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Abstract 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 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.

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.

BackgroundIn an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. ObjectiveThis 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). MethodsConducted 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. ResultsAmong 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). ConclusionsSociodigital 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.

IntroductionSmall Island Developing States have disproportionately high food insecurity rates, related to complex challenges and vulnerabilities. The COVID-19 pandemic highlighted that within these settings, crises often overlap. We aimed to assess the impact of the concurrent COVID-19 pandemic and volcanic eruption on food production and security in St. Vincent and the Grenadines (SVG).MethodsAn interpretive mixed-methods study was conducted among a convenience sample of consenting adults ≥18 years from 100 households in SVG through a cross-sectional survey and participant interviews (10 households) between September 2021 and March 2022. Food insecurity prevalence over the past year was assessed using the Food Insecurity Experience Scale (FIES; Rasch modeling) and impacts to livelihoods from the pandemic and volcanic eruption was assessed using an adapted Caribbean COVID-19 Food Security and Livelihoods Impact Survey (Caribbean COVID-19 FS&L Survey). Data were analyzed using logistic regression.ResultsDuring the pandemic, 59% of the participants reported decreased income, 63% had no access to markets, 81% had no access to food aid; 34% of the participants had a change in food sources, and 81% reported that food production was negatively impacted by the volcanic eruptions, of which 68% reported decreased food production. The interviews highlighted that access to markets were restricted by fear of leaving home and contracting the COVID-19 virus, and participants who received food aid stated that the number of items were not sufficient for larger families. Almost half of the participants were severely food insecure [48% (95% C.I. 31.2,57.8)]; almost two thirds were moderately to severely food insecure [64% (95% C.I. 50.0, 74.2)]; mean FIES score 5.31 (95% C.I. 5.0,5.6). After adjusting for gender, age, education, and household size, moderate to severe food insecurity was associated with no access to food aid during the pandemic and post-eruptions (odds ratio 3.7; 95% confidence interval 1.5, 9.1; p = 0.004).ConclusionFood insecurity rates were high during the COVID-19 pandemic, exacerbated by volcanic eruptions and insufficient access to food aid. Our results suggest the need for the development of strategies and interventions aimed at increasing the resilience of food systems to mitigate the effects of future disasters.

Abstract The global COVID-19 pandemic brought considerable public and policy attention to the field of infectious disease modelling. A major hurdle that modellers must overcome, particularly when models are used to develop policy, is quantifying the uncertainty in a model’s predictions. By including the most recent available data in a model, the quality of its predictions can be improved and uncertainties reduced. This paper adapts an existing, large-scale, individual-based COVID-19 model to explore the benefits of updating the model in pseudo-real time. We use Approximate Bayesian Computation (ABC) to dynamically recalibrate the model’s parameter values as new data emerge. ABC offers advantages over alternative calibration methods by providing information about the uncertainty associated with particular parameter values and the resulting COVID-19 predictions through posterior distributions. Analysing such distributions is crucial in fully understanding a model and its outputs. We find that forecasts of future disease infection rates are improved substantially by incorporating up-to-date observations and that the uncertainty in forecasts drops considerably in later simulation windows (as the model is provided with additional data). This is an important outcome because the uncertainty in model predictions is often overlooked when models are used in policy.

IntroductionSmall island developing states (SIDS) are a diverse group of coastal and tropical island countries primarily located in the Caribbean and Pacific. SIDS share unique social, economic, and environmental vulnerabilities, high dependency on food imports, and susceptibility to inadequate, unhealthy diets, with high burdens of two or more types of malnutrition. Our objective was to examine trends in food availability, imports, local production, and risks of non-communicable diseases (NCDs) in three SIDS: Haiti, Saint Vincent and the Grenadines (SVG) and Fiji.MethodsData on food availability, imports, exports, and production was extracted from the Food and Agriculture Organization Database (FAOSTAT), and on overweight, obesity and diabetes prevalence from the NCD Risk Factor Collaboration database (NCD-RisC) from 1980 to 2018. Data were collated, graphed, and used to calculate import dependency ratios (IDRs) using Excel and R software.ResultsBetween 1980 and 2018, the availability of calories per capita per day has risen in Fiji and SVG by over 500, to around 3000. In Haiti, the increase is around 200, to a level of 2,200 in 2018, and in all three settings, > 10% of calories in 2018 came from sugar. In Fiji and Haiti, the availability of fruit and vegetables is 30 Kg/m2) has increased since 1980 (by 126% to 800%) and is substantially higher in women. In the most recent data for Fiji, an estimated 35% of women are obese (24% men); in SVG, 30% women (15% men); and in Haiti, 26% women (15% men).ConclusionThe increase in per capita availability of calories, which has taken place since 1980, is concurrent with an increase in IDR, a loss of local food, and increases in obesity prevalence. These findings highlight the importance of further research to understand the drivers of food supply transformations, and to influence improving nutrition, through production, availability, and consumption of nutritious local foods.

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.

Abstract 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).

Abstract 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.

