搜索结果：Public health research (Southampton, England)

Inequitable access to health care increases morbidity and mortality among people experiencing homelessness. Peer advocates ('peers') with lived experience may help others to access health care. To evaluate the impact and cost-consequence of Groundswell's Homeless Health Peer Advocacy programme on healthcare access, the processes through which it operates and the impact for peer advocates themselves. A participatory mixed-method design with three components: qualitative study (A), prospective cohort (B), and cost-consequence analysis (C) using cohort and programmatic data. Ethical approval: Dulwich Research Ethics Committee (Integrated Research Application System 271312). London, United Kingdom (2019-23) coinciding with COVID-19 and disruptions to the National Health Service, Homeless Health Peer Advocacy and housing services. Homeless Health Peer Advocacy clients and non-clients (A-C); Homeless Health Peer Advocacy staff, volunteers and homelessness-sector stakeholders (A). Peer advocates accompany clients to healthcare appointments and provide support to address barriers to access. Primary: probability of 'did not attend' at a scheduled outpatient appointment within 12 months of cohort enrolment. Secondary: number of inpatient admissions and accident and emergency visits. (A) In-depth interviews and focus groups; (B) Structured questionnaires and National Health Service Hospital Episode Statistics; (C) Groundswell programme data and cohort findings. Qualitative (A): Peer advocacy empowered clients by building cultural health capitals (skills and communication that support healthcare interactions) and strengthening social and economic resources. Advocates themselves gained social, cultural, human and physical resources, though benefits were greatest for those with some pre-existing stability. Cohort (B): Compared with non-clients, Homeless Health Peer Advocacy clients showed no difference in did not attend rates (rate ratio 0.97, 95% confidence interval 0.67 to 1.42) or accident and emergency visits (mean difference 0.86, 95% confidence interval -0.06 to 1.79) for the other pre-specified outcomes. Clients had 1.14 more inpatient admissions (95% confidence interval 0.52 to 1.75). Sensitivity analyses with imputed data suggested higher numbers of outpatient attendances, outpatient 'did not attends', accident and emergency visits and admissions among clients. Secondary analyses suggested differences by levels of anxiety and depression. Cost-consequence (C): Median annual cost per client was £353 (£176 per scheduled engagement). Evidence of National Health Service cost saving was inconclusive. The COVID-19 disrupted both Homeless Health Peer Advocacy delivery and National Health Service services. Non-randomised design may have introduced bias. Homeless Health Peer Advocacy enhances clients' cultural health capital and helps peer advocates achieve their goals. We cannot state whether peer advocacy reduces 'did not attends' or demonstrate cost savings, but it was associated with more inpatient admissions and, in sensitivity analyses, more outpatient appointments. Research should explore how peer advocacy addresses stigma in health care and hostel settings and develop outcome measures that capture wider systemic change. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/44/40. Groundswell pioneered Homeless Health Peer Advocacy in London, where people with lived experience of homelessness support others to access health care, a model being adapted by others. Peer advocates provide one-to-one support, helping clients attend healthcare appointments and navigate services. Evidence on the impacts, costs and mechanisms of Homeless Health Peer Advocacy remains limited. Our study asked: how, and to what extent, can peer support change hospital use by people experiencing homelessness? We combined qualitative and quantitative methods. First, we conducted in-depth interviews with peer advocates, clients, homeless people not in the programme and staff in the homelessness sector. These interviews explored how peer advocacy may affect health engagement, well-being, housing and employment. Second, we analysed National Health Service hospital data for 158 people who attended appointments with peer advocates and 153 similar people without advocates, comparing healthcare use over 12 months. Finally, we estimated programme costs and potential National Health Service savings. The research took place during COVID-19 lockdowns when peer advocacy services and wider health care were disrupted. Interviews identified three main mechanisms of peer advocacy: (1) building clients’ skills to manage their health care, (2) advocating directly with services and (3) providing material or social support. Benefits were reported for both clients and peer advocates, with some peers achieving personal goals through their role. Quantitative findings were mixed. Homeless Health Peer Advocacy did not clearly reduce missed appointments or emergency service use but was associated with more outpatient attendance, particularly among people with moderate anxiety or depression, and more hospital admissions for treatment. Homeless Health Peer Advocacy cost £176 per healthcare appointment supported. We found no clear evidence that Homeless Health Peer Advocacy saved National Health Service money, given uncertain effects on service use. In conclusion, Homeless Health Peer Advocacy helps people who are homeless through skills-building, advocacy and support. Future research should examine its role in reducing stigma within health care and hostel settings.

Exposure to particulate matter is linked to increased mortality, respiratory and cardiovascular diseases, including lung cancer, ischaemic heart disease and asthma, among other adverse health outcomes. Emissions of particulate matter from agriculture occur directly from farming activities and from reaction of ammonia with acidic pollutants to form fine particles (PM2.5: particles with diameter of 2.5 μm or less). In the United Kingdom, ammonia has slightly increased in recent years, in contrast to other PM2.5 sources. In addition, NH3 emissions can contribute to nitrogen deposition, which, in excess of critical thresholds, may result in biodiversity loss. Our objectives were to assess the effectiveness and cost-effectiveness of inter-related interventions to: (1) assess the annual health impacts of air pollution (PM2.5) from intensive livestock agriculture and farming on the general population; (2) valuate the effectiveness and cost-effectiveness of the specific interventions at the national level; (3) assess impacts on ecosystems; and (4) examine the extent to which rural residents are concerned about agriculture and their health. We performed a health impact assessment based on PM2.5 exposures associated with three levels of agricultural intervention. We also performed an economic analysis, capturing valuation of health and productivity, and costs to the national health service, as well as an assessment of ecosystem impacts based on nitrogen deposition and biodiversity loss. A survey of rural residents' health was undertaken to investigate links between self-reported health and agriculture. The three intervention scenarios comprised 19 individual mitigation actions at a farm level, each with differing uptake levels in low, medium and high scenarios. The health impact assessment and economic analyses included all-cause mortality, and incidence of lung cancer, ischaemic heart disease, cerebrovascular disease, and childhood asthma incidence. The ecosystem analysis examined biodiversity loss, and the rural residents survey addressed respiratory, gastrointestinal, and neurological diseases. Modest changes in PM2.5 concentrations across the United Kingdom associated with the low, medium and high intervention scenarios resulted in relatively small impacts compared to national baseline levels of mortality and morbidity (i.e. -0.01% to -0.05%). Overall, United Kingdom-wide avoided costs ranged from £78.1 to £93.4M, with much lower annual avoided costs to the national health service. All habitats had a relative increase in biodiversity under all scenarios with expected benefits of £3.4-4M. There were 450-500 respondents in each of the 2 waves of the rural resident surveys. No associations were identified between any self-reported disease occurrence and farm-related variables. Our approach used several different models, requiring important assumptions and uncertainties. Respondents to the residents' survey tended to be aged over 45 and female and findings are applicable primarily to this demographic. Based on the modest modelled changes in PM2.5 concentrations associated with the intervention scenarios, we estimated small impacts with human health, as well as economic and ecosystem effects. We found no evidence of self-reported health issues in relation to farms or farming practices. Impacts from alternative farming interventions should be assessed to maximise PM2.5 reductions in the United Kingdom. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129449. Air pollution, such as particulate matter, can cause poor health. There are different sources of particulate matter, one of which is ammonia from farming. Other sources of particulate matter have decreased in the United Kingdom, but ammonia has increased recently. This study aimed to evaluate interventions to reduce the particulate matter created from farming. We included three different farming scenarios, or interventions, to limit particulate matter releases. We analysed the health impacts, costs, and possible effects on ecosystems of scenarios with less particulate matter. The health and economic assessments looked at deaths, lung cancer, heart disease, stroke, and childhood asthma. The study examined biodiversity loss from nitrogen pollution. We also asked how rural residents felt about their health and living near farms. Our results showed that the small particulate matter reductions from the interventions would have little benefit on the rates of death and disease. The cost-savings to the national health service were also small. The interventions would benefit ecosystems by increasing biodiversity. Surveys of rural residents did not show health problems were related to farming. Overall, the interventions would have small positive effects on health, the economy, and ecosystems. In general, people did not think farming caused poorer health. It would be useful to study other farming interventions to help reduce particulate matter and compare impacts on health, economy and the environment.

