BACKGROUND:Policymakers lack comparative information about the social costs of specific early disadvantages. We compared six policy-relevant childhood (0-5 years) disadvantages and their diverse social costs over 17 years for the UK and Bradford (a multi-ethnic district of about 550 000 in the northeast of England with high levels of deprivation). METHODS:Using a microsimulation model, we compared the harms to well-being (proxied by parent-reported emotional problems), health and educational attainment and government spending (such as inpatient NHS costs) up to age 17 of the following: having a teenage mother, preterm birth, low birthweight-for-gestational-age, low height-for-age-and-sex (age 5), disability (age 5) and cognitive delay (age 5). We modelled a UK birth cohort born in 2000 and a Bradford cohort born in 2019 based on local prevalence data, uprated to 2023 prices and discounted at 3.5%. RESULTS:Disability imposed the highest per-child cost, with a well-being loss of 7.2 WELLBYs (CI 6.1 to 8.2; monetised value £89 k) and public cost £64 k (CI £37 k-£91 k) per child by age 17. Cognitive delay had a smaller per-child loss of 3.8 WELLBYs (3.2-4.5), but the largest population-level loss was in both the UK and Bradford at 728K WELLBYs (600 K-856K; monetised value £9,044 m) and £5,588 m (£1,872-£9,303) public cost per cohort of 679 000 children born in the UK. Monetised well-being loss is almost always higher than public cost and sometimes more than twice as high. CONCLUSIONS:Cognitive delay at 5 years of age imposed larger total social costs than the other early disadvantages. For an individual child, however, well-being loss was most affected by disability or having a teenage mother.

‘Not in Education, Employment or Training’ (NEET) categorisation is widely used to monitor societal disengagement in young people, but its binary form obscures policy relevant variation (e.g., conflating short disruption with sustained disengagement). We used 26,513 linked administrative records to construct monthly participation sequences over 24 months post-compulsory schooling. Clustering techniques revealed six trajectories: three ‘stable’ (education, employment, training) and three ‘unstable’ trajectories. The unstable trajectories reflected persistent disengagement (‘High Risk’), intermittent disruption (‘Moderate Risk’), and administrative uncertainty (‘Low Contact’). Multinomial models showed that unstable trajectories were associated with vulnerability indicators (e.g., children’s social care involvement, deprivation, exclusions). Low Contact trajectories closely resembled High Risk profiles, indicating that administrative non contact is a meaningful risk signal. School suspensions were associated with a higher likelihood of Steady Employment relative to continued education, suggesting employment led reengagement can support young people with fractured school relationships. Training trajectories were notably less stable than education or employment, challenging assumptions that all participation is equivalent. We conclude: (i) binary NEET metrics mask heterogeneity in an unhelpful manner: (ii) trajectory based measures support prioritising prevention, targeting early support, and identifying persistent non contact as a participation/safeguarding concern rather than a measurement artefact.

Introduction Improving 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. Methods Longitudinal pseudonymised data from the Connected Bradford dataset was used to undertake multiple regression analyses. Results From 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). Conclusion This 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This is independent research funded by a Wellcome Trust Discovery Award (BiBBS Achieve, 310017/Z/24/Z ) and the National Institute for Health and Care Research (NIHR) - YX, RS and HH are supported by NIHR Bradford Health Determinants Research Collaboration (HDRC); JD, MMW & JW are supported by the NIHR Yorkshire and Humber Applied Research Collaboration (ARC-YH; Ref: NIHR200166, see https://www.arc-yh.nihr.ac.uk); JD is further funded by a Population Health Career Scientist Award, NIHR302938 for this research project. The views in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study is based on data from Connected Yorkshire which has ethical approval to use data for research purposes (NHS REC 18/YH/0200 & 22/EM/0127). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data used in this study is a part of the Connected Bradford dataset. Data can be accessed at: https://bradfordresearch.nhs.uk/connected-bradford/governance-and-ethics/

