Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England.

BACKGROUND: Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs. METHODS: We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation). RESULTS: Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods. CONCLUSIONS: English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.

Associations between residential greenspace exposure and mortality in 4 645 581 adults living in London, UK: a longitudinal study.

BACKGROUND: Urban greenspaces could reduce non-communicable disease (NCD) risk. The links between greenspaces and NCD-related mortality remain unclear. We aimed to estimate associations between residential greenspace quantity and access and all-cause mortality, cardiovascular disease mortality, cancer mortality, respiratory mortality, and type 2 diabetes mortality. METHODS: We linked 2011 UK Census data of London-dwelling adults (aged ≥18 years) to data from the UK death registry and the Greenspace Information for Greater London resource. We calculated percentage greenspace area, access point density (access points per km2), and distance in metres to the nearest access point for each respondent's residential neighbourhood (defined as 1000 m street network buffers) for greenspaces overall and by park type using a geographic information system. We estimated associations using Cox proportional hazards models, adjusted for a range of confounders. FINDINGS: Data were available for 4 645 581 individuals between March 27, 2011, and Dec 31, 2019. Respondents were followed up for a mean of 8·4 years (SD 1·4). All-cause mortality did not differ with overall greenspace coverage (hazard ratio [HR] 1·0004, 95% CI 0·9996-1·0012), increased with increasing access point density (1·0076, 1·0031-1·0120), and decreased slightly with increasing distance to the nearest access point (HR 0·9993, 0·9987-0·9998). A 1 percentage point (pp) increase in pocket park (areas for rest and recreation under 0·4 hectares) coverage was associated with a decrease in all-cause mortality risk (0·9441, 0·9213-0·9675), and an increase of ten pocket park access points per km2 was associated with a decreased respiratory mortality risk (0·9164, 0·8457-0·9931). Other associations were observed, but the estimated effects were small (eg, all-cause mortality risk for increases of 1 pp in regional park area were 0·9913, 0·9861-0·9966 and increases of ten small open space access points per km2 were 1·0247, 1·0151-1·0344). INTERPRETATION: Increasing the quantity of, and access to, pocket parks might help mitigate mortality risk. More research is needed to elucidate the mechanisms that could explain these associations. FUNDING: Health Data Research UK (HDRUK).

Typology of how 'harmful commodity industries' interact with local governments in England: a critical interpretive synthesis.

INTRODUCTION: Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and 'harmful commodity industries' (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs). METHODS: Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs. RESULTS: We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples. CONCLUSION: Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decision-makers to maximise population health while minimising negative impacts of HCIs. PROSPERO REGISTRATION NUMBER: CRD42021257311.

Neighborhood environment and socioeconomic inequalities in cancer admissions: a prospective study using UK Biobank and linked hospital records.

PURPOSE: Neighborhood environments may influence cancer risk. Average population effect estimates might mask differential effects by socioeconomic position. Improving neighborhood environments could inadvertently widen health inequalities if important differences are overlooked. METHODS: Using linked records of hospital admissions in UK Biobank, we assessed associations between admission with a primary diagnosis of cancer (any/breast/colorectal), and exposure to neighborhood greenspace, physical activity facilities, and takeaway food stores, and whether household income and area deprivation modify these associations. We used adjusted Cox proportional hazards models, and estimated relative excess risks due to interaction (RERI) to assess effect modification. RESULTS: Associations between neighborhood exposures and cancer-related hospitalizations were weak to null overall, but with some evidence of effect modification. Most notably, more greenspace near home was associated with 16% lower hazard of cancer-related hospital admission in deprived areas (95% CI 2-29%). This was further pronounced for people in low-income households in deprived areas, and for breast cancer. CONCLUSION: In deprived neighborhoods, increasing the amount of greenspace may help reduce cancer-related hospitalizations. Examining effect modification by multiple socioeconomic indicators can yield greater insight into how social and environmental factors interact to influence cancer incidence. This may help avoid perpetuating cancer inequalities when designing neighborhood environment interventions.

The case for developing a cohesive systems approach to research across unhealthy commodity industries.

