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There are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment; where it can be found, and potential exposure determinants, limiting our ability to effectively model and compare interventions for risk management.This study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and air, alongside ventilation and patient care activities.Air sampling at 200 L/min for 20 minutes and surface sampling were performed in two wards designated to treat COVID-19 -positive patients and two non-COVID-19 wards across three hospitals in November and December 2020.Detectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7x10Non-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance.

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection.DesignWe analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from December 1st2020 to 11thMay 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups.SettingResultsEstimated rates of triple-vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%), and retail (85%). High rates were observed for individuals working in health (95% for office-based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios reduced from 1.38 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. Conversely, estimated relative risk for some occupational groups, such as people working in education, remained high despite high vaccine coverage.ConclusionsVariation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

ObjectivesThis systematic review aimed to evaluate the evidence for air and surface contamination of workplace environments with SARS-CoV-2 RNA and the quality of the methods used to identify actions necessary to improve the quality of the data.MethodsWe searched Web of Science and Google Scholar until 24th December 2020 for relevant articles and extracted data on methodology and results.ResultsThe vast majority of data come from healthcare settings, with typically around 6 % of samples having detectable concentrations of SARS-CoV-2 RNA and almost none of the samples collected had viable virus. There were a wide variety of methods used to measure airborne virus, although surface sampling was generally undertaken using nylon flocked swabs. Overall, the quality of the measurements was poor. Only a small number of studies reported the airborne concentration of SARS-CoV-2 virus RNA, mostly just reporting the detectable concentration values without reference to the detection limit. Imputing the geometric mean air concentration assuming the limit of detection was the lowest reported value, suggests typical concentrations in health care settings may be around 0.01 SARS-CoV-2 virus RNA copies/m3. Data on surface virus loading per unit area were mostly unavailable.ConclusionThe reliability of the reported data is uncertain. The methods used for measuring SARS-CoV-2 and other respiratory viruses in work environments should be standardised to facilitate more consistent interpretation of contamination and to help reliably estimate worker exposure.Key messagesWhat is already known about this subject?Low level contamination of air and surfaces in hospitals with SARS-CoV-2 RNA have been reported during the Covid-19 pandemic.Limited data have published from non-healthcare settings.What are the new findings?Typically, around 6% of air and surface samples in hospitals were positive for SARS-COV-2 RNA, although there is very limited data for non-healthcare settings.The quality of the available measurement studies is generally poor, with little consistency in the sampling and analytical methods used.Few studies report the concentration of SARS-CoV-2 in air or as surface loading of virus RNA, and very few studies have reported culture of the virus.The best estimate of typical air concentrations in health care settings is around 0.01 SARS-CoV-2 virus RNA copies/m3How might this impact on policy or clinical practice in the foreseeable future?There should be concerted efforts to standardise the methods used for measuring SARS-CoV-2 and other respiratory viruses in work environments.

The presence of urban greenspace may lead to reduced personal exposure to air pollution via several mechanisms, for example, increased dispersion of airborne particulates; however, there is a lack of real-time evidence across different urban contexts. Study participants were 79 adolescents with asthma who lived in Delhi, India and were recruited to the Delhi Air Pollution and Health Effects (DAPHNE) study. Participants were monitored continuously for exposure to PM2.5 (particulate matter with an aerodynamic diameter of less than 2.5 μm) for 48 h. We isolated normal day-to-day walking journeys (n = 199) from the personal monitoring dataset and assessed the relationship between greenspace and personal PM2.5 using different spatial scales of the mean Normalised Difference Vegetation Index (NDVI), mean tree cover (TC), and proportion of surrounding green land use (GLU) and parks or forests (PF). The journeys had a mean duration of 12.7 (range 5, 53) min and mean PM2.5 personal exposure of 133.9 (standard deviation = 114.8) μg/m3. The within-trip analysis showed weak inverse associations between greenspace markers and PM2.5 concentrations only in the spring/summer/monsoon season, with statistically significant associations for TC at the 25 and 50 m buffers in adjusted models. Between-trip analysis also indicated inverse associations for NDVI and TC, but suggested positive associations for GLU and PF in the spring/summer/monsoon season; no overall patterns of association were evident in the autumn/winter season. Associations between greenspace and personal PM2.5 during walking trips in Delhi varied across metrics, spatial scales, and season, but were most consistent for TC. These mixed findings may partly relate to journeys being dominated by walking along roads and small effects on PM2.5 of small pockets of greenspace. Larger areas of greenspace may, however, give rise to observable spatial effects on PM2.5, which vary by season.

