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HighlightsThis special issue explores how indoor environments affect health inequalities, inequities and injustices. Despite the recognition of the importance of the built environment for health – in particular, the indoor environment – as a crucial health improvement policy domain, major methodological and evidence gaps emerged. The small number of appropriate studies identified for inclusion is partly attributed to limited collaboration between relevant research, policy and practice communities, such as between the built environment and public health sector. Data availability and integration challenges were also identified as a significant barrier to robust analysis of the role of indoor environments for health inequalities at different scales, settings and populations. The complexity of these challenges and the value of developing novel methods for linking diverse datasets are highlighted by the five papers published in the special issue. They emphasise the role of governance and local policy in shaping the built environment, but also outline the potential to improve indoor environments through behaviour change. They also highlight how the complex links between building performance, outdoor conditions and structural inequalities related to occupant socio-economic status can result in inequalities in exposure to indoor risk factors and in health outcomes, including mental health. Policy action should be prioritised over putting the onus on individuals to create safe and healthy indoor environments for all. Policy instruments could include planning and building regulations, financial and reputation incentives, capacity-building, information and awareness campaigns. A series of future research recommendations is provided that includes the development of shared protocols that facilitate data collection on both health, socio-demographic and built-environment data, as well as ethics clearance, sharing and linkage, to ensure the optimisation of funding allocation; the adoption of crowdsourcing, low-cost, smart and wearable technology; and the fostering of inter- and transdisciplinary research for mutual understanding of built-environment and health equity among researchers, practitioners and policymakers.

ObjectivesThis research aims to explore the factors that hinder professionals in delivering integrated care for children under 5 in temporary accommodation (TA) and understand their experiences of collaboration during the pandemic to inform recommendations.DesignSemistructured qualitative interviews.SettingEngland, UK.Participants45 professionals working across health, housing, education and non-profit sectors in England. Purposive and snowball sampling was employed to recruit a representation of key professionals across England. Those not eligible to take part in the study included people who did not work with families and/or children in TA settings.Outcome measuresTo explore cross-sector learnings that are applicable to improving integrated care and to tailor recommendations to the needs of families and children under 5 experiencing homelessness in the UK today.ResultsThis study highlights the complex, multilevel barriers that professionals face when delivering integrated care to children under 5 in TA. Findings are organised using a framework that distinguishes between practice-level, organisational and systemic challenges. From siloed working practices and limited training to staffing shortages and restrictive data-sharing policies, these challenges collectively hinder service continuity and collaboration.ConclusionsAlthough this project was conducted during the COVID-19 pandemic, the challenges identified reflect deeper, long-standing issues in service delivery. As services continue to recover and prepare for future crises, these insights remain highly relevant and can inform more resilient, integrated recovery plans to support children in TA beyond the pandemic context. Addressing these barriers, through improved collaboration, training and data-sharing, is key to strengthening care for this vulnerable population.

Background There is a growing body of research into the total amount and patterns of sitting, standing and stepping in office-based workers and few studies using objectively measured sitting and standing. Understanding these patterns may identify daily times opportune for interventions to displace sitting with activity. Methods A sample of office-based workers (n = 164) residing in England were fitted with thigh-worn ActivPal accelerometers and devices were worn 24 hours a day for five consecutive days, always including Saturday and Sunday and during bathing and sleeping. Daily amounts and patterns of time spent sitting, standing, stepping and step counts and frequency of sit/stand transitions, recorded by the ActivPal accelerometer, were reported. Results Total sitting/standing time was similar on weekdays (10.6/4.1 hrs) and weekends (10.6/4.3 hrs). Total step count was also similar over weekdays (9682 ± 3872) and weekends (9518 ± 4615). The highest physical activity levels during weekdays were accrued at 0700 to 0900, 1200 to 1400, and 1700 to 1900; and during the weekend at 1000 to 1700. During the weekday the greatest amount of sitting was accrued at 0900 to 1200, 1400 to 1700, and 2000 to 2300, and on the weekend between 1800 and 2300. During the weekday the greatest amount of standing was accrued between 0700 and 1000 and 1700 and 2100, and on the weekend between 1000 and 1800. On the weekday the highest number of sit/stand transitions occurred between 0800 to 0900 and remained consistently high until 1800. On the weekend, the highest number occurred between 1000 to 1400 and 1900 to 2000. Conclusion Office based-workers demonstrate high levels of sitting during both the working week and weekend. Interventions that target the working day and the evenings (weekday and weekend) to displace sitting with activity may offer most promise for reducing population levels of sedentary behaviour and increasing physical activity levels, in office-based workers residing in England.

