Journal of Public Health

PurposeThis study aimed to estimate the prevalence of serious psychological distress (SPD) among slum dwellers and homeless individuals in Ho Chi Minh City, Vietnam, and to identify factors associated with SPD. MethodA cross-sectional survey of 415 individuals with unstable housing, including 383 slum dwellers and 32 homeless individuals, was conducted from November 2023 to April 2024. Data were collected using a structured questionnaire that included the Kessler Psychological Distress Scale (K6). ResultsThe prevalence of SPD was 19.8% (18.5% among slum dwellers and 34.4% among the homeless). Multiple logistic regression revealed significant associations between SPD and female gender (p=0.000), labor exploitation (p=0.046), and debt (p=0.000). Notably, 68.7% of participants reported experiencing some form of labor exploitation, commonly involving contract rejections, forced overwork, wage theft, and physical or verbal abuse. Additionally, 43.7% were in debt, with 38.6% borrowing from moneylenders. ConclusionsThe prevalence of SPD among individuals with unstable housing in Ho Chi Minh City was significantly higher than that of the general population. Those with SPD frequently faced both labor and economic exploitation, without insufficient social protection. In terms of labor exploitation, policy interventions, particularly from an occupational health perspective, are necessary. To address economic exploitation through debt, given the prevalence of loan sharks, efforts to crack down on predatory lending and promote financial inclusion are essential.

BackgroundThe public health grant is used by upper-tier and unitary local authorities in England to fund public health services. Public health grant allocations have declined by 26% per person since 2015/16, with cuts being made without any adjustment based on population needs, resulting in absolute cuts often being greater for more deprived local authorities. This study seeks to investigate how these cuts have affected spending decisions across different areas of public health and how changes in spend relate to population health needs. MethodsIn this longitudinal ecological study, data on local government revenue expenditure and financing to 146 upper-tier local authorities in England were extracted from the Ministry of Housing, Communities, and Local Government for the years 2017/18, 2018/19 2019/20 and 2022/23. Demand for each function of the public health grant was proxied using a publicly available indicator of need. Descriptive analyses explored changes to grant expenditure over time by function and IMD quintile. A compositional regression model was developed to account for the relatedness of spend data. The significance of associations between indicators of need and spend on functions of the grant was tested using MANOVA, producing Pillais Trace statistics as an indication of the effect size of each explanatory variable relative to others. FindingsPublic health grant spending reductions were widespread. More deprived local authorities often experienced deeper absolute cuts against a backdrop of greater need, with spend being protected across all IMD quintiles in only three areas: childrens 0 to 5 non-prescribed functions, health protection, and public mental health. In the multivariate regression, there was limited relationship between indicators of health need and patterns of grant spend between public health categories. InterpretationThere is no clear relationship between potential indicators of need and expenditure of the public health grant in different reporting categories. Instead, spending decisions are being driven by other factors that may include historic spend, wider local priorities and financial pressures. These findings suggest a review of the public health grant formula to support local authority public health teams to more strategically apportion spend based on population health need. O_LIWhat is already known on this topic O_LILocal authority public health teams in England receive a ring-fenced grant from central government which was originally based on an allocation formula that has not been updated since 2012/13. C_LIO_LIThe grant has been cut substantially over the past decade, often with larger absolute cuts for more deprived local authorities. C_LIO_LINo previous study has investigated how public health teams allocate a diminishing grant across competing areas of public health need and how this may vary by deprivation. C_LI C_LIO_LIWhat this study adds O_LIThis study found limited evidence that indicators of health need have driven public health grant allocation in related spend categories, nor any differences by deprivation. Our analysis is the first to explore multiple indicators of need and to employ compositional regression to account for corelations between categories of grant spend. C_LI C_LIO_LIHow this study might affect research, practice and policy O_LIThis study supports a review of the public health grant funding formula to better distribute the public health grant according to local population health need. C_LI C_LI

