Healthy Communities Publications

Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care

Wieringa S, Neves AL, Rushforth A, Ladds E, Husain L, Finlay T, Pope C, Greenhalgh T

The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians' experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care.

https://doi.org/10.1136/bmjqs-2021-013305

December 2023

Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis

Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Cherry MG, Bee P, Lovell K, Downs J, Edwards BM, Vassilev I, Bush L, Rogers A

People with mental health difficulties often experience social isolation. The importance of interventions to enhance social networks and reduce this isolation is increasingly being recognised. However, the literature has not yet been systematically reviewed with regards to how these are best used. This narrative synthesis aimed to investigate the role of social network interventions for people with mental health difficulties and identify barriers and facilitators to effective delivery. This was undertaken with a view to understanding how social network interventions might work best in the mental health field.

https://doi.org/10.1186/s12888-023-04881-y

July 2023

Normalisation of alcohol misuse and alcohol-related harms: a mixed methods analysis exploring alcohol misuse, morbidity and healthcare engagement in people experiencing homelessness

Wells   C, Dewar-Haggart R, Glyn-Owen K, Stevens H, Parkes J, Kim Y, Buchanan RM

The aim of this study is to understand the views and experiences of homeless adults who drink hazardously around alcohol use, alcohol harms and access to liver healthcare, and to quantify the prevalence of alcohol-related morbidity in this population.

https://doi.org/10.1093/alcalc/agaf071

November 2025

"Am I normal? Is this normal?": Supporting a community approach to grief.

Myall M,   Lund S, Campling N

The grief literacy movement promotes normalizing and regaining conversations about death, dying and grief within communities and networks. Enhancing grief literacy enables the public to identify grief, seek relevant information and adopt appropriate support. 

Historically families have been the primary provider of such support, but recently in the Global North these skills and knowledge have been lost. Families and communities need to be supported to regain ownership and relearn these skills. An online resource was developed and evaluated to explore its value in supporting the knowledge, skills and values required to embed grief literacy in family and friends-based networks. This paper presents findings from qualitative and group interviews. 

These rich datasets confirmed the resource to be an effective mechanism by increasing knowledge and skills to enhance grief literacy and supporting collective grief, where loss transcends the individual and becomes a social or cultural experience for the majority who deal with their grief with the support of family and friends rather than bereavement professionals.

https://doi.org/10.1080/07481187.2025.2598312

December 2025

Early environmental risks and the developmental dynamics of internalizing and externalizing problems from birth to adolescence

Wu K,   Zecchinato F, Guan C, Sun H

Internalizing and externalizing problems often co-exist throughout an individual’s development, shaped by a shared set of early environmental risks. However, most existing studies focused on discrete developmental periods, limiting understanding of how the negative impact of early-life adversity on mental health varies with age. Using data from 7,377 participants across seven waves of the UK Millennium Cohort Study (MCS), the current study investigated the bidirectional associations between internalizing and externalizing problems from ages 5 to 17, as well as the long-term impact of early environmental risks (i.e., prenatal influences, neonatal factors, maternal mental health, harsh parenting, and socioeconomic status) on the two symptom domains across time.

 Analyses indicated that individuals with higher internalizing symptoms tended to report higher externalizing symptoms, with both symptom domains showing high stability over time. A significant positive bidirectional relationship between internalizing and externalizing problems was found from childhood to early adolescence. However, this pattern diverged in late adolescence: internalizing problems at age 14 no longer predict externalizing problems at age 17, whereas externalizing problems negatively predict subsequent internalizing symptoms. Early environmental risk factors significantly predicted both internalizing and externalizing problems from ages 5 to 14, with the effects generally decreasing with age, except for an increase at age 11. Gender differences were also observed in both the bidirectional relationships between the symptom domains and the long-term impact of early environmental risks. 

