130 results found
Seferidi P, Millett C, Laverty AA, 2021, Industry self-regulation fails to deliver healthier diets, again Public Health England's replacement must take bolder action, BMJ-BRITISH MEDICAL JOURNAL, Vol: 372, ISSN: 1756-1833
Hopkinson N, Rossi N, El-Sayed Moustafa JS, et al., 2021, Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people, Thorax, ISSN: 0040-6376
Background: The association between current tobacco smoking, the risk of developing symptomatic COVID-19 and the severity of illness is an important information gap.Methods: UK users of the Zoe COVID Symptom Study App provided baseline data including demographics, anthropometrics, smoking status and medical conditions, and were asked to log their condition daily. Participants who reported that they did not feel physically normal were then asked by the app to complete a series of questions, including 14 potential COVID-19 symptoms and about hospital attendance. The main study outcome was the development of “classic” symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness and their association with current smoking. The number of concurrent COVID-19 symptoms was used as a proxy for severity and the pattern of association between symptoms was also compared between smokers and non-smokers. Results: Between 24th March 2020 to 23rd April 2020, data were available on 2,401,982 participants, mean(SD) age 43.6(15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834,437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to report symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR[95%CI] 1.14[1.10 to 1.18]; >5 symptoms 1.29[1.26 to 1.31]; >10 symptoms 1.50[1.42 to 1.58]. The pattern of association between reported symptoms did not vary between smokers and non-smokers.Interpretation: These data are consistent with people who smoke being at an increased risk of developing symptomatic COVID-19.
Laverty AA, Hone T, Goodman A, et al., 2021, Associations of active travel with adiposity among children and socioeconomic differentials: a longitudinal study, BMJ OPEN, Vol: 11, ISSN: 2044-6055
Laverty AA, Millett C, Hopkinson NS, et al., 2021, Introduction of standardised packaging and availability of illicit cigarettes: a difference-in-difference analysis of European Union survey data 2015-2018., Thorax, Vol: 76, Pages: 89-91
Standardised packaging of tobacco products is intended to reduce the appeal of smoking, but the tobacco industry claims this increases illicit trade. We examined the percentage of people reporting being offered illicit cigarettes before and after full implementation of standardised packaging in the UK, Ireland and France and compared this to other European Union countries. Reported ever illicit cigarette exposure fell from 19.8% to 18.1% between 2015 and 2018 in the three countries fully implementing the policy, and from 19.6% to 17.0% in control countries (p for difference=0.320). Standardised packaging does not appear to increase the availability of illicit cigarettes.
Laverty A, Millett C, Filippidis FT, 2020, Associations between cigarette prices and consumption in Europe 2004 - 2014, Tobacco Control, Vol: 30, Pages: 111-113, ISSN: 0964-4563
IntroductionWhile tobacco price increases are known to reduce smoking prevalence, these relationships may be blunted by the availability of budget cigarettes, promoted by the tobacco industry to maintain profits. There has been limited previous research on the impact of budget cigarettes on cigarette consumption and used data from Europe 2004-2014 to investigate this.MethodsAnnual population-weighted cigarette consumption per adult data come from the International Cigarette Consumption Database. Annual tobacco price data come from Euromonitor International for 23 European countries. We examined median prices as well as price differentials, operationalised as percentages obtained by dividing the difference between median and minimum prices by median price. We used a linear random-effects model to assess associations between these and cigarette consumption within-year and with a one-year time lag.ResultsCigarette consumption per capita has declined over the study period (-29.5 cigarettes per capita per year, 95% Confidence Intervals -46.8 to -12.1). Our analysis suggests that increases in cigarette price differentials, a marker of opportunities for smokers to switch to less expensive cigarettes, are associated with greater consumption in the same year (+6.4 for a 10% increase in differential, -40.0 to 52.6) and are associated with greater consumption the following year (+67.6, 25.8 to 109.5). ConclusionThese analyses suggest that even in Europe where tobacco taxes are relatively high compared with other regions, differential cigarette pricing strategies may undermine tobacco control. Further research is needed on links between tobacco price structures and consumption and policy design to maximise the effectiveness of tobacco tax.
