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Williams PJ, Buttery SC, Laverty AA, Hopkinson NS. Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence. Am J Respir Crit Care Med 2024; 209:938-946. [PMID: 38300144 DOI: 10.1164/rccm.202309-1650ci] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 02/02/2024] Open
Abstract
Lung health, the development of lung disease, and how well a person with lung disease is able to live all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice can be thought of as "structural violence." To make the causal processes relating to chronic obstructive pulmonary disease (COPD) more apparent, and the responsibility to interrupt or alleviate them clearer, we have developed a taxonomy to describe this. It contains five domains: 1) avoidable lung harms (processes impacting lung development, processes that disadvantage lung health in particular groups across the life course), 2) diagnostic delay (healthcare factors; norms and attitudes that mean COPD is not diagnosed in a timely way, denying people with COPD effective treatment), 3) inadequate COPD care (ways in which the provision of care for people with COPD falls short of what is needed to ensure they are able to enjoy the best possible health, considered as healthcare resource allocation and norms and attitudes influencing clinical practice), 4) low status of COPD (ways COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems), and 5) lack of support (factors that make living with COPD more difficult than it should be, i.e., socioenvironmental factors and factors that promote social isolation). This model has relevance for policymakers, healthcare professionals, and the public as an educational resource to change clinical practices and priorities and stimulate advocacy and activism with the goal of the elimination of COPD.
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Affiliation(s)
| | | | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Williams PJ, Bachir L, Philip KEJ, Cumella A, Polkey M, Laverty AA, Hopkinson NS. Impact of omitting annual reviews for COPD on patient reported care quality- outcomes from the Asthma+Lung COPD patient passport. BMJ Open 2024; 14:e080282. [PMID: 38604645 PMCID: PMC11015218 DOI: 10.1136/bmjopen-2023-080282] [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: 10/06/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Regular clinical reviews of people with COPD provide an opportunity to optimise management and are recommended in national and international guidelines. However, there are limited data about the relationship between having an annual review and other aspects of care quality, which might influence decision-making by healthcare professionals and commissioners. METHOD Using data from 74 827 people with COPD completing the Asthma+Lung UK COPD Patient Passport, between 2014 and 2022, we conducted adjusted logistic regression (adjusting for year) and compared receipt of key items of care between those reporting that they had had an annual review (65.3%) and those who did not (34.7%). To further capture patient experience, we also analysed 4228 free-text responses to the 2021 Asthma+Lung UK annual COPD survey to the question 'What is the one thing that could improve your COPD care?' RESULTS We found that the absence of an annual review was associated with significantly worse COPD care across all domains studied; in particular, inhaler training (yes: 80.8% vs no: 38.4%, adjusted OR (AOR): 8.18, 95% CI (7.89 to 8.47), having a written care plan (89.6% vs 56.9%, AOR 6.68 (95% CI 6.35 to 7.05) and medication knowledge (72.6% vs 33.6%, AOR 5.73 (95% CI 5.51 to 5.96). Thematic analysis of the 2021 COPD survey responses identified three areas to improve care: (1) access and support from healthcare services, (2) improved treatment effectiveness and (3) interaction between COPD and the social environment. DISCUSSION Failure to deliver annual COPD reviews is associated with worse patient-reported experience of care quality. In parallel, people with COPD express a desire for greater support and access to healthcare services.
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Affiliation(s)
| | | | | | | | - Mike Polkey
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Anthony A Laverty
- Department Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Bijlani C, Vrinten C, Junghans C, Chang K, Lewis E, Mulla U, Seferidi P, Laverty AA, Vamos EP. Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward. BMC Public Health 2024; 24:800. [PMID: 38481177 PMCID: PMC10938768 DOI: 10.1186/s12889-024-18192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Local authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London. METHODS The Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6-11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status. RESULTS After three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes. CONCLUSION Local authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviours following programme implementation. These results underline the importance of a coordinated and comprehensive policy response to support changes in wider environmental and social conditions as well as appropriate and holistic evaluations of initiatives to inform local actions on obesogenic environments.
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Affiliation(s)
- Charan Bijlani
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- National Institute of Health Research (NIHR) School of Public Health Research (SPHR), London, UK.
| | - Charlotte Vrinten
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Cornelia Junghans
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- National Institute for Health and Care Research Applied Research Collaboration Northwest London, London, UK
| | - Kiara Chang
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | | | - UmmeZeinab Mulla
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Paraskevi Seferidi
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Anthony A Laverty
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Eszter P Vamos
- Department of Primary Care & Public Health, Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
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Radó MK, Kisfalusi D, Laverty AA, van Lenthe FJ, Been JV, Takács K. Socio-economic inequalities in smoking and drinking in adolescence: Assessment of social network dynamics. Addiction 2024; 119:488-498. [PMID: 37994195 DOI: 10.1111/add.16384] [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: 03/08/2023] [Accepted: 10/04/2023] [Indexed: 11/24/2023]
Abstract
AIMS We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups. DESIGN This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves. SETTING Eight Hungarian secondary schools with socio-economically diverse classes took part. PARTICIPANTS This study comprised 232 adolescents aged between 14 and 15 years in the first wave. MEASUREMENTS Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit. FINDINGS Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES. CONCLUSIONS Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.
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Affiliation(s)
- Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden
- Division of Neonatology, Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Dorottya Kisfalusi
- HUN-REN Centre for Social Sciences, Computational Social Science-Research Center for Educational and Network Studies (CSS - RECENS), Budapest, Hungary
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Károly Takács
- Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden
- HUN-REN Centre for Social Sciences, Computational Social Science-Research Center for Educational and Network Studies (CSS - RECENS), Budapest, Hungary
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Williams PJ, Philip KEJ, Buttery SC, Perkins A, Chan L, Bartlett EC, Devaraj A, Kemp SV, Addis J, Derbyshire J, Chen M, Polkey MI, Laverty AA, Hopkinson NS. Immediate smoking cessation support during lung cancer screening: long-term outcomes from two randomised controlled trials. Thorax 2024; 79:269-273. [PMID: 37875371 DOI: 10.1136/thorax-2023-220367] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/24/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Immediate smoking cessation interventions delivered alongside targeted lung health checks (TLHCs) to screen for lung cancer increase self-reported abstinence at 3 months. The impact on longer term, objectively confirmed quit rates remains to be established. METHODS We followed up participants from two clinical trials in people aged 55-75 years who smoked and took part in a TLHC. These randomised participants in the TLHC by day of attendance to either usual care (UC) (signposting to smoking cessation services) or an offer of immediate smoking cessation support including pharmacotherapy. In the QuLIT1 trial, this was delivered face to face and in QuLIT2, it was delivered remotely. Follow-up was conducted 12 months after the TLHC by telephone interview with subsequent biochemical verification of smoking cessation using exhaled CO. RESULTS 430 people were enrolled initially (115 in QuLIT1 and 315 in QuLIT2), with 4 deaths before 12 months leaving 426 (62.1±5.27 years old and 48% women) participants for analysis. At 12 months, those randomised to attend on smoking cessation support intervention days had higher quit rates compared with UC adjusted for age, gender, deprivation, and which trial they had been in; self-reported 7-day point prevalence (20.0% vs 12.8%; adjusted OR (AOR)=1.78; 95% CI 1.04 to 2.89) and CO-verified quits (12.1% vs 4.7%; AOR=2.97; 95% CI 1.38 to 6.90). Those in the intervention arm were also more likely to report having made a quit attempt (30.2% vs UC 18.5%; AOR 1.90; 95% CI 1.15 to 3.15). CONCLUSION Providing immediate smoking cessation support alongside TLHC increases long term, biochemically confirmed smoking abstinence. TRIAL REGISTRATION NUMBER ISRCTN12455871.
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Affiliation(s)
- Parris J Williams
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Alexis Perkins
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Ley Chan
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Emily C Bartlett
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Samuel V Kemp
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - James Addis
- Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane Derbyshire
- West London Cancer Alliance, Royal Marsden Partners, London, UK
| | - Michelle Chen
- West London Cancer Alliance, Royal Marsden Partners, London, UK
| | - Michael I Polkey
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Vincent H, Laverty AA, Brown J, Beard E, Bogdanovica I. Association between the implementation of standardised tobacco packaging legislation and illicit tobacco and cross-border purchasing in England: a time-series analysis between 2012 and 2020. Tob Control 2024:tc-2023-058253. [PMID: 38184372 DOI: 10.1136/tc-2023-058253] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND In May 2016, the UK announced standardising packaging legislation for tobacco products. There was a 12-month transition period with both branded and standardised packs on the market until May 2017. The aim of this study was to investigate whether the implementation of standardised packaging in England was associated with changes in illicit tobacco and cross-border purchasing. METHODS We used Smoking Toolkit Study data covering the time period from 2012 to 2020. We ran time-series analysis using Autoregressive Integrated Moving Average with Exogenous Variable models to investigate the monthly changes in illicit tobacco and cross-border purchasing in England. The model was adjusted for other tobacco control policies implemented during the relevant time period and tobacco pricing. We used May 2017 as an implementation point and run sensitivity analysis using July 2016 and February 2017 as alternative implementation points given phased introduction of the policy. RESULTS The average prevalence of illicit tobacco and cross-border purchasing in the past 6 months was 14.4%. The implementation of standardised tobacco packaging legislation was associated with a monthly decline in illicit tobacco and cross-border purchases after May 2017 by 0.16% per month (beta=-0.158, 95% CI -0.270 to -0.046). The results were robust to considering different implementation points for the policy (July 2016: beta=-0.109, 95% CI -0.213 to -0.005; February 2017: beta=-0.141, 95% CI -0.245 to -0.036). CONCLUSIONS In contrast to the tobacco industry's argument that the legislation would lead to an increase in the illicit tobacco and cross-border market, this study demonstrates that the implementation of the policy is associated with a decline in illicit tobacco and cross-border purchases in England.