Background and ObjectiveMental health outcomes have reportedly worsened in several countries during the Covid-19 pandemic and associated lockdowns. In the present study we examined whether suicides increased in Greece during the first wave of the pandemic. MethodsWe used daily suicide estimates from a Suicide Observatory in Greece from 2015-2020 and followed three methodologies: A descriptive approach, an interrupted time series analysis, and a differences-in-differences econometric model. ResultsWe did not find any empirical evidence of any increase in suicides during the first wave of Covid-19 and the lockdown in any of the three approaches used. ConclusionsSuicides did not seem to increase during the first wave of covid-19 and lockdown in Greece. However, this does not mean that mental health did not deteriorate, or that we will not observe an increase in suicides during the second wave. Protective factors for Greece during the first wave may include working from home (for those able to tele-work), strong family ties, advertising of a suicide hotline and income support for the unemployed.

Past studies have shown that the more unaffordable housing is to people, the worse their health, particularly mental health. However, the commonly used housing affordability indicator, the 30% measure, has limitations. There is evidence that other indicators, including the 30/40 measure, might be more precise in characterizing housing unaffordability by taking into account absolute values of household incomes. In this paper, we use cross-sectional data from the UK Household Longitudinal Study, to evaluate relationships between two affordability measures (30%, 30/40) with 3 health measures: general, physical and mental health. We use logistic regression and effect modification to test whether relationships varied by age, ethnicity, housing tenure, urbanicity and sex. Out of 35,114 participants with complete data, housing was classified as unaffordable for 24.2% using the 30% measure and 10.2% for the 30/40 measure. In age-adjusted analyses, higher unaffordability was associated with worse health for all three health measures, with associations stronger for the 30/40 vs the 30% unaffordability measure. In models adjusted for age, sex and urbanicity, both ethnicity and tenure independently modified associations; with modification showing small differences by unaffordability and health measure. Further studies are needed to disentangle complex relationships between household income, housing costs, ethnicity and tenure.

ObjectiveTo re-estimate and re-validate the Area Deprivation Index to address recent criticism of the existing index, which is calculated and distributed by Neighborhood Atlas. Data SourcesTo calculate the updated Area Deprivation Index (ADI), we obtained 17 census measures from the 2018-2022 American Community Survey (ACS) 5-year data that reflected poverty, housing, employment, and education within census block groups, census tracts, and counties. To validate the association of the updated index with health outcomes, we obtained the most recent census tract-level life table data from the U.S. Small-area Life Expectancy Estimates Project (USALEEP). Study DesignWe used principal components analysis to estimate new factor weights associated with the primary component summarizing the 17 selected census measures. The resulting scores were ranked into percentiles to arrive at the updated ADI. We compared this updated ADI to the existing ADI distributed by the Neighborhood Atlas. We calculated average life expectancy and age-specific mortality rates by groups defined by the updated ADI. Principal FindingsThe principal components analysis identified a single factor that explained 46% of variance at the census tract level. There were noticeable differences in factor loadings for the unemployment rate and the proportion of households without a motor vehicle compared to the original loadings. Results were similar at the county and block group levels. Compared to existing ADI values, there were substantive changes in the updated ADI values for many geographic ares with high home values, but low employment and educational attainment. The updated ADI demonstrated robust associations with age-specific mortality and life expectancy. ConclusionsThe updated ADI better summarized the 17 underlying census variables than the current ADI. The updated index was strongly correlated with life expectancy and mortality. Callout BoxWhat is known on this topic O_LIADI is a measure of area-level deprivation that summarizes 17 Census measures regarding poverty, housing, employment, and education. The original ADI demonstrated associations with mortality and clinical outcomes. C_LIO_LIThe current version of the ADI made available by the Neighborhood Atlas relies on old factor weights and appears to have flaws in its construction that lead to overreliance on home value and income variables. C_LI What this study adds O_LITo address these concerns, this study re-estimates the ADI properly from source data to ensure that the final index reflects a combination of all 17 census measures, and not just home value and income. C_LIO_LIThe updated ADI more accurately reflects the distribution of deprivation in neighborhoods across the country and is highly correlated with life expectancy and age-specific mortality rates. C_LIO_LIThe updated ADI is available publicly and should be used by researchers who would like to utilize a broad measure of neighborhood deprivation. C_LI