ObjectiveIn middle-income to high-income countries, temporary accommodation (TA), regardless of type, is considered a form of homelessness. Families with young children living in these countries, in these circumstances, often become disconnected from friends, family and services (such as health and welfare support). The additional impact of pandemic restrictions on parents with children under 5 already living in TA had the potential to be considerable. However, this remains an area of limited research. To address this, this study explored the experiences of parents with children under 5, who lived in TA during the pandemic.DesignThe research adopted a qualitative descriptive approach, using semi-structured telephone interviews with 41 families, to explore parents’ experiences of living in TA during the pandemic, with a child under 5. Interviews considered a broad range of factors such as housing quality, access to healthcare and education and the environment. Interviews were audio-recorded, transcribed verbatim and then analysed using a thematic analysis approach.ResultsParent interviews identified that living in TA with a child under 5 during the pandemic impacted their access to services such as healthcare and ability to gather resources, while also affecting their mental health and general well-being. These parent experiences were detailed in three themes, including: (1) effect of restrictions on access, which included healthcare, environment and basic necessities; (2) impact on parents, which included mental health, physical and social impacts and (3) supports, including support services and networks.ConclusionThe challenges conveyed by COVID-19 restrictions, on those already parenting a young child while living in TA, caused concerning health impacts for those affected, while also having potential developmental side effects on their children. This indicates the urgent need for targeted interventions and policies to support vulnerable families in TA, ensuring their well-being during crises and beyond.

Poor air quality is associated with poor health. Little attention is given to the complex array of environmental exposures and air pollutants that affect mental health during the life course. We gather interdisciplinary expertise and knowledge across the air pollution and mental health fields. We seek to propose future research priorities and how to address them. Through a rapid narrative review, we summarise the key scientific findings, knowledge gaps and methodological challenges. There is emerging evidence of associations between poor air quality, both indoors and outdoors, and poor mental health more generally, as well as specific mental disorders. Furthermore, pre-existing long-term conditions appear to deteriorate, requiring more healthcare. Evidence of critical periods for exposure among children and adolescents highlights the need for more longitudinal data as the basis of early preventive actions and policies. Particulate matter, including bioaerosols, are implicated, but form part of a complex exposome influenced by geography, deprivation, socioeconomic conditions and biological and individual vulnerabilities. Critical knowledge gaps need to be addressed to design interventions for mitigation and prevention, reflecting ever-changing sources of air pollution. The evidence base can inform and motivate multi-sector and interdisciplinary efforts of researchers, practitioners, policy makers, industry, community groups and campaigners to take informed action. There are knowledge gaps and a need for more research, for example, around bioaerosols exposure, indoor and outdoor pollution, urban design and impact on mental health over the life course.

