Caroline Frostick

During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the Development and Infancy Study

While recreational drug use in UK women is prevalent, to date there is little prospective data on patterns of drug use in recreational drug-using women immediately before and during pregnancy. A total of 121 participants from a wide range of backgrounds were recruited to take part in the longitudinal Development and Infancy Study (DAISY) study of prenatal drug use and outcomes. Eighty-six of the women were interviewed prospectively while pregnant and/or soon after their infant was born. Participants reported on use immediately before and during pregnancy and on use over their lifetime. Levels of lifetime drug use of the women recruited were high, with women reporting having used at least four different illegal drugs over their lifetime. Most users of cocaine, 3,4-methylenedioxy-N-methylamphetamine (MDMA) and other stimulants stopped using these by the second trimester and levels of use were low. However, in pregnancy, 64% of the sample continued to use alcohol, 46% tobacco and 48% cannabis. While the level of alcohol use reduced substantially, average tobacco and cannabis levels tended to be sustained at pre-pregnancy levels even into the third trimester (50 cigarettes and/or 11 joints per week). In sum, while the use of ‘party drugs’ and alcohol seems to reduce, levels of tobacco and cannabis use are likely to be sustained throughout pregnancy. The data provide polydrug profiles that can form the basis for the development of more realistic animal models.

The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results

BackgroundThe Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here.MethodsThe CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys.ResultsThere were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys.ConclusionsRandomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.Trial registrationCurrent Controlled Trials ISRCTN68175121

Brain responses and looking behavior during audiovisual speech integration in infants predict auditory speech comprehension in the second year of life

The use of visual cues during the processing of audiovisual (AV) speech is known to be less efficient in children and adults with language difficulties and difficulties are known to be more prevalent in children from low-income populations. In the present study, we followed an economically diverse group of thirty-seven infants longitudinally from 6–9 months to 14–16 months of age. We used eye-tracking to examine whether individual differences in visual attention during AV processing of speech in 6–9 month old infants, particularly when processing congruent and incongruent auditory and visual speech cues, might be indicative of their later language development. Twenty-two of these 6–9 month old infants also participated in an event-related potential (ERP) AV task within the same experimental session. Language development was then followed-up at the age of 14–16 months, using two measures of language development, the Preschool Language Scale and the Oxford Communicative Development Inventory. The results show that those infants who were less efficient in auditory speech processing at the age of 6–9 months had lower receptive language scores at 14–16 months. A correlational analysis revealed that the pattern of face scanning and ERP responses to audiovisually incongruent stimuli at 6–9 months were both significantly associated with language development at 14–16 months. These findings add to the understanding of individual differences in neural signatures of AV processing and associated looking behavior in infants.

Physical Activity in Deprived Communities in London: Examining Individual and Neighbourhood-Level Factors

Introduction The objectives of this study were to examine relationships between neighbourhood-level and individual-level characteristics and physical activity in deprived London neighbourhoods. Methods In 40 of the most deprived neighbourhoods in London (ranked in top 11% in London by Index of Multiple Deprivation) a cross-sectional survey (n = 4107 adults aged > = 16 years), neighbourhood audit tool, GIS measures and routine data measured neighbourhood and individual-level characteristics. The binary outcome was meeting the minimum recommended (CMO, UK) 5×30 mins moderate physical activity per week. Multilevel modelling was used to examine associations between physical activity and individual and neighbourhood-level characteristics. Results Respondents living more than 300 m away from accessible greenspace had lower odds of achieving recommended physical activity levels than those who lived within 300 m; from 301–600 m (OR = 0.7; 95% CI 0.5–0.9) and from 601–900 m (OR = 0.6; 95% CI 0.4–0.8). There was substantial residual between-neighbourhood variance in physical activity (median odds ratio = 1.7). Other objectively measured neighbourhood-level characteristics were not associated with physical activity levels. Conclusions Distance to nearest greenspace is associated with meeting recommended physical activity levels in deprived London neighbourhoods. Despite residual variance in physical activity levels between neighbourhoods, we found little evidence for the influence of other measured neighbourhood-level characteristics.

A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.

