Publications by authors named "Louise Foley"

50 Publications

Foodwork in the United Kingdom from 1983 to 2014: A compositional data analysis of repeat cross-sectional time use surveys.

Appetite 2021 Sep 11;168:105694. Epub 2021 Sep 11.

Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. Electronic address:

Background: While foodwork (tasks required to access food, including home food preparation) in the UK declined toward the end of the 20th century, it is not known whether this trend has continued into the 21st century. While evidence suggests many people feel they lack the time to cook, it is not known whether this is attributable to increasing demands on their time.

Methods: Analysis of repeat cross-sectional data from three UK time use surveys: 1983, 2000 and 2014; participants aged 19+ (N = 14,810). We analysed changes in foodwork participation across survey years using linear regression, adding interaction terms to determine whether trends varied between different socio-demographic groups. We categorized time use over 24 h into eight parts, forming a composition: (1) personal care; (2) sleep; (3) eating; (4) physical activity; (5) leisure screen time; (6) work (paid and unpaid); (7) socialising and hobbies; and (8) foodwork. We examined whether the time-use composition varied across survey years, testing for interactions with socio-demographic characteristics.

Results: Foodwork declined significantly between 1983 and 2014. However, a concurrent increase in time spent on work was not observed. Instead, time spent on sleep and screen time increased significantly. The decline in foodwork was significant among women but not among men.

Conclusion: While many people in the UK continue to allocate time to foodwork on a daily basis, foodwork has continued to decline into the 21st century, though there was no concurrent increase in time being allocated to work, suggesting external and non-discretionary demands on time have not increased. Practitioners seeking to address a lack of time as a barrier to foodwork may wish to accommodate a broad definition of what this could mean.
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http://dx.doi.org/10.1016/j.appet.2021.105694DOI Listing
September 2021

Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis.

BMJ Open 2021 09 2;11(9):e044987. Epub 2021 Sep 2.

School of Psychology, National University of Ireland Galway, Galway, Ireland.

Objectives: This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised.

Results: The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, =8, =97%, <0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs.

Conclusions: The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management.

Prospero Registration Number: CRD42019133849.
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http://dx.doi.org/10.1136/bmjopen-2020-044987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413882PMC
September 2021

Sharing believable stories: A qualitative study exploring the relevance of case studies for influencing the creation of healthy environments.

Health Place 2021 Jul 25;71:102615. Epub 2021 Jul 25.

European Centre for Environment and Human Health, University of Exeter Medical School, Truro, TR1 3HD, UK.

Case study examples can inform policy recommendations and action to create healthy environments. This qualitative study, using semi-structured interviews with nine cross-sectoral stakeholders in England, explored the role of context in case study examples. We found that case studies can not only be a 'practical example' but also used as a 'believable story' with the power to influence decision-making. Case studies may be deemed believable if similar and locally relevant, but judgements can be inherently political and politicised. Metrics used to measure case study outcomes can differ in believability. Storytellers who understand different audiences can be used to build support.
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http://dx.doi.org/10.1016/j.healthplace.2021.102615DOI Listing
July 2021

A protocol for the evaluation of the process and impact of embedding formal and experiential Public and Patient Involvement training in a structured PhD programme.

J Comorb 2021 Jan-Dec;11:26335565211024793. Epub 2021 Jun 28.

PPI Ignite Network, National University of Ireland Galway, Galway, Ireland.

Background: Incorporating Public and Patient Involvement (PPI) into doctoral research is valued by PhD scholars. The importance of providing early career researchers with appropriate education and training to develop skills to conduct meaningful involvement has been articulated. The Collaborative Doctoral Award in MultiMorbidity (CDA-MM) PhD programme embedded formal PPI training as a postgraduate education component. Four PhD scholars taking part in the CDA-MM established a PPI panel comprising people, and carers of people, living with multimorbidity (≥2 chronic conditions), presenting an opportuning for experiential PPI training. The proposed study aims to evaluate the process and impact of formal and experiential PPI training during a PhD programme.

Design: Embedding PPI training in a PhD programme is a novel approach. This evaluation will include a process evaluation to provide an understanding of the workings of the PPI panel and explore the experiences of key stakeholders involved, and an impact evaluation to assess the impact of embedding PPI training in a PhD programme. This study is a longitudinal mixed-methods evaluation, conducted over 24 months. Participants include PhD scholars, PPI contributors and PhD supervisors. An independent researcher not aligned with the CDA-MM will lead the evaluation. Data collection methods include focus groups, individual interviews, an impact log and group reflections. Qualitative data will be analysed using thematic and content analysis and quantitative data will be analysed using descriptive statistics.

Discussion: This evaluation will report the learnings from embedding formal and experiential PPI training and education across a PhD programme.
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http://dx.doi.org/10.1177/26335565211024793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243087PMC
June 2021

Evidence for factors associated with diet and physical activity in African and Caribbean countries.

Bull World Health Organ 2021 Jun 1;99(6):464-472I. Epub 2021 Apr 1.

MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, England.

Objective: To identify and describe summarized evidence on factors associated with diet and physical activity in low- and middle-income countries in Africa and the Caribbean by performing a scoping review of reviews.

Methods: We searched the Medline®, LILACS, Scopus, Global Health and Web of Science databases for reviews of factors associated with diet or physical activity published between 1998 and 2019. At least 25% of studies in reviews had to come from African or Caribbean countries. Factors were categorized using Dahlgren and Whitehead's social model of health. There was no quality appraisal.

Findings: We identified 25 reviews: 13 on diet, four on physical activity and eight on both. Eighteen articles were quantitative systematic reviews. In 12 reviews, 25-50% of studies were from Africa or the Caribbean. Only three included evidence from the Caribbean. Together, the 25 reviews included primary evidence published between 1926 and 2018. Little of the summarized evidence concerned associations between international health or political factors and diet or associations between any factor and physical activity across all categories of the social model of health.

Conclusion: The scoping review found a wide range of factors reported to be associated with diet and physical activity in Africa and the Caribbean, but summarized evidence that could help inform policies encouraging behaviours linked to healthy diets and physical activity in these regions were lacking. Further reviews are needed to inform policy where the evidence exists, and to establish whether additional primary research is needed.
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http://dx.doi.org/10.2471/BLT.20.269308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164182PMC
June 2021

Age-related change in sedentary behavior during childhood and adolescence: A systematic review and meta-analysis.

Obes Rev 2021 Sep 3;22(9):e13263. Epub 2021 Jun 3.

School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.

Sedentary behaviors are highly prevalent in youth and may be associated with markers of physical and mental health. This systematic review and meta-analysis aimed to quantify the age-related change in sedentary behavior during childhood and adolescence. Ten electronic databases were searched. Inclusion criteria specified longitudinal observational studies or control group from an intervention; participants aged ≥5 and ≤18 years; a quantitative estimate of the duration of SB; and English language, peer-reviewed publication. Meta-analyses summarized weighted mean differences (WMD) in device-assessed sedentary time and questionnaire-assessed screen-behaviors over 1-, 2-, 3-, or more than 4-year follow-up. Effect modification was explored using meta-regression. Eighty-five studies met inclusion criteria. Device-assessed sedentary time increased by (WMD 95% confidence interval [CI]) 27.9 (23.2, 32.7), 61.0 (50.7, 71.4), 63.7 (53.3, 74.0), and 140.7 (105.1, 176.4) min/day over 1-, 2-, 3-, and more than 4-year follow-up. We observed no effect modification by gender, baseline age, study location, attrition, or quality. Questionnaire-assessed time spent playing video games, computer use, and a composite measure of sedentary behavior increased over follow-up duration. Evidence is consistent in showing an age-related increase in various forms of sedentary behavior; evidence pertaining to variability across socio-demographic subgroups and contemporary sedentary behaviors are avenues for future research.
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http://dx.doi.org/10.1111/obr.13263DOI Listing
September 2021

Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study.

Glob Health Action 2021 01;14(1):1898130

SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa.

: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment.: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge.: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted.: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs.: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.
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http://dx.doi.org/10.1080/16549716.2021.1898130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288764PMC
January 2021

Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol.

HRB Open Res 2019 17;2:29. Epub 2021 Mar 17.

School of Psychology, National University of Ireland, Galway, Galway, Ireland.

Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009-2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions.  The systematic review is prospectively registered in PROSPERO ( CRD42019133849); registered on 12 June 2019.
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http://dx.doi.org/10.12688/hrbopenres.12961.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140769.2PMC
March 2021

Impacts of a New Supermarket on Dietary Behavior and the Local Foodscape in Kisumu, Kenya: Protocol for a Mixed Methods, Natural Experimental Study.

JMIR Res Protoc 2020 Dec 21;9(12):e17814. Epub 2020 Dec 21.

Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.

Background: Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation.

Objective: The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status.

Methods: We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no hypermarket (ie, Homabay). The study is comprised of 4 pieces of primary data collection: a quantitative household survey with local residents, a qualitative study consisting of focus group discussions with local residents and semistructured interviews with government and private sector stakeholders, an audit of the local foodscape using on-the-ground data collection, and an intercept survey of shoppers in the hypermarket. Assessments will be undertaken at baseline and approximately 1 year after the hypermarket opens.

Results: Baseline assessments were conducted from March 2019 to June 2019. From a total sampling frame of 400 households, we recruited 376 of these households, giving an overall response rate of 94.0%. The household survey was completed by 516 individuals within these households. Across the two study areas, 8 focus groups and 44 stakeholder interviews were conducted, and 1920 food outlets were geocoded.

Conclusions: This study aims to further the understanding of the relationship between food retail and dietary behaviors in Kenya. Baseline assessments for the study have been completed.

International Registered Report Identifier (irrid): DERR1-10.2196/17814.
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http://dx.doi.org/10.2196/17814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781801PMC
December 2020

Making sense of the evidence in population health intervention research: building a dry stone wall.

