Publications by year
Hansford KM, Gillingham EL, Vaux AGC, Cull B, McGinley L, Catton M, Wheeler BW, Tschirren B, Medlock JM (2023). Impact of green space connectivity on urban tick presence, density and Borrelia infected ticks in different habitats and seasons in three cities in southern England. Ticks and Tick-borne Diseases, 14(2), 102103-102103.
Hansford KM, McGinley L, Wheeler BW, Tschirren B, Medlock JM
(2023). Ixodes ricinus density, Borrelia prevalence and the density of infected nymphs along an urban-rural gradient in southern England. Zoonoses Public Health
Ixodes ricinus density, Borrelia prevalence and the density of infected nymphs along an urban-rural gradient in southern England.
Ticks are found across a range of habitats, with woodland being particularly important for high densities and prevalence of Borrelia infection. Assessments of risk in urban woodland can be difficult if there are low densities and small sample sizes for Borrelia prevalence estimates. This study targeted six urban woodlands with established tick populations, as well as six woodlands in peri-urban zones and six woodlands in rural zones in and around the cities of Bath and Southampton, in the South of England. Nymph densities were estimated, and 100 nymphs were tested from each of the 18 woodlands studied. Ixodes ricinus ticks were found in all woodlands surveyed, and overall density of nymphs (DON) per 100 m2 was 18.17 in urban woodlands, 26.0 in peri-urban woodlands and 17.67 in rural woodlands. Out of 600 nymphs tested across urban woodlands, 10.3% were infected with Borrelia. The same proportion of nymphs collected in rural woodlands were positive for Borrelia. In peri-urban woodlands, 10.8% of nymphs tested positive. Across both cities combined, density of infected nymphs (DIN) was 2.73 per 100 m2 in peri-urban woodland, 1.87 per 100 m2 in urban woodland and 1.82 per 100 m2 in rural woodland. Overall, DON, Borrelia prevalence and DIN did not differ significantly along an urban-rural gradient. This suggests the risk of Lyme borreliosis transmission could be similar, or perhaps even elevated in urban woodland if there is higher public footfall, subsequent contact with ticks and less awareness of the risks. This is particularly important from a public health perspective, as Borrelia garinii dominated across the gradient and this genospecies is linked to neuroborreliosis. Abstract
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Jones L, Anderson S, Læssøe J, Banzhaf E, Jensen A, Bird DN, Miller J, Hutchins MG, Yang J, Garrett J, et al (2022). A typology for urban Green Infrastructure to guide multifunctional planning of nature-based solutions. Nature-Based Solutions, 2, 100041-100041.
Thompson DA, Geary RS, Rowney FM, Fry R, Watkins A, Wheeler BW, Mizen A, Akbari A, Lyons RA, Stratton G, et al (2022). Cohort Profile: the Green and Blue Spaces (GBS) and mental health in Wales e-cohort. International Journal of Epidemiology, 51(5), e285-e294.
(2022). Ecology and Public Health Risk of Ixodes ricinus (Acari: Ixodidae) in Urban Green Space.
Ecology and Public Health Risk of Ixodes ricinus (Acari: Ixodidae) in Urban Green Space.
Lyme borreliosis is the most common tick-borne disease reported across Europe and North America. Intrinsically linked to the distribution of key tick vector species, it is important to better understand ecological factors that may result in changes in tick distribution and the potential impact this may have on tick-borne disease risk. Abstract
The main objective of this thesis was to better determine the spatial distribution of questing Ixodes ricinus across urban landscapes and to investigate site level and landscape level factors that have a significant influence on Lyme borreliosis risk. A multidisciplinary approach, using literature, field, and laboratory-based research, as well as geospatial datasets, was used to investigate and highlight the potential risk posed by urban Lyme borreliosis transmission cycles.
Four studies were completed, the first (Chapter 3) being a review of questing I. ricinus data published from studies in urban areas across Europe over the last 32 years. Three other studies were conducted, centred around questing tick presence, nymph density, Borrelia prevalence and the density of infected nymphs (Lyme borreliosis risk indicators). One investigated the effect of habitat in and around the city of Bath in 2015 and 2016 (Chapter 4). Another investigated local and wider habitat and connectivity factors in Bath, Bristol, and Southampton in 2017 (Chapter 5). The final study incorporated data along an urban-rural gradient in the cities of Bath and Southampton in 2018 (Chapter 6).
Key findings from this thesis were evidence of the presence of I. ricinus infected with Borrelia in a wide range of urban green spaces across Europe (Chapter 3), confirming the potential for contact and possible subsequent transmission of Lyme borreliosis to humans. Tick presence and nymph density were significantly higher in woodland compared to other urban green space habitats (Chapters 4 and 5), and better connectivity to woodland had a similar significant effect (Chapter 5). A seasonal pattern in questing I. ricinus activity was observed in urban green space, with density being significantly higher in spring and summer (Chapter 5). Woodlands across an urban-rural gradient supported similar nymph densities and Borrelia prevalence (Chapter 6), suggesting risk to public health could be similar, or perhaps elevated in urban woodland where potential for human-tick contact could be higher. This could be worsened by the dominance of Borrelia garinii detected in questing I. ricinus in urban green space (Chapters 4, 5 and 6), as this genospecies is linked to neuroborreliosis. Overall, the density of infected nymphs, a key Lyme borreliosis risk indicator, was low (Chapters 4, 5 and 6) compared to other studies in southern England, and indeed the average across Europe (Chapter 3). Key questions remain, however, around the risk of urban woodlands for Lyme borreliosis transmission due to high numbers of visitors.
This thesis presents Lyme borreliosis risk indicators for urban green space, synthesising European and country-level estimates from existing studies and generating new data for southern England. This contributes to the growing evidence of potential risk posed by Borrelia infected ticks in urban areas, which requires further consideration by scientists, policy makers and public health professionals alike. This is particularly crucial as urbanisation and urban greening accelerate, bringing members of the public into proximity with infected ticks, potentially increasing the risk of Lyme borreliosis transmission.
Hunter RF, Rodgers SE, Hilton J, Clarke M, Garcia L, Ward Thompson C, Geary R, Green MA, O'Neill C, Longo A, et al
(2022). GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health – a new initiative. Wellcome Open Research
GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health – a new initiative
Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes, with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application. Abstract
Hansford KM, Wheeler BW, Tschirren B, Medlock JM (2022). Questing. <i>Ixodes ricinus</i>. ticks and. <i>Borrelia</i>. spp. in urban green space across Europe: a review. Zoonoses and Public Health, 69(3), 153-166.
Bu F, Mak HW, Steptoe A, Wheeler BW, Fancourt D (2022). Urban greenspace and anxiety symptoms during the COVID-19 pandemic: a 20-month follow up of 19,848 participants in England.
Bu F, Mak HW, Steptoe A, Wheeler BW, Fancourt D (2022). Urban greenspace and anxiety symptoms during the COVID-19 pandemic: a 20-month follow up of 19,848 participants in England. Health & Place, 77, 102897-102897.
Hansford KM, Wheeler BW, Tschirren B, Medlock JM (2022). Urban woodland habitat is important for tick presence and density in a city in England. Ticks and Tick-borne Diseases, 13(1), 101857-101857.
Geary RS, Wheeler B, Lovell R, Jepson R, Hunter R, Rodgers S
(2021). A call to action: Improving urban green spaces to reduce health inequalities exacerbated by COVID-19. Prev Med
A call to action: Improving urban green spaces to reduce health inequalities exacerbated by COVID-19.
Health is not equally distributed across society; there are avoidable, unfair, systematic differences in health between population groups. Some of these same groups (older people, BAME communities, those with some non-communicable diseases (NCDs)) may be particularly vulnerable to risk of exposure and severe COVID-19 outcomes due to co-morbidities, structural vulnerabilities, and public-facing or health and social care jobs among other factors. Additionally, some of the restrictions designed to reduce SARS-CoV-2 spread impact specifically on these same groups by limiting their activity and access to preventive or health promotion services. Greenspaces, accessed with social distancing, may mitigate some of the predicted negative health effects of COVID-19 restrictions. Maintaining or increasing publicly accessible urban greenspaces, particularly for marginalised groups, is reflected in the Sustainable Development Goals, and its importance amplified in the COVID-19 pandemic. Urban greenspaces should be considered a public health and social investment and a chance to rebalance our relationship with nature to protect against future pandemics. By investing in urban public greenspaces, additional benefits (job/food creation, biodiversity promotion, carbon sequestration) may coincide with health benefits. Realising these requires a shift in the balance of decision making to place weight on protecting, enhancing and providing more appropriate greenspaces designed with local communities. The current pandemic is a reminder that humanity placing too many pressures on nature has damaging consequences. COVID-19 economic recovery programs present an opportunity for sustainable transformation if they can be leveraged to simultaneously protect and restore nature and tackle climate change and health inequalities. Abstract
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Remme RP, Frumkin H, Guerry AD, King AC, Mandle L, Sarabu C, Bratman GN, Giles-Corti B, Hamel P, Han B, et al
(2021). An ecosystem service perspective on urban nature, physical activity, and health. Proceedings of the National Academy of Sciences
An ecosystem service perspective on urban nature, physical activity, and health
Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature–physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature’s potential contribution to creating more equitable, green, livable cities with active inhabitants. Abstract
Garrett J, Wheeler B, Akbari A, Fry R, Geary R, Lovell R, Lyons RA, Mizen A, Nieuwenhuijsen M, Rowney F, et al
(2021). Association between greenspace and time spent in nature with subjective wellbeing: a cross-sectional data linkage study. Author URL
Creer S, Rowney FM, Brennan GL, Skjoth C, Griffith G, Mcinnes RN, Clewlow Y, Adams-Groom B, Barber A, Devere N, et al
(2021). Environmental DNA analyses reveal links between abundance and composition of airborne grass pollen and population scale respiratory health. Author URL
Rowney FM, Brennan GL, Skjøth CA, Griffith GW, McInnes RN, Clewlow Y, Adams-Groom B, Barber A, de Vere N, Economou T, et al (2021). Environmental DNA reveals links between abundance and composition of airborne grass pollen and respiratory health. Current Biology, 31(9), 1995-2003.e4.
(2021). Examining the influence of socio-economic status, area level deprivation and exposure to air pollution on asthma in childhood in England.
Examining the influence of socio-economic status, area level deprivation and exposure to air pollution on asthma in childhood in England
The co-location of air pollution and socio-economic deprivation is increasingly well documented and studies have found that the socio-spatial distribution of health-related environmental characteristics, specifically air pollution, can be an important driver of geographical inequalities in health. The most deprived members of society face the highest exposures and the greatest risks due to a concept termed the triple jeopardy. Children face an increased susceptibility to air pollution exposure, and exposure can result in a range of health issues, such as asthma. Abstract
Linking longitudinal data from the Millennium Cohort Study (MCS), air pollution data available from EMEP4UK, and area level deprivation data from the Index of Multiple Deprivation, this thesis aims to explore the relationship between air pollution exposure, and both individual and area level socio-economic status to understand how these exposures interact to impact respiratory health in children. Following data linkage, cross-sectional analysis, time series analysis and multilevel modelling are employed to examine the data. Multilevel modelling is used to appropriately attribute variations in spatial health outcomes to differences between places, differences between people within places and differences over time. The use of multilevel modelling is an innovative step in understanding the relationship between socio-economic factors, air pollution and health outcomes.
Multilevel modelling found that 85% of the variation in asthma prevalence in children lies within MSOAs, whilst 14% of the variation was found to be over time. In comparison, 47% of the variation in wheezing was found to be due to differences over time. Two- and three-way interaction terms were included in the analysis to explore the impact of individual level socio-economic status, area level deprivation and air pollution exposure on asthma and wheezing prevalence in children, however no association was found. Moving forward, focussing interventions on improving both individual and area level socio-economic status, and implementing policies to lower pollution in the most deprived areas could help alleviate the health burden faced by the most deprived in society when exposed to air pollution.
