Adolescents' unhealthy snacking behaviour during the school journey and the association with transport modes and food outlets along the school route.

AIMS: Active transport to and from school provides an opportunity for adolescents to engage in physical activity, but travelling through an obesogenic environment may have unintended consequences on their snacking behaviour. This study aimed to: (1) identify whether adolescents' unhealthy snacking behaviour was associated with school transport modes and food outlets on their estimated school route and (2) explore whether food outlet density on the school route differed between school transport modes. METHODS: Adolescents (n = 406; aged 15.1 ± 1.4 years; 50.7% boys; 63.5% New Zealand European) from all 12 secondary schools in Dunedin city, Aotearoa New Zealand, completed an online survey. School transport modes (active, motorised or mixed) and unhealthy snacking data were collected. Food outlet data were collected using Google Places Application Programming Interface (API). Home-to-school route and distance were estimated using geographical information system (GIS) analysis based on a walkable road network. Data were analysed using the chi-square test and logistic regression. RESULTS: Overall, 26.4% of adolescents reported purchasing and consuming unhealthy snacks or soft drinks on the way to school and 41.4% from school. The odds of unhealthy snacking during the school journey was higher among mixed transport users than active transport users on the way to (odds ratio (OR) = 2.73, 95% confidence interval (CI) = 1.39-5.36) and from school (OR = 2.68, 95% CI = 1.40-5.13). No differences were observed by food outlet type. There were no food outlets on the estimated school route for 44.8% of adolescents. The presence of more than one food outlet per kilometre of the estimated school route differed between active (38.7%), motorised (42.6%) and mixed transport users (46.4%; p = 0.006). CONCLUSION: School transport modes were significantly associated with adolescents' unhealthy snacking behaviour and food outlets on their school journey. Policy measures which minimise exposure to unhealthy food outlets may reduce unhealthy snacking among adolescents.

Home injuries in British Columbia: patterns across the deprivation spectrum.

The significant burden of home injuries has become a growing concern that affect thousands of people every year across Canada. This study examined the relationship between neighbourhood deprivation and unintentional injuries occurring at home leading to hospitalizations in British Columbia (BC) between 2015 and 2019. This study used de-identified hospitalization data on unintentional home-related injuries from the Discharge Abstract Database (DAD) and population data for each dissemination area from Statistics Canada's 2016 Census Profiles. Hospitalization rates were computed for unintentional home-related injuries across four dimensions specified in the Canadian Index of Multiple Deprivation (CIMD) for BC. For three CIMD dimensions (situational vulnerability, economic dependency, and residential instability), unintentional home injury rates were higher in areas with higher deprivation, while the inverse was observed for ethno-cultural diversity. Understanding socio-economic disparities within neighbourhoods enables injury prevention partners to identify vulnerable populations and prioritize the development and implementation of evidence-based injury prevention interventions.

Ethnic Density and Mental Health: Does it Matter Whether the Ethnic Density is Co-ethnic or Multi-ethnic and How Important is Change in Ethnic Density?

The ethnic density thesis suggests a protective health benefit for ethnic minorities living in places with higher concentration of co-ethnic residents. This paper aims to make a step change in the examination of this thesis by proposing ethnic diversity rather than co-ethnic density will be more protective for mental health. The paper proposes ethnic diversity could be a community asset that benefits the health of all people in a neighbourhood regardless of their own ethnic group. Individual data is taken from the UK Household Longitudinal Study, 2009-2019 linked to aggregate data from the 2001 and 2011 Censuses to test the association between co-ethnic density, ethnic diversity and mental health using the General Health Questionnaire 12-item scale. The paper takes a novel approach by measuring pre-existing (in 2001) and change in (2001-2011) co-ethnic density and ethnic diversity. Moderating effects of individual ethnic group, neighbourhood deprivation and perceived social cohesion are tested. Results show lower pre-existing co-ethnic density is related to lower mental health amongst the White British ethnic group but not in most ethnic minority groups. Greater pre-existing ethnic diversity in more deprived neighbourhoods is associated with better mental health regardless of individual ethnic group. A point of contention in the findings is no association between change in ethnic diversity and mental health.

Distribution of legal retail cannabis stores in Canada by neighbourhood deprivation.