Net Zero policies rarely consider air quality and physical activity health cobenefits, cost-benefit analysis, exposure indoors and exposure inequalities. To calculate the air quality, health and economic costs and benefits of United Kingdom Net Zero policy, impacts on inequalities and consult the public on the acceptance of Net Zero policy. We used sophisticated emissions and air quality models, Life Table health impact analysis, United Kingdom Government cost-benefit methods and estimated exposure inequalities. We compared 2030 and 2040 United Kingdom PM10, PM2.5, nitrogen dioxide and ozone predictions using existing air quality policy, or Business as Usual, with Net Zero policy. We predicted Net Zero 2050 pollutant concentrations. Business as Usual scenarios were from United Kingdom Government projections and Net Zero scenarios were from the Climate Change Committee's sixth Carbon Budget. We used the Balanced Net Zero and Widespread Innovation Pathways for road transport, building heating and active travel. United Kingdom air pollution, including exposure inequalities, mortality, morbidity and economic costs and benefits. Air quality: Under Business as Usual, nitrogen dioxide and particulate matter reduced by 2030 due to new vehicles. The 2040 Balanced Net Zero Pathway and Widespread Innovation scenarios showed further reductions, driven by electric vehicle uptake, reduced vehicle kilometre travelled compared with Business as Usual, and low-carbon building heating. Particulate matter reductions from buildings was two and three times greater than from road transport, for Widespread Innovation and Balanced Net Zero Pathways, respectively. Balanced Net Zero Pathway+ 2050 predictions showed additional air pollution benefits. Exposure inequalities analysis: In 2019, urban central professionals experienced 14 µg m-3 higher nitrogen dioxide concentrations than rural elderly. At 1.5 µg m-3, PM2.5 concentrations varied less across geodemographic groups. Despite future improvements in nitrogen dioxide, inequalities persisted, but were less pronounced, due in part to Net Zero policies. Indoor air pollution: Removing gas cooking at home for Net Zero may result in greater nitrogen dioxide reductions than changes in outdoor air pollution. Health and active travel impacts: Compared with Business as Usual, Balanced Net Zero Pathway gave 4.9 (95% confidence interval 1.0 to 9.0) million life-years gained across the United Kingdom, to 2154, including 1.1 (95% confidence interval 0.7 to 1.6) million life-years gained from active travel. Avoided chronic obstructive pulmonary disease and childhood asthma cases were 201,000 (95% confidence interval 150,000 to 250,000) and 192,000 (95% confidence interval 64,600 to 311,000). Monetised morbidity benefits of £52.1B (95% confidence interval 36.4 to 67.8) added significantly to mortality benefits of £77.9B (95% confidence interval 42.9 to 90.8). Total yearly air pollution and active travel benefits were £153B (95% confidence interval 122 to 184), rising to £278B (95% confidence interval 228 to 334), including outcomes with weaker evidence. Costs/benefits: Building sector Balanced Net Zero Pathway air quality health benefits were £21.3B (95% confidence interval 16.4 to 26.2) by 2050 and were £98.4B (95% confidence interval 75.7 to 121.1) by 2154. Transport benefits were £9.1B (95% confidence interval 7.0 to 11.2) by 2050 and were £36.5B (95% confidence interval 28.1 to 44.9) by 2154. Balanced Net Zero Pathway building sector operating costs alone did not achieve break-even, but with greenhouse gases reductions (lower benefits) break-even was achieved by 2052. Air pollution health benefits reduced the building sector time to break-even by between 3.1 (95% confidence interval 2.5 to 4.7) and 6.3 (95% confidence interval 4.7 to 7.6) years. Public engagement: Conversations reflected an intergenerational commitment to Net Zero policies, although there was uncertainty about an individual's impact. Uncertainties in future air quality and meteorological conditions; through lack of evidence, being unable to use multipollutant models and indoor air pollution, missing indoor health and monetised benefits; some health outcomes with weaker health evidence strongly influenced the results. The COVID pandemic prevented us from exploring social acceptance as planned. This study identified health and economic cobenefits through reductions in greenhouse gases, air pollution, inequalities and increased exercise. To separately evaluate the health and monetary impacts of indoor and outdoor air pollution; to understand the overlapping effects of PM2.5 and nitrogen dioxide health impacts; to develop effective ways of communicating the health and economic benefits and to increase the social acceptability of Net Zero. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129406. We wanted to know how climate policies like Net Zero can help reduce air pollution and bring benefits for our health, the environment and the economy. We compared future air pollution predicted under current policies with that predicted under more ambitious Net Zero policies. We focused on electric vehicles in transport, using electricity to heat buildings and for cooking, and using more e-bikes. If Net Zero policies are adopted, harmful air pollution will reduce. These policies support switching to electric vehicles, driving less, cycling and walking more and using cleaner energy like electricity to heat our homes and for cooking. We found that Net Zero policies made people healthier, bringing benefits of billions of pounds. Increases in cycling, because of Net Zero, also led to large health benefits. Air pollution in your home can affect your health. Net Zero policies that promote home insulation, electric heating and the removal of home fossil fuel use altogether, including gas cooking, are highly effective in reducing harmful pollutants indoors. We highlighted that poorer communities live in areas with higher air pollution than richer ones but that the difference between those with the highest and lowest air pollution levels reduces with Net Zero policies. It is important that Net Zero policy focuses on the most in need in society and addresses affordability. Understanding the combined effect of air pollution and climate policy offers the potential to be more ambitious. Our study contributes to the evidence on Net Zero’s health and economic benefits and supports policy action.

Regional economic disparities in the United Kingdom lead to large differences in health. Previous attempts to address this issue have had limited success. Community Wealth Building is an economic strategy that aims to address these inequalities by redirecting wealth back into the local economy and increasing community control over the economy. The City of Preston initiated a Community Wealth Building strategy in 2012. We investigate the health impact of this approach in Preston up to 2019, a period during which their strategy largely focused on progressive procurement and the adoption of the Living Wage by employers within Preston. We estimate the impact of Community Wealth Building in Preston on mental health problems as measured by the Small Area Mental Health Index and its constituent components (antidepressants, depression diagnoses and mental health-related hospital attendances), self-reported life satisfaction, wages, employment and the number of non-profit enterprises. We use matching and difference-in-differences analysis to compare changes in outcomes in Preston before and after the intervention with changes in the outcomes in comparison areas. We use data on invoices and contracts issued by local authorities to compare procurement by Preston City Council with other similar local authorities, assessing the impact of local procurement on employment, wages and the cost of contracts. Finally, we use a combination of interviews and workshops to understand the process of change that has taken place in Preston and what has helped or hindered this. We found that, in Preston, the introduction of Community Wealth Building was associated with a reduction in mental health problems (-0.11 reduction in Small Area Mental Health Index, 95% confidence interval -0.16 to -0.06) alongside improvements in life satisfaction (0.06, 95% confidence interval 0.01 to 1.3), wages (£38 per week, 95% confidence interval £6.8 to £62.1), employment (4.1%, 95% confidence interval 2.3% to 5.8%) and a growth in non-profit enterprises (additional 20 enterprises 95% confidence interval 6 to 50). These economic improvements tended to be greatest among more disadvantaged groups, reducing inequalities. Preston City Council was much more likely to procure services from local suppliers compared to other similar local authorities, and this practice is likely to have contributed to these economic benefits. We found no evidence that procuring locally increased costs. Stakeholders in Preston highlighted that economic pathways to health impact were the most developed particularly in relation to procurement policy, while the community pathways to impact were less developed. Lack of widespread public involvement and engagement with smaller Voluntary, Community, Faith and Social Enterprise organisations in Preston had arguably limited the potential impact of Community Wealth Building in Preston. Despite this, appreciation for the approach and its aims remains strong. Community Wealth Building in Preston has led to economic gains that disproportionately benefited less advantaged groups, and this led to improvements in mental health and well-being. This seems to have been largely driven by changes in procurement practices of anchor institutions alongside policies to improve working conditions - such as the Living Wage. Future development should aim to shift the balance toward bottom-up civic engagement, which will help enhance sustainability of the approach. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130808. Economic differences between places lead to large differences in health, with poorer areas having poorer health. Community Wealth Building in Preston aimed to boost the economy for more disadvantaged groups by encouraging public sector and large charitable organisations to buy more services from local suppliers, help develop new charities and co-operatives and improve wages. By improving wages and reducing employment, which are important for good health, these changes could lead to improvements in health. We compared changes in mental health problems, well-being, wages, employment and the numbers of new charities established, in Preston, following this initiative, to changes in comparison areas with similar characteristics. We looked at contracts and invoices from local authorities across England to understand whether procurement practices were different in Preston compared to similar areas, whether this explained changes in the local economy and whether buying from local suppliers costs councils more than buying from further afield. We spoke to people from across Preston to understand what has helped or hindered these changes. Community Wealth Building in Preston led to a reduction in mental health problems, improved well-being, wages, employment and the establishment of new charities in Preston compared to the comparison areas. These improvements tended to be greatest in more disadvantaged groups. Preston City Council was more likely to buy services from local suppliers compared to other similar local authorities, and this practice is likely to have contributed to economic benefits. We found no evidence that procuring locally increased costs. People interviewed highlighted that the programme had initially focused on changes in how institutions spent their money, involvement of the public and community groups had been more limited. Community Wealth Building offers an effective strategy for promoting inclusive economic growth that improves mental health and well-being and reduces inequalities. Future development should aim for greater civic engagement.

