Urban Areas Of England Research Articles

Associations between urban metrics and mortality rates in England.

BackgroundSeventy-five percent of the population in Europe live in urban areas and analysing the effects of urban form on the health of the urban population is of great public health interest. Not much is known, however, on the effects of urban form on the health of city dwellers. This study uses a novel approach to investigate whether associations exist between different measures of urban form and mortality risks in cities in England.MethodsWe conducted an ecological, cross-sectional study for urban areas in England with more than 100,000 residents (n = 50) and included all registered premature deaths (<65 years) between 1st January 2002 and 31st December 2009. To describe and categorise urban form we quantified the distribution and density of population, land cover and transport networks and measures of geographical characteristics. We used Poisson regression models to examine associations between the measures of urban form and age-standardised risks of deaths from all causes, cardiovascular disease, and traffic accidents after adjustment for socioeconomic status and smoking. Analysis was stratified by gender to explore differential associations between females and males.ResultsThere were a total of 200,200 premature deaths during the study period (Females: 37 %; Males: 63 %). Transport network patterns were associated with overall and cardiovascular mortality rates in cities. We saw 12 % higher mortality risk after adjustment in cities with high junction density compared to cities with low density [Females: RR 1.12 (95 % CI 1.10 – 1.15); Males: RR 1.12 (95 % CI 1.10–1.14)]; the risk was slightly higher for cardiovascular mortality [Females: RR 1.16 (95 % CI 1.10 – 1.22); Males: RR 1.12 (95 % CI 1.09 – 1.16)]. Associations between mortality and population patterns were of similar magnitude [Females: RR 1.10 (95 % CI 1.09 – 1.13); Males: RR 1.09 (95 % CI 1.07–1.10)]; associations between mortality and land cover patterns were inconclusive.ConclusionsWe found an association between transport patterns and risk of premature mortality. Associations between urban form and mortality observed in this study suggest that characteristics of city structure might have negative effects on the overall health of urban communities. Future urban planning and regeneration strategies can benefit from such knowledge to promote a healthy living environment for an increasing urban population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0106-3) contains supplementary material, which is available to authorized users.

Is supplementary feeding in gardens a driver of evolutionary change in a migratory bird species?

Human activities are causing rapid environmental change at a global scale. Urbanization is responsible for some of the most extreme human-altered habitats and is a known driver of evolutionary change, but evidence and understanding of these processes is limited. Here, we investigate the potential underlying mechanisms contributing to the contemporary evolution of migration behaviour in the Eurasian blackcap (Sylvia atricapilla). Blackcaps from central Europe have been wintering in urban areas of Britain with increasing frequency over the past 60years, rather than migrating south to the Mediterranean. It has been hypothesized that the popularization of providing supplementary foods for wild birds within Britain may have influenced this marked migratory change, but quantifying the selective forces shaping evolutionary changes remains challenging. Using a long-term national scale data set, we examine both the spatial distribution and interannual variation in blackcap wintering behaviour in Britain in relation to supplementary food availability and local climate. Over a 12-year period, we show that blackcaps are becoming increasingly associated with the provision of supplementary foods in British gardens, and that the reliability of bird food supplies is influencing their winter distribution at a national scale. In addition, local climatic temperatures and broader scale weather variation are also important determinants of blackcap wintering patterns once they arrive in Britain. Based on our findings, we conclude that a synergistic effect of increased availability of feeding resources, in the form of garden bird food, coupled with climatic amelioration, has enabled a successful new wintering population to become established in Britain. As global biodiversity is threatened by human-induced environmental change, this study presents new and timely evidence of the role human activities can play in shaping evolutionary trajectories.

Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study

ObjectivesIn England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process. MethodsA documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n=20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories. ResultsThe commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners’ dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven. DiscussionGovernment policy emphasises the importance of clinical leadership and ‘evidence’ in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care.

