner in policymaking, differentiating themselves from the tobacco industry and referencing a history of successful collaboration, while also invoking multistakeholder norms and good governance principles to portray collaboration as required. Respondents contrasted this with the limits of WHO's mandate, portraying it as out of step with the SDGs and framing NCD decision-making as a matter of national sovereignty. CONCLUSION We observed that the UN's call for partnerships to support the SDGs is invoked to defend corporate access to NCD policy. This highlights the need for more cautious approaches which are mindful of the commercial determinants of health. Systematic opposition to regulation and to governance approaches which may compromise commercial actors' insider role in global health by food industry actors shown here, and the strategic use of the Sustainable Development agenda to this purpose, raises questions about the value of collaboration from the perspective of international health agencies such as WHO.
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Affiliation(s)
- Kathrin Lauber
- Tobacco Control Research Group, University of Bath, Bath, UK.
- SPECTRUM Consortium, Edinburgh, UK.
| | - Rob Ralston
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Mélissa Mialon
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Anna B Gilmore
- Tobacco Control Research Group, University of Bath, Bath, UK
- SPECTRUM Consortium, Edinburgh, UK
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29
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Brose LS, Brown J, Robson D, McNeill A. Mental health, smoking, harm reduction and quit attempts - a population survey in England. BMC Public Health 2020; 20:1237. [PMID: 32795286 PMCID: PMC7427923 DOI: 10.1186/s12889-020-09308-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tobacco control strategies have engendered overall declines in smoking; however, a large gap remains between people with and without mental health problems, causing substantial health inequalities. Population-level information on barriers and opportunities for improvements is scarce. We aimed to assess mental health status of cigarette smokers and recent ex-smokers ('past-year smokers') in England, and smoking and harm reduction behaviour and quit attempts by mental health status. METHODS Data were collected from 5637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate, serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status. RESULTS Among past-year smokers: 35.9% ever had a diagnosis; 24.3% had experienced moderate, an additional 9.7% serious, past-month distress; 21.9% had had past-year treatment. Those with an indication of a mental health problem were more highly dependent and more likely to smoke roll-your-own cigarettes but also more likely to be motivated to stop smoking, to cut down, use nicotine replacement therapy or e-cigarettes and to have attempted to quit in the past year. CONCLUSIONS About a third of cigarette smokers in England have mental health problems. Interventions should address their increased dependence and leverage higher prevalence of harm reduction behaviours, motivation to stop and attempts to stop smoking.
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Affiliation(s)
- Leonie S Brose
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- , SPECTRUM Consortium, UK.
| | - Jamie Brown
- , SPECTRUM Consortium, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Robson
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
- , SPECTRUM Consortium, UK
| | - Ann McNeill
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
- , SPECTRUM Consortium, UK
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30
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Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, Petticrew MP. Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks. Eur J Public Health 2020; 30:660-664. [PMID: 31953933 PMCID: PMC7445044 DOI: 10.1093/eurpub/ckz197] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The term 'commercial determinants of health' (CDOH) is increasingly focussing attention upon the role of tobacco, alcohol and food and beverage companies and others-as important drivers of non-communicable diseases (NCDs). However, the CDOH do not seem to be clearly represented in the most common social determinants of health (SDOH) frameworks. We review a wide range of existing frameworks of the determinants of health to determine whether and how commercial determinants are incorporated into current SDOH thinking. METHODS We searched for papers and non-academic reports published in English since 2000 describing influences on population health outcomes. We included documents with a formal conceptual framework or diagram, showing the integration of the different determinants. RESULTS Forty-eight framework documents were identified. Only one explicitly included the CDOH in a conceptual diagram. Ten papers discussed the commercial determinants in some form in the text only and fourteen described negative impacts of commercial determinants in the text. Twelve discussed positive roles for the private sector in producing harmful commodities. Overall, descriptions of commercial determinants are frequently understated, not made explicit, or simply missing. The role of commercial actors as vectors of NCDs is largely absent or invisible in many of the most influential conceptual diagrams. CONCLUSIONS Our current public health models may risk framing public health problems and solutions in ways that obscure the role that the private sector, in particular large transnational companies, play in shaping the broader environment and individual behaviours, and thus population health outcomes.
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Affiliation(s)
- Nason Maani
- London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, Boston University, Boston, MA, USA
| | - Jeff Collin
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Sharon Friel
- SPECTRUM Consortium, UK
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, ACT, Australia
| | - Anna B Gilmore
- SPECTRUM Consortium, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lindsay Robertson
- SPECTRUM Consortium, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Mark P Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
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Abstract
BACKGROUND To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. METHODS Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. RESULTS Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). CONCLUSIONS Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.
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Affiliation(s)
- Leonie S Brose
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- , .
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ann McNeill
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
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Coggon J, Gostin LO. Global Health with Justice: Controlling the Floodgates of the Upstream Determinants of Health through Evidence-Based Law. Public Health Ethics 2020; 13:4-9. [PMID: 32765646 PMCID: PMC7392640 DOI: 10.1093/phe/phaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This article introduces a special issue on the legal determinants of health, following the publication of the Lancet-O'Neill Institute of Georgetown University Commission's report on the subject. We contextualize legal determinants as a significant and vital aspect of the social determinants of health, explain the work of the Lancet-O'Neill Commission and outline where consequent research will usefully be directed. We also introduce the papers that follow in the special issue, which together set out in greater detail the work of the Commission and critically engage with different aspects of the report and the application of its findings and recommendations.
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Affiliation(s)
- John Coggon
- O'Neill Institute for National and Global Health Law, Georgetown Law, McDonough Hall, Washington, DC 20001, USA.
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown Law, McDonough Hall, Washington, DC 20001, USA.
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