Understanding the environmental determinants of physical activity in populations at high risk of inactivity could contribute to the development of effective interventions. Socioecological models of activity propose that environmental factors have independent and interactive effects of physical activity but there is a lack of research into interactive effects. This study aimed to explore independent and interactive effects of social and physical environmental factors on self-reported physical activity in income-deprived communities. Participants were 5,923 adults in Glasgow, United Kingdom. Features of the social environment were self-reported. Quality of the physical environment was objectively-measured. Neighbourhood walking and participation in moderate physical activity [MPA] on ≥5 days/week was self-reported. Multilevel multivariate logistic regression models tested independent and interactive effects of environmental factors on activity. 'Social support' (walking: OR:1.22,95%CI = 1.06-1.41,p<0.01; MPA: OR:0.79,95%CI = 0.67-0.94,p<0.01), 'social interaction' (walking: OR:1.25,95%CI = 1.10-1.42,p<0.01; MPA: OR:6.16,95%CI = 5.14-7.37,p<0.001) and 'cohesion and safety' (walking: OR:1.78,95%CI = 1.56-2.03,p<0.001; MPA: OR:1.93,95%CI = 1.65-2.27,p<0.001), but not 'trust and empowerment', had independent effects on physical activity. 'Aesthetics of built form' (OR:1.47,95%CI = 1.22-1.77,p<0.001) and 'aesthetics and maintenance of open space' (OR:1.32, 95%CI = 1.13-1.54,p<0.01) were related to walking. 'Physical disorder' (OR:1.63,95%CI = 1.31-2.03,p<0.001) had an independent effect on MPA. Interactive effects of social and physical factors on walking and MPA were revealed. Findings suggest that intervening to create activity-supportive environments in deprived communities may be most effective when simultaneously targeting the social and physical neighbourhood environment.

Little is known of the patterns of physical activity, standing and sitting by office workers. However, insight into these behaviours is of growing interest, notably in regard to public health priorities to reduce non-communicable disease risk factors associated with high levels of sitting time and low levels of physical activity. With the advent and increasing availability of indoor tracking systems it is now becoming possible to build detailed pictures of the usage of indoor spaces. This paper reports initial results of indoor tracking used in conjunction with the ActivPAL activity monitoring device. In this paper we give an overview of the usage of the tracking system and its installation and illustrate some of the resultant data. We also provide preliminary results that investigate the relationship between location, light physical activity and sitting in a small sample of office workers (n=33) from two separate office environments in order to demonstrate the relevance and explanatory power of the technique.

To explore the associations of exposure to carbon dioxide with adults’ response speed, 69 participants were invited to participate in the experiment conducted in an environmentally controlled chamber. Participants were exposed alone in three separate sessions, each lasting one hour, with a fixed ventilation rate, temperature and relative humidity level and the CO2 levels fixed at 600ppm, 1500ppm and 2100ppm, respectively. A validated neurobehavioral test battery, the Behavioural Assessment and Research System (BARS) was used to assess participants’ cognitive performance, and response times were collected. Response speed was assessed in ten different tests. After adjusting for potential confounders (age, gender, and education), results showed no significant differences in eight out of the ten neurobehavioral tests. For the Selective Attention test, participants responded faster (lower response time) under CO 2 levels of 2100ppm compared to 600ppm (adj.β-coef. -17.57, 95% CI (-29.45, -5.68), p-value=0.004). For the Progressive Ratio Test, participants’ response times significantly decreased with CO 2 levels increased. Results indicate no statistical link between CO 2 levels and response speed, with only two out of ten comparisons being significant.

Poor air quality can both trigger and aggravate lung and heart conditions, as well as affecting child development. It can even lead to neurological and mental health problems. However, the precise mechanisms by which air pollution affect human health are not well understood. To promote interdisciplinary dialogue and better research based on a critical summary of evidence on air quality and health, with an emphasis on mental health, and to do so with a special focus on bioaerosols as a common but neglected air constituent. A rapid narrative review and interdisciplinary expert consultation, as is recommended for a complex and rapidly changing field of research. The research methods used to assess exposures and outcomes vary across different fields of study, resulting in a disconnect in bioaerosol and health research. We make recommendations to enhance the evidence base by standardising measures of exposure to both particulate matter in general and bioaerosols specifically. We present methods for assessing mental health and ideal designs. There is less research on bioaerosols, and we provide specific ways of measuring exposure to these. We suggest research designs for investigating causal mechanisms as important intermediate steps before undertaking larger-scale and definitive studies. We propose methods for exposure and outcome measurement, as well as optimal research designs to inform the development of standards for undertaking and reporting research and for future policy.

Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.