Thompson DA, Fry R, Watkins A, Mizen A, Akbari A, Garrett J, Geary R, Lovell R, Lyons RA, Nieuwenhuijsen M, et al
(2021). Exposure to green-blue spaces and mental health: a retrospective e-cohort study in Wales. Author URL
Leonelli S, Lovell R, Wheeler B, Fleming L, Williams H (2021). From FAIR Data to Fair Data Use: Methodological Data Fairness in Health-Related Social Media Research. Big Data and Society
Kurganskiy A, Creer S, de Vere N, Griffith GW, Osborne NJ, Wheeler BW, McInnes RN, Clewlow Y, Barber A, Brennan GL, et al
(2021). Predicting the severity of the grass pollen season and the effect of climate change in Northwest Europe. Sci Adv
Predicting the severity of the grass pollen season and the effect of climate change in Northwest Europe.
Allergic rhinitis is an inflammation in the nose caused by overreaction of the immune system to allergens in the air. Managing allergic rhinitis symptoms is challenging and requires timely intervention. The following are major questions often posed by those with allergic rhinitis: How should I prepare for the forthcoming season? How will the season's severity develop over the years? No country yet provides clear guidance addressing these questions. We propose two previously unexplored approaches for forecasting the severity of the grass pollen season on the basis of statistical and mechanistic models. The results suggest annual severity is largely governed by preseasonal meteorological conditions. The mechanistic model suggests climate change will increase the season severity by up to 60%, in line with experimental chamber studies. These models can be used as forecasting tools for advising individuals with hay fever and health care professionals how to prepare for the grass pollen season. Abstract
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(2021). Sunshine, Vitamin D and Oral Health.
Sunshine, Vitamin D and Oral Health
Poor oral health, in particular dental caries and periodontal disease, is a Abstract
common problem in the UK population. Previous research has suggested an association between vitamin D deficiency and increased risk of poor oral health.
The main source of vitamin D for people resident in the UK is via exposure to solar irradiance. This study aims to determine if an association exists between sunshine exposure and better oral health, also specifically asking if increased exposure to UVB light between the wavelengths 290-315 nm approximately, from natural or artificial sources, affects the incidence of caries and periodontal disease. The findings of the study aim to inform novel public health measures to improve oral health.
Following a review of the existing literature and a scoping review of
previous relevant studies, a protocol was developed and a systematic review undertaken. The findings supported the presence of a positive association, but highlighted the lack of good quality observational trials and cohort studies. The scoping review highlighted a number of ecological studies, which further supported the existence of an association, but were outdated and limited in their methodology. These studies inspired the empirical studies undertaken in this thesis which used secondary data from modern epidemiological studies to investigate the hypothesis further.
The findings of these studies suggested that increased exposure to
sunshine is associated with a small, but consistent, reduction in the presence of dental caries in children in the UK. The evidence did not support an association between sunshine hours and a reduction in the prevalence of periodontal disease.
Further research could focus on repeating these analyses using other
datasets to see if relationships are replicated. Furthermore, the relationship between sunshine and other pertinent oral health outcomes such as oral cancer should be considered. Longer term studies could be undertaken using more accurate personal exposure measures and personalised health data, a viable possibility with the increasing use of wearables for data collection.
This research undertaken uses a novel approach to investigate the
relationship between sunlight, UVB and oral health, and to inform future public guidance, policy and health interventions.
Rodgers SE, Rowney F, Thompson D, Mizen A, White M, Lovell R, Fry R, Watkins A, Wheeler B, Akbari A, et al (2020). Is Wellbeing Associated with Time Spent in Nature?. International Journal for Population Data Science, 5(5).
Martin L, White MP, Pahl S, May J, Wheeler BW
(2020). Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England. Social science & medicine (1982)
Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England
OBJECTIVE: the current study investigated whether people are less likely to be smokers when they live in greener neighbourhoods, and whether such an association is attributable to lower rates of ever-smoking and/or higher rates of smoking cessation. METHOD: Using a representative sample of the adult population of England (N = 8,059), we investigated the relationships between neighbourhood greenspace and three inter-related smoking outcomes (current smoking, ever-smoking and smoking cessation). RESULTS: After controlling for a range of individual and area-level covariates, including socioeconomic status, income and education, living in the highest greenspace quartile was associated with a 20% lower prevalence of current smoking, compared to living in the lowest greenspace quartile (PR = 0.80, CI = 0.67, 0.96, p <. 017). Neighbourhood greenspace was not significantly associated with ever-smoking. However, amongst ever-smokers, residing in the two highest quartiles of neighbourhood greenspace quartiles (vs. 1st quartile) was associated with a 10% and 12% higher prevalence of smoking cessation (PR = 1.10, CI = 1.02, 1.18, p =. 012; PR = 1.12, CI = 1.02, 1.22, p =. 016, respectively). This suggests that the association between greenspace and current smoking is due to a higher likelihood of smoking cessation, rather than lower rates of ever- smoking. The associations between greenspace, current smoking and smoking cessation were similar in magnitude to those of having high (vs. low) household income and were largely unmoderated by socioeconomic measures. IMPLICATIONS: Our findings advocate the need to protect and invest in local greenspaces, to maximise the public health benefits they may afford. Improving access to greenspace may constitute an overlooked public health strategy for reducing smoking prevalence. Abstract
Elliott LR, White MP, Grellier J, Garrett JK, Cirach M, Wheeler BW, Bratman GN, van den Bosch MA, Ojala A, Roiko A, et al (2020). Research Note: Residential distance and recreational visits to coastal and inland blue spaces in eighteen countries. Landscape and Urban Planning, 198, 103800-103800.
de Bell S, White M, Griffiths A, Darlow A, Taylor T, Wheeler B, Lovell R (2020). Spending time in the garden is positively associated with health and wellbeing: Results from a national survey in England. Landscape and Urban Planning, 200, 103836-103836.
Garrett JK, White MP, Elliott LR, Wheeler BW, Fleming LE (2020). Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income. Environmental Research, 190, 109899-109899.
Brennan G, Potter C, Adams-Groom B, Barber A, Clewlow Y, De Vere N, Griffith G, Hanlon HM, Hegarty M, Kurganskiy A, et al
(2019). Assessing quantitative taxon-specific grass pollen biodiversity in time and space using targeted molecular analysis of aerial environmental DNA. Author URL
Foley R, Kearns R, Wheeler B, Kistemann T
(2019). Blue Space, Health and Wellbeing: Hydrophilia Unbounded.
Blue Space, Health and Wellbeing: Hydrophilia Unbounded
Garrett JK, Clitherow TJ, White MP, Wheeler BW, Fleming LE
(2019). Coastal proximity and mental health among urban adults in England: the moderating effect of household income. Health Place
Coastal proximity and mental health among urban adults in England: the moderating effect of household income.
After adjusting for covariates, self-reported general health in England is higher among populations living closer to the coast, and the association is strongest amongst more deprived groups. We explored whether similar findings were present for mental health using cross-sectional data for urban adults in the Health Survey for England (2008-2012, N ≥25,963). For urban adults, living ≤1 km from the coast, in comparison to >50 km, was associated with better mental health as measured by the GHQ12. Stratification by household income revealed this was only amongst the lowest-earning households, and extended to ≤5 km. Our findings support the contention that, for urban adults, coastal settings may help to reduce health inequalities in England. Abstract
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Hunter RF, Cleland C, Cleary A, Droomers M, Wheeler BW, Sinnett D, Nieuwenhuijsen MJ, Braubach M
(2019). Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis. Environ Int
Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis.
BACKGROUND: As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. OBJECTIVES: to perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. DATA SOURCES: Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. STUDY APPRAISAL AND SYNTHESIS METHODS: Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. RESULTS: of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised. Abstract
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Sharpe RA, Machray KE, Fleming LE, Taylor T, Henley W, Chenore T, Hutchcroft I, Taylor J, Heaviside C, Wheeler BW, et al
(2019). Household energy efficiency and health: Area-level analysis of hospital admissions in England. Environment International
Household energy efficiency and health: Area-level analysis of hospital admissions in England
Introduction: Fuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study. Methods: in this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions. Results: in the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature. Discussion: Despite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of “whole house approaches” when retrofitting the existing housing stock. Conclusion: to be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative ‘greener’ and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health. Study implications: This study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes. Abstract
Mizen A, Song J, Fry R, Akbari A, Berridge D, Parker SC, Johnson R, Lovell R, Lyons RA, Nieuwenhuijsen M, et al
(2019). Longitudinal access and exposure to green-blue spaces and individual-level mental health and well-being: protocol for a longitudinal, population-wide record-linked natural experiment. BMJ Open
Longitudinal access and exposure to green-blue spaces and individual-level mental health and well-being: protocol for a longitudinal, population-wide record-linked natural experiment.
INTRODUCTION: Studies suggest that access and exposure to green-blue spaces (GBS) have beneficial impacts on mental health. However, the evidence base is limited with respect to longitudinal studies. The main aim of this longitudinal, population-wide, record-linked natural experiment, is to model the daily lived experience by linking GBS accessibility indices, residential GBS exposure and health data; to enable quantification of the impact of GBS on well-being and common mental health disorders, for a national population. METHODS AND ANALYSIS: This research will estimate the impact of neighbourhood GBS access, GBS exposure and visits to GBS on the risk of common mental health conditions and the opportunity for promoting subjective well-being (SWB); both key priorities for public health. We will use a Geographic Information System (GIS) to create quarterly household GBS accessibility indices and GBS exposure using digital map and satellite data for 1.4 million homes in Wales, UK (2008-2018). We will link the GBS accessibility indices and GBS exposures to individual-level mental health outcomes for 1.7 million people with general practitioner (GP) data and data from the National Survey for Wales (n=~12 000) on well-being in the Secure Anonymised Information Linkage (SAIL) Databank. We will examine if these associations are modified by multiple sociophysical variables, migration and socioeconomic disadvantage. Subgroup analyses will examine associations by different types of GBS. This longitudinal study will be augmented by cross-sectional research using survey data on self-reported visits to GBS and SWB. ETHICS AND DISSEMINATION: all data will be anonymised and linked within the privacy protecting SAIL Databank. We will be using anonymised data and therefore we are exempt from National Research Ethics Committee (NREC). An Information Governance Review Panel (IGRP) application (Project ID: 0562) to link these data has been approved.The research programme will be undertaken in close collaboration with public/patient involvement groups. A multistrategy programme of dissemination is planned with the academic community, policy-makers, practitioners and the public. Abstract
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O’Brien L, Ambrose-Oji B, Wheeler B
(2019). Mental health and wellbeing: the contribution of trees and forests to diverse populations in Britain. Sante Publique
Mental health and wellbeing: the contribution of trees and forests to diverse populations in Britain
This paper explores the potential contribution of trees and forest to the mental wellbeing of diverse populations in Britain. We use a conceptual framework that makes a distinction between three different levels of engagement: everyday life; green health promotion; and green therapeutic care. We then use researched and evaluated case studies in Britain to provide examples associated with these three levels of engagement. The case studies illustrate that practical approaches and interventions are developing rapidly in the Britain. Finally we discuss the main pathways and mechanisms that link mental health and wellbeing and trees and forests. We outline that there are limitations to the current international evidence base and call for consistent approaches within and between countries using a range of methodologies to capture the nuances of the complex relationships between trees, forests and mental health and wellbeing. Abstract
Bratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, Folke C, Frumkin H, Gross JJ, Hartig T, et al
(2019). Nature and mental health: an ecosystem service perspective. Sci Adv
Nature and mental health: an ecosystem service perspective.
A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so. Abstract
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Pasanen TP, White MP, Wheeler BW, Garrett JK, Elliott LR
(2019). Neighbourhood blue space, health and wellbeing: the mediating role of different types of physical activity. Environ Int
Neighbourhood blue space, health and wellbeing: the mediating role of different types of physical activity.
