Background: In England, during 2009–2014 the ‘Time to Change’ anti-stigma programme has included a social marketing campaign (SMC) using mass media channels, social media and social contact events but the efficacy of such approach has not been evaluated yet.Methods: The target population included people aged between mid-twenties/mid-forties, from middle-income groups. Participants were recruited through an online market research panel, before and after each burst of the campaign (with a mean number of unique participants per each burst: 956.9 ± 170.2). Participants completed an online questionnaire evaluating knowledge [Mental Health Knowledge Schedule (MAKS)]; attitudes [Community Attitudes toward Mental Illness (CAMI)]; and behaviours [Reported and Intended Behaviour Scale (RIBS)]. Socio-demographic data and level of awareness of the SMC were also collected.Results: A total of 10,526 people were interviewed. An increasing usage of the SMC-media channels as well as of the level of awareness of SMC was found (P < 0.001). Being aware of the SMC was found to be associated with higher score at MAKS (OR = 0.95, CI = 0.68 to 1.21; P < 0.001), at ‘tolerance and support’ CAMI subscale (OR = 0.12, CI = 0.09 to 0.16; P < 0.001), and at RIBS (OR = 0.71, CI = 0.51 to 0.92; P < 0.001), controlling for confounders.Conclusion: The SMC represents an important way to effectively reduce stigma. Taking into account these positive findings, further population-based campaigns using social media may represent an effective strategy to challenge stigma.

Purpose: The World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health. Methods: A prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO₂) and oxides (NO_x), ozone (O₃), particulate matter with an aerodynamic diameter < 10 μm (PM₁₀) and < 2.5 μm (PM_2.5) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals’ socioeconomic position and exposure to road-traffic noise. Results: We found robust evidence for interquartile range increases in PM_2.5, NO_x and NO₂ to be associated with 18–39% increased odds of common mental disorders, 19–30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM₁₀. These longitudinal associations were more pronounced in the subset of non-movers for NO₂ and NO_x. Conclusions: The findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.

People diagnosed with depression are at increased risk of major cardiovascular events (MACEs), including coronary heart disease and stroke.^1-4 Arterial stiffness (AS), a hardening of the artery wall because of aging and diverse pathologic states, is a key mediator of MACE,⁵ and growing evidence has found an association of depression with AS.⁶ Components of metabolic syndrome (MetS), such as hypertension, dyslipidemia, obesity, and hyperglycemia, represent leading promoters of AS.⁵ Consistent with the key role of AS in predicting MACE incidence, carotid pulse wave velocity represents the criterion-standard measure for central AS,^7,8 and several other noninvasive techniques (eg, photoplethysmography) are available as indicators of specific AS parameters (eg, wave reflections).^5,9 While the interchangeability of these measures needs further research,¹⁰ they were found to be independently associated with incident MACE across different subgroups.^9,11,12 Therefore, a key unanswered question for public health is the extent to which the adverse effect of depression on MACE might be mitigated by targeting modifiable metabolic mediators. To address this concern, we need to better understand the role of MetS in mediating the association of depression with AS. The extent to which this mediation differs by sex is critical given that the prevalence of MACE, MetS, and depression is often greater among women compared with men.^13,14 Sex-specific mediating effects of MetS are generally underresearched but are a growing issue given the increasing prevalence of MetS in women.¹⁵ The present study adopted a mediation analysis approach to quantify to what extent MetS and its individual components mediated the association of depression with AS. The study also aimed to investigate the extent to which the hypothesized mediation varied by sex.

