Generating small-area prevalence of psychological distress and alcohol consumption: validation of a spatial microsimulation method.

PURPOSE: Public mental health surveillance data are rarely available at a fine geographic scale. This study applies a spatial microsimulation procedure to generate small-area (lower super outputs areas [LSOA]) estimates of psychological distress and alcohol consumption. The validity of LSOA estimates and their associations with proximal and broader socioeconomic conditions are examined. METHODS: A deterministic reweighting methodology assigns prevalence estimates for psychological distress and heavy alcohol consumption through a process of matching individuals from a large, population-representative dataset (Health Survey for England) to known LSOA populations (from the 2001 population Census). 'goodness-of-fit' of LSOA estimates is assessed by their comparison to observed prevalence of these health indicators at higher levels of aggregation (local authority districts [LAD]). Population prevalence estimates are correlated to the mental health needs index (MINI) and other health indicators; ordered logistic regression is applied to investigate their associations with proximal and broader socioeconomic conditions. RESULTS: Performance of microsimulation models is high with no more than 10% errors in at least 90% of LAD for psychological distress and moderate and heavy alcohol consumption. The MINI is strongly correlated with psychological distress (r = 0.910; p value < 0.001) and moderately with heavy drinking (r = 0.389; p value < 0.001). Psychological distress and heavy alcohol consumption are differently associated with socioeconomic and rurality indicators at the LSOA level. Associations further vary at the LAD level and regional variations are apparent. CONCLUSION: Spatial microsimulation may be an appropriate methodological approach for replicating social and demographic health patterns at the local level.

Patients' ratings of family physician practices on the internet: usage and associations with conventional measures of quality in the English National Health Service.

BACKGROUND: Patients are increasingly rating their family physicians on the Internet in the same way as they might rate a hotel on TripAdvisor or a seller on eBay, despite physicians' concerns about this process. OBJECTIVE: This study aims to examine the usage of NHS Choices, a government website that encourages patients to rate the quality of family practices in England, and associations between web-based patient ratings and conventional measures of patient experience and clinical quality in primary care. METHODS: We obtained all (16,952) ratings of family practices posted on NHS Choices between October 2009 and December 2010. We examined associations between patient ratings and family practice and population characteristics. Associations between ratings and survey measures of patient experience and clinical outcomes were examined. RESULTS: 61% of the 8089 family practices in England were rated, and 69% of ratings would recommend their family practice. Practices serving younger, less deprived, and more densely populated areas were more likely to be rated. There were moderate associations with survey measures of patient experience (Spearman ρ 0.37-0.48, P<.001 for all 5 variables), but only weak associations with measures of clinical process and outcome (Spearman ρ less than ± 0.18, P<.001 for 6 of 7 variables). CONCLUSION: The frequency of patients rating their family physicians on the Internet is variable in England, but the ratings are generally positive and are moderately associated with other measures of patient experience and weakly associated with clinical quality. Although potentially flawed, patient ratings on the Internet may provide an opportunity for organizational learning and, as it becomes more common, another lens to look at the quality of primary care.

Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions.

BACKGROUND: In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ. METHODS: We held interviews with stakeholders (n = 14) and completed a scoping review to identify appropriate variables to create an updated risk measure. We then sourced a range of open access secondary data to develop an indices of food insecurity risk in English neighbourhoods. Following a process of data transformation and normalisation, we tested combinations of variables and identified the most appropriate data to reflect household food insecurity risk in urban and rural areas. RESULTS: Eight variables, reflecting both household circumstances and local service availability, were separated into two domains with equal weighting for a new index, the Complex Index, and a subset of these to make up the Simple Index. Within the Complex Index, the Compositional Domain includes population characteristics while the Structural Domain reflects small area access to resources such as grocery stores. The Compositional Domain correlated well with free school meal eligibility (rs = 0.705) and prevalence of childhood obesity (rs = 0.641). This domain was the preferred measure for use in most areas when shared with stakeholders, and when assessed alongside other configurations of the variables. Areas of highest risk were most often located in the North of England. CONCLUSION: We recommend the use of the Compositional Domain for all areas, with inclusion of the Structural Domain in rural areas where locational disadvantage makes it more difficult to access resources. These measures can aid local policy makers and planners when allocating resources and interventions to support households who may experience food insecurity.

Adult diet in England: Where is more support needed to achieve dietary recommendations?

