The business impact of the Brexit vote: a view from housing associations

Following the Brexit vote, housing associations are now faced with a number of uncertainties regarding funding, workforce supply, regulation and the very future of their business. Lucy Pedrick from the National Housing Federation outlines the four key themes organisations are currently considering

Neighbourhood active living environment and obesity in adolescents using the Millennium Cohort Study

Objectives Youth obesity has increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear. This study examines whether more walkable neighbourhoods are associated with lower levels of overweight/obesity for adolescents compared to less walkable neighbourhoods, after considering the potential role of socio-economic and lifestyle characteristics. Methods We examine overweight/obesity levels for all singleton 14 years-old children living in Wales, using the UK Millennium Cohort Study. Children are classified as healthy weight, overweight and obese using international age and sex adjusted cut-offs for body mass index (BMI). The built environment is assessed using the active living environments (ALE) index for 2017-2018 classified into 5 categories (1-low walkability and 5 – high walkability). We apply regression analysis and adjust for children characteristics (e.g., physical activity), parental socio-economic circumstances and lifestyle choices (e.g., maternal education, physical activity). Results We assess the hypothesis that the built environment is associated with adolescents’ overweight/obesity levels and examine how much of this association could be modified by parental socioeconomic circumstances and lifestyle choices. The ALE index is higher in urban compared to rural areas. To capture variations in Wales’ population, we are conducting a stratified analysis to explore any differences on the association between ALE index and adolescents’ overweight/obesity by urban and rural areas. Accounting for the potential role of lifestyle and socio-economic characteristics is key for future research, as understanding the underlying pathways of this association is necessary to design effective interventions. Conclusion Findings can help us develop a better understanding of associations between the built environment and overweight/obesity status to inform evidence-based planning policy and practice strategies on how to modify the built environment to promote child health in future generations by increasing better opportunities for diet and activity

Multi-sectoral data linkages to explore associations between the built environment and BMI.

Objectives In Wales almost a quarter of adults and 1 in 8 reception age children are obese. Linked data is a key tool to understanding the role of the built environment on obesity rates and is an important part of developing strategies to combat the obesity epidemic in Wales. Approach We set out to develop an analytical platform for generating evidence on key aspects of the built environment which impact child and adult obesity including; walkability, fast food availability, green space size and qualities, active transport routes and school environments. Utilising the Secure Anonymised Information Linkage (SAIL) Databank We linked multi-sectoral data including routine health data, cohort data, administrative data and linked Geographic Information Systems generated metrics at household and school level. The platform will inform policy makers with and facilitate a  better understanding of associations between a range of social, health and built environment factors. Results We have created a range of built environment variables including temporally and age varying walkability indices, viewable greenspace, garden and house size, access to services and parks for 1.5 million households. In the first instance, as part of the BEACHES project, this data has been linked to several health datasets including the Child Measurement Programme (CMP, n=188,800) where initial results have shown that associations between garden size and Body Mass Index in children displays a non-linear negative correlation. We have also created follow-up measures for the CMP using routinely collected general practice data which further enables linking 28,389 height and weight measurements. However, potential bias in these follow-up measures is poorly understood with further work being undertaken to assess usability. Conclusion The integrated multi-sectoral data platform approach to linking environmental, administrative, health and cohort data aims to develop insights on a range of public health issues. We are working with a range of stakeholders to develop evidence-based policy initiatives to reduce obesity in Wales

Neighbourhood walkability and body mass index in children: Evidence from the Millennium Cohort Study in Wales

