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Background: Research and policy have identified social cohesion as a potentially modifiable determinant of health and wellbeing that could contribute to more sustainable development. However, the function of social cohesion appears to vary between communities. The aim of this study was to analyse the levels of, and associations, between social cohesion, mental wellbeing, and physical and mental health-related quality of life among a cohort of social housing residents from low socioeconomic status communities in Cornwall, UK. Social housing is below market-rate rental accommodation made available to those in certain health or economic circumstances. These circumstances may impact on the form and function of social cohesion.Methods: During recruitment, participants in the Smartline project completed the Short Warwick-Edinburgh Mental Wellbeing Scale, SF-12v2 and an eight item social cohesion scale. Cross sectional regression analyses of these data adjusted for gender, age, national identity, area socioeconomic status, rurality, education, employment, and household size were undertaken to address the study aim.Results: Complete data were available from 305 (92.7%) participants in the Smartline project. Univariable analyses identified a significant association between social cohesion, mental wellbeing and mental health-related quality of life. Within fully adjusted multivariable models, social cohesion only remained significantly associated with mental wellbeing. Sensitivity analyses additionally adjusting for ethnicity and duration of residence, where there was greater missing data, did not alter the findings.Conclusions: Among a relatively homogeneous cohort, the reported level of social cohesion was only found to be significantly associated with higher mental wellbeing, not physical or mental health-related quality of life. The efforts made by social housing providers to offer social opportunities to all their residents regardless of individual physical or mental health state may support the development of a certain degree of social cohesion. Sense of control or safety in communities may be more critical to health than social cohesion. Additional observational research is needed before attempts are made to alter social cohesion to improve health. [ABSTRACT FROM AUTHOR]

Background: Little is known about whether digital competence is related to psychological wellbeing, with most previous research focusing on students and elderly people. There is also limited evidence on seasonal changes in psychological wellbeing, particularly in specific groups. Social housing residents are an underserved and under-researched population. The objectives of this study were to explore associations between digital competence (assessed by general technology self-efficacy) and psychological wellbeing (assessed by mental wellbeing and life satisfaction), and to explore seasonal effects, in social housing residents. Methods: A repeated survey design was used. The Happiness Pulse questionnaire with a bespoke digital module was sent via post or e-mail at four timepoints between July 2021 and July 2022 to 167 social housing residents in West Cornwall, England. There were 110 respondents in total; thirty completed all four questionnaires and 59 completed an autumn/winter and summer questionnaire. Data were analysed using descriptive and inferential methods including regression, repeated measures analysis of variance and panel analysis. Results: Significant positive associations were found between digital self-efficacy and mental wellbeing, and between digital self-efficacy and life satisfaction. However, there were no significant seasonal changes in psychological wellbeing. Conclusions: The findings extend the existing literature beyond student and elderly populations and suggest that improving digital competence is a potential pathway to improving psychological wellbeing. Surveys with larger samples and qualitative studies are needed to elucidate the mechanisms involved. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? Methods: An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. Results: We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. Conclusion: The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors. [ABSTRACT FROM AUTHOR]

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning. [ABSTRACT FROM AUTHOR]

A large evidence base demonstrates that the outcomes of COVID-19 and national and local interventions are not distributed equally across different communities. The need to inform policies and mitigation measures aimed at reducing the spread of COVID-19 highlights the need to understand the complex links between our daily activities and COVID-19 transmission that reflect the characteristics of British society. As a result of a partnership between academic and private sector researchers, we introduce a novel data driven modelling framework together with a computationally efficient approach to running complex simulation models of this type. We demonstrate the power and spatial flexibility of the framework to assess the effects of different interventions in a case study where the effects of the first UK national lockdown are estimated for the county of Devon. Here we find that an earlier lockdown is estimated to result in a lower peak in COVID-19 cases and 47% fewer infections overall during the initial COVID-19 outbreak. The framework we outline here will be crucial in gaining a greater understanding of the effects of policy interventions in different areas and within different populations. • A microsimulation framework for modelling disease transmission within communities. • Integration of data from multiple, diverse sources to estimate exposure and risk. • Computationally efficient implementation allows rapid assessment of scenarios. • Allows the effects of different non-pharmaceutical interventions to be assessed. • Results show substantial reduction in infections associated with earlier UK lockdown. [ABSTRACT FROM AUTHOR]