BACKGROUND: Small-area estimation models are regularly commissioned by public health bodies to identify areas of greater inequality and target areas for intervention in a range of behaviours and outcomes. Such local modelling has not been completed for diet consumption in England despite diet being an important predictor of health status. The study sets out whether aspects of adult diet can be modelled from previously collected data to define and evaluate area-level interventions to address obesity and ill-health. METHODS: Adults aged 16 years and over living in England. Consumption of fruit, vegetables, and sugar-sweetened beverages (SSB) are modelled using small-area estimation methods in English neighbourhoods (Middle Super Output Areas [MSOA]) to identify areas where reported portions are significantly different from recommended levels of consumption. The selected aspects of diet are modelled from respondents in the National Diet and Nutrition Survey using pooled data from 2008-2016. RESULTS: Estimates indicate that the average prevalence of adults consuming less than one portion of fruit, vegetables or 100% juice each day by MSOA is 6.9% (range of 4.3 to 14.7%, SE 0.06) and the average prevalence of drinking more than 330ml/day of SSB is 11.5% (range of 5.7 to 30.5%, SE 0.03). Credible intervals around the estimates are wider for SSB consumption. The results identify areas including regions in London, urban areas in the North of England and the South coast which may be prioritised for targeted interventions to support reduced consumption of SSB and/or an increase in portions of fruit and vegetables. CONCLUSION: These estimates provide valuable information at a finer spatial scale than is presently feasible, allowing for within-country and locality prioritisation of resources to improve diet. Local, targeted interventions to improve fruit and vegetable consumption such as subsidies or voucher schemes should be considered where consumption of these foods is predicted to be low.

Variations in fresh fruit and vegetable quality by store type, urban-rural setting and neighbourhood deprivation in Scotland.

OBJECTIVE: Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural-urban location and neighbourhood deprivation in a selection of communities across Scotland. DESIGN: Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban-rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban-rural classification. SETTING: Scotland. RESULTS: Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items. CONCLUSIONS: The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

Alcohol licensing data: why is it an underused resource in public health?

Alcohol-related harm is related to alcohol availability. Due to complex regulatory and environmental factors, alcohol availability varies spatially. However, the extent of this variation is largely unknown in the UK, despite its potential influence on patterns of alcohol-related harm. We investigate why administrative data is underused in the study of alcohol-related harm in the UK. We found that local authorities routinely collect a rich supply of licensing data. However, this information is stored in databases that are sometimes difficult to access. With greater coordination between researchers and practitioners, this data can be used to fulfil its primary administrative purpose and also contribute to understanding and prevention of alcohol-related health and social problems.

Can a deterministic spatial microsimulation model provide reliable small-area estimates of health behaviours? An example of smoking prevalence in New Zealand.

Models created to estimate neighbourhood level health outcomes and behaviours can be difficult to validate as prevalence is often unknown at the local level. This paper tests the reliability of a spatial microsimulation model, using a deterministic reweighting method, to predict smoking prevalence in small areas across New Zealand. The difference in the prevalence of smoking between those estimated by the model and those calculated from census data is less than 20% in 1745 out of 1760 areas. The accuracy of these results provides users with greater confidence to utilize similar approaches in countries where local-level smoking prevalence is unknown.

Neighbourhood food environment and area deprivation: spatial accessibility to grocery stores selling fresh fruit and vegetables in urban and rural settings.

BACKGROUND: The 'deprivation amplification' hypothesis suggests that residents of deprived neighbourhoods have universally poorer access to high-quality food environments, which in turn contributes to the development of spatial inequalities in diet and diet-related chronic disease. This paper presents results from a study that quantified access to grocery stores selling fresh fruit and vegetables in four environmental settings in Scotland, UK. METHODS: Spatial accessibility, as measured by network travel times, to 457 grocery stores located in 205 neighbourhoods in four environmental settings (island, rural, small town and urban) in Scotland was calculated using Geographical Information Systems. The distribution of accessibility by neighbourhood deprivation in each of these four settings was investigated. RESULTS: Overall, the most deprived neighbourhoods had the best access to grocery stores and grocery stores selling fresh produce. Stratified analysis by environmental setting suggests that the least deprived compared with the most deprived urban neighbourhoods have greater accessibility to grocery stores than their counterparts in island, rural and small town locations. Access to fresh produce is better in more deprived compared with less deprived urban and small town neighbourhoods, but poorest in the most affluent island communities with mixed results for rural settings. CONCLUSIONS: The results presented here suggest that the assumption of a universal 'deprivation amplification' hypothesis in studies of the neighbourhood food environment may be misguided. Associations between neighbourhood deprivation and grocery store accessibility vary by environmental setting. Theories and policies aimed at understanding and rectifying spatial inequalities in the distribution of neighbourhood exposures for poor diet need to be context specific.