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Affiliation(s)
- Hannah Vincent
- School of Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Ilze Bogdanovica
- SPECTRUM Consortium, London, UK
- School of Medicine, University of Nottingham, Nottingham, UK
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Kc S, Tewolde S, Laverty AA, Costelloe C, Papoutsi C, Reidy C, Gudgin B, Shenton C, Majeed A, Powell J, Greaves F. Uptake and adoption of the NHS App in England: an observational study. Br J Gen Pract 2023; 73:e932-e940. [PMID: 37783512 PMCID: PMC10562999 DOI: 10.3399/bjgp.2022.0150] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Technological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a 'front door' to digitally enabled health services. AIM To evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19. DESIGN AND SETTING An observational study using monthly NHS App user data at general-practice level in England was conducted. METHOD Descriptive statistics and time-series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables. RESULT Between January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P<0.001), and 44% more registrations in the largest sized practices (P<0.001). Registration rates were 36% higher in practices with the highest proportion of registered White patients (P<0.001), 23% higher in practices with the largest proportion of 15-34-year-olds (P<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (P<0.001). CONCLUSION The uptake of the NHS App substantially increased post-lockdown, most significantly after the NHS COVID Pass feature was introduced. An unequal pattern of app registration was identified, and the use of different functions varied. Further research is needed to understand these patterns of inequalities and their impact on patient experience.
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Affiliation(s)
- Sukriti Kc
- Department of Primary Care and Public Health, Imperial College London
| | - Salina Tewolde
- Department of Primary Care and Public Health, Imperial College London
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Bernard Gudgin
- Patient and public involvement representative and a member of the University of Oxford Advanced Research Computing board
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, UK
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8
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McKevitt S, White M, Petticrew M, Summerbell C, Vasiljevic M, Boyland E, Cummins S, Laverty AA, Millett C, de Vocht F, Junghans C, Vamos EP. Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England. J Public Health (Oxf) 2023; 45:878-887. [PMID: 37608490 PMCID: PMC10687598 DOI: 10.1093/pubmed/fdad155] [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: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs. METHODS We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation). RESULTS Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods. CONCLUSIONS English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.
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Affiliation(s)
- Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Martin White
- MRC Epidemiology Unit, School of Clinical Sciences, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carolyn Summerbell
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Milica Vasiljevic
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Cornelia Junghans
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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9
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Mi J, Ishida M, Anindya K, McPake B, Fitzgibbon B, Laverty AA, Tran-Duy A, Lee JT. Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis. Front Public Health 2023; 11:1077793. [PMID: 38089024 PMCID: PMC10711273 DOI: 10.3389/fpubh.2023.1077793] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia. Methods We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status. Results After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates. Conclusion Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.
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Affiliation(s)
- Jun Mi
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kanya Anindya
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bernadette Fitzgibbon
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony A. Laverty
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Vrinten C, Parnham JC, Radó MK, Filippidis FT, Vamos E, Laverty AA. Associations of social media use with smoking and e-cigarettes: a national longitudinal study. Lancet 2023; 402 Suppl 1:S91. [PMID: 37997138 DOI: 10.1016/s0140-6736(23)02125-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Social media use is high among children and young people and might influence health behaviours. We examined social media use and use of tobacco and e-cigarettes in the UK. METHODS We used data from participants aged 10-25 years from the UK Household Longitudinal Study (January 2015-January 2022). Participants were asked: "On a normal weekday, that is Monday to Friday, how many hours do you spend chatting or interacting with friends through a social website or app like that?". Specific social media platforms were not specified. Responses were none, less than 1 h, 1-3 h, 4-6 h, 7 h or more. Outcomes were current tobacco smoking and e-cigarette use. Generalised Estimating Equation (GEE) logistic regression models investigated associations of social media use with tobacco and e-cigarette use, and fixed effects analyses investigated changes in social media use with uptake of both products. Models included possible confounders such as age, sex, household income, ethnicity (White vs non-White) and use of tobacco or e-cigarettes by others within the home. All participants gave written informed consent. FINDINGS The analytic sample included 10 808 participants with 27 962 observations (mean age 15·7 years [SD 3·8], 5080 [47%] male, 5728 [53%] female, and 7868 [73%] White). Current tobacco smoking was reported at one or more timepoints by 929 (8·6%) participants, and current e-cigarette use by 270 (2·5%) participants. In adjusted GEE models, all levels of social media use were associated with greater odds of current smoking than no use. This association was particularly apparent at higher levels of use adjusted odds ratio [aOR] 3·11, 95% CI 2·41-4·03 for ≥7 h use vs no use), with similar associations for e-cigarettes (aOR 3·04, 2·11-4·40 for ≥7 h use vs no use). Fixed effects analyses also found increased use of social media to be associated with increased uptake of both products (eg, changing to using social media for ≥7 h/day was associated with >2 times the odds of taking up tobacco smoking [aOR 2·33, 1·28-4·24]). INTERPRETATION These analyses suggest an association between social media use and e-cigarette and tobacco use. Potential pathways include promotion of these products on social media. Further research with details on specific platforms would be useful as well as with longer follow-up time. FUNDING Cancer Research UK.
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Affiliation(s)
- Charlotte Vrinten
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eszter Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
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11
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Vrinten C, Parnham JC, Radó MK, Filippidis FT, Creese H, Hopkinson NS, Laverty AA. Patterns of cigarette and e-cigarette use among UK adolescents: a latent class analysis of the Millennium Cohort Study. Eur J Public Health 2023; 33:857-863. [PMID: 37573139 PMCID: PMC10567249 DOI: 10.1093/eurpub/ckad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Patterning of cigarette and e-cigarette use among young people remains poorly characterized. We aimed to describe these patterns in the UK Millennium Cohort Study at age 14 and 17 years. METHODS Data on cigarette and e-cigarette use come from 9731 adolescents. Latent class analysis assigned participants to membership of classes of product use and multinomial logistic regression analyses assessed differences in the likelihood of belonging to classes by sociodemographic (age, gender, ethnicity, household income, maternal education and country of residence) and smoking-related social factors (caregiver tobacco use, caregiver e-cigarette use and peer smoking). RESULTS We identified four classes of use: 45.8% of adolescents 'continued to abstain' from cigarettes or e-cigarettes; 21.3% 'experimented' (used once or in the past but not currently) with cigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were 'late adopters', characterized by low levels of use at age 14 but high levels of experimentation and current use at age 17; and 13.9% were 'early adopters', characterized by high levels of experimentation and current use at ages 14 and 17. At age 17, 70.4% of 'early adopters' smoked cigarettes regularly plus an additional 27.3% experimented with cigarettes. Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and e-cigarette use by caregivers, and cigarette use by peers, were associated with being both 'late adopters' and 'early adopters'. CONCLUSIONS Approximately one in seven adolescents in the UK are 'early adopters' of nicotine products. This highlights the need to develop and implement effective policies to prevent nicotine use uptake.
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Affiliation(s)
- Charlotte Vrinten
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Hanna Creese
- Child Health Unit, School of Public Health, Imperial College London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Campus, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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12
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Patterson R, Ogilvie D, Laverty AA, Panter J. Equity impacts of cycling investment in England: A natural experimental study using longitudinally linked individual-level Census data. SSM Popul Health 2023; 23:101438. [PMID: 37304734 PMCID: PMC10251149 DOI: 10.1016/j.ssmph.2023.101438] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cycling is beneficial for health and the environment but the evidence on the overall and differential impacts of interventions to promote cycling is limited. Here we assess the equity impacts of funding awarded to support cycling in 18 urban areas between 2005 and 2011. Methods We used longitudinally linked 2001 and 2011 census data from 25,747 individuals in the Office for National Statistics Longitudinal Study of England and Wales. Logistic regression was used to assess the impacts of funding on commute mode as the interaction between time and area (intervention/comparison) in individual-level difference-in-difference analyses, adjusting for a range of potential confounding factors. Differential impacts were examined by age, gender, education and area-level deprivation, and uptake and maintenance of cycling were examined separately. Results Difference-in-difference analyses showed no intervention impact on cycle commuting prevalence in the whole sample (AOR = 1.08; 95% CI 0.92, 1.26) or among men (AOR = 0.91; 95% CI 0.76, 1.10) but found an intervention effect among women (AOR = 1.56; 95% CI 1.16, 2.10). The intervention promoted uptake of cycling commuting in women (AOR = 2.13; 95% CI 1.56, 2.91) but not men (AOR = 1.19; 95% CI 0.93, 1.51). Differences in intervention effects by age, education and area-level deprivation were less consistent and more modest in magnitude. Conclusions Living in an intervention area was associated with greater uptake of cycle commuting among women but not men. Potential gender differences in the determinants of transport mode choice should be considered in the design and evaluation of future interventions to promote cycling.