The latest scientific advances on the impacts of climate change on the health of the elderly in East China were reviewed consulting peer-reviewed publications from 2000 to 2017. The direct impacts of climate change result from rising temperatures, heat waves, and increases in the frequency of complex extreme weather events such as windstorms, floods, and droughts. The health and social consequences of these events are far reaching, ranging from reduced labour productivity and heat-related deaths through to direct physical injury during extreme weather events, the spread of infectious diseases, and mental health effects following widespread flooding or prolonged drought. Research has indicated that climate change will have the greatest impact on vulnerable groups of people, including the elderly population. However, there is a dearth of empirical evidence, a lack of focus on vulnerable segments of the population (especially elderly), limited understanding of how health status will change in the future, and lack of acknowledgement of how different regions in China vary in terms of the consequences of climate change. The main risk in East China that climate change may exacerbate is flooding (sea level rise, coastal and riverine, flood risk). However in some regions of East China such as in the provinces of Anhui, Jiangsu, Hebei, and Shandong the biggest climate change risk is considered to be drought. Main health risks linked to climate change are evident as cardiovascular and respiratory diseases (heat stroke, exhaustion, and asthma), often caused by interactions between heat wave episodes and concurrent poor air quality. [ABSTRACT FROM AUTHOR]

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean's health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean's natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion., Objective: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging)., Methods: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority's Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention., Results: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size)., Conclusions: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies., (©Tim Walker, Sarah Ann Buckingham, Ria Poole, Lewis Roland Elliott, Tamaryn Menneer, Gengyang Tu, Karyn Morrissey. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.01.2024.)

Competing Interests: Declaration of interests 14 of the authors (MRo, MWa, LJ, MBO'H, CO, HW, CdN, HK, PL, DS, CG, ZA, MY-G, and KRvD) were compensated for their time while drafting and developing the Lancet Countdown's report. OG was supported by the EU Horizon Grant: Climate Action To Advance Healthy Societies in Europe (Project 101057131–CATALYSE), for which there is overlap of data collection and preprocessing with the materials submitted in this report. MSp was supported by the Wellcome Trust Livestock, Environment and People (grant number 205212/Z/16/Z) and Wellcome Trust (grant number 225318/Z/22/Z). JT was supported by the Academy of Finland grants for the T-Winning (grant number 353327). CD was supported by the UK Natural Environment Research Council Independent Research Fellowship (grant number NE/N01524X/1), which ended in 2021, and by the European Research Council starting grant FLORA (grant number 101039402). OJ was supported by the NHMRC Investigator Grant entitled Heat and Health: Building resilience to extreme heat in a warming world (GNT20009507), the Wellcome Trust grant Heat stress in ready-made garment factories in Bangladesh (216059/Z/19/Z), and the Resilience New South Wales grant A new heat stress scale for general public (PJ-0000850). YL was supported by funding from the National Aeronautics and Space Administration (grant number: 80NSSC21K0507) for the wildfire population exposure and fire danger indicators. TO and IH were supported by the UK Research and Innovation Engineering and Physical Sciences Research Council Centre for Research in Energy Demand Solutions (grant number EP/R035288/1). MRo was supported by funding from IDAlert project (UK Research and Innovation project reference number 10056533). KB was supported by funding from the National Institute for Health and Care Research (NIHR) Centre on Non-communicable Diseases and Environmental Change (NIHR203247). All other authors declare no competing interests. The authors alone are responsible for the views expressed in this Commission, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Globalized food systems are a major driver of climate change, biodiversity loss, environmental degradation, and the increasing prevalence of overweight and obesity in society. Small Island Developing States (SIDS) are particularly sensitive to the negative effects of rapid environmental change, with many also exhibiting a heavy reliance on food imports and high burdens of nutrition-related disease, resulting in calls to (re)localize their food systems. Such a transition represents a complex challenge, with adaptation interventions in one part of the food system contingent on the success of interventions in other parts. To help address this challenge, we used group model-building techniques from the science of system dynamics to engage food system stakeholders in Caribbean and Pacific SIDS. Our aim was to understand the drivers of unhealthy and unsustainable food systems in SIDS, and the potential role that increased local food production could play in transformative adaptation. We present two causal loop diagrams (CLDs) considered helpful in designing resilience-enhancing interventions in local food systems. These CLDs represent 'dynamic hypotheses' and provide starting points that can be adapted to local contexts for identifying food system factors, understanding the interactions between them, and co-creating and implementing adaptation interventions, particularly in SIDS. The results can help guide understanding of complexity, assist in the co-creation of interventions, and reduce the risk of maladaptive consequences., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Guariguata 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.)

