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School-level variation in children's moderate to vigorous intensity physical activity before and after COVID-19: a multilevel model analysis. COVID-19 前后儿童中等强度到高强度体育锻炼在学校层面的变化：多层次模型分析。
Public health research (Southampton, England)
Pub Date : 2024-10-02 DOI: 10.3310/WQJK9893
Ruth Salway, Danielle House, Robert Walker, Lydia Emm-Collison, Katie Breheny, Kate Sansum, Joanna G Williams, William Hollingworth, Frank de Vocht, Russell Jago
<p><strong>Background and objectives: </strong>Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children's physical activity and the school environment. It is essential to understand between-school differences in children's physical activity post lockdown, to determine if and how the role of schools has changed.</p><p><strong>Design and participants: </strong>Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10-11 pre-COVID-19 (2017-8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively.</p><p><strong>Methods: </strong>Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors.</p><p><strong>Results: </strong>Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2.</p><p><strong>Limitations: </strong>Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were
背景和目标：学校在促进儿童体育锻炼方面起着至关重要的作用，但 COVID-19 大流行对儿童的体育锻炼和学校环境都产生了影响。有必要了解学校封锁后儿童体育活动的校际差异，以确定学校的作用是否以及如何发生了变化：Active-6是一项自然实验，将封锁后加速度计估算的体育活动与COVID-19前的比较组进行比较。我们收集了 1296 名年龄在 10-11 岁的儿童的加速度计和个人数据，这些数据是在 COVID-19 前（2017-8 年）收集的，并从他们就读的 50 所学校收集了学校特征。封锁后，我们分别于 2021 年（第 1 波）和 2022 年（第 2 波）收集了 23 所相同学校的 393 名儿童和 27 所相同学校的 436 名儿童的加速度计、个人和学校数据：我们使用线性混合效应模型，利用学校层面的波次随机系数，对每个波次的儿童平日中等强度至剧烈运动的变化来源（学校间、学生间和学生内）进行了建模。我们对模型进行了扩展，以估算学校政策、课程和物理环境因素以及学校分类学生特征所解释的校际差异比例。我们还探讨了个人或学校因素对停课后中度到剧烈运动的影响程度：结果：校际间的差异占 COVID-19 前总差异的 13%，第一波为 7%，第二波为 13%。与中度至剧烈运动相关的学校因素如下：体育课是否因场地问题而受到影响（经常：中度至剧烈运动时间减少 9 分钟；有时：减少 5.4 分钟）；高年级学生的体育课时间减少（经常：中度至剧烈运动时间减少 9 分钟；有时：减少 5.4 分钟5.4 分钟）；课后俱乐部参加率高（学校平均每多参加一个俱乐部，中度至剧烈运动时间就多出 7 分钟）；自行车训练政策（中度至剧烈运动时间多出 4 分钟）；以及积极出行的普及率高（普及率每提高 10%，中度至剧烈运动时间就多出 1 分钟）。这些因素解释了《COVID-19》前校际差异的 22%，在第二波中解释了 72%。相对重要性发生了变化，COVID-19 前，自行车训练政策和积极出行最为重要，而在第二波中，自行车训练政策、积极的课后俱乐部和妥协的体育教育空间最为重要。没有发现任何因素可以调节停课后中度到剧烈运动的差异，但体育空间不足除外，因为在第 2 波中，体育空间不足具有抑制作用：局限性：在最初的 50 所学校中，只有 27 所参加了封锁后的调查，这限制了我们进行跨波比较的能力。此外，一些变量的数据缺失也影响了样本量：尽管学校在促进儿童体育锻炼方面仍发挥着重要作用，但在 COVID-19 后，促进体育锻炼的因素发生了变化，自行车训练、活跃的课后俱乐部以及确保体育课在空间有限的情况下也能得到优先考虑，这些因素现在可以解释儿童中度至剧烈体育锻炼校际差异中近四分之三的原因。以这些领域为重点的学校干预措施以及支持这些措施的政策，可能会为增加儿童体育活动提供潜力：本文为独立研究，由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助，奖励编号为NIHR131847。
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引用次数: 0
Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study. 英国 COVID-19 病毒锁定后短期和中期阶段的生活质量、能力福祉、经济压力和体育活动：重复横断面研究。
Public health research (Southampton, England)
Pub Date : 2024-09-25 DOI: 10.3310/LYJG6305
Katie Breheny, Ruth Salway, Danielle House, Robert Walker, Lydia Emm-Collison, Kate Sansum, Joanna G Williams, Frank de Vocht, Russell Jago, William Hollingworth
<p><strong>Background: </strong>The COVID-19 lockdowns had negative effects on children's and adults' mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being.</p><p><strong>Methods: </strong>Cross-sectional data were collected in May-December 2021 (Wave 1) and January-July 2022 (Wave 2). Children (aged 10-11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability well-being (adults - ICECAP-A) and family financial strain (adults - Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored.</p><p><strong>Results: </strong>Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA.</p><p><strong>Limitations and future work: </strong>Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL.</p><p><strong>Conclusions: </strong>There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the U
背景：COVID-19 封锁对儿童和成人的身心健康产生了负面影响。然而，很少有研究探讨 COVID-19 封锁解除后，随着时间的推移，与健康相关的生活质量（HRQL）和幸福感的差异。封锁期间的休假、失业率的上升以及新出现的生活费用危机都给家庭经济带来了压力，这可能会对生活质量和幸福感产生不利影响。这项研究是更广泛的 "Active-6 "研究的一部分，它探讨了停工后心血管健康质量、能力幸福感和家庭经济压力的变化情况，这些结果之间的关系，以及体育锻炼是否对心血管健康质量和能力幸福感的差异有任何调节作用：横断面数据收集于 2021 年 5 月至 12 月（第 1 波）和 2022 年 1 月至 7 月（第 2 波）。每波分别从 23 至 27 所学校招募了 10-11 岁的儿童及其父母/监护人，并填写了测量 HRQL（成人--EQ-5D-5L，儿童--CHU9D）、能力幸福感（成人--ICECAP-A）和家庭经济压力（成人--家庭经济压力量表，FESS）的有效问卷。儿童也填写了有关能力幸福感的问题。使用加速度计测量了平日中等强度到高强度体力活动（MVPA）的分钟数。混合效应回归模型根据性别、年龄组（仅限成人）、IMD 和最高家庭教育程度进行调整，以探讨不同波次之间在 HRQL 和能力幸福感方面的差异。此外，还探讨了经济压力的调节作用和 MVPA 对 HRQL 和能力幸福感的中介作用：Active-6 第 1 波招募了 393 对亲子，第 2 波招募了 436 对亲子。不同波次之间的 HRQL（EQ-5D、CHU9D）和能力幸福感（ICECAP-A）得分没有差异，但与第 1 波次相比，第 2 波次的经济压力更严重（FESS 分数差异为 1.14，调整后 95% CI 为 0.15 至 2.12）。经济压力的增加与 EQ-5D-5L、CHU9D 和 ICECAP-A 分数的降低（恶化）有关。没有证据表明 MVPA 有中介效应：未收集COVID-19前的HRQL数据，因此分析仅限于锁定后。参与研究的家长以女性为主，社会经济地位较低的群体参与度较低，这限制了我们探讨不平等现象的能力。在 COVID-19 恢复期间，为增加体育锻炼和健康福祉而制定的干预计划应考虑到家庭正在经历的经济压力以及经济压力对 HRQL 的负面影响：在 2021 年解除封锁和一年后的 2022 年解除封锁后，儿童和成人的 HRQL 和能力福祉没有差异。研究结果表明，经济压力越来越大，这可能反映了英国的 "生活成本危机"：本文是由英国国家健康与护理研究所（NIHR）公共卫生研究项目资助的独立研究，获奖编号为NIHR131847。
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引用次数: 0
East London Project: a participatory mixed-method evaluation on how removing enforcement could affect sex workers' safety, health and access to services in East London. 东伦敦项目：参与式混合方法评价取消执法如何影响东伦敦性工作者的安全、健康和获得服务的机会。
