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Background Exposure to cold is known to be associated with severe health impacts. The primary epidemiological evidence for this is the seasonal variation in mortality. However, there is a paucity of directly measured data for personal cold temperature exposure. This paper develops the concept of experienced temperature, and reports how it varies with season, demographics and housing factors. Methods This study uses data from 77 743 UK Biobank participants. A novel method to directly measure participant's exposure to low temperatures using a thermistor in a wrist-worn activity monitor is described. These readings are combined with demographic and housing factor variables in a multiple regression model to understand underlying relationships. Results The study reveals a significant difference in experienced temperature of ~1.8°C between the periods of coldest and hottest external temperature. A number of demographic differences were also observed—such as people of Chinese ethnic background experiencing 0.65°C lower temperatures than other groups. Conclusions This paper presents primary evidence for a seasonal variation in experienced temperature. This variation likely contributes to cold related mortality and morbidity. It is hypothesized that this relationship would be less strong in countries which suffer fewer impacts of cold winter temperatures. [ABSTRACT FROM AUTHOR]

Background This paper presents the results of an exercise to scope the potential of a virtual network to support dissemination, collaboration and innovation among the UK research community on the topic of 'work and health and well-being'. Methods Through a search of the literature and internet searches, a database of 333 individuals and 10 organizations (stakeholders) was developed to whom an online questionnaire was sent. The questionnaire scoped the potential of a virtual network on work and health and well- being. We compared respondents' aspirations for a network with the critical management literature examining the core conditions under which networks work best. Results We identified 1435 papers, published since 2008. In the UK, 333 individuals and 10 organizations were identified as working within the broad topic of Work and Health and Well-being. Of the 110 (a 34% response) responses to our online questionnaire, the majority (80%, n = 88) stated they would be interested in joining a virtual network. Conclusions Respondents indicated a willingness to engage with the network. They had a range of ideas regarding how a network could operate, which broadly match the conditions that support network effectiveness. A virtual-enabled network would be best supplemented by opportunities for face-to-face interaction. [ABSTRACT FROM AUTHOR]

Background Secondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes. Methods Repeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation. Results SHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing <0.1 ng/ml (i.e. undetectable) cotinine increased from 31.0 to 41.0%. Although across the whole SES spectrum, there was no evidence of displacement of smoking into the home or increased SHS exposure, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased. Among children from the poorest families, 96.9% of post-legislation samples contained detectable cotinine, compared with 38.2% among the most affluent. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, one in three samples contained >3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained. Conclusions Urgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes. [ABSTRACT FROM AUTHOR]

Background The Short Form 36 Health Survey Questionnaire (SF-36) is used to indicate the health status of particular populations, to help with service planning and to measure the impact of clinical and social interventions. Culture-specific data are required to calculate SF-36 norm-based scores. Currently, in the UK normative sources are nearly two decades old, Anglocentric and lack data on the older population. We draw on raw data from the Welsh Health Survey (2007) to provide population norms for the eight SF-36 dimensions for Wales and its regions. Methods We test the SF-36 dimensions for reliability and rating scaling assumptions and construct validity. We compare the Wales’ norms to those reported in existing UK sources and examine the data between countries and by region. Results The scale is reliable and has content validity. The relationships found between the SF-36 domains and a range of variables known to be related to health also demonstrate construct validity. There are differences in population health norms between England and Wales and between the regions of Wales. Conclusions The results suggest that it is imperative that the accurate normative data provided in this paper is used in population studies in Wales to provide an indication of the health status of particular populations. [ABSTRACT FROM PUBLISHER]

