Nudging customers towards healthier food and beverage purchases in a real-life online supermarket: a multi-arm randomized controlled trial

Background Nudging is increasingly used to promote healthy food choices in supermarkets. Ordering groceries online is gaining in popularity and nudging seems efficacious there as well, but is never comprehensively tested in real-life. We evaluated the real-life effectiveness of nudging in an online supermarket on healthy food purchases. Methods We conducted a multi-arm, parallel-group, individually randomized controlled trial in an online supermarket. During 1 month, all customers were randomized to (1) control condition, (2) information nudges, (3) position nudges, and (4) information and position nudges combined. Allocation was concealed and customers were not blinded, but unaware of the intervention. Mean differences between the control condition and the intervention arms in the total percentage of healthy purchases were assessed with a linear mixed model. We tested for effect modification by area-level deprivation. Results Based on sales data from 11,775 shoppers, no overall significant effects were detected. Yet, effects were modified by area-level deprivation (pArm 2 < 0.001). Among shoppers from deprived areas, those allocated to information nudges purchased a 2.4% (95%CI 0.8, 4.0) higher percentage of healthy products compared to controls. No significant differences were observed for position (− 1.3%; 95%CI − 2.8, 0.3) and combined nudges (− 0.1%; 95%CI − 1.7, 1.5). Shoppers from non-deprived areas exposed to information nudges (− 1.6%; 95%CI − 3.2, − 0.1) and the combined nudges (− 2.1%; 95%CI − 3.6, − 0.6), but not position nudges (− 0.9%; 95%CI − 2.4, 0.7), purchased a lower percentage of healthy products. Conclusion Information nudges in an online supermarket can increase healthy product purchases, but only for those living in deprived areas. The adverse effects found on purchasing behaviors for those from non-deprived areas call for further research. Further research should also focus on real-life effects of online healthy food nudging as part of a broader nutrition intervention strategy, and on the equitability of the online nudging intervention within populations. Trial registration Retrospectively registered in the ISRCTN registry at May 21, 2021 (ISRCTN10491616).

An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales

Background People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation. Methods Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20–99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects. Results For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing “degree-level qualification and higher” to “no qualification” and EHR = 0.74 [0.56;0.97] comparing “apprenticeships and vocational qualification” to “no qualification”, adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing “managerial/professional occupations” to “manual/technical,” and EHR = 0.81 [0.63;1.06] comparing “intermediate” to “manual/technical”, adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects. Conclusions Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice.

Study of Effective Factors in the Tendency of Young People to Smoke Hookah in Teahouses in Deprived Areas of Zahedan in 2018 - 2019

Background: Given the increasing trend of hookah use among youth in deprived areas and the increasing number of traditional teahouses serving hookahs, it is critical to investigate the reasons for this issue. Objectives: The aim was to determine the factors affecting the tendency to use hookahs. Methods: This study was conducted in Zahedan City, the capital of Sistan and Baluchestan Province. The sampling method in this study was cluster sampling, such that among 15 traditional teahouses, 4 teahouses were randomly chosen. After referring to each of these teahouses, 1385 questionnaire forms were distributed among all youth, and 300 questionnaire forms were returned. The structured questionnaire consisted of a series of questions about demographic data, favorite flavor, duration of using a hookah, the main reason for hookah smoking, etc. The analysis of the data involved both descriptive and inferential statistics, including mean, SD, and linear regression. The obtained data were analyzed using SPSS version 23. Results: The results of linear regression showed that the duration of smoking (B = 0.30; 95% CI, 0.22-0.37) and reason for smoking were significantly associated with the rate of hookah smoking (B = 0/56; 95% CI, 0.45 - 0.68). Conclusions: As a result, there is a strong association between smoking duration and the atmosphere of traditional teahouses with the rate of hookah smoking. Thus, other places with a healthy atmosphere (such as gyms and sports clubs) should be made for youths to spend their time.

Economic and social deprivation predicts impulsive choice in young children.

Impulsivity is an individual difference in decision-making that is a risk factor for a number of health concerns including addiction and obesity. Although impulsivity has a large heritable component it, the health concerns associated with impulsivity are not uniformly distributed across society. For example, people from poorer backgrounds are more likely to be overweight, and be dependent on tobacco or alcohol. This suggests that the environmental component of impulsivity night be related to economic circumstances and availability of resources. This paper provides evidence that children aged 4 to 12 from the most deprived areas show greater impulsivity in the form of delay discounting than do children from the least deprived areas. The data are discussed with reference to scarcity based models of decision-making and to public health inequalities.

Exploring the health impacts and inequalities of the new way of working: findings from a cross-sectional study.