Going into the groin: Injection into the femoral vein among people who inject drugs in three urban areas of England

BackgroundThere have been increasing concerns about injection into the femoral vein – groin injecting – among people who inject drugs in a number of countries, though most studies have been small. The extent, reasons and harms associated with groin injecting are examined. MethodParticipants were recruited using respondent driven sampling (2006–2009). Weighted data was examined using bivariate analyses and logistic regression. ResultsThe mean age was 32 years; 25% were women (N=855). During the preceding 28 days, 94% had injected heroin and 13% shared needles/syringes. Overall, 53% reported ever groin injecting, with 9.8% first doing so at the same age as starting to inject. Common reasons given for groin injecting included: “Can’t get a vein elsewhere” (68%); “It is discreet” (18%); and “It is quicker” (14%). During the preceding 28 days, 41% had groin injected, for 77% this was the only body area used (for these “It is discreet” was more frequently given as a reason). In the multivariable analysis, groin injection was associated with: swabbing injection sites; saving filters for reuse; and receiving opiate substitution therapy. It was less common among those injecting into two body areas, and when other people (rather than services) were the main source of needles. Groin injection was more common among those with hepatitis C and reporting ever having deep vein thrombosis or septicaemia. ConclusionsGroin injection was common, often due to poor vascular access, but for some it was out of choice. Interventions are required to reduce injecting risk and this practice.

Factors that influence the way communities respond to proposals for major changes to local emergency services: a qualitative study.

ObjectiveAccording to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions.DesignCross-sectional study involving in-depth interviews. Participants selected their priorities for emergency care, including aspects they might be prepared to have ‘less’ of (e.g. rapid access) if it meant having ‘more’ of another (e.g. consultant-delivered care). A thematic analysis was carried out, combining inductive and deductive approaches, drawing on theories about risk perception.SettingTwo urban areas of England; one where changes to emergency services were under consideration (‘Greenville’), and one where they were not (‘Hilltown’).Participants28 participants in total. Greenville interviewees included more common emergency service users - parents of young children (n=5) and older people (n=6) - plus patient representatives and individuals campaigning against service closures (n=9). Hilltown interviewees (n=8) received outpatient care for Chronic Obstructive Pulmonary Disease, an important cause of emergency admission.ResultsMost participants, in both areas, were not willing to accommodate the trade-offs involved in consolidating emergency services, principally because of the belief that timely access is associated with better outcomes. Participants did not consider the proposed improvements as gains worth having; interviewees believed care quality would be adversely impact, partly because increased patient numbers would place staff under greater pressure and result in longer waiting times.ConclusionsVisible clinical leadership and detailed explanation of the case for change were insufficient to overcome opposition to the reconfiguration in Greenville, challenging the assumption that communities can be persuaded by evidence. Commissioners should make explicit credible plans to accommodate changes in patient flows, as well as clarifying the roles played by key staff groups.

Contrasts in active transport behaviour across four countries: How do they translate into public health benefits?

ObjectiveCountries and regions vary substantially in transport related physical activity that people gain from walking and cycling and in how this varies by age and gender. This study aims to quantify the population health impacts of differences between four settings. MethodThe Integrated Transport and Health Model (ITHIM) was used to estimate health impacts from changes to physical activity that would arise if adults in urban areas in England and Wales adopted travel patterns of Switzerland, the Netherlands, and California. The model was parameterised with data from travel surveys from each setting and estimated using Monte Carlo simulation. Two types of scenarios were created, one in which the total travel time budget was assumed to be fixed and one where total travel times varied. ResultsSubstantial population health benefits would accrue if people in England and Wales gained as much transport related physical activity as people in Switzerland or the Netherlands, whilst smaller but still considerable harms would occur if active travel fell to the level seen in California. The benefits from achieving the travel patterns of the high cycling Netherlands or high walking Switzerland were similar. ConclusionDifferences between high income countries in how people travel have important implications for population health.

Targeting educational disadvantage by area: continuity and change in urban areas in England, 1968–2014

Focusing on data and policies from England, trends in educational disadvantage by area are traced from the late 1960s when the first pilot projects were established in the UK, to the present. The origins of these developments and the subsequent rises and falls of such area-based policies in England are reviewed. Specially collected data for the pilot areas from the 1960s and national data for England from 2000 are used to draw out some striking patterns of changes over the period. Though many of the areas remain highly disadvantaged, educational measures at age 16 and at entry to higher education (HE) indicate some important changes. Thus the settled, white working-class pilot area in the 1960s with just below average results had fallen back very substantially by 2013, particularly in entry to HE. By contrast the newly settled Asian immigrant area in Birmingham where educational performance was exceptionally poor in the 1960s had moved above average despite remaining highly disadvantaged. Analysis of the national results since 2000 using local area data showed that these trends were widespread across England. Disadvantaged ‘multicultural urban areas’ were doing markedly better than the disadvantaged white working-class urban areas, where in many cases traditional industries had closed. This was especially marked at entry to HE where multicultural areas had rates close to the national average of 40% while white working-class urban areas had rates of entry to HE of between 10% and 15% of the age group and this gap has widened rapidly in recent years. These trends are likely to be the source of major resentment, with one group finding itself increasingly excluded from higher level employment opportunities, and the other failing to find opportunities that match their expectations once they leave education.