BackgroundConcern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain occupations with the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic.MethodsAnalysis of cohort data from the UK Office of National Statistics COVID-19 Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression were used to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions.ResultsBased on 3 910 311 observations (visits) from 312 304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared with non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates.ConclusionsElevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.

Background International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. Methods Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009–15). Regional economic trends were characterized by annual full-time employment data (2004–14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010–15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. Results Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08–1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7–61%) of this association was explained by the impact of welfare benefit reforms on average incomes. Conclusions Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.

BackgroundConsiderable concern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain which occupations had the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic.MethodsAnalysis of cohort data from the UK Office of National Statistics Coronavirus (COVID-19) Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions.ResultsBased on 3,910,311 observations from 312,304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared to non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates.ConclusionsElevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.What is already known on this topicSome occupational groups have observed increased rates of disease and mortality relating to COVID-19.What this study addsRelative differences between occupational groups have varied during different stages of the COVID-19 pandemic with risks for healthcare workers diminishing over time and workers in the education sector seeing persistent elevated risks.How this study might affect research, practice or policyIncreased long term mitigation such as ventilation should be considered in sectors with a persistent elevated risk. It is important for workplace policy to be responsive to evolving pandemic risks.

Excessive exposure to ultraviolet (UV) radiation from the sun in summer can cause skin cancer and in Britain there are around 1500 new cases of non-melanoma skin cancer (NMSC) each year, caused by exposure to solar UV at work. Little is known about the magnitude of UV exposure amongst outdoor construction workers in Britain, although this is one of the main groups at risk. The aim of this paper is to summarise measurements of erythema-weighted UVB radiation amongst construction workers in Scotland and the Southeast of England and interpret the data in terms of the risk of NMSC. The measurements were made as part of an intervention study using short mobile phone text messages to alter worker behaviour to either reduce UV exposure in summer or increase serum vitamin D in winter; the intervention is only briefly reported here. Data were collected from 67 workers from 9 worksites, of whom 41 provided measures of UV exposure for 758 working days. Daily exposure ranged from 0 to 13.47 standard erythema dose (SED), with the mean exposure for outdoor workers being 2.0 SED and the corresponding value for indoor workers being 0.7 SED. These data were obtained from a sensor located on the back of the workers hard hat; others have measured exposure on the wrist or upper arm and these locations probably, on average, have higher levels of UV exposure. It is likely that an outdoor construction worker in Britain could accumulate sufficient solar UV exposure over 30–40 years of work to more than double their risk of NMSC. We argue that employers in Britain should take a more proactive approach to manage sun safety and they should take responsibility for skin health surveillance for their workers.

Excessive exposure to solar ultra-violet (UV) radiation can cause skin cancer, but inadequate exposure to sunlight limits the production of vitamin D. We report a text messaging and supportive smar...

The presence of urban greenspace may lead to reduced personal exposure to air pollution via several mechanisms, for example, increased dispersion of airborne particulates; however, there is a lack of real-time evidence across different urban contexts. Study participants were 79 adolescents with asthma who lived in Delhi, India and were recruited to the Delhi Air Pollution and Health Effects (DAPHNE) study. Participants were monitored continuously for exposure to PM

Background Risk of preeclampsia varies by month of delivery. We tested whether this seasonal patterning may be mediated through maternal vitamin D concentration using antenatal exposure to UV‐B radiation as an instrumental variable. Methods and Results Scottish maternity records were linked to antenatal UV‐B exposure derived from satellites between 2000 and 2010. Logistic regression analyses were used to explore the association between UV‐B and preeclampsia, adjusting for the potential confounding effects of month of conception, child's sex, gestation, parity, and mean monthly temperature. Of the 522 896 eligible singleton deliveries, 8689 (1.66%) mothers developed preeclampsia. Total antenatal UV‐B exposure ranged from 43.18 to 101.11 kJ/m 2 and was associated with reduced risk of preeclampsia with evidence of a dose‐response relationship (highest quintile of exposure: adjusted odds ratio, 0.57; 95% CI, 0.44–0.72; P Conclusions The seasonal patterning of preeclampsia may be mediated through low maternal vitamin D concentration in winter resulting from low UV‐B radiation. Interventional studies are required to determine whether vitamin D supplements or UV‐B–emitting light boxes can reduce the seasonal patterning of preeclampsia.

