Publications

@article{,
title = {Occupational Physical Activity Habits of UK Office Workers: Cross-Sectional Data from the Active Buildings Study},
author = {Lee Smith, Alexia Sawyer, Benjamin Gardner, Katri Seppala, Marcella Ucci, Alexi Marmot, Pippa Lally & Abi Fisher. },
doi = {10.3390/ijerph15061214},
year = {2018},
date = {2018-06-09},
journal = {International Journal of Environmental Research and Public Health },
abstract = {Habitual behaviours are learned responses that are triggered automatically by associated environmental cues. The unvarying nature of most workplace settings makes workplace physical activity a prime candidate for a habitual behaviour, yet the role of habit strength in occupational physical activity has not been investigated. Aims of the present study were to: (i) document occupational physical activity habit strength; and (ii) investigate associations between occupational activity habit strength and occupational physical activity levels. A sample of UK office-based workers (n = 116; 53% female, median age 40 years, SD 10.52) was fitted with activPAL accelerometers worn for 24 h on five consecutive days, providing an objective measure of occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. A self-report index measured the automaticity of two occupational physical activities (“being active” (e.g., walking to printers and coffee machines) and “stair climbing”). Adjusted linear regression models investigated the association between occupational activity habit strength and objectively-measured occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. Eighty-one per cent of the sample reported habits for “being active”, and 62% reported habits for “stair climbing”. In adjusted models, reported habit strength for “being active” were positively associated with average occupational sit-to-stand transitions per hour (B = 0.340, 95% CI: 0.053 to 0.627, p = 0.021). “Stair climbing” habit strength was unexpectedly negatively associated with average hourly stepping time (B = −0.01, 95% CI: −0.01 to −0.00, p = 0.006) and average hourly occupational step count (B = −38.34, 95% CI: −72.81 to −3.88, p = 0.030), which may reflect that people with stronger stair-climbing habits compensate by walking fewer steps overall. Results suggest that stair-climbing and office-based occupational activity can be habitual. Interventions might fruitfully promote habitual workplace activity, although, in light of potential compensation effects, such interventions should perhaps focus on promoting moderate-intensity activity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {‘A true partner around the table?’ Perceptions of how to strengthen public health’s contributions to the alcohol licensing process},
author = {Joanna Reynolds, Michael McGrath, Jessica Engen, Ghazaleh Pashmi, Matthew Andrews, Carolyn Sharpe, Matt Egan, Jin Lim, Karen Lock.},
doi = {10.1093/pubmed/fdy093},
year = {2018},
date = {2018-06-01},
journal = {Journal of Public Health},
abstract = {Introduction
There are increased opportunities for public health practitioners (PHPs) in England to shape alcohol availability and reduce harms through a statutory role in licensing processes in local government. However, how public health can effectively influence alcohol licence decision-making is little understood.

Methods
A mixed methods study was conducted to identify challenges faced by PHPs and mechanisms to strengthen their role. This involved a survey of practitioners across London local authorities (n = 18) and four focus group discussions with a range of licensing stakeholders (n = 36).

Results
Survey results indicated a varied picture of workload, capacity to respond to licence applications and levels of influence over decision-making among PHPs in London. Practitioners described a felt lack of status within the licence process, and difficulties using and communicating public health evidence effectively, without a health licensing objective. Strategies considered supportive included engaging with other responsible authorities and developing understanding and relationships over time.

Conclusions
Against political and resource constraints at local and national government levels, pragmatic approaches for strengthening public health influence over alcohol licensing are required, including promoting relationships between stakeholders and offering opportunities for PHPs to share best practice about making effective contributions to licensing.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Associations between the Objectively Measured Office Environment and Workplace Step Count and Sitting Time: Cross-Sectional Analyses from the Active Buildings Study},
author = {Abi Fisher, Marcella Ucci, Lee Smith, Alexia Sawyer, Richard Spinney, Marina Konstantatou & Alexi Marmot. },
doi = {10.3390/ijerph15061135},
year = {2018},
date = {2018-06-01},
journal = { International Journal of Environmental Research and Public Health},
abstract = {Office-based workers spend a large proportion of the day sitting and tend to have low overall activity levels. Despite some evidence that features of the external physical environment are associated with physical activity, little is known about the influence of the spatial layout of the internal environment on movement, and the majority of data use self-report. This study investigated associations between objectively-measured sitting time and activity levels and the spatial layout of office floors in a sample of UK office-based workers. Participants wore activPAL accelerometers for at least three consecutive workdays. Primary outcomes were steps and proportion of sitting time per working hour. Primary exposures were office spatial layout, which was objectively-measured by deriving key spatial variables: ‘distance from each workstation to key office destinations’, ‘distance from participant’s workstation to all other workstations’, ‘visibility of co-workers’, and workstation ‘closeness’. 131 participants from 10 organisations were included. Fifty-four per cent were female, 81% were white, and the majority had a managerial or professional role (72%) in their organisation. The average proportion of the working hour spent sitting was 0.7 (SD 0.15); participants took on average 444 (SD 210) steps per working hour. Models adjusted for confounders revealed significant negative associations between step count and distance from each workstation to all other office destinations (e.g., B = −4.66, 95% CI: −8.12, −1.12, p < 0.01) and nearest office destinations (e.g., B = −6.45, 95% CI: −11.88, −0.41, p < 0.05) and visibility of workstations when standing (B = −2.35, 95% CI: −3.53, −1.18, p < 0.001). The magnitude of these associations was small. There were no associations between spatial variables and sitting time per work hour. Contrary to our hypothesis, the further participants were from office destinations the less they walked, suggesting that changing the relative distance between workstations and other destinations on the same floor may not be the most fruitful target for promoting walking and reducing sitting in the workplace. However, reported effect sizes were very small and based on cross-sectional analyses. The approaches developed in this study could be applied to other office buildings to establish whether a specific office typology may yield more promising results.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Alcohol Screening and Brief Intervention in Police Custody Suites: Pilot Cluster Randomised Controlled Trial (AcCePT)},
author = {Michelle Addison, Ruth Mcgovern, Colin Angus, Frauke Becker, Alan Brennan, Heather Brown, Simon Coulton, Lisa Crowe, Eilish Gilvarry, Matthew Hickman, Denise Howel, Elaine Mccoll, Colin Muirhead, Dorothy Newbury-Birch, Muhammad Waqas, Eileen Kaner.},
doi = {10.1093/alcalc/agy039},
year = {2018},
date = {2018-05-28},
journal = {Alcohol and Alcoholism },
abstract = {Aims
There is a clear association between alcohol use and offending behaviour and significant police time is spent on alcohol-related incidents. This study aimed to test the feasibility of a trial of screening and brief intervention in police custody suites to reduce heavy drinking and re-offending behaviour.

Short summary
We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely.

Methods
A three-armed pilot Cluster Randomised Controlled Trial with an embedded qualitative interview-based process evaluation to explore acceptability issues in six police custody suites (north east and south west of the UK). Interventions included: 1. Screening only (Controls), 2. 10 min Brief Advice 3. Brief Advice plus 20 min of brief Counselling.

Results
Of 3330 arrestees approached: 2228 were eligible for screening (67%) and 720 consented (32%); 386 (54%) scored 8+ on AUDIT; and 205 (53%) were enroled (79 controls, 65 brief advice and 61 brief counselling). Follow-up rates at 6 and 12 months were 29% and 26%, respectively. However, routinely collected re-offending data were obtained for 193 (94%) participants. Indices of deprivation data were calculated for 184 (90%) participants; 37.6% of these resided in the 20% most deprived areas of UK. Qualitative data showed that all arrestees reported awareness that participation was voluntary, that the trial was separate from police work, and the majority said trial procedures were acceptable.

