Current issues in the impacts of transport on health

INTRODUCTION OR BACKGROUND: Transport affects health in many ways. Benefits include access to education, employment, goods, services and leisure, and opportunities for incorporating physical activity into daily living. There are major inequalities: benefits generally accrue to wealthier people and harms to the more deprived, nationally and globally. SOURCES OF DATA: Health on the Move 2; Journal of Transport and Health. AREAS OF AGREEMENT: Benefits of travel for access and physical activity. Harms include health impacts of air and noise pollution; injuries and fatalities from falls or collisions; sedentary behaviour with motorized transport; community severance (barrier effect of busy roads and transport infrastructure); global climate change; impacts on inequalities; transport's role in facilitating spread of communicable diseases. AREAS OF CONTROVERSY INCLUDE: Biofuels; cycle safety; driving by older people. GROWING POINTS AND AREAS FOR RESEARCH INCLUDE: Effects of default 20 mph speed limits; impacts of autonomous vehicles on health and inequalities

Manufacturing doubt: assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages

Background Manufacturers of harmful products engage in misinformation tactics long employed by the tobacco industry to emphasize uncertainty about scientific evidence and deflect negative attention from their products. This study assessed the effects of one type of tactic, the use of "alternative causation" arguments, on public understanding. Methods In five trials (one for each industry) anonymized Qualtrics panel respondents were randomized to receive a message on the risk in question from one of four industry sponsored organizations (exposure), or from one of four independent organizations (control), on risks related to alcohol, tobacco, fossil fuel and sugar sweetened beverages. Logistic regression models were used to evaluate the effect of industry arguments about uncertainty on the primary outcome of public certainty about product risk, adjusting for age, gender and education. The results from all five trials were pooled in a random-effects meta-analysis. Findings In total, n=3284 respondents were exposed to industry-sponsored messaging about product-related risks, compared to n=3297 exposed to non-industry messages. Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages [Summary odds ratio (OR) 1·60, confidence interval (CI) 1·28-1·99]. The effect was greater among those who self-rated as not/slightly knowledgeable (OR 2·24, CI 1·61-3·12), or moderately knowledgeable (OR 1·85, CI 1·38-2·48) compared to those very/extremely knowledgeable (OR 1·28, CI 1·03-1·60). Conclusions This study demonstrates that exposure to industry sponsored messages which appear intended to downplay risk significantly increases uncertainty or false certainty, with the effect being greater in less knowledgeable participants

Access to influenza immunisation services by HIV positive patients in the UK.

Influenza is an important cause of morbidity in HIV positive adults, who may be more susceptible and more likely to develop severe disease.(1,2) Annual influenza immunisation is recommended for all HIV positive adults in the UK, supported by British HIV Association (BHIVA) guidelines,(1) with evidence for reasonably good uptake (3). HIV services do not receive specific funding to provide immunisation; and the National Flu Immunisation Programme offers this instead via Primary Care and pharmacies.(4) Whether this meets the needs of people living with HIV has not been evaluated. This article is protected by copyright. All rights reserved

CAR-T cell. the long and winding road to solid tumors

Adoptive cell therapy of solid tumors with reprogrammed T cells can be considered the "next generation" of cancer hallmarks. CAR-T cells fail to be as effective as in liquid tumors for the inability to reach and survive in the microenvironment surrounding the neoplastic foci. The intricate net of cross-interactions occurring between tumor components, stromal and immune cells leads to an ineffective anergic status favoring the evasion from the host's defenses. Our goal is hereby to trace the road imposed by solid tumors to CAR-T cells, highlighting pitfalls and strategies to be developed and refined to possibly overcome these hurdles

A critical analysis of UK gambling policy: A public health perspective

Policy changes have rendered the United Kingdom (UK) one of the most liberalised gambling markets globally. Product design, marketing sophistication, and industry strategies are evolving at considerable pace, posing challenges for existing regulations. Concomitantly, the extent and diversity of gambling harms are receiving greater recognition as a public health issue. Gambling regulation and the problem definition are highly contested. In 2019 the UK Government committed to reforming gambling law, initiating a formal review of the Gambling Act in 2020. However, critical analysis of UK gambling policy, including how it is formed, who seeks to influence these processes, whose problem definition and solutions are adopted, and with what consequences, is lacking, particularly from a public health perspective. Drawing on poststructural discourse theory (PSDT), the critical logics approach (CLA), and the literature on both the commercial determinants of health (CDOH) and ignorance studies, the research presented in the thesis provides a critical analysis of UK gambling policies and practices, and how these have been formed, challenged, and maintained. A range of complementary methods were used, including document analysis, stakeholder interviews, and case studies and data derived from these. The findings represent an analysis that explains the emergence and reproduction of an industry-favourable gambling policy regime and provide a detailed account as to how and why this regime has resisted transformational change, demonstrating the role of particular social and political practices that maintain the status quo at the expense of public health. The knowledge generated from this programme of research is intended to support public health practice and advocacy by opening spaces for debate, exposing what has been taken for granted and what possibilities have been concealed, by whom, how, and with what consequences. The potential application of the methods and findings to the study of other industries and their public health impacts is also explored. Through this the research aims to contribute to the wider literature on the CDOH

Agnogenic practices: an analysis of UK gambling industry-funded youth education programmes