Pollen from alder (Alnus sp.), birch (Betula sp.) and oak (Quercus sp.) in the UK originate from small woodlands

We have analysed the pollen seasons in Worcester for the period 2005–12 for alder (Alnus), birch (Betula) and oak (Quercus) by using back trajectory calculations and produced the first detailed source maps for these three pollen types.The study shows considerable variations in the source–receptor relationship of three of the most important tree pollen types in England with respect to allergy. Long Distance Transport is observed for Quercus and Betula but not for Alnus. The new source maps show a number of high emitting areas for Betula and Quercus, mainly near London, in the Midlands and in Wales. The production of source maps is sensitive to the used type of land cover data and how well they incorporate small woodlands. Two satellite products, Corine Land Cover and Globcover, are compared with the detailed national land cover product Land Cover Map 2007. The broad scale satellite products show either up to 50% less woody coverage or a direct misplacement of woodlands.The Lagrangian back trajectory model, the pollen count observations and the source maps altogether suggest that small woodlands (below 25ha) play a major role in the overall pollen load in urban areas in England.

Intra-class differences in the post-16 educational trajectories of young people from lower socioeconomic groups

This paper draws on research with young people from similar working-class backgrounds in a deprived urban area in England. Although all the participants achieved a high enough attainment level to remain in full-time education beyond compulsory schooling, they each elected to follow different post-16 pathways. Drawing on in-depth interviews with nine young people, the paper focuses on the social and educational lives of these young adults as they reflect on their schooling and the decisions they made regarding their post-16 pathway. The analysis and discussion draws on the concepts of approaches to learning and self-efficacy to support a more nuanced understanding of intra-class differences in the educational experiences of these young people that may have influenced the pathway they followed when they left compulsory schooling. The findings of this research suggest a potential relationship between these concepts, the nature of which may influence educational outcomes and notions around possible post-16 futures.

Mental health commissioning: master or subject of change?

Purpose – The purpose of this paper is to explore change within the commissioning of third sector mental health services in England. Design/methodology/approach – A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation. Findings – Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners’ capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors. Research limitations/implications – The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought. Practical implications – To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes. Originality/value – This research adds to the limited body of empirical work regarding commissioning in mental health.

Changes in the distribution of red foxes (Vulpes vulpes) in urban areas in Great Britain: findings and limitations of a media-driven nationwide survey.

Urbanization is one of the major forms of habitat alteration occurring at the present time. Although this is typically deleterious to biodiversity, some species flourish within these human-modified landscapes, potentially leading to negative and/or positive interactions between people and wildlife. Hence, up-to-date assessment of urban wildlife populations is important for developing appropriate management strategies. Surveying urban wildlife is limited by land partition and private ownership, rendering many common survey techniques difficult. Garnering public involvement is one solution, but this method is constrained by the inherent biases of non-standardised survey effort associated with voluntary participation. We used a television-led media approach to solicit national participation in an online sightings survey to investigate changes in the distribution of urban foxes in Great Britain and to explore relationships between urban features and fox occurrence and sightings density. Our results show that media-based approaches can generate a large national database on the current distribution of a recognisable species. Fox distribution in England and Wales has changed markedly within the last 25 years, with sightings submitted from 91% of urban areas previously predicted to support few or no foxes. Data were highly skewed with 90% of urban areas having <30 fox sightings per 1000 people km−2. The extent of total urban area was the only variable with a significant impact on both fox occurrence and sightings density in urban areas; longitude and percentage of public green urban space were respectively, significantly positively and negatively associated with sightings density only. Latitude, and distance to nearest neighbouring conurbation had no impact on either occurrence or sightings density. Given the limitations associated with this method, further investigations are needed to determine the association between sightings density and actual fox density, and variability of fox density within and between urban areas in Britain.

Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England

People who inject drugs (PWID) are vulnerable to infections and injuries at injection sites. The factors associated with reporting symptoms of these, seeking related advice, and hospital admission are examined. PWID were recruited in Birmingham, Bristol and Leeds using respondent-driven sampling (N = 855). During the preceding year, 48% reported having redness, swelling and tenderness (RST), 19% an abscess, and 10% an open wound at an injection site. Overall, 54% reported ⩾1 symptoms, with 45% of these seeking medical advice (main sources emergency departments and General Practitioners). Advice was often sought ⩾5 days after the symptom first appeared (44% of those seeking advice about an abscess, 45% about an open wound, and 35% for RST); the majority received antibiotics. Overall, 9·5% reported hospital admission during the preceding year. Ever being diagnosed with septicaemia and endocarditis were reported by 8·8% and 2·9%, respectively. Interventions are needed to reduce morbidity, healthcare burden and delays in accessing treatment.

