<p><strong>Background: </strong>Reducing private car use and increasing active travel is essential for transport decarbonisation and addressing public health crises of road traffic injuries, physical inactivity and air pollution. Low Traffic Neighbourhoods have emerged as a key intervention, particularly in London, United Kingdom, to create better environments for walking, wheeling and cycling by restricting through traffic on residential streets. While evidence suggests that Low Traffic Neighbourhoods reduce car use, increase walking and cycling, and improve road safety, their implementation has been politically contentious and has elicited a wide range of public reactions.</p><p><strong>Methods: </strong>This paper presents findings from the qualitative strand of a wider 3.5-year mixed-methods study of Low Traffic Neighbourhoods in London. Qualitative data were collected to explore the lived experiences of Low Traffic Neighbourhood residents, with a focus on how residents - including disabled residents - perceive and navigate the schemes. Participants were selected from among those living in or on the road adjacent to four selected Low Traffic Neighbourhoods, to ensure a diversity of views on the schemes, and diverse demographic characteristics were represented. Using 61 go-along interviews and 7 focus groups, we explore how Low Traffic Neighbourhoods influence residents' experiences and perceptions of travel.</p><p><strong>Results: </strong>Our findings show that residents' attitudes towards Low Traffic Neighbourhoods often shape their reported experiences: those who are initially supportive tend to notice and highlight positive impacts, while opponents are more likely to report no change or negative impacts. Overall, participants observed increased walking and cycling, improved perceptions of road safety, and reduced noise and air pollution within Low Traffic Neighbourhoods. However, concerns were raised by some disabled residents about longer journey times and accessibility problems. Notably, many residents living on boundary roads perceived an increase in traffic and pollution, although quantitative data on the impacts of Low Traffic Neighborhoods on boundary roads remain mixed.</p><p><strong>Conclusions: </strong>Our findings highlight the importance of considering residents' lived experiences in scheme evaluations. While Low Traffic Neighbourhoods contribute to climate and health objectives, their implementation should be guided by a just transition framework to ensure benefits are equitably distributed.</p><p><strong>Limitations and future work: </strong>Our study's main limitation is that it contributes to an evidence body of research on Low Traffic Neighbourhoods being predominantly from London. Future research should extend beyond London, explore a wider range of schemes and attend to experiences of further marginalised population groups.</p><p><strong>Funding: </strong>This article presents independent research funded by the National
{"title":"Resident experience of new Low Traffic Neighbourhoods in London: qualitative insights from a mixed methods study.","authors":"Harriet Myfanwy Larrington-Spencer, Ersilia Verlinghieri, Rachel Aldred, Emma Lawlor, Jamie Furlong","doi":"10.3310/GJEV0805","DOIUrl":"https://doi.org/10.3310/GJEV0805","url":null,"abstract":"<p><strong>Background: </strong>Reducing private car use and increasing active travel is essential for transport decarbonisation and addressing public health crises of road traffic injuries, physical inactivity and air pollution. Low Traffic Neighbourhoods have emerged as a key intervention, particularly in London, United Kingdom, to create better environments for walking, wheeling and cycling by restricting through traffic on residential streets. While evidence suggests that Low Traffic Neighbourhoods reduce car use, increase walking and cycling, and improve road safety, their implementation has been politically contentious and has elicited a wide range of public reactions.</p><p><strong>Methods: </strong>This paper presents findings from the qualitative strand of a wider 3.5-year mixed-methods study of Low Traffic Neighbourhoods in London. Qualitative data were collected to explore the lived experiences of Low Traffic Neighbourhood residents, with a focus on how residents - including disabled residents - perceive and navigate the schemes. Participants were selected from among those living in or on the road adjacent to four selected Low Traffic Neighbourhoods, to ensure a diversity of views on the schemes, and diverse demographic characteristics were represented. Using 61 go-along interviews and 7 focus groups, we explore how Low Traffic Neighbourhoods influence residents' experiences and perceptions of travel.</p><p><strong>Results: </strong>Our findings show that residents' attitudes towards Low Traffic Neighbourhoods often shape their reported experiences: those who are initially supportive tend to notice and highlight positive impacts, while opponents are more likely to report no change or negative impacts. Overall, participants observed increased walking and cycling, improved perceptions of road safety, and reduced noise and air pollution within Low Traffic Neighbourhoods. However, concerns were raised by some disabled residents about longer journey times and accessibility problems. Notably, many residents living on boundary roads perceived an increase in traffic and pollution, although quantitative data on the impacts of Low Traffic Neighborhoods on boundary roads remain mixed.</p><p><strong>Conclusions: </strong>Our findings highlight the importance of considering residents' lived experiences in scheme evaluations. While Low Traffic Neighbourhoods contribute to climate and health objectives, their implementation should be guided by a just transition framework to ensure benefits are equitably distributed.</p><p><strong>Limitations and future work: </strong>Our study's main limitation is that it contributes to an evidence body of research on Low Traffic Neighbourhoods being predominantly from London. Future research should extend beyond London, explore a wider range of schemes and attend to experiences of further marginalised population groups.</p><p><strong>Funding: </strong>This article presents independent research funded by the National","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-32"},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefan Reis, Rachel Beck, Ed Carnell, Ulrike Dragosits, Rosemary Green, Mike Holland, Megan Jones, Scott Jones, Alison McCann, Mark Miller, James Milner, Ai Milojevic, Tom Misselbrook, Angelica Orsi, Silvia Pastorino, Jennifer Raftis, Anoop Sv Shah, Massimo Vieno, Ryan Wereski
<p><strong>Methods: </strong>This study employed an interdisciplinary approach to assess the impact of agricultural production modifications and dietary changes on ammonia emissions, health outcomes and health inequalities. Statistical and econometric methods were applied to analyse agricultural emission trends and dietary patterns. Spatial data analysis and numerical modelling techniques were used to simulate the dispersion and transformation of atmospheric pollutants. Health impact modelling estimated mortality and morbidity outcomes under various policy scenarios, while cost-effectiveness and cost-benefit analyses supported decision-making. A participatory approach involving multistakeholder engagement was utilised to enhance policy relevance and implementation feasibility. A systematic scoping review of academic studies on agricultural-derived air pollution and clinically coded outcomes revealed very limited research on this topic, which presents an inconsistent picture as to whether agricultural-derived particulate matter affects health.