Tobacco

Could a tobacco license scheme in Scotland disincentivise tobacco sales?

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The Scottish Government has committed to achieving a smoke-free generation by 2034. This ambitious goal has sparked debate about which measures will drastically reduce tobacco use and sales of tobacco products. One option is the introduction of a tobacco license scheme. A new study in Scotland from the SPECTRUM team shows that the introduction of a tobacco license scheme has the potential to disincentivise tobacco sales and reduce the availability of tobacco products.

In 2010, the Scottish Government introduced a registration system that was mandatory for businesses selling tobacco. However, there is no cost associated with registering to sell tobacco products. One option for helping to meet the smoke-free generation target is the introduction of a tobacco licensing scheme in Scotland.  

A tobacco retail license is a regulatory mechanism that requires retailers to purchase a special license to legally sell tobacco products. Tobacco license schemes are crucial for monitoring sales of tobacco products, reducing illicit sales, and enforcing regulations such as sales prohibition to minors. By charging fees to obtain a license can increase the cost of selling tobacco, making the product more expensive for consumers and less profitable for retailers. Consequently, this can lead to reduced tobacco product availability as retailers may choose to diversify their business models away from tobacco. A tobacco retailer reduction has been widely associated with lower smoking prevalence and fewer tobacco-attributable diseases.

However, the implementation of license fees has faced challenges from retailers and the tobacco industry, who raise concerns about their impact on business profitability. Retailers also provide essential local services and if the introduction of a tobacco license fee undermines the viability of the business, then this could negatively impact local communities. Therefore, the public health benefits of fee-based license systems that reduces tobacco availability have to be considered against the potential financial impacts on retailers.

Although many countries worldwide have considered different forms of license schemes, little is known about the effectiveness of these different schemes in disincentivising tobacco sales and their financial impacts on retailers.

Simulating the implementation of a tobacco license fee in Scotland: a case of study

As part of the SPECTRUM Consortium we addressed this question by analysing data from over one million commercial transactions across 179 smaller retailers (convenience stores) in Scotland between 2019 and 2022. We found that stores generate an annual median of £15,859 revenue from tobacco sales. Retailers in the most deprived areas of Scotland received 1.6 times more revenue than those in low-deprivation neighbourhoods. Moreover, urban retailers obtained 2.3 times higher revenues than rural stores (see table 1 below).

All RetailersHigh deprived areasMedium deprived areasLow deprived areasUrban areasRural areas
Median Gross Revenues£15,859£18,403£17,694£11,609£18,247£7,638
Table 1. Baseline annual median revenues from tobacco sales among retailers by area types within 2019 and 2022.

We found that the magnitude of the financial impacts of schemes on Scottish retailers varied in relation to the level at which the fee was set. For instance, adopting a low license fee similar to the one operating in New Brunswick, Canada, (a universal fee of CA$50/year, approximately £29/year), would result in a median tobacco revenue reduction of 0.18% among retailers in Scotland. However, if following Finland’s example of requiring a universal fee of €500/year (approximately £428/year) smaller retailers in Scotland would see their revenues reduced by 2.70% (see table 2 below). In both cases, the impacts of these licenses’ fees may not deter tobacco sales. In order to achieve a significant revenues reduction, such as a 30% reduction, would require a universal fee to be set at £4,758/year, which is substantially higher than those currently active in other countries.

Additionally, our results showed that each scheme type impacted differently on retailers located in different types of areas of the country. Universal and urban/rural flat fees would result in higher revenues reductions for retailers in low deprivation areas. Using a high-level universal fee (similar to Finland), results in a revenue reduction of 3.61% in low deprivation areas. This decline is more significant than the 2.70% reduction observed in high deprivation neighbourhoods. In contrast, volumetric schemes would lead to similar percent revenue reductions across all retailers.

Fee scheme and levelAll retailersHigh DeprivedMedium deprivedLow deprived
Universal low: £29/yr-0.18%-0.16%-0.17%-0.25%
Universal medium:£139/yr-0.88%-0.76%-0.79%-1.20%
Universal high: £428/yr-2.70%-2.32%-2.42%-3.67%
Volumetric low: £0.06/1000 sticks-0.18%-0.18%-0.18%-0.18%
Volumetric medium: £0.29/1000 sticks-0.86%-0.87%-0.89%-0.87%
Volumetric high: £0.91/1000 sticks-2.70%-2.72%-2.78%-2.73%
Urban/Rural low: U=£33/yr R=£14/yr-0.18%-0.17%-0.18%-0.22%
Urban/Rural medium: U=£161/yr R=£67/yr-0.88%-0.83%-0.86%-1.07%
Urban/Rural high: U=£493 R=£206/yr-2.70%-2.53%-2.65%-3.27%
Table 2. Median percentage reduction in tobacco revenues across retailers after the implementation of different license fees by area types.

Implications for Tobacco Control policies

These findings have implications for how we develop our approach to reducing tobacco harms in Scotland. Our study showed the potential of license fee schemes to disincentivise tobacco sales as they effectively increase the cost of selling tobacco. However, to significantly impact tobacco revenues and encourage retailers to diversify their business models away from tobacco sales, this policy would necessitate the implementation of relatively high-level fees.

The study described unequal financial impacts from each license scheme among retailers. The effectiveness of universal and urban/rural flat fees to reduce tobacco outlet availability could be questioned, as they would have a lower impact on retailers in high deprivation areas. These areas are typically targeted in tobacco control efforts since they present the highest densities of tobacco retailers and the worst smoking outcomes.

In contrast, volumetric fees could ensure an equal reduction of tobacco revenues across all retailers. Nevertheless, retailers with greater sales volume, more diversified business models (large retailers and supermarkets) or located in more profitable neighbourhoods (ie, urban areas) might have greater financial resources to cope with a given loss of 10% of their profits compared with other retailers.

Policymakers should carefully design and implement policies that maximise a reduction in tobacco outlet availability in all areas to mitigate smoking-related harms without threatening retail viability. One possible strategy in Scotland might include a modest flat fee, considering a lower fee in rural areas where retailers might be more vulnerable to potential shutdowns (ie, urban/rural scheme), along with an additional moderate volumetric fee.

Find out more about this study

The full study methods, findings and discussion of this study are published in Tobacco Control: “Geographical differences in the financial impacts of different forms of tobacco licence fees on small retailers in Scotland”.

About the author:

Roberto Valiente is postdoctoral researcher in Health and Environment at the Centre for Research on Environment, Society and Health (CRESH) and the SPECTRUM Consortium in the University of Edinburgh. His work is focused on the use of Geographic Information Systems to explore how the physical and social environment may shape population behaviours and health. His current research is focused on the study of commercial determinants of health from a spatial perspective, particularly those related with tobacco and alcohol issues.

Tobacco

The declining importance of tobacco sales to convenience stores in Britain

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Tobacco products are becoming less important to the business models of convenience stores across Britain. This is the finding of our new study of the products sold in convenience stores over a 3 year period across England, Scotland and Wales prior to the start of the Covid pandemic. 

