Exploring attitudes and variation by sociodemographic factors in consent provided for financial data linkage in an experimental birth cohort study.

BACKGROUND: Improving our understanding of household incomes and what constitutes financial insecurity can help us to better understand how financial insecurity is experienced and how this can change over time within and between individuals and populations. However, financial circumstances are often perceived as sensitive and stigmatising, particularly within some ethnic minority groups. This research aims to explore attitudes and variation by sociodemographic factors in consent provided for financial data linkage in an experimental birth cohort study, in order to obtain validated income and benefits data and to better understand the impact of community interventions on the financial security of its participants and their families. METHODS: This research utilises an observational study design to explore consent rates, attitudes and variation in sociodemographic factors between participants of an experimental birth cohort in a deprived and ethnically diverse setting who consent and do not consent to financial data linkage. RESULTS: Overall, participants were equally likely to consent and decline consent for financial data linkage. Measures of socioeconomic insecurity were associated with being more likely to provide consent for financial data linkage. Participants who were not employed (OR 1.49 95% CI 0.93, 2.40) and were more financially insecure (OR 1.85 95% CI 1.14, 3.93) were more likely to provide consent for financial data linkage. Where the participant's first language was a language other than English, participants were also less likely to provide consent for data linkage (OR 0.65 95% CI 0.39, 0.98). The choice of consent for financial data linkage was not associated with: ethnicity; relationship factors; employment status of the participant's partner; person present at time of recruitment; and measures of health, such as general health, mental health, wellbeing and health-related quality of life. CONCLUSIONS: This research sets out an approach to obtaining validated income and benefits data, as a proxy measure for financial security, within an experimental birth cohort study in a deprived and ethnically diverse setting. It achieves good consent rates and demonstrates greater input from those who report greater potential need for financial support. Further research should be conducted to further understand the interplay of language spoken in this context.

Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study.

BACKGROUND: Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants. METHODS: An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice. RESULTS: Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data. CONCLUSIONS: This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.

The long-term impact of the Covid-19 pandemic on financial insecurity in vulnerable families: Findings from the Born in Bradford Covid-19 longitudinal study.

There is growing recognition that the public health measures employed to control the spread of the COVID-19 pandemic had unintended consequences on socioeconomic security and health inequalities, having the greatest impact on the most vulnerable groups. This longitudinal study aims to explore the medium to long-term impacts of the COVID-19 pandemic and subsequent public health measures on financial security for families living in the deprived and ethnically diverse city of Bradford. We collected data at four time points before and during the pandemic from mothers who participated in one of two prospective birth cohort studies in Bradford. The findings demonstrate that the risk of experiencing financial insecurity rose sharply during the pandemic and has not returned to pre-COVID-19 baseline levels. Several individual characteristics were found to be possible predictors of financial insecurity, including homeowner status, free school meal eligibility and not working. Protective factors against financial insecurity include: living in more affluent areas; greater levels of educational attainment; and families with two or more adults in the household. Notably, families of Pakistani Heritage were found to have the greatest risk of experiencing financial insecurity throughout the pandemic. Furthermore, this study demonstrated that there were strong associations between financial insecurity and maternal health and wellbeing outcomes, with mothers experiencing financial insecurity being more likely to report unsatisfactory general health and clinically important symptoms of depression and anxiety. The findings of this study highlight that the impact of financial insecurity experienced by mothers and their families throughout the pandemic was severe, wide ranging and affected the most vulnerable. In the wake of the pandemic, the emerging cost of living and energy crisis emphasises the urgent need for policy makers to act to support vulnerable families to prevent further widening of existing health and social inequalities.

Examining individual social status using the MacArthur Scale of Subjective Social Status: Findings from the Born in Bradford study.

