Early Life and Prevention Publications

Research papers published by our team

2022

Authors -

https://www.mdpi.com/1660-4601/18/20/10741

Abstract

Although the built environment (BE) is important for children’s health, there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative review was undertaken by a multi-disciplinary team of researchers to summarise ways in which the BE is measured, and how this links to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The most commonly addressed health-related outcomes were active travel, physical activity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (perceived) measurements of the BE. However, there was a wide variety, and sometimes inconsistency, in their definition and use. There were clear associations between the BE and children’s health. Objective physical activity and self-reported active travel, or obesity, were positively associated with higher street connectivity or walkability measures, while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Despite the high heterogeneity found in BE measures and health outcomes, the meta-narrative approach enabled us to identify ten BE categories that are likely to support children’s health and be protective against some non-communicable disease risk factors. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential unintended health consequences of making changes to the BE.

DOI: https://doi.org/10.3390/ijerph182010741

Authors - Deepika Deepika, Raju Prasad Sharma, Marta Schuhmacher, Amrit Kaur Sakhi, Cathrine Thomsen, Leda Chatzi, Marina Vafeiadi, Joane Quentin, Remy Slama, Regina Grazuleviciene, Sandra Andrušaitytė, Dagmar Waiblinger, John Wright, Tiffany C. Yang, Jose Urquiza, Martine Vrijheid, Maribel Casas, José L. Domingo, Vikas Kumar

https://www.sciencedirect.com/science/article/pii/S0013935122014013?via%3Dihub

Abstract

Bisphenol A (BPA) is a widely known endocrine disruptor (ED) found in many children's products such as toys, feeding utensils, and teething rings. Recent epidemiology association studies have shown postnatal BPA exposure resulted in developing various diseases such as diabetes, obesity, and neurodegeneration, etc., later in their lives. However, little is known about its sex-specific metabolism and consequently internal exposure. The aim of this study was to develop a sex-specific pediatric physiologically based pharmacokinetic model (PBPK) for BPA to compare their toxicokinetic differences. First, the published adult PBPK model was re-validated, and then this model was extended by interpolation to incorporate pediatric sex specific physiological and biochemical parameters. We used both the classical body weight and ontogeny-based scaling approach to interpolate the metabolic process. Then, the pharmacokinetic attributes of the models using the two-scaling approach mentioned above were compared with adult model. Further, a sex-specific PBPK model with an ontogeny scaling approach was preferred to evaluate the pharmacokinetic differences. Moreover, this model was used to reconstruct the BPA exposure from two cohorts (Helix and PBAT Cohort) from 7 EU countries. The half-life of BPA was found to be almost the same in boys and girls at the same exposure levels. Our model estimated BPA children's exposure to be about 1500 times higher than the tolerable daily intake (TDI) recently set by European Food Safety Authority (EFSA) i.e., 0.04 ng/kg BW/day. The model demonstrated feasibility of extending the adult PBPK to sex-specific pediatric, thus investigate a gender-specific health risk assessment.

DOI: https://doi.org/10.1016/j.envres.2022.114074

Authors - Ellen J. Thompson, Dylan M. Williams, Alex J. Walker, Ruth E. Mitchell, Claire L. Niedzwiedz, Tiffany C. Yang, Charlotte F. Huggins, Alex S. F. Kwong, Richard J. Silverwood, Giorgio Di Gessa, Ruth C.E. Bowyer, Kate Northstone, Bo Hou, Michael J. Green, Brian Dodgeon, Katie J. Doores, Emma L. Duncan, Frances M. K. Williams, OpenSAFELY Collaborative, Andrew Steptoe, David J. Porteous, Rosemary R. C. McEachan, Laurie Tomlinson, Ben Goldacre, Praveetha Patalay, George B. Ploubidis, Srinivasa Vittal Katikireddi, Kate Tilling, Christopher T. Rentsch, Nicholas J Timpson, Nishi Chaturvedi, Claire J. Steves"

https://www.nature.com/articles/s41467-022-30836-0

Abstract

The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.

DOI: https://doi.org/10.1038/s41467-022-30836-0

Authors - Frankie J Fair, Helen Watson, Katie Marvin-Dowle, Rachael Spencer, Hora Soltani

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270470

Abstract

Introduction

Maternal weight management services have been recognised as a good opportunity to influence lifestyle and dietary behaviour of mothers and families. Exploring women’s views of maternal weight management services is paramount to understand what constitutes the most suitable service. This study therefore explored experiences among women with a raised body mass index (BMI) of maternal weight management service provision and the barriers and facilitators to weight management during pregnancy.

Method

Thirteen women with a BMI≥40kg/m² undertook semi-structured interviews around weight management experiences during pregnancy. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was undertaken.

Results

Four themes emerged. 1). "Understanding where I am at" showed current readiness and motivation of women varied, from being avoidant to being motivated to make changes. 2). "Getting information" revealed inconsistent information provision during pregnancy. Women particularly wanted practical advice. Some attempted to find this for themselves from friends or the internet, however this left some women feeling confused when different sources provided inconsistent advice. 3). "Difficulties I face" identified physical, emotional and financial barriers and the strategies some women used to overcome these. 4). "Encountering professionals–a mixed experience" demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals tread was demonstrated by women thinking that they had received inadequate information and yet too much focus was placed on their weight and the associated risks during pregnancy without practical solutions to their weight management challenges.

Discussion

Women were empowered when practical advice was provided, not just the continual repetition of the risks of being obese during pregnancy. Antenatal weight management services need to be clear, sensitive and respectful. Services centred on individual women’s needs and on their current and previous experiences are required. The psychological and social contexts of weight management also need to be addressed.

DOI: https://doi.org/10.1371/journal.pone.0270470

Authors - Vashti Berry, Siobhan B Mitchell, Sarah L Blower, Karen Whittaker, Kath Wilkinson, Sinead McGilloway, Amanda Mason-Jones, Rachel Margaret Carr, Tracey Bywater.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265946

Abstract

Background

A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs).

Methods

An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions.

Results

The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance.

Conclusions

Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.

DOI: https://doi.org/10.1371/journal.pone.0265946

Authors - Tiffany C Yang, Madeleine Power, Rachael H Moss, Bridget Lockyer, Wendy Burton, Bob Doherty, Maria Bryant

https://bmjopen.bmj.com/content/12/6/e059047.abstract

Abstract

Objective

Food insecurity is linked to poor health and well-being in children and rising prevalence rates have been exacerbated by COVID-19. Free school meals (FSM) are considered a critical tool for reducing the adverse effects of poverty but apply a highly restrictive eligibility criteria. This study examined levels of food security and FSM status to support decision-making regarding increasing the current eligibility criteria.


Design

Two cross-sectional national surveys administered in August–September 2020 and January–February 2021 were used to examine the impact of COVID-19 on the food experiences of children and young people.

