Children's perceptions of environment and health in two Scottish neighbourhoods

This article explores children's understanding of the role that neighbourhood plays in their health and well-being. Whilst evidence exists on the relationship between the environment and children's health, we have little knowledge of this from the perspective of children themselves. Children's experiences are all too frequently researched through the eyes of adults. Following a Rights of the Child framework, respecting children's views and giving them due weight, this paper reports from a project that worked with children from two relatively deprived urban neighbourhoods in Scotland. Using this framework, the children themselves were the researchers who designed the themes, decided upon the methods, conducted the research and analysed the resulting data. Using focus groups, visual mapping and community walks the children explored their local neighbourhoods and the findings reveal features of the environment that the children perceive as important for their health and well-being. The children selected three themes to explore in the research: safety, littering, and family and friends, through which they elicit their experiences, feelings and attitudes towards the environment and their well-being. The paper reveals that not only do the children have a deep understanding of the link between environment and health, but that they also understand how aspects of disadvantage, including place-based stigma, can limit their social participation and inclusion in society. We conclude with recommendations made by the children themselves, ranging from access to affordable activities, improved open spaces, ‘support not stigma’ and the need to be heard in local decision making

Tobacco Retail Environment and Smoking: A Systematic Review of Geographic Exposure Measures and Implications for Future Studies

Introduction: To review the geographic exposure measures used to characterize the tobacco environment in terms of density of tobacco outlets and proximity to tobacco outlets, and its association with smoking-related outcomes. Methods: We used PubMed and Google Scholar to find articles published until December 2019. The search was restricted to studies that (1) measured the density of and/or proximity to tobacco outlets and (2) included associations with smoking outcomes. The extraction was coordinated by several observers. We gathered data on the place of exposure, methodological approaches, and smoking outcomes. Results: Forty articles were eligible out of 3002 screened papers. Different density and proximity measures were described. 47.4% density calculations were based on simple counts (number of outlets within an area). Kernel density estimations and other measures weighted by the size of the area (outlets per square kilometer), population, and road length were identified. 81.3% of the articles which assessed proximity to tobacco outlets used length distances estimated through the street network. Higher density values were mostly associated with higher smoking prevalence (76.2%), greater tobacco use and smoking initiation (64.3%), and lower cessation outcomes (84.6%). Proximity measures were not associated with any smoking outcome except with cessation (62.5%). Conclusion: Associations between the density of tobacco outlets and smoking outcomes were found regardless of the exposure measure applied. Further research is warranted to better understand how proximity to tobacco outlets may influence the smoking outcomes. This systematic review discusses methodological gaps in the literature and provides insights for future studies exploring the tobacco environment. Implications: Our findings pose some methodological lessons to improve the exposure measures on the tobacco outlet environment. Solving these methodological gaps is crucial to understand the influence of the tobacco environment on the smoking outcomes. Activity spaces should be considered in further analyses because individuals are exposed to tobacco beyond their residence or school neighborhood. Further studies in this research area demand density estimations weighted by the size of the area, population, or road length, or measured using Kernel density estimations. Proximity calculations should be measured through the street network and should consider travel times apart from the length distance

Evidence-based selection of environmental factors and datasets for measuring multiple environmental deprivation in epidemiological research

This Environment and Human Health project aims to develop a health-based summary measure of multiple physical environmental deprivation for the UK, akin to the measures of multiple socioeconomic deprivation that are widely used in epidemiology. Here we describe the first stage of the project, in which we aimed to identify health-relevant dimensions of physical environmental deprivation and acquire suitable environmental datasets to represent population exposure to these dimensions at the small-area level. We present the results of this process: an evidence-based list of environmental dimensions with population health relevance for the UK, and the spatial datasets we obtained and processed to represent these dimensions. This stage laid the foundations for the rest of the project, which will be reported elsewhere

Inequalities in children’s exposure to alcohol outlets in Scotland: a GPS study

Background: Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children—a vulnerable, formative development stage—may help understand alcohol use in later life. Methods: GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child’s GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child’s home and school. Results: Off-sales alcohol outlets accounted for 47% of children’s exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04–7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11–7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22—32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation. Conclusions: Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives

“Availability is the poor cousin of marketing and pricing”: qualitative study of stakeholders’ views on policy priorities around tobacco and alcohol availability

