Healthy Communities Publications

Development of two short food frequency questionnaires to assess diet quality in UK pre-school and primary school-aged children based on National Diet and Nutrition Survey data

Mason M, Shaw SC, Baird J, Barrett M, Lovelock D, Woods-Townsend K, Godfrey KM, Vogel CA, Crozier SR

Assessing children’s diets is currently challenging and burdensome. Abbreviated food frequency questionnaires (FFQ) have potential to assess dietary patterns in a rapid and standardised manner. Using nationally representative UK dietary intake and biomarker data, we developed abbreviated FFQs to calculate dietary quality scores for pre-school and primary school-aged children. 

UK National Diet and Nutrition Survey (2008-2016) weekly consumption frequencies of 129 food groups from four-day diaries were cross-sectionally analysed using principal component analysis. A 129-item score was derived, alongside a 12-item score based on foods with the six highest and six lowest coefficients. Participants included 1,069 pre-schoolers and 2,565 primary school children. 

https://doi.org/10.1017/s0007114525103449

May 2025

'I cannot be what I don't see': an evaluation of Academic Intersectionality Mentoring in medical schools (AIMMS Mentoring)

Woodrow M, Benedikz E, Bryant LD, Illés J, Jagpal P, Jennings HM, Monks E, Nayak V, Reza MM, Saha S, Upadhyaya M, Williams K, Winpenny JP, Zamani R, Alwan NA

Approximately 18% of the population of England and Wales belong to a black, Asian, mixed or other ethnic group. If this demography was reflected amongst UK academic professors, we would expect approximately 9% of professors to be female and belonging to ethnic minorities groups. Latest data demonstrate that the proportion of professors who are women from ethnic minorities falls far short of this, with about two-thirds (63.6%) of professors white males, about one quarter (26.5%) white female, 7.2% males from ethnic minority backgrounds and only 2.7% females from ethnic minority backgrounds .

The concept of intersectionality acknowledges that no individual has a single-dimension identity and that social constructs shaping identity dimensions can lead to compound disadvantage. Intersectionality critical theory conceptualises knowledge as contextual, relational, and reflective of political and economic power. For example, the experiences of a lesbian black woman are vastly different to those of a heterosexual white woman, even though they share one dimension of their identity (gender). Multiple other identity dimensions may shape life experiences, such as disability, caring responsibilities, language, or migration status, and may overlap in a way that exacerbates the experiences of disadvantage and hardship. Addressing inequities and structural discrimination through the lens of intersectionality is not easy, though much needed. Analyses of research funding programmes show that disparities span across more than one identity dimension. For example, over the course of seven decades, the prestigious Lasker biomedical research award was given to only one non-white woman out of 397. Intersectional inequalities can span across pay, recognition and promotion, and the answer is not to prioritise one identity dimension over the other as some initiatives do (e.g., gender over ethnicity, but to adopt an intersectional approach to addressing inequities entrenched in the sector.

The most significant initiative developed to redress gender imbalance in UK higher education, Athena Swan, has recently increased its focus on intersectionality; however clear impact cases are still rare. Still relatively new, Advance HE’s Race Equality Charter and the BMA’s Racial Harassment Charter for Medical Schools, which provide frameworks for institutions’ action against discrimination, have not yet enabled large-scale change in the race profile of staff in Higher Education Institutions (HEI) or academic medicine.

There is evidence that having a same-gender role model is influential for early-career women in some medical specialties. Mentorship is an activity in which professionals engage to help develop the next generation of professionals in their field and a popular initiative widely regarded as being a useful way to try to address inequalities in the workplace. However, there is limited evidence around how mentoring can help achieve equity in the higher education sector or on whether matching mentor/mentees based on intersectional backgrounds is beneficial, and, if so, how. Evidence of mentoring effectiveness in reducing gender inequalities is largely lacking and evaluation of mentoring schemes needs to be more robust. This paper describes the formation, design and evaluation of the Academic Intersectionality Mentoring in Medical Schools scheme (AIMMS Mentoring).

https://doi.org/10.1371/journal.pone.0318326

April 2025

Improving the growth of infants with congenital heart disease using a consensus-based nutritional Pathway - A follow up study

Young A, Fandinga C, Davis C, Andrews E, Johnson MJ, Bharucha T, Beattie RM, Marino LV