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Affiliation(s)
- Richard Patterson
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, Imperial College London, Reynold Building, St Dunstan's Road, London, W6 8RP, UK
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
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13
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Kc S, Filippidis FT, Laverty AA. Legislative provisions for standardised tobacco packaging and changes in public support in 27 European countries. Tob Control 2023; 32:664-666. [PMID: 35017263 DOI: 10.1136/tobaccocontrol-2021-057068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Global adoption of standardised packaging requirements for tobacco products is a victory for public health, but their proliferation and impacts rely partly on public support. How this is related to legislation remains underassessed. This study explored change over time in public support for standardised packaging in countries with varying degrees of legislative provisions. METHODS We used data from 27 European countries, collected from 2017 (n=28, 300) and 2020 (n=27, 901) waves of the Eurobarometer survey, to assess self-reported support for standardised packaging regulations among both smokers and non-smokers. Countries were grouped into three categories of policy adoption (policy implemented; policy legislated; no legislation) and changes in support were assessed using multilevel Poisson regression models. RESULTS In 2020, public support for standardised packaging was 71% (95% CI 68% to 74%) in countries that implemented standardised packaging legislation, 57% (55% to 60%) in countries that had legislated but not yet implemented legislation and 41% (40%to 42%) in countries with no legislation. Compared with 2017, this represented a relative change of +8% (1% to 15%), +12% (5% to 21%) and -5% (95% CI -2% to -8%), respectively, in the three country categories. Among smokers, there was no indication of change in support across the three groups. Among non-smokers, support increased in countries with existing legislation (adjusted prevalence ratio [aPR]=1.14, 95% CI 1.06 to 1.23) and decreased in countries with no legislation (aPR=0.93, 0.90 to 0.97). CONCLUSIONS Public support for standardised packaging regulations increased in countries implementing and legislating for these measures, particularly among non-smokers. An overall increase in support provides reassurance for policymakers defending policy action on tobacco packaging, as well as for those seeking to implement standardised packaging in their own countries. .
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Affiliation(s)
- Sukriti Kc
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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14
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Parnham JC, Vrinten C, Cheeseman H, Bunce L, Hopkinson NS, Filippidis FT, Laverty AA. Changing awareness and sources of tobacco and e-cigarettes among children and adolescents in Great Britain. Tob Control 2023:tc-2023-058011. [PMID: 37524388 DOI: 10.1136/tc-2023-058011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among children and adolescent users over time METHODS: Data from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12 445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables. RESULTS Of 12 040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs 2019 (34.2%) (OR 2.02, 95% CI 1.24, 3.29). CONCLUSION This study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policies on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children and adolescents.
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Affiliation(s)
- Jennie C Parnham
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Charlotte Vrinten
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Laura Bunce
- Action on Smoking and Health (ASH), London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | | | - Anthony A Laverty
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
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15
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Tinner L, Holman D, Ejegi-Memeh S, Laverty AA. Use of Intersectionality Theory in Interventional Health Research in High-Income Countries: A Scoping Review. Int J Environ Res Public Health 2023; 20:6370. [PMID: 37510601 PMCID: PMC10379482 DOI: 10.3390/ijerph20146370] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. METHODS We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. RESULTS After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to improve future treatments and to structure interventions to focus on power and structural dynamics. CONCLUSIONS Intersectionality theory is not yet commonly used in interventional health research, in either design or analysis. Conditions such as mental health have more studies using intersectionality, while studies considering LGBTQ+ and physical disability as axes of inequality are particularly sparse. The lack of studies in our review suggests that theoretical and methodological advancements need to be made in order to increase engagement with intersectionality in interventional health.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Daniel Holman
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Stephanie Ejegi-Memeh
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London SW7 2BX, UK
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16
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Parnham JC, McKevitt S, Vamos EP, Laverty AA. Evidence use in the UK's COVID-19 Free School Meals Policy: a thematic content analysis. Policy Des Pract 2023; 6:328-343. [PMID: 37635908 PMCID: PMC7614982 DOI: 10.1080/25741292.2022.2112640] [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: 02/23/2022] [Accepted: 08/01/2022] [Indexed: 08/29/2023]
Abstract
Free School Meals (FSM) are a well-recognised intervention for tackling food insecurity among school children. National school closures during the COVID-19 pandemic meant that there was a need to rapidly adapt the delivery of FSM. A range of food-assistance policies were implemented, but it is not clear if they were evidence-based. This study aimed to determine the transparency of evidence use and identify other competing influences in the UK's FSM policy decisions. Thematic content analysis was used to review 50 publicly available policy documents and debate transcripts on FSM policy published between March 2020-2021. This period covered the first national school closures (March 2020-July 2020), school holidays and the second national school closures (January 2021- March 2021). The Evidence Transparency Framework was used to assess the transparency of evidence use in policy documents. We found that overall transparency of evidence use was poor but was better for the Holiday Activities and Food (HAF) programme. The Government showed preference for replacing FSM with food parcels, rather than more agentic modes of food assistance such as cash-vouchers. This preference appeared to be closely aligned with ideological views on the welfare state. With an absence of evidence, value-based reasoning took precedent and was polarised by social media. This paper highlights the need for a formal review into FSM, one which includes a comparison of low and high agentic food assistance policies. Such a review would address the evidence gap, improve food assistance policy, and aid policymakers in future periods of uncertainty.
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Affiliation(s)
- Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
| | - Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
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17
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Chamberlain RC, Fecht D, Davies B, Laverty AA. Health effects of low emission and congestion charging zones: a systematic review. Lancet Public Health 2023; 8:e559-e574. [PMID: 37393094 DOI: 10.1016/s2468-2667(23)00120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 07/03/2023]
Abstract
Low emission zones (LEZs) and congestion charging zones (CCZs) have been implemented in several cities globally. We systematically reviewed the evidence on the effects of these air pollution and congestion reduction schemes on a range of physical health outcomes. We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and Transport Research International Documentation databases from database inception to Jan 4, 2023. We included studies that evaluated the effect of implementation of a LEZ or CCZ on air pollution-related health outcomes (cardiovascular and respiratory diseases, birth outcomes, dementia, lung cancer, diabetes, and all-cause) or road traffic injuries (RTIs) using longitudinal study designs and empirical health data. Two authors independently assessed papers for inclusion. Results were narratively synthesised and visualised using harvest plots. Risk of bias was assessed using the Graphic Appraisal Tool for Epidemiological studies. The protocol was registered with PROSPERO (CRD42022311453). Of 2279 studies screened, 16 were included, of which eight assessed LEZs and eight assessed CCZs. Several LEZ studies identified positive effects on air pollution-related outcomes, with reductions in some cardiovascular disease subcategories found in five of six studies investigating this outcome, although results for other health outcomes were less consistent. Six of seven studies on the London CCZ reported reductions in total or car RTIs, although one study reported an increase in cyclist and motorcyclist injuries and one reported an increase in serious or fatal injuries. Current evidence suggests LEZs can reduce air pollution-related health outcomes, with the most consistent effect on cardiovascular disease. Evidence on CCZs is mainly limited to London but suggests that they reduce overall RTIs. Ongoing evaluation of these interventions is necessary to understand longer term health effects.
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Affiliation(s)
- Rosemary C Chamberlain
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK; NIHR Health Protection Research Unit in Chemical Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
| | - Bethan Davies
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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18
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Kc S, Reidy C, Laverty AA, Papoutsi C, Powell J, Tewolde S, Costelloe C, Gudgin B, Greaves F. Adoption and Use of the NHS App in England: a mixed-methods evaluation. Br J Gen Pract 2023; 73:bjgp23X733737. [PMID: 37479282 DOI: 10.3399/bjgp23x733737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The NHS App was launched as a 'front door' to digitally enabled health services, offering a range of services including appointment booking and ordering prescriptions. The extent of App use and its impacts on digital inclusion is under-explored. AIM To evaluate patterns of App uptake and adoption among different population groups. METHOD Interrupted time series analyses explored aggregate monthly App usage from January 2019 - May 2021. Regression model assessed differences in App registration by markers of GP level socio-demographic variables. Qualitative interviews and focus groups involving 83 participants were conducted and analysed thematically. RESULTS There were 8,524,882 App downloads and 4,449,869 registrations. Negative binomial models found 25% less registrations in the most deprived practices (P <0.001) and 44% more registrations in the largest practices (P<0.001). Registration was 36% more in practices with the highest percentage of White patients (P <0.001) and 23% more in practices with highest percentage of 15-34-year-olds (P <0.001). In contrast, App registration was 13% less in practices with highest percentage of males (P <0.001) and 2% less in those with highest percentage of people with long-term care needs (P <0.001). Qualitative evaluation found that the App was not perceived as relevant or accessible for all and there are important cultural considerations (for example, language barriers and some restrictions in symptom checking for non-White skin). However, it can enable patients to hold services accountable. CONCLUSION There is high uptake of the NHS App but there are differences in adoption rates among different population groups and issues of relevance and accessibility, that warrant further work.