Summary Background Understanding factors impacting deaths from COVID‐19 is of the highest priority. Seasonal variation in environmental meteorological conditions affects the incidence of many infectious diseases and may also affect COVID‐19. Ultraviolet (UV) A (UVA) radiation induces release of cutaneous photolabile nitric oxide (NO) impacting the cardiovascular system and metabolic syndrome, both COVID‐19 risk factors. NO also inhibits the replication of SARS‐CoV2. Objectives To investigate the relationship between ambient UVA radiation and COVID‐19 deaths. Methods COVID‐19 deaths at the county level, across the USA, were modelled in a zero‐inflated negative‐binomial model with a random effect for states adjusting for confounding by demographic, socioeconomic and long‐term environmental variables. Only those areas where UVB was too low to induce significant cutaneous vitamin D3 synthesis were modelled. We used satellite‐derived estimates of UVA, UVB and temperature and relative humidity. Replication models were undertaken using comparable data for England and Italy. Results The mortality rate ratio (MRR) in the USA falls by 29% [95% confidence interval (CI) 40% to 15%) per 100 kJ m–2 increase in mean daily UVA. We replicated this in independent studies in Italy and England and estimate a pooled decline in MRR of 32% (95% CI 48% to 12%) per 100 kJ m–2 across the three studies. Conclusions Our analysis suggests that higher ambient UVA exposure is associated with lower COVID‐19‐specific mortality. Further research on the mechanism may indicate novel treatments. Optimized UVA exposure may have population health benefits., What is already known about this topic? Infectious disease often shows seasonality.Cutaneous production of nitric oxide (NO) following ultraviolet A (UVA) exposure reduces blood pressure, a cardiovascular risk factor.Comorbid cardiovascular disease worsens COVID‐19 outcomes.NO limits SARS‐CoV and SARS‐CoV2 replication in vitro. What does this study add? Higher ambient UVA is associated with lower risk of COVID‐19 death in three countries, when vitamin D synthesis would have been limited.Sun exposure may reduce death from COVID‐19 independently of vitamin D.

This paper examines trends in mental health among adults in England during the period of economic recovery and austerity following the 2008 ‘great recession’. We report analysis of data on 17,212 individuals living in England, from the longitudinal Understanding Society Survey (USS). We examined how individual’s self-reported mental health over time (2011 -2017), related to their changing socio-geographical status.Self-reported mental health is reported in the USS using version 2 of the SF12 Mental Component Summary. Trends in this score (across 5 observations per subject) were categorised into Mental Health Trajectory Groups (MHTGs) using Group Based Trajectory Modelling. We used maximum-likelihood multinomial logit models to estimate for individuals the relative likelihood of belonging to different Mental Health Trajectory categories as compared with a ‘base’ category, for whom mental health was good and stable throughout the period. We focus on likelihood of belonging to a group showing ‘declining’ mental health. Predictor variables included individuals’ attributes and area conditions in their places of residence (including Office of National Statistics indicators of local employment deprivation and data on average income loss within districts due to welfare benefit reforms, published by the Centre of Regional Economic and Social Research at Sheffield Hallam University, UK).Our results emphasise the multiple socio-geographical ‘determinants’ likely to be operating on individual mental health. Declining mental health was associated both with conditions at the start of the study period and with social and socio-geographical mobility by the end of the study period. Risks of declining mental health were significantly greater for more deprived individuals and also (controlling for individual attributes) among those living in English neighbourhoods that were already economically disadvantaged at the beginning of the ‘great recession’ and located in districts where average incomes were most severely impacted by the effects of governmental austerity programmes on welfare benefits.