OBJECTIVES: In legal cannabis markets, the distribution of retail stores has the potential to influence transitions from illegal to legal sources as well as consumer patterns of use. The current study examined the distribution of legal cannabis stores in Canada according to level of neighbourhood deprivation. METHODS: Postal code data for all legal cannabis stores in Canada were collected from government websites from October 2018 to September 2021. This data was linked to the Institut National de Santé Publique du Québec measures for material and social neighbourhood deprivation. Descriptive data are reported, including differences across provinces with different retail systems. RESULTS: At the national level, there were approximately 8.0 retail cannabis stores per 100,000 individuals age 15+ in September 2021. The distribution of stores was closely aligned with the expected distribution across levels of material deprivation: for example, 19.5% of stores were located in neighbourhoods with the lowest level of material deprivation versus 19.1% in the highest level. More cannabis stores were located in the 'most socially deprived' or 'socially deprived' neighbourhoods (37.2% and 22.1%, respectively), characterized by a higher proportion of residents who live alone, are unmarried, or in single-parent families. The distribution of stores in provinces and territories were generally consistent with national patterns with a few exceptions. CONCLUSION: In the first 3 years following cannabis legalization in Canada, retail cannabis stores were evenly distributed across materially deprived neighbourhoods but were more common in socially deprived neighbourhoods. Future monitoring of retail store locations is required as the legal retail market evolves in Canada.

A longitudinal analysis of the impact of the local tobacco retail availability and neighbourhood deprivation on male smoking behaviours in Shanghai, China.

Some evidence from Western high-income countries suggests local tobacco retail availability and neighbourhood deprivation may influence smoking behaviours. However, this assertion has not been considered in China, where 44% of males continue to smoke. Data were analysed from Chinese males (n = 2054) who participated in Waves 3-5 (2009-2015) of the International Tobacco Control (ITC) China Survey by linking information on tobacco retail availability (estimated through population weighted Kernel Density of tobacco retailers in 2019) and neighbourhood deprivation (calculated as a composite score derived from the 2010 Chinese census) across Shanghai. Generalised Estimating Equation models were fitted to examine the impacts of local tobacco availability and neighbourhood deprivation on smoking behaviours (current smoking versus current non-smoking, quitting versus current smoking, longer durations of smoking abstinence versus current smoking) using the longitudinal data. Examining the impacts separately, participants living in neighbourhoods with greater availability and higher levels of deprivation were less likely to maintain longer durations of smoking abstinence in both unadjusted and adjusted models. Neighbourhood deprivation, but not availability, was found to be associated with higher odds of being a current smoker. Examining the impacts jointly, neighbourhood deprivation was still positively associated with current smoking and negatively associated with longer durations of smoking abstinence, but the negative association between availability and longer durations of smoking abstinence disappeared. The findings offer some evidence that greater tobacco retail availability and deprivation are obstacles on prolonged smoking cessation among males in Shanghai, China. Policymakers should consider small-area level place-based restrictions in China, such as reducing the availability of tobacco, as part of a comprehensive tobacco control strategy aimed at addressing the high prevalence of smoking.

Neighbourhood deprivation and type 2 diabetes in patients with bipolar disorder: A nationwide follow-up study.

Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997-2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40-1.86) for men and 1.83 (1.60-2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17-1.56) in men and 1.39 (1.20-1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment.

Neighbourhood deprivation in childhood and adulthood and risk of arterial stiffness: the Cardiovascular Risk in Young Finns study.

Purpose: Individual socioeconomic status is associated with increased arterial stiffness, but limited data are available on the relations of neighbourhood deprivation with this vascular measure. We prospectively examined whether neighbourhood deprivation in childhood and adulthood predicts arterial stiffness indicated by pulse wave velocity (PWV).Materials and methods: The study population comprised 1,761 participants aged 3-18 years at baseline (1980) from the longitudinal Cardiovascular Risk in Young Finns cohort study. PWV was measured in 2007 by whole-body impedance cardiography at ages 30-45 years. Cumulative lifetime neighbourhood deprivation was assessed using data from socioeconomic circumstances in participants' lifetime residential neighbourhoods, categorised as low versus high deprivation.Results: High deprivation in childhood and adulthood was associated with higher PWV in adulthood after adjustment for age, sex, and place of birth (mean difference = 0.57 m/s, 95%CI = 0.26-0.88, P for trend = 0.0004). This association was attenuated but remained statistically significant after further adjustment for childhood parental socioeconomic status and adulthood individual socioeconomic status (mean difference = 0.37 m/s, 95%CI = 0.05-0.70, P for trend 0.048). Also, low individual socioeconomic status in adulthood was associated with higher PWV when adjusted for age, sex, place of birth, parental socioeconomic status in childhood, and lifetime neighbourhood deprivation (mean difference = 0.54 m/s, 95%CI = 0.23-0.84, P for trend 0.0001).Conclusion: These findings suggest that lifetime neighbourhood deprivation and low adulthood socioeconomic status are independent risk factors for increased arterial stiffness in adulthood.

