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Abstract The environment may lead to lower body mass index (BMI) and obesity risk by providing opportunities to be physically active. However, while intuitively appealing, associations are often inconsistent in direction and small scale. This longitudinal study examined if change in BMI and obesity was associated with the availability of physical activity (PA) facilities and parks and explored if these associations differed by age. Longitudinal data (n = 8,864, aged 18–86 years) were provided at baseline (wave I: 2010–2012) and follow up (wave II: 2013–2015) of the Yorkshire Health Study. BMI was calculated using self-reported height (cm) and weight (kg) (obesity = BMI≥30.00). To define availability, home addresses were geocoded based on postcode zone centroids and neighbourhood was defined as a 2 km radial buffer. PA facilities were sourced from Ordnance Survey Points of Interest (PoI) and parks were sourced from OpenStreetMap. Environmental data temporally matched individual-level baseline data collection. PA facilities (b = −0.006 [-0.015, 0.003]) and parks (b = −0.001 [-0.015, 0.013]) at baseline were not associated with change in BMI. Change in obesity was unrelated to parks (OR = 0.994 [0.975, 1.015]) and while PA facilities were related (OR = 0.979 [0.965, 0.993]), effects were small. A combined measure of the recreational PA environment including parks and PA facilities was unrelated to change in BMI and obesity. Despite this, statistically significant interactions were found for both PA facilities, parks, and change in obesity by age. Based on the premise that an individual's mobility varies with age, and although effects were small, this offers tentative evidence which suggests it may be useful for policymakers in Public Health and Planning to consider the impact of environmental interventions across the life course. Highlights • Recreational physical activity environments (RPE) may be related to BMI and obesity. • In this study, the RPE was not related to change in BMI or obesity. • The relationship between the RPE, change in BMI and obesity differs by age. • It may help policy to consider environmental interventions across the life course. [ABSTRACT FROM AUTHOR]

Understanding the determinants of attendance at public health interventions is critical for effective policy development. Most research focuses on individual-level determinants of attendance, while less is known about environmental-level determinants. Data were obtained from the Leeds Let's Get Active public health intervention in Leeds, England. Longitudinal data (April 2015-March 2016) on attendance were obtained for n = 25,745 individuals (n = 185,245 total visits) with baseline data on sociodemographic determinants and lifestyle practices obtained for n = 3621 individuals. This resulted in a total of n = 744,468 days of attendance and non-attendance. Random forests were used to explore the relative importance of the determinants on attendance, while generalised linear models were applied to examine specific associations (n = 3621). The probability that a person will attend more than once, the number of return visits, and the probability that a person will attend on a particular day were investigated. When considering if a person returned to the same leisure centre after one visit, the most influential determinant was the distance from their home. When considering number of return visits overall however, age group was the most influential. While distance to a leisure centre was less important for predicting the number of return visits, the difference between estimates for 300 m and 15,000 m was 7-10 visits per year. Finally, calendar month was the most important determinant of daily attendance. This longitudinal study highlights the importance of both individual and environmental determinants in predicting various aspects of attendance. It has implications for strategies aiming to increase attendance at public health interventions. [ABSTRACT FROM AUTHOR]

International research linking food outlets and body mass index (BMI) is largely cross-sectional, yielding inconsistent findings. However, addressing the exposure of food outlets is increasingly considered as an important adult obesity prevention strategy. Our study investigates associations between baseline food environment types and change in BMI over time. Survey data were used from the Yorkshire Health Study (n=8,864; wave one: 2010-2012, wave two: 2013-2015) for adults aged 18-86. BMI was calculated using self-reported height (cm) and weight (kg). Restaurants, cafés, fast-food, speciality, convenience and large supermarkets were identified from the Ordnance Survey Point of Interest database within 1600m radial buffer of home postcodes. K-means cluster analysis developed food environment typologies based on food outlets and population density. Large supermarkets, restaurants, cafés, fast-food, speciality and convenience food outlets all clustered together to some extent. Three neighbourhood typologies were identified. However, multilevel models revealed that relative to cluster one all were unrelated to change in BMI (cluster 2, b= -0.146 [-0.274, 0.566]; cluster 3, b= 0.065 [-0.224, 0.356]). There was also little evidence of gender-based differences in these associations when examined in a three-way interaction. Policymakers may need to begin to consider multiple types of food outlet clusters, while further research is needed to confirm how these relate to changed BMI. • Developed a typology of neighbourhood food environments by population density. • Considers if food environments were associated with change in BMI by gender. • Supermarkets, restaurants, cafés, fast-food, speciality and convenience outlets clustered. • A focus on multidimensional food environments may be warranted in policy and research. • Food environments were unrelated to change in BMI over time with no difference by gender. [ABSTRACT FROM AUTHOR]

