Adolescent alcohol use and participation in organised activities: A mixed methods study of British young people

Those who misuse alcohol are a burden on health services, the economy and society generally. Compared to their peers, British adolescents report some of the highest levels of alcohol use in Europe. Community organisations can potentially play an important role in the delivery of policy interventions aimed at reducing alcohol misuse. However, little is known about British adolescents’ engagement with these organisations, and related activities, and therefore the role that participation in community activities plays in adolescent alcohol use. This thesis presents findings from an investigation into young people’s participation in organised activities (OAs), such as sports and special groups. While the research was primarily motivated by psychological theories of adolescent risk taking their application was in an ecological framework that identified broader social and environmental determinants of behaviour. An explanatory mixed method design was used. This consisted of two longitudinal studies using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), two cross-sectional studies of male young offenders and non-offenders and a qualitative study involving practitioners involved with the care and management of vulnerable young people. Findings revealed that individual-level characteristics associated with risk-taking behaviours predicted OA participation and that more vulnerable young people participated less in OAs. The analysis of qualitative data indicated that there were barriers to youngsters’ participation in OAs at multiple levels. Longitudinal analyses showed that those participating in sport OAs were more likely to report alcohol use compared to adolescents who did not participate in any OA and participants in non-sport OAs. Cross-sectional analyses showed that young offenders in team sports reported lower levels of hazardous alcohol use compared to young offenders who did not participate in any OA. Qualitative work explored how OA participation might impact vulnerable young people’s alcohol use and showed that the structures of organisations were important for how practitioners worked and the mechanisms identified. These findings highlighted OA participation inequalities among British adolescents and the importance of community contexts for future adolescent alcohol use interventions

Exploratory studies to inform full-scale evaluations of complex public health interventions: the need for guidance

No abstract available

Predictors of physical activity and sedentary behaviours among 11-16 year olds: Multilevel analysis of the 2013 Health Behaviour in School-aged Children (HBSC) study in Wales

Background The present study investigated associations between individual- and school-level predictors and young people’s self-reported physical activity (total activity and moderate-to-vigorous activity) and sedentary behaviours. Methods Individual-level data provided by the 2013/14 cross-sectional survey ‘Health Behaviour in School-aged Children (HBSC) study in Wales’ were linked to school-level data within the ‘HBSC School Environment Questionnaire’. The final sample comprised 7,376 young people aged 11-16 years across 67 schools. Multilevel modelling was used to examine predictors of total physical activity, moderate-to-vigorous physical activity (MVPA) and sedentary behaviours (screen-based behaviours). Results Taking more physical activity (less than 5 days vs. 5 or more days per week), engaging in higher levels of MVPA (less than 4 hours vs. 4 or more hours per week) and reporting 2 or less hours of sedentary time were predicted by several individual level variables. Active travel to school positively predicted high levels of physical activity, however, gender stratified models revealed active travel as a predictor amongst girls only (OR:1.25 (95 % CI:1.05 - 1.49)). No school-level factors were shown to predict physical activity levels, however, a lower school socio-economic status was associated with a higher level of MVPA (OR:1.02 (95 % CI:1.01 - 1.03)) and a lower risk of sedentary behaviour (OR:0.97 (95 % CI:0.96 – 0.99)). A shorter lunch break (OR:1.33 (95 % CI:1.11 - 1.49)) and greater provision of facilities (OR:1.02 (95 % CI:1.00 - 1.05)) were associated with increased sedentary activity. Gender stratified models revealed that PE lesson duration (OR:1.18 (95 % CI:1.01 - 1.37)) and the provision of sports facilities (OR:1.03 (95 % CI:1.00 - 1.06)) were predictors of boy’s sedentary behaviours only. Conclusion Shorter lunch breaks were associated with increased sedentary time. Therefore, while further research is needed to better understand the causal nature of this association, extending lunch breaks could have a positive impact on sedentary behaviour through the provision of more time for physical activity. The findings also suggest that active travel could offer a mechanism for increasing physical activity levels particularly amongst girls. Particularly, the design and evaluation of interventions to promote physical activity during school hours should employ a comprehensive approach, including a focus on school policies and behaviours both in and out of school hours. Keywords Physical activity – Sedentary behaviour – Active travel – School – Policy – Environmen

Mixed-Methods Systematic Review to Identify Facilitators and Barriers for Parents/Carers to Engage Pre-School Children in Community-Based Opportunities to Be Physically Active