Public health research (Southampton, England)
Pub Date : 2024-09-11 DOI: 10.3310/GFVC7006
Pippa Grenfell, Jocelyn Elmes, Rachel Stuart, Janet Eastham, Josephine Walker, Chrissy Browne, Carolyn Henham, M Paz Hernandez Blanco, Kathleen Hill, Sibongile Rutsito, Maggie O'Neill, M D Sarker, Sarah Creighton, Peter Vickerman, Marie-Claude Boily, Lucy Platt
<p><strong>Background: </strong>Sex workers' risk of violence and ill-health is shaped by their work environments, community and structural factors, including criminalisation.</p><p><strong>Aim: </strong>We evaluated the impact of removing police enforcement on sex workers' safety, health and access to services.</p><p><strong>Design: </strong>Mixed-methods participatory study comprising qualitative research, a prospective cohort study, mathematical modelling and routine data collation.</p><p><strong>Setting: </strong>Three boroughs in London, UK.</p><p><strong>Participants: </strong>People aged ≥ 18 years, who provided in-person sexual services.</p><p><strong>Interventions: </strong>Simulated removal of police enforcement.</p><p><strong>Outcomes: </strong>Primary - recent or past experience of sexual, physical or emotional violence. Secondary - depression/anxiety symptoms, physical health, chlamydia/gonorrhoea, and service access.</p><p><strong>Results: </strong>A combination of enforcement by police, local authorities and immigration, being denied justice when reporting violence, and linked cuts to specialist health and support services created harmful conditions for sex workers. This disproportionately affected cisgender and transgender women who work on the streets, use drugs, are migrants and/or women of colour. Among women (<i>n</i> = 197), street-based sex workers experienced higher levels than indoor sex workers of recent violence from clients (73% vs. 36%), police (42% vs. 7%) and others (67% vs. 17%); homelessness (65% vs. 7%); anxiety and depression (71% vs 35%); physical ill-health (57% vs 31%); and recent law enforcement (87% vs. 9%). For street-based sex workers, recent arrest was associated with violence from others (adjusted odds ratio (AOR)) 2.77, 95% confidence interval (CI) 1.11 to 6.94). Displacement by police was associated with client violence (AOR 4.35; 95% CI 1.36 to 13.90) as were financial difficulties (AOR 4.66; CI 1.64 to 13.24). Among indoor sex workers, unstable residency (AOR 3.19; 95% CI 1.36 to 7.49) and financial difficulties (AOR 3.66; 95% CI 1.64 to 8.18) contributed to risk of client violence. Among all genders (<i>n</i> = 288), ethnically and racially minoritised sex workers (26.4%) reported more police encounters than white sex workers, partly linked to increased representation in street settings (51.4% vs. 30.7%; <i>p</i> = 0.002) but associations remained after adjusting for work setting. Simulated removal of police displacement and homelessness was associated with a 71% reduction in violence (95% credible interval 55% to 83%). Participants called for a redirection of funds from enforcement towards respectful, peer-led services.</p><p><strong>Limitations: </strong>Restriction to one urban locality prevents generalisability of findings. More interviews with under-represented participants (e.g. trans/non-binary sex workers) may have yielded further insights into inequities. Correlation between different risk
背景：性工作者遭受暴力和健康状况不佳的风险是由其工作环境、社区和结构性因素（包括定罪）决定的。目的：我们评估了取消警察执法对性工作者的安全、健康和获得服务的影响。设计：混合方法参与性研究，包括定性研究、前瞻性队列研究、数学建模和常规数据整理。背景：英国伦敦的三个行政区。参与者：年龄≥18岁，提供面对面性服务的人群。干预措施：模拟移除警察执法。结果：原发性-最近或过去有过性暴力、身体暴力或情感暴力的经历。继发性：抑郁/焦虑症状、身体健康、衣原体/淋病和服务获取。结果：警察、地方当局和移民的联合执法，在举报暴力行为时得不到正义，以及与之相关的专业保健和支助服务的削减，为性工作者创造了有害的条件。这对街头工作、吸毒、移民和/或有色人种妇女的顺性和变性妇女的影响尤为严重。在妇女（n = 197）中，街头性工作者比室内性工作者近期遭受客户（73%对36%）、警察（42%对7%）和其他人（67%对17%）暴力的程度更高；无家可归者（65%对7%）；焦虑和抑郁（71%对35%）；身体不健康（57%对31%）；最近的执法（87%对9%）。对于街头性工作者，最近被捕与他人的暴力行为有关（调整优势比（AOR）） 2.77, 95%可信区间（CI） 1.11至6.94)。警察的流离失所与案主暴力有关(AOR 4.35；95% CI 1.36 - 13.90)，财务困难(AOR 4.66；CI 1.64 ~ 13.24)。在室内性工作者中，居住地不稳定(AOR 3.19；95% CI 1.36 ~ 7.49)和财务困难(AOR 3.66；95%可信区间1.64 - 8.18)对客户暴力风险的影响。在所有性别（n = 288）中，少数民族和种族性工作者（26.4%）比白人性工作者报告更多的警察遭遇，部分原因是街头性工作者的代表性增加(51.4%对30.7%；P = 0.002)，但在调整工作环境后，相关性仍然存在。模拟警察迁移和无家可归与暴力减少71%相关（95%可信区间为55%至83%）。与会者呼吁将资金从执法转向相互尊重、由同行主导的服务。局限性：局限于一个城市地区妨碍了调查结果的普遍性。对代表性不足的参与者（例如跨性别/非二元性工作者）进行更多采访，可能会对不平等现象有更深入的了解。不同风险因素之间的相关性限制了建模分析的结果，这主要限于暴力经历。结论：我们的研究为刑事定罪和执法的危害提供了国际证据，特别是对街头工作的妇女和/或种族或少数民族的危害。调查结果进一步呼吁将性工作合法化，解决警察和其他机构中针对性工作者的制度性种族主义、厌女主义和其他歧视行为，并（重新）委托性工作者提供基于经验的、以同伴为主导的服务，特别是使最边缘化的社区受益。今后的工作：与性工作者共同制作的现实主义知情试验将为保护性工作者的健康、安全和权利的有效方法提供严格的证据。资助：本摘要介绍由国家卫生和保健研究所（NIHR）公共卫生研究方案资助的独立研究，奖励号为15/55/58。