Linking novel real-time sensor data with comprehensive individual baseline survey data, this study estimates the effect of fuel poverty on the physical and mental health of social housing tenants in the southwest of the UK. Structural equation modeling is applied to show that fuel poverty has a significant negative effect on mental health. Other socio-economic characteristics (such as age, household size) and house characteristics (e.g., energy-efficient rating, house type) are associated with fuel poverty. Fuel poverty is also related to poorer mobility. Our results suggest that special attention should be paid to tenants with disabilities and chronic diseases since they are more vulnerable to fuel poverty and health issues.

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.

The Philippines, as a tropical archipelagic country, is particularly vulnerable to environmental changes affecting coastal and marine settings. However, there are limited studies investigating how these changes are perceived by the local populations who depend directly on the marine environment for their livelihoods, health, and well-being, and who are the most vulnerable to such changes. To explore these issues, we conducted an in-home face-to-face structured survey in 10 coastal communities in Palawan, Philippines (n = 431). As part of the survey, respondents were asked to comment on how important they believed a list of 22 drivers/pressures (e.g., “land-use change”) were in affecting their local marine environment. Statistical analysis of this list using Exploratory Factor Analysis suggested the 22 drivers/pressures could be categorized into 7 discrete groups (or in statistical terms “factors”) of drivers/pressures (e.g., “urbanization,” “unsustainable fishing practices” etc.). We then used ordinary least squared regression to identify similarities and differences between the perspectives within and across communities, using various socio-demographic variables. Results suggested that among the seven identified factors, four were perceived by the local communities as making the marine environment worse, two were perceived as having no impact, and one was perceived to be making the marine environment better. Perceptions differed by gender, education, ethnicity, and study site. A subsequent survey with 16 local coastal resource management experts, suggested that public perceptions of the most critical drivers/pressures were broadly consistent with those of this expert group. Our findings highlight how aware local coastal communities are of the drivers/pressures underpinning the threats facing their livelihoods, health, and well-being. Ultimately, this information can support and inform decisions for the management of local marine resources.

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.

Policing has become an increasingly sedentary occupation. At the same time, rates of depression are increasing across the police force. Vigorous physical activity (VPA) has been associated with decreasing rates of depression, yet studies of VPA in policing are limited. This study aimed to explore the prevalence of depression and examine its association with VPA in police officers and staff in England, further stratified by gender. A cross-sectional, secondary data analysis of the Airwave dataset was undertaken. The data were analyzed using descriptive statistics and multivariate logistic regression. Of 28,465 police officers and staff in England, 12% reported having doctor-diagnosed depression and 25% were physically inactive. Relative to being physically inactive, undertaking VPA for either four or seven days was significantly associated with having the lowest odds of reporting depression (OR 0.59, 95% CI: 0.51–0.70, p < 0.001) (OR 0.59, 95% CI: 0.45–0.77, p < 0.001), respectively, suggesting a U-shaped/non-linear relationship. This relationship was also observed in the gender-stratification analysis. While the odds of reporting depression were significantly lower for men than women, VPA was significantly associated with reducing the odds of reporting depression slightly more in women (OR 0.43, 95% CI: 0.27–0.67, p < 0.001) than in men (OR 0.50, 95% CI: 0.33–0.75, p < 0.01), indicating women may be more likely to benefit from VPA than men. Vigorous physical activity may provide a protective effect against depression. To prevent the onset of depression in the target population, policy-makers should consider designing physical activity guidelines for police officers to promote VPA in the target population.

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.

This paper examines the association between financial hardship in childhood and adulthood, and depression and anxiety in adulthood with reference to the accumulation, critical period and social mobility hypotheses in lifecourse epidemiology. Using the BBC Stress test, linear regression models were used to investigate the associations for the whole population and stratifying by gender and adjusting for age and highest education attainment. The critical period hypothesis was not confirmed. The accumulation hypothesis was confirmed and stratifying by gender women had a higher estimated mean GAD score if they were poor in both childhood and adulthood compared to men. Our findings do not support the social mobility hypothesis. However, stratifying by gender, a clear difference emerged with upward mobility having a favourable impact (lower) on women's mean GAD scores, while upward social mobility in adulthood did not attenuate the impact of financial hardship in childhood or men. The impact of financial hardship in childhood on later mental health outcomes is particularly concerning for future health outcomes as current levels of child poverty increases in the UK.

This paper examines the association between financial hardship in childhood and adulthood, and depression and anxiety in adulthood with reference to the accumulation, critical period and social mobility hypotheses in lifecourse epidemiology. Using the BBC Stress test, linear regression models were used to investigate the associations for the whole population and stratifying by sex and adjusting for age and highest education attainment. The critical period hypothesis was not confirmed. The accumulation hypothesis was confirmed and stratifying by sex women had a higher estimated mean GAD score if they were poor in both childhood and adulthood compared to men. Our findings do not support the social mobility hypothesis. However, stratifying by sex, a clear difference emerged with upward mobility having a favourable impact (lower) on women's mean GAD scores, while upward social mobility in adulthood did not attenuate the impact of financial hardship in childhood or men. The impact of financial hardship in childhood on later mental health outcomes is particularly concerning for future health outcomes as current levels of child poverty increases in the UK.

