Triantafyllos Pliakas

A qualitative geographical information systems approach to explore how older people over 70 years interact with and define their neighbourhood environment.

A growing body of literature explores the relationship between the built environment and health, and the methodological challenges of understanding these complex interactions across the lifecourse. The impact of the neighbourhood environment on health and behaviour amongst older adults has received less attention, despite this age group being potentially more vulnerable to barriers in their surrounding social and physical environment. A qualitative geographical information systems (QGIS) approach was taken to facilitate the understanding of how older people over 70 in 5 UK towns interact with their local neighbourhood. The concept of neighbourhood changed seasonally and over the lifecourse, and was associated with social factors such as friends, family, or community activities, rather than places. Spaces stretched further than the local, which is problematic for older people who rely on variable public transport provision. QGIS techniques prompted rich discussions on interactions with and the meanings of ‘place’ in older people.

Optimising measurement of health-related characteristics of the built environment: comparing data collected by foot-based street audits, virtual street audits and routine secondary data sources

ABSTRACT The role of the neighbourhood environment in influencing health behaviours continues to be an important topic in public health research and policy. Foot‐based street audits, virtual street audits and secondary data sources are widespread data collection methods used to objectively measure the built environment in environment‐health association studies. We compared these three methods using data collected in a nationally representative epidemiological study in 17 British towns to inform future development of research tools. There was good agreement between foot‐based and virtual audit tools. Foot based audits were superior for fine detail features. Secondary data sources measured very different aspects of the local environment that could be used to derive a range of environmental measures if validated properly. Future built environment research should design studies a priori using multiple approaches and varied data sources in order to best capture features that operate on different health behaviours at varying spatial scales. HighlightsThis study compares multiple data collection methods for measuring built environment features.Virtual street audits are reliable for more objective built environment measures.Street‐based audits are superior for collecting fine detail environmental features.Routine secondary data sources need less resources but must be properly validated.Appropriate methods for health studies vary depending on the research question and resources.

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetic time-series method

Background Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime. Methods We used Home Office licensing data (2007–2012) to identify (1) interventions: local areas where both a cumulative impact zone and increased licensing enforcement were introduced in 2011; and (2) controls: local areas with neither. Outcomes were 2009–2015 alcohol-related hospital admissions, violent and sexual crimes, and antisocial behaviour. Bayesian structural time series were used to create postintervention synthetic time series (counterfactuals) based on weighted time series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls. Results 5 intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% credible intervals (CI) −12.8% to 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (–4.6%, 95% CI −10.7% to 1.4%). There was weak evidence of an effect on sexual crimes up 2013 (–8.4%, 95% CI −21.4% to 4.6%) and insufficient evidence of an effect on antisocial behaviour as a result of a change in reporting. Conclusion Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health.

Competing for space in an already crowded market: a mixed methods study of why an online community of practice (CoP) for alcohol harm reduction failed to generate interest amongst the group of public health professionals at which it was aimed

BackgroundImproving mechanisms for knowledge translation (KT) and connecting decision-makers to each other and the information and evidence they consider relevant to their work remains a priority for public health. Virtual communities of practices (CoPs) potentially offer an affordable and flexible means of encouraging connection and sharing of evidence, information and learning among the public health community in ways that transgress traditional geographical, professional, institutional and time boundaries. The suitability of online CoPs in public health, however, has rarely been tested. This paper explores the reasons why particular online CoP for alcohol harm reduction hosted by the UK Health Forum failed to generate sufficient interest from the group of public health professionals at which it was aimed.MethodsThe study utilises online web-metrics demonstrating a lack of online activity on the CoP. One hundred and twenty seven responses to an online questionnaire were used to explore whether the lack of activity could be explained by the target audience’s existing information and evidence practices and needs. Qualitative interviews with 10 members describe in more detail the factors that shape and inhibit use of the virtual CoP by those at which it was targeted.ResultsQuantitative and qualitative data confirm that the target audience had an interest in the kind of information and evidence the CoP was set up to share and generate discussion about, but also that participants considered themselves to already have relatively good access to the information and evidence they needed to inform their work. Qualitative data revealed that the main barriers to using the CoP were a proliferation of information sources meaning that participants preferred to utilise trusted sources that were already established within their daily routines and a lack of time to engage with new online tools that required any significant commitment.ConclusionsSpecialist online CoPs are competing for space in an already crowded market. A target audience that regards itself as busy and over-supplied is unlikely to commit to a new service without the assurance that the service will provide unique and valuable well-summarised information, which would reduce the need to spend time accessing competing resources.