Many countries have adopted targets to increase marine protected areas (MPAs) to limit the degradation of water bodies. Although there is evidence that MPAs can conserve marine life and promote biodiversity, there are limited data on the human health implications of MPAs. Using panel data from 1990, 2000, and 2014, we estimated the country-level associations between MPAs (i.e., percentage of territorial waters designated as marine reserves) and age-standardized mortality (i.e., age-standardized probability of dying between 15 and 60 years from all-causes among ages 15-60/100,000 population) by sex, among 110 countries. We fit mixed-effects linear regression models of mortality as a function of current MPA coverage, gross domestic product growth, year, the prior extent of MPA, electricity coverage, governance, and country-level random effects. We observed a significant inverse association between current MPA coverage and adult mortality. For each 5-percentage-point increase in current MPA coverage, a country had 0.982 times the geometric means of female and male mortality [geometric mean ratio: 0.982 (95% CI 0·976, 0·988)] conditional on past %MPA coverage and other modeled variables. The model showed no significant residual association of mortality with past %MPA conditional on current %MPA and other modeled variables. This is one of the first studies to show a positive association between increasing marine conservation and human health. This macro-level study suggests there may be important co-benefits for human health from expanding MPAs that merit further investigation., (© 2023. The Author(s).)

Previous research has indicated that the role of childhood circumstances on adult mental health is primarily mediated through adult socioeconomic circumstances. Using linear regression models and mediation analysis this paper examines whether childhood financial circumstances is associated with adult mental wellbeing and to what extent any association is explained by adult financial circumstances. Adjusting for age and highest education attainment, we found that childhood financial circumstances predict wellbeing in adulthood. However, stratifying by age (respondents aged 18-40, 41-65 and 66 years plus), a more complicated pattern of associations emerged with potential cohort and age effects emerging. Only adult financial circumstances significantly impact adult wellbeing in our youngest group, while neither childhood nor adult financial circumstances are significantly associated with wellbeing in the oldest age group (66 years plus). However, both childhood and adult financial circumstances were significantly associated with wellbeing in middle age, and this effect was mostly direct (OR-1.09: CI 95%: -1.63, -0.17) rather than indirect (OR-0.08: CI 95%: -0.17, -0.01). This research adds to the evidence base that childhood is a critical period for wellbeing in middle age (41-65 years). Previous research has found that subjective wellbeing plays an important role in physical and mental health outcomes in adulthood. The impact of financial hardship in childhood on wellbeing in adulthood found in this study is particularly concerning as levels of child poverty increase in the UK., Competing Interests: Competing InterestsNone. , (© The International Society for Quality-of-Life Studies (ISQOLS) and Springer Nature B.V. 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Competing Interests: Declaration of interests CD was supported by the UK Natural Environment Research Council (NE/R010811/1) and the UK Natural Environment Research Council Independent Research Fellowship (NE/N01524X/1) and contributes to the Sustainable and Healthy Food Systems project supported by the Wellcome Trust (205200/Z/16/Z). MD was supported by the Wellcome Trust's Complex Urban Systems for Sustainability and Health (CUSSH) project (209387/Z/17/Z). YL was supported by the US National Aeronautics and Space Administration Applied Sciences Program (80NSSC21K0507). RL was supported by a Royal Society Dorothy Hodgkin Fellowship. MSo was supported by Horizon 2020 project EXHAUSTION (820655) and Academy of Finland HEATCOST (334798). SHG and JKWL were supported by Singapore's National Research Foundation, Singapore's Prime Minister's Office, under its Campus for Research Excellence and Technological Enterprise programme. IH was supported by the UK Research and Innovation (UKRI) Engineering and Physical Sciences Research Council Centre for Research in Energy Demand Solutions (EP/R035288/1) and UKRI APEx (NE/T001887/1). JM was supported by the German Ministry for Education and Research (01LA1826A and 03SFK5J0). ML was supported by the Sloan Foundation. All other authors declare no competing interests.