Findings underscore the enduring impact of early adversity on adolescent mental health and highlight the complex, evolving interaction between internalizing and externalizing problems. The study offers critical insights for early, sustained interventions that address multiple risks and adapt to adolescents’ changing mental health needs over time.

https://doi.org/10.1007/s00787-025-02887-3

November 2025

 "It will sort of drive us to rethink our approach to high fat salt sugar products"- a qualitative analysis of businesses' reactions to the landmark Food (Promotion and Placement) Regulations in England

Dhuria P, Muir S, Shaw S, Lawrence W, Roe E, Baird J, Vogel C

Retail food environments have largely become settings which promote less healthy foods to their customers. In an effort to prompt healthier choices, the UK Government introduced regulations in October 2022 restricting most retailers in England from promoting products high in fat, sugar, or salt (HFSS) at store entrances, aisle-ends, and checkouts, and their online equivalents. Evidence is needed on how businesses approach compliance and adapt to these regulations. This study used in-depth interviews to examine business responses and generate insights to support effective implementation.

https://doi.org/10.1186/s12916-025-04384-5

October 2025

Process evaluation of a randomised controlled trial aimed at improving health behaviours and vitamin D status during pregnancy: Implementation of the SPRING trial

Proebstl S, Vogel C, Lawrence W, Strömmer S, Inskip H, Hammond J, Hart K, McGill K, Harvey NC, Barker M, Baird J

The Southampton PRegnancy Intervention for the Next Generation (SPRING) aimed to assess the efficacy of vitamin D supplementation and the behaviour change intervention 'Healthy Conversation Skills' (HCS) in improving the nutritional status of pregnant women. This paper describes the implementation of these interventions. Efficacy of HCS in improving diet quality and physical activity was evaluated in subgroups of women who discussed ways to improve these behaviours.

https://doi.org/10.1371/journal.pone.0319224

September 2025

The association between adolescents' independent food purchasing and dietary quality differs by socioeconomic status: Findings from a pilot study.

Shaw S, Crozier S, Cooper C, Smith D, Barker M, Vogel C

During adolescence, many young people start to make more independent food purchases. Subsequently, these independent food choices will increasingly contribute to their overall diet quality; little is known, however, about this relationship. This pilot study aimed to examine the role adolescents' independent food purchases play in their diet quality and assess if these relationships vary according to socio-economic status. A convenience sample of adolescents aged 11-18 years and attending secondary school or college in Hampshire, England, were recruited to participate in a one-week cross-sectional observational study

https://doi.org/10.1371/journal.pone.0312903

September 2025

Accountability for tackling childhood obesity: insights from local councillors in England

Taheem R, Woods-Townsend K, Lawrence W, Baird J, Godfrey KM, Hanson MA

Tackling the complex drivers of childhood obesity requires action across sectors and at all levels of government. Elected officials in local government can influence policies targeting communities to prevent childhood obesity, but little is known about their views on local government accountability for tackling the issue. Accountability is the obligation to justify actions on a topic and it could strengthen policy implementation. 

A qualitative study was conducted involving semi-structured interviews with sixteen Southampton City Council local government councillors. Factors limiting accountability included low citizen engagement, the lack of a national mandate to support local action and unachievable targets. Factors that improved accountability included setting a local mandate, public health officers proactively keeping the issue on the agenda and oversight from other system leaders. The findings from this study inform how public health officers and other stakeholders can work within the local system to progress childhood obesity prevention policies.

https://doi.org/10.1057/s41271-025-00573-x

July 2025

Maternal Dietary Inflammatory Status and Serum Neopterin During Pregnancy: Influence on Infantile Atopic Eczema in the Offspring

El-Heis S, Crozier SR, Loo EX, Tham EH, Harvey NC, Inskip HM; Southampton Women's Survey Study Group; Godfrey KM

Atopic eczema is a common inflammatory skin condition, globally affecting 1 in 5 children. It often runs a chronic relapsing and remitting course and can have a significant impact on sleep, growth and development. It can also have a bearing on the families of affected infants as well as the healthcare system.

There is increasing evidence for the importance of early life influences on infantile atopic eczema. Maternal diet before and during pregnancy and specific micronutrient status have been previously examined for their potential to modify the developing immune system risk of offspring atopic eczema. Reports of this have been largely inconsistent but evidence for healthy eating in pregnancy for allergy prevention has been well documented.

A lower risk of allergic conditions has been reported in infants whose mothers had higher serum levels of the pro-inflammatory Th1 markers MCP-1 and neopterin (produced through stimulation of M1 macrophages and monocytes by interferon-gamma) during pregnancy. It has therefore been hypothesized that a Th1 pro-inflammatory intrauterine environment may lower the risk of offspring atopic eczema by diminishing offspring Th2 responses, but supportive evidence is sparse.