Subjective social status is how a person perceives their social class relative to other people and has frequently been associated with people's health and well-being. A frequently used measure of subjective social status is the MacArthur Scale of Subjective Social Status that depicts social status as a 10 rung ladder, asking individuals to rank themselves on this ladder relative to other people, either in their local neighbourhood or wider society. The Born in Bradford's Better Start birth cohort study aims to understand the lives, relationships, wellbeing, and social and economic circumstances of pregnant women and their children in three inner city areas of Bradford, UK. Pregnant mothers were asked to report their subjective social status, using the MacArthur subjective social status scales, comparing themselves to other people in their local neighbourhood and in England as a whole. This paper explores the characteristics of the women who gave responses, examines associations between the MacArthur subjective social status measures and other subjective and objective measures and looks specifically at the characteristics of women who reported either very low or very high subjective social status. On average, women reported that they had a higher social status compared to others within their local neighbourhood (mean ladder rung = 6) and, although participants were from areas of Bradford with very high levels of deprivation, 23% placed themselves on the top three rungs, 8-10. Respondents reported that they had an average social status when comparing themselves to people in all of England (mean ladder rung = 5) and 13% placed themselves on the top rungs 8-10. These findings raise important questions about the interpretation of the MacArthur scale of subjective social status.

Turning their backs on the 'ladder of success'? Unexpected responses to the MacArthur Scale of Subjective Social Status.

Subjective social status measures a person's perception of their social class relative to other people and has theoretically and empirically been positively associated with health and wellbeing. A widely used measure of this construct is the MacArthur Scale of Subjective Social Status, which asks people to report their social status by placing themselves on a ladder which represents the social hierarchy of their society or community; the scale has been used with many different populations across many countries. In this research note, we describe two cases where we encountered unexpected reactions to the MacArthur Scale that we believe highlight (a) the salience of relative social status for people's wellbeing in contemporary society and (b) the concomitant sensitivities raised by measuring this subjective experience. We discuss the implications of these observations for future research.

Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries.

INTRODUCTION: In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes. METHODS: We outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies. RESULTS: We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population. DISCUSSION: We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.

The socioeconomic context of stigma: examining the relationship between economic conditions and attitudes towards people with mental illness across European countries.

Introduction: Efforts to reduce the stigma associated with mental illness have intensified over the past 30 years with a particular focus on improving public attitudes. Difficult economic circumstances can be harmful to intergroup relations, but little is known about whether there is a relationship between socioeconomic conditions and attitudes towards people with mental illnesses. Methods: Random effects logistic regression modelling was employed to explore the relationship between individual financial circumstances, contextual socioeconomic factors and difficulty speaking to a person with a significant mental illness across European countries. Results: Lower GDP per capita and higher income inequality at the country level, alongside individual financial difficulties, were each associated with a greater likelihood of reporting difficulty speaking to a person with a significant mental illness. Discussion: Micro and macro-economic factors are associated with public attitudes towards people with mental illness across Europe. With prolonged economic instability predicted over the coming years in Europe it is important that these findings are taken into consideration when designing mental health and social policies, in order to safeguard the progress that has been made in reducing mental health stigma to date.

Study Protocol. Evaluating the life-course health impact of a city-wide system approach to improve air quality in Bradford, UK: A quasi-experimental study with implementation and process evaluation.

