Publications
338 results found
Borges MC, Louzada ML, de Sá TH, et al., 2017, Artificially sweetened beverages and the response to the global obesity crisis, Plos Medicine, Vol: 14, ISSN: 1549-1676
In March 2015, the World Health Organization (WHO) published revised guidelines onsugar intake that call on national governments to institute policies to reduce sugarintake and increase the scope for regulation of sugar-sweetened beverages (SSBs).• In face of the growing threat of regulatory action on SSBs, transnational beverage companiesare responding in multiple ways, including investing in the formulation and salesof artificially sweetened beverages (ASBs), promoted as healthier alternatives to SSBs.• The absence of consistent evidence to support the role of ASBs in preventing weightgain and the lack of studies on other long-term effects on health strengthen the positionthat ASBs should not be promoted as part of a healthy diet.• The promotion of ASBs must be discussed in a broader context of the additional potentialimpacts on health and the environment. In addition, a more robust evidence base,free of conflicts of interest, is needed.
Hone T, Rasella D, Barreto M, et al., 2017, Large reductions In amenable mortality associated with Brazil's primary care expansion and strong health governance, Health Affairs, Vol: 36, Pages: 149-158, ISSN: 0278-2715
Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000-12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems.
Jawad M, Khader A, Millett C, 2016, Differences in tobacco smoking prevalence and frequency between adolescent Palestine refugee and non-refugees populations in Jordan, Lebanon, Syria, and the West Bank: cross-sectional analysis of the Global Youth Tobacco Survey, Conflict and Health, Vol: 10, ISSN: 1752-1505
Background: Evidence is conflicting as to the whether tobacco smoking prevalence is higher in refugee thannon-refugee populations. The aim of this study was to compare the prevalence and frequency of tobacco smokingin Palestine refugee and non-refugee adolescent populations in the Middle East.Methods: We conducted a cross-sectional analysis of the Global Youth Tobacco Survey (GYTS) conducted inJordan, Lebanon, Syria, and the West Bank among adolescent Palestine refugees and non-refugees. Age- and sexadjustedregression models assessed the association between refugee status and current (past-30 day) tobacco useprevalence and frequency.Results: Prevalence estimates for current tobacco smoking were similar between Palestine refugee and nonrefugeegroups in Jordan (26.7 % vs. 24.0 %), Lebanon (39.4 % vs. 38.5 %), and the West Bank (39.5 % vs. 38.4 %).In Syria, Palestine refugees had nearly twice the odds of current tobacco smoking compared to non-refugees(23.2 % vs. 36.6 %, AOR 1.96, 95 % CI 1.46–2.62). Palestine refugees consumed more cigarettes per month thannon-refugees in Lebanon (β 0.57, 95 % CI 0.17–0.97) and Palestine refugees consumed more waterpipe tobaccoper month than non-refugees in Syria (β 0.40, 95 % CI 0.19–0.61) and the West Bank (β 0.42, 95 % CI 0.21–0.64).Conclusions: Current tobacco smoking prevalence is in excess of 20 % in both adolescent Palestine refugee andnon-refugee populations in Middle Eastern countries, however Palestine refugees may smoke tobacco morefrequently than non-refugees. Comparison of simple prevalence estimates may therefore mask importantdifferences in tobacco use patterns within population groups.