Background Public Health registrars (SpRs) were an important component of the workforce that contributed to the COVID-19 response. This study explores their contribution and the impact the early stages of the pandemic had on their learning and training. Methods Data were collected from SpRs in the London and Kent, Surrey, Sussex training programme between July and September 2020 through a mixture of questionnaires and semi-structured interviews. A thematic analysis of interview transcripts was undertaken to identify themes. Results 35/128 SpRs responded to the survey and 11 were interviewed. SpRs were placed across a range of organizations and made a significant contribution to the COVID-19 response. Overall, SpRs learned important skills but working on the response may for some have impacted negatively on training. A number of facilitators and barriers to learning were identified. Conclusion The study findings highlight the opportunities for learning created by the pandemic. However, changing projects and the desire of SpRs to contribute to the response meant the impacts on training were mixed. Future deployment of SpRs should consider the balance of responsibility and pace when delegating work, as well as the need to supervise effectively and support remote working to maintain good mental wellbeing. [ABSTRACT FROM AUTHOR]

Background Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. Methods UK Biobank (N  = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. Results Associations with alcohol consumption were found for alcohol price (β  = −0.56, 95% CI, −0.92 to −0.20) and availability (β  = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (β  = −0.26, 95% CI, −0.50 to −0.03). Alcohol (B  = 0.001, 95% CI, 0.0004 to 0.001) and food (B  = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ  = 0.57, P  < 0.001). Conclusion Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation. [ABSTRACT FROM AUTHOR]

Background Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing. Methodology BMI data for the UK were extracted from the Health Survey for England (2004–14), Scottish Health Survey (2008–14) and the Welsh Health Survey (2004–14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level. Results Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females). Discussion A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities. [ABSTRACT FROM AUTHOR]

Background Rising use of foodbanks highlights food insecurity in the UK. Adverse life events (e.g. unemployment, benefit delays or sanctions) and financial strains are thought to be the drivers of foodbank use. This research aimed to explore who uses foodbanks, and factors associated with increased food insecurity. Methods We surveyed those seeking help from front line crisis providers from foodbanks (N = 270) and a comparison group from Advice Centres (ACs) (N = 245) in relation to demographics, adverse life events, financial strain and household food security. Results About 55.9% of foodbank users were women and the majority were in receipt of benefits (64.8%). Benefit delays (31.9%), changes (11.1%) and low income (19.6%) were the most common reasons given for referral. Compared to AC users, there were more foodbank users who were single men without children, unemployed, currently homeless, experiencing more financial strain and adverse life events (P = 0.001). Food insecurity was high in both populations, and more severe if they also reported financial strain and adverse life events. Conclusions Benefit-related problems appear to be a key reason for foodbank referral. By comparison with other disadvantaged groups, foodbank users experienced more financial strain, adverse life events, both increased the severity of food insecurity. [ABSTRACT FROM AUTHOR]

Background The health risks of cigarette smoking are well established. As a result, reducing cigarette smoking is a key concern for public health agencies. Little is known about rates of smoking among adults with disabilities. Methods Secondary analysis of data collected in Waves 2 and 7 of 'Understanding Society', an annual household panel study. Results Age and gender adjusted odds ratios (AORs) of adults with disabilities smoking increased significantly from 1.41 (1.33–1.49) in 2010–12 to 1.57 (1.45–1.70) in 2015–17 (P = 0.032). AORs of adults with disabilities smoking 20 or more cigarettes a day increased non-significantly from 1.83 (1.66–2.02) in 2010–12 to 1.90 (1.65–2.20) in 2015–17. These changes were evident for both men and women and across age groups. Additionally adjusting these estimates to take account of between group differences in socioeconomic position significantly reduced the AORs for both smoking outcomes. Changes over time in AORs reflected a more rapid decline in smoking among participants without a disability. Conclusions Adults with disabilities are more likely than their peers to smoke. Public health agencies and practitioners may wish to consider what reasonable adjustments may need to be made to policies and interventions to ensure that they are effective for adults with disabilities. [ABSTRACT FROM AUTHOR]

