Public Health Sciences Unit Research Articles

Home-based cardiac rehabilitation and health-related quality of life in people with heart failure: the SCOT:REACH-HF study

British Journal of Cardiac NursingVol. 18, No. 5 Short ReportHome-based cardiac rehabilitation and health-related quality of life in people with heart failure: the SCOT:REACH-HF studyRod S Taylor, Carrie PurcellRod S TaylorCorrespondence to: Rod S Taylor; ???MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UKSearch for more papers by this author, Carrie PurcellFaculty of Wellbeing, Education and Language Studies, Open University, Edinburgh, UKSearch for more papers by this authorRod S Taylor; Carrie PurcellPublished Online:31 May 2023AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Dalal HM, Taylor RS, Jolly K et al. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. Eur J Prev Cardiol. 2019;26:262-272. https://doi.org/10.1177/2047487318806358 Crossref, Google ScholarDalal HM, Doherty P, McDonagh ST et al. Virtual and in-person cardiac rehabilitation. Br Med J. 2021;3;373:n1270. https://doi.org/10.1136/bmj.n1270 Google ScholarGhisi GLM, Taylor RS, Seron P et al. Factors hindering cardiac rehabilitation in low-and middleincome countries, by level and setting. J Cardiopulm Rehabil Prev. 2023;43(2):143-144. https://doi.org/10.1097/HCR.0000000000000774 Google ScholarPurcell C, Purvis A, Cleland JGF et al. Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study). Eur J Cardiovasc Nurs. 2023;zvad004. https://doi.org/10.1093/eurjcn/zvad004 Google ScholarTaylor RS, Sadler S, Dalal HM et al. The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. Eur J Prev Cardiol. 2019;26(12):1252-1261. https://doi.org/10.1177/2047487319833507 Google ScholarTurk-Adawi K, Supervia M, Lopez-Jimenez F et al. Cardiac rehabilitation availability and density around the globe. EClinicalMedicine 2019;13:31-45. https://doi.org/10.1016/j.eclinm.2019.06.007 Google Scholar FiguresReferencesRelatedDetails 2 May 2023Volume 18Issue 5ISSN (online): 2052-2207 Metrics History Published online 31 May 2023 Published in print 2 May 2023 Information© MA Healthcare LimitedPDF download

Initial impacts of the COVID-19 pandemic on sexual and reproductive health service use and unmet need in Britain: findings from a quasi-representative survey (Natsal-COVID)

SummaryBackgroundThe COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. We aimed to determine the proportion of participants reporting sexual risk behaviours, SRH service use and unmet need, and to assess remote sexually transmitted infection (STI) testing service use after the first national lockdown in Britain.MethodsWe used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)-COVID cross-sectional, quasi-representative web survey (Natsal-COVID Wave 1). Adults aged 18–59 years who resided in England, Scotland, or Wales completed the survey between July 29 and Aug 10, 2020, which included questions about the approximate 4-month period after announcement of the initial lockdown in Britain (March 23, 2020). Quota-based sampling and weighting were used to achieve a quasi-representative population sample. Participants aged 45–59 years were excluded from services analysis due to low rates of SRH service use. Among individuals aged 18–44 years, we estimated reported SRH service use and inability to access, and calculated age-adjusted odds ratios (aORs) among sexually experienced individuals (those reporting any sexual partner in their lifetime) and sexually active individuals (those reporting any sexual partner in the past year). Unweighted denominators and weighted estimates are presented hereafter.Findings6654 individuals had complete interviews and were included in the analysis. Among 3758 participants aged 18–44 years, 82·0% reported being sexually experienced, and 73·7% reported being sexually active. 20·8% of sexually experienced participants aged 18–44 years reported using SRH services in the 4-month period. Overall, 9·7% of 3108 participants (9·5% of men; 9·9% of women) reported being unable to use a service they needed, although of the participants who reported trying but not being able to use a SRH service at least once, 76·4% of participants also reported an instance of successful use. 5·9% of 1221 sexually active men and 3·6% of 1560 sexually active women reported use of STI-related services and 14·8% of 1728 sexually experienced women reported use of contraceptive services, with SRH service use highest among individuals aged 18–24 years. Sexually active participants reporting condomless sex with new partners since lockdown were much more likely to report using STI-related services than those who did not report condomless sex (aOR 23·8 [95% CI 11·6–48·9]) for men, 10·5 [3·9–28·2] for women) and, among men, were also more likely to have an unsuccessful attempt at STI-service use (aOR 13·3 [5·3–32·9]). Among 106 individuals who reported using STI testing services, 64·4% accessed services remotely (telephone, video, or online). Among 2581 women aged 25–59 years, 2·4% reported cervical screening compared with an estimated 6% in a comparable 4-month period before the pandemic.InterpretationMany people accessed SRH care during the initial lockdown; however, young people and those reporting sexual risk behaviours reported difficulties in accessing services and thus such services might need to address a backlog of need.FundingWellcome Trust, The Economic and Social Research Council, The National Institute for Health Research, Medical Research Council/Chief Scientist Office and Public Health Sciences Unit, and UCL Coronavirus Response Fund.