Filippidis F, Chang C-M, Blackmore I, et al., 2020, Prices and illicit trade of cigarettes in the European Union, a cross-sectional analysis, Nicotine and Tobacco Research, Vol: 22, Pages: 2271-2275, ISSN: 1462-2203
IntroductionWithin the context of the World Health Organization Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products and the impending revision of the EU directive on tobacco excise rules we assessed whether cigarettes price is linked to being offered illicit cigarettes.MethodsWe combined data being offered illicit cigarettes from the 2015 Special Eurobarometer Survey on Illicit Tobacco (N=27,672) with area-level data on Gross Domestic Product, unemployment, perceived corruption and sharing a border with a non-European Economic Area (non-EEA) state. We used the 2015 Weighted Average Price of cigarettes (WAP), which reflects the average price of a cigarette pack in each member state. We assessed associations between prices and illicit trade using 3-level ordered regression models.Results19.6% of respondents reported ever being offered illicit cigarettes, 6.4% repeatedly. In fully adjusted models WAP was not associated with being more likely to have been offered illicit market cigarettes more often (adjusted Odds Ratio=1.02, 95% Confidence Interval 0.91; 1.15). Sharing a border with a non-EEA member state was associated with increased likelihood of reporting being offered illicit cigarettes more often (1.73, 1.26;2.39).ConclusionThis study found no significant association between cigarette prices and reporting being offered illicit cigarettes; sharing a border with a non-EEA member state was linked to illicit trade. This study adds to evidence that increasing prices of cigarettes are not associated with illicit trade and that the focus should remain on securing supply chains, including through features such independent traceability systems.ImplicationsAfter adjusting for individual and regional factors, we did not identify an association between prices of cigarettes and likelihood of reporting being offered illicit cigarettes in the EU. Sharing a border with a non-EEA state however, was associated with increased likelihood of
Laverty AA, Vamos EP, Panter J, et al., 2020, Road user charging: a policy whose time has finally arrived, The Lancet Planetary Health, Vol: 4, Pages: e499-e500, ISSN: 2542-5196
Parnham JC, Laverty AA, Majeed A, et al., 2020, Half of children entitled to free school meals did not have access to the scheme during COVID-19 lockdown in the UK, Public Health, Vol: 187, Pages: 161-164, ISSN: 0033-3506
OBJECTIVES: The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. STUDY DESIGN: The study design was cross-sectional analyses of questionnaire data collected in April 2020. METHODS: Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. RESULTS: Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. CONCLUSIONS: In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improve
Laverty AA, Been JV, 2020, Two simple ways for governments to clear the air for children, The Lancet Public Health, Vol: 5, Pages: E465-E466, ISSN: 2468-2667
Seferidi P, Laverty AA, Collins B, et al., 2020, Potential impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease in England: a modelling study, BMJ Nutrition, Prevention & Health, Vol: 3, ISSN: 2516-5542
Background Current proposals for post-Brexit agricultural policy do not explicitly incorporate public health goals. The revised agricultural policy may be an opportunity to improve population health by supporting domestic production and consumption of fruits and vegetables (F&V). This study aims to quantify the potential impacts of a post-Brexit agricultural policy that increases land allocated to F&V on cardiovascular disease (CVD) mortality and inequalities in England, between 2021 to 2030.Methods We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to translate changes in land allocated to F&V into changes in F&V intake and associated CVD deaths, stratified by age, sex and Index of Multiple Deprivation. The model combined data on F&V agriculture, waste, purchases and intake, CVD mortality projections and appropriate relative risks. We modelled two scenarios, assuming that land allocated to F&V would gradually increase to 10% and 20% of land suitable for F&V production.Results We found that increasing land use for F&V production to 10% and 20% of suitable land would increase fruit intake by approximately 3.7% (95% uncertainty interval: 1.6% to 8.6%) and 17.4% (9.1% to 36.9%), and vegetable intake by approximately 7.8% (4.2% to 13.7%) and 37% (24.3% to 55.7%), respectively, in 2030. This would prevent or postpone approximately 3890 (1950 to 7080) and 18 010 (9840 to 28 870) CVD deaths between 2021 and 2030, under the first and second scenario, respectively. Both scenarios would reduce inequalities, with 16% of prevented or postponed deaths occurring among the least deprived compared with 22% among the most deprived.Conclusion Post-Brexit agricultural policy presents an important opportunity to improve dietary intake and associated cardiovascular mortality by supporting domestic production of F&V as part of a comprehensive strategy that intervenes across the supply chain.