BackgroundOver the past decade, antidepressant prescriptions have increased in European countries and the United States, partly due to an increase in the number of new cases of mental illness. This paper demonstrates an innovative approach to the classification of population level change in mental health status, using administrative data for a large sample of the Scottish population. We aimed to identify groups of individuals with similar patterns of change in pattern of prescribing, validate these groups by comparison with other indicators of mental illness, and characterise the population most at risk of increasing mental ill health.MethodsNational Health Service (NHS) prescription data were linked to the Scottish Longitudinal Study (SLS), a 5.3% sample of the Scottish population (N = 151,418). Antidepressant prescription status over the previous 6 months was recorded for every month for which data were available (January 2009–December 2014), and sequence dissimilarity was computed by optimal matching. Hierarchical clustering was used to create groups of participants who had similar patterns of change, with multi-level logistic regression used to understand group membership.ResultsFive distinct prescription pattern groups were observed, indicating: no prescriptions (76%), occasional prescriptions (10%), continuation of prior use of prescriptions (8%), a new course of prescriptions started (4%) or ceased taking prescriptions (3%). Young, white, female participants, of low social grade, residing in socially deprived neighbourhoods, living alone, being separated/divorced or out of the labour force, were more likely to be in the group that started a new course of antidepressant prescriptions.ConclusionsThe use of sequence analysis for classifying individual antidepressant trajectories offers a novel approach for capturing population-level changes in mental health risk. By classifying individuals into groups based on their anti-depressant medication use we can better identify how over time, mental health is associated with individual risk factors and contextual factors at the local level and the macro political and economic scale.

Background/Aim Several exposures contribute to human vitamin D levels including solar irradiation, diet, behaviour and genes. This study was designed to examine meteorological factors that influenc...

BackgroundAir pollution has been consistently linked with dementia and cognitive decline. However, it is unclear whether risk is accumulated through long-term exposure or whether there are sensitive/critical periods. A key barrier to clarifying this relationship is the dearth of historical air pollution data.ObjectiveTo demonstrate the feasibility of modelling historical air pollution data and using them in epidemiological models.MethodsUsing the EMEP4UK atmospheric chemistry transport model, we modelled historical fine particulate matter (PM2.5) concentrations for the years 1935, 1950, 1970, 1980, and 1990 and combined these with contemporary modelled data from 2001 to estimate life course exposure in 572 participants in the Lothian Birth Cohort 1936 with lifetime residential history recorded. Linear regression and latent growth models were constructed using cognitive ability (IQ) measured by the Moray House Test at the ages of 11, 70, 76, and 79 years to explore the effects of historical air pollution exposure. Covariates included sex, IQ at age 11 years, social class, and smoking.ResultsHigher air pollution modelled for 1935 (when participants would have been in utero) was associated with worse change in IQ from age 11-70 years (β=-0.006, SE=0.002, P=0.03) but not cognitive trajectories from age 70-79 years (P>0.05). There was no support for other critical/sensitive periods of exposure or an accumulation of risk (all P>0.05).ConclusionsThe life course paradigm is essential in understanding cognitive decline and this is the first study to examine life course air pollution exposure in relation to cognitive health.

There is an urgent need to examine what individual and environmental risk factors are associated with COVID-19 mortality. This objective of this study is to investigate the association between long term exposure to air pollution and COVID-19 mortality. We conducted a nationwide, ecological study using zero-inflated negative binomial models to estimate the association between long term (2014-2018) small area level exposure to NOx, PM2.5, PM10 and SO2 and COVID-19 mortality rates in England adjusting for socioeconomic factors and infection exposure. We found that all four pollutant concentrations were positively associated with COVID-19 mortality. The increase in mortality risk ratio per inter quarter range increase was for PM2.5:11%, 95%CIs 6%-17%), PM10 (5%; 95%CIs 1%-11%), NOx (11%, 95%CIs 6%-15%) and SO2 (7%, 95%CIs 3%-11%) were respectively in adjusted models. Public health intervention may need to protect people who are in highly polluted areas from COVID-19 infections.

