A number of studies based in the US, Canada, and Australia, have found evidence of associations between the built environment (BE) and mode of transport to school, and links between active travel and deprivation. Limited research in the UK compares potential BE supports for walking to school by area deprivation. Within this study, we gathered data on BE attributes previously linked to active travel, i.e., street/path connectivity, and dwelling density, created a composite ‘walkability score’ (WS) for areas around primary schools across urban Scotland, and explored whether poorer areas exhibit lower scores than more affluent areas, or vice versa. We consider this to be a novel approach as few studies have compared BE features by deprivation across a whole country. Address and road/path maps were obtained and primary schools (N = 937) across mainland Scotland were mapped. Schools were attributed income deprivation scores (scores divided into quintiles (Q1: least deprived, Q5: most deprived)). Catchment area (CA) boundaries, i.e., the geographic area representing eligibility for local school attendance, were drawn around schools, and WS calculated for each CA. We compared mean WS by income quintile (ANOVA), for all local authorities (LAs) combined (N = 29), and separately for the four LAs with the greatest number of schools included in the analysis. For all LAs combined, the least deprived quintile (Q1) showed a significantly lower WS (−0.61), than quintiles 3, 4 and 5 (Q2: −0.04 (non-sig), Q3: 0.38, Q4: 0.09, Q5: 0.18); while for Glasgow the second least deprived quintile (Q2) showed significantly higher WS (Q1: 1.35, Q2: 1.73), than middling (Q3: 0.18) and most deprived quintiles (Q4: 0.06, Q5: −0.10). WS differ by deprivation with patterns varying depending on the spatial scale of the analysis. It is essential that less walkable areas are provided with the resources to improve opportunities to engage in active travel.

Exposure to nature views has been associated with diverse mental health and cognitive capacity benefits. Yet, much of this evidence was derived in adult samples and typically only involves residential views of nature. Findings from studies with children suggest that when more greenness is available at home or school, children have higher academic performance and have expedited attention restoration, although most studies utilize coarse or subjective assessments of exposure to nature and largely neglect investigation among young children. Here, we investigated associations between objectively measured visible nature at school and children’s behavior problems (attention and externalizing behaviors using the Brief Problem Monitor Parent Form) in a sample of 86 children aged seven to nine years old from 15 classrooms across three schools. Images of classroom windows were used to quantify overall nature views and views of specific nature types (sky, grass, tree, shrub). We fitted separate Tobit regression models to test associations between classroom nature views and attention and externalizing behaviors, accounting for age, sex, race/ethnicity, residential deprivation score, and residential nature views (using Google Street View imagery). We found that higher levels of visible nature from classroom windows were associated with lower externalizing behavior problem scores, after confounder adjustment. This relationship was consistent for visible trees, but not other nature types. No significant associations were detected for attention problems. This initial study suggests that classroom-based exposure to visible nature, particularly trees, could benefit children’s mental health, with implications for landscape and school design.

Background Natural space is associated with reduced risk of, and narrower socioeconomic inequalities in, diseases that affect older populations, and some contributors to premature mortality in younger individuals. Burden of disease measures such as years of life lost (YLL) are influenced by premature poor health and death. We hypothesised some association between natural space and both rates of and inequalities in YLL might be present. Methods The outcome data were the YLL component from Scottish Burden of Disease 2016, provided at small-area level (datazone) for males and females under 65 years of age in Scotland, UK. Exposure variables were the percentages of land cover within each datazone defined as ‘natural space’ (NS), and ‘natural space and private gardens’ (NSG). Together with a measure of area income deprivation, these were fitted in a multilevel Poisson model accounting for intra-datazone level variation, and spatial autocorrelation between datazones. Results An increased percentage cover of NSG was associated with lower YLL in males (incident rate ratio (IRR) 0.993, 95% credible interval (CrI) 0.989 to 0.997) and females (IRR 0.993, CrI 0.987 to 0.998); each 10% increase of natural space cover was associated with a 7% decrease in the incidence rate. An increased amount of natural space within local areas was associated with reduced disparity in YLL between the most and least income deprived areas. Conclusions The health benefits of natural space also apply when indicators sensitive to health events at younger ages are used. An increased amount of natural space within local areas has the potential to reduce the disparity in YLL between the most and least income deprived areas—the ‘equigenic’ effect.

Background Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better population health and whether BE change can help narrow health inequalities. This knowledge gap is partly due to a lack of suitable longitudinal BE data in most countries. We devised a method to quantify BE change longitudinally and explored associations with mortality. The method is replicable in any nation that captures BE vector map data. Methods Ordnance Survey data were used to categorise small areas as having no change, loss or gain, in buildings, roads, and woodland between 2015 and 2019. We examined individual mortality records for 2012–2015 and 2016–2019, using negative binomial regression to explore associations between BE change and all-cause and cause-specific mortality, adjusting for income deprivation. Results BE change varied significantly by deprivation and urbanicity. Change in the BE and change in mortality were not related, however, areas that went on to experience BE change had different baseline mortality rates compared with those that did not. For example, areas that gained infrastructure already had lower mortality rates. Conclusion We provide new methodology to quantify BE change over time across a nation. Findings provide insight into the health of areas that do/do not experience change, prompting critical perspectives on cross-sectional studies of associations between BE and health. Methods and findings applied internationally could explore the context of BE change and its potential to improve health in areas most in need beyond the UK.

Objectives Existing research highlights the beneficial nature of heritage engagement for mental health, but engagement varies geographically and socially, and few studies explore spatial exposure (ie, geographic availability) to heritage and heritage visits. Our research questions were ‘does spatial exposure to heritage vary by area income deprivation?’, ‘is spatial exposure to heritage linked to visiting heritage?’ and ‘is spatial exposure to heritage linked to mental health?’. Additionally, we explored whether local heritage is associated with mental health regardless of the presence of green space. Design Data were collected from January 2014 to June 2015 via the UK Household Longitudinal Study (UKHLS) wave 5. Our study is cross-sectional. Setting UKHLS data were either collected via face-to-face interview or online questionnaire. Participants 30 431 adults (16+ years) (13 676 males, 16 755 females). Participants geocoded to Lower Super Output Area (LSOA) ‘neighbourhood’ and ‘English Index of Multiple Deprivation’ 2015 income score. Main exposures/outcome measures LSOA-level heritage exposure and green space exposure (ie, population and area densities); heritage site visit in the past year (outcome, binary: no, yes); mental distress (outcome, General Health Questionnaire-12, binary: less distressed 0–3, more distressed 4+). Results Heritage varied by deprivation, the most deprived areas (income quintile (Q)1: 1.8) had fewer sites per 1000 population than the least deprived (Q5: 11.1) (p<0.01). Compared with those with no LSOA-level heritage, those with heritage exposure were more likely to have visited a heritage site in the past year (OR: 1.12 (95% CI 1.03 to 1.22)) (p<0.01). Among those with heritage exposure, visitors to heritage had a lower predicted probability of distress (0.171 (95% CI 0.162 to 0.179)) than non-visitors (0.238 (95% CI 0.225 to 0.252)) (p<0.001). Conclusions Our research contributes to evidence for the well-being benefits of heritage and is highly relevant to the government’s levelling-up heritage strategy. Our findings can feed into schemes to tackle inequality in heritage exposure to improve both heritage engagement and mental health.

This study examined urban-rural and socioeconomic differences in adolescent toothbrushing. The data were modelled using logistic multilevel modelling and the Markov Chain Monte Carlo method of estimation. Twice-a-day toothbrushing was regressed upon age, family affluence, family structure, school type, area-level deprivation and rurality, for boys and girls separately. Boys' toothbrushing was associated with area-level deprivation but not rurality. Variance at the school level remained significant in the final model for boys' toothbrushing. The association between toothbrushing and area-level deprivation was particularly strong for girls, after adjustment for individuals' family affluence and type of school attended. Rurality too was independently significant with lower odds of brushing teeth in accessible rural areas. The findings are at odds with the results of a previous study which showed lower caries prevalence among children living in rural Scotland. A further study concluded that adolescents have a better diet in rural Scotland. In total, these studies highlight the need for an examination into the relative importance of diet and oral health on caries, as increases are observed in population obesity and consumption of sugars.