Measuring the impact of COVID-19 on sexual and reproductive health in the UK: web-panel surveys with qualitative follow-up

BackgroundThe UK's National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been done every 10 years since 1990, and provide a key data source to underpin sexual and reproductive health policy. The COVID-19 pandemic disrupted many lifestyle aspects, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard, in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the effect of COVID-19 on the nation's sexual and reproductive health. MethodsData were collected over 4 months (survey wave one; July 29 to Aug 10, 2020) and 1 year (wave two; March 27 to April 26, 2021) after the announcement of the UK's first lockdown (March 23, 2020). Data were collected online via web-panel surveys administered by Ipsos MORI. Eligible participants were UK residents aged 18–59 years, and the samples included a boost of those aged 18–29 years. Questions covered participants' sexual behaviour, relationships, and sexual and reproductive health service use. Quotas and weighting were used to achieve a quasi-representative sample of the UK general population. Participants meeting criteria of interest and agreeing to be recontacted were selected for qualitative follow-up interviews over the months of October and November, 2020. Comparisons were made with contemporaneous national probability surveys (2019 Annual Population Survey and 2018 Health Survey for England) and Natsal-3 (2010–12) to understand bias in sociodemographic characteristics, general health, and sexual behaviours. We obtained ethical approval from the ethics committees of the University of Glasgow College of Medical, Veterinary & Life Sciences College (reference 20019174) and the London School of Hygiene & Tropical Medicine Research (reference 22565). Findings6654 participants completed wave one of the study, of which 45 (0·7%) completed qualitative interviews. A further 6658 participants completed wave two, of which 2098 (31·5%) were wave one participants. Compared with probability surveys, the weighted Natsal-COVID participants were more educated, less sexually experienced, and in poorer health. In wave one, we found that 20·8% of respondents (95% CI 19·3–22·3%) reported using sexual and reproductive health services in the first 4 months of lockdown, whereas 9·7% (8·6–10·8%) reported difficulty accessing services. Wave two allowed for the generation of 1-year estimates, including of chlamydia testing (5·4% [4·7–6·2%]), HIV testing (7·2% [6·4–8·1%]), and cervical cancer screening (10·3% [9·2–11·6%]). Qualitative interviews suggested that participants often required repeated attempts to access sexual and reproductive health services. InterpretationNatsal-COVID rapidly collected quasi-representative population data to evaluate the population-level effect of COVID-19 and lockdown measures on sexual and reproductive health in the UK and to inform sexual and reproductive health policy. Although less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022). FundingNatsal is a collaboration between University College London (UK), the London School of Hygiene & Tropical Medicine (UK), the University of Glasgow (UK), Örebro University Hospital (Sweden), and NatCen Social Research (UK). The Natsal Resource, which is supported by the Wellcome Trust (via grant number 212931/Z/18/Z), with contributions from the UK's Economic and Social Research Council and National Institute for Health Research, supports the Natsal-COVID study through funding from the University College London COVID-19 Rapid Response Fund and the MRC/CSO Social and Public Health Sciences Unit (Core funding, grant numbers MC_UU_00022/3 and SPHSU18). The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Long term outcomes following critical care hospital admission: A prospective cohort study of UK biobank participants✰,★.