BackgroundReducing the local availability of tobacco is identified as the ‘next frontier’ in tobacco control. This paper examines the roles of tobacco retail outlet density and tobacco visibility in changing exposure to tobacco retailing before and after the introduction of point-of-sale (POS) legislation in Scotland.MethodsNational tobacco retailer register data were analysed to examine time trends in tobacco retailer density (2012–2017). Results were stratified by local authority, neighbourhood deprivation and urbanity. Next, an annual retail audit using a POS tobacco visibility tool assessed changes in total product visibility in all retail outlets in four study communities between 2013 and 2017. A longitudinal survey (2013–2017) of 5527 adolescents aged 12–17 in the four study communities enabled the calculation of residential and journey-to-school measures of tobacco retailer exposure. Trends were stratified by deprivation, urbanity and socioeconomic status.ResultsRetail provision of tobacco declined following the introduction of the POS legislation in 2013. However, there were strong geographic differences; nationally, one-fifth of local authorities have increased provision since 2015. In the four study communities, tobacco retail provision was generally stable over the study period. Although product visibility of tobacco products reduced for adolescents there was growing socioeconomic disparity in the density of tobacco retailers and the visibility of tobacco storage.ConclusionsThe POS ban reduced exposure to tobacco products in communities across Scotland. However, tobacco products remain widely available, and there is growing socioeconomic disparity in the availability and visibility of tobacco.

Background Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015. Objective To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation. Design Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years. Setting Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities. Participants In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17. Main outcome measures Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation. Data platform and methods The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils. Limitations The study was based on a small number of communities and did not include communities in remote areas. Results Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced. Conclusions The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation. Future work Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

Background Myocardial infarction exhibits seasonal patterning, with higher amplitude at increased latitude. Epidemiological evidence suggests that sunlight is protective against cardiovascular disease, independent of ambient temperature, but ultraviolet B–mediated vitamin D production has been discounted as causal. We aimed to determine whether ultraviolet A is associated with the seasonal patterning of myocardial infarction. Methods and Results Routine hospitalization data were used to determine monthly incidence of myocardial infarction in Scotland between 2000 and 2011. Small‐area–level aggregated data were obtained on ambient temperature from the Meteorological Office and ultraviolet A and ultraviolet B irradiance from NASA satellites. Autoregressive distributed lag models were run for ultraviolet A and myocardial infarction, including adjustment for ambient temperature and ultraviolet B. Monthly incidence of myocardial infarction displayed winter peaks and summer troughs superimposed on the underlying trend, with a mean amplitude of 0.31 (95% CI : 0.21, 0.41) myocardial infarctions per 100 000 population per month. Ultraviolet A exposure was inversely associated with myocardial infarction independent of ambient temperature (coefficient, −0.05; 95% CI , −0.09, −0.01; P =0.015) and ultraviolet B UVB (coefficient, −0.05; 95% CI, −0.09, −0.02; P =0.004). Conclusions Further research is required to explore whether an ultraviolet‐mediated mechanism different to vitamin D, such as nitric oxide–mediated vasodilatation, may play a causal role in the seasonal and geographical patterning of myocardial infarction.

Background: There is increasing policy interest in the potential for vegetation in urban areas to mitigate harmful effects of air pollution on respiratory health. We aimed to quantify relationships between tree and green space density and asthma-related hospitalisations, and explore how these varied with exposure to background air pollution concentrations. Methods: Population standardised asthma hospitalisation rates (1997–2012) for 26,455 urban residential areas of England were merged with area-level data on vegetation and background air pollutant concentrations. We fitted negative binomial regression models using maximum likelihood estimation to obtain estimates of asthma-vegetation relationships at different levels of pollutant exposure. Results: Green space and gardens were associated with reductions in asthma hospitalisation when pollutant exposures were lower but had no significant association when pollutant exposures were higher. In contrast, tree density was associated with reduced asthma hospitalisation when pollutant exposures were higher but had no significant association when pollutant exposures were lower. Conclusions: We found differential effects of natural environments at high and low background pollutant concentrations. These findings can provide evidence for urban planning decisions which aim to leverage health co-benefits from environmental improvements. Keywords: Ecosystem management, Air pollutants, Green space, Urban land use, Pollen, Allergy

