A content analysis of the aims, strategies, and effects of food and nonalcoholic drink advertising based on advertising industry case studies.

Background: Placing limitations on advertising of food and nonalcoholic drinks to children is an effective strategy in addressing childhood obesity. The industry maintains that further restrictions are unnecessary. Aims: To ascertain whether the advertising campaigns were successful according to the industry evaluations and more specifically the effects of marketing on children. Materials & Methods: A total of 117 case studies (1980-2016) published by the advertising industry which evaluate the effects of advertising campaigns were reviewed. This industry data source had been previously used to analyze the effects of alcohol advertising campaigns. The nutrition profile of the products was assessed by applying the World Health Organisation Nutrition Profile model designed to restrict the marketing of foods and beverages to children. Results: The food and drink industry advertising campaigns target specific consumers including children, use several persuasive marketing techniques (utilizing celebrities and gamification), often position unhealthy products as healthy, and lead to increased sales of the advertised product with good returns on investment. The health-related claims made, and aspects of the campaigns related to the marketing of the products to children are summarized. Discussion: Our analysis of food and non-alcoholic drinks case studies aligns with similar analyses of tobacco and alcohol advertising. Conclusion: This analysis, based on internal industry data, presents important evidence on the effects of advertising on consumption-related outcomes and the mechanisms by which they are achieved.

Treatment fidelity in the Camden Weight Loss (CAMWEL) intervention assessed from recordings of advisor-participant consultations.

BACKGROUND: Variations in the delivery of content and process can alter the effectiveness of complex interventions. This study examined the fidelity of a weight loss intervention (Camden Weight Loss) from recorded consultations by assessing advisors' delivery of content, use of motivational interviewing approach and therapeutic alliance. METHODS: A process evaluation was conducted of advisor-participant consultations in a 12-month randomised controlled trial of an intervention for adult volunteers with a body mass index categorised as overweight or obese. A convenience sample of 22 consultations (12% of 191 participants) recorded at the intervention mid-point were available for analysis. Consultations were independently rated by two observers independent of intervention or study delivery, using: a fidelity scale, the Motivational Interviewing Treatment Integrity Scale and the Primary Care Therapy Process Rating Scale. Raters were blind to participants' responses to the intervention and weight outcomes. Half the participants (N = 11) achieved significant weight loss (≥ 5% of baseline weight). RESULTS: A mean of 41% of prescribed content was delivered, with a range covered per session of 8-98%, falling below the 100% content expected per session. Tasks included most frequently were: taking weight and waist measurements (98%), scheduling next appointment (86%), review of general progress (85%) and reviewing weight change (84%). Individual items most frequently addressed were 'giving encouragement' and 'showing appreciation of participant's efforts' (95 and 88% respectively). Consultation length (mean 19 min, range 9-30) was shorter than the 30-min allocation. Quantity of content correlated with consultation length (p < 0.01). Advisors' use of motivational interviewing was rated at 'beginner proficiency' for Global Clinician Rating, Reflection to Question Ratio and Percent Open Questions. Therapeutic alliance scores were moderate. Affective aspects were rated highly (e.g. supportive encouragement, involvement and warmth). CONCLUSIONS: Intervention fidelity varied in both content and process, emphasising the importance of ongoing fidelity checks in a complex intervention. Advisors focused on certain practical aspects of the intervention and providing an encouraging interpersonal climate. This concurs with other research findings, which have revealed the value participants in a weight loss intervention place on an empathic advisor-participant relationship. CLINICAL TRIALS REGISTRATION: Registered with Clinicaltrials.gov, number NCT00891943, on 1 May 2009.

Optimising measurement of health-related characteristics of the built environment: Comparing data collected by foot-based street audits, virtual street audits and routine secondary data sources.

The role of the neighbourhood environment in influencing health behaviours continues to be an important topic in public health research and policy. Foot-based street audits, virtual street audits and secondary data sources are widespread data collection methods used to objectively measure the built environment in environment-health association studies. We compared these three methods using data collected in a nationally representative epidemiological study in 17 British towns to inform future development of research tools. There was good agreement between foot-based and virtual audit tools. Foot based audits were superior for fine detail features. Secondary data sources measured very different aspects of the local environment that could be used to derive a range of environmental measures if validated properly. Future built environment research should design studies a priori using multiple approaches and varied data sources in order to best capture features that operate on different health behaviours at varying spatial scales.