BackgroundThis study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. A secondary aim was to examine the interrelationship between emotional, physical, and social problems during recovery.MethodsWe utilised data from the UK Biobank, an on-going, prospective population-based cohort study. We employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital (first admission to hospital available) without critical care. Structural equation modelling was used to analyse emotional, physical and social outcomes following critical illness and the relationships between these health domains.FindingsData from 1,618 patients were analysed. The median time to follow-up in the critical care cohort was 4427 days (IQR:788–6146) vs 4516 days (IQR: 811–6369) in the non-critical care, hospitalised cohort. Across the two time periods assessed (pre and post 2000), patients exposed to critical care were more likely to experience mental health issues such as depression (p < 0.01) and social isolation (p = 0.01) following discharge from hospital. The critical care cohort were also more likely to have social problems such as the requirement for government funded welfare support (p = 0.02). In the critical care cohort, social and emotional health were closely correlated (p < 0.001, 95% CI:0.33–0.54). The nature of physical problems changed over time; pre-2000 there was a significant difference between the critical and non-critical care in physical outcomes following discharge from hospital, however, there was no difference detected between the two cohorts post-2000.InterpretationThis cohort study has demonstrated that survivors of critical illness have different psycho-social outcomes to matched patients, hospitalised without a critical care encounter.FundingJM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019–02–16). AHL is part of the Social and Public Health Sciences Unit, funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).

How Public Health Crises Expose Systemic, Day-to-Day Health Inequalities in Low- and-Middle Income Countries - An Example From East Africa

Background: The Coronavirus disease pandemic reveals political and structural inequities of the world’s poorest people who have little or no access to health care and with the largest burdens of poor health. This is in parallel to a more persistent but global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. Methods: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. Findings: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. Interpretation: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in ‘normal’ circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges. Funding Statement: This research was funded by the Antimicrobial Resistance Cross-Council Initiative through a grant from the Medical Research Council, a Council of UK Research and Innovation and the National Institute for Health Research (MRC/AMR/ MR/S004815/1). Hilton’s time was also funded by a core grant for the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit (MC_UU_12017/14; SPHSU14; MC_UU_12017/15; SPHSU15). This publication was supported by the University of Edinburgh and the University of Glasgow Jointly Funded PhD studentships (Loosli).Declaration of Interests: There are no conflicts of interests between the authors and/or institutions.Ethics Approval Statement: The study received approval from the Kilimanjaro Christian Medical University College Ethics Review committee with certificate n. 2408 and the Catholic University Health and Allied Sciences committee with certificate n. CREC/318/2018; National Institute for Medical Research (NIMR), Tanzania, with Reference Number NIMR/HQ/R.8a/Vol. IX/3017; Tanzanian Commission for Science and Technology (Davis, permit n. 2020-335-NA-2019-205; Lembo, permit n. 2020-333-NA-2019-205; Laurie, permit n. 2020-332-NA-2019-205; Mutua, permit n. 2020-334-NA-2019-205; Nthambi, permit n. 2020-336-NA-2019-205; Matthews, permit n. 2019-482-NA-2019-205; and Hilton, permit n.2019-476-NA-2019-205); and College of Medical Veterinary and Life Sciences ethics committee at the University of Glasgow (project application number 200180046). Permission for research in communities was obtained from relevant local and district authorities. All participants were explained study objectives and written and/or verbal informed consent was obtained. Verbal consent was utilised instead of written consent with participants who were unable to write. Informed consent forms and participant information sheets were approved by all ethics panels.

Readers’ comments of UK online news media about the Zika virus: a qualitative content analysis