Asthma is a complex disease with multiple environmental factors proposed to contribute to aetiology. Geographical analyses can shed light on the determinants of asthma. Ultraviolet radiation has been associated with asthma prevalence in past ecological studies. We have increased the detail of examining the association between asthma and ultraviolet radiation with addition of the variables of temperature, relative humidity and precipitation. An ecological study was designed to investigate meteorological factors associated with asthma prevalence in England. Data from the 2005 quality outcomes framework were used to determine the prevalence of asthma in primary care in England. This information was supplemented with indicators of obesity and smoking of the General Practitioner practice and population (by age and sex), deprivation and ethnicity at lower super output level from the 2001 and 2011 census. Annual mean meteorological data was attained from the Met Office and Joint Research Centre. We used a multiple linear regression to examine individual and multiple climatic factors through a principal components analysis. We tested for an association with asthma prevalence, after taking into account the spatial autocorrelation of the data. Asthma prevalence from general practice surgeries in England was 5.88% (95% CI 5.83 to 5.92). In the highest ultraviolet radiation weighted by the pre-vitamin D action spectrum (UVvitd) quartile (2.12 to 2.50 kJ/m2/day), asthma had a 5% reduction in prevalence; compared to the lowest quartile here (0.95 (95% CI 0.92 to 0.98)). Similar reductions were found in the higher temperature 0.93 (95% CI 0.90 to 96). The opposite was found with relative humidity 1.09 (95% CI 1.05 to 1.12). A combination of high temperature and UVvitd highlighted postcode districts in the South East of England with a climate beneficial to low asthma prevalence. The South West of England represented a climate which had both beneficial and detrimental associations with asthma development. Climate is associated with asthma prevalence in England. Understanding the contribution of multiple climatic factors and the relationship with the indoor environment could help to explain the population distribution of asthma.

Our research examines how local labour market trends during the early stages of the ‘great recession’ (in the period 2007-2011) related to change in individuals’ self-reported illness. We report results from analyses of a dataset drawn from the Longitudinal Study (LS) for England and Wales (source: Office of National Statistics), a very large longitudinal sample of individuals from the population census, followed up over time at each decennial census. These were linked to employment trend data for Local Authority Districts for the period 2007-2011, based on employment statistics for Local Authority Districts (LAs) in England and Wales. Controlling for various individual attributes, the risk of development of a ‘new’ long term illness during the ‘great recession’ was greater for those living in LAs where levels of employment were persistently low or declining to relatively low levels.

Learning disability varies by month of conception. The underlying mechanism is unknown but vitamin D, necessary for normal brain development, is commonly deficient over winter in high latitude countries due to insufficient ultraviolet radiation. We linked the 2007–2016 Scottish School Pupil Censuses to Scottish maternity records and to sunshine hours and antenatal ultraviolet A/B radiation exposure derived from weather stations and satellites respectively. Logistic regression analyses were used to explore the associations between solar radiation, then ultraviolet B, and learning disabilities, adjusting for the potential confounding effects of month of conception and sex. Of the 422,512 eligible, singleton schoolchildren born at term in Scotland, 79,616 (18.8%) had a learning disability. Total antenatal sunshine hours (highest quintile; adjusted OR 0.89; 95% CI: 0.86, 0.93; p

The exposure to green space in early life may support better cognitive aging in later life. However, this exposure is usually measured using the residential location alone. This disregards the exposure to green spaces in places frequented during daily activities (i.e., the &lsquo, activity space&rsquo, ). Overlooking the multiple locations visited by an individual over the course of a day is likely to result in poor estimation of the environmental exposure and therefore exacerbates the contextual uncertainty. A child&rsquo, s activity space is influenced by factors including age, sex, and the parental perception of the neighborhood. This paper develops indices of park availability based on individuals&rsquo, activity spaces (home, school, and the optimal route to school). These measures are used to examine whether park availability in childhood is related to cognitive change much later in life. Multi-level linear models, including random effects for schools, were used to test the association between park availability during childhood and adolescence and cognitive aging (age 70 to 76) in the Lothian Birth Cohort 1936 participants (N = 281). To test for the effect modification, these models were stratified by sex and road traffic accident (RTA) density. Park availability during adolescence was associated with better cognitive aging at a concurrently low RTA density (&beta, = 0.98, 95% CI: 0.36 to 1.60), but not when the RTA density was higher (&beta, = 0.22, 95% CI: &minus, 0.07 to 0.51). Green space exposure during early life may be important for optimal cognitive aging, this should be evidenced using activity space-based measures within a life-course perspective.