The impact of academies on school connectedness, future aspirations and mental health in adolescents from areas of deprivation in London

ABSTRACT Research shows that school environment impacts significantly on students’ mental health, future aspirations and feelings of school connectedness, which in turn can improve academic outcomes. The UK has seen rising numbers of academy schools in recent years which have been scrutinised for academic performance but overlooked in terms of important aspects of school environment. This study compares outcomes for mental health, school connectedness and future aspirations in low-socioeconomic status adolescents attending academy and non-academy schools. Data came from 1284 11-16yr olds attending 1 of 67 academy or non-academy schools from areas of deprivation in London. A total of 639 complete cases were analysed. Self-reported measures of school connectedness, future aspirations and mental health, including self-esteem, were analysed and compared using linear regression clustered at school level, adjusting for the effects of gender, ethnicity, school year and affluence. Adolescents attending academies were found to have significantly higher levels of school connectedness than those at non-academy schools. No direct effect of academies on mental health or aspirations was found, however school connectedness had a significant, mediating effect on pro-social mental health scores. Academies in this sample can therefore be said to indirectly increase levels of mental health by increasing levels of school connectedness. These findings highlight the importance of school connectedness for adolescent wellbeing and suggest that academies can be more successful in promoting levels of school connectedness which can then impact positively on individual mental health. More work needs to be done on identifying the structures and processes at work.

Well London: Results of a Community Engagement Approach to Improving Health Among Adolescents from Areas of Deprivation in London

ABSTRACT This article reports findings among adolescents of the impact of Well London, a program of wellbeing interventions delivered across 20 deprived neighbourhoods of London using a community engagement model. Twelve hundred and fifty-four adolescents were surveyed from matched intervention and control areas. There was no significant intervention effect on the main outcome measures: unhealthy eating, physical activity, and mental health. Factors influencing the results may include the possibility that the communities defined by the cluster randomized controlled trial (CRCT) were not an accurate reflection of the adolescent’s natural community, and interactions within the school environment in particular could have led to a dilution of effect.

Determinants of physical activity in deprived communities in London: Examining the effects of individual and neighbourhood characteristics

Background The benefits of regular physical activity are well known. Few adults in the UK meet the recommended levels. There is growing evidence suggesting that neighbourhood characteristics interact with individual characteristics to determine physical activity levels. Objective Examine relationships between neighbourhood-level and individual-level characteristics and physical activity. Setting 40 of the most deprived neighbourhoods in London (census lower super output areas (LSOA) ranked in the top 11% of LSOAs in London by Index of Multiple Deprivation). Design Cross-sectional, interviewer-administered survey with households in the 40 neighbourhoods (n=4107 adults aged >=16 years); fieldworker-completed neighbourhood audit tool to measure area characteristics. Methods Physical activity was measured using the International Physical Activity Questionnaire in the household survey. The outcome measure was meeting the minimum recommended levels of physical activity (5 x 30 min moderate activity per week). Multilevel modelling in Stata 11 was used to examine the effects of individual and neighbourhood characteristics on achieving the recommended weekly physical activity levels. Multiple imputation was used to account for missing data. Results 70% of respondents reported physical activity equivalent to the recommended 5x30 min per week; the intra-neighbourhood correlation coefficient was 0.15. Preliminary results (adjusted for socio-demographic characteristics) indicate that women were less likely than men to meet the recommended physical activity levels (OR=0.6; 95% CI 0.4 to 0.7); individuals with positive mental health were more likely to meet the recommended levels (OR for 1 point increase in Hope Scale=1.2; 95% CI 1.0 to 1.3). After adjusting for individual characteristics, 9% of the residual variance in propensity to meet recommended physical activity was attributable to neighbourhood differences. Neighbourhood levels of incivilities, proximity and quality of parks/green space, walkability and cyclability were not associated with meeting recommended physical activity levels. Further results for other neighbourhood characteristics will be presented and social inequalities in the effects of neighbourhoods on health will be examined. Conclusion The level of physical activity in low income communities in London is higher than the national average measured in the Health Survey for England. In preliminary analyses we found no evidence of neighbourhood effects on physical activity levels in deprived London neighbourhoods. These observations may be due to: (i) limited clustering of physical activity levels across the most deprived neighbourhoods in London; (ii) limited variability in neighbourhood environments in these communities; (iii) individual level characteristics are stronger determinants of physical activity in these communities; (iv) complex and contingent causal pathways of physical activity, not captured in our models.