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Affiliation(s)
- Sukriti Kc
- Public Health Policy Evaluation Unit, School of Public health, Imperial College London
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public health, Imperial College London
| | | | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Salina Tewolde
- Global Digital Health Unit, School of Public health, Imperial College London
| | - Céire Costelloe
- Global Digital Health Unit, School of Public health, Imperial College London
| | - Bernard Gudgin
- PPI representative, and a member of the CRN Thames Valley and South Midlands Board and RDS South Central Board
| | - Felix Greaves
- Global Digital Health Unit, School of Public health, Imperial College London
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19
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Albers PN, Rinaldi C, Brown H, Mason KE, d'Apice K, McGill E, McQuire C, Craig P, Laverty AA, Beeson M, Campbell M, Egan M, Gibson M, Fuller M, Dillon A, Taylor-Robinson D, Jago R, Tilling K, Barr B, Sniehotta FF, Hickman M, Millett CJ, de Vocht F. Natural experiments for the evaluation of place-based public health interventions: a methodology scoping review. Front Public Health 2023; 11:1192055. [PMID: 37427271 PMCID: PMC10323422 DOI: 10.3389/fpubh.2023.1192055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomization assumption. Methods A systematic search of three bibliographic databases (Pubmed, Web of Science and Ovid-Medline) was conducted in January 2020 to capture publications that reported a natural experiment of a place-based public health intervention or outcome. For each, study design elements were extracted. An additional evaluation of as-if randomization was conducted by 12 of this paper's authors who evaluated the same set of 20 randomly selected studies and assessed 'as-if ' randomization for each. Results 366 NEE studies of place-based public health interventions were identified. The most commonly used NEE approach was a Difference-in-Differences study design (25%), followed by before-after studies (23%) and regression analysis studies. 42% of NEEs had likely or probable as-if randomization of exposure (the intervention), while for 25% this was implausible. An inter-rater agreement exercise indicated poor reliability of as-if randomization assignment. Only about half of NEEs reported some form of sensitivity or falsification analysis to support inferences. Conclusion NEEs are conducted using many different designs and statistical methods and encompass various definitions of a natural experiment, while it is questionable whether all evaluations reported as natural experiments should be considered as such. The likelihood of as-if randomization should be specifically reported, and primary analyses should be supported by sensitivity analyses and/or falsification tests. Transparent reporting of NEE designs and evaluation methods will contribute to the optimum use of place-based NEEs.
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Affiliation(s)
- Patricia N. Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chiara Rinaldi
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heather Brown
- Health Research, Lancaster University, Lancaster, United Kingdom
| | - Kate E. Mason
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Centre for Health Policy, University of Melbourne, Parkville, VIC, Australia
| | - Katrina d'Apice
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elizabeth McGill
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Anthony A. Laverty
- School of Public Health, Imperial College London, London, United Kingdom
| | - Morgan Beeson
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marcia Gibson
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Maxwell Fuller
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy Dillon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems. University of Liverpool, Liverpool, United Kingdom
| | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Benjamin Barr
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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20
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Parnham JC, Vrinten C, Radó MK, Bottle A, Filippidis FT, Laverty AA. Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK. Tob Control 2023:tc-2022-057777. [PMID: 36898842 DOI: 10.1136/tc-2022-057777] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION E-cigarette use remains a controversial topic, with questions over how people transition between e-cigarette use and cigarette smoking. This paper examined transitions into and out of nicotine product use in a representative sample of UK youth. METHODS We used Markov multistate transition probability models on data from 10 229 participants (10-25 years old) in the UK Household Longitudinal Study (2015-2021). We used four product use states ('never', 'non-current use', 'e-cigarette only' and 'smoking and dual use') and estimated likelihood of transitions according to sociodemographic characteristics. RESULTS Among participants who had never used nicotine products, most were still non-users a year later (92.9% probability; 95% CI 92.6%, 93.2%); a small proportion transitioned to using e-cigarettes only (4.0%; 95% CI 3.7%, 4.2%) and cigarettes (2.2%; 95% CI 2.0%, 2.4%). Those aged 14-17 years were the most likely to start using a nicotine product. E-cigarette use was less persistent overtime than cigarette smoking, with a 59.1% probability (95% CI 56.9%, 61.0%) of e-cigarette users still using after 1 year compared with 73.8% (95% CI 72.1%, 75.4%) for cigarette smoking. However, there was a 14% probability (95% CI 12.8%, 16.2%) that e-cigarette users went onto smoke cigarettes after 1 year, rising to 25% (95% CI 23%, 27%) after 3 years. CONCLUSION This study found that although overall nicotine product use was relatively rare, participants were more likely to experiment with e-cigarette use than cigarette smoking. This was mostly not persistent over time; however, approximately one in seven transitioned to cigarette smoking. Regulators should aim to deter all nicotine product use among children.
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Affiliation(s)
- Jennie C Parnham
- Primary Care and Public Health, Imperial College London, London, UK
| | - Charlotte Vrinten
- Primary Care and Public Health, Imperial College London, London, UK.,Department of Management and Engineering, Institute for Analytical Sociology, Linköping University, Linköping, Sweden
| | - Márta K Radó
- Department of Management and Engineering, Institute for Analytical Sociology, Linköping University, Linköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alex Bottle
- Dr Foster Unit, School of Public Health, Imperial College London, London, UK
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21
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Williams PJ, Cheeseman H, Arnott D, Bunce L, Hopkinson NS, Laverty AA. Use of tobacco and e-cigarettes among youth in Great Britain in 2022: Analysis of a cross-sectional survey. Tob Induc Dis 2023; 21:05. [PMID: 36721858 PMCID: PMC9865634 DOI: 10.18332/tid/156459] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere. METHODS Using data from an online survey of 2613 youth aged 11-18 years, conducted by the market research company YouGov in March 2022, we present prevalence estimates of e-cigarette and tobacco use. We use logistic regression models to assess differences in e-cigarette use, tobacco use and use of disposable e-cigarettes across a range of covariates including age, sex, tobacco smoking status, social class, and country. RESULTS Among the 18.0% of those surveyed who reported ever having smoked a cigarette, 83.9% were not regular (at least once per week) smokers and 16.1% were (15.1% and 2.9% of the total sample, respectively). Among the 19.2% of those surveyed who had ever used an e-cigarette, 79.2% were not regular users, while 20.8% were (15.2% and 4.0% of the total sample, respectively). Regular e-cigarette use was more common than regular tobacco smoking (4.0% vs 2.9%). E-cigarette use was more common among those who also smoked tobacco, with 9.0% of never e-cigarette users ever smoking tobacco, compared with 89.4% of regular e-cigarette users. Both smoking and e-cigarette use were associated with increasing age and use by others within the home, but not with social class. Use of disposable e-cigarettes was reported by 53.8% of those who have ever used an e-cigarette, and more common among females than males. CONCLUSIONS Regular e-cigarette use is now more common than smoking in children and youth, though the majority of this is among those who have also smoked tobacco. Measures to reduce the appeal of both e-cigarettes and tobacco to children and young people are warranted.
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Affiliation(s)
- Parris J. Williams
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Laura Bunce
- Action on Smoking and Health, London, United Kingdom
| | | | - Anthony A. Laverty
- School of Public Health, Imperial College London, London, United Kingdom
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22
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Rajani NB, Hoelscher J, Laverty AA, Filippidis FT. A multi-country analysis of transnational tobacco companies' market share. Tob Induc Dis 2023; 21:03. [PMID: 36721861 PMCID: PMC9853956 DOI: 10.18332/tid/157090] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally. METHODS A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level. RESULTS The average maximal market share of one company in a country was 50% (IQR: 40.0-63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3-69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries. CONCLUSIONS The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.
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Affiliation(s)
- Nikita B. Rajani
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jule Hoelscher
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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23
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McKevitt S, White M, Petticrew M, Summerbell C, Vasiljevic M, Boyland E, Cummins S, Laverty AA, Junghans C, Millett C, De Vocht F, Hrobonova E, Vamos EP. Typology of how 'harmful commodity industries' interact with local governments in England: a critical interpretive synthesis. BMJ Glob Health 2023; 8:e010216. [PMID: 36690378 PMCID: PMC9872461 DOI: 10.1136/bmjgh-2022-010216] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and 'harmful commodity industries' (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs). METHODS Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs. RESULTS We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples. CONCLUSION Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decision-makers to maximise population health while minimising negative impacts of HCIs. PROSPERO REGISTRATION NUMBER CRD42021257311.
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Affiliation(s)
- Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mark Petticrew
- PHP, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Summerbell
- Fuse - Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Milica Vasiljevic
- Fuse - Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychology, Durham University, Durham, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Cornelia Junghans
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank De Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, Bristol, UK
| | | | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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24
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Williams PJ, Philip KE, Alghamdi SM, Perkins AM, Buttery SC, Polkey MI, Laverty AA, Hopkinson NS. Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis. Chron Respir Dis 2023; 20:14799731231183446. [PMID: 37311772 DOI: 10.1177/14799731231183446] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. METHODS We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431). RESULTS 10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49-2.72 p < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, p < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 p = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39-2.08 p = 0.80). DISCUSSION Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.