BackgroundIn 2016, Zika virus disease became a global viral public health threat. Although the Zika virus predominantly affected low-income and middle-income countries, WHO's zika communications strategy also targeted non-endemic countries where residents might travel to endemic areas. A key source of public information was online news media. Online articles often feature user-generated content from readers responding to journalists’ news articles. This study aimed to understand how readers’ comments add to and alter media representations of emerging viral threats. MethodsQualitative content analysis of 3218 online readers’ comments on 27 UK news media stories about the Zika virus, drawn from four online publication websites (Daily Mail, Independent, Guardian, and Buzzfeed). Data were analysed thematically using NVivo 12 software. Analysis explored commenters’ use of evidence sources, framing and narratives in comparison to the content of the news media being commented on. FindingsResults suggest that although readers engage with article content and framings, they also use and share alternative evidence sources; and frame the problem of Zika virus disease, its causal factors, and appropriate solutions differently to journalists’ news articles. The presence and content of comments varies between publications, changing the public health messages different audiences receive. InterpretationReaders of online news articles who also read comment sections are likely to engage with alternative ideas about disease genesis, risk, and appropriate mitigating actions. This behaviour might expose readers to risk even in the face of responsible journalism. This result is further complicated in the case of emerging threats in which scientific uncertainty is highlighted. Solutions to address potentially damaging user comments, through resource-intensive active moderation or comprehensive restriction of user comments, is part of a wider challenge facing online platforms and requires additional research and debate. A strength of this study is its in-depth manual analysis; a potential weakness is the small sample size of articles. FundingAN, CP, and SH were funded by the Informing Healthy Public Policy programme (MC_UU_12017-15 and SPHSU15) of the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. The funding bodies had no role in the design, collection, analysis, or interpretation of this study.

Re. Sensitivity Analyses Without Assumptions.

To the Editor: Ding and VanderWeele’s article on sensitivity analysis for uncontrolled confounding published in this journal was a major step forward for quantitative bias analysis.1 Given an observed effect estimate, the authors define a bound (B) for the impact of uncontrolled confounding. We make the observation that, while not equivalent in terms of subject matter, there is a simple algebraic equivalence between the calculations of B and the familiar epidemiologic measure of population attributable fraction (PAF), which measures “the fraction of all cases of a disease or other adverse condition in a population that is attributable to a specific exposure.”2 As B is a relative risk (RR) and PAF an absolute proportion (P) we use the association between these measures (assuming RR ≥ 1; if RR < 1 the inverse can be used). B is calculated using: where RReu is the relative relationship between the exposure and uncontrolled confounding and RRud is the relative relationship between unobserved confounding and the outcome.1 PAF is calculated as:2,3 where RRE, is the risk of disease in the exposed relative to the risk in those unexposed and PT is the proportion of those with the disease who are exposed. Given (2) and (4a) can be rewritten as: where RPT is the total number (or total proportion) of cases relative to the number (or proportion) of cases in the nonexposed. Substituting RReu for RPT and RRud for RRE (or vice versa), (4b) can be used to calculate the “attributable proportion (4) of B (APB),” which can, in turn, be used to calculate B using (1). Similarly, (3) can be used to calculate a relative PAF for conversion to the absolute PAF using (2). To illustrate we use hypothetical data where the 1-year risk of lung cancer among smokers is 39/30,000 = 0.0013 and among nonsmokers is 6/60,000 = 0.0001.4 These data give RRE = 13 and RPT, the ratio of total to nonexposed cases, 45/6 = 7.5. Using (4b) gives a relative PAF of five, which corresponds to an absolute PAF of (5-1)/5 = 0.8 or 80%. Setting RPeu = 13 and RRud = 7.5 in (3) gives the same result. So 80% of lung cancer in this population is due to smoking. Equivalently, on a relative scale, the lung cancer risk in this population is five times greater compared to one where no one smokes. The same values can also be applied to the uncontrolled confounding paradigm. For a known exposure-outcome association consider an unobserved confounding factor that has an association with the outcome of 13 (RRud) and is 7.5 times more common in those with the exposure of interest (RReu). Using (3), B = 5. B is a measure of the impact of uncontrolled confounding, so dividing the observed exposure-outcome RR by B gives an estimate of the association after adjustment for the unmeasured confounder. Equivalently, the “attributable fraction of B,” from (4b), gives the same result as an 80% relative reduction. Although this equivalence is of interest algebraically, there may also be practical implications. The E-value is the minimum value of both RReu and RRud (assuming they are equal) required to reduce an observed RR to exactly one.5 Importantly, the E-value is calculated just from RR: For example, for an observed RR of three to be completely explained by confounding would require both RReu and RRud to be at least 5.45, which, in many circumstances, is unlikely. Similarly, in PAF terms, for a known population risk of disease relative to those unexposed to a risk factor, (5) could be used to calculate the minimum values of RPT and RRE needed for the exposure to completely explain the excess of disease in the population and, therefore, the potential impact on population health of removing or eliminating the exposure. Frank Popham and Elise WhitleyMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland

Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study

Background Rising levels of obesity require interventions that support people in long-term weight loss. The Football Fans in Training (FFIT) programme uses loyalty to football teams to engage men in weight loss. In 2011/12, a randomised controlled trial (RCT) found that the FFIT programme was effective in helping men lose weight up to 12 months. Objectives To investigate the long-term weight, and other physical, behavioural and psychological outcomes up to 3.5 years after the start of the RCT; the predictors, mediators and men’s qualitative experiences of long-term weight loss; cost-effectiveness; and the potential for long-term follow-up via men’s medical records. Design A mixed-methods, longitudinal cohort study. Setting Thirteen professional Scottish football clubs from the RCT and 16 additional Scottish football clubs that delivered the FFIT programme in 2015/16. Participants A total of 665 men who were aged 35–65 years at the RCT baseline measures and who consented to follow-up after the RCT (intervention group, n = 316; comparison group, n = 349), and 511 men who took part in the 2015/16 deliveries of the FFIT programme. Interventions None as part of this study. Main outcome measures Objectively measured weight change from the RCT baseline to 3.5 years. Results In total, 488 out of 665 men (73.4%) attended 3.5-year measurements. Participants in the FFIT follow-up intervention group sustained a mean weight loss from baseline of 2.90 kg [95% confidence interval (CI) 1.78 to 4.02 kg; p &lt; 0.001], and 32.2% (75/233) weighed ≥ 5% less than at baseline. Participants in the FFIT follow-up comparison group (who participated in routine deliveries of the FFIT programme after the RCT) lost a mean of 2.71 kg (95% CI 1.65 to 3.77 kg; p &lt; 0.001), and 31.8% (81/255) achieved ≥ 5% weight loss. Both groups showed long-term improvements in body mass index, waist circumference, percentage body fat, blood pressure, self-reported physical activity (PA) (including walking), the consumption of fatty and sugary foods, fruit and vegetables and alcohol, portion sizes, self-esteem, positive and negative affect, and physical and mental health-related quality of life (HRQoL). Mediators included self-reported PA (including walking) and sitting time, the consumption of fatty and sugary foods and fruit and vegetables, portion sizes, self-esteem, positive affect, physical HRQoL, self-monitoring of weight, autonomous regulation, internal locus of control, perceived competence, and relatedness to other FFIT programme participants and family members. In qualitative interviews, men described continuing to self-monitor weight and PA. Many felt that PA was important for weight control, and walking remained popular; most were still aware of portion sizes and tried to eat fewer snacks. The FFIT programme was associated with an incremental cost-effectiveness of £10,700–15,300 per quality-adjusted life-year (QALY) gained at 3.5 years, and around £2000 per QALY gained in the lifetime analysis. Medical record linkage provided rich information about the clinical health outcomes of the FFIT RCT participants, and 90% of men (459/511) who took part in the 2015/16 FFIT programme gave permission for future linkage. Conclusions Participation in the FFIT programme under both research (during the FFIT RCT) and routine (after the FFIT RCT) delivery conditions led to significant long-term weight loss. Further research should investigate (1) how to design programmes to improve long-term weight loss maintenance, (2) longer-term follow-up of FFIT RCT participants and (3) very long-term follow-up via medical record linkage. Trial registration Current Controlled Trials ISRCTN32677491. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 9. See the NIHR Journals Library website for further project information. The Scottish Executive Health Department Chief Scientist Office (CSO) funded the feasibility pilot that preceded the FFIT RCT (CZG/2/504). The Medical Research Council (MRC) funded Kate Hunt and additional developmental research through the MRC/CSO Social and Public Health Sciences Unit Gender and Health programme (5TK50/25605200-68094).

The relationship between big food corporations and professional sports clubs: a scoping review