How the local built environment affects physical activity behaviour in older adults in the UK: a cross-sectional analysis linked to two national cohorts

Abstract Background Policy makers are increasingly interested in how changes in local neighbourhood environments can affect health behaviours, especially physical activity, but individual studies rarely consider multiple environmental dimensions. Although older people can be particularly at risk of physical challenges in their local environment, few studies have focused on this age group. Methods We developed a local environment audit instrument to capture multiple dimensions of the built environment that could affect the physical activity of older people; we linked the environmental data to physical activity behaviour collected in two nationally representative cohorts: the British Regional Heart Study and British Womens Heart and Health Study. Comprehensive foot-based audits were conducted by trained field staff in 20 towns across England and Scotland covering 590 lower super output areas and data zones; interobserver reliability of the instrument was high. The primary outcome was time spent in moderate-to-vigorous physical activity measured in participants for 1 week during 2010–12 with GT3X accelerometers (Actigraph, Pensacola, FL, USA). Using multilevel regression analysis, we assessed the association between aspects of the built environment and physical activity adjusted for individual-level confounders and area-level population density. Findings 686 men and 638 women aged 69–92 years participated in the accelerometer study and were included in the analysis. Geometric mean time in moderate-to-vigorous physical activity was 26·3 min/day (geometric SD 2·7) in men and 23·8 min/day (SD 2·5) in women. There was no evidence of associations between any of the domains studied (quality of the built environment defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and moderate-to-vigorous physical activity. Relative to areas with the worst quality walking environment, people living in areas with the best walking environments spent 2% more time in moderate-to-vigorous physical activity (95% CI −11 to 17, p=0·78 for overall trend). Interpretation Although small effect sizes cannot be discounted, this study suggests that older individuals might be less affected by their local neighbourhood environment than is often presumed in the scientific literature, reflecting both the heterogeneous functionality of this age group and the varying nature of their activity spaces. Funding This study was funded by a grant from the Medical Research Council (MR/J007145/1). The collection and extraction of data on physical activity in these cohorts was supported by grants from the British Heart Foundation (PG/09/024 and PG/13/66/304422) and National Institute for Health Research (PDF 2010-03-23).

Use of retail data in the assessment of natural experiments: the case of Reducing the Strength, an intervention to reduce alcohol availability

Abstract Background Retailers routinely collect data about peoples purchasing behaviours and access to consumer products associated with health and wellbeing. Here we discuss how retail data can be used in public health research and consider potential strengths and limitations to such research. To illustrate the discussion we refer to an evaluation of an intervention called Reducing the Strength, whereby off-licence shops and supermarkets voluntarily stopped selling inexpensive superstrength (≥6·5% alcohol by volume) beers and ciders. Methods Monthly data from a large retail chain (East of England Co-operative Society) were obtained for three UK counties (141 stores). In one county the intervention started 12 months earlier than the others, allowing for a pre–post study design with a delayed implementation comparator. Difference-in-differences analysis of unit alcohol sales controlled for socioenvironmental confounders and shop-level characteristics including shop size, parking facilities, cash machines, opening hours, and other factors. Findings The retail data detailed shop-level characteristics and sales data such as prices, quantities, product brands, alcohol content, sales, and factors affecting sales. The wide geographical coverage, shop-level data, including data for potential confounding factors, and frequent timepoints made the retail data well-suited for a quasi-experimental evaluation capitalising on temporal and spatial variations in intervention exposure. Limitations of this study include a lack of longitudinal data for individual customers, and shops that are not covered by the data. Qualitative interviews with shop workers and customers, and triangulation using alternative data sources can help to address limitations. Alternative sources of retail data such as private sector consultants who specialise in collecting shop-level and sales data for a range of companies might also address some limitations; however, there are potential barriers of expense, accessibility, and coverage associated with the use of such consultants. Interpretation Increasingly, researchers recognise the potential of retail data for evaluating interventions affecting social determinants of health and inequalities, such as local access to alcohol. However, shop-level data have frequently proved difficult for researchers to obtain. By obtaining such data we have been able to assess, using a quasi-experimental design, the effects of removing strong, cheap beers and ciders from shops. We have also been able to explore in more detail how to optimise the strengths and address some limitations of the data in ways that could potentially assist others planning to use this important data source in their research. Funding The study is funded as part of the School of Public Health Research by NHS National Institute of Health Research. AJ, SA, and JW contributed as employees of Public Health Suffolk, Suffolk County Council.

