The Association between Fast Food Outlets and Overweight in Adolescents Is Confounded by Neighbourhood Deprivation: A Longitudinal Analysis of the Millennium Cohort Study

The aim of our study is to utilise longitudinal data to explore if the association between the retail fast food environment and overweight in adolescents is confounded by neighbourhood deprivation. Data from the Millennium Cohort Study for England were obtained for waves 5 (ages 11/12; 2011/12; n = 13,469) and 6 (ages 14/15; 2014/15; n = 11,884). Our outcome variable was overweight/obesity defined using age and sex-specific International Obesity Task Force cut points. Individuals were linked, based on their residential location, to data on the density of fast food outlets and neighbourhood deprivation. Structural Equation Models were used to model associations and test for observed confounding. A small positive association was initially detected between fast food outlets and overweight (e.g., at age 11/12, Odds Ratio (OR) = 1.0006, 95% Confidence Intervals (CI) = 1.0002–1.0009). Following adjusting for the confounding role of neighbourhood deprivation, this association was non-significant. Individuals who resided in the most deprived neighbourhoods had higher odds of overweight than individuals in the least deprived neighbourhoods (e.g., at age 11/12 OR = 1.95, 95% CIs = 1.64–2.32). Neighbourhood deprivation was also positively associated to the density of fast food outlets (at age 11/12 Incidence Rate Ratio = 3.03, 95% CIs = 2.80–3.28).

Impact of local air quality management policies on emergency hospitalisations for respiratory conditions in the North West Coast region of England: a longitudinal controlled ecological study

Background Air quality is monitored at a local level in the UK as part of the Local Air Quality Management (LAQM) system. If air quality objectives within an area are not achieved an Air Quality Management Area (AQMA) is declared and action plan developed. The efficacy of this system in reducing air pollution has increasingly come into question, however very little is known about its impact on health or health inequalities. We therefore investigated the effect of declaring an AQMA on emergency hospitalisations for respiratory conditions in the North West Coast region of England, and examined whether the effect differed between more compared to less deprived neighbourhoods. Methods This longitudinal controlled ecological study analysed neighbourhoods located within or touching the boundaries of AQMAs declared in the North West Coast region between 2006 and 2016. Each of these intervention neighbourhoods were matched with five control neighbourhoods which had never been located within/touching an AQMA boundary. Difference-in-differences methods were used to compare the change in hospitalisation rates in the intervention neighbourhoods to the change in hospitalisation rates in the matched control neighbourhoods, before and after the declaration of an AQMA. Results In total, 108 intervention neighbourhoods and 540 control neighbourhoods were analysed over the period 2005–2017, giving a total sample size of 8424 neighbourhood-years. Emergency hospitalisations for respiratory conditions decreased in the intervention neighbourhoods by 158 per 100,000 per year [95% CI 90 to 227] after an AQMA was declared relative to the control neighbourhoods. There was a larger decrease in hospitalisation rates following the declaration of an AQMA in more compared to less income deprived neighbourhoods. Conclusions Our results suggest the LAQM system has contributed to a reduction in emergency hospitalisations for respiratory conditions, and may represent an effective strategy to reduce inequalities in health. These findings highlight the importance of measuring the success of air quality policies not just in terms of air pollution but also in terms of population health.

Loneliness Among Migrants in Italy: Risks and Protectors

In this study we focused on migrants’ loneliness, in order to unpack risks for, and protective factors against, loneliness among migrants in Italy. Our data come from the ‘Social Condition and Integration among Foreign Citizens’ survey conducted by ISTAT during 2011–2012 on a sample of 25,000 individuals living in a household with at least one foreign-born member. Our results show that economic resources and employment protect from loneliness feelings, whereas education does not. Family and social embeddedness and satisfaction with life are protective factors, whereas discrimination, language barriers, deprived neighbourhoods and poor health are associated with a higher risk of loneliness. Gender is a key lens to consider when analysing loneliness especially in relation to fragile populations like those with a migratory background.

