Category Archives: Inequalities

What next for tobacco control in Scotland?

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

Neighbourhood problems lead to depression, but effects vary across countries

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

New ESRC funded study on Tobacco and Alcohol

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

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

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.

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

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

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

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.

New evidence linking availability of tobacco & smoking

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.

Do people actually use the facilities in their home neighbourhood?

This blog explores a key question in neighbourhood and health research: if there is a facility or amenity close to someone’s home, is it OK to assume they use it? Surprisingly, this assumption is at the heart of a lot of health and environment research.

We often have data which tells us where facilities and amenities are, and we tend to make the assumption that proximity means use. So, for example, if we see that some neighbourhoods have more parks or more leisure facilities, we expect the people who live in that neighbourhood use them more. Understanding local amenity and facility use is important because we want to know whether / how these things affect health.

With technological advances in recent years, studies have started to collect precise data which tell us exactly where people go using global position system (GPS) devices. We no longer have to assume, for example, that if there’s a park close to a child’s home, they will visit it. The GPS tracks we collect will tell us if they did or not. That presents an opportunity to test our assumptions.

Do children use facilities they have access to in their home neighbourhood?

Our team is interested in children’s use of facilities in and around their homes and to test whether we need GPS to research this we conducted an analysis of facility availability and facility use for 30 10-year-old children living in Glasgow. We used data from GPS devices worn by the children for eight days. These children were part of our ‘Studying Physical Activity in Children’s Environments across Scotland’ Study (SPACES).

The diagram below shows what we did. Our key finding was that facility availability in the home neighbourhood is not a good indicator of facility use; the children used facilities from across a much wider area in the city, even if they had a facility close to their home.  For example, 18 of the 30 children (60%) had a leisure centre within their ‘neighbourhood’ (which we defined as 800m around their home). Only 3 of the 18 actually visited that facility (as identified by their GPS tracks). Of those 18 children, 8 actually visited a leisure centre outside of their ‘neighbourhood’. We saw the same kind of pattern when exploring availability and visits to playing fields, public parks and libraries

Blog graphic

Are our results similar to other research?

Yes, other studies that used GPS devices have found that children do spend time outside of their immediate home area for specific purposes. For example, a 2017 study by Chambers and colleagues in Wellington, New Zealand analysed leisure time GPS data (before and after school) in 114 children aged 11 to 13 years from 16 schools, and found that 38% of their leisure time was spent outside of the home neighbourhood (using a 750m buffer around the home). Time outside of the home neighbourhood was mostly spent visiting their school, other residential locations, and fast food outlets.

These results, and those from similar studies, show that it is important not to treat what’s in someone’s immediate home neighbourhood as a good measure of what they do, or in epidemiological language ‘what they are exposed to’. We must challenge the idea that residential neighbourhood is an adequate way to capture the socio-environmental factors which contribute to health. Many people, including children, can and do access environments well beyond their immediate home neighbourhood. We think that a much wider geographic area should be considered when we’re asking questions about how environment affects health and we call this the city-wide landscape.

What does this mean for future research?

It’s clear that the ‘traditional’ approach which uses someone’s neighbourhood (often defined by a distance around their home, or an administrative area in which their home sits) to assess their access to facilities or exposure to environments is seriously flawed.

  • Other methodological approaches are required to measure ‘exposure’ to environment;
  • We must move beyond traditional fixed neighbourhood-health relationships (although we can’t ignore them);
  • We should embrace and integrate innovative technology to explore mobility (e.g. GPS and accelerometer).

Of course, even when we’re able to see exactly where people go and what they do, we still need to understand the decisions people make about whether or not to visit or spend time at different places.

By Jon Olsen, Research Associate with the Neighbourhoods and Communities programme, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

Hard Times: Mental Health under Austerity event

How important for mental health are the changing social, economic and environmental conditions in the places where we live? Our research, funded by ESRC, addresses this question through a new and innovative study of mental health of people living in different parts of Scotland. We are focussing especially on the period since 2007 when economic recession and austerity have impacted to a varying extent across the country. This event will use interactive data visualisations to present our research findings, showing how audience polling techniques allow the participants to select topics of special interest for them, to help determine in ‘real time’ the focus of the results presented. This will be combined with an opportunity for group discussion and exchange of ideas among diverse participants, many of whom will be involved in mental health care and promotion of better mental health. We will be sharing new evidence and discussing the implications for policy and practice in different parts of Scotland. The event is also intended to help shape the future research agenda.