Laverty AA, Millett C, Majeed A, et al., 2020, COVID-19 presents opportunities and threats to transport and health, Journal of the Royal Society of Medicine, Vol: 113, Pages: 251-254, ISSN: 0141-0768
Parnham J, Laverty A, Majeed A, et al., 2020, Half of children entitled to free school meals do not have access to the scheme during the COVID-19 lockdown in the UK., Publisher: medRxiv
Objectives To investigate access to free school meals (FSM) among eligible children, to describe factors associated with uptake and investigate whether receiving FSM was associated with measures of food insecurity in the UK using the COVID-19 wave of the UK Household Longitudinal Study (UKHKS). Study design Cross sectional analyses of UKHLS COVID-19 wave data collected in April 2020. Methods UKHLS participants completed a COVID-19 questionnaire in April 2020. 635 children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as having receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSM and (ii) associations between access to FSM and household food insecurity measures. All analyses accounted for survey design and sample weights. Results 51% of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (OR 11.81; 95% CI 5.54,25.19), who were low income (AOR 4.81; 95% CI 2.10,11.03) or still attending schools (AOR 5.87; 95% CI 1.70,20.25) were more likely to receive FSM. Children in Wales were less likely to access FSM than those in England (AOR 0.11; 95% CI 0.03,0.43). Receiving a FSM was associated with an increased odds of recently using a food bank, but not reporting feeling hungry. Conclusions In the month following the COVID-19 lockdown, 49% of eligible children did not receive any form of FSM. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needed to access a foodbank. As scheme may be continued in summer or in second wave, large improvements will be needed to improve its reach.
McKay A, Negi NS, Murukutla N, et al., 2020, Trends in tobacco, alcohol and branded fast-food imagery in Bollywood films, 1994-2013, PLoS One, Vol: 15, ISSN: 1932-6203
Background and aimsExposure to tobacco, alcohol and fast-food use in films is associated with initiation of these behaviours. India is the world’s largest film producer, but the extent of such imagery in Bollywood (Hindi cinema) films is unclear. We therefore aimed to describe the extent of and trends in tobacco, alcohol and fast-food imagery in Bollywood films, between 1994–2013.MethodsFor the 15 top-grossing films each year between 1994–2013, the number of five-minute intervals containing product images were determined separately for tobacco, alcohol and fast-food. Both the proportion of films containing at least one image occurrence, and occurrences per film, were described overall and by year. Negative binomial regression described associations between film rating and occurrences/film, and estimated time-trends in occurrences/film, adjusted for rating.ResultsWe analysed 93 U-rated (unrestricted), 150 U/A-rated (parental guidance for children aged <12 years) and 55 A-rated (restricted to adult audience) films, containing 9,226 five-minute intervals (mean intervals/film 30.8, SD 4.0). 70% (n = 210), 93% (n = 278) and 21% (n = 62) of films contained at least one tobacco, alcohol and fast-food occurrence, respectively. Corresponding total mean occurrences/film were 4.0 (SD 4.9), 7.0 (4.7) and 0.4 (0.9). Tobacco occurrences were more common in U/A films (incidence rate ratio 1.49, 95% confidence interval 1.06–2.09) and A films (2.95; 1.95–4.48) than U-rated films. Alcohol occurrences were also more common in A-rated films than U-rated films (1.48; 1.15–1.85). Tobacco occurrences/film became less common over the observed period (adjusted trend -4% per annum; -2 to -7%; p <0.001), while alcohol (+2%; 0–3%; p = 0.02), and fast food (+8%; 2–14%; p = 0.01) occurrences/film became more common.ConclusionsAlthough the extent of tobacco imagery in Bollywood films fell over 1994–2013, it is still frequently observed.