Limited data is available about the association between neighbourhood deprivation and arterial stiffening.We prospectively examined whether neighbourhood deprivation in childhood and adulthood predicts arterial stiffness indicated by pulse wave velocity (PWV) in 1,761 participants aged 3-18 years at baseline (1980) from the longitudinal Cardiovascular Risk in Young Finns cohort study.PWV was measured by whole-body impedance cardiography at ages 30-45 years. Cumulative lifetime neighbourhood deprivation was assessed using data from socioeconomic circumstances in participants' lifetime residential neighbourhoods, categorised as low versus high deprivation.high lifetime neighbourhood deprivation was associated with high PWV in adulthood independently of childhood parental SES and adulthood individual SES.Low individual SES in adulthood was also associated with higher PWV in adulthood and this association was robust to adjustment for parental SES in childhood and lifetime neighbourhood deprivation.These findings suggest that neighbourhood deprivation and low adulthood socioeconomic status are independent risk factors for increased arterial stiffness in adulthood.

Patterns of problematic cannabis use in Canada pre- and post-legalisation: Differences by neighbourhood deprivation, individual socioeconomic factors and race/ethnicity.

INTRODUCTION: The legalisation of cannabis in Canada in 2018, and subsequent increase in prevalence of use, has generated interest in understanding potential changes in problematic patterns of use, including by socio-demographic factors such as race/ethnicity and neighbourhood deprivation level. METHODS: This study used repeat cross-sectional data from three waves of the International Cannabis Policy Study web-based survey. Data were collected from respondents aged 16-65 prior to cannabis legalisation in 2018 (n = 8704), and post-legalisation in 2019 (n = 12,236) and 2020 (n = 12,815). Respondents' postal codes were linked to the INSPQ neighbourhood deprivation index. Multinomial regression models examined differences in problematic use by socio-demographic and socio-economic factors and over time. RESULTS: No evidence of a change in the proportion of those aged 16-65 in Canada whose cannabis use would be classified as 'high risk' was noted from before cannabis legalisation (2018 = 1.5%) to 12 or 24 months after legalisation (2019 = 1.5%, 2020 = 1.6%; F = 0.17, p = 0.96). Problematic use differed by socio-demographic factors. For example, consumers from the most materially deprived neighbourhoods were more likely to experience 'moderate' vs 'low risk' compared to those living outside deprived neighbourhoods (p < 0.01 for all). Results were mixed for race/ethnicity and comparisons for high risk were limited by small sample sizes for some groups. Differences across subgroups were consistent from 2018 to 2020. DISCUSSION AND CONCLUSIONS: The risk of problematic cannabis use does not appear to have increased in the 2 years following cannabis legalisation in Canada. Disparities in problematic use persisted, with some racial minority and marginalised groups experiencing higher risk.

Serum cotinine as a predictor of lipid-related indices in Turkish immigrants with type 2 diabetes: A clinic-based cross-sectional study.

Background: Turkish immigrants form the largest ethnic minority group in the Netherlands and show a higher prevalence of (i) cardiovascular disease (CVD), (ii) cigarette smoking, and (iii) type 2 diabetes (T2D) as compared to the native Dutch. This study examines the association of CVD risk factors: serum cotinine, as an indicator of cigarette smoke, and lipid-related indices among first-generation (foreign-born) Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands. Methods: A total of 110 participants, physician-diagnosed with T2D, aged 30 years and older, were recruited by convenience sampling from the Schilderswijk neighbourhood of The Hague in a clinic-based cross-sectional design. Serum cotinine (independent variable) was measured with a solid-phase competitive chemiluminescent immunoassay. Serum lipids/lipoproteins (dependent variables) were determined by enzymatic assays and included: total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG). The Castelli Risk Index-I (CRI-I), and Atherogenic Coefficient (AC) were calculated using standardised formulas and assessed as dependent variables in multiple linear regression (MLR) models. Log-transformation of HDL-c, TG, CRI-I, and AC values were performed to account for the extreme right skewness of the data. Statistical analyses included descriptive characteristics and MLR models were adjusted for all major confounders of cotinine and lipids. Results: The sample size had a mean age of 52.5 years [standard deviation (SD) = 9.21]. The geometric mean of serum cotinine level was 236.63 ng/mL [confidence interval (CI) = 175.89 ± 318.36]. The MLR models indicated that high serum cotinine levels (≥10 ng/mL) was positively associated with HDL-c (P = 0.04), CRI-I (P = 0.03), and AC (P = 0.03) in the age, gender, WC, diabetes medications, and statins-adjusted models (n = 32). Conclusion: This study indicated that lipid ratios of HDL-c, CRI-I and AC are dependent determinants of serum cotinine and higher serum cotinine levels (≥10 ng/mL) are associated with worse HDL-c, CRI-I and AC values in participants with T2D. Clinical comprehension of these biochemical indicators (lipids/lipoproteins) and symptomatic results (CVD risk) in individuals with T2D will aid in the intervention (smoking) approach for this vulnerable cohort (Turkish immigrants). Therapy that is targetted to modify this behavioural risk factor may improve cardiovascular health outcomes and prevent comorbidities in Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands. In the meantime, this report contributes to a growing body of information and provides essential guidance to researchers and clinicians.