FREE to attend. Registration via Eventbrite. Refreshments provided.

LOCATION

The Melting Pot, 5 Rose Street, Edinburgh, EH2 2PR

Update 21/12/18

We had a really productive day on the 7th of November, thanks to the helpful and encouraging input from all the attendees. Please feel free to download and share the Powerpoint slides. We have collated the information gathered using Mentimeter and transcribed the written notes. The report which features a discussion on how these findings relate to the wider project is now available to download.

 

 

Changing places and mental health: do changes in perceptions of neighbourhood influence anxiety and depression in adults?

Written by Dr Jon Olsen, Research Associate with the Neighbourhoods and Communities programme, MRC/CSO Social and Public Health Sciences Unit. This blog is mirrored on the SPHSU website.

Mental health problems are a global issue. In 2013 over 615 million individuals suffered from anxiety and/or depression across the world, a rise of 50% since 1990. How people experience their local environment can impact on mental health. Living in areas that are perceived to have higher levels of neighbourhood problems such as poor housing quality, limited amounts of greenspace, industrial activity, and high traffic volume, has been linked to poorer mental health by some research studies. But, few studies have explored how change in what people think about their neighbourhood is linked to change in their mental health. It would be useful to know this as improving the neighbourhood environment could strengthen mental health.

In our recently published study, we wanted to see how changes in what people thought about their neighbourhood impacted on residents’ mental health over time. We looked at two mental health outcomes: anxiety and depression. Adults who lived in West Central Scotland, an area including Glasgow and eight neighbouring local authorities, were asked to complete the same questionnaire in 1997 and 2010.

Glasgow, United Kingdom – October 20, 2013: People come to walk around and shop at the historic Barras Market Place flea market.

What did we find?

Overall, anxiety and depression in the people we spoke to reduced between 1997 and 2010. However, those who experienced worsening neighbourhood perceptions from 1997 to 2010 also had increased anxiety and depression scores.

Why this matters

Our study showed that worsening neighbourhood perceptions were linked with small increases in anxiety and depression scores. People living in areas where perceptions of the neighbourhood got worse, did not benefit from the general improvements in anxiety and depression scores enjoyed by the population as a whole; this could widen health inequalities.

Wheelie bins (blue for recycling, green for general refuse) lined up for collection in a Glasgow alley.

 

The take home message from this study

There is a clear need for national and local policy to target areas where neighbourhood conditions are substantially deteriorating to ensure people’s mental health does not suffer.

Further information about the study

We used data from the Transport, Housing and Well-being study; a postal survey of adults in eight local authority areas in the west of Scotland in 1997 and 2010. More information and a link to the full questionnaire can be found here: http://thaw.sphsu.mrc.ac.uk/.

Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS), a common measure of psychological distress that has been in use for over 30 years.

The full paper was published in the International Journal of Environmental Research and Public Health and is freely available here.

Disclaimer: The views expressed in this blog are those of the author.

The MRC/CSO Social and Public Health Sciences Unit is funded by the Medical Research Council and the Scottish Government Chief Scientist Office. The views expressed are not necessarily those of the Medical Research Council or the Scottish Government.

Jobs at the GCRF Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods

Five Research Fellow posts are available at the GCRF Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods (SHLC). SHLC is one of the 37 major projects funded for 4 years by the Global Challenges Research Fund (GCRF) Research Councils UK Collective Fund, which aims to build upon research knowledge in the UK, and strengthen research capacity overseas, to help address challenges in the developing countries.

SHLC will conduct comparative studies of urbanisation and the formation and differentiation of neighbourhoods in cities in order to address the challenges associated with large-scale rural-to-urban migration in Africa and Asia. The Centre, based at Glasgow, has eight international partners in South Africa, Tanzania, Rwanda, India, Bangladesh, China and the Philippines.

These jobs require expert knowledge in the areas of education, health, or urban studies in relation to developing countries from the perspective of development studies, geography, urban planning, urban studies, migration, public policy or other relevant social science disciplines.

