Explore the vast range of titles available.

A crucial social determinant of health that demands more attention

[This corrects the article DOI: 10.1371/journal.pone.0288500.].

In England, 1 in 5 children and young people (CYP; aged 8-25 years) has a probable mental disorder with higher rates among those living in poverty, and among white children compared with other ethnic groups. However, in the UK, research shows that the prevalence of mental health conditions and associated service use differs among some ethnic minority groups (e.g., Asians) suggesting potential unmet mental health need. Early interventions have been shown to improve life outcomes, and UK government policies encourage the promotion of mental health and wellbeing in schools and colleges, but poor mental health continues to rise. Despite evidence showing that mental health problems occur as early as age 5 years, limited research focusses on primary schools (children aged 5-10 years). Northwest London (NWL), UK, is a diverse region in London, is in the top 20% most deprived, and has a high demand for CYP mental health services. The aim of our study was to explore teachers' perspectives of promoting positive mental health in NWL primary schools. We created a semi-structured interview based on policy guidance. Nine teachers were recruited and interviewed during June and July 2024. Thematic analysis identified six overarching themes: (1) mental health needs; (2) responsibility; (3). factors contributing to poor mental health; (4). barriers and (5) facilitators to providing support; and (6) collaboration. Subthemes included lack of skills to address the broad spectrum of mental health needs, funding, resources, and lack of support systems to ensure all children receive the right support at the right time. Our study highlights implementation gaps for promoting mental health policy in diverse real-world settings, and suggests that whilst schools play an important role for early mental health intervention, wider complexities limit sufficient support provision. Our findings have potential implications for mental health promotion policies in school settings.

School-based physical activity interventions are considered ideal given their potential to reach most children. They can help children achieve the recommended guidelines of 60 minutes of moderate-to-vigorous physical activity per day. The Daily Mile is a popular school-based active mile intervention with a global reach. It recommends ten core principles for successful implementation, three of which are key for effectiveness: that it is quick (15 minutes), the whole school participates, and that it takes place in the school day during lessons (excluding physical education lessons and scheduled breaks). Studies assessing the impacts of The Daily Mile do not often report implementation of the ten core principles which is crucial to identifying the potential impact and feasibility of scalable interventions in real-world settings. Our aim was to assess adherence to The Daily Mile’s ten core principles in Greater London primary schools. We created and distributed a survey to 1717 primary schools during September 2020 and achieved a 21% (n = 369/1717) response rate by September 2021. Our sample was representative of Greater London primary schools with responses from every London borough. A total of 196/369 (53%) schools reported implementing The Daily Mile but none of them reported adherence to all ten core principles. Adherence to at least 6/10 principles in various combinations was reported by 54/196 (28%) schools. Only 19/196 (10%) schools that reported implementing The Daily Mile reported adherence to the three key principles recommended for effectiveness. Despite its popularity and global reach, our findings suggest that an implementation gap exists when The Daily Mile is adopted in real-world settings which is likely to challenge its intended purpose. Further research in school settings is needed to understand factors that can improve adherence to increase the potential public health impact of The Daily Mile and other similar interventions.

BackgroundSchools in England need effective, simple interventions to address shortfalls in children’s physical activity. Areas in England where physical activity is low among children may particularly benefit from school-based physical activity interventions. Further, stark geographical inequalities for children’s physical activity exist and have widened during Covid-19 lockdowns. The Daily Mile (TDM) is a school-based running programme that has been widely adopted across England. However, there is limited evidence of its equitability and whether it reaches children in most need. We aimed to i) identify local authorities in England with the highest need for children’s physical activity promotion and ii) determine whether TDM reaches schools in areas of high need.MethodsThis was a cross-sectional study linking routinely collected data from a range of sources including the Active Lives Surveys and national datasets. Characteristics of need were identified following a literature review to identify determinants of children’s physical activity. Our assessment of local authority ‘need’ included measures of children and adult’s physical activity and excess weight, children’s mental health needs, access and utilisation of outdoor space for exercise, and deprivation. We grouped local authorities using a hierarchical cluster analysis. The optimal number of clusters for our data was three clusters. We estimated the association between ‘need’ and registration to TDM with a Poisson regression.ResultsWe identified three distinct clusters of need for children’s physical activity interventions representing 4.5 million primary school children. High-need, medium- need, and low- need local authorities included 24%, 56% and 20% of 123 upper-tier English local authorities respectively. Schools in local authorities of high-need were more likely to be registered to TDM (IRR: 1.25, 95%CI:1.12–1.39) compared with schools in low-need local authorities, where registration to TDM ranged from one in five schools in the low-need cluster to one in four in the high-need cluster.ConclusionOur study suggests that TDM is an equitable intervention reaching schools in areas with the highest need. Areas of highest need are concentrated in particular areas in England, for example the North East. Matching public health interventions to the needs of the population is more efficient and equitable than blanket policies directed at whole populations. This identification of clusters of local authorities that share patterns of need may guide shared learning between local authorities that share similar challenges and contextual features.