We examined the variation in 16-18 year olds’ participation trajectories across secondary schools, after accounting for student characteristics. In England, close to one million young people are currently not in education, employment or training (NEET), despite substantial public investment in expanding training and employment opportunities. Research and policy have predominantly focused on identifying individual characteristics associated with disengagement. However, there is evidence to suggest that structural contexts also matter (Evans et al 2026). Moreover, binary measures of NEET obscure meaningful variation in the pathways young people follow, limiting understanding of how trajectories of participation are shaped. Analysis of linked administrative data for 24,635 young people in the North of England showed substantial school differences in the likelihood of the post-16 trajectories followed by the young people they served. School differences were greatest for students experiencing circumstances associated with increased risk of poor outcomes, with predicted probabilities of persistently disengaged or disrupted trajectories ranging from 8% to 71%, depending on the secondary school attended. These findings challenge monocausal student‑deficit accounts of youth disengagement and suggest that schools may represent important risk‑mitigating environments, particularly for young people experiencing greater disadvantage. A critical priority for future research and policy is testing approaches that enable schools to help vulnerable young people make successful post-16 transitions.

Background: Approximately 5% of children are affected by a neurodevelopmental disorder of their sensorimotor skills. DSM-V and ICD-10, the two most widely used classifications systems, define this diagnostically as either ‘Developmental Coordination Disorder’ (DCD) or ‘Specific Developmental Disorder of Motor Function’ (SDDMF, respectively). Being diagnosed with DCD/SDDMF has been found to have a detrimental impact on long-term health and education outcomes. Research repeatedly highlights parental dissatisfaction with the pathways for assessment and support of DCD/SDDMF, however, there has been a lack of research quantitatively exploring the diagnostic landscape. This study therefore aimed to evaluate the incidence of DCD/SDDMF in a diverse District (Bradford, UK) from 1950 -December 2024. Methods: Clinical codes related to sensorimotor skill assessments and diagnoses were searched for within the Connected Bradford dataset, which houses routinely collected primary and secondary healthcare data for over 800,000 residents. Results: There are 182,978 children currently in the Connected Bradford primary care records, suggesting there should be ~9149 children with a diagnosis (given estimated prevalence rates of 5%). But over 74 years of records available, there were only 152 recorded childhood diagnoses of SDDMF (the ICD-10 used in the UK and Europe for diagnosis). When exploring related diagnoses and findings there were 1037 cases (~14 per year), however this amount over 74 years is still nine times lower than would be expected within current childhood populations in Bradford. Moreover, there were low levels of recorded assessments and a lack of clarity regarding how children are being assessed. Conclusion: Diagnosis is the current pathway to accessing support across UK services, yet the current study highlights that children with DCD/SDDMF are not being diagnosed within Bradford. This likely reflects national and international challenges. Further research is needed to investigate the barriers and facilitators to assessing, diagnosing, and supporting children with DCD/SDDMF.

BACKGROUND:Fine-motor difficulties are associated with adverse educational, physical and socioemotional outcomes. Multiple tools are used to assess these difficulties. The International Classification of Functioning, Disability and Health (ICF) distinguishes body function, activity and participation as separate domains requiring measurement. We examined whether scores from measures sampling these domains align sufficiently for the tools to be treated as interchangeable. METHODS:Data were collected across four groups: (i)a whole-school sample(n = 415); (ii)a nested subsample with teacher-identified handwriting difficulties(n = 91; not independent of the whole school sample); (iii)a multi-school sample with teacher-identified handwriting difficulties(n = 172); and (iv)a clinical sample referred for occupational-therapy assessment(n = 33). Measures included the relevant fine-motor subscales of the Movement Assessment Battery for Children, Clinical Kinematic Assessment Tool, DCD Questionnaire, Detailed Assessment of Speed of Handwriting, and Beery-Buktenica Developmental Test of Visual-Motor Integration. Correlation and linear regression quantified observed-score associations and shared variance. Principal component analysis was used as exploratory data reduction. RESULTS:Cross-tool associations were generally small, if significant. Regression models showed that any given tool predicted only a small proportion of variance in scores on the remaining tools (approximately 1-22 %). Principal component analyses consistently yielded multiple components, with scores from different tools often represented on different components. CONCLUSION:Measures commonly described as assessing fine-motor skills were not sufficiently aligned to be treated as interchangeable, consistent with the tools sampling different combinations of ICF domains and task demands. An ICF-informed assessment battery may provide a more useful basis for characterising need and planning targeted support than reliance on a single score.