Specifically, we expect each of the five posts to contribute specialist knowledge to the Centre in at least one of the following areas:

  • Cities, urbanisation and urban development in Africa, South Asia and/or East Asia
  • Education policy research and provision in developing countries
  • Health policy research and health facility provision in developing countries
  • Quantitative research and analytical skills including social survey, spatial analysis, GIS, Big Data.
  • Qualitative research and analytical skills and methods

    For further information and applying, please visit the following web site:
    https://www.gla.ac.uk/it/iframe/jobs/

    Search College of Social Sciences (Job Reference Number: 019448) Closing Date: 13th December 2017

Does place matter during recovery from alcohol dependence?

In a new paper, published in Health and Place, Niamh Shortt, Sarah Rhynas and Aisha Holloway ask ‘Can the environment play a role in recovery?’ Here they discuss the findings from the paper.

Place matters for health. We know that features of the natural, built, and social environment can be either health promoting or health damaging.  From previous research we know that the environment is likely to be significant in shaping health-related behaviours, including alcohol consumption (here and here) and smoking patterns (here and here). In a new paper we have explored individuals’ experience and perceptions of the role of place in recovery from alcohol dependence. We wanted to gain a better understanding of the influence of the environment on the everyday experiences of those in recovery.

In order to do this we worked alongside a group of individuals who attend a recovery café in Central Scotland.  We used photovoice, a participatory research method that enabled the participants to capture images of their recovery. Individuals at various stages of recovery, but all at least one year sober, were able to document features of the environment that enable and/or hinder their journey.  Nine participants captured a total of 468 photographs. During focus group discussions participants identified features of the environment that were therapeutic and risky.

Therapeutic environments

Almost all of the participants made references to natural, wide-open spaces, such as hills, the sea, green spaces, in which they found calm and healing.  Participants associated such spaces with escape, meditation, clearing a busy mind, calm and support (Figure 1).

Figure 1: ‘I’ve took a, a picture at the top of the Braids. Eh, one that looks onto Arthur’s seat. Really green Arthur’s seat. And to the right a bit looks as far doon, I think you can see Bass Rock. Eh, and all that beauty and scenery and it’s on our doorstep. And I use it for a bit of my meditation and clearing my mind and that’.

therapeutic

Aside from vast open spaces, participants also found support in more everyday spaces, including the recovery café itself or in their homes. The café provides a space where the participants could see that they are ‘not the only one’, other café users understand their behaviour and the café itself was seen as a place of refuge following difficult moments.

Risky environments

All of the participants highlighted places of risk within their everyday environments, for most the single biggest element of risk was the retail environment, including both the sale and marketing of alcohol. For one participant the constant presence of alcohol was summed up with a photograph of the view from his window that included the local shop (Figure 2).

Figure 2: ‘it’s just there right on my doorstep and the first sign is beers and ciders’.

risky

The same participant noted that, before recovery, he was able to navigate the city to buy alcohol 24 hours a day, the challenge for him now is to try to avoid it in an environment where it is so readily available.  Participants spoke of the difficulty of avoiding such triggers in the everyday.

Further themes discussed in this paper include the transitory nature of place (places moving from supportive to risky and vice versa) and shame and stigma. This paper demonstrates that the journey of recovery from alcohol dependence is embedded in place, with place both supporting and hindering recovery.  The findings confirm that people in recovery experience a particular set of challenges on a day-to-day basis. Of particular note here was the ubiquitous sale of alcohol and presence of alcohol marketing and promotions.  By viewing recovery as a journey we can begin to frame alcohol dependence as a process of change; change in both the individual and in the way in which the individual sees and interacts with the environment. According to Banonis ‘recovering from addiction is a daily choice’ (Banonis 1989, p.37), however such choices are not made in a vacuum. This paper extends previous work by the CRESH team that argues that such health-related choices can be made more or less difficult by the environment in which one lives.

 

Edinburgh Science Festival Event 2017: Why Places Matter for Mental Health and Wellbeing

The important influence of the places in which we live, work and play on our mental health and wellbeing was the topic of a recent lively discussion at the Edinburgh Science Festival 2017 organized through Centre for Research on Environment, Society and Health (CRESH).