</p><p><strong>Results: </strong>Key findings indicate that dietary modifications have greater potential health benefits than direct reductions in particulate matter exposure from ammonia emissions. Small reductions in meat and dairy consumption, supported by taxation and subsidies, could help achieve environmental and health targets. A 20% meat and dairy tax, coupled with a 20% subsidy on fruits and vegetables, could reduce meat consumption by 21.5% and increase fruit and vegetable intake by up to 13.5%. These dietary shifts also significantly lower greenhouse gas emissions and water use. While ammonia's environmental effects are well documented, its direct health impacts remain uncertain. Epidemiological studies suggest a possible association between ammonium-derived particulate matter and increased mortality and cardiorespiratory diseases, though findings are inconsistent. Toxicological assessments indicate limited intrinsic toxicity of ammonium nitrate and sulfate. A 'high-ambition mitigation' scenario integrating ammonia reduction measures with dietary shifts could prevent 67,000 premature deaths and 270,000 cases of respiratory diseases over 30 years. Notably, older adults and lower-income populations would experience the greatest health benefits. Most farm-based ammonia reduction strategies demonstrated net economic benefits, with only a few measures having limited abatement potential. Additionally, reduced greenhouse gas emissions further amplified the benefits of each scenario.</p><p><strong>Limitations: </strong>Despite robust modelling techniques and multistakeholder engagement, several limitations exist. The direct health effects of ammonia-derived particulate matter remain an area of uncertainty, necessitating further epidemiological research. Additionally, while economic and environmental benefits were quantified, behavioural responses to policy interventions - such as consumer acceptance of die
{"title":"Impact of local and national policies to reduce agriculture-related air pollution through improving diet and farm management: the AMPHoRA mixed methods study.","authors":"Stefan Reis, Rachel Beck, Ed Carnell, Ulrike Dragosits, Rosemary Green, Mike Holland, Megan Jones, Scott Jones, Alison McCann, Mark Miller, James Milner, Ai Milojevic, Tom Misselbrook, Angelica Orsi, Silvia Pastorino, Jennifer Raftis, Anoop Sv Shah, Massimo Vieno, Ryan Wereski","doi":"10.3310/GJSR2325","DOIUrl":"https://doi.org/10.3310/GJSR2325","url":null,"abstract":"<p><strong>Methods: </strong>This study employed an interdisciplinary approach to assess the impact of agricultural production modifications and dietary changes on ammonia emissions, health outcomes and health inequalities. Statistical and econometric methods were applied to analyse agricultural emission trends and dietary patterns. Spatial data analysis and numerical modelling techniques were used to simulate the dispersion and transformation of atmospheric pollutants. Health impact modelling estimated mortality and morbidity outcomes under various policy scenarios, while cost-effectiveness and cost-benefit analyses supported decision-making. A participatory approach involving multistakeholder engagement was utilised to enhance policy relevance and implementation feasibility. A systematic scoping review of academic studies on agricultural-derived air pollution and clinically coded outcomes revealed very limited research on this topic, which presents an inconsistent picture as to whether agricultural-derived particulate matter affects health.</p><p><strong>Results: </strong>Key findings indicate that dietary modifications have greater potential health benefits than direct reductions in particulate matter exposure from ammonia emissions. Small reductions in meat and dairy consumption, supported by taxation and subsidies, could help achieve environmental and health targets. A 20% meat and dairy tax, coupled with a 20% subsidy on fruits and vegetables, could reduce meat consumption by 21.5% and increase fruit and vegetable intake by up to 13.5%. These dietary shifts also significantly lower greenhouse gas emissions and water use. While ammonia's environmental effects are well documented, its direct health impacts remain uncertain. Epidemiological studies suggest a possible association between ammonium-derived particulate matter and increased mortality and cardiorespiratory diseases, though findings are inconsistent. Toxicological assessments indicate limited intrinsic toxicity of ammonium nitrate and sulfate. A 'high-ambition mitigation' scenario integrating ammonia reduction measures with dietary shifts could prevent 67,000 premature deaths and 270,000 cases of respiratory diseases over 30 years. Notably, older adults and lower-income populations would experience the greatest health benefits. Most farm-based ammonia reduction strategies demonstrated net economic benefits, with only a few measures having limited abatement potential. Additionally, reduced greenhouse gas emissions further amplified the benefits of each scenario.</p><p><strong>Limitations: </strong>Despite robust modelling techniques and multistakeholder engagement, several limitations exist. The direct health effects of ammonia-derived particulate matter remain an area of uncertainty, necessitating further epidemiological research. Additionally, while economic and environmental benefits were quantified, behavioural responses to policy interventions - such as consumer acceptance of die","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"14 3","pages":"1-120"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Niven, Martine Miller, James White, Leon Noble, Heather Wardle, Andrew Stoddart, David Griffiths, Christopher Weir, Hannah Ensor, Conor Maxwell, Freya Howell, Richard Purves, Fiona Dobbie
<p><strong>Background: </strong>Young people's engagement in gambling can be linked to gambling-related harm. There is a lack of independently funded and evidence-based school-based interventions that seek to prevent and reduce the harms associated with gambling.</p><p><strong>Objectives: </strong>To conduct a pilot cluster randomised controlled trial of a gambling prevention intervention (Preventing Gambling Related Harm in Adolescents) among young people aged 13-15 years to determine the utility of conducting a phase III randomised controlled trial assessing effectiveness and cost-effectiveness.</p><p><strong>Design and methods: </strong>Two-arm, pilot cluster randomised controlled trial with an embedded process evaluation, health economic scoping study and social network analysis.</p><p><strong>Setting: </strong>Six state schools across Scotland: four intervention and two control.</p><p><strong>Participants: </strong>Students aged 13-15 years (baseline: intervention <i>N</i> = 762 students, control <i>N</i> = 352 students. Follow-up: intervention <i>N</i> = 598 students, control <i>N</i> = 295 students).</p><p><strong>Intervention: </strong>Preventing Gambling Related Harm in Adolescents is a peer-led, social network intervention to prevent adolescent gambling and reduce gambling-related harm. Students, nominated by peers in their year group, attended a 2-day training workshop outside of school, which was delivered by trained youth workers. After completing the 2-day training workshop, students were then assigned the role of 'peer supporters'. Peer supporters then attended three in-school follow-up sessions, with the same youth workers, to refresh the learning they had received during the workshop. After the workshop and during the follow-up sessions, peer supporters were encouraged to have conversations about their learning on the topic of gambling and gambling-related harm with their friends and family. Social network maps were created by peer supporters to: (1) help them identify people to speak to and (2) record to who they spoke to about gambling and gambling-related harm.</p><p><strong>Main outcome measures: </strong>Progression to a full-scale Phase III cluster randomised control trial, using pre-set progression criteria. Progression criteria were: (1) successful recruitment of six schools; (2) five schools remain in the pilot study; (3) the intervention being delivered with 80% fidelity to the manual; (4) the process evaluation indicates the intervention is acceptable to students and staff and (5) 70% of students complete the student questionnaire at baseline and follow-up.</p><p><strong>Results: </strong>All five progression criteria were met. All schools were recruited and retained in the study and there were low levels of missing data on outcomes. The process evaluation indicated that Preventing Gambling Related Harm in Adolescents was acceptable to all stakeholders and was delivered with fidelity to the delivery manual. Some minor