BACKGROUND: Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential mechanism, we know little about the types of PA that might account for this. OBJECTIVES: to explore the mediating role of: a) 'watersports' (e.g. sailing/canoeing); b) 'on-land outdoor PA' in natural/mixed settings (e.g. walking/running/cycling); and, c) 'indoor/other PA' (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes. METHODS: Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level. RESULTS: Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA. CONCLUSIONS: Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health. Abstract
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Maguire K, Garside R, Poland J, Fleming LE, Alcock I, Taylor T, Macintyre H, Lo Iacono G, Green A, Wheeler BW, et al
(2019). Public involvement in research about environmental change and health: a case study. Health
Public involvement in research about environmental change and health: a case study.
Involving and engaging the public are crucial for effective prioritisation, dissemination and implementation of research about the complex interactions between environments and health. Involvement is also important to funders and policy makers who often see it as vital for building trust and justifying the investment of public money. In public health research, ‘the public’ can seem an amorphous target for researchers to engage with, and the short-term nature of research projects can be a challenge. Technocratic and pedagogical approaches have frequently met with resistance, so public involvement needs to be seen in the context of a history which includes contested truths, power inequalities and political activism. It is therefore vital for researchers and policy makers, as well as public contributors, to share best practice and to explore the challenges encountered in public involvement and engagement. This article presents a theoretically informed case study of the contributions made by the Health and Environment Public Engagement Group to the work of the National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Change and Health (HPRU-ECH). We describe how Health and Environment Public Engagement Group has provided researchers in the HPRU-ECH with a vehicle to support access to public views on multiple aspects of the research work across three workshops, discussion of ongoing research issues at meetings and supporting dissemination to local government partners, as well as public representation on the HPRU-ECH Advisory Board. We conclude that institutional support for standing public involvement groups can provide conduits for connecting public with policy makers and academic institutions. This can enable public involvement and engagement, which would be difficult, if not impossible, to achieve in individual short-term and unconnected research projects. Abstract
White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, Fleming LE
(2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep
Spending at least 120 minutes a week in nature is associated with good health and wellbeing.
Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15-2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120-179 mins: ORs [95%CIs]: Health = 1.59 [1.31-1.92]; Well-being = 1.23 [1.08-1.40]). Positive associations peaked between 200-300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity. Abstract
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Brennan GL, Potter C, de Vere N, Griffith GW, Skjøth CA, Osborne NJ, Wheeler BW, McInnes RN, Clewlow Y, Barber A, et al
(2019). Temperate airborne grass pollen defined by spatio-temporal shifts in community composition. Nature Ecology and Evolution
Temperate airborne grass pollen defined by spatio-temporal shifts in community composition
Grass pollen is the world’s most harmful outdoor aeroallergen. However, it is unknown how airborne pollen assemblages change across time and space. Human sensitivity varies between different species of grass that flower at different times, but it is not known whether temporal turnover in species composition match terrestrial flowering or whether species richness steadily accumulates over the grass pollen season. Here, using targeted, high-throughput sequencing, we demonstrate that all grass genera displayed discrete, temporally restricted peaks of incidence, which varied with latitude and longitude throughout Great Britain, revealing that the taxonomic composition of grass pollen exposure changes substantially across the grass pollen season. Abstract
Turner RA, Sainsbury NC, Wheeler BW
(2019). The health of commercial fishers in England and Wales: Analysis of the 2011 census. Marine Policy
The health of commercial fishers in England and Wales: Analysis of the 2011 census
Studies of commercial fishing have shown that it is a hazardous occupation with high rates of injury and fatal accidents. Research has also identified a range of other health risks faced by fishers, yet the general health outcomes of fishers have not been compared to those of workers in other industries. This study aimed to assess self-reported health outcomes among workers in the fishing industry, and to compare this to those working in other industries. Drawing on 2011 census data for England and Wales we used generalised linear models to compare self-reported measures of 1) general health and 2) limiting long-term illness across industry categories, calculating odds ratios adjusted for age, geographic region and socio-economic profile of local authorities. of the population working in 87 industry classes, those in category ‘03 Fishing and aquaculture’ had the fifth highest rate of poor general health (2.8% reported ‘bad’ or ‘very bad’ health) and the sixth highest rate of reporting limiting long-term illness (10.3% reported their activities to be limited ‘a lot’ or ‘a little’). Odds ratios adjusted for age, geographic region and socio-economic profile of local authorities showed that only two other industries demonstrated statistical evidence for higher odds of poor general health or limiting long-term illness than workers in fishing and aquaculture. This study demonstrates that fishing is among the industries with the poorest general health and limiting long-term illness outcomes in the UK, demonstrating the need for tailored occupational health services to support UK fishing communities. Abstract
Bell SL, Hollenbeck J, Lovell R, White M, Depledge M (2019). The shadows of risk and inequality within salutogenic coastal waters. In Foley R, Kearns R, Kistemann T, Wheeler B (Eds.) Hydrophilia Unbounded: Blue Space, Health and Place, Routledge Taylor and Francis.
Song J, Fry R, Mizen A, Akbari A, Wheeler B, White J, White M, Lovell R, Parker C, Berridge D, et al (2018). Association between blue and green space availability with mental health and wellbeing. International Journal for Population Data Science, 3(4).
Fleming LE, Leonardi GS, White MP, Medlock J, Alcock I, Macintyre HL, Maguire K, Nichols G, Wheeler BW, Morris G, et al
(2018). Beyond climate change and health: Integrating broader environmental change and natural environments for public health protection and promotion in the UK. Atmosphere
Beyond climate change and health: Integrating broader environmental change and natural environments for public health protection and promotion in the UK
Increasingly, the potential short and long-term impacts of climate change on human health and wellbeing are being demonstrated. However, other environmental change factors, particularly relating to the natural environment, need to be taken into account to understand the totality of these interactions and impacts. This paper provides an overview of ongoing research in the Health Protection Research Unit (HPRU) on Environmental Change and Health, particularly around the positive and negative effects of the natural environment on human health and well-being and primarily within a UK context. In addition to exploring the potential increasing risks to human health from water-borne and vector-borne diseases and from exposure to aeroallergens such as pollen, this paper also demonstrates the potential opportunities and co-benefits to human physical and mental health from interacting with the natural environment. The involvement of a Health and Environment Public Engagement (HEPE) group as a public forum of "critical friends" has proven useful for prioritising and exploring some of this research; such public involvement is essential to minimise public health risks and maximise the benefits which are identified from this research into environmental change and human health. Research gaps are identified and recommendations made for future research into the risks, benefits and potential opportunities of climate and other environmental change on human and planetary health. Abstract
Bateman I, Wheeler BW
(2018). Bringing Health and the Environment into Decision-Making: the Natural Capital Approach.
Rockefeller Foundation Economic Council on Planetary Health, Oxford, Rockefeller Foundation Economic Council on Planetary Health.
Bringing Health and the Environment into Decision-Making: the Natural Capital Approach
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O’brien L, Ambrose-Oji B, Wheeler B
(2018). Mental health and wellbeing: the contribution of trees and forests to diverse populations in britain. Revue Forestiere Francaise
Mental health and wellbeing: the contribution of trees and forests to diverse populations in britain
This paper explores the potential contribution of trees and forest to the mental wellbeing of diverse populations in Britain. We use aconceptual framework that makes adistinction between three different levels of engagement: everyday life; green health promotion; and green therapeutic care. We then use researched and evaluated case studies in Britain to provide examples associated with these three levels of engagement. The case studies illustrate that practical approaches and interventions are developing rapidly in the Britain. Finally we discuss the main pathways and mechanisms that link mental health and wellbeing and trees and forests. We outline that there are limitations to the current international evidence base and call for consistent approaches within and between countries using arange of methodologies to capture the nuances of the complex relationships between trees, forests and mental health and wellbeing. Abstract
White MP, Elliott LR, Wheeler BW, Fleming LE
(2018). Neighbourhood greenspace is related to physical activity in England, but only for dog owners. Landscape and Urban Planning
Neighbourhood greenspace is related to physical activity in England, but only for dog owners
Evidence supporting a positive association between neighbourhood greenspace and physical activity is equivocal. Using data from a large, nationally representative survey in England (n = 280,790), we found that while a positive relationship between the amount of neighbourhood greenspace and the odds of achieving recommended weekly physical activity existed for dog owners, no relationship was found for non-dog owners. The findings highlight the importance of neighbourhood greenspaces for supporting physical activity through dog walking in the UK context, but also raise the issue of how to encourage non-dog owners to use greenspaces in health-promoting ways. The results may also help to explain previously mixed findings in the international evidence base, and emphasise the need to adequately account for dog-ownership in future research exploring the relationship between greenspaces and physical activity. Abstract
Brennan GL, Potter C, de Vere N, Griffith GW, Skjøth CA, Osborne NJ, Wheeler BW, McInnes RN, Clewlow Y, Barber A, et al (2018). Temperate grass allergy season defined by spatio-temporal shifts in airborne pollen communities.
White M, Lovell R, Wheeler B, Pahl S, Voelker S, Depledge M (2017). Blue Landscapes and Public Health. In van den Bosch M, Bird W (Eds.) Landscape and Public Health, Oxford OU.
Bell SL, Westley M, Lovell R, Wheeler BW (2017). Everyday green space and experienced wellbeing: the significance of wildlife encounters. Landscape Research
Depledge MH, Lovell R, Wheeler BW, Morrissey KM, White M, Fleming LE
(2017). Future of the Sea: Health and Wellbeing of Coastal Communities.
Governtment Office for Science, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/639432/Health_and_Wellbeing_Final.pdf.
Future of the Sea: Health and Wellbeing of Coastal Communities
Alcock I, White M, Cherrie M, Wheeler B, Taylor J, McInnes R, Otte im Kampe E, Vardoulakis S, Sarran C, Soyiri I, et al
(2017). Land cover and air pollution are associated with asthma hospitalisations: a cross-sectional study. Environment International
Land cover and air pollution are associated with asthma hospitalisations: a cross-sectional study
© 2017 Elsevier Ltd Background There is increasing policy interest in the potential for vegetation in urban areas to mitigate harmful effects of air pollution on respiratory health. We aimed to quantify relationships between tree and green space density and asthma-related hospitalisations, and explore how these varied with exposure to background air pollution concentrations. Methods Population standardised asthma hospitalisation rates (1997–2012) for 26,455 urban residential areas of England were merged with area-level data on vegetation and background air pollutant concentrations. We fitted negative binomial regression models using maximum likelihood estimation to obtain estimates of asthma-vegetation relationships at different levels of pollutant exposure. Results Green space and gardens were associated with reductions in asthma hospitalisation when pollutant exposures were lower but had no significant association when pollutant exposures were higher. In contrast, tree density was associated with reduced asthma hospitalisation when pollutant exposures were higher but had no significant association when pollutant exposures were lower. Conclusions We found differential effects of natural environments at high and low background pollutant concentrations. These findings can provide evidence for urban planning decisions which aim to leverage health co-benefits from environmental improvements. Abstract
White MP, Pahl S, Wheeler BW, Depledge MH, Fleming LE
(2017). Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health and Place
Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing
Despite growing interest in the relationships between natural environments and subjective wellbeing (SWB), previous studies have various methodological and theoretical limitations. Focusing on urban/peri-urban residents (n=7272) from a nationally representative survey of the English population, we explored the relationships between three types of exposure: i) ‘neighbourhood exposure’, ii) ‘visit frequency’, and iii) ‘specific visit’; and four components of SWB: i) evaluative, ii) eudaimonic, iii) positive experiential and iv) negative experiential. Controlling for area and individual level socio-demographics and other aspects of SWB, visit frequency was associated with eudaimonic wellbeing and a specific visit with positive experiential wellbeing. People who visited nature regularly felt their lives were more worthwhile, and those who visited nature yesterday were happier. The magnitude of the association between weekly nature visits and eudaimonic wellbeing was similar to that between eudaimonic wellbeing and life circumstances such as marital status. Findings are relevant for policies to protect and promote public access to natural environments. Abstract
Osborne NJ, Alcock I, Wheeler BW, Hajat S, Sarran C, Clewlow Y, McInnes RN, Hemming D, White M, Vardoulakis S, et al
(2017). Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city. International Journal of Biometeorology
Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city
Exposure to pollen can contribute to increased hospital admissions for asthma exacerbation. This study applied an ecological time series analysis to examine associations between atmospheric concentrations of different pollen types and the risk of hospitalization for asthma in London from 2005 to 2011. The analysis examined short-term associations between daily pollen counts and hospital admissions in the presence of seasonal and long-term patterns, and allowed for time lags between exposure and admission. Models were adjusted for temperature, precipitation, humidity, day of week, and air pollutants. Analyses revealed an association between daily counts (continuous) of grass pollen and adult hospital admissions for asthma in London, with a 4–5-day lag. When grass pollen concentrations were categorized into Met Office pollen ‘alert’ levels, ‘very high’ days (vs. ‘low’) were associated with increased admissions 2–5 days later, peaking at an incidence rate ratio of 1.46 (95%, CI 1.20–1.78) at 3 days. Increased admissions were also associated with ‘high’ versus ‘low’ pollen days at a 3-day lag. Results from tree pollen models were inconclusive and likely to have been affected by the shorter pollen seasons and consequent limited number of observation days with higher tree pollen concentrations. Future reductions in asthma hospitalizations may be achieved by better understanding of environmental risks, informing improved alert systems and supporting patients to take preventive measures. Abstract
Alcock. I, Cherrie M, White M, Wheeler B, Vardoulakis S, Kampe EOI, Fleming L (2016). Asthma hospitalisation is associated with natural environments and their interaction with long-term pollutant exposure. ISEE Conference Abstracts, 2016(1).