Introduction: Food security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and, in many, persistent childhood stunting. This is associated with an increasing reliance on imported processed food of poor nutritional quality. Calls have been made for strengthening local food systems, resilient to climate change, to increase the consumption of nutritious locally produced food. We aimed to systematically review interventions intended to improve diet in SIDS, and specifically explore whether these interventions applied a local food approach., Methods: The search strategy was applied to 11 databases, including in health, social science and agriculture. Screening of titles, abstracts and data extraction was undertaken in duplicate. Risk of bias was assessed using Cochrane tools. Narrative synthesis of the results was undertaken. The study protocol was registered (PROSPERO registration number: 2020CRD42020201274)., Results: From 26 062 records, 154 full texts were reviewed and 24 were eligible. Included studies were from the Caribbean, Pacific, Mauritius and Singapore. Five were a randomised study design, one an interrupted time series analysis, eight controlled and ten uncontrolled pre-test and post-test. Nine studies included some aspect of a local food approach. Most interventions (n=15) included nutrition education, with evidence of effectiveness largely limited to those that also included practical skills training, such as vegetable gardening or food preparation. Three studies were considered low risk of bias, with the majority (n=13) of moderate risk., Conclusion: There is a lack of robust evidence on interventions to improve diet in SIDS. The evidence suggests that multifaceted approaches are likely to be the most effective, and local food approaches may promote effectiveness, through mechanisms of cultural and contextual relevance. Further development and evaluation of interventions is urgently required to increase the comparability of these studies, to help guide policy on improving nutrition in SIDS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000−2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level., Competing Interests: The authors declare no conflict of interest. This publication will be used as a chapter of a PhD Thesis.

Background: There is limited knowledge on the distribution of the health co-benefits of reduced air pollutants and carbon emissions in the transport sector across populations., Methods: This Article describes a health impact assessment used to estimate the health co-benefits of alternative land passenger transport scenarios for the city of Beijing, China, testing the effect of five transport-based scenarios from 2020 to 2050 on health outcomes. New potential scenarios range from implementing a green transport infrastructure, to scenarios primarily based on the electrification of vehicle fleets and a deep decarbonisation scenario with near zero carbon emissions by 2050. The health co-benefits are disaggregated by age and sex and estimated in monetary terms., Findings: The results show that all the alternative mitigation scenarios result in reduced PM 2·5 and CO 2 emissions compared to a business-as-usual scenario during 2020-50. The near zero scenario achieves the largest health co-benefits and economic benefits annually relative to the sole mitigation strategy, preventing 300 (95% CI 229-450) deaths, with health co-benefits and CO 2 cost-saving an equivalent of 0·01% (0·00-0·03%) of Beijing's Gross domestic product in 2015 by 2050. Given Beijing's ageing population and higher mortality rate, individuals aged 50 years and older experience the greatest benefit from the mitigation scenarios. Regarding sex, the greatest health benefits occur in men., Interpretation: This assessment provides estimates of the demographic distribution of benefits from the effects of combinations of green transport and decarbonising vehicles in transport futures. The results show that there are substantial positive health outcomes from decarbonising transport in Beijing. Policies aimed at encouraging active travel and use of public transport, increasing the safety of active travel, improving public transport infrastructure, and decarbonising vehicles lead to differential benefits. In addition, disaggregation by age and sex shows that the health impacts related to transport pollution disproportionately influence different age cohorts and genders., Funding: National Natural Science Foundation of China and FRIEND Project (through the National Research Foundation of Korea, funded by the Ministry of Science and ICT)., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: The aim of this study was to explore the feasibility and acceptability of digital technology for improving health and wellbeing in social housing residents living in a deprived area in Cornwall, England., Methods: Qualitative scoping study with focus groups and telephone interviews (23 participants in total). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically., Results: Levels of use and experience with digital technology were diverse in this group, ranging from 'willing and unable' to 'expert' on a self-perceived scale. Overall, participants had positive perceptions of technology and were keen to try new technologies. Five categories of factors influencing technology use were identified: functional, physical / health, psychological and attitudinal, technology-associated barriers, and privacy, safety and security. Preferred types of digital technology were wearable activity monitors (e.g. Fitbit®), virtual assistants (e.g. Amazon Alexa) and social messaging (e.g. WhatsApp). There was a strong consensus that technology should be easy to use and should have a clear purpose. There was a need to improve awareness, knowledge and confidence in technology use and participants desired further training and support., Conclusions: There is a need and desire to use digital technology to improve health, wellbeing and social connectedness in social housing residents in Cornwall. The findings will be used to inform a digital training and support programme for the participants of the Smartline project. This study also serves as a template for future research that seeks to scope the feasibility and acceptability of different digital interventions in similar populations., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

