Improving their living conditions may benefit both health and exam results, say researchers

Children living in substandard housing in England miss 15 more school days and achieve worse test scores in English and maths than their peers living in better quality housing, suggests research published online in the Journal of Epidemiology & Community Health.

Improving their living conditions—specifically reducing overcrowding and damp, and upgrading heating systems—may not only benefit their health, but also their grades,conclude the researchers.

One in 7 families in England live in homes that fail to meet the official decent homes standard, point out the researchers. Housing is a key determinant of child health, yet relatively little is known about how its quality may affect educational outcomes, particularly the number of missed school days and exam grades, they add.

To explore this further, the researchers drew on data for 8992 children, born between 2000 and 2002 participating in the nationally representative Millennium Cohort Study.

Housing quality at the age of 7 was calculated from 6 key indicators: accommodation type; floor level; lack of access to a garden; presence of damp; inadequate/no heating; and overcrowding.

Housing quality was linked to the percentage of missed school days and standardised test results in maths and English at the ages of 7, 11, and 16 in the National Pupil Database.

On average, children missed 5% (86 days) of compulsory schooling (years 1–11). And approximately 16% of them lived in poor quality housing, defined as meeting at least 2 of the 6 indicators.

After accounting for potentially influential factors, including parental educational attainment and ethnicity, analysis of the data showed that children living in poor quality housing missed more school days and achieved worse grades than children living in better quality housing.

These children missed nearly 1.5 more school days, on average, for each of the 11 years of compulsory schooling than their peers living in higher quality housing (based on 7272 children). Damp, overcrowding, and living in a flat were most strongly associated with missed schooling.

Test scores in maths and English during primary and secondary school were between 0.07 and 0.13 points (2-5%) lower for children living in poorer quality housing (based on 6741 children), mainly driven by overcrowding, and to a lesser extent, lack of central heating.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, added to which data on school absences or test results on at least one data collection point were missing for 10% of the participants.

Children exclusively in home schooling and attending private schools (7%) aren’t captured in the National Pupils Database. And housing conditions were subjectively assessed by parents rather than being objectively measured.

Nevertheless there are plausible explanations for the observed associations, suggest the researchers, with living in damp housing increasing the risk of respiratory illness.

“While study participants were not asked directly about the presence of mould, damp conditions are a major determinant of fungal growth which can in turn release hazardous spores, fragments, and microbial volatile organic compounds into indoor air,” they explain.

Overcrowding also creates an unfavourable environment for study, they add. “Crowded housing is linked to behavioural problems and to worse health in children…Living in crowded homes is linked to lower academic achievement due to noise, lack of study space, insufficient sleep, reduced concentration and added responsibilities (eg, childcare).”

They conclude: “Improving housing conditions, especially reducing damp and overcrowding, and updating heating systems and energy efficiency can have significant benefits.

“Given the magnitude of the problem in England, national and local public health and housing policies targeting these features of housing quality could improve children’s health and school outcomes across the country and narrow the health inequality gaps.”

The NHS could also save the £1.4 (€1.6, US$1.8) billion every year it spends on treatment associated with the effects of poor housing, they add.

16/12/2025

Notes for editors
Research: Housing quality and school outcomes in England: a nationally representative linked cohort study Doi: 10.1136/jech-2025-224495

Journal: Journal of Epidemiology & Community Health

External funding: Economic and Social Research Council

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational cohort study
Subjects: People

The post Living in substandard housing linked to kids’ missed schooling and poor grades first appeared on BMJ Group.

European/US stars seem to die around 4 years earlier than those not in the limelight
Effects of fame comparable to certain other health risks, suggest the researchers

Fame itself may be a critical factor in shortening singers’ lives beyond the hazards of the job—at least those in the UK/Europe and North America—suggests research published online in the Journal of Epidemiology & Community Health.

These stars seem to die around 4 years earlier, on average, than their peers who haven’t achieved celebrity status, and the effects of fame are on a par with certain other health risks, suggest the researchers.

Previously published research indicates that famous singers tend to die earlier than the general public. But it’s far from clear whether it’s fame itself, the demands of the music industry, or the lifestyle associated with being a musician, which contribute to this heightened risk, explain the researchers.

To shed more light on this conundrum, they retrospectively compared the risk of death in 648 singers, half of whom had achieved celebrity status and half of whom hadn’t.