Setting

UK.

Participants

2166 children (aged 7–17 years) and parents/guardians.

Main outcome measures

Participant characteristics were described by food security and FSM status; estimated marginal means were calculated to obtain the probability of poor mental health, expressed as children reporting feeling stressed or worried in the past month, by food security status and FSM status.

Results

We observed food insecurity among both children who did and did not receive of FSM: 23% of children not receiving FSM were food insecure. Children who were food insecure had a higher probability of poor mental health (31%, 95% CI: 23%, 40%) than children who were food secure (10%, 95% CI: 7%, 14%). Food insecure children receiving FSM had a higher probability of poor mental health (51%, 95% CI: 37%, 65%) than those who were food insecure and not receiving FSM (29%, 95% CI: 19%, 42%).

Conclusion

Many children experienced food insecurity regardless of whether they received FSM, suggesting the eligibility criteria needs to be widened to prevent overlooking those in need.

DOI: http://dx.doi.org/10.1136/bmjopen-2021-059047

Authors - Fuentes-Paez, G., Escaramís, G., Aguilar-Lacasaña, S., Andrusaityte, S., Brantsæter, A. L., Casas, M., Charles, M. A., Chatzi, L., Lepeule, J., Grazuleviciene, R., Gützkow, K. B., Heude, B., Maitre, L., Ruiz-Arenas, C., Sunyer, J., Urquiza, J., Yang, T. C., Wright, J., Vrijheid, M., Vilor-Tejedor, N., … Bustamante, M.

https://www.frontiersin.org/articles/10.3389/fgene.2022.867611/full

Background

Maternal smoking during pregnancy has adverse health effects on the offspring, including lower birth weight and increased risk for obesity. These outcomes are also influenced by common genetic polymorphisms. We aimed to investigate the combined effect of maternal smoking during pregnancy and genetic predisposition on birth weight and body mass index (BMI)-related traits in 1,086 children of the Human Early Life Exposome (HELIX) project.

Methods

Maternal smoking during pregnancy was self-reported. Phenotypic traits were assessed at birth or at the age of 8 years. Ten polygenic risk scores (PRSs) per trait were calculated using the PRSice v2 program. For birth weight, we estimated two sets of PRSs based on two different base GWAS summary statistics: PRS-EGG, which includes HELIX children, and PRS-PanUK, which is completely independent. The best PRS per trait (highest R2) was selected for downstream analyses, and it was treated in continuous or categorized into three groups. Multivariate linear regression models were applied to evaluate the association of the explanatory variables with the traits of interest. The combined effect was evaluated by including an interaction term in the regression models and then running models stratified by the PRS group.

Results

BMI-related traits were correlated among them but not with birth weight. A similar pattern was observed for their PRSs. On average, the PRSs explained ∼4% of the phenotypic variation, with higher PRS values related to higher trait values (p-value <5.55E-08). Sustained maternal smoking was associated with lower birth weight and higher BMI and related traits (p-value <2.99E-02). We identified a gene by environment (GxE) interaction for birth weight between sustained maternal smoking and the PRS-EGG in three groups (p-value interaction = 0.01), which was not replicated with the PRS-PanUK (p-value interaction = 0.341). Finally, we did not find any statistically significant GxE interaction for BMI-related traits (p-value interaction >0.237).

Conclusion

Sustained maternal smoking and the PRSs were independently associated with birth weight and childhood BMI-related traits. There was low evidence of GxE interactions.

DOI: https://doi.org/10.3389/fgene.2022.867611

Authors - Gillian Santorelli, John Wright, Duncan Cooper, Laura Lennon, Sarah Muckle, Jane West

https://wellcomeopenresearch.org/articles/7-145/v1

Abstract

Background

The National Child Measurement Programme (NCMP) reported an increase in the prevalence of children in Reception (4-5 years) and Year 6 (10-11 years) with overweight/obesity during the coronavirus disease 2019 (COVID-19) pandemic compared to the previous year. This prompted us to conduct a longitudinal analysis to compare weight status before and during the pandemic.

Methods:

We compared the change in overweight/obesity status of children in Year 1 (Y1) (during the pandemic) who had also been measured as part of the NCMP in Reception (the year before the pandemic), with the change in a sample of children during a two-year ‘pre-pandemic’ period.

Results

Overweight/obesity increased by 1.2% to 24.8% (p=0.582) between Reception and Y1 in the pre-pandemic group and by 5.4% to 28.5% (p=0.002) in the pandemic group. This was mainly driven by an increase in the proportion of overweight boys in the pandemic group (22% to 30%) compared to the pre-pandemic group rates (~24% at both time-points). Rates in girls increased by 2.0% to 24.8% in the pre-pandemic group and by 3.3% to 27.6% in the pandemic group. A higher proportion of Reception-aged White children in the pre-pandemic group were overweight/obese compared to the pandemic group, but by Y1 the rates were higher in the pandemic group. In children of South Asian (SA) heritage, the proportion with excess weight in Reception was 18.3% in the pre-pandemic group, increasing to 21.6% by Y1. The increase was substantially higher in the pandemic group of SA children, with an increase from 22.9% in Reception to 30.3% by Y1.

Conclusions

We observed a marked increase in the proportion of children with an unhealthy body mass index (BMI) during the first year of the pandemic, suggesting that the societal disruptions caused by lockdown may have adversely affected children’s diet and levels of physical activity.

DOI: https://doi.org/10.12688/wellcomeopenres.17830.1

Authors - Halima Iqbal, Jane West, Rosemary R. C. McEachan, Melanie Haith-Cooper

https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01659-1

Abstract

Introduction

British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner-city areas of Bradford.

Methods

Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically.

Results

This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women-only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information.

Conclusion

These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels.

Patient or Public Contribution

Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis.

DOI: https://doi.org/10.1111/hex.13527

Authors - Amrit Bhatti, Faye Wray, Ieva Eskytė, Kara A Gray-Burrows, Jenny Owen, Erin Giles, Timothy Zoltie, Victoria Smith, Sue Pavitt, Robert West, Rosemary RC McEachan, Zoe Marshman & Peter F Day

https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01659-1

Background

To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9–12 months and health visitors.

Methods

Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability).

Results

Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be ‘trusted’ and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits.

Conclusion

The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child.

DOI: https://doi.org/10.1186/s12875-022-01659-1

Authors - Alicia Abellan, Sara M.Mensink-Bout, Raquel Garcia-Esteban, Andrea Beneitog, Leda Chatzi, Talita Duarte-Salles Mariana F.Fernandez, Judith Garcia-Aymerich, Berit Granum, Carmen Iñiguez, Vincent W.V.Jaddoee, Kurunthachalam Kannan, Aitana Lertxundi, Maria-Jose Lopez-Espinosa, Claire Philippat, Amrit K.Sakhi, Susana Santos, Valérie Siroux, Maribel Casas

https://www.sciencedirect.com/science/article/pii/S0160412022001040?via%3Dihub

Background

In utero exposure to bisphenols, widely used in consumer products, may alter lung development and increase the risk of respiratory morbidity in the offspring. However, evidence is scarce and mostly focused on bisphenol A (BPA) only.