BMJ Glob Health 2020 12;5(12)

MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.

To effectively tackle population health challenges, we must address the fundamental determinants of behaviour and health. Among other things, this will entail devoting more attention to the evaluation of upstream intervention strategies. However, merely increasing the supply of such studies is not enough. The pivotal link between research and policy or practice should be the cumulation of insight from multiple studies. If conventional evidence synthesis can be thought of as analogous to building a wall, then we can increase the supply of bricks (the number of studies), their similarity (statistical commensurability) or the strength of the mortar (the statistical methods for holding them together). However, many contemporary public health challenges seem akin to herding sheep in mountainous terrain, where ordinary walls are of limited use and a more flexible way of combining dissimilar stones (pieces of evidence) may be required. This would entail shifting towards generalising the functions of interventions, rather than their effects; towards inference to the best explanation, rather than relying on binary hypothesis-testing; and towards embracing divergent findings, to be resolved by testing theories across a cumulated body of work. In this way we might channel a spirit of pragmatic pluralism into making sense of complex sets of evidence, robust enough to support more plausible causal inference to guide action, while accepting and adapting to the reality of the public health landscape rather than wishing it were otherwise. The traditional art of dry stone walling can serve as a metaphor for the more 'holistic sense-making' we propose.
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http://dx.doi.org/10.1136/bmjgh-2020-004017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733100PMC
December 2020

The experience of financial burden for people with multimorbidity: A systematic review of qualitative research.

Health Expect 2021 Apr 2;24(2):282-295. Epub 2020 Dec 2.

HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland.

Background: Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden.

Objective: To synthesize qualitative research exploring experience of financial burden for people with multimorbidity.

Search Strategy: Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted.

Inclusion Criteria: Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community-dwelling adult participant with two or more chronic conditions.

Data Extraction And Synthesis: Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE-CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis.

Main Results: Forty-six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well-being. Health insurance and government supports determine the manageability and level of costs experienced.

Discussion: Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue.

Patient Or Public Contribution: Results were presented to a panel of people with multimorbidity to check whether the language and themes 'resonated' with their experiences.
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http://dx.doi.org/10.1111/hex.13166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077119PMC
April 2021

Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean.

Nutrients 2020 Oct 30;12(11). Epub 2020 Oct 30.

European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK.

Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (β = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.
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http://dx.doi.org/10.3390/nu12113350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692177PMC
October 2020

The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts.

Global Health 2020 10 19;16(1):100. Epub 2020 Oct 19.

MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK.

Background: Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs.

Partnership: The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders.

Conclusion: We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.
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http://dx.doi.org/10.1186/s12992-020-00630-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570103PMC
October 2020

Implications of COVID-19 control measures for diet and physical activity, and lessons for addressing other pandemics facing rapidly urbanising countries.

Glob Health Action 2020 12;13(1):1810415

MRC Epidemiology Unit, University of Cambridge , Cambridge, UK.

At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have been shown to have some effects in slowing down the progress of the pandemic, effectively buying time to prepare the healthcare system. However, there has been less of a focus on the indirect impacts of these measures on health behaviours and the consequent health risks, particularly in the most vulnerable. In this current debate piece, focusing on two of the four risk factors that contribute to >80% of the NCD burden, we consider the possible ways that the restrictions put in place to control the pandemic, have the potential to impact on dietary and physical activity behaviours and their determinants. By considering mitigation responses implemented by governments in several LMIC cities, we identify key lessons that highlight the potential of economic, political, food and built environment sectors, mobilised during the pandemic, to retain health as a priority beyond the context of pandemic response. Such whole-of society approaches are feasible and necessary to support equitable healthy eating and active living required to address other epidemics and to lower the baseline need for healthcare in the long term.
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http://dx.doi.org/10.1080/16549716.2020.1810415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480567PMC
December 2020

How Does Time Use Differ between Individuals Who Do More versus Less Foodwork? A Compositional Data Analysis of Time Use in the United Kingdom Time Use Survey 2014-2015.

Nutrients 2020 Jul 30;12(8). Epub 2020 Jul 30.

MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR), Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK.

Background: Increased time spent on home food preparation is associated with higher diet quality, but a lack of time is often reported as a barrier to this practice. We compared time use in individuals who do more versus less foodwork (tasks required to feed ourselves and our households, including home food preparation).

Methods: Cross-sectional analysis of the UK Time Use Survey 2014-15, participants aged 16+ ( = 6143). Time use over 24 h was attributed to seven compositional parts: personal care; sleep; eating; physical activity; leisure screen time; work (paid and unpaid); and socialising and hobbies. Participants were categorised as doing no, 'some' (<70 min), or 'more' foodwork (≥70 min). We used compositional data analysis to test whether time-use composition varied between these participant groups, determine which of the parts varied between groups, and test for differences across population subgroups.