Filippidis FT, Mian SS, Millett C, 2016, Perceptions of quality and safety and experience of adverse events in 27 European Union healthcare systems, 2009-2013, International Journal for Quality in Health Care, Vol: 28, Pages: 721-727, ISSN: 1464-3677
OBJECTIVE: To assess trends in the perception of quality and safety between 2009 and 2013 in the European Union (EU). DESIGN: We analysed data from waves 72.2 and 80.2 of the Eurobarometer survey. Multilevel logistic regression models adjusted for sociodemographic factors and country-level health expenditure were fitted to assess changes between 2009 and 2013 in each of the assessed outcomes. SETTING: Twenty-seven EU member states. PARTICIPANTS: A total of n = 26 663 (2009) and n = 26 917 (2013) individuals aged ≥15 years. MAIN OUTCOME MEASURES: Outcomes included the perception of being harmed in hospital and non-hospital care; rating of the overall quality of the healthcare system; and personal or family experience of adverse events. RESULTS: Respondents in 2013 were more likely to think that it was likely to be harmed in hospital (Odds Ratio [OR] = 1.09; 95% Confidence Interval [CI]: 1.05-1.13; P < 0.001) and non-hospital care (OR = 1.11; 95% CI: 1.07-1.15; P < 0.001), compared to 2009. However, they were more likely to rate the quality of their country's healthcare system as good (OR = 1.26; 95% CI: 1.21-1.32; P < 0.001) and no significant change over time was identified in reported experience of adverse events (OR = 1.00; 95% CI: 0.95-1.05; P = 0.929). Lower health expenditure and decrease in health expenditure between the two waves were associated with worse outcomes in overall quality and perceptions of harm. There was significant variation between and within countries in all indicators. CONCLUSIONS: The public's perception of safety in European healthcare systems declined in recent years, which highlights that there are safety issues that could be addressed.
Vamos EP, Lewis E, Junghans C, et al., 2016, Community-based pilot intervention to tackle childhood obesity: a whole-system approach, Public Health, Vol: 140, Pages: 109-118, ISSN: 0033-3506
Objectives: Go-Golborne is a pilot intervention to prevent childhood obesity in the Royal Borough of Kensington and Chelsea between 2014 and 2018. It is a multi-strategy approach targeting children aged 0-16 years and their families in all settings where children live, learn and play. This paper describes the methodology and the practical steps in the development of Go-Golborne. Study design: The programme uses a quasi-experimental design for the evaluation of changes in weight status using data from the extended National Child Measurement Programme across local schools. For specific behavioural change objectives, baseline self-reported lifestyle measures will be compared against annual follow-up data over the 3-year study period. Qualitative methods will be used to explore the perceptions of stakeholders and participants and organizational change.Methods: Go-Golborne aims to mobilize everyone in the community who has a role or interest in shaping the local environment, norms and behaviors across a range of sectors. A community network of local organisations has been established to co-design all programme activities. A Steering Group of Council officers supports programme implementation and environmental changes. The programme has identified six specific behavior change objectives representing the key areas of need in Golborne and all activities in the council and the community target these objectives during specific programme phases. Key components include community capacity building, community-wide social marketing, environment and policy change and evaluation.Results (Progress): The programme is currently at the beginning of its implementation phase with activities in the community and council targeting the first behavior change objective. Conclusions: The pilot aims to test the effectiveness of this approach to support behavior change and prevent unhealthy weight gain in children using multiple strategies. This programme will inform the development of an interve
Hone TV, Gurol-Urganci I, Millett C, et al., 2016, Effect of primary health care reforms in Turkey on health service utilisation and user satisfaction, Health Policy and Planning, Vol: 32, Pages: 57-67, ISSN: 1460-2237
Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilisation and user satisfaction. The effect of health system reforms that introduced family medicine on utilisation was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services were explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs. secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings. Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (p<0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30 respectively a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8% respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (p<0.001) in PHC settings, but remained higher among urban, low-income and working-age populations.