Background Dating and relationship violence (DRV) is under-researched in the UK, especially among Further Education (FE) students. This study examines the association between DRV victimization and socio-demographic characteristics, sexual identity and dating and relationship behaviours among 16–19 year olds FE students. Methods Cross-sectional self-report data were collected from 1751 students aged 16–19 at six FE settings in England and Wales. Factor analysis examined the structure of DRV victimization by gender. Multilevel logistic regression examined the odds ratios of DRV victimization according to socio-demographics, sexual identity and dating behaviours. Results DRV victimization clusters into two categories for females, and three for males. Among females, 46.1% experienced controlling behaviours and 31.6% threatening behaviours; 49.9% of males experienced controlling behaviours, 27.1% threatening behaviours and 5.8% online sexual violence. The odds of DRV victimization were 2–8 times greater for males and 2–4 times greater for females who had ever sent a sexually explicit image. No consistent association was found between DRV and age, spending money per week, educational attainment or meeting partners online. Conclusions The high prevalence, absence of gender differences and social patterning, suggests DRV victimization may be becoming normalized and is of significant public health importance for young people in England and Wales. [ABSTRACT FROM AUTHOR]

Background While the consequences of body weight for physical health are well explored, the evidence for psychological well-being is less straightforward. An instrumental variable approach is used to address the endogenous relationship between body weight and well-being in the UK general population. Methods Data from the Health Survey for England (2003, 2004 and 2006) are used to fit linear and ordered probit instrument variable models for a sample of 13 862 individuals, with frequent white meat consumption instrumenting for body-weight. Non-linearities in the relationship, robustness to weak instruments and relaxation of strict exogeneity assumption are further examined. Results Accounting for endogeneity and conditional on health a protective effect on well-being is observed. A unit increase in body mass index (BMI) improves General Health Questionnaire (GHQ) by 0.17 (95% CI: 0.02–0.31) points and reduces the probability of reporting very low GHQ by 2.5% (95% CI: 0.01–0.05). Empirical testing showed that the instrument performs well, with increased meat consumption adding 0.58 points (95% CI: 0.42–0.74) to ones’ BMI. Conclusions We present support for the jolly-fat hypothesis, however, caution is recommended in drawing inferences. Further research needs to resolve the mixed findings in the literature. [ABSTRACT FROM AUTHOR]

Background Non-prescription medicines (NPMs) can be misused, abused or lead to dependence, but the prevalence of these problems within the UK general population was unknown. The aim of this study was to estimate the prevalence of self-reported misuse, abuse and dependence to NPMs. Methods A cross-sectional postal survey was sent to 1000 individuals aged ≥18 randomly drawn from the UK Edited Electoral Register. Results A response rate of 43.4% was achieved. The lifetime prevalence of NPM misuse was 19.3%. Lifetime prevalence of abuse was 4.1%. Younger age, having a long-standing illness requiring regular NPM use and ever having used illicit drugs or legal highs were predictive of misuse/ abuse of NPMs. In terms of dependence, lifetime prevalence was 2% with 0.8% currently dependent and 1.3% dependent in the past. Dependence was reported with analgesics (with and without codeine), sleep aids and nicotine products. Conclusion Given the increasing emphasis on self-care and empowering the public to manage their health with NPMs, the findings highlight the need for improved pharmacovigilance of these medicines to maximize benefits with minimal risk. Healthcare providers need to be aware of the potential for misuse, abuse and dependence, particularly in patients with long-term illness. [ABSTRACT FROM AUTHOR]

Background Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomized control trial (RCT) with people who inject drugs (PWID) in a low-threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OSTat 3 months, compared with offering advice and case management. Methods Un-blinded RCTwas conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health-related quality of life measures. Results Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57)). Opioid use reduced by 79 and 73%, respectively (OR of intervention success 1.38 (0.5-3.7)). Physical and mental health improved but there was little differences between groups. Conclusions The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared with intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted. [ABSTRACT FROM AUTHOR]

Background Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of 'prudent healthcare' championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. Methods A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. Results A sum of £86.9 million was spent on respiratory care in 2012-13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. Conclusions This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. [ABSTRACT FROM AUTHOR]