The event was chaired by Professor Jamie Pearce, (from School of GeoSciences at the University of Edinburgh and CRESH) and, in his introduction, he emphasised the policy-relevance of the event as evidenced by  the Scottish Government’s newly released Mental Health Strategy 2017-2027. The Strategy details how institutions, services and organisations will work together to enhance mental health in Scotland. Especially relevant for this discussion was the acknowledgement on P8 of the report that ‘Working to improve mental health care is not just the preserve of the NHS or the health portfolio. We will be working not only across the Scottish Government, but also across the wider public services to harness the broadest range of opportunities to improve the population’s mental health…’.  It is therefore acknowledged that promoting good mental health and wellbeing is not only about medical care, but also involves action to improve the ‘wider determinants’ of mental health – especially how conditions in the places where we live, work, learn and play can affect mental health and wellbeing.

We were therefore interested to explore how academic research contributes to our understanding of how places affect wellbeing.  Our main aim was to exchange ideas with our audience of over 70 people, representing a range of views from those living in the communities in and around Edinburgh. Several participants also reported on knowledge and experience gained in their professional lives, including medical practitioners, public health specialists, leaders in independent organisations whose mission relates to mental health and wellbeing (such as Support in Mind, and the Cyrenians), urban planners and architects and social service providers.

The event started with a series of comments from a panel of academic researchers representing a variety of social science disciplines, who introduced ideas from academic research that may help to frame thinking on these issues.

Professor Sarah Curtis (Professor Emeritus at Durham University) used her own experience of volunteering in the Edible Garden project at the Botanic Gardens to illustrate ideas from Health Geography about Therapeutic Landscapes, originally put forward by Wil Gesler (e.g. in his book on Healing Places).  This conceptual framework suggests we can think of places in terms of: material and physical landscapes (agreeable and relaxing green spaces, water spaces and built environments), social landscapes (supportive social relationships and community processes) and symbolic landscapes (features of our environment that stand for beliefs, principles and memories that are important for us). All of these dimensions of places, experienced in the different settings where we spend our lives, can be important for creating and maintaining our sense of mental wellbeing.  These features of landscapes, the ways they change, and how different groups of people experience them over time, have been studied extensively by health geographers (e.g. reviewed by Sarah Curtis in her book Space, Place and Mental Health).

Professor Steve Platt (Professor Emeritus at University of Edinburgh) then presented ideas from research in Sociology and Health Policy about what we might consider the ‘reverse’ of therapeutic landscapes; focussing on factors that are associated with risk of suicide and why suicide matters for suicide prevention. He used the example of the iconic Golden Gate Bridge in San Francisco, which has been a ‘magnet’ for people intent on taking their own lives.  He described the public controversies surrounding action to alter the architectural form of the bridge in order to install protective structures to reduce the suicide risk. He also underlined the evidence for socio-economic deprivation as a risk factor for suicide, with the risk of suicide being 2-3 times higher in the local areas in Scotland ranked among the worst 10% for social deprivation, as compared with populations living in areas ranked in the least deprived areas. He went on to elaborate further on the idea of suicidogenic contexts combining various dimensions that may be cultural, socio-economic, political, historical, as well as including built infrastructures and other aspects of the physical environment.

The significance for wellbeing of green space, viewed from a Landscape Architecture perspective, was introduced by Professor Catharine Ward Thompson, Director of the OPENspace Centre at the University of Edinburgh’s College of Art. She underlined that, since stress is a major problem for society and is associated with physiological as well as mental illness, researchers at OPENspace, together with their colleagues from around the world, are exploring how attractive and accessible green spaces can have beneficial ‘restorative’ effects on our mental state and help us to cope better with stress.  Studies using biomarkers (that measure the functioning of psychoneuroendochrine systems in the human body) show that our mental and physical states are linked, which helps to explain why environments that help to restore mental wellbeing are also helpful for our physical health. Good access to green and natural spaces in the residential environment is associated with lower levels of stress as shown by these biomarkers, as well as from self-reports of stress among people out of work and living in urban poverty. Attractive green spaces are often also places where we enjoy supportive social relationships and healthy physical exercise.  Conversely, when there is a shortage of green space in the urban environment, this appears to be associated with feelings of loneliness and lack of social support. Professor Ward Thompson has published research exploring these relationships in the journal Landscape and Urban Planning and the International Journal of Environmental Research and Public Health. Findings such as these help to strengthen the case for providing and maintaining access to healthy green spaces, such as public parks and gardens, allotments, and public rights of way in the countryside.