ObjectivesTo examine associations between The Daily Mile, a school-based active mile intervention, and pupils’ physical activity, mental health and educational performance.MethodsYear 1 pupils (aged 5–6 years) from Greater London primary schools were invited. Schools were allocated to The Daily Mile or non-Daily Mile group based on their reported Daily Mile participation. We measured weekday school hours mean minutes of moderate-to-vigorous physical activity (MVPA) using GENEActiv accelerometers. Other outcomes included time spent sedentary and in light activity, mental health and educational performance. Multi-level linear regression models examined differences accounting for repeated measurements (day) clustered by pupils-, class- and school-level, with adjustments for sex, ethnic group, area-level deprivation and month of assessment.ResultsA total of 1004 pupils/40 schools were recruited and assessed between October 2021 and January 2023; 21 schools/499 pupils comprised The Daily Mile group; 19 schools/505 pupils the non-Daily Mile group. Daily Mile pupils spent 2.2 min more in MVPA compared with non-Daily Mile pupils, but the difference was not significant (0.78, 95% CI −2.14 to 3.69). Daily Mile pupils spent less time sedentary and more time in light activity compared with the non-Daily Mile pupils, but not significantly (−5.06, 95% CI −15.37 to 5.26 and 3.27, 95% CI −4.26 to 10.81, respectively). There were no differences in mental health or educational performance.ConclusionsWe found no associations between The Daily Mile and pupils’ physical activity, mental health and educational performance. Pupils in our study were in year 1 with early exposure to the intervention; assessments over longer periods are needed to understand any benefits.

BackgroundNeighbourhood characteristics may affect mental health and well-being, but longitudinal evidence is limited. We examined the effect of relocating to East Village (the former London 2012 Olympic Athletes’ Village), repurposed to encourage healthy active living, on mental health and well-being.Methods1278 adults seeking different housing tenures in East village were recruited and examined during 2013–2015. 877 (69%) were followed-up after 2  years; 50% had moved to East Village. Analysis examined change in objective measures of the built environment, neighbourhood perceptions (scored from low to high; quality −12 to 12, safety −10 to 10 units), self-reported mental health (depression and anxiety) and well-being (life satisfaction, life being worthwhile and happiness) among East Village participants compared with controls who did not move to East Village. Follow-up measures were regressed on baseline for each outcome with group status as a binary variable, adjusted for age, sex, ethnicity, housing tenure and household clustering (random effect).ResultsParticipants who moved to East Village lived closer to their nearest park (528 m, 95% CI 482 to 575 m), in more walkable areas, and had better access to public transport, compared with controls. Living in East Village was associated with marked improvements in neighbourhood perceptions (quality 5.0, 95% CI 4.5 to 5.4 units; safety 3.4, 95% CI 2.9 to 3.9 units), but there was no overall effect on mental health and well-being outcomes.ConclusionDespite large improvements in the built environment, there was no evidence that moving to East Village improved mental health and well-being. Changes in the built environment alone are insufficient to improve mental health and well-being.

IntroductionSchool environments that encourage children to be physically active can embed lifelong positive health behaviours and contribute towards reducing health inequalities. The Health and Activity of Pupils in the Primary Years (HAPPY) study aims to: (1) explore the extent to which the WHO criteria for creating active school environments are implemented by primary schools and (2) examine associations between active school environments and children’s physical activity, mental health and educational performance.Methods and analysisThe HAPPY study is a quasi-experimental study comprising: (1) a survey of state-funded Greater London primary schools to identify implementation of the WHO’s six criteria and (2) a cross-sectional study to examine associations between schools’ active environment score (derived from the school survey) and pupils’ physical activity, mental health and educational performance. For our cross-sectional study, we will recruit up to 1000 year-three children (aged 7–8 years). Our primary outcome is accelerometer (GENEActiv) assessed physical activity, our secondary outcomes are parent-reported child mental health (Strengths and Difficulties Questionnaire) and teacher-reported educational performance (age-related expectations). Using multilevel mixed-effects regression models, we will examine associations between the active environment score and physical activity. Physical activity will be included as a measure of acceleration and also different intensities (light, moderate, vigorous). We will repeat this analysis to examine associations between the active environment score and mental health and educational performance. We will adjust for school characteristics and area-level deprivation and include pupil characteristics (eg, sex, ethnic group) as covariates. Clustering at the school level will be included as a random effect.Ethics and disseminationEthical approval has been obtained from Imperial College Research Ethics Committee (ref: 6800895). Findings will be disseminated through a summary report to all participating schools, peer-reviewed publications, presentations at national and international conferences and National Institute for Health and Care Research policy briefings.

ObjectivesTo develop a core outcome set (COS) for physical activity interventions in primary schools.DesignModified-Delphi study.SettingThe UK and international.Participants104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8–9 years) from 1 London primary school.InterventionsPhysical activity interventions.MethodsFour-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a two-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a nine-point Likert Scale from ‘not important’ to ‘critical’: a>70% participant threshold identified the outcomes rated ‘critical’ to measure, and outcomes important to children were identified through a workshop; and (4) a stakeholder meeting to achieve consensus of the outcomes to include in the COS.ResultsIn total, 74 studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains were established: ‘physical activity and health’ (16 outcomes), ‘social and emotional health’ (22 outcomes) and ‘educational performance’ (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. In total, 13 outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the COS: five outcomes for physical activity and health (diet (varied and balanced), energy, fitness, intensity of physical activity, sleep (number of hours)); seven outcomes for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, well-being); and two outcomes for educational performance (concentration, focus).ConclusionsWe have developed the first COS for physical activity interventions in primary schools in consultation with those interested in the development and application of an agreed standardised set of outcomes. Future studies including these outcomes will reduce heterogeneity across studies.Trial registration numberCore Outcome Measures in Effectiveness Trials Initiative registration number 1322; Results.

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