A multitude of studies have demonstrated that individual circumstances throughout life influence subsequent health and well-being outcomes. The life-course perspective emphasises that health is affected by the accumulation of social and economic (dis)advantages over an individual’s life but, importantly, also that there can also be critical periods where the effects of exposure can be greater. Yet few researchers have applied a life-course perspective to the study of health and place, which has resulted in a partial understanding of the dynamics of person-health-place relations. By explicitly recognising that places are spatial-temporal products, and applying a novel longitudinal life-course approach, this study examines the opportunities for incorporating aspects of place into a life course framework. The focus is the influence of neighbourhood social deprivation and provision of local green space on mental health (particularly anxiety and depression). Historical and contemporary place-based information from the Lothian region of Scotland are combined with data from a cohort of individuals born in 1936 (the Lothian Birth Cohort 1936) to consider the influence of these environmental factors over the life course on mental health outcomes later in life. The results establish the utility of the life course of place approach, and demonstrate how this concept can be operationalised using historical data sources. The findings suggest that, after adjustment, residing in the most socially disadvantaged neighbourhoods in childhood was detrimental to mental health outcomes at age 70. Further, green space provision in early life environments is related to mental health outcomes in later life, but any effect may be restricted to those residing in socially disadvantaged places, and dependent on the specific mental health outcome being considered. The findings emphasise the potential of the life course of place approach for enhancing the evidence base considering the relationships between health and place.

Background This research focusses on geographical variation in population mental health over the period 2007–2011 (during the onset of the economic recession). We report preliminary results from a project recently funded under the ESRC SDAI programme, seeking to explore variability in mental illness in Scotland during this period. Our methods combine information on individual lifecourse changes, as well as change over time in areas where the individuals are living. This research contributes to a growing field concerned with the relationships between population health and changes in wider determinants of health, operating over time for both individual people and places where they live. Methods We are making innovative use of a variety of data sources including individual data from the Scottish Longitudinal Study (SLS), a large (5%) sample from the Scottish population; drawn from the population census made available under secure conditions at the Longitudinal Studies Centre Scotland, with help and supervision of SLS staff. (SLS is supported by the ESRC/JISC, the Scottish Funding Council, the Scientists Office and the Scottish Government.) We report on work which has linked these data to information on prescriptions likely to be used to treat mental illness (provided by the Electronic Data Research & Innovation Service (eDRIS) and information on area socio-economic conditions publicly available via Scottish National Government and NOMIS (Durham University) a service provided by the Office for National Statistics, ONS. Results We report preliminary results from a dataset for more than 1 20 000 people. Most of those reporting mental illness were taking antidepressants. There is a significant statistical association between risk of reporting mental illness in 2011 and employment trajectory of local authority of residence by 2011, (after controlling for individual risk factors and for neighbourhood deprivation in 2001, before the onset of the recession). Conclusion Various personal, family and neighbourhood factors are associated with self-reported mental illness. Allowing for individual/family factors and local deprivation, people in local authorities where employment rates remained higher during the recession had lower risk of reporting mental illness, especially in the highlands and Islands of Scotland. Further research is being carried out to explore these relationships (eg controlling for migration and other possible area level determinants of mental health). The research underlines the importance of maintaining mental health services across Scotland during the recession to protect mental health and control inequality.

The major circulating metabolite of vitamin D (25(OH)D) has been implicated in the pathogenesis for atopic dermatitis, asthma and other allergic diseases due to downstream immunomodulatory effects. However, a consistent association between 25(OH)D and asthma during adulthood has yet to be found in observational studies. We aimed to test the association between 25(OH)D and asthma during adulthood and hypothesised that this association would be stronger in non-atopic participants. Using information collected on the participants of the 1958 birth cohort, we developed a novel measure of atopic status using total and specific IgE values and reported history of eczema and allergic rhinitis. We designed a nested case-control analysis, stratified by atopic status, and using logistic regression models investigated the association between 25(OH)D measured at age 46 years with the prevalence of asthma and wheezy bronchitis at age 50 years, excluding participants who reported ever having asthma or wheezy bronchitis before the age of 42. In the fully adjusted models, a 10 nmol/L increase in serum 25(OH)D prevalence had a significant association with asthma (aOR 0.94, 95% CI 0.88&ndash, 1.00). There was some evidence of an atopic dependent trend in the association between 25(OH)D levels and asthma. Further analytical work on the operationalisation of atopy status would prove useful to uncover whether there is a role for 25(OH)D and other risk factors for asthma.

Background/Aim: Vitamin D derived through solar irradiation is an important pathway to bone health. Many populations have been found to be vitamin D deficient cross-sectionally but little longitudi...

