Dianna Smith

Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland

OBJECTIVE Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural-urban location and neighbourhood deprivation in a selection of communities across Scotland. DESIGN Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban-rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban-rural classification. SETTING Scotland. RESULTS Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items. CONCLUSIONS The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis

CONTEXT Exercise could be beneficial for prostate cancer survivors. However, no systematic review across cancer stages and treatment types addressing potential benefits and harms exists to date. OBJECTIVE To assess the effects of exercise on cancer-specific quality of life and adverse events in prostate cancer trials. EVIDENCE ACQUISITION We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, SPORTDiscus, and PEDro. We also searched grey literature databases, including trial registers. Searches were from database inception to March 2015. Standardised mean differences (SMDs) were calculated for meta-analysis. EVIDENCE SYNTHESIS We included 16 randomised controlled trials (RCTs) involving 1574 men with prostate cancer. Follow-up varied from 8 wk to 12 mo. RCTs involved men with stage I-IV cancers. A high risk of bias was frequently due to problematic intervention adherence. Seven trials involving 912 men measured cancer-specific quality of life. Pooling of the data from these seven trials revealed no significant effect on this outcome (SMD 0.13, 95% confidence interval [CI] -0.08 to 0.34, median follow-up 12 wk). Sensitivity analysis of studies that were judged to be of high quality indicated a moderate positive effect estimate (SMD 0.33, 95% CI 0.08-0.58; median follow-up 12 wk). Similar beneficial effects were seen for cancer-specific fatigue, submaximal fitness, and lower body strength. We found no evidence of benefit for disease progression, cardiovascular health, or sexual function. There were no deaths attributable to exercise interventions. Other serious adverse events (eg, myocardial infarction) were equivalent to those seen in controls. CONCLUSIONS These results support the hypothesis that exercise interventions improve cancer-specific quality of life, cancer-specific fatigue, submaximal fitness, and lower body strength. PATIENT SUMMARY This review shows that exercise/physical activity interventions can improve quality of life, fatigue, fitness, and function for men with prostate cancer.

Improving the Synthetic Data Generation Process in Spatial Microsimulation Models

Simulation models are increasingly used in applied research to create synthetic micro-populations and predict possible individual-level outcomes of policy intervention. Previous research highlights the relevance of simulation techniques in estimating the potential outcomes of changes in areas such as taxation and child benefit policy, crime, education, or health inequalities. To date, however, there is very little published research on the creation, calibration, and testing of such micro-populations and models, and little on the issue of how well synthetic data can fit locally as opposed to globally in such models. This paper discusses the process of improving the process of synthetic micropopulation generation with the aim of improving and extending existing spatial microsimulation models. Experiments using different variable configurations to constrain the models are undertaken with the emphasis on producing a suite of models to match the different sociodemographic conditions found within a typical city. The results show that creating processes to generate area-specific synthetic populations, which reflect the diverse populations within the study area, provides more accurate population estimates for future policy work than the traditional global model configurations.

Geography, Community, and Morality

Recognition of a moral turn in geography leads to the suggestion that looking at ‘community’ through a moral lens reveals some important issues at the interface of geography and moral philosophy. The notion of community is usually associated with social ties and interaction within a locality, but it also has a normative interpretation. Communitarianism as an expression of the good of community is experiencing a revival: the author reviews the content of communitarianism, observing similarities with the ethic of care which has featured in some feminist critiques of mainstream moral philosophy. However, the ideal of community and the partiality of care are open to critique, which requires a rethinking of community in the context of the changing nature of personal relationships and of localities. This has implications for moral learning and development, or how behavioural norms are transmitted and possibly transformed.

Does the local food environment around schools affect diet? Longitudinal associations in adolescents attending secondary schools in East London

BackgroundThe local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools?MethodsThe locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were ‘healthy’ and ‘unhealthy’ diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001–2005 n=757) approaches.ResultsBetween 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p< 0.001). Longitudinal analyses showed a decrease of the mean healthy (−1.12, se 0.12) and unhealthy (−0.48, se 0.16) diet scores. There were significant positive relationships between the distances travelled to grocers and healthy diet scores though effects were very small (0.003, 95%CI 0.001 – 0.006). Significant negative relationships between proximity to takeaways and unhealthy diet scores also resulted in small parameter estimates.ConclusionsThe results provide some evidence that the local food environment around secondary schools may influence adolescent diet, though effects were small. Further research on adolescents’ food purchasing habits with larger samples in varied geographic regions is required to identify robust relationships between proximity and diet, as small numbers, because of confounding, may dilute effect food environment effects. Data on individual foods purchased in all shop formats may clarify the frequent, overly simple classification of grocers as ‘healthy’.

Neighbourhood deprivation and the price and availability of fruit and vegetables in Scotland

BACKGROUND Previous research has suggested that fruits and vegetables are more expensive and less readily available in more deprived communities. However, this evidence is mainly based on small samples drawn from specific communities often located in urban settings and thus is not generalisable to national contexts. The present study explores the influence of neighbourhood deprivation and local retail structure on the price and availability of fruit and vegetables in a sample of areas representing the diversity of urban-rural environments across Scotland, UK. METHODS A sample of 310 stores located in 10 diverse areas of Scotland was surveyed and data on the price and availability of a basket of 15 fruit and vegetable items were collected. The data were analysed to identify the influence of store type and neighbourhood deprivation on the price and availability of fruits and vegetables. RESULTS Neighbourhood deprivation and store type did not significantly predict the price of a basket of fruit and vegetables within the sample, although baskets did decrease in price as store size increased. The highest prices were found in the smallest stores located in the most deprived areas. Availability of fruit and vegetables is lower in small shops located within deprived neighbourhoods compared to similar shops in affluent areas. Overall, availability increases with increasing store size. CONCLUSIONS Availability of fruit and vegetables significantly varies by neighbourhood deprivation in small stores. Policies aimed at promoting sales of fruit and vegetable in these outlets may benefit residents in deprived areas.

