SummaryBackgroundThe built environment might be associated with development of obesity and related disorders. We examined whether neighbourhood exposure to fast-food outlets and physical activity facilities were associated with adiposity in UK adults.MethodsWe used cross-sectional observational data from UK Biobank. Participants were aged 40–70 years and attended 21 assessment centres between 2006 and 2010. Using linked data on environments around each participant's residential address, we examined whether density of physical activity facilities and proximity to fast-food outlets were associated with waist circumference, body-mass index (BMI), and body fat percentage. We used multilevel linear regression models adjusted for potential confounders, and conducted several sensitivity analyses.FindingsComplete case sample sizes were 401 917 (waist circumference models), 401 435 (BMI), and 395 640 (body fat percentage). Greater density of physical activity facilities within 1000 m of home was independently associated with smaller waist circumference and lower BMI and body fat percentage. Compared with people with no nearby facilities, those with at least six facilities close to home had 1·22 cm smaller waist circumference (95% CI −1·64 to −0·80), 0·57 kg/m2 lower BMI (−0·74 to −0·39), and 0·81 percentage points lower body fat (−1·03 to −0·59). Living further from a fast-food outlet was weakly associated with waist circumference and BMI, mostly among women. Compared with people living fewer than 500 m from a fast-food outlet, those living at least 2000 m away had 0·26 cm smaller waist circumference (−0·52 to 0·01).InterpretationThis study shows strong associations between high densities of physical activity facilities and lower adiposity for adults in mid-life. We observed weaker associations for access to fast food, but these are likely to be underestimated owing to limitations of the food environment measure. Policy makers should consider interventions aimed at tackling the obesogenic built environment.FundingCommonwealth Scholarship Commission, Wellcome Trust Institutional Strategic Support Fund.

No abstract

This study demonstrates that strong adherence and SVR with DAAs is achievable, with appropriate supports, even in the context of substance use, and complex health/social issues.

Background: Observational studies are necessary to assess the impact of population screening on breast cancer mortality. While some ecological studies have notably found little or no association, case-control studies consistently show strong inverse associations, but they are sometimes ignored, perhaps due to theoretical biases arising from the study design. We conducted a case-control study of breast cancer deaths in Western Australia to evaluate the effect of participation in the BreastScreen Australia program, paying particular attention to potential sources of bias, and undertook an updated meta-analysis of case-control studies.Methods: Our study included 427 cases (women who died from breast cancer), each matched to up to 10 controls. We estimated the association between screening participation and breast cancer mortality, quantifying the effect of potential sources of bias on our findings, including selection bias, information bias, and confounding. We also conducted a meta-analysis of published case-control studies.Results: The OR for participation in the Western Australian BreastScreen program in relation to death from breast cancer was 0.48 [95% confidence interval (CI), 0.38-0.59; P < 0.001]. We were unable to identify biases that could negate this finding: sensitivity analyses generated ORs from 0.45 to 0.52. Our meta-analysis yielded an OR of 0.51 (95% CI, 0.46-0.55).Conclusions: Our findings suggest an average 49% reduction in breast cancer mortality for women who are screened. In practice, theoretical biases have little effect on estimates from case-control studies.Impact: Case-control studies, such as ours, provide robust and consistent evidence that screening benefits women who choose to be screened. Cancer Epidemiol Biomarkers Prev; 21(9); 1479-88. Ó2012 AACR.

We found strong evidence of healthier fruit and vegetable purchasing in households located in areas where the proportion of food stores that were healthy was greater. Policies aimed at improving the balance between healthy and unhealthy stores within areas may therefore be effective in promoting greater consumption of fruit and vegetables.

Evidence about the mental health consequences of unaffordable housing is limited. The authors investigated whether people whose housing costs were more than 30% of their household income experienced a deterioration in their mental health (using the Short Form 36 Mental Component Summary), over and above other forms of financial stress. They hypothesized that associations would be limited to lower income households as high housing costs would reduce their capacity to purchase other essential nonhousing needs (e.g., food). Using fixed-effects longitudinal regression, the authors analyzed 38,610 responses of 10,047 individuals aged 25-64 years who participated in the Household, Income, and Labour Dynamics in Australia (HILDA) Survey (2001-2007). Respondents included those who remained in affordable housing over 2 consecutive waves (reference group) or had moved from affordable to unaffordable housing over 2 waves (comparison group). For individuals living in low-to-moderate income households, entering unaffordable housing was associated with a small decrease in their mental health score independent of changes in equivalized household income or having moved house (mean change = -1.19, 95% confidence interval: -1.97, -0.41). The authors did not find evidence to support an association for higher income households. They found that entering unaffordable housing is detrimental to the mental health of individuals residing in low-to-moderate income households.

Background: Initial reports suggest that ethnic minorities may be experiencing more severe coronavirus disease 2019 (COVID19) outcomes. We therefore assessed the association between ethnic composition, income deprivation and COVID19 mortality rates in England. Methods:We performed a cross-sectional ecological analysis across England's upper-tier local authorities. We assessed the association between the proportion of the population from Black, Asian and Minority Ethnic (BAME) backgrounds, income deprivation and COVID19 mortality rates using multivariable negative binomial regression, adjusting for population density, proportion of the population aged 50-79 and 80+ years, and the duration of the epidemic in each area.Findings: Local authorities with a greater proportion of residents from ethnic minority backgrounds had statistically significantly higher COVID19 mortality rates, as did local authorities with a greater proportion of residents experiencing deprivation relating to low income. After adjusting for income deprivation and other covariates, each percentage point increase in the proportion of the population from BAME backgrounds was associated with a 1% increase in the COVID19 mortality rate [IRR=1.01, 95%CI 1.01-1.02]. Each percentage point increase in the proportion of the population experiencing income deprivation was associated with a 2% increase in the COVID19 mortality rate [IRR=1.02, 95%CI 1.01-1.04]. Interpretation:This study provides evidence that both income deprivation and ethnicity are associated with greater COVID19 mortality. To reduce these inequalities, Government needs to target effective control and recovery measures at these disadvantaged communities, proportionate to their greater needs and vulnerabilities, during and following the pandemic.

Housing tenure sits at the heart of much academic and policy literature across many post-industrial countries, and, while debate is often centred on promoting tenure choice, surprisingly little is known of the underlying ways that the tenure chosen can affect health. While population characteristics tend to vary between tenure types, this largely reflects the forces of broader social and economic selection into those tenures. This paper examines what identifiable effect tenure has upon the mental health of individuals, over and above the characteristics of selection. The analysis is based upon 40 828 responses of 10 245 individuals in the Australian working-age population who participated in the Household, Income and Labour Dynamics in Australia study between 2001 and 2007. It is found that, while mental health varies significantly between tenure types, once tenure population differences are accounted for there is little evidence of an intrinsic relationship between tenure and mental health.Emma Baker is in the