bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP64 The Contribution of Media Analysis to the Evaluation of Environmental Interventions: The Commuting and Health in Cambridge Study
Authors: Kesten J M K , Cohn S C , Ogilvie D O 
Published: September 2013

BackgroundThe media has the potential to define the terms in which we think about the world, both reflecting and constructing reality. Media content can consequently increase people’s awareness of, and shape their interactions with, public health interventions. As part of a mixed-method, natural experimental evaluation of the travel, physical activity and health impacts of the Cambridgeshire Guided Busway (CGB), this paper analyses related print and social media (Twitter) to understand how the new infrastructure has become embedded in public discourse and the implications for evaluation.MethodsUsing systematic searches, newspaper articles from 2004 to 2012 were retrieved from the Lexis Nexus database and tweets from 2008 to 2012 were identified from an online archive. An inductive thematic analysis was performed and the interaction between Twitter and print media was explored by examining how print coverage was reconceptualised.ResultsThe media facilitated the promotion of the CGB to non-bus users, for example by appealing to those who perceived buses to be uncomfortable through the publicising of features such as leather seats, free WiFi and air-conditioning. Passenger numbers and a transport award for innovation were publicised as markers of the interventions success. The process by which the CGB then became part of people’s everyday lives was reflected in references to shared experiences and familiarisation with novel aspects, such as railway-style ticket machines. Initial impressions were important, and if the anticipated immediate benefits — such as reduced journey times — were not realised, some users reported reluctance to use the service. The walking and cycling route alongside the busway received less media attention than the new bus service. The lack of lighting was defended by stakeholders as environmentally friendly, but criticised by the public, on Twitter and in print, on safety grounds. The Twitter content (including re-tweets and conversations) decoded the print media in a variety ways. By repeating, opposing and supporting messages, Twitter users frequently reconceptualised official media, for example using humorous puns such as ‘the mis-guided busway’. Through this process, print communication was often recontextualised to convey a different meaning.ConclusionMedia content offers an indication of the public discourse surrounding an issue and can inform public attitudes, beliefs and behaviours. These findings contribute to further evaluation of the CGB, informing hypotheses about how the local population interact with the infrastructure, which will be explored further in interviews. Future natural experimental studies should acknowledge the media’s contribution to people’s experience, interpretation and acceptance of environmental interventions.
PP72 Does Investment in the Health Sector Promote or Inhibit Economic Growth?
Authors: Reeves A , Basu S , McKee M , Meissner C , Stuckler D 
Published: September 2013

BackgroundIs existing provision of health services in Europe affordable during the recession or could cuts damage economic growth? This debate centres on whether government spending has beneficial or perverse effects on economic growth. We assessed the return on government investment by estimating the “fiscal multiplier” (number of PPP dollars returned in economic growth for each PPP $1 government spending).MethodsCross-national data on government expenditure among 25 EU countries from 1995 to 2007 were used to estimate fiscal multipliers using fixed-effects regression.ResultsThe multiplier for total government spending was 1.61 (95% CI 1.37, 1.86). Results ranged widely across sectors, from -9.8 for defence (-16.7, -3.0) and 0.06 for economic affairs including bailouts (-0.71, 0.84) to 2.9 for social protection spending (1.9, 3.8) and 4.3 for health (2.5, 6.1). The degrees of domestic absorption of investment explain these differences. Tradable components of government spending, like defence, are linked to significantly more negative trade balance (β = -2.87, p = 0.02), whereas non-tradable areas of the budget, including health and education, had no such association (peducation = 0.22; phealth = 0.21).ConclusionGovernment spending on health may have short-term effects that make recovery more likely.
OP20 The Effects of Social Mobility on Blood Pressure at Ages 50 and 60 years- In the Newcastle Thousand Families Study
Authors: Howe N L , Mann K D , Pearce M S 
Published: September 2013

BackgroundMany studies have suggested an association between early life circumstances and adult health. Relatively few studies have explored the effects on health of social mobility, the movement of an individual through social classes throughout their lifecourse. This study aimed to examine the effect of social mobility on blood pressure at age 50 and 60 years.MethodsUsing data from the Newcastle Thousand Families study, a prospective birth cohort, linear and logistic regression examined the potential association between social mobility, sex, Body Mass Index (BMI), smoking status, physical activity and hypertensive medication upon systolic and diastolic blood pressures at age 50 and 60 years.ResultsUpward social mobility was associated with decreased blood pressure, whilst downward mobility was associated with increased blood pressure, compared to socially stable individuals. Social mobility between 25-60 years significantly predicted systolic (P = 0.042) and diastolic (P = 0.041) blood pressure at age 50 years. Social mobility between 25-60 years was a significant predictor of systolic blood pressure (P = 0.044) after adjusting for sex, and diastolic blood pressure (P = 0.002), after adjusting for smoking status but was not significant after adjustment for BMI and physical activity. Social mobility between 50-60 years was significantly associated with high blood pressure at age 50 years (P = 0.009).ConclusionSocial mobility between certain life stages may be predictive of blood pressure in later life. However, blood pressure is also influenced, to a greater extent, by confounding factors such as BMI.
OP22 Effectiveness and Equity Impact of Town-Wide Cycling Investment in England: A Longitudinal, Controlled Natural Experimental Study
Authors: Goodman A , Panter J , Sharp S , Ogilvie D 
Published: September 2013