Conclusion
Despite hitting target recruitment and same-day brief intervention delivery, a future trial of alcohol screening and brief intervention in a police custody setting would only be feasible if routinely collected re-offending and health data were used for outcome measurement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {The development of Drink Less: an alcohol reduction smartphone app for excessive drinkers},
author = {Claire Garnett, David Crane, Robert West, Jamie Brown and Susan Michie. },
doi = {10.1093/tbm/iby043},
year = {2018},
date = {2018-05-04},
journal = {Translational Behavioral Medicine},
abstract = {Excessive alcohol consumption poses a serious problem for public health. Digital behavior change interventions have the potential to help users reduce their drinking. In accordance with Open Science principles, this paper describes the development of a smartphone app to help individuals who drink excessively to reduce their alcohol consumption. Following the UK Medical Research Council’s guidance and the Multiphase Optimization Strategy, development consisted of two phases: (i) selection of intervention components and (ii) design and development work to implement the chosen components into modules to be evaluated further for inclusion in the app. Phase 1 involved a scoping literature review, expert consensus study and content analysis of existing alcohol apps. Findings were integrated within a broad model of behavior change (Capability, Opportunity, Motivation-Behavior). Phase 2 involved a highly iterative process and used the “Person-Based” approach to promote engagement. From Phase 1, five intervention components were selected: (i) Normative Feedback, (ii) Cognitive Bias Re-training, (iii) Self-monitoring and Feedback, (iv) Action Planning, and (v) Identity Change. Phase 2 indicated that each of these components presented different challenges for implementation as app modules; all required multiple iterations and design changes to arrive at versions that would be suitable for inclusion in a subsequent evaluation study. The development of the Drink Less app involved a thorough process of component identification with a scoping literature review, expert consensus, and review of other apps. Translation of the components into app modules required a highly iterative process involving user testing and design modification.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Reciprocity in the Co-Production of Public Services: The Role of Volunteering through Community Time Exchange?},
author = {Gemma Burgess, Daniel Durrant. },
doi = {10.1017/S1474746418000076},
year = {2018},
date = {2018-03-26},
journal = {Social Policy and Society},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {A smartphone app to reduce excessive alcohol consumption: Identifying the effectiveness of intervention components in a factorial randomised control trial},
author = {David Crane, Claire Garnett, Susan Michie, Robert West and Jamie Brown. },
url = {https://www.nature.com/articles/s41598-018-22420-8},
year = {2018},
date = {2018-03-12},
journal = {Scientific Reports},
abstract = {Our aim was to evaluate intervention components of an alcohol reduction app: Drink Less. Excessive drinkers (AUDIT> =8) were recruited to test enhanced versus minimal (reduced functionality) versions of five app modules in a 25 factorial trial. Modules were: Self-monitoring and Feedback, Action Planning, Identity Change, Normative Feedback, and Cognitive Bias Re-training. Outcome measures were: change in weekly alcohol consumption (primary); full AUDIT score, app usage, app usability (secondary). Main effects and two-way interactions were assessed by ANOVA using intention-to-treat. A total of 672 study participants were included. There were no significant main effects of the intervention modules on change in weekly alcohol consumption or AUDIT score. There were two-way interactions between enhanced Normative Feedback and Cognitive Bias Re-training on weekly alcohol consumption (F = 4.68, p = 0.03) and between enhanced Self-monitoring and Feedback and Action Planning on AUDIT score (F = 5.82, p = 0.02). Enhanced Self-monitoring and Feedback was used significantly more often and rated significantly more positively for helpfulness, satisfaction and recommendation to others than the minimal version. To conclude, in an evaluation of the Drink Less smartphone application, the combination of enhanced Normative Feedback and Cognitive Bias Re-training and enhanced Self-monitoring and Feedback and Action Planning yielded improvements in alcohol-related outcomes after 4-weeks.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression},
author = {Claire Garnett, David Crane, Jamie Brown, Eileen Kaner, Fiona Beyer, Colin Muirhead, Matthew Hickman, James Redmore, Frank de Vocht, Emma Beard and Susan Michie. },
doi = {10.2196/jmir.8807},
year = {2018},
date = {2018-02-28},
journal = {Journal of Medical Internet Research},
volume = {20},
number = {2},
abstract = {Background
Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this.

Objective
The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness.

Methods
Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models.

Results
Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. Conclusions
Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {NHS Diabetes Prevention Programme in England: formative evaluation of the programme in early phase implementation},
author = {Penn L, Rodrigues A, Haste A, Marques MM, Budig K, Sainsbury K, Bell R, Araújo-Soares V, White M, Summerbell C, Goyder E, Brennan A, Adamson AJ, Sniehotta FF.},
doi = {10.1136/bmjopen-2017-019467},
year = {2018},
date = {2018-02-21},
journal = {BMJ Open},
abstract = {Objectives
Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide recommendations informing decision makers on programme quality, improvements and future evaluation.

Design
We reviewed programme documents, mapping against the NHS DPP specification and National Institute for Health and Care Excellence (NICE) public health guideline: Type 2 diabetes (T2D) prevention in people at high risk (PH38), conducted qualitative research using individual interviews and focus group discussions with stakeholders and examined recruitment, fidelity and data collection procedures.

Setting
Seven NHS DPP demonstrator sites and, subsequently, 27 first wave areas across England.

Interventions
Intensive behavioural intervention with weight loss, diet and physical activity goals. The national programme specifies at least 13 sessions over 9 months, delivered face to face to groups of 15–20 adults with non-diabetic hyperglycaemia, mainly recruited from primary care and NHS Health Checks.

Participants
Participants for qualitative research were purposively sampled to provide a spread of stakeholder experience. Documents for review were provided via the NHS DPP Management Group.

Findings
The NHS DPP specification reflected current evidence with a clear framework for service provision. Providers, with national capacity to deliver, supplied intervention plans compliant with this framework. Stakeholders highlighted limitations in fidelity assessment and recruitment and retention challenges, especially in reach and equity, that could adversely impact on implementation. Risk assessment for first wave eligibility differed from NICE guidance.

Conclusions
The NHS DPP provides an evidence-based behavioural intervention for prevention of T2D in adults at high risk, with capacity to deliver nationally. Framework specification allows for balance between consistency and contextual variation in intervention delivery, with session details devolved to providers. Limitations in fidelity assurance, data collection procedures and recruitment issues could adversely impact on intervention effectiveness and restrict evaluation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? },
author = {Ronzi S, Orton L, Pope D, Valtorta N, Bruce N.},
doi = {10},
year = {2018},
date = {2018-01-30},
journal = {Systematic Reviews},
abstract = {Background
Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature.

Methods
Eligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes.

Results
Of the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation.

Conclusions
Whilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression},
author = {Claire V Garnett, David Crane, Jamie Brown, Eileen F S Kaner, Fiona R Beyer, Colin R Muirhead, Matthew Hickman, Emma Beard, James Redmore, Frank de Vocht and Susan Michie.},
doi = {10.1093/abm/kax029},
year = {2018},
date = {2018-01-27},
journal = {Annals of Behaviour Medicine},
volume = {52},
number = {6},
abstract = {Background
Digital behavior change interventions (DBCIs) appear to reduce alcohol consumption, but greater understanding is needed of their mechanisms of action.

Purpose
To describe the behavior change techniques (BCTs) used in DBCIs and examine whether individual BCTs, the inclusion of more BCTs or more Control Theory congruent BCTs is associated with increased effectiveness.

Methods
Forty-one randomized control trials were extracted from a Cochrane review of alcohol reduction DBCIs and coded for up to 93 BCTs using an established and reliable method. Random effects unadjusted and adjusted meta-regression models were performed to assess associations between BCTs and intervention effectiveness.

Results
Interventions used a mean of 9.1 BCTs (range 1–22), 23 different BCTs were used in four or more trials. Trials that used “Behavior substitution” (−95.112 grams per week [gpw], 95% CI: −162.90, −27.34), “Problem solving” (−45.92 gpw, 95% CI: −90.97, −0.87) and “Credible source” (−32.09 gpw, 95% CI: −60.64, −3.55) were significantly associated with greater alcohol reduction than trials without these BCTs. The “Behavior substitution” result should be treated as preliminary because it was reported in only four trials, three of which were conducted by the same research group. “Feedback” was used in 98% of trials (n = 41); other Control Theory congruent BCTs were used less frequently: for example, “Goal setting” 43% (n = 18) and “Self-monitoring” 29%, (n = 12).

Conclusions
“Behavior substitution,” “Problem solving,” and “Credible source” were associated with greater alcohol reduction. Many BCTs were used infrequently in DBCIs, including BCTs with evidence of effectiveness in other domains, such as “Self-monitoring” and “Goal setting.”},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {The challenges of interventions to promote healthier food in independent takeaways in England: qualitative study of intervention deliverers},
author = {Louis Goffe, Linda Penn, Jean Adams, Vera Araujo-Soares, Carolyn D. Summerbell, Charles Abraham, Martin White, Ashley Adamson, Amelia A. Lake.},
doi = {10.1186/s12889-018-5096-3},
year = {2018},
date = {2018-01-27},
journal = {BMC Public Health },
abstract = {Background
Much of the food available from takeaways, pubs and restaurants particularly that sold by independent outlets, is unhealthy and its consumption is increasing. These food outlets are therefore important potential targets for interventions to improve diet and thus prevent diet related chronic diseases. Local authorities in England have been charged with delivering interventions to increase the provision of healthy food choices in independent outlets, but prior research shows that few such interventions have been rigorously developed or evaluated. We aimed to learn from the experiences of professionals delivering interventions in independent food outlets in England to identify the operational challenges and their suggestions for best practice.

Methods
We used one-to-one semi-structured qualitative interviews to explore the views and experiences of professionals who were either employees of, or contracted by, a local authority to deliver interventions to increase the provision of healthier food choices in independent food outlets. Purposive sampling was used to recruit a sample which included men and women, from a range of professional roles, across different areas of England. Interviews were informed by a topic guide, and proceeded until no new themes emerged. Interviews were recorded, transcribed verbatim and analysed using the Framework method.