Takeaway food outlets ('takeaways') sell hot food for consumption off the premises. Takeaway management zones are areas around schools where new takeaways are not allowed to open. They are the most common planning intervention targeting takeaways across local authorities in England to date. We conducted an evaluation of these zones to: model their impact on adult health model their associated economic costs and benefits explore their acceptability and perceived effectiveness among young people investigate support and perceived effectiveness among adults explore barriers to and facilitators of their adoption and implementation among local authority staff. We used a forecast of takeaway growth and a statistical model to estimate the impact of zones on diet-related health outcomes, quality-adjusted life-years and healthcare costs to 2040. We did this for adults aged 25-64 years in six different local authorities. We conducted a linked economic analysis to understand the future costs and benefits of zones to local authorities, the National Health Service and national government. We estimated costs when denial of planning permission results in a 3-, 6- or 12-month vacancy before alternative retail uptake. We asked 46 young people about how acceptable they thought the policy was. By conducting 'go along' interviews, we gained insights into their everyday food habits within and outside the school gates. We used survey data to understand public acceptability and perceived effectiveness of zones. We also asked whether having fewer takeaways near schools could reduce how often young people consume takeaway food. To evaluate adoption and implementation, we interviewed 29 local authority public health and planning officers about what lessons they had learned. Compared to no intervention, future reductions in takeaway exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. Obesity prevalence was reduced in both sexes in all local authorities, for example, in Manchester, by 2.3 percentage points for males. We observed reductions in disease incidence, for example, in Manchester, by 964 type II diabetes cases/100,000 males. Zones produced a positive net economic impact of, for example, £8.49-12.78M in Manchester. Despite objections on economic grounds, zones are associated with economic benefits for local authorities, the National Health Service and national government. Young people found zones to be acceptable and perceived them to have some positive impacts. But, a wider policy, including other types of outlets selling convenience food, may better limit dietary risk. Out of 3323 adults, 51% supported zone adoption. Almost three-quarters believed that zones would help young people to eat better. Among those aged 16-17 years, 33% agreed that young people would consume takeaway food less often if there were fewer takeaways near schools. Effective working relationships between local authority colleagues were important for adoption and implementation. Some local authorities ensured this by developing cross-departmental roles and policy 'champions'. A formal implementation process ensured confidence and consistency in implementation. Takeaway management zones around schools were forecast to reduce obesity prevalence and disease incidence by 2040, with no net economic costs. The public see zones as acceptable and potentially effective. However, the reality of adopting and implementing zones is challenging, while other aspects of food retail also influence the behaviours of young people. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130597. There are many ways in which our neighbourhoods can make it hard to make healthy choices. Having more takeaway outlets means people tend to eat more of the unhealthy foods they sell. Designating zones around schools where new takeaways are not allowed to open is one way that local councils can encourage healthier lifestyles in children and adults. By 2019, 41 of 325 local councils in England had takeaway ‘management’ zones around schools. However, these councils have been working in the absence of evidence of their impact and acceptability. These evidence gaps have made it difficult for councils to demonstrate the value of management zones, curtailing further adoption and successful implementation. We used a computer model to estimate the impact of takeaway management zones on health to 2040. We also wanted to understand the costs and benefits of zones to local and national economies and the National Health Service over this period. We ran a survey to understand how acceptable and effective people thought zones would be and spoke to young people directly about what they thought of the policy overall. Finally, we asked public health and planning colleagues in local councils about their experiences of zones and what lessons they had learned. Although imperfect, takeaway management zones around schools were forecast to reduce obesity and related disease. For example, in Manchester, we forecast obesity prevalence for males to reduce by 2.3 percentage points. These health benefits were achieved with no overall economic harm. In fact, in Manchester, we forecast their adoption to save the council between £8M and £12M. Local communities saw zones as acceptable and potentially effective. However, the reality of adopting and managing the ongoing implementation of zones was a challenge for councils, while other aspects of high street food retail also influence young people’s diets.

Agriculture dominates United Kingdom ammonia emissions, from livestock manure exposed to the atmosphere via livestock housing, storage, land and grazing. Ammonia significantly contributes to the formation of PM2.5 (particles with diameter of 2.5 μm or less) concentrations in Europe which are associated with adverse human health outcomes. Ammonia emissions contribute to nitrogen deposition, whereby reactive compounds of nitrogen are deposited into the biosphere, potentially resulting in biodiversity loss. Recent research has not found sufficient evidence for effectiveness of interventions to reduce ammonia emissions and little evidence on the cost-effectiveness of interventions. The current study aimed to address this knowledge gap. The study aimed to assess effectiveness and cost-effectiveness of two agricultural interventions to mitigate ammonia emissions - improved housing for farmed animals and improved manure application. Emission measurements were made at five farms (dairy, pig, poultry). Information on uptake of mitigation measures, barriers and enablers for implementation were determined through an online survey and focus groups with farmers, supplemented by stakeholder interviews. Chemical transport and dispersion modelling estimated population exposures to air pollution at local and national levels under three scenarios (low, medium, high intervention uptake). A health impact assessment estimated health effects associated with the scenarios, and data on self-reported health issues were collected via an online survey of rural residents. Economic evaluation methods estimated cost-benefits of the scenarios and impact on ecosystems. Farmers favour mitigation measures which are cheaper, and build on existing practices, such as amending diet or extending the grazing season. However, these are less effective in decreasing ammonia emissions. Scenarios based on realistic current, and future, uptake levels of measures showed little impact on air quality, partly due to the ammonia-rich United Kingdom atmosphere minimising conversion of ammonia emissions to particulate matter. Consequently, minimal impact of mitigation measures was evident on health outcomes and costs. There was no evidence that self-reported health symptoms from rural residents were related to living near a farm, type of farm or seasonality of farm activities, consistent with results of local dispersion modelling which estimated that most emissions from animal housing dispersed within 1 km. Impacts of COVID-19 and the United Kingdom's withdrawal from the European Union on the agricultural industry affected the recruitment and availability of farms and farmers, resulting in fewer field measurements than planned. A lower response to the farmers' survey was mitigated by the quality of data provided by participants and the successful series of focus groups. The study highlights the need for enhanced communication with the farming community to encourage implementation of more effective mitigation measures, such as air scrubbers, or those relating to slurry storage, currently perceived to be too expensive and complex. Greater clarity on benefits is essential so that farmers understand not only what they need to do but also how and why. Further investigation of the health impacts of ammonia emission should focus on those exposed on the farm, or resident nearby animal houses. Further modelling development of key atmospheric processes is also indicated to minimise uncertainties associated with the regional modelling. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129449. Air pollution damages lung and heart health, contributing to premature death and hospital admissions. These health effects are associated with exposure to very small particles, including from reactions of ammonia emitted from farming, the main United Kingdom producer of ammonia, principally from animal manure in livestock housing, fertilisation of fields and animal grazing. Recently, other United Kingdom sources of particles have decreased, but ammonia levels have not. This study aimed to assess the effectiveness of improved cattle housing and manure storage and application, at reducing emissions of gases and particles. We measured ammonia emissions from five farms and used surveys, focus groups and interviews with farmers and stakeholders to understand views on ammonia reduction measures. Computer models were used to estimate the impact of emissions reduction on exposure and related health issues of people near farms and the wider United Kingdom population. We calculated savings in National Health Service costs. We also surveyed people living near farms about their health. The study found that the measures that farmers were currently prepared to consider implementing reduced ammonia emissions by up to 13%, but the overall reduction in air pollution particles was limited (around 1%). Improvements in health and cost-savings were also small, and surveys of rural residents did not show health problems were related to farming. The study also showed that emissions from farms almost entirely dispersed into the background air within 1 km. Farmers were interested in reducing their environmental impact and favoured cheaper interventions building on existing practices, which also tended to be less effective in reducing ammonia emissions. Barriers to using these interventions were costs and lack of knowledge. To reduce ammonia emissions, future policies should address the barriers and clearly communicate benefits to the environment and to farmers. It would be useful to study more effective farming interventions to reduce air pollution.