Looking at the sales of tobacco and other products sold alongside tobacco is important because it tells us about how much profit is made from tobacco by smaller retailers but also about the role of tobacco in generating greater ‘footfall’ for these smaller retailers. It is argued that footfall products, such as milk or bread, bring customers into the store and lead to wider expenditure on other (non-footfall) items.  The tobacco industry has long argued that tobacco is vital for increasing customer footfall and therefore tobacco products help drive the sales of other (potentially more profitable) items that retailers stock. Our new results recently published in the journal Tobacco Control suggest the footfall argument made by the tobacco industry does not hold-up to scrutiny.

How did we go about our research? We looked at this issue by examining the electronic till receipts of all items purchased in almost 1300 retailers across the country during 4 corresponding weeks in 2016 and 2019. We found that the number of shopping baskets containing tobacco fell by nearly half (47%) over these 3 years. When we compared tobacco to other commonly purchased products (such as milk, bread, newspapers and alcohol) we found that the decline in sales was much higher for tobacco.

We also discovered that the price of tobacco products rose significantly over this time period yet at the same time the proportion of total store turnover accounted for by shoppers who included a tobacco product in their basket fell. In 2016, 11 per cent of transactions involved only tobacco, but this fell to 6 per cent in 2019. The proportion of sales containing a mix of tobacco products and other items also declined, falling from 14 per cent to 9 per cent.  It was also evident that as the frequency of tobacco transactions declined so the financial value of non-tobacco items bought alongside tobacco also reduced.

When we examined geographical differences in the sales data, we found that retailers’ declining reliance on tobacco sales was seen across the country. Tobacco product sales, and their contribution towards weekly turnover, were higher in shops in urban, more economically deprived areas compared with rural stores and those in affluent areas. However, these stores saw the greatest reductions over time, narrowing the differences between areas.

Why does all this matter? The governments in England, Scotland and Wales all have ambitious targets to eliminate smoking over the next decade. For example, in Scotland the Scottish Government is committed to reducing the proportion of the population who smoke to 5% by 2034. Similar targets are in place in England and Wales. Yet meeting these goals will require a wide range of policies including reducing the availability of tobacco products. In Scotland, for example, tobacco remains highly available with around 10,000 retailers selling tobacco which means it can be purchased on most street corners. A key obstacle to reducing the number of places where tobacco can be purchased has been concerns about how this will affect smaller businesses that may be particularly dependent on selling tobacco, and also that selling tobacco helps to drive the sales of other (more profitable) products. Our findings counter this claim and show that tobacco is becoming less important to smaller retailers.

We, therefore, encourage policymakers in the UK to follow the lead of the New Zealand government who have an ambitious plan to greatly reduce the number of tobacco retailers, as well as the recommendations of The Khan review: making smoking obsolete report commissioned by the UK Government to develop new policies in England that will lessen the availability of tobacco in our local communities. Policy approaches should include help for businesses to diversify away from tobacco, including support for smaller stores to focus on more health enabling and more profitable products. This would be a crucial step towards reducing the number of people who smoke, and eliminating a product that is responsible for the deaths of 78,000 people in the UK each year.

Tunstall H, Shortt N, Kong A, Pearce J, 2022. Is tobacco a driver of footfall amongst small retailers? A geographical analysis of tobacco purchasing using electronic point-of-sale data. Tobacco Control. In Press.

Crime, Inequalities, mental health, Social and Physical Environment

Crime and violence in the neighbourhood affects our mental health

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Our review published in Social Science and Medicine synthetized available evidence on the relationship between living in neighbourhoods affected by crime and violence, and residents’ mental health problems. The findings clearly showed that people residing in unsafe areas are more likely to report mental health problems, including depression and psychological distress, but we also found some indication for elevated levels of anxiety and psychotic symptoms.

The places where we live, work and age are important in shaping our health and wellbeing. There have been a number of recent studies that have considered whether and how physical and social features of these places may influence mental health. Characteristics of places including economic and social disadvantage, lack of social cohesion between neighbours or restricted access to green space are seem to be important in affecting the mental health of local people. Another aspect of place that might matter is the level of local crime and violence but we don’t have a clear picture of the importance of these processes because the research in this area has not be systematically reviewed and assessed.

Crime events tend not to be random but instead concentrate in certain neighbourhoods. Research in criminology suggests that disadvantaged and low-income areas are particularly affected by crime and violence, especially when there is a lack of social cohesion in the area and it is therefore difficult for people living in this area to collaborate together and make the changes that they want to see in their community (Figure 1). We also know that within most neighbourhoods there are particular places   where crime is more frequent (e.g. areas with poor quality street lighting).

Figure 1: Neighbourhood crime and mental health

Once crime occurred, people directly affected as being victim or witnessing crime, are at risk of developing mental health problems, such as depression and post-traumatic stress disorder. However, and importantly, residents of higher crime areas, even without direct experiences of crime, may be affected through increased fear and chronic stress, and through other responses such as lower engagement in physical and social activities in their communities. These can all contribute to mental health problems in high crime areas.

In order to get a better understanding of what the international evidence tells us about the connections between local crime and mental health, we screened over 10,000 research articles from 11 major databases and identified 63 relevant studies published in over 30 countries and across a wide range of disciplines (e.g. psychology, public health, economics and criminology). We then used these findings to create a comparable metric across studies which were then quantitatively summarized across the 63 studies – an approach known as ‘meta-analysis’. We found that people living in local areas with higher levels of crime and violence suffered more often from depression and psychological distress. A variety of additional analyses confirmed these results, and findings remained robust when we considered differences across sample and methodological characteristics, such as age of participants, study design or methodological quality. We found comparably fewer studies focussing on anxiety and psychosis, but they also pointed towards increased mental health problems in unsafe neighbourhoods.

This systematic review and meta-analysis is the first in the literature exploring the relationship between local crime and mental health. Although the impact of neighbourhood crime on mental health is comparably smaller than the impact of well-established risk factors, such as being unemployed or experiencing maltreatment, we have to consider that large parts of the population are living in areas seriously affected by crime. Urban centres, especially in low- and middle-income countries, experienced a recent surge in crime and violence, which likely affects residents’ well-being.

Neighbourhood crime and violence is a significant social, economic, legal and global health concern. The results of our review are important because they suggest that reducing crime levels and increasing the feeling of safety among residents can benefit population mental health. Policymakers might consider targeting the physical (e.g. reducing alcohol availability, area rehabilitation) and social (e.g. supporting social cohesion and participation) determinants of crime by complex neighbourhood interventions, as these have the potential to reduce crime levels in a sustainable way. Healthcare planners should be mindful about the increased mental health needs of communities affected by high crime. Scaling up mental health services by providing access to treatment for those in need and considering preventive measures, such as developing skills and coping strategies, may tackle the mental health burden of disadvantaged neighbourhoods.

You can find the paper here:

Baranyi G, Di Marco MH, Russ TC, Dibben C, Pearce J. The impact of neighbourhood crime on mental health: A systematic review and meta-analysis. Social Science & Medicine 2021; 282: 114106. https://www.sciencedirect.com/science/article/abs/pii/S027795362100438X

Alcohol, Inequalities, Job, Tobacco

New job at CRESH: Postdoctoral Researcher, Environment and Health

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This is a full time (35 hours per week), fixed term post available for 3 years.