Dr Niamh Shortt (School of GeoSciences at the University of Edinburgh) leads research at CRESH relating to how aspects of consumption and retail environments are significant for behaviours linked to mental health and wellbeing. She focused her talk especially on issues associated with alcohol consumption and unhealthy drinking, which can be closely linked to mental distress and mental health conditions. While lower income groups report consuming the same, or less, alcohol on average than higher income groups, they suffer more from alcohol related harm. This has been called the ‘Alcohol Harm Paradox’. Dr Shortt presented findings from research she is leading which show that risks of unhealthy alcohol use are not only associated with individual level characteristics, but can also be influenced by the social and commercial environment.   Access to and advertising of retail outlets selling alcohol is not currently controlled to the same extent as for tobacco sales, yet research is showing that there the ways people drink may be influenced by the organization and availability of alcohol retailing in their neighbourhood, and that this is especially important for those living in poorer areas who may be most reliant on their local retail facilities. This research demonstrates the importance for wellbeing of work of retail planning and licensing systems.

As the discussion widened to include the audience at this event, a number of other thoughtful and important points were made. We heard from a number of representatives of relevant non-academic organizations, explaining how actions to promote mental wellbeing and to prevent and treat mental illness may draw upon research, and also contributes to knowledge about ‘what works’ to promote wellbeing.

Dr Margaret Douglas, Consultant in Public Health Medicine for NHS Lothian, underlined concerns about the unequal impacts of places on both health for different groups in Scottish society. She highlighted links between physical and mental health. The geographical variations in mental health and wellbeing, and inequalities between rich and poor areas, are a major issue for public health in Scotland, as in other countries, so research is important to help to identify the places where health disadvantage is most concentrated and needs for mental health care are greatest. This said, not all of the people most at risk of poor mental wellbeing and mental illness live in the poorest areas, so that there is also a need for information on the social and geographical pattern of mental health problems across the whole of Scotland. Dr Douglas particularly noted the range of aspects of the environment that are important for health. Her comments drew attention to the range of partners who need to collaborate to address actions to improve the various environmental factors that are beneficial for wellbeing and can help to prevent mental health problems. The Scottish Health and Inequalities Impact Assessment Network has produced documents summarising evidence on several aspects of the environment including community venues, greenspace, transport and housing.

These comments were reinforced by Johnny Cadell, from Architecture and Design Scotland, who underlined the significance of Scottish Government architecture policy (Creating Places), Scottish Planning Policy and the Place Standard, which promote healthy environments across Scotland. The Place Standard is a joint initiative between Scottish Government, Health Scotland and Architecture & Design Scotland. The discussion highlighted the strong interest in how good urban design can benefit mental health. We noted that there is very good potential for the transfer of knowledge from research into policy and practice, and this is gaining momentum through collaboration between researchers and government agencies promoting various initiatives, such as work by the Design Council entitled ‘Active by Design’ and, in Scotland, initiatives such as ‘Good Places Better Health’, ‘Go Well in Glasgow’ and, most recently, the development of the ‘Place Standard Tool’ to guide local development. Increasingly, Health Impact Assessment is being applied to interventions outside the medical sector, to ensure that health impacts of new urban developments are considered at the planning stage. The Place Standard brings together commitments in architecture policy (Creating Places) to produce a tool linking spatial design with the health/wellbeing agenda and the commitment in Good Places Better Health to produce a ‘Neighbourhood Quality Standard’.  Those involved in Good Places Better Health and Go Well were closely involved in the design of the new tool.

Frances Simpson, from Support in Mind, helpfully drew attention to the fact that a good deal of research is currently focussed on more urban communities, but that it is also important to understand the experience of the rural communities in Scotland.  Among a range of activities promoted by Support in Mind is a project that is currently collecting valuable information on what it is like living with mental ill-health in rural Scotland.  Communities in rural areas may benefit from greater proximity to extensive green spaces than those living in cities, but there are other issues such as social isolation and exclusion, and problems of access to the right kinds of mental health services, which need to be considered in rural settings. These points resonate with an article recently published by Hester Parr and Chris Philo in The Geographer magazine reporting research involving participants in rural areas.

Hugo Whitaker, from the charitable organization Cyrenians, also pointed out that recovering from mental illness can be a long process and that access to supportive environments over time can be very helpful to restoring mental wellbeing. He provided examples (including 2 film clips) of how community gardens and healthy activities organised in grounds that are part of NHS estates can help to restore and maintain good health.