Congenital Heart Disease (CHD) is one of the most common congenital disorders occurring in about 9–10 per 1000 live births worldwide. Advances in surgical techniques have improved survival and clinical outcomes. Despite this, many infants with CHD experience growth failure prior to surgery which is associated with poorer neurodevelopmental outcomes, increased risk of mortality, and metabolic syndrome in adulthood. Although most infants are born with a normal weight-for-age, growth failure often occurs within the first few weeks of life with a reported prevalence of malnutrition during the first 12 months. Poor growth appears to occur irrespective of geographical location or disease severity. Features correlated with increased risk of malnutrition are antenatal diagnosis, associated genetic syndrome, birth weight ≤3 kg, complexity of CHD (≥2 significant lesions, or double outlet right ventricle or single ventricle physiology), cardiac surgery after 30 days of life, or diuretic medication before surgery or 1 month following surgery. Up to 35 % of infants with CHD experience nutrition and feeding difficulties as a result of i) restricted intake, ii) increased metabolic demand or iii) increased losses and often require the use of nutrient energy dense feeds or nasogastric tube feeding. Nutrition awareness tools providing a standardised approach to identifying infants and children with CHD at risk may provide opportunities to for earlier nutrition support.

In other groups of vulnerable infants (e.g. preterm infants) at risk of poor growth, the implementation of nutritional care pathways has been associated with reduced incidence of growth faltering and subsequent malnutrition. Similar efforts to prevent malnutrition in a CHD cohort during the first month of life, with to the use of nutrient energy dense feeds to support growth before surgery, have been shown to reduce weight loss following cardiac surgery and promote post-operative catch-up weight gain and reduce the length of paediatric intensive care unit (PICU) and hospital stay . In 2017, we developed a nutrition pathway to promote weight gain in infants with CHD before surgery using Delphi consensus methodology. Following this, the pathway was implemented into a regional paediatric cardiology service. An initial study (n = 44) considering the use of a nutrition pathway to support growth in infants with CHD before surgery demonstrated significantly improved growth outcomes at 4 and 12 months of age. We therefore aimed to evaluate the impact of this consensus-based nutrition pathway on growth in a larger cohort of infants with CHD following the implementation in a regional paediatric cardiology service over a five-year period.

https://doi.org/10.1016/j.clnu.2025.03.012

May 2025

Health literacy profiling of parents in two disadvantaged inner-city areas in the United Kingdom

Belfrage S, Husted M, Fraser S, Patel S, Faulkener J

Health literacy refers to the skills needed to access, understand, and navigate health information and services. Limited parental health literacy is associated with ineffective preventive behaviours and worse child health outcomes. People with limited financial and social resources are more likely to have limited health literacy. Profiling health literacy strengths and limitations of a population allows the multidimensional nature of health literacy to be considered and highlight patterns of need.

This study aimed to identify the health literacy profiles of parents of children aged 0–4 years in two cities in the United Kingdom with high levels of deprivation (Portsmouth, Southampton), and develop vignettes to illustrate their diverse experiences.

https://doi.org/10.1080/28355245.2025.2489383

April 2025

Liver Fibrosis Assessed Via Noninvasive Tests Is Associated With Incident Heart Failure in a General Population Cohort

Hydes TJ, Kennedy OJ, Glyn-Owen K, Buchanan R, Parkes J, Cuthbertson DJ, Roderick P, Byrne CD

The aim of this study was to determine whether liver fibrosis is associated with heart failure in a general population cohort, and if genetic polymorphisms (PNPLA3 rs738409; TM6SF2 rs58542926), linked to increased risk of liver fibrosis and decreased risk of coronary artery disease, modify this association.

https://doi.org/10.1016/j.cgh.2024.03.045

May 2024

Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis

Ostinelli EG, Schulze M, Zangani C, Farhat LC, Tomlinson A, Del Giovane C, Chamberlain SR, Philipsen A, Young S, Cowen PJ, Bilbow A, Cipriani A, Cortese S

The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.

In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. 

Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. 

People with relevant lived experience were involved in the conduct of the research and writing process.

https://doi.org/10.1016/s2215-0366(24)00360-2

January 2025

An out-of-court community-based programme to improve the health and well-being of young adult offenders: the Gateway RCT

Booth A, Morgan S, Walker I, Mitchell A, Barlow-Pay M, Chapman C, Cochrane A, Filby E, Fleming J, Hewitt C, Raftery J, Torgerson D, Weir L, Parkes J

Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences.