A Qualitative Study of Participant Engagement With a Weight Loss Intervention.

BACKGROUND: Overweight and obesity are major public health problems and an increasing global challenge. In lieu of wider policy changes to tackle the obesogenic environment in which we presently reside, improving the design of individual-level weight loss interventions is important. AIM: To identify which aspects of the Camden Weight Loss randomized controlled trial weight loss intervention participants engaged with, with the aim of improving the design of future studies and maximizing retention. METHOD: A qualitative study comprising semistructured interviews ( n = 18) and a focus group ( n = 5) with intervention participants. RESULTS: Two important aspects of participant engagement with the intervention consistently emerged from interviews and focus group: the advisor-participant relationship and the program structure. Some materials used during the program sessions were important in supporting the intervention; however, others were not well received by participants. CONCLUSION: An individual-level weight loss intervention should be acceptable from the patient perspective in order to ensure participants are engaged with the program for as long as possible to maximize favorable results. Providing ongoing support in a long-term program with a trained empathetic advisor may be effective at engaging with people trying to lose weight in a weight loss intervention.

A qualitative geographical information systems approach to explore how older people over 70 years interact with and define their neighbourhood environment.

A growing body of literature explores the relationship between the built environment and health, and the methodological challenges of understanding these complex interactions across the lifecourse. The impact of the neighbourhood environment on health and behaviour amongst older adults has received less attention, despite this age group being potentially more vulnerable to barriers in their surrounding social and physical environment. A qualitative geographical information systems (QGIS) approach was taken to facilitate the understanding of how older people over 70 in 5 UK towns interact with their local neighbourhood. The concept of neighbourhood changed seasonally and over the lifecourse, and was associated with social factors such as friends, family, or community activities, rather than places. Spaces stretched further than the local, which is problematic for older people who rely on variable public transport provision. QGIS techniques prompted rich discussions on interactions with and the meanings of 'place' in older people.

Hearing-aid use and its determinants in the UK National Health Service: a cross-sectional study at the Royal Surrey County Hospital.

OBJECTIVES: The aim of this study was to investigate the rate of and factors contributing to non-adherence to hearing-aid use in the UK National Health Service. DESIGN: A cross-sectional postal questionnaire survey. STUDY SAMPLE: A questionnaire, including the International Outcome Inventory for Hearing Aids, was sent to all patients fitted with hearing aids at the Royal Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023 questionnaires were completed and returned (response rate of 55%). RESULTS: A total of 29% of responders did not use their hearing aids on a regular basis (i.e. used them less than four hours per day). Non-regular use was more prevalent in new (40%) than in existing patients (11%). Factors that reduced the risk of non-regular use included bilateral versus unilateral amplification, and moderate or severe hearing loss in the better ear. 16% of responders fitted with bilateral amplification used only one of their hearing aids. CONCLUSIONS: The level of non-regular use of hearing aids in NHS found in this study was comparable to those for other countries. Additional support might be needed for patients at a higher risk of non-regular use.

Patient preferences and performance bias in a weight loss trial with a usual care arm.

OBJECTIVES: This qualitative study examines performance bias, i.e. unintended differences between groups, in the context of a weight loss trial in which a novel patient counseling program was compared to usual care in general practice. METHODS: 14/381 consecutive interviewees (6 intervention group, 8 control group) within the CAMWEL (Camden Weight Loss) effectiveness trial process study were asked about their engagement with various features of the research study and a thematic content analysis undertaken. RESULTS: Decisions to participate were interwoven with decisions to change behavior, to the extent that for many participants the two were synonymous. The intervention group were satisfied with their allocation. The control group spoke of their disappointment at having been offered usual care when they had taken part in the trial to access new forms of help. Reactions to disappointment involved both movements toward and away from behavior change. CONCLUSION: There is a prima facie case that reactions to disappointment may introduce bias, as they lead the randomized groups to differ in ways other than the intended experimental contrast. PRACTICE IMPLICATIONS: In-depth qualitative studies nested within trials are needed to understand better the processes through which bias may be introduced.