BACKGROUND: Air quality is a major public health threat linked to poor birth outcomes, respiratory and cardiovascular disease, and premature mortality. Deprived groups and children are disproportionately affected. Bradford will implement a Clean Air Zone (CAZ) as part of the Bradford Clean Air Plan (B-CAP) in 2022 to reduce pollution, providing a natural experiment. The aim of the current study is to evaluate the impact of the B-CAP on health outcomes and air quality, inequalities and explore value for money. An embedded process and implementation evaluation will also explore barriers and facilitators to implementation, impact on attitudes and behaviours, and any adverse consequences. METHODS: The study is split into 4 work packages (WP). WP1A: 20 interviews with decision makers, 20 interviews with key stakeholders; 10 public focus groups and documentary analysis of key reports will assess implementation barriers, acceptability and adverse or unanticipated consequences at 1 year post-implementation (defined as point at which charging CAZ goes 'live'). WP1B: A population survey (n = 2000) will assess travel behaviour and attitudes at baseline and change at 1 year post-implementation). WP2: Routine air quality measurements will be supplemented with data from mobile pollution sensors in 12 schools collected by N = 240 pupil citizen scientists (4 within, 4 bordering and 4 distal to CAZ boundary). Pupils will carry sensors over four monitoring periods over a 12 month period (two pre, and two post-implementation). We will explore whether reductions in pollution vary by CAZ proximity. WP3A: We will conduct a quasi-experimental interrupted time series analysis using a longitudinal routine health dataset of > 530,000 Bradford residents comparing trends (3 years prior vs 3 years post) in respiratory health (assessed via emergency/GP attendances. WP3B: We will use the richly-characterised Born in Bradford cohort (13,500 children) to explore health inequalities in respiratory health using detailed socio-economic data. WP4: will entail a multi-sectoral health economic evaluation to determine value for money of the B-CAP. DISCUSSION: This will be first comprehensive quasi-experimental evaluation of a city-wide policy intervention to improve air quality. The findings will be of value for other areas implementing this type of approach. TRIAL REGISTRATION: ISRCTN67530835 https://doi.org/10.1186/ISRCTN67530835.

The Impact of the Pandemic on Mental Health in Ethnically Diverse Mothers: Findings from the Born in Bradford, Tower Hamlets and Newham COVID-19 Research Programmes.

Restrictions implemented by the UK Government during the COVID-19 pandemic have served to worsen mental health outcomes, particularly amongst younger adults, women, those living with chronic health conditions, and parents of young children. Studies looking at the impact for ethnic minorities have reported inconsistent findings. This paper describes the mental health experiences of mothers from a large and highly ethnically diverse population during the pandemic, using secondary analysis of existing data from three COVID-19 research studies completed in Bradford and London (Tower Hamlets and Newham). A total of 2807 mothers participated in this study with 44% White British, 23% Asian/Asian British Pakistani, 8% Other White and 7% Asian/Asian British Bangladeshi backgrounds. We found that 28% of mothers experienced clinically important depressive symptoms and 21% anxiety symptoms during the pandemic. In unadjusted analyses, mothers from White Other, and Asian/Asian British Bangladeshi backgrounds had higher odds of experiencing symptoms, whilst mothers from Asian/Asian British Indian backgrounds were the least likely to experience symptoms. Once loneliness, social support and financial insecurity were controlled for, there were no statistically significant differences in depression and anxiety by ethnicity. Mental health problems experienced during the pandemic may have longer term consequences for public health. Policy and decision makers must have an understanding of the high risk of financial insecurity, loneliness and a lack of social support on mother's mental health, and also recognise that some ethnic groups are far more likely to experience these issues and are, therefore, more vulnerable to poor mental health as a consequence.

"If I get sick here, I will never see my children again": The mental health of international migrants during the COVID-19 pandemic in Chile.

BACKGROUND: The COVID-19 pandemic has had an impact on the mental health of international migrants globally. Chile has managed its response to the pandemic in an ongoing context of social unrest and combined regional migratory and humanitarian crisis. The country's population presents a high prevalence of common mental disorders and a high suicide rate, with limited access to mental healthcare. International migrants in Chile represent 8% of the total population, and although a socioeconomically heterogenous group, they face social vulnerability, a range of mental health stressors and additional barriers to access mental healthcare. This study describes the mental health outcomes, stressors, response, and coping strategies perceived by international migrants during the COVID-19 pandemic in Chile. METHODS AND FINDINGS: A qualitative case study was carried out through individual online interviews to 30 international migrants living in Chile during the pandemic and 10 experts of the social and health care sectors. An inductive content analysis was carried out, a process during which the researchers sought to identify patterns and themes derived from the data. Participants experienced mainly negative mental health outcomes, including anxiety and depression symptomatology. Stressors included the virus itself, work, living and socioeconomic conditions, discrimination, fear for their family and distance caring. Institutional responses to address the mental health of international migrants during the pandemic in Chile were limited and participants relied mainly on individual coping strategies. CONCLUSIONS: The pandemic can represent an important opportunity to strengthen mental health systems for the general population as well as for population groups experiencing social vulnerability, if the issues identified and the lessons learned are translated into action at national, regional, and international level. Promoting the mental health of international migrants means recognising migration as a social determinant of mental health and adopting a cross-cultural as well as a Human Rights approach.