{"title":"Preventing Gambling Related Harm in Adolescents: PRoGRAM - A pilot cluster RCT - Synopsis Report.","authors":"Angela Niven, Martine Miller, James White, Leon Noble, Heather Wardle, Andrew Stoddart, David Griffiths, Christopher Weir, Hannah Ensor, Conor Maxwell, Freya Howell, Richard Purves, Fiona Dobbie","doi":"10.3310/GJFD3715","DOIUrl":"https://doi.org/10.3310/GJFD3715","url":null,"abstract":"<p><strong>Background: </strong>Young people's engagement in gambling can be linked to gambling-related harm. There is a lack of independently funded and evidence-based school-based interventions that seek to prevent and reduce the harms associated with gambling.</p><p><strong>Objectives: </strong>To conduct a pilot cluster randomised controlled trial of a gambling prevention intervention (Preventing Gambling Related Harm in Adolescents) among young people aged 13-15 years to determine the utility of conducting a phase III randomised controlled trial assessing effectiveness and cost-effectiveness.</p><p><strong>Design and methods: </strong>Two-arm, pilot cluster randomised controlled trial with an embedded process evaluation, health economic scoping study and social network analysis.</p><p><strong>Setting: </strong>Six state schools across Scotland: four intervention and two control.</p><p><strong>Participants: </strong>Students aged 13-15 years (baseline: intervention <i>N</i> = 762 students, control <i>N</i> = 352 students. Follow-up: intervention <i>N</i> = 598 students, control <i>N</i> = 295 students).</p><p><strong>Intervention: </strong>Preventing Gambling Related Harm in Adolescents is a peer-led, social network intervention to prevent adolescent gambling and reduce gambling-related harm. Students, nominated by peers in their year group, attended a 2-day training workshop outside of school, which was delivered by trained youth workers. After completing the 2-day training workshop, students were then assigned the role of 'peer supporters'. Peer supporters then attended three in-school follow-up sessions, with the same youth workers, to refresh the learning they had received during the workshop. After the workshop and during the follow-up sessions, peer supporters were encouraged to have conversations about their learning on the topic of gambling and gambling-related harm with their friends and family. Social network maps were created by peer supporters to: (1) help them identify people to speak to and (2) record to who they spoke to about gambling and gambling-related harm.</p><p><strong>Main outcome measures: </strong>Progression to a full-scale Phase III cluster randomised control trial, using pre-set progression criteria. Progression criteria were: (1) successful recruitment of six schools; (2) five schools remain in the pilot study; (3) the intervention being delivered with 80% fidelity to the manual; (4) the process evaluation indicates the intervention is acceptable to students and staff and (5) 70% of students complete the student questionnaire at baseline and follow-up.</p><p><strong>Results: </strong>All five progression criteria were met. All schools were recruited and retained in the study and there were low levels of missing data on outcomes. The process evaluation indicated that Preventing Gambling Related Harm in Adolescents was acceptable to all stakeholders and was delivered with fidelity to the delivery manual. Some minor ","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"14 4","pages":"1-31"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Georgios Tsakos, Paul R Brocklehurst, Saif Syed, Michelle Harvey, Sana Daniyal, Sinead Watson, Nia Goulden, Anna Verey, Peter Cairns, Anja Heilmann, Zoe Hoare, Frank Kee, Joe Langley, Nat Lievesley, Ciaran O'Neill, Andrea Sherriff, Craig J Smith, Rebecca R Wassall, Richard G Watt, Gerald McKenna
<p><strong>Background: </strong>The National Institute for Health and Care Excellence guideline NG48 aims to maintain and improve the oral health of care home residents. However, evidence on oral health interventions among care home residents is weak. A co-design process with residents and care home staff refined National Institute for Health and Care Excellence guidance NG48 aspects to facilitate implementation. This study aimed to assess the feasibility of undertaking a large-scale definitive trial on this intervention. A parallel theoretically informed process evaluation explored factors affecting implementation. The feasibility of collecting data to inform a cost-consequence model was also explored.</p><p><strong>Methods: </strong>A pragmatic cluster randomised feasibility study with 12-month follow-up was undertaken in 22 care homes across two sites (London, Northern Ireland). Care homes were randomised into an intervention arm (<i>n</i> = 11) that received the National Institute for Health and Care Excellence guidance NG48-based complex oral health intervention, and a control arm (<i>n</i> = 11) that continued with routine practice. The complex intervention included a training package for care home staff in oral health promotion knowledge and skills; using the Oral Health Assessment Tool to assess residents' oral health needs; and a 'support worker assisted' daily toothbrushing regime with 1500 ppm fluoride toothpaste. Dentate residents aged 65 years or over without severe cognitive impairment were recruited, resulting in a sample of 119 participants. Assessments were undertaken at baseline and 12 months through clinical dental examination and questionnaires. A parallel process evaluation involved semistructured interviews to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention and intervention fidelity were also recorded. Economic evaluation or cost-consequence indicators were collected through interviews with stakeholders, survey and questionnaire data.</p><p><strong>Results: </strong>Eighty-four per cent of care homes and 88% of residents agreed to participate; 86% of care homes and 69% of residents were retained at 12-month follow-up. Researcher-collected data on clinical and subjective measures had successful completion rates, but completion rates were very low for the weekly symptoms checklist collected by care home staff. The process evaluation highlighted that most care homes were keen to participate, as accessing oral care provision was challenging. The values and beliefs of managers and staff within each care home were key to intervention adoption. Collecting outcomes relevant for cost-consequence modelling is feasible, therefore, supporting an economic evaluation alongside the definite trial. Residents' quality of life was identified as a key outcome for stakeholders, including care home managers.</p><p><strong>Limitations: </strong>As ethical approval was granted for care home r
{"title":"Improving the Oral Health of Older People In Care Homes: the TOPIC randomised feasibility study.","authors":"Georgios Tsakos, Paul R Brocklehurst, Saif Syed, Michelle Harvey, Sana Daniyal, Sinead Watson, Nia Goulden, Anna Verey, Peter Cairns, Anja Heilmann, Zoe Hoare, Frank Kee, Joe Langley, Nat Lievesley, Ciaran O'Neill, Andrea Sherriff, Craig J Smith, Rebecca R Wassall, Richard G Watt, Gerald McKenna","doi":"10.3310/GJGT0613","DOIUrl":"https://doi.org/10.3310/GJGT0613","url":null,"abstract":"<p><strong>Background: </strong>The National Institute for Health and Care Excellence guideline NG48 aims to maintain and improve the oral health of care home residents. However, evidence on oral health interventions among care home residents is weak. A co-design process with residents and care home staff refined National Institute for Health and Care Excellence guidance NG48 aspects to facilitate implementation. This study aimed to assess the feasibility of undertaking a large-scale definitive trial on this intervention. A parallel theoretically informed process evaluation explored factors affecting implementation. The feasibility of collecting data to inform a cost-consequence model was also explored.