Hopkinson NS, Rossi N, El-Sayed Moustafa J, et al., 2020, Current tobacco smoking and risk from COVID-19: results from a population symptom app in over 2.4 million people, Publisher: Cold Spring Harbor Laboratory
Background The association between current tobacco smoking, the risk of developing COVID-19 and the severity of illness is an important information gap.Methods UK users of the COVID Symptom Study app provided baseline data including demographics, anthropometrics, smoking status and medical conditions, were asked to log symptoms daily from 24th March 2020 to 23rd April 2020. Participants reporting that they did not feel physically normal were taken through a series of questions, including 14 potential COVID-19 symptoms and any hospital attendance. The main study outcome was the association between current smoking and the development of “classic” symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness. The number of concurrent COVID-19 symptoms was used as a proxy for severity. In addition, association of subcutaneous adipose tissue expression of ACE2, both the receptor for SARS-CoV-2 and a potential mediator of disease severity, with smoking status was assessed in a subset of 541 twins from the TwinsUK cohort.Results Data were available on 2,401,982 participants, mean(SD) age 43.6(15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834,437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to develop symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR[95%CI] 1.14[1.10 to 1.18]; >5 symptoms 1.29[1.26 to 1.31]; >10 symptoms 1.50[1.42 to 1.58]. Smoking was associated with reduced ACE2 expression in adipose tissue (Beta(SE)=-0.395(0.149); p=7.01×10-3).Interpretation These data are consistent with smokers having an increased risk from COVID-19.Funding Zoe provided in kind support for all aspects of building, running and supporting the app and service to all users worldwide. The study was also supported by grants from the Wellcome Trust, UK Research and Innovation and British Heart Foundation.
Patterson R, Panter J, Vamos EP, et al., 2020, Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study, Lancet Planetary Health, Vol: 4, Pages: E186-E194, ISSN: 2542-5196
BackgroundActive travel is increasingly recognised as an important source of physical activity. We aimed to describe associations between commute mode and cardiovascular disease, cancer, and all-cause mortality.MethodsWe analysed data from the Office for National Statistics Longitudinal Study of England and Wales (ONS-LS), which linked data from the Census of England and Wales (henceforth referred to as the Census) for 1991, 2001, and 2011 to mortality and cancer registrations. The cohort included individuals traced in the ONS-LS who were economically active (ie, aged ≥16 years, not retired from work, and not a full-time carer). Commuting by private motorised transport, public transport, walking, and cycling were compared in terms of all-cause mortality, cancer mortality, cardiovascular disease mortality, and cancer incidence, using Cox proportional-hazards models with time-varying covariates. Models were adjusted for age, sex, housing tenure, marital status, ethnicity, university education, car access, population density, socioeconomic classification, Carstairs index quintile, long-term illness, and year entered the study, and were additionally stratified by socioeconomic group.FindingsBetween the 1991 Census and the 2011 Census, 784 677 individuals contributed data for at least one Census, of whom 394 746 were included in the ONS-LS and were considered to be economically active working-age individuals. 13 983 people died, 3172 from cardiovascular disease and 6509 from cancer, and there were 20 980 incident cancer cases. In adjusted models, compared with commuting by private motorised vehicle, bicycle commuting was associated with a 20% reduced rate of all-cause mortality (hazard ratio [HR] 0·80, 95% CI 0·73–0·89), a 24% decreased rate of cardiovascular disease mortality (0·76, 0·61–0·93), a 16% lower rate of cancer mortality (0·84, 0·73–0·98), and an 11% reduced rate of incident ca
Laverty A, Hone T, Vamos EP, et al., 2020, Impact of banning smoking in cars with children on exposure to second-hand smoke: a natural experiment in England and Scotland, Thorax, Vol: 75, Pages: 345-347, ISSN: 0040-6376
England banned smoking in cars carrying children in 2015 and Scotland in 2016. With survey data from three years for both countries (NEngland=3,483-6,920,NScotland=232-319), we used this natural experiment to assess impacts of the English ban using logistic regression within a difference-in-differences framework. Among children aged 13-15 years, self-reported levels of regular exposure to smoke in cars were 3.4% in 2012, 2.2% in 2014 and 1.3% in 2016 for Scotland and 6.3%, 5.9% and 1.6% in England. The ban in England was associated with a -4.1% (95%CI -4.9%;-3.3%) absolute reduction (72% relative reduction) in exposure to tobacco smoke among children.