OBJECTIVES: Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs. METHODS: We held an expert consultation on analysing the involvement of UCIs in public health policy, conducted an analysis of business links across UCIs, and employed taxonomies of corporate political activity to collate, compare and illustrate strategies employed by the alcohol, ultra-processed food and drink products, tobacco and gambling industries. RESULTS: There are clear commonalities across UCIs' strategies in shaping evidence, employing narratives and framing techniques, constituency building and policy substitution. There is also consistent evidence of business links between UCIs, as well as complex relationships with government agencies, often allowing UCIs to engage in policy-making forums. This knowledge indicates that the role of all UCIs in public health policy would benefit from a common approach to analysis. This enables the development of a theoretical framework for understanding how UCIs influence the policy process. It highlights the need for a deeper and broader understanding of conflicts of interests and how to avoid them; and a broader conception of what constitutes strong evidence generated by a wider range of research types. CONCLUSION: UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and also to inform a more effective and coherent response.

Do neighbourhood characteristics act together to influence BMI? A cross-sectional study of urban parks and takeaway/fast-food stores as modifiers of the effect of physical activity facilities.

Studies exploring associations between neighbourhood environment and obesity often overlook the fact that neighbourhoods are multi-dimensional and that the effects of one environmental exposure may be modified by another. We examine whether associations between neighbourhood density of formal physical activity (PA) facilities and body mass index (BMI) are modified by the density of neighbourhood green spaces and takeaway stores. We used cross-sectional data from the UK Biobank cohort and linked UK Biobank Urban Morphometric Platform (UKBUMP) for 345,269 urban-dwelling adults aged 40-69. We examined associations between objectively measured BMI and the number of formal PA facilities (gyms, pools, etc.) within 1 km of each individual's home, testing separately for interactions with the number of local public green spaces, and number of takeaway stores, within the same 1 km buffers. We estimated modifier-stratified associations using multivariable, multilevel models to account for a clustered sampling design and potential confounding. Likelihood ratio tests were used to assess statistical interaction. We found that the association between a greater number of local PA facilities and lower BMI was stronger among people with fewer urban green spaces in their neighbourhood than among those with more green spaces (Pinteraction = 0.021). The same relationship between PA facilities and BMI was also noticeably attenuated among those with more takeaway stores near home, compared with people with none (Pinteraction = 0.014). We conclude that formal PA facilities may buffer against a lack of informal, green resources for PA in areas where the latter are scarce. However, the potential benefits of formal PA facilities in terms of obesity risk may be undermined by an unhealthy food environment close to home. Locating formal PA facilities in places with fewer public green resources and reducing the prevalence of takeaway stores in areas with formal PA resources may maximise the health benefits to be derived from these neighbourhood resources.

Longitudinal impact of changes in the residential built environment on physical activity: findings from the ENABLE London cohort study.

BACKGROUND: Previous research has reported associations between features of the residential built environment and physical activity but these studies have mainly been cross-sectional, limiting inference. This paper examines whether changes in a range of residential built environment features are associated with changes in measures of physical activity in adults. It also explores whether observed effects are moderated by socio-economic status. METHODS: Data from the Examining Neighbourhood Activity in Built Living Environments in London (ENABLE London) study were used. A cohort of 1278 adults seeking to move into social, intermediate, and market-rent East Village accommodation was recruited in 2013-2015, and followed up after 2 years. Accelerometer-derived steps (primary outcome), and GIS-derived measures of residential walkability, park proximity and public transport accessibility were obtained both at baseline and follow-up. Daily steps at follow-up were regressed on daily steps at baseline, change in built environment exposures and confounding variables using multilevel linear regression to assess if changes in neighbourhood walkability, park proximity and public transport accessibility were associated with changes in daily steps. We also explored whether observed effects were moderated by housing tenure as a marker of socio-economic status. RESULTS: Between baseline and follow-up, participants experienced a 1.4 unit (95%CI 1.2,1.6) increase in neighbourhood walkability; a 270 m (95%CI 232,307) decrease in distance to their nearest park; and a 0.7 point (95% CI 0.6,0.9) increase in accessibility to public transport. A 1 s.d. increase in neighbourhood walkability was associated with an increase of 302 (95%CI 110,494) daily steps. A 1 s.d. increase in accessibility to public transport was not associated with any change in steps overall, but was associated with a decrease in daily steps amongst social housing seekers (- 295 steps (95%CI - 595, 3), and an increase in daily steps for market-rent housing seekers (410 95%CI -191, 1010) (P-value for effect modification = 0.03). CONCLUSION: Targeted changes in the residential built environment may result in increases in physical activity levels. However, the effect of improved accessibility to public transport may not be equitable, showing greater benefit to the more advantaged.

Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study.