The salary for this role is £33,797 – £40,322 per annum.

We are seeking to appoint a Postdoctoral Researcher in the field of ‘Environment and Health  for a period of 3 years to contribute a UK Prevention Research Partnership (UKPRP) Consortium – SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harm) www.ed.ac.uk/spectrum. SPECTRUM has an ambitious programme of research, knowledge exchange and public engagement focusing on the commercial determinants of health relating to tobacco, alcohol and food. In this role you will work under the supervision and mentorship of Professor Jamie Pearce and Professor Niamh Shortt.

The successful candidate will play a lead role in a programme of work aiming to identify how the local environment can be shaped to change behaviour, prevent harm and reduce inequalities. The aim is to examine the intended and unintended impacts of (and interventions in) the local commercial environment on the consumption of unhealthy commodities. The focus of this role will be to conduct spatial and quantitative analyses, contribute to final publications and help to accelerate the impact of the research.

Informal enquiries to Prof Jamie Pearce (jamie.pearce@ed.ac.uk), Prof Niamh Shortt (niamh.shortt@ed.ac.uk)

For more details and how to apply click here.

Job, Natural Environments, News

Job Opportunity: Green space quality

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We have a post available at the MRC/CSO Social and Public Health Sciences Unit in Glasgow, working on our project measuring green space quality, and looking at its association with health. It’s very cool.

Apply here: https://my.corehr.com/pls/uogrecruit/erq_jobspec_version_4.jobspec?p_id=049068

Closing Date: 8th March 2021

Funding is approved on a full-time basis (35 hours) until 1st May 2023.

As a successful candidate you will contribute to the project `Better Parks, Healthier for All?. This project will make a systematic, longitudinal assessment of associations between a range of green space qualities, and risk factors for/measures of cardiometabolic disease and poor mental health. This is a joint UK-Australia project, led in the UK by Prof Rich Mitchell and in Australia by Prof Xiaoqi Feng. Whilst the state and third sectors in both countries have blueprints for what to capture in measuring green space qualities, there are no spatially comprehensive validated secondary measures of quality available. This post is particularly focused on the co-production of measures of urban green space qualities for 4 cities in Scotland and Australia, using secondary map data, remote imagery including Google Earth and Lidar, and secondary crowd-sourced biodiversity measures.

The successful candidate will also be expected to contribute to the formulation and submission of research publications and research proposals as well as help manage and direct this complex and challenging project as opportunities allow.

Main Duties and Responsibilities

  1. Implement the access, analysis and interpretation of secondary spatial and satellite imagery data that will underpin an assessment of green space quality.
  2. Contribute to the creation and use of the green space quality measures and analysis of their association with measures of health cardiometabolic and mental health.
  3. Document research output including analysis and interpretation of all data, maintaining records and databases, drafting technical/progress reports and papers as appropriate.
  4. Establish and maintain your research profile and reputation and that of The University of Glasgow/ School/ Research Group, including establishing and sustaining a track record of independent and joint publications of international quality in high profile/quality refereed journals, enhancing the research impact in terms of economic/societal benefit, and gathering indicators of esteem.
  5. Contribute to surveying the research literature and environment, understanding the research challenges associated with the project & subject area, & developing/implementing a suitable research strategy.
  6. Present work at international and national conferences, at internal and external seminars, colloquia and workshops to develop and enhance our research profile.
  7. Contribute to the identification of potential funding sources and to assist in the development of proposals to secure funding from internal and external bodies to support future research.
  8. Contribute to developing and maintaining collaborations with colleagues in Australia, and across the research group/School/College/University and wider community (e.g. Academic and Industrial Partners).
  9. Contribute to programme / Unit meetings/seminars/workshops and Institute research activities to enhance the wider knowledge, outputs and culture of the Unit and Institute.
  10. Perform administrative tasks related to the activities of the Programme
  11. Keep up to date with current knowledge and recent advances in the field/discipline.
  12. Engage in personal, professional and career development, to enhance both specialist and transferable skills in accordance with desired career trajectory.
  13. Carry out modest teaching / supervision activities if and when requested by the Programme Leader.
  14. Undertake any other reasonable duties as required by the Programme Leader or Unit Director
  15. Contribute to the enhancement of the University¿s international profile in line with the University¿s Strategic Plan, Inspiring People Changing The World.

For appointment at Grade 7:

  1. Perform the above duties with a higher degree of independence, leadership and responsibility, particularly in relation to planning, funding, collaborating and publishing research and mentoring colleagues.
  2. Establish and sustain a track record of independence and joint published research to establish and maintain your expert reputation in subject area.
  3. Survey the research literature and environment, understand the research challenges associated with the project & subject area, & develop/implement a suitable research strategy.

Qualifications

Essential
A1. Scottish Credit and Qualification Framework level 10 (Honours degree) in a relevant subject or a cognate discipline, or equivalent

For grade 7:
A2 Normally Scottish Credit and Qualification Framework level 12 (PhD) or alternatively the equivalent in professional qualifications and experience, with experience of personal development in a similar or related role(s)

Desirable:
B1 An awarded (or recently submitted or near completion) PhD in subject specialism or equivalent

Knowledge, Skills & Experience

Knowledge & Skills

Essential
C1. A comprehensive and up to date knowledge of GIS (ArcGIS or QGIS) / spatial analysis as applicable to the relationships between environment and health.
C2. Management & handling of big and/or spatial data, including parallel and/or automated processing techniques
C3 Excellent communication skills (oral and written), including public presentations and ability to communicate complex date/concepts clearly and concisely.
C4 Expertise in the access and use of satellite &/or aerial imagery for analysis of landscape features and content.
C5 Excellent interpersonal skills including team working and a collegiate approach
C6 Ability to search and synthesise literature from different disciplines.
C7 Self-motivation, initiative and independent thought/working
C8 Commitment to open research, through open data, open code, open educational resources, and practices that support replication.
C9 Problem solving skills including a flexible and pragmatic approach

For appointment at grade 7
C10 Ability to lead the design and implementation of spatial analysis of relationships between environment and health
C11 Ability to lead the drafting, revision, and submission of academic research articles.
C12 Sufficient depth of relevant research experience, normally including sufficient postdoctoral experience in a related field, appropriate to an early career researcher

Desirable
D1. Knowledge of the impacts of urban natural environments on human health
D2 Knowledge of urban analytics, &/or spatial ecology, &/or applied human/physical geography
D3 Knowledge of the use of biomarkers and clinical measurements of cardiovascular / cardiometabolic health
D4 Programming (ideally R or Python) or platforms (e.g., Google Earth Engine) for spatial data handling and analysis

Essential

Experience
E1 Sufficient relevant research experience [or equivalent] appropriate to an early career researcher
E2. Experience of running stakeholder workshops or similar
E3. Experience of scientific writing
E4. Proven ability to deliver quality outputs in a timely and efficient manner
E5. Evidence of an emerging track record of publications in a relevant field

For appointment at grade 7
E6. Proven ability to deliver quality outputs in a timely and efficient manner
E7. A strong track record of presentation and publication of research results in quality journals/conferences
E8. Experience of making a leading contribution in academic activities
E9. Ability to demonstrate a degree of independence as illustrated by identification of project objectives from assessment of the literature, design & analysis of experiments & drafting of papers.
E10. Experience in undertaking independent research

Desirable
F1. Experience of collaborative working across disciplines.
F2. Experience of using cardiovascular / cardiometabolic health indicators

Standard Terms & Conditions:

Salary will be on the University’s Research and Teaching Grade, 6/7 £29,176 – £32,817/£35,845 – £40,322 per annum.