{"title":"East London Project: a participatory mixed-method evaluation on how removing enforcement could affect sex workers' safety, health and access to services in East London.","authors":"Pippa Grenfell, Jocelyn Elmes, Rachel Stuart, Janet Eastham, Josephine Walker, Chrissy Browne, Carolyn Henham, M Paz Hernandez Blanco, Kathleen Hill, Sibongile Rutsito, Maggie O'Neill, M D Sarker, Sarah Creighton, Peter Vickerman, Marie-Claude Boily, Lucy Platt","doi":"10.3310/GFVC7006","DOIUrl":"https://doi.org/10.3310/GFVC7006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sex workers' risk of violence and ill-health is shaped by their work environments, community and structural factors, including criminalisation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;We evaluated the impact of removing police enforcement on sex workers' safety, health and access to services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Mixed-methods participatory study comprising qualitative research, a prospective cohort study, mathematical modelling and routine data collation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Three boroughs in London, UK.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;People aged ≥ 18 years, who provided in-person sexual services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Simulated removal of police enforcement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Primary - recent or past experience of sexual, physical or emotional violence. Secondary - depression/anxiety symptoms, physical health, chlamydia/gonorrhoea, and service access.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A combination of enforcement by police, local authorities and immigration, being denied justice when reporting violence, and linked cuts to specialist health and support services created harmful conditions for sex workers. This disproportionately affected cisgender and transgender women who work on the streets, use drugs, are migrants and/or women of colour. Among women (&lt;i&gt;n&lt;/i&gt; = 197), street-based sex workers experienced higher levels than indoor sex workers of recent violence from clients (73% vs. 36%), police (42% vs. 7%) and others (67% vs. 17%); homelessness (65% vs. 7%); anxiety and depression (71% vs 35%); physical ill-health (57% vs 31%); and recent law enforcement (87% vs. 9%). For street-based sex workers, recent arrest was associated with violence from others (adjusted odds ratio (AOR)) 2.77, 95% confidence interval (CI) 1.11 to 6.94). Displacement by police was associated with client violence (AOR 4.35; 95% CI 1.36 to 13.90) as were financial difficulties (AOR 4.66; CI 1.64 to 13.24). Among indoor sex workers, unstable residency (AOR 3.19; 95% CI 1.36 to 7.49) and financial difficulties (AOR 3.66; 95% CI 1.64 to 8.18) contributed to risk of client violence. Among all genders (&lt;i&gt;n&lt;/i&gt; = 288), ethnically and racially minoritised sex workers (26.4%) reported more police encounters than white sex workers, partly linked to increased representation in street settings (51.4% vs. 30.7%; &lt;i&gt;p&lt;/i&gt; = 0.002) but associations remained after adjusting for work setting. Simulated removal of police displacement and homelessness was associated with a 71% reduction in violence (95% credible interval 55% to 83%). Participants called for a redirection of funds from enforcement towards respectful, peer-led services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Restriction to one urban locality prevents generalisability of findings. More interviews with under-represented participants (e.g. trans/non-binary sex workers) may have yielded further insights into inequities. Correlation between different risk ","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":" ","pages":"1-53"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879012","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}
引用次数: 0
An out-of-court community-based programme to improve the health and well-being of young adult offenders: the Gateway RCT. 旨在改善年轻成年罪犯健康和福祉的庭外社区计划：Gateway RCT。
Public health research (Southampton, England)
Pub Date : 2024-09-01 DOI: 10.3310/NTFW7364
Alison Booth, Sara Morgan, Inna Walker, Alex Mitchell, Megan Barlow-Pay, Caroline Chapman, Ann Cochrane, Emma Filby, Jenny Fleming, Catherine Hewitt, James Raftery, David Torgerson, Lana Weir, Julie Parkes
<p><strong>Background: </strong>Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences.</p><p><strong>Objective: </strong>To evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution).</p><p><strong>Design, setting and participants: </strong>Pragmatic, multisite, parallel-group, superiority randomised controlled trial with two 6-month internal pilots and a target sample size of 334. Randomisation between Gateway and usual process was on a 1 : 1 basis. Four Hampshire Constabulary sites recruited 18- to 24-year-old residents of Hampshire and Isle of Wight who were questioned for an eligible low-level offence. Semistructured interviews were also held with a sample of Gateway programme participants, staff and police study recruiters.</p><p><strong>Main outcome measures: </strong>Primary outcome was the Warwick-Edinburgh Mental Wellbeing Scale score at 12 months. Secondary outcomes included health status, alcohol and drug use, recidivism and resource use.