Dietary inflammatory indices have been used to characterize the inflammatory potential of dietary patterns and can provide insights beyond those from individual nutrients. The Dietary Inflammatory Index (DII) is derived based on 45 dietary parameters linked to circulating levels of 6 inflammatory markers (IL-1b, IL-4, IL-6, IL-10, TNF-a, C-reactive protein).  The energy-adjusted DII (E-DII) was subsequently designed. It additionally accounts for potential impacts of energy intake on inflammatory potential and has been shown to correlate with DII. The E-DII allows more precise comparison of inflammatory potential of diets that vary in caloric intake.

Within a mother-offspring cohort, we aimed to examine the roles of an inflammatory maternal dietary pattern and serum neopterin in modifying the infant's risk of atopic eczema.

https://doi.org/10.1002/clt2.70080

July 2025

Systematic review of fruit and vegetable voucher interventions for pregnant women and families with young children

Grove G, Ziauddeen N, Malone M, Smith D, Alwan N

Health, poverty and poor diet quality are inextricably linked. Poor diet quality is linked with  many adverse health outcomes, both for children: obesity, gastrointestinal issues and  constipation , dental caries, hypertension, diabetes and growth stunting , and for pregnant  women: gestational diabetes, gestational hypertension and excessive weight gain.  

Looking at the impacts from a societal perspective, poor health can result in time away from  school or work, increased healthcare costs and losses to the economy. Food insecurity has  been associated with increased healthcare costs and poor health outcomes. Poverty has  been linked with childhood obesity, with children from the most deprived decile being  twice as likely to be obese as children from the least deprived decile . Maintaining a good quality diet is particularly challenging for those on low incomes.  Children from deprived backgrounds are more likely to have poorer diet quality than children  from more affluent backgrounds. 

In the UK, healthy diets are comparatively more  expensive, with Fruits & Vegetables (F&Vs) costing significantly more per 1,000 kcal energy provided (£11.79)  than foods and drinks high in fat and sugar (£5.82/1,000kcal). This makes it increasingly  difficult for families under financial strain to maintain healthy diets. F&V vouchers aim to improve dietary quality by safeguarding or increasing spend on F&Vs  in low-income families. They are intended to ensure that families can access F&Vs that may  be out of reach otherwise. Critics may argue that F&V vouchers could be used to offset  current spending, and could paradoxically decrease diet quality by freeing up money to be  spent on unhealthy foods. Evidence to support interventions such as F&V vouchers can  be challenging to gather and we are not aware of any previous mixed methods reviews that  have considered the impact of F&V voucher interventions on the diet and health of pregnant  women and families with young children. 

This review aimed to systematically synthesize  published studies (peer reviewed and grey literature) to assess the impact of F&V vouchers  on the diets and health of recipients (pregnant women and families with children under the  age of 5). The review also aimed to explore recipients’ experiences of F&V vouchers, where  F&V voucher schemes face challenges, and what might be done to mitigate these issues.

https://doi.org/10.1017/s1368980025100657

July 2025

Understanding food insecurity in England: a systems-based approach

Bijlani C, Ndlovu D, Smith D, Thompson C, Garcia L, Junghans C, Vamos EP, Seferidi P

Food insecurity is a significant public health issue in England. National and local policies have not been able to adequately address its complex drivers, in part due to unintended consequences that arise from the way these policies interact with the system. 

Through an integrative review and group model building workshops with 17 subject matter experts, we developed four causal loop diagrams (CLDs) to map the interactions between food insecurity drivers and major policies such as Universal Credit, Healthy Start, and School Meal programs. The CLDs reveal that while these policies and interventions are intended to reduce food insecurity, specific implementation issues can unintentionally perpetuate food insecurity. These unintended consequences result in a shift in responsibility between governments and communities, with a subsequent erosion of public trust in governments and policies. 

This study highlights the need for redistributing responsibility back to governments, rebuilding trust and mitigating unintended consequences of current policies. By addressing the feedback mechanisms driving food insecurity, this research provides actionable insights and policy recommendations for creating equitable and effective policies.

https://doi.org/10.1080/25741292.2025.2523114

June 2025