Sridhar K, Millett C, Laverty AA, et al., 2016, Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia—A multi-centre study, BMC Public Health, Vol: 16, ISSN: 1471-2458
Background: We report the prevalence of recommended physical activity levels (RPALs) and examine the correlatesof achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.Methods: This analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease RiskFactor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Dataon socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administeredquestionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used toexamine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) wereassociated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were usedto investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).Results: The majority of children (71.8 %) belonged to households where a parent had at least a secondary education.Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years,OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel activelyto school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children inMatlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3;95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education(OR = 2.1; 95 % CI: 1.1, 4.1). In multivariat
Vamos EP, Pape UJ, Curcin V, et al., 2016, Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes., Canadian Medical Association Journal, ISSN: 0008-4409
BACKGROUND: The health burden caused by seasonal influenza is substantial. We sought to examine the effectiveness of influenza vaccination against admission to hospital for acute cardiovascular and respiratory conditions and all-cause death in people with type 2 diabetes. METHODS: We conducted a retrospective cohort study using primary and secondary care data from the Clinical Practice Research Datalink in England, over a 7-year period between 2003/04 and 2009/10. We enrolled 124 503 adults with type 2 diabetes. Outcome measures included admission to hospital for acute myocardial infarction (MI), stroke, heart failure or pneumonia/influenza, and death. We fitted Poisson regression models for influenza and off-season periods to estimate incidence rate ratios (IRR) for cohorts who had and had not received the vaccine. We used estimates for the summer, when influenza activity is low, to adjust for residual confounding. RESULTS: Study participants contributed to 623 591 person-years of observation during the 7-year study period. Vaccine recipients were older and had more comorbid conditions compared with nonrecipients. After we adjusted for covariates and residual confounding, vaccination was associated with significantly lower admission rates for stroke (IRR 0.70, 95% confidence interval [CI] 0.53-0.91), heart failure (IRR 0.78, 95% CI 0.65-0.92) and pneumonia or influenza (IRR 0.85, 95% CI 0.74-0.99), as well as all-cause death (IRR 0.76, 95% CI 0.65-0.83), and a nonsignificant change for acute MI (IRR 0.81, 95% CI 0.62-1.04) during the influenza seasons. INTERPRETATION: In this cohort of patients with type 2 diabetes, influenza vaccination was associated with reductions in rates of admission to hospital for specific cardiovascular events. Efforts should be focused on improvements in vaccine uptake in this important target group as part of comprehensive secondary prevention.
Bakolis I, Kelly R, Fecht D, et al., 2016, Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design, Epidemiology, Vol: 27, Pages: 810-818, ISSN: 1531-5487
Background: Environmental tobacco smoke has an adverse impact on preterm birth and birthweight. England introduced a new law to make virtually all enclosed public places andworkplaces smoke free on July 1 2007. We investigated the effect of smoke-free legislation onbirth outcomes in England using Hospital Episode Statistics (HES) maternity data.Methods: We used regression discontinuity, a quasi-experimental study design, which canfacilitate valid causal inference, to analyse short-term effects of smoke-free legislation on birthweight, low birth weight, gestational age, preterm birth and small for gestational age.Results: We analysed 1,800,906 pregnancies resulting in singleton live-births in Englandbetween January 1 2005 and December 31 2009. In the one to five months following theintroduction of the smoking-free legislation, for those entering their third trimester, the risk oflow birth weight decreased by between 8% (95% CI: 4%-12%) and 14% (95% CI: 5%-23%),very low birth weight between 28% (95% CI: 19%-36%) and 32% (95% CI: 21%-41%), pretermbirth between 4% (95% CI: 1%-8%) and 9% (95% CI: 2%-16%), and small for gestational agebetween 5% (95% CI: 2%-8%) and 9% (95% CI: 2%-15%). The impact of the smoke-freelegislation varied by maternal age, deprivation, ethnicity and region.Conclusions: The introduction of smoke-free legislation in England had an immediate beneficialimpact on birth outcomes overall, although this benefit was not observed across all age, ethnic, ordeprivation groups.