Vulnerabilities in child well-being among primary school children: a cross-sectional study in Bradford, UK.

OBJECTIVE: To describe the prevalence of factors related to well-being among primary school children in a deprived multiethnic community in the UK. DESIGN AND PARTICIPANTS: Cross-sectional survey of 15 641 children aged 7-10 years in Born in Bradford's Primary School Years study: whole-classroom samples in 89 Bradford primary schools between 2016 and 2019. MAIN OUTCOME MEASURES: Prevalence estimates by ethnicity (%, 95% CI) of single and multiple vulnerabilities in child well-being within and across four domains (Home, Family, Relationships; Material Resources; Friends and School; Subjective Well-being). RESULTS: Only 10% of children had no vulnerabilities in any domain of well-being; 10% had one or more vulnerabilities in all four domains. The highest prevalence estimates were for being bullied some or all of the time (52.7%, 95% CI: 51.9% to 53.4%), keeping worries to oneself (31.2%, 95% CI: 30.5% to 31.9%), having no park near home (30.8%, 95% CI: 30.1% to 31.5%) and worrying all the time about how much money their family has (26.3%, 95% CI: 25.6% to 27%). Boys were consistently significantly more likely than girls to report all of the vulnerabilities in the Home, Family and Family Relationships domain, and the majority of indicators in the other domains, and in all domains except Friends and School, boys were significantly more likely to have at least one vulnerability. Girls were significantly more likely to report not having many friends (16.7%, 95% CI: 15.9% to 17.6% vs 12.5%, 95% CI: 11.8% to 13.2%), being bullied some or all of the time (55.8%, 95% CI: 54.7% to 56.9% vs 49.7%, 95% CI: 48.6% to 50.8%) and feeling left out all the time (12.1%, 95% CI: 11.4% to 12.8%) versus (10.3%, 95% CI: 9.7% to 11.0%). Variations in vulnerabilities by ethnicity were complex, with children in black, Asian and minority ethnic groups sometimes reporting more vulnerabilities and sometimes fewer than white British children. For example, compared with children of Pakistani heritage, white British children were more likely to say that their family never gets along well (6.3%, 95% CI: 5.6% to 7.1% vs 4.1%, 95% CI: 3.6% to 4.6%) and to have no access to the internet at home (22.3%, 95% CI: 21% to 23.6% vs 18%, 95% CI: 17% to 18.9%). Children with Pakistani heritage were more likely than white British children to say they had no park near their home where they can play with friends (32.7%, 95% CI: 31.6% to 33.9% vs 29.9%, 95% CI: 28.6% to 31.3%), to report not having three meals a day (17.9%, 95% CI: 16.9% to 18.8% vs 11.9%, 95% CI: 10.9% to 12.9%) and to worry all the time about how much money their families have (29.3%, 95% CI: 28.2% to 30.3%) vs (21.6%, 95% CI: 20.4% to 22.9%). Gypsy/Irish Traveller children were less likely than white British children to say they were bullied some or all of the time (42.2%, 95% CI: 35.4% to 49.4% vs 53.8%, 95% CI: 52.3% to 55.3%), but more likely to say they were mean to others all the time (9.9%, 95% CI: 6.3% to 15.2% vs 4%, 95% CI: 3.5% to 4.7%) and can never work out what to do when things are hard (15.2%, 95% CI: 10.6% to 21.2% vs 9%, 95% CI: 8.2% to 9.9%). We considered six vulnerabilities to be of particular concern during the COVID-19 pandemic and associated national and local lockdowns: family never gets along well together; no garden where child can play; no nearby park where they can play; not having three meals a day; no internet at home; worried about money all the time. Pre-pandemic, 37.4% (95% CI: 36.6% to 38.3%) of Bradford children had one of these vulnerabilities and a further 29.6% (95% CI: 28.9% to 30.4%) had more than one. CONCLUSIONS: Although most primary school children aged 7-10 in our study had good levels of well-being on most indicators across multiple domains, fewer than 10% had no vulnerabilities at all, a worrying 10% had at least one vulnerability in all the four domains we studied and two-thirds had vulnerabilities of particular concern during the COVID-19 lockdowns.