BackgroundAnalysing large qualitative datasets can present significant challenges, including the time and resources required for manual analysis and the potential for missing nuanced insights. This paper aims to address these challenges by exploring the application of Big Qualitative (Big Qual) and artificial intelligence (AI) methods to efficiently analyse Big Qual data while retaining the depth and complexity of human understanding. The free-text responses from the Royal College of Anaesthetists 7th National Audit Project (NAP7) baseline survey on peri-operative cardiac arrest experiences serve as a case study to test and validate this approach. Methodology/Principal FindingsQuantitative analysis segmented the data and identified keywords using AI methods. In-depth sentiment and thematic analysis combined natural language processing (NLP) and machine learning (ML) with human input - researchers assigned topic/theme labels and sentiments to responses, while discourse analysis explored sub-topics and thematic diversity. Human annotation refined the machine-generated sentiments, leading to an additional "ambiguous" category to capture nuanced, mixed responses. Comparative analysis was used to evaluate the concordance between human and machine-assisted sentiment labelling. While ML reduced analysis time significantly, human input was crucial for refining sentiment categories and capturing nuances. Conclusions/SignificanceThe application of AI-assisted data analysis tools, combined with human expertise, offers a powerful approach to efficiently analyse large-scale qualitative datasets while preserving the nuance and complexity of the data. This study demonstrates the potential of this novel methodology to streamline the analysis process, reduce resource requirements, and generate meaningful insights from Big Qual data. The integration of NLP, ML, and human input allows for a more comprehensive understanding of the themes, sentiments, and experiences captured in free-text responses. This study underscores the importance of continued interdisciplinary collaboration among domain experts, data scientists, and AI specialists to optimise these methods, ensuring their reliability, validity, and ethical application in real-world contexts. Author SummaryThe use of Artificial intelligence (AI) in health research has grown over recent years. However, analysis of large qualitative datasets known as Big Qualitative Data, in public health using AI, is a relatively new area of research. Here, we use novel techniques of machine learning and natural language processing where computers learn how to handle and interpret human language, to analyse a large national survey. The Royal College of Anaesthetists 7th National Audit Project is a large UK-wide initiative examining peri- operative cardiac arrest. We use the free-text data from this survey to test and validate our novel methods and compare analysing the data by hand (human) vs. human-machine learning also known as machine-assisted analysis. Using two AI tools to conduct the analysis we found that the machine- assisted analysis significantly reduced the time to analyse the dataset. Extra human input, however, was required to provide topic expertise and nuance to the analysis. The AI tools reduced the sentiment analysis to positive, negative or neutral, but the human input introduced a fourth ambiguous category. The insights gained from this approach present ways that AI can help inform targeted interventions and quality improvement initiatives to enhance patient safety, in this case, in peri-operative cardiac arrest management.

Background and objectivePeople experiencing homelessness (PEH) face significant health challenges and disparities in healthcare access due to barriers such as unstable housing, limited resources, and social stigma. In response, the European Union has initiated efforts to address these disparities. The CANCERLESS project, part of this initiative, has created the first European multi-centre dataset for cancer prevention in PEH. This work aims to evaluate and describe the heterogeneity of PEH across pilot sites and to provide data quality metrics for reliable future research. MethodsThe dataset comprises 652 cases: 142 from Vienna, 158 from Athens and Thessaloniki, 197 from Madrid, and 155 from the United Kingdom. All participants fit classifications from the European Typology of Homelessness and Housing Exclusion. This longitudinal study collected questionnaires at baseline, four weeks, and at the end of the intervention. The 180-question survey covered socio-demographic data, overall health, mental health, empowerment, and interpersonal communication. Data variability was assessed using information theory and geometric methods to analyse discrepancies in distributions and completeness across the dataset. ResultsSignificant variability was found among the four pilot countries, both overall and within specific sections, except for the health section. Madrid showed the largest discrepancies, with a high number of missing values related to interpersonal communication and healthcare service use. ConclusionHealth data may be comparable across the four countries, but further analysis should account for location-specific differences. This study underscores the heterogeneity among PEH and the critical need for data quality assessments to inform future research and policymaking in this field.