BackgroundProfessional sport occupies a prominent place in cultures across the globe. Commercial organisations often use this prominence as a vehicle to promote their brands and products. There are increasing concerns about the growing number of people who are overweight and obese and the contributory role that marketing of processed food and drink plays. We therefore undertook a scoping review to explore the relationship between professional sports clubs and food and drink marketing. MethodsWe searched six databases (CINALH Plus, MEDLINE, PsycINFO, PubMed, SPORTDiscus, and Web of Science) from database start dates to March 27–31, 2017, using Boolean operators and search terms around professional sports clubs, marketing, food and drink, and health impacts (appendix). Experts were also consulted. Only English language publications were included. We excluded mega events (eg, Olympics, football World Cup) because of the attention already given to them. We likewise excluded alcohol marketing and sport, in view of the established literature exploring that relationship. FindingsWe identified 18 166 titles for examination after removing duplicates and 163 abstracts for reviews; and obtained the full text for 26 publications. We included six papers in the review; four were from Australia and New Zealand. The Australasian literature was concerned with the marketing of (unhealthy) food and beverages to children and the potential (negative) impact on eating patterns. Rugby league, Australian football, and cricket were sports that were identified. Single papers from Turkey and the USA explored issues around marketing and professional sports clubs. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed that food and beverage (including alcohol) companies were the most common sponsors. The paper from the USA examined a mixed reaction to a football team named after an energy drink. InterpretationGiven the current focus on how processed food is marketed to children, it is surprising that professional sports clubs have eluded the scrutiny of academic public health in the UK. Our review highlights the lack of public health research in this area. Research that explores the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. FundingUniversity of Glasgow in collaboration with the Medical Research Council's Social and Public Health Sciences Unit.

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

Background Pregnancy and the period around birth are critical for the development and improvement of population health as well as the health of mothers and babies, with outcomes such as birthweight influencing adult health. Objectives We evaluated the clinical effectiveness and cost-effectiveness of the Health in Pregnancy (HiP) grants in Scotland, looking for differential outcomes when the scheme was in place, as well as before its implementation and after its withdrawal. Design The HiP grants were evaluated as a natural experiment using interrupted time series analysis. We had comparison groups of women who delivered before the grants were introduced and after the grants were withdrawn. Setting Scotland, UK. Participants A total of 525,400 singleton births delivered between 24 and 44 weeks in hospitals across Scotland between 1 January 2004 and 31 December 2014. Intervention The HiP grant was a universal, unconditional cash transfer of £190 for women in Great Britain and Northern Ireland reaching 25 weeks of pregnancy if they had sought health advice from a doctor or midwife. The grant was introduced for women with a due date on or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on or after 1 January 2011. The programme was paid for by Her Majesty’s Treasury. Main outcome measures Our primary outcome measure was birthweight. Secondary outcome measures included maternal behaviour, measures of size, measures of stage and birth outcomes. Data sources The data came from the Scottish maternity and neonatal database held by the Information and Services Division at the NHS National Services Scotland. Results There was no statistically significant effect on birthweight, with births during the intervention period being, on average, 2.3 g [95% confidence interval (CI) –1.9 to 6.6 g] lighter than would have been expected had the pre-intervention trend continued. Mean gestational age at booking (i.e. the first antenatal appointment with a health-care professional) decreased by 0.35 weeks (95% CI 0.29 to 0.41 weeks) and the odds of booking before 25 weeks increased by 10% [odds ratio (OR) 1.10, 95% CI 1.02 to 1.18] during the intervention but decreased again post intervention (OR 0.91, 95% CI 0.83 to 1.00). The odds of neonatal death increased by 84% (OR 1.84, 95% CI 1.22 to 2.78) and the odds of having an emergency caesarean section increased by 7% (OR 1.07, 95% CI 1.03 to 1.10) during the intervention period. Conclusions The decrease in the odds of booking before 25 weeks following withdrawal of the intervention makes it likely that the HiP grants influenced maternal health-care-seeking behaviour. It is unclear why neonatal mortality and emergency caesarean section rates increased, but plausible explanations include the effects of the swine flu outbreak in 2009 and the global financial crisis. The study is limited by its non-randomised design. Future research could assess an eligibility threshold for payment earlier than the 25th week of pregnancy. Funding The National Institute for Health Research Public Health Research programme. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).