Objective

To examine the associations of in utero exposure to BPA, bisphenol F (BPF), and bisphenol S (BPS) with asthma, wheeze, and lung function in school-age children, and whether these associations differ by sex.

Methods

We included 3,007 mother–child pairs from eight European birth cohorts. Bisphenol concentrations were determined in maternal urine samples collected during pregnancy (1999–2010). Between 7 and 11 years of age, current asthma and wheeze were assessed from questionnaires and lung function by spirometry. Wheezing patterns were constructed from questionnaires from early to mid-childhood. We performed adjusted random-effects meta-analysis on individual participant data.

Results

Exposure to BPA was prevalent with 90% of maternal samples containing concentrations above detection limits. BPF and BPS were found in 27% and 49% of samples. In utero exposure to BPA was associated with higher odds of current asthma (OR = 1.13, 95% CI = 1.01, 1.27) and wheeze (OR = 1.14, 95% CI = 1.01, 1.30) (p-interaction sex = 0.01) among girls, but not with wheezing patterns nor lung function neither in overall nor among boys. We observed inconsistent associations of BPF and BPS with the respiratory outcomes assessed in overall and sex-stratified analyses.

Conclusion

This study suggests that in utero BPA exposure may be associated with higher odds of asthma and wheeze among school-age girls.

Authors - Philippa K Bird, Zoe Hindson, Abigail Dunn, Anna Cronin de Chavez, Josie Dickerson, Joanna Howes, Tracey Bywater

https://wellcomeopenresearch.org/articles/7-85/v1

Background

A secure parent-infant relationship lays the foundations for children’s development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors’ views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted).

Methods

Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis.

Results

Health visitors saw identification and support of the parent-infant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing and workload, the appropriateness of language, perceived intrusiveness and understanding of the questions, and the length of the tool. Suggestions for improvements to the tool were put forwards.

Conclusions

The experiences, benefits and challenges identified help to explain results in Dunn et al, and the wide-ranging challenges identified would hinder assessment of the parent-infant relationship in routine practice. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

Authors - Abigail Dunn, Philippa K Bird, Charlotte Endacott, Tracey Bywater, Joanna Howes, Josie Dickerson

https://wellcomeopenresearch.org/articles/7-88/v1

Background

Positive parent infant relationships are key to achieving long term child outcomes. Identifying parents who may need support is difficult because of a lack of robust assessment tools. Working in partnership with health services we piloted the Maternal Postnatal Attachment Scale (MPAS) in a deprived, multi-ethnic urban community in Bradford, UK. The pilot aimed to assess the clinical utility of MPAS to identify need for support: Was it administered to a representative group of women? Is MPAS valid for this population?

Methods

Data were linked to a cohort study in the pilot area (Born in Bradford’s Better Start - BiBBS). Chi Square tests assessed sample representativeness (age, ethnicity, parity, English language, education, deprivation). Exploratory factor analysis explored MPAS’ validity.

Results

563 women in BiBBS were eligible, 210 (37%) completed MPAS. No differences were found between completers and non-completers, suggestive of a representative sample. In total, 336 women completed MPAS in the pilot. MPAS had ceiling effects and a satisfactory factor structure could not be identified, indicating poor psychometric properties

Conclusions

Health visitors were successful in administering MPAS to a representative sample, but poor psychometric robustness indicates that MPAS is unsuitable for routine use in this setting. A gap for such a measure remains.

Authors - Tracey Bywater, Abigail Dunn, Charlotte Endacott, Karen Smith, Paul A. Tiffin, Matthew Price and Sarah Blower

https://www.frontiersin.org/articles/10.3389/fpsyg.2022.804885/full

Introduction

The National Institute for Health and Care Excellence (NICE) guidelines acknowledge the importance of the parent–infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under 1 year. This study explores the acceptability and psychometric properties of a co-developed tool, ‘Me and My Baby’ (MaMB).

Study design

A cross-sectional design was applied. The MaMB was administered universally (in two sites) with mothers during routine 6–8-week Health Visitor contacts. The sample comprised 467 mothers (434 MaMB completers and 33 ‘non-completers’). Dimensionality of instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modeling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of ‘fundamental measurement’. Tool acceptability was evaluated via completion rates and comparing ‘completers’ and ‘non-completers’ demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarized. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies.

Results

High completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially (>0.4) on a single underlying factor (latent variable). The item response modeling showed that most MaMB items fitted the Rasch model. (Rasch) item reliability was high (0.94) yet the test yielded little information on each respondent, as highlighted by the relatively low ‘person separation index’ of 0.1.

Conclusion and next steps

MaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with ‘enriched population samples’ to include higher-need/risk families. The MaMB tool may benefit from reduced response categories (from four to three) and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions.

2021

Authors - Jennifer Hall, Daniel D. Bingham, Amanda Seims, Sufyan Abid Dogra, Jan Burkhardt, James Nobles, Jim McKenna, Maria Bryant, Sally E. Barber & Andy Daly-Smith

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12255-w

Background

Engaging in regular physical activity requires continued complex decision-making in varied and dynamic individual, social and structural contexts. Widespread shortfalls of physical activity interventions suggests the complex underlying mechanisms of change are not yet fully understood. More insightful process evaluations are needed to design and implement more effective approaches. This paper describes the protocol for a process evaluation of the JU:MP programme, a whole systems approach to increasing physical activity in children and young people aged 5–14 years in North Bradford, UK.

Methods

This process evaluation, underpinned by realist philosophy, aims to understand the development and implementation of the JU:MP programme and the mechanisms by which JU:MP influences physical activity in children and young people. It also aims to explore behaviour change across wider policy, strategy and neighbourhood systems. A mixed method data collection approach will include semi-structured interview, observation, documentary analysis, surveys, and participatory evaluation methods including reflections and ripple effect mapping.

Discussion

This protocol offers an innovative approach on the use of process evaluation feeding into an iterative programme intended to generate evidence-based practice and deliver practice-based evidence. This paper advances knowledge regarding the development of process evaluations for evaluating systems interventions, and emphasises the importance of process evaluation.

Authors - Maiken Pontoppidan, Sarah Blower, Julie Nygaard Solvang & Tracey Bywater

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05826-0

Background

Lower than expected recruitment and retention rates are common challenges in parenting trials—particularly for community-based trials targeting parents of young children that rely on face-to-face recruitment by frontline workers. Recruitment requires parental informed consent, yet information sheets have been criticized for being lengthy and complex, and particularly challenging for parents with low literacy. Recent innovations include ‘talking head’ information videos. This paper aims to explore parent perceptions of using a ‘talking head’ video to support informed consent, recruitment, and retention procedures in parenting trials.