BackgroundIn England, six Cycling Demonstration Towns received substantial, town-wide cycling investment from 2005 to 2011, as did 12 Cycling Cities and Towns from 2008 to 2011. The initiatives included a mixture of capital investment (e.g. cycle lanes, cycle parking) and revenue investment (e.g. promotional activities, cycle training). We examined the effects of these investments on the prevalence of cycling, walking and driving to work and whether and how those effects differed by socio-economic deprivation.MethodsThis controlled before-after natural experimental study used data on travel to work from successive decennial English censuses up to and including 2011. Our outcomes were the proportion of commuters reporting cycling, walking and driving as their usual, main mode of travel to work (‘commute modal share’). We measured pre-post changes among commuters living in the 18 intervention towns and compared these to changes in three comparison groups (matched towns, unfunded towns and a national comparison group) using the difference-of-differences method. We used the Indices of Multiple Deprivation to measure area deprivation at Lower Super Output Area level and used random-effects meta-analysis to compare effects across towns.ResultsAmong 1.3 million commuters in the 18 intervention towns, the commute modal share for cycling rose from 5.8% in 2001 (pre-intervention) to 6.6% in 2011 (post-intervention). This represented a significant increase relative to all three comparison groups (e.g. difference-of-differences 0.64 percentage points (95% CI 0.56, 0.73) for intervention vs. matched towns). Walking to work also increased significantly in intervention towns versus comparison towns, while driving to work declined. These changes were observed across all fifths of area deprivation, with larger changes in deprived areas relative to comparison groups or national trends. There was, however, substantial heterogeneity between towns, with the overall positive effects being driven by large increases in a few large towns. The pooled town-level effect estimates were therefore non-significant (e.g. difference-of-differences 0.23 (-0.31, 0.8) for intervention vs. matched towns).ConclusionThe proportion of commuters cycling to work has increased significantly in the intervention towns, while the proportion driving to work has decreased. The distribution of these changes appears relatively equitable, with the observed socio-economic differences being smaller than would otherwise have been expected given unfavourable background trends. The heterogeneity in effects between towns indicates uncertainty regarding the likely impact of comparable investment in future towns. Nevertheless these results support the case for considering and evaluating further town-wide cycling investment.
OP24 Are Fast Food Outlets Concentrated in more Deprived Areas? A Geo-Statistical Analysis of an Urban Area in Central England
Authors: Rudge G M , Suglani N , Saunders P , Middleton J 
Published: September 2013

BackgroundThe concept of an ‘obesogenic environment’ a term first used in 1997 has become embedded in Public Health and health geography research. Research suggests that deprived populations in Britain not only have worse access to sources of affordable, healthy foodstuffs, but they also appear to be more exposed to take-away outlets offering cheap, energy-dense food. However measuring the relationship between socio-economic factors and food geography is methodologically complex. This observational study has two aims. Firstly, to describe the availability of pre-prepared hot food in a large urban population, with reference to walk-time geography and secondly, to explore the association between access to take-away outlets and neighbourhood deprivation.MethodsUsing Geographical Information System (GIS) software, we measured access to fast food outlets from a large number of randomly generated points (n = 3803) in residential areas of two Local Authorities in central England. Two regression models were built. One modelled the relationship between deprivation and walking distance to the nearest outlet and the other modelled the relationship between deprivation and the number of outlets within a 640 metre ‘short walk’. Adjustments were made for interactions, road connectivity and population density.ResultsAfter adjustment for other variables, we found a statistically significant association (p < 0.001) between deprivation and fast food accessibility. Points in poorer neighbourhoods were closer to an outlet and had a greater density of outlets within a short walking distance. The effect size was modest however. Adjusting for other variables, our model predicted points at the 75thcentile of deprivation were about two minutes closer to the nearest outlet by foot, compared to points at the 25thcentile of deprivation (467 m, lcl = 455m, ucl = 480 m compared to 603 m, lcl = 588 m, ucl = 618 m). In the density analysis, our model predicts that there will be fewer than one outlet in a 640 metre walk where deprivation is at the 25th centile (0.84, lcl = 0.78, ucl = 0.91) and at least one in the same radius at the 75thcentile (1.41, lcl = 1.34, ucl = 1.48).ConclusionMany Local Authorities, including those in this study, have policies to restrict the growth of take-away outlets, especially near to schools. However we concluded that the existing food landscape already has an abundance of outlets and all neighbourhoods both deprived and less deprived have a large choice and ready access. This calls into question how effective planning laws will be in modifying the food environment.
OP27 Marital Status and Ischaemic Heart Disease: The Prospective Million Women Study
Authors: Floud S , Cairns B , Balkwill A , Reeves G , Green J , Beral V 
Published: September 2013