Right Here Right Now: Developing an understanding of responses to smoking policy developments using online data collection in near to real time

Right Here Right Now: Developing an understanding of responses to smoking policy developments using online data collection in near to real time

7.E. Regular workshop: Corporate portrayals and perceptions in public health debates&lt;subtitle&gt;Organised by: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK&lt;/subtitle&gt;

7.E. Regular workshop: Corporate portrayals and perceptions in public health debates&lt;subtitle&gt;Organised by: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK&lt;/subtitle&gt;

Do regional labour market conditions affect transitions into employment from health-related inactivity? Multilevel analysis of longitudinal UK Labour Force Survey data

BackgroundLong-term worklessness (unemployment or economic inactivity) is associated with adverse health outcomes and inequalities. Recent UK welfare reforms, alongside other return-to-work policies, have aimed to increase employment rates for people who have been out of the labour market because of sickness and disability. However, sickness benefit claimant counts vary substantially by geographical area and are highest in the post-industrial regions with the weakest economies. The aim of this study was to investigate whether local labour market conditions affect transitions from health-related inactivity into employment and compare them with transitions from unemployment to work. MethodsLongitudinal Labour Force Survey datasets were used to follow working age individuals resident in Great Britain over five consecutive quarters. Datasets from 1999–2013 were pooled (quarter 1 health-related inactivity group n=29 130, unemployed group n=14 873). Multilevel logistic regression models (region at level 3, year-within-region at level 2) were constructed with employment at quarter 5 (Q5) as the main outcome measure. Annual male regional employment rates were used as a proxy for local labour market conditions. FindingsTransitions into employment for the health-related inactivity group were rare (1057/29 130 [3·6%] at Q5) compared with the unemployed group (6255/14 873 [42·1%]). Regional variance was significant at baseline (p=0·03), and adding local employment rates as a fixed effect eliminated all observed area-level variability. A 1% increase in local employment rates was associated with an unadjusted odds ratio (OR) of transition to employment for the health-related inactivity group of 1·08 (95% CI 1·05–1·10) and for the unemployed group 1·08 (1·06–1·10). Adjustment for sex, age, education, and long-term health status had little effect (health-related inactivity group adjusted OR 1·07, 1·05–1·10). InterpretationLocal labour market conditions fully account for regional differences in transition rates from health-related inactivity into employment. Higher regional employment rates are associated with increased rates of return to employment, and this association is similar to that for unemployed groups; however, overall rates of transition were low compared with unemployed groups. One limitation of our study is loss to follow-up. Local labour market improvement could potentially increase return-to-work rates for the sick and disabled. Public health advocacy and collaborative action with policy makers in local and national government is needed to address this issue. FundingEC receives funding from the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU1) as part of the Evaluating the Health Effects of Social Interventions programme at the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. AHL receives core funding from the UK Medical Research Council (MC_UU_12017/5) and the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU2) as part of the Measuring Health programme at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. FP receives core funding from the UK Medical Research Council (MC_UU_12017/7) as part of the Social Patterning of Health over the Lifecourse Programme at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

Public Health and Advocacy: Lessons from and for Urban Regeneration

Public Health and Advocacy: Lessons from and for Urban Regeneration

A Handbook of Statistical Analyses UsingSAS(Third Edition)

Updated to reflect SAS 9.2, A Handbook of Statistical Analyses using SAS, Third Edition continues to provide a straightforward description of how to conduct various statistical analyses using SAS. Each chapter shows how to use SAS for a particular type of analysis. The authors cover inference, analysis of variance, regression, generalized linear models, longitudinal data, survival analysis, principal components analysis, factor analysis, cluster analysis, discriminant function analysis, and correspondence analysis. They demonstrate the analyses through real-world examples, including methadone maintenance treatment, the relation of cirrhosis deaths to alcohol consumption, a sociological study of children, heart transplant treatment, and crime rate determinants. With the data sets and SAS code available online, this book remains the go-to resource for learning how to use SAS for many kinds of statistical analysis. It serves as a stepping stone to the wider resources available to SAS users. About the Authors Geoff Der works as a consulting statistician at the Medical Research Council Social and Public Health Sciences Unit in Glasgow, Scotland. His current research interests include the relationship between cognitive functioning and health, income and health, and models for longitudinal data. In 2005, Brian S. Everitt retired from being head of the Department of Biostatistics and Computing in the Institute of Psychiatry at Kings College London, UK. Currently working on his 60th statistics book, he acts as a statistical consultant to a number of companies.

News and Notes

News and Notes

Built Environment: Does Poor Housing Raise Diabetes Risk?