</p><p><strong>Results: </strong>Recruitment commenced in October 2019 and the trial stopped in April 2021. A total of 191 participants were recruited, with 109 randomised to Gateway and 82 to usual process. Due to an initial overestimation of potentially eligible young people and low retention rates, recruitment targets were adjusted, and a range of mitigating measures introduced. Although recruitment broadly met study progression criteria [35/50 (70%) Pilot 1: 64/74 (86%) Pilot 2], retention was low throughout (overall: data collected at week 4 was 50%: at week 16 it was 50%: 1-year 37%). Low retention was multifactorial, with one of the main barriers being difficulties contacting participants. It was therefore not possible to complete the randomised controlled trial or the health economics analyses. Qualitative interviews held with 58 individuals yielded rare insights into the benefits and limitations of this type of intervention, as well as barriers and facilitators in relation to recruitment in this setting.</p><p><strong>Limitations: </strong>Despite close collaboration with the police to address recruitment and consent issues, expansion of the inclusion criteria and recruitment area a
背景：年轻成年人占英国监狱服刑人口的三分之一，他们面临着不良健康后果的风险，包括滥用药物和酒精、自残和自杀。法院转送干预措施旨在减少刑事制裁的负面影响，并从根本上解决犯罪问题。然而，其有效性的证据尚未确立。以有条件警告形式发布的 "网关 "方案旨在改善犯有低级罪行的年轻成年人的生活机会。参与者同意在为期 16 周的有条件警告期间不再犯罪，并在接受需求评估后，接受 "门户 "导航员的个别支持，并参加两个鼓励分析自身行为及其后果的讲习班：评估与常规程序（法院传票或不同的有条件警告）相比，Gateway 在参与者的健康和福祉方面的有效性和成本效益：务实、多地点、平行组、优越性随机对照试验，有两个为期 6 个月的内部试点，目标样本量为 334 人。在 "网关 "和常规流程之间进行的随机分配为 1:1。汉普郡警察局的四个地点招募了汉普郡和怀特岛的 18 至 24 岁居民，他们因符合条件的低级犯罪而接受了询问。此外，还对Gateway计划的参与者、工作人员和警方研究招募人员进行了半结构化访谈：主要结果为 12 个月时的沃里克-爱丁堡心理健康量表得分。次要结果包括健康状况、酗酒和吸毒情况、累犯情况和资源使用情况：招募工作于 2019 年 10 月开始，试验于 2021 年 4 月结束。共招募了 191 名参与者，其中 109 人被随机分配到 Gateway，82 人被随机分配到常规流程。由于最初高估了可能符合条件的青少年人数，且保留率较低，因此对招募目标进行了调整，并引入了一系列缓解措施。虽然招募情况大致符合研究进展标准[试点 1：35/50（70%）；试点 2：64/74（86%）]，但整个保留率较低（总体情况：第 4 周收集的数据为 50%；第 16 周为 50%：1 年 37%）。保留率低的原因是多方面的，其中一个主要障碍是难以与参与者取得联系。因此，无法完成随机对照试验或健康经济学分析。通过对 58 名参与者进行定性访谈，对此类干预措施的益处和局限性，以及在这种环境下招募参与者的障碍和促进因素有了难得的认识：尽管研究人员与警方密切合作，解决了招募和同意问题，扩大了纳入标准和招募范围，并采取了其他措施，但仍无法在可接受的时间范围内收集到足够的数据：网关研究是一项独特的工作，旨在为一项可能改变未得到充分服务人群生活的干预措施收集证据。所获得的经验表明，在这种情况下，可以对与健康相关的干预措施进行随机对照试验，但需要对目标人群的招募和保留情况进行保守估计。应考虑其他研究设计。定性评估为那些寻求设计类似干预措施或在类似环境中开展研究的人提供了一系列宝贵经验：本研究的注册号为 ISRCTN11888938：本奖项由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖项编号：16/122/20），全文发表于《公共卫生研究》（Public Health Research）第12卷第7期。更多奖项信息，请参阅 NIHR Funding and Awards 网站。
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引用次数: 0
An 'alcohol health champions' intervention to reduce alcohol harm in local communities: a mixed-methods evaluation of a natural experiment. 在当地社区开展 "酒精健康倡导者 "干预活动以减少酒精危害：自然实验的混合方法评估。
Public health research (Southampton, England)
Pub Date : 2024-09-01 DOI: 10.3310/HTMN2101
Elizabeth J Burns, Frank de Vocht, Noemia Siqueira, Cathy Ure, Suzanne Audrey, Margaret Coffey, Susan Hare, Suzy C Hargreaves, Mira Hidajat, Steve Parrott, Lauren Scott, Penny A Cook
<p><strong>Background: </strong>Globally alcohol consumption is a leading risk factor for premature death and disability and is associated with crime, social and economic consequences. Local communities may be able to play a role in addressing alcohol-related issues in their area.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and cost-benefit of an asset-based community development approach to reducing alcohol-related harm and understand the context and factors that enable or hinder its implementation.</p><p><strong>Design: </strong>A mixed-methods evaluation. Area-level quasi-experimental trial analysed using four different evaluation methods (a stepped-wedge design where each area was a control until it entered the intervention, comparison to matched local/national controls and comparison to synthetic controls), alongside process and economic evaluations.</p><p><strong>Setting: </strong>Ten local authorities in Greater Manchester, England.</p><p><strong>Participants: </strong>The outcomes evaluation was analysed at an area level. Ninety-three lay persons representing nineareas completed questionnaires, with 12 follow-up interviews in five areas; 20 stakeholders representing ten areas were interviewed at baseline, with 17 follow-up interviews in eight areas and 26 members of the public from two areas attended focus groups.</p><p><strong>Interventions: </strong>Professionals in a co-ordinator role recruited and supported lay volunteers who were trained to become alcohol health champions. The champion's role was to provide informal, brief alcohol advice to the local population and take action to strengthen restrictions on alcohol availability.</p><p><strong>Main outcome measures: </strong>Numbers of alcohol-related hospital admissions, accident and emergency attendances, ambulance call-outs, street-level crime and antisocial behaviour in the intervention areas (area size: 1600-5500 residents). Set-up and running costs were collected alongside process evaluation data exploring barriers and facilitators.