BackgroundThe COVID-19 pandemic had an early impact on employment, with the United States (US) and the United Kingdom (UK) experiencing more severe immediate labour market impacts than other Western countries. Emerging evidence from the initial phase of the pandemic highlighted that job losses were experienced more by those holding atypical contracts. Furthermore, it is predicted that this associated unemployment will increase precarious employment arrangements during the COVID-19 pandemic. In this paper we seek to answer the following research questions: O_LIWhat is the prevalence of precarious employment in Wales and are there differences in employment precariousness by socio-demographic characteristics and self-reported health status? C_LIO_LIWhich domains are the main contributing factors of precarious employment in Wales? C_LIO_LIWhich domains of precarious employment are associated with poorer health? C_LIO_LIHaves there been changes in job quality (as reflected by precarious employment domains) during the COVID pandemic (between February 2020 and Winter 2020/2021)? C_LI MethodsData was collected from a national household survey carried out in May/June 2020, with a sample of 1,032 residents in Wales and follow-up responses from 429 individuals collected between November 2020 and January 2021. To examine the associations between experiencing precarious employment or the separate domains of employment precariousness and socio-demographics and health, chi-squared analyses and logistic regression models (multinomial and binary) were used. To determine longitudinal changes in precarious employment experienced by socio-demographic groups and furlough status, McNemars test was used. The data is presented as proportion of respondents or adjusted odds ratios (aOR) and 95% confidence intervals following logistic regression. ResultsOverall, pre-pandemic, one in four respondents were determined to be in precarious employment (26.5%). A higher proportion of females (28.3%) and those aged 18-29 years (41.0%) were in precarious employment in February 2020. In addition, a greater percentage of individuals who reported poorer health across all self-reported measures were in precarious employment compared to those reporting better health. Worse perceived treatment at work was twice as likely in those who reported a pre-existing condition (aOR 2.45 95% CI [1.33-4.49]), poorer general health (aOR 2.33 95% CI [1.22-4.47]) or low mental wellbeing (aOR 2.81 95% CI [1.34-5.88]) when compared to their healthier counterparts. Those calculated to have high wage precariousness were three times more likely to report low mental wellbeing (aOR 3.12 95% CI [1.54-6.32]). In the subsample, there was an observed increase in the prevalence of precarious employment, with this being attributable to lower affordability of wages and a perceived increase in vulnerability at work. The subgroups that were most impacted by this decrease in job quality were females and the 30-39 years age group. ImplicationsImproving the vulnerability and wages domains, through the creation and provision of secure, adequately paid job opportunities has the potential to reduce the prevalence of precarious employment in Wales. In turn, these changes would improve the health and wellbeing of the working age population, some of which are already adversely impacted by the COVID-19 pandemic.

We evaluated the association between preventative social behaviour and government stringency. Additionally, we sought to evaluate the influence of additional factors including time, need to protect others (using the reported number of COVID-19 deaths as a surrogate measure) and reported confidence in government handling of the COVID-19 pandemic. We used repeated national cross-sectional surveys the UK over the course of 41 weeks from 1st April 2020 to January 28th, 2021, including a total of 38,092 participants. Preventative social behaviour and government stringency index scores were significantly associated on linear regression analyses (R2 =0.6468, p<0.001, and remained significant after controlling for the effect of reported COVID-19 deaths, confidence in government handling of the pandemic, and time (R2=0.898, p<0.001). Longitudinal data suggest that government stringency is an effective tool in promoting preventative social behaviour in the fight against COVID-19.