Background: Low physical activity levels in young children is a major concern. For children aged 0–5 years, engagement with opportunities to be physically active are often driven by the adults responsible for the child’s care. This systematic review explores the barriers and facilitators to parents/caregivers engaging pre-school children in community-based opportunities for physical activity, within real-world settings, or as part of an intervention study. Methods: EBSCOhost Medline, CINHAL plus, EBSCOhost SPORTDiscus, Web of Science, ProQuest, and ASSIA were systematically searched for quantitative and qualitative studies published in English between 2015 and 16 May 2022. Data extracted from 16 articles (485 parents/carers; four countries) were quality-assessed using the Mixed Methods Assessment Tool and coded and themed via thematic analysis. Results: Nine themes (eight core, one minor) were identified and conceptualised into a socio-ecological model, illustrating factors over four levels: Individual—beliefs and knowledge (and parental parameters); Interpersonal—social benefits, social network, and family dynamic; Community—organisational factors and affordability; and Built and Physical Environment—infrastructure. Discussion: The findings provide valuable insights for practitioners and policy makers who commission, design, and deliver community-based physical activity opportunities for pre-school children. Developing strategies and opportunities that seek to address the barriers identified, as well as build on the facilitators highlighted by parents, particularly factors related to infrastructure and affordability, are imperative for physical activity promotion in pre-school children. The perspectives of fathers, socioeconomic and geographical differences, and the importance parents place on physical activity promotion all need to be explored further

The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak

Research has consistently shown that access to parks and gardens is beneficial to people’s health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis

Associations of socioeconomic status, parental smoking and parental e-cigarette use with 10–11-year-old children’s perceptions of tobacco cigarettes and e-cigarettes: cross sectional analysis of the CHETS Wales 3 survey

Background: This study examines primary schoolchildren’s perceptions of e-cigarettes and tobacco cigarettes, and associations with parental smoking, vaping and socioeconomic status. Methods: Survey of 2218 10–11-year-old children in 73 schools in Wales. Results: Overall, 36% reported that a parent figure smoked compared to 21% for vaping, with parental smoking lower in affluent families (OR = 0.72; 95% CI = 0.68 to 0.76). Overall, 1% had tried a cigarette, while 5% had tried an e-cigarette. Most said they would not smoke or vape in 2 years’ time; susceptibility to vaping (20%) was higher than smoking (12%). Exposure to and perceptions of tobacco cigarettes were more positive for children of smokers. Having a parent who vaped was associated with exposure to and positive perceptions of e-cigarettes, but not smoking. Most children perceived e-cigarettes as used by adults to stop smoking (64%). Susceptibility to smoking (OR = 0.57; 95% CI = 0.41 to 0.79) and vaping (OR = 0.78; 95% CI = 0.62 to 0.99) were lower among children who perceived e-cigarettes as cessation aids. Conclusions: Parental smoking continues to be concentrated in poorer families. This study provides no evidence that parental vaping in the absence of smoking is associated with more positive perceptions of tobacco cigarettes. Communicating to children the role of e-cigarettes as cessation devices for smokers may help to limit their appeal to young people

Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales

Background Small yet significant impacts of e-cigarettes on population smoking cessations rates indicate promise for harm reduction. However, non-smoking young people are increasingly experimenting with e-cigarettes, and while regular use remains rare, arguments for regulation have been driven by fears that e-cigarettes re-normalize smoking. Others counter that e-cigarettes may displace youth smoking and further de-normalize it. This study tests whether the secular decline in youth smoking prevalence, as well as perceived smoking norms, slowed or accelerated during the period from 2011–2015 (when e-cigarettes were emerging but prior to recent moves to regulate their use). Methods Data were taken from the Smoking Drinking and Drug Use survey in England, Health Behaviour in School Aged Children/School Health Research Network surveys in Wales, and the Scottish Adolescents Lifestyle and Substance Use Surveys between 1998 and 2015, including 247,515 13 and 15 year-old respondents. Segmented regression analyses examined trends for smoking prevalence (ever smoking and weekly smoking) and perceived smoking norms, testing for change in trend from 2011–15. Falsifiability checks examined change in trends for alcohol use and cannabis use for the same period. Results In final models for the whole sample, there was no change in rate of decline for ever smoking (OR=1.01; CI 0.99 to 1.03), with a marginally significant slowing in the rate of decline for weekly smoking (OR=1.04; CI 1.00 to 1.08). This slowing decline in weekly smoking was however limited to groups for whom rates were declining prior to 2010 at a rate which could not be sustained (i.e. girls and 13 year olds), and occurred in a greater magnitude for other substances, including cannabis use (OR=1.21, CI 1.18 to 1.25) and alcohol use (OR=1.17; CI 1.14 to 1.19). There was consistent evidence across all subgroups of an increased rate of decline in the percentage of young people saying that smoking is ok (OR=0.83; CI 0.81 to 0.86). Conclusion We found no evidence that the growing prevalence of e-cigarette use has led to increased experimentation with smoking, and some evidence that young people’s perceptions against smoking as a normative behavior have hardened rather than softened. Although the decline in weekly smoking rates is slowing, this appears to reflect a floor effect and is of smaller magnitude than change in trend for other substances. While the idea that e-cigarettes renormalize smoking has been central to much policy debate surrounding regulation, these findings indicate no reason to believe that this renormalization is occurring

A qualitative study of e-cigarette emergence and the potential for renormalisation of smoking in UK youth

Background: Growth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research. Methods: This paper reports results from twenty-one group interviews with 14–15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them. Results: Young people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as ‘vapes’. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally. Conclusion: The extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary

Exploratory studies to inform full-scale evaluations of complex public health interventions: the need for guidance

No abstract available