Existing evidence on the beneficial effects of nature on mental health comes from studies using cross-sectional designs. We developed a smartphone-based tool (Urban Mind; www.urbanmind.info) to examine how exposure to natural features within the built environment affects mental well-being in real time. The tool was used to monitor 108 individuals who completed 3013 assessments over a 1-week period. Significant immediate and lagged associations with mental well-being were found for several natural features. These associations were stronger in people with higher trait impulsivity, a psychological measure of one's tendency to behave with little forethought or consideration of the consequences, which is indicative of a higher risk of developing mental-health issues. Our investigation suggests that the benefits of nature on mental well-being are time-lasting and interact with an individual's vulnerability to mental illness. These findings have potential implications from the perspectives of global mental health as well as urban planning and design.

Designing implementation research can be a complex and daunting task, especially for applied health researchers who have not received specialist training in implementation science. We developed the Implementation Science Research Development (ImpRes) tool and supplementary guide to address this challenge and provide researchers with a systematic approach to designing implementation research. A multi-method and multi-stage approach was employed. An international, multidisciplinary expert panel engaged in an iterative brainstorming and consensus-building process to generate core domains of the ImpRes tool, representing core implementation science principles and concepts that researchers should consider when designing implementation research. Simultaneously, an iterative process of reviewing the literature and expert input informed the development and content of the tool. Once consensus had been reached, specialist expert input was sought on involving and engaging patients/service users; and economic evaluation. ImpRes was then applied to 15 implementation and improvement science projects across the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, a research organisation in London, UK. Researchers who applied the ImpRes tool completed an 11-item questionnaire evaluating its structure, content and usefulness. Consensus was reached on ten implementation science domains to be considered when designing implementation research. These include implementation theories, frameworks and models, determinants of implementation, implementation strategies, implementation outcomes and unintended consequences. Researchers who used the ImpRes tool found it useful for identifying project areas where implementation science is lacking (median 5/5, IQR 4–5) and for improving the quality of implementation research (median 4/5, IQR 4–5) and agreed that it contained the key components that should be considered when designing implementation research (median 4/5, IQR 4–4). Qualitative feedback from researchers who applied the ImpRes tool indicated that a supplementary guide was needed to facilitate use of the tool. We have developed a feasible and acceptable tool, and supplementary guide, to facilitate consideration and incorporation of core principles and concepts of implementation science in applied health implementation research. Future research is needed to establish whether application of the tool and guide has an effect on the quality of implementation research.

Electronic cigarette (e-cigarette) use is associated with smoking initiation among young people; however, it is also possible that smoking is associated with e-cigarette initiation. This study explores these associations among young people in Great Britain. A longitudinal survey of 1,152 11- to 18-year-olds was conducted with baseline in April 2016 and follow-up between August and October 2016. Logistic regression models and causal mediation analyses assessed whether (1) ever e-cigarette use and escalation were associated with smoking initiation (ever smoking at follow-up) among baseline never smokers (n = 923), and (2) ever smoking and escalation were associated with e-cigarette initiation (ever e-cigarette use at follow-up) among baseline never e-cigarette users (n = 1,020). At baseline, 19.8% were ever smokers and 11.4% were ever e-cigarette users. Respondents who were ever e-cigarette users (vs. never users, 53% vs. 8%, odds ratio [OR] = 11.89, 95% confidence interval [CI] = 3.56-39.72) and escalated their e-cigarette use (vs. did not, 41% vs. 8%, OR = 7.89, 95% CI = 3.06-20.38) were more likely to initiate smoking. Respondents who were ever smokers (vs. never smokers, 32% vs. 4%, OR = 3.54, 95% CI = 1.68-7.45) and escalated their smoking (vs. did not, 34% vs. 6%, OR = 5.79, 95% CI = 2.55-13.15) were more likely to initiate e-cigarette use. There was a direct effect of ever e-cigarette use on smoking initiation (OR = 1.34, 95% CI = 1.05-1.72), and ever smoking on e-cigarette initiation (OR = 1.08, 95% CI = 1.01-1.17); e-cigarette and smoking escalation, respectively, did not mediate these effects. Among young people in Great Britain, ever e-cigarette use is associated with smoking initiation, and ever smoking is associated with e-cigarette initiation.