Can a deterministic spatial microsimulation model provide reliable small-area estimates of health behaviours? An example of smoking prevalence in New Zealand.

Models created to estimate neighbourhood level health outcomes and behaviours can be difficult to validate as prevalence is often unknown at the local level. This paper tests the reliability of a spatial microsimulation model, using a deterministic reweighting method, to predict smoking prevalence in small areas across New Zealand. The difference in the prevalence of smoking between those estimated by the model and those calculated from census data is less than 20% in 1745 out of 1760 areas. The accuracy of these results provides users with greater confidence to utilize similar approaches in countries where local-level smoking prevalence is unknown.

Feasibility study of geospatial mapping of chronic disease risk to inform public health commissioning.

Objective To explore the feasibility of producing small-area geospatial maps of chronic disease risk for use by clinical commissioning groups and public health teams. Study design Cross-sectional geospatial analysis using routinely collected general practitioner electronic record data. Sample and setting Tower Hamlets, an inner-city district of London, UK, characterised by high socioeconomic and ethnic diversity and high prevalence of non-communicable diseases. Methods The authors used type 2 diabetes as an example. The data set was drawn from electronic general practice records on all non-diabetic individuals aged 25–79 years in the district (n=163 275). The authors used a validated instrument, QDScore, to calculate 10-year risk of developing type 2 diabetes. Using specialist mapping software (ArcGIS), the authors produced visualisations of how these data varied by lower and middle super output area across the district. The authors enhanced these maps with information on examples of locality-based social determinants of health (population density, fast food outlets and green spaces). Data were piloted as three types of geospatial map (basic, heat and ring). The authors noted practical, technical and information governance challenges involved in producing the maps. Results Usable data were obtained on 96.2% of all records. One in 11 adults in our cohort was at ‘high risk’ of developing type 2 diabetes with a 20% or more 10-year risk. Small-area geospatial mapping illustrated ‘hot spots’ where up to 17.3% of all adults were at high risk of developing type 2 diabetes. Ring maps allowed visualisation of high risk for type 2 diabetes by locality alongside putative social determinants in the same locality. The task of downloading, cleaning and mapping data from electronic general practice records posed some technical challenges, and judgement was required to group data at an appropriate geographical level. Information governance issues were time consuming and required local and national consultation and agreement. Conclusions Producing small-area geospatial maps of diabetes risk calculated from general practice electronic record data across a district-wide population was feasible but not straightforward. Geovisualisation of epidemiological and environmental data, made possible by interdisciplinary links between public health clinicians and human geographers, allows presentation of findings in a way that is both accessible and engaging, hence potentially of value to commissioners and policymakers. Impact studies are needed of how maps of chronic disease risk might be used in public health and urban planning.

Alcohol licensing data: Why is it an underused resource in public health?

Alcohol-related harm is related to alcohol availability. Due to complex regulatory and environmental factors, alcohol availability varies spatially. However, the extent of this variation is largely unknown in the UK, despite its potential influence on patterns of alcohol-related harm. We investigate why administrative data is underused in the study of alcohol-related harm in the UK. We found that local authorities routinely collect a rich supply of licensing data. However, this information is stored in databases that are sometimes difficult to access. With greater coordination between researchers and practitioners, this data can be used to fulfil its primary administrative purpose and also contribute to understanding and prevention of alcohol-related health and social problems.

Proportional responsibility versus individual responsibility for healthy eating: a complex systems analysis

Abstract Background Most public health interventions on diet place responsibility on individuals (eg, to use information to make healthy food choices); on a population level, such strategies are ineffectual. Here we report on research into perceptions of responsibility for healthy eating, using a complex systems framework. The aim of the research was to provide insights into the impact of the food system—rather than single variables—on the publics diet. Methods The data gathered comprised eight industry and government documents, from the baseline of Foresights 2007 obesity report to the 2011 Public Health Responsibility Deal, including corporate signatories to the latter; eight focus groups with members of the public; and 18 interviews with representatives from sectors responsible for creating the food environment (ie, food industry, government, and non-governmental organisation). Responsibility for healthy eating was explored using Foucauldian discourse analysis; this incorporated consideration of the properties of complex systems, such as the inter-relatedness of actors and the fluid, non-linearity of interactions, interventions, and outcomes. Findings The data show that despite claims of shared responsibility for dietary behaviour, government and corporations use rhetoric and measures that deflect regulations or action for which they are responsible that could help improve the populations diet, such as food reformulation or advertising restrictions. They also favour downstream interventions, such as food labelling, that place high agency on individuals, rather than more effective, upstream, regulatory or fiscal strategies. Interpretation Problematising responsibility highlights how the onus is mostly on individuals for healthy food choices even though individuals themselves have the least power over key drivers of those choices: taste, cost, convenience, promotions. A complex systems approach helps explain how the mismatch between power and responsibility contributes to a food system in which many people consume diets detrimental to their health. Proportional responsibility offers a counterfactual framework to the dominant policies that attribute ultimate responsibility for eating healthily to individuals, given that they have proportionally less influence over the determinants of their food choices than do government and the food industry. This concept could be explored as a potential framework for examining whether policies attribute responsibility for health-promoting behaviour proportionally to a groups capacity to act. Funding This research was funded by Queen Mary University of London and the London School of Hygiene & Tropical Medicine as a PhD scholarship (to NS).