McKay A, Goodman A, van Sluijs E, et al., 2020, Cycle training and factors associated with cycling among adolescents in England, Journal of Transport & Health, Vol: 16, Pages: 1-7, ISSN: 2214-1405
BackgroundCycling has the potential to encourage physical activity as well as advancing societal goals such as reducing carbon emissions; encouraging cycling is therefore a policy goal in many contexts. We analysed individual level data from the whole of England on factors associated with cycling among adolescents, including cycle training delivered by the age of 11 years in primary schools.MethodsData came from the nationally representative Millennium Cohort Study collected when participants were aged 13–15 years (adolescents). We assessed frequency of cycling at least once per week (regular cycling) and used logistic regression to assess how this differed across characteristics including demographic, health and environmental factors, as well as receiving cycle training (‘Bikeability’) in primary school.ResultsWe found that 21.0% of adolescents cycled at least once per week. In fully adjusted analyses, this was more common among boys than girls (32.5% vs. 9.4%, p < 0.001), and those in rural areas than urban areas (24.9% vs. 20.3%, p < 0.001). Adolescents in areas with higher prevalence of adult cycle commuting were more likely to cycle regularly (26.1% in high cycling areas vs. 19.3% in low cycling areas, p < 0.001). Participants offered cycle training in primary school were not more likely to cycle regularly as adolescents (21.7% vs. 22.3%, p = 0.528).DiscussionApproximately one in five adolescents in England cycles regularly, although being offered cycle training in primary school was not linked to greater cycling. Many of the factors associated with adolescent cycling are similar to those for adults and adolescents are more likely to cycle in areas with higher levels of adult cycling.
Filippidis F, Chang KCM, Blackmore I, et al., 2019, Prices and Illicit Trade of Cigarettes in the European Union, a Cross-sectional Analysis, Nicotine and Tobacco Research, ISSN: 1462-2203
Seferidi P, Laverty AA, Pearson-Stuttard J, et al., 2019, Impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Laverty A, Kypridemos C, Seferidi P, et al., 2019, IMPACT OF THE PUBLIC HEALTH RESPONSIBILITY DEAL ON SALT INTAKE, CARDIOVASCULAR DISEASE AND GASTRIC CANCER: INTERRUPTED TIME SERIES AND MICROSIMULATION STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A5-A5, ISSN: 0143-005X
Laverty AA, Vamos E, Millett C, et al., 2019, Child awareness of and access to cigarettes – impacts of the point of sale display ban in England, Tobacco Control, Vol: 28, Pages: 526-531, ISSN: 0964-4563
Introduction England introduced a tobacco display ban for shops with >280 m2 floor area (‘partial ban’) in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes.Methods Data come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11–15 years for 2010–2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shopsResults During the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did.Discussion Tobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.