Ohly H, White MP, Wheeler BW, Bethel A, Ukoumunne OC, Nikolaou V, Garside R
(2016). Attention Restoration Theory: a systematic review of the attention restoration potential of exposure to natural environments. Journal of Toxicology and Environmental Health - Part B: Critical Reviews
Attention Restoration Theory: a systematic review of the attention restoration potential of exposure to natural environments
Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to the quantity of empirical evidence that supports this. A systematic review regarding the impact of exposure to natural environments on attention was conducted. Seven electronic databases were searched. Studies were included if (1) they were natural experiments, randomized investigations, or recorded “before and after” measurements; (2) compared natural and nonnatural/other settings; and (3) used objective measures of attention. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by another. Where possible, random effects meta-analysis was used to pool effect sizes. Thirty-one studies were included. Meta-analyses provided some support for ART, with significant positive effects of exposure to natural environments for three measures (Digit Span Forward, Digit Span Backward, and Trail Making Test B). The remaining 10 meta-analyses did not show marked beneficial effects. Meta-analysis was limited by small numbers of investigations, small samples, heterogeneity in reporting of study quality indicators, and heterogeneity of outcomes. This review highlights the diversity of evidence around ART in terms of populations, study design, and outcomes. There is uncertainty regarding which aspects of attention may be affected by exposure to natural environments. Abstract
Hunter JG, Madden RG, Stone AM, Osborne N, Wheeler B, Vine L, Dickson A, Barlow M, Lewis J, Bendall RP, et al
(2016). Coastal clustering of HEV; Cornwall, UK. Eur J Gastroenterol Hepatol
Coastal clustering of HEV; Cornwall, UK.
BACKGROUND AND AIMS: Autochthonous hepatitis E virus (HEV) infection is a porcine zoonosis and increasingly recognized in developed countries. In most cases the route of infection is uncertain. A previous study showed that HEV was associated geographically with pig farms and coastal areas. AIM: the aim of the present research was to study the geographical, environmental and social factors in autochthonous HEV infection. METHODS: Cases of HEV genotype 3 infection and controls were identified from 2047 consecutive patients attending a rapid-access hepatology clinic. For each case/control the following were recorded: distance from home to nearest pig farm, distance from home to coast, rainfall levels during the 8 weeks before presentation, and socioeconomic status. RESULTS: a total of 36 acute hepatitis E cases, 170 age/sex-matched controls and 53 hepatitis controls were identified. The geographical spread of hepatitis E cases was not even when compared with both control groups. Cases were more likely to live within 2000 m of the coast (odds ratio=2.32, 95% confidence interval=1.08-5.19, P=0.03). There was no regional difference in the incidence of cases and controls between west and central Cornwall. There was no difference between cases and controls in terms of distance from the nearest pig farm, socioeconomic status or rainfall during the 8 weeks before disease presentation. CONCLUSION: Cases of HEV infection in Cornwall are associated with coastal residence. The reason for this observation is uncertain, but might be related to recreational exposure to beach areas exposed to HEV-contaminated 'run-off' from pig farms. This hypothesis merits further study. Abstract
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Wood SL, Demougin PR, Higgins S, Husk K, Wheeler BW, White M
(2016). Exploring the relationship between childhood obesity and proximity to the coast: a rural/urban perspective. Health and Place
Exploring the relationship between childhood obesity and proximity to the coast: a rural/urban perspective
Childhood obesity is one of the 21st century's most serious global health challenges. Research suggests that better access to 'greenspace' (e.g. parks) may encourage physical activity and reduce the risk of obesity amongst children. We extend earlier work by considering childhood obesity in relation to proximity to the coast, using data from England's National Child Measurement Programme. Results suggest that although the overall prevalence of childhood obesity is slightly lower at the coast (-0.68% points comparing 20 km, p Abstract
Salmond JA, Tadaki M, Vardoulakis S, Arbuthnott K, Coutts A, Demuzere M, Dirks KN, Heaviside C, Lim S, Macintyre H, et al
(2016). Health and climate related ecosystem services provided by street trees in the urban environment. Environ Health
, 15 Suppl 1
Health and climate related ecosystem services provided by street trees in the urban environment.
Urban tree planting initiatives are being actively promoted as a planning tool to enable urban areas to adapt to and mitigate against climate change, enhance urban sustainability and improve human health and well-being. However, opportunities for creating new areas of green space within cities are often limited and tree planting initiatives may be constrained to kerbside locations. At this scale, the net impact of trees on human health and the local environment is less clear, and generalised approaches for evaluating their impact are not well developed.In this review, we use an urban ecosystems services framework to evaluate the direct, and locally-generated, ecosystems services and disservices provided by street trees. We focus our review on the services of major importance to human health and well-being which include 'climate regulation', 'air quality regulation' and 'aesthetics and cultural services'. These are themes that are commonly used to justify new street tree or street tree retention initiatives. We argue that current scientific understanding of the impact of street trees on human health and the urban environment has been limited by predominantly regional-scale reductionist approaches which consider vegetation generally and/or single out individual services or impacts without considering the wider synergistic impacts of street trees on urban ecosystems. This can lead planners and policymakers towards decision making based on single parameter optimisation strategies which may be problematic when a single intervention offers different outcomes and has multiple effects and potential trade-offs in different places.We suggest that a holistic approach is required to evaluate the services and disservices provided by street trees at different scales. We provide information to guide decision makers and planners in their attempts to evaluate the value of vegetation in their local setting. We show that by ensuring that the specific aim of the intervention, the scale of the desired biophysical effect and an awareness of a range of impacts guide the choice of i) tree species, ii) location and iii) density of tree placement, street trees can be an important tool for urban planners and designers in developing resilient and resourceful cities in an era of climatic change. Abstract
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Osborne. N, Alcock I, Wheeler B, White M, Eggen B, Vardoulakis S, Hajat S, Hemming D, Clewlow Y, McInnes R, et al (2016). Pollen exposure and hospital admissions for asthma in London, UK 2005-11. ISEE Conference Abstracts, 2016(1).
White MP, Elliott LR, Taylor T, Wheeler BW, Spencer A, Bone A, Depledge MH, Fleming LE
(2016). Recreational physical activity in natural environments and implications for health: a population based cross-sectional study in England. Preventive Medicine
Recreational physical activity in natural environments and implications for health: a population based cross-sectional study in England
Background Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. Methods a cross-sectional analysis of six waves (2009/10–2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n = 280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n = 112,422), including: a) duration; b) activity; and c) environment type. Results Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one ‘active visit’ (i.e. ≥ 30 min, ≥ 3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) ‘active visits’ annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥ 5 × 30 min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. Conclusions Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes. Abstract
Wheeler BW, Depledge MH (2016). Section 3: Indicators of urban green space availability, accessibility and usage, and assessment of their health relevance. World Health Organisation, Copenhagen, WHO Regional Office for Europe.
White MP, Bell S, Jenkin R, Wheeler B, Depledge M (2016). The benefits of blue exercise. In Barton J, Bragg R, Wood C, Pretty J (Eds.) Green Exercise: Linking Nature, Health and Well-Being, Routledge.
White MP, Bell S, Elliott LR, Jenkin R, Wheeler BW, Depledge MH
(2016). The health benefits of blue exercise in the UK. In (Ed) Green Exercise: Linking Nature, Health and Well-being
The health benefits of blue exercise in the UK
Appleby T, Kinsey S, Wheeler B, Cunningham E
(2016). The marine biology of law and human health. Journal of the Marine Biological Association of the United Kingdom
The marine biology of law and human health
This review uses a multidisciplinary approach to investigate legal issues concerning the oceans and human health. It firstly seeks to define the boundaries of oceans and human health research. We use three case studies as examples: biomedical research, marine litter and human well-being. Biomedical research raises complex issues relating to coastal states' sovereign rights to exploit their marine resources and the patenting processes. Coastal states have differing degrees of control over research at sea. There are differences in EU and US law over the status of genetic discoveries, with the US having stricter criteria to qualify for patent protection. International law sets the standard for bioprospecting in developing countries under the Nagoya Protocol. The cost and complexity of marine biomedical research mean that it cannot be left to commercial exploration and needs some public funding. The second case study highlights the rise in marine plastics pollution using Marine Conservation Society beachwatch data. It details the need to alter product design to avoid marine pollution and records an unsuccessful attempt by academics and an NGO to make contact with the manufacturers of one polluting product. It also introduces the concept that faulty design could amount to a public nuisance. The third case study highlights the potential health benefits from access to the coast and the statutory responsibility which sits with the US and UK authorities in the provision of well-being. It posits that there needs to be greater inter-agency coordination to promote access to the coast for human well-being. Abstract
White MP, Pahl S, Wheeler BW, Fleming LEF, Depledge MH
(2016). The ‘Blue Gym’: What can blue space do for you and what can you do for blue space?. Journal of the Marine Biological Association of the United Kingdom
The ‘Blue Gym’: What can blue space do for you and what can you do for blue space?
The Blue Gym Initiative was created in the UK in 2009 to explore: (1) whether blue space environments might be positively related to human health and well-being; and (2) whether the public could be encouraged to preserve and protect these environments. Whilst the wider initiative considers all blue spaces including inland bodies of water (e.g. lakes, rivers and canals as well as the coasts and oceans), to date the focus has been primarily on marine and coastal environments. In this paper, we provide a brief history of the Blue Gym Initiative, and outline some of the research that has emerged to date. An important early finding was the observation that individuals living near the coast are generally healthier and happier than those living inland; much subsequent work has tried to understand why this might be. More recently we have begun to focus on how to promote pro-marine behaviours (e.g. sustainable fish choice, reduction of plastic use, avoidance of littering). This strand is still very much work in progress but highlights the importance of understanding public awareness, values and attitudes and the power of visualization in communicating the marine sustainability issues. We conclude with a brief discussion of some of the implications of the findings and future research needs. Abstract
Bell SL, Wheeler BW, Phoenix C (2016). Using geo-narratives to explore the diverse temporalities of therapeutic landscapes: perspectives from ‘green’ and ‘blue’ settings. Annals of the Association of American Geographers, 107, 93-108.
Wheeler BW, Lovell R, Higgins SL, White MP, Alcock I, Osborne NJ, Husk K, Sabel CE, Depledge MH
(2015). Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality. Int J Health Geogr
Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality.
BACKGROUND: Many studies suggest that exposure to natural environments ('greenspace') enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that "greenspace" is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents. METHODS: This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics. RESULTS: Positive associations were observed between good health prevalence and the density of the greenspace types, "broadleaf woodland", "arable and horticulture", "improved grassland", "saltwater" and "coastal", after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of "saltwater". Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators. CONCLUSIONS: the findings indicate that the type, quality and context of 'greenspace' should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection. Abstract
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Cherrie MPC, Wheeler BW, White MP, Sarran CE, Osborne NJ
(2015). Coastal climate is associated with elevated solar irradiance and higher 25(OH)D level. Environment International
Coastal climate is associated with elevated solar irradiance and higher 25(OH)D level
Introduction: There is evidence that populations living close to the coast have improved health and wellbeing. Coastal environments are linked to promotion of physical activity through provision of safe, opportune, aesthetic and accessible spaces for recreation. Exposure to coastal environments may also reduce stress and induce positive mood. We hypothesised that coastal climate may influence the vitamin D status of residents and thus partly explain benefits to health. Materials and methods: Ecological and cross-sectional analyses were designed to elucidate the connection between coastal residence and vitamin D status. We divided residential data, from developed land use areas and the Lower Super Output Areas or Data Zones (Scotland) of the 1958 Birth Cohort participants, into the following coastal bands: Abstract
Calitri RA, Warren FC, Wheeler B, Chaplin K, Fletcher E, Murdoch J, Richards SH, Taylor R, Varley A, Campbell JL, et al
(2015). Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care. Journal of Health & Place
Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care
The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient’s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice. Abstract
Bell SL, Wheeler BW (2015). Local Environments and Activity in Later Life: Meaningful Experiences in Green and Blue Spaces. In Tulle E, Phoenix C (Eds.) Physical Activity and Sport in Later Life: Critical Perspectives, Basingstoke: Palgrave Macmillan.
Taylor MS, Wheeler BW, White MP, Economou T, Osborne NJ
(2015). Research note: Urban street tree density and antidepressant prescription rates—A cross-sectional study in London, UK. Landscape and Urban Planning
Research note: Urban street tree density and antidepressant prescription rates—A cross-sectional study in London, UK
Abstract Growing evidence suggests an association between access to urban greenspace and mental health and wellbeing. Street trees may be an important facet of everyday exposure to nature in urban environments, but there is little evidence regarding their role in influencing population mental health. In this brief report, we raise the issue of street trees in the nature-health nexus, and use secondary data sources to examine the association between the density of street trees (trees/km street) in London boroughs and rates of antidepressant prescribing. After adjustment for potential confounders, and allowing for unmeasured area-effects using Bayesian mixed effects models, we find an inverse association, with a decrease of 1.18 prescriptions per thousand population per unit increase in trees per km of street (95% credible interval 0.00, 2.45). This study suggests that street trees may be a positive urban asset to decrease the risk of negative mental health outcomes. Abstract
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Bell SL, Phoenix C, Lovell R, Wheeler BW
(2015). Seeking everyday wellbeing: the coast as a therapeutic landscape. Social Science and Medicine
Seeking everyday wellbeing: the coast as a therapeutic landscape
Recent research suggests coastal environments may promote human health and wellbeing. This article explores the diverse coastal experiences sought out by residents of two towns in south west England to promote and preserve their personal wellbeing in the context of their everyday lives. It draws on the findings of an in-depth interpretive study conducted from May to November 2013 that examined the relative contribution of varied green and blue space experiences to individual wellbeing through the life course. Personalised activity maps produced using accelerometer and Global Positioning System (GPS) data were used to guide in-depth geo-narrative interviews with a purposive sample of 33 participants. This was combined with a subset of nine case study go-along interviews in places deemed therapeutic by the participants themselves, offering deeper insight into the lived experiences and relationships playing out within such places. Situated in a novel adaptation of the therapeutic landscapes framework, this article explores how symbolic, achievement-oriented, immersive and social experiences contributed to participants' sense of wellbeing in their local coastal areas. Participants expressed particularly strong and often enduring connections to the local coastline, with different coastal stretches perceived to cater for varied therapeutic needs and interests, at multiple scales and intensities. The findings suggest the need for greater acknowledgement of people's emotional, deeply embodied and often shared connections to the coast within coastal management policy and practice, both nationally and internationally. Importantly, such efforts should recognise the fluid, dynamic nature of this land-sea boundary, and the valued therapeutic experiences linked to this fluidity. Abstract
Taylor M, Wheeler B, White MP, Economou T, Osborne N (2015). Urban street tree density and antidepressant prescription rates; a cross-sectional study in London, UK. Landscape and Urban Planning, 174-179.
Bell SL, Phoenix C, Lovell R, Wheeler BW
(2015). Using GPS and geo-narratives: a methodological approach for understanding and situating everyday green space encounters. AREA
(1), 88-96. Author URL
Alcock I, White MP, Lovell R, Higgins SL, Osborne NJ, Husk K, Wheeler BW (2015). What accounts for ‘England’s green and pleasant land’? a panel data analysis of mental health and land cover types in rural England. Landscape and Urban Planning, 142, 38-46.
Lovell R, Wheeler BW, Higgins SL, Irvine KN, Depledge MH
(2014). A systematic review of the health and well-being benefits of biodiverse environments. J Toxicol Environ Health B Crit Rev
A systematic review of the health and well-being benefits of biodiverse environments.
Recent ecosystem service models have placed biodiversity as a central factor in the processes that link the natural environment to health. While it is recognized that disturbed ecosystems might negatively affect human well-being, it is not clear whether biodiversity is related to or can promote "good" human health and well-being. The aim of this study was to systematically identify, summarize, and synthesize research that had examined whether biodiverse environments are health promoting. The objectives were twofold: (1) to map the interdisciplinary field of enquiry and (2) to assess whether current evidence enables us to characterize the relationship. Due to the heterogeneity of available evidence a narrative synthesis approach was used, which is textual rather than statistical. Extensive searches identified 17 papers that met the inclusion criteria: 15 quantitative and 2 qualitative. The evidence was varied in disciplinary origin, with authors approaching the question using different study designs and methods, and conceptualizations of biodiversity, health, and well-being. There is some evidence to suggest that biodiverse natural environments promote better health through exposure to pleasant environments or the encouragement of health-promoting behaviors. There was also evidence of inverse relationships, particularly at a larger scale (global analyses). However, overall the evidence is inconclusive and fails to identify a specific role for biodiversity in the promotion of better health. High-quality interdisciplinary research is needed to produce a more reliable evidence base. of particular importance is identifying the specific ecosystem services, goods, and processes through which biodiversity may generate good health and well-being. Abstract
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Clark NE, Lovell R, Wheeler BW, Higgins SL, Depledge MH, Norris K
(2014). Biodiversity, cultural pathways, and human health: a framework. Trends in Ecology and Evolution
Biodiversity, cultural pathways, and human health: a framework
Direct contact with biodiversity is culturally important in a range of contexts. Many people even join conservation organisations to protect biodiversity that they will never encounter first-hand. Despite this, we have little idea how biodiversity affects people's well-being and health through these cultural pathways. Human health is sensitive to apparently trivial psychological stimuli, negatively affected by the risk of environmental degradation, and positively affected by contact with natural spaces. This suggests that well-being and health should be affected by biodiversity change, but few studies have begun to explore these relationships. Here, we develop a framework for linking biodiversity change with human cultural values, well-being, and health. We argue that better understanding these relations might be profoundly important for biodiversity conservation and public health. © 2014 the Authors. Abstract
White MP, Wheeler BW, Herbert S, Alcock I, Depledge MH (2014). Coastal proximity and physical activity. Is the coast an underappreciated public health resource?. Preventive Medicine, 69, 135-140.
Bell SL, Phoenix C, Lovell R, Wheeler BW
(2014). Green space, health and wellbeing: Making space for individual agency. Health and Place
Green space, health and wellbeing: Making space for individual agency
This essay examines the assumptions of green space use underpinning much existing green space and health research. It considers opportunities to move the field forward through exploring two often overlooked aspects of individual agency: the influence of shifting life circumstances on personal wellbeing priorities and place practices, and the role of personal orientations to nature in shaping how green space wellbeing opportunities are perceived and experienced. It suggests such efforts could provide more nuanced insights into the complex, personal factors that define and drive individual choices regarding the use of green spaces for wellbeing over time, thereby strengthening our understanding of the salutogenic potential (and limits) of green spaces. Abstract
Wheeler B, White M, Fleming LE, Taylor T, Harvey A, Depledge MH (2014). Influences of the Oceans on human health and wellbeing. In Bowen R, Depledge MH, Carlarne CP, Fleming LE (Eds.) Oceans and Human Health: Implications for Society and Well-Being, London: Wiley.
Alcock I, White MP, Wheeler BW, Fleming L, Depledge MH (2014). Longitudinal Effects on Mental Health of Moving to Greener and Less Green Urban Areas. Environmental Science and Technology (Washington), 48(2), 1247-1255.
Heffley JD, Comber SDW, Wheeler BW, Redshaw CH
(2014). Parameterization of pharmaceutical emissions and removal rates for use in UK predictive exposure models: steroid estrogens as a case study. Environ Sci Process Impacts
Parameterization of pharmaceutical emissions and removal rates for use in UK predictive exposure models: steroid estrogens as a case study.
Newly available prescription data has been used along with census data to develop a localised method for predicting pharmaceutical concentrations in sewage influent and effluent for England, and applied to a case study: the steroid estrogens estrone, 17β-estradiol, and 17α-ethinylestradiol in a selected catchment. The prescription data allows calculation of the mass consumed of synthetic estrogens, while use of highly localised census data improves predictions of naturally excreted estrogens by accounting for regional variations in population demographics. This serves two key purposes; to increase the accuracy of predictions in general, and to call attention to the need for more accurate predictions at a localised and/or catchment level, especially in light of newly proposed regulatory measures which may in the future require removal of steroid estrogens by sewage treatment facilities. In addition, the general lack of measured sewage works data necessitated the development of a novel approach which allowed comparison of localised predictions to average national measurements of influent and effluent. Overall in the case study catchment, estrogen predictions obtained using the model described herein were within 95% confidence intervals of measured values drawn from across the UK, with large improvements to predictions of EE2 being made compared with previous predictive methods. Abstract
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(2013). Atlas of epidemic Britain: a twentieth century picture. CRITICAL PUBLIC HEALTH
(1), 121-122. Author URL
White MP, Alcock I, Wheeler BW, Depledge MH
(2013). Coastal proximity, health and well-being: Results from a longitudinal panel survey. Health & Place
Coastal proximity, health and well-being: Results from a longitudinal panel survey
Abstract Analysis of English census data revealed a positive association between self-reported health and living near the coast. However that analysis was based on cross-sectional data and was unable to control for potential selection effects (e.g. generally healthier, personality types moving to coastal locations). In the current study we have used English panel data to explore the relationship between the proximity to the coast and indicators of generic and mental health for the same individuals over time. This allowed us to control for both time-invariant factors such as personality and compare the strength of any relationship to that of other relationships (e.g. employment vs. unemployment). In support of cross-sectional analysis, individuals reported significantly better general health and lower levels of mental distress when living nearer the coast, controlling for both individual (e.g. employment status) and area (e.g. green space) level factors. No coastal effect on life satisfaction was found. Although individual level coastal proximity effects for general health and mental distress were small, their cumulative impact at the community level may be meaningful for policy makers. Abstract
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Wheeler BW, Kothencz G, Pollard AS (2013). Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England. British Journal of Cancer
Wheeler BW, Kothencz G, Pollard AS
(2013). Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England. Br J Cancer
Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England.
BACKGROUND: This study investigates the geography of non-melanoma skin cancer (NMSC) in England, and ecological associations with three widespread environmental hazards: radon, arsenic and ultraviolet radiation from the sun. METHODS: Age-/sex-standardised registration rates of NMSC were mapped for local authority (LA) areas (n=326), along with geographical data on bright sunshine, household radon and arsenic. Associations between NMSC and environmental variables, adjusted for socio-economic confounders, were investigated. RESULTS: There was a substantial geographical variation in NMSC rates across English local authorities and between cancer registration regions. Forty percent of variance in rates was at registry region level and 60% at LA level. No association was observed between environmental arsenic and NMSC rates. Rates were associated with area-mean bright sunshine hours. An association with area-mean radon concentration was suggested, although the strength of statistical evidence was sensitive to model specification. CONCLUSION: the significant geographical variation across England in NMSC registration rate is likely to be partly, but not wholly, explained by registry differences. Findings tentatively support suggestions that environmental radon may be a risk factor for NMSC. Although NMSC is rarely fatal, it has significant implications for individuals and health services, and further research into NMSC geographical and environmental risk factors is warranted. Abstract
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Wheeler B, Kothencz G, Pollard A (2013). Non-melanoma skin cancer geography and ecological associations with environmental risk factors in England.
Phoenix C, Osborne NJ, Redshaw C, Moran R, Stahl-Timmins W, Depledge MH, Fleming LE, Wheeler BW
(2013). Paradigmatic approaches to studying environment and human health: (Forgotten) implications for interdisciplinary research. Environmental Science and Policy
Paradigmatic approaches to studying environment and human health: (Forgotten) implications for interdisciplinary research
Interdisciplinary research is increasingly promoted in a wide range of fields, especially so in Abstract
the study of relationships between the environment and human health. However, many
projects and research teams struggle to address exactly how researchers from a multitude of
disciplinary and methodological backgrounds can best work together to maximize the value
of this approach to research. In this paper, we briefly review the role of interdisciplinary
research, and emphasise that it is not only our discipline and methods, but our research
paradigms, that shape the way that we work. We summarise three key research paradigms –
positivism, postpositivism and interpretivism – with an example of how each might
approach a given environment-health research issue. In turn, we argue that understanding
the paradigm from which each researcher operates is fundamental to enabling and optimizing
the integration of research disciplines, now argued by many to be necessary for our
understanding of the complexities of the interconnections between human health and our
environment as well as their impacts in the policy arena. We recognise that a comprehensive
interrogation of research approaches and philosophies would require far greater length
than is available in a journal paper. However, our intention is to instigate debate, recognition,
and appreciation of the different worlds inhabited by the multitude of researchers
involved in this rapidly expanding field.
Phoenix C, Osborne NJ, Redshaw C, Moran R, Stahl-Timmins W, Depledge MH, Fleming LE, Wheeler BW
(2013). Paradigmatic approaches to studying environment and human health: (Forgotten) implications for interdisciplinary research. Environmental Science and Policy
Paradigmatic approaches to studying environment and human health: (Forgotten) implications for interdisciplinary research
Interdisciplinary research is increasingly promoted in a wide range of fields, especially so in the study of relationships between the environment and human health. However, many projects and research teams struggle to address exactly how researchers from a multitude of disciplinary and methodological backgrounds can best work together to maximize the value of this approach to research. In this paper, we briefly review the role of interdisciplinary research, and emphasise that it is not only our discipline and methods, but our research paradigms, that shape the way that we work. We summarise three key research paradigms - positivism, postpositivism and interpretivism - with an example of how each might approach a given environment-health research issue. In turn, we argue that understanding the paradigm from which each researcher operates is fundamental to enabling and optimizing the integration of research disciplines, now argued by many to be necessary for our understanding of the complexities of the interconnections between human health and our environment as well as their impacts in the policy arena. We recognise that a comprehensive interrogation of research approaches and philosophies would require far greater length than is available in a journal paper. However, our intention is to instigate debate, recognition, and appreciation of the different worlds inhabited by the multitude of researchers involved in this rapidly expanding field. © 2012 Elsevier Ltd. Abstract
White MP, Alcock I, Wheeler BW, Depledge MH
(2013). Would you be happier living in a greener urban area? a fixed-effects analysis of panel data. Psychol Sci
Would you be happier living in a greener urban area? a fixed-effects analysis of panel data.
Urbanization is a potential threat to mental health and well-being. Cross-sectional evidence suggests that living closer to urban green spaces, such as parks, is associated with lower mental distress. However, earlier research was unable to control for time-invariant heterogeneity (e.g. personality) and focused on indicators of poor psychological health. The current research advances the field by using panel data from over 10,000 individuals to explore the relation between urban green space and well-being (indexed by ratings of life satisfaction) and between urban green space and mental distress (indexed by General Health Questionnaire scores) for the same people over time. Controlling for individual and regional covariates, we found that, on average, individuals have both lower mental distress and higher well-being when living in urban areas with more green space. Although effects at the individual level were small, the potential cumulative benefit at the community level highlights the importance of policies to protect and promote urban green spaces for well-being. Abstract
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Southward EF, Page AS, Wheeler BW, Cooper AR
(2012). Contribution of the school journey to daily physical activity in children aged 11-12 years. Am J Prev Med
Contribution of the school journey to daily physical activity in children aged 11-12 years.
BACKGROUND: Active travel is a possible method to increase physical activity in children, but the precise contribution of walking to school to daily physical activity is unclear. PURPOSE: to combine accelerometer and GPS data to quantify moderate-to-vigorous physical activity (MVPA) on the walk to and from school in relation to overall daily levels. METHODS: Participants were 141 children aged 11-12 years from the PEACH Project (Personal and Environmental Associated with Children's Health) in Bristol, England, measured between 2008 and 2009. Eighty-four children met the inclusion criteria and were included in the final analysis. Accelerometers measured physical activity, GPS receivers recorded location, and mode of travel was self-reported. Data were analyzed between April and October 2011. Combined accelerometer and GPS data were mapped in a GIS. Minutes of MVPA were compared for school journeys taking place between 8:00 AM and 9:00 AM and between 3:00 PM and 5:00 PM and in relation to whole-day levels. RESULTS: Physical activity levels during journeys to and from school were highly similar, and contributed 22.2 minutes (33.7%) of total daily MVPA. In addition, MVPA on the journey did not differ between boys and girls, but because girls have lower levels of daily physical activity than boys, the journey contributed a greater proportion of their daily MVPA (35.6% vs 31.3%). CONCLUSIONS: the journey to and from school is a significant contributor to MVPA in children aged 11-12 years. Combining GPS and accelerometer data within a GIS is a useful approach to quantifying specific journeys. Abstract
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Wheeler BW, White M, Stahl-Timmins W, Depledge MH (2012). Does living by the coast improve health and wellbeing?. Health and Place
Hunter J, Madden R, Stone A, Osborne N, Wheeler B, Barlow M, Bendall R, Lin N, Henley W, Gaze W, et al
(2012). HEPATITIS E (HEV) IN SOUTH WEST ENGLAND. GEOGRAPHICAL, ENVIRONMENTAL AND SOCIAL FACTORS: a CASE CONTROL STUDY. Author URL
Audrey S, Wheeler BW, Mills J, Ben-Shlomo Y
(2012). Health promotion and the social gradient: the free swimming initiative for children and young people in Bristol. Public Health
Health promotion and the social gradient: the free swimming initiative for children and young people in Bristol.
OBJECTIVES: to examine whether the free swimming initiative in Bristol was associated with higher uptake in more affluent areas ('inverse use law'). STUDY DESIGN: Secondary analysis of statistical data on free swimming session attendances in Bristol, recorded from January to June 2010. Individual postcode data were linked to lower-layer super output area (LSOA) of residence and the specific pool attended. METHODS: the dataset comprised 58,582 swims by 13,881 unique individuals between January and June 2010. The influence of age group, gender, season, distance from pool and area deprivation score (English Index of Multiple Deprivation) on swimming uptake rates was examined. RESULTS: Higher uptake rates were found amongst girls and older children. Higher attendance was also related to proximity to pool and warmer season. No association was found between area deprivation and uptake rate (P = 0.31). Lower uptake rates in deprived areas were more marked if they were further away from a pool and in the winter season (P-value for interactions Abstract
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Wheeler BW, Allen J, Depledge MH, Curnow A
(2012). Radon and skin cancer in southwest England: an ecologic study. Epidemiology
Radon and skin cancer in southwest England: an ecologic study.
BACKGROUND: Radon, a naturally occurring radioactive gas, is a carcinogen that causes a small proportion of lung cancers among exposed populations. Theoretical models suggest that radon may also be a risk factor for skin cancer, but epidemiologic evidence for this relationship is weak. In this study, we investigated ecologic associations between environmental radon concentration and the incidence of various types of skin cancer. METHODS: We analyzed data for 287 small areas (postcode sectors) in southwest England for the years 2000-2004. Poisson regression was used to compare registration rates of malignant melanoma, basal cell carcinoma, and squamous cell carcinoma across mean indoor radon concentrations from household surveys. Analyses were adjusted for potentially confounding factors, including age, sex, population socioeconomic status, and mean hours of bright sunshine. RESULTS: No association was observed between mean postcode sector radon concentration and either malignant melanoma or basal cell carcinoma registration rates. However, sectors with higher radon levels had higher squamous cell carcinoma registration rates, with evidence of an exposure-response relationship. Comparing highest and lowest radon categories, postcode sectors with mean radon ≥ 230 Bq/m(3) had registration rates 1.76 (95% confidence interval = 1.46-2.11) times those with mean radon 0-39 Bq/m(3). Associations persisted after adjustment for potential confounders. CONCLUSIONS: This ecologic study suggests that environmental radon exposure may be a risk factor for squamous cell carcinoma. Further study is warranted to overcome ecologic design limitations and to determine whether this relationship is generalizable to national and international settings. Abstract
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Lachowycz K, Jones AP, Page AS, Wheeler BW, Cooper AR
(2012). What can global positioning systems tell us about the contribution of different types of urban greenspace to children's physical activity?. Health and Place
What can global positioning systems tell us about the contribution of different types of urban greenspace to children's physical activity?
Urban greenspace is hypothesised to be an important location for physical activity in children, but their actual use of the resource to be active is not well known. In this study, global positioning systems (GPS) and accelerometers were used to measure activity within green environments for 902 English children aged 11-12. We summarised activity intensities in different types of greenspace on weekday evenings, weekend days and by season. Around half of outdoor moderate-vigorous activity took place in greenspace at the weekend and use was consistent across seasons. The findings suggest the importance of certain types of greenspace to children's physical activity. © 2012 Elsevier Ltd. Abstract
Chang S-S, Sterne JAC, Wheeler BW, Lu T-H, Lin J-J, Gunnell D
(2011). Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates. Health Place
Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates.
In industrialised Western nations suicide rates tend to be high in inner city areas and socially fragmented neighbourhoods. Few studies have investigated spatial variations in suicide in non-Western settings. We estimated smoothed standardised mortality ratios (1999-2007) for suicide for each of the 358 Taiwanese districts (median population aged 15+: 27,000) and investigated their associations with area characteristics using Bayesian hierarchical models. The geographic distribution of suicide was similar in men and women; young people showed the greatest spatial variation in rates. Rates were highest in East Taiwan, a mostly mountainous rural area. There was no evidence of above average rates in large cities. Spatial patterns of method-specific suicide rates varied markedly, with solids/liquids poisonings showing the greatest geographic variation and hangings the least. Factors most strongly associated with area suicide rates were median household income, population density and lone-parent households. Spatial patterning of suicide in Taiwan differed from that observed in Western nations. Suicide prevention strategies should take into account unique local patterns. Abstract
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Fahmy E, Gordon D, Dorling D, Rigby J, Wheeler B
(2011). Poverty and place in Britain, 1968-99. Environ Plann A
Poverty and place in Britain, 1968-99
To date, analyses of long-term trends in the spatial distribution of poverty in Britain have been frustrated by a lack of consistency in definitions, data sources and measures, as well as by changes over time in census and administrative geographies. This paper draws upon a series of national poverty surveys in order to derive methodologically consistent estimates of breadline and core poverty. These models are then applied to census data in order to describe the changing geography of poverty in Britain over the 1968-99 period. The primary concern is to reveal the changing spatial distribution of poverty that lies behind the headline figures. These analyses suggest that not only has poverty become increasingly prevalent amongst British households, it also became increasingly spatially concentrated between 1968 and 1999. Abstract
Wheeler BW (2010). Book Reviews. Sociology of Health & Illness, 32(1), 167-168.
Gunnell D, Wheeler B, Chang SS, Thomas B, Sterne JA, Dorling D
(2010). Changes in the geography of suicide in young men: England and Wales 1981-2005. J Epidemiol Community Health
Changes in the geography of suicide in young men: England and Wales 1981-2005
Background Suicide rates changed considerably in men aged Abstract
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Wheeler BW, Cooper AR, Page AS, Jago R
(2010). Greenspace and children's physical activity: a GPS/GIS analysis of the PEACH project. Prev Med
Greenspace and children's physical activity: a GPS/GIS analysis of the PEACH project.
OBJECTIVE: to quantify the volume and intensity of children's physical activity after school in greenspace and elsewhere. METHODS: Data were collected between 2006 and 2008 from 1,307 children aged 10-11 in Bristol, UK. Accelerometers and Global Positioning System receivers measured activity and location every 10 s (epoch) after school for four days. Data were mapped in a Geographic Information System with a greenspace dataset. Activity volume (accelerometer counts per minute), time in moderate-vigorous physical activity (MVPA), and the odds of an epoch being MVPA (using logistic regression) were compared for greenspace, non-greenspace and indoors. RESULTS: 13% of monitored time was spent outdoors (2% in greenspace), during which time 30% of activity volume and 35% of MVPA was accumulated. 7% of boys' activity volume and 9% of MVPA were in greenspace with girls slightly lower (5% and 6% respectively). The odds of an epoch being MVPA in greenspace relative to outdoor non-greenspace was 1.37 (95% CI 1.22-1.53) for boys and 1.08 (95% CI 0.95-1.22) for girls. CONCLUSION: Most activity occurring outdoors is not in greenspace and non-green urban environments are therefore very important for children's activity. However, when boys are in greenspace, activity is more likely to be of higher intensity. Abstract
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Metcalfe C, Wheeler BW, Gunnell D, Martin RM
(2010). International regulatory activity restricting COX-2 inhibitor use and deaths due to gastrointestinal haemorrhage and myocardial infarction. Pharmacoepidemiol Drug Saf
International regulatory activity restricting COX-2 inhibitor use and deaths due to gastrointestinal haemorrhage and myocardial infarction.
PURPOSE: to investigate trends in mortality rates due to both myocardial infarction and gastrointestinal haemorrhage before and after rofecoxib withdrawal and the release of regulatory guidance regarding the use of other COX-2 inhibitors. METHODS: International ecological study of temporal trends in deaths from myocardial infarction and gastrointestinal haemorrhage around 2004 when regulatory activity restricted the use of COX-2 inhibitors. Mortality data in countries with low child and adult male mortality (WHO mortality stratum A) were analysed. RESULTS: Comparing, on a country-by-country basis, post-2004 mortality rates with those expected from a continuation of preceding trends, there was no evidence of a deviation from the earlier trends in mortality from gastrointestinal haemorrhage or acute myocardial infarction in 50-69 year olds. Amongst 70+ year olds however, there was evidence of lower gastrointestinal haemorrhage mortality (rate ratio 0.963, 95% confidence interval 0.948 to 0.977) and of lower acute myocardial infarction mortality (rate ratio 0.981, 95% confidence interval 0.977 to 0.986) after 2004. These associations were similar for males and females. CONCLUSIONS: We did not find evidence of an increase in mortality due to gastrointestinal haemorrhage following the withdrawal of rofecoxib in 2004, and coincident concern amongst regulatory bodies about other COX-2 inhibitors. In fact in men and women aged 70 years or older there appeared to be reduced mortality due to gastrointestinal haemorrhage and acute myocardial infarction compared to what was expected from mortality trends before 2004. Abstract
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Cooper AR, Page AS, Wheeler BW, Griew P, Davis L, Hillsdon M, Jago R
(2010). Mapping the walk to school using accelerometry combined with a global positioning system. Am J Prev Med
Mapping the walk to school using accelerometry combined with a global positioning system.
BACKGROUND: Walking to school is associated with higher levels of physical activity, but the contribution of the journey itself to physical activity before school is unknown. PURPOSE: This study combined accelerometer and GPS data to investigate the level and location of physical activity in children walking to school. METHODS: Participants were 137 children (aged 11.3 + or - 0.3 years) from London, England, measured in June-July 2006. Physical activity was measured by accelerometry, and location was determined with a GPS receiver. Travel mode was self-reported. Accelerometer and GPS data were time-matched to provide activity level and location for each 10-second epoch where both were available. Journeys were mapped in a GIS. RESULTS: Mean accelerometer counts per minute before school (8:00 am to 9:00 am) were 43% higher in those who walked to school than those traveling by car (878.8 + or - 387.6 vs 608.7 + or - 264.1 counts per minute [cpm], p Abstract
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Cooper AR, Page AS, Wheeler BW, Hillsdon M, Griew P, Jago R
(2010). Patterns of GPS measured time outdoors after school and objective physical activity in English children: the PEACH project. Int J Behav Nutr Phys Act
Patterns of GPS measured time outdoors after school and objective physical activity in English children: the PEACH project.
BACKGROUND: Observational studies have shown a positive association between time outdoors and physical activity in children. Time outdoors may be a feasible intervention target to increase the physical activity of youth, but methods are required to accurately measure time spent outdoors in a range of locations and over a sustained period. The Global Positioning System (GPS) provides precise location data and can be used to identify when an individual is outdoors. The aim of this study was to investigate whether GPS data recorded outdoors were associated with objectively measured physical activity. METHODS: Participants were 1010 children (11.0 +/- 0.4 years) recruited from 23 urban primary schools in South West England, measured between September 2006 and July 2008. Physical activity was measured by accelerometry (Actigraph GT1M) and children wore a GPS receiver (Garmin Foretrex 201) after school on four weekdays to record time outdoors. Accelerometer and GPS data were recorded at 10 second epochs and were combined to describe patterns of physical activity when both a GPS and accelerometer record were present (outdoors) and when there was accelerometer data only (indoors). ANOVA was used to investigate gender and seasonal differences in the patterns of outdoor and indoor physical activity, and linear regression was used to examine the cross-sectional associations between GPS-measured time outdoors and physical activity. RESULTS: GPS-measured time outdoors was a significant independent predictor of children's physical activity after adjustment for potential confounding factors. Physical activity was more than 2.5 fold higher outdoors than indoors (1345.8 +/- 907.3 vs 508.9 +/- 282.9 counts per minute; F = 783.2, p <. 001). Overall, children recorded 41.7 +/- 46.1 minutes outdoors between 3.30 pm and 8.30 pm, with more time spent outdoors in the summer months (p <. 001). There was no gender difference in time spent outdoors. Physical activity outdoors was higher in the summer than the winter (p <. 001), whilst there was no seasonal variation in physical activity indoors. CONCLUSIONS: Duration of GPS recording is positively associated with objectively measured physical activity and is sensitive to seasonal differences. Minute by minute patterning of GPS and physical activity data is feasible and may be a useful tool to investigate environmental influences on children's physical activity and to identify opportunities for intervention. Abstract
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(2010). Social Inequality and Public Health. [Book Review]. SOCIOLOGY OF HEALTH & ILLNESS
(1), 167-168. Author URL
Chang S-S, Gunnell D, Wheeler BW, Yip P, Sterne JAC
(2010). The evolution of the epidemic of charcoal-burning suicide in Taiwan: a spatial and temporal analysis. PLoS Med
The evolution of the epidemic of charcoal-burning suicide in Taiwan: a spatial and temporal analysis.
BACKGROUND: an epidemic of carbon monoxide poisoning suicide by burning barbecue charcoal has occurred in East Asia in the last decade. We investigated the spatial and temporal evolution of the epidemic to assess its impact on the epidemiology of suicide in Taiwan. METHODS AND FINDINGS: Age-standardised rates of suicide and undetermined death by charcoal burning were mapped across townships (median population aged 15 y or over = 27,000) in Taiwan for the periods 1999-2001, 2002-2004, and 2005-2007. Smoothed standardised mortality ratios of charcoal-burning and non-charcoal-burning suicide and undetermined death across townships were estimated using Bayesian hierarchical models. Trends in overall and method-specific rates were compared between urban and rural areas for the period 1991-2007. The epidemic of charcoal-burning suicide in Taiwan emerged more prominently in urban than rural areas, without a single point of origin, and rates of charcoal-burning suicide remained highest in the metropolitan regions throughout the epidemic. The rural excess in overall suicide rates prior to 1998 diminished as rates of charcoal-burning suicide increased to a greater extent in urban than rural areas. CONCLUSIONS: the charcoal-burning epidemic has altered the geography of suicide in Taiwan. The observed pattern and its changes in the past decade suggest that widespread media coverage of this suicide method and easy access to barbecue charcoal may have contributed to the epidemic. Prevention strategies targeted at these factors, such as introducing and enforcing guidelines on media reporting and restricting access to charcoal, may help tackle the increase of charcoal-burning suicides. Please see later in the article for the Editors' Summary. Abstract
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Martin RM, Wheeler BW, Metcalfe C, Gunnell D
(2010). What was the immediate impact on population health of the recent fall in hormone replacement therapy prescribing in England? Ecological study. J Public Health (Oxf)
What was the immediate impact on population health of the recent fall in hormone replacement therapy prescribing in England? Ecological study.
BACKGROUND: the publication in 2002 of the women's health initiative (WHI) trial revealed long-term risks and benefits of hormone replacement therapy (HRT). Increased cardiovascular disease, venous thromboembolism and breast cancer risks outweighed benefits on hip fracture, colorectal and endometrial cancer. We investigated whether the subsequent 50% fall in HRT use in England impacted on population rates of these outcomes. METHODS: Time-series analysis of hospital admissions, incidence and mortality amongst women aged 50-69, England 1997-2006. RESULTS: There was no relationship between reduced HRT prescribing after 2002 and trends in breast cancer, colorectal cancer or hip fracture. Amongst 50-59 year olds, the annual percentage change in venous thromboembolism hospitalizations fell from 0.0% [95% confidence interval (CI): -2.3 to 2.3%] between 1997 and 2000 to -5.7% (-7.7 to -3.6%) between 2000 and 2006 (P-value = 0.001); the annual change in endometrial cancer mortality increased from 0.7% (-3.2 to 4.8%) between 1997 and 2003 to 11.0% (0.2 to 22.9%) after 2003 (P-value = 0.07); and previously falling acute myocardial infarction hospitalizations (annual change: -6.8%) and stroke (-3.0%) stabilized (-0.4%) or increased (+0.8%), respectively, around 2001 (P < 0.0001). CONCLUSION: Although rates of venous thromboembolism (decline) and endometrial cancer mortality (increase) changed in line with WHI findings, the decline in venous thromboembolism may have started before 2002 and increased fatal endometrial cancers could be a chance finding. Abstract
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Wheeler BW, Metcalfe C, Martin RM, Gunnell D
(2009). International impacts of regulatory action to limit antidepressant prescribing on rates of suicide in young people. Pharmacoepidemiol Drug Saf
International impacts of regulatory action to limit antidepressant prescribing on rates of suicide in young people.
PURPOSE: Concerns that selective serotonin reuptake inhibitors (SSRIs) may increase the risk of suicidal behaviour amongst young people led to regulatory action in 2003/4 in many countries. Antidepressant prescribing to young people in various countries declined, but subsequent analyses have demonstrated mixed effects on population suicide rates. METHODS: Annual, national suicide mortality rates from 1990 to 2006 for 10-19 year-olds in World Health Organisation (WHO) Mortality Stratum a countries were studied using the WHO mortality database. Departures from country-specific trends in 2004-2006 relative to overall trends 1990-2006 were calculated to estimate the impact of regulatory actions in 2003/4. RESULTS: There was no consistent change in rate after 2003, with some countries experiencing more and some fewer suicides than expected. Amongst 15-19 year olds the rate ratio was 0.999 (95%CI: 0.971-1.028), and in 10-14 year olds was 0.999 (95%CI: 0.929-1.074). There was some evidence of differential results for males and females. In 15-19 year olds there were 1.8% fewer (95%CI: -5.0 to +1.5%) suicides than expected amongst males and 8.1% more (95%CI: +1.9 to +14.6%) suicides than expected amongst females during 2004-2006. Rate ratios for 10-14 year-olds demonstrated a similar pattern, but with much greater uncertainty. CONCLUSIONS: There was no evidence of an overall effect on suicides of regulatory action to restrict prescribing of SSRIs to young people, although there was weak evidence of an increase in suicide amongst young women internationally. Abstract
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Wheeler BW, Metcalfe C, Gunnell D, Stephens P, Martin RM
(2009). Population impact of regulatory activity restricting prescribing of COX-2 inhibitors: ecological study. Br J Clin Pharmacol
Population impact of regulatory activity restricting prescribing of COX-2 inhibitors: ecological study.
AIMS: to investigate impacts of withdrawal and regulatory advice regarding cyclooxygenase-2 (COX-2) inhibitors on UK population rates of gastrointestinal haemorrhage and acute myocardial infarction (MI). METHODS: Ecological time series study of prescribing, mortality and hospital admission trends in people aged > or = 55 years. RESULTS: Withdrawal and regulatory advice limiting COX-2 inhibitor availability from 2004 were temporally associated with reversal of previously unfavourable trends in emergency MI admissions among people aged > or = 65 years. Annual admission rate trends changed from +4.6% to -3.1% (P < 0.001) among women and from +2.1% to -3.8% (P= 0.003) among men. Absolute changes in average annual trend in the number of individuals aged > or = 65 years admitted following MI were from +981 (1999-2004) to -819 (2004-2006) per year for women and from +713 to -995 for men. No change in trend was apparent among people aged 55-64 years, or in MI mortality trends. There was some suggestion of an unfavourable change in admission trends for gastrointestinal haemorrhage among 55-64-year-olds, although this appeared to occur prior to COX-2 inhibitor withdrawal/regulation by up to 2 years. These trends were not apparent in older people, or in gastrointestinal haemorrhage mortality rates. CONCLUSIONS: Withdrawal/regulation of COX-2 inhibitors was temporally associated with a favourable reversal of population-level hospital admission trends in MI among people aged > or = 65 years. Unfavourable reversal of previous declines in gastrointestinal haemorrhage admissions probably occurred before changes in COX-2 inhibitor availability. Withdrawal/ regulation of COX-2 inhibitors did not appear to have any adverse impact on population health and may have been beneficial. Abstract
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Shaw M, Wheeler BW, Mitchell R, Dorling D (2008). Health and disabilty. In Ridge T, Wright S (Eds.) Understanding inequality, poverty and wealth: Policies and prospects, Bristol: the Policy Press.
Fahmy E, Dorling D, Rigby J, Wheeler B, Ballas D, Gordon D, Lupton R (2008). Poverty, Wealth and Place in Britain, 1968 - 2005. Radical Statistics(97), 11-30.
Wheeler BW (2008). SSRIs and young suicides. GP
Wheeler BW, Gunnell D, Metcalfe C, Stephens P, Martin RM
(2008). The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study. BMJ
The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study.
OBJECTIVE: to investigate the population impact on the incidence of suicide and non-fatal self harm of regulatory action in 2003 to restrict the use of selective serotonin reuptake inhibitors (SSRIs) in under 18s. DESIGN: Ecological time series study. SETTING: United Kingdom. Populations Young people in the UK aged 12-19 years (prescribing trends), in England and Wales aged 12-17 years (mortality), and in England aged 12-17 years (hospital admissions). MAIN OUTCOME MEASURES: Deaths from suicide and hospital admissions for self harm. RESULTS: Antidepressant prescribing doubled between 1999 and 2003 but fell to the 1999 level between 2004 and 2005. These large changes in prescribing did not seem to be associated with temporal trends in suicide or self harm. In the years 1993 to 2005 the annual percentage reduction for suicide among 12-17 year olds was -3.9% (95% confidence interval -6.2% to -1.5%) in males and -3.0% (-6.6% to 0.6%) in females, with no indication of a substantial change in this rate of decrease during that period. Similarly, hospital admission rates for self harm in the years 1999 to 2005 indicated an annual percentage increase for males of 1.1% (-0.5% to 2.7%) and for females of 5.7% (3.6% to 7.8%), again with no statistical evidence of a change in rate after the regulatory action. CONCLUSIONS: the noticeable reduction in prescribing of antidepressants since regulatory action in 2003 to restrict the use of SSRIs in under 18s does not seem to have been associated with changes in suicidal behaviour in young people. Specifically, these data for England do not indicate that reductions in antidepressant use have led to an increase in suicidal behaviour. Abstract
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Dorling D, Wheeler B, Shaw M, Mitchell R (2007). Counting the 21st Century Children of Britain: the extent of advantage and disadvantage. 21st Century: Journal of the Academy of Social Sciences, 2, 173-189.
Shaw M, Galobardes B, Lawlor DA, Lynch J, Wheeler B, Davey SG (2007). Handbook of Measures of Socioeconomic Position and Inequalities. Bristol, the Policy Press.
Dorling D, Barford A, Wheeler B (2007). Health impacts of an environmental disaster: a polemic. Environmental Research Letters(2), 1-11.
Dorling D, Rigby J, Wheeler B, Ballas D, Thomas B, Fahmy E, Gordon D, Lupton R (2007). Poverty, wealth and place in Britain 1968 to 2005. Bristol, the Policy Press.
Shaw M, Galobardes B, Lawlor DA, Lynch J, Wheeler B, Smith GD
(2007). The handbook of inequality and socioeconomic position: Concepts and measures.
The handbook of inequality and socioeconomic position: Concepts and measures
Wheeler BW, Michell R, Shaw M, Dorling D (2006). 2001 Census: the geography of education in Britain. Geography Review, 1(20), 16-20.
Wheeler BW, Michell R, Shaw M, Dorling D (2006). 2001 Census: the geography of health in Britain. Geography Review, 5(19), 21-25.
Pearce J, Dorling D, Wheeler B, Barnett R, Rigby J
(2006). Geographical inequalities in health in New Zealand, 1980-200: the gap widens. Aust N Z J Public Health
Geographical inequalities in health in New Zealand, 1980-200: the gap widens.
OBJECTIVE: to monitor geographical inequalities in health in New Zealand during the period 1980 to 2001, a time of rapid social and economic change in society. METHODS: Age-standardised mortality rates were calculated using mortality records aggregated to a consistent set of geographical areas (the 2001 District Health Boards) for the periods 1980-82, 1985-87, 1990-92, 1995-97 and 1999-2001. In addition, the Relative Index of Inequality (RII) was calculated for each period to provide a robust measure of mortality rates over time. RESULTS: Although overall mortality rates have declined through the period 1980 to 2001, the reduction has not been consistent for all areas of New Zealand. Indeed for a small number of DHBs, mortality rates have increased slightly. There has been an increase in the geographical inequalities in health as measured by the RII between each time period except for between 1986 and 1991, where there was a small reduction. CONCLUSIONS: at the start of the 21st century, geographical inequalities in health in New Zealand have reached very high levels and continue to increase. The excess mortality for the worst areas in New Zealand increased from 15% in 1981 to 25% in 2000. If policy makers are committed to reducing health inequalities then more redistributive economic policies are required. Abstract
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Wheeler BW, Rigby JE, Huriwai T
(2006). Pokies and poverty: problem gambling risk factor geography in New Zealand. Health Place
Pokies and poverty: problem gambling risk factor geography in New Zealand.
Up to 2% of adults in New Zealand can be considered problem gamblers, where the activity has an impact on the well-being of those who gamble, and often their close associates. The most common activity involves non-casino gaming machines (NCGMs). This paper explores the geography of gambling 'opportunity' at small-area scales, and finds excess provision in those areas classified as highly deprived. Geographically weighted regression has been used to investigate the possibility that the degree of inequity in NCGM provision varies across New Zealand. As machines are licensed, this provides an opportunity for policy implementation towards risk reduction. Abstract
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Wheeler BW, Mitchell R, Shaw M, Dorling D (2006). The geography of housing in Britain. Geography Review, 3(20), 2-6.
Ballas D, Clarke G, Dorling D, Rigby J, Wheeler B (2006). Using geographical information systems and spatial microsimulaton for the analysis of health inequalities. Health Informatics J(12), 65-79.
Mitchell R, Wheeler R, Shaw M, Dorling D (2006). What can the 2001 census tell us about education in Scotland?. Scottish Educational Review, 1(38), 54-60.
Wheeler BW, Ben-Shlomo Y
(2005). Environmental equity, air quality, socioeconomic status, and respiratory health: a linkage analysis of routine data from the Health Survey for England. J Epidemiol Community Health
Environmental equity, air quality, socioeconomic status, and respiratory health: a linkage analysis of routine data from the Health Survey for England.
STUDY OBJECTIVE: to assess relations between socioeconomic status and local air quality, and combined effects on respiratory health, in the context of environmental and health inequality. DESIGN: Data on people taking part in the Health Survey for England were attributed with a small area index of air pollution using annual mean concentrations of nitrogen dioxide, sulphur dioxide, benzene, and particulates (PM10). Regression models were used to measure associations between social class, air quality, forced expiratory volume in one second (FEV1), and self reported asthma. PARTICIPANTS: Participants aged 16-79 in the Health Survey for England 1995, 1996, and 1997. MAIN RESULTS: Urban lower social class households were more likely to be located in areas of poor air quality, but the association in rural areas was, if anything reversed. Low social class and poor air quality were independently associated with decreased lung function (FEV1), but not asthma prevalence, after adjustment for a number of potential confounders. Social class effects were not attenuated by adjustment for air quality. In men, a differential effect of air pollution on FEV1 was found, with its effect in social classes III to V about double that in social classes I and II (p value for interaction = 0.04). This effect modification was not seen for women. CONCLUSIONS: Further evidence of environmental inequity in the UK is provided. The association between FEV1 and local air quality is of similar magnitude to that with social class, and the adverse effects of air pollution seem to be greater in men in lower social classes. Abstract
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Wheeler BW, Shaw M, Mitchell R, Dorling D (2005). Life in Britain: Using millennial Census data to understand poverty, inequality and place. Bristol, the Policy Press.
(2004). Health-related environmental indices and environmental equity in England and Wales. Environment and Planning A
Health-related environmental indices and environmental equity in England and Wales
This study developed small-area health-related environmental indices for England and Wales in the context of an investigation into socioeconomic inequity in the distribution of environmental risk. Selection of environmental hazards, relevant datasets, and their attribution to standard small-area geography using a geographic information system are described. Four indices for 1991 Census wards are proposed, relating to ambient air quality, atmospheric chemical releases from large-scale industrial processes, landfills, and sites registered under Control of Major Accident Hazard regulations. Ecological measures of association between these indices and the Carstairs material deprivation index and its components are presented in the context of variations by urban-rural status. Based on these analyses, the study generally supports previous findings of environmental inequity in England and Wales, but highlights that associations are dependent on the environmental and deprivation measures under consideration, and urban-rural context. It is proposed that environmental indices such as those described here should be included in considerations of area deprivation, could assist with equitable environmental decisionmaking and planning, and that measures of environmental inequity could be considered as indicators of progress towards sustainable development. Abstract
Rivett AC, Shallcross DE, Wood R, Wheeler BW, Gunnell DJ (2003). Deadly Urban Cocktail - Air polution and health in Bristol. Environmental Health Journal, 4-7.
Lawlor DA, Maxwell R, Wheeler BW
(2002). Rurality, deprivation, and excess winter mortality: an ecological study. J Epidemiol Community Health
(5), 373-374. Author URL