Background: Reducing alcohol and tobacco availability is one potential way to reduce harm from these unhealthy commodities. This study explores key stakeholders’ views in relation to policy priorities and considerations for both alcohol and tobacco availability. Methods: We conducted semi-structured interviews with 14 stakeholders from alcohol and/or tobacco third sector organizations, government, public health and licensing in Scotland. Interviews explored their views on alcohol/tobacco availability, including its place in the policy landscape and experiences in gaining support for policies. Data were analyzed using thematic analysis. Results: Stakeholders believed that alcohol and tobacco availability have not received as much policy attention as pricing and marketing. Stakeholders highlighted the importance of public support and having sufficient evidence to inform policy. Key considerations for future policies include: drawing on lessons from tobacco control policies to address alcohol availability, considering different aspects of availability (especially online availability), ensuring policies reflect their local context, considering the impact of policies on children, and managing retailers’ involvement in the policy process. Conclusion: This study highlights key considerations for policies to address alcohol and tobacco availability. There is a need for more research to consider retailers’ views and provide greater detail on specific policy suggestions.</p

Exploring the influence of local alcohol availability on drinking norms and practices: a qualitative scoping review

Introduction: High alcohol availability is related to increased alcohol consumption and harms. Existing quantitative research provides potential explanations for this relationship but there is little understanding of how people experience local alcohol availability. This is the first review to synthesise qualitative research exploring the relationship between alcohol availability and other factors in local alcohol environments. Methods: The scoping review includes qualitative studies exploring community‐level alcohol availability and other factors, facilitating the purchase and consumption of alcohol. We included studies focusing on children and adolescents as well as adults. Study findings were brought together using thematic analysis and the socio‐environmental context model, which explains how certain environments may facilitate drinking. Results: The review includes 34 articles. The majority of studies were conducted since 2012. Most studies were conducted in the United Kingdom, Australia and South Africa. The physical availability of alcohol and proximity to local amenities and temporal aspects, like late night opening hours, may be linked to social factors, such as normalisation of drinking and permissive drinking environments. The review highlights the importance of social and cultural factors in shaping interactions with local alcohol environments. Discussion and Conclusion: This qualitative scoping review advances understanding of the pathways linking alcohol availability and alcohol harms by showing that availability, accessibility and visibility of alcohol may contribute towards permissive drinking environments. Further research is needed to better understand how people experience alcohol availability in their local environment and how this can inform alcohol control policies

Taking health geography out of the academy:Measuring academic impact

In recent years the academic landscape has been shifting and significantly affected by the introduction of an ‘impact agenda’. Academics are increasingly expected to demonstrate their broader engagement with the world and evidence related outcomes. Whilst different countries are at various stages along this impact journey, the UK is the first country to link impact to funding outcomes; here impact now accounts for 20% of an academic unit of assessment’s Research Excellence Framework (REF) result. This concept of ‘research impact’ implies that our work can effect change through one or more identifiable events in a direct, preferably linear and certainly measurable manner. In this paper, focusing on impact in social science, and policy-related impact in particular, we argue that such a cause and effect model is inappropriate. Furthermore that impact is not immediate or indeed linear within social science research. Drawing on recent work on alcohol and tobacco environments in Scotland we present a case study of impact, reflect on the process and respond to the challenges of moving beyond ‘business as usual’ public participation towards the measurement of outcomes. In doing so we critique the way in which ‘impact’ is currently measured and suggest a move towards an enlightenment model with greater recognition of process

The neighbourhood social environment and alcohol use among urban and rural Scottish adolescents

Funding for the Scottish Health Behaviour in School-aged Children was provided by NHS Scotland. This work was also supported by the 600th Anniversary Ph.D. Scholarship which was awarded to Gina Martin by the University of St Andrews.Objectives This research examined the relationship between neighbourhood social environmental characteristics and drinking outcomes among a sample of urban and rural adolescents. Methods From a sample of 1558 Scottish secondary schoolchildren, surveyed as part of the 2010 Health Behaviour in School-aged Children study, we modelled three drinking outcomes on a variety of neighbourhood conditions, including social cohesion, disorder, alcohol outlet density, deprivation, and urban/rurality. Nested and cross-classified multilevel logistic regressions were specified. Results An urban-to-rural gradient was found with non-urban adolescents exhibiting higher odds of having ever drank. Neighbourhood social cohesion related to having ever drank. Among drinkers, those living in accessible small towns had higher odds of weekly drinking and drunkenness compared to urban areas. Higher odds of drunkenness were also found in remote rural areas. Those residing in the least deprived areas had lower odds of weekly drinking. Conclusions In Scotland, inequalities exist in adolescent alcohol use by urban/rurality and neighbourhood social conditions. Findings support regional targeting of public health efforts to address inequalities. Future work is needed to develop and evaluate intervention and prevention approaches for neighbourhoods at risk.Publisher PDFPeer reviewe