Methods

We conducted semi-structured interviews with a sample of 24 mothers recruited after their final follow-ups in two different parenting trials in Denmark. Before consenting to participate in the trials, parents were invited to view a video of a member of the study team giving information about the study, and again before the interviews for the current study. The audio data was transcribed and thematic analysis was conducted.

Results

We identified three overarching themes: (1) general impression of the video, (2) thoughts on participation in research, and (3) recruitment and retention. Participants were generally positive in their appraisal of the two talking head informational videos. We found that participants felt that a mix of paper-based and video-based sources of information would enable them to make an informed choice about whether to participate in a research study. We also found that a professionally produced video featuring a key member of the study team produced a feeling of commitment to the study that could impact retention rates.

Conclusions

Informational videos are acceptable to parents; however, co-production or participant/patient involvement in the development of such videos is recommended. Informational videos may not increase recruitment but have the potential for improving retention. Key design recommendations are to ensure a ‘professional’ look to the video, to supplement videos with paper-based information, to keep the length to < 3 min, and for the ‘talking head’ part to feature a key member of the study team.

Authors - Martine Vrijheid , Xavier Basagaña, Juan R Gonzalez, Vincent W V Jaddoe, Genon Jensen, Hector C Keun, Rosemary R C McEachan, Joana Porcel, Valerie Siroux, Morris A Swertz, Cathrine Thomsen, Gunn Marit Aasvang, Sandra Andrušaitytė, Karine Angeli, Demetris Avraam, Ferran Ballester, Paul Burton, Mariona Bustamante, Maribel Casas, Leda Chatzi, Cécile Chevrier, Natacha Cingotti, David Conti, Amélie Crépet, Payam Dadvand, Liesbeth Duijts, Esther van Enckevort, Ana Esplugues, Serena Fossati, Ronan Garlantezec, María Dolores Gómez Roig, Regina Grazuleviciene, Kristine B Gützkow, Mònica Guxens, Sido Haakma, Ellen V S Hessel, Lesley Hoyles, Eleanor Hyde, Jana Klanova, Jacob D van Klaveren, Andreas Kortenkamp, Laurent Le Brusquet, Ivonne Leenen, Aitana Lertxundi, Nerea Lertxundi, Christos Lionis, Sabrina Llop, Maria-Jose Lopez-Espinosa, Sarah Lyon-Caen, Lea Maitre, Dan Mason, Sandrine Mathy, Edurne Mazarico, Tim Nawrot, Mark Nieuwenhuijsen, Rodney Ortiz, Marie Pedersen, Josep Perelló, Míriam Pérez-Cruz, Claire Philippat, Pavel Pile, Costanza Pizzi, Joane Quentin, Lorenzo Richiardi, Adrian Rodriguez, Theano Roumeliotaki, José Manuel Sabin Capote, Leonardo Santiago, Susana Santos, Alexandros P Siskos, Katrine Strandberg-Larsen, Nikos Stratakis, Jordi Sunyer, Arthur Tenenhaus, Marina Vafeiadi, Rebecca C Wilson, John Wright , Tiffany Yang, Remy Slama

https://pubmed.ncbi.nlm.nih.gov/34934888/

Abstract

Early life stages are vulnerable to environmental hazards and present important windows of opportunity for lifelong disease prevention. This makes early life a relevant starting point for exposome studies. The Advancing Tools for Human Early Lifecourse Exposome Research and Translation (ATHLETE) project aims to develop a toolbox of exposome tools and a Europe-wide exposome cohort that will be used to systematically quantify the effects of a wide range of community- and individual-level environmental risk factors on mental, cardiometabolic, and respiratory health outcomes and associated biological pathways, longitudinally from early pregnancy through to adolescence. Exposome tool and data development include as follows: (1) a findable, accessible, interoperable, reusable (FAIR) data infrastructure for early life exposome cohort data, including 16 prospective birth cohorts in 11 European countries; (2) targeted and nontargeted approaches to measure a wide range of environmental exposures (urban, chemical, physical, behavioral, social); (3) advanced statistical and toxicological strategies to analyze complex multidimensional exposome data; (4) estimation of associations between the exposome and early organ development, health trajectories, and biological (metagenomic, metabolomic, epigenetic, aging, and stress) pathways; (5) intervention strategies to improve early life urban and chemical exposomes, co-produced with local communities; and (6) child health impacts and associated costs related to the exposome. Data, tools, and results will be assembled in an openly accessible toolbox, which will provide great opportunities for researchers, policymakers, and other stakeholders, beyond the duration of the project. ATHLETE's results will help to better understand and prevent health damage from environmental exposures and their mixtures from the earliest parts of the life course onward.

Authors - Halima Iqbal, Jane West, Melanie Haith-Cooper, Rosemary R. C. McEachan

https://doi.org/10.1371/journal.pone.0251685

Background

Black, Asian and minority ethnic communities suffer from disproportionately poorer health than the general population. This issue has been recently exemplified by the large numbers of infection rates and deaths caused by covid-19 in BAME populations. Future research has the potential to improve health outcomes for these groups. High quality research priority setting is crucial to effectively consider the needs of the most vulnerable groups of the population.

Objective

The purpose of this systematic review is to identify existing research priority studies conducted for BAME health and to determine the extent to which they followed good practice principles for research priority setting.

Method

Included studies were identified by searching Medline, Cinnahl, PsychINFO, Psychology and Behavioral Sciences Collection, as well as searches in grey literature. Search terms included “research priority setting”, “research prioritisation”, “research agenda”, “Black and minority ethnic”, “ethnic group”. Studies were included if they identified or elicited research priorities for BAME health and if they outlined a process of conducting a research prioritisation exercise. A checklist of Nine Common Themes of Good Practice in research priority setting was used as a methodological framework to evaluate the research priority processes of each study.

Results

Out of 1514 citations initially obtained, 17 studies were included in the final synthesis. Topic areas for their research prioritisation exercise included suicide prevention, knee surgery, mental health, preterm birth, and child obesity. Public and patient involvement was included in eleven studies. Methods of research prioritisation included workshops, Delphi techniques, surveys, focus groups and interviews. The quality of empirical evidence was diverse. None of the exercises followed all good practice principles as outlined in the checklist. Areas that were lacking in particular were: the lack of a comprehensive approach to guide the process; limited use of criteria to guide discussion around priorities; unequal or no representation from ethnic minorities, and poor evaluation of their own processes.

Conclusions

Research priority setting practices were found to mostly not follow good practice guidelines which aim to ensure rigour in priority setting activities and support the inclusion of BAME communities in establishing the research agenda. Research is unlikely to deliver useful findings that can support relevant research and positive change for BAME communities unless they fulfil areas of good practice such as inclusivity of key stakeholders’ input, planning for implementation of identified priorities, criteria for deciding on priorities, and evaluation of their processes in research priority setting.

