Healthy Communities Publications

Clusters and associations of adverse neonatal events with adult risk of multimorbidity: A secondary analysis of birth cohort data

John J, Stannard S, Fraser SDS, Berrington A, Alwan NA

Multimorbidity is commonly defined as the co-occurrence of two or more Long-Term Conditions (LTCs). This phenomenon is growing in prevalence , including amongst younger age groups, and represents a significant public health issue. 

An estimated one in three individuals will develop multimorbidity in their lifetimes. Multimorbidity results in higher rates of premature mortality, reduced quality of life, and greater demand on health services. Previous evidence has demonstrated that multimorbidity is a significant driver of costs in many health and social care systems, independent of biological factors such as advanced age. Multimorbidity also potentiates health inequalities; it is well established that the prevalence of multimorbidity is higher, and the age of onset is up to ten years earlier, in the most disadvantaged communities, and amongst certain ethnic minorities. It is therefore vital that risk factors of multimorbidity are identified to facilitate timely detection and management of susceptible individuals, and aid the development and implementation of preventative interventions .

Research has demonstrated that certain early-life characteristics are associated with multimorbidity in adulthood.

The effect of early life events on multimorbidity can be broadly explained by two main lifecourse epidemiological paradigms: the “critical period” theory, in which biological imprinting at important time-points, make an individual more susceptible to compromised health in adult life and; the “accumulation of risk” model, which states that cumulative adverse early-life events contribute to poor adult health. Both theories have potential relevance to the aetiology of multimorbidity, and have therefore been considered as a potential mechanism for this study.

It is plausible that events surrounding the birth of an individual represent an opportunity for early intervention, with the aim to prevent later-life multimorbidity. Yet, the association between multiple adverse neonatal events such as gestational age, birthweight, neonatal resuscitation, neonatal cyanosis, neonatal cerebral signs, duration to establishment of respiratory rate at birth, neonatal cephalohematoma, neonatal illnesses and breathing difficulties, and adult risk of multimorbidity is under-researched. Additionally, despite advancements in neonatal care in recent decades, the sizeable global burden posed by poor birth outcomes has persisted. Preterm birth rates have not seen a decline globally, constituting approximately 10% of all livebirths worldwide.

We hypothesised that an increased number of adverse neonatal events would be associated with a greater burden of multimorbidity across adulthood. By considering the outcome of multimorbidity at various ages between 34 and 46 years, we also investigated whether experiencing a greater number of adverse neonatal events at birth was associated with an earlier onset of multimorbidity.

https://doi.org/10.1371/journal.pone.0319200

March 2025

Exploring Long Covid Prevalence and Patient Uncertainty by Sociodemographic Characteristics Using GP Patient Survey Data

Woodrow M, Ziauddeen N, Smith D, Alwan NA

In the UK, the Office for National Statistics estimated in March 2024 that 2 million adults and children experience Long Covid (LC) (3.3% of the population), with 69% and 41% experiencing it for at least 1 and 2 years respectively and 19% reporting that LC limits their ability to undertake day to day activities ‘a lot’ . There is also evidence of inequalities in LC prevalence, with higher prevalence associated with being female, of older or middle age, having a higher body mass index (BMI) , smoking , and belonging to an ethnic minority group. Higher prevalence is also associated with greater deprivation . There is also unequal impact of the condition on people's lives and inequitable support for the condition. More research is needed to understand the extent of this inequality and the action needed to address it.

As a relatively novel condition, knowledge about LC is still in its infancy amongst researchers and health care professionals but there is even more lack of awareness, exacerbated by barriers and stigma, in the general population leaving unwell people unsure if they have LC. This high and unequal burden of illness from LC has significant implications for society in terms of the infrastructure of accessible diagnosis, support and treatment needed for people with LC.

The General Practice Patient Survey (GPPS) is an annual survey of GP-registered people aged 16 years+ in England, administered by Ipsos on behalf of NHS England. Established in 2007, it asks respondents about their experience of their local GP, other local NHS services and respondents' general health. In 2022 a new question was added that asked whether respondents had LC.

The aims of this study were to (1) explore prevalence of LC, (2) examine its potential sociodemographic and health characteristics and (3) explore factors associated with being unsure about having LC.

https://doi.org/10.1111/hex.70202

March 2025

 The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement.

Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM

Hepatitis C (HCV) is a blood-borne virus (BBV) that can cause severe liver scarring (known as cirrhosis) and primary liver cancer – most commonly hepatocellular carcinoma. There are now effective, widely available, well-tolerated oral treatments for HCV that have few contraindications and high rates of cure. In 2016, the World Health Organization (WHO) set a global target for the elimination of HCV by 2030 with elimination being defined as detection of 80% of prevalent cases and successful treatment in 90%. 