Each of the 324 stars was matched for birth year, gender, nationality, ethnicity, music genre and solo/lead singer in a band status with their lesser known peers.

Most (83.5%) were male, and the average year of birth was 1949, but ranged from 1910 to 1975. Over half (61%) the singers were from North America, with the remainder from Europe/the UK. And most were White (77%), with only 19% being of Black and 4% of other or mixed ethnicities.

Most singers were in the Rock genre (65%), followed by R&B (14%), Pop (9%), New-Wave (6%), Rap (4%), and Electronica (2%). Over half (59%) the singers were in a band; 29% were solo artists; and 12% performed both solo and in a band.

The sample of famous singers was drawn from the Top 2000 Artists of All Time on acclaimedmusic.net, a database that aggregates global rankings based on published lists from music critics, journalists, and industry professionals, but not audience polls or sales data.

Only artists active after 1950 and before 1990 were included to gather sufficient tracking information on the risk of death by the end of December 2023.

Analysis of the data showed that, on average, famous singers survived until they were 75; less famous singers survived until they were 79.

While band membership was associated with a 26% lower risk of death compared with going it alone, the inclusion of this variable didn’t influence the overall effect of fame, as famous singers were still 33% more likely to die earlier than their less well known counterparts.

Only two (0.6%) of the stars achieved fame posthumously, and the heightened risk of death started only once fame had been achieved and remained significantly associated throughout the period of fame.

This suggests that the heightened risk of death isn’t attributable to baseline differences or to reverse causation, whereby earlier death contributes to fame, but that this risk emerges specifically after the attainment of fame, say the researchers.

“Together, the analyses indicate that an elevated risk emerges specifically after achieving fame, which highlights fame as a potential temporal turning point for health risks including mortality. Beyond occupational explanations, our findings suggest that fame adds further vulnerability within an already at-risk group,” they explain.

The heightened risk associated with fame is comparable to other known health risks, such as occasional smoking, which confers a heightened risk of death of 34%, they add.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that their study sample wasn’t global and was confined to singers, meaning that their observations might not apply to other regions of the world or to other domains of fame, such as acting or sport.

But a possible explanation for the findings may lie in “the unique psychosocial stress that accompanies fame, such as intense public scrutiny, performance pressure, and loss of privacy,” they suggest.

“These stressors may fuel psychological distress and harmful coping behaviours, making fame a chronic burden that amplifies existing occupational risk,” they add.

Fame brings with it significant financial security, a factor that is frequently associated with healthy ageing, while wealth is usually associated with a lower risk of premature death, they point out.

But they conclude: “Being famous appears so detrimental that it overrides any potential benefits associated with high socioeconomic status. Again, this highlights the increased vulnerability of famous individuals, suggesting a need for targeted protection and support for this population.”

25/11/2025

Notes for editors
Research: The price of fame? Mortality risk among famous singers Doi: 10.1136/jech-2025-224589

Journal: Journal of Epidemiology & Community Health

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Case-control study
Subjects: Musicians

About the journal
The Journal of Epidemiology & Community Health is one of 70 journals published by BMJ Group.
https://jech.bmj.com

The post Fame itself may be critical factor in shortening singers’ lives first appeared on BMJ Group.

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: Children

This press release draws on the raw, unedited manuscript accepted for publication.
The final version will be posted online on the journal’s homepage in due course.

The post Food stamp expansion in 2021 reduced odds of needy US kids going hungry first appeared on BMJ Group.

Likely stronger determinant of health than education, suggest researchers

Voting behaviour in elections is strongly linked to the future risk of death, and is likely a stronger determinant of health than education—considered a key influence on health—suggests research published online in the Journal of Epidemiology & Community Health.

Over the past several years, voting in national and local elections has increasingly been seen as a potential social determinant of health—the non-medical factors that influence health and wellbeing—explain the researchers.

And previously published research suggests that voters generally have better health than non-voters, but it’s not clear if electoral participation might also be a predictor of future death risk.

To explore this further, the researchers drew on electoral participation information in the 1999 parliamentary elections for the entire electorate of Finnish citizens living in mainland Finland and aged at least 30.

Turnout among this age group was 71.5% for men and 72.5% for women. In all, 3,185, 572 people (1,508,824 men; 1,676,748 women) were included in the study and their survival was tracked from 21 March 1999 (election day) to death or the end of 2020, whichever came first.