Palladino R, Lee JT, Hone T, et al., 2016, The Great Recession And Increased Cost Sharing In European Health Systems, Health Affairs, Vol: 35, Pages: 1204-1213, ISSN: 0278-2715
European health systems are increasingly adopting cost-sharingmodels, potentially increasing out-of-pocket expenditures for patientswho use health care services or buy medications. Government policiesthat increase patient cost sharing are responding to incremental growthin cost pressures from aging populations and the need to invest in newhealth technologies, as well as to general constraints on publicexpenditures resulting from the Great Recession (2007–09). We used datafrom the Survey of Health, Ageing and Retirement in Europe to examinechanges from 2006–07 to 2013 in out-of-pocket expenditures amongpeople ages fifty and older in eleven European countries. Our resultsidentify increases both in the proportion of older European citizens whoincurred out-of-pocket expenditures and in mean out-of-pocketexpenditures over this period. We also identified a significant increaseover time in the percentage of people who incurred catastrophic healthexpenditures (greater than 30 percent of the household income) in theCzech Republic, Italy, and Spain. Poorer populations were less likely thanthose in the highest income quintile to incur an out-of-pocketexpenditure and reported lower mean out-of-pocket expenditures, whichsuggests that measures are in place to provide poorer groups with somefinancial protection. These findings indicate the substantial weakening offinancial protection for people ages fifty and older in European healthsystems after the Great Recession
Hopkinson NS, Millett C, Glantz S, et al., 2016, UK government should fund stop smoking media campaigns not give tax breaks to films with smoking imagery, Addiction, Vol: 111, Pages: 2066-2067, ISSN: 1360-0443
Mulley C, Ignacio Rizzi L, Millett C, et al., 2016, Public transport and health: Publicising the evidence, Journal of Transport & Health, Vol: 3, Pages: 131-132, ISSN: 2214-1405
Majeed F, Hansell A, Saxena S, et al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095
CHANG C, LEE T, VAMOS E, et al., 2016, Impact of NHS Health Check on cardiovascular disease risk: difference-in-differences matching analysis, Canadian Medical Association Journal, ISSN: 1488-2329
Bhan N, Karan A, Srivastava S, et al., 2016, Have Socioeconomic Inequalities in Tobacco Use in India Increased Over Time? Trends From the National Sample Surveys (2000–2012), Nicotine & Tobacco Research, Vol: 18, Pages: 1711-1718, ISSN: 1469-994X
INTRODUCTION: India has experienced marked sociocultural change, economic growth and industry promotion of tobacco products over the past decade. Little is known about the influence of these factors on socioeconomic patterning of tobacco use. This study examines trends in tobacco use by socioeconomic status (SES) in India between 2000 and 2012. METHODS: We analyzed data in 2014 from nationally-representative repeated cross-sectional National Sample Surveys (NSS) in India for 1999-2000, 2004-2005 and 2011-2012 (n = 346 612 households). Prevalence and volume trends in cigarette, "bidi" and smokeless tobacco use were examined by household expenditure, educational attainment and caste/tribe status using Two-part model. RESULTS: Prevalence of any tobacco use remained consistent in the poorest households (61.5% to 62.7%) and declined among the richest (43.8% to 36.8%) between 2000-2012. Bidi use declined across all groups (poorest: 26.3% to 16.8%, richest: 19.8% to 10.7%) while cigarette use increased (poorest: 1.2% to 1.3%, richest: 6.5% to 7.0%). Relative to educated and general caste households, between 2000 and 2012 cigarette use in illiterate households increased by 38% and among Scheduled Tribe households increased by 32%. Smokeless tobacco use increased for all households (poorest: 26.2% to 33.9%, richest: 11.4% to 13.5%, Scheduled Tribe: 31.1% to 34.8%, general caste: 13.6% to 18.5%), with greater increases among richer, more educated and general caste households. CONCLUSION: Marked SES patterning of tobacco use has persisted in India. Improving enforcement of tobacco control policies and monitoring comprehensive smoke-free legislations are needed to address this growing burden. IMPLICATIONS: We found "resilient" tobacco patterns in the last decade despite prevention interventions. SES continues to be inversely associated with tobacco products, with the exception of cigarettes. The declines in bidi use may be getting replaced by increase in cig
Palladino R, Tayu Lee J, Ashworth M, et al., 2016, Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries, Age and Ageing, Vol: 45, Pages: 431-435, ISSN: 1468-2834
Background: with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe.Methods: we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011–12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity.Results: overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27–0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42–1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03–2.24), being depressed (AOR 1.48, 95% CI = 1.42–1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02–2.22).Conclusion: multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.