</p><p><strong>Methods: </strong>A pragmatic cluster randomised feasibility study with 12-month follow-up was undertaken in 22 care homes across two sites (London, Northern Ireland). Care homes were randomised into an intervention arm (<i>n</i> = 11) that received the National Institute for Health and Care Excellence guidance NG48-based complex oral health intervention, and a control arm (<i>n</i> = 11) that continued with routine practice. The complex intervention included a training package for care home staff in oral health promotion knowledge and skills; using the Oral Health Assessment Tool to assess residents' oral health needs; and a 'support worker assisted' daily toothbrushing regime with 1500 ppm fluoride toothpaste. Dentate residents aged 65 years or over without severe cognitive impairment were recruited, resulting in a sample of 119 participants. Assessments were undertaken at baseline and 12 months through clinical dental examination and questionnaires. A parallel process evaluation involved semistructured interviews to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention and intervention fidelity were also recorded. Economic evaluation or cost-consequence indicators were collected through interviews with stakeholders, survey and questionnaire data.</p><p><strong>Results: </strong>Eighty-four per cent of care homes and 88% of residents agreed to participate; 86% of care homes and 69% of residents were retained at 12-month follow-up. Researcher-collected data on clinical and subjective measures had successful completion rates, but completion rates were very low for the weekly symptoms checklist collected by care home staff. The process evaluation highlighted that most care homes were keen to participate, as accessing oral care provision was challenging. The values and beliefs of managers and staff within each care home were key to intervention adoption. Collecting outcomes relevant for cost-consequence modelling is feasible, therefore, supporting an economic evaluation alongside the definite trial. Residents' quality of life was identified as a key outcome for stakeholders, including care home managers.</p><p><strong>Limitations: </strong>As ethical approval was granted for care home r","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"14 5","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julian Pt Higgins, Francesca Spiga, Annabel L Davies, Jennifer C Palmer, Sarah Dawson, Deborah M Caldwell, Lucy Condon, Fiona B Gillison, Eve Tomlinson, Theresa Hm Moore, Katie Breheny, James Nobles, Sharea Ijaz, Jelena Savović, Rona M Campbell, Carolyn D Summerbell
<p><strong>Background: </strong>Childhood obesity is a major public health concern worldwide, yet the best way to prevent it remains unknown.</p><p><strong>Objective(s): </strong>To determine what types of intervention strategy are most effective at preventing the development of obesity in children aged 5-18 years, as measured by change in body mass index, and to determine whether interventions work differentially in children with different characteristics associated with inequities.</p><p><strong>Design: </strong>Systematic reviews and statistical evidence syntheses.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials of dietary and/or activity interventions that aimed to prevent overweight or obesity in children and young people aged 5-18 years and reported outcomes at least 12 weeks after baseline. Non-randomised evidence was identified through an overview of systematic reviews. Sources of inequity of interest were those defined by the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital) acronym: place, race/ethnicity, occupation (of parents), gender/sex, religion, education (of parents), socioeconomic status and social capital.</p><p><strong>Data sources: </strong>Updating of an existing Cochrane Review, searching bibliographic databases up to February 2023, including MEDLINE, EMBASE, PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials on the Cochrane Library, international trial registers and grey literature databases, and examining reference lists. Results subgrouped by inequity factors were sought directly from trialists.</p><p><strong>Review methods: </strong>Cochrane Reviews followed standard Cochrane procedures. The main statistical synthesis was informed by a novel analytic framework developed iteratively through discussions with children and young people, schoolteachers and public health professionals. Methodology was developed to analyse the data using multilevel metaregression. To examine the impact of inequity factors, we performed a two-stage meta-analysis of interactions, based on subgroup-level aggregate data collected directly from the trialists. We collected available information on intervention costs.</p><p><strong>Results: </strong>We included 172 trials in ages 5-11 and 74 in ages 12-18. In the main synthesis, of 204 trials from both reviews, we found interventions were effective on average (mean difference in standardised body mass index -0.037, 95% credible interval -0.053 to -0.022, which would correspond to a reduction in a proportion of 2.3% with obesity to a proportion of approximately 2.1%). Larger effects were associated with physical activity rather than dietary interventions, after 12 months of follow-up and in the older age group. The overview of non-randomised evidence included 24 systematic reviews, yielding mixed results. The inves
{"title":"Towards optimal public health interventions for preventing obesity in children: a synopsis of a novel evidence synthesis.","authors":"Julian Pt Higgins, Francesca Spiga, Annabel L Davies, Jennifer C Palmer, Sarah Dawson, Deborah M Caldwell, Lucy Condon, Fiona B Gillison, Eve Tomlinson, Theresa Hm Moore, Katie Breheny, James Nobles, Sharea Ijaz, Jelena Savović, Rona M Campbell, Carolyn D Summerbell","doi":"10.3310/AKHD0407","DOIUrl":"https://doi.org/10.3310/AKHD0407","url":null,"abstract":"<p><strong>Background: </strong>Childhood obesity is a major public health concern worldwide, yet the best way to prevent it remains unknown.</p><p><strong>Objective(s): </strong>To determine what types of intervention strategy are most effective at preventing the development of obesity in children aged 5-18 years, as measured by change in body mass index, and to determine whether interventions work differentially in children with different characteristics associated with inequities.</p><p><strong>Design: </strong>Systematic reviews and statistical evidence syntheses.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials of dietary and/or activity interventions that aimed to prevent overweight or obesity in children and young people aged 5-18 years and reported outcomes at least 12 weeks after baseline. Non-randomised evidence was identified through an overview of systematic reviews. Sources of inequity of interest were those defined by the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital) acronym: place, race/ethnicity, occupation (of parents), gender/sex, religion, education (of parents), socioeconomic status and social capital.</p><p><strong>Data sources: </strong>Updating of an existing Cochrane Review, searching bibliographic databases up to February 2023, including MEDLINE, EMBASE, PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials on the Cochrane Library, international trial registers and grey literature databases, and examining reference lists. Results subgrouped by inequity factors were sought directly from trialists.</p><p><strong>Review methods: </strong>Cochrane Reviews followed standard Cochrane procedures. The main statistical synthesis was informed by a novel analytic framework developed iteratively through discussions with children and young people, schoolteachers and public health professionals. Methodology was developed to analyse the data using multilevel metaregression. To examine the impact of inequity factors, we performed a two-stage meta-analysis of interactions, based on subgroup-level aggregate data collected directly from the trialists. We collected available information on intervention costs.