BackgroundBeing married is known to decrease the risk of all cause and cardiovascular mortality for men, but it is not clear if marriage confers a similar benefit for women. In addition, few studies have examined marital status in relation to both mortality and disease incidence to determine whether the beneficial effects of marriage influence the aetiology or prognosis of disease.MethodsA total of 747,532 women (mean age: 59.8, SD 4.9), without previous heart disease, stroke or cancer, were followed prospectively for an average of 6.1 years for hospital admissions and deaths. We used Cox regression models to calculate relative risks for the first ischaemic heart disease (IHD) event and for IHD deaths comparing married women to unmarried women, adjusting for age, region of residence, socio-economic status, health-related behaviours, social support, depression and self-rated health. We also calculated relative risk of subsequent death in participants whose first IHD event was a hospital admission (n = 19,506, mean follow-up 2.7 years).ResultsAt baseline, 2000-2003, 81% of the sample was married or living with a partner. Over follow-up, there were 20,458 first IHD events (19,572 non-fatal and 886 fatal), and among those whose first event was a hospital admission there were 407 deaths. Married women had lower rates of smoking and physical inactivity, were less deprived, and less likely to rate their health as poor. In women who had no prior hospital admissions for IHD, married women had a 34% lower risk of IHD death as a first event than unmarried women (p < 0.001), but no significantly decreased risk of non-fatal hospital admission for IHD. Among the women whose first IHD event was a (non-fatal) hospital admission, married women did not have a significant reduction in subsequent mortality.ConclusionBeing married or living with a partner appears to reduce the risk of death from IHD for women, which is not fully explained by health-related behaviours or by socio-economic status.
OP28 Trends in Mortality from Stroke, and Stroke Subtypes, in the Oxford Region 1979-2011
Authors: Seminog O O , Goldacre R , Goldacre M J 
Published: September 2013

BackgroundA decline in mortality rates from stroke has been observed in many industrialised countries in recent decades. We were interested in whether any of the observed decline in stroke, and its subtypes, might be artefactual rather than real. In particular, we wanted to determine whether any of the trends over time might be attributable to shifts in death certification practice between underlying cause and contributory cause, and/or shifts over time between certification of specific subtypes (haemorrhagic and ischaemic stroke) and stroke without specification of type.MethodsWe analysed mortality data from the former Oxford NHS region 1979–2011. This has a longer run of multiple-cause coded mortality data than all-England mortality (though findings from the latter will also be shown). We calculated age-standardised rates, presented as mortality rates per million population, in each year from 1979–2011 and in grouped years for periods defined by national changes to the rules for selection of underlying cause (the rules changed in 1984, 1992 and 2001).ResultsMortality rates based on any mention of stroke on the death certificate, and on underlying cause, showed broadly similar trends. Mortality rates for each code for stroke – ischaemic, haemorrhagic and ‘unspecified’ – and for stroke overall fell at a broadly similar rate between 1979–1992. Thereafter, trends diverged. The average annual rate for mortality in men from ischaemic stroke in 2001–2011, at 72.7 per million, was 11% lower than that in 1993–2000 at 84.2. The corresponding rates for haemorrhagic stroke were 93.6 and 92.7, i.e. they did not fall at all. By contrast, the average annual rate for stroke ‘unspecified’ in men was 355.9 in 2001–11 which was 56% lower than the rate of 600.8 in 1993–2000. Stroke mortality, overall, fell from 768.1 to 504.5 between 1993–2000 and 2001–2011. In recent years, when national multiple-cause coding data were available, national trends were similar to those in Oxford in these respects. Rates for women will also be shown (they exhibited the same pattern).ConclusionThere have been substantial changes in certification practice with a shift in recent years away from specifying stroke type. Studies of trends in mortality from ischaemic stroke alone, or haemorrhagic stroke alone, without being put into the broader context of all stroke, would be seriously misleading. They would suggest a levelling off of the decline in ischaemic and haemorrhagic stroke mortality in recent years which is, in fact, an artefact of certification and coding practice.
OP03 Assessing the Evidence Base of Tobacco Industry Submissions to Public Consultations: The case of ‘plain Packaging’ of Tobacco Products in the UK
Authors: Hatchard J , Fooks G J , Evans-Reeves K A , Gilmore A 
Published: September 2013