Results
We conducted 11 individual interviews. Participants focussed on independent takeaways and their unhealthy food offerings, and highlighted the advantages and disadvantages of intervention delivery methods, their evaluation and impact.

The main barriers to implementation of interventions in independent takeaways were identified as limited funding and the difficulties of engaging the food outlet owner/manager. Engagement was thought to be facilitated by delivering intensive, interactive and tailored interventions, clear and specific information, and incentives, whilst accounting for practical, primarily financial, constraints of food businesses. Alternative intervention approaches, targeting suppliers or customers, were suggested.

Conclusions
Participants emphasised independent takeaways as particularly challenging, but worthwhile intervention targets. Participants perceived that interventions need to take account of the potentially challenging operating environment, particularly the primacy of the profit motive. Upstream interventions, engaging suppliers, as well as those that drive consumer demand, may be worth exploring. Rigorous, evidence-informed development and evaluation of such interventions is needed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Motivation to reduce alcohol consumption and subsequent attempts at reduction and changes in consumption in increasing and higher‐risk drinkers in England: a prospective population survey},
author = {Frank de Vocht, Jamie Brown, Emma Beard, Robert West, Susan Michie, Rona Campbell and Matthew Hickman.},
doi = {10.1111/add.14132},
year = {2018},
date = {2018-01-25},
journal = {Addiction},
abstract = {Aims
To assess how far motivation to reduce alcohol consumption in increasing and higher‐risk drinkers in England predicts self‐reported attempts to reduce alcohol consumption and changes in alcohol intake during the following 6 months.

Methods
This study used self‐reported data from 2928 higher‐risk drinkers in the Alcohol Toolkit Study (ATS): a series of monthly cross‐sectional household surveys of adults aged 16+ years of age in England. Alcohol consumption was measured in an initial survey and in a 6‐month telephone follow‐up interview using the Alcohol Use Disorders Identification Test (AUDIT)‐C questionnaire. Motivation was measured in the initial survey using the Motivation to Reduce Alcohol Consumption (MRAC) scale. Attempts to reduce alcohol consumption during the past 6 months were recorded at follow‐up. Data were analysed using repeated‐measures difference‐in‐differences and logistic regression models.

Results
Participants with higher initial motivation to reduce alcohol consumption were more likely to report that they had made an attempt to reduce consumption at follow‐up [adjusted odds ratio (ORadj) = 2.39, 95% confidence interval (CI) = 1.75–3.29]. There was an overall reduction in alcohol consumption between initial survey and follow‐up (ORadj = 0.72, 95% CI = 0.65–0.79), but there was insufficient evidence of an additional effect of motivation to reduce consumption on subsequent changes in alcohol consumption, with the difference‐in‐differences effect instead suggesting an average increase (ORadj = 1.37, 95% CI = 1.00–1.88).

Conclusions
Increasing and higher‐risk drinkers in England who report greater motivation to reduce their consumption are more likely to report making an attempt to reduce during the next 6 months, but this may not be associated with a reduction in alcohol consumption.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Impact of free access to leisure facilities and community outreach on inequalities in physical activity: a quasi-experimental study},
author = {James Higgerson, Emma Halliday, Aurora Ortiz-Nunez, Richard Brown, Ben Barr.},
doi = {10.1136/jech-2017-209882},
year = {2018},
date = {2018-01-12},
journal = {Journal of Epidemiology & Community Health},
volume = {72},
number = {3},
abstract = {Background
There are large inequalities in levels of physical activity in the UK, and this is an important determinant of health inequalities. Little is known about the effectiveness of community-wide interventions to increase physical activity and whether effects differ by socioeconomic group.

Methods
We conducted interrupted time series and difference-in-differences analyses using local administrative data and a large national survey to investigate the impact of an intervention providing universal free access to leisure facilities alongside outreach and marketing activities in a deprived local authority area in the northwest of England. Outcomes included attendances at swimming and gym sessions, self-reported participation in gym and swim activity and any physical activity.

Results
The intervention was associated with a 64% increase in attendances at swimming and gym sessions (relative risk 1.64, 95% CI 1.43 to 1.89, P<0.001), an additional 3.9% of the population participating in at least 30 min of moderate-intensity gym or swim sessions during the previous four weeks (95% CI 3.6 to 4.1) and an additional 1.9% of the population participating in any sport or active recreation of at least moderate intensity for at least 30 min on at least 12 days out of the last four weeks (95% CI 1.7 to 2.1). The effect on gym and swim activity and overall levels of participation in physical activity was significantly greater for the more disadvantaged socioeconomic group. Conclusions
The study suggests that removing user charges from leisure facilities in combination with outreach and marketing activities can increase overall population levels of physical activity while reducing inequalities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Leisure centre entrance charges and physical activity participation in England},
author = {F Ward, E C Halliday, B Barr, J Higgerson, V Holt.},
doi = {10.1093/heapro/dax095},
year = {2017},
date = {2017-12-11},
journal = {Health Promotion International},
abstract = {Reducing or eliminating the cost to the public of using leisure facilities is one tool that local authorities have available to reduce inequalities in physical activity (PA). There is limited evidence about the effect of leisure entrance charges and their impact on participation. This study aimed to ascertain how facility pricing influenced the decisions people made about how to pay and what to pay for and how, in turn, these decisions impacted on participation for different groups. A total of 83 members of the public living in 4 local authorities in the North West of England were involved in focus groups or individual interviews. The results show that cost was a key factor which influenced PA participation in low income neighbourhoods. In practise, however, the majority of service users navigated the range of prices or payment options to find one that was suitable rather than simply reporting whether leisure was affordable or not. Whilst pre-paid options (e.g. direct debit memberships) encouraged participation, entrance charges incurred each time an individual participated had a negative impact on frequency but were a convenient way of paying for occasional use or for people who were unable to afford a pre-paid option. Free access also helped people who could not afford pre-paid membership to exercise regularly as well as incentivizing non-users to try activities. The research concluded that policies that include components of free access and offer more flexible payment options are most likely to contribute to reducing inequalities in PA.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {How do public health professionals view and engage with research? A qualitative interview study and stakeholder workshop engaging public health professionals and researchers},
author = {van der Graaf P, Forrest LF, Adams J, Shucksmith J, White M.},
doi = {10.1186/s12889-017-4896-1},
year = {2017},
date = {2017-11-22},
journal = {BMC Public Health },
abstract = {Background
With increasing financial pressures on public health in England, the need for evidence of high relevance to policy is now stronger than ever. However, the ways in which public health professionals (PHPs) and researchers relate to one another are not necessarily conducive to effective knowledge translation. This study explores the perspectives of PHPs and researchers when interacting, with a view to identifying barriers to and opportunities for developing practice that is effectively informed by research.

Methods
This research focused on examples from two responsive research schemes, which provide university-based support for research-related enquiries from PHPs: the NIHR SPHR Public Health Practitioner Evaluation Scheme1 and the responsive research service AskFuse2. We examined enquiries that were submitted to both between 2013 and 2015, and purposively selected eight enquiries for further investigation by interviewing the PHPs and researchers involved in these requests. We also identified individuals who were eligible to make requests to the schemes but chose not to do so. In-depth interviews were conducted with six people in relation to the PHPES scheme, and 12 in relation to AskFuse. The interviews were transcribed and analysed using thematic framework analysis. Verification and extension of the findings were sought in a stakeholder workshop.

Results
PHPs recognised the importance of research findings for informing their practice. However, they identified three main barriers when trying to engage with researchers: 1) differences in timescales; 2) limited budgets; and 3) difficulties in identifying appropriate researchers. The two responsive schemes addressed some of these barriers, particularly finding the right researchers to work with and securing funding for local evaluations. The schemes also supported the development of new types of evidence. However, other barriers remained, such as differences in timescales and the resources needed to scale-up research.

Conclusions
An increased mutual awareness of the structures and challenges under which PHPs and researchers work is required. Opportunities for frequent and meaningful engagement between PHPs and researchers can help to overcome additional barriers to co-production of evidence. Collaborative models, such as the use of researchers embedded in practice might facilitate this; however, flexible research funding schemes are needed to support these models.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {What are older smokers’ attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study},
author = {Hannah Jordan, Mira Hidajat, Nick Payne, Jean Adams, Martin White and Yoav Ben-Shlomo.},
doi = {10.1136/bmjopen-2017-018150},
year = {2017},
date = {2017-11-15},
journal = {BMJ Open},
volume = {7},
number = {11},
abstract = {Objectives
To investigate whether age is associated with access to smoking cessation services.

Design
Data from the Smoking Toolkit Study 2006–2015, a repeated multiwave cross-sectional household survey (n=181 157).

Setting
England.

Participants
Past-year smokers who participated in any of the 102 waves stratified into age groups.