Our objective is to evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution).

https://doi.org/10.3310/ntfw7364

Sept 2024

The Relationship Between Paternal Smoking and Overweight/Obesity with Childhood Overweight/Obesity: A Systematic Review

Hussain U, Ziauddeen N, Taylor E, Alwan NA

Overweight and obesity are global health issues, defined as abnormal or excessive fat accumulation that may harm health. Among children and adolescents worldwide, the rate of obesity in 2022 was four times higher than in 1990. The rise in childhood obesity has heightened focus on its long-term health consequences.

Research has primarily focused on maternal factors and childhood overweight/obesity, with less emphasis on paternal factors. Evidence suggests that paternal health is crucial; a cross-sectional study found children of fathers with obesity are at higher risk of metabolic disease, regardless of maternal weight.

Paternal smoking also impacts childhood health. A review of 14 studies found children whose mothers smoked during pregnancy were at increased risk of being overweight between ages 3–33. Limited research exists on the effect of paternal smoking on childhood overweight/obesity. An individual participant data meta-analysis of 229,158 families across 28 birth cohorts showed a higher risk of childhood overweight in children whose mothers smoked during the first trimester and throughout pregnancy, compared to those whose mothers did not smoke. This analysis also found that paternal smoking was associated with a higher risk of childhood overweight, independent of maternal smoking. However, the study focused on Europe and North America, and did not extend the observation period beyond 1-year post-birth, or tracking obesity risk progression over time.

A UK based cross-sectional study found no association between paternal smoking and childhood overweight/obesity but did find an association between maternal smoking and childhood overweight/obesity when considering prenatal cigarette smoke exposure.  A previous systematic review examining the association between environmental smoking exposure and childhood obesity found a positive association for both maternal and paternal smoking, with a higher effect estimate for maternal smoking. However, this review focussed on environmental smoking exposure for the mother and source of exposure was unclear in some of the included studies, our review aims to focus solely on paternal smoking during the pregnancy period.

When examining the relationship between paternal smoking and child obesity, any observed association may be due to confounding factors like paternal obesity. People with overweight/obesity may be more likely to start smoking. A Mendelian randomization study from the UK Biobank showed each standard deviation increment in BMI increased the risk of being a smoker.

We aimed to systematically review the literature to examine the consistency of evidence exploring the relationship between paternal smoking and/or paternal overweight/obesity with childhood overweight/obesity.

https://doi.org/10.1007/s13679-025-00617-z

March 2025

A mixed methods study exploring food insecurity and diet quality in households accessing food clubs in England

Ziauddeen N, Taylor E,  Alwan NA, Richards F, Margetts B, Lloyd T, Disegna M, Mason N, Taheem R and Smith D

Food clubs are a higher-agency food aid intervention that charge a small fee for a set number of items. Some incorporate longer-term solutions such as budgeting support and cooking skills. These are in place in England to help address inadequate reliable access to affordable, nutritious food. We used a convergent parallel mixed methods design to describe the food insecurity households accessing food clubs experience and to assess diet quality and wellbeing at the start and after at least three months of using food clubs in the South of England.

https://doi.org/10.1186/s12889-025-22353-8

March 2025

Clusters and associations of adverse neonatal events with adult risk of multimorbidity: A secondary analysis of birth cohort data

John J, Stannard S, Fraser SDS, Berrington A, Alwan NA

Multimorbidity is commonly defined as the co-occurrence of two or more Long-Term Conditions (LTCs). This phenomenon is growing in prevalence , including amongst younger age groups, and represents a significant public health issue. 

An estimated one in three individuals will develop multimorbidity in their lifetimes. Multimorbidity results in higher rates of premature mortality, reduced quality of life, and greater demand on health services. Previous evidence has demonstrated that multimorbidity is a significant driver of costs in many health and social care systems, independent of biological factors such as advanced age. Multimorbidity also potentiates health inequalities; it is well established that the prevalence of multimorbidity is higher, and the age of onset is up to ten years earlier, in the most disadvantaged communities, and amongst certain ethnic minorities. It is therefore vital that risk factors of multimorbidity are identified to facilitate timely detection and management of susceptible individuals, and aid the development and implementation of preventative interventions .

Research has demonstrated that certain early-life characteristics are associated with multimorbidity in adulthood.

The effect of early life events on multimorbidity can be broadly explained by two main lifecourse epidemiological paradigms: the “critical period” theory, in which biological imprinting at important time-points, make an individual more susceptible to compromised health in adult life and; the “accumulation of risk” model, which states that cumulative adverse early-life events contribute to poor adult health. Both theories have potential relevance to the aetiology of multimorbidity, and have therefore been considered as a potential mechanism for this study.