A number of useful film clips have also been published by the Green Exercise Partnership  to help spread the word about this kind of activity (see example film here), as well as recordings of individual accounts from the perspective of those involved in design and planning (here) and stories of patient users’ experiences: (here).

Also relevant to this debate is the Our Natural Health Service action programme. It shows how “high quality local greenspace, supportive nature-based projects, and better links between health and social care practitioners and the environment sector, can be part of the solution to many of Scotland’s health issues.” NHS Lothians’s report ‘Health Promoting Health Service: Action in Secondary Care Settings’ issued by the Chief Medical Officer in October 2015 includes targets on “current use and improved plans of the outdoor estate for physical activity (green exercise and active travel) for staff, patients and the local community” as well as targets for staff health and wellbeing.

The debate included further comments from a number of other members of the audience. Points made by the panel about long term effects were picked up on by a retired General Practitioner who practised in one of the most deprived areas in Scotland. He commented that deprivation was transmitted across generations and that the conditions causing mental health problems in one generation would resurface in the next generation who were also treated in his surgery. Research reporting on the environmental experiences of people at different life stages was considered. For example, experiences of adolescents were commented on and it was pointed out that mental health problems can become apparent relatively early in life, and that young people have relatively little control over the social and physical environment, so it is important for their voices to be heard in environmental planning processes. Aspects of the environment that are beneficial for wellbeing of young people vary from those which are important for adults, so their experience needs to be taken into consideration.

Individuals with different characteristics may react quite variably a given environment and research can help to improve understanding of how places interacting with personal characteristics relate to mental wellbeing. It was noted, for example, that people vary in terms of cognitive and physical abilities and that making public spaces well adapted and inclusive for people with a range of abilities can help to promote mental wellbeing for all ability groups.

Other comments underlined the importance of a sense of autonomy and freedom to exercise independence and choice in the way we interact with our environment. It was noted that it was not only the visual aspect of the environment that was important, and that it was important for architects and others designing the environment to be sensitive to aspects such as noise levels and ambient temperature which can also affect one’s sense of wellbeing in a particular setting.

Overall, this event clearly demonstrated the breadth of interest in the question of why places matter for mental health and wellbeing. The panel were very grateful to the audience for engaging in the discussion and making such thoughtful comments and to SciFest for organizing the event. We felt this was a good example of how academic researchers and others with relevant ideas and experiences can join together to ‘co-produce’ our understanding of the research agenda and how research can help to inform action. We hope to be able to keep in touch with participants, via the CRESH webpages and blog, in order to share future research findings and knowledge of what is important for our wellbeing in the places where we live.

To Understand Place, Sometimes You Need to Go Places

By Jon Olsen

I recently spent a week as a visiting postdoctoral researcher at the Built Environment and Health (BEH) research group at the Mailman School of Public Health at Columbia University.

My visit was funded by the University of Glasgow’s Principal’s Early Career Mobility Scheme, a scheme which aims to give the opportunity for postdoctoral researchers to visit international institutions, providing the time and space to develop high-impact collaboration with staff there.

I organised the visit and developed a proposal on how I would spend my time at Columbia with Kathryn Neckerman, a senior research scientist at the Columbia Population Research Centre and co-director of BEH. Now I am back, it’s time to reflect.

Why is international research collaboration important?

Improving population health and well-being is a focus of Governments and health organisations globally and, while there is continued focus and resource, poor health and inequalities remain. This is partly because improving health and well-being, and reducing inequalities is complex and requires complex solutions. Professor David Hunter in an article in the Journal of Public Health describes improving health and well-being as a ‘wicked problem’. A ‘Wicked’ issue in the sense these problems “defy easy or single bullet solutions” and “have complex causes and require complex solutions”. Collaboration is vital to bring together ideas and resources to tackle complex problems.

An article on international research collaboration in Elsevier connect, following the Times Higher Education World Academic Summit in Melbourne in 2015, stated that “researchers collaborate to share their knowledge and combine the perspectives they have to solve complex problems that are increasingly cross-disciplinary in nature”. It argued that international collaboration provides many benefits, including “enabling researchers in institutions to access resources beyond their own, especially funding, talent and equipment”.

Furthermore, the article suggested that regional universities could collaborate when research is centred on a common regional challenge. However, there are further opportunities for international collaboration and learning, such as where research themes and methodologies are overlapping. All this potential was in mind as I travelled to Columbia University and I was able to explore this through my visit to BEH. For me, the question was how could the similarities that exist in Neighbourhood and Health research themes in Glasgow and in New York benefit research and help further understand complex problems.