Outcome measures
Amount smoked and nicotine dependency, self-reported quit attempts and use of smoking cessation interventions. Self-report of whether the general practitioner (GP) raised the topic of smoking and made referrals for pharmacological support (prescription of nicotine replacement therapies (NRTs)) or other support (counselling or support groups).

Results
Older smokers (75+ years) were less likely to report that they were attempting to quit smoking or seek help from a GP, despite being less nicotine-dependent. GPs raised smoking as a topic equally across all age groups, but smokers aged 70+ were more likely not to be referred for NRT or other support (ORs relative to 16–54 years; 70–74 years 1.27, 95% CI 1.03 to 1.55; 75–79 years 1.87, 95% CI 1.43 to 2.44; 80+ years 3.16, 95% CI 2.20 to 4.55; p value for trend <0.001). Conclusions
Our findings suggest that there are potential missed opportunities in facilitating smoking cessation in older smokers. In this large population-based study, older smokers appeared less interested in quitting and were less likely to be offered support, despite being less addicted to nicotine than younger smokers. It is unclear whether this constitutes inequitable access to services or reflects informed choices by older smokers and their GPs. Future research is needed to understand why older smokers and GPs do not pursue smoking cessation. Service provision should consider how best to reduce these variations, and a stronger effectiveness evidence base is required to support commissioning for this older population so that, where appropriate, older smokers are not missing out on smoking cessation therapies and the health benefits of cessation at older ages.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {An evaluation tool for Age-Friendly and Dementia Friendly Communities},
author = {Stefanie Buckner, Calum Mattocks, Melanie Rimmer, Louise Lafortune},
url = {https://doi.org/10.1108/WWOP-11-2017-0032},
doi = {10},
issn = {1366-3666},
year = {2017},
date = {2017-11-01},
journal = {Working With Older People},
volume = {22},
number = {1},
pages = {48-58},
abstract = {Purpose
The purpose of this paper is to report how an evaluation tool originally developed for Age-Friendly Cities was pilot-tested in the context of the Dementia Friendly Community (DFC) initiative of the city of Sheffield/UK. It presents finding and outputs on which other communities with dementia friendly agendas can draw.

Design/methodology/approach
The original evaluation tool was adapted to a focus on dementia friendliness. Data collection involved scoping conversations, documentary analysis, interviews and group discussions. Following evidence appraisal, Sheffield’s approach to dementia friendliness was assessed. A local steering group was central to the study.

Findings
The evidence indicates areas of strength in Sheffield’s approach to dementia friendliness: involvement of older people; service provision; collaboration; monitoring and evaluation. Scope for improvement was identified around resource allocation, and use of existing guidance on dementia friendliness. Recommendations for policy and practice include enhancing pooling of resources, more detailed recording of resources allocated to dementia-related activity, and collection of evidence on how people affected by dementia have shaped the city’s DFC initiative. Key research outputs are an adaptable logic model and an emerging evaluation framework for DFCs.

Research limitations/implications
The study was a short pilot with limited resources. Its findings and outputs must be considered preliminary.

Originality/value
The findings and outputs provide a basis for further research. The study has suggested key components of an evaluation framework for DFCs. It is informing ongoing work to develop such a framework.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Sexual orientation and tobacco and hazardous alcohol use – findings from a cross-sectional representative population survey.},
author = {Lion Shahab, Jamie Brown, Gareth Hagger-Johnson, Susan Michie, Joanna Semlyen, Robert West and Catherine Meads.},
doi = {10.1136/bmjopen-2016-015058},
year = {2017},
date = {2017-10-25},
journal = {BMJ Open},
abstract = {Objectives
To assess the association between tobacco and hazardous alcohol use and sexual orientation and whether such an association could be explained by other sociodemographic characteristics.

Design
Cross-sectional household survey conducted in 2014–2016.

Setting
England, UK.

Participants
Representative English population sample (pooled n=43 866).

Main outcomes
Sexual orientation identity (lesbian/gay, bisexual, heterosexual, prefer-not-to-say); current tobacco and hazardous alcohol use (defined as Alcohol Use Disorders Identification Test Score ≥8). All outcomes were self-reported.

Results
Due to interactions between sexual orientation and gender for substance use, analyses were stratified by gender. Tobacco use prevalence was significantly higher among lesbian/gay (women: 24.9%, 95% CI 19.2% to 32.6%; men: 25.9%, 95% CI 21.3% to 31.0%) and bisexual participants (women: 32.4%, 95% CI 25.9% to 39.6%; men: 30.7%, 95% CI 23.7% to 30.7%) and significantly lower for prefer-not-to-say participants in women (15.5%, 95% CI 13.5% to 17.8%) but not men (22.7%, 95% CI 20.3% to 25.3%) compared with heterosexual participants (women: 17.5%, 95% CI 17.0% to 18.0%; men: 20.4%, 95% CI 19.9% to 21.0%; p<0.001 for omnibus test). Similarly, hazardous alcohol use was significantly more prevalent for lesbian/gay (women: 19.0%, 95% CI 14.0% to 25.3%; men: 30.0%, 25.2%–35.3%) and bisexual participants (women: 24.4%, 95% CI 18.7% to 31.3%; men: 24.3%, 95% CI 17.9% to 32.1%) and lower for prefer-not-to-say participants (women: 4.1%, 95% CI 3.0% to 5.4%; men: 13.7%; 95% CI 11.8% to 16.0%) compared with heterosexuals (women: 8.3%, 95% CI 7.9% to 8.7%; men: 18.4%, 95% CI 17.9% to 18.9%; p<0.001 for omnibus test). However, after adjusting for sociodemographic confounders, tobacco use was similar across all sexual orientation groups among both women and men. By contrast, sexual orientation differences in hazardous alcohol use remained even after adjustment among women but not for bisexual and gay men. Conclusions
In England, higher rates of tobacco use among sexual minority men and women appear to be attributable to other sociodemographic factors. Higher rates of hazardous alcohol use among sexual minority men may also be attributable to these factors, whereas this is not the case for sexual minority women.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {A review of Grey and academic literature of evaluation guidance relevant to public health interventions},
author = {Sarah Denford, Charles Abraham, Margaret Callaghan, Peter Aighton, Frank De Vocht, Steven Arris.},
doi = {10.1186/s12913-017-2588-2},
year = {2017},
date = {2017-10-12},
journal = {BMC Health Services Research},
abstract = {Background
Public Health evaluation is essential to understanding what does and does not work, and robust demonstration of effectiveness may be crucial to securing future funding. Despite this, programs are often implemented with poor, incomplete or no evaluation. Public health practitioners are frequently required to provide evidence for the effectiveness of their services; thus, there is a growing need for evaluation guidance on how to evaluate public health programs. The aim of this study is to identify accessible high-quality, evaluation guidance, available to researchers and practitioners and to catalogue, summarise and categorise the content of a subset of accessible, quality guides to evaluation.

Methods
We systematically reviewed grey and academic literature for documents providing support for evaluation of complex health interventions. Searches were conducted January to March 2015, and included academic databases, internet search engines, and consultations with academic and practicing public health experts. Data were extracted by two authors and sent to the authors of the guidance documents for comments.

Results
Our initial search identified 402 unique documents that were screened to identify those that were (1) developed by or for a national or international organization (2) freely available to all (3) published during or after 2000 (4) specific to public health. This yielded 98 documents from 43 organisations. Of these, 48 were reviewed in detail. This generated a detailed catalogue of quality evaluation guidance. The content included in documents covers 37 facets of evaluation.

Conclusions
A wide range of guidance on evaluation of public health initiatives is available. Time and knowledge constraints may mean that busy practitioners find it challenging to access the most, up-to-date, relevant and useful guidance. This review presents links to and reviews of 48 quality guides to evaluation as well as categorising their content. This facilitates quick and each access to multiple selected sources of specific guidance.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data},
author = {K. Walters, M. Falcaro, N. Freemantle, M. King and Y. Ben-Shlomo. },
doi = {10.1017/S0033291717003014},
year = {2017},
date = {2017-10-11},
journal = {Psychological Medicine},
volume = {48},
number = {9},
abstract = {Background
We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies.

Methods
Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009–2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset.

Results
Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55–59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75–79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1–0.29) than those aged 55–59 years, and men aged 80–84 years had around seven times lower (OR 0.14, 95% CI 0.05–0.36).