</p><p><strong>Results: </strong>We included 172 trials in ages 5-11 and 74 in ages 12-18. In the main synthesis, of 204 trials from both reviews, we found interventions were effective on average (mean difference in standardised body mass index -0.037, 95% credible interval -0.053 to -0.022, which would correspond to a reduction in a proportion of 2.3% with obesity to a proportion of approximately 2.1%). Larger effects were associated with physical activity rather than dietary interventions, after 12 months of follow-up and in the older age group. The overview of non-randomised evidence included 24 systematic reviews, yielding mixed results. The inves","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"14 2","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Research in Children's Social Care in the United Kingdom operates in a framework that was initially designed to support medical research within healthcare settings. Although adaptations to this framework have been made for social care settings, our experience suggested that significant systemic and organisational challenges to conducting large-scale randomised controlled trials in fostering services in the United Kingdom still remain, which work against the likelihood of such studies being completed successfully. A further challenge we faced was that that many fostering services were relatively inexperienced with research and lacked the infrastructure to support it.</p><p><strong>Objective: </strong>To report on the opportunities, obstacles and challenges faced when conducting a trial evaluating foster care support in a children's social care setting and to describe how those working on this research project came together to adapt the existing systems and processes and overcome the challenges.</p><p><strong>Design: </strong>The Reflective Fostering Study was a randomised controlled trial evaluating an intervention to help foster carers care for the children they look after.</p><p><strong>Setting and participants: </strong>Local authority and independent fostering services in the United Kingdom. The main study recruited 524 foster carers and kinship carers. The main study was evaluating the Reflective Fostering Programme, a group intervention designed to improve reflective functioning in foster and kinship carers.</p><p><strong>Results: </strong>The main challenges identified in this study were lack of infrastructure, both within fostering organisations and outside, a lack of capacity, and on occasion, unnecessary bureaucracy. Working with fostering sites, the Clinical Research Network and across collaborating partners, we were able to make changes to existing processes so that the governance and oversight of the study were proportionate and the workload for our sites was minimised. Identifying likely departments to obtain key approvals, working with local Clinical Research Networks and providing templates made the site set-up process faster and supported recruitment.</p><p><strong>Limitations: </strong>The challenges reported were those encountered by a study that took place in fostering services in the United Kingdom. The challenges faced, and solutions identified, may not be mirrored in other sectors of children's social care, or other countries.</p><p><strong>Conclusions: </strong>Carrying out high-quality clinical trials within fostering services in the United Kingdom can face significant barriers. There has been a move to address these issues, but our study suggests that more could be done so that research in these settings increases. Ongoing review of the regulatory framework, which is designed to ensure best practice for research in children's social care, could ensure that research governance is proportiona
{"title":"Conducting a large-scale randomised controlled trial in children's social care: reflections on challenges, successes and lessons learned from the Reflective Fostering Study.","authors":"Karen Irvine, Beth Rider, Caroline Cresswell, Shayma Izzidien, Erika Sims, Caroline Smith, Rachael Stemp, Nick Midgley","doi":"10.3310/GJNM1603","DOIUrl":"https://doi.org/10.3310/GJNM1603","url":null,"abstract":"<p><strong>Background: </strong>Research in Children's Social Care in the United Kingdom operates in a framework that was initially designed to support medical research within healthcare settings. Although adaptations to this framework have been made for social care settings, our experience suggested that significant systemic and organisational challenges to conducting large-scale randomised controlled trials in fostering services in the United Kingdom still remain, which work against the likelihood of such studies being completed successfully. A further challenge we faced was that that many fostering services were relatively inexperienced with research and lacked the infrastructure to support it.</p><p><strong>Objective: </strong>To report on the opportunities, obstacles and challenges faced when conducting a trial evaluating foster care support in a children's social care setting and to describe how those working on this research project came together to adapt the existing systems and processes and overcome the challenges.</p><p><strong>Design: </strong>The Reflective Fostering Study was a randomised controlled trial evaluating an intervention to help foster carers care for the children they look after.</p><p><strong>Setting and participants: </strong>Local authority and independent fostering services in the United Kingdom. The main study recruited 524 foster carers and kinship carers. The main study was evaluating the Reflective Fostering Programme, a group intervention designed to improve reflective functioning in foster and kinship carers.</p><p><strong>Results: </strong>The main challenges identified in this study were lack of infrastructure, both within fostering organisations and outside, a lack of capacity, and on occasion, unnecessary bureaucracy. Working with fostering sites, the Clinical Research Network and across collaborating partners, we were able to make changes to existing processes so that the governance and oversight of the study were proportionate and the workload for our sites was minimised. Identifying likely departments to obtain key approvals, working with local Clinical Research Networks and providing templates made the site set-up process faster and supported recruitment.</p><p><strong>Limitations: </strong>The challenges reported were those encountered by a study that took place in fostering services in the United Kingdom. The challenges faced, and solutions identified, may not be mirrored in other sectors of children's social care, or other countries.</p><p><strong>Conclusions: </strong>Carrying out high-quality clinical trials within fostering services in the United Kingdom can face significant barriers. There has been a move to address these issues, but our study suggests that more could be done so that research in these settings increases. Ongoing review of the regulatory framework, which is designed to ensure best practice for research in children's social care, could ensure that research governance is proportiona","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver Lloyd-Houldey, Neisha Sundaram, Semina Michalopoulou, Joanna Sturgess, Rosa Legood, Oliver Carlile, Elizabeth Allen, Stephen Scott, Dasha Nicholls, Steven Hope, Lee Hudson, Deborah Christie, Andrew Briggs, Russell Viner, Chris Bonell
<p><strong>Background: </strong>Young people's mental health worsened during and since the coronavirus disease discovered in 2019 pandemic. School environments play a key role in young people's mental health. Learning Together for Mental Health is a whole-school intervention aiming to promote mental health in secondary schools, adapted from the previous Learning Together intervention which was found effective in reducing bullying and promoting mental health.</p><p><strong>Objective: </strong>To adapt Learning Together to increase focus on mental health so producing the Learning Together for Mental Health intervention and evaluate the appropriateness of conducting a Phase III trial of the Learning Together for Mental Health intervention regarding pre-defined progression criteria relating to the intervention and trial methods, and assessing intervention feasibility, reach and acceptability, feasibility of trial measures and procedures, potential mechanisms and possible harms.</p><p><strong>Design and methods: </strong>We conducted a feasibility study with baseline and follow-up surveys, process evaluation and economic-evaluation feasibility-testing.</p><p><strong>Setting and participants: </strong>One school participated in intervention adaptation. Our feasibility study included four state, mixed-sex secondary schools in southern England (one of which dropped out after baselines and was replaced with another). We recruited 640 year-7 (age 11-12) students at baseline survey and 566 year-10 (age 14-15) students at 12-month follow-up. Baseline and follow-up participants were different groups, as the focus was assessing feasibility for the age groups to be surveyed at baseline and follow-up in a Phase III randomised controlled trial. Twenty staff, 27 year-8 (age 12-13) students and 22 year-10 students participated in qualitative research as did two trainers and one external facilitator.