A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme.

OBJECTIVES: To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals. DESIGN: Randomised controlled trial. SETTING: 23 general practices in Camden, London. PARTICIPANTS: 381 adults with body mass index ≥25 kg/m(2) randomly assigned to intervention (n=191) or control (n=190) group. INTERVENTIONS: A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice. OUTCOME MEASURES: Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months. RESULTS: 217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group. CONCLUSIONS: Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary. CLINICAL TRIAL REGISTRATION NUMBER: Trial registrationClincaltrials.gov NCT00891943.

Economic evaluations of adult weight management interventions: a systematic literature review focusing on methods used for determining health impacts.

BACKGROUND: One of the challenges when undertaking economic evaluations of weight management interventions is to adequately assess future health impacts. Clinical trials commonly measure impacts using surrogate outcomes, such as reductions in body mass index, and investigators need to decide how these can best be used to predict future health effects. Since obesity is associated with an increased risk of numerous chronic diseases occurring at different future time points, modelling is needed for predictions. OBJECTIVE: To assess the methods used in economic evaluations to determine health impacts of weight management interventions and to investigate whether differences in methods affect the cost-effectiveness estimates. METHODS: Eight databases were systematically searched. Included studies were categorized according to a decision analytic approach and effect measures incorporated. RESULTS: A total of 44 articles were included; 21 evaluated behavioural interventions, 12 evaluated surgical procedures and 11 evaluated pharmacological compounds. Of the 27 papers that estimated future impacts, eleven used Markov modelling, seven used a decision tree, five used a mathematical application, two used patient-level simulation and the modelling method was unclear in two papers. The most common types of effects included were co-morbidity treatment costs, heath-related quality of life due to weight loss and gain in survival. Only 12 of the studies included heath-related quality of life gains due to reduced co-morbidities and only one study included productivity gains. Despite consensus that trial-based analysis on its own is inadequate in guiding resource allocation decisions, it was used in 39% of the studies. Several of the modelling papers used model structures not suitable for chronic diseases with changing health risks. Three studies concluded that the intervention dominated standard care; meaning that it generated more quality-adjusted life-years (QALYs) for less cost. The incremental costs per QALY gained varied from $US235 to $US56,836 in the remaining studies using this outcome measure. An implicit hypothesis of the review was that studies including long-term health effects would illustrate greater cost effectiveness compared with trial-based studies. This hypothesis is partly confirmed with three studies arriving at dominating results, as these reach their conclusion from modelling future co-morbidity treatment cost savings. However, for the remaining studies there is little indication that decision-analytic modelling disparities explain the differences. CONCLUSIONS: This is the first literature review comparing methods used in economic evaluations of weight management interventions, and it is the first time that observed differences in study results are addressed with a view to methodological explanations. We conclude that many studies have methodological deficiencies and we urge analysts to follow recommended practices and use models capable of depicting long-term health consequences.

Suicide by burning in the South Asian origin population in England and Wales a secondary analysis of a national data set.

Objectives A descriptive analysis of suicide by burning in England and Wales in the general population and in people of South Asian origin. Design A cross-sectional secondary analysis of a national data set. Setting A population study of all those who died by suicide in England and Wales between 1993 and 2003 inclusive. Participants All cases of suicide and undetermined intent identified by the Office for National Statistics for England and Wales. A computer algorithm was used to identify people of the South Asian origin from their names. There were 55 140 suicides in the UK between 1993 and 2003. The ratio of male to female suicides was 3:1. There were 1455 South Asian suicides identified by South Asian Name and Group Recognition Algorithm. Primary and secondary outcome measures Death by suicide and undetermined intent, as determined by Coroner's Inquest. ICD9 codes E958.1 and E988.1 and ICD10 codes X76 and Y26. Results 1.77% of suicides in the general population and 8.45% of suicides in the South Asian origin population were by burning. The suicide rate by burning was 0.8/100 000 person-years for England and Wales and 2.9/100 000 person-years for the South Asian origin population. The odds of suicide by burning were increased in the South Asian group as a whole (OR 3.06, 95% CI 2.30 to 4.08). Those born in Asia and Africa were at higher risk than those born in the UK (OR 2.69, 95% CI 2.01 to 3.60 and OR 2.10, 95% CI 1.46 to 3.01, respectively). The increased risk was for those aged 25-64 years. Conclusion Suicide by burning remains a significant issue in the South Asian origin working-age population in England and Wales. A prevention strategy could target working-age people of South Asian origin born abroad as they are at the highest risk. More in depth research on the reasons for using this method may help to identify possible prevention strategies.

