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Background There is a growing body of literature supporting positive associations between natural environments and better health. The type, quality and quantity of green and blue space (‘green-space’) in proximity to the home might be particularly important for less mobile populations, such as for some older people. However, considerations of measurement and definition of green-space, beyond single aggregated metrics, are rare. This constitutes a major source of uncertainty in current understanding of public health benefits derived from natural environments. We aimed to improve our understanding of how such benefits are conferred to different demographic groups through a comprehensive evaluation of the physical and spatial characteristics of urban green infrastructure. Methods We employed a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. This allowed for a comprehensive characterization of a densely populated, polycentric city-region. We produced multiple GI attributes including, for example, urban vegetation health. We used a series of step-wise multi-level regression analyses to test associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient. Results GI attributes demonstrated associations with health in all socio-demographic contexts even where associations between health and overall green cover were non-significant. Associations varied by urban socio-demographic group. For areas characterised by having higher proportions of older people (‘older neighbourhoods’), associations with better health were exhibited by land-cover diversity, informal greenery and patch size in high income areas and by proximity to public parks and recreation land in low income areas. Quality of GI was a significant predictor of good health in areas of low income and low GI cover. Proximity of publicly accessible GI was also significant. Conclusions The influence of urban GI on population health is mediated by green-space form, quantity, accessibility, and vegetation health. People in urban neighbourhoods that are characterised by lower income and older age populations are disproportionately healthy if their neighbourhoods contain accessible, good quality public green-space. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation’s Age-Friendly Cities programme.

Background Cigarette smoking cessation has been described as the world’s most important public health intervention. Electronic cigarettes are a relatively new tool for assisting smoking cessation but there is a lack of data on their efficacy. This article reports on a pharmacy supported e-cigarette smoking cessation intervention undertaken in a metropolitan area in the north of England. Methods Longitudinal mixed-methods evaluation incorporating analysis of secondary data, interviews with service users, and interviews with service providers at 3-month and 12-month follow-up, with an additional text message survey of service users at 12-month follow-up. Results The four-week follow-up data suggest that for every twenty people given an e-cigarette, six quit smoking tobacco and three people cut their cigarette intake by more than five cigarettes per day. Long-term follow-up results were positive but only a small number of participants were still engaged with the study at 12 months. Service users and providers spoke positively about the combination of e-cigarettes and pharmacy support. Conclusions E-cigarette distribution combined with pharmacy support appears to be an agreeable and effective intervention for smoking cessation, but further data are needed on long-term quit rates and health effects.

Common approaches to mapping green infrastructure in urbanised landscapes invariably focus on measures of land use or land cover and associated functional or physical traits. However, such one-dimensional perspectives do not accurately capture the character and complexity of the landscapes in which urban inhabitants live. The new approach presented in this paper demonstrates how open-source, high spatial and temporal resolution data with global coverage can be used to measure and represent the landscape qualities of urban environments. Through going beyond simple metrics of quantity, such as percentage green and blue cover, it is now possible to explore the extent to which landscape quality helps to unpick the mixed evidence presented in the literature on the benefits of urban nature to human well-being. Here we present a landscape approach, employing remote sensing, GIS and data reduction techniques to map urban green infrastructure elements in a large U.K. city region. Comparison with existing urban datasets demonstrates considerable improvement in terms of coverage and thematic detail. The characterisation of landscapes, using census tracts as spatial units, and subsequent exploration of associations with social–ecological attributes highlights the further detail that can be uncovered by the approach. For example, eight urban landscape types identified for the case study city exhibited associations with distinct socioeconomic conditions accountable not only to quantities but also qualities of green and blue space. The identification of individual landscape features through simultaneous measures of land use and land cover demonstrated unique and significant associations between the former and indicators of human health and ecological condition. The approach may therefore provide a promising basis for developing further insight into processes and characteristics that affect human health and well-being in urban areas, both in the United Kingdom and beyond.

Background It is widely recognised that complex public health interventions roll out in distinct phases, within which external contextual factors influence implementation. Less is known about relationships with external contextual factors identified a priori in the pre-implementation phase. We investigated which external contextual factors, prior to the implementation of a community-centred approach to reducing alcohol harm called ‘Communities in Charge of Alcohol’ (CICA), were related to one of the process indicators: numbers of Alcohol Health Champions (AHCs) trained. Methods A mixed methods design was used in the pre-implementation phase of CICA. We studied ten geographic communities experiencing both high levels of deprivation and alcohol-related harm in the North West of England. Qualitative secondary data were extracted from pre-implementation meeting notes, recorded two to three months before roll-out. Items were coded into 12 content categories using content analysis. To create a baseline ‘infrastructure score’, the number of external contextual factors documented was counted per area to a maximum score of 12. Descriptive data were collected from training registers detailing training numbers in the first 12 months. The relationship between the baseline infrastructure score, external contextual factors, and the number of AHCs trained was assessed using non-parametric univariable statistics. Results There was a positive correlation between baseline infrastructure score and total numbers of AHCs trained (R s  = 0.77, p  = 0.01). Four external contextual factors were associated with significantly higher numbers of lay people recruited and trained: having a health care provider to coordinate the intervention ( p  = 0.02); a pool of other volunteers to recruit from ( p  = 0.02); a contract in place with a commissioned service ( p  = 0.02), and; formal volunteer arrangements ( p  = 0.03). Conclusions Data suggest that there were four key components that significantly influenced establishing an Alcohol Health Champion programme in areas experiencing both high levels of deprivation and alcohol-related harm. There is added value of capturing external contextual factors a priori and then testing relationships with process indicators to inform the effective roll-out of complex interventions. Future research could explore a wider range of process indicators and outcomes, incorporating methods to rate individual factors to derive a mean score. Trial registration ISRCTN81942890, date of registration 12/09/2017.