Domestic energy use in England and Wales: a 3D density grid approach

Household energy use is of relevance for studies of sustainability and fuel poverty. Detailed mapping and spatial analysis is possible in the UK due to the release of fine-scale household energy-use data. The cartographical approach used here focuses on urban energy use and the relative performance of urban areas in England and Wales. The energy-use data were transformed to a 1 km2 grid of cells allowing consistent comparisons to be made between urban areas at the same zonal scale. Additionally cells were extruded according to population density, highlighting basic relationships between density and energy use. The urban perspective on energy use is important due to the strong influence of the built environment in determining energy efficiency, and furthermore due to the clustering of affluent and deprived social groups in cities. The results of the mapping highlight how the lowest and the highest energy-use districts are located within the same city-regions, and how further variations in energy use relate to housing density and energy-efficiency behaviours.

Back-trajectories show export of airborne fungal spores (Ganoderma sp.) from forests to agricultural and urban areas in England

We propose here the hypothesis that all of United Kingdom (UK) is likely to be affected by Ganoderma sp. spores, an important plant pathogen. We suggest that the main sources of this pathogen, which acts as a bioaerosol, are the widely scattered woodlands in the country, although remote sources must not be neglected. The hypothesis is based on related studies on bioaerosols and supported by new observations from a non-forest site and model calculations to support our hypothesis.Hourly concentrations of Ganoderma sp. spores were measured from 2006 to 2010 using a 7-day volumetric spore trap at the city of Worcester. The concentrations peak during the night and early in the morning. This suggests that the main spore sources are located a few hours away with respect to air masses transport and reach urban areas thanks to air masses transport.The back-trajectory analysis was applied to determine the location of Ganoderma sp. spore sources. The analysis of back-trajectories demonstrated that 78% of the air masses reached Worcester from a 180° arc direction from the East to West. Three episodes were selected for detailed investigation and they revealed that during the episodes air masses always passed main UK woodlands before the arrival in Worcester, independently of their origin, but the long distance transport under certain conditions might be possible.Our studies suggest that the sources of UK Ganoderma sp. spores are mainly to be found in UK. Hence our studies suggest that research and mitigation strategies in UK should give their main attention to national sources, without neglecting the contribution from long distance transport.

‘A big night out’: Young people’s drinking, social practice and spatial experience in the ‘liminoid’ zones of English night-time cities

This paper frames the debate on ‘binge’ drinking amongst young people within the perspectives of materialism and cultural geography. Drawing on the concept of social practice as interpreted through the perspective of urban design, the research investigated spatial variations in youth drinking using a case study approach to examine two urban areas in England. The study confirmed that the social practice of the ‘big night out’ has become an established feature of youth drinking. The research found the practice constituted in specialist ‘clusters’ of venues and it is argued that place-based characteristics form a significant component of its production and experience. The paper concludes with a reflection on the challenges the evidence poses to previous interpretations of leisure divisions within mainstream nightlife and to the theorisation of place-based differences in drinking milieux oriented towards young people. The implications for public policies are considered.

The importance of identity and empowerment to teenagers with developmental co‐ordination disorder

The aim of the current study was to gain an understanding of the experiences and aspirations of young people living with Developmental Coordination Disorder (DCD) in their own words. Eleven young people aged 11-16 years with a prior diagnosis of DCD were identified from child health records of two participating NHS trusts. The sample included seven boys and four girls, from different socio-economic backgrounds living in different parts of one large urban area in England. In depth one-to-one semi-structured interviews and subsequent follow-up small group interviews were carried out with the young people. Interviews were enhanced using participatory arts-based techniques. All interviews were recorded verbatim and transcribed. Narrative data were analysed using Lindseth's interpretive phenomenology. The central theme of 'We're all different' described how the young person saw themselves and encompassed the formation of identity. Subthemes illustrated the attitude of the young people to their day to day lives, their difficulties and strategies used by the young people to overcome these difficulties in school and at home. The attitude of the school to difference, the presence of bullying, the accepting nature of the class, teachers and peers were vitally important. Areas of life that encouraged a positive sense of identity and worth included being part of a social network that gave the young people a sense of belonging, potentially one that valued differences as well as similarities. The current work highlights the need for services to adopt a model of DCD where the young person talks about what they can do and considers strategies of overcoming their difficulties. This has implications for education and future intervention strategies that focus on fostering psychological resilience and educational coping strategies rather than simply attempting to improve motor skills.