Funding is approved on a full-time basis (35 hours) until 1st May 2023.

New entrants to the University will be required to serve a probationary period of 6 months.

The successful applicant will be eligible to join the Universities’ Superannuation Scheme. Further information regarding the scheme is available from the Superannuation Officer, who is also prepared to advise on questions relating to the transfer of Superannuation benefits.

All research and related activities, including grants, donations, clinical trials, contract research, consultancy and commercialisation are required to be managed through the University¿s relevant processes (e.g. contractual and financial), in accordance with the University Court’s policies.

It is the University of Glasgow’s mission to foster an inclusive climate, which ensures equality in our working, learning, research and teaching environment.

We strongly endorse the principles of Athena SWAN, including a supportive and flexible working environment, with commitment from all levels of the organisation in promoting gender equality.

The University of Glasgow, charity number SC004401.

Vacancy Ref : 049068, Closing date : 8 March 2021.

Uncategorized

Job opportunity: urban forestry and human wellbeing

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We are currently looking to recruit a postdoctoral researcher to contribute to an ESRC funded study concerned with the role of urban forestry in understanding human wellbeing, particularly amongst children.

https://elxw.fa.em3.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1001/job/339

Fixed Term, 19 months, Full Time (35 hours per week)

1/04/2021 – 30/10/2022 (dates negotiable)

Closing date: 12th February 2021

The researcher will be appointed based on the statistical and geospatial skills that this study will require. They will be responsible (under supervision of the Investigator team) for preparing and quality checking variables to measure woodland and forest exposure over time. They will also be responsible for identifying relevant data from the Scottish Longitudinal Study (SLS) and associated linked health datasets to provide longitudinal data for SLS members and their children over the period of the WIAT programme, and for undertaking appropriate statistical analyses.

The post involves working in the context of two world-leading centres of research, exploring links between environment and health. The post is based in OPENspace research centre, which focuses on inclusive access to outdoor environments and their associated benefits for wellbeing and quality of life. The study will involve close collaboration with the Centre for Research on Environment, Society and Health (CRESH), a virtual centre joining scientists from the Universities of Edinburgh and Glasgow, focused on exploring how physical and social environments can influence population health, for better and for worse.

The successful candidate will play a lead role in utilising environmental datasets provided by Scottish Forestry (SF) to extract and process relevant geographical data that records details of SF’s Woods In and Around Towns (WIAT) programme from 2005-2015, link them to individual level census, health and child development data, and use appropriate analyses to provide better evidence on the contribution urban forestry can make to human wellbeing. The post-holder will contribute to final publications and support the impact activities relating to the research.

The study and work of the post-holder will be overseen by Professor Catharine Ward Thompson, as Principal Investigator, with experience of multi-disciplinary research and engagement with research partners and end-users. Co-supervision of the post-holder by Co-Investigators (Co-Is) Professor Jamie Pearce and Dr Tom Clemens (CRESH, University of Edinburgh) will assist with details of data identification, manipulation and longitudinal analysis. The post-holder will also collaborate with Co-I Professor Richard Mitchell (MRC/CSO Social & Public Health Sciences Unit/CRESH, University of Glasgow) on operationalisation, linkage and analysis of environmental datasets in relation to health outcomes.

 Other key contacts will include liaison with staff in Scottish Forestry, Forest Research, Public Health Scotland and other stakeholders as necessary to undertake the project, and to share and disseminate its results.

For further details please contact Professor Catharine Ward Thompson c.ward-thompson@ed.ac.uk

Job, Uncategorized

Job Opportunity at CRESH

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We are looking to appoint a Postdoctoral Researcher in the field of ‘Environment and Health for a period of 4 years to contribute a UK Prevention Research Partnership (UKPRP) Consortium – SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harm) https://www.ed.ac.uk/spectrum.   SPECTRUM has an ambitious programme of research, knowledge exchange and public engagement focusing on the commercial determinants of health relating to tobacco, alcohol and food.

The successful candidate will play a lead role in a programme of work aiming to identify how the local environment can be shaped to change behaviour, prevent harm and reduce inequalities. The aim is to examine the intended and unintended impacts of (and interventions in) the local commercial environment on the consumption of unhealthy commodities. The focus of this role will be to conduct spatial and quantitative analyses, contribute to final publications and help to accelerate the impact of the research.

For further details – including how to apply – can be found here.

Data, Inequalities, Tobacco, Uncategorized, wellbeing

What next for tobacco control in Scotland?

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New research from the CRESH team using data from 124,566 shopping baskets purchased in convenience stores across Scotland has found that the purchase price of tobacco is lower in more disadvantaged neighbourhoods, largely because of the higher sales of the cheapest brands in these areas.

Cigarette smoking is one of the leading causes of preventable ill-health, hospitalisations and deaths in Scotland. Approximately 19% of adults in Scotland smoke, this rises to 32% in our most deprived fifth of neighbourhoods and falls to 9% in the most affluent neighbourhoods. As Scotland moves towards a ‘Tobacco Endgame’ the Scottish Government have a target to reduce smoking prevalence to less than 5% by 2034. A recent review of smoking projections by CRUK however suggests that Scotland may miss this target by 16 years in the poorest neighbourhoods. It is important that we continue to explore all potential determinants of smoking, particularly those that drive smoking in our most deprived communities.

We know that tobacco price is one of the most important determinants of smoking behaviour and that many smokers are price sensitive. Whilst it may appear that all tobacco products are becoming increasingly expensive, research suggests that the average tobacco price in the UK has remained relatively unchanged in real terms over the past 20 years in spite of numerous tax increases. A practice, known as ‘undershifting’, has seen tobacco companies limit price increases on the cheapest brands and instead increase the price of the most expensive brands by larger margins, thus absorbing the tax increases on the cheapest cigarettes allowing them to remain cheap (Hiscock et al. 2018).  As a result, the price of the lowest priced cigarette brands has remained relatively steady and the tobacco market as a whole has become increasingly stratified by price between the cheapest ‘sub value’ , ’value’, ‘mid price’ and high priced ‘premium’ brands. We wanted to understand these differentials in price a little better, so we carried out some research that was published recently in Tobacco Control. We explored whether the price paid for tobacco (both cigarettes and roll your own tobacco) was different in different types of neighbourhoods. We compared areas by deprivation, by the density of tobacco outlets and by rurality.

