Exploring sentinel conditions and the accrual sequence of multiple long-term condition multimorbidity using birth cohort and primary care data: an exploratory retrospective cohort study

Background Evidence suggests that the sequence of accrual of conditions varies considerably and affects outcomes. We aimed to explore whether sentinel conditions (the first long-term condition occurring in the life course) and accrual sequences of long-term conditions in the development of early onset multimorbidity can be characterised using birth cohort and primary care data. Methods In this retrospective cohort study, we used data from the 1970 British Birth Cohort Study (BCS70) and pseudonymised data from the Care and Health Information Analytics database (CHIA). Age 26 years is the first BCS70 adulthood sweep (round of data collection) age 46 years the most recent (age 50 sweep delayed by COVID-19) and we investigated an exemplar multiple long-term condition multimorbidity (MLTC-M) group with adequate numbers (ie, mental ill-health, backpain, and high blood pressure). In CHIA we defined MLTC-M as two or more (of 21) conditions occurring by age 50. Sequencing identified the timepoint at which sentinel conditions were reported. Findings The BCS70 age 46 years sample comprised of 8581 participants (4427 [52%] women and 4154 [48%] men). For participants who reported the exemplar MLTC-M outcome (n=163), mental ill-health was the sentinel condition for 25% (n=41), with 12% (n=20) reporting mental ill-health at age 26 years. Pain was the second commonest sentinel condition (21%;n=35) with 16% (n=26) reporting pain at age 26 years. 45% (n=74) reported their sentinel condition by age 26. For the exemplar MLTC-M group the most common accrual sequence was mental ill-health and back pain followed by high blood pressure (n=35;21%). The CHIA sample included 702 265 participants (373 553 [53%] women and 328 712 [47%] men). Out of a total 335 963 people under 50, 65 757 (20%) had MLTC-M. Common sentinel conditions were asthma (44%;n=29 228) and anxiety or depression (37%;n=24 634). Hypertension was a sentinel condition for 4% (n=2580). Interpretation We identified possible sentinel conditions of burdensome MLTC-M in birth cohort and primary care datasets. Continued development of this methodology, drawing together learning from complementary datasets, might help inform the timing and nature of interventions endeavouring to alter health trajectories and preventing the development of MLTC-M. Funding National Institute for Health Research (number NIHR202644).

Altering product placement to create a healthier layout in supermarkets: Outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study.

BACKGROUND: Previous product placement trials in supermarkets are limited in scope and outcome data collected. This study assessed the effects on store-level sales, household-level purchasing, and dietary behaviours of a healthier supermarket layout. METHODS AND FINDINGS: This is a prospective matched controlled cluster trial with 2 intervention components: (i) new fresh fruit and vegetable sections near store entrances (replacing smaller displays at the back) and frozen vegetables repositioned to the entrance aisle, plus (ii) the removal of confectionery from checkouts and aisle ends opposite. In this pilot study, the intervention was implemented for 6 months in 3 discount supermarkets in England. Three control stores were matched on store sales and customer profiles and neighbourhood deprivation. Women customers aged 18 to 45 years, with loyalty cards, were assigned to the intervention (n = 62) or control group (n = 88) of their primary store. The trial registration number is NCT03518151. Interrupted time series analysis showed that increases in store-level sales of fruits and vegetables were greater in intervention stores than predicted at 3 (1.71 standard deviations (SDs) (95% CI 0.45, 2.96), P = 0.01) and 6 months follow-up (2.42 SDs (0.22, 4.62), P = 0.03), equivalent to approximately 6,170 and approximately 9,820 extra portions per store, per week, respectively. The proportion of purchasing fruits and vegetables per week rose among intervention participants at 3 and 6 months compared to control participants (0.2% versus -3.0%, P = 0.22; 1.7% versus -3.5%, P = 0.05, respectively). Store sales of confectionery were lower in intervention stores than predicted at 3 (-1.05 SDs (-1.98, -0.12), P = 0.03) and 6 months (-1.37 SDs (-2.95, 0.22), P = 0.09), equivalent to approximately 1,359 and approximately 1,575 fewer portions per store, per week, respectively; no differences were observed for confectionery purchasing. Changes in dietary variables were predominantly in the expected direction for health benefit. Intervention implementation was not within control of the research team, and stores could not be randomised. It is a pilot study, and, therefore, not powered to detect an effect. CONCLUSIONS: Healthier supermarket layouts can improve the nutrition profile of store sales and likely improve household purchasing and dietary quality. Placing fruits and vegetables near store entrances should be considered alongside policies to limit prominent placement of unhealthy foods. TRIAL REGISTRATION: ClinicalTrials.gov NCT03518151 (pre-results).

Women’s reactions to the COVID-19 food system shock and insights for strategies supporting healthy purchasing and dietary behaviours: a qualitative study

BackgroundThe COVID-19 pandemic disrupted usual routines, including families’ food acquisition and consumption patterns. This pandemic could have lasting effects on consumer behaviour and implications for future strategies to improve population diet. The aim of this study was to gain in-depth understanding of families lived experiences by i) examining the impact of disruption resulting from the pandemic on the food purchasing and eating behaviours of young women, and ii) identifying the insights these experiences bring to designing future healthy eating interventions.MethodsA cross-sectional sample of 34 customers aged 18–45 years, from a UK discount supermarket chain completed semi-structured telephone interviews. Women were asked questions to understand their lived experiences of food shopping, cooking, and eating during the COVID-19 lockdown. Interviews were transcribed verbatim and analysed thematically using QSR NVIVO software. Six researchers were involved in developing the initial coding framework, double coding of eleven interview transcripts and refining the coding framework.ResultsParticipants’ median age was 35 years and 56% were in paid employment. Findings show that participants displayed emotional responses to COVID-19 pandemic disruptions of their food purchasing and dietary behaviours. Anxiety was common, with many feeling anxious about not acquiring enough or preferred foods for their families;contracting COVID-19 while food shopping;or needing to balance food costs, meal/snack variety and health. Frustration was also widespread, particularly about those who stockpiled;the poor availability of products which caused challenging situations at family mealtimes;shoppers who did not respect social distancing rules;and queues/one-way systems that made food shopping longer or less successful. These negative emotions were balanced against feelings of empathy, altruism, and pleasure. Many participants were understanding of government and supermarket restrictions or took the risk of shopping in-store to leave delivery slots for vulnerable customers or to help neighbours. Several women enjoyed leaving the house/family to go food shopping but missed being able to browse for meal ideas;others liked having more family meals and time to cook healthier dishes together.ConclusionStrategies to improve food purchasing and diet may be enhanced if positive emotions, like pleasure in families cooking and eating together, are targeted. As communicating the necessity for COVID-19 rules increased the public acceptance of these restrictions, a similar approach could be adopted for government policies to improve supermarket environments that may disrupt shoppers’ routines but are necessary to improve shopping patterns.