Adverse social and economic conditions negatively impact mental health and well-being. The present systematic review is the first to investigate the association between housing insecurity and mental health outcomes among renters, with a focus on housing affordability and instability. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in December 2022 across four databases (MEDLINE, PsycINFO, Web of Science, and ASSIA). Quantitative studies from OECD (Organisation for Economic Co-operation and Development) member countries were eligible for inclusion if they investigated housing insecurity by examining at least one independent variable related to housing affordability and/or instability, and included at least one mental health-related outcome among adult renters. Due to heterogeneity of the identified studies, we performed a narrative synthesis. Twenty-two studies met the inclusion criteria, of which 14 applied a longitudinal design, five a cross-sectional design, and three a quasi-experimental design. Among the nine studies examining housing affordability, six reported significant associations between unaffordable rent and poor mental health in low-income renters. Regarding housing instability, 12 out of 14 studies reported significant associations between unstable housing and renters mental health issues. Measures of housing insecurity varied, with rent-to-income ratio and forced moves being most commonly employed. Mental health outcomes focused primarily on overall mental health, well-being, and depressive symptoms, while few studies explored other mental health outcomes. The findings suggest that experiencing unaffordable or unstable housing has a negative impact on renters overall mental health and depressive symptoms. Housing insecurity poses a significant challenge for renters in OECD countries, highlighting the need for policymakers to implement supportive housing policies and tenure protection measures in order to improve renters housing security and ultimately public health.

BackgroundTo maintain good standards of care, evaluations of policy interventions or potential improvements to care are required. A number of quality of life (QoL) measures could be used but there is little evidence for England as to which measures would be appropriate. Using data from a pilot Minimum Data Set (MDS) for care home residents from the Developing resources And minimum dataset for Care Homes Adoption (DACHA) study, we assessed the construct validity of QoL measures and analysed factors associated with QoL. This was to demonstrate the value of the pilot MDS data and to provide evidence for the inclusion of QoL measures in a future MDS. MethodsCare home records for 679 residents aged over 65 from 34 care homes were available that had been linked to health records and official care home provider data. In addition to data on demographics, level of needs and impairment, several questions about the social care- and health-related QoL of participants were completed through proxy report (ASCOT proxy-resident, ICECAP-O, EQ5D-5D-5L Proxy 2). Construct validity was assessed through testing hypotheses developed from previous research and QoL measure constructs using discriminant analysis. Multilevel regression models were developed to understand how QoL was influenced by personal characteristics (e.g. sex, levels of functional and cognitive ability), care home level factors (type of home, level of quality) and resident use of health services (potentially avoidable emergency hospital admissions). Multiple imputation was used for missing data. ResultsAll three measures were negatively associated with levels of cognitive impairment, whilst ICECAP-O and EQ-5D-5L Proxy 2 were negatively associated with low levels of functional ability. ASCOT Proxy-Resident was positively associated with aspects of quality and care effectiveness at both resident- and care home-level. All three QoL measures had acceptable construct validity and captured different aspects of QoL. ConclusionThe study found acceptable construct validity for ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L Proxy 2 in care homes as complementary measures based on different constructs. The study has demonstrated both the value of the DACHA study pilot MDS data and a rationale for the inclusion of these QoL measures in any future MDS.

IntroductionThis study estimated the extent of psychological distress among people losing work during the coronavirus disease of 2019 (COVID-19) pandemic in Australia, and examined associations between distress, nature of work loss and degree of social interaction. MethodsData were from a baseline online survey of an inception cohort recruited in the weeks following the introduction of physical distancing and movement restrictions to contain the spread of COVID-19 in Australia. These restrictions resulted in widespread unemployment and working hour reduction. Psychological distress was measured using the Kessler-6 scale. Data on nature of work loss, social interactions, demographic, job and occupational characteristics were also collected. Regression modelling was conducted to determine the relationship between work loss, social interactions and psychological distress, accounting for confounders. ResultsAmong the 551 study participants 31% reported severe psychological distress, 35% in those with job loss and 28% in those still employed but working less. Those who had significantly greater odds of high psychological distress were younger, female, had lost their job and had lower social interactions. The relationship between job loss and distress became non-significant when financial stress, and occupation were included in the regression model, but the protective effect of higher social interactions remained significant. DiscussionThere was a high prevalence of psychological distress in people losing work during the coronavirus pandemic. Age, gender, job loss and social interactions were strongly associated with distress. Interventions that promote social interaction may help to reduce distress during among people losing work during the COVID-19 pandemic.