It is plausible that events surrounding the birth of an individual represent an opportunity for early intervention, with the aim to prevent later-life multimorbidity. Yet, the association between multiple adverse neonatal events such as gestational age, birthweight, neonatal resuscitation, neonatal cyanosis, neonatal cerebral signs, duration to establishment of respiratory rate at birth, neonatal cephalohematoma, neonatal illnesses and breathing difficulties, and adult risk of multimorbidity is under-researched. Additionally, despite advancements in neonatal care in recent decades, the sizeable global burden posed by poor birth outcomes has persisted. Preterm birth rates have not seen a decline globally, constituting approximately 10% of all livebirths worldwide.

We hypothesised that an increased number of adverse neonatal events would be associated with a greater burden of multimorbidity across adulthood. By considering the outcome of multimorbidity at various ages between 34 and 46 years, we also investigated whether experiencing a greater number of adverse neonatal events at birth was associated with an earlier onset of multimorbidity.

https://doi.org/10.1371/journal.pone.0319200

March 2025

Exploring Long Covid Prevalence and Patient Uncertainty by Sociodemographic Characteristics Using GP Patient Survey Data

Woodrow M, Ziauddeen N, Smith D, Alwan NA

In the UK, the Office for National Statistics estimated in March 2024 that 2 million adults and children experience Long Covid (LC) (3.3% of the population), with 69% and 41% experiencing it for at least 1 and 2 years respectively and 19% reporting that LC limits their ability to undertake day to day activities ‘a lot’ . There is also evidence of inequalities in LC prevalence, with higher prevalence associated with being female, of older or middle age, having a higher body mass index (BMI) , smoking , and belonging to an ethnic minority group. Higher prevalence is also associated with greater deprivation . There is also unequal impact of the condition on people's lives and inequitable support for the condition. More research is needed to understand the extent of this inequality and the action needed to address it.

As a relatively novel condition, knowledge about LC is still in its infancy amongst researchers and health care professionals but there is even more lack of awareness, exacerbated by barriers and stigma, in the general population leaving unwell people unsure if they have LC. This high and unequal burden of illness from LC has significant implications for society in terms of the infrastructure of accessible diagnosis, support and treatment needed for people with LC.

The General Practice Patient Survey (GPPS) is an annual survey of GP-registered people aged 16 years+ in England, administered by Ipsos on behalf of NHS England. Established in 2007, it asks respondents about their experience of their local GP, other local NHS services and respondents' general health. In 2022 a new question was added that asked whether respondents had LC.

The aims of this study were to (1) explore prevalence of LC, (2) examine its potential sociodemographic and health characteristics and (3) explore factors associated with being unsure about having LC.

https://doi.org/10.1111/hex.70202

March 2025

 The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement.

Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM

Hepatitis C (HCV) is a blood-borne virus (BBV) that can cause severe liver scarring (known as cirrhosis) and primary liver cancer – most commonly hepatocellular carcinoma. There are now effective, widely available, well-tolerated oral treatments for HCV that have few contraindications and high rates of cure. In 2016, the World Health Organization (WHO) set a global target for the elimination of HCV by 2030 with elimination being defined as detection of 80% of prevalent cases and successful treatment in 90%. 

The identification of undiagnosed prevalent cases of HCV and incident infections is a major challenge for the HCV elimination programme. HCV is prevalent in socioeconomically deprived and marginalised groups, such as people who inject drugs (PWID), and most incident infections are occurring in this population. Therefore, specific programmes are required to increase testing and diagnoses in deprived and marginalised populations, including PWID. PWID do engage with opiate substitution therapy (OST) and needle and syringe programmes (NSPs) in community pharmacies, and PWID are known to develop strong and trusting relationships with their pharmacist. 

 Community pharmacies have been shown to be effective locations for HCV testing in PWID in multiple pilot studies, and pharmacy testing has been recommended in European guidelines for BBV testing. In 2020, NHS England (NHSE) commissioned a national advanced service for community pharmacies to perform HCV testing as part of the NHSE elimination strategy. However, there were significant differences between the NHSE commissioned service and the successfully published pilot services. 

The discrepancy between the success of the pilot services compared with the NHSE service suggests that the relative differences in service specification led to differential testing uptake. 

The aim of the I-COPTIC study is to define the characteristics of a successful community pharmacy HCV testing service to support future implementation.

https://doi.org/10.1016/j.puhe.2024.04.017

July 2024