Energy consumption in the residential sector is increasing rapidly in China. This study applies an integrated assessment model to investigate the adverse impacts of household energy consumption by various fuel types across rural and urban areas on age- and sex-specific premature deaths associated with PM _2.5 pollution at provincial levels for 2015. We further estimate the economic and health co-benefits of a switch from solid fuels to electricity within households. We find that energy consumed by Chinese urban households is nearly 1.6 times than that of rural households. However, premature deaths due to household energy usage is 1.1 times higher in rural areas compared to urban areas due to direct use of coal for heating in rural households. The majority of household consumption-related premature deaths are predominately in the Southern area of China due to the population size and aging population. By replacing coal and biomass with electricity, this paper estimates economic benefits equal to 0.09% (95% CI: 0.08%–0.1%) GDP for rural areas and 0.006% (0.005%–0.007%) of GDP for urban areas of China. The results suggest that mitigation measures such as the promotion and subsidization of cleaner fuels, modern stove within rural households would yield these potential significant economic benefits.

This study assesses the impact of a decrease in air quality and the risk of hospital admissions to a public hospital for chronic respiratory diseases for residents of Petaling Jaya, a city in the Greater Kuala Lumpur area in Malaysia. Data on hospital admissions for asthma, bronchitis, emphysema and other chronic obstructive pulmonary disease, weather conditions and the Malaysian Air Pollution Index, a composite indicator of air quality, were collated. An unconstrained distributed lag model to obtain risk of hospitalization for a 10 μg/m3 increase in the API. The lag cumulative effect for a 10 μg/m3 increase in the API was calculated to test for harvesting in the short term. Findings indicate that after an initial decrease in admissions (days 3 and 4), admissions increased again at day 7 and 8 and this relationship was significant. We therefore conclude that a 10 μg/m3 increase has a greater effect on admissions for respiratory health in the short term than a harvesting effect alone would suggest. These results suggest that while air quality is improving in the Greater Kuala Lumpur area, no level of air pollution can be deemed safe.

This study explores longitudinal relationships between material, psycho-social and behavioural social determinants of health and multimorbidity of people aged 50 years or older in England. We used data from the English Longitudinal Study of Ageing collected biannually between 2002 and 2015. Apart from the basic measure of multimorbidity (two or more diseases within a person) we constructed two distinct measures of health in order to take into account the biology of ageing (complex multimorbidity and multiple functional limitations).We found that the likelihood of multimorbidity and multiple functional limitations was consistently associated with the levels of household wealth, sense of control over one's life, physical activity and loneliness. Larger health inequalities were observed when health was measured as complex multimorbidity and multiple functional limitations than basic multimorbidity. Compared to the population group with the highest wealth, those with the lowest wealth had 47% higher odds of basic multimorbidity (95% C.I. 1.34-1.61), 73% higher odds of complex multimorbidity (95% C.I. 1.52-1.96) and 90% higher odds of having 10 or more functional limitations (95% C.I. 1.59-2.26). We did not find a dose-response relationship between alcohol consumption, smoking and multimorbidity but rather evidence of people in ill health actively moderating their health behaviour.We suggest that materialist models of multimorbidity and functional limitation at older age can not, on their own, explain the health inequalities as the behavioural and psycho-social factors play an important role. Policies aiming to reduce the risk of multimorbidity and functional limitation should address the issue at these three levels simultaneously, using the existing national infrastructure of General Practices. Keywords: Multimorbidity, Complex multimorbidity, Multiple functional limitations, Social determinansts of health, Ageing, Health inequalities

This study aimed to estimate the prevalence of three measures of multimorbidity among people aged 50 years or older in England. Beside the basic measure of two or more diseases within a person, we added a measure of three or more affected body systems (complex multimorbidity) and a measure of 10 or more functional limitations. We found that the three health outcomes became more prevalent between 2002 and 2015. They were more common among females than males and were becoming more common among younger age groups. While in 2002, the prevalence of basic multimorbidity overcame 50% from the 70–74 age group upwards, in 2015 it crossed the same threshold in the 65–69 age group. The distribution of multimorbidity and multiple functional limitations were stratified by the amount of household wealth. Multiple functional limitations reflected the largest differences between the most and the least affluent groups (5.9-fold in 2014/2015), followed by the measure of complex multimorbidity (2.8-fold in 2014/2015) and basic multimorbidity (1.9-fold) in 2014/2015.While age acted as a levelling factor for the wealth differences in basic multimorbidity, it had no such effect on the two other outcomes. Our study observed social polarization among multimorbid ageing population in England where complex multimorbidity and multiple functional limitations increase faster and reflect stronger inequality than basic multimorbidity.

Objective This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings. Methods Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London – Refined (CALO-RE) taxonomy. Results Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as ‘strong’ methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time. Conclusions While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions. Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856

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.

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.