Between 1999 and 2020, 1,053,483 people died: 95,350 from external causes (accidents, violent and alcohol-attributable causes); 955,723 from other underlying causes; 2410 people whose cause of death wasn’t known were excluded from the final analysis.

Not voting was consistently associated with a 73% heightened risk of death from any cause among men and a 63% heightened risk of death among women.

After adjusting for education level (basic or unknown; secondary; or tertiary) this reduced to a 64% heightened risk among men and a 59% heightened risk among women.

The difference in the risk of death between voters and non-voters was larger than it was between those with basic and tertiary level education.

The association between voting participation and death was stronger for external causes of death rather than for other causes. And when adjusted for age, this risk was twice as high among both men and women who didn’t vote than it was among those who did.

The difference in the relative risk of death between voters and non-voters was strongest among men under 50. Among 75 to 94-year olds, women who didn’t vote had a higher risk of death than men who voted, whereas the reverse was true for younger age groups.

And among men in the lowest 25% of household income, the risk of death associated with not voting was 9–12% higher than it was for other income groups.

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge various limitations to their findings, including that some people might have wanted to vote, but were unable to do so, or simply chose not to vote.

Nevertheless, the fact that voting was more strongly associated with the risk of death than educational level “suggests a strong association between voting and mortality, given that a substantial education gradient in mortality is among the most robustly established sociodemographic mortality patterns,” they suggest.

“Voting, as a form of participation, is a type of social capital, which is linked to health benefits. In addition, voting may increase other forms of civic participation,” they explain.

“Health problems and related difficulties in functioning may also negatively affect many important prerequisites of participation, including enhancing resources, motivation to vote, and political mobilisation,” they add.

They conclude: “Information on voting may be useful in clinical settings – for example, abandonment of voting habits may be an early signal of significant health decline – and in monitoring population wellbeing, health, and health disparities. Additionally, a strong association between voting and mortality raises concerns about equal political representation.”

04/11/2025

Notes for editors
Research: Voting is a stronger determinant of mortality than education: a full- electorate survival analysis with 21-year follow-up Doi 10.1136/jech-2025-224663
Journal: Journal of Epidemiology & Community Health

External funding: European Research Council; Strategic Research Council of the Research Council of Finland

About the journal
The Journal of Epidemiology & Community Health is one of 70 journals published by BMJ Group.
https://jech.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Voting behaviour in elections strongly linked to future risk of death first appeared on BMJ Group.

Linked to 16% rise for each unit increase in dietary measure of inflammatory food intake 

A diet high in foods with the potential to promote low grade inflammation during pregnancy may raise that child’s risk of developing type 1 diabetes, suggests Danish research published online in the Journal of Epidemiology & Community Health.

This dietary pattern was associated with a 16% heightened risk for every unit increase in a dietary measure of inflammatory food intake, the findings show.

Type 1 diabetes is an autoimmune disorder characterised by the destruction of insulin-producing β-cells in the pancreas, necessitating lifelong insulin treatment.

New cases of type 1 diabetes have been rising steadily, increasing by an average of 3–4% every year, especially in developed nations, strongly suggesting a major role for environmental factors, note the researchers.

And since the immune system develops and establishes in early life, and to a certain degree before birth, there is a strong case for exploring the role of the mother’s diet during her pregnancy, especially as mounting evidence suggests that diet is a modifiable contributory factor to low grade systemic inflammation, they explain.

To explore this further, the researchers drew on pregnant women in The Danish National Birth Cohort (DNBC) (January 1996 to October 2002).

They calculated a score based on the inflammatory potential of the mother’s usual dietary intake (EDII score) in mid-pregnancy from a comprehensive food frequency questionnaire, covering 38 food groups (360 separate items), which was completed at around 25 weeks of pregnancy.

Foods that are often reported to have inflammatory properties include: red/processed meats; sugar sweetened drinks: commercial baked goods; refined grain products, such as white bread and pasta; deep fried foods; foods high in added sugar; and trans fats found in non-dairy creamers and some margarines.

In all, 67,701 mother-child pairs were included in the final analysis.

Information on type 1 diabetes diagnoses in the children was obtained through registry linkage to the Danish Registry of Childhood and Adolescent Diabetes. Some 281 (nearly 0.5%) developed the condition during an average tracking period of 17 years. Their average age at diagnosis was 10.