Conclusions
The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Developing Age-Friendly Cities: an Evidence-Based Evaluation Tool},
author = {Stefanie Buckner, Daniel Pope, Calum Mattocks, Louise Lafortune, Mukesh Dherani and Nigel Bruce.},
doi = {10.1007/s12062-017-9206-2},
year = {2017},
date = {2017-10-06},
journal = {Journal of Population Ageing},
abstract = {Recent years have seen a proliferation of initiatives aimed at enhancing the age-friendliness of urban settings. The World Health Organization’s (WHO) global Age-Friendly Cities (AFC) programme has been central to these. Cities seeking to become more age-friendly need reliable ways of assessing their efforts. This article describes an evidence-based evaluation tool for age-friendly initiatives whose development was informed by fieldwork in Liverpool/UK. The tool complements existing assessment frameworks, including those provided by WHO, by paying particular attention to the structures and processes underlying age-friendly initiatives. It reflects the complexity of age-friendliness by reconciling a focus on breadth with detail and depth, and it allows for a highly accessible visual presentation of findings. Using selected examples from Liverpool, the article illustrates how the evaluation tool can be applied to guide policy and practice with an age-friendly focus in different urban contexts. Pilot testing in further settings is underway to refine the tool as a practical method for evaluation and for supporting city-level decision making.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations},
author = {Eileen Kaner, Fiona R Beyer, Claire Garnett, David Crane, Jamie Brown, Colin Muirhead, James Redmore, Amy O'Donnell, James J Newham, Frank de Vocht, Matthew Hickman, Heather Brown, Gregory Maniatopoulos and Susan Michie.},
doi = {10.1002/14651858.CD011479.},
year = {2017},
date = {2017-09-25},
journal = {Cochrane Database of Systematic Reviews},
abstract = {Background
Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation‐based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption.

Objectives
To assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost‐effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face‐to‐face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community‐based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes.

Search methods
We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews.

Selection criteria
We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face‐to‐face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption.

Data collection and analysis
We used standard methodological procedures expected by The Cochrane Collaboration.

Main results
We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence).

Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence).

Only five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI ‐24.59 to 25.63; low‐quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.

A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B ‐43.94, 95% CI ‐78.59 to ‐9.30), problem solving (B ‐48.03, 95% CI ‐77.79 to ‐18.27), information about antecedents (B ‐74.20, 95% CI ‐117.72 to ‐30.68), behaviour substitution (B ‐123.71, 95% CI ‐184.63 to ‐62.80) and credible source (B ‐39.89, 95% CI ‐72.66 to ‐7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B ‐95.12, 95% CI ‐162.90 to ‐27.34), problem solving (B ‐45.92, 95% CI ‐90.97 to ‐0.87), and credible source (B ‐32.09, 95% CI ‐60.64 to ‐3.55) were associated with reduced alcohol consumption.

The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.

Authors' conclusions
There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions.

The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.

Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Relationship between mean daily energy intake and frequency of consumption of out-of-home meals in the UK National Diet and Nutrition Survey},
author = {Louis Goffe, Stephen Rushton, Martin White, Ashley Adamson, Jean Adams.},
doi = {10.1186/s12966-017-0589-5},
year = {2017},
date = {2017-09-22},
journal = {International Journal of Behavioral Nutrition and Physical Activity},
abstract = {Background
Out-of-home meals have been characterised as delivering excessively large portions that can lead to high energy intake. Regular consumption is linked to weight gain and diet related diseases. Consumption of out-of-home meals is associated with socio-demographic and anthropometric factors, but the relationship between habitual consumption of such meals and mean daily energy intake has not been studied in both adults and children in the UK.

Methods
We analysed adult and child data from waves 1–4 of the UK National Diet and Nutrition Survey using generalized linear modelling. We investigated whether individuals who report a higher habitual consumption of meals out in a restaurant or café, or takeaway meals at home had a higher mean daily energy intake, as estimated by a four-day food diary, whilst adjusting for key socio-demographic and anthropometric variables.

Results
Adults who ate meals out at least weekly had a higher mean daily energy intake consuming 75–104 kcal more per day than those who ate these meals rarely. The equivalent figures for takeaway meals at home were 63–87 kcal. There was no association between energy intake and frequency of consumption of meals out in children. Children who ate takeaway meals at home at least weekly consumed 55–168 kcal more per day than those who ate these meals rarely. Additionally, in children, there was an interaction with socio-economic position, where greater frequency of consumption of takeaway meals was associated with higher mean daily energy intake in those from less affluent households than those from more affluent households.

Conclusions
Higher habitual consumption of out-of-home meals is associated with greater mean daily energy intake in the UK. More frequent takeaway meal consumption in adults and children is associated with greater daily energy intake and this effect is greater in children from less affluent households. Interventions seeking to reduce energy content through reformulation or reduction of portion sizes in restaurants, cafés and takeaways could potentially lead to reductions in mean daily energy intake, and may reduce inequalities in health in children.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Blood Pressure Trajectories in the 20 Years Before Death},
author = {João Delgado, Kirsty Bowman, Alessandro Ble, Jane Masoli, Yang Han, William Henley, Scott Welsh, George A. Kuchel, Luigi Ferrucci and David Melzer. },
doi = {10.1001/jamainternmed.2017.7023},
year = {2017},
date = {2017-09-10},
journal = {JAMA International Medicine},
abstract = {Importance
There is mixed evidence that blood pressure (BP) stabilizes or decreases in later life. It is also unclear whether BP trajectories reflect advancing age, proximity to end of life, or selective survival of persons free from hypertension.

Objective
To estimate individual patient BP for each of the 20 years before death and identify potential mechanisms that may explain trajectories.

Design, Study, and Participants
We analyzed population-based Clinical Practice Research Datalink primary care and linked hospitalization electronic medical records from the United Kingdom, using retrospective cohort approaches with generalized linear mixed-effects modeling. Participants were all available individuals with BP measures over 20 years, yielding 46 634 participants dying aged at least 60 years, from 2010 to 2014. We also compared BP slopes from 10 to 3 years before death for 20 207 participants who died, plus 20 207 birth-year and sex-matched participants surviving longer than 9 years.

Main Outcomes and Measures
Clinically recorded individual patient repeated systolic BP (SBP) and diastolic BP (DBP).

Results
In 46 634 participants (51.7% female; mean [SD] age at death, 82.4 [9.0] years), SBPs and DBPs peaked 18 to 14 years before death and then decreased progressively. Mean changes in SBP from peak values ranged from −8.5 mm Hg (95% CI, −9.4 to −7.7) for those dying aged 60 to 69 years to −22.0 mm Hg (95% CI, −22.6 to −21.4) for those dying at 90 years or older; overall, 64.0% of individuals had SBP changes of greater than −10 mm Hg. Decreases in BP appeared linear from 10 to 3 years before death, with steeper decreases in the last 2 years of life. Decreases in SBP from 10 to 3 years before death were present in individuals not treated with antihypertensive medications, but mean yearly changes were steepest in patients with hypertension (−1.58; 95% CI, −1.56 to −1.60 mm Hg vs −0.70; 95% CI, −0.65 to −0.76 mm Hg), dementia (−1.81; 95% CI, −1.77 to −1.87 mm Hg vs −1.41; 95% CI, −1.38 to −1.43 mm Hg), heart failure (−1.66; 95% CI, −1.62 to −1.69 mm Hg vs −1.37; 95% CI, −1.34 to −1.39 mm Hg), and late-life weight loss.

Conclusions and Relevance
Mean SBP and DBP decreased for more than a decade before death in patients dying at 60 years and older. These BP decreases are not simply attributable to age, treatment of hypertension, or better survival without hypertension. Late-life BP decreases may have implications for risk estimation, treatment monitoring, and trial design.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Boundary work: understanding enactments of ‘community’ in an area-based, empowerment initiative},
author = {Joanna Reynolds },
doi = {10.1080/09581596.2017.1371276},
year = {2017},
date = {2017-09-04},
journal = {Critical Public Health},
volume = {28},
number = {2},
pages = {201-212},
abstract = {Engaging the community in initiatives to improve health and inequalities is a prominent feature of contemporary public health approaches. Yet, how ‘community’ might be differently interpreted and experienced through mechanisms of engagement is little understood, with potential implications for how the pathways of effect of such initiatives, and their impacts on health inequalities, might be evaluated. This study sought to explore how community was enacted through the delivery of an area-based, empowerment initiative underway in disadvantaged areas of England. An ethnographic approach was used to identify enactments of community arising around the core activities and decision-making processes of the resident-led initiative in two sites. Enactments comprised ‘boundary work’: the ongoing assertion and negotiation of boundaries around who or what was, and was not, eligible to contribute to decision-making, and / or benefit from the initiative. Boundary work arose around practices of connecting with and consulting residents, protecting locally defined interests and autonomy, negotiating different sets of interests, and navigating representation. The multiple, shifting enactments of community and its boundaries highlight implications for understanding processes of inclusion and exclusion inherent to community engagement, and for interpreting pathways between collective empowerment and improved health. The study also raises questions for evaluating similar complex, community initiatives, where community cannot be taken as a fixed analytical unit, but something continually in process through the interplay between the initiative and the wider context. This must inform interpretations of how, and for whom, community engagement might – or might not – improve health.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Assessing the potential return on investment of the proposed UK NHS diabetes prevention programme in different population subgroups: an economic evaluation},
author = {Chloe Thomas, Susi Sadler, Penny Breeze, Hazel Squires, Michael Gillett, Alan Brennan.},
doi = {10.1136/bmjopen-2016-014953},
year = {2017},
date = {2017-08-21},
journal = {BMJ Open},
volume = {7},
number = {8},
abstract = {Objectives
To evaluate potential return on investment of the National Health Service Diabetes Prevention Programme (NHS DPP) in England and estimate which population subgroups are likely to benefit most in terms of cost-effectiveness, cost-savings and health benefits.