AimTo describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas. MethodsThe 10 council areas were a convenience sample. Council websites were examined for smokefree policies and a systematic attempt was made to identify the five largest pedestrian-only sites with permanent seating in each council area (10 sites each for two larger cities). Field visits were conducted to all selected sites. ResultsSmokefree policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), albeit with some gaps (eg, around signage and vaping policy). A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed. Of these 63% were officially designated smokefree. Smokefree signage was only present in 15% (9/60) of all the sites and in 24% (9/38) of the designated smokefree sites. In these designated sites the average number of smokefree signs was only 1.4 (range: 0 to 14). Issues identified with the signs included small size, being only a small part of a larger other sign, limited use of te reo M[a]ori wording, and not covering vaping. At sites where tables were present, 12% had ash trays on the tables (none where smokefree). ConclusionsSmokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national smokefree goal for 2025. There is scope to address these issues with an upgrade to the national smokefree law.

BackgroundThe COVID-19 pandemic, declared in March 2020, is suspected to have greatly impacted Scotlands accident and emergency (A&E) services. Stringent public health measures, including lockdowns, heightened pressures on A&E departments, but their long-term effects remain understudied. This study examines how the pandemic influenced A&E attendances over a broader time-frame. MethodsSecondary data from Public Health Scotland (2018-2022) on monthly A&E attendances was analysed, standardised per 1,000 population using census data. Choropleth maps visualised A&E attendances and wait times across health boards during key pandemic periods. A Poisson generalised linear model (GLM) assessed the influence of COVID restrictions, demographics, and service factors on attendance rates. ResultsA&E attendances dropped from 2018 to 2022, with NHS Lanarkshire (-32.7%) and NHS Borders (-27.9%) seeing the largest declines. Despite reduced attendances, the percentage of patients seen within four hours also dropped (-29.4% in NHS Lanarkshire). The Poisson GLM confirmed that COVID-19 restrictions influenced attendance rates with a lower incident rate (IRR: 0.89, 95% CI: 0.88-0.90) during lockdowns and an increased incident rate (IRR: 1.04, 95% CI: 1.03-1.05) during easing periods. Health board-level effects varied substantially. DiscussionCOVID-19 disrupted A&E services, causing fluctuating attendances and worsening wait times. Large health board-level variations suggest local policies, behaviours, and existing pressures significantly influenced outcomes. These findings highlight the need to address systemic issues alongside localised strategies for future resilience.

Private law childrens proceedings typically involve court disputes between parents who have separated and disagree about child arrangements, and are asking the court to make orders that determine where a child should live and with whom they should spend time. Children involved in private law, who potentially represent a vulnerable group, commonly receive less attention in policy than those in public law cases. The aim of this review was to shine a light on the wellbeing and other important characteristics or outcomes of children who are currently, or have been, involved in family law proceedings due to parental separation, to identify the support needs of these children who are often overlooked in policy. This rapid review is intended for policymakers who are responsible for policy concerning children and families as well as for family law professionals and families in private law childrens proceedings. The literature searches were conducted between June and August 2024. The included literature was published between 2001 and 2022. 22 studies reported in 25 documents were identified (8 published in academic journals and 17 in reports produced by organisations). Originated in England and Wales (n=13), Australia (n=7), Canada (n=1), New Zealand (n=1). Most studies aimed to describe the characteristics of children who are or have been involved in private family law proceedings, whilst only one compared the outcomes of such children to those in the general population. Almost all of the studies addressed mental health and emotional wellbeing. Written accounts of children, parents, and professionals described children as having anxiety, depression, anger, post-traumatic stress disorder symptoms, and eating disorders, and experiencing self-harm and suicide attempts. In Wales, children with a history of involvement in private law proceedings had higher incidence of depression and anxiety than children in the general population. From the evidence, it was unclear whether the poor mental health was associated with parental separation, the court proceedings, court orders, or some other factors, but some participants attributed difficulties to unwanted court orders. Other key areas of evidence included engagement with mental health services, behaviour, development, social relationships, learning and education, and physical health. Cardiff Evidence Synthesis Collaborative were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.

BackgroundMajor societal stressors such as wars, natural disasters and pandemics severely disrupt family life. However, not all families are impacted equally. During the COVID-19 pandemic, surveys highlighted how most of UK society coped, but tended to exclude high-risk families. We sought to redress this. MethodsForty-three participants (25 parents from high-risk families; 18 family-support professionals) were interviewed about family their experiences during the first three months of lockdown. Interviews were conducted in two phases: around the start of the pandemic in April 2020, and during the first easing of restrictions in July 2020. Interviews were analysed using Thematic Analysis. ResultsSix major themes were identified: health & wellbeing, family dynamics, work & employment, education, home environment and adherence to government restrictions. Families faced challenges in creating a balance between parents work and childcare. A wide range of risk and protective factors, and the influence of pre-existing experiences, contributed to whether a family entered a Virtuous (supportive) or a Vicious (maladaptive) cycle of family coping. Negative pre-existing experiences worsened some families adaptation but helped other families to have resilience. ConclusionThis study extends the Family Stress Model by illustrating the potential for resilience among high-risk families, highlighting potential mechanisms that might enable some families to transform adversity into strength. These findings may be useful for professionals supporting high-risk families coping with societal stressors and for the development of recommendations for future pandemic preparedness.

ObjectivesThis systematic review addresses the question "Is any job better than no job?" Specifically, it compares health and well-being outcomes in those who are unemployed with those who are in jobs that could be considered poor or low quality and the impact of any movement between them. MethodWe conducted a systematic review following a PROSPERO-registered protocol (CRD42020182794). Medline, Embase, PsycINFO, HMIC, ASSIA, TRIP, Google Scholar and 10 websites were searched in April 2020 and again in May 2021 without date limits. Two reviewers working independently screened search results against the inclusion/exclusion criteria. A checklist for quantitative studies reporting correlations was used to critically appraise articles included at full text. We undertook synthesis without meta-analysis (narrative synthesis) and explored a range of variables (for example, study design and quality, type of outcome measure) that we considered might have an impact on the association between exposure and outcome. ResultsWe included 25 studies reported in 30 journal articles. All 25 studies involved secondary analysis of data from national cohorts, including six from the UK. The most frequent outcomes reported were measures of mental well-being. There was considerable heterogeneity across included studies in terms of design, population, definition of poor/bad or low quality job and outcome types and measures. Overall the quality of the included studies was moderate. The evidence base is inconsistent. There are studies that suggested either labour market position might be preferable, but a number of studies found no statistically significant difference. Cohort and case- control studies looking at mental well-being outcomes showed some support for a poor job being better than unemployment. However, we did not find sufficient numbers of well-designed studies showing a strong association to support a causal relationship. Most included study designs were unable to distinguish whether changes in employment status occurred before a change in outcome. Three studies looking at employment transitions found that moving to a poor job from unemployment was not associated with improved mental health, but moving from a poor job to unemployment was associated with a deterioration. ConclusionEvidence that better health and well-being outcomes are more likely to be associated with a poor/bad or low quality job than with unemployment is inconsistent. Studies conducted in the UK suggest that a poor job is not significantly associated with better health and well-being outcomes than unemployment. The studies we identified do not allow us to distinguish whether this lack of association is the result of a state welfare regime preventing some of the worst ills associated with unemployment, or a reflection of job quality. The evidence base has significant limitations in study design and conduct. In summary, the evidence we found suggests it is not safe to assume that, in the UK, any job will lead to better health and well-being outcomes than unemployment.