</p><p><strong>Data sources: </strong>Routinely collected quantitative data on outcome measures aggregated at the intervention area and matched control and synthetic control areas. Data from policy documents, licensing registers, meeting notes, invoices, time/cost diaries, training registers, questionnaires, interviews, reflective diaries and focus groups.</p><p><strong>Results: </strong>The intervention rolled out in nine out of ten areas, seven of which ran for a full 12 months. Areas with better-established infrastructure at baseline were able to train more champions. In total, 123 alcohol health champions were trained (95 lay volunteers and 28 professionals): lay volunteers self-reported positive impact. Champions engaged in brief advice conversations more readily than taking action on alcohol availability. There were no consistent differences in the health and crime area-level indicators between intervention areas and controls
背景：在全球范围内，饮酒是导致过早死亡和残疾的主要风险因素，并与犯罪、社会和经济后果相关。地方社区可以在解决本地区与酒精有关的问题方面发挥作用：评估以资产为基础的社区发展方法的有效性和成本效益，以减少与酒精有关的伤害，并了解促进或阻碍其实施的背景和因素：设计：混合方法评估。采用四种不同的评估方法对地区级准实验性试验进行分析（阶梯式楔形设计，即在进入干预措施之前，每个地区都是对照组；与匹配的地方/国家对照组进行比较；与合成对照组进行比较），同时进行过程评估和经济评估：地点：英格兰大曼彻斯特地区的十个地方政府：结果评估在地区层面进行分析。代表九个地区的 93 名非专业人士填写了调查问卷，并在五个地区进行了 12 次后续访谈；代表十个地区的 20 名利益相关者接受了基线访谈，并在八个地区进行了 17 次后续访谈；来自两个地区的 26 名公众参加了焦点小组：干预措施：由专业人员担任协调员，招募并支持非专业志愿者，这些志愿者经过培训后成为酒精健康倡导者。倡导者的职责是向当地居民提供非正式的、简短的酒精建议，并采取行动加强对酒精供应的限制：主要结果测量指标：干预地区与酒精相关的入院人数、事故和急诊就诊人数、救护车出车次数、街头犯罪和反社会行为（地区规模：1600-5500 名居民）。在收集设置和运行成本的同时，还收集了探索障碍和促进因素的过程评估数据：数据来源：在干预区、匹配对照区和合成对照区收集的有关结果测量的常规定量数据。数据来自政策文件、许可证登记簿、会议记录、发票、时间/成本日记、培训登记簿、调查问卷、访谈、反思日记和焦点小组：结果：干预措施在 10 个地区中的 9 个地区展开，其中 7 个地区持续了整整 12 个月。基线基础设施较完善的地区能够培训更多的倡导者。总共有 123 名酒精健康倡导者接受了培训（95 名非专业志愿者和 28 名专业人员）：非专业志愿者自述受到了积极影响。与就酒精供应采取行动相比，倡导者更愿意参与简短的建议对话。采用三种不同的分析方法对自然实验进行评估后证实，干预地区与对照地区在健康和犯罪地区指标方面没有一致的差异。干预措施并未带来成本效益：局限性：虽然干预措施的推出顺序是随机的，但干预地区的选择并非如此。由于项目的高知名度，自我报告的影响可能会受到社会期望偏差的影响：结论：对健康和犯罪结果没有产生可衡量的影响。可能的原因包括接受培训的志愿者人数太少、志愿者不愿意参与许可决策，或者干预措施对选定的结果没有直接影响：今后的工作：今后类似的干预措施应使用共同制定的社区成果框架。其他自然实验评估应使用三角测量方法，以加强对有效性的推断：试验注册：本试验注册为 ISRCTN81942890：该奖项由国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖项编号：15/129/03），全文发表于《公共卫生研究》第12卷第9期。欲了解更多获奖信息，请访问 NIHR Funding and Awards 网站。
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引用次数: 0
The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis. 改善食品环境的监管、自愿和合作政策的有效性、成本效益和政策进程：证据综述。
Public health research (Southampton, England)
Pub Date : 2024-09-01 DOI: 10.3310/JYWP4049
Laurence Blanchard, Stephanie Ray, Cherry Law, María Jesús Vega-Sala, Julia Bidonde, Gemma Bridge, Matt Egan, Mark Petticrew, Harry Rutter, Cécile Knai
<p><strong>Background: </strong>Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments.</p><p><strong>Objectives: </strong>This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches.</p><p><strong>Data sources: </strong>Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020.</p><p><strong>Methods: </strong>Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments.</p><p><strong>Results: </strong>A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches.</p><p><strong>Conclusion: </strong>From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets.</p><p><strong>Limitations: </strong>This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest.</p><p><strong>Future work: </strong>Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporti
背景：在英格兰，膳食因素是导致慢性疾病的最大、最昂贵的因素之一。作为应对措施，政府针对食品环境实施了一系列人口干预措施，以促进健康饮食：本研究旨在对国家和各州改善食品环境政策的有效性、成本效益和政策过程的实际评估进行系统性回顾，重点关注这些政策是监管性、自愿性还是合作性方法：2020 年 11 月，在 14 个相关英文数据库中检索了 2010 年至 2020 年间发表的研究：方法：进行了六项独立的证据审查，以评估改善食品环境政策的有效性、成本效益和政策流程的证据：结果：共纳入了 483 项主要研究评估和 14 项证据综述。这项研究揭示了文献中存在的相当大的地域、方法和其他方面的不平衡，例如，81%的出版物只关注 12 个国家。系统综述还揭示了经审查的旨在改善健康、消费者行为和食品环境结果的监管方法的有效性和成本效益，而通过重新配方、广告和促销限制或其他环境变化来改善饮食的公私伙伴关系和自愿方法的有效性和成本效益则很有限。研究还揭示了监管、自愿和公私伙伴关系方法的主要有利和阻碍因素：本研究从审查的现有证据中发现，监管方法在改善食品环境方面似乎最为有效，而自愿协议和伙伴关系的效果有限。在未来的公共卫生政策制定过程中，应认真考虑这些研究结果，同时也应认真考虑证据中的地域不平衡问题，以及政策评估中对公平层面的表述不够充分的问题。我们发现，食品政策有时受证据以外的因素驱动，并受妥协和实用主义的影响。食品政策的设计和制定首先应遵循最有效的证据，以改善食品环境，促进更健康的饮食：由于范围所限，这是一项复杂的证据综述，由于文献检索不包括具体的政策名称，因此可能遗漏了一些政策评估。文献仅限于 2010 年至 2020 年发表的英文研究，可能会遗漏一些感兴趣的研究：优先事项包括需要指导评估非临床研究的偏倚风险和质量、在评估中报告政策特征、支持跨地域公平评估真实世界政策、在政策评估中捕捉公平维度，以及制定政策评估质量和偏倚风险的指南：本研究注册为 PROSPERO CRD42020170963：本奖励项目由国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖励编号：NIHR128607），全文发表于《公共卫生研究》第12卷第8期。如需了解更多奖项信息，请访问 NIHR Funding and Awards 网站。
{"title":"The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis.","authors":"Laurence Blanchard, Stephanie Ray, Cherry Law, María Jesús Vega-Sala, Julia Bidonde, Gemma Bridge, Matt Egan, Mark Petticrew, Harry Rutter, Cécile Knai","doi":"10.3310/JYWP4049","DOIUrl":"https://doi.org/10.3310/JYWP4049","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Future work: &lt;/strong&gt;Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporti","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"12 8","pages":"1-173"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334012","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}
引用次数: 0