BACKGROUND: Active travel is increasingly recognised as an important source of physical activity. We aimed to describe associations between commute mode and cardiovascular disease, cancer, and all-cause mortality. METHODS: We analysed data from the Office for National Statistics Longitudinal Study of England and Wales (ONS-LS), which linked data from the Census of England and Wales (henceforth referred to as the Census) for 1991, 2001, and 2011 to mortality and cancer registrations. The cohort included individuals traced in the ONS-LS who were economically active (ie, aged ≥16 years, not retired from work, and not a full-time carer). Commuting by private motorised transport, public transport, walking, and cycling were compared in terms of all-cause mortality, cancer mortality, cardiovascular disease mortality, and cancer incidence, using Cox proportional-hazards models with time-varying covariates. Models were adjusted for age, sex, housing tenure, marital status, ethnicity, university education, car access, population density, socioeconomic classification, Carstairs index quintile, long-term illness, and year entered the study, and were additionally stratified by socioeconomic group. FINDINGS: Between the 1991 Census and the 2011 Census, 784 677 individuals contributed data for at least one Census, of whom 394 746 were included in the ONS-LS and were considered to be economically active working-age individuals. 13 983 people died, 3172 from cardiovascular disease and 6509 from cancer, and there were 20 980 incident cancer cases. In adjusted models, compared with commuting by private motorised vehicle, bicycle commuting was associated with a 20% reduced rate of all-cause mortality (hazard ratio [HR] 0·80, 95% CI 0·73-0·89), a 24% decreased rate of cardiovascular disease mortality (0·76, 0·61-0·93), a 16% lower rate of cancer mortality (0·84, 0·73-0·98), and an 11% reduced rate of incident cancer (0·89, 0·82-0·97). Compared with commuting by private motorised vehicle, rail commuters had a 10% lower rate of all-cause mortality (HR 0·90, 95% CI 0·83-0·97) and a 21% decreased rate of cardiovascular disease mortality (0·79, 0·67-0·94), in addition to a 12% reduced rate of incident cancer (0·88, 0·83-0·94). Walk commuting was associated with 7% lower cancer incidence (HR 0·93, 95% CI 0·89-0·97) Stratified analyses did not indicate differences in associations between socioeconomic groups. INTERPRETATION: Our findings augment existing evidence for the beneficial health effects of physically active commute modes, particularly cycling and train use, and suggest that all socioeconomic groups could benefit. FUNDING: National Institute for Health Research.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil / Ambiente alimentar, renda e obesidade: uma análise multinível da realidade de mulheres no Sul do Brasil / Entorno alimentario, renta y obesidad: un análisis multinivel de la realidad de mujeres en el Sur de Brasil

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

O estudo teve como objetivo explorar as relações entre o ambiente alimentar da vizinhança e obesidade em mulheres na área urbana de São Leopoldo, Rio Grande do Sul, Brasil, através de um inquérito transversal. O estudo teve uma amostra de 1.096 mulheres. Foram realizadas entrevistas estruturadas com um questionário padronizado e previamente testado. A obesidade foi definida como índice de massa corporal (IMC) ≥ 30kg/m2. Foram criadas zonas-tampão com raio de 400m em torno do centroide das residências das participantes nos 45 setores censitários. Os estabelecimentos varejistas com venda de alimentos na vizinhança foram identificados através de uma pesquisa sistemática das áreas do estudo, e foram coletadas as coordenadas geográficas dessas lojas. Os estabelecimentos foram avaliados com a ferramenta NEMS. A prevalência de obesidade foi 33% entre as participantes. Depois de ajustar para as variáveis individuais, os supermercados e os estabelecimentos com alimentos saudáveis mostraram uma associação positiva com a obesidade, RP = 1,05 (IC95%: 1,01-1,10), RP = 1,02 (IC95%: 1,00-1,04), respectivamente, enquanto que a renda média da zona-tampão mostrou associação negativa, RP = 0,64 (IC95%: 0,49-0,83). Os fatores de ambiente alimentar da vizinhança estiveram associados à obesidade, mesmo depois de controlar para as variáveis individuais, socioeconômicas, comportamentais e de compra de alimentos.