High levels of smoking among people who experience imprisonment contribute to their high mortality and morbidity rates and to inequalities. Scotland's prisons became smokefree in 2018. However, questions remain about how to prevent high relapse to smoking post release. Summarise evidence on supporting people to reduce tobacco-related harms post release. Understand experiences, opportunities and challenges for reducing tobacco-related harms for people leaving smokefree prisons and for families. Feasibility test a household-targeted intervention to support people released from smokefree prisons to reduce tobacco-related harms. Update cost-effectiveness of smokefree prison policy. Partnership-working with key stakeholders. Scoping reviews; qualitative; health economic modelling. Prisons in Scotland; staff, people in prison, family members. Our scoping reviews show that evidence on interventions to support people leaving smokefree prisons to remain tobacco-free is weak. There is no evidence on smoking rates among people released from smokefree prisons allowing vaping. Significant barriers remain for people from underserved communities to create smokefree homes. Our modelling highlights that offering effective smoking cessation support to people leaving smokefree prisons would be cost saving at both the personal and societal levels. The challenges people face on release from prison and variability in throughcare support often render smoking relapse prevention a low priority for them, their families and service providers. However, in terms of long-term prevention of ill health and premature death, the high rates of relapse to smoking (~50-80%) continue to fuel inequalities. Supporting people leaving smokefree prisons to remain abstinent will help governments to achieve ambitions to create smokefree societies. Progress may be achieved by greater integration of support for tobacco-harm reduction with services addressing interconnected needs, such as harmful use of other substances and underlying mental ill health. The extensive impact of coronavirus disease discovered in 2019 in prisons into 2023, alongside challenges due to overcrowding and staffing pressures, limited the opportunities for partnership working and the number of interviews we could conduct. This meant that we were unable to test the feasibility of delivering a household-based intervention to reduce tobacco-related harms in this population. Progress in developing suitable interventions to prevent very high relapse-to-smoking rates following release from smokefree prisons is required. Helping people released from smokefree prisons to remain abstinent from tobacco post release could deliver considerable benefits. However, in the face of substantial challenges, preventing relapse to smoking has become entrenched as a low priority - for many service providers, people leaving smokefree prisons and their families. Greater success in reducing tobacco-related harms among this often-overlooked population may be achieved through more holistic models of service delivery. Aspirations for countries to become tobacco-free may require a rethink of what is needed to support underserved populations in whom smoking remains entrenched. Further research is required to better understand what approaches are feasible and effective for maintaining smoking abstinence following release from prison, including development and evaluation of integrated/holistic approaches which tackle smoking/vaping behaviours in the context of use of other substances and needs. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131613. Smoking and breathing other people’s smoke (‘second-hand smoke’ exposure) damages health. In 2018, a new law was introduced to stop people in prison from smoking tobacco in Scottish prisons (‘smoke-free prisons’). Afterwards, second-hand smoke levels in prisons were much lower than before, but we know that most people go back to smoking after leaving prison. We also know that smoking inside homes is more common in the communities to which people often return to after leaving prison. We wanted to find out what opportunities and challenges are there to helping reduce smoking and second-hand smoke exposures for people leaving smoke-free prisons and families. We looked at other recent studies to find out what works best to (1) support people to not smoke after leaving prison and (2) support people to not smoke indoors at home. We interviewed people in prison, staff and families. We also studied what things might make the wider benefits of smoke-free prisons cost saving for everyone. We found that not enough is known about how to help people not to smoke after leaving a smoke-free prison or how to help people to overcome their difficulties with taking smoking outside. We learned from people in prison, staff and families about the many reasons why people often go back to smoking after leaving prison. One important reason is that stopping smoking is often a low priority for people who are struggling with basic needs, like finding suitable housing. Our study suggests that giving people who leave prison support that works to help stop smoking indoors at home or to stop smoking completely would be good for them and for society. A limit to our study was that, due to COVID-19 impacts, we were unable to develop a programme to reduce smoking and second-hand smoke exposure in people leaving prison.

People leaving prison face significant barriers to reintegration, often resulting in homelessness, which exacerbates health issues and increases recidivism. Critical time interventions aim to support vulnerable individuals during significant life transitions by providing time-limited, emotional and practical support. While effective in other contexts, the impact of housing-led critical time interventions for people leaving prison in the United Kingdom remains unclear. The PHaCT study was a pilot randomised controlled trial of a housing-led critical time intervention for people leaving prison at risk of homelessness. This study aimed to determine whether a full-scale randomised controlled trial of the critical time intervention model in prison leavers at risk of homelessness was feasible. The pilot was a parallel two-arm, individual-level randomised controlled trial of a pre-existing critical time intervention intervention with an integrated process evaluation and embedded exploratory health economic evaluation. Recruitment occurred in fours male prisons across England and Wales with participants followed up in the communities. Prisons were randomised by site to either receive the critical time intervention or receive usual support, and participants were recruited within 12 weeks of their release. The locations were predetermined by where the intervention was already being delivered by the intervention provider (critical time intervention teams). Critical time intervention included pre-engagement, transition to community, try-out and transfer of care phases, each lasting 3 months. Data collection methods included baseline surveys, follow-up assessments at 3, 6 and 9 months, qualitative interviews, and session observations. Routine data linkage was explored separately to assess feasibility. Progression criteria included recruitment, retention, process evaluation and fidelity. Thirty-four male participants (mean age 38 years) were recruited, with 19 assigned to the intervention and 15 to control. The study achieved a high recruitment rate of 92%, but retention was a significant challenge, with only 18% of participants retained at 9 months follow-up. The process evaluation found critical time intervention was acceptable to staff and participants, but ethical concerns around randomisation and informed consent were raised. Fidelity to the critical time intervention model was generally high, though contextual instability in housing and criminal justice systems posed challenges. Data collection methods for health economics and data linkage were feasible and acceptable. The approval to access prisons was lengthy and support provided by Clinical Research Networks was delayed. Contextual instability within the housing and criminal justice systems, including a lack of social housing, high recall rates, the removal of the requirement to have a probation officer and the emergency early release of people in prison, further complicated the trial. Ethical concerns around randomisation and informed consent affected trial acceptability. The trial methodology faced significant challenges. Low retention rates, ethical concerns by intervention delivery staff around randomisation and contextual instability suggest that a full-scale randomised controlled trial is not feasible. The findings highlight the need for systemic changes within the research support provided to prison-based studies, housing and criminal justice systems to support research in prisons and interventions for people leaving prison. Decision-makers should prioritise policies that increase the availability of affordable housing and provide post-release support. Future research should explore alternative study designs and more intensive recruitment and retention strategies. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR134281. People leaving prison often struggle when returning to the community, leading to homelessness, worse health and higher chances of committing more crimes. Critical time intervention is a structured support model delivered by trained caseworkers to help during this transition. Critical time intervention includes four phases, pre-engagement, transition to community, try-out and transfer of care, each lasting 3 months. Caseworkers support individuals to secure housing, access services and build life skills. From October 2023 to August 2024, 34 men leaving three prisons in England and Wales were recruited for a pilot study. Participants were randomly assigned to either receive critical time intervention or usual support. The study aimed to test whether a full-scale research project could be done to evaluate critical time intervention. We assessed recruitment (did people take part), retention (could we stay in touch), fidelity (was critical time intervention delivered as planned) and acceptability (were the study and intervention acceptable to participants and staff). Data were collected through surveys at baseline and at 3, 6 and 9 months, interviews and session observations. Most people agreed to take part, but it was difficult to maintain contact over time. Critical time intervention was well received by staff and participants, but the research process faced challenges. These included high rates of return to prison, limited housing options, reduced probation contact and emergency early releases. Critical time intervention was valued by those who delivered and received it, but conducting a larger study to evaluate its effects would be difficult. Maintaining contact with participants was challenging, and wider issues in housing and criminal justice systems suggest a full-scale trial may not be feasible. Future work should focus on improving support for prison leavers and adapting research methods to better suit this population.