Introduction: Secure infant/child–caregiver attachment is crucial for the development of social and emotional functioning and can affect long-term outcomes, such as adult relationships, but it may also be influenced by prenatal and early childhood risk factors. Children with a history of prenatal alcohol exposure (PAE) have a complex spectrum of strengths and difficulties and often have the additional risk of early life adversity. There is some evidence that children with PAE are at increased risk of insecure attachment, but it is unclear whether this is consistent or why it is the case. No published review has focused on the relationship between PAE and attachment. Methods: A systematic search of seven academic databases using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines was undertaken by two reviewers to identify primary studies that have focused on the relationship between PAE and attachment. Quality assessments were undertaken using the Quality of Observational Cohort and Cross-Sectional Studies tool, and the report was written following the PRISMA-ScR checklist. Results: A total of 4199 records were returned from the database searches. A total of 11 studies (eight peer-reviewed papers and three dissertations), published between 1987 and 2021, met the criteria. Five studies showed that PAE was related to insecure or disorganised attachment, two of which showed that infant irritability and caregiver–infant interaction mediated this relationship. The other six studies found no significant relationship between PAE and attachment. Conclusions: This scoping review demonstrates that there is a dearth of published research on this topic, and none that takes advantage of more recent understanding of the relationship between adverse childhood experiences and neurodevelopmental disorders. There is some evidence that PAE may impact the attachment relationship via caregiver–infant interaction and infant irritability, but further studies, including those that assess the additional impact of early life adversity, are needed.

With the global population projected to continue growing, there are concerns that health services are beginning to be stretched beyond working limits, particularly in the Global North, where many nations face ageing populations and similar obstacles. One suggested radical method to tackle these issues would be to provide access to Green Infrastructure (GI) interventions, including the development of social farms, particularly within urban areas and across deprived communities; enabling conventional health services to be supplemented by nature-based therapy. Social farms incapsulate this ideology, by enabling spaces for farming practices to also be used for therapeutic outcomes: providing care, rehabilitation, and even educational programmes. This focuses around the concept of social prescribing, with activities within social farms, amongst other spaces, such as community gardens and urban farms, acting as non-medical approaches to aid people with mental health or related conditions. Currently, research across social farming and social prescribing is relatively novel and therefore tends to be based in Scandinavian countries or the USA, in which these spaces are more readily available. This paper focuses on the concept of social farming, which has received increased attention in the UK context, particularly within the Department for Environment, Food, and Rural Affairs (DEFRA) recent 25-year Environment Plan. The paper argues that there is a need for development of this practice within urban settings, with findings showing an agglomeration of sites in the rural context. In addition, we discuss tools for development and barriers, to illustrate opportunities for the future.

Background Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited ‘Alcohol Health Champions’ to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm. Methods A natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes. Discussion We will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health. Trial registration ISRCTN 81942890 , date of registration 12/09/2017.

Purpose of review Biodiversity underpins urban ecosystem functions that are essential for human health and well-being. Understanding how biodiversity relates to human health is a developing frontier for science, policy and practice. This article describes the beneficial, as well as harmful, aspects of biodiversity to human health in urban environments. Recent findings Recent research shows that contact with biodiversity of natural environments within towns and cities can be both positive and negative to human physical, mental and social health and well-being. For example, while viruses or pollen can be seriously harmful to human health, biodiverse ecosystems can promote positive health and well-being. On balance, these influences are positive. As biodiversity is declining at an unprecedented rate, research suggests that its loss could threaten the quality of life of all humans. Summary A key research gap is to understand—and evidence—the specific causal pathways through which biodiversity affects human health. A mechanistic understanding of pathways linking biodiversity to human health can facilitate the application of nature-based solutions in public health and influence policy. Research integration as well as cross-sector urban policy and planning development should harness opportunities to better identify linkages between biodiversity, climate and human health. Given its importance for human health, urban biodiversity conservation should be considered as public health investment.

Background There is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking. Methods An opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined. Results Proportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places. Conclusion There is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to reduce alcohol-related harms in children should ensure bingeing is avoided entirely, address the excessively low cost of many alcohol products, and tackle the ease with which it can be accessed, especially outside of supervised environments.

(1) It might be implied that those with Fetal Alcohol Spectrum Disorder (FASD) with fewer sentinel facial features have a “milder” neuropsychological presentation, or present with fewer impairments than those with more sentinel facial features. The aim of this service evaluation was to compare the neuropsychological profile of people with FASD with varying numbers of sentinel facial features. (2) A clinical sample of 150 individuals with FASD, aged between 6 and 37 years, completed various standardised assessments as part of their diagnostic profiling. These included the documented level of risk of prenatal alcohol exposure (4-Digit Diagnostic Code), sensory needs (Short Sensory Profile), cognition (Wechsler Intelligence Scale for Children—4th Edition; WISC-IV), and communication and socialisation adaptive behaviours (Vineland Adaptive Behavior Scale—2nd Edition; VABS-II). As FASD has high comorbidity rates of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), these were also reviewed. The profiles of the ‘FASD with 2 or 3 sentinel facial features’ group (n = 41; 28 male, 13 female) were compared with the ‘FASD with 0 or 1 sentinel facial features’ group (n = 109; 50 male, 59 female) using Chi² tests, independent sample t-tests, and Mann-Whitney U analyses (where appropriate). (3) There were no significant differences between the two comparison groups across any measure included in this service evaluation. (4) Whilst sentinel facial features remain an important aspect in recognising FASD, our service evaluation indicates that there is no significant relationship between the number of sentinel facial features and the neuropsychological profile of people with FASD in terms of severity of presentation.