</p><p><strong>Interventions: </strong>As part of our feasibility study, all schools received the Learning Together for Mental Health intervention for one academic school year.</p><p><strong>Main outcome measures: </strong>Pre-defined criteria for progression to a Phase III trial.</p><p><strong>Results: </strong>The intervention was successfully adapted from the previous intervention using public involvement. The trial met all criteria for progression to Phase III. The all-staff and in-depth restorative practice training were implemented with fidelity in all schools and all schools had at least two staff trained in-depth in restorative practice. Curriculum training was delivered with fidelity in three of four schools. The response rate to the baseline (needs) survey across the three participating schools was 79%. Progression required at least two schools to have delivered the curriculum with at least 50% fidelity, which was achieved; one of the two schools which delivered the curriculum reported over 80% fidelity and the other school reported over 75% fidelity. All stude
{"title":"Learning together to promote mental health and well-being in English secondary schools: LTMH study refinement and feasibility evaluation, a comprehensive synopsis.","authors":"Oliver Lloyd-Houldey, Neisha Sundaram, Semina Michalopoulou, Joanna Sturgess, Rosa Legood, Oliver Carlile, Elizabeth Allen, Stephen Scott, Dasha Nicholls, Steven Hope, Lee Hudson, Deborah Christie, Andrew Briggs, Russell Viner, Chris Bonell","doi":"10.3310/PFHR4141","DOIUrl":"https://doi.org/10.3310/PFHR4141","url":null,"abstract":"<p><strong>Background: </strong>Young people's mental health worsened during and since the coronavirus disease discovered in 2019 pandemic. School environments play a key role in young people's mental health. Learning Together for Mental Health is a whole-school intervention aiming to promote mental health in secondary schools, adapted from the previous Learning Together intervention which was found effective in reducing bullying and promoting mental health.</p><p><strong>Objective: </strong>To adapt Learning Together to increase focus on mental health so producing the Learning Together for Mental Health intervention and evaluate the appropriateness of conducting a Phase III trial of the Learning Together for Mental Health intervention regarding pre-defined progression criteria relating to the intervention and trial methods, and assessing intervention feasibility, reach and acceptability, feasibility of trial measures and procedures, potential mechanisms and possible harms.</p><p><strong>Design and methods: </strong>We conducted a feasibility study with baseline and follow-up surveys, process evaluation and economic-evaluation feasibility-testing.</p><p><strong>Setting and participants: </strong>One school participated in intervention adaptation. Our feasibility study included four state, mixed-sex secondary schools in southern England (one of which dropped out after baselines and was replaced with another). We recruited 640 year-7 (age 11-12) students at baseline survey and 566 year-10 (age 14-15) students at 12-month follow-up. Baseline and follow-up participants were different groups, as the focus was assessing feasibility for the age groups to be surveyed at baseline and follow-up in a Phase III randomised controlled trial. Twenty staff, 27 year-8 (age 12-13) students and 22 year-10 students participated in qualitative research as did two trainers and one external facilitator.</p><p><strong>Interventions: </strong>As part of our feasibility study, all schools received the Learning Together for Mental Health intervention for one academic school year.</p><p><strong>Main outcome measures: </strong>Pre-defined criteria for progression to a Phase III trial.</p><p><strong>Results: </strong>The intervention was successfully adapted from the previous intervention using public involvement. The trial met all criteria for progression to Phase III. The all-staff and in-depth restorative practice training were implemented with fidelity in all schools and all schools had at least two staff trained in-depth in restorative practice. Curriculum training was delivered with fidelity in three of four schools. The response rate to the baseline (needs) survey across the three participating schools was 79%. Progression required at least two schools to have delivered the curriculum with at least 50% fidelity, which was achieved; one of the two schools which delivered the curriculum reported over 80% fidelity and the other school reported over 75% fidelity. All stude","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"14 1","pages":"1-34"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linda J Cobiac, Cherry Law, Richard Smith, Steven Cummins, Harry Rutter, Mike Rayner, Oliver Mytton, Adam D M Briggs, Henning Tarp Jensen, Marcus Keogh-Brown, Jean Adams, Martin White, Peter Scarborough
<p><strong>Background: </strong>The United Kingdom Soft Drinks Industry Levy was introduced in April 2018, resulting both in changes in sugar levels in drinks and purchases of drinks. Both mechanisms could impact on the incidence and prevalence of raised body weight, diabetes and diet-related diseases, and therefore, have implications for economic costs to the health sector.</p><p><strong>Objectives: </strong>To model future impacts of the Soft Drinks Industry Levy on population health and health sector costs and to estimate net monetary benefit to the health system.</p><p><strong>Design and methods: </strong>Proportional multistate lifetable modelling study - open and closed cohort analyses.</p><p><strong>Setting and population: </strong>All children and adults in the United Kingdom.</p><p><strong>Intervention: </strong>The Soft Drinks Industry Levy is a two-tier levy of £0.18/l on drinks with between 5 and 8 g of total sugars/100 ml and of £0.24/l on drinks with ≥ 8 g of total sugars/100 ml.</p><p><strong>Main outcome measures: </strong>We evaluated impact of the sugar reduction on: (1) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050 and (2) lifetime population health (measured in quality-adjusted life-years), change in costs to the health sector and the resulting net monetary benefit.</p><p><strong>Data sources: </strong>We estimated a per person reduction in sugar from a previously published interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval 2.4 to 13.6) reduction in sugar at 1 year after implementation. Our multistate lifetable model is parameterised using data from population health monitoring surveys, the Global Burden of Disease project, the Human Mortality Database and the Office for National Statistics. Health sector costs were obtained from Department of Health and Social Care budget allocations.</p><p><strong>Results: </strong>The model predicts that the Soft Drinks Industry Levy will reduce the prevalence of overweight and obesity in the United Kingdom by 0.18% points (95% uncertainty interval: 0.059 to 0.31) for males and by 0.20% points (0.064 to 0.34) for females. In the first 10 years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000-600,000) dental caries, 12,000 (3700-20,000) cases of type 2 diabetes, 3800 (1200-6700) cases of cardiovascular diseases and 350 (110-590) cases of obesity-related cancer. For the current United Kingdom population, it is estimated that the Soft Drinks Industry Levy will add 200,000 quality-adjusted life-years (63,500-342,000) over their lifetime and avert £174 million (£53.6-319) in their costs of health care (discounted at United Kingdom Treasury rates). At a United Kingdom Treasury value of £60,000 per quality-adjusted life-year, it is estimated that the Soft Drinks Industry Levy will produce a net monetary benefit of £12.2 billion (£3.88-20.8) for the he