Despite national efforts to improve research inclusion, people from underserved communities remain underrepresented in dementia trials. Barriers occur at the point of initial engagement and also within the participation pathway itself, as the structure and burden of early screening procedures can discourage continuation. ACCESS D (Advancing Community Collaboration and Engagement Strategies in Dementia) aims to address these challenges by testing a community-based model that combines co-produced engagement events, low-burden research participation, and real-time support from the South Central Ambulance Service (SCAS), a trusted, community-visible National Health Service (NHS) healthcare workforce serving the counties of Hampshire, Oxfordshire, Buckinghamshire and Berkshire in Southern England, UK. ACCESS D is a 12-month mixed-methods feasibility study recruiting 100 adults aged 50-90 years with either (1) a diagnosis of mild cognitive impairment or dementia or (2) a self- or proxy-reported memory concern affecting daily life. The study will deliver between 12-18 co-produced community outreach events in non-clinical settings, supported by SCAS research paramedics and nurses. Following written (paper or digital) informed consent, participants will complete a core questionnaire and may optionally take part in one or more low-burden research opportunities designed to provide supported, first-hand experience of dementia research. Feasibility outcomes, including pathway progression and opt-in to future dementia research contact, will be descriptively summarised and stratified using National Institute of Health and Care Research (NIHR) INCLUDE-aligned underserved characteristics. Qualitative interviews and focus groups with participants and staff will examine acceptability, perceived value, barriers and enablers and implementation learning, analysed using thematic analysis and integrated with quantitative findings. The study has received a favourable opinion from the Southwest-Frenchay Research Ethics Committee and Health Research Authority approval (IRAS 361074). Findings will be disseminated via peer-reviewed publications, conference presentations and co-produced lay outputs for community partners and participants. These outputs will be accompanied by an implementation toolkit for research teams and a visual summary for potential participants.

Poor diet is a leading risk factor of non-communicable diseases. Product placement strategies in retail outlets can influence customers' food preferences. The United Kingdom government introduced legislation in October 2022 restricting chain retailers from using location promotions on unhealthy food and drinks. High-quality scientific evidence is needed to inform the inclusion of healthier product placement approaches into these regulations. In the context of Brexit, COVID-19 and the cost-of-living crisis, this study assessed whether positioning an expanded fresh fruit and vegetable section near store entrances in discount supermarkets, which do not routinely market produce this way, improved store sales, household purchasing and diet. This natural experiment had a prospective matched controlled cluster design, involving 36 stores (18 intervention and 18 control) across England. The intervention was implemented continuously for 6 months. Control stores were matched on store sales, customer profiles and neighbourhood deprivation. Participants were women, aged 18-60 years, with loyalty cards and were assigned to their primary store (n = 280 intervention and n = 300 control). Weekly store sales and household data from loyalty cards were provided by the collaborating supermarket chain. Dietary quality, household food waste and demographic characteristics were collected through questionnaires. A process evaluation and economic evaluation were completed. Store-level sales of fruit and vegetables were greater in intervention stores than predicted at intervention implementation and 3 and 6 months' follow-up, equivalent to ≈ 2525, ≈ 1940 and ≈ 1450 extra portions per store per week, respectively. Effect sizes were somewhat stronger in stores where the produce section moved forwards more than 14 m. The proportion of households purchasing fruit and vegetables were somewhat protected among intervention compared to control participants after 3 and 6 months. Changes in dietary quality were small but generally in the expected direction for health benefit. Changes in frequency of household fruit and vegetable waste were negligible at 3 months' follow-up but increased at 6 months. The intervention was implemented according to the study protocol, with marked differences in the positioning of fresh fruit and vegetables between intervention and control stores post-intervention implementation. Fresh fruit and vegetable availability increased post intervention in intervention compared with control stores. Interviews with store staff demonstrated that changes in staff attitudes had a positive reinforcing effect on intervention implementation. Assessment of the policy context showed that stakeholders across the food system largely support the United Kingdom government's unhealthy placement ban; some felt it does not go far enough. This study shows that positioning produce sections near supermarket entrances can improve the nutrition profile of store sales and may improve household purchasing and diet. The United Kingdom Food (Promotion and Placement) Regulations could be refined to require a produce section near supermarket entrances to increase its health impact. Future research should continue to build the evidence for which healthy eating interventions are effective in retail outlets. Further evaluations of real-world supermarket intervention studies using robust scientific study designs are required, alongside process and economic evaluations, to provide evidence for policy intervention to improve retail food environments in the United Kingdom and internationally. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/44/46. Supermarkets are a major source of food for families. Discount supermarkets have less-healthy environments than other supermarkets and are used more by families living on lower incomes. We worked with a United Kingdom discount supermarket chain to assess if moving a bigger fresh fruit and vegetable section near store entrances improves what people buy. A total of 580 women aged 18–60 years who regularly shopped at one of 36 stores (18 with changes and 18 with no changes) across England took part. Women did a survey over the phone four times (once before the change in layout and 1, 3 and 6 months after). The survey asked about the foods they and their young children (aged 2–6 years) usually ate, where they shopped for food and how much they spent each week, as well as their age, number of children and highest educational qualification. Information about the food each woman bought from loyalty card data and the total sales of fruit and vegetables for each store in the study was given by the supermarket. We found that the sales of fruit and vegetables were higher in stores where they had been moved to the front when compared to stores where they remained at the back of the store, though the size of the impact decreased over time. We found that during the time of Brexit, COVID-19 and the cost-of-living crisis, all families bought fewer fruit and vegetables over time. Families who shopped mostly at study stores with fruit and vegetables near the front entrance had a smaller decline in fruit and vegetable purchases than families who shopped at stores with fruit and vegetables towards the back. Our study provides new information that governments could use to make all supermarkets place fruit and vegetables near the front of their stores so people buy and eat more fresh produce.

From early adolescence, girls face greater risk of experiencing low mood and anxiety, with recent evidence that this may be worsening. This is increasingly recognised as a critical public health issue, with an imperative for research that meaningfully progresses our understanding of how to reduce the risk of these experiences, including research that asks adolescent girls themselves. We set out to explore what adolescent girls think can be done to reduce rates of low mood and anxiety among their population, and to understand how such options can be enacted. We adopted a coproduced qualitative design, conducting focus groups in 2022 with 32 adolescent girls aged 16-18 years in England. We analysed data with content analysis to construct candidate 'programme theories', or models for intervention, and refined these through discussion with four professionals. We produced five candidate programme theories: (A) social media education and campaigning, (B) school staff training and culture change on gender stereotypes, (C) comprehensive approach to sexual harassment in schools, (D) social hobby spaces in schools and/or communities and (E) relationally grounded whole-school approach to mental health and well-being. Guided by the Medical Research Council guidance for complex interventions, for each we describe required resources, activities, mechanisms, outcomes and key considerations for context and successful implementation. While the study offers valuable, coproduced insights into adolescent girls' mental health, limitations include a relatively small and self-selecting adolescent sample and under-representation of certain demographic groups, which may have meant some perspectives were not included; a small sample size of professional participants which may have limited discussion and affected transferability of insights across varied contexts and approaches to mental health provision; limited engagement with wider stakeholder groups which could have augmented and contextualised findings more deeply, and context-specific constraints such as recruitment in England only and timing of data collection (shortly before high-stakes exams following COVID-19 restrictions) that may affect wider applicability. These coproduced candidate programme theories provide valuable insights on opportunities to develop, extend and challenge the ways in which we currently work to improve the mental health of adolescent girls. Future research should employ multimethod, participatory approaches across diverse populations and contexts to refine and test these youth-informed programme theories and explore their implementation in varied educational, social and cultural settings. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135295. Adolescent girls are more likely to experience low mood and anxiety, and this might be getting worse. This is known to be an important issue, but there is not much research that helps us understand how to reduce these mental health challenges, particularly by asking girls themselves what they think might be useful. We talked to 32 girls aged 16–18 years old in England, meeting with them in small groups to hear directly from them about what they believe could help reduce low mood and anxiety among girls their age. We analysed what they told us and developed five ideas or ‘programme theories’ for possible interventions. These ideas were developed further through discussions with four professionals. We produced five theories of approaches that might be useful: Educating young people about using social media and taking care of themselves online, and running campaigns to help them understand what is and isn’t real online. Training staff in schools to challenge gender stereotypes. Having a comprehensive way to deal with sexual harassment in schools. Providing spaces in schools or communities where girls (and other adolescents) can engage in hobbies and socialise in a relaxed environment. Developing a school-wide approach to mental health that is centred around building positive relationships and a supportive atmosphere. These ideas give us new ways to better improve the mental health of teenage girls, showing how we can advance and build on what we currently do. However, further exploration of these and other approaches to improving girls’ mental health require ongoing discussions and collaborative working with various stakeholders to allow understanding of how we can use these approaches to good effect in practice.