Results: Participants who spent more time on foodwork spent less time on sleep, eating, and personal care and more time on work. Women who did more foodwork spent less time on personal care, socialising, and hobbies, which was not the case for men.

Conclusion: Those who seek to encourage home food preparation should be aware of the associations between foodwork and other activities and design their interventions to guard against unintended consequences.
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http://dx.doi.org/10.3390/nu12082280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469020PMC
July 2020

The experience of financial burden for patients with multimorbidity: A protocol for a systematic review of qualitative research.

HRB Open Res 2019 26;2:16. Epub 2020 Mar 26.

HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland.

Multimorbidity is increasingly important due to its high disease burden, prevalence and related high healthcare utilisation. For patients, there is also a high financial burden due to direct and indirect costs arising from their multimorbidity. It is unclear how this financial burden affects patients. This study aims to synthesise qualitative evidence exploring the experience of financial burden from the perspective of patients with multimorbidity. The review will be reported using the ENTREQ guidelines. A systematic search of Lilacs, PubMed, CINAHL, EMBASE, PsycINFO, and Applied Social Sciences Index and Abstracts will be conducted using a predefined search strategy. A search of fourteen pre-specified websites will be conducted for grey literature. Forward and backward citation checking of included studies will be conducted also. Studies will be included if they contain primary qualitative research and reference the experience of financial burden from the perspective of adult (≥ 18 years) community dwelling patients with multimorbidity. Studies from any country and in any language will be included. Titles and abstracts of search results will be screened; if a study appears relevant, then full-texts will be screened for eligibility. Study characteristics of included articles will be extracted. Study quality will be evaluated using the critical appraisal skills programme (CASP) checklist for qualitative research. These three processes will be carried out by two reviewers independently. Thematic-synthesis will be used to analyse data. This will be carried out by one reviewer and cross-checked by a second reviewer. The GRADE CERQual approach will be used to assess the overall confidence in the evidence. This review will identify evidence on the experiences of financial burden for patients with multimorbidity and forms part of a project to support consideration of financial burden for patients in the development of clinical guidelines in Ireland.  CRD42019135284.
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http://dx.doi.org/10.12688/hrbopenres.12915.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309055PMC
March 2020

Local walking and cycling by residents living near urban motorways: cross-sectional analysis.

BMC Public Health 2019 Nov 1;19(1):1434. Epub 2019 Nov 1.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.

Background: Everyday activities, such as walking or cycling, may be a feasible and practical way to integrate physical activity into everyday life. Walking and cycling for transport or recreation in the area local to a person's home may have additional benefits. However, urban planning tends to prioritise car use over active modes. We explored the cross-sectional association between living near an urban motorway and local walking and cycling.

Methods: In 2013, residents living in an area (a) near a new urban motorway (M74), (b) near a longstanding urban motorway (M8), or (c) without a motorway, in Glasgow, Scotland, were invited to complete postal surveys assessing local walking and cycling journeys and socio-demographic characteristics. Using adjusted regression models, we assessed the association between motorway proximity and self-reported local walking and cycling, as well as the count of types of destination accessed. We stratified our analyses according to study area.

Results: One thousand three hundred forty-three residents (57% female; mean age: 54 years; SD: 16 years) returned questionnaires. There was no overall association between living near an urban motorway and the likelihood of local walking or cycling, or the number of types of local destination accessed by foot or bicycle. In stratified analyses, for those living in the area around the new M74 motorway, increasing residential proximity to the motorway was associated with lower likelihood of local recreational walking and cycling (OR 0.63, 95% CI: 0.39 to 1.00) a pattern not found in the area with the longstanding M8 motorway. In the area near the M8 motorway residential proximity was statistically significantly (p = 0.014) associated with a 12% decrease in the number of types of destination accessed, a pattern not found in the M74 study area.

Conclusions: Our findings suggest that associations between living near a motorway and local walking and cycling behaviour may vary by the characteristics of the motorway, and by whether the behaviour is for travel or recreation. The lack of associations seen in the study area with no motorway suggests a threshold effect whereby beyond a certain distance from a motorway, additional distance makes no difference.
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http://dx.doi.org/10.1186/s12889-019-7621-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824089PMC
November 2019

Cross-sectional and longitudinal associations between active commuting and patterns of movement behaviour during discretionary time: A compositional data analysis.

PLoS One 2019 16;14(8):e0216650. Epub 2019 Aug 16.

School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

Background: Active living approaches seek to promote physical activity and reduce sedentary time across different domains, including through active travel. However, there is little information on how movement behaviours in different domains relate to each other. We used compositional data analysis to explore associations between active commuting and patterns of movement behaviour during discretionary time.