Poor housing may increase the risk of developing diabetes mellitus among middle-aged black Americans, suggests research published in the 15 August 2007 edition of the American Journal of Epidemiology. What exactly causes this link, however, remains to be explained. “Many factors linked with the development of diabetes, such as obesity or the use of alcohol or smoking, are commonly present in the lives of people living in poorer housing,” explains first author Mario Schootman, chief of the Division of Health Behavior Research at Washington University in St. Louis, Missouri. But when his team adjusted for these factors, living in a poorly maintained house remained a significant risk for diabetes in its own right. In contrast, the quality of the neighborhood overall was not associated with increased risk. According to the American Diabetes Association, diabetes already affects some 7% of the U.S. population and 13.3% of non-Hispanic blacks, with 90% of these cases comprising type 2 diabetes. The prevalence of diabetes could double by 2050—even triple among blacks, says Schootman. To better understand why this is so, the environmental context in which individuals live, work, and play needs to be taken into account, but until now no work has focused on the effect of neighborhood and housing conditions, factors that have been associated with other health problems including depression. The researchers interviewed 644 middle-aged subjects enrolled in the African American Health Study who lived in either a poor inner-city area of St. Louis or a less impoverished suburb of the city. At the time of initial interview, no subject declared having been diagnosed with diabetes (the interviewers did not ask specifically about type 1, type 2, or other types of diabetes), although 10.3% went on to develop some form of the problem within three years. During the first interviews the researchers took note of the respondents’ neighborhood and personal housing conditions. Neighborhoods were rated on a four-point scale ranging from excellent to poor depending on the general condition of the houses, the amount of ambient noise, general air quality, the state of repair of the streets, and other factors. Individual respondents’ housing conditions were similarly rated, on the basis of the physical condition of the interior, cleanliness, and the quality of the furnishings. “We then looked for an association between these conditions and the development of diabetes among the study subjects,” explains Schootman, “and found every housing condition rated fair to poor, as well as the overall housing rating, to be associated with around a doubled risk of developing [diabetes].” When the researchers used regression analysis to identify factors that might mediate this association—including household income, level of education, marital status, social support, access to medical care, health behaviors, body mass index, hypertension, number of medications used, and many other possibilities—none was found to be responsible. Hilary Thomson, a research scientist at the Social and Public Health Sciences Unit of the U.K. Medical Research Council, remarks, “The authors have provided a thorough analysis and critique of the data, and it is difficult to think of additional important factors that might be responsible for this association, although it would be interesting to know of any interactions between the pathways. It would also be interesting to know what sort of interventions could be recommended.” “Better housing variable scores, which are associated with a reduced odds ratio for developing diabetes, may identify resilient families who not only work to maintain their homes, but have good diets and exercise regularly,” suggests Philippa Howden-Chapman, program director of the Housing and Health Research Programme at the University of Otago in Wellington, New Zealand. “Also, housing attributes may be important, whether multilevel inner-city apartments or stand-alone suburban houses, in influencing availability of fresh food and places to exercise.” Schootman agrees that the situation is complex. Whether other ethnic groups living in poor housing conditions face the same problem remains to be seen.

Child public health and social welfare: lessons from the evidence

Child: Care, Health and DevelopmentVolume 30, Issue 6 p. 667-669 Child public health and social welfare: lessons from the evidence M. Petticrew, M. Petticrew MRC Social and Public Health Sciences Unit, University of Glasgow, Scotland, andSearch for more papers by this authorH. Roberts, Corresponding Author H. Roberts Child Health Research and Policy Unit, City University, London, UKDr Helen Roberts, Professor of Child Health, Child Health Research and Policy Unit, Institute of Health Sciences, City University, 24 Chiswell Street, London EC1Y 4TY, UK E-mail: h.roberts@city.ac.ukSearch for more papers by this author M. Petticrew, M. Petticrew MRC Social and Public Health Sciences Unit, University of Glasgow, Scotland, andSearch for more papers by this authorH. Roberts, Corresponding Author H. Roberts Child Health Research and Policy Unit, City University, London, UKDr Helen Roberts, Professor of Child Health, Child Health Research and Policy Unit, Institute of Health Sciences, City University, 24 Chiswell Street, London EC1Y 4TY, UK E-mail: h.roberts@city.ac.ukSearch for more papers by this author First published: 04 November 2004 https://doi.org/10.1111/j.1365-2214.2004.00482.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume30, Issue6November 2004Pages 667-669 RelatedInformation