BackgroundThe UK’s public consultation on ‘plain packaging’ of tobacco products generated an unprecedented volume of responses. Given the track record of the tobacco industry’s misuse of science to oppose policy change, and the fact that plain packaging has only recently been introduced in a single jurisdiction – Australia, December 2012 – how can policymakers weigh up evidence submitted to them? In this paper, the authors deliver an analysis of the relevance and quality of evidence on ‘plain packaging’ submitted to the UK Department of Health by the UK’s four largest tobacco companies to support their argument that plain packaging will not meet associated public health objectives for disease prevention.MethodsWe conducted a case-study based comparative analysis of the quality of evidence cited in tobacco industry submissions consultation with that presented in favour of ‘plain packaging’ in a ‘Systematic Review’ of the literature. We coded each piece of evidence for relevance of subject matter and three quality criteria - funding source, primary or secondary research and peer-review status – and compared the relevance and quality of the two bodies of evidence.ResultsWe identified 112 pieces of evidence which present arguments about whether or not plain packaging will influence smoking behaviour – 65 from industry submissions, and 37 from the ‘Systematic Review’. Our preliminary findings are that the tobacco industry cited 10 sources of evidence which critique the evidence for ‘plain packaging’. These were funded by the tobacco companies and were not peer-reviewed. The tobacco companies cited a further 55 sources of new evidence, 34 presenting primary research. Of these 34, 2 related directly to ‘plain packaging’, one of which was funded by the tobacco industry and 14 of the 34 appeared in peer-reviewed journals. In contrast, all of the 37 ‘Systematic Review’ papers were funded independently of the tobacco industry and presented primary research directly related to plain packaging. 22 of these reports appeared in peer-reviewed journals.ConclusionOur preliminary findings suggest that evidence cited by the tobacco industry to oppose ‘plain packaging’ is, overall, not as relevant or robust as the growing body of evidence in favour of this regulatory proposal. We propose that an evidence assessment framework, based on four criteria – relevance of research, independence of funding, nature of research and peer-review may offer a structure by which policy-makers can make an assessment of the evidence base of submissions to public consultations, especially where response volumes are high.
OP31 Is Excess Mortality in Glasgow an Artefact of Inadequate Control for Deprivation: A Case-Control Study
Authors: Dundas R , Ralston K , Walsh D , Leyland A H 
Published: September 2013

BackgroundScotland experiences higher mortality than the rest of Western Europe with Glasgow experiencing higher mortality than the rest of Scotland. This excess persists even when controlling for socio-economic status and levels of deprivation. Moreover, available measures of deprivation have accounted for less of the Glasgow excess over last 30 years. Many theories have been put forward to account for these differences and a recent review identified seventeen hypotheses. One hypothesis, investigated here, was an artefact of inadequate control for deprivation.MethodsPrevious analyses of Glasgow’s ‘excess’ within Scotland have been based on comparison with nationally derived deprivation groupings (e.g. quintiles, deciles). Glasgow’s unique deprivation profile in comparison to the rest of Scotland renders such approaches problematic. Our approach, therefore, is as follows: small area geographies (datazones) were ranked by the Scottish Index of Multiple Deprivation (SIMD) income domain. Using a case control design datazones in Glasgow (cases) were matched with the closest non Glasgow datazone ranked above and below (controls). Geocoded mortality and population data were available for all deaths by age and sex for 2000-2002. Age-standardised all-cause mortality rates were calculated for men and women between the ages of 0–64, and for all ages. Age-standardised mortality rates by sex were compared for cases and matched controls for each quintile of deprivation.ResultsMen in the 3 most deprived quintiles in Glasgow experienced higher levels of mortality compared to both the nearest non-Glasgow datazones and all non-Glasgow datazones within the quintile. Excess mortality was reduced for the 2 most affluent quintiles. The pattern was broadly similar for women, with the excess reduced for the 3 most affluent quintiles. The age-standardised mean mortality rate for men aged 0–64 in Glasgow in the most deprived quintile was 769 per 100,000. The corresponding rate for all non-Glasgow datazones was 582 per 100,000. The mortality rate for the control group was 688 per 100,000, suggesting a substantially smaller excess. Using this case-control approach, the excess is reduced by 57% in the most deprived quintile. In the second most deprived quintile it is reduced by 15%. The corresponding results for women are reductions of 57% (most deprived quintile) and 47% (second most deprived quintile).ConclusionUsing national population and mortality data, the excess mortality in Glasgow in the most deprived area is halved by means of a closer control for deprivation. Explanations are still required for the remaining excess suggesting it is only partly artefactual.