Are perceived neighbourhood problems associated with the likelihood of smoking?

<p><b>Objective:</b></p> <p>To explore associations between residents’ perceptions of the local residential environment and the likelihood of their smoking.</p> <p><b>Design:</b></p> <p>Using data (n = 2615) from the West of Scotland Twenty-07 Study, separately by gender, cross-sectional associations between respondents’ perceptions of neighbourhood (perceived absence of goods, incivilities and physical environmental problems) and the likelihood of being a current smoker and the amount smoked were examined.</p> <p><b>Results:</b></p> <p>Perceived neighbourhood problems are associated with the likelihood of smoking but mainly among those with the most negative view of the local neighbourhood. Perceptions of the provision of neighbourhood amenities seems to be more strongly associated with women’s than men’s smoking status, whereas the perceived quality of the local neighbourhood appears to be a better predictor of men’s smoking.</p> <p><b>Conclusions:</b></p> <p>Efforts to reduce smoking levels among more deprived groups may need to pay more attention to the role of local environmental conditions in influencing smoking behaviour.</p&gt

Are housing tenure and car access still associated with health? A repeat cross-sectional study of UK adults over a 13-year period

Background: It is usually assumed that housing tenure and car access are associated with health simply because they are acting as markers for social class or income and wealth. However, previous studies conducted in the late 1990s found that these household assets were associated with health independently of social class and income. Here, we set out to examine if this is still the case. Methods: We use data from our 2010 postal survey of a random sample of adults (n=2092) in 8 local authority areas in the West of Scotland. Self-reported health measures included limiting longstanding illness (LLSI), general health over the last year and the Hospital Anxiety and Depression Scale. Results: We found a statistically significant relationship between housing tenure and all 4 health measures, regardless of the inclusion of social class or income as controls. Compared with owner occupiers, social renters were more likely to report ill-health (controlling for social class—LLSI OR: 3.24, general health OR: 2.82, anxiety η2: 0.031, depression η2: 0.048, controlling for income—LLSI OR: 3.28, general health OR: 2.82, anxiety η2: 0.033, depression η2: 0.057) (p<0.001 for all models). Car ownership was independently associated with depression and anxiety, with non-owners at higher risk of both (controlling for income—anxiety η2: 0.010, depression η2: 0.023, controlling for social class—anxiety η2: 0.013, depression η2: 0.033) (p<0.001 for all models). Conclusions: Our results show that housing tenure and car ownership are still associated with health, after taking known correlates (age, sex, social class, income) into account. Further research is required to unpack some of the features of these household assets such as the quality of the dwelling and access to and use of different forms of transport to determine what health benefits or disbenefits they may be associated with in different contexts

Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey

Obesity levels are high and increasing worldwide. Being overweight is linked with increased death rates and contributes to a wide range of conditions, including ischaemic heart disease, hypertension, stroke, diabetes, certain cancers, and diseases of the gall bladder.1 The principal cause of obesity is an imbalance between energy intake and energy expenditure. And there is growing recognition that, independently of individual characteristics, place of residence may be associated with health outcomes, including body size2 and health related behaviours, such as level of physical exercise.3 Few studies have explored which features of the local neighbourhood might be related to these outcomes or behaviours, although perceived attractiveness has been found to be related to levels of physical activity.4 Levels of incivilities, such as litter and graffiti, are associated with poorer health outcomes such as general wellbeing but not, to our knowledge, with levels of physical activity. Few studies use objectively measured indicators of the residential environment or similar research instruments across different settings. Based on our previous work, we hypothesised that areas which are pleasant with lots of greenery and few incivilities might encourage people to take exercise and thereby influence levels of obesity

Lack of agreement between measured and self-reported distance from public green parks in Glasgow, Scotland