Laverty AA, Kypridemos C, Seferidi P, et al., 2019, Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study, Journal of Epidemiology and Community Health, Vol: 73, Pages: 881-887, ISSN: 0143-005X
Background In 2011, England introduced the PublicHealth Responsibility Deal (RD), a public-privatepartnership (PPP) which gave greater freedom to thefood industry to set and monitor targets for salt intakes.We estimated the impact of the RD on trends in saltintake and associated changes in cardiovascular disease(CVD) and gastric cancer (GCa) incidence, mortality andeconomic costs in England from 2011–2025.Methods We used interrupted time series modelswith 24 hours’ urine sample data and the IMPACTNCDmicrosimulation model to estimate impacts of changes insalt consumption on CVD and GCa incidence, mortalityand economic impacts, as well as equity impacts.Results Between 2003 and 2010 mean salt intake wasfalling annually by 0.20 grams/day among men and 0.12g/d among women (P-value for trend both < 0.001).After RD implementation in 2011, annual declines insalt intake slowed statistically significantly to 0.11 g/damong men and 0.07 g/d among women (P-values fordifferences in trend both P < 0.001). We estimated thatthe RD has been responsible for approximately 9900(interquartile quartile range (IQR): 6700 to 13,000)additional cases of CVD and 1500 (IQR: 510 to 2300)additional cases of GCa between 2011 and 2018. Ifthe RD continues unchanged between 2019 and 2025,approximately 26 000 (IQR: 20 000 to 31,000) additionalcases of CVD and 3800 (IQR: 2200 to 5300) cases ofGCa may occur.Interpretation Public-private partnerships such as theRD which lack robust and independent target setting,monitoring and enforcement are unlikely to produceoptimal health gains.
Patterson RA, Webb E, Millett C, et al., 2019, Physical activity accrued as part of public transport use in England, Journal of Public Health, Vol: 41, Pages: 222-230, ISSN: 1741-3842
Background:Walking and cycling for transport (active travel) is an important source of physical activity with established health benefits. However, levels of physical activity accrued during public transport journeys in England are unknown.Methods:Using the English National Travel Survey 2010–14 we quantified active travel as part of public transport journeys. Linear regression models compared levels of physical activity across public transport modes, and logistic regression models compared the odds of undertaking 30 min a day of physical activity.Results:Public transport users accumulated 20.5 min (95% confidence interval=19.8, 21.2) a day of physical activity as part of public transport journeys. Train users accumulated 28.1 min (26.3, 30.0) with bus users 16.0 min (15.3, 16.8). Overall, 34% (32%, 36%) of public transport users achieved 30 min a day of physical activity in the course of their journeys; 21% (19%, 24%) of bus users and 52% (47%, 56%) of train users.Conclusion:Public transport use is an effective way to incorporate physical activity into daily life. One in three public transport users meet physical activity guidelines suggesting that shifts from sedentary travel modes to public transport could dramatically raise the proportion of populations achieving recommended levels of physical activity.
Laverty AA, Filippidis FT, Taylor-Robinson D, et al., 2019, Smoking uptake in UK children: Analysis of the UK Millennium Cohort Study., Thorax, Vol: 74, Pages: 607-610, ISSN: 0040-6376
We used data from 11 577 children in the UK Millennium Cohort Study, collected at approximately 14 years of age (early teens), to assess characteristics associated with smoking, and generated regional estimates of numbers of smokers. 13.8% of UK early teens studied had ever smoked; 1.9% were current smokers. This corresponds to 2 28 136 and 39 653 (13-14 year olds) in the UK, respectively. Ever smoking risk increased if caregivers (26.0% vs 10.9%) or friends smoked (35.1% vs 4.0%), with a dose-response effect for friends' smoking. Caregiver and peer-group smoking remain important drivers of child smoking uptake and thus important targets for intervention.
Hone T, Szklo AS, Filippidis F, et al., 2019, Smoke-free legislation and neonatal and infant mortality in Brazil: a longitudinal quasi-experimental study, Tobacco Control, Vol: 29, Pages: 312-319, ISSN: 0964-4563
Objective To examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design.Design Monthly longitudinal (panel) ecological study from January 2000 to December 2016.Setting All Brazilian municipalities (n=5565).Participants Infant populations.Intervention Smoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes.Statistical analyses Municipal-level linear fixed-effects regression models.Main outcomes measures Infant and neonatal mortality.Results Implementation of partial smoke-free legislation was associated with a −3.3 % (95% CI −6.2% to −0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with −5.2 % (95% CI −8.3% to −2.1%) and −3.4 % (95% CI −6.7% to −0.1%) step reductions in infant and neonatal mortality, respectively, and a −0.36 (95% CI −0.66 to−0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted.Conclusions Strengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes—particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation’s Sustainable Development Goal three.