Webb E, Laverty A, Mindell J, et al., 2016, Free Bus Travel and Physical Activity, Gait Speed, and Adiposity in the English Longitudinal Study of Ageing, American Journal of Public Health, Vol: 106, Pages: 136-142, ISSN: 1541-0048
Objectives. We investigated associations between having a bus pass, enabling free local bus travel across the United Kingdom for state pension–aged people, and physical activity, gait speed, and adiposity.Methods. We used data on 4650 bus pass–eligible people (aged ≥ 62 years) at wave 6 (2012–2013) of the English Longitudinal Study of Ageing in regression analyses.Results. Bus pass holders were more likely to be female (odds ratio [OR] = 1.67; 95% confidence interval [CI] = 1.38, 2.02; P < .001), retired (OR = 2.65; 95% CI = 2.10, 3.35; P < .001), without access to a car (OR = 2.78; 95% CI = 1.83, 4.21; P < .001), to use public transportation (OR = 10.26; 95% CI = 8.33, 12.64; P < .001), and to be physically active (OR = 1.43; 95% CI = 1.12, 1.84; P = .004). Female pass holders had faster gait speed (b = 0.06 meters per second; 95% CI = 0.02, 0.09; P = .001), a body mass index 1 kilogram per meter squared lower (b = –1.20; 95% CI = –1.93, –0.46; P = .001), and waist circumference 3 centimeters smaller (b = –3.32; 95% CI = –5.02, –1.62; P < .001) than women without a pass.Conclusions. Free bus travel for older people helps make transportation universally accessible, including for those at risk for social isolation. Those with a bus pass are more physically active. Among women in particular, the bus pass is associated with healthier aging.
Mathur MR, Tsakos G, Parmar P, et al., 2016, Socioeconomic inequalities and determinants of oral hygiene status among Urban Indian adolescents, Community Dentistry and Oral Epidemiology, Vol: 44, Pages: 248-254, ISSN: 0301-5661
Objectives To assess the socioeconomic inequalities in oral hygiene and to explore the role of various socioeconomic and psychosocial factors as determinants of these inequalities among adolescents residing in Delhi National Capital Territory. Methods A cross-sectional study was conducted among 1386 adolescents aged 12-15 years from three different socioeconomic groups according to their area of residence (middle-class areas, resettlement colonies and urban slum colonies). Level of oral hygiene was examined clinically using the Simplified Oral Hygiene Index (OHI-S), and an interviewer-administered questionnaire was used to measure key socio-demographic variables and psychosocial and health-related behaviours. Logistic regression analysis tested the association between area of residence and poor oral hygiene. Results Poor oral hygiene was observed in 50.2% of the adolescents. There was a socioeconomic gradient in poor oral hygiene, with higher prevalence observed at each level of deprivation. These differences were only partly explained, and the differences between adolescent groups remained statistically significant after adjusting for various demographic variables, standard of living, social capital, social support and health-affecting behaviours (OR: 1.96, 95% CI: 1.30-2.76; and OR: 2.50, 95% CI: 1.60-3.92 for adolescents from resettlement colonies and urban slums, respectively, than middle-class adolescents). Conclusion Area of residence emerged as a strong socioeconomic predictor of prevalence of poor oral hygiene among Indian adolescents. Various material, psychosocial and behavioural factors did not fully explain the observed inequalities in poor oral hygiene among different adolescent groups.
Basu S, Yudkin JS, Sussman JB, et al., 2016, Alternative strategies to achieve cardiovascular mortality goals in China and India: a microsimulation of target- versus risk-based blood pressure treatment, Circulation, Vol: 133, Pages: 840-848, ISSN: 0009-7322
Background—The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization.Methods and Results—We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥10% used similar financial resources but averted ≈5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy.Conclusions—In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.