Authors - Ieva Eskytė, Kara A. Gray-Burrows, Jenny Owen, Bianca Sykes-Muskett, Sue H. Pavitt, Robert West, Zoe Marshman and Peter F. Day

https://www.frontiersin.org/articles/10.3389/fpubh.2021.578168/full

Background

Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the “Healthy Child Programme.” The “Healthy Child Programme,” which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place.

Objective

Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health.

Methods

Qualitative interviews and focus groups were held with health visiting teams (n = 18) conducting home visits with parents of 9–12-month olds in a deprived, urban area in England.

Results

The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change.

Conclusion

Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory.

Authors - Josie Dickerson, Rachael H. Moss, Charlotte Endacott, Brian Kelly, Sally Bridges, Kirsty L. Crossley, Maria Bryant, Trevor A. Sheldon, John Wright, Kate E. Pickett, Rosemary R.C. McEachan, Bradford Institute for Health Research COVID-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/6-23/v1

Background

The roll out of coronavirus disease 2019 (COVID-19) vaccines are now underway in the UK, and ensuring good uptake in vulnerable communities will be critical to reducing hospital admissions and deaths. There is emerging evidence that vaccine hesitancy is higher in ethnic minorities and deprived areas, and that this may be caused by misinformation in the community. This study aims to understand COVID-19 vaccine hesitancy in an ethnically diverse and deprived population.

Methods

Questionnaire surveys were sent to parents in the Born in Bradford study. Cross tabulations explored variation by ethnicity and deprivation. Text from open-ended questions was analysed using thematic analysis.

Results

535 (31%) of 1727 invited between 29th October-9th December 2020 participated in the study. 154 (29%) of respondents do want a vaccine, 53 (10%) do not. The majority had not thought about it (N=154, 29%) or were unsure (N=161, 30%). Vaccine hesitancy differed significantly by ethnicity and deprivation: 43% (95% CIs: 37-54%) of White British and 60% (35-81%) in the least deprived areas do want a vaccine, compared to 13% (9-19%) of Pakistani heritage and 20% (15-26%) in the most deprived areas. Those that distrusted the NHS were more likely to not want a vaccine (30%, 15-50%). Reasons for not wanting a vaccine were commonly explained by confusion and distrust caused by prevalent misinformation.

Conclusions

There is a much higher level of vaccine hesitancy in ethnic minorities, those living in deprived areas and those that distrust the NHS. There is an urgent need to tackle the overwhelming misinformation about COVID-19 that is leading to this uncertainty and confusion about the vaccines. If not addressed there is a high risk of unequitable roll out of the vaccination programme in the UK.

2020

Authors - Katy A. Shire, Jo Atkinson, Emily A. Williams, John Pickavance, Sara Magallón, Liam JB. Hill, Amanda H. Waterman, David A. Sugden & Mark Mon-Williams

https://www.tandfonline.com/doi/full/10.1080/19411243.2020.1837047

ABSTRACT

We describe the development of an evidence-based motor intervention and an implementation pilot study in ten primary schools, involving 515 children (4–11 years). ‘Helping Handwriting SHINE’ (HHS) is a novel, school-led, group-based handwriting intervention. Teaching staff delivered HHS and provided feedback through a questionnaire, reporting that: (i) the children found the tasks enjoyable; (ii) the background and booklet instructions were easy to understand, (iii) there was a need for more comprehensive staff training. The teaching staff made recommendations about session duration, group size, resource availability, and age differentiation of tasks. These suggestions are applicable to the development of any school-based group-led motor intervention, and we used this feedback to refine the HHS intervention. This study shows that implementing school-led motor interventions at scale is possible. Moreover, the work provides insights into the factors to consider when developing school-based motor interventions prior to conducting randomized controlled trials (RCT). The process outlined in this manuscript has led to an RCT to test the effectiveness of HHS within primary schools.

Authors - Josie Dickerson, Brian Kelly, Bridget Lockyer, Sally Bridges, Christopher Cartwright, Kathryn Willan, Katy Shire, Kirsty Crossley, Trevor A. Sheldon, Deborah A. Lawlor, John Wright, Rosemary R C McEachan, Kate E. Pickett, on behalf of the Bradford Institute for Health Research Covid-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-228/v1

Background

Lockdown measures implemented to contain the Covid-19 virus may be increasing health inequalities, with families from deprived and ethnically diverse backgrounds most likely to be adversely affected. This paper presents findings of the experiences of the Covid-19 lockdown on families living in the multi-ethnic and deprived city of Bradford, England.

Methods

Questionnaire surveys were sent during the Covid-19 UK lockdown (10th April to 30th June 2020) to parents in two prospective birth cohort studies. Cross tabulations explored variation by ethnicity and employment status. Text from open questions were analysed using thematic analysis.

Results

Of 7,652 families invited, 2,144 (28%) participated. Ethnicity of respondents was: 957 (47%) Pakistani heritage, 715 (35%) White British and 356 (18%) other. 971 (46%) live in the most deprived decile of material deprivation in England. 2,043 (95%) were mothers and 101 were partners. The results summarised below are based on the mothers’ responses. Many families live in poor quality (N=574, 28%), and overcrowded (N=364, 19%) housing; this was more common in families of Pakistani heritage and other ethnicities. Financial (N=738 (37%), food (N=396, 20%), employment (N=728, 37%) and housing (N=204, 10%) insecurities were common, particularly in those who were furloughed, self-employed not working or unemployed. Clinically significant depression and anxiety symptoms were reported by 372 (19%) and 318 (16%) of the mothers and were more common in White British mothers and those with economic insecurity. Open text responses corroborated these findings and highlighted high levels of anxiety about becoming ill or dying from Covid-19.

Conclusions

The experiences of the Covid-19 lockdown in this ethnically diverse and deprived population highlight a large number of families living in poor housing conditions, suffering from economic insecurity and poor mental health. There is a need for policy makers and commissioners to better support these families.

Authors - Aron P. Sherry, Natalie Pearson, Nicola D. Ridgers, William Johnson, Sally E. Barber, Daniel D. Bingham, Liana C. Nagy and Stacy A. Clemes

https://www.mdpi.com/1660-4601/17/19/7048

Abstract

Traditional classroom furniture dictates that children predominantly sit during class time. This study evaluated the impact of providing standing desks within a deprived UK primary school setting over 8 months using mixed-method approaches. All children within a Year 5 class (9–10-year-olds, n = 30) received an adjustable sit–stand desk, while another Year 5 class (n = 30) in a nearby school retained traditional furniture as a control classroom. At baseline, 4 months, and 8 months, activPAL monitors (PAL Technologies, Glasgow, UK) were worn for 7 days to provide time spent sitting and standing. Behavior-related mental health, musculoskeletal discomfort surveys, and a cognitive function test battery were also completed at all three timepoints. Intervention experiences from pupils and the teacher were captured using focus groups, interviews, and classroom observations. At both 4 months and 8 months, multi-level models revealed a reduction in class time sitting in the intervention group compared to the control group ((β (95%CI) 4 months −25.3% (−32.3, −18.4); 8 months −19.9% (−27.05, −12.9)). Qualitative data revealed challenges to teaching practicalities and a gradual decline in behavior-related mental health was observed (intervention vs. control: 4 months +5.31 (+2.55, +8.08); 8 months +7.92 (+5.18, +10.66)). Larger trials within similar high-priority settings are required to determine the feasibility and cost-effectiveness of providing standing desks to every child in the classroom.

