Levelling Up for health in towns? Development of a new deprivation index: the 'Stronger Towns Index' and its association with self-rated health and migration in England, between 2001 and 2011.

Aim: To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011. Subject and methods: All members of the ONS Longitudinal Study in England aged 16 and over in 2001 whose records included a self-rated health response and a valid local authority code.Local authorities in England were ranked using a composite index developed using the five metrics set out in the Stronger Towns Funding: productivity, income, skills, deprivation measures, and the proportion of people living in towns.The index was split into deciles, and logistic regression carried out on the association between decile and self-rated health in 2001 in the main sample (n = 407,878) and decile change and self-rated health in 2011 in a subsample also present in 2011, with migration information (n = 299,008). Results: There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011. Conclusion: It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health.

Is studying medicine good for your health? Long-term health outcomes of a cohort of clinical medicine graduates in England and Wales in the ONS Longitudinal Study.

OBJECTIVE: To quantify the potential protective effect on health associated with study of a clinical medicine degree. DESIGN: Prospective population-based cohort data collected at census and linked over time: cohort born before 1976 and survived to 2011. Subgroup analysis on those who reported having a degree at 1991 census. SETTING: England and Wales population-based, including institutions. PARTICIPANTS: 159 116 men and 174 062 women; 13 390 men with degrees and 8143 women with degrees. MAIN OUTCOME MEASURE: Self-reported general health in 2011 based on logistic regression analysis. RESULTS: Male graduates had 92% higher odds of having good or very good health than male non-graduates after adjustment for age and socioeconomic position (CI 1.82 to 2.03). Female graduates had 85% higher odds of having good or very good health than female non-graduates after adjustment for age and socioeconomic position (CI 1.73 to 1.98). Male clinical medicine graduates had 45% higher odds of having good or very good health than male humanities graduates after adjustment for age and socioeconomic position (CI 1.09 to 1.92). Male physical sciences graduates also had higher odds of having good or very good health than male humanities graduates after adjustment for age and socioeconomic position, but life sciences and social science graduates did not. There were no significant differences by degree subject for women. CONCLUSIONS: Male graduates in clinical medicine have higher odds of good self-reported health. Knowledge of medicine may confer a health advantage for men above that of other degrees.

Physically Active Lessons Improve Lesson Activity and On-Task Behavior: A Cluster-Randomized Controlled Trial of the "Virtual Traveller" Intervention.

BACKGROUND: Physically active lessons have not often been assessed with randomized controlled trials. AIMS: Evaluate the effects of the "Virtual Traveller" (VT) intervention delivered using classroom interactive whiteboards on physical activity, on-task behavior, and student engagement. METHODS: Participants were 219 children aged 8 to 9 years from 10 schools in Greater London, assessed in a cluster-randomized controlled trial between March 2015 and May 2016. For 6 weeks, intervention children received 10-minute VT sessions three times a week during math and English lessons (VT group: n = 113). Children in control schools received regular teaching (COM group: n = 106). Outcomes were school-day, weekend-day, and lesson-time sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), and on-task behavior and student engagement, assessed at baseline (T0), 2 weeks (T1), and 4 weeks (T2) during the VT intervention and 1 week (T3) and 3 months (T4) postintervention using multilevel modeling. RESULTS: VT pupils engaged in significantly more school-day MVPA at T1 only, with no other significant differences between groups in overall school-day or weekend-day activity. VT pupils engaged in significantly less SB and more MVPA during lesson time than COM pupils. More on-task behavior was shown in VT pupils than COM pupils but there was no difference in student engagement. DISCUSSION: VT reduced sedentary behavior and increased physical activity during lesson time but not across overall school or weekend days. VT improved on-task behavior but had no effect on student engagement. CONCLUSION: Physical activity can be integrated into teaching using interactive whiteboards with no detriment to educational outcomes.

Development of a novel walkability index for London, United Kingdom: cross-sectional application to the Whitehall II Study.