Patterson R, Webb E, Hone T, et al., 2019, Associations of public transportation use with cardiometabolic health: a systematic review and meta-analysis, American Journal of Epidemiology, Vol: 188, Pages: 785-795, ISSN: 1476-6256
Public transport provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. Literature searches were carried out up to December 2017 using Medline, Embase, Transport Database, Scopus, Cochrane Library, opengrey.eu and Google. We identified longitudinal studies which examined associations between public transport and cardio-metabolic health including: adiposity, type II diabetes, and cardiovascular disease. We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, seven investigating use of public transport and three examining proximity to public transport. Seven studies used individual level data on changes in BMI with objective outcomes measured in six studies. Study follow-up ranged from one to ten years with three studies adjusting for non-transport physical activity. We found a consistent association between public transport use and lower BMI. Meta-analysis of data from five comparable studies found that switching from car to public transport was associated with lower BMI: −0.30 kg/m2 (−0.47, −0.14). Few studies have investigated associations between public transport use and non-adiposity outcomes. These findings suggest that sustainable urban design which promotes public transport use may produce modest reductions in population BMI.
Seferidi P, Laverty A, Pearson-Stuttard J, et al., 2019, Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives To estimate the potential impacts of different Brexit trade policy scenarios on the price and intake of fruits and vegetables (F&V) and consequent cardiovascular disease (CVD) deaths in England between 2021 and 2030.Design Economic and epidemiological modelling study with probabilistic sensitivity analysis.Setting The model combined publicly available data on F&V trade, published estimates of UK-specific price elasticities, national survey data on F&V intake, estimates on the relationship between F&V intake and CVD from published meta-analyses and CVD mortality projections for 2021–2030.Participants English adults aged 25 years and older.Interventions We modelled four potential post-Brexit trade scenarios: (1) free trading agreement with the EU and maintaining half of non-EU free trade partners; (2) free trading agreement with the EU but no trade deal with any non-EU countries; (3) no-deal Brexit; and (4) liberalised trade regime that eliminates all import tariffs.Outcome measures Cumulative coronary heart disease and stroke deaths attributed to the different Brexit scenarios modelled between 2021 and 2030.Results Under all Brexit scenarios modelled, prices of F&V would increase, especially for those highly dependent on imports. This would decrease intake of F&V between 2.5% (95% uncertainty interval: 1.9% to 3.1%) and 11.4% (9.5% to 14.2%) under the different scenarios. Our model suggests that a no-deal Brexit scenario would be the most harmful, generating approximately 12 400 (6690 to 23 390) extra CVD deaths between 2021 and 2030, whereas establishing a free trading agreement with the EU would have a lower impact on mortality, contributing approximately 5740 (2860 to 11 910) extra CVD deaths.Conclusions Trade policy under all modelled Brexit scenarios could increase price and decrease intake of F&V, generating substantial additional CVD mortality in England. The UK government should consider the population healt
Filippidis FT, Laverty AA, Mons U, et al., 2018, Changes in smoking cessation assistance in the European Union between 2012 and 2017: pharmacotherapy versus counselling versus e-cigarettes, Tobacco Control, Vol: 28, Pages: 95-100, ISSN: 0964-4563
BACKGROUND: The landscape of smoking cessation may have changed in Europe recently. OBJECTIVES: To identify changes in use of smoking cessation assistance in the European Union (EU) and factors associated with use of cessation assistance. METHODS: Data from the 2012 (n=9921) and 2017 (n=9489) waves of the Eurobarometer survey were used. Self-reported use of smoking cessation assistance was assessed among smokers who had ever tried to quit and former smokers. Changes in use of each type of assistance were assessed using logistic regression. RESULTS: Among current and former smokers, those who had ever attempted to quit without assistance increased from 70.3% (2012) to 74.8% (2017). Current smokers were more likely to have used any assistance compared with former smokers (P<0.001). Use of e-cigarettes for smoking cessation assistance increased (3.7% to 9.7%)%), while use of pharmacotherapy (14.6% to 11.1%)%) and smoking cessation services (7.5% to 5.0%)%) declined. Younger people were more likely to have reported e-cigarette use for smoking cessation but less likely to have used a cessation service. Individuals living in countries with comprehensive smoking cessation policies were more likely to have used any cessation assistance (adjusted OR (aOR)=1.78; 95% CI 1.15 to 2.76), pharmacotherapy (aOR=3.44; 95% CI 1.78 to 6.66) and smoking cessation services (aOR=2.27; 95% CI 1.27 to 4.06) compared with those living in countries with weak smoking cessation policies. CONCLUSIONS: These findings highlight the need for approaches that ensure that smokers get support to quit smoking across the EU. The question of whether the availability of e-cigarettes will displace other methods, and the impact of such a displacement, should be closely evaluated.