Labour migration, communities and perceptions of social cohesion in England

The unexpected scale of labour migration from eastern Europe to the UK following EU enlargement in 2004 was thought to pose a threat to the cohesiveness of those local communities hosting larger influxes of migrants. Nevertheless, areas rich in community capacity may have been able to incorporate migrant workers in ways that sustained social cohesion. This paper explores the effects of labour migration on residents’ perceptions of social cohesion in urban areas in England using multivariate statistical techniques. The statistical results suggest that post-enlargement migration weakened social cohesion, but that the prospects of social incorporation were better in areas with stronger community capacity. Theoretical and practical implications of the findings are discussed.

Developing a nutrition intervention in children's centres: exploring views of parents in rural/urban settings in the UK.

The present study explored parents’ requirements for healthy eating support prior to the development of a tailored intervention. A cross-sectional study of parents attending children’s centres. Children’s centres in Cornwall (rural south-west England) and Islington (urban London borough). A total of 261 parents (94.2% female) of pre-school children (aged 2–5 years) completed a questionnaire on factors influencing food choice, and preferences for and views on healthy eating support. Parents reported that health, taste, freshness and quality were the most important factors influencing their food choices for their pre-school children. The importance of individual factors varied according to level of educational attainment. Over a third (38 %) of parents said they wanted more advice on healthy eating for children. Less educated parents showed the greatest interest in learning more about several aspects: what a ‘healthy diet’ means, how to prepare and cook healthy food, how to understand food labels, budgeting for food, examples of healthy food and snacks for children, appropriate portion sizes for children and ways to encourage children to eat well. There was demand for healthy eating support among parents of pre-school children, especially those who are less educated, in one rural and one urban area of England

Household Factors Influencing Participation in Bird Feeding Activity: A National Scale Analysis

Ameliorating pressures on the ecological condition of the wider landscape outside of protected areas is a key focus of conservation initiatives in the developed world. In highly urbanized nations, domestic gardens can play a significant role in maintaining biodiversity and facilitating human-wildlife interactions, which benefit personal and societal health and well-being. The extent to which sociodemographic and socioeconomic factors are associated with engagement in wildlife gardening activities remain largely unresolved. Using two household-level survey datasets gathered from across Britain, we determine whether and how the socioeconomic background of a household influences participation in food provision for wild birds, the most popular and widespread form of human-wildlife interaction. A majority of households feed birds (64% across rural and urban areas in England, and 53% within five British study cities). House type, household size and the age of the head of the household were all important predictors of bird feeding, whereas gross annual household income, the occupation of the head of the household, and whether the house is owned or rented were not. In both surveys, the prevalence of bird feeding rose as house type became more detached and as the age of the head of the household increased. A clear, consistent pattern between households of varying size was less evident. When regularity of food provision was examined in the study cities, just 29% of households provided food at least once a week. The proportion of households regularly feeding birds was positively related to the age of the head of the household, but declined with gross annual income. As concerns grow about the lack of engagement between people and the natural environment, such findings are important if conservation organizations are successfully to promote public participation in wildlife gardening specifically and environmentally beneficial behaviour in society more generally.

Psychosocial routes from housing investment to health: Evidence from England's home energy efficiency scheme

Over the past decade the Warm Front Scheme has been the English Government's principal programme for improving domestic energy efficiency and reducing fuel poverty. This paper reports on a cross-sectional survey of low income householders participating in the Warm Front Scheme in five urban areas of England. Surveys were conducted of 2685 individuals, before and or after intervention. Pathways to self reported health were modelled by logistic regression. Of all the dimensions of health examined, only self reported mental health is directly associated with Warm Front measures. Intermediary variables associated with Warm Front intervention were shown to be significantly correlated with more dimensions of self reported health status. Higher temperatures, satisfaction with the heating system, greater thermal comfort, reductions in fuel poverty and lower stress were significantly correlated with improved health. Alleviating fuel poverty and reducing stress appeared to be the main route to health. We conclude there are complex and indirect relationships linking energy efficiency measures to outcomes on all dimensions of health which contribute to significant material and psychosocial benefits. The impact of the Warm Front Scheme cannot be fully understood by a limited analysis which merely relates indoor temperature and property characteristics to physiological health outcomes.