The Social and Emotional Education and Development intervention to address wellbeing in primary school age children: the SEED cluster RCT. 针对小学学龄儿童福祉的社会和情感教育与发展干预：SEED 群组 RCT。
Public health research (Southampton, England)
Pub Date : 2024-06-01 DOI: 10.3310/LYRQ5047
Sarah Blair, Marion Henderson, Alex McConnachie, Emma McIntosh, Susie Smillie, Kirsty Wetherall, Daniel Wight, Yiqiao Xin, Lyndal Bond, Lawrie Elliott, Sally Haw, Caroline Jackson, Kate Levin, Philip Wilson
<p><strong>Background: </strong>Stronger social and emotional well-being during primary school is positively associated with the health and educational outcomes of young people. However, there is little evidence on which programmes are the most effective for improving social and emotional well-being.</p><p><strong>Objective: </strong>The objective was to rigorously evaluate the Social and Emotional Education and Development (SEED) intervention process for improving pupils' social and emotional well-being.</p><p><strong>Design: </strong>This was a stratified cluster randomised controlled trial with embedded process and economic evaluations. Thirty-eight primary schools were randomly assigned to the SEED intervention or to the control group. Hierarchical regression analysis allowing for clustering at school learning community level was conducted in R (statistical package).</p><p><strong>Setting: </strong>The SEED intervention is a whole-school intervention; it involved all school staff and two cohorts of pupils, one starting at 4 or 5 years of age and the second starting at 8 or 9 years of age, across all 38 schools.</p><p><strong>Participants: </strong>A total of 2639 pupils in Scotland.</p><p><strong>Intervention: </strong>The SEED intervention used an iterative process that involved three components to facilitate selection and implementation of school-based actions: (1) questionnaire completion, (2) benchmarked feedback to all staff and (3) reflective discussions (all staff and an educational psychologist).</p><p><strong>Main outcome measure: </strong>The primary outcome was pupils' Strengths and Difficulties Questionnaire-Total Difficulties Score when pupils were 4 years older than at baseline.</p><p><strong>Results: </strong>The primary outcome, pupils' Strengths and Difficulties Questionnaire-Total Difficulties Score at follow-up 3, showed improvements for intervention arm pupils, compared with those in the control arm [relative risk -1.30 (95% confidence interval -1.87 to -0.73), standardised effect size -0.27 (95% confidence interval -0.39 to -0.15)]. There was no evidence of intervention effects according to deprivation: the results were significant for both affluent and deprived pupils. Subgroup analysis showed that all effect sizes were larger for the older cohort, particularly boys [relative risk -2.36 (95% confidence interval -3.62 to -1.11), standardised effect size -0.42 (95% confidence interval -0.64 to -0.20)]. Although there was no statistically significant difference in incremental cost and quality-adjusted life-years, the probability that the intervention is cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year was high, at 88%. Particularly valued mechanisms of the SEED intervention were its provision of time to reflect on and discuss social and emotional well-being and its contribution to a culture of evaluating practice.</p><p><strong>Limitations: </strong>It was a challenge to retain scho
背景：小学阶段较强的社交和情感幸福感与青少年的健康和教育成果呈正相关。然而，关于哪些计划对提高社交和情感幸福感最有效的证据却很少：目的：旨在严格评估社会和情感教育与发展（SEED）干预过程，以改善学生的社会和情感福祉：这是一项分层分组随机对照试验，其中包含过程评估和经济评估。38所小学被随机分配到SEED干预组或对照组。在 R（统计软件包）中进行了分层回归分析，允许在学校学习社区层面进行聚类：SEED干预措施是一种全校干预措施；它涉及所有38所学校的所有教职员工和两批学生，一批学生从4或5岁开始学习，另一批学生从8或9岁开始学习：苏格兰共有 2639 名学生：SEED 干预采用了一个迭代过程，包括三个组成部分，以促进选择和实施校本行动：(1) 填写调查问卷；(2) 向所有教职员工提供基准反馈；(3) 反思性讨论（所有教职员工和一名教育心理学家）。主要结果测量：主要结果是学生在比基线年龄大 4 岁时的优势和困难问卷--困难总分：与对照组相比，干预组学生的主要结果，即随访 3 期时的学生优势与困难问卷--总困难得分，有所改善[相对风险-1.30（95% 置信区间-1.87 至-0.73），标准化效应大小-0.27（95% 置信区间-0.39 至-0.15）]。没有证据表明干预效果与贫困程度有关：富裕学生和贫困学生的干预效果都很显著。分组分析表明，高年级学生，尤其是男生的所有效果大小都较大[相对风险-2.36（95%置信区间-3.62至-1.11），标准化效果大小-0.42（95%置信区间-0.64至-0.20）]。虽然在增量成本和质量调整生命年数方面没有统计学意义上的显著差异，但在每质量调整生命年数 20,000 英镑的支付意愿阈值下，干预措施具有成本效益的概率很高，达到 88%。SEED干预措施特别值得重视的机制是，它提供了反思和讨论社会与情感福祉的时间，以及它对评估实践文化的贡献：在五次数据收集过程中留住学校是一项挑战：这项试验表明，SEED 干预措施是一种可接受的、具有成本效益的方法，可以适度改善学生的幸福感和学校氛围，尤其是对年龄较大的男生和心理障碍较严重的男生而言。在从小学升入中学的过渡时期，SEED 干预是有益的，但 6 年后效果会减弱。SEED干预措施可以与现有的学生幸福感管理系统一起实施，并与其他干预措施相辅相成：评估 SEED 干预措施是否会对学业成绩产生有利影响，是否可以推广到其他国家和其他组织环境，是否可以通过在干预过程中增加核心培训元素来加强干预措施，是否可以推广到中学。了解该试验结果所显示的性别差异。就如何处理复杂社会干预纵向研究中的缺失数据开展进一步的统计研究：该试验的注册号为 ISRCTN51707384：该奖项由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖项编号：10/3006/13），全文发表于《公共卫生研究》（Public Health Research）第12卷第6期。如需了解更多奖项信息，请访问 NIHR Funding and Awards 网站。
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引用次数: 0
Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation. 氟化水对成人侵入性 NHS 牙科治疗的影响：LOTUS 回顾性队列研究和经济评估。
Public health research (Southampton, England)
Pub Date : 2024-05-01 DOI: 10.3310/RFQA3841
Deborah Moore, Blessing Nyakutsikwa, Thomas Allen, Emily Lam, Stephen Birch, Martin Tickle, Iain A Pretty, Tanya Walsh