El objetivo de este estudio fue investigar las relaciones entre el entorno alimentario del vecindario y la obesidad en mujeres que viven en áreas urbanas de São Leopoldo, Rio Grande do Sul, Brasil. Se llevó a cabo un estudio transversal. Este estudio se realizó con 1.096 mujeres. Se realizaron entrevistas estructuradas, usando un cuestionario estándar probado previamente. La obesidad se definió como un índice de masa corporal (IMC) ≥ 30kg/m2. Se crearon amortiguadores circulares en un radio de 400m, basados en el centroide de las casas de las mujeres que participaron, en los 45 distritos censales donde residían. Los establecimientos de comida del vecindario fueron identificados mediante un estudio sistemático de todas las calles en las áreas de estudio y también se recabaron las coordenadas geográficas de las tiendas. Los establecimientos fueron evaluados usando el instrumento NEMS. La prevalencia de obesidad fue de un 33% entre las mujeres participantes. Tras el ajuste de las variables individuales, los supermercados y los establecimientos de comida sana estuvieron positivamente asociados con la obesidad, RP = 1,05 (IC95%: 1,01-1,10), RP = 1,02 (IC95%: 1,00-1,04), respectivamente, mientras que un promedio de renta media estuvo negativamente asociado, RP = 0,64 (IC95%: 0,49-0,83). Los factores del vecindario en el entorno alimentario estuvieron asociados con la obesidad incluso después de ser controlados por variables individuales como: socioeconómicas, comportamentales y de compra de comida.

Using alternatives to the car and risk of all-cause, cardiovascular and cancer mortality.

OBJECTIVE: To investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and morbidity and mortality. METHODS: We conducted a prospective study using data from 3 58 799 participants, aged 37-73 years, from UK Biobank. Commute and non-commute travel were assessed at baseline in 2006-2010. We classified participants according to whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time. The main outcome measures were incident cardiovascular disease (CVD) and cancer, and CVD, cancer and all-cause mortality. We excluded events in the first 2 years and conducted analyses separately for those who regularly commuted and those who did not. RESULTS: In maximally adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal (HR 0.70, 95% CI 0.51 to 0.95) CVD. Those regular commuters who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99). CONCLUSIONS: More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease.

Associations between fast food and physical activity environments and adiposity in mid-life: cross-sectional, observational evidence from UK Biobank.

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

The relationship between dietary quality and the local food environment differs according to level of educational attainment: A cross-sectional study.

There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children's centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (ß = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (ß = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers' food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.

Education and the Relationship Between Supermarket Environment and Diet.

INTRODUCTION: Supermarkets are a major source of food for many families. Knowledge of how educational attainment affects the relationship between in-store environments of supermarkets and diet is needed. This study examined the relationship between maternal dietary quality and overall in-store supermarket environment, and assessed the effect modification of educational attainment. METHODS: Dietary quality z-scores were calculated for 829 mothers with young children using cross-sectional data collected in 2010-2011 from a 20-item food frequency questionnaire. Information about nine in-store factors (variety, price, quality, promotion, shelf placement, store placement, nutrition information, healthier alternatives, and single fruit sale) on 12 foods known to discriminate between better and poorer dietary quality were collected to create a standardized "healthfulness" z-score for each supermarket where mothers shopped. RESULTS: Multilevel unadjusted linear regression analysis completed in 2014-2015 showed that shopping at more-healthful supermarkets was associated with better dietary quality (ß=0.39 SD/SD, p=0.01, 95% CI=0.10, 0.68). However, the relationship differed according to educational attainment (interaction, p=0.006). Among mothers who left school at age 16 years, those who shopped at less healthful supermarkets had poorer dietary quality (ß=0.31 SD/SD, 95% CI=0.07, 0.55). Among mothers with degrees, those who shopped at less healthful supermarkets had better dietary quality (ß=-0.59 SD/SD, 95% CI=-1.19, 0.00). CONCLUSIONS: Mothers with low educational attainment show greater susceptibility to less healthful in-store environments than mothers with higher educational attainment who may be protected by greater psychological and financial resources. Policy initiatives to improve supermarket environments may be necessary to address dietary inequalities.

Active commuting and obesity in mid-life: cross-sectional, observational evidence from UK Biobank.