Methods And Findings: We analysed cross-sectional and longitudinal data from the UK Biobank study. At baseline (2006-2010) and follow up (2009-2013) participants reported their mode of travel to work, dichotomised as active (walking, cycling or public transport) or inactive (car). Participants also reported activities performed during discretionary time, categorised as (i) screen time; (ii) walking for pleasure; and (iii) sport and do-it-yourself (DIY) activities, summed to produce a total. We applied compositional data analysis to test for associations between active commuting and the composition and total amount of discretionary time, using linear regression models adjusted for covariates. Adverse events were not investigated in this observational analysis. The survey response rate was 5.5%. In the cross-sectional analysis (n = 182,406; mean age = 52 years; 51% female), active commuters engaged in relatively less screen time than those who used inactive modes (coefficient -0.12, 95% confidence interval [CI] -0.13 to -0.11), equating to approximately 60 minutes less screen time per week. Similarly, in the longitudinal analysis (n = 4,323; mean age = 51 years; 49% female) there were relative reductions in screen time in those who used active modes at both time points compared with those who used inactive modes at both time points (coefficient -0.15, 95% confidence interval [CI] -0.24 to -0.06), equating to a difference between these commute groups of approximately 30 minutes per week at follow up. However, as exposures and outcomes were measured concurrently, reverse causation is possible.

Conclusions: Active commuting was associated with a more favourable pattern of movement behaviour during discretionary time. Active commuters accumulated 30-60 minutes less screen time per week than those using inactive modes. Though modest, this could have a cumulative effect on health over time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216650PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697339PMC
March 2020

Activity spaces in studies of the environment and physical activity: A review and synthesis of implications for causality.

Health Place 2019 07 8;58:102113. Epub 2019 Aug 8.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK. Electronic address:

Activity spaces are increasingly used to understand how people interact with their environment and engage in activity but their use may raise challenges regarding causal inference. We conducted a systematic review of findings and the methodological, analytical and conceptual issues relevant to causal inference. Studies were included if they comprised a spatial summary of locations visited, assessed any part of the causal pathway between the environment, physical activity and health, and used quantitative or qualitative methods. We searched seven electronic databases in January 2018 and screened 11910 articles for eligibility. Forty-seven studies were included for review. Studies answered research questions about features of or environmental features within activity spaces using a range of spatial and temporal summary techniques. The conceptual challenge of using activity spaces to strengthen causal inference was rarely considered, although some studies discussed circularity, temporality, and plausibility. Future studies should use longitudinal and experimental designs and consider the potential and actual use of spaces for physical activity, and their relationship with total levels of activity.
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http://dx.doi.org/10.1016/j.healthplace.2019.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737923PMC
July 2019

Longitudinal association between change in the neighbourhood built environment and the wellbeing of local residents in deprived areas: an observational study.

BMC Public Health 2018 04 24;18(1):545. Epub 2018 Apr 24.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.

Background: Features of the urban neighbourhood influence the physical, social and mental wellbeing of residents and communities. We explored the longitudinal association between change to the neighbourhood built environment and the wellbeing of local residents in deprived areas of Glasgow, Scotland.

Methods: A cohort of residents (n = 365; mean age 50 years; 44% male; 4.1% of the 9000 mailed surveys at baseline) responded to a postal survey in 2005 and 2013. Wellbeing was assessed with the mental (MCS-8) and physical (PCS-8) components of the SF-8 scale. We developed software to aid identification of visible changes in satellite imagery occurring over time. We then used a Geographical Information System to calculate the percentage change in the built environment occurring within an 800 m buffer of each participant's home.

Results: The median change in the neighbourhood built environment was 3% (interquartile range 6%). In the whole sample, physical wellbeing declined by 1.5 units on average, and mental wellbeing increased by 0.9 units, over time. In multivariable linear regression analyses, participants living in neighbourhoods with a greater amount of change in the built environment (unit change = 1%) experienced significantly reduced physical (PCS-8: -0.13, 95% CI -0.26 to 0.00) and mental (MCS-8: -0.16, 95% CI -0.31 to - 0.02) wellbeing over time compared to those living in neighbourhoods with less change. For mental wellbeing, a significant interaction by baseline perception of financial strain indicated a larger reduction in those experiencing greater financial strain (MCS-8: -0.22, 95% CI -0.39 to - 0.06). However, this relationship was reversed in those experiencing lower financial strain, whereby living in neighbourhoods with a greater amount of change was associated with significantly improved mental wellbeing over time (MCS-8: 0.38, 95% CI 0.04 to 0.72).

Conclusions: Overall, we found some evidence that living in neighbourhoods experiencing higher levels of physical change worsened wellbeing in local residents. However, we found a stronger negative relationship in those with lower financial security and a positive relationship in those with higher financial security. This is one of few studies exploring the longitudinal relationship between the environment and health.
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http://dx.doi.org/10.1186/s12889-018-5459-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921539PMC
April 2018

Changes in the mode of travel to work and the severity of depressive symptoms: a longitudinal analysis of UK Biobank.

Prev Med 2018 07 28;112:61-69. Epub 2018 Mar 28.

MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, United Kingdom.