We analysed tobacco purchase data provided to us by The Retail Data Partnership. We looked at more than 124,000 purchases in 274 stores across Scotland in April 2018. For cigarettes the average price paid for a pack of 20 was £8.49, ranging from £7.20 to £13.25. For roll your own tobacco (RYO) 30g the average price paid was £12.14, with prices ranging from £9.80 to £15.99. We found that the price paid for tobacco did vary by neighbourhood type. In neighbourhoods with the lowest average household income the average purchase was 50p less for a pack of 20 cigarettes, and 34p less for roll your own tobacco compared with the most affluent neighbourhoods.

We then asked whether this was driven by individual brands being cheaper in more deprived areas, or whether cheaper, sub-value, brands were just more popular in such places. We found little evidence that individual brands were priced differently. Although the cheaper brands are the most popular in all neighbourhoods and across Scotland, accounting for 52% of sales, there’s a big difference in popularity between more and less deprived areas, In the most deprived areas these brands account for 58%  of sales, but in most affluent areas it was just 39% (See Figure 1 below). So, it is the dominance of cheaper brands in more deprived areas that drives the 50p difference in average price paid per pack between deprived and affluent areas. Remember this matters because the tobacco companies work to subdue tax-based price rises on the cheapest brands.

We also explored whether the density of tobacco retailers and/or rurality had an impact on tobacco price. We found little evidence of a density effect, but we did find that the individual brands analysed were significantly cheaper in rural areas.

So what does this mean and what can we take from this research? It is clear from the CRUK review that we need to work harder in order to reach the 2034 target of less than 5% of the population smoking. Price is a lever that we can pull, but to date this has been largely done through tax increases. This research shows us that the cheapest brands are the most popular in all neighbourhood types, but much more so in our most deprived neighbourhoods where smoking rates are highest. We found that the price paid for tobacco is lower in more deprived areas compared to more affluent areas. Our results confirm that the dominance of cheaper, so called ‘sub-value’ brands in more deprived areas, is a driving force behind the difference in price paid for tobacco between neighbourhoods. This highlights the importance of cheaper tobacco products to the consumer and the market.  Cheap tobacco may help tobacco companies to retain price sensitive consumers who live in the most deprived areas, which, in turn, contributes to health inequalities. In addition to increases to the duty rates on tobacco, more radical policy responses are likely to be required. These include a combination of minimum unit pricing (MUP) and a price cap at the upper end. The MUP would raise the cost of cheaper cigarettes and the price cap at the upper end would prevent the more expensive brands being used to ‘protect’ the cheaper ones from tax rises.

With growing international interest in the ‘Tobacco Endgame’, policymakers should identify measures that counter industry tactics that enable the continued sales of cheap tobacco. We published this paper in the first week of the COVID-19 pandemic in the UK. These are clearly strange times and we should rightly focus on the public health impacts of the global pandemic, and in particular the vast health inequalities that are arising. We must not however forget that the public health challenges we were faced with before this pandemic remain. Tobacco, and other unhealthy commodities, require our attention and the inequalities that arise from them remain a matter of social justice.

You can find the paper here:

Shortt, N., Tunstall, H., Mitchell, R., Coombes, E., Jones, A., Reid, G. & Pearce, J. Using point-of-sale data to examine tobacco pricing across neighbourhoods in Scotland. Tobacco Control, Published Online First: 19 March 2020. doi: 10.1136/tobaccocontro

References

Hiscock R, Branston JR, McNeill A, et al. Tobacco industry strategies undermine government tax policy: evidence from commercial data. Tob Control 2018;27:488 LP – 497. doi:10.1136/tobaccocontrol-2017-053891

Job

Come and join the CRESH team!

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We are currently recruiting a Postdoctoral Researcher in the field of ‘Environment and Health’ for 20 months to contribute to an interdisciplinary ESRC funded study entitled ‘Lifecourse of Place: how environments throughout life can support healthy ageing’. In this role, you will work under the supervision of Professor Jamie Pearce and Professor Niamh Shortt (School of GeoSciences), as well as collaborate with colleagues in Psychology in the School of Philosophy, Psychology and Language Sciences (Professor Ian Deary and Dr Simon Cox) and Edinburgh College of Art (Professor Catharine Ward Thompson).

The successful candidate will play a lead role in utilising environmental datasets and the Lothian Birth Cohort 1936 to explore how different environments over the lifecourse influence healthy ageing. The focus of this role will be to conduct longitudinal data analysis, contribute to final publications and help to accelerate the impact of the research. You will be a self-motivated individual with the ability to take responsibility for key components of the research plan. There are opportunities to shape the details of the research agenda.

Based at the School of GeoSciences, University of Edinburgh you will join the Centre for Research on Environment, Society and Health (CRESH).

For further details click here.

Informal enquiries to Prof Jamie Pearce (jamie.pearce@ed.ac.uk), Prof Niamh Shortt (niamh.shortt@ed.ac.uk)

News

New journal: Wellbeing, Space & Society

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CRESH co-Director Jamie Pearce who is co-editing a new journal focused on the role of place in understanding human health and wellbeing along with Susan Elliott who is a Professor at the University of Waterloo, Canada.The journal, named Wellbeing, Space & Society, is an interdisciplinary journal concerned with the difference that space, place and location make to wellbeing. It welcomes submissions that are theoretically informed, empirically supported, of interest to an international readership, address a problem of interest to society, and illustrate the links (potential or theorized) between (aspects of) society and space and wellbeing. We publish papers from a range of social science disciplines – geography, sociology, social psychology, social epidemiology, economics, anthropology, political science, amongst others.

The editors are particularly interested in the policy implications of the research, including work informed by policy analysis. Methodological plurality and innovation are encouraged; interpretation of wellbeing in this context may be subjective or objective, eudonic or hedonic, and may also be at the individual and/or community levels. But they are particularly interested in the wellbeing of places – how is that conceptualized, theorized, operationalised and translated?

For more information please contact Jamie Pearce

Inequalities, Social and Physical Environment

Neighbourhood problems lead to depression, but effects vary across countries

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Neighbourhood characteristics are linked to mental health in older age, but the magnitude of effects might differ across countries. Using data from 16 different countries, our paper in the American Journal of Epidemiology indicated that country-level social, political, economic and environmental characteristics may explain differences in how neighbourhood affects mental health.

Depression, local area and macro-level context

Depression is a common mental disorder with substantial disability and economic burden worldwide. More than 10% of adults aged 50 years and older present depressive symptoms with an even greater proportion of the population suffering in older age groups. Older adults spend more time in their neighbourhood, so that social and physical features of the residential area become increasingly important for them.

Signs of neighbourhood disorder, such as crime, vandalism and exposure to rubbish, are thought to indicate problems in the residential environment, by elevating the level of stress and fear among residents. On the other hand, positive aspects of neighbourhoods such as social cohesion – which is often characterised as a sense of community, help and support among neighbours – have the potential to buffer the effects of stress and contribute to healthy ageing. Both neighbourhood disorder and social cohesion has been linked to mental health problems.

Neighbourhoods are situated within macro-level environments capturing larger geographic areas such as local authorities, counties or even countries (Figure 1). Policies, as well as social, economic and environmental characteristics of macro environments can affect citizens’ life and health, and also shape the physical and social characteristics of local communities, where people live and age. It is important, as both local and macro-level environments are modifiable, presenting opportunities for improving population mental health and contributing to healthy ageing.