Neighbourhood and Health research themes in Glasgow and New York

The BEH research group has an interdisciplinary programme of research which uses spatial data to examine the impact of the built environment (including land use, public transit, and housing) on physical activity, diet, obesity, and other aspects of health. The group’s research themes have many parallels to ours in the Neighbourhoods and Communities Programme at the MRC/CSO Social and Public Health Sciences Unit (SPHSU), University of Glasgow, and at the Centre for Research on the Environment, Society and Health (CRESH). We all seek to understand how neighbourhood environments impact upon health outcomes and health inequalities.

For example, researchers at SPHSU and CRESH have recently described an association between alcohol and tobacco outlet density across Scotland and area level deprivation such that the poorest neighbourhoods had the highest densities of outlet. However, this is a complex issue as highlighted by a Glasgow based study conducted at SPHSU, ‘The socio-spatial distribution of alcohol outlets in Glasgow city’, which did not find the same association. My colleague Laura Macdonald’s recent paper described that perceptions of being well-placed for amenities and the presence of amenities in the local neighbourhood were not necessarily correlated.

In New York, BEH group have recently developed a tool that allows the automated auditing of neighbourhood environments using Google Street View. This project developed a system called the ‘Computer Assisted Neighborhood Visual Assessment System’ (CANVAS), to conduct Street View based audits of neighbourhoods. The software developed can be used for neighbourhood audits conducted at a desktop computer for a much lower cost than sending out trained auditors to survey the neighbourhood.

CANVAS creates opportunities a richer understanding of neighbourhood environments than using only the geographical location of amenities or outlets. This could include an understanding of visual stimuli in the neighbourhood on individual behavioural choices, such as advertising of health/fast foods, whether amenities and outlets are visible to individuals travelling along streets, and changes in this over time. Approaches like CANVAS could bring advances in our field which often currently assumes that proximity to facilities is the primary mediator in access. As our research has shown, perception and presence of amenities are not necessarily correlated.

Our programme has recently completed data collection for the Studying Physical Activity in Children’s Environments across Scotland (SPACES) study. The SPACES study is the first national representative study in Scotland to collect both Global Positioning System (GPS) and accelerometer (i.e. movement) data of over 800 children, 10-11 years old. Indeed, a study I am currently leading utilises the SPACES dataset to describe children’s patterns of movement within the landscape and how this may be affected by the surrounding neighbourhoods in terms of its makeup, size, shape and proximity to each other. Paul McCrorie and colleagues’ review the use of such devices to explore the physical activity and environment relationship in children and young people highlighted that describing people’s movement in time and space is a field which is advancing rapidly, driven by the advancements in wearable technologies that collect GPS data. But this also means that it’s imperative we understand and develop the methodological options for analysing the gathered data to ensure robust and generalizable conclusions.

The Potential of Collaboration

Spending time with BEH, I could more readily see that the two programmes share a clear focus to establish a grounded and robust methodological framework for describing patterns of movement and environmental exposures in neighbourhoods.

It was this first-hand opportunity to share learning both from the analysis of our studies and our approaches which can, I believe, lead to better collaboration. Modern technology is great for communication, but direct dialogue and the time and space to be with potential colleagues in their environment can perhaps offer richer experience than a scheduled video-conference or a meeting of minds at a conference, (valuable as those are).

For example, last year the BEH group published a study using GPS data to study neighborhood walkability and physical activity’ in the American Journal of Preventive Medicine. This measured the size and characteristics of residential neighbourhood areas utilised, and those not utilised, by people in New York City. I was able to discuss this with the lead author, Andrew Rundle, who is also co-director of BEH, during my visit and the strengths and limitations of different geospatial analytical and statistical techniques for neighbourhood GPS studies, which I also picked up with Stephen Mooney while I was there.

I am now continuing to explore ideas around methodological development and carrying on these discussions. International travel schemes are invaluable. It is important to step outside of your own research group to gain a wider academic perspective of world-leading research. Although my visit to BEH was not about collaboraton in the sense of producing a research paper or grant, it allowed us to share practice, knowledge and ideas.