The promise of endogenous potential in times of crisis

The measures against the spread of the Covid-19 virus have massive effects on local economies. By means of an explorative qualitative case study in deprived neighbourhoods in the Middle Lower Rhine region of Germany, this paper explicitly aims at examining the Corona pandemic’s impact on their endogenous potential. In this context, the focus is on organisations whose main contribution lies in the fulfilment of the function of integration and communication. The analysis is based on theoretical concepts of the local economy, but it also refers to crisis as well as transition research, especially the multilevel perspective framework. By means of desktop research, a focus group with multipliers involved in local economic contexts as well as thirteen guideline-based interviews with the heads of local organisations, the subsequent analysis reveals the partially counteracting effects of the Corona pandemic on the organisations’ socio-economic embeddedness. On the one hand, they are threatened by economic bottlenecks, by pending social consequences of a longer period without or with minimized offerings as well as by fear of contagion and exhaustion. While the organisation’s perceived level of urgency varies greatly, their level of uncertainty is generally high. On the other hand, organisations of the local economy benefit from a positive push in the areas of digitization and new life and working environments (home-based work), as well as from a strengthening of local solidarity and cohesion.

Seroprevalence of anti-SARS-CoV-2 antibodies after the first wave of the COVID-19 pandemic in a vulnerable population in France: a cross-sectional study

ObjectivesWe aimed to assess the level of prior SARS-CoV-2 infection in socially deprived neighbourhoods after the first wave of the pandemic, and to identify factors associated with seropositivity.DesignA cross-sectional study.SettingThree socially deprived neighbourhoods of the city of Perpignan, in the south of France, where large settled Roma communities live.ParticipantsPeople aged 6 years old or over, living in the study area. 700 people were included in the study using two-stage stratified sampling design.InterventionsThe study included a questionnaire and SARS-CoV-2 antibody testing by the Roche Elecsys immunoassay between 29 June and 17 July 2020.Primary and secondary outcome measuresSARS-CoV-2 antibody seroprevalence was estimated from weighted data. Associated factors and reported symptoms were investigated using univariable and multivariable logistic regressions.ResultsThe seroprevalence of anti-SARS-CoV-2 antibodies was 35.4% (95% CI 30.2% to 41.0%). People aged 15–64 years old had increased odds of being seropositive than those aged 65 years or over. Obese people had higher odds of being seropositive (adjusted OR (aOR)=2.0, 95% CI 1.1 to 3.8). The odds of being seropositive were higher in households with clinical COVID-19 cases (one case: aOR=2.5, 95% CI 1.3 to 5.0; several cases: aOR=6.9, 95% CI 3.1 to 15.2). In the neighbourhood with the highest measured seroprevalence, people living in a dwelling with one to two rooms had higher odds of being seropositive than those living in a four-room house (aOR=2.8, 95% CI 1.2 to 6.3). Working during the lockdown was associated with lower odds of being seropositive (aOR=0.2, 95% CI 0.03 to 1.0).ConclusionTransmission of SARS-COV-2 in this vulnerable population was very high during the COVID-19 pandemic’s first wave. Our results highlight the need to strengthen and adapt preventive measures taking into account all social determinants of health, especially housing conditions.

Reminder system for health screening in early childhood – an analysis regarding different social circumstances