Heat-related first cardiovascular event incidence in the city of Madrid (Spain): Vulnerability assessment by demographic, socioeconomic, and health indicators.

While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations.

Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017).

BACKGROUND: frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE: to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN: population-based cohort study. SETTING: communities in England. SUBJECTS: in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS: multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS: the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS: in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Who Is Able to Resist What Is Forbidden?-The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context.

In the last Health Behaviour in School-Aged Children (HBSC) survey conducted in Poland in 2018, a group of 17-year-old adolescents (n = 1663; mean age 17.63 ± 0.36 years) was included outside the international protocol. This allowed an assessment to be made of their level of health literacy (HL) using the 10-point HBSC research tool. The aim of the study was to investigate the relationship between HL and risk behaviours (RB). A standardised index of RB in the last 30 days was considered as an outcome measure. This index was significantly higher in the group with low HL (0.318 ± 1.269) in comparison with the group with high HL (-0.083 ± 0.962). In a multivariate linear regression model, the strongest predictors of RB were gender, academic performance and level of regional deprivation, but the association with HL remained significant. This significant association persisted in general schools and in girls but disappeared in vocational schools and in boys. It was also shown that in rural areas, good academic performance has a less significant impact on RB if the HL level is low. The analyses led to the conclusion that when examining the relationship between HL and RB in older adolescents, it is advisable to take into account gender, the educational track and neighbourhood characteristics.

Neighbourhood deprivation and intersectional inequalities in biomarkers of healthy ageing in England.

While social and spatial determinants of biomarkers have been reported, no previous study has examined both together within an intersectional perspective. We present a novel extension of quantitative intersectional analyses using cross-classified multilevel models to explore how intersectional positions and neighbourhood deprivation are associated with biomarkers, using baseline UK Biobank data (collected from 2006 to 2010). Our results suggest intersectional inequalities in biomarkers of healthy ageing are mostly established by age 40-49, but different intersections show different relationships with deprivation. Our study suggests that certain biosocial pathways are more strongly implicated in how neighbourhoods and intersectional positions affect healthy ageing than others.

Associations of private residential gardens versus other greenspace types with cardiovascular and respiratory disease mortality: Observational evidence from UK Biobank.

BACKGROUND: Longitudinal evidence linking urban greenspace to reduced rates of all-cause and cause-specific mortality has mostly been established using greenness measures of limited specificity such as vegetation indices. Evidence on specific green space types, including private residential gardens is less well established. METHODS: We examined associations of greenspace with all-cause, non-injury, cardiovascular disease (CVD) and respiratory disease deaths in UK Biobank - a national prospective cohort of adults with linked Office for National Statistics mortality records. We included private residential gardens and other greenspace types, e.g., public parks, sport facilities, using categories from Ordnance Survey MasterMap™ Greenspace. We used Cox proportional hazards models, adjusted for individual and area-level covariates, and stratified analyses by sex, household income, and area-level deprivation. In sensitivity analyses, we further adjusted for air pollution, road-traffic noise, indirect tobacco smoke exposure, and physical activity, and restricted analyses to non-movers. RESULTS: In 232,926 participants, we observed 13,586 all-cause, 13,159 non-injury, 2,796 cardiovascular (CVD), and 968 respiratory disease deaths. Private residential garden cover showed inverse associations with all-cause, non-injury, CVD, and chronic respiratory disease mortality, after adjustment for covariates and other types of greenspace, with hazard ratios and 95 % confidence intervals of 0.94 (0.91, 0.97), 0.95 (0.92, 0.97), 0.92 (0.86, 0.98) and 0.87 (0.78, 0.98), respectively, per interquartile range (IQR) increase in private residential garden cover (IQR = 21.6 % increase within 100 m buffer). Other greenspace types showed weaker inverse associations with CVD and chronic respiratory disease mortality than private residential gardens. Sex, household income, and area level deprivation modified associations. Findings were robust to sensitivity analyses. CONCLUSION: Our finding that private residential gardens substantially contributed to inverse associations of total greenspace with premature mortality has implications for public health and urban planning. Inequities in access, ownership, views and use of private residential gardens, and potential health inequities, should be addressed.