BACKGROUND: Physical inactivity is a leading cause of obesity and premature mortality. We aimed to examine the relation between active commuting and obesity in mid-life using objectively measured anthropometric data from UK Biobank. METHODS: Cross-sectional, observational data from UK Biobank were used. These were collected from individuals aged 40-69 years who visited 22 assessment centres across the UK between 2006 and 2010. Self-reported commuting method was operationalised into seven categories, ordered to reflect typical levels of physical exertion. The outcomes assessed were BMI (based on objectively measured weight and height) and percentage body fat. Hypothesised confounders were income, area deprivation, urban or rural residence, education, alcohol intake, smoking, leisure physical activity, recreational walking, occupational physical activity, general health, and limiting illness or disability. We used sex-stratified multivariate linear-regression models. FINDINGS: Final complete case sample sizes were 72 999 men and 83 667 women for the BMI outcome and 72 139 men and 82 788 women for the percentage body fat outcome. Active commuting was significantly and independently associated with reduced BMI and percentage body fat for both sexes, with a graded pattern apparent across the seven commuting categories. In fully adjusted models, compared with their car-only counterparts, mixed public and active transport commuters had significantly lower BMI (men: ß coefficient -1·00 kg/m(2) [95% CI -1·14 to -0·87], p<0·0001; women: -0·67 kg/m(2) [-0·86 to -0·47], p<0·0001), as did cycling or cycling and walking commuters (men: -1·71 kg/m(2) [95% CI -1·86 to -1·56], p<0·0001; women: -1·65 kg/m(2) [-1·92 to -1·38], p<0·0001). Similarly, compared with car-only commuters, mixed public transport and active commuters had significantly lower percentage body fat (men: -1·32% [95% CI -1·53 to -1·12], p<0·0001; women: -1·10% [-1·40 to -0·81], p<0·0001), as did cycling or cycling and walking commuters (men: -2·75% [95% CI -3·03 to -2·48], p<0·0001; women: -3·26% [-3·80 to -2·71], p<0·0001). INTERPRETATION: This study is the first to use UK Biobank data to address the topic of active commuting and obesity and shows robust, independent associations between active commuting and healthier bodyweight and composition. These findings support the case for interventions to promote active travel as a population-level policy response for prevention of obesity in mid-life. FUNDING: UK Medical Research Council.

The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families.

INTRODUCTION: Recent systematic reviews suggest that there is a dearth of evidence on the effectiveness of large-scale urban regeneration programmes in improving health and well-being and alleviating health inequalities. The development of the Olympic Park in Stratford for the London 2012 Olympic and Paralympic Games provides the opportunity to take advantage of a natural experiment to examine the impact of large-scale urban regeneration on the health and well-being of young people and their families. DESIGN AND METHODS: A prospective school-based survey of adolescents (11-12 years) with parent data collected through face-to-face interviews at home. Adolescents will be recruited from six randomly selected schools in an area receiving large-scale urban regeneration (London Borough of Newham) and compared with adolescents in 18 schools in three comparison areas with no equivalent regeneration (London Boroughs of Tower Hamlets, Hackney and Barking & Dagenham). Baseline data will be completed prior to the start of the London Olympics (July 2012) with follow-up at 6 and 18 months postintervention. Primary outcomes are: pre-post change in adolescent and parent mental health and well-being, physical activity and parental employment status. Secondary outcomes include: pre-post change in social cohesion, smoking, alcohol use, diet and body mass index. The study will account for individual and environmental contextual effects in evaluating changes to identified outcomes. A nested longitudinal qualitative study will explore families' experiences of regeneration in order to unpack the process by which regeneration impacts on health and well-being. ETHICS AND DISSEMINATION: The study has approval from Queen Mary University of London Ethics Committee (QMREC2011/40), the Association of Directors of Children's Services (RGE110927) and the London Boroughs Research Governance Framework (CERGF113). Fieldworkers have had advanced Criminal Records Bureau clearance. Findings will be disseminated through peer-reviewed publications, national and international conferences, through participating schools and the study website (http://www.orielproject.co.uk).

Work group IV: Future directions for measures of the food and physical activity environments.

Much progress has been made in the past 5 to 10 years in measuring and understanding the impact of the food and physical activity environments on behavioral outcomes. Nevertheless, this research is in its infancy. A work group was convened to identify current evidence gaps and barriers in food and physical activity environments and policy research measures, and develop recommendations to guide future directions for measurement and methodologic research efforts. A nominal group process was used to determine six priority areas for food and physical activity environments and policy measures to move the field forward by 2015, including: (1) identify relevant factors in the food and physical activity environments to measure, including those most amenable to change; (2) improve understanding of mechanisms for relationships between the environment and physical activity, diet, and obesity; (3) develop simplified measures that are sensitive to change, valid for different population groups and settings, and responsive to changing trends; (4) evaluate natural experiments to improve understanding of food and physical activity environments and their impact on behaviors and weight; (5) establish surveillance systems to predict and track change over time; and (6) develop standards for adopting effective health-promoting changes to the food and physical activity environments. The recommendations emanating from the work group highlight actions required to advance policy-relevant research related to food and physical activity environments.

Pathways to obesity: identifying local, modifiable determinants of physical activity and diet.

Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.