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Affiliation(s)
- Parris J Williams
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
| | - Keir Ej Philip
- National Heart and Lung Institute, Imperial College, London, UK
| | - Saeed M Alghamdi
- National Heart and Lung Institute, Imperial College, London, UK
- Clinical Technology Department, Respiratory Care Program, College of Applied Medical Science, Umm-Al Qura University, Mecca, Saudi Arabia
| | | | - Sara C Buttery
- National Heart and Lung Institute, Imperial College, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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25
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Anindya K, Marthias T, Zulfikar Biruni M, Hage S, Ng N, Laverty AA, McPake B, Millett C, Haregu TN, Hulse ESG, Cao Y, Lee JT. Low physical activity is associated with adverse health outcome and higher costs in Indonesia: A national panel study. Front Cardiovasc Med 2022; 9:972461. [PMID: 36588560 PMCID: PMC9800782 DOI: 10.3389/fcvm.2022.972461] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Aims To assess the association between low physical activity, cardiovascular disease (CVD) and risk factors, health service utilization, risk of catastrophic health expenditure, and work productivity in Indonesia. Methods In this population-based, panel data analysis, we used data from two waves of the Indonesian Family Life Survey (IFLS) for 2007/2008 and 2014/2015. Respondents aged 40-80 years who participated in both waves were included in this study (n = 5,936). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Multinomial logistic regression model was used to examine factors associated with physical activity levels (low, moderate, and high). We applied a series of multilevel mixed-effect panel regression to examine the associations between physical activity and outcome variables. Results The prevalence of low physical activity increased from 18.2% in 2007 to 39.6% in 2014. Compared with those with high physical activity, respondents with low physical activity were more likely to have a 10-year high CVD risk (AOR: 2.11, 95% CI: 1.51-2.95), use outpatient care (AOR: 1.26, 95% CI: 1.07-1.96) and inpatient care (AOR 1.45, 95% CI: 1.07-1.96), experience catastrophic health expenditure of 10% of total household expenditure (AOR: 1.66, 95% CI: 1.21-2.28), and have lower labor participation (AOR: 0.24, 95% 0.20-0.28). Conclusions Low physical activity is associated with adverse health outcomes and considerable costs to the health system and wider society. Accelerated implementation of public health policies to reduce physical inactivity is likely to result in substantial population health and economic benefits.
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Affiliation(s)
- Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tiara Marthias
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Tiara Marthias
| | - Muhammad Zulfikar Biruni
- Directorate of Pharmaceutical Services, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Sophia Hage
- Royal Sports Performance Center, Jakarta, Indonesia,Indonesia Sports Medicine Doctor Association, Jakarta Pusat, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Tilahun Nigatu Haregu
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily S. G. Hulse
- Center for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yingting Cao
- Non-Communicable Disease Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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26
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Parnham JC, Vamos EP, McKevitt S, Laverty AA. The UK's Free School Meals policy during the pandemic: a thematic content analysis of policy documents and debates. Lancet 2022; 400 Suppl 1:S62. [PMID: 36930009 DOI: 10.1016/s0140-6736(22)02272-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A Free School Meals (FSM) policy is a well recognised intervention for tackling food insecurity among children (up to the age 18 years) whose parents receive state benefits. National school closures during the COVID-19 pandemic resulted in the need to rapidly adapt the delivery of FSM to protect the most disadvantaged children in the UK from increased food insecurity. A range of food assistance policies were implemented, but whether they were evidence-based is unclear. The aim of study was to establish the transparency of evidence use behind FSM policy decisions in the UK during the COVID-19 pandemic and to identify other factors influencing decision making. METHODS We used thematic content analysis to analyse publicly available policy documents and parliamentary debate transcripts relating to FSM published in the first year of the COVID-19 pandemic in the UK (March, 2020, to March, 2021). This period covered the first national school closures (March, 2020, to July, 2020), all school holidays, and the second national school closures (January, 2021, to March, 2021). The evidence transparency framework was used to evaluate transparency of evidence-use in policy decisions. FINDINGS We analysed 50 documents and debates. Overall transparency of evidence-use was low, but more evident for the Holiday Activities and Food programme than for the FSM programme. Replacing FSM with food parcels was favoured by the UK Government over more agentic modes of food assistance, such as cash vouchers. This preference seemingly aligned with politicians' ideological views on the welfare state, influenced by social media, as assessed from the analysis of available policy documents and parliamentary debate transcripts. Other influences on decision making included policy delivery and responding to increased public attention. INTERPRETATION Evidence use behind the deployment of FSM was not transparent. Overall, value-based reasoning took precedent over evidence and was polarised by social media. A comprehensive review of the FSM policy in this period could increase understanding and the likelihood that future food assistance policy is evidence-based. The lessons must be incorporated into a future pandemic plan that prioritises protecting low-income families from food insecurity. FUNDING Newton's Apple (registered charity number 1121719). The authors are funded by the UK National Institute for Health and Care Research's School for Public Health Research. The views expressed herein are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care.
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Affiliation(s)
- Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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27
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Rojas-García A, Holman D, Tinner L, Ejegi-Memeh S, Ben-Shlomo Y, Laverty AA. Use of intersectionality theories in interventional health research in high-income countries: a systematic scoping review. Lancet 2022; 400 Suppl 1:S58. [PMID: 36930004 DOI: 10.1016/s0140-6736(22)02268-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intersectionality theory suggests that multiple forms of inequality need to be considered simultaneously. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review explores the use of intersectionality when designing and implementing interventions to reduce health inequalities, or when analysing the impact of these interventions. METHODS We did a systematic search of MEDLINE and Scopus for articles published from inception up to June 30, 2021, with the key search terms "intersectionality", "interventions", and "public health". References were screened and those including use of intersectionality and primary data from high-income countries were included and relevant data synthesised. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines extension for scoping reviews. FINDINGS 2108 studies were screened, of which 12 met inclusion criteria Six (50%) of the 12 studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study), and housing interventions (one study). The three quantitative studies (25%) examined mental health (two studies) and smoking cessation (one study), whereas the three mixed-methods studies (25%) examined mental health (two studies) and sexual exploitation (one study). Nine studies (75%) used intersectionality to analyse intervention effects, two studies (25%) used intersectionality for intervention design, and one study (8%) used intersectionality for both design and analysis of an intervention. Ethnicity and gender were the most commonly included axes of inequality (11 studies [92%]), followed by socioeconomic status (ten studies [83%]). Only four studies (33%) included consideration of LGBTQ+ individuals and only one (8%) considered physical disabilities. INTERPRETATION Intersectionality theories are not yet commonly used in either the design or the evaluation of interventional health research, and evidence on the implementation of some key elements of intersectionality is still scarce. Studies on some conditions, such as mental health, have more often used intersectionality, whereas studies considering the LGBTQ+ community and individuals with physical disabilities as axes of inequality are particularly scarce. FUNDING National Institute for Health and Care Research School for Public Health Research.
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Affiliation(s)
- Antonio Rojas-García
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London, UK; Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Laura Tinner
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Stephanie Ejegi-Memeh
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London, UK.
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28
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Parnham JC, Chang K, Rauber F, Levy RB, von Hinke S, Laverty AA, Millett C, Vamos EP. The ultra-processed food content of school meals and packed lunches in the UK, 2008-17: a pooled cross-sectional study. Lancet 2022; 400 Suppl 1:S12. [PMID: 36929954 DOI: 10.1016/s0140-6736(22)02222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND British children have the highest ultra-processed food (UPF) intake in Europe, concerning as UPF is linked to adverse health outcomes. Schools are a potential setting for intervention, yet the rate of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK and to explore differences in UPF content by meal type (school meals and packed lunches [food from home]) and children's household income. METHODS We performed a pooled cross-sectional analysis of 1895 primary school children (aged 4-11 years) and 1408 secondary school children (aged 11-18 years) using data from the UK's National Diet and Nutrition Survey (from Feb, 2008, to June, 2017). Student's meal type was recorded using food diaries. UPF intake was defined using the NOVA food classification system. Income was measured through interview. We used quantile regression models to assess the association between meal type and lunchtime UPF intake (by both the percentage of calories and weight). We stratified models by school phase (primary or secondary) and interacted meal type with income. FINDINGS The majority of schoolchildren's lunch was defined as UPFs, with secondary school children having higher median intakes of UPFs than primary school children (78% kcal [IQR 58-95] vs 73% kcal [55-86). School meals were associated with a lower median UPF intake than packed lunches for primary school children (61% kcal [IQR 44-75] vs 81% kcal [71-91]) and for secondary school children (70% kcal [IQR 48-89] vs 84% kcal [65-99]). Results were similar when UPFs were analysed as a percentage of the total weight of lunch. Overall, income was inversely associated with UPF lunch content. However, in primary school children, there was no significant association between percentage of UPF content of school meals by weight. INTERPRETATION In the first nationally representative study, we showed that UK school children have a high intake of UPFs at lunch. UPF intake was increased in children who consumed packed lunches, secondary school children, and children of a lower income. School meal procurement policies must be re-evaluated to protect children from high UPF intake. FUNDING This study was funded by the National Institute for Health Research School for Public Health Research.
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Affiliation(s)
- Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK.