An algorithm to identify residential mobility from electronic health-record data.

BACKGROUND: Environmental, social and economic exposures can be inferred from address information recorded in an electronic health record. However, these data often contain administrative errors and misspellings. These issues make it challenging to determine whether a patient has moved, which is integral for accurate exposure assessment. We aim to develop an algorithm to identify residential mobility events and avoid exposure misclassification. METHODS: At Penn Medicine, we obtained a cohort of 12 147 pregnant patients who delivered between 2013 and 2017. From this cohort, we identified 9959 pregnant patients with address information at both time of delivery and one year prior. We developed an algorithm entitled REMAP (Relocation Event Moving Algorithm for Patients) to identify residential mobility during pregnancy and compared it to using ZIP code differences alone. We assigned an area-deprivation exposure score to each address and assessed how residential mobility changed the deprivation scores. RESULTS: To assess the accuracy of our REMAP algorithm, we manually reviewed 3362 addresses and found that REMAP was 95.7% accurate. In this large urban cohort, 41% of patients moved during pregnancy. REMAP outperformed the comparison of ZIP codes alone (82.9%). If residential mobility had not been taken into account, absolute area deprivation would have misclassified 39% of the patients. When setting a threshold of one quartile for misclassification, 24.4% of patients would have been misclassified. CONCLUSIONS: Our study tackles an important characterization problem for exposures that are assigned based upon residential addresses. We demonstrate that methods using ZIP code alone are not adequate. REMAP allows address information from electronic health records to be used for accurate exposure assessment and the determination of residential mobility, giving researchers and policy makers more reliable information.

Longitudinal effects of physical and social neighbourhood change on suicide mortality: A full population cohort study among movers and non-movers in the Netherlands.

Associations between the residential neighbourhood environment and suicide mortality are well-established; however, most evidence is cross-sectional and not capable of incorporating place-based and residential moving-related neighbourhood changes. We studied how suicide mortality is associated with changes in the physical and social neighbourhood environment for movers and non-movers. Our retrospective analysis was based on longitudinal register data for the entire Dutch population aged 25-64 years enriched with annually time-varying data on the residential neighbourhood environment between 2007 and 2016. A total of 8,741,021 people were followed-up between 2007 and 2016 of which 10,019 committed suicide. Upward and downward neighbourhood change was measured by comparing neighbourhood conditions separately at two time points. Cox proportional hazard models indicated that movers had a significantly lower risk of suicide compared to non-movers. Suicide risk was lower for people experiencing improvements in social fragmentation and deprivation compared to those remaining in poor conditions. Change from rural to urban conditions also resulted in lower suicide risk, while a gain in green space put people at increased risk. For those stable neighbourhood conditions over time, suicide mortality was lower for men and women in urban vs. rural neighbourhoods as well as for women in neighbourhoods with low vs. high social fragmentation. Stable exposure to high levels of green space resulted in higher suicide risk among women. Interactions and stratification by moving type revealed associations between neighbourhood change and suicide were more pronounced in non-movers. Our findings suggest that neighbourhood improvements might contribute to a lower suicide risk, especially for long-term residents in poor neighbourhood conditions.

Life Course Neighbourhood Deprivation and Self-Rated Health: Does It Matter Where You Lived in Adolescence and Do Neighbourhood Effects Build Up over Life?

There is an overreliance on concurrent neighbourhood deprivation as a determinant of health. Only a small section of the literature focuses on the cumulative exposure of neighbourhood deprivation over the life course. This paper uses data from the 1958 National Child Development Study, a British birth cohort study, linked to 1971-2011 Census data at the neighbourhood level to longitudinally model self-rated health between ages 23 and 55 by Townsend deprivation score between ages 16 and 55. Change in self-rated health is analysed using ordinal multilevel models to test the strength of association with neighbourhood deprivation at age 16, concurrently and cumulatively. The results show that greater neighbourhood deprivation at age 16 predicts worsening self-rated health between ages 33 and 50. The association with concurrent neighbourhood deprivation is shown to be stronger compared with the measurement at age 16 when both are adjusted in the model. The concurrent association with change in self-rated health is explained by cumulative neighbourhood deprivation. These findings suggest that neglecting exposure to neighbourhood deprivation over the life course will underestimate the neighbourhood effect. They also have potential implications for public policy suggesting that neighbourhood socioeconomic equality may bring about better population health.