Background: Overweight and obesity in children continues to increase. Yet, the role of active transport, namely walking, in mitigating these trends remains unclear. This study examined the cross-sectional association between walkability and children’s Body Mass Index (BMI) and how this varies by socio-economic and lifestyle characteristics. Methods: We analysed BMI for 14-year-old children living in Wales from the UK Millennium Cohort Study. Children were categorised as healthy weight, overweight or obese using the British 1990 cut-off points. Walkability was assessed using the Wales Active Living Environments (Wal-ALE) database, categorised as 1 (least walkable environments) to 5 (most walkable environments). We applied multinomial logistic regression analysis and adjusted for ethnicity, having a limiting longstanding illness, parental BMI, socio-economic circumstances, and lifestyle characteristics. Results: Children were more likely to be obese if they lived in areas classed as more walkable in unadjusted analysis [Relative Risk Ratio (RRR)=1.72 (95% CI =1.15 - 2.58)] and following adjustment for ethnicity, limiting longstanding illness and parental BMI [RRR= 1.83 (95%CI=1.12 – 3.00)].). Significant associations remained even after further adjustment for lifestyle characteristics and socio-economic circumstances [RRR=1.76 (95%CI=1.05 – 2.96)]. Further, children were more likely to be obese if their parents were overweight or obese and if they were living in poverty. Children were less likely to be obese if they spent 3 or more days per week in moderate-to-vigorous physical activity (MVPA) and if they ate breakfast every day vs. some days or never. Conclusion: Findings demonstrate that walkable environments are not associated with lower rates of obesity in children, indicating that the relationship between the built environment and child health is complex and requires further study

Residential mobility amongst children and young people in Wales: A longitudinal study using linked administrative records

BackgroundChild poverty remains a major global concern and a child's experience of deprivation is heavily shaped by where they live and the stability of their local neighbourhood. This study examines frequencies and patterns of residential mobility in children and young people (CYP) at a population level using novel geospatial techniques to assess how often their physical environment changes and to identify geographical variations in social mobility. MethodsWe used routinely collected administrative records held in the Secure Anonymised Information Linkage (SAIL) Databank for CYP aged under 18 living in Wales between 2012 and 2022. We calculated the Moran’s I statistic to assess the magnitude of Lower layer Super Output Area (LSOA)-level geographic variation in residential mobility and used the Local Indicator of Spatial Association (LISA) to identify clusters of LSOAs where there are higher rates of residential mobility.ResultsThis study included 923,531 CYP, with 58% having moved at least once during the study period. A total number of 1,209,102 house moves were recorded, 59% of which occurred between the ages of 0 and 5. Almost 10% of the cohort resided in five or more dwellings before the age of 18. In terms of area-level (LSOA) deprivation, 75% of house moves were to areas with the same or higher levels of deprivation, leaving only 25% of house moves that achieved upward social mobility. Clustering of residential mobility was identified predominantly in areas of high deprivation.ConclusionThe findings of this study show that residential mobility is linked with socio-economic circumstances and is experienced by over half of CYP in Wales. Understanding where CYP live, their mobility patterns and which areas have high levels of influx and efflux is crucial for policymakers to generate well-informed, targeted and effective child-focused interventions

Built Environments And Child Health in WalEs and AuStralia (BEACHES): a study protocol

Introduction Childhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments And Child Health in WalEs and AuStralia (BEACHES) study is to identify and understand how complex and interacting factors in the built environment influence modifiable risk factors for NCDs across childhood. Methods and analysis This is an observational study using data from five established cohorts from Wales and Australia: (1) Wales Electronic Cohort for Children; (2) Millennium Cohort Study; (3) PLAY Spaces and Environments for Children\u27s Physical Activity study; (4) The ORIGINS Project; and (5) Growing Up in Australia: the Longitudinal Study of Australian Children. The study will incorporate a comprehensive suite of longitudinal quantitative data (surveys, anthropometry, accelerometry, and Geographic Information Systems data) to understand how the built environment influences children\u27s modifiable risk factors for NCDs (body mass index, physical activity, sedentary behaviour and diet). Ethics and dissemination This study has received the following approvals: University of Western Australia Human Research Ethics Committee (2020/ET000353), Ramsay Human Research Ethics Committee (under review) and Swansea University Information Governance Review Panel (Project ID: 1001). Findings will be reported to the following: (1) funding bodies, research institutes and hospitals supporting the BEACHES project; (2) parents and children; (3) school management teams; (4) existing and new industry partner networks; (5) federal, state and local governments to inform policy; as well as (6) presented at local, national and international conferences; and (7) disseminated by peer-reviewed publications