Background: There continues to be a lack of understanding as to the geographical area at which the environment exerts influence on behaviour and health. This exploratory study compares different potential methods of both researcher- and participant-defined definitions of neighbourhood reflect an adolescent's activity space.Methods: Seven consecutive days of global positioning system (GPS) tracking data were collected at 15 s intervals using a small exploratory adolescent sample of 14-18 year olds (n = 69) in West Yorkshire, England. A total of 304,581 GPS tracking points were collected and compared 30 different definitions of researcher-defined neighbourhoods including radial, network and ellipse buffers at 400 m, 800 m, 1000 m, 1600 m and 3000 m, as well as participant-defined self-drawn neighbourhoods.Results: This exploratory study supports emerging evidence cautioning against the use of static neighbourhood definitions for defining exposure. Traditional buffers (network and radial) capture at most 67% of activity space (home radial), and at worst they captured only 3.5% (school network) and range from capturing between 3 and 88% of total time. Similarly, self-drawn neighbourhoods captured only 10% of actual daily movement. Interestingly, 40% of an adolescent's self-drawn neighbourhood was not used. We also demonstrate that buffers capture a range of space (22-95%) where adolescents do not go, thus misclassifying the exposure.Conclusion: Our exploratory findings demonstrate that neither researcher- nor participant-defined definition of neighbourhood adequately captures adolescent activity space. Further research with larger samples are needed to confirm the findings of this exploratory study. [ABSTRACT FROM AUTHOR]

Background: There is a persistent lack of understanding on the influence of the environment on behaviour and health. While the environment is considered an important modifiable determinant of health behaviour, past research assessing environments often relies on static, researcher-defined buffers of arbitrary distance. This likely leads to misrepresentation of true environmental exposures. This exploratory study aims to compare researcher-defined and self-drawn buffers in reflecting the spaces and time adolescents engage in physical activity (PA) and sedentary behaviour. It also investigates if adolescent's access the PA facility and greenspace nearest their home or school for PA, as well as examine how much time adolescents spent in PA at any PA facilities and greenspaces., Methods: Adolescents (aged 14-18 years; n = 34) were recruited from schools in West Yorkshire, England. Seven consecutive days of global positioning system (GPS) and accelerometer data were collected at 15 second intervals. Using ArcGIS, we compared 30 different researcher-defined buffers including: radial, network and ellipse buffers at 400m, 800m, 1000m, 1600m and 3000m and participant-defined self-drawn neighbourhoods to objectively measured PA and sedentary space and PA time. Location of PA was also compared to Points of Interest data to determine if adolescents use the nearest PA facility or greenspace to their home or school and to examine how much PA was undertaken within these locations., Results: Our exploratory findings show the inadequacy of researcher-defined buffer size in assessing MVPA space or sedentary space. Furthermore, less than 35% of adolescents used the greenspaces or PA facilities nearest to their home or school. Approximately 50% of time spent in PA did not occur within the home, school, PA facility, or greenspace environments., Conclusion: Our exploratory findings help to begin to quantify the inadequacy of researcher-defined, and self-drawn buffers in capturing adolescent MVPA and sedentary space, as well as time spent in PA. Adolescents often do not use PA facilities and greenspaces nearest their home and school and a large proportion of PA is achieved outside PA facilities and greenspaces. Further research with larger samples are needed to confirm the findings of this exploratory study., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Christensen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: A large majority of primary school pupils fail to achieve 30-min of daily, in-school moderate-to-vigorous physical activity (MVPA). The aim of this study was to investigate MVPA accumulation and subject frequency during academic lesson segments and the broader segmented school day., Methods: 122 children (42.6% boys; 9.9 ± 0.3 years) from six primary schools in North East England, wore uniaxial accelerometers for eight consecutive days. Subject frequency was assessed by teacher diaries. Multilevel models (children nested within schools) examined significant predictors of MVPA across each school-day segment (lesson one, break, lesson two, lunch, lesson three)., Results: Pupils averaged 18.33 ± 8.34 min of in-school MVPA, and 90.2% failed to achieve the in-school 30-min MVPA threshold. Across all school-day segments, MVPA accumulation was typically influenced at the individual level. Lessons one and two-dominated by maths and English-were less active than lesson three. Break and lunch were the most active segments., Conclusion: This study breaks new ground, revealing that MVPA accumulation and subject frequency varies greatly during different academic lessons. Morning lessons were dominated by the inactive delivery of maths and English, whereas afternoon lessons involved a greater array of subject delivery that resulted in marginally higher levels of MVPA.