Seferidi P, Laverty AA, Pearson-Stuttard J, et al., 2018, Implications of Brexit on the effectiveness of the UK soft drinks industry levy upon coronary heart disease in England: a modelling study, Public Health Nutrition, Vol: 21, Pages: 3431-3439, ISSN: 1368-9800
Objective:An industry levy on sugar-sweetened beverages (SSB) was implemented in the UK in 2018. One year later, Brexit is likely to change the UK trade regime with potential implications for sugar price. We modelled the effect of potential changes in sugar price due to Brexit on SSB levy impacts upon CHD mortality and inequalities.Design:We modelled a baseline SSB levy scenario; an SSB levy under ‘soft’ Brexit, where the UK establishes a free trading agreement with the EU; and an SSB levy under ‘hard’ Brexit, in which World Trade Organization tariffs are applied. We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to estimate the effect of each scenario on CHD deaths prevented or postponed and life-years gained, stratified by age, sex and socio-economic circumstance, in 2021.Setting:England.Subjects:Adults aged 25 years or older.Results:The SSB levy was associated with approximately 370 (95 % uncertainty interval 220, 560) fewer CHD deaths and 4490 (2690, 6710) life-years gained in 2021. Associated reductions in CHD mortality were 4 and 8 % greater under ‘soft’ and ‘hard’ Brexit scenarios, respectively. The SSB levy was associated with approximately 110 (50, 190) fewer CHD deaths in the most deprived quintile compared with 60 (20, 100) in the most affluent, under ‘hard’ Brexit.Conclusions:Our study found the SSB levy resilient to potential effects of Brexit upon sugar price. Even under ‘hard’ Brexit, the SSB levy would yield benefits for CHD mortality and inequalities. Brexit negotiations should deliver a fiscal and regulatory environment which promotes population health.
Patterson R, Webb E, Mindell JS, et al., 2018, Ethnic group differences in impacts of free bus passes in England: A national study, Journal of Transport and Health, Vol: 11, Pages: 1-14, ISSN: 2214-1405
BackgroundA pass permitting free bus travel for older people (aged ≥60 years) in England was introduced in 2006. There has been no examination of whether this scheme has differential effects across ethnic groups. We examined whether Black and South Asian participants were more likely to hold a bus pass and have higher associated levels of active travel than White participants.MethodsData come from the National Travel Survey, a nationally representative sample of the travel patterns of households in England. Using cross-sectional data from 33,344 participants eligible for a bus pass 2006–2014, we investigated ethnic differences in bus pass uptake and associations with bus use, active travel and walking ≥3 times per week.ResultsBlack participants were more likely to hold a bus pass (84%) than South Asian or White participants (74% and 75% respectively). Black participants accumulated 56% of their active travel as part of bus journeys, compared with 29% in White and 44% in South Asian participants. Bus pass possession was associated with increased odds of bus-related active travel in all ethnic groups.ConclusionsThese findings suggest that the free bus pass scheme in England is associated with higher levels of active travel and that these may be greater among minority ethnic groups. Removing financial barriers to active travel could produce important health benefits particularly among ethnic minority groups, who have low levels of leisure-based physical activity.
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