Investigating associations between the built environment and physical activity among older people in 20 UK towns

Background Policy initiatives such as WHO Age Friendly Cities recognise the importance of the urban environment for improving health of older people, who have both low physical activity (PA) levels and greater dependence on local neighbourhoods. Previous research in this age group is limited and rarely uses objective measures of either PA or the environment. Methods We investigated the association between objectively measured PA (Actigraph GT3x accelerometers) and multiple dimensions of the built environment, using a cross-sectional multilevel linear regression analysis. Exposures were captured by a novel foot-based audit tool that recorded fine-detail neighbourhood features relevant to PA in older adults, and routine data. Results 795 men and 638 women aged 69–92 years from two national cohorts, covering 20 British towns, were included in the analysis. Median time in moderate to vigorous PA (MVPA) was 27.9 (lower quartile: 13.8, upper quartile: 50.4) minutes per day. There was little evidence of associations between any of the physical environmental domains (eg, road and path quality defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and MVPA. However, analysis of area-level income deprivation suggests that the social environment may be associated with PA in this age group. Conclusions Although small effect sizes cannot be discounted, this study suggests that older individuals are less affected by their local physical environment and more by social environmental factors, reflecting both the functional heterogeneity of this age group and the varying nature of their activity spaces.

Getting shops to voluntarily stop selling cheap, strong beers and ciders: a time-series analysis evaluating impacts on alcohol availability and purchasing.

ABSTRACT The objectives of this research were to study a smoking cessation program using 5A’s indental clinics, the Health Department of the BMA, dental personnel’s opinions on organizationcontexts, attitudes towards a smoking cessation program, and the relationships between theirattitudes and the program. The questionnaires were administered to 193 personnel. Descriptive andstatistical analyses were used. There was an 80.82% response rate. The results showed that 98%reported that their workplace had a tobacco control policy, 92.9% had information and a tobaccocessation service. The application of the 5A’s were as follows: Asking (96.8%), Advising (98.1%),Assessing (89.1%), Assisting (57.1%) and Arranging or follow-up (60.9%). About 80% used teamworkin cessation services, 93.6% reported that they had assigned responsible persons. Thirty percentreported that health education materials in smoking cessation were inadequate, whereas 19.9% neededsmoking cessation training in order to improve skills necessary to run an effective cessationservice. Overall dental personnel attitudes towards a smoking cessation program were positive(mean 3.99, SD 0.53). There is a relationship between the overall attitude scores and the smoking cessationservices : assisting and arranging activities ( p=0.004, p=0.004). Statistically significant relationshipswere found between attitudes and smoking cessation services in the following aspects: Dentalpersonnel can motivate a patient to quit smoking (A4; p = 0.004, A5; p = 0.001); thesmoking status of patients should be asked as a part of routine history taking (A4; = 0.021, A5; =0.005); a smoking cessation program might interrupt dental services (A4; p = 0.013), andit is not the responsibility of the smoking cessation service (A4; p = 0.025, A5;p = 0.027). Appropriate training, capacity building in order to increase positive attitudesin those aspects, and health education materials are needed to support a smoking cessation programin dental clinics, and at the Health Department, BMA. Key words: Smoking cessation program; 5A’s; Dental clinics

Do cumulative impact zones reduce alcohol availability in UK high streets? Assessment of a natural experiment introducing a new licensing policy

Abstract Background The Licensing Act 2003 enables English local authorities to implement Cumulative Impact Policies (CIPs). CIPs strengthen the powers of local authorities to reject licence applications for retail alcohol sales in cumulative impact zones (CIZs), where adverse effects of alcohol availability can be demonstrated. We assessed the impact of a CIP in one London borough on granting alcohol sales licences for off premise (off-licence) and on premise (on-licence) consumption and on the trading and closing times of premises. Methods We conducted a time-series analysis using Poisson regression of licensing data from April 1, 2008, to July 31, 2015, to estimate immediate and longer-term impacts of introducing CIP in 2013. Primary outcomes were number of licence applications, proportion of applications granted (success rates), and trading and closing times of licensed premises within and outside CIZs. Models were adjusted for overdispersion and underlying seasonal and secular trends, and checked for autocorrelation. In sensitivity analysis we examined the impact of CIP on outcomes in CIZs controlling for underlying trends in non-CIZs. Findings There were 409 and 278 alcohol licence applications for off-licences and on-licences, respectively. There was no significant impact of CIP introduction on number of applications submitted, or on trading and closing times of premises between areas or over time. There were statistically significant impacts immediately after CIP introduction of reduced application success rates in CIZs (−27·80%, 95% CI −42·33 to −9·60) and outside CIZs (−47·12%, −64·72 to −20·74) mostly driven by decreases in success rates for off-licence applications (−39·56% [–56·40 to −16·23] and −52·18% [–71·06 to −20·99], respectively). Subsequent years showed that application success rates for all licences increased in both areas (4·17% [0·43 to 8·05] and 13·64% [6·43 to 21·34], respectively). We found little evidence of CIP impact on primary outcomes in CIZs when controlling for non-CIZs. Interpretation Although CIPs led to short-term decreases in rates of alcohol licences granted, these reductions were not sustained. Previous research proposed that CIPs mainly affect premise type and licence conditions (eg, opening hours) rather than number of premises. Further research should explore these other potential impacts and whether non-CIZs are affected by spillover effects from CIZs. Funding National Institute for Health Research (NIHR) School for Public Health Research.

PP42 A mixed methods evaluation of a local-level alcohol availability intervention: “reducing the strength”

Background Reducing the local availability of alcohol may reduce alcohol-related harms. In the UK, local authorities are becoming increasingly interested in an intervention called ‘Reducing the Strength’ (RtS) whereby off-licence shops and supermarkets voluntarily stop selling inexpensive super strength (≥6.5% alcohol by volume) beers and ciders. We conducted a mixed methods evaluation to describe, measure and understand the effects of this example of local policy innovation. Methods The qualitative phase involved documentary analysis and interviews with public health, police, licensing and retail professionals (n = 15) to gain multi-sectoral perspectives of the intervention, its aims, implementation and perceived impacts. The quantitative phase involved difference-in-differences analysis of data from a large retail chain: data on unit alcohol sales were obtained for three UK counties (131 stores). In one county the intervention started 12 months earlier than the others, allowing for a pre–post study design with a delayed implementation comparator. Results Qualitative findings highlighted multiple perspectives from different stakeholders. Those responsible for intervention development emphasised the need to link it with support services and policing strategies. Street drinkers were the initial target for the intervention, but public health practitioners suggested mechanisms for broader population impacts through reduced purchasing and consumption of alcohol units. Our retail analysis found that during the baseline/pre-intervention period, the intervention and comparison areas sold, on average, 170393 and 183296 alcohol units per store (respectively), and 174703 and 201453 units at follow up. Therefore both intervention and comparison areas experienced increased sales at follow-up, with the difference between the two areas widening from 12903 to 26750 (p = 0.690). Conclusion Findings from our quantitative analysis were inconclusive. The implementation did demonstrate the feasibility of co-opting retailer and public sectors into strategies that linked community safety, store security and public health goals.