Socioeconomic disadvantage and ethnicity are associated with large differences in children's working memory ability: analysis of a prospective birth cohort study following 13,500 children.

Working memory is a limited capacity system that stores and processes information over short time periods and is essential for learning new information. Some studies have investigated the associations between socioeconomic position and working memory, however none have examined this across potentially dissociable aspects of working memory. Further, there are very few studies about children's working memory differences across and within different ethnic groups. Therefore, there is a need to understand the potential associations between socioeconomic position, ethnicity, and different aspects of children's working memory. We investigated children's working memory (n = 15,154) by socioeconomic group, using a latent class measure of family socioeconomic position, and then by ethnic group. To account for potential problems in applying socioeconomic measures across different ethnic groups, we then examined associations using an ethnic-specific socioeconomic measure within the ethnic majority group (White British) and the largest ethnic minority group (Pakistani). We found a strong association between socioeconomic group at birth and working memory at age 7-10 years, where the difference between the least and most deprived socioeconomic groups was equivalent to at least a 1-year age difference. We also found substantial differences in working memory between nine ethnic groups that varied by working memory task, where the difference between groups was equivalent to an age difference of between 6 and 24 months. Finally, we found evidence for a socioeconomic gradient in working memory for White British children, but this was considerably reduced in Pakistani children. These findings show the importance of separating out different ethnic groups when investigating associations between socioeconomic position and cognitive function, and that researchers need to be mindful when applying socioeconomic measures across ethnic groups. Where possible, ethnic-specific measures of socioeconomic position should be developed and applied for studies like these. Future research considering the possible mechanisms behind associations between ethnicity and working memory, and mechanisms by which socioeconomic position differentially influences working memory performance for different ethnic groups would shed further light on this important topic.

A review of the effectiveness and experiences of welfare advice services co-located in health settings: A critical narrative systematic review.

We conducted a narrative systematic review to assess the health, social and financial impacts of co-located welfare services in the UK and to explore the effectiveness of and facilitators and barriers to successful implementation of these services, in order to guide future policy and practice. We searched Medline, EMBASE and other literature sources, from January 2010 to November 2020, for literature examining the impact of co-located welfare services in the UK on any outcome. The review identified 14 studies employing a range of study designs, including: one non-randomised controlled trial; one pilot randomised controlled trial; one before-and-after-study; three qualitative studies; and eight case studies. A theory of change model, developed a priori, was used as an analytical framework against which to map the evidence on how the services work, why and for whom. All studies demonstrated improved financial security for participants, generating an average of £27 of social, economic and environmental return per £1 invested. Some studies reported improved mental health for individuals accessing services. Several studies attributed subjective improvements in physical health to the service addressing key social determinants of health. Benefits to the health service were also demonstrated through reduced workload for healthcare professionals. Key components of a successful service included co-production during service development and ongoing enhanced multi-disciplinary collaboration. Overall, this review demonstrates improved financial security for participants and for the first time models the wider health and welfare benefits for participants and for health service from these services. However, given the generally poor scientific quality of the studies, care must be taken in drawing firm conclusions. There remains a need for more high quality research, using experimental methods and larger sample sizes, to further build upon this evidence base and to measure the strength of the proposed theoretical pathways in this area.