Background Bisexual- and lesbian-identified women have significantly worse mental health than heterosexual women. Less evidence exists about mental health differences between lesbian and bisexual women. Methods Self-completion survey with community-based, opportunistic sampling recruited 937 bisexual-identified and 4769 lesbian-identified women. Associations between sexual identity and mental health indicators were assessed by logistic regression, controlling for age, income, student status and employment. Results As a group, bisexual women were younger, poorer, and more likely to be trans-identified, minority ethnic identified and to use marijuana, compared with lesbians. Bisexuals were more likely than lesbians to report eating problems (adjusted odds ratio (AOR) = 1.64, P< 0.001), self-harm (AOR = 1.37, P = 0.001), depressed feelings (AOR = 1.26, P = 0.022) and anxiety (AOR = 1.20, P = 0.037). Fewer bisexual women attended lesbian or bisexual social events, were ‘out', or had experienced any sexuality-related discrimination, compared with lesbians. Conclusion More bisexual women reported poor mental health or psychological distress than did lesbians. Bisexual women may be more likely to experience social stress due to the ‘double discrimination' of homophobia and biphobia. This stress, experienced mainly as internalized and felt stigma, could result in greater risk for poor mental health compared with lesbians. Addressing both biphobia and homophobia within UK society has important preventative mental health implications. [ABSTRACT FROM AUTHOR]

Background The NHS Health Check Programme was launched in England in 2009, offering a vascular risk assessment to people aged 40-74 years without established disease. Socio-economic deprivation is associated with higher risk of cardiovascular disease and lower uptake of screening.We evaluated the potential impact of a community-based health check service that sought to address health inequalities through the involvement of lay health trainers. Methods Key stakeholder discussions (n = 20), secondary analysis of client monitoring data (n = 774) and patient experience questionnaires (n = 181). Results The health check programme was perceived as an effective way of engaging people in conversations about their health. More than half (57.6%) of clients were aged under 50 years and a similar proportion (60.5%) were from socio-economically deprived areas. Only 32.7% from the least affluent areas completed a full health check in comparison with 44.4% from more affluent areas. Eligible men were more likely than eligible women to complete a health check (59.4 versus 33.8%). Conclusions A community-based, health trainer-led approach may add value by offering an acceptable alternative to health checks delivered in primary care settings. The service appeared to be particularly successful in engaging men and younger age groups. However, there exists the potential for intervention-generated inequalities. [ABSTRACT FROM AUTHOR]

Background Despite a wealth of research and policy initiatives, progress in tackling the UK's health inequalities has been limited. This article explores whether there appears to be consensus among researchers about the kinds of policies likely to reduce health inequalities. Methods Ninety-nine proposals for addressing health inequalities were identified from multiple sources. Forty-one researchers participated in a survey assessing the extent to which they believed each proposal would reduce health inequalities, based on three criteria. The 20 proposals generating most support were employed in a second stage, in which 92 researchers indicated which proposals they felt would have the greatest impact on reducing health inequalities. Results Some consensus exists among researchers about the policy approaches likely to reduce UK health inequalities: a more progressive distribution of income/wealth, greater investment in services for deprived communities, plus regulatory policies to limit the impact of lifestyle-behavioural risks. However, researchers' support for proposals varies depending whether they are asked to express their expert opinion or to comment on the strength of the available evidence. Conclusions When consulting researchers about health inequalities, policymakers need to consider whether they are seeking research-informed expertise or assessments of the available evidence; these questions are likely to yield different responses. [ABSTRACT FROM PUBLISHER]

Background Reducing preventable sight loss is an increasing priority for public health and health care providers. We examined the factors affecting people's use of optometry services in population groups at increased risk of sight loss. Methods This is a qualitative study in five UK locations. In England, participants were from the Pakistani and Black Caribbean communities; in Scotland from the Pakistani community; and in Northern Ireland and Wales from white socio-economically deprived communities. Thirty-four focus groups were conducted (n = 289). The study included people who attend optometry services and people not engaged with services. Results Barriers to access included limited awareness of eye health and eye disease, concern about the cost of spectacles and the appropriateness of optometry in a commercial setting. Attendance at the optometrist was primarily symptom led. A positive previous experience or continuing relationship with the optometrist helped to alleviate the barriers and promote attendance. Conclusion Addressing the disparity between the broader messages about eye health and the current perception of the function of optometry could help improve access to services. Uptake may be improved through the co-production of interventions that better resonate with local communities. Non-retail service delivery options should be explored. [ABSTRACT FROM AUTHOR]