Aim To explore the working Welsh adult population's ability to work from home, their preferences for the future, and the self-reported health impacts of home-working. Subject and Method: A nationally-representative household survey was undertaken across Wales (Public Health Wales' COVID-19, Employment and Health in Wales study), with cross-sectional data on home-working being collected between November 2020 and January 2021 from 615 employed working-aged adults in Wales (63.7% female, 32.7% aged 50-59). Respondents were asked about their ability to work from home, their perceptions of its impact on their health and their preferences for time spent home-working in future. Results Over 50% were able to work from home, and showed a preference towards home-working to some capacity, with over a third wishing to work from home at least half the time. However, those living in the most deprived areas, in atypical employment, with high wage precarity or with limiting pre-existing conditions were less likely to report being able to work from home. Of those that could work from home, over 40% reported that it worsened their mental well-being and loneliness, and for people in poorer health, home-working negatively impacted their diet, physical activity, smoking and alcohol use. People aged 30 to 39 and those who lived alone were more likely to report wanting to spend some time working in an office/base instead of at home. Conclusion The inequity in the ability to work from home reflects underlying inequalities in Wales, with those facing the greatest insecurity (e.g. those living in most deprived areas, those with more precarious work or financial circumstances) being less able to participate in home-working. Working from home offers greater flexibility, reduces the financial and time costs associated with commuting, and protects individuals from exposure to communicable diseases. However, working from home presents an enormous challenge to preserving the mental-wellbeing of the workforce, particularly for younger individuals and those with low mental well-being. Younger respondents and those in poorer health who could work from home were also more likely to engage in health-harming behaviours, and reduce their engagement in health-protective behaviours such as eating well and moving more. Reflecting on the future, providing pathways for accessing work from home arrangements, integrating hybrid models and preparing targeted health support for at risk groups may be best suited to the working population's preferences and needs.

The French domestic "sanitary pass" did not solve Covid-19 vaccination inequities in France

The French sanitary pass led to an increase in vaccination rates in France, but local heterogeneities in vaccination rates remain. To identify potential determinants of these heterogeneities and how the French sanitary pass influenced them, we used a data-driven approach on exhaustive nationwide data, gathering 181 socio-economic and geographic factors. Our analysis reveals that, both before and after the introduction of the French sanitary pass, factors with the largest impact are related to poverty, with the most deprived areas having greater than 10 times the odds of being among the districts with lower vaccination rates.

Developing a fast-track COVID-19 vaccination clinic for pregnant people

A pilot fast-track COVID-19 vaccination clinic was created in the east of England to provide expert advice, education and support for pregnant people. As the COVID-19 pandemic has progressed, it is clear that pregnant people are at high risk of becoming seriously unwell with the COVID-19 virus. Establishment of the clinic led to a 20% increase in COVID-19 vaccine uptake in this group, with 211 vaccinations between 28 June and 30 September 2021. Almost two-thirds (59%) of pregnant people reported they would not have taken up the vaccination if they had not discussed it as part of this service. Over half of those attending (50.2%) reside within the index of multiple deprivation levels 1–4, the most severely deprived areas. This article explores the development of the fast-track vaccination service and seeks to support others wishing to replicate its delivery in their areas.

Trends, Variation, and Factors Influencing Antibiotic Prescribing: A Longitudinal Study in Primary Care Using a Multilevel Modelling Approach

Antimicrobial resistance has become one of the greatest threats to global health. Over 80% of antibiotics are prescribed in primary care, with many prescriptions considered to be issued inappropriately. The aim of this study was to examine the association between prescribing rates and demographic, practice, geographic, and socioeconomic characteristics using a multilevel modelling approach. Antibiotic prescribing data by 320 GP surgeries in Northern Ireland were obtained from Business Services Organisation for the years 2014–2020. A linear mixed-effects model was used to identify factors influencing antibiotic prescribing rates. Overall, the number of antibacterial prescriptions decreased by 26.2%, from 1,564,707 items in 2014 to 1,155,323 items in 2020. Lower levels of antibiotic prescribing were associated with urban practices (p < 0.001) and practices in less deprived areas (p = 0.005). The overall decrease in antibacterial drug prescriptions over time was larger in less deprived areas (p = 0.03). Higher prescribing rates were linked to GP practices located in areas with a higher percentage of the population aged ≥65 (p < 0.001) and <15 years (p < 0.001). There were also significant regional differences in antibiotic prescribing. We advocate that any future antibiotic prescribing targets should account for local factors.

Is Foundational Movement Skill Competency Important for Keeping Children Physically Active and at a Healthy Weight?

This longitudinal study examines the associations between foundational movement skills (FMS) competency, moderate-to-vigorous physical activity (MVPA) and weight status among children (n = 75) attending preschools in deprived areas from early to late childhood. Twelve FMS were assessed using the Children’s Activity and Movement in Preschool Motor Skills Protocol and video analysis. Physical activity was measured via hip-mounted accelerometry. Data was collected over a five-year period, with Baseline Follow Up data collected between 2010 and 2015. There was an overall pattern of increase for total, object-control and locomotor scores between Baseline and Follow-Up. Conversely, there was an overall pattern of decline for MVPA among participants. There was a positive significant (p < 0.05) association between total and locomotor scores and MVPA at Baseline. However, these associations weakened over time and no significant associations were found at Follow-Up. Baseline competency failed to predict Follow-Up MVPA or weight status. Likewise, Baseline MVPA was not found to be a predictor of Follow-Up FMS competency. Further longitudinal research is required to explore these associations among children from highly deprived areas. Future interventions may require a more holistic approach to improving FMS competency and increasing PA in order to account for the number of variables that can affect these outcomes.