This paper reports research exploring how trends in local labour market conditions during the period 2007-2011 (early stages of the 'great recession') relate to reported mental illness for individuals. It contributes to research on spatio-temporal variation in the wider determinants of health, exploring how the lifecourse of places relates to socio-geographical inequalities in health outcomes for individuals. This study also contributes to the renewed research focus on the links between labour market trends and population health, prompted by the recent global economic recession. We report research using the Scottish Longitudinal Study (SLS), a 5.3% representative sample of the Scottish population, derived from census data (https://sls.lscs.ac.uk/). In Scotland, (2011) census data include self-reported mental health. SLS data were combined with non-disclosive information from other sources, including spatio-temporal trends in labour market conditions (calculated using trajectory modelling) in the 32 local authority areas in Scotland. We show that, for groups of local authorities in Scotland over the period 2007-2011, trends in employment varied. These geographically variable trends in employment rates were associated with inequalities in self-reported mental health across the country, after controlling for a number of other individual and neighbourhood risk factors. For residents of regions that had experienced relatively high and stable levels of employment the odds ratio for reporting a mental illness was significantly lower than for the 'reference group', living in areas with persistently low employment rates. In areas where employment declined markedly from higher levels, the odds ratio was similar to the reference group. The findings emphasise how changes in local economic conditions may influence people's health and wellbeing independently of their own employment status. We conclude that, during the recent recession, the economic life course of places across Scotland has been associated with individual mental health outcomes.

Introduction: There is evidence that populations living close to the coast have improved health and wellbeing. Coastal environments are linked to promotion of physical activity through provision of safe, opportune, aesthetic and accessible spaces for recreation. Exposure to coastal environments may also reduce stress and induce positive mood. We hypothesised that coastal climate may influence the vitamin D status of residents and thus partly explain benefits to health. Materials and methods: Ecological and cross-sectional analyses were designed to elucidate the connection between coastal residence and vitamin D status. We divided residential data, from developed land use areas and the Lower Super Output Areas or Data Zones (Scotland) of the 1958 Birth Cohort participants, into the following coastal bands: 50 km. This relationship was modified by latitude with settlements at a lower latitude exhibiting a greater effect. Individuals living closer to the coast in England had higher vitamin D levels than those inland, particularly in autumn. Conclusion: Geographic location may influence biochemistry and health outcomes due to environmental factors. This can provide benefits in terms of vitamin D status but may also pose a risk due to higher skin cancer risk. We provide further evidence in support of the claim that coastal environments can provide opportunities for health and wellbeing. Keywords: Ultraviolet radiation, Vitamin D, Coastal residence, Health

Introduction Although neighborhood crime has been associated with mental health problems, longitudinal research utilizing objective measures of small-area crime and mental health service use is lacking. This study examines how local crime is associated with newly prescribed psychotropic medications in a large longitudinal sample of Scottish adults and explores whether the relationships vary between sociodemographic groups. Methods Data from the Scottish Longitudinal Study, a 5.3% representative sample of the population, were linked with police-recorded crime in 2011 for residential locality and with psychotropic medications from 2009 to 2014, extracted from the prescription data set of National Health Service Scotland. Individuals receiving medication during the first 6 months of observation were excluded; the remaining sample was followed for 5.5 years. Covariate-adjusted, multilevel mixed-effects logistic models estimated associations between area crime and prescriptions for antidepressants, antipsychotics, and anxiolytics (analyzed in 2018–2019). Results After adjustment for individual and neighborhood covariates, findings on 129,945 adults indicated elevated risk of antidepressant (OR=1.05, 95% CI=1.00, 1.10) and antipsychotic (OR=1.20, 95% CI=1.03, 1.39), but not anxiolytic (OR=0.99, 95% CI=0.93, 1.05) medication in high-crime areas. Crime showed stronger positive association with antidepressants among individuals (especially women) aged 24–53 years in 2009 and with antipsychotics among men aged 44–53 years in 2009. Skilled workers and people from lower nonmanual occupations had increased risk of medications in high-crime areas. Conclusions Local crime is an important predictor of mental health, independent of individual and other contextual risk factors. Place-based crime prevention and targeting vulnerable groups may have benefits for population mental health.