The mental wellbeing of those living in resource poor and rural localities is a public health priority. Despite evidence of a link between social networks and mental wellbeing, little is known about this relationship in the context of rural and resource poor environments. The current study uses novel social network methodology to investigate the extent to which social network size and composition is related to mental wellbeing in a social housing community in rural England. Data come from 88 individuals living in social housing in Cornwall. These participants are part of a larger study of 329 social housing households surveyed in 2017 and 2018. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). A series of multivariable linear regression models were used to test associations between social network characteristics and mental wellbeing. Social network size was significantly associated with the SWEMWBS (b = 0.39, p < 0.01), such that individuals with larger networks reported better mental wellbeing, but after controlling for community social cohesion, this effect dissipated. Neither gender composition or talking with network members about health and wellbeing were significantly associated with the SWEMWBS. Findings suggest that both the quantity of social connections and perceptions of community cohesion are moderately associated with mental wellbeing in rural and resource poor localities. As such, efforts to improve mental wellbeing would benefit from targeting multiple aspects of social relationships, rather than focusing solely on increasing the size of individuals' social networks., Competing Interests: Conflicts of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s) 2022.)

Competing Interests: Declaration of interests We declare no competing interests.

Background: Single-use personal protective equipment (PPE) has been essential to protect healthcare workers during the COVID-19 pandemic. However, intensified use of PPE could counteract the previous efforts made by the UK NHS Trusts to reduce their plastic footprint., Design and Methods: In this study, we conducted an in-depth case study in the Royal Cornwall Hospitals NHS Trust to investigate plastic-related issues in a typical NHS Trust before, during and after the pandemic. We first collected hospital routine data on both procurement and usage of single-use PPE (including face masks, aprons, and gowns) for the time period between April 2019 and August 2020. We then interviewed 12 hospital staff across a wide remit, from senior managers to consultants, nurses and catering staff, to gather qualitative evidence on the overall impact of COVID-19 on the Trust regarding plastic use., Results: We found that although COVID-19 had increased the procurement and the use of single-use plastic substantially during the pandemic, it did not appear to have changed the focus of the hospital on implementing measures to reduce single-use plastic in the long term. We then discussed the barriers and opportunities to tackle plastic issues within the NHS in the post-COVID world, for example, a circular healthcare model., Conclusion: investment is needed in technologies and processes that can recycle and reuse a wider range of single-use plastics, and innovate sustainable alternatives to replace single-use consumables used in the NHS to construct a fully operational closed material loop healthcare system.

Background: Personas, based on customer or population data, are widely used to inform design decisions in the commercial sector. The variety of methods available means that personas can be produced from projects of different types and scale., Objective: This study aims to experiment with the use of personas that bring together data from a survey, household air measurements and electricity usage sensors, and an interview within a research and innovation project, with the aim of supporting eHealth and eWell-being product, process, and service development through broadening the engagement with and understanding of the data about the local community., Methods: The project participants were social housing residents (adults only) living in central Cornwall, a rural unitary authority in the United Kingdom. A total of 329 households were recruited between September 2017 and November 2018, with 235 (71.4%) providing complete baseline survey data on demographics, socioeconomic position, household composition, home environment, technology ownership, pet ownership, smoking, social cohesion, volunteering, caring, mental well-being, physical and mental health-related quality of life, and activity. K-prototype cluster analysis was used to identify 8 clusters among the baseline survey responses. The sensor and interview data were subsequently analyzed by cluster and the insights from all 3 data sources were brought together to produce the personas, known as the Smartline Archetypes., Results: The Smartline Archetypes proved to be an engaging way of presenting data, accessible to a broader group of stakeholders than those who accessed the raw anonymized data, thereby providing a vehicle for greater research engagement, innovation, and impact., Conclusions: Through the adoption of a tool widely used in practice, research projects could generate greater policy and practical impact, while also becoming more transparent and open to the public., (©Andrew James Williams, Tamaryn Menneer, Mansi Sidana, Tim Walker, Kath Maguire, Markus Mueller, Cheryl Paterson, Michael Leyshon, Catherine Leyshon, Emma Seymour, Zoë Howard, Emma Bland, Karyn Morrissey, Timothy J Taylor. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 16.02.2021.)