Although commuting provides an opportunity for incorporating physical activity into daily routines, little is known about the effect of active commuting upon depressive symptoms. This study aimed to determine whether changes in commute mode are associated with differences in the severity of depressive symptoms in working adults. Commuters were selected from the UK Biobank cohort if they completed ≥2 assessment centre visits between 2006 and 2016. Modes of travel to work were self-reported at each visit. Participants were categorised as 'inactive' (car only) or 'active' commuters (any other mode(s), including walking, cycling and public transport). Transitions between categories were defined between pairs of visits. The severity of depressive symptoms was defined using the two-item Patient Health Questionnaire (PHQ-2). Scores were derived between zero and six. Higher values indicate more severe symptoms. Separate analyses were conducted in commuters who were asymptomatic (zero score) and symptomatic (non-zero score) at baseline. The analytical sample comprised 5474 participants aged 40-75 at baseline with a mean follow-up of 4.65 years. Asymptomatic commuters who transitioned from inactive to active commuting reported less severe symptoms at follow-up than those who remained inactive (β -0.10, 95% CI [-0.20, 0.00]; N = 3145). A similar but non-significant relationship is evident among commuters with pre-existing symptoms (β -0.60, 95% CI [-1.27, 0.08]; N = 1078). After adjusting for transition category, longer commutes at baseline were associated with worse depressive symptoms at follow-up among symptomatic participants. Shifting from exclusive car use towards more active commuting may help prevent and attenuate depressive symptoms in working adults.
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http://dx.doi.org/10.1016/j.ypmed.2018.03.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999356PMC
July 2018

Patterns of health behaviour associated with active travel: a compositional data analysis.

Int J Behav Nutr Phys Act 2018 03 21;15(1):26. Epub 2018 Mar 21.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.

Background: Active travel (walking or cycling for transport) is associated with favourable health outcomes in adults. However, little is known about the concurrent patterns of health behaviour associated with active travel. We used compositional data analysis to explore differences in how people doing some active travel used their time compared to those doing no active travel, incorporating physical activity, sedentary behaviour and sleep.

Methods: We analysed cross-sectional data from the 2014/15 United Kingdom Harmonised European Time Use Survey. Participants recorded two diary days of activity, and we randomly selected one day from participants aged 16 years or over. Activities were categorised into six mutually exclusive sets, accounting for the entire 24 h: (1) sleep; (2) leisure moderate to vigorous physical activity (MVPA); (3) leisure sedentary screen time; (4) non-discretionary time (work, study, chores and caring duties); (5) travel and (6) other. This mixture of activities was defined as a time-use composition. A binary variable was created indicating whether participants reported any active travel on their selected diary day. We used compositional multivariate analysis of variance (MANOVA) to test whether mean time-use composition differed between individuals reporting some active travel and those reporting no active travel, adjusted for covariates. We then used adjusted linear regression models and bootstrap confidence intervals to identify which of the six activity sets differed between groups.

Results: 6143 participants (mean age 48 years; 53% female) provided a valid diary day. There was a statistically significant difference in time-use composition between those reporting some active travel and those reporting no active travel. Those undertaking active travel reported a relatively greater amount of time in leisure MVPA and travel, and a relatively lower amount of time in leisure sedentary screen time and sleep.

Conclusions: Compared to those not undertaking active travel, those who did active travel reported 11 min more in leisure MVPA and 18 min less in screen time per day, and reported lower sleep. From a health perspective, higher MVPA and lower screen time is favourable, but the pattern of sleep is more complex. Overall, active travel was associated with a broadly health-promoting composition of time across multiple behavioural domains, which supports the public health case for active travel.
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http://dx.doi.org/10.1186/s12966-018-0662-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861598PMC
March 2018

Experiences of connectivity and severance in the wake of a new motorway: Implications for health and well-being.

Soc Sci Med 2018 01 29;197:78-86. Epub 2017 Nov 29.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom.

The construction of new urban roads may cause severance, or the separation of residents from local amenities or social networks. Using qualitative data from a natural experimental study, we examined severance related to a new section of urban motorway constructed through largely deprived residential neighbourhoods in Glasgow, Scotland. Semi-structured and photo-elicitation interviews were used to better understand severance and connectivity related to the new motorway, and specifically implications for individual and community-level health and well-being through active travel and social connections. Rather than a clear severance impact attributable to the motorway, a complex system of connection and severance was spoken about by participants, with the motorway being described by turns as a force for both connection and severance. We conclude that new transport infrastructure is complex, embedded, and plausibly causally related to connectedness and health. Our findings suggest the potential for a novel mechanism through which severance is enacted: the disruptive impacts that a new road may have on third places of social connection locally, even when it does not physically sever them. This supports social theories that urge a move away from conceptualising social connectedness in terms of the local neighbourhood only, towards an understanding of how we live and engage dynamically with services and people in a much wider geographical area, and may have implications for local active travel and health through changes in social connectedness.
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http://dx.doi.org/10.1016/j.socscimed.2017.11.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777829PMC
January 2018

Population levels of, and inequalities in, active travel: A national, cross-sectional study of adults in Scotland.

Prev Med Rep 2017 Dec 28;8:129-134. Epub 2017 Sep 28.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.