Associations between neighbourhood deprivation and engagement in arts, culture and heritage: evidence from two nationally-representative samples.

BACKGROUND: Previous research has shown the benefits of arts and cultural engagement for physical, mental and social wellbeing. This engagement is socially and geographically patterned. Yet it remains unclear whether place-based attributes are associated with engagement behaviour independent of individual factors. Therefore, the aim of this cross-sectional study was to robustly disentangle associations between geographical deprivation and arts engagement from the individual socio-demographic factors that tend to correlate with residential locations. METHODS: Two different samples drawn from two representative surveys of adults living in England were compared - Understanding Society Wave 2 (2010/12) (N = 14,782) and Taking Part survey (2010/11) (N = 4575). Propensity score matching (PSM) was applied to investigate the association between neighbourhood deprivation (20% most deprived vs 20% least deprived) and arts engagement (arts participation, cultural attendance and museums and heritage engagement). RESULTS: Higher levels of neighbourhood deprivation were associated with lower arts, culture and heritage engagement independent of individuals' demographic backgrounds, socio-economic characteristics and regional locations. When exploring subcategories of deprivation, similar results were obtained across deprivation domains. Results were also consistent when using more distinct categories of deprivation (i.e. 10% most deprived vs 10% least deprived) and when comparing people living in the 20% most deprived neighbourhoods with those living in the 40% medium-deprived areas. CONCLUSION: This study is the first to apply a robust PSM technique to examine the association between neighbourhood deprivation and arts engagement using two nationally-representative samples. Results show that neighbourhood deprivation may act as a barrier that could prevent people from engaging in the arts, which in turn may exacerbate social and health inequalities. This highlights the importance of place-based schemes that focus on increasing individual motivation and capacity to engage in arts and cultural activities, especially in areas of high deprivation.

Allostatic Load and Exposure Histories of Disadvantage.

The stress pathway posits that those in disadvantaged circumstances are exposed to a higher degree of stressful experiences over time resulting in an accumulated biological burden which subsequently relates to poorer health. Trajectories of disadvantage, in the form of neighbourhood deprivation and structural social capital, are evaluated in their relation to allostatic load representing the cumulative "wear and tear" of chronic stress. This paper uses data from the British Household Panel Survey and Understanding Society in a latent class growth analysis. We identify groups of exposure trajectories over time using these classes to predict allostatic load at the final wave. The results show that persistent exposure to higher deprivation is related to worse allostatic load. High structural social capital over time relates to lower allostatic load, in line with a stress buffering effect, though this relationship is not robust to controlling for individual sociodemographic characteristics. By demonstrating a gradient in allostatic load by histories of deprivation, this analysis supports a biological embedding of disadvantage through chronic exposure to stressful environments as an explanation for social health inequalities.

Neighbourhood deprivation effects on young people's mental health and well-being: A systematic review of the literature.

Since the growth of research into neighbourhood effects on young people's health in the 1980s, there have been major societal changes and scientific methodological advancements. In this systematic review we will, therefore, discuss the recent (>2009) literature on the association between neighbourhood deprivation and young people's (0-19 years old) mental health and well-being. We focus on whether neighbourhood deprivation effects exist, and how and for whom the neighbourhood matters. Together, the thirty studies included in the review indicate that overall there are neighbourhood effects on young people's mental health and well-being. The comparison of results from these studies suggests that such associations were more commonly found for well-being and externalising problem behaviour rather than internalising problem behaviour. Also, mental health and well-being seemed to be more often associated with the neighbourhood social environment than neighbourhood socio-economic status and neighbourhood disorder. Studies investigating mediating processes between the linkage between neighbourhood deprivation and mental health and well-being were rare although there was some evidence that processes within the family and peer context are important mechanisms in this linkage. Inconsistent evidence was found regarding the moderating role of age, gender, and ethnicity. There are ongoing challenges of researching the how and for whom neighbourhoods are important. We should work towards rigorous theory and evidence on how different features of residential contexts matter and on differential exposure and vulnerability to these contexts.