BACKGROUND: Physical activity is essential for health; walking is the easiest way to incorporate activity into everyday life. Previous studies report positive associations between neighbourhood walkability and walking but most focused on cities in North America and Australasia. Urban form with respect to street connectivity, residential density and land use mix-common components of walkability indices-differs in European cities. The objective of this study was to develop a walkability index for London and test the index using walking data from the Whitehall II Study. METHODS: A neighbourhood walkability index for London was constructed, comprising factors associated with walking behaviours: residential dwelling density, street connectivity and land use mix. Three models were produced that differed in the land uses included. Neighbourhoods were operationalised at three levels of administrative geography: (i) 21,140 output areas, (ii) 633 wards and (iii) 33 local authorities. A neighbourhood walkability score was assigned to each London-dwelling Whitehall II Study participant (2003-04, N = 3020, mean ± SD age = 61.0 years ± 6.0) based on residential postcode. The effect of changing the model specification and the units of enumeration on spatial variation in walkability was examined. RESULTS: There was a radial decay in walkability from the centre to the periphery of London. There was high inter-model correlation in walkability scores for any given neighbourhood operationalisation (0.92-0.98), and moderate-high correlation between neighbourhood operationalisations for any given model (0.39-0.70). After adjustment for individual level factors and area deprivation, individuals in the most walkable neighbourhoods operationalised as wards were more likely to walk >6 h/week (OR = 1.4; 95 % CI: 1.1-1.9) than those in the least walkable. CONCLUSIONS: Walkability was associated with walking time in adults. This walkability index could help urban planners identify and design neighbourhoods in London with characteristics more supportive of walking, thereby promoting public health.

Virtual field trips as physically active lessons for children: a pilot study.

BACKGROUND: The modern classroom is an inherently sedentary environment. Virtual Field Trips (VFTs) using interactive whiteboards to explore virtual scenes are a potential method of converting sedentary class-time into physically active teaching. This pilot aimed to assess the effects of a developed VFT on physical activity and learning in primary-school children. METHODS: Participants (n = 85) were randomly assigned to a) a 30-minute physically active London 2012 Olympics-themed VFT, or b) a 30-minute sedentary version of the same VFT. Activity was measured using GT1M Actigraphs, content recall was assessed with a quiz and user evaluations were gained from teacher and pupil questionnaires. RESULTS: Pupils in the active VFT displayed significantly less sedentary time (p < 0.001), and significantly more light (p < 0.001), moderate (p = 0.01) and vigorous physical activity (p < 0.001) than sedentary VFT pupils. No differences in content recall were found between intervention groups: suggesting that adding physical activity into classroom teaching may not compromise attainment. High acceptability was found in teachers and active VFT students rated their session significantly higher than sedentary pupils (p < 0.002). CONCLUSIONS: This one-day pilot provides early evidence of the ability of VFTs to convert sedentary academic time into active time. Longitudinal research is needed to assess prolonged effects of active VFTs in reducing sedentary time.

Small area inequalities in health: are we underestimating them?

Spatially aggregated data are frequently used for official statistics and by researchers investigating the contextual determinants of health. Results of reporting and analysis vary according to the choice of areal unit. This is the well-known Modifiable Areal Unit Problem or MAUP. Its implication for the monitoring and understanding of area inequalities in health has received little empirical attention in the public health literature. Health differences will likely be smallest across arbitrarily chosen areas whereas boundaries acknowledging the physical and social geography should indicate greater differences between areas. Here we use three methods to define area boundaries and compare the extent of health inequalities across each drawing on data from the London boroughs of Camden and Islington. Irrespective of the boundary definition used, between-area inequalities in obesity, alcohol intake, smoking, walking and self-rated health were small compared with inequalities between individuals. There was a tendency for slightly larger estimated inequalities across areas defined by socioeconomic homogeneity compared with other definitions, but differences between methods were very small in magnitude. Existing studies predominantly use area boundaries that are based on administrative boundaries. Although these have little theoretical basis for the study of neighbourhood inequalities in health, our findings indicate that alternative definitions of the neighbourhood boundaries have no substantive effect on the estimates of those inequalities. Based on these findings, we can have greater confidence in the results of numerous studies which have used administrative boundaries to define the neighbourhood.