Figure 1: Local and macro-level determinants of depression

Neighbourhoods influence mental health among older adults

We investigated the associations between neighbourhood disorder, lack of social cohesion and depression among adults aged 50 and over. Longitudinal information on perceived neighbourhood characteristics and depressive symptoms across 16 high-income countries were utilised, including 32000 older adults. Results showed that living in an area with significant neighbourhood disorder increased the chance of developing depression (Figure 2), and so did lack of social cohesion (Figure 3). If people were already in retirement, effects became stronger.

Figure 2: Neighbourhood disorder impacting depression across 16 high-income countries. Odds Ratios <1.0 indicate decreased odds of depression by exposure to neighbourhood disorder; Odds Ratios >1.0 express increased odds. Small black diamonds are country-specific estimates, larger empty diamonds are pooled effects across group of countries. Abbreviations: ELSA, English Longitudinal Study of Ageing; HRS, Health and Retirement Study; SHARE, Survey of Health, Ageing and Retirement in Europe.

Neighbourhood effects differ across countries

As the magnitude of the associations varied across the 16 included countries, we further explored country-level differences.

Figure 3: Lack of social cohesion impacting depression across 16 high-income countries. Odds Ratios <1.0 indicate decreased odds of depression by lack of social cohesion; Odds Ratios >1.0 express increased odds. Small black diamonds are country-specific estimates, larger empty diamonds are pooled effects across group of countries. Abbreviations: ELSA, English Longitudinal Study of Ageing; HRS, Health and Retirement Study; SHARE, Survey of Health, Ageing and Retirement in Europe.

Amongst other, we found that in countries with higher population density, lack of social cohesion was more detrimental for mental health. Particularly in the oldest age groups, where limited mobility is more likely present, neighbours can be an important source of social and emotional support. In countries where people live closer to each other, not having proper social ties to neighbours can lead to social isolation and higher risk of developing mental health problems.

Also, in countries with higher pension spending, the adverse effect of neighbourhood disorder on depression was buffered for individuals already in retirement. It is plausible that by providing material resources, more generous welfare states equip older people to deal with stressors arising from less safe and deteriorated residential neighbourhoods.

Macro-level context and policy recommendations

Understanding how larger context can influence mental health inequalities across neighbourhoods has the potential to inform policy, and provide more tailored recommendations. For example, tackling crime and vandalism in countries with lower pension spending would be particularly beneficial for mental health, as older people has less material resources to protect themselves from the negative effects of neighbourhood disorder. Supporting social ties and improving social capital in densely populated areas may stronger contribute to healthy ageing and lead to better mental health among older adult.

By Gergő Baranyi, School of Geosciences, University of Edinburgh

Uncategorized

Two Postdoctoral Researchers (Health & Environment)

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We are currently seeking to recruit two Postdoctoral Researchers (Health & Environment) to join the CRESH team at the University of Edinburgh and contribute to two studies on the geography of unhealthy commodities.

The first position is part of the UK Prevention Research Partnership (UKPRP) Consortium – SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harm). SPECTRUM has an ambitious programme of research, knowledge exchange and public engagement focusing on the commercial determinants of health relating to tobacco, alcohol and food.

The second role will contribute to an ESRC funded project ‘Change in alcohol and tobacco availability, population health and the lived experience’ which will measure change in the availability of alcohol and tobacco in Scottish neighbourhoods over time and explore how this change relates to health outcomes and how residents experience the availability of alcohol and tobacco in their neighbourhoods.

Closing date for both positions is 16th October 2019.

Please get in touch with Professor Jamie Pearce or Professor Niamh Shortt to discuss either role: Jamie.Pearce@ed.ac.uk Niamh.Shortt@ed.ac.uk

https://www.jobs.ac.uk/job/BVI122/postdoctoral-researcher-health-and-environment-tobacco-and-alcohol

https://www.jobs.ac.uk/job/BVI153/postdoctoral-researcher-health-and-environment

Alcohol, Built Environment, Data, Inequalities, Tobacco, Uncategorized, wellbeing

New ESRC funded study on Tobacco and Alcohol

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We are delighted to announce that we have been awarded funding from the ESRC for a project exploring tobacco and alcohol environments in Scotland. The project ‘Change in alcohol and tobacco availability, population health and the lived experience’ will be funded for 3 years, beginning December 2019 for a total of £761, 470. The project will be led by Professor Niamh Shortt with co-investigators from the University of Edinburgh (Professor Jamie Pearceand Dr Tom Clemens), Glasgow Caledonian University (Professor Carol Emslie) and the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (Professor Richard Mitchell).

This research will measure change in the availability of alcohol and tobacco in Scottish neighbourhoods over time and explore how this change relates to health outcomes and how residents experience the availability of alcohol and tobacco in their neighbourhoods. The findings will be important because smoking and alcohol consumption are leading causes of illness and death. In Scotland smoking causes one in every 5 deaths and one in 20 deaths is related to alcohol. This harm is not equally shared; those on the lowest incomes suffer the greatest harm. These illnesses and deaths are preventable. The World Health Organisation recommends that nations prioritise interventions that reduce the supply of alcohol and tobacco.

Why might neighbourhood supply of alcohol and tobacco matter? Research suggests that when there are a lot of outlets in a neighbourhood this impacts upon consumption in three ways. 1. The outlets may be more competitive and drive prices down to attract customers. 2. Oversupply may normalise the products when they are sold alongside everyday commodities, such as bread and milk. 3. Tobacco and alcohol may simply be easier to buy in areas where there are more outlets.

In order to explore the relationship between supply, behaviour and harm we need data on the location of every outlet in Scotland selling tobacco and/or alcohol. Ideally, to be able to say something about whether the relationship may be causal, we need this data over time. We have already collected data on the specific location of every outlet selling tobacco and licensed to sell alcohol over multiple time periods (2012 and 2016 (nationwide alcohol and tobacco – see paper here) and 2008 (alcohol in four cities – see paper here)). As part of this project we will collect updated data for 2019/20. This will allow us to measure this change over time. Using an approach called trajectory modelling we will group neighbourhoods that have had a similar degree of change; some neighbourhoods may have lost, or gained, local shops or pubs, whereas some may not have changed at all. We will then identify features of these neighbourhoods that may be driving this change, for example the age profile of the population or poverty levels. This will help policy makers understand the drivers of change in our neighbourhoods.

To measure the relationship between changing supply and harm we will link these trajectories, and our measures of availability at each time point, to alcohol and tobacco health outcomes (behaviour, illness and death). We will use statistical models to see whether areas experiencing an increase or decrease in outlets have seen a corresponding increase or decrease in these outcomes. This will allow us to get a better understanding of whether an over supply of alcohol and tobacco is related to smoking and alcohol consumption and harm. These findings will provide important evidence related to the provision of such commodities in our neighbourhoods.