Of course, embracing an international spirit also means following the ‘when in Rome’ philosophy, so before I left, as a keen runner, I also made time to tread some miles amongst the amazing New York scenery. And as a geographer interested in spatial epidemiology, and like other geographers, I track all my runs using GPS! I have included the routes for those who might want to check them out: Two Bridges, Lower Manhattan to Battery Park, and a foggy 5k across the Manhattan Bridge.

 

 

Being a Scout or Guide protects mental health and narrows inequalities in later life

By Rich Mitchell and Chris Dibben

beaver-scouts-plant-trees-for-their-gardener-badge-pic-credit-the-scout-association
Today, with colleagues from the Longitudinal Studies Centre Scotland at Edinburgh University, we have published a study
which found that being in the Guides or Scouts as a child seems to protect your mental health long into adulthood. Those who were in the Guides or Scouts were about 18% less likely to have a mood or anxiety disorder at age 50, than those who were not. This protective link seems especially strong for children who grew up in less advantaged households, so much so that the usual ‘gap’ in mental health between those from richer and poorer backgrounds does not exist among those who were Scouts or Guides. Continue reading Being a Scout or Guide protects mental health and narrows inequalities in later life

Loneliness is an issue of inequality

By Claire Niedzwiedz

Loneliness is increasingly being prioritised as a public health issue, due to its strong links to illness and premature mortality.  Our new article published in Preventive Medicine (open access version here) highlights that older people’s loneliness varies according to their level of wealth: those with the least experience more loneliness than the wealthiest. We found that taking part in formal social activities, such as attending a sport or social club, may help to reduce the gap in loneliness between the poorest and richest older people, especially among men. But wealthier people are on the whole more likely to participate in such activities.

Continue reading Loneliness is an issue of inequality

Seeing e-cigarettes in shops may influence their use by teenagers

By Jamie Pearce

Adolescents who recall seeing e-cigarettes in shops are more likely to have tried them in the past and are more likely to intend to try them in the future, according to a study published in the open access journal BMC Public Health.

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Source: http://www.ecigclick.co.uk. Creative Commons License

Continue reading Seeing e-cigarettes in shops may influence their use by teenagers

Regions of Europe gaining migrants have lower death rates

By Helena Tunstall

New research just published by CRESH in the European Journal of Public Health suggests there is a strong correlation between net migration, 2000-2010, and age- and sex- standardised death rates, 2008-2010 among the regions of Europe (Figure 1). The recent ‘migrant crisis’ in Europe has ensured that European political debate about migration, long centred on immigration, has continued to focus upon areas receiving migrants. This analysis suggests however that difficulties associated with immigration are the problems of advantage. Regions of Europe which experienced significant population growth through migration, were found mostly in Western countries with higher incomes and lower death rates. In contrast, Europe regions with net out-migration, predominantly located in the East, are burdened by the combined problems of low incomes, high death rates and population decline.

EJPH_scatterplot_blog
Figure 1 Death rates and migration among European regions

 

Continue reading Regions of Europe gaining migrants have lower death rates

Income deprivation and ethnicity

By Helena Tunstall & Stephanie Prady

Do deprivation indices based on means-tested benefits underestimate poverty in neighbourhoods with large minority ethnic populations? 

BorninBradford1Research has just been published which assesses how well the Income Deprivation Affecting Children Index (IDACI) identifies neighbourhood poverty in areas of Bradford with different ethnic populations.

This study was a collaboration between researchers at the University of York, the Bradford Institute for Health Research and CRESH. It compared neighbourhood IDACI scores, based upon social security benefit claims, to socio-economic data collected from families in the Born in Bradford (BiB) cohort study.

This study concludes that income deprivation measures based on means-tested benefits may underestimate deprivation in neighbourhoods with large minority ethnic populations due to the low take-up of benefits among poor families in some ethnic groups.

Continue reading Income deprivation and ethnicity

Financial distress and inequalities in wellbeing across 13 European countries

By Claire Niedzwiedz

Governments are increasingly recognising the wellbeing of their citizens as a policy priority.  But in times of economic difficulty the welfare ‘safety net’ is often reduced, which may adversely affect the wellbeing of those most threatened by financial insecurities. Focusing on social inequalities in wellbeing across different countries – as we do in our latest paper – is therefore crucial.

By alf.melin, Flickr. Creative Commons (CC BY-SA 2.0) Continue reading Financial distress and inequalities in wellbeing across 13 European countries