The views of genitourinary medicine (GUM) clinic users on unlinked anonymous testing for HIV: evidence from a pilot study of clinics in two English cities.

A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT.

'Talking of Sex': developing and piloting a sexual health communication tool for use in primary care.

OBJECTIVE: To develop and pilot a communication aid aimed at increasing the frequency with which sexual health issues are raised proactively with young people in primary care. METHODS: Group interviews among primary health care professionals to guide development of the tool, simulated consultations to pre-test it, and a pilot study to assess effectiveness. RESULTS: We developed an electronic consultation aid: Talking of Sex and piloted it in eight general practices across the UK. 188 patients and 58 practitioners completed questionnaires pre-intervention, and 92 patients and 45 practitioners post-intervention. There was a modest increase in the proportion of consultations in which sexual health was raised, from 28.1% pre-intervention to 32.6% post-intervention. In consultations with nurses the rise was more marked. More patients reported discussing preventive practices such as condom use post-intervention. Patients unanimously welcomed the opportunity to discuss sexual health matters with their practitioner. CONCLUSION: The tool has capacity to increase the frequency with which sexual health is raised in primary care, particularly by nurses, to influence the topics discussed, and to improve patient satisfaction. PRACTICE IMPLICATIONS: The tool has potential in increasing the proportion of young people whose sexual health needs are addressed in general practice.

Weight-management interventions in primary care: a pilot randomised controlled trial.

BACKGROUND: There is a paucity of randomised controlled trials of weight management in primary care. AIM: To ascertain the feasibility of a full trial of a nurse-led weight-management programme in general practice. DESIGN OF STUDY: Factorial randomised control trial. SETTING: Primary care, UK. METHOD: A total of 123 adults (80.3% women, mean age 47.2 years) with body mass index > or =27 kg/m(2), recruited from eight practices, were randomised to receive structured lifestyle support (n = 30), structured lifestyle support plus pedometer (n = 31), usual care (n = 31), or usual care plus pedometer (n = 31) for a 12-week period. RESULTS: A total of 103 participants were successfully followed up. The adjusted mean difference in weight in structured support compared to usual care groups was -2.63 kg (95% confidence interval [CI] = -4.06 to -1.20 kg), and for pedometer compared to no pedometer groups it was -0.11 kg (95% CI = -1.52 to 1.30 kg). One in three participants in the structured-support groups (17/50, 34.0%) lost 5% or more of their initial weight, compared to less than one in five (10/53, 18.9%) in usual-care groups; provision of a pedometer made little difference (14/48, 29.2% pedometer; 13/55, 23.6% no pedometer). Difference in waist circumference change between structured-support and usual-care groups was -1.80 cm (95% CI = -3.39 to -0.20 cm), and between the pedometer and no pedometer groups it was -0.84 cm (95% CI = -2.42 to 0.73 cm). When asked about their experience of study participation, most participants found structured support helpful. CONCLUSION: The structured lifestyle support package could make substantial contributions to improving weight-management services. A trial of the intervention in general practice is feasible and practicable.

Recent heterosexual partnerships and patterns of condom use: a weighted analysis.