This study aimed to describe active travel (walking or cycling) in Scotland and explore potential demographic, geographic, and socio-economic inequalities in active travel. We extracted data for the period 2012-13 (39,585 journey stages) from the Scottish Household Survey. Survey travel diaries recorded all journeys made on the previous day by sampled individuals aged 16 + living within Scotland, and the stages within each journey. Descriptive statistics were calculated for journey stages, mode, purpose and distance. Logistic regression models were fitted to examine the relationship between the likelihood of a journey stage being active, age, sex, area deprivation and urban/rural classification. A quarter of all journey stages were walked or cycled (26%, n: 10,280/39,585); 96% of these were walked. Those living in the least deprived areas travelled a greater average distance per active journey stage than those in the most deprived. The likelihood of an active journey stage was higher for those living in the most deprived areas than for those in the least deprived (Odds Ratio (OR) 1.21, 95% CI 1.04-1.41) and for those in younger compared to older age groups (OR 0.44, 95% CI 0.34-0.58). In conclusion, socio-economic inequalities in active travel were identified, but - contrary to the trends for many health-beneficial behaviours - with a greater likelihood of active travel in more deprived areas. This indicates a potential contribution to protecting and improving health for those whose health status tends to be worse. Walking was the most common mode of active travel, and should be promoted as much as cycling.
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http://dx.doi.org/10.1016/j.pmedr.2017.09.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633838PMC
December 2017

A Domain-Specific Approach for Assessing Physical Activity Efficacy in Adolescents: From Scale Conception to Predictive Validity.

Psychol Sport Exerc 2016 Jan;22:20-26

The Exercise and Health Psychology Laboratory, The University of Western Ontario London, Ontario, Canada, N6A 3K7.

Objective: To develop and test the utility of a domain-specific scale in adolescents for predicting physical activity behaviour.

Design: Two independent studies were conducted. Study 1 examined the psychometric properties of a newly constructed Domain-Specific Physical Activity Efficacy Questionnaire (DSPAEQ) and study 2 tested the utility of the scale for predicting leisure- and school-time physical activity.

Methods: In study 1, descriptive physical activity data were used to generate scale items. The scales factor structure and internal consistency were tested in a sample of 272 adolescents. A subsequent sample of Canadian ( = 104) and New Zealand ( = 29) adolescents, was recruited in study 2 to explore the scale's predictive validity using a subjective measure of leisure- and school-time physical activity.

Results: A principle axis factor analysis in study 1 revealed a 26-item, five-factor coherent and interpretable solution; representative of leisure and recreation, household, ambulatory, transportation, and school physical activity efficacy constructs, respectively. The five-factor solution explained 81% of the response variance. In study 2 the domain-specific efficacy model explained 16% and 1% of leisure- and school-time physical activity response variance, respectively, with identified as a unique and significant contributor of leisure-time physical activity.

Conclusion: Study 1 provides evidence for the tenability of a five factor DSPEAQ, while study 2 shows that the DSPEAQ has utility in predicting domain-specific physical activity. This latter finding underscores the importance of scale correspondence between the behavioral elements (leisure-time physical activity) and cognitive assessment of those elements ().
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http://dx.doi.org/10.1016/j.psychsport.2015.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412952PMC
January 2016

Effects of living near an urban motorway on the wellbeing of local residents in deprived areas: Natural experimental study.

PLoS One 2017 5;12(4):e0174882. Epub 2017 Apr 5.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.

Background: Health and wellbeing are partly shaped by the neighbourhood environment. In 2011, an eight kilometre (five mile) extension to the M74 motorway was opened in Glasgow, Scotland, constructed through a predominantly urban, deprived area. We evaluated the effects of the new motorway on wellbeing in local residents.

Methods: This natural experimental study involved a longitudinal cohort (n = 365) and two cross-sectional samples (baseline n = 980; follow-up n = 978) recruited in 2005 and 2013. Adults from one of three study areas-surrounding the new motorway, another existing motorway, or no motorway-completed a postal survey. Within areas, individual measures of motorway proximity were calculated. Wellbeing was assessed with the mental (MCS-8) and physical (PCS-8) components of the SF-8 scale at both time points, and the short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) at follow-up only.

Results: In multivariable linear regression analyses, cohort participants living nearer to the new M74 motorway experienced significantly reduced mental wellbeing over time (MCS-8: -3.6, 95% CI -6.6 to -0.7) compared to those living further away. In cross-sectional and repeat cross-sectional analyses, an interaction was found whereby participants with a chronic condition living nearer to the established M8 motorway experienced reduced (MCS-8: -3.7, 95% CI -8.3 to 0.9) or poorer (SWEMWBS: -1.1, 95% CI -2.0 to -0.3) mental wellbeing compared to those living further away.