The mothers’ average EDII scores ranged from −5.3 to 4.1, with higher scores indicating higher dietary intake of inflammatory foods.

Higher EDII scores were associated with younger maternal age, lower alcohol consumption, shorter breastfeeding period, and less favourable socioeconomic circumstances. They were also associated with higher BMI (weight) and a tendency to smoke beyond the first 12 weeks of pregnancy.

There was no significant difference in total energy intake between those women with the highest and lowest EDII scores. But higher daily intake of red meats, dairy low fat, pizza, margarine, potatoes, low energy drinks, French fries, and savoury snacks was reflected in higher EDII scores.

On the other hand, higher daily intake of alliums (onions and garlic), tomatoes, whole grains, coffee, green leafy vegetables, fruit juice, dark meat fish, tea, and fruits was reflected in lower EDII scores.

The risk of a child’s type 1 diabetes was associated with their mother’s EDII score, rising by 16% for each unit increase in score up to the age of 18, after accounting for potentially influential factors. Put simply, 1 unit of EDII, which is one standard deviation of the distribution of EDII, corresponds approximately to going from the bottom 3rd to the top 3rd of the population.

This risk wasn’t affected by the child’s sex or weight at birth, but it did seem to be affected by the mother’s intake of gluten, and whether she smoked during her pregnancy.

A 10 g increase in estimated intake of gluten was associated with a 36% increase in risk.

This is an observational study, and as such, can’t establish cause and effect. And the researchers weren’t able to account for the child’s diet.

But they write: “A low-grade inflammatory state secondary to an altered immune cell profile, which triggers pro-inflammatory pathways, is increasingly acknowledged as a critical early-life factor influencing offspring health.”

They caution: “The precise mechanisms by which diet modulates the immune response remain elusive, although some clues can be offered for specific dietary components.”

They add: “Of particular note is the fact that three factors during mid pregnancy, a pro-inflammatory dietary pattern, gluten, and smoking, seemed to independently predict the child’s risk of type 1 diabetes. This suggests that mid-pregnancy may be a critical period during which the fetus is particularly susceptible to maternal lifestyle influences in relation to the individual’s later risk for developing type 1 diabetes during childhood or adolescence.”

02/07/2025

Notes for editors
Research: Association between a pro-inflammatory dietary pattern during pregnancy and type 1 diabetes risk in offspring: prospective cohort study Doi: 10.1136/jech-2024-223320

Journal: Journal of Epidemiology & Community Health

External funding: European Foundation for the Study of Diabetes Programme; Juvenile Diabetes Research Foundation; Innovation Fund Denmark; and March of Dimes.

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post ‘Inflammatory’ diet during pregnancy may raise child’s diabetes type 1 risk first appeared on BMJ Group.

These kids more likely to carry/use weapons and get on wrong side of the law by age of 17
Factors may explain nearly third of UK teen weapon issues + quarter of police contact cases

Living with persistent poverty and/or parental mental illness throughout childhood may double the risk of carrying and/or using a weapon and getting on the wrong side of the law by the age of 17, suggests research published online in the Journal of Epidemiology & Community Health.

These factors may account for nearly 1 in 3 cases of weapon use or carriage and more than a quarter of all police contact among 17 year olds, nationwide, estimate the researchers.

Youth crime and violence are common around the world, they note. In England and Wales, for example, around 104,400 first-time offenders were recorded in the criminal justice system in 2020, with 11% of them aged between 10 and 17.

As risk factors tend to cluster, the researchers set out to assess the extent to which early life exposure to poverty and family adversities might be associated with involvement in youth violence, crime, and contact with the justice system.

They drew on long term data from the representative UK Millennium Cohort Study for 9316 children whose exposure to family adversities and household poverty had been reported from birth to the age of 14.

When they were 17 the teens were asked, via questionnaire, if they had carried or used a weapon, such as a knife, and/or had been in contact with the police, to include being stopped and questioned, given a formal warning or caution, or being arrested.

The overall prevalence of weapon use/carriage was just over 6%, while that of police contact was 20%.

Analysis of the data showed that exposure to poverty and family adversity throughout childhood, either singly or combined, significantly increased the likelihood of violence and criminal justice involvement during their teenage years.

Nearly 1 in 10  (just under 9%) of the teens exposed to persistent poverty and poor parental mental health throughout childhood said they had carried or used a weapon while more than 1 in 4 (28%) of them had come into contact with the police.