This study investigates the determinants of health literacy in Newham, London, using a statistical modelling approach. Health literacy is defined using literacy, numeracy, and Information and Communication Technology (ICT) literacy from the ONS Skills for Life (SfL) survey 2011. The research combines survey, the Newham Residents Survey (NRS), and the UK 2021 Census data. Multilevel regression with poststratification (MRP) and average treatment effects (ATE) are used to quantify the impact of various factors on health literacy at the local level. The study identifies several significant determinants of health literacy, including age, ethnicity, qualification level, English as a first language, job status, gross income, and home ownership. Specifically, individuals aged 45 years and over are estimated to have lower ICT health literacy. White ethnicity is associated with higher numeracy scores. Additionally, health literacy worsens as area deprivation increases. Qualification level is estimated to be the most influential factor across all health literacy outcomes. The ultimate aim of this study is to inform targeted health literacy interventions at the local level by quantifying the impact of key determinants with uncertainty, thereby aiding in the prioritisation of resources.

IntroductionImproving the number of children who achieve a good level of development (GLD) on the Early Years Foundation Stage Profile (EYFSP) at the end of their first school year (aged five), and reducing the equity gap in this outcome was made a national priority in England in 2025. Children in England also receive a developmental assessment - the Ages and Stages Questionnaire-3 (ASQ-3) aged two. No study to date has explored the association between the ASQ-3 and EYFSP assessments. The aim of this study is to explore whether a GLD on the ASQ-3 is predictive of a GLD on the EYFSP using a longitudinal sample of children. MethodsLongitudinal pseudonymised data from the Connected Bradford dataset was used to undertake multiple regression analyses. ResultsFrom September 2013 to May 2025, 47,046 children had an ASQ-3 record, of whom 6,021 (13%) had a linked EYFSP record. Boys and children living in the lowest quintiles of the Index of Multiple Deprivation were less likely to achieve a GLD on both the ASQ-3 and the EYFSP. Children from South Asian ethnic groups were least likely to achieve a GLD on the ASQ-3, whilst White Other children were least likely to achieve a GLD on the EYFSP. Achieving a GLD on the ASQ-3 was predictive of a GLD on the EYFSP, with children who achieved a GLD on the ASQ-3 having more than three-times the odds of achieving a GLD on the EYFSP (OR 3.18, 95% CI 2.70 to 3.75). ConclusionThis study highlights the potential value of using the ASQ-3 results to intervene early and support more children to become school ready. These findings also show that many children have fallen behind by the age of two, thus emphasising the importance of intervening from the earliest possible moment to reduce inequities in child development. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIIn England, approximately 3 in 10 children do not reach a Good Level of Development (GLD) on the Early Years Foundation Stage Profile (EYFSP) which is undertaken at the end of the Reception year of school. Reaching a GLD is associated with later educational attainment. C_LI What this study addsO_LIThis study is the first to use longitudinal data to explore whether achieving a GLD on the developmental assessment undertaken at age 2 - the Ages and Stages Questionnaire 3 (ASQ-3), can predict the GLD on the EYFSP at school. C_LIO_LIThis study found that children who did not achieve a GLD on the ASQ-3 had three times the odds of not achieving a GLD on the EYFSP. Boys, those living in areas of high deprivation, and those from White Other backgrounds were also less likely. C_LI How this study might affect research, practice or policyO_LIThis study highlights the potential value of using the ASQ-3 results to intervene early and support more children to become school ready. These findings also show that many children have fallen behind by the age of two, thus emphasising the importance of intervening from the earliest possible moment to reduce inequities in child development. C_LI

The end-of-career stage of the police lifecycle represents a profound shift in identity and psychological stability, yet it remains historically neglected in research. This mixed-methods study investigated perspectives of UK police leavers and those approaching retirement (N = 325) regarding desired improvements to organisational support. Content analysis identified four themes: Holistic support and long-term welfare, Institutional culture and professional worth, Navigating the structural transition, and Individual and systemic perspectives. Findings suggest that the psychological contract between the officer and the organisation is often breached at the exit point, shifting from a relational bond to a transactional disposal. Middle-ranking officers and early leavers report the highest levels of institutional abandonment. To address these gaps, this paper makes recommendations for developing effective transitions. By implementing post-service welfare, and adopting structured resettlement models, police organisations can fulfil their duty of care and mend the psychological contract for those who have served.