BACKGROUND: In epidemiologic studies of sexual partnerships, characteristics are often collected in part through detailed questions concerning recent partnerships. These data present challenges for analysis. First, although research interest generally lies in all partnerships in a certain time period, participants may be asked to provide detailed information only concerning their most recent, up to a fixed number. As more recent partnerships may differ from others, a simple analysis of these data may lead to bias. Second, the total number of partnerships for a study participant may be informative, so the analyst must choose between inference for the population of partnerships or for a typical partnership from the population of individuals. Third, data may be more fully recorded for study participants than their partners, and not all partners may be eligible to participate. METHODS: We propose weighting to deal with these challenges. Weighting provides a sensitivity analysis for the possible selection bias due to incomplete reporting. We analyze heterosexual condom use in Britain, using data from the National Survey of Sexual Attitudes and Lifestyles 2000. RESULTS: The sensitivity of estimates to possible selection bias is low. We find that the choice of population for inference is important for prevalence estimates, but has relatively little impact on measures of association. By defining within-participant partnership predictors we demonstrate how participants vary their condom use. We establish that, at least for male participants, shorter partnership duration is linked to a higher probability of condom use at last sex but lower probability at first sex. CONCLUSION: We recommend a weighted analysis approach to recent partnership data, which can be simply implemented in standard survey analysis software. In other surveys the sensitivity of estimates to possible selection bias may be substantial and this will need to be assessed in each case.

Suicide rates in people of South Asian origin in England and Wales: 1993-2003.

BACKGROUND: Low rates of suicide in older men and high rates in young women have been reported in the South Asian diaspora worldwide. Calculating such suicide rates in the UK is difficult because ethnicity is not recorded on death certificates. AIMS: To calculate the South Asian origin population suicide rates and to assess changes over time using new technology. METHOD: Suicide rates in England and Wales were calculated using the South Asian Name and Group Recognition Algorithm (SANGRA) computer software. RESULTS: The age-standardised suicide rate for men of South Asian origin was lower than other men in England and Wales, and the rate for women of South Asian origin was marginally raised. In aggregated data for 1999-2003 the age-specific suicide rate in young women of South Asian origin was lower than that for women in England and Wales. The suicide rate in those over 65 years was double that of England and Wales. CONCLUSIONS: Older, rather than younger, women of South Asian origin seem to be an at-risk group. Further research should investigate the reasons for these changes and whether these patterns are true for all South Asian origin groups.

Self-reported never-drinkers in England 1994-2003: characteristics and trends in adults aged 18-54 years.

AIMS: This paper describes prevalences, time-trends and characteristics of self-reported never-drinkers, during the period 1994-2003, focussing particularly on white adults aged 18-54. METHODS: Data on 122,809 adults (18 + ) were obtained from the Health Survey for England (HSfE). Logistic regressions were used to estimate time trends in self-reported never-drinking, and associations between never-drinking and living alone, and educational qualification. Analyses were stratified by gender, age group and period. RESULTS: The overall proportion of white, female never-drinkers was 5.5%, rising monotonically with age. Proportions among men were much lower, with the lowest proportion (1.1%) in the 30-54 age group. Odds of never-drinking increased by 3% per year in those aged 30-54, a trend not explained by any covariates. Smaller increases were seen among those aged 18-29. Never-drinking was strongly associated with living with another adult and with lower qualification. The association with qualification increased over time among young women, and the association with living with another adult increased among men aged 30-54. CONCLUSIONS: Never-drinkers are a significant minority in England, whose prevalence rose, between 1994 and 2003, among adults aged under 55 years. The prevalence varies considerably by age, sex, and social characteristics, and the social discrepancies in never-drinking appear to be widening.

Ethnic variations in sexual activity and contraceptive use: national cross-sectional survey.

OBJECTIVES: Our objective was to compare data on contraceptive use in relation to reported sexual activity in women from different minority ethnic groups. DESIGN: We analyzed the National Survey of Sexual Attitudes and Lifestyles 2000. SUBJECTS: Women aged 16-44 years, numbering 6932 and residing in Britain, participated in this study. MAIN OUTCOME MEASURES: Our main outcome measures are as follows: percentage of women reporting sexual activity, use of contraception and type of contraception (hormonal, barrier or permanent methods). RESULTS: Overall, fewer women from the UK's four main ethnic minority groups reported recent sexual activity, compared with white women. Among sexually active women, contraceptive use was significantly lower in all ethnic minority groups than in white women, but this pattern differed according to marital status. In ever-married or cohabiting women, lower contraceptive use was reported by Indian (78%) and Pakistani women (74%) than by other groups. Among single women, black Caribbean (88%) and black African (82%) women reported using less contraception compared with white (95%) and Indian (100%) women. Women from all ethnic minority groups were less likely than white women to report using hormonal contraception and permanent methods and were more likely to use barrier methods. The differences between ethnic groups remained significant after adjusting for educational achievement and parity. Deprivation and acculturation did not account for the use of contraception or the type of contraceptive method used. CONCLUSION: Sexually active married Pakistani and Indian women reported the lowest overall use of contraception. Among sexually active single women, black African and black Caribbean women reported levels of contraceptive use that were lower than those reported by white women. Sexually active women from all four minority ethnic groups were less likely than white women to use reliable methods of contraception.