The identification of undiagnosed prevalent cases of HCV and incident infections is a major challenge for the HCV elimination programme. HCV is prevalent in socioeconomically deprived and marginalised groups, such as people who inject drugs (PWID), and most incident infections are occurring in this population. Therefore, specific programmes are required to increase testing and diagnoses in deprived and marginalised populations, including PWID. PWID do engage with opiate substitution therapy (OST) and needle and syringe programmes (NSPs) in community pharmacies, and PWID are known to develop strong and trusting relationships with their pharmacist. 

 Community pharmacies have been shown to be effective locations for HCV testing in PWID in multiple pilot studies, and pharmacy testing has been recommended in European guidelines for BBV testing. In 2020, NHS England (NHSE) commissioned a national advanced service for community pharmacies to perform HCV testing as part of the NHSE elimination strategy. However, there were significant differences between the NHSE commissioned service and the successfully published pilot services. 

The discrepancy between the success of the pilot services compared with the NHSE service suggests that the relative differences in service specification led to differential testing uptake. 

The aim of the I-COPTIC study is to define the characteristics of a successful community pharmacy HCV testing service to support future implementation.

https://doi.org/10.1016/j.puhe.2024.04.017

July 2024

Exploring the Intersection of Cancer, Domestic Homicide, and Domestic Abuse-Related Suicides Using Domestic Homicide Reviews

Dheensa S, Bracewell K, Boughton G, Hepworth E, Myall M and Rowlands J

Due to the scant research about the cancer and Domestic Abuse intersection, we decided to analyze Domestic Homiceide Review (DHR) reports while acknowledging these limitations and engaging critically with them as a data source. No published research has explored this intersection using DHRs. 

Our research questions (RQs) were: 

according to DHR reports where the victim had a cancer diagnosis, or the victim was caring for a partner/family member with a cancer diagnosis: 

1 - how did the cancer diagnosis affect experiences of DA, risk of DA, and risk of domestic homicide and DA-related suicide, and how did DA affect the experience of cancer care?

2 - what were professionals’ documented identifications of DA, identifications of its risk factors, or responses to these for those affected by a cancer diagnosis? 

A less central research question was 

3 - to identify relevant learnings for the conduct of DHRs.

Overall, we aimed to develop and deepen understanding at the intersection of cancer and DA for researchers which

could in turn inform training and policy, primarily for UK cancer HCPs.

https://doi.org/10.1007/s10896-025-00839-8

February 2025

Neighbourhood socioeconomic deprivation associated with poorer psychological therapy outcomes for PTSD: an audit of a single NHS Talking Therapies (IAPT) service

Richardson T,  Ferrie O, Smith D, Ellis-Nee C, Smart T, Gray E, Roberts N, Delgadillo J and Simmons-Dauvin M

Economic variables such as socioeconomic status and debt are linked with an increased risk of a range of mental

health problems and appear to increase the risk of developing of post-traumatic stress disorder (PTSD).

Previous research has shown that people living in more deprived areas have more severe symptoms of

depression and anxiety after treatment in England’s NHS Talking Therapies services. However, no research has

examined if there is a relationship between neighbourhood deprivation and outcomes for PTSD specifically.

This study was an audit of existing data from a single NHS Talking Therapies service

doi:10.1017/S1754470X25000029

February 2025

 The effect of pregnancy vitamin D supplementation on maternal blood pressure: real-world data analysis within the MAVIDOS randomised placebo-controlled trial

Citeroni-Clark NL, D'Angelo S, Crozier SR, Kermack A, Godfrey KM, Cooper C, Harvey NC, Moon RJ

Hypertensive disorders of pregnancy, including pregnancy-induced hypertension (PIH) and pre-eclampsia (PET) affect around 5–10% and 2–5% of all pregnancies, respectively. These conditions may have significant consequences for the mother, including maternal end-organ damage and death, and for the fetus, such as fetal growth restriction, preterm delivery and intrauterine death.

Several risk factors for hypertensive disorders of pregnancy have been identified, including a previous history or family history of PIH or PET, nulliparity, raised pre-pregnancy body mass index (BMI), multiple pregnancies, inter-pregnancy interval greater than 10 years, pre-existing renal disease and autoimmunity. However, the exact pathophysiologies of PIH and PET are not fully understood. 

Most recently, a potential role of the maternal cardiovascular system has also been proposed. This is in part due to the known increased risk for women with underlying hypertensive and cardiorenal disorders, in addition to greater circulating antiangiogenic factors associated with abnormal vascular function observed in both PIH and PET. An effect of maternal vitamin D status on the risk of PIH and PET has also been hypothesised due to the recognised role of vitamin D in immunological function and the possible impact of this on placental function. 