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK
| | - Fernanda Rauber
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Renata B Levy
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Stephanie von Hinke
- School of Economics, University of Bristol, Bristol, UK; Department of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Fiscal Studies, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK
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Chamberlain RC, Fecht D, Davies B, Laverty AA. Effects of low emission zones and congestion charging zones on physical health outcomes: a systematic review. Lancet 2022; 400 Suppl 1:S30. [PMID: 36929974 DOI: 10.1016/s0140-6736(22)02240-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Road traffic impacts human health through air pollution and road safety issues. Low emission zones (LEZs) and congestion charging zones (CCZs) have therefore been implemented in several cities globally. We systematically reviewed the evidence on the effects of these pollution or congestion reduction schemes on specific physical health outcomes associated with air pollution or traffic exposure. METHODS We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and TRID databases from database inception to Feb 22, 2022, using search terms such as "low emission/congestion charge/zone" and "cardiovascular/respiratory/injury". Searches were limited to English-language records. We included studies that evaluated the effect of a LEZ or CCZ on air pollution-related outcomes (ie, cardiovascular disease, respiratory disease, birth outcomes, dementia, lung cancer, diabetes) or road traffic injuries, using longitudinal study designs. We excluded studies without empirical health data. Two authors independently assessed papers for inclusion. Results were narratively synthesised and summarised using harvest plots. Risk of bias was assessed using the Graphic Appraisal Tool for Epidemiological studies for correlation studies. This systematic review was registered with PROSPERO, number CRD42022311453. FINDINGS Of 2068 post-deduplication records screened, fifteen studies were included, with two further studies included from references of eligible studies. Nine (53%) of 17 studies assessed LEZs in London, Milan, Tokyo, and several German cities, seven (41%) assessed the London CCZ, and one (6%) assessed the Stockholm CCZ. Each predefined health outcome was considered by at least one study. Six (75%) of eight LEZ studies considering pollution-related outcomes identified reductions in at least one outcome, with all five on cardiovascular disease identifying reductions for at least one disease subcategory. Of seven London CCZ studies, six (86%) reported clear reductions in total or car injuries, although one (14%) reported increases for cyclist or motorcyclist injuries and one (14%) for serious or fatal injuries. INTERPRETATION Although inter-study heterogeneity exists, current evidence suggests that LEZs reduce some air pollution-related health outcomes. CCZ evidence is mainly limited to London but suggests that they reduce overall road traffic injuries. FUNDING National Institute for Health and Care Research (NIHR) School for Public Health Research, NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, MRC Centre for Environment and Health.
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Affiliation(s)
- Rosemary C Chamberlain
- MRC Centre for Environment and Health and Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK.
| | - Daniela Fecht
- MRC Centre for Environment and Health and Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Bethan Davies
- MRC Centre for Environment and Health and Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Vrinten C, Parnham JC, Filippidis FT, Hopkinson NS, Laverty AA. Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study. Lancet 2022; 400 Suppl 1:S57. [PMID: 36930003 DOI: 10.1016/s0140-6736(22)02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake. METHODS Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates. FINDINGS Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit between the age of 14 years and 17 years. INTERPRETATION Our findings are a reminder of the transmissibility of the smoking epidemic. Although we only assessed social media use, not actual exposure to online tobacco advertising, our findings strengthen calls for awareness of the changing landscape of tobacco advertising. FUNDING Cancer Research UK (grant reference PPRCTAGPJT\100005) and the UK National Institute for Health and Care Research School for Public Health Research. The funders had no role in the writing of the manuscript or the decision to submit for publication.
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Affiliation(s)
- Charlotte Vrinten
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Hospital Campus, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
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Parnham JC, Chang K, Rauber F, Levy RB, von Hinke S, Laverty AA, Millett C, Vamos EP. The ultra-processed food content of school meals and packed lunches in the United Kingdom (2008-2017). Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
British children have the highest ultra-processed food (UPF) intake in Europe, which is linked to adverse health outcomes. Schools are posited as a setting for dietary intervention, yet the level of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK, explore the UPF content of school meals and packed lunches (food from home) and examine whether UPF differs by children's household income.
Methods
A pooled cross-sectional analysis of primary (4-11 years, n = 1,895) and secondary schoolchildren (11-18 years, n = 1,408) from the UK's National Diet and Nutrition Survey (2008-2017) was conducted. Food diaries recorded student's meal-type (school meal/packed lunch). UPF intake was defined using the NOVA food classification system. Quantile regression models assessed the association between meal-type and lunchtime UPF intake (%kcal and % grams). Models were stratified by school phase (primary/secondary) and interacted meal-type with income.
Results
Schoolchildren consumed most of their lunch as UPF, with higher median intakes in secondary schoolchildren than primary schoolchildren (77.8 %kcal vs 72.6 %kcal). School meals were associated with lower median UPF intake (%kcal) in both primary (-20 percentage-points[pp] [95% CI -22.2, -17.4]) and secondary schoolchildren (-11pp [-16.0,-7.0]) compared with packed lunches. Results were similar when UPF %g was analysed. Overall, income was inversely associated with UPF content. However, in primary schoolchildren there was no significant income gradient in the UPF(%g) content of school meals.
Conclusions
In the first nationally representative study, we showed that on average UPF intake was high in all UK schoolchildren. Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those with a lower income. Procurement policies must be revaluated to protect children from high UPF intake.
Funders: NIHR School for Public Health Research
Key messages
• In the first study of ultra-processed food content of UK school food, we show that children consumed around three quarters of their energy as ultra-processed food at lunch.
• Children who were older, took food from home or were from a low-income household were more likely to consume higher levels of ultra-processed food. Regulation is needed to protect these children.
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Affiliation(s)
- JC Parnham
- Public Health Policy Evaluation Unit, Imperial College London , London, UK
| | - K Chang
- Public Health Policy Evaluation Unit, Imperial College London , London, UK
| | - F Rauber
- Department of Nutrition, University of São Paulo , São Paulo, Brazil
- Department of Preventive Medicine, University of São Paulo , São Paulo, Brazil
| | - RB Levy
- Department of Nutrition, University of São Paulo , São Paulo, Brazil
- Department of Preventive Medicine, University of São Paulo , São Paulo, Brazil
| | - S von Hinke
- School of Economics, University of Bristol , Bristol, UK
| | - AA Laverty
- Public Health Policy Evaluation Unit, Imperial College London , London, UK
| | - C Millett
- Public Health Policy Evaluation Unit, Imperial College London , London, UK
| | - EP Vamos
- Public Health Policy Evaluation Unit, Imperial College London , London, UK
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Kyriakos CN, Qi D, Chang K, Laverty AA, Filippidis FT. Global market trends of flavour capsule and menthol cigarettes in 78 countries, 2010-2020. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Flavoured tobacco products, including innovative flavour capsule cigarettes (FCCs) and menthol cigarettes, can increase appeal and encourage smoking initiation and use. Global epidemiological data on these products are scarce.
Methods
This study examined market trends of FCCs and menthol (non-capsule) cigarettes across 78 countries from 2010 to 2020 and assessed ecological-level factors associated with market shares of these products. Market share and retail volume data came from Euromonitor Passport and country-specific sociodemographic data come from the WHO and World Bank. Adjusted linear fixed effects panel regression analyses were used to evaluate the relationship between predictors variables and market outcomes.
Results
Global total retail volume of FCCs increased over time (0.2% in 2010 to 4.5% in 2020) and market share was associated with year and unemployment rate and inversely associated with % urban population and smoking prevalence (p < 0.001). In contrast, menthol retail volume decreased over time (5.0% to 3.8%) and market share was associated with % urban population (p = 0.001) and inversely associated with year (p = 0.004) and unemployment rate (p = 0.017). The greatest market increase of FCCs was observed in the Americas region and among upper-middle income countries. In Europe, there was a decrease of 0.64 percentage points from 2019 to 2020.
Conclusions
Overall, FCCs experienced substantial global growth in the recent decade, with the exception of Europe whose slight decrease may be attributable to the European Union ban on flavours in cigarettes. Findings indicate that there is a need for increased efforts to address flavours and innovative features used in tobacco products, which are known to appeal to youth.
Key messages
• This study contributes to global monitoring of tobacco products.
• Findings can be used by advocates and policy makers to support countries in adopting measures to ban flavoured tobacco products.
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Affiliation(s)
- CN Kyriakos
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - D Qi
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - K Chang
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - AA Laverty
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - FT Filippidis
- Department of Primary Care and Public Health, Imperial College London , London, UK
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Kyriakos CN, Qi D, Chang K, Laverty AA, Filippidis FT. Global market trends of flavor capsule cigarettes and
menthol (non-capsule) cigarettes: An ecological analysis
using commercial data across 78 countries, 2010–2020. Tob Induc Dis 2022; 20:85. [PMID: 36304063 PMCID: PMC9549585 DOI: 10.18332/tid/153974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study describes market trends of flavor capsule cigarettes (FCCs) and menthol (non-capsule) cigarettes (MNCCs) across 78 countries from 2010 to 2020 and examines country-level factors associated with market shares of these products. METHODS Market share and retail volume data came from the Euromonitor Passport database and country-level data came from the World Health Organization (WHO), World Bank, and International Monetary Fund. Multivariable linear fixed effects panel regression analyses were conducted to evaluate the relationship between predictor variables and the market shares of menthol (non-capsule) cigarettes and flavor capsule cigarettes. RESULTS The overall market share (i.e. the percentage retail volume out of total retail volume of all cigarette types) increased from 0.23% in 2010 to 4.5% in 2020 for FCCs and decreased from 5.0% to 3.8% for MNCCs. Market shares of FCCs grew most rapidly in the Americas region and among upper middle-income countries. Market shares of MNCCs remained stable across most regions and were highest in the Western Pacific and Africa regions. The overall market share of FCCs was positively associated with the unemployment rate (β=0.28; 95% CI: 0.12–0.44, p=0.001), and inversely associated with the percent of the population aged 15–29 years (β= -0.57, 95% CI: -0.98 – -0.15, p=0.008), percent of urban population (β= -0.88; 95% CI: -1.28 – -0.48, p<0.001), GDP PPP per capita (β= -0.13; 95% CI: -0.24 – -0.03, p=0.015), and age-standardized prevalence of cigarette smoking (β= -0.93; 95% CI: -1.38 – -0.49, p<0.001). In contrast, the overall market share of MNCCs was positively associated with urbanicity (β=0.24; 95% CI: 0.08–0.40, p=0.003), and negatively associated with the unemployment rate (β= -0.09; 95% CI: -0.17 – -0.02, p=0.014). CONCLUSIONS Global sales of flavor capsule cigarettes grew substantially in the last decade, surpassing menthol (non-capsule) cigarettes, which also continued to be high in many regions. There is a need for increased efforts to address flavors and novel tobacco products, features that are known to appeal to youth.