Although these statistics are important to report we also need to understand why an oversupply of alcohol and tobacco may influence behaviour and harm. Whilst the literature suggests the pathways listed above, we know little about the experiences of individuals living in neighbourhoods with contrasting availability. We don’t understand the individual experience of any of these pathways. Professor Carol Emslie will lead a qualitative work package and researchrs will meet with groups of individuals, in neighbourhoods of contrasting trajectories, to talk to them about the supply of alcohol and tobacco. We will explore their experiences of neighbourhood and assess how their perceived notions of their neighbourhood availability contrast with our statistical measures. Finally, we will meet with residents, retailers and policy stake-holders to explore potential interventions related to supply. Policies at this level require public, retailer and political support. We will discuss the priorities held by various groups, present our quantitative results and gauge attitudes towards potential interventions.

Throughout the project will be committed to knowledge exchange, public events and speaking with non academic partners. If you wish to know more about this research, or would like one of the researchers to come to your organisation to provide you initial findings (once the project is under way) then contact the Principal Investigator here: niamh.shortt@ed.ac.uk

Built Environment, Data, News

An atlas of change in Scotland’s built environment 2016-17

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By Laura Macdonald from the MRC/CSO  Social and Public Health Sciences Unit, University of Glasgow @theSPHSU

Our neighbourhood environments change and evolve often; some changes are minor, while others involve major transformation. Change can take various forms; green space created or removed, existing housing or amenities demolished, new housing estates built, new motorways created, or existing transport infrastructure modified or extended. Change may affect neighbourhood residents’ physical or mental health, or health-related behaviours, to their benefit or to their detriment. To study how change in our neighbourhoods might affect our health we need robust information but data showing how our neighbourhoods are changing, at a fine geographic scale, for the whole of Scotland, did not exist – until now! This is why we created an atlas showing what’s changed, and an interactive mapping application which allows you to explore the data yourself. Continue reading An atlas of change in Scotland’s built environment 2016-17 →

Built Environment, Inequalities, Tobacco

Children in deprived areas encounter shops selling tobacco six times more frequently than those in well-off areas

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By Dr Fiona Caryl.

Our new study  looking at exposure of children to tobacco retailing, recently published in the journal Tobacco Control, shows that an average 10-to-11-year-old child in Scotland comes within 10m of a shop selling tobacco 43 times a week. This rises to 149 times a week for children living in the poorest areas—six times more than the 23 encounters a week experienced by children living in affluent areas. This demonstrates an unexpectedly large inequality in the amount of times children are exposed to tobacco sales. Unexpected because in the same study we showed that tobacco outlets are 2.6 times more common around the homes of children living in the most deprived areas than the least. Yet we found a six-fold difference in exposure because we used GPS trackers (fully consented and ethics-approved, of course) to follow exactly where children moved through their environments. We found that most exposure came from convenience stores (41%) and newsagents (15%) on school days, with peaks before and after school hours. At weekends, we found most exposure came from supermarkets (14%), with a peak around midday.

Why does this matter? This may not sound like a lot of exposure, and we might ask if a child is really exposed to tobacco just by being in or near a shop selling tobacco, especially after the ban on point-of-sale (POS) tobacco displays. But then we don’t actually know how many micro-exposures it takes to make a child think that smoking is a normal, acceptable and widespread behaviour rather than a major cause of premature death. Research into advertising suggests that the mere-exposure to indirect and incidental stimuli can influence attitudesnon-consciously when they’re repeatedly presented. The ban on POS tobacco displays has reduced children’s susceptibility to smoking, but children still notice tobacco on sale. In fact, recent research shows that the conspicuousness and prominence of tobacco in shops varies considerably between areas of high and low deprivation. And the difference in prominence has been increasing since the POS ban.

The difference in the number of times children in poor areas are in or near to places selling tobacco is most concerning when you consider the pathways leading people to start smoking. Most adult smokers start when they are teenagers, and the availability of tobacco products is a key factor in in why people start to smoke and why they find it hard to give-up. Our findings raise important questions about when and where tobacco products are sold and the messaging this is sending to children.

Uncategorized

Liveable urban environments: an opportunity or threat to reducing health inequities?

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Creating ‘liveable’ urban environments is seen as an important way of improving the health and wellbeing of the residents in our towns and cities. Yet it is not clear whether the focus amongst planners and other policymakers on fashioning liveability is an opportunity – or threat – to reducing health inequities. On the one hand improving the resources and infrastructure in local communities might benefit everyone but particularly those who are most dependent on what is close by. On the other hand, it is possible that if liveability interventions are poorly or unevenly implemented, or inappropriate to the particular needs of the local population, then health inequities may widen. This issue was the focus of our new research recently published in Social Science & Medicine where we found evidence that some aspects of liveability have reduced inequities, whereas other aspects have not led to a reduction, or in some cases even increased, health inequities.

The notion of liveability has been around for a long while and is underpinned by the United Nation’s New Urban Agenda. The aim is to ensure equitable delivery of sustainable urban development – including local infrastructure and services, and housing amongst many other urban features – and to improve the living social and physical conditions for urban dwellers, including their health. Given these important and laudable goals it is perhaps surprising that so few studies have looked at what effects liveability has on health inequities. Health inequities continue to increase across many countries, including the UK and Australia; identifying what works in the long-term to reduce health inequities remains a policy priority for many national governments and international agencies.

In our new work we examined the international evidence to see when and where urban liveability might pose an opportunity or threat to reducing health inequities. We looked across a series of urban liveability features (education; employment; food, alcohol, and tobacco; green space; housing; transport; and walkability) and asked whether intervening on these aspects of place can serve to widen or narrow inequities.

Our findings show that the urban liveability agenda offers opportunities to help address health inequities but the effects differ from place to place. It was also clear that we need to keep in mind that urban liveability is just one part of a much broader urban system; whilst improving aspects of urban liveability can improve the health for some populations in a local area, it may not be the case for others. In some cases, the health benefits of urban liveability are restricted to specific (and sometimes more prosperous) communities. In fact, in more extreme cases urban liveability interventions can result in local people being pushed out of their community (e.g. through associated hikes in rental prices), with negative implications for their health and wellbeing.

We believe that the findings from this research include some important messages for policymakers and urban planners tasked with identifying ways to improve people’s health and reduce health inequities. Designing our neighbourhoods to become more liveable offers some significant opportunities to enhance health. However, it is also apparent liveability interventions need to be implemented in ways that meet the needs of all population groups living in the area, including the most vulnerable. As researchers, it is important that we continue to monitor the impact of liveability interventions on inequities and seek a better understanding of how these issue relate to the wider urban and social systems affecting our health.

Hannah Badland & Jamie Pearce

Alcohol, Inequalities, wellbeing

Mental health problems are common among prisoners in low-income and middle-income countries

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In a major international review, we found very high rates of psychiatric and substance use disorders among prisoners in low-income and middle-income countries. The results from the systematic review and meta-analysis published in Lancet Global Health showed that the prevalence of psychosis, depression, and drug and alcohol use disorders is much higher in this marginalised population in comparison to the community, pointing to unmet needs and calling for action in research and policy.

Mental health and substance use problems are common among individuals involved in the criminal justice system. Incarcerated men and women often come from disadvantaged socioeconomic and family background, and frequently have a life history of victimisation and substance use, making them more vulnerable to mental health problems. While in prison, they often remain undiagnosed and untreated. Prisoners with unmet mental health needs have higher mortality, especially by suicide, and greater risk of recidivism and reoffending after release in the community, leading to multiple imprisonments.