'When will this end? Will it end?' The impact of the March-June 2020 UK COVID-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study.

OBJECTIVES: To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN: Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS: 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES: ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS: The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS: Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.

Born in Bradford's Better Start (BiBBS) interventional birth cohort study: Interim cohort profile.

Background: The Born in Bradford's Better Start (BiBBS) interventional birth cohort study was designed as an innovative cohort platform for efficient evaluation of early life interventions delivered through the Better Start Bradford programme. There are a growing number of interventional cohorts being implemented internationally. This paper provides an interim analysis of BiBBS in order to share learning about the feasibility and value of this method. Methods: Recruitment began in January 2016 and will complete in December 2023 with a target sample of 5,000 pregnancies. An interim analysis was completed for all pregnancies recruited between January 2016 and November 2019 with an expected due date between 1 st April 2016 and 8 th March 2020. Descriptive statistics were completed on the data. Results: Of 4,823 eligible pregnancies, 2,626 (54%) pregnancies were recruited, resulting in 2,392 mothers and 2,501 children. The sample are representative of the pregnant population (61% Pakistani heritage; 12% White British; 8% other South Asian and 6% Central and Eastern European ethnicity). The majority of participants (84%) live in the lowest decile of the Index of Multiple Deprivation, and many live in vulnerable circumstances. A high proportion (85%) of BiBBS families have engaged in one or more of the Better Start Bradford interventions. Levels of participation varied by the characteristics of the interventions, such as the requirement for active participation and the length of commitment to a programme. Conclusions: We have demonstrated the feasibility of recruiting an interventional cohort that includes seldom heard families from ethnic minority and deprived backgrounds. The high level of uptake of interventions is encouraging for the goal of evaluating the process and outcomes of multiple early life interventions using the innovative interventional cohort approach. BiBBS covers a period before, during and after the coronavirus disease 2019 (COVID-19) pandemic which adds scientific value to the cohort.

Changes in children's wellbeing in Bradford during COVID-19: The Born in Bradford COVID-19 longitudinal research study.

Background: Concerns have been raised about the potential impact of COVID-19 and associated lockdown measures on child mental wellbeing, but emerging evidence suggests mixed results and there is a dearth of information from ethnically diverse samples. The current study aims to explore the impact of the pandemic on wellbeing using longitudinal data collected from the multi-ethnic Born in Bradford family cohort study. Methods: Within-child changes in wellbeing were explored using data collected pre-pandemic and again during the first UK lockdown for 500 children aged 7-13 from a range of ethnic and socioeconomic backgrounds, using self-reported feelings of happiness and sadness. Associations between changes in wellbeing, demographic factors, quality of social relationships and physical activity levels were explored using multinomial logistic regression models. Results: In this sample, 55% of children reported no change in their wellbeing from pre-pandemic to during the first lockdown (n=264). Children of Pakistani heritage were more than twice as likely to report feeling sad less often than White British children (RRR: 2.61, 95% CI: 1.23, 5.51) during the first lockdown. Those who reported being left out by other children before the pandemic were over three times as likely than those who did not (RRR: 3.72: 1.51, 9.20) to report feeling sad less often during the pandemic. Around a third of children reported feeling happier (n=152, 31.6%), but these changes did not relate to any of the explanatory variables included in this analysis. Conclusion: Many children in this study reported no changes in their wellbeing during the first UK lockdown compared to before the pandemic and some described improved wellbeing. These findings suggest that children have coped well with the significant changes over the past year, though targeted support, particularly for those children who felt excluded before the pandemic, would be beneficial.