An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England

Objective: To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people. Design: Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation. Setting: Middlesbrough and Redcar and Cleveland in South Teesside. Participants: N/A Results: 832 advertisements were identified, almost half (48.9%) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35.1% were less healthy. Most food advertisements (98.9%) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years (71.9%). No differences in healthiness of advertised foods were found by level of deprivation. Conclusions: Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

Socioeconomic patterning of food and drink advertising at public transport stops in Edinburgh, UK

Objective: Outdoor advertisements for food and drink products form a large part of the food environment and they disproportionately promote unhealthy products. However, less is known about the social patterning of such advertisements. The main aim of this study was to explore the socioeconomic patterning of food and drink advertising at bus stops in Scotland’s capital city, Edinburgh. Design: Bus stop advertisements were audited to identify food/drink adverts and classify them by food/drink category (i.e. ‘advert category’). This data was then linked to area-based deprivation and proximity measures. Neighbourhood deprivation was measured using the bus stop x/y co-ordinates, which were converted to postcodes to identify the matching 2012 deprivation level via the Scottish Index of Multiple Deprivation (SIMD). Distance to schools and leisure centres were also collected using location data. Generalized Estimating Equations (GEE) and linear regression analyses were used to assess associations between the promotion of advert categories and deprivation and proximity to schools/leisure centres, respectively. Setting: Edinburgh city, United Kingdom Results: 561 food/drink advertisements were identified across 349 bus stops, with eight advertisement categories noted and included in the final analysis, including alcohol, fast food outlets and confectionary. The majority of adverts were for ‘unhealthy’ food and drink categories, however there was no evidence for any socioeconomic patterning of these advertisements. There was no evidence of a relationship between advertisements and proximity to schools and leisure centres. Conclusions: While there is no evidence for food and drink advertising being patterned by neighbourhood deprivation, the scale of unhealthy advertising is an area for policy evaluations and interventions on the control of such outdoor advertising.

A national population-based study of patients, bystanders and contextual factors associated with resuscitation in witnessed cardiac arrest: insight from the french RéAC registry

Background In out-of-hospital cardiac arrest (OHCA), bystander initiated cardiopulmonary resuscitation (CPR) increases the chance of return of spontaneous circulation and survival with a favourable neurological status. Socioeconomic disparities have been highlighted in OHCA field. In areas with the lowest average socioeconomic status, OHCA incidence increased, and bystander CPR decreased. Evaluations were performed on restricted geographical area, and European evaluation is lacking. We aimed to analyse, at a national level, the impact of area-level social deprivation on the initiation of CPR in case of a witnessed OHCA. Methods We included all witnessed OHCA cases with age over 18 years from July 2011 to July 2018 form the OHCA French national registry. We excluded OHCA occurred in front of rescue teams or in nursing home, and patients with incomplete address or partial geocoding. We collected data from context, bystander and patient. The area-level social deprivation was estimated by the French version of the European Deprivation Index (in quintile) associated with the place where OHCA occurred. We assessed the associations between Utstein variables and social deprivation level using a mixed-effect logit model with bystander-initiated CPR. Results We included 23,979 witnessed OHCA of which 12,299 (51%) had a bystander-initiated CPR. More than one third of the OHCA (8,326 (35%)) occurred in an area from the highest quintile of social deprivation. The higher the area-level deprivation, the less the proportion of bystander-initiated CPR (56% in Quintile 1 versus 48% in Quintile 5). The In the multivariable analysis, bystander less often began CPR in areas with the highest deprivation level, compared to those with the lowest deprivation level (OR=0.69, IC95%: 0.63-0.75). Conclusions The level of social deprivation of the area where OHCA occurred was associated with bystander-initiated CPR. It decreased in the more deprived areas although these areas also concentrate more younger patients.

COVID-19 Inequalities: Individual and Area Socioeconomic Factors (Aragón, Spain)

It is essential to understand the impact of social inequalities on the risk of COVID-19 infection in order to mitigate the social consequences of the pandemic. With this aim, the objective of our study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. We conducted a retrospective cohort study and included data from all individuals tested for COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals) in Aragón (Spain). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area of residence (deprivation level and type of zone). Inequalities in the risk of COVID-19 confirmed infection were observed at both the individual and area level. There was a predominance of low-paid employees living in deprived areas. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥ €18,000 per year. Inequalities were greater in women and in the second wave. The deprivation level of areas of residence influenced the risk of COVID-19 infection, especially in the second wave. It is necessary to develop individual and area coordinated measures by areas in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.