Background UK clinical guidance for lung cancer (NICE 141) includes pathways for chest X-rays (CXRs). Many patients fulfilling the criteria do not receive one, either because they do not consult their doctor or because their doctor does not refer them. The town of Corby, UK, has particularly high incidence and mortality rates for lung cancer and was chosen as a pilot site for a new, patient-requested X-ray service. Methods The number of community-initiated CXRs were compared before and after the introduction of the service and between similar geographical areas. Clinical data and patient questionnaires were analysed for those attending the service. Results There was a 63% increase in the total number of community-initiated CXRs in Corby for the year following the introduction of the service, compared with the year before. This was statistically greater than in surrounding geographical areas. Corby General Practitioners also requested 47% more CXRs than in the previous year. Conclusions The implementation of the service was associated with a significant increase in the numbers of clinically indicated CXRs in an area of high lung cancer incidence and mortality. The service attracted a clinically appropriate population. The numbers of cancers detected were in line with statistical expectations. [ABSTRACT FROM AUTHOR]

Background Health-care organizations need to prioritize their resource use and should incorporate the public's preferences into their priority setting process. Methods We apply a discrete choice experiment (DCE) to obtain weights, from the public, for use in a priority setting exercise. Ten attributes were chosen: location of care, public consultation, use of technology, service availability, patient involvement, management of care, evidence of effectiveness, health gain, risk avoidance and priority area. From the DCE responses, weighted benefit scores were calculated and used to rank development bids from across a health-care organization. Results Sixty-eight members of the public completed the DCE. All attributes except risk avoidance were significant. The most important attribute levels were a large health gain to many people: care being provided in teams, using latest or cutting-edge technology and 24 h service availability. Local priorities were valued higher than national priorities. Ninety-five bids were ranked in order of overall score. The ranked list of development bids provided a useful tool to inform prioritization decisions. Conclusions DCEs can offer a theoretically valid and practical means of incorporating the views of the public in an accessible, transparent and streamlined decision-making process when health-care organizations are prioritizing their resources. [ABSTRACT FROM AUTHOR]

Background Lead has been recognized increasingly as a public health risk, although with the introduction of wide-ranging occupational and public health measures, levels of blood lead in the general population of the UK and other developed nations have been in decline in recent years. Nonetheless, cases of lead poisoning still occur. Methods We report on a large cluster of exposed lead workers and their families, including several children. The focus of the occupational and public health investigations was to identify the different groups at risk and the pathways by which potential exposures were taking place. Results Lead in the workplace was found to account for the raised blood lead levels amongst the workers with exposure occurring as a result of insufficient demarcation between ‘clean’ and ‘dirty’ areas, and from contamination of personal belongings with lead. Furthermore, there was evidence of para-occupational exposure of family members. Conclusions The successful control of lead in this case required multidisciplinary working. Efforts included extensive workplace controls, along with the education and care of workers and their families, though complicated by lack of familiarity with the UK health service amongst the affected groups, language barriers, underlying low levels of literacy and high mobility. [ABSTRACT FROM PUBLISHER]

Background Since 1998 BUPA has used the Short‐Form 36 (SF‐36) questionnaire to monitor changes in health status after adult elective surgery. Over 70 independent hospitals across the United Kingdom have collected data on over 100000 patient episodes. SF‐36 is one of a number of tools that support clinical governance in the sector. Results are reported confidentially, putting the emphasis on supporting a learning culture. [ABSTRACT FROM PUBLISHER]

Background Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. Methods A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. Results Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. Conclusions Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health. [ABSTRACT FROM AUTHOR]