Household overcrowding is a growing problem in England. It increases the risk of health outcomes including infections, injuries and poor mental health. For councils to monitor overcrowding at household level, methods are required to identify which homes are overcrowded and how it affects residents. Measures may need to be tailored for families, where overcrowding limits children's ability to play, study and socialise. To establish the feasibility of developing a method to identify households with families at high risk of overcrowding affecting their well-being. Describe effects of household overcrowding on family well-being through discussions with people with experience of overcrowding. Operationalise a method in one council, by combining publicly available and council-held data, to identify households with families at risk of the health effects of overcrowding. Understand the wider applicability of this method to other councils and its implications for population-level intervention design. An explanatory sequential mixed-methods design was used with resident and community engagement throughout. First, interviews and focus groups were conducted with parents with lived experience of overcrowding and community representatives and service professionals in two boroughs of London. From discussions with these groups, a description of overcrowding affecting households with families was shared with one London local authority. Informed by this information, this local authority obtained and combined relevant population and housing data to generate two measures of household overcrowding in households with dependent children. The first measure replicated the 'bedroom standard', the most used overcrowding metric. The second measure assessed overcrowding by space available to families. A logistic regression was conducted to examine associations between overcrowding and repairs for damp and mould was undertaken. The methods and illustrative results on overcrowding prevalence from one council were shared with other councils, housing associations and researchers to understand its wider applicability. Analysis of data from 47 parents (n = 25) and staff (n&#x2005;=&#x2005;22) illustrated how effects of living in overcrowding can be influenced by the space available, and the number of bedrooms in the home, by the condition of the property (particularly damp/mould) and children's age. Using data available to councils, we identified overcrowding in families comparable to national estimates of overcrowding using the 'bedroom standard' and the 'space standard'. While prevalences were similar using space and bedroom standards [34.6% (95% confidence interval: 34.0% to 35.3%) vs. 36.1% (95% confidence interval: 35.4% to 36.8%)], each identified distinct cohorts of households). Using one of the local measures, we found overcrowded council homes had 1.31 times (95% confidence interval: 1.14 to 1.50, p&#x2005;<&#x2005;0.001) higher risk of needing damp and mould repairs than households not in overcrowding. Stakeholder discussion with 30 participants across six English regions emphasised the importance of local measures for identifying populations at risk and for evaluating impacts of local policies and interventions. This project demonstrated the feasibility of generating locally derived measures of overcrowding at household level that are granular enough to: (1) examine variations in overcrowded by household composition and (2) evaluate potential impacts of other policies/services on overcrowded households. The project was limited in its geographical transferability; the qualitative research was conducted in two boroughs of London and the quantitative research in only one borough. There were also limitations to data access and quality on population data and housing data which affected the robustness of overcrowding indices. Household-level identification of overcrowding is needed to develop and evaluate public health interventions to support families living in overcrowding. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR154776. Household overcrowding is a growing problem in England, particularly in urban areas. It can lead to health problems including infections, injuries and poor mental health. It can affect children particularly, by limiting their play and study. Councils who want to help people living in overcrowding need new ways to find which homes are overcrowded and how it affects families. We wanted to find out if a typical council could identify families living in overcrowding and how it affected their well-being. We used data available to a typical council to test this. First, researchers worked with voluntary organisations to ask parents in North London about their experiences of raising children in overcrowded homes. We also spoke with council and community staff about their experiences of helping families. We then worked with one London council on ways to measure overcrowding in families, using our understanding from families and staff and by integrating council and public data. We used these measures to find out how overcrowding affected families&#x2019; risk of damp and mould in their homes. Finally, we discussed what we learnt with other councils. Families and staff told us that overcrowding affected them in many ways. Experiences of overcrowding were worse when families did not have enough space in their bedrooms for people to sleep safely and when their home was damp or in poor condition. They also described how experiences changed as children grew older. We measured overcrowding in families in two ways &#x2013; by the space and by the number of bedrooms in their homes. We compared overcrowding in families with children of different ages. We also showed that damp and mould problems were more common in council homes where families were living in overcrowding than in homes where they had enough space.

Little is known about the psychological impact of community crime in older victims, whether signposting to their general practitioner is helpful, or the barriers and facilitators to help-seeking. Previous pilot work suggested that a 'cognitive-behavioural therapy'-informed Victim Improvement Package showed promise for treating psychological distress in older victims, but further evaluation was needed. The study was undertaken between June 2017 and June 2023 in selected areas of a United Kingdom city using Safer Neighbourhood Teams. Safer Neighbourhood Teams consist of a group of police personnel, working across several local authority areas, who are dedicated to managing victims in the community. Within 2 months of the crime, police Safer Neighbourhood Teams screened 3192 victims, aged 65 or over who had reported a crime, for psychological distress using the Generalised Anxiety Disorder-2 and Patient Health Questionnaire-2 items. Those identified as distressed were advised (signposted) by the police to seek help from their general practitioner. The impact of signposting was evaluated using qualitative and quantitative methods. At 3 months post crime, 877 older victims were reassessed by our researchers and, if still distressed, invited to participate in a randomised controlled trial. This compared the addition of our Victim Improvement Package to treatment as usual against treatment as usual alone. The Victim Improvement Package used a manual to guide our talking therapy (cognitive-behavioural therapy), delivered individually and weekly, for up to an hour by a mental health charity. Up to 10 sessions were offered. The Beck Depression Inventory, version 2, and the Beck Anxiety Inventory, combined in a composite score, were used to evaluate clinical effectiveness. Measures were collected at baseline (3 months post crime), post intervention (primary end point) and follow-up; 6 and 9 months post crime, respectively. Cost-effectiveness was evaluated using the EuroQol-5 Dimensions and a modified Client Service Receipt Inventory. The police screened 24% of older victims (n&#x2005;=&#x2005;17,611) in our selected areas. A third of the police-screened victims were significantly distressed, and for those we rescreened at 3 months post crime, almost half remained distressed. Few distressed older victims (13%) approached their general practitioner (barriers included wait times and personal beliefs they should cope), and only a third of those who did so received help. One hundred and thirty-one participants were randomised (65&#x2005;=&#x2005;Victim Improvement Package; 66&#x2005;=&#x2005;treatment as usual) at 3 months post crime. The primary outcome was completed in 87 (66.4%). The Victim Improvement Package was acceptable to participants, although it was not possible to recruit our target sample of 226, because of a number of hurdles, which included changes in police leadership, the coronavirus disease discovered in 2019 pandemic and possible reduced confidence in the police. We report on these, the lessons learnt, and make recommendations for further research. No treatment effect was found for the Victim Improvement Package. Mean Victim Improvement Package -0.41 (standard deviation 0.89) versus mean treatment as usual -0.19 (standard deviation 1.11); adjusted difference in means -0.039, 95% confidence interval (-0.39 to 0.31) and the Victim Improvement Package was not cost-effective. Recruitment was challenging, with insufficient numbers recruited to meet the sample size calculation. While appearing representative of the population, only 0.7% (131/17,611) of older victims reporting a crime participated in the trial. Assessing the quality of delivery of cognitive-behavioural therapy was challenging. Crime significantly psychologically impacts older victims, with chronicity of symptoms. Distress can be identified by incorporating screening into routine police visits. While Victim Improvement Package remains acceptable and promising, more research is needed, including the feasibility of using typical clinical services to assess clinical effectiveness. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 13/164/32. Many older people are adversely psychologically affected by a community crime but do not seek formal help. Our review of existing research suggested a talking therapy called cognitive-behavioural therapy may be promising for treating distress, but it is unclear whether it specifically helps older crime victims. The police identified and screened older victims of crime for distress within 2 months of a crime through face-to-face visits or over the telephone using two questions about mood and worry, respectively. Distressed victims were advised to see their general practitioner for help. We then reassessed older victims 3 months after the crime to see who had acted on our advice and whether they remained upset. Those still distressed were offered the opportunity to participate in a trial comparing 2 interventions: usual care alone or usual care plus up to 10 cognitive&#x2013;behavioural therapy sessions, adapted for crime victims and delivered by a mental health charity. The treatment intervention was decided at random by a computer. The responses to the interventions were determined using two questionnaires measuring low mood and anxiety, respectively. Two-fifths of older victims were distressed within 2 months of a crime, and only 15% of these had taken up the advice to see their general practitioner. Half of distressed victims reassessed were still distressed at 3 months. Because of service demands on the police caused by public events, the COVID-19 pandemic, changes in the priorities of police leads and possibly decreased public confidence in the police, we could not recruit enough people to determine whether cognitive&#x2013;behavioural therapy was effective, and we found the quality of therapy needed improving. Community crime impacts older people, distress is sustained, but help is rarely sought. In addition to the police, further research may consider working with a range of other agencies, such as the charities, to enhance recruitment and retention of older victims. Conflicting service demands make needed research in this population challenging.