Authors - Katherine H KACZMARCZYK, Kara A GRAY-BURROWS, Karen VINALL-COLLIER, Peter F DAY

https://academic.oup.com/intqhc/article-abstract/33/1/mzaa112/5903600?redirectedFrom=fulltext

Background

Oral health worldwide needs improving: untreated dental caries is the most common health condition affecting people globally. Mobile applications (apps) have potential to provide preventative oral health interventions. This study aimed to investigate the quality of available oral health promotion apps, assessing information provided and the barriers to oral health addressed using psychological frameworks.

Methods

A content assessment of oral health promotion apps targeted at adults in the UK iTunes store was conducted. The quality of 22 apps was assessed against 3 objective indices derived from the Delivering Better Oral Health toolkit, Theoretical Domains Framework and Behaviour Change Technique Taxonomy. Index scores were calculated and descriptive analyses were completed.

Results

On average, four Delivering Better Oral Health messages, seven Theoretical Domains Framework components and eight Behaviour Change Technique Taxonomy components were addressed per app. The most common components were: ‘take at least two minutes to brush’ for the Delivering Better Oral Health index, ‘goals’ and ‘intentions’ for the Theoretical Domains Framework index and ‘goal setting (behaviour)’ for the Behaviour Change Technique Taxonomy index.

Conclusion

The quality of information available in oral health apps requires improvement with the majority addressing only a few barriers to oral health. Currently, there is no recognized scale for evaluating oral health apps: this study provides a suggested method for future app evaluation. There is opportunity for a new app to be created based on health behaviour change theory which includes all the Delivering Better Oral Health messages.

Authors - Peter Nelson, Paul Bissell, Catherine Homer, Lee Pollard, Vanessa Powell-Hoyland

https://academic.oup.com/bjsw/advance-article-abstract/doi/10.1093/bjsw/bcaa100/5892777?redirectedFrom=fulltext

Abstract

Childhood obesity is a key public health concern. Obesity has an impact on morbidity and mortality, child development, and has links to child sexual abuse. The costs of childhood obesity on the health service and society are well recognised. Whether childhood obesity should also be a child protection concern has divided commentators and professionals. They pose a juxtaposition questioning whether childhood obesity is a consequence of neglect and obese children should potentially be removed from parents who do not seek to reduce their child’s weight, whilst expressing resistance to a role focused on bodily surveillance. This research sought to identify existing practice, through interviews (N23) and focus groups (N3:24) with key professional stakeholders, from social care, health and education, in one area in the UK. The research aimed to explore the decision-making, views and experiences of those working with obesity and the child protection system. The data were subject to Framework Analysis. Key findings include multi-agency working, personal and professional standpoint, and the complex and nuanced impact of individual and agency thresholds on practice. The research demonstrates how the tensions surrounding a child protection paradigm impact on individual and agency practice, potentially inhibiting the support offered to service users.

Authors - Lucy H. Eddy, Daniel D. Bingham, Kirsty L. Crossley, Nishaat F. Shahid, Marsha Ellingham-Khan, Ava Otteslev, Natalie S. Figueredo, Mark Mon-Williams, Liam J. B. Hill

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237919

Background

Fundamental Movement Skills (FMS) play a critical role in ontogenesis. Many children have insufficient FMS, highlighting the need for universal screening in schools. There are many observational FMS assessment tools, but their psychometric properties are not readily accessible. A systematic review was therefore undertaken to compile evidence of the validity and reliability of observational FMS assessments, to evaluate their suitability for screening.

Methods

A pre-search of ‘fundamental movement skills’ OR ‘fundamental motor skills’ in seven online databases (PubMed, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, EBSCO SPORTDiscus, Ovid PsycINFO and Web of Science) identified 24 assessment tools for school-aged children that: (i) assess FMS; (ii) measure actual motor competence and (iii) evaluate performance on a standard battery of tasks. Studies were subsequently identified that: (a) used these tools; (b) quantified validity or reliability and (c) sampled school-aged children. Study quality was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklists.

Results

Ninety studies were included following the screening of 1863 articles. Twenty-one assessment tools had limited or no evidence to support their psychometric properties. The Test of Gross Motor Development (TGMD, n = 34) and the Movement Assessment Battery for Children (MABC, n = 37) were the most researched tools. Studies consistently reported good evidence for validity, reliability for the TGMD, whilst only 64% of studies reported similarly promising results for the MABC. Twelve studies found good evidence for the reliability and validity of the Bruininks-Oseretsky Test of Motor Proficiency but poor study quality appeared to inflate results. Considering all assessment tools, those with promising psychometric properties often measured limited aspects of validity/reliability, and/or had limited feasibility for large scale deployment in a school-setting.

Conclusion

There is insufficient evidence to justify the use of any observational FMS assessment tools for universal screening in schools, in their current form.

Authors - Rosemary R C McEachan, Josie Dickerson, Sally Bridges, Maria Bryant, Christopher Cartwright, Shahid Islam, Bridget Lockyer, Aamnah Rahman, Laura Sheard, Jane West, Deborah A. Lawlor, Trevor A. Sheldon, John Wright, Kate E. Pickett, on behalf of the Bradford Institute for Health Research COVID-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-191/v1

Abstract

The UK COVID-19 lockdown has included restricting social movement and interaction to slow the spread of disease and reduce demand on NHS acute services. It is likely that the impacts of restrictions will hit the least advantaged disproportionately and will worsen existing structural inequalities amongst deprived and ethnic minority groups.

The aim of this study is to deliver rapid intelligence to enable an effective COVID-19 response, including co-production of interventions, that address key issues in the City of Bradford, UK, and nationally. In the longer term we aim to understand the impacts of the response on health trajectories and inequalities in these.