This compares with 5% and just over 17%, respectively, of those who had not grown up in this environment.

Overall, those who had been exposed to persistent poverty and poor parental mental health throughout their childhood were twice as likely to carry/use a weapon and to report contact with the police, after accounting for potentially influential factors, including the mother’s ethnic background and educational attainment.

And as teens, they were more than 5 times as likely to be arrested or taken into police custody, 3 times as likely to be warned or cautioned by the police, and twice as likely to be stopped and questioned by them.

Based on these figures, and population estimates, the researchers estimate that persistent poverty and family adversities account for around a third (32%) of all cases of weapon use/carriage and nearly 1 in 4 (23%) cases of contact with the police among 17 year olds across the UK.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that there might have been other as yet unaccounted for influential factors.

But they write: “Our analysis provides strong evidence that persistent adversity throughout childhood is strongly associated with risk of involvement in violence and contact with police in adolescence, highlighting the negative effects of both accumulation and duration of childhood adversity.”

And they conclude: “Our findings suggest the need for a whole system approach and the implementation and strengthening of national and local policies focused on early intervention and support for families with low incomes and those experiencing family adversity, such as mental health problems.

“Addressing these issues comprehensively and syndemically earlier in the life course across multiple sectors, such as schools, communities, healthcare providers, and the law system, may reduce risk-taking behaviours in adolescence, ultimately contributing to better outcomes for young people.”

22/01/2025

Notes for editors
Research: Impact of family childhood adversity on risk of violence and involvement with police in adolescence: findings from the UK Millennium Cohort Study Doi: 10.1136/jech-2024-223168
Journal: Journal of Epidemiology & Community Health

External funding: NIHR Public Health Policy Research Unit (PH-PRU)

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Childhood poverty and/or parental mental illness may double teens’ risk of violence and police contact first appeared on BMJ Group.

Clocking up recommended nightly hours of sleep doesn’t offset these risks, study shows

An irregular sleep-wake cycle is associated with a heightened risk of major cardiovascular events, such as heart attack and stroke, even for those who clock up the recommended nightly hours of shut-eye, finds research published online in the Journal of Epidemiology & Community Health.

Most studies looking at the impact of sleep on health have focused on sleep length and less is known about the impact of sleep patterns, in particular the impact of irregular sleep—defined as variations in the time a person goes to sleep and wakes up.

To explore this further, the researchers drew on 72,269 people aged 40 to 79, taking part in the UK Biobank study, none of whom had any history of major cardiovascular events.

They wore an activity tracker for 7 days to record their sleep, the data from which were used to calculate each person’s Sleep Regularity Index (SRI) score.

People with an SRI score of more than 87 were considered to have a regular sleep pattern, while those with an SRI score of less than 72 were categorised as irregular sleepers. And those whose scores fell between this range were regarded as moderately irregular sleepers.

Incidents of cardiovascular death, heart attack, heart failure, and stroke over the next 8 years were collected from death registries and hospital records and used to calculate the risk of these events for each sleep pattern group.

After accounting for a range of potentially influential factors, such as age, physical activity levels, discretionary screen time, fruit, vegetable, and coffee intake, alcohol consumption, smoking, mental health issues, medication use, and shift work, irregular sleepers were 26% more likely to have a major cardiovascular event than those with a regular sleep wake-cycle, while moderately irregular sleepers were 8% more likely to do so.

More detailed analysis of the data showed that the relationship between decreasing SRI score and higher risk of events was almost linear, with a steeper reduction in risk at higher (better) SRI scores.

The recommended amount of nightly sleep is 7 to 9 hours for 18 to 64 year olds and 7 to 8 hours for those aged 65 and above. A greater proportion of regular sleepers met the recommended sleep quota than irregular sleepers: 61% vs 48%.

But when the impact of clocking up the recommended sleep quota was taken into account, the risk of a major cardiovascular event wasn’t offset in irregular sleepers who achieved this, although it was in moderately irregular sleepers.

This is an observational study, and as such, can’t establish cause and effect, and the researchers acknowledge various imitations to their findings.

While the study’s sample size was large, the UK Biobank may not accurately reflect the UK population. Sleep patterns were also assessed during a single week only. The activity tracker didn’t distinguish between quiet wakefulness and sleep, and the sleep algorithm used to calculate SRI scores didn’t take napping into account, only the longest period of sleep.