Background: Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults.

Objective: To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design.

Design: Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data.

Setting: National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services.

Participants: Dental patients aged 12 years and over living in England (n = 6,370,280).

Intervention and comparison: Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores.

Outcome measures: Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment.

Data sources: National Health Service Business Services Authority dental claims data. Water quality monitoring data.

Primary outcome: Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful.

Secondary outcomes: Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 les

背景：大多数水氟化研究都是在含氟牙膏广泛使用之前对儿童进行的。缺乏可应用于当代人群，尤其是青少年和成年人的证据：采用自然实验设计，务实地评估氟化水在当代成年人群中预防牙科治疗和改善口腔健康的临床效果和成本效益：设计：使用常规收集的国民健康服务牙科索赔（FP17）数据进行回顾性队列研究：环境：国民健康服务初级牙科保健：普通牙科诊所、监狱、社区牙科服务、家庭服务、急诊/非工作时间服务以及仅需转诊的专业服务：干预和比较：接触过含氟水的饮用水的人：干预和比较：在 2010 年至 2020 年期间接触氟化物浓度≥ 0.7 毫克/升的饮用水的人与未接触的人在主要特征上使用倾向得分进行匹配：主要指标：2010 年至 2020 年间每人接受的国民健康服务侵入性牙科治疗（修复/"补牙 "和拔牙）的次数。次要指标：蛀牙、缺牙和补牙、缺失牙、不平等、成本效益和投资回报：数据来源：国民健康服务商业服务管理局牙科索赔数据。水质监测数据：最佳氟化组的侵入性牙科治疗预测平均次数比次优/非最佳氟化组低 3%（发病率比 0.969，95% CI 0.967 至 0.971），侵入性牙科治疗的差异为 -0.173 次（95% CI -0.185 至 -0.161）。这一影响程度小于我们所接触的大多数利益相关者（n = 50/54）认为有意义的影响程度：最佳含氟组的平均蛀牙、缺失牙和补牙率低 2%，蛀牙、缺失牙和补牙率差异为 -0.212（95% CI -0.229--0.194）。每人平均缺失牙齿数量在统计学上没有明显差异（0.006，95% CI -0.008-0.021）。没有令人信服的证据表明，水氟化减少了接受治疗或缺失牙齿方面的社会不平等；但是，蛀牙、缺失牙和补牙数据并未显示出典型的不平等梯度。据估计，2010-20 年间英格兰水氟化的最佳成本为每人 10.30 英镑（不包括最初的设置成本）。2010-20年氟化患者的平均国民健康服务治疗成本降低了5.5%，每人降低了22.26英镑（95% CI为-23.09英镑至-21.43英镑），患者支付的国民健康服务牙科费用每人减少了7.64英镑（2020年价格）：局限性：实事求是的观察性研究，可能存在氟化分配和结果测量中的非差异性误差，以及残留和/或未测量的混杂因素。蛀牙、缺牙和补牙数据未经验证。水氟化成本估算基于 2010 年至 2020 年间的现有计划，因此不包括新计划可能需要的大量资本投资：结论：2010 年至 2020 年期间，接受最佳水氟化治疗对健康的影响非常小，可能对个人没有意义，而且我们没有发现任何证据表明社会不平等现象有所减少。由于国民健康服务的治疗成本略有降低，英格兰现有的水氟化计划在 2010 年至 2020 年间产生了积极的投资回报。在评估这些相对较小的节省时，应考虑到任何拟议的水氟化资本投资（包括新计划）的预计成本和寿命：国民健康服务牙科数据是一项宝贵的研究资源。今后的工作：国民健康服务牙科数据是研究的宝贵资源，需要进一步验证并采取措施提高质量和完整性：该试验的注册号为 ISRCTN96479279，CAG：20/CAG/0072，IRAS：20/NE/0144：该奖项由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖项编号：NIHR128533），全文发表于《公共卫生研究》第12卷第5期。如需了解更多奖项信息，请访问 NIHR Funding and Awards 网站。
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引用次数: 0
A smoking cessation smartphone app that delivers real-time 'context aware' behavioural support: the Quit Sense feasibility RCT. 提供实时 "情境感知 "行为支持的戒烟智能手机应用：戒烟感知可行性研究试验。
Public health research (Southampton, England)
Pub Date : 2024-04-01 DOI: 10.3310/KQYT5412
Felix Naughton, Aimie Hope, Chloë Siegele-Brown, Kelly Grant, Caitlin Notley, Antony Colles, Claire West, Cecilia Mascolo, Tim Coleman, Garry Barton, Lee Shepstone, Toby Prevost, Stephen Sutton, David Crane, Felix Greaves, Juliet High

Background: During a quit attempt, cues from a smoker's environment are a major cause of brief smoking lapses, which increase the risk of relapse. Quit Sense is a theory-guided Just-In-Time Adaptive Intervention smartphone app, providing smokers with the means to learn about their environmental smoking cues and provides 'in the moment' support to help them manage these during a quit attempt.

Objective: To undertake a feasibility randomised controlled trial to estimate key parameters to inform a definitive randomised controlled trial of Quit Sense.

Design: A parallel, two-arm randomised controlled trial with a qualitative process evaluation and a 'Study Within A Trial' evaluating incentives on attrition. The research team were blind to allocation except for the study statistician, database developers and lead researcher. Participants were not blind to allocation.

Setting: Online with recruitment, enrolment, randomisation and data collection (excluding manual telephone follow-up) automated through the study website.

Participants: Smokers (323 screened, 297 eligible, 209 enrolled) recruited via online adverts on Google search, Facebook and Instagram.

Interventions: Participants were allocated to 'usual care' arm (n = 105; text message referral to the National Health Service SmokeFree website) or 'usual care' plus Quit Sense (n = 104), via a text message invitation to install the Quit Sense app.

Main outcome measures: Follow-up at 6 weeks and 6 months post enrolment was undertaken by automated text messages with an online questionnaire link and, for non-responders, by telephone. Definitive trial progression criteria were met if a priori thresholds were included in or lower than the 95% confidence interval of the estimate. Measures included health economic and outcome data completion rates (progression criterion #1 threshold: ≥ 70%), including biochemical validation rates (progression criterion #2 threshold: ≥ 70%), recruitment costs, app installation (progression criterion #3 threshold: ≥ 70%) and engagement rates (progression criterion #4 threshold: ≥ 60%), biochemically verified 6-month abstinence and hypothesised mechanisms of action and participant views of the app (qualitative).

Results: Self-reported smoking outcome completion rates were 77% (95% confidence interval 71% to 82%) and health economic data (resource use and quality of life) 70% (95% CI 64% to 77%) at 6 months. Return rate of viable saliva samples for abstinence verification was 39% (95% CI 24% to 54%). The per-participant recruitment cost was £19.20, which included advert (£5.82) and running costs (£13.38). In the Quit Sense arm, 75% (95% CI 67% to 83%; 78/104) installed the app and, of these, 100% set a quit date within the app and 51% engaged with it for more than 1 week. The rate of 6-mo

背景：在尝试戒烟的过程中，吸烟者所处环境的暗示是导致短暂吸烟的主要原因，而这又会增加复吸的风险。Quit Sense是一款以理论为指导的及时适应性干预智能手机应用程序，它为吸烟者提供了了解环境中吸烟暗示的途径，并提供 "即时 "支持，帮助他们在尝试戒烟期间控制这些暗示：开展可行性随机对照试验，估算关键参数，为戒烟感知的最终随机对照试验提供依据：设计：平行、双臂随机对照试验，包括定性过程评估和 "试验中的研究"，评估激励措施对自然减员的影响。除研究统计员、数据库开发人员和首席研究员外，研究团队对分配结果保密。参与者对分配不设盲区：通过研究网站自动进行在线招募、注册、随机化和数据收集（不包括人工电话随访）：通过谷歌搜索、Facebook 和 Instagram 上的在线广告招募的吸烟者（筛选 323 人，符合条件 297 人，注册 209 人）：干预措施：参与者被分配到 "常规护理 "组（n = 105；通过短信转介到国家卫生服务局无烟网站）或 "常规护理 "加戒烟感知组（n = 104），通过短信邀请安装戒烟感知应用程序：入组后6周和6个月的随访通过带有在线问卷链接的自动短信进行，未回复者则通过电话进行。如果先验阈值包含或低于估计值的 95% 置信区间，则符合确定的试验进展标准。衡量标准包括健康经济和结果数据完成率（进展标准＃1阈值：≥70%），包括生化验证率（进展标准＃2阈值：≥70%）、招募成本、应用程序安装率（进展标准＃3阈值：≥70%）和参与率（进展标准＃4阈值：≥60%）、经生化验证的6个月戒烟率、假设的作用机制以及参与者对应用程序的看法（定性）：结果：6 个月的自我报告吸烟结果完成率为 77%（95% 置信区间为 71% 至 82%），健康经济数据（资源使用和生活质量）为 70%（95% 置信区间为 64% 至 77%）。用于禁欲验证的有效唾液样本的回收率为 39%（95% 置信区间为 24% 至 54%）。每位参与者的招募成本为19.20英镑，其中包括广告费用（5.82英镑）和运营成本（13.38英镑）。在 "戒烟感知 "研究组中，75%（95% CI 67%至83%；78/104）的人安装了该应用，其中100%的人在应用中设定了戒烟日期，51%的人使用该应用超过1周。经生化验证的6个月持续戒烟率在 "戒烟感知 "治疗组为11.5%（12/104），在常规治疗组为2.9%（3/105）（估计效应大小：调整后的几率比=4.57，95% CI为1.23至16.94）。在假设的作用机制方面，没有证据表明治疗组之间存在差异。符合四项进展标准中的三项。对 "试验中的研究 "进行分析后发现，20英镑与10英镑的激励措施并没有显著提高随访率，但却减少了人工随访的需求，并提高了响应速度。过程评估确定了戒烟感知的几种潜在戒烟途径、导致脱离应用的因素以及应用改进建议：局限性：生化验证率低于预期，且两组之间不平衡。与COVID-19相关的限制可能限制了Quit Sense提供因地制宜支持的机会：试验设计和程序证明了其可行性，并产生了支持 "戒烟感知 "潜在疗效的证据：试验注册：该试验的注册号为 ISRCTN12326962：该奖项由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助（NIHR奖项编号：17/92/31），全文发表于《公共卫生研究》（Public Health Research）第12卷第4期。如需了解更多奖项信息，请访问 NIHR Funding and Awards 网站。
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引用次数: 0
Exploring parents' physical activity motivation during the COVID-19 pandemic: a mixed-methods study from a self-determination theory perspective. 探索 COVID-19 大流行期间家长的体育锻炼动机：从自我决定理论角度进行的混合方法研究。
Public health research (Southampton, England)
Pub Date : 2024-03-27 DOI: 10.3310/KPKW8220
Lydia Emm-Collison, Robert Walker, Ruth Salway, Danielle House, Kate Sansum, Katie Breheny, Sarah Churchward, Joanna G Williams, Frank de Vocht, Russell Jago