Background Children with a low socio-economic position (SEP) participate in prevention and health examinations less often. In order to increase participation, reminder systems have been implemented in Germany since 2009. The aim of the study is to investigate whether this implementation is associated with an increased participation in health examination in early childhood for children in disadvantaged social circumstances. Methods We used data from the school enrolment examination from 2002 to 2017 from the city of Duesseldorf (n = 64,883 children). With a trend analysis we observed health examination over time and we compared rates of children after implementation of the reminder system (2010 or later) to those who were not exposed to the programme (earlier than 2010). Health examination was measured by participation in the last examination before school entry (“U9”) documented by paediatricians. Social circumstances included neighbourhood deprivation (very high to very low), migration background (foreign first language vs. German) and family status (one-parent vs. two-parent families). Poisson regression estimated adjusted Prevalence Ratios (PR) with a 95% confidence interval (CI) of U9 participation by reminder system exposure, both for the total population and within groups of social circumstances. Based on that, we calculated adjusted participation rates (predictive margins) by reminder system exposure for the different social circumstances. Results Participation rates increased slightly, but gradually over time. The probability of U9 participation for children exposed to the reminder system is 1.04-fold (1.03–1.04 CI) compared to children who were not exposed to it. The association of the reminder system and U9 participation differs according to social circumstances. Adjusted prevalences increased the most in the group of children from very deprived neighbourhoods, ranging from 84.3 to 91.4% (PR = 1.07; 1.03–1.10 CI); in all language groups; more in children from one-parent families ranging from 82.4 to 88.9% (PR = 1.07; 1.05–1.09 CI). Conclusion Our results suggest that reminder systems have a moderate impact on the participation in health examinations in early childhood in the general population. In vulnerable groups, however, they could make a difference. Reminder systems should be combined with further activities of tailored prevention.

Associations between neighbourhood deprivation and engagement in arts, culture and heritage: evidence from two nationally-representative samples

Background Previous research has shown the benefits of arts and cultural engagement for physical, mental and social wellbeing. This engagement is socially and geographically patterned. Yet it remains unclear whether place-based attributes are associated with engagement behaviour independent of individual factors. Therefore, the aim of this cross-sectional study was to robustly disentangle associations between geographical deprivation and arts engagement from the individual socio-demographic factors that tend to correlate with residential locations. Methods Two different samples drawn from two representative surveys of adults living in England were compared – Understanding Society Wave 2 (2010/12) (N = 14,782) and Taking Part survey (2010/11) (N = 4575). Propensity score matching (PSM) was applied to investigate the association between neighbourhood deprivation (20% most deprived vs 20% least deprived) and arts engagement (arts participation, cultural attendance and museums and heritage engagement). Results Higher levels of neighbourhood deprivation were associated with lower arts, culture and heritage engagement independent of individuals’ demographic backgrounds, socio-economic characteristics and regional locations. When exploring subcategories of deprivation, similar results were obtained across deprivation domains. Results were also consistent when using more distinct categories of deprivation (i.e. 10% most deprived vs 10% least deprived) and when comparing people living in the 20% most deprived neighbourhoods with those living in the 40% medium-deprived areas. Conclusion This study is the first to apply a robust PSM technique to examine the association between neighbourhood deprivation and arts engagement using two nationally-representative samples. Results show that neighbourhood deprivation may act as a barrier that could prevent people from engaging in the arts, which in turn may exacerbate social and health inequalities. This highlights the importance of place-based schemes that focus on increasing individual motivation and capacity to engage in arts and cultural activities, especially in areas of high deprivation.

Asthma in Paediatric Intensive Care in England Residents: Observational Study

Purpose Despite high prevalence of asthma in children in the UK, there are no prior report on asthma admissions in paediatric intensive care units (PICU). Methods PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 till March 2013. Results There were 2,195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0-4 years. The fourth and fifth deprivation quintiles represented 61% (1,329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10-14 years age (n=11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and decreasing age (0-4-year-olds: 49%, 409/828). Conclusions This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

Where Do the Less Affluent Vote? The Effect of Neighbourhood Social Context on Individual Voting Intentions in England

A widely accepted finding in the literature on political participation is that individuals living in poorer neighbourhoods are less likely to vote than those living in more affluent neighbourhoods. Yet, why some poor residents of the most deprived neighbourhoods are more likely to vote than others is still understudied. This article presents a new theoretical framework arguing that when they believe that most others vote in the neighbourhood, poor citizens are more likely to follow their example than wealthy citizens. To empirically test these claims, I develop a two-level multilevel model using survey data and the Index of Multiple Deprivation for England. My findings point to the higher importance of a social norm of voting for the political behaviour of poor individuals than wealthy individuals. Social norms define which behaviour is right and proper. They are enforced through social interactions with others.