Background: Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013., Methods: CHD hospitalisations for individuals aged 35-84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and 'other CHD'). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression., Results: From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004-2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: -7.1 %/year, 95% CI -7.2 to -7.0; women: -7.5 %/year, 95% CI -7.7 to -7.3; Australia: men: -8.5 %/year, 95% CI -8.6 to -8.4; women: -8.6 %/year, 95% CI -8.8 to -8.4). Other CHD rates increased in individuals aged 75-84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention., Conclusions: Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study investigated if the relationship between residential fast-food outlet availability and obesity varied due to methodological diversity or by age. Cross-sectional data (n = 22,889) from the Yorkshire Health Study, England were used. Obesity was defined using self-reported height and weight (BMI ≥ 30). Food outlets ("fast-food", "large supermarkets", and "convenience or other food retail outlets") were mapped using Ordnance Survey Points of Interest (PoI) database. Logistic regression was used for all analyses. Methodological diversity included adjustment for other food outlets as covariates and continuous count vs. quartile. The association between residential fast-food outlets and obesity was inconsistent and effects remained substantively the same when considering methodological diversity. This study contributes to evidence by proposing the use of a more comprehensive conceptual model adjusting for wider markers of the food environment. This study offers tentative evidence that the association between fast-food outlets and obesity varies by age., (Copyright © 2018. Published by Elsevier Ltd.)

Background: The importance of having hope for recovery has been highlighted in numerous qualitative studies of recovery. It is identified as a vital part of this process, and guidelines suggest that service providers should therefore facilitate hope in their clinical work; however, they do not indicate how this guidance can be operationalised., Aims: To identify the sources of hope for recovery based on the accounts of people with experience of recovery; to ascertain how these accounts show service providers can facilitate such hope in their therapeutic work., Method: Semi-structured interviews were conducted with eight people with experience of recovering from mental health problems. A grounded theory analysis was undertaken., Results: A model conceptualising the role of hope in recovery was developed with three categories: "influence of others on hope", "personal hope" and "doing recovery". The model indicates a complex interaction between hope and recovery with an important role for social context and interpersonal relationships, including those with clinicians., Conclusions: Mental health service providers occupy a powerful position in relation to service users' hope, and must carefully consider how they communicate their own hopefulness about clients' recovery. Suggestions are made about facilitating hope for recovery.

Comparisons are made between the principal diagnosis on discharge from hospital in successive periods of inpatient care for persons in the Oxford Record Linkage Study area admitted over a period of years. The observed numbers of pairs of diagnoses are compared with expected numbers computed to take account of the discharge rates in the population by age and sex and the number of man years of exposure. Three topics have been selected to display some of the types of analysis possible with the very extensive material: mental disorder and diseases of the central nervous system, hospital discharges preceding those for neoplasm, and discharges following those for tuberculosis. The details of the method of calculation of the observed and expected numbers and the assumptions and approximations involved are given in an Appendix.