Substance use behaviours and the UK furlough scheme: evidence from eight longitudinal population surveys

Disruptions to economic activity such as job loss can impact substance use behaviours. During the COVID-19 pandemic many countries implemented a furlough scheme to prevent job loss. We examine how furlough was associated with respondents' substance use behaviours in the initial stages of the pandemic in the UK. Data were from over 27,000 participants in eight adult longitudinal surveys. Participants self-reported economic activity (furlough or job loss vs stable employment) and smoking (any current), vaping (any current) and drinking alcohol (>4 days/week or 5+ drinks per typical occasion) both before and during the initial stages of the pandemic. Changes in frequency/quantity of substance use were also examined. Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour (though this was excluded in analyses of behaviour change). Findings were synthesised using a random effects meta-analysis. Compared to stable employment, participation in the furlough scheme was associated with smoking (risk ratio: 1.24 [95% CI: 1.08-1.42]; I2=0%) while job loss was associated with vaping (1.72 [1.10-2.71]; I2=25%) and heavier drinking (1.21 [1.02-1.43]; I2=2%), but these associations were largely accounted for by confounders (adjusted risk ratios: smoking: 1.06 [0.96-1.16]; I2=8%; vaping: 1.55 [0.93-2.56]; I2=42%; and drinking: 1.03 [0.89-1.20]; I2=35%). Furlough was associated with drinking more than before the pandemic (adjusted risk ratio: 1.15 [1.00-1.33]; I2=70%), and with increases in vaping behaviour (1.54 [1.14-2.07]; I2=0%). Increased drinking associated with furlough is concerning, while increased vaping likely represents moves to reduce smoking and may be positive.

Mental health inequalities in disruptions across multiple domains during COVID -19: an investigation in 12 population-based longitudinal studies

Disruptions related to the COVID-19 pandemic and its associated virus suppression measures have affected many worldwide but those already suffering from psychological distress may have been especially vulnerable. We investigated associations between pre-pandemic psychological distress and disruptions to healthcare, economic activity, housing, and cumulative disruptions. Data were from 59,482 participants in 12 UK longitudinal adult population surveys with both pre-pandemic and COVID-19 surveys. Participants self-reported disruptions since the start of the pandemic to: healthcare (medication access, procedures, or appointments); economic activity (negative changes in employment, income or working hours); and housing (change of address or household composition). Logistic regression models were used to estimate associations between pre-pandemic standardised psychological distress scores and disruption outcomes. Findings were synthesised using a random effects meta-analysis with restricted maximum likelihood. Approximately one to two thirds of study participants experienced some form of disruption during the pandemic. One standard deviation higher pre-pandemic psychological distress was associated with: increased odds of any healthcare disruption (odds ratio: 1.30 [95% CI: 1.20-1.40]; I2: 65%); increased odds of experiencing any economic disruption (1.11 [1.03-1.16]; I2: 61%); no associations with housing disruptions; and increased likelihood of experiencing a disruption in at least two domains (1.25 [1.18-1.32]; I2: 38%) or one domain (1.11 [1.07-1.16]; I2: 32%) compared to no disruptions. Associations did not differ by sex, ethnicity, education, or age. Individuals suffering from psychological distress pre-pandemic may need additional support to manage stressful life disruptions. Considering mental ill-health was already unequally distributed in the UK population, this may exacerbate existing inequalities related to sex, ethnicity, education and age.

Diet, physical activity, and sleep in relation to furlough during the COVID-19 pandemic in the UK: evidence from eight longitudinal studies

The recent Covid-19 pandemic, and its mitigations, are expected to have long-term consequences on the health and health behaviours. In an effort to reduce the effect of lockdown on the economy, the UK government launched their Coronavirus Job Retention Scheme (commonly known as furlough) in March 2020, which entitled employees who were unable to work to 80% of their monthly pay up to a cap of £2,500. We investigated the association between changes in economic activity and health behaviours of the working-age participants of eight longitudinal studies, during the early stages of the pandemic. Specifically, we investigate the post-pandemic levels, and the pre-to-post pandemic change, in fruit and vegetable consumption, physical activity, and sleeping patterns. We obtained study-specific estimates using modified Poisson regression, adjusting for a comparable set of potential confounders, and combined results in a random-effects meta-analyses. Compared to those who continually worked, furloughed workers were more likely to report an increase in their fruit and vegetable consumption (1.22 [1.04-1.43]; I2 = 52%), and an increase in their physical activity (1.19 [1.04-1.35]; I2 = 73%). However, furlough appears to have a polarizing effect on sleeping patterns (change from 6 - 9 h to outside this range: 1.46 [1.03, 2.08]; I2 = 75%; change from outside of the 6 -9 h to within this range: 1.78 [1.03, 3.07]; I2 = 75%), especially amongst women and those with no higher education degree. This polarization is partially explained by the age of the survey participants, indicating that sleeping patterns of the younger cohorts were more adversely affected. Furlough schemes may be associated with better diet and more physical activity, while inconsistent effects on sleeping patterns may place younger generations at particular risk of atypical sleep.

Health care disruption inequalities during Covid-19: Evidence from eleven longitudinal studies

Like other health systems worldwide, the UK, the National Health Service (NHS) has faced major disruptions due to high Covid-19 burden and repeated lockdown measures. These disruptions can have both short and long-term health impacts. The NHS provides free healthcare and prioritises equity of delivery, but despite this, inequalities in access to health care remain and it is plausible that pandemic-related disruptions affect different groups disproportionally, thus widening health inequalities. This paper investigates associations between well-established axes of health inequality (sex, age, social class, education and ethnicity) and self-reported health care disruptions (medication access, procedures, or appointments) in over 65,000 participants across eleven longitudinal studies in the UK. Participants reported disruptions from March 2020 through to as late as January 2021. We obtained study-specific estimates using logistic regression models and combined them in a random-effects meta-analysis. Analyses were adjusted for sex, age and ethnicity where relevant. Between 10.1% (Millennium Cohort Study) and 31.8 % (Understanding Society) of study participants reported experiencing health care disruptions. Results show that females (OR: 1.27 [95%CI: 1.15,1.4]; I2=56%), older participants (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and non-white ethnic minorities (OR: 1.17 [1.02,1.34]; I2=0% vs white) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.18 [1.08, 1.21]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed for education. Our findings highlight inequities in healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.

Psychosexual distress following routine primary human papillomavirus testing: a longitudinal evaluation within the English Cervical Screening Programme

OBJECTIVE

To assess psychosexual distress over a 12-month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot.

DESIGN

Longitudinal, between-group study.

SETTING

Five sites in England where primary HPV testing was piloted.

POPULATION

Women aged 24-65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme.

METHODS

Women were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test.

MAIN OUTCOME MEASURES

Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q).

RESULTS

At all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1-5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96-1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78-1.27) and persistent HPV (B = 0.90, 95% CI 0.70-1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller.

CONCLUSIONS

Our findings suggest receiving an HPV-positive result can cause psychosexual distress, particularly in the short-term. Developing interventions to minimise the psychosexual burden of testing HPV-positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening.

TWEETABLE ABSTRACT

Receiving an HPV-positive result following primary HPV testing can cause psychosexual distress, particularly in the short-term.

Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

Background

Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults.

Methods

Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs.

Results

The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications.

Conclusions

The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.