There is limited robust population level evidence on the widely reported disparities in autism diagnosis by sex and ethnicity. Universal measures of school readiness, particularly the domains measuring social and emotional development, have been proposed as early indicators of developmental need, but whether the disparities in formal diagnoses across demographic groups are reflected in these population-level measures remains unclear. This study examined how sex, ethnicity, and their intersection were associated with the frequency and timing of childhood autism diagnoses and whether school readiness measures were associated with subsequent diagnosis across demographic groups. Linked health and education records for 55,054 children from a Northwest District of England were analysed using Poisson regression. Children from minoritised ethnic backgrounds and females were less like to receive an autism diagnosis and experienced significantly longer times to diagnosis than males and White British children. South Asian heritage females showed the greatest disadvantage. These patterns were not reflected across distributions of school readiness scores, suggesting diagnostic disparities by sex and ethnicity may reflect structural inequalities within identification pathways rather than true differences in underlying need. Developmental differences are evident and measurable by age five across demographics, highlighting the opportunity for earlier identification and support.

Children and adolescents, the primary participants in developmental neuroscience research, are rarely consulted or included in the research design process. By neglecting their perspectives and needs, we risk limiting the relevance and effectiveness of translational research that might emerge from such research. Here, we report on a process of co-development with adolescents in the UK city of Bradford to inform the generation of a new developmental neuroimaging research programme. We employed a two-study community-based participatory approach and used mixed methods to identify the research priorities of this community. In the first study, 79 secondary school students from four schools were introduced to fundamental neuroscience concepts during five one-hour workshops. In groups, they then designed research studies, centred around topics they deemed imported, and were asked to present their ideas on posters, role playing as neuroscientists. Reflexive thematic analysis was conducted on these posters, extracting ten key themes. In the second study, 387 students from four schools ranked the ten extracted themes in order of importance. Mental health and stress consistently emerged as the highest priorities across groups. Exploratory analysis revealed that the priority for themes exploring healthy routines and understanding anti-social behaviours varied across schools and the importance of mental health, and topics related to video gaming varied significantly between genders. This work provides an illustration of how a place-based participatory approach can inform the design of developmental neuroscience programmes, improving both equity and translational relevance. ### Competing Interest Statement The authors have declared no competing interest.

AbstractChildren's mental health and education are profoundly affected by natural, human‑made and pandemic‑related disasters, but policymakers lack synthesized evidence across health and education on effective post-disaster interventions, hindering post-disaster recovery. We searched 13 databases for peer-reviewed randomized controlled trials (RCTs) published after 2000. Eligible studies included children aged less than 18 years exposed to environmental, human or COVID-19-related disasters, with mental health or educational outcomes measured using standardized tools and assessed with RoB2 to be low risk of bias. A total of 25 RCTs met the inclusion criteria: nine non-COVID mental health studies, 11 COVID-19 mental health studies and five COVID-19 education studies. No eligible non-COVID education RCTs were identified. Trauma-focused cognitive behavioural therapy was consistently reported to reduce post-traumatic stress disorder, depression and anxiety following natural and human-made disasters. Psychotherapeutic approaches were reported to improve mental health post-COVID-19, despite some anomalous findings. Physical activity emerged as a cross-cutting mechanism supporting well-being and academic outcomes. Group-based interventions within schools and delivered by educational staff were effective. Structured tutoring and carer-supported home learning improved literacy and numeracy. These findings provide evidence towards the importance of education and health systems working more collaboratively to effectively facilitate post-disaster recovery, where further high-quality RCTs are needed.