Jawad M, Choaie E, Brose L, et al., 2016, Waterpipe tobacco use in the United Kingdom: a cross-sectional study among university students and stop smoking practitioners, PLOS One, Vol: 11, ISSN: 1932-6203
IntroductionDespite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners’ encounter of waterpipe tobacco smoking.MethodsWe distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly.Resultsf 2217 student responses, 66.0% (95% CI 63.9–68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8–15.8%) reported past-30 day use, and 8.7% (95% CI 7.6–9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91–0.99), male (AOR 1.44, 95% CI 1.08–1.94), higher SES (AOR 1.16, 95% CI 1.06–1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66–3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seei
Nazar GP, Lee JT, Arora M, et al., 2015, Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries, Nicotine & Tobacco Research, Vol: 18, Pages: 1230-1239, ISSN: 1469-994X
Introduction: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs).Methods: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008–2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality.Results: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04–1.22] in Turkey to 3.31 [95% CI 2.91–3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02–0.11] in Turkey to 0.43 [95% CI 0.38–0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education.Conclusion: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure.Implications: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Compre
Laverty AA, Magee L, Monteiro CA, et al., 2015, Sugar and artificially sweetened beverage consumption and adiposity changes: National longitudinal study, International Journal of Behavioral Nutrition and Physical Activity, Vol: 12, ISSN: 1479-5868
BackgroundIn response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), there is increased promotion of artificially sweetened beverages (ASBs). These have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children.MethodsWe conducted a longitudinal study of 13,170 children aged 7–11 years in the UK Millennium Cohort Study, collected in 2008 and 2012. Logistic regression was used to assess socio-demographic and behavioural correlates of weekly SSB and ASB consumption at 11 years. Linear regression examined associations between SSB/ASB consumption and changes in adiposity measures between 7 and 11 years.ResultsBoys were more likely to consume SSBs weekly (62.3 % v 59.1 %) than girls at age 11 years. South Asian children were more likely to consume SSBs weekly (78.8 % v 58.4 %) but less likely to consume ASBsweekly (51.7 % v 66.3 %) than White children. Daily SSB consumption was associated with increases in percentage body fat between ages 7 and 11 (+0.57 %, 95 % confidence intervals 0.30;0.83). Daily ASB consumption was associated with increased percentage body fat at age 11 (+1.18 kg/m 2 , 0.81;1.54) and greater increases between ages 7 and 11 (+0.35 kg/m 2 , 0.09;0.61).ConclusionConsumption of SSBs and ASBs was associated with BMI and percentage body fat increases in UK children. Obesity prevention strategies which encourage the substitution of SSBs with ASBs may not yield the adiposity benefits originally intended and this area should be a focus for further research.
McKay AJ, Laverty AA, Shridhar K, et al., 2015, Associations between active travel and adiposity in rural India and Bangladesh: a cross-sectional study, BMC Public Health, Vol: 15, ISSN: 1471-2458
BackgroundData on use and health benefits of active travel in rural low- and middle- income country settings are sparse. We aimed to examine correlates of active travel, and its association with adiposity, in rural India and Bangladesh.MethodsCross sectional study of 2,122 adults (≥18 years) sampled in 2011–13 from two rural sites in India (Goa and Chennai) and one in Bangladesh (Matlab). Logistic regression was used to examine whether ≥150 min/week of active travel was associated with socio-demographic indices, smoking, oil/butter consumption, and additional physical activity. Adjusting for these same factors, associations between active travel and BMI, waist circumference and waist-to-hip ratio were examined using linear and logistic regression.ResultsForty-six percent of the sample achieved recommended levels of physical activity (≥150 min/week) through active travel alone (range: 33.1 % in Matlab to 54.8 % in Goa). This was more frequent among smokers (adjusted odds ratio 1.36, 95 % confidence interval 1.07–1.72; p = 0.011) and those that spent ≥150 min/week in work-based physical activity (OR 1.71, 1.35–2.16; p < 0.001), but less frequent among females than males (OR 0.25, 0.20–0.31; p < 0.001). In fully adjusted analyses, ≥150 min/week of active travel was associated with lower BMI (adjusted coefficient −0.39 kg/m² , −0.77 to −0.02; p = 0.037) and a lower likelihood of high waist circumference (OR 0.77, 0.63–0.96; p = 0.018) and high waist-to-hip ratio (OR 0.72, 0.58–0.89; p = 0.002).ConclusionsUse of active travel for ≥150 min/week was associated with being male, smoking, and higher levels of work-based physical activity. It was associated with lower BMI, and lower risk of a high waist circumference or high waist-to-hip ratio. Promotion of active travel is an important component of strategies to