But the researchers nevertheless conclude that the findings suggest that irregular sleep is strongly associated with a risk of major adverse cardiovascular events in adults, irrespective of whether or not recommended sleep quotas are met.

“More importantly, our results suggest that sleep regularity may be more relevant than sufficient sleep duration in modulating MACE [major adverse cardiovascular event] risk,” they say.

They add: “Findings from this study suggest that more attention needs to be paid to sleep regularity in public health guidelines and clinical practice due to its potential role in cardiovascular health.”

27/11/2024

Notes for editors
Research: Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults Doi: 10.1136/jech-2024-222795
Journal: Journal of Epidemiology & Community Health

External funding: Australian National Health and Medical Research Council

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Irregular sleep-wake cycle linked to heightened risk of major cardiovascular events first appeared on BMJ Group.

Provision lowest in most deprived neighbourhoods in 3 of the 4 UK nations
Green space investment might be key preventive public health strategy, say researchers 

The provision of just 1% more green space in the most deprived urban neighbourhoods in 3 out of the 4 UK nations may be linked to around 40% fewer preventable deaths in these areas, finds research published online in the Journal of Epidemiology & Community Health.

Green space is unequally distributed in England, Scotland, and Northern Ireland, with the lowest amounts in the most deprived areas, the findings show, prompting the researchers to suggest that green space investment might be an important public health strategy for tackling health inequalities.

Spending time in green space, such as grassland, woodland, and parks, is not only associated with lower rates of death and ill health, and improved wellbeing, but also with environmental benefits, note the researchers.

In Europe, access to green space tends to be poorer in areas of deprivation. But data on the distribution of these spaces in disadvantaged urban neighbourhoods across the UK isn’t known, they add.

The researchers therefore wanted to investigate inequalities in the distribution of green space in both urban and rural areas (for comparison); and the association between its availability and numbers of preventable deaths in urban neighbourhoods in all 4 UK nations, stratified by level of deprivation.

They drew on local authority data, national statistics, the Index of Multiple Deprivation, and national land survey data, to calculate: the percentage of green space in urban and rural areas; population size and density; deprivation levels; and deaths from preventable causes—those that could be avoided through effective public health and primary prevention interventions.

They included 6791 defined geographical areas in England; 410 in Wales; 1279 in Scotland; and 890 in Northern Ireland.

The average percentage of green space was highest in Wales (45%), followed by Northern Ireland (24%), England (21%), and Scotland (16%). In all 4 countries, the average percentage of total green space in urban areas was significantly lower than that of rural areas.

Of the 4 nations, only in Wales was green space distributed equitably across neighbourhoods with differing levels of deprivation in both urban and rural areas.

In the other 3, the amount of green space was significantly associated with the number of preventable deaths among the most deprived urban areas.

In England, every 1% increase in green space in a defined geographical area was associated with 37% fewer annual preventable deaths.

In Scotland and Northern Ireland, a 1% increase in green space in a defined geographical area was associated with 37% and 41% fewer preventable deaths, respectively, over a period of 5 years.

“With the known health benefits of green space, this discrepancy may help to explain the wide health inequalities in urban areas in which the poorest and most vulnerable are most impacted,” suggest the researchers.

This is an observational study, precluding firm conclusions to be drawn about causal factors, and the researchers point to various limitations to their findings. These include assumed social and financial homogeneity of the geographical areas studied and the use of ‘land cover’ rather than ‘land use’ data.

“The unequal distribution of [green space] in urban areas demonstrates the need to target interventions at more deprived urban areas. Studies have shown that [green space] brings about greater benefit to those of lower socioeconomic position than those who belong to the more privileged groups, particularly in mental health and social integration,” they add.

“Although the study results show the association between lower number of preventable deaths and higher percentage of [green space] area, investment should not solely focus on increasing the existence of [green space] but also on [its] accessibility and quality,” they caution.

13/11/2024

Notes for editors
Research: Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation Doi: 10.1136/jech-2024-222485
Journal: Journal of Epidemiology & Community Health

External funding: UK Prevention Research Partnership

Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post More green space linked to fewer preventable deaths in most deprived areas of UK first appeared on BMJ Group.

Around 40% of postmenopausal hormone positive breast cancer cases may be linked to excess body fat, suggests Spanish research published online in the Journal of Epidemiology & Community Health.