OBJECTIVE:Assess sociodemographic disparities in attention-deficit hyperactivity disorder (ADHD) diagnoses and determine whether England's universal assessment of 'school readiness' could provide a signal for ADHD-related educational needs. DESIGN:Population-based cohort study. SETTING:Bradford, UK. METHOD:Education and health records were linked using the Connected Bradford database for individuals who completed their first year of compulsory schooling (age 4-5 years) between the 2006/2007 and 2018/2019 academic years (n=1 25 330). School readiness was indexed by the 'good level of development' threshold within the Early Years Foundation Stage Profile. Primary healthcare records were used to identify individuals with clinical codes recorded that indicate ADHD diagnosis. Regression analyses allowed controlling for covariates, including sex, ethnicity, free school meals receipt and local area deprivation. RESULTS:Male and White British heritage individuals were more likely to have received a diagnosis for ADHD than females and those of South Asian heritage or other ethnicities, with the lowest diagnosis rates among South Asian girls. Those who attained a 'good level of development' were also less likely to have received a diagnosis for ADHD (attained: 1.0%; not attained: 2.6%, OR=0.40, 95% CI (0.35, 0.45)), even after controlling for covariates (OR=0.42, 95% CI (0.37, 0.48)). CONCLUSIONS:There are structural inequalities in ADHD diagnosis, particularly across sex and ethnicity. Universal school readiness assessments, such as the Early Years Foundation Stage Profile used in England, could act as a signal of ADHD-related educational needs and aid more equitable pathways for ADHD identification and support.

Abstract Children's mental health and education are profoundly affected by natural, human‑made and pandemic‑related disasters, but policymakers lack synthesized evidence across health and education on effective post-disaster interventions, hindering post-disaster recovery. We searched 13 databases for peer-reviewed randomized controlled trials (RCTs) published after 2000. Eligible studies included children aged less than 18 years exposed to environmental, human or COVID-19-related disasters, with mental health or educational outcomes measured using standardized tools and assessed with RoB2 to be low risk of bias. A total of 25 RCTs met the inclusion criteria: nine non-COVID mental health studies, 11 COVID-19 mental health studies and five COVID-19 education studies. No eligible non-COVID education RCTs were identified. Trauma-focused cognitive behavioural therapy was consistently reported to reduce post-traumatic stress disorder, depression and anxiety following natural and human-made disasters. Psychotherapeutic approaches were reported to improve mental health post-COVID-19, despite some anomalous findings. Physical activity emerged as a cross-cutting mechanism supporting well-being and academic outcomes. Group-based interventions within schools and delivered by educational staff were effective. Structured tutoring and carer-supported home learning improved literacy and numeracy. These findings provide evidence towards the importance of education and health systems working more collaboratively to effectively facilitate post-disaster recovery, where further high-quality RCTs are needed.

BackgroundApproximately 5% of children are affected by a neurodevelopmental disorder of their sensorimotor skills. DSM-V and ICD-10, the two most widely used diagnostic systems, define this diagnostically as 'Developmental Coordination Disorder' (DCD) or 'Specific Developmental Disorder of Motor Function' (SDDMF), respectively. A diagnosis of DCD has been found to have a detrimental impact on a range of outcomes (e.g., health and education). It is therefore crucial that these children receive timely intervention. This is reliant, however, on effective assessment and support pathways. Research has shown there is great parental dissatisfaction, but there has been limited research exploring a clinical and education perspective. This study therefore aimed to understand barriers and facilitators for clinical and education practitioners in the pathway in a diverse district in the UK (Bradford).MethodsSemi-structured interviews were completed with stakeholders across the pathway to identify barriers and facilitators to assessing, diagnosing, and supporting children with sensorimotor skill difficulties. Theoretical thematic analysis aligned to the Capability, Opportunity, Motivation model of Behