There are considerable difficulties associated with calculating the prevalence of covert, illegal... more There are considerable difficulties associated with calculating the prevalence of covert, illegal and stigmatized activities. This paper outlines new methods we have developed for calculating the prevalence of both drug-injecting street prostitution and non-injecting street prostitution in Glasgow. Our data indicate that Glasgow has a much higher level of injecting drug use than has been reported among prostitutes in other British cities.
Compared with the volume of research on school effects on educational outcomes, and in spite of g... more Compared with the volume of research on school effects on educational outcomes, and in spite of growing interest in the health promoting school, there are very few studies that have investigated the way schools influence pupils' health behaviours. This paper reports the results of a longitudinal study of over 2000 young people in the West of Scotland who were followed from the end of primary school (age 11) to the end of statutory education (age 15), a design permitting investigation of school effects on smoking, drinking, drug use, and 'unhealthy diet' at two time-points in secondary school (age 13 and 15). The results showed considerable variation in the rates of these health behaviours between 43 secondary schools. Using multi-level modelling, and adjusting for prior (age 11) behaviour, sociodemographic characteristics, religion, family characteristics, disposable income, and parental health behaviours, the analyses showed that, with the exception of diet, school level variation (school effects) remained, meaning that pupil composition did not account for these differences. School effects were stronger for smoking and drinking than drugs, the effect remaining in a cross-classification analysis of school and neighbourhood (as measured by postcode district). Using data from pupils about characteristics of their schools, together with three independent measures, higher levels of smoking, drinking, and drug use were found in schools containing more pupils who were disengaged from education and knew fewer teachers, and in larger schools independently rated as having a poorer ethos. These results raise several issues of interpretation, but are compatible with the attention given to school ethos in the health promoting school model.
Increasing employment among older workers is a policy priority given the increase in life expecta... more Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how best to support this group back to work. The Work Programme is the UK Government's flagship policy to facilitate return to work (RTW) among those at risk of long-term unemployment. 'Supporting Older People Into Employment' (SOPIE) is a mixed-methods longitudinal study involving a collaboration between academics and a major Work Programme provider (Ingeus). The study will investigate the relationship between health, worklessness and the RTW process for the over 50s. There are three main study components. Embedded fieldwork will document the data routinely collected by Ingeus and the key interventions/activities delivered. The quantitative stud...
Abstract Multilevel modelling facilitates the analysis of hierarchical data where observations ma... more Abstract Multilevel modelling facilitates the analysis of hierarchical data where observations may be nested within higher levels of classification. In health care research, for example, a study may be undertaken to determine the variability of patient outcomes where these also ...
Despite recent increases in life expectancy, inequalities in mortality in Scotland have been wide... more Despite recent increases in life expectancy, inequalities in mortality in Scotland have been widening. Previous research has suggested that one of the potential drivers of geographical inequalities in health is the process of selective migration. Although support for the effect of selective migration on widening geographic inequalities in health has been mixed, several studies have shown that people in good health move away from deprived areas while people in poor health move towards more deprived areas. In this paper, we examine mortality rates in Scotland by area deprivation and population mobility. Previous research in Scotland has shown that the relationship between population mobility and migration disappears once deprivation is accounted for. However, the authors measure population mobility over a longer time period than we do here and at a different geographical level. We consider small area population mobility on the basis of moves made in the year prior to the 2001 Scottish census. Areas were classified as one of four types: decreasing, increasing or stable (with high or low turnover). Mortality rates, calculated for the period 2000-2002, were found to be highest in deprived areas that had declined in population over the previous year. In the most deprived quintile, the causes of death contributing disproportionately to the excess mortality in decreasing areas were causes linked to alcohol and drug use, suicides and assault. Focussing on those individuals in the most deprived areas who live in areas that are declining in population could help to reduce widening inequalities for these causes of death. This work shows the extent to which population migration can influence small areas over a relatively short time period and gives some insight into potential factors, not measured by traditional indices of area level deprivation, which may lead to differences in the health status of areas.
Atmospheric environment (Oxford, England : 1994), 2015
It has been well documented that air pollution adversely affects health, and epidemiological poll... more It has been well documented that air pollution adversely affects health, and epidemiological pollution-health studies utilise pollution data from automatic monitors. However, these automatic monitors are small in number and hence spatially sparse, which does not allow an accurate representation of the spatial variation in pollution concentrations required for these epidemiological health studies. Nitrogen dioxide (NO2) diffusion tubes are also used to measure concentrations, and due to their lower cost compared to automatic monitors are much more prevalent. However, even combining both data sets still does not provide sufficient spatial coverage of NO2 for epidemiological studies, and modelled concentrations on a regular grid from atmospheric dispersion models are also available. This paper proposes the first modelling approach to using all three sources of NO2 data to make fine scale spatial predictions for use in epidemiological health studies. We propose a geostatistical fusion m...
Health Services and Outcomes Research Methodology, 2015
In this paper, we introduce several statistical methods to evaluate the uncertainty in the concen... more In this paper, we introduce several statistical methods to evaluate the uncertainty in the concentration index (C) for measuring socioeconomic equality in health and health care using aggregated total population register data. The C is a widely used index when measuring socioeconomic inequality, but previous studies have mainly focused on developing statistical inference for sampled data from population surveys. While data from large population-based or national registers provide complete coverage, registration comprises several sources of error. We simulate confidence intervals for the C with different Monte Carlo approaches, which take into account the nature of the population data. As an empirical example, we have an extensive dataset from the Finnish cause-of-death register on mortality amenable to health care interventions between 1996 and 2008. Amenable mortality has been often used as a tool to capture the effectiveness of health care. Thus, inequality in amenable mortality provides evidence on weaknesses in health care performance between socioeconomic groups. Our study shows using several approaches with different parametric assumptions that previously introduced methods to estimate the uncertainty of the C for sampled data are too conservative for aggregated population register data. Consequently, we recommend that inequality indices based on the register data should be presented together with an approximation of the uncertainty and suggest using a simulation approach we propose. The approach can also be adapted to other measures of equality in health.
There are considerable difficulties associated with calculating the prevalence of covert, illegal... more There are considerable difficulties associated with calculating the prevalence of covert, illegal and stigmatized activities. This paper outlines new methods we have developed for calculating the prevalence of both drug-injecting street prostitution and non-injecting street prostitution in Glasgow. Our data indicate that Glasgow has a much higher level of injecting drug use than has been reported among prostitutes in other British cities.
Compared with the volume of research on school effects on educational outcomes, and in spite of g... more Compared with the volume of research on school effects on educational outcomes, and in spite of growing interest in the health promoting school, there are very few studies that have investigated the way schools influence pupils' health behaviours. This paper reports the results of a longitudinal study of over 2000 young people in the West of Scotland who were followed from the end of primary school (age 11) to the end of statutory education (age 15), a design permitting investigation of school effects on smoking, drinking, drug use, and 'unhealthy diet' at two time-points in secondary school (age 13 and 15). The results showed considerable variation in the rates of these health behaviours between 43 secondary schools. Using multi-level modelling, and adjusting for prior (age 11) behaviour, sociodemographic characteristics, religion, family characteristics, disposable income, and parental health behaviours, the analyses showed that, with the exception of diet, school level variation (school effects) remained, meaning that pupil composition did not account for these differences. School effects were stronger for smoking and drinking than drugs, the effect remaining in a cross-classification analysis of school and neighbourhood (as measured by postcode district). Using data from pupils about characteristics of their schools, together with three independent measures, higher levels of smoking, drinking, and drug use were found in schools containing more pupils who were disengaged from education and knew fewer teachers, and in larger schools independently rated as having a poorer ethos. These results raise several issues of interpretation, but are compatible with the attention given to school ethos in the health promoting school model.
Increasing employment among older workers is a policy priority given the increase in life expecta... more Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how best to support this group back to work. The Work Programme is the UK Government's flagship policy to facilitate return to work (RTW) among those at risk of long-term unemployment. 'Supporting Older People Into Employment' (SOPIE) is a mixed-methods longitudinal study involving a collaboration between academics and a major Work Programme provider (Ingeus). The study will investigate the relationship between health, worklessness and the RTW process for the over 50s. There are three main study components. Embedded fieldwork will document the data routinely collected by Ingeus and the key interventions/activities delivered. The quantitative stud...
Abstract Multilevel modelling facilitates the analysis of hierarchical data where observations ma... more Abstract Multilevel modelling facilitates the analysis of hierarchical data where observations may be nested within higher levels of classification. In health care research, for example, a study may be undertaken to determine the variability of patient outcomes where these also ...
Despite recent increases in life expectancy, inequalities in mortality in Scotland have been wide... more Despite recent increases in life expectancy, inequalities in mortality in Scotland have been widening. Previous research has suggested that one of the potential drivers of geographical inequalities in health is the process of selective migration. Although support for the effect of selective migration on widening geographic inequalities in health has been mixed, several studies have shown that people in good health move away from deprived areas while people in poor health move towards more deprived areas. In this paper, we examine mortality rates in Scotland by area deprivation and population mobility. Previous research in Scotland has shown that the relationship between population mobility and migration disappears once deprivation is accounted for. However, the authors measure population mobility over a longer time period than we do here and at a different geographical level. We consider small area population mobility on the basis of moves made in the year prior to the 2001 Scottish census. Areas were classified as one of four types: decreasing, increasing or stable (with high or low turnover). Mortality rates, calculated for the period 2000-2002, were found to be highest in deprived areas that had declined in population over the previous year. In the most deprived quintile, the causes of death contributing disproportionately to the excess mortality in decreasing areas were causes linked to alcohol and drug use, suicides and assault. Focussing on those individuals in the most deprived areas who live in areas that are declining in population could help to reduce widening inequalities for these causes of death. This work shows the extent to which population migration can influence small areas over a relatively short time period and gives some insight into potential factors, not measured by traditional indices of area level deprivation, which may lead to differences in the health status of areas.
Atmospheric environment (Oxford, England : 1994), 2015
It has been well documented that air pollution adversely affects health, and epidemiological poll... more It has been well documented that air pollution adversely affects health, and epidemiological pollution-health studies utilise pollution data from automatic monitors. However, these automatic monitors are small in number and hence spatially sparse, which does not allow an accurate representation of the spatial variation in pollution concentrations required for these epidemiological health studies. Nitrogen dioxide (NO2) diffusion tubes are also used to measure concentrations, and due to their lower cost compared to automatic monitors are much more prevalent. However, even combining both data sets still does not provide sufficient spatial coverage of NO2 for epidemiological studies, and modelled concentrations on a regular grid from atmospheric dispersion models are also available. This paper proposes the first modelling approach to using all three sources of NO2 data to make fine scale spatial predictions for use in epidemiological health studies. We propose a geostatistical fusion m...
Health Services and Outcomes Research Methodology, 2015
In this paper, we introduce several statistical methods to evaluate the uncertainty in the concen... more In this paper, we introduce several statistical methods to evaluate the uncertainty in the concentration index (C) for measuring socioeconomic equality in health and health care using aggregated total population register data. The C is a widely used index when measuring socioeconomic inequality, but previous studies have mainly focused on developing statistical inference for sampled data from population surveys. While data from large population-based or national registers provide complete coverage, registration comprises several sources of error. We simulate confidence intervals for the C with different Monte Carlo approaches, which take into account the nature of the population data. As an empirical example, we have an extensive dataset from the Finnish cause-of-death register on mortality amenable to health care interventions between 1996 and 2008. Amenable mortality has been often used as a tool to capture the effectiveness of health care. Thus, inequality in amenable mortality provides evidence on weaknesses in health care performance between socioeconomic groups. Our study shows using several approaches with different parametric assumptions that previously introduced methods to estimate the uncertainty of the C for sampled data are too conservative for aggregated population register data. Consequently, we recommend that inequality indices based on the register data should be presented together with an approximation of the uncertainty and suggest using a simulation approach we propose. The approach can also be adapted to other measures of equality in health.
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Papers by Alastair H Leyland