Background: Policing is a highly stressful and increasingly sedentary occupation. The study aim was to assess the acceptability and impact of a mobile health (mHealth) technology intervention (Fitbit® activity monitor and 'Bupa Boost' smartphone app) to promote physical activity (PA) and reduce sedentary time in the police force., Methods: Single-group, pre-post, mixed methods pilot study. Police officers and staff (n = 180) were recruited from two police forces in South West England. Participants used the technology for 12 weeks (an 'individual' then 'social' phase) followed by 5 months of optional use. Data sources included Fitbit®-recorded objective step count, questionnaire surveys and semi-structured interviews (n = 32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Paired t-tests were used to investigate changes in quantitative outcomes. Qualitative analysis involved framework and thematic analysis., Results: Changes in mean daily step count were non-significant (p > 0.05), but self-reported PA increased in the short term (e.g. + 465.4 MET-minutes/week total PA baseline to week 12, p = 0.011) and longer term (e.g. + 420.5 MET-minutes/week moderate-to-vigorous PA baseline to month 8, p = 0.024). The greatest impact on behaviour was perceived by less active officers and staff. There were no significant changes in sedentary time; the qualitative findings highlighted the importance of context and external influences on behaviour. There were no statistically significant changes (all p-values > 0.05) in any secondary outcomes (physical and mental health-related quality of life, perceived stress and perceived productivity), with the exception of an improvement in mental health-related quality of life (SF-12 mental component score + 1.75 points, p = 0.020) from baseline to month 8. Engagement with and perceived acceptability of the intervention was high overall, but a small number of participants reported negative physical (skin irritation) and psychological (feelings of guilt and anxiety) consequences of technology use. Individual app features (such as goal-setting and self-monitoring) were generally preferred to social components (social comparison, competitions and support)., Conclusions: mHealth technology is an acceptable and potentially impactful intervention for increasing PA in the police force. The intervention was less useful for reducing sedentary time and the impact on secondary outcomes is unclear., Trial Registration: NCT03169179 (registered 30th May 2017).

The rapidly evolving ocean economy, driven by human needs for food, energy, transportation and recreation, has led to unprecedented pressures on the ocean that are further amplified by climate change, loss of biodiversity and pollution. The need for better governance of human activities in the ocean space has been widely recognized for years, and is now also incorporated in the United Nations Sustainable Development Goals. Even so, many challenges relating to the implementation of existing governance frameworks exist. Here, we argue that integrated ocean management (IOM) should be the key overarching approach-building upon and connecting existing sectoral governance efforts-for achieving a sustainable ocean economy. IOM is a holistic, ecosystem-based and knowledge-based approach that aims to ensure the sustainability and resilience of marine ecosystems while integrating and balancing different ocean uses to optimize the overall ocean economy. We discuss examples of IOM in practice from areas where preconditions differ substantially, and identify six universal opportunities for action that can help achieve a sustainable ocean economy.

Introduction: Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined., Methodology and Analysis: The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

In June 2011 the BBC Lab UK carried out a web-based survey on the causes of mental distress. The 'Stress Test' was launched on 'All in the Mind' a BBC Radio 4 programme and the test's URL was publicised on radio and TV broadcasts, and made available via BBC web pages and social media. Given the large amount of data created, over 32,800 participants, with corresponding diagnosis, demographic and socioeconomic characteristics; the dataset are potentially an important source of data for population based research on depression and anxiety. However, as respondents self-selected to participate in the online survey, the survey may comprise a non-random sample. It may be only individuals that listen to BBC Radio 4 and/or use their website that participated in the survey. In this instance using the Stress Test data for wider population based research may create sample selection bias. Focusing on the depression component of the Stress Test, this paper presents an easy-to-use method, the Two Step Probit Selection Model, to detect and statistically correct selection bias in the Stress Test. Using a Two Step Probit Selection Model; this paper did not find a statistically significant selection on unobserved factors for participants of the Stress Test. That is, survey participants who accessed and completed an online survey are not systematically different from non-participants on the variables of substantive interest., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Ecological influences on health outcomes are associated with the spatial stratification of health. However, the majority of studies that seek to understand these ecological influences utilise aspatial methods. Geographically weighted regression (GWR) is a spatial statistics tool that expands standard regression by allowing for spatial variance in parameters. This study contributes to the urban health literature, by employing GWR to uncover geographic variation in Limiting Long Term Illness (LLTI) and area level effects at the small area level in a relatively small, urban environment. Using GWR it was found that each of the three contextual covariates, area level deprivation scores, the percentage of the population aged 75 years plus and the percentage of residences of white ethnicity for each LSOA exhibited a non-stationary relationship with LLTI across space. Multicollinearity among the predictor variables was found not to be a problem. Within an international policy context, this research indicates that even at the city level, a "one-size fits all" policy strategy is not the most appropriate approach to address health outcomes. City "wide" health polices need to be spatially adaptive, based on the contextual characteristics of each area.