In this paper we describe our approach and protocol. We plan an adaptive longitudinal mixed methods approach embedded with Born in Bradford (BiB) birth cohorts which have rich existing data (including questionnaire, routine health and biobank). All work packages (WP) interact and are ongoing. WP1 uses co-production and engagement methods with communities, decision-makers and researchers to continuously set (changing) research priorities and will, longer-term, co-produce interventions to aid the City’s recovery. In WP2 repeated quantitative surveys will be administered during lockdown (April-June 2020), with three repeat surveys until 12 months post-lockdown with an ethnically diverse pool of BiB participants (parents, children aged 9-13 years, pregnant women: total sample pool N=7,652, N=5,154, N=1,800). A range of health, social, economic and education outcomes will be assessed. In WP3 priority topics identified in WP1 and WP2 will be explored qualitatively. Initial priority topics include children’s mental wellbeing, health beliefs and the peri/post-natal period. Feedback loops will ensure findings are fed directly to decision-makers and communities (via WP1) to enable co-production of acceptable interventions and identify future priority topic areas. Findings will be used to aid development of local and national policy to support recovery from the pandemic and minimise health inequalities.

Authors - Stacy A. Clemes, Daniel D. Bingham, Natalie Pearson, Yu-Ling Chen, Charlotte L. Edwardson, Rosemary R. C. McEachan, Keith Tolfrey, Lorraine Cale, Gerry Richardson, Mike Fray, James Altunkaya, Stephan Bandelow, Nishal Bhupendra Jaicim, Jo Salmon, David W. Dunstan & Sally E. Barber

https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00958-z

Background

Excessive sedentary behaviour (sitting) is a risk factor for poor health in children and adults. Incorporating sit-stand desks in the classroom environment has been highlighted as a potential strategy to reduce children’s sitting time. The primary aim of this study was to examine the feasibility of conducting a cluster randomised controlled trial (RCT) of a sit-stand desk intervention within primary school classrooms.

Methods

We conducted a two-armed pilot cluster RCT involving 8 primary schools in Bradford, United Kingdom. Schools were randomised on a 1:1 basis to the intervention or usual practice control arm. All children (aged 9–10 years) in participating classes were eligible to take part. Six sit-stand desks replaced three standard desks (sitting 6 children) in the intervention classrooms for 4.5-months. Teachers were encouraged to use a rotation system to ensure all pupils were exposed to the sit-stand desks for > 1 h/day on average. Trial feasibility outcomes (assessed using quantitative and qualitative measures) included school and participant recruitment and attrition, intervention and outcome measure completion rates, acceptability, and preliminary effectiveness of the intervention for reducing sitting time. A weighted linear regression model compared changes in weekday sitting time (assessed using the activPAL accelerometer) between trial arms.

Results

School and child recruitment rates were 33% (n = 8) and 75% (n = 176). At follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63 to 97%. A preliminary estimate of intervention effectiveness revealed a mean difference in change in sitting of − 30.6 min/day (95% CI: − 56.42 to − 4.84) in favour of the intervention group, after adjusting for baseline sitting and wear time. Qualitative measures revealed the intervention and evaluation procedures were acceptable to teachers and children, except for some problems with activPAL attachment.

Conclusion

This study provides evidence of the acceptability and feasibility of a sit-stand desk intervention and evaluation methods. Preliminary evidence suggests the intervention showed potential in reducing children’s weekday sitting but some adaptations to the desk rotation system are needed to maximize exposure. Lessons learnt from this trial will inform the planning of a definitive trial.

Authors - Elnaz Aliakbari, Kara A. Gray-Burrows, Karen A. Vinall-Collier, Sakina Edwebi, Zoe Marshman, Rosemary R. C. McEachan, Peter F. Day

https://onlinelibrary.wiley.com/doi/10.1111/ipd.12658

Background

Dental caries is the most prevalent preventable condition in children. A key preventive home-based oral health behaviour is the adoption and maintenance of parental supervised toothbrushing until 8 years of age.

Aim

To examine interventions promoting parental supervised toothbrushing practices to reduce dental caries in young children (<8 years old).

Design

Interventions promoting parental involvement in home-based toothbrushing in children under 8 years old and their impact on caries were subjected to review. Electronic databases (MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, Scopus, and the Cochrane Library), references, and unpublished literature databases were searched for relevant literature.

Results

Of the 10 176 articles retrieved, forty-two articles were included. The Theoretical Domains Framework was used to code intervention content, with the main domains addressed being knowledge (41/42), skills (35/42), and environmental context and resources (22/42). Sufficient descriptions of the intervention development, delivery, and evaluation were lacking, with only 18 studies being underpinned by theory. Twenty-nine studies explored the impact on caries yielding mixed results.

Conclusions

There are few interventions targeting home-based oral health behaviours underpinned by theory and methodological rigour in their development and evaluation. This demonstrates a clear need for future interventions to be guided by complex intervention methodology.

Authors - Paul J. Collings, Diane Farrar, Joanna Gibson, Jane West, Sally E. Barber, and John Wright

https://journals.humankinetics.com/view/journals/jpah/17/2/article-p236.xml

Background

Physical activity performed while pregnant is beneficially associated with maternal cardiovascular health. It is unknown if benefits extend to neonatal cardiovascular health. This study investigated associations of maternal physical activity with neonatal cord blood lipid and lipoprotein concentrations.

Methods

Cord blood lipids were measured at birth in a pseudorandomly selected subgroup of Born in Bradford birth cohort participants (N = 1634). Pregnant women were grouped into 4 activity categories (inactive/somewhat active/moderately active/active) based on their self-reported physical activity at 26- to 28-weeks gestation. Regression was used to calculate adjusted mean differences in neonatal cord blood lipid concentrations among the 4 groups of physical activity.

Results

Maternal physical activity was associated with higher neonatal cord blood high-density lipoprotein cholesterol. Cord blood high-density lipoprotein cholesterol was higher in neonates of women who were somewhat and moderately active compared with neonates of women who were inactive. There were no associations of pregnancy physical activity with triglycerides, low-density lipoprotein, very low-density lipoprotein cholesterol, or adiponectin levels.

Conclusions

Maternal physical activity is favorably associated with neonatal cord blood high-density lipoprotein cholesterol levels. This novel beneficial finding highlights the potential for physical activity in pregnancy to aid the early prevention of cardiovascular disease.

Authors - Paul J. Collings, Sufyan A. Dogra, Silvia Costa, Daniel D. Bingham & Sally E. Barber

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-8132-z

Background

Evidence suggests that South Asian school-aged children and adults are less active compared to the white British population. It is unknown if this generalises to young children. We aimed to describe variability in levels of physical activity and sedentary time in a bi-ethnic sample of young children from a deprived location.

Methods

This observational study included 202 South Asian and 140 white British children aged 1.5 to 5y, who provided 3181 valid days of triaxial accelerometry (Actigraph GT3X+). Variability in sedentary time and physical activity levels were analysed by linear multilevel modelling. Logistic multilevel regression was used to identify factors associated with physical inactivity (failing to perform ≥180 min of total physical activity including ≥60 min moderate-to-vigorous physical activity (MVPA) per day).