Background: The corporate political activities of harmful industries, including the use of agnogenic (ignorance or doubt producing) practices and the construction of dystopian narratives, directed at influencing policymaking are well documented. However, the use of agnogenic practices by industry-funded organisations who deliver industry-favoured education-based measures remains unexplored. This study aims to build understanding of this by analysing three UK gambling industry-funded youth education programmes that represent key policy responses to gambling harms. Methods: Using a published typology of corporate agnogenic practices the ways that evidence is used within the programmes’ resources to legitimise their content and implementation were analysed. Programme evaluations and claims about the programmes’ evidence base and effectiveness were also analysed. Results: Agnogenic practices, including confounding referencing, misleading summaries and evidential landscaping, that resemble those adopted by harmful industries are used within gambling industry-funded youth education programmes and by the charities that oversee their delivery. These practices serve corporate interests, distort the limited evidence in support of youth gambling education measures, and legitimise industry favoured policies. Conclusions: This novel study demonstrates that agnogenic practices are used to construct utopian narratives that claim that gambling industry-favoured youth education programmes are evidence-based and evaluation-led. These practices misrepresent the literature and evaluation findings and may undermine effective policymaking to protect children and young people from gambling harms. Key messages: • Gambling industry-funded education programmes warrant greater scrutiny and conflicts of interest need to be addressed. • The methods and findings of this study are of relevance to other contexts and areas in the field of the commercial determinants of health given other harmful industries adopt similar approaches

Agnogenic practices: an analysis of UK gambling industry-funded youth education programmes

Background: The corporate political activities of harmful industries, including the use of agnogenic (ignorance or doubt producing) practices and the construction of dystopian narratives, directed at influencing policymaking are well documented. However, the use of agnogenic practices by industry-funded organisations who deliver industry-favoured education-based measures remains unexplored. This study aims to build understanding of this by analysing three UK gambling industry-funded youth education programmes that represent key policy responses to gambling harms. Methods: Using a published typology of corporate agnogenic practices the ways that evidence is used within the programmes’ resources to legitimise their content and implementation were analysed. Programme evaluations and claims about the programmes’ evidence base and effectiveness were also analysed. Results: Agnogenic practices, including confounding referencing, misleading summaries and evidential landscaping, that resemble those adopted by harmful industries are used within gambling industry-funded youth education programmes and by the charities that oversee their delivery. These practices serve corporate interests, distort the limited evidence in support of youth gambling education measures, and legitimise industry favoured policies. Conclusions: This novel study demonstrates that agnogenic practices are used to construct utopian narratives that claim that gambling industry-favoured youth education programmes are evidence-based and evaluation-led. These practices misrepresent the literature and evaluation findings and may undermine effective policymaking to protect children and young people from gambling harms. Key messages: • Gambling industry-funded education programmes warrant greater scrutiny and conflicts of interest need to be addressed. • The methods and findings of this study are of relevance to other contexts and areas in the field of the commercial determinants of health given other harmful industries adopt similar approaches

Analysis of tobacco industry pricing strategies in 23 European Union countries using commercial pricing data

Background The tobacco industry (TI) can act to undermine the impact of tobacco tax increases by adopting various pricing strategies. Little is known about strategies used across the European Union (EU), except for the UK. Aim To examine pricing strategies adopted by the TI in the EU, and whether they differ by cigarette price segment, or between manufactured and roll-your-own (RYO) cigarettes. Methods This is a longitudinal analysis of commercial pricing data for manufactured and RYO cigarettes from 23 EU countries in 2006–2017. Price and revenue trends were explored. Linear regression estimated the average annual change in revenue, and linear fixed-effects panel regression models were used to explore the association between changes in median revenue (net of tax and adjusted for inflation) and tax increases in different price segments of manufactured cigarettes. Results Over the 11-year period price gaps were observed in all countries. The average annual adjusted median net revenue per pack increased in 19 of 23 countries for manufactured and RYO cigarettes. A tax increase was associated with a significant decrease of −€0.09 in adjusted median net revenue per pack (95% CI −0.16 to −0.03) in the cheap cigarette price segment, while no change was detected in the expensive cigarette price segment (−€0.05, 95% CI −0.11 to 0.01). Conclusion Across the EU, pricing strategies adopted by the TI maintained or increased price gaps and retained cheaper tobacco products in the market, diminishing the impact of tobacco tax increases. Further strengthening of tobacco taxation policy is needed to maximise public health impact

“When the Fun Stops, Stop”: An analysis of the provenance, framing and evidence of a ‘responsible gambling’ campaign

When the Fun Stops, Stop, is a prominent 'responsible gambling' campaign in the UK, originally funded and delivered by the industry-initiated and funded Senet Group. Since the Senet Group's dissolution in 2020, the campaign has been overseen by the Betting and Gambling Council (BGC), the main gambling industry trade body. There has been no prior analysis of the activities, ideas and framing adopted by the Senet Group, who claimed to be acting as an industry 'watchdog' and oversaw what they characterised as a major public education campaign. We collated written and image-based material related to the Senet Group and its When the Fun Stops, Stop campaign from multiple sources. Guided by Entman's four functions of framing, we analysed the Senet Group's framing of the issues it sought to address, particularly harmful gambling, as well as its causes, and the solutions, focusing on the group's main activity: the delivery of the When the Fun Stops, Stop campaign. We also critically appraised an evaluation of the campaign funded by the Senet Group, using the findings to interrogate the stated claims about the campaign's effectiveness. The analysis showed that the Senet Group's framing of the problem, its causes, and proposed responses resemble those adopted by other industries and industry-funded groups. This involves portraying any harms caused by their products as limited to an atypical minority, rejecting upstream determinants of harm, and promoting individually-targeted voluntary measures, all contrary to the evidence of what works in health promotion, and what would characterise a public health approach. Neither the existing evidence base nor the evidence presented by the Senet Group support their claims about the campaign's effectiveness. These findings add to concerns about industry-funded campaigns in other areas. To minimise conflicts of interest, interventions intended to address gambling-related harms, such as public education campaigns, should be evidence-based and developed, implemented and evaluated completely independent of the industry and industry-funded organisations