This proportion is significantly higher than 1 in 10 such cases currently attributed to excess weight, using the widely used measure of body mass index (BMI), and indicates that the real impact of obesity on breast cancer risk has likely been underestimated, say the researchers.

The post Around 40% of postmenopausal hormone positive breast cancers linked to excess body fat first appeared on BMJ Group.

Adds to evidence for would-be mums to stub out smoking, say researchers

Even light smoking of just 1-2 cigarettes a day either before or at any time during pregnancy is significantly associated with major health problems in the newborn, finds research published online in the Journal of Epidemiology & Community Health.

The findings add to the evidence indicating that women hoping to become, or who are, pregnant should stub out smoking to protect their newborn’s health, say the researchers.

Deaths and serious health issues among newborns have fallen sharply, largely due to improvements in maternity care. But admission to a neonatal intensive care unit is not uncommon, added to which any neurodevelopmental deficits may persist into adulthood, say the researchers.

In the USA, around 1 in 10 pregnant women smokes, and it’s well known that smoking during pregnancy is associated with heightened risks of preterm delivery, low birth weight, and restricted growth while in the womb.

But less well known, is whether the timing and intensity of maternal cigarette smoking may affect the newborn. This is important because many women believe it’s OK to smoke cigarettes before conception or in the first 3 months of pregnancy, or that light smoking is unlikely to be harmful, point out the researchers.

To explore this further, they drew on national birth certification data from the US National Vital Statistics System (NVSS) from 2016 to 2019, which included a total of 15,379,982 registered live births.

After excluding multiple births, women who had high blood pressure or diabetes before pregnancy, or without information on cigarette smoking in the 3 months before and during their pregnancy, 12,150,535 mother-infant pairs was available for data analyses.

Of these pairs, just over 9%, 7%, 6%, and just under 6% of the mums reported smoking cigarettes before pregnancy, and in the first, second, and third trimester, respectively.  Smoking intensity was classified as  0, 1–2, 3–5, 6–9, 10–19, and 20 or more cigarettes/day.

The women who smoked had more risk factors for neonatal health issues: they tended to be younger, non-Hispanic White, unmarried, and obese, and to have low educational attainment, more previous births, and fewer attendances for prenatal care.

Major neonatal health issues were defined as: the need for assisted ventilation immediately after delivery; assisted ventilation for more than 6 hours; NICU admission for continuous mechanical ventilation; surfactant replacement therapy; suspected sepsis; and seizure or serious neurological problems.

The prevalence of all these issues was just under 9.5%.

Smoking either before pregnancy or in each of the 3 trimesters of pregnancy was associated with an increased risk of major neonatal health issues, either separately or combined, after adjusting for potentially influential factors, including age, ethnicity, and weight (BMI) before pregnancy.

The risk of more than one major neonatal health issue if the mother smoked before pregnancy was 27% higher, and 31-32% higher if she smoked at any time during her pregnancy.

And for individual components, the risk of admission to neonatal intensive care, for example, was 24% higher if the mother smoked before pregnancy, and 30-32% higher if she smoked during her pregnancy.

As to timing, women who smoked only before pregnancy or only during the first, second, or third trimester had higher odds of their newborn experiencing more than one major health issue than women who didn’t smoke at any point.

After adjusting for potentially influential factors, these odds were, respectively, 12%, 23%, 40%, and 21% higher.

Even light smoking—1–2 cigarettes  a day—was associated with a heightened risk of major neonatal health issues.

For example, among mothers who smoked 1–2 cigarettes a day before pregnancy, the risk was 16% higher, rising to 31% higher if they smoked 20 or more a day.

And the risk of admission to intensive care for their newborn was 13% higher with a daily tally of 1-2 cigarettes, rising to 29% higher for 20 or more cigarettes.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, added to which the data before pregnancy didn’t differentiate between those who smoked at any point in the preceding 3 months and those who smoked throughout, acknowledge the researchers. Nor was there any information on second hand exposure to tobacco smoke.

Nevertheless, they conclude that their findings suggest “that there is no safe period and no safe level of cigarette smoking shortly before or during pregnancy.” and “re-emphasise the need to prevent smoking initiation for non-smokers and to promote smoking cessation for smokers.”

21/08/2024

Research: Maternal cigarette smoking before or during pregnancy increases the risk of severe neonatal morbidity after delivery: a nationwide population based retrospective cohort study
Journal: Journal of Epidemiology & Community Health

External funding: None declared

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

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