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Affiliation(s)
- Christina N. Kyriakos
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Dickson Qi
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Kiara Chang
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Laverty AA, Millett C, Been JV, Filippidis FT, Radó MK. A healthy future for children and adolescents. Lancet 2022; 400:1100. [PMID: 36183722 DOI: 10.1016/s0140-6736(22)01598-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony A Laverty
- Public Health Policy Evaluation Unit, Imperial College London, London W6 8RP, UK.
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London W6 8RP, UK
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | - Márta K Radó
- Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden
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35
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Vrinten C, Parnham JC, Filippidis FT, Hopkinson NS, Laverty AA. Risk factors for adolescent smoking uptake: Analysis of
prospective data from the UK Millennium Cohort Study. Tob Induc Dis 2022; 20:83. [PMID: 36249346 PMCID: PMC9521183 DOI: 10.18332/tid/152321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Charlotte Vrinten
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Jennie C. Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Nicholas S. Hopkinson
- National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Jenkins R, Vamos EP, Mason KE, Daras K, Taylor-Robinson D, Bambra C, Millett C, Laverty AA. Local area public sector spending and nutritional anaemia hospital admissions in England: a longitudinal ecological study. BMJ Open 2022; 12:e059739. [PMID: 36175095 PMCID: PMC9528630 DOI: 10.1136/bmjopen-2021-059739] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Reductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local authority (LA) services (eg, housing services) on personal resources and food access, availability and provision. We therefore investigated the association between changes in LA spending and nutritional anaemia-related hospital admissions. Specifically, we address whether greater cuts to LA spending were linked to increased hospital admissions for nutritional anaemias. DESIGN Longitudinal analysis of LA panel data using Poisson fixed effects regression models. SETTING 312 LAs in England (2005-2018). MAIN EXPOSURE Total LA service expenditure per capita per year. MAIN OUTCOME Principal and total nutritional anaemia hospital admissions, for all ages and stratified by age (0-14, 15-64, 65+ years). RESULTS LA service expenditure increased by 9% between 2005 and 2009 then decreased by 20% between 2010 and 2018. Total nutritional anaemia hospital admissions increased between 2005 and 2018 from 173 to 633 admissions per 100 000 population. A £100 higher LA service spending was associated with a 1.9% decrease in total nutritional anaemia hospital admissions (adjusted incidence rate ratio (aIRR): 0.98, 95% CI: 0.96 to 0.99). When stratified by age, this was seen only in adults. A £100 higher LA service spending was associated with a 2.6% decrease in total nutritional anaemia hospital admissions in the most deprived LAs (aIRR: 0.97, 95% CI: 0.95 to 1.0). CONCLUSION Increased LA spending was associated with reduced hospital admissions for nutritional anaemia. Austerity-related reductions had the opposite effect, increasing admissions, with greater impacts in more deprived areas. This adds further evidence to the potential negative impacts of austerity policies on health and health inequalities. Among other impacts, re-investing in LA services may prevent hospital admissions associated with nutritional anaemias.
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Affiliation(s)
- Rosemary Jenkins
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK
| | - Kate E Mason
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK
| | - Konstantinos Daras
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, NE1 4LE, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK
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Parnham JC, Chang K, Rauber F, Levy RB, Millett C, Laverty AA, von Hinke S, Vamos EP. The Ultra-Processed Food Content of School Meals and Packed Lunches in the United Kingdom. Nutrients 2022; 14:2961. [PMID: 35889918 PMCID: PMC9318725 DOI: 10.3390/nu14142961] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023] Open
Abstract
British children have the highest levels of ultra-processed food (UPF) consumption in Europe. Schools are posited as a positive setting for impacting dietary intake, but the level of UPFs consumed in schools is currently unknown. This study determined the UPF content of school food in the UK. We conducted a pooled cross-sectional analysis of primary (4-11 years, n = 1895) and secondary schoolchildren (11-18 years, n = 1408) from the UK's National Diet and Nutrition Survey (2008-2017). Multivariable quantile regression models determined the association between meal-type (school meal or packed lunch) and lunchtime UPF intake (NOVA food classification system). We showed that on average, UPF intake was high in both primary (72.6% total lunch Kcal) and secondary schoolchildren (77.8% total lunch Kcal). Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those in lower income households. This study highlights the need for a renewed focus on school food. Better guidance and policies that consider levels of industrial processing in food served in schools are needed to ensure the dual benefit of encouraging school meal uptake and equitably improving children's diets.
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Affiliation(s)
- Jennie C. Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Fernanda Rauber
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-904, Brazil; (F.R.); (R.B.L.)
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Renata B. Levy
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-904, Brazil; (F.R.); (R.B.L.)
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
- Public Health Research Centre & Comprehensive Health Research Center (CHRC), National School of Public Health, NOVA University of Lisbon, 1600-1500 Lisbon, Portugal
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Stephanie von Hinke
- School of Economics, University of Bristol, Priory Road Complex, Bristol BS8 1TU, UK;
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
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Radó MK, van Lenthe FJ, Laverty AA, Filippidis FT, Millett C, Sheikh A, Been JV. Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study. The Lancet Public Health 2022; 7:e616-e625. [DOI: 10.1016/s2468-2667(22)00112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
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Williams PJ, Cumella A, Philip KEJ, Laverty AA, Hopkinson NS. Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey. BMJ Open Respir Res 2022; 9:9/1/e001290. [PMID: 35853736 PMCID: PMC9315910 DOI: 10.1136/bmjresp-2022-001290] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Understanding the factors driving acute exacerbations of chronic obstructive pulmonary disease (COPD) is key to reducing their impact on human health and well-being. Methods 5997 people with COPD, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD, developed by the charity Asthma + Lung UK. Results The 3731 (62.2%) survey participants reporting frequent (≥2/year) exacerbations were more likely to smoke (adjusted OR (AOR) 1.70, 95% CI 1.470 to 1.98), have lower annual household income (≤£20 000 (AOR 1.72, 95% CI 1.36 to 2.17), live in a cold and damp home (AOR 1.78, 95% CI 1.50 to 2.11) and report previous occupational exposure to dust, fumes and chemicals. Smokers were more likely to report attending hospital to manage their most recent acute exacerbation of COPD compared with ex-smokers (AOR 1.25, 95% CI 0.99 to 1.59). Discussion Strategies to improve COPD outcomes must address issues of deprivation and social justice.
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Affiliation(s)
- Parris J Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Anthony A Laverty
- Department Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Teshima A, Laverty AA, Filippidis FT. Burden of current and past smoking across 28 European
countries in 2017: A cross-sectional analysis. Tob Induc Dis 2022; 20:56. [PMID: 35799620 PMCID: PMC9194927 DOI: 10.18332/tid/149477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most studies use the prevalence of current smoking as an indicator to quantify the burden of smoking. However, length and intensity of smoking, as well as time since cessation for former smokers are also known to impact smoking-related health risks. The aim of this study was to quantify and compare the burden of smoking across the European Union (EU) using a range of smoking burden indicators. METHODS We conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1 (n=27901, people aged ≥15 years) in 28 European Union Member States (EU MS) and the Tobacco Control Scale. We defined five indicators of smoking burden including the prevalence of current and ever smoking, length of smoking, pack-years, and discounted pack-years, and ranked EU MS by each indicator. Two-level linear and logistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors. RESULTS Wide variations across the EU countries were observed in all smoking burden indicators. While some MS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom) in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MS such as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were lower among women and respondents without financial difficulties; however, the magnitude of those inequalities varied two-fold among the different indicators. CONCLUSIONS Using a range of smoking burden indicators can be more informative than relying on prevalence alone. Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimate the burden of smoking and the potential value of more nuanced indicators. We recommend that multiple and more nuanced indicators that consider former smokers, intensity and duration of smoking should be utilized to monitor tobacco use and evaluate tobacco control policies.