Mathur MR, Watt RG, Millett CJ, et al., 2015, Determinants of Socioeconomic Inequalities in Traumatic Dental Injuries among Urban Indian Adolescents, PLOS One, Vol: 10, ISSN: 1932-6203
ObjectivesTo assess socioeconomic inequalities in traumatic dental injuries (TDIs) in adolescents in New Delhi and examine the role of material, psychosocial and behavioural factors in explaining these inequalities.MethodsWe conducted a cross sectional study of 1386 adolescents aged between 12–15 years residing in three diverse areas of New Delhi. A non-invasive clinical examination was used to estimate the prevalence of TDIs, and an interviewer-administered questionnaire was used to gather relevant behavioural and socio-demographic data. Multiple logistic regression models were used to assess the association between area based socioeconomic position and TDIs.ResultsThe overall prevalence of TDIs was 10.9%. Social inequalities in the prevalence of TDIs were observed across the adolescent population according to their area of residence. Socio-economic group differences in the prevalence of TDIs remained statistically significant after adjusting for demographic factors, material resources, social capital, social support and health affecting behaviours (OR 3.36, 95% CI 1.75–6.46 and OR 3.99, 95% CI 1.86–8.56 for adolescents from resettlement areas and urban slums respectively in comparison to middle class adolescents). Different psychosocial, material and socio-demographic variables did not attenuate the estimates for the relationship between area socioeconomic position and TDIs.ConclusionArea of residence was a strong predictor of TDIs in adolescents with a higher prevalence in more deprived areas. Social inequalities in TDIs were not explained by psychosocial and behavioural variables. Health promoting policies aimed at improving the physical environment in which adolescents reside might be instrumental in reducing the prevalence of TDIs and associated inequalities.
Been JV, Millett C, Lee JT, et al., 2015, Smoke-free legislation and childhood hospitalisations for respiratory tract infections, EUROPEAN RESPIRATORY JOURNAL, Vol: 46, Pages: 697-706, ISSN: 0903-1936
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- Citations: 40
Been JV, Mackay DF, Millett C, et al., 2015, Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study, Scientific Reports, Vol: 5, ISSN: 2045-2322
Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6–5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4–11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.
Sarkar C, Dodhia H, Crompton J, et al., 2015, Hypertension: a cross-sectional study of the role of multimorbidity in blood pressure control, BMC Family Practice, Vol: 16, ISSN: 1471-2296
BackgroundHypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investigate the relationship between multimorbidity and systolic blood pressure (SBP) in patients with hypertension.MethodsA cross-sectional analysis of anonymised primary care data was performed for a total of 299,180 adult patients of whom 31,676 (10.6 %) had a diagnosis of hypertension. We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP. We constructed a regression model to identify the determinants of SBP control.ResultsThe strongest predictor of mean SBP was the number of comorbidities, β −0.13 (p < 0.05). Other predictors included Afro-Caribbean ethnicity, β 0.05 (p < 0.05), South Asian ethnicity, β −0.03 (p < 0.05), age, β 0.05 (p < 0.05), male gender, β 0.05 (p < 0.05) and number of hypotensive drugs β 0.06 (p < 0.05). SBP was lower by a mean of 2.03 mmHg (−2.22, −1.85) for each additional comorbidity and was lower in MM regardless of the type of morbidity.ConclusionHypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP. We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity. Further research is needed to determine whether consultation rate, “white-coat hypertension” or medication adherence influence BP control in MM.
Lee T, Millett, 2015, Impact of noncommunicable disease multimorbidity onhealthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis, PLOS One, Vol: 10, ISSN: 1932-6203
BackgroundThe burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa.MethodsSecondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007–2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models.ResultsThe prevalence of multimorbidity in the adult population varied from 3∙9% in Ghana to 33∙6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0∙56, 95% CI = 0∙46, 0∙66), a higher likelihood of being hospitalised in India (AOR = 1∙59, 95% CI = 1∙45, 1∙75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88∙3% for outpatient, 55∙9% for inpatient visit in China) in most countries.ConclusionMultimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups su
Yudkin JS, Millett C, 2015, Diabetes prevention in England, LANCET DIABETES & ENDOCRINOLOGY, Vol: 3, Pages: 502-502, ISSN: 2213-8587
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- Citations: 2
Jawad M, Millett C, 2015, Epidemiological surveys might underestimate waterpipe smoking, BMJ-BRITISH MEDICAL JOURNAL, Vol: 350, ISSN: 1756-1833
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