Design
Economic analysis using the School for Public Health Research Diabetes Prevention Model.

Setting
England 2015–2016.

Population
Adults aged ≥16 with high risk of type 2 diabetes (HbA1c 6%–6.4%). Population subgroups defined by age, sex, ethnicity, socioeconomic deprivation, baseline body mass index, baseline HbA1c and working status.

Interventions
The proposed NHS DPP: an intensive lifestyle intervention focusing on dietary advice, physical activity and weight loss. Comparator: no diabetes prevention intervention.

Main outcome measures
Incremental costs, savings and return on investment, quality-adjusted life-years (QALYs), diabetes cases, cardiovascular cases and net monetary benefit from an NHS perspective.

Results
Intervention costs will be recouped through NHS savings within 12 years, with net NHS saving of £1.28 over 20 years for each £1 invested. Per 100 000 DPP interventions given, 3552 QALYs are gained. The DPP is most cost-effective and cost-saving in obese individuals, those with baseline HbA1c 6.2%–6.4% and those aged 40–74. QALY gains are lower in minority ethnic and low socioeconomic status subgroups. Probabilistic sensitivity analysis suggests that there is 97% probability that the DPP will be cost-effective within 20 years. NHS savings are highly sensitive to intervention cost, effectiveness and duration of effect.

Conclusions
The DPP is likely to be cost-effective and cost-saving under current assumptions. Prioritising obese individuals could create the most value for money and obtain the greatest health benefits per individual targeted. Low socioeconomic status or ethnic minority groups may gain fewer QALYs per intervention, so targeting strategies should ensure the DPP does not contribute to widening health inequalities. Further evidence is needed around the differential responsiveness of population subgroups to the DPP.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {“DrinkThink” Alcohol Screening and Brief Intervention for Young People: a qualitative evaluation of training and implementation.},
author = {Jane Derges, Judi Kidger, Fiona Fox, Rona Campbell, Eileen Kaner, Gordon Taylor, C McMahon, L Reeves and Matthew Hickman},
doi = {10.1093/pubmed/fdx090},
year = {2017},
date = {2017-08-09},
journal = {Journal of Public Health},
volume = {40},
number = {2},
pages = {381-388},
abstract = {Background
Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery.

Methods
A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken.

Results
DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use.

Conclusions
Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs’ perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Unlocking the benefits of Age-Friendly Cities},
author = {Stefanie Buckner, Calum Mattocks, Louise Lafortune, Melanie Rimmer, Daniel Pope, Nigel Bruce},
url = {http://www.nationalhealthexecutive.com/Comment/unlocking-the-benefits-of-age-friendly-cities},
doi = {0},
year = {2017},
date = {2017-08-04},
journal = {National Health Executive},
abstract = {Stefanie Buckner, Calum Mattocks and Louise Lafortune \emph{from the Cambridge Institute of Public Health, alongside} Melanie Rimmer\emph{ from the School of Health and Related Research at the University of Sheffield, and} Daniel Pope \emph{and} Nigel Bruce\emph{from the University of Liverpool’s Institute of Psychology Health and Society, discuss the role of the health sector and other local stakeholders in creating environments to foster healthy ageing.}},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Determinants of Change in Physical Activity in Children 0–6 years of Age: A Systematic Review of Quantitative Literature},
author = {Kathryn R. Hesketh, Claire O’Malley, Veena Mazarello, PaesHelen Moore, Carolyn Summerbell, Ken K. Ong, Rajalakshmi Lakshman, Esther M. F. van Sluijs.},
doi = {10.1007/s40279-016-0656-0},
year = {2017},
date = {2017-07-17},
journal = {Sports Medicine},
volume = {47},
number = {7},
pages = {1349-1374},
abstract = {Background
Understanding the determinants of children’s health behaviours is important to develop successful behaviour-change interventions.

Objective
We aimed to synthesise the evidence around determinants (‘preceding predictors’) of change in physical activity (PA) in young children (0–6 years of age).

Methods
As part of a suite of reviews, prospective quantitative studies investigating change in physical activity in children aged 0–6 years were identified from eight databases (to October 2015): MEDLINE, Embase, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, Applied Social Sciences Index and Abstracts, and Sociological Abstracts. Determinants and direction of association were extracted, described and synthesised according to the socio-ecological model (individual, interpersonal, organisational, community, policy).

Results
Forty-four determinants, predominantly in the interpersonal and organisational domains, were reported across 44 papers (six prospective cohort, 38 interventional); 14 determinants were assessed in four or more papers. Parental monitoring showed a consistent positive association with change in PA; provider training was positively associated with change in children’s moderate-to-vigorous PA only. Five (sex, parental goal setting, social support, motor skill training and increased time for PA) showed no clear association. A further seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children’s PA. Maternal role-modelling was positively associated with change in PA in all three studies in which it was examined.

Conclusions
A range of studied determinants of change in young children’s PA were identified, but only parental monitoring was found to be consistently positively associated. More evidence dealing with community and policy domains from low-/middle-income countries and about lesser-explored modifiable family- and childcare-related determinants is required.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Link worker social prescribing to improve health and well-being for people with long-term conditions: qualitative study of service user perceptions},
author = {Suzanne Moffatt, Mel Steer, Sarah Lawson, Linda Penn and Nicola O’Brien.},
doi = {10.1136/bmjopen-2016-015203},
year = {2017},
date = {2017-07-16},
journal = {BMJ Open},
abstract = {Objectives
To describe the experiences of patients with long-term conditions who are referred to and engage with a Link Worker social prescribing programme and identify the impact of the Link Worker programme on health and well-being.

Design
Qualitative study using semistructured interviews with thematic analysis of the data.

Intervention
Link Worker social prescribing programme comprising personalised support to identify meaningful health and wellness goals, ongoing support to achieve agreed objectives and linkage into appropriate community services.

Setting
Inner-city area in West Newcastle upon Tyne, UK (population n=132 000) ranked 40th most socioeconomically deprived in England, served by 17 general practices.

Participants
Thirty adults with long-term conditions, 14 female, 16 male aged 40–74 years, mean age 62 years, 24 white British, 1 white Irish, 5 from black and minority ethnic communities.

Results
Most participants experienced multimorbidity combined with mental health problems, low self-confidence and social isolation. All were adversely affected physically, emotionally and socially by their health problems. The intervention engendered feelings of control and self-confidence, reduced social isolation and had a positive impact on health-related behaviours including weight loss, healthier eating and increased physical activity. Management of long-term conditions and mental health in the face of multimorbidity improved and participants reported greater resilience and more effective problem-solving strategies.

Conclusions
Findings suggest that tackling complex and long-term health problems requires an extensive holistic approach not possible in routine primary care. This model of social prescribing, which takes into account physical and mental health, and social and economic issues, was successful for patients who engaged with the service. Future research on a larger scale is required to assess when and for whom social prescribing is clinically effective and cost-effective.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Identifying inequitable healthcare in older people: systematic review of current research practice},
author = {Sarah M. Salway, Nick Payne, Melanie Rimmer, Stefanie Buckner, Hannah Jordan, Jean Adams, Kate Walters, Sarah L. Sowden, Lynne Forrest, Linda Sharp, Mira Hidajat, Martin White and Yoav Ben-Shlomo.},
doi = {10.1186/s12939-017-0605-z},
year = {2017},
date = {2017-07-11},
journal = {International Journal for Equity in Health},
abstract = {Background
There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair.

Method
A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability.

Results
Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were ‘inequitable’. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles.