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Affiliation(s)
- Ayaka Teshima
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Haney E, Parnham JC, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, White M, Millett C, Vamos EP. Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK. Public Health Nutr 2022; 26:1-12. [PMID: 35641314 DOI: 10.1017/s1368980022001355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE School lunches represent a key opportunity to improve diets and health of schoolchildren. No recent nationally representative studies have examined the nutritional differences between school meals and packed lunches in the UK. This study aimed to characterise and compare the nutritional quality of school meals and packed lunches among primary and secondary school-age children. DESIGN A pooled cross-sectional analysis of the UK's National Diet and Nutrition Survey (2008-2017). SETTING United Kingdom. PARTICIPANTS 3001 children (aged 4-16 years) who completed a 3/4-d food diary which recorded meal type (school meal/packed lunch). Multivariable logistic regression models assessed associations of meeting food and nutrient recommendations by meal type. Analyses were stratified by academic key stages (KS). RESULTS KS-1 (4-7 years) and 2 (8-11 years) children consuming school meals were more likely to meet minimum recommendations for vegetables, protein-rich foods and fibre, and not exceed maximum recommendations for salt, savoury and sweet snacks compared with pupils consuming packed lunches. However, in KS-3 (12-14 years) and 4 (14-16 years), these effects were reduced. As children aged, the median weight of fruits, vegetables, protein-rich foods and dairy products consumed typically decreased for both school meals and packed lunches, and generally an increasing proportion of school meals contained sweet and savoury snacks. CONCLUSION These findings suggest school meals are nutritionally superior to packed lunches but are not yet optimal. Quality declined at higher KS. Actions to improve lunches of primary and secondary schoolchildren across the UK are needed, with attention to KS-3 and 4 in secondary schools.
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Affiliation(s)
- Erin Haney
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Stephanie von Hinke
- School of Economics, University of Bristol, Bristol, UK
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon-Tyne, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
- Public Health Research Centre & Comprehensive Health Research Center (CHRC), National School of Public Health, Lisbon, Portugal
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
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El Asmar ML, Laverty AA, Vardavas CI, Filippidis FT. How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries. BMJ Open 2022; 12:e059068. [PMID: 35487758 PMCID: PMC9058771 DOI: 10.1136/bmjopen-2021-059068] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP. SETTING We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries. PARTICIPANTS A representative sample of individuals residing in these countries aged ≥15 years. PRIMARY AND SECONDARY OUTCOME MEASURES Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately. RESULTS 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid. CONCLUSION Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
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Affiliation(s)
- Marie Line El Asmar
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Parnham JC, Chang K, Millett C, Laverty AA, von Hinke S, Pearson-Stuttard J, de Vocht F, White M, Vamos EP. The Impact of the Universal Infant Free School Meal Policy on Dietary Quality in English and Scottish Primary School Children: Evaluation of a Natural Experiment. Nutrients 2022; 14:1602. [PMID: 35458164 PMCID: PMC9029848 DOI: 10.3390/nu14081602] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023] Open
Abstract
The Universal Infant Free School Meal (UIFSM) policy was introduced in September 2014 in England and January 2015 in Scotland and offered all infant schoolchildren (ages 4-7 years) a free school lunch, regardless of income. Yet, impacts of UIFSM on dietary intakes or social inequalities are not known. A difference-in-differences study using the National Diet and Nutrition Survey assessed pooled pre-UIFSM (2010-2014) and post-UIFSM (2014-2017) dietary data. English or Scottish infant schoolchildren (4-7 years; n = 458) were the intervention group, with junior schoolchildren (8-11 years; n = 401) as controls. We found that implementation of UIFSM led to an increase in infant schoolchildren having a school meal. Impacts on key food groups such as fruit and vegetables or sweetened beverages were not seen. However, there was evidence that the UIFSM policy lowered consumption of foods associated with packed lunches, such as crisps, and some nutrients, such as total fat and sodium. Policy impacts differed by income group, with larger effect sizes in low-income children. In conclusion, evaluation of UIFSM demonstrated some improvements in dietary quality but the findings suggest school meal quality needs to be improved to fully realise the benefits of UIFSM.
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Affiliation(s)
- Jennie C. Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Stephanie von Hinke
- Erasmus School of Economics, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands;
- School of Economics, University of Bristol, Priory Road Complex, Bristol BS8 1TU, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK;
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon-Tyne NE27 0QJ, UK
- Health Analytics, Lane Clark & Peacock LLP, London W1U 1DQ, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK;
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK;
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
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Laverty AA, Millett C. A respiratory pandemic should focus the mind on tobacco control. Thorax 2022; 77:7-8. [PMID: 34580194 DOI: 10.1136/thoraxjnl-2021-217685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Radó MK, Laverty AA, Hone T, Chang K, Jawad M, Millett C, Been JV, Filippidis FT. Cigarette taxation and neonatal and infant mortality: A longitudinal analysis of 159 countries. PLOS Glob Public Health 2022; 2:e0000042. [PMID: 36962262 PMCID: PMC10021450 DOI: 10.1371/journal.pgph.0000042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008-2018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of tobacco use, and reliance on taxation data only for the cigarette brands most sold in each country. In line with limited existing evidence conducted in HICs, we found that raising taxes on tobacco was associated with a reduction in neonatal and infant mortality globally. Implementing recommended levels of taxation in LMICs should be a priority since this is where the lowest levels of taxation and the largest potential infant mortality benefits exist.
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Affiliation(s)
- Márta K Radó
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Jenkins RH, Vamos EP, Taylor-Robinson D, Mason KE, Laverty AA. Changes to local area public sector spending and food purchasing in England: a longitudinal ecological study. BMJ Nutr Prev Health 2022; 5:72-86. [PMID: 35814722 PMCID: PMC9237904 DOI: 10.1136/bmjnph-2021-000346] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Changes in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods. Design Longitudinal panel survey at the LA level (2008-2015) using fixed effects linear regression. Setting 324 LAs in England. Main exposure Expenditure per capita on total LA services, highways and transport services, and housing services. Main outcome measures LA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure. Results Total LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI -0.093 to -0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI -0.009 to -0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI -0.010 to -0.002). Conclusion Changes in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships.
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Affiliation(s)
- Rosemary H Jenkins
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Kate E Mason
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
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Chan JJL, Tran-Nhu L, Pitcairn CFM, Laverty AA, Mrejen M, Pescarini JM, Hone TV. Inequalities in the prevalence of cardiovascular disease risk factors in Brazilian slum populations: A cross-sectional study. PLOS Glob Public Health 2022; 2:e0000990. [PMID: 36962864 PMCID: PMC10022010 DOI: 10.1371/journal.pgph.0000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Social and environmental risk factors in informal settlements and slums may contribute to increased risk of cardiovascular disease (CVD). This study assesses the socioeconomic inequalities in CVD risk factors in Brazil comparing slum and non-slum populations. METHODS Responses from 94,114 individuals from the 2019 Brazilian National Health Survey were analysed. The United Nations Human Settlements Programme definition of a slum was used to identify slum inhabitants. Six behavioural risk factors, four metabolic risk factors and doctor-diagnosed CVD were analysed using Poisson regression models adjusting for socioeconomic characteristics. RESULTS Compared to urban non-slum inhabitants, slum inhabitants were more likely to: have low (less than five days per week) consumption of fruits (APR: 1.04, 95%CI 1.01-1.07) or vegetables (APR: 1.08, 95%CI 1.05-1.12); drink four or more alcoholic drinks per day (APR: 1.05, 95%CI 1.03-1.06); and be physically active less than 150 minutes per week (APR: 1.03, 95%CI 1.01-1.04). There were no differences in the likelihoods of doctor-diagnosed metabolic risk factors or CVD between the two groups in adjusted models. There was a higher likelihood of behavioural and metabolic risk factors among those with lower education, with lower incomes, and the non-White population. CONCLUSIONS Brazilians living in slums are at higher risk of behavioural risk factors for CVD, suggesting local environments might impact access to and uptake of healthy behaviours.
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Affiliation(s)
- Jasper J L Chan
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Linh Tran-Nhu
- Division of Biosciences, University College London, London, United Kingdom
| | - Charlie F M Pitcairn
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Matías Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas V Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Parnham J, Millett C, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, Vamos EP. Is the healthy start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom? BMC Public Health 2021; 21:2220. [PMID: 34915897 PMCID: PMC8680244 DOI: 10.1186/s12889-021-12222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
Background Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods Cross-sectional analyses of the Living Costs and Food Survey dataset (2010–2017). All households with a child (0–3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households). Results Of 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12222-5.
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Affiliation(s)
- Jennie Parnham
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK.
| | - Christopher Millett
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Kiara Chang
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Anthony A Laverty
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Stephanie von Hinke
- University of Bristol, Bristol, UK.,Erasmus University Rotterdam, Rotterdam, The Netherlands.,Institute for Fiscal Studies, London, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC Centre for Environment and Health, Imperial College London, London, UK.,Northumbria Healthcare NHS Foundation Trust, London, UK.,Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Eszter P Vamos
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
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Abstract
Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children's health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right's issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known: • Tobacco exposure is associated with a range of adverse health effects among babies and children. • Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New: • Protecting the rights and health of children provides a strong starting point for tobacco control advocacy. • The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.
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Affiliation(s)
- Jasper V Been
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Aikaterini Tsampi
- Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, Groningen, Netherlands
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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50
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Pitcairn CFM, Laverty AA, Chan JJL, Oyebode O, Mrejen M, Pescarini JM, Machado DB, Hone TV. Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis. Epidemiol Psychiatr Sci 2021; 30:e66. [PMID: 34670640 PMCID: PMC8546499 DOI: 10.1017/s204579602100055x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations. METHODS Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression. RESULTS Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes. CONCLUSIONS Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.
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Affiliation(s)
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | | | - Matías Mrejen
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Julia M. Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas V. Hone
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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