Health economics and implementation science play a critical role in the uptake of evidence-based practice but have largely sat siloed. This paper summarises findings from a 3-day workshop on health economics and implementation science. Workshop attendees included 30 health economists, implementation scientists, patient contributors, and patient and public involvement and engagement researchers from Australia and the United Kingdom. A shared vision for moving from siloed to synergistic disciplinary approaches was derived through consensus. This article outlines to researchers and methodologists what synergistic disciplinary approaches could look like. We highlight opportunities for health economics and implementation science to integrate along the innovation pathway, from the development and evaluation of innovation to eventual uptake and spread. Greater collaboration between implementation scientists and health economists has the potential to optimise implementation strategies, provide robust evidence for value for money and ultimately improve care delivery. Stronger integration of health economics and implementation science may also shed more light on the equity impacts of implementation strategies and guide their further design to promote more equitable care and outcomes.

Return to work is achieved by <&#x2005;50% stroke survivors. Evidence on support for return to work is lacking. To determine whether Early Stroke Specialist Vocational Rehabilitation is more clinically effective and cost-effective at supporting return to work 12 months after stroke than usual care. Pragmatic, observer-blind, multicentre superiority randomised controlled trial with embedded health economic evaluation. Participants were individually randomised, 5&#x2005;:&#x2005;4, to receive occupational therapy-led Early Stroke Specialist Vocational Rehabilitation&#x2005;+&#x2005;usual care. Questionnaire follow-up at 3, 6 and 12 months post randomisation. Mixed-methods process evaluation explored intervention experience, fidelity, compliance and implementation. Twenty-one NHS stroke services in England and Wales. Patients with new stroke within 12 weeks, aged &#x2265;&#x2005;18, in paid/unpaid work at stroke onset. People not intending to return to work excluded. Occupational therapists assessed stroke impact on participants and their job; co-ordinated NHS/employer/other stakeholders' support; negotiated job accommodations, monitored return to work and explored alternatives if return to work were unfeasible. Usual care involved NHS rehabilitation provided by community teams and medical follow-up. Primary outcome: self-reported return to work for &#x2265;&#x2005;2 hours/week 12 months post randomisation. Secondary outcomes: mood, functional ability, participation, productivity, work self-efficacy, health-related quality of life, confidence, mortality, carer strain, cost-consequences, COVID-19 impact. Between 1 June 2018 and 7 March 2022, 583 participants [mean age 54 years (standard deviation 11.1), 69.0% male, mean 29.9 days (standard deviation 20.0) post stroke, 452 (82.8%) ischaemic stroke] were randomised to Early Stroke Specialist Vocational Rehabilitation (n&#x2005;=&#x2005;324) or usual care (n&#x2005;=&#x2005;259). Primary and secondary outcome data were available for 454 (77.9%) and 316 (54.2%) participants, respectively. Intention-to-treat analysis showed no statistically significant difference in return to work between groups at 12 months [165/257 (64.2%) Early Stroke Specialist Vocational Rehabilitation vs. 117/197 (59.4%) usual-care, adjusted odds ratio 1.12 (95% confidence interval 0.8 to 1.87), p&#x2005;=&#x2005;0.3582]. Similar proportions of adverse events occurred in both groups [40/241 (16.6%) attended accident and emergency, 24/244 (9.1%) hospital admissions, 6/266 (2.3%) work accidents at 12 months]. Exploratory subgroup analyses indicated Early Stroke Specialist Vocational Rehabilitation potentially benefits older people (60+), and those with two or more post-stroke impairments. Health economic outcomes were consistent with primary clinical outcomes. Analysis using multiple imputation, adjusting for age, sex, utility or cost at baseline and site found Early Stroke Specialist Vocational Rehabilitation had higher costs [incremental cost &#xa3;1337 (95% confidence interval -1113 to 3787) and slightly more favourable incremental quality-adjusted life-years of 0.019 (95% confidence interval -0.012 to 0.051)]. Early Stroke Specialist Vocational Rehabilitation was valued by participants and service managers. In contrast, usual-care participants reported limited or no vocational rehabilitation and poor communication. Intervention compliance was achieved for 244 (75.3%) participants. Mentor support for occupational therapies appeared to increase fidelity. Most participants had mild-moderate stroke, unlike our feasibility evaluation which informed the sample size (powered to detect an absolute 13% difference in return to work). More people return to work than anticipated. There was significant loss to follow-up for primary, secondary and health economic outcomes. Employers proved difficult to recruit and engage. REturn To work After stroKE was unable to demonstrate an effect or cost effect of Early Stroke Specialist Vocational Rehabilitation on return to work 12 months post randomisation. The COVID-19 pandemic influenced employer behaviour, and remote working diluted Early Stroke Specialist Vocational Rehabilitation mechanisms in a predominantly mild-moderate sample, many of whom were able to self-navigate return to work. Research is needed to confirm Early Stroke Specialist Vocational Rehabilitation benefits in people marginalised by age or post-stroke impairment, and determine what interventions benefit younger stroke survivors. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11. Many people cannot REturn To work After stroKE and there is little National Health Service support for this. We developed early, stroke specialist vocational rehabilitation to support people to return to and remain in work. This was available for up to 1 year. We recruited working people aged 18 or over, within 12 weeks of new stroke and allocated at random, whether they received the new rehabilitation in addition to usual National Health Service care or usual National Health Service care only. Twelve months later we compared the potential benefits of the new rehabilitation to its costs in terms of how many in each group had returned to work. The trial recruited 583 stroke patients from 21 hospitals. Most people recruited had mild&#x2013;moderate stroke. Although 5% more people returned to work with the new rehabilitation, this difference was not statistically significant and might have happened by chance rather than because of the new rehabilitation. Overall, the new rehabilitation was found unlikely to offer the National Health Service value for money in the short term. Additional exploratory analysis suggested older people and those with more stroke disability might be more likely to benefit from the new rehabilitation. However, more research is needed to confirm these findings. The new rehabilitation was delivered as intended and valued by stroke survivors and National Health Service managers. Stroke survivors who received usual National Health Service care only, received little rehabilitation, which was poorly co-ordinated with limited or no vocational rehabilitation. The COVID-19 pandemic came at a critical point. It made flexible, home-based working the norm, particularly for managerial roles, reducing the effect of the new rehabilitation. People who sustain stroke with few lasting disabilities may be able to return to work without specialist support. However, further research is needed to confirm this and determine whether this applies to people of all ethnicities and job types.