Results

There were no significant ethnic differences in the overall levels of behaviours; South Asian and white British children spent half of daily time sedentary, just over 40% in light physical activity, and the remaining 7.5 to 8% of time in MVPA. Sedentary time was lower and physical activity levels were higher in older children, and levels of MVPA and vector magnitude counts per minute (CPM) were higher on weekends compared to weekdays. In South Asian children, sedentary time was lower on weekends. Sedentary time was lower and physical activity levels were higher in spring compared to winter in white British children, and in all seasons compared to winter in South Asian children. South Asian children born at high birth weight performed more MVPA, and in both ethnicities there was some evidence that children with older mothers were more sedentary and less active. Sedentary time was higher and light physical activity was lower in South Asian children in the highest compared to the lowest income families. South Asian girls performed less MVPA, registered fewer vector magnitude CPM, and were 3.5 times more likely to be physically inactive than South Asian boys.

Conclusions

Sedentary time and physical activity levels vary by socio-demographic, temporal and perinatal characteristics in young children from a deprived location. South Asian girls have the most to gain from efforts to increase physical activity levels.

Authors - Josie Dickerson, Brian Kelly, Bridget Lockyer, Christopher Cartwright, Kathryn Willan, Katy Shire, Kirsty Crossley, Trevor A Sheldon, Deborah A, John Wright, Rosemary R C McEachan, Kate E Pickett, on behalf of the Bradford Institute for Health Research Covid-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-228

Background

Lockdown measures implemented to contain the Covid-19 virus may be increasing health inequalities, with families from deprived and ethnically diverse backgrounds most likely to be adversely affected. This paper presents findings of the experiences of the Covid-19 lockdown on families living in the multi-ethnic and deprived city of Bradford, England.

Methods

Questionnaire surveys were sent during the Covid-19 UK lockdown (10th April to 30th June 2020) to parents in two prospective birth cohort studies. Cross tabulations explored variation by ethnicity and employment status. Text from open questions were analysed using thematic analysis.

Results

Of 7,652 families invited, 2,144 (28%) participated. Ethnicity of respondents was: 957 (47%) Pakistani heritage, 715 (35%) White British and 356 (18%) other. 971 (46%) live in the most deprived decile of material deprivation in England. 2,043 (95%) were mothers and 101 were partners. The results summarised below are based on the mothers’ responses. Many families live in poor quality (N=574, 28%), and overcrowded (N=364, 19%) housing; this was more common in families of Pakistani heritage and other ethnicities. Financial (N=738 (37%), food (N=396, 20%), employment (N=728, 37%) and housing (N=204, 10%) insecurities were common, particularly in those who were furloughed, self-employed not working or unemployed. Clinically significant depression and anxiety symptoms were reported by 372 (19%) and 318 (16%) of the mothers and were more common in White British mothers and those with economic insecurity. Open text responses corroborated these findings and highlighted high levels of anxiety about becoming ill or dying from Covid-19.

Conclusions

The experiences of the Covid-19 lockdown in this ethnically diverse and deprived population highlight a large number of families living in poor housing conditions, suffering from economic insecurity and poor mental health. There is a need for policy makers and commissioners to better support these families

Authors - Nick Axford, Gretchen Bjornstad, Justin Matthews, Sarah Heilmann, Anam Raja, Obioh C.Ukoumunne, Vashti Berry, Tom Wilkinson, Luke Timmons, Tim Hobbs, TimEames, Angeliki Kallitsoglou, SarahBlower, Georgina Warner

https://www.sciencedirect.com/science/article/abs/pii/S0190740920303170?via%3Dihub

Objective

The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10–12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element.

Methods/Design

In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills.

Results

All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ Total Difficulties (standardized mean difference: −0.07; 95% CI: −0.30 to 0.16; p = 0.54). There were no sub-group effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Independent observation indicated scope to improve fidelity in terms of adherence, quality and participant responsiveness.

Conclusions

The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.

Sarah Blower, Veronica Swallow, Camila Maturana, Simon Stones, Robert Phillips, Paul Dimitri, Zoe Marshman, Peter Knapp, Alexandra Dean, Steven Higgins, Ian Kellar, Penny Curtis, Nathaniel Mills, Jacqueline Martin-Kerry

https://adc.bmj.com/content/105/11/1093

Background

The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies.

Aims To identify children and young people’s reported concerns or needs in relation to using health technologies to self-manage long-term conditions.

Methods

A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations.

Results

Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5–18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people’s main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information.

Discussion

This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.

Authors - Gillian Santorelli, Trevor Sheldon, Jane West, Chris Cartwright, John Wright

https://wellcomeopenresearch.org/articles/5-86/v1

Abstract

There is debate about the extent to which COVID-19 affects ethnic groups differently. We explored if there was variation in hospital mortality in patients with COVID. Mortality rates in 1,276 inpatients in Bradford with test results for COVID-19 were analysed by ethnic group. The age-adjusted risk of dying from COVID-19 was slightly lower in South Asian compared to White British patients. (RR =0.87, 95% CI: 0.41 to 1.84).

Authors - Katy Shire, Elizabeth Andrews, Sally Barber, Alison Bruce, John Corkett, Liam J. B. Hill, Brian Kelly, Rosemary R C McEachan, Louise Tracey, Amanda H. Waterman, John Wright

https://wellcomeopenresearch.org/articles/5-47/v1

Abstract

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

2019

Authors - Katherine J Pettinger, Brian Kelly, Trevor A Sheldon, Mark Mon-Williams, John Wright, Liam J B Hill

https://adc.bmj.com/content/105/2/160

Objective

To estimate the impact on early development of prematurity and summer birth and the potential ‘double disadvantage’ created by starting school a year earlier than anticipated during pregnancy, due to being born preterm.

Design, setting and patients

We investigated the impact of gestational and school-entry age on the likelihood of failing to achieve a ‘Good Level of Development’ (GLD) on the Early Years Foundation Stage Profile in 5-year-old children born moderate-to-late preterm using data from the Born in Bradford longitudinal birth cohort. We used hierarchical logistic regression to control for chronological maturity, and perinatal and socioeconomic factors.

Results

Gestational age and school-entry age were significant predictors of attaining a GLD in the 10 337 children who entered school in the correct academic year given their estimated date of delivery. The odds of not attaining a GLD increased by 1.09 (95% CI 1.06 to 1.11) for each successive week born early and by 1.17 for each month younger within the year group (95% CI 1.16 to 1.18). There was no interaction between these two effects. Children starting school a year earlier than anticipated during pregnancy were less likely to achieve a GLD compared with (1) other children born preterm (fully adjusted OR 5.51 (2.85–14.25)); (2) term summer births (3.02 (1.49–6.79)); and (3) preterm summer births who remained within their anticipated school-entry year (3.64 (1.27–11.48)).

Conclusions

These results confirm the developmental risks faced by children born moderate-to-late preterm, and—for the first time—illustrate the increased risk associated with ‘double disadvantage’.