We hypothesised that vitamin D supplementation in pregnancy would lower maternal BP during pregnancy, and as a result would reduce the incidence of hypertensive disorders of pregnancy. We sought to examine this by integrating real-world BP data collected during pregnancy care with trial data within the MAVIDOS RCT of vitamin D supplementation in pregnancy.

https://doi.org/10.1007/s00404-025-07958-z

January 2024

 Dietary inflammation and childhood adiposity: Analysis of individual participant data from six birth cohorts

Vingrys K, Hébert JR, Chen LW, Crozier S, Duijts L, Harvey NC, Jaddoe VWV, Kelleher C, McAuliffe FM, Polanska K, Suderman M, Jerzynska J, Bottai M, Segurado R, Phillips CM

Childhood adiposity and inflammation impact long-term health. However, associations between dietary inflammation and childhood adiposity are unclear. We investigated if more pro-inflammatory diets are associated with greater adiposity in early-, mid-, and late-childhood.

https://doi.org/10.1016/j.clnu.2024.12.023

January 2025

The Evolving Workplace: The Possible Impacts of Hybrid Working and Hotdesking on Retention of Social Workers

Pulman A, Fenge LA

Challenges with the retention of social workers have increased over the past ten years with links made to higher caseloads, increased stress, shrinking office space and hybridisation of work roles driven by both austerity and changes resulting from the coronavirus disease 2019 (COVID-19) pandemic. 

This article reports on findings from a study developed with two local authorities exploring retention in adult social care from the perspective of practitioners working in the South of England. A mixed methods approach was taken. A group of (n = 57) social workers at two local authorities completed an online survey and (n = 13) were interviewed in depth. A semi-structured interview schedule was constructed to collect expanded reflections on issues affecting retention. 

Several themes emerged concerning the differential impacts of the changing workplace post-COVID-19. These include increased stress and high caseloads and the potential negative impact of hotdesking and hybrid working on supervision and well-being. We discuss areas where changes might address some of the current concerns highlighted by participants, which may in turn exert a positive impact on retention.

https://doi.org/10.1093/bjsw/bcae120

JUly 2024

Can nudge interventions targeting healthy food purchases in real-world grocery stores reduce diet-related health disparities? A pooled analysis of four controlled trials

Stuber JM, Beulens JW, Ayala GX, Crozier SR, Dijkstra SC, Lin SF, Vogel C, Mackenbach JD

Healthy food nudges may be more, or especially, effective among groups experiencing socioeconomic disadvantage. We investigated the modifying role of socioeconomic and demographic characteristics in the effectiveness of nudge interventions targeting healthy foods in real-world grocery store settings on food purchasing patterns.

https://doi.org/10.1186/s12966-024-01687-3

December 2024

Developing consensus on priorities for preconception care in the general practice setting in the UK: Study protocol

Schoenaker   D, Lovegrove E, Santer M, Matvienko-Sikar K, Carr H, Alwan NA, Kubelabo L,   Davies N, Godfrey KM

Preconception medical, behavioural and socioeconomic risk factors are common among people of reproductive age and can impact pregnancy and offspring outcomes. In line with clinical guidance, primary care practitioners are encouraged to support patients to manage and optimise their health prior to pregnancy. Due to barriers, including lack of time and resources, this support is not currently part of routine practice.

As a first step towards the co-development of practical and realistic best practice guidance, this study aims to achieve consensus on a list of priority risk factors that can be used in general practice to guide opportunistic preconception care for patients of reproductive age.

https://doi.org/10.1371/journal.pone.0311578

Novmber 2024

 The Role of the Public Health Workforce in Securing Political Commitment for Tackling Childhood Obesity in Local Government

Taheem R, Woods-Townsend K, Lawrence W, Baird J, Godfrey KM, Chase D, Hanson MA

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce.

https://doi.org/10.1177/15248399241294231

November 2024

Implementation of a UK supermarket intervention to increase purchasing of fresh fruit and vegetables: process evaluation of the WRAPPED natural experiment

Baird J, Dhuria P, Payne H, Crozier S, Lawrence W, Vogel C

Placement interventions, characterised by greater availability and more prominent positioning of healthy food products in supermarkets and other food stores, are associated with healthier patterns of purchasing and diet. The WRAPPED intervention study is a natural experiment that aims to evaluate a supermarket placement intervention to improve fruit and vegetable sales, household purchasing and the dietary quality of women and their children. Process evaluation, alongside the evaluation of outcomes, is essential to understand how interventions are implemented, under what circumstances they are effective, and their mechanisms of impact. This study aimed to assess the implementation of the WRAPPED placement intervention.

10.1186/s12966-024-01679-3

Novmeber 2024