<p><b>Background:</b></p> <p>Reviews have reported mixed findings for associations between physical activity and proximity to a range of environmental resources. Initially most studies used self reported proximity, but more are now using GIS techniques to measure proximity objectively. We know little about the extent of agreement between self reported and directly measured proximity of the same resource.</p> <p><b>Methods:</b></p> <p>We used previously collected data in a community survey in Glasgow in which 658 respondents aged around 40 and 60 were asked whether they lived within half a mile of a public park. We compared their answers with GIS measures of whether there was a park within a half mile service area of their home (and whether their home was within a half mile crow fly buffer of a park).</p> <p><b>Results:</b></p> <p>Agreement was poor; percentage agreement between measured network distance and reported residence within 0.5 miles of a park was 62.0%, and the kappa value was 0.095. Agreement was no higher than poor in any socio-demographic subgroup, or when using crow fly buffers instead of service areas.</p> <p><b>Conclusion:</b></p> <p>One should be cautious about assuming that respondents' self reports of proximity to a resource are a valid proxy for actual distance, or vice versa. Further research is needed to establish whether actual or self-reported proximity predict physical activity or other behaviours, and if so which is the strongest predictor. Further, qualitative study, also needs to examine the basis of people's judgements about the location of resources, and the possibility that these are shaped by their social and personal significance.</p&gt

The food retail environment and area deprivation in Glasgow City

It has previously been suggested that deprived neighbourhoods within modern cities have poor access to general amenities, for example, fewer food retail outlets. Here we examine the distribution of food retailers by deprivation in the City of Glasgow, UK.We obtained a list of 934 food retailers in Glasgow, UK, in 2007, and mapped these at address level. We categorised small areas (data zones) into quintiles of area deprivation using the 2006 Scottish Index of Multiple Deprivation Income sub-domain score. We computed mean number of retailers per 1000 residents per data zone, and mean network distance to nearest outlet from data zone centroid, for all retailers combined and for each of seven categories of retailer separately (i.e. bakers, butchers, fruit and vegetable sellers, fishmongers, convenience stores, supermarkets and delicatessens).The most deprived quintile (of areas) had the greatest mean number of total food retailers per 1000 residents while quintile 1 (least deprived) had the least, and this difference was statistically significant (Chi-square p < 0.01). The closest mean distance to the nearest food retailer was within quintile 3 while the furthest distance was within quintile 1, and this was also statistically significant (Chi-square p < 0.01). There was variation in the distribution of the seven different types of food retailers, and access to amenities depended upon the type of food retailer studied and whether proximity or density was measured. Overall the findings suggested that deprived neighbourhoods within the City of Glasgow did not necessarily have fewer food retail outlets

Reuse as heuristic : from transmission to nurture in learning activity design

In recent years a combination of ever more flexible and sophisticated Web technologies and an explosion in the quantity of online content has sparked learning technologists around the world to pursue the promise of the 'reusable learning object' or RLO with the idea that RLOs could be reused in different educational contexts, thereby providing greater overall flexibility and return on investment. In 2002 the ACETS Project undertook a three-year study in the UK to investigate whether RLOs worked in practice and how the pursuit of reuse affected the teacher and their teaching. Teachers working in healthcare-related subjects in Higher and Further Education were asked to create an original learning design or activity from third-party digital resources and to reflect both on the process and its outcomes. The expectation was that teachers would be the ones selecting and reusing third-party materials. This paper describes how one of the ACETS exemplifiers reinterpreted this remit, challenged the anticipated transmissive model of learning, and instead, gave their students an opportunity to create their own original learning designs and learning activities from third-party digital resources. By describing the educational enhancements, the resulting heightened levels of critical thinking, and sensitivity to patient needs, 'reuse' will be shown to be an effective heuristic for student self-direction and professional development

Associations between health and different types of environmental incivility : a Scotland-wide study

Objectives: Concern about the impact of the environment on health and well being has tended to focuson the physical effects of exposure to toxic and infectious substances, and on the impact of large scale infrastructures. Less attention has been paid to the possible psychosocial consequences of people's subjective perceptions of their everyday, street level environment, such as the incidence of litter and graffiti. As little is known about the potential relative importance for health of perceptions of different types of environmental incivility, a module was developed for inclusion in the 2004 Scottish Social Attitudes survey in order to investigate this relationship. Study design: A random sample of 1637 adults living across a range of neighbourhoods throughout Scotland was interviewed. Methods: Respondents were asked to rate their local area on a range of possible environmental incivilities. These incivilities were subsequently grouped into three domains: (i) street level incivilities (e.g. litter, graffiti); (ii) large scale infrastructural incivilities (e.g. telephone masts); and (iii) the absence of environmental goods (e.g. safe play areas for children). For each of the three domains, the authors examined the degree to which they were thought to pose a problem locally, and how far these perceptions varied between those living in deprived areas and those living in less deprived areas. Subsequently, the relationships between these perceptions and self assessed health and health behaviours were explored, after controlling for gender, age and social class. Results: Respondents with the highest levels of perceived street level incivilities were almost twice aslikely as those who perceived the lowest levels of street level incivilities to report frequent feelings of anxiety and depression. Perceived absence of environmental goods was associated with increased anxiety (2.5 times more likely) and depression (90% more likely), and a 50% increased likelihood of being a smoker. Few associations with health were observed for perceptions of large scale infrastructural incivilities. Conclusions: Environmental policy needs to give more priority to reducing the incidence of street levelincivilities and the absence of environmental goods, both of which appear to be more important for health than perceptions of large scale infrastructural incivilities