Socioeconomic Inequalities in COVID-19 Confirmed Infection Across Three Waves. A Multilevel Approach in a Southern European Region

Background: The aim of our study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. Methods: Retrospective cohort study. We included data from all individuals tested by COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area (BHA) of residence (deprivation level and type of zone). Results: Patient profile changed through the pandemic, with a predominance of low-paid employees living in deprived BHA. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥€18,000 per year. Inequalities were higher in women and in the second wave. The deprivation level of BHA of residence influenced the risk of COVID-19 infection, especially in the second wave. Conclusions: There are inequalities in the risk of COVID-19 confirmed infection, both at individual and area level. It is necessary to develop individual and area coordinated measures in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.

318 Area Deprivation and Sleep Health among White, Black, and Hispanic/Latina Women

Introduction Although neighborhood environments have been shown to affect sleep health, few studies have directly measured multiple indicators of both neighborhood deprivation and sleep while considering modification by race/ethnicity. Methods Among 49,833 eligible U.S. women enrolled in the Sister Study from 2003 to 2009, we investigated associations between neighborhood deprivation (e.g., percentage of residents unemployed, household crowding) and multiple sleep dimensions. Participants’ addresses were linked to U.S. census block group level Area Deprivation Index rankings (range: 1–100) for the year 2000, and participant rankings were divided into quintiles where the highest quintile represented the highest deprivation level. Participants self-reported habitual sleep duration, sleep debt, frequent napping, and insomnia symptoms. Adjusting for sociodemographic and clinical characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions among participants within quintiles (Qs) 2–5 vs. Q1. Interaction terms were used to assess modification by race/ethnicity. Results Mean age ± standard deviation was 55 ± 9 years. Women with higher neighborhood deprivation were more likely to self-identify as a racial/ethnic minority and had higher unadjusted prevalence of poor sleep dimensions. After adjustment, higher ADI was positively associated with very short sleep (≤5 hours), and race/ethnicity was a modifier (e.g., race-stratified results for Q5 vs. Q1:PRWhite=1.31 [95% CI: 1.14–1.51], PRBlack=0.91 [0.71–1.18], PRHispanic/Latina= 1.17 [0.68–2.04], p-interaction <0.05). Although race/ethnicity did not modify remaining associations, women with higher neighborhood deprivation also had a higher prevalence of sleep debt, frequent napping, and insomnia symptoms. When compared to White women with the lowest neighborhood deprivation, Black women across all deprivation levels and Hispanic/Latina women in Q2-Q5 were substantially more likely to report each poor sleep dimension (PR range: 1.21 to 5.01). Conclusion A multidimensional measure of neighborhood deprivation was associated with poor sleep and sleep disparities among a diverse cohort of U.S. women. Support (if any):

Are the effects of air pollution on birth weight modified by infant sex and neighborhood socioeconomic deprivation? A multilevel analysis in Paris (France)

Adverse birth outcomes related to air pollution are well documented; however, few studies have accounted for infant sex. There is also scientific evidence that the neighborhood socioeconomic profile may modify this association even after adjusting for individual socioeconomic characteristics. The objective is to analyze the association between air pollution and birth weight by infant sex and neighborhood socioeconomic index. All birth weights (2008–2011) were geocoded at census block level. Each census block was assigned a socioeconomic deprivation level, as well as daily NO2 and PM10 concentrations. We performed a multilevel model with a multiple statistical test and sensible analysis using the spline function. Our findings suggest the existence of a differential association between air pollution and BW according to both neighborhood socioeconomic level and infant sex. However, due to multiple statistical tests and controlling the false discovery rate (FDR), all significant associations became either not statistically significant or borderline. Our findings reinforce the need for additional studies to investigate the role of the neighborhood socioeconomic which could differentially modify the air pollution effect.

How material deprivation impacted economic stress across European countries during the great recession. A lesson on social comparisons

The development of a common standard of consumption is one goal of the ongoing harmonization of the EU member states’ economies. As a result, the degree to which household deprivation affects people’s economic stress should converge. Based on comparison theory, such convergence could be one indicator for Europe growing together (‘Europeanization’). The association between deprivation and economic stress is tested across and between 28 EU countries with EU-SILC data. Moreover, it is examined whether this association changed between 2007 and 2015, as the great recession starting in 2008 affected European countries differently. The results show that, given a certain level of household deprivation, people judge their situation differently across Europe. Whereas economic stress levels are higher in relatively poor countries, the deprivation-stress link is stronger in rich countries. Across-time comparisons suggest no decline in the extent to which a country’s deprivation level moderated the effect of household deprivation on economic stress. The findings support the persistence of national reference groups against which individuals judge their own economic situation.