Background and objectives: The COVID-19 lockdowns impacted physical activity for all, but especially parents, because they had to balance home, work and leisure activities. Motivation for exercise is consistently shown to be associated with physical activity levels. Self-determination theory provides a framework through which the motivation for exercise and its social-contextual antecedents can be explored. The purpose of this study is to explore the role of motivation in determining physical activity in parents and carers of English primary school children before, during and after the COVID-19 lockdowns.

Design, setting and participants: This study uses a mixed-methods design combining quantitative data and individual interviews. Participants were all parents/carers of children in year 6 (aged 10-11 years) at English primary schools in the United Kingdom.

Methods: Quantitative data were collected on three occasions: between March 2017 and May 2018 (Wave 0, N = 1296), between May and December 2021 (Wave 1, N = 393) and between January and July 2022 (wave 2, N = 436). Motivation for exercise was assessed using the Behavioural Regulations in Exercise Questionnaire-2 and moderate-to-vigorous physical activity was estimated via waist-worn accelerometers. Data were analysed via regression models. Interviews with a subsample of parents (N = 43) were conducted on two occasions: between September and December 2021 and between February and July 2022. Interviews covered the impact of the pandemic on children and parents' physical activity and changes over time. This study focuses on discussions around the parents' own physical activity behaviour and their motivation. The framework method was used for analysis.

Results: In separate linear regression models, intrinsic and identified regulation were associated with higher moderate-to-vigorous physical activity in waves 0 and 2. Amotivation was associated with lower moderate-to-vigorous physical activity in waves 0 and 2. In fully adjusted multivariable regression models, identified regulation was associated with a 4.9-minute increase in moderate-to-vigorous physical activity and introjected regulation was associated with a 2.3-minute decrease in moderate-to-vigorous physical activity at wave 0. Associations with moderate-to-vigorous physical activity were different in wave 2, with introjected regulation changing direction and a negative association with amotivation, although confidence intervals were wide due to smaller sample sizes. In the interviews, parents spoke of the effects that the COVID-19 lockdowns had on their motivation to be physically active in four theoretically driven themes: (1) motivation for physical activity, (2) perceived autonomy for physical activity, (3) perceived competence for physical activity and (4) perceived relatedness for physical activity.

Limitati

背景和目标：COVID-19 封锁影响了所有人的体育锻炼，尤其是家长，因为他们必须兼顾家庭、工作和休闲活动。运动动机一直被证明与体育锻炼水平相关。自我决定理论提供了一个框架，通过该框架可以探索锻炼动机及其社会背景前因。本研究的目的是探讨在 COVID-19 封锁之前、期间和之后，动机在决定英国小学生的家长和看护者的体育锻炼中的作用：本研究采用混合方法设计，结合了定量数据和个别访谈。参与者均为英国小学六年级（10-11 岁）学生的家长/监护人：定量数据在三个场合收集：2017 年 3 月至 2018 年 5 月（第 0 波，N = 1296）、2021 年 5 月至 12 月（第 1 波，N = 393）和 2022 年 1 月至 7 月（第 2 波，N = 436）。运动动机通过 "运动行为规范问卷-2 "进行评估，中等至剧烈运动量通过腰部佩戴的加速度计进行估算。数据通过回归模型进行分析。在 2021 年 9 月至 12 月期间和 2022 年 2 月至 7 月期间，对家长的子样本（N = 43）进行了两次访谈。访谈内容包括大流行病对儿童和家长体育锻炼的影响以及随着时间推移发生的变化。本研究的重点是围绕父母自身的体育锻炼行为及其动机展开讨论。采用框架法进行分析：在单独的线性回归模型中，内在调节和识别调节与第 0 波和第 2 波中较高的中强度体育活动有关。在第 0 波和第 2 波中，动机不足与中强度体力活动较少有关。在经过充分调整的多变量回归模型中，在第 0 次调查中，识别调节与中强度体力活动增加 4.9 分钟相关，而内驱调节与中强度体力活动减少 2.3 分钟相关。 在第 2 次调查中，与中强度体力活动的相关性有所不同，内驱调节改变了方向，与非激励负相关，但由于样本量较小，置信区间较宽。在访谈中，家长们谈到了COVID-19封锁对他们体育锻炼动机的影响，这些影响有四个理论驱动的主题：（1）体育锻炼的动机；（2）体育锻炼的自主感知；（3）体育锻炼的能力感知；（4）体育锻炼的相关感知：局限性：第 1 和第 2 次调查的样本量较小，这可能限制了确定大流行后行为规范与适度至剧烈体育活动之间关系的能力。在所有波次中，父母主要是活跃的女性、白人和来自社会经济地位较高地区的人，因此可能无法反映更广泛的经验：自主动机，尤其是乐趣和对身心健康的重要性，是家长在封锁期间保持积极活动的主要驱动力，对封锁后的体育活动仍然很重要，引入调节可能会发挥更大的作用。家长们在访谈中强调，虽然对一些家长来说，封锁促进了自主锻炼的动力，但对另一些家长来说，封锁对他们的自主性、能力和亲和力产生了持久的负面影响，这可能会损害他们的幸福。重点为家长提供一系列新颖活动并将家长团体聚集在一起的策略可能会有效：本文是由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助的独立研究，获奖编号为NIHR131847。
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