Loneliness, social relations and health and wellbeing in deprived communities

There is growing policy concern about the extent of loneliness in advanced societies, and its prevalence among various social groups. This study looks at loneliness among people living in deprived communities, where there may be additional barriers to social engagement including low incomes, fear of crime, poor services and transient populations. The aim was to examine the prevalence of loneliness, and also its associations with different types of social contacts and forms of social support, and its links to self-reported health and wellbeing in the population group. The method involved a cross-sectional survey of 4,302 adults across 15 communities, with the data analysed using multinomial logistic regression controlling for sociodemographics, then for all other predictors within each domain of interest. Frequent feelings of loneliness were more common among those who: had contact with family monthly or less; had contact with neighbours weekly or less; rarely talked to people in the neighbourhood; and who had no available sources of practical or emotional support. Feelings of loneliness were most strongly associated with poor mental health, but were also associated with long-term problems of stress, anxiety and depression, and with low mental wellbeing, though to a lesser degree. The findings are consistent with a view that situational loneliness may be the product of residential structures and resources in deprived areas. The findings also show that neighbourly behaviours of different kinds are important for protecting against loneliness in deprived communities. Familiarity within the neighbourhood, as active acquaintance rather than merely recognition, is also important. The findings are indicative of several mechanisms that may link loneliness to health and wellbeing in our study group: loneliness itself as a stressor; lonely people not responding well to the many other stressors in deprived areas; and loneliness as the product of weak social buffering to protect against stressors

Do residents’ perceptions of being well-placed and objective presence of local amenities match? A case study in West Central Scotland, UK

Background:<p></p> Recently there has been growing interest in how neighbourhood features, such as the provision of local facilities and amenities, influence residents’ health and well-being. Prior research has measured amenity provision through subjective measures (surveying residents’ perceptions) or objective (GIS mapping of distance) methods. The latter may provide a more accurate measure of physical access, but residents may not use local amenities if they do not perceive them as ‘local’. We believe both subjective and objective measures should be explored, and use West Central Scotland data to investigate correspondence between residents’ subjective assessments of how well-placed they are for everyday amenities (food stores, primary and secondary schools, libraries, pharmacies, public recreation), and objective GIS-modelled measures, and examine correspondence by various sub-groups.<p></p> Methods:<p></p> ArcMap was used to map the postal locations of ‘Transport, Health and Well-being 2010 Study’ respondents (n = 1760), and the six amenities, and the presence/absence of each of them within various straight-line and network buffers around respondents’ homes was recorded. SPSS was used to investigate whether objective presence of an amenity within a specified buffer was perceived by a respondent as being well-placed for that amenity. Kappa statistics were used to test agreement between measures for all respondents, and by sex, age, social class, area deprivation, car ownership, dog ownership, walking in the local area, and years lived in current home.<p></p> Results:<p></p> In general, there was poor agreement (Kappa <0.20) between perceptions of being well-placed for each facility and objective presence, within 800 m and 1000 m straight-line and network buffers, with the exception of pharmacies (at 1000 m straight-line) (Kappa: 0.21). Results varied between respondent sub-groups, with some showing better agreement than others. Amongst sub-groups, at 800 m straight-line buffers, the highest correspondence between subjective and objective measures was for pharmacies and primary schools, and at 1000 m, for pharmacies, primary schools and libraries. For road network buffers under 1000 m, agreement was generally poor.<p></p> Conclusion:<p></p> Respondents did not necessarily regard themselves as well-placed for specific amenities when these amenities were present within specified boundaries around their homes, with some exceptions; the picture is not clear-cut with varying findings between different amenities, buffers, and sub-groups

Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes