Understanding engagement in diet and dementia prevention research among British South Asians: a short report of findings from a patient and public involvement group.

BACKGROUND: Dementia is a global public health challenge. Evidence suggests that individuals from South Asian communities are an at-risk group for dementia, partly as a result of early and cumulative exposure to known dementia risk factors, such as obesity and type 2 diabetes. There needs to be more culturally appropriate community engagement to increase awareness of dementia and identify better strategies to encourage participation in dementia-related research. METHODS: We aimed to better understand the barriers and facilitators towards engaging with, and participating in, diet and dementia related research among British South Asians. This was achieved using a public and patient involvement (PPI) approach. A community-based, engagement event involving information sharing from experts and roundtable discussions with South Asian communities (n = 26 contributors) was held in June 2023 in Newcastle-upon-Tyne, UK. Collaboration from preidentified PPI representatives (n = 3) informed the content and structure of PPI activities, as well as recruitment. Data were synthesised using template analysis, a form of codebook thematic analysis. This involved deductively analysing data using relevant a priori themes, which were expanded upon, or modified, via inductive analysis. RESULTS: The findings highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research. Consideration of language barriers, time constraints, social influences and how to embed community outreach activities were reported as driving factors to maximise participation. CONCLUSIONS: This PPI work will inform the design and co-creation of a culturally adapted dietary intervention for brain health in accordance with the Medical Research Council and National Institute for Health and Care Research guidance for developing complex interventions.

Socioeconomic risks of food insecurity during the Covid-19 pandemic in the UK: findings from the Understanding Society Covid Survey.

BACKGROUND: We estimated socioeconomic factors associated with food insecurity during the first year of the Covid pandemic in the UK and explored potential mechanisms explaining these associations. METHODS: Data were from the April, July, and September 2020 waves of the UK Understanding Society Covid Survey. Food insecurity was measured as 'not having access to healthy and nutritious food' and 'reporting being hungry but not eating'. Logistic regression estimated the relationship between socioeconomic factors and food insecurity. A decomposition approach explored if financial vulnerability and having Covid-19 explained associations between socioeconomics factors and food insecurity. RESULTS: Single parents and young people aged 16-30 years had a higher odds of reporting both measures of food insecurity. Financial insecurity explained 5% to 25% of the likelihood of reporting being food insecure for young people and single parents depending on the food insecurity measure used. Experiencing Covid-19 symptoms explained less than 5% of the likelihood of being food insecure for single parents but approximately 30% of not having access to healthy and nutritious food for young people. CONCLUSION: Policies providing additional financial support may help to reduce the impact of Covid-19 on food insecurity in the UK.

Sociodemographic characteristics and frequency of consuming home-cooked meals and meals from out-of-home sources: cross-sectional analysis of a population-based cohort study.

OBJECTIVE: To identify sociodemographic characteristics associated with frequency of consuming home-cooked meals and meals from out-of-home sources. DESIGN: Cross-sectional analysis of a population-based cohort study. Frequency of consuming home-cooked meals, ready meals, takeaways and meals out were derived from a participant questionnaire. Sociodemographic characteristics regarding sex, age, ethnicity, working overtime and socio-economic status (SES; measured by household income, educational attainment, occupational status and employment status) were self-reported. Sociodemographic differences in higher v. lower meal consumption frequency were explored using logistic regression, adjusted for other key sociodemographic variables. SETTING: Cambridgeshire, UK. SUBJECTS: Fenland Study participants (n 11 326), aged 29-64 years at baseline. RESULTS: Eating home-cooked meals more frequently was associated with being female, older, of higher SES (measured by greater educational attainment and household income) and not working overtime. Being male was associated with a higher frequency of consumption for all out-of-home meal types. Consuming takeaways more frequently was associated with lower SES (measured by lower educational attainment and household income), whereas eating out more frequently was associated with higher SES (measured by greater educational attainment and household income) and working overtime. CONCLUSIONS: Sociodemographic characteristics associated with frequency of eating meals from different out-of-home sources varied according to meal source. Findings may be used to target public health policies and interventions for promoting healthier diets and dietary-related health towards people consuming home-cooked meals less frequently, such as men, those with lower educational attainment and household income, and overtime workers.

Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study.

BACKGROUND: Reported associations between preparing and eating home cooked food, and both diet and health, are inconsistent. Most previous research has focused on preparing, rather than eating, home cooked food; used small, non-population based samples; and studied markers of nutrient intake, rather than overall diet quality or health. We aimed to assess whether frequency of consuming home cooked meals was cross-sectionally associated with diet quality and cardio-metabolic health. METHODS: We used baseline data from a United Kingdom population-based cohort study of adults aged 29 to 64 years (n = 11,396). Participants self-reported frequency of consuming home cooked main meals. Diet quality was assessed using the Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) score, fruit and vegetable intake calculated from a 130-item food frequency questionnaire, and plasma vitamin C. Markers of cardio-metabolic health were researcher-measured body mass index (BMI), percentage body fat, haemoglobin A1c (HbA1c), cholesterol and hypertension. Differences across the three exposure categories were assessed using linear regression (diet variables) and logistic regression (health variables). RESULTS: Eating home cooked meals more frequently was associated with greater adherence to DASH and Mediterranean diets, greater fruit and vegetable intakes and higher plasma vitamin C, in adjusted models. Those eating home cooked meals more than five times, compared with less than three times per week, consumed 62.3 g more fruit (99% CI 43.2 to 81.5) and 97.8 g more vegetables (99% CI 84.4 to 111.2) daily. More frequent consumption of home cooked meals was associated with greater likelihood of having normal range BMI and normal percentage body fat. Associations with HbA1c, cholesterol and hypertension were not significant in adjusted models. Those consuming home cooked meals more than five times, compared with less than three times per week, were 28% less likely to have overweight BMI (99% CI 8 to 43%), and 24% less likely to have excess percentage body fat (99% CI 5 to 40%). CONCLUSIONS: In a large population-based cohort study, eating home cooked meals more frequently was associated with better dietary quality and lower adiposity. Further prospective research is required to identify whether consumption of home cooked meals has causal effects on diet and health.

Health and social determinants and outcomes of home cooking: A systematic review of observational studies.

Many dietary interventions assume a positive influence of home cooking on diet, health and social outcomes, but evidence remains inconsistent. We aimed to systematically review health and social determinants and outcomes of home cooking. Given the absence of a widely accepted, established definition, we defined home cooking as the actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients. Nineteen electronic databases were searched for relevant literature. Peer-reviewed studies in English were included if they focussed mainly on home cooking, and presented post 19th century observational or qualitative data on participants from high/very high human development index countries. Interventional study designs, which have previously been reviewed, were excluded. Themes were summarised using narrative synthesis. From 13,341 unique records, 38 studies - primarily cross-sectional in design - met the inclusion criteria. A conceptual model was developed, mapping determinants of home cooking to layers of influence including non-modifiable, individual, community and cultural factors. Key determinants included female gender, greater time availability and employment, close personal relationships, and culture and ethnic background. Putative outcomes were mostly at an individual level and focused on potential dietary benefits. Findings show that determinants of home cooking are more complex than simply possessing cooking skills, and that potential positive associations between cooking, diet and health require further confirmation. Current evidence is limited by reliance on cross-sectional studies and authors' conceptualisation of determinants and outcomes.

Access to food retail outlets in County Durham, UK: a pragmatic cross-sectional study.

BACKGROUND: Strong links exist between deprivation, obesity, and dietary quality. Increasing interest has focussed on the concept of access to food and so-called food deserts, defined by a policy working group of the UK Low Income Project Team in 1995 as "areas of relative exclusion where people experience physical and economic barriers to accessing healthy food". We aimed to establish the accessibility of food retail outlets in County Durham, a county in north-east England, UK, considering physical access, affordability, and food range and quality. METHODS: In a pragmatic cross-sectional study in County Durham, we used information from town surveys and food business databases to locate and identify food retail outlets. The prevalence of deprivation, obesity, retail outlets, takeaway outlets, and ratio of retail to takeaway outlets was mapped, to establish local food access, and any associations with deprivation and obesity. The times taken to travel from residences to supermarkets using private car and public transport were also measured. 400 members of the community participated in eight focus groups and commissioned on-street surveys. Focus group transcripts were reviewed alongside the on-street survey responses to identify key issues. FINDINGS: Most residents shopped at least weekly for food (n=368, 92%), used a supermarket for their main food shop (372, 93%), travelled for up to 15 min (340, 85%), and used a car for transport (188, 47%). Many survey respondents indicated high levels of satisfaction with food retail outlets (average rating 8·7 out of 10 for agreement with the statement "Overall I am satisfied with the shop where I do my main food shopping"), although financial constraints and transport inconvenience were identified as barriers. Difficulties with food shopping were more widely described in focus groups, and many individuals felt that local shopping provision had declined, with an emergent excess of takeaway outlets. Food retail access was reduced for the disabled, full-time workers, elderly people, and people with children. INTERPRETATION: These findings suggest a potential role for individual behaviour change, planning and policy bodies, and the food retail industry in addressing food access. The multiple methods used in this study enabled triangulation; however, the conclusions are limited by the pragmatic nature of data collection and analysis. FUNDING: Durham County Council.