Conclusions
Caution is needed among clinicians and other evidence-users in accepting claims of healthcare ‘ageism’ in some published papers. Principles for improved research practice are proposed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {What is the potential for community currencies to deliver positive public health outcomes? Case study of Time Credits in Wisbech, Cambridgeshire, UK},
author = {Burgess, G.},
doi = {10.17863/CAM.13906},
year = {2017},
date = {2017-07-06},
journal = {ournal of International Community Currencies},
volume = {21},
number = {2},
pages = {19-32},
abstract = {There is evidence that increased levels of community engagement and social participation can improve population health. Community currencies such as Time Credits are one way to support and encourage people to be more involved in their local community. As a result, they have attracted investment by local governments in the UK, with the hope of finding new ways to work with deprived communities, improve individual outcomes that lead to better health, and reduce the use of public services at a time of financial austerity. The aim of this research was to evaluate the health related outcomes of volunteering through Time Credits in Wisbech, Cambridgeshire. The conceptual model developed during the research shows how Time Credits were expected to influence some of the social determinants of health and, by doing so, enhance health outcomes and reduce health inequalities. This in depth empirical study shows the potential of such activity to support pathways to better health, but equally demonstrates the challenges in quantifying such outcomes and in evidencing any reduction in the use of public services as a result.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {What is best practice in sex and relationships education? A synthesis of evidence, including stakeholders’ views},
author = {Pandora Pound, Sarah Denford, Janet Shucksmith, Clare Tanton, Anne M Johnson, Jenny Owen, Rebecca Hutten, Leanne Mohan, Chris Bonell, Charles Abraham and Rona Campbell.},
doi = {10.1136/bmjopen-2016-014791},
year = {2017},
date = {2017-07-02},
journal = {BMJ Open},
volume = {7},
number = {5},
abstract = {Objectives
Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation.

Design
This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations.

Settings
Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide.

Results
Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence.

Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants},
author = {Kirsty Bowman, Janice L Atkins, João Delgado, Katarina Kos, George A Kuchel, Alessandro Ble, Luigi Ferrucci and David Melzer.},
doi = {doi.org/10.3945/ajcn.116.147157},
year = {2017},
date = {2017-07-01},
journal = {The American Journal of Clinical Nutrition},
volume = {106},
number = {1},
pages = {130 -135},
abstract = {Background
For older groups, being overweight [body mass index (BMI; in kg/m2): 25 to <30] is reportedly associated with a lower or similar risk of mortality than being normal weight (BMI: 18.5 to <25). However, this “risk paradox” is partly explained by smoking and disease-associated weight loss. This paradox may also arise from BMI failing to measure fat redistribution to a centralized position in later life. Objective
This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD).

Design
This study followed 130,473 UK Biobank participants aged 60–69 y (baseline 2006–2010) for ≤8.3 y (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a “healthier agers” group. Survival models were adjusted for age, sex, alcohol intake, smoking history, and educational attainment. Population and sex-specific lower and higher WHR tertiles were <0.91 and ≥0.96 for men and <0.79 and ≥0.85 for women, respectively. Results
Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects (HR: 1.09; 95% CI: 0.99, 1.19; P = 0.066). However, among normal-weight subjects, mortality increased for those with a higher WHR (HR: 1.33; 95% CI: 1.08, 1.65) compared with a lower WHR. Being overweight with a higher WHR was associated with substantial excess mortality (HR: 1.41; 95% CI: 1.25, 1.61) and greatly increased CAD incidence (sub-HR: 1.64; 95% CI: 1.39, 1.93) compared with being normal weight with a lower WHR. There was no interaction between physical activity and BMI plus WHR groups with respect to mortality.

Conclusions
For healthier agers (i.e., nonsmokers without disease-associated weight loss), having central adiposity and a BMI corresponding to normal weight or overweight is associated with substantial excess mortality. The claimed BMI-defined overweight risk paradox may result in part from failing to account for central adiposity, rather than reflecting a protective physiologic effect of higher body-fat content in later life.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {A model of how targeted and universal welfare entitlements impact on material, psycho-social and structural determinants of health in older adults.},
author = {Judith Green, Stefanie Buckner, Sarah Milton, Katie Powell, Sarah Salway and Suzanne Moffatt.},
doi = {10.1016/j.socscimed.2017.06.015},
year = {2017},
date = {2017-06-15},
journal = {Social Science & Medicine},
volume = {187},
pages = {20 - 28},
abstract = {A growing body of research attests to the impact of welfare regimes on health and health equity. However, the mechanisms that link different kinds of welfare entitlement to health outcomes are less well understood. This study analysed the accounts of 29 older adults in England to delineate how the form of entitlement to welfare and other resources (specifically, whether this was understood as a universal entitlement or as targeted to those in need) impacts on the determinants of health. Mechanisms directly affecting access to material resources (through deterring uptake of benefits) have been well documented, but those that operate through psychosocial and more structural pathways less so, in part because they are more challenging to identify. Entitlement that was understood collectively, or as arising from financial or other contributions to a social body, had positive impacts on wellbeing beyond material gains, including facilitating access to important health determinants: social contact, recognition and integration. Entitlement understood as targeted in terms of individualised concepts of need or vulnerability deterred access to material resources, but also fostered debate about legitimacy, thus contributing to negative impacts on individual wellbeing and the public health through the erosion of social integration. This has important implications for both policy and evaluation. Calls to target welfare benefits at those in most need emphasise direct material pathways to health impact. We suggest a model for considering policy change and evaluation which also takes into account how psychosocial and structural pathways are affected by the nature of entitlement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Processes of local alcohol policy-making in England: Does the theory of policy transfer provide useful insights into public health decision-making?},
author = {Lucy Gavens, John Holmes, Penny Buykx, Frank de Vocht, Matt Egan, Daniel Grace, Karen Lock, John D.Mooney and Alan Brennan. },
doi = {10.1016/j.healthplace.2017.05.016},
year = {2017},
date = {2017-06-13},
journal = {Health & Place},
abstract = {Background and aims
Recent years have seen a rise in new and innovative policies to reduce alcohol consumption and related harm in England, which can be implemented by local, as opposed to national, policy-makers. The aim of this paper is to explore the processes that underpin the adoption of these alcohol policies within local authorities. In particular, it aims to assess whether the concept of policy transfer (i.e. a process through which knowledge about policies in one place is used in the development of policies in another time or place) provides a useful model for understanding local alcohol policy-making.

Methods
Qualitative data generated through in-depth interviews and focus groups from five case study sites across England were used to explore stakeholder experiences of alcohol policy transfer between local authorities. The purposive sample of policy actors included representatives from the police, trading standards, public health, licensing, and commissioning. Thematic analysis was used inductively to identify key features in the data.

Results
Themes from the policy transfer literature identified in the data were: policy copying, emulating, hybridization, and inspiration. Participants described a multitude of ways in which learning was shared between places, ranging from formal academic evaluation to opportunistic conversations in informal settings. Participants also described facilitators and constraints to policy transfer, such as the historical policy context and the local cultural, economic, and bureaucratic context, which influenced whether or not a policy that was perceived to work in one place might be transferred successfully to another context.

Conclusions
Theories of policy transfer provide a promising framework for characterising processes of local alcohol policy-making in England, extending beyond debates regarding evidence-informed policy to account for a much wider range of considerations. Applying a policy transfer lens enables us to move beyond simple (but still important) questions of what is supported by ‘robust’ research evidence by paying greater attention to how policy making is carried out in practice and the multiple methods by which policies diffuse across jurisdictions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review},
author = {Jane Derges, Judi Kidger, Fiona Fox, Rona Campbell, Eileen Kaner, Matthew Hickman},
doi = {10.1186/s12889-017-4476-4},
year = {2017},
date = {2017-06-09},
journal = {BMC Public Health},
abstract = {Background
Systematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people.

Methods
This review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis.

Results
From a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs.

Conclusions
There remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Perceived office environments and occupational physical activity in office-based workers},
author = {A. Sawyer, L. Smith, M. Ucci, R. Jones, A. Marmot, A. Fisher. },
doi = {10.1093/occmed/kqx022},
year = {2017},
date = {2017-06-01},
journal = {Occupational Medicine},
abstract = {Background
Individuals in office-based occupations have low levels of physical activity but there is little research into the socio-ecological correlates of workplace activity.

Aims
To identify factors contributing to office-based workers’ perceptions of the office environment and explore cross-sectional relationships between these factors and occupational physical activity.

Methods
Participants in the Active Buildings study reported perceptions of their office environment using the Movement at Work Survey. A principal component analysis (PCA) was conducted on survey items. A sub-sample wore the ActivPAL3TM accelerometer for ≥3 workdays to measure occupational step count, standing, sitting and sit-to-stand transitions. Linear regression analyses assessed relationships between environmental perceptions and activity.

Results
There were 433 participants, with accelerometer data available for 115 participants across 11 organ izations. The PCA revealed four factors: (i) perceived distance to office destinations, (ii) perceived office aesthetics and comfort, (iii) perceived office social environment and (iv) perceived management discouragement of unscheduled breaks. Younger participants perceived office destinations as being closer to their desk. Younger and female participants perceived more positive office social environments; there were no other socio-demographic differences. Within the sub-sample with accelerometer data, perceived discouragement of breaks by management was related to occupational step count/hour (B = −64.5; 95% CI −109.7 to −19.2). No other environmental perceptions were related to activity or sitting.

Conclusions
Perceived managerial discouragement of breaks could be related to meaningful decreases in occupational step count. Future research should aim to elucidate the role of the workplace socio-cultural environment in occupational walking, with a focus on the role of management.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project},
doi = {10.3310/pgfar05110},
year = {2017},
date = {2017-05-22},
journal = { NIHR Journals Library},
abstract = {Background
The prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.