{"title":"Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study.","authors":"Linda J Cobiac, Cherry Law, Richard Smith, Steven Cummins, Harry Rutter, Mike Rayner, Oliver Mytton, Adam D M Briggs, Henning Tarp Jensen, Marcus Keogh-Brown, Jean Adams, Martin White, Peter Scarborough","doi":"10.3310/GJMW1501","DOIUrl":"https://doi.org/10.3310/GJMW1501","url":null,"abstract":"<p><strong>Background: </strong>The United Kingdom Soft Drinks Industry Levy was introduced in April 2018, resulting both in changes in sugar levels in drinks and purchases of drinks. Both mechanisms could impact on the incidence and prevalence of raised body weight, diabetes and diet-related diseases, and therefore, have implications for economic costs to the health sector.</p><p><strong>Objectives: </strong>To model future impacts of the Soft Drinks Industry Levy on population health and health sector costs and to estimate net monetary benefit to the health system.</p><p><strong>Design and methods: </strong>Proportional multistate lifetable modelling study - open and closed cohort analyses.</p><p><strong>Setting and population: </strong>All children and adults in the United Kingdom.</p><p><strong>Intervention: </strong>The Soft Drinks Industry Levy is a two-tier levy of £0.18/l on drinks with between 5 and 8 g of total sugars/100 ml and of £0.24/l on drinks with ≥ 8 g of total sugars/100 ml.</p><p><strong>Main outcome measures: </strong>We evaluated impact of the sugar reduction on: (1) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050 and (2) lifetime population health (measured in quality-adjusted life-years), change in costs to the health sector and the resulting net monetary benefit.</p><p><strong>Data sources: </strong>We estimated a per person reduction in sugar from a previously published interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval 2.4 to 13.6) reduction in sugar at 1 year after implementation. Our multistate lifetable model is parameterised using data from population health monitoring surveys, the Global Burden of Disease project, the Human Mortality Database and the Office for National Statistics. Health sector costs were obtained from Department of Health and Social Care budget allocations.</p><p><strong>Results: </strong>The model predicts that the Soft Drinks Industry Levy will reduce the prevalence of overweight and obesity in the United Kingdom by 0.18% points (95% uncertainty interval: 0.059 to 0.31) for males and by 0.20% points (0.064 to 0.34) for females. In the first 10 years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000-600,000) dental caries, 12,000 (3700-20,000) cases of type 2 diabetes, 3800 (1200-6700) cases of cardiovascular diseases and 350 (110-590) cases of obesity-related cancer. For the current United Kingdom population, it is estimated that the Soft Drinks Industry Levy will add 200,000 quality-adjusted life-years (63,500-342,000) over their lifetime and avert £174 million (£53.6-319) in their costs of health care (discounted at United Kingdom Treasury rates). At a United Kingdom Treasury value of £60,000 per quality-adjusted life-year, it is estimated that the Soft Drinks Industry Levy will produce a net monetary benefit of £12.2 billion (£3.88-20.8) for the he","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rabeea'h Waseem Aslam, Rhys Williams-Thomas, Julia Townson, Ruth Lewis, Jason Madan, G J Melendez-Torres, Fiona Lugg-Widger, Philip Pallmann, Rachel Brown, Chris Bonell, Gemma S Morgan, James White, Honor Young
<p><strong>Background: </strong>Adverse sexual health, dating and relationship violence, and sexual harassment are significant public health concerns, especially among young people. Sexually transmitted infection rates are at a 10-year high, and dating and relationship violence affects nearly half of young people. Further education provides a population-wide setting for delivering dating and relationship violence and sexual health interventions, but only a few interventions have been shown to be effective in further education.</p><p><strong>Objectives: </strong>To optimise intervention materials and identify refinements for the Sexual Health and Healthy Relationships for further education (SaFE) intervention, an intervention to improve sexual health and reduce dating and relationship violence and sexual harassment among young people attending further education. Optimised materials were used in a pilot cluster randomised controlled trial of SaFE. SaFE had three components: (1) onsite access to sexual health and relationship services in further education settings provided by sexual health nurses for 2 hours, 2 days per week; (2) publicity about onsite services and (3) further education staff training on how to promote sexual health and recognise and respond to dating and relationship violence and sexual harassment. This paper reports on the optimisation of the SaFE intervention materials.</p><p><strong>Design and methods: </strong>A multistage iterative process was used to optimise further education staff training and publicity materials. This involved a series of consultation and focus group feedback sessions.</p><p><strong>Setting and participants: </strong>In Stage 1, feedback was collected from the SaFE Trial Management Group. Stage 2 involved: (1) two focus groups; one with four further education staff and one with three further education students at one further education institution and (2) stakeholder consultation with seven experts. Stage 3 saw consultation with the Trial Steering Committee who had independent oversight of the study. The operational feasibility of the training was evaluated in Stage 4 through a trial run with further education safeguarding and well-being teams. Stage 5 comprised a final review of intervention material by the Trial Management Group. Stage 6 gained online feedback from a young people's advisory group. The study was conducted in England and Wales.</p><p><strong>Results: </strong>In Stage 1, Trial Management Group reviewers recommended improving clarity and factual accuracy, reducing the length of slide decks and adding content on sending explicit images. Stage 2 feedback from further education staff and students focused on training content addressing comprehensiveness, structure and visual design and training delivery addressing preferred training formats and opportunities for scenario-based learning. The Trial Steering Committee in Stage 3 advised on managing participant disclosures and reordering content. St
{"title":"Optimisation of a sexual health and healthy relationships intervention for Further Education in England and Wales (SaFE).","authors":"Rabeea'h Waseem Aslam, Rhys Williams-Thomas, Julia Townson, Ruth Lewis, Jason Madan, G J Melendez-Torres, Fiona Lugg-Widger, Philip Pallmann, Rachel Brown, Chris Bonell, Gemma S Morgan, James White, Honor Young","doi":"10.3310/AHDP8546","DOIUrl":"https://doi.org/10.3310/AHDP8546","url":null,"abstract":"<p><strong>Background: </strong>Adverse sexual health, dating and relationship violence, and sexual harassment are significant public health concerns, especially among young people. Sexually transmitted infection rates are at a 10-year high, and dating and relationship violence affects nearly half of young people. Further education provides a population-wide setting for delivering dating and relationship violence and sexual health interventions, but only a few interventions have been shown to be effective in further education.</p><p><strong>Objectives: </strong>To optimise intervention materials and identify refinements for the Sexual Health and Healthy Relationships for further education (SaFE) intervention, an intervention to improve sexual health and reduce dating and relationship violence and sexual harassment among young people attending further education. Optimised materials were used in a pilot cluster randomised controlled trial of SaFE. SaFE had three components: (1) onsite access to sexual health and relationship services in further education settings provided by sexual health nurses for 2 hours, 2 days per week; (2) publicity about onsite services and (3) further education staff training on how to promote sexual health and recognise and respond to dating and relationship violence and sexual harassment. This paper reports on the optimisation of the SaFE intervention materials.</p><p><strong>Design and methods: </strong>A multistage iterative process was used to optimise further education staff training and publicity materials. This involved a series of consultation and focus group feedback sessions.