This article is an opinion paper which reflects on the recently published Food Strategy for England and how it frames the food system in the context of social and cultural factors, which is explored in relation to young people. In relation to outlining these issues, the authors draw out the implications for public health practice in local government.

Economic variables such as debt can impact mental health. This study explored the impact of the cost-of-living crisis on mental health services users and staff, and aimed to identify potential support. Mental health service users and mental health service staff took part in interviews exploring the relationship between the cost of living and mental health, which were analysed thematically. Findings suggest that finances and mental health can be interlinked during the cost-of-living crisis, with sub-themes of &#x2018;Economic hardship has an impact on everyone&#x2019; and &#x2018;Hopelessness, frustration and desperate situations.&#x2019; A second theme identified was &#x2018;Barriers to obtaining financial and mental health support&#x2019; with sub-themes of &#x2018;Service and support accessibility,&#x2019; &#x2018;Receiving inadequate support&#x2019; and &#x2018;Increasing demand on services and staff pressures.&#x2019; A final theme was identified of &#x2018;Learning from and developing on what works&#x2019;. The cost-of-living crisis has had a wide-ranging impact on those using mental health services.

Men with obesity infrequently engage with weight management services. To determine: (1) percentage weight loss at 12 and 24 months for text messages with or without financial incentives compared to control; (2) secondary outcomes; (3) cost-effectiveness; (4) moderators of effectiveness and (5) participant and stakeholder perspectives. Assessor-blinded randomised controlled trial. United Kingdom National Health Service perspective cost-effectiveness over 24 months and modelled lifetime horizon. Mixed-methods process evaluation. Five hundred and eighty-five men with body mass index &#x2265;&#x2005;30&#x2005;kg/m2 enrolled (July 2021-May 2022) in Belfast, Bristol and Glasgow; final follow-up June 2024. Random allocation to 12 months of behavioural text messages plus financial incentives (N&#x2005;=&#x2005;196), same texts alone (N&#x2005;=&#x2005;194) or 12-month waiting list control group offered 3 months of texts between 12 and 15 months (N&#x2005;=&#x2005;195). A &#xa3;400 financial incentive was lost if weight loss targets were not met. Weight change as a percentage of baseline weight at 12 and 24 months comparing control with (1) texts with financial incentives and (2) texts alone. Of 585 men (mean age 51 years; mean weight: 119&#x2005;kg), 227 (39%) lived in lower socioeconomic areas, 146 (25%) reported a mental health condition and 253 (40%) had multiple long-term conditions. Follow-up was completed by 426 (73%) at 12 months and 377 (64%) at 24 months. At 12 months, mean percentage weight changes (standard deviation) were -4.8% (6.1) (-5.7&#x2005;kg), -2.7% (6.3) (-3.0&#x2005;kg), and&#x2005;-&#x2005;1.3% (5.5) (-1.5&#x2005;kg) for the incentives, text-only, and control groups, respectively. Compared to control, weight loss was significantly greater with incentives [-3.2% (97.5% confidence interval -4.6 to -1.9; p&#x2005;<&#x2005;0.001)] but not texts alone (-1.4%; confidence interval -2.9 to 0.0; p&#x2005;=&#x2005;0.053). At 24 months, changes were -3.9% (-4.6&#x2005;kg), -2.6% (-3.1&#x2005;kg), and -2.2% (-2.6&#x2005;kg), no significant between-group differences. Intervention costs were &#xa3;243 for texts with incentives, &#xa3;110 for texts alone. There were no significant differences between 24-month costs and quality-adjusted life-years. Long-term modelling found texts with incentives versus control were: quality-adjusted life-year difference (95% confidence interval): 0.02 (0.007 to 0.029); cost difference: &#xa3;176 (&#xa3;43; &#xa3;311); incremental cost-effectiveness ratio: &#xa3;9748 (&#xa3;7705 to &#xa3;11,791). For texts alone versus control: quality-adjusted life-year difference: 0.03 (0.015 to 0.037); cost difference: &#xa3;16.5 (-&#xa3;117; &#xa3;152); incremental cost-effectiveness ratio: &#xa3;628 (-&#xa3;5914 to &#xa3;5384). There were no moderator effects for socioeconomic, health or well-being status for either comparison versus control. The texts with incentives group had a higher engagement in weight goal setting, food changes, self-weighing, confidence, satisfaction and quality of life compared to the control. Generalisability to women, diverse ethnic groups and people with low literacy is uncertain. Not generalisable to people with no mobile phone access. Retention was lowest in the text messages alone group. Texts with financial incentives have a modest but important effect to 12 months with clinically relevant weight loss maintenance to 24 months, are cost-effective and equally effective regardless of socioeconomic or health characteristics. Implementation, adapt for women, other cultures and longer-term follow-up. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129703. The Game of Stones study aimed to help men lose weight and keep it off for at least 2 years. Five hundred and eighty-five men living with obesity across the United Kingdom were split into three groups by chance: supportive text messages for 1 year and opportunity to get money for weight loss the same text messages alone for 1 year neither for 1 year, then text messages for 3 months. The first two groups received the same daily text messages about changing weight-related behaviours. Group 1 was told at the start that &#xa3;400 had been put aside for them and that money would be lost if weight targets were missed. The targets were 5% weight loss at 3 months, 10% at 6 months and maintaining that 10% loss at 12 months. Money was then paid to the men after being weighed at 12 months. Every man was asked questions about their health, well-being and experiences of being in the study. After 1 year, the men in group 1 lost the most weight (5%, 5.7&#x2005;kg). The men in group 2 lost some weight (3%, 3.0&#x2005;kg) but not as much as the first group. The men in group 3 lost the smallest amount of weight (1%, 1.5&#x2005;kg). On average, men in group 1 received &#xa3;128 for meeting weight loss targets. One year after the 12-month measures, men in groups 1 and 2 had gained back some weight. Men in group 3 lost a bit more weight between year 1 and 2. Weight loss was similar whether or not men had long-term health conditions, disability, mental health issues or lived in the most deprived areas. This study showed that Game of Stones was a popular, low-cost and modestly effective way of helping men to lose weight.

Loneliness has received attention in recent years as an important public health issue due to its associations with poorer mental and physical health. This study aimed to assess the effectiveness and cost-effectiveness of a facilitated social network intervention to alleviate loneliness and social isolation in community settings. A pragmatic, cluster-randomized controlled trial (RCT) was conducted to compare participants receiving the intervention with a wait-list control group. This trial also included an embedded economic evaluation and took place in two cities in England, UK. The intervention was a facilitated social network tool. It connects people to local community resources to potentially increasing their social involvement. First, participants mapped out and reflected on their personal social networks. Second, they completed a questionnaire to ascertain their preferred activities, interests, and support needs linked to a local resource database. The intervention was delivered by a trained facilitator, either in person or remotely. Community-based organizations (n&#x202f;=&#x202f;44) identified adults at risk of social isolation and/or loneliness. The control group received" usual care" from the organization that recruited them. The primary outcome was the 6-month 12-Item Short Form (SF-12) Health Survey mental health composite score. Physical health, wellbeing, loneliness, social isolation, and collective efficacy were explored as secondary outcomes. Intervention costs, healthcare resource use, quality-adjusted life years (QALYs), and net monetary benefit (NMB) were included in the economic analysis. A total of 469 adults were recruited between November 2018 and November 2021, with an 8-month in recruitment due to the coronavirus disease 2019 (COVID-19) in 2020 (242 participants in the intervention group and 227 participants in the control group). The results showed no clinically meaningful treatment effect of the intervention on the primary (0.21; 95% confidence interval [CI]: -1.74-2.16; p&#x202f;=&#x202f;0.834) or secondary outcomes when compared to the usual care control group. The economic evaluation indicated no significant difference in QALYs and did not demonstrate cost-effectiveness despite being inexpensive to deliver. The findings indicate that the intervention was not effective under trial conditions. Future interventions aimed at reducing loneliness and social isolation would likely benefit from a multi-step approach that includes tailored psychological, relational, and social components and considers the structural availability of community assets. https://doi.org/10.1186/ISRCTN19193075, ISRCTN19193075.