Conclusions: We found some evidence that living near to a new motorway worsened local residents' wellbeing. In an area with an existing motorway, negative impacts appeared to be concentrated in those with chronic conditions, which may exacerbate existing health inequalities and contribute to poorer health outcomes. Health impacts of this type of urban regeneration intervention should be more fully taken into account in future policy and planning.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174882PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381791PMC
September 2017

Determinants of Three-Year Change in Children's Objectively Measured Sedentary Time.

PLoS One 2016 12;11(12):e0167826. Epub 2016 Dec 12.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom.

Background: Sedentary behaviours (SB) are highly prevalent in young people and may be adversely associated with physical and mental health. Understanding of the modifiable determinants of SB is necessary to inform the design of behaviour change interventions but much of the existing research is cross-sectional and focussed upon screen-based behaviours.

Purpose: To examine the social, psychological and environmental determinants of change in children's objectively measured sedentary time from age 11 to 14 years.

Methods: Data are from the second (2008) and third (2011) waves of assessment in the Sport, Physical Activity, and Eating Behaviour: Environmental Determinants in Young People (SPEEDY) study, conducted in the county of Norfolk, United Kingdom. Longitudinal data on accelerometer assessed sedentary time were available for 316 (53.5% female, 11.2±0.3 years at baseline) and 264 children after-school and at the weekend respectively. Information on 14 candidate determinants, including school travel mode and electronic media ownership, was self-reported. Change in the proportion of registered time spent sedentary was used as the outcome variable in cross-classified linear regression models, adjusted for age, sex, body mass index and baseline sedentary time. Simple and multiple models were run and interactions with sex explored.

Results: Daily sedentary time increased by 30-40 minutes after-school and at the weekend from baseline to follow-up. Participants who travelled to school by cycle exhibited smaller increases in after-school sedentary time (beta; 95%CI for change in % time spent sedentary: -3.3;-6.7,-0.07). No significant determinants of change in weekend sedentary time were identified.

Conclusions: Time spent sedentary increased during the three-year duration of follow-up but few of the variables examined were significantly associated with changes in sedentary time. Children's mode of school travel may influence changes in their sedentary time over this period and should be examined further, alongside broader efforts to identify modifiable determinants of SB during childhood.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167826PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152854PMC
June 2017

Effects of living near a new urban motorway on the travel behaviour of local residents in deprived areas: Evidence from a natural experimental study.

Health Place 2017 01 26;43:57-65. Epub 2016 Nov 26.

MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.

We evaluated the effects of a new motorway built through deprived neighbourhoods on travel behaviour in residents. This natural experiment comprised a longitudinal cohort (n=365) and two cross-sectional samples (baseline n=980; follow-up n=978) recruited in 2005 and 2013. Adults from one of three study areas - surrounding the new motorway (South), an existing motorway (East), or no motorway (North) - completed a previous day travel record. Adjusted two-part regression models examined associations between exposure and outcome. Compared to the North, cohort participants in the South were more likely to undertake travel by any mode (OR 2.1, 95% CI 1.0-4.2) at follow-up. Within the South study area, cohort participants living closer to a motorway junction were more likely to travel by any mode at follow-up (OR 4.7, 95% CI 1.1-19.7), and cross-sectional participants living closer were more likely to use a car at follow-up (OR 3.4, 95% CI 1.1-10.7), compared to those living further away. Overall, the new motorway appeared to promote travel and car use in those living nearby, but did not influence active travel. This may propagate socioeconomic inequalities in non-car owners.
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http://dx.doi.org/10.1016/j.healthplace.2016.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292101PMC
January 2017

Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH): process evaluation of a randomised controlled trial intervention.

BMC Public Health 2016 05 26;16:439. Epub 2016 May 26.

National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.

Background: The Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH) trial tested a family intervention to reduce screen-based sedentary behaviour in overweight children. The trial found no significant effect of the intervention on children's screen-based sedentary behaviour. To explore these null findings, we conducted a pre-planned process evaluation, focussing on intervention delivery and uptake.

Methods: SWITCH was a randomised controlled trial of a 6-month family intervention to reduce screen time in overweight children aged 9-12 years (n = 251). Community workers met with each child's primary caregiver to deliver the intervention content. Community workers underwent standard training and were monitored once by a member of the research team to assess intervention delivery. The primary caregiver implemented the intervention with their child, and self-reported intervention use at 3 and 6 months. An exploratory analysis determined whether child outcomes at 6 months varied by primary caregiver use of the intervention.

Results: Monitoring indicated that community workers delivered all core intervention components to primary caregivers. However, two thirds of primary caregivers reported using any intervention component "sometimes" or less frequently at both time points, suggesting that intervention uptake was poor. Additionally, analyses indicated no effect of primary caregiver intervention use on child outcomes at 6 months, suggesting the intervention itself lacked efficacy.

Conclusions: Poor uptake, and the efficacy of the intervention itself, may have played a role in the null findings of the SWITCH trial on health behaviour and body composition.

Trial Registration: The trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12611000164998 ); registration date: 10/02/2011.
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http://dx.doi.org/10.1186/s12889-016-3124-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881049PMC
May 2016
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