</p><p><strong>Setting and participants: </strong>In Stage 1, feedback was collected from the SaFE Trial Management Group. Stage 2 involved: (1) two focus groups; one with four further education staff and one with three further education students at one further education institution and (2) stakeholder consultation with seven experts. Stage 3 saw consultation with the Trial Steering Committee who had independent oversight of the study. The operational feasibility of the training was evaluated in Stage 4 through a trial run with further education safeguarding and well-being teams. Stage 5 comprised a final review of intervention material by the Trial Management Group. Stage 6 gained online feedback from a young people's advisory group. The study was conducted in England and Wales.</p><p><strong>Results: </strong>In Stage 1, Trial Management Group reviewers recommended improving clarity and factual accuracy, reducing the length of slide decks and adding content on sending explicit images. Stage 2 feedback from further education staff and students focused on training content addressing comprehensiveness, structure and visual design and training delivery addressing preferred training formats and opportunities for scenario-based learning. The Trial Steering Committee in Stage 3 advised on managing participant disclosures and reordering content. St","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jinshuo Li, Qi Wu, Steve Parrott, Sharon Cox, Francesca Pesola, Kirstie Soar, Rachel Brown, Allison Ford, Peter Hajek, Caitlin Notley, Deborah Robson, Emma Ward, Anna Varley, Charlotte Mair, Lauren McMillan, Jessica Lennon, Janine Brierley, Amy Edwards, Bethany Gardner, Allan Tyler, Linda Bauld, Lynne Dawkins
<p><strong>Background: </strong>While smoking is common among those experiencing homelessness, the effectiveness of an e-cigarette intervention to reduce smoking in this population is unclear.</p><p><strong>Objective: </strong>To determine the cost-effectiveness of providing an e-cigarette for smoking cessation in homeless support centres compared to usual care.</p><p><strong>Design and methods: </strong>A multicentre two-arm cluster randomised controlled trial, with data collection time points at baseline, 4, 12 and 24 weeks post baseline.</p><p><strong>Setting and participants: </strong>Adults (aged 18+) who smoked daily and accessed 32 homeless support centres across six areas of Great Britain received either e-cigarette intervention (<i>n</i> = 239 in 16 centres) or usual care (<i>n</i> = 236 in 16 centres) by centre (cluster) randomisation.</p><p><strong>Intervention: </strong>The intervention was the provision of an e-cigarette starter kit plus 4 weeks' supply of e-liquids. The usual care comprised very brief advice for smoking cessation and signposting to local Stop Smoking Services.</p><p><strong>Main outcome measures: </strong>The total costs included costs of intervention/usual care, costs of smoking cessation outside of the trial and costs of general healthcare services use over 24 weeks. Quality-adjusted life-years were derived from EuroQol-5 Dimensions, five-level version administered at each data collection point. An incremental cost-effectiveness ratio was calculated for 24 weeks using the difference between groups in total costs and quality-adjusted life-years, with cost-effectiveness acceptability curve constructed based on bootstrap to examine uncertainty. A long-term model was employed to project a lifetime incremental cost-effectiveness ratio with probabilistic sensitivity analysis to examine uncertainty.</p><p><strong>Data sources: </strong>The analysis over 24 weeks was based on research team records and data collected via self-reported questionnaires. Unit costs for valuation were extracted from published secondary sources. The parameters of the long-term model were based on the 24-week results and published secondary sources.</p><p><strong>Results: </strong>Mean intervention costs were estimated at £92 [standard error (SE) £0] per participant and mean usual care costs at £50 (SE £0) per participant. Mean total costs per participant were estimated at £3859 (SE £441) in the e-cigarette group and £2716 (SE £386) in the usual care group. Mean quality-adjusted life-years were estimated at 0.303 (SE 0.008) in the e-cigarette group and 0.295 (SE 0.010) in the usual care group. Adjusting for baseline covariates and respective baseline values, e-cigarette group were £1267 (95% confidence interval £600 to £1938) more costly and yielded 0.007 (95% confidence interval -0.017 to 0.027) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was calculated at £181,000 per quality-adjusted life-year gai
{"title":"Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH cRCT.","authors":"Jinshuo Li, Qi Wu, Steve Parrott, Sharon Cox, Francesca Pesola, Kirstie Soar, Rachel Brown, Allison Ford, Peter Hajek, Caitlin Notley, Deborah Robson, Emma Ward, Anna Varley, Charlotte Mair, Lauren McMillan, Jessica Lennon, Janine Brierley, Amy Edwards, Bethany Gardner, Allan Tyler, Linda Bauld, Lynne Dawkins","doi":"10.3310/GJLD2428","DOIUrl":"https://doi.org/10.3310/GJLD2428","url":null,"abstract":"<p><strong>Background: </strong>While smoking is common among those experiencing homelessness, the effectiveness of an e-cigarette intervention to reduce smoking in this population is unclear.</p><p><strong>Objective: </strong>To determine the cost-effectiveness of providing an e-cigarette for smoking cessation in homeless support centres compared to usual care.</p><p><strong>Design and methods: </strong>A multicentre two-arm cluster randomised controlled trial, with data collection time points at baseline, 4, 12 and 24 weeks post baseline.</p><p><strong>Setting and participants: </strong>Adults (aged 18+) who smoked daily and accessed 32 homeless support centres across six areas of Great Britain received either e-cigarette intervention (<i>n</i> = 239 in 16 centres) or usual care (<i>n</i> = 236 in 16 centres) by centre (cluster) randomisation.</p><p><strong>Intervention: </strong>The intervention was the provision of an e-cigarette starter kit plus 4 weeks' supply of e-liquids. The usual care comprised very brief advice for smoking cessation and signposting to local Stop Smoking Services.</p><p><strong>Main outcome measures: </strong>The total costs included costs of intervention/usual care, costs of smoking cessation outside of the trial and costs of general healthcare services use over 24 weeks. Quality-adjusted life-years were derived from EuroQol-5 Dimensions, five-level version administered at each data collection point. An incremental cost-effectiveness ratio was calculated for 24 weeks using the difference between groups in total costs and quality-adjusted life-years, with cost-effectiveness acceptability curve constructed based on bootstrap to examine uncertainty. A long-term model was employed to project a lifetime incremental cost-effectiveness ratio with probabilistic sensitivity analysis to examine uncertainty.</p><p><strong>Data sources: </strong>The analysis over 24 weeks was based on research team records and data collected via self-reported questionnaires. Unit costs for valuation were extracted from published secondary sources. The parameters of the long-term model were based on the 24-week results and published secondary sources.</p><p><strong>Results: </strong>Mean intervention costs were estimated at £92 [standard error (SE) £0] per participant and mean usual care costs at £50 (SE £0) per participant. Mean total costs per participant were estimated at £3859 (SE £441) in the e-cigarette group and £2716 (SE £386) in the usual care group. Mean quality-adjusted life-years were estimated at 0.303 (SE 0.008) in the e-cigarette group and 0.295 (SE 0.010) in the usual care group. Adjusting for baseline covariates and respective baseline values, e-cigarette group were £1267 (95% confidence interval £600 to £1938) more costly and yielded 0.007 (95% confidence interval -0.017 to 0.027) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was calculated at £181,000 per quality-adjusted life-year gai","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-45"},"PeriodicalIF":0.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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