Learning about sex: results from Natsal 2000.

To date, the focus of sex education research has tended to be on the effect of education on behavioral outcomes. There is little data on the felt needs of young people, how well they are met, and how provision might be improved. Here we report on main source of information about sexual matters, adequacy of knowledge, further needs, and preferred source of additional information, using data from a probability sample survey of people aged 16 to 44 years in Britain (Natsal 2000). A total of 11,161 participants (4,762 men and 6,399 women) were interviewed. The response rate was 65.4%. The results show that despite the assumed worldliness and sophistication of young people about sexual matters, there is a great deal of self-perceived ignorance among them. Parents and schools are the preferred source of further information. We need to enable parents to provide information to their children, especially their sons.

Epidemiological correlates of asymptomatic gonorrhea.

OBJECTIVES: To assess correlates of asymptomatic gonorrhea among patients attending Genitourinary Medicine Clinics participating in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England for 2001-2003. STUDY DESIGN: GRASP is a sentinel surveillance program that monitors antimicrobial resistance to Neisseria gonorrhoeae. Data collection occurs annually in June to August each year. RESULTS: Women with previously diagnosed gonorrhea had decreased odds of asymptomatic gonococcal infection, as did women diagnosed with other sexually transmitted infections (all except chlamydia, syphilis, herpes, and warts). Heterosexual men, but not women, coinfected with chlamydia had significantly higher likelihood of being diagnosed with asymptomatic gonorrhea, as did homosexual men coinfected with syphilis and warts. CONCLUSION: The heterogeneity in correlates of asymptomatic gonorrhea has implications for screening in clinical settings. Such findings also depend on the extent of testing on sexually transmitted infections from different sites of infection, which has particular relevance in homosexual men and would thus need to be investigated in other studies.

Changes in the circumstances of young mothers in Britain: 1990 to 2000.

OBJECTIVES: To assess changes between 1990 and 2000 in the circumstances of women who became mothers before the age of 18. DESIGN: Two cross sectional probability sample surveys of the general population carried out in 1989-1991 (Natsal 1990) and 1999-2001 (Natsal 2000). SETTING: British households. PARTICIPANTS: Women aged 18 to 27 years at time of survey (Natsal 1990: 2575, Natsal 2000: 1757). MAIN OUTCOME MEASURES: Educational attainment, participation in education/work or training, living in social housing, social class, living as lone adult, parity, ill health, and health related behaviours at the time of the interview. RESULTS: The proportion of women who were sexually active before 18 increased between 1990 and 2000 from 58.9% to 71.3% (p<0.0001). There was no significant change in the proportion who had a child before the age of 18 (4.7% in 1990, 5.3% in 2000, p=0.390). The proportion who had attained no educational qualifications and were not participating in education/work or training was significantly lower in 2000 than in 1990 for all women aged 18-27, but higher among those who were mothers before age 18, although the relative difference was not statistically significant. The proportion living in social housing or reporting a recent long term illness at time of interview was higher and this trend was more pronounced among women who did not experience motherhood before 18 than those who did, but the differences between these groups of women were not statistically significant. CONCLUSION: Motherhood before the age of 18 continues to be related to a variety of adverse circumstances in adult life, including lack of educational attainment, not being in education/work or training, lone parenthood, and a reduced likelihood of home ownership. There is little evidence of improvement in the circumstances of young mothers between 1990 and 2000 despite improvements in life chances among young women in general.