Although 70% of the worldwide prison population are residing in low-income and middle-income countries (LMIC), almost all scientific evidence is coming from studies conducted in high-income countries. It is an important limitation as recommendations from a mostly Western context might not be applicable or generalizable to poorly resourced settings. Prison conditions in LMICs are usually very harsh, characterised by overcrowding, poor nutrition, and sanitation, and limited or complete lack of access to basic health care. To provide evidence for future research and policy making, we conducted a systematic review and meta-analysis on prison prevalence studies in LMICs.

After screening 6000 titles and abstracts from 17 electronic global databases, we identified 23 relevant publications based on 14,527 prisoners from 13 different LMICs. Considering a one year time interval, approximately 6.2% of the prisoners had psychosis, 16.0% major depression, 3.8% alcohol use disorders, and 5.1% drug use disorders. To illustrate the immense burden of mental health problems, we quantified the difference between the prevalence among prisoners in each sample and in the sex-matched general populations of the respective countries. Prevalence rates among prisoners were 16 times higher for psychosis, 6 times higher for major depression and illicit drug use disorder prevalence, and twice as high for alcohol use disorders, indicating a significant public health concern and large unmet health care needs in this marginalised group. Moreover, rates in prison populations of LMICs might be even higher than in high-income countries.

Based on our findings, we presented several implications and recommendations for research and policy.

  1. While a review from 2012 on prison mental health in high-income countries identified over 100 samples, we were able to find only 23 studies from a much larger and diverse group of countries. There is a need further evidence from LMICs to adequately plan interventions for prisoners with mental disorders, especially from regions underrepresented in research such as Central and East Asia, and Central America.
  2. Because correctional facilities in LMICs often lack basic health care, the implementation of cost-effective interventions and scalable treatments for individuals with mental health problems is crucial.
  3. Imprisonment could present an opportunity to treat people with mental health and substance use problems who otherwise would be difficult to reach for health services. National governments in LMICs should move the responsibility for prison health care from prison administrations to the national health services.
  4. Since human right violations, and physical and psychological abuse are more common in resource-poor correctional settings, increasing mental health literacy among staff and protecting the rights and health of people with mental illnesses should be a priority for penal justice policies.

The invited comment on our paper gives a valuable and very practical recommendation on how to improve mental health services in correctional facilities. Training prison health workers by mental health professionals using the WHO’s Intervention Guide for mental disorders (mhGAP-IG), could be a cost-effective and valuable programme for addressing the treatment gap among prisoners in LMICs and coming closer to the Sustainable Development Goals declared by the United Nations.

By Gergo Baranyi, PhD Student in Human Geography and Marie Sklodowska-Curie Early Stage Researcher, The University of Edinburgh

Built Environment, Inequalities, Natural Environments, Physical Environment, wellbeing

What is ‘on the ground’ in a city linked to levels of inequality in life satisfaction

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In a European-wide study of 63,554 people from 66 cities in 28 countries, we found links between urban design and levels of inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample.

Cities with an even distribution of facilities, housing and green space were linked with lower levels of inequality between residents’ life satisfaction levels, suggesting that more equal access to a range of facilities and types of land may help reduce the gap in life satisfaction between the most economically-deprived and most affluent residents of a city.

There was a strong link between higher life satisfaction and living in cities with homes surrounded by natural, green space. However, lower life satisfaction was linked to living in cities that had more wasteland, more space dedicated to housing, and more space in which all the land is concrete or tarmacked.

Implications for policy and planning.

The findings of our study suggest that urban planning has a role to play in addressing inequalities in cities. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic – that is, could create equality.

What people want or need from their city varies moment to moment, day to day, life stage to life stage. If a city is varied enough to offer people what they need, when they need it, it is likely to support a higher quality of life.

Three Generation Out Walking

Why understanding city design is important for population health and well-being?

With the United Nations reporting that more than half the world’s population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environment might improve, and reduce inequalities in, quality of life. Therefore, understanding the influence urban environments can have on all aspects of health and wellbeing is increasingly important. Cities are continuously evolving and there is ample opportunity to ensure these are healthier and happier place to live.

What we did:

We applied theory and methods from landscape ecology to explore associations between cities’ land cover/use, residents’ reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012 and 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries.

The study, ‘Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European Cities’ is published in Social Science & Medicine (Open Access). The work was funded by The Medical Research Council (MRC) and Scottish Government Chief Scientist Office.

By Rich Mitchell, Natalie Nicholls & Jon Olsen , Neighbourhoods and Communities programme, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

event, Uncategorized

CRESH seminar – Bombarded by Booze

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Title: Bombarded by Booze: Children’s real-time exposure to alcohol marketing using wearable cameras and GPS devices

Presenter: Professor Louise Signal, University of Otago, Wellington, New Zealand

Description: This presentation highlights innovative New Zealand research with children using wearable cameras and GPS devices to capture the extent and nature of their exposure to alcohol marketing.

When: Thursday 31st January, 11-12

Where: Lister Learning and Teaching Centre – 2.14 – Teaching Studio, 5 Roxburgh Pl, Edinburgh EH8 9SU

Inequalities, News, Social and Physical Environment, Tobacco

New evidence linking availability of tobacco & smoking

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The connection between the local availability of tobacco products and smoking behaviour has been underlined in new research from the CRESH team this week. Published in the journal Tobacco Control, we show how moving into an area of Scotland where tobacco products are more readily available can significantly increase the risk of smoking while pregnant. We estimate that a pregnant woman living in an area with the highest tobacco availability is 70% more likely to smoke than when she was living in an area with the lowest availability of tobacco products.

Why is this important? Firstly, smoking during pregnancy is a vital Public Health issue and is recognised as a key priority area for UK health policy. It is harmful for both the mother and the developing fetus and the effects for social and health outcomes can persist into childhood and adulthood. Since smoking is so strongly associated with poverty and deprivation, it also has an important role to play in the persistence of health inequalities across generations.

But there are other reasons why the research is important. Much of what we know, including previous research from CRESH, is based on information from a single point in time. While these studies are crucial in establishing the strength of associations, they are less useful for determining mechanisms. A key question that remains is whether high availability is the cause of smoking behaviour or whether retailers preferentially locate in areas of high demand. Both pathways are plausible but both carry very different conclusions and policy recommendations. Our latest research is able to address this question using information on smoking during pregnancy which is collected routinely as part of Scotland’s hospital maternity records. By looking at multiple pregnancies to the same individual, we were able to relate changes in smoking behaviour between pregnancies to changes in exposure to tobacco retailers from residential moves. This approach provides strong evidence that availability is causally linked to behaviour.

The policy implications are clear. As more and more countries move towards a “Tobacco Endgame” policy this, and other research, highlights how a focus on tackling the local availability of tobacco products will be crucial. In a week where the UK government has suggested that preventing poor health lies with “people choosing to look after themselves better, staying active and stopping smoking” our findings are a timely reminder of the importance of considering the wider set of structural factors that shape our health of which our residential environment is one important component.