What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach.

OBJECTIVES: Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients' physical and mental health. This study sought to identify the key influences and challenges around weight management in UK adult secure mental health settings. DESIGN: Qualitative focused ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. SETTING: Low secure male mental health ward and associated patient activities and events, in a National Health Service Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. PARTICIPANTS: 12 males (primarily white British) on the low secure ward; additional male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a 6-month period from April 2022. RESULTS: Secure mental healthcare delivered an environment predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and a ward culture that was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. CONCLUSIONS: Weight management in secure services is a complex challenge. In future, whole setting-based interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.

Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence.

BACKGROUND: Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown. METHODS: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143). FINDINGS: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes. INTERPRETATION: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes. FUNDING: Epilepsy Research Institute UK.

Communication and building social capital in community supported agriculture.

Community supported agriculture (CSA) schemes (programs) provide an alternative means for obtaining produce, through direct purchase from farms. They are also often driven by a vision of transforming the current mainstream food system and seek to build a community of people who support this vision. Social capital refers to the networks and ties between people and groups and the impact of these ties on access to influence, information, opportunity, and ability to organize. Social capital is built by CSAs and helps foster and stabilize the grassroots agricultural innovations that are needed for the development of sustainable food systems. Using the concept of social capital, we studied communication methods of four CSAs in the UK, examining the interactions between CSAs and their members and within each of their membership groups. We carried out in-depth interviews with 49 CSA members to establish what interactions they had with their CSA and with other members, and analyzed our data thematically to identify the characteristics of interactions that were important to participants. We consider how our research may benefit CSA organizations by enabling them to learn what their members want and to learn about the varied ways in which members conceptualize their experiences of community derived from their membership. We found that the various CSA communication strategies, which consist of frequent and varying virtual and face-to-face interactions, are able to promote development of both bridging and bonding social capital. Overall, there is a desire for social connection in CSA memberships. Furthermore, in CSAs where members can interact easily, there is potential for CSA membership to provide members with communication that is important as a source of both knowledge and social connection. CSAs can maximize both social capital and member satisfaction by using a range of communication media and methods to meet their members' circumstances and preferences.

Perceptions of 'Home Cooking': A Qualitative Analysis from the United Kingdom and United States.

Cooking at home is likely to be associated with benefits to diet and health. However, the nuanced perceptions and practices linked to different types of cooking are not yet fully understood. This research aimed to explore the specific concept of 'home cooking', using qualitative research from the UK and US. Data from two previously completed studies exploring cooking at home were combined and a new secondary analysis was undertaken using the Framework Method. Data in the first study were drawn from participants in the North East of the UK who were interviewed. Data in the second study were drawn from participants in Baltimore, US, who took part in focus groups. Data from a total of 71 adults (18 UK and 53 US), with diverse sociodemographic characteristics and experiences of cooking, were analysed. In both countries, participants distinguished 'home cooking' as a distinct subtype of cooking at home. 'Home cooking' was defined in terms of preparing a meal from scratch, cooking with love and care, and nostalgia. Cooking at home had a range of dimensions, and perceptions of 'home cooking' tended to focus on social and emotional associations. In future, public health initiatives might, therefore, highlight the potential social and emotional benefits of 'home cooking', rather than emphasising implications for physical health.

Home food preparation practices, experiences and perceptions: A qualitative interview study with photo-elicitation.

Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people's food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participants developed photographic food diaries that were used as prompts during semi-structured interviews. Data were analysed using the Framework Method. Interviews were conducted with 18 adults (five men and 13 women), aged approximately 20 to 80 years, to reach data saturation. Participants' practices varied widely, from reliance on pre-prepared foods, to preparing complex meals entirely from basic ingredients. Key themes emerged regarding the cook (identity), the task (process of cooking), and the context (situational drivers). Resources, in terms of time, money and facilities, were also underpinning influences on food preparation. Participants' practices were determined by both personal motivations to cook, and the influence of others, and generally reflected compromises between varied competing demands and challenges in life. Most people appeared to be overall content with their food preparation behaviour, though ideally aspired to cook more frequently, using basic ingredients. This often seemed to be driven by social desirability. Home food preparation is complex, with heterogeneous practices, experiences and perceptions both between individuals and within the same individual over time, according to shifting priorities and circumstances. Generalisability of these findings may be limited by the regional participant sample; however the results support and build upon previous research. Focussing interventions on life transition points at which priorities and circumstances change, with careful targeting to stimulate personal motivation and social norms, may prove effective in encouraging home food preparation.

Systematic review of the health and social determinants and outcomes of home cooking: protocol.

BACKGROUND: The United Kingdom (UK) and wider world are experiencing an obesity epidemic, with lower socio-economic groups disproportionately affected. Dietary quality is also socio-economically patterned, with an estimated quarter of observed inequalities in UK mortality due to inequalities in diet. Food preparation and eating patterns clearly have an impact on dietary intake and hence health. A growing body of evidence indicates that out of home food consumption and eating ready meals may be associated with negative outcomes. However, to date no systematic reviews have assessed the health and social determinants and outcomes of home cooking. Here, home cooking refers to the combination of actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients. METHODS/DESIGN: A systematic review of peer-reviewed literature on home cooking will be undertaken. Studies will be considered for inclusion if they present qualitative or quantitative data on participants from high/very high human development index countries, including all relevant study designs. No language or date of publication restrictions will be applied. Determinants will be considered as factors that influence behaviour and outcomes as potential advantages and disadvantages of engaging in home cooking. Electronic databases of peer-reviewed journal articles covering health, psychology, social sciences and consumer practices will be searched. Published postgraduate theses will also be considered for inclusion. Additional strategies to identify relevant studies will be used, such as citation searches of included articles, evaluation of references from relevant reviews and included articles and the 'related/similar to' function found in certain databases. Two independent researchers will be involved in literature screening (10% at first screen and 100% at second screen), data extraction and quality appraisal. Studies included in the review will be analysed by thematic synthesis and narrative synthesis, as appropriate for the nature of the data retrieved. DISCUSSION: This review will provide key empirical evidence to inform the development of recommendations for public health policy makers and practitioners to encourage healthier home food preparation, thereby impacting on dietary-related health. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered with the PROSPERO international prospective register of systematic reviews, reference CRD42014013984 .

Socioeconomic and behavioural risk factors for adverse winter health and social outcomes in economically developed countries: a systematic review of quantitative observational studies.

BACKGROUND: Mortality and morbidity rates are often highest during the winter period, particularly in countries with milder climates. A growing body of research has identified potential socioeconomic, housing and behavioural mediators of cold weather-related adverse health and social outcomes, but an inclusive systematic review of this literature has yet to be performed. METHODS: A systematic review, with narrative synthesis, of observational research published in English between 2001 and 2011, which quantified associations between socioeconomic, housing or behavioural factors and cold weather-related adverse health or social outcomes. RESULTS: Thirty-three studies met the inclusion criteria. Average study quality was not high. Most studies failed to control for all relevant confounding factors, or to conduct research over a long enough period to ascertain causality. Low income, housing conditions and composite fuel poverty measures were most consistently associated with cold weather-related adverse health or social outcomes. CONCLUSIONS: This review identified socioeconomic, housing and behavioural factors associated with a range of cold weather-related adverse health or social outcomes. Only tentative conclusions can be drawn due to the limitations of existing research. More robust studies are needed to address the methodological issues identified and uncover causal associations. A review of qualitative and intervention studies would help to inform policies to reduce the adverse health and social impacts of cold weather.