Objectives
The objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).

Settings
Leicestershire, UK.

Participants
Adults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2 and/or IGR were invited to take part in the education programme.

Main outcome measures
The primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.

Data sources
Participants were recruited from general practices, specialist ID services and clinics, and through direct contact.

Results
A total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals, n = 14; people with ID, n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.

Limitations
We were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.

Conclusion
The results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review},
author = {Anne Scott , Duncan Chambers, Elizabeth Goyder, Alicia O’Cathain},
doi = {10.1371/journal.pone.0177210},
year = {2017},
date = {2017-05-10},
journal = {PLOS One},
abstract = {Aims
To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management.

Methods
We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted.

Results
A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies.

Conclusions
Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Strategies to improve engagement of ‘hard to reach’ older people in research on health promotion: a systematic review},
author = {Ann E. M. Liljas, Kate Walters, Ana Jovicic, Steve Iliffe, Jill Manthorpe, Claire Goodman and Kalpa Kharicha.},
doi = {10.1186/s12889-017-4241-8},
year = {2017},
date = {2017-04-21},
journal = {BMC Public Health },
abstract = {Background
This systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas.

Methods
Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people.

Results
Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions.

Conclusions
This review identified facilitators, barriers and strategies for engaging ‘hard to reach’ older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Mapping Patterns and Trends in the Spatial Availability of Alcohol Using Low-Level Geographic Data: A Case Study in England 2003–2013},
author = {Colin Angus, John Holmes, Ravi Maheswaran, Mark A. Green, Petra Meier and Alan Brennan.},
doi = {10.3390/ijerph14040406},
year = {2017},
date = {2017-04-12},
journal = {International Journal of Environmental Research and Public Health },
abstract = {Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (−2.2 outlets within 1 km (Inter-Quartile Range (IQR) −3–0), although access to restaurants has increased (+1.0 outlets (IQR 0–1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0–3)). Availability is highest in the most deprived areas (p < 0.0001) although these areas have also seen the greatest falls in on-trade outlet availability (p < 0.0001). This study underlines the importance of using detailed, low-level geographic data to understand patterns and trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Co- located welfare advice in general practice: A realist qualitative study},
author = {Woodhead C, Collins H, Lomas R, Raine R.},
doi = {10.1111/hsc.12453},
year = {2017},
date = {2017-04-10},
journal = {Health & Social Care in the Community},
abstract = {General practitioners (GPs) engage with patients about a variety of social issues dis-tinct from direct clinical work (“non- health” issues), such as health- related benefits and debt. Co- located welfare advice services could provide support to practices but have usually been considered in terms of patient rather than practice outcomes. We aimed to develop an initial programme theory for how the provision of co- located advice supports specific practice outcomes, and to identify salient barriers and enabling fac-tors. Twenty- four semi- structured interviews with general practice staff, advice staff and service funders in two UK urban localities were conducted between January and July 2016. Data were thematically analysed and a modified Realist Evaluation ap-proach informed the topic guide, thematic analysis and interpretation. Two outcomes are described linked to participant accounts of the impact of such non- health work on practices: reduction of GP consultations linked to non- health issues and reduced prac-tice time spent on non- health issues. We found that individual responses and actions influencing service awareness were key facilitators to each of the practice outcomes, including proactive engagement, communication, regular reminders and feedback be-tween advice staff, practice managers and funders. Facilitating implementation factors were: not limiting access to GP referral, and offering booked appointments and advice on a broader range of issues responsive to local need. Key barriers included pre- existing sociocultural and organisational rules and norms largely outside of the control of service implementers, which maintained perceptions of the GP as the “go- to- location”. We conclude that co- location of welfare advice services alone is unlikely to enable positive outcomes for practices and suggest several factors amenable to inter-vention that could enhance the potential for co- location to meet desired objectives.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies},
author = {David Crane, Claire Garnett, Jamie Brown, Robert West and Susan Michie.},
doi = {10.3389/fpubh.2017.00039},
year = {2017},
date = {2017-04-03},
journal = {Frontiers in Public Health Digital Health },
abstract = {Background
Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimize engagement and reduce the high rates of attrition associated with the use of digital interventions, it is necessary to ensure that an app’s design and functionality is appropriate for its intended purposes and target population.

Aims
To understand the usability of an app to help people reduce their alcohol consumption.

Method
The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a “think aloud” study performed with people using the app for the first time and a semistructured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the “think aloud” and interview transcripts was conducted by one coder and verified by a second.

Results
Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were “Feeling lost and unsure of what to do next,” “Make the app easy to use,” and “Make the app beneficial and rewarding to use.” These themes reflected participants’ need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached.

Conclusion
First-time and experienced users want an alcohol reduction app to be easy, rewarding, and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help, and be esthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress, and demonstrate credibility. Users need help when first using the app, and they need a compelling reason to continue using it.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {User characteristics of a smartphone app to reduce alcohol consumption},
author = {Claire Garnett, David Crane, Robert West, Susan Michie, Jamie Brown and Adam Winstock.},
doi = {10.1007/s13142-017-0477-1},
year = {2017},
date = {2017-03-17},
journal = {Translational Behavioral Medicine},
volume = {7},
number = {4},
pages = {845-853},
abstract = {Digital interventions are available to help people reduce their alcohol consumption, but it is not known who uses these interventions and how this treatment-seeking group compares with the general population of drinkers. The study objective was to compare the socio-demographic and drinking characteristics of users of the ‘Drinks Meter’ smartphone app with the general population of drinkers in England and website users of the same intervention. Data were used from the Drinks Meter app and website, and a nationally representative cross-sectional survey in England (Alcohol Toolkit Study). Participants were drinkers aged 16+ in England. Data were collected on participants’ age, gender, region, sexual orientation, social grade and AUDIT score. Regression analyses were conducted to assess differences in socio-demographic and drinking characteristics between samples. Drinks Meter app users, compared with drinkers of the general population, were younger, more likely to be from the South, not heterosexual, less likely to be of a lower social grade and had a higher mean AUDIT score. Drinks Meter app users were younger than website users and reported greater alcohol consumption and related harms. Drinkers using the Drinks Meter app are more likely to be younger and report greater alcohol consumption and related harms compared with the general population of drinkers in England and website users of the same intervention. Apps that provide feedback on drinking appear to be reaching those who report greater alcohol consumption and related harms.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Cost‐effectiveness of population‐based, community, workplace and individual policies for diabetes prevention in the UK},
author = {P. R. Breeze, C. Thomas, H. Squires, A. Brennan, C. Greaves, P. Diggle, E. Brunner, A. Tabak, L. Preston, J. Chilcott.},
doi = {10.1111/dme.13349 },
year = {2017},
date = {2017-03-10},
journal = {Diabetic Medicine},
abstract = {Aim
To analyse the cost‐effectiveness of different interventions for Type 2 diabetes prevention within a common framework.

Methods
A micro‐simulation model was developed to evaluate the cost‐effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community‐based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality‐adjusted life‐years are collected for each person.

Results
All interventions generate more life‐years and lifetime quality‐adjusted life‐years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost‐saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs.

Conclusion
The model enables a wide range of diabetes prevention interventions to be evaluated according to cost‐effectiveness, employment and equity impacts over the short and long term, allowing decision‐makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Predictors of and reasons for attempts to reduce alcohol intake: a population survey of adults in England. },
author = {Emma Beard, Jamie Brown, Eileen Kaner, Robert West and Susan Michie.},
doi = {10.1371/journal.pone.0173458},
year = {2017},
date = {2017-03-09},
journal = {PLOS one},
abstract = {Objective
This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption.

Method
Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so.

Results
Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn’t know why they were cutting down (β -0.25, p<0.05). Conclusions
Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking},
author = {Emma Beard, Jamie Brown, Robert West, Colin Angus, Eileen Kaner and Susan Michie.},
doi = {10.1136/bmjopen-2016-014210},
year = {2017},
date = {2017-03-01},
journal = {BMJ Open},
abstract = {Objectives
This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design
Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures
Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results
In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Conclusions
In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

@article{,
title = {Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation},
author = {Ruth Bell, Svetlana V Glinianaia, Zelda van der Waal, Andrew Close, Eoin Moloney, Susan Jones, Vera Araújo-Soares, Sharon Hamilton, Eugene MG Milne, Janet Shucksmith, Luke Vale, Martyn Willmore, Martin White, Steven Rushton.},
doi = {10.1136/tobaccocontrol-2016-053476},
year = {2017},
date = {2017-02-15},
journal = {Tobacco Control},
volume = {27},
number = {1},
abstract = {Objectives
To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.

Design
Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation.

Setting
Eight acute NHS hospital trusts and 12 local authority areas in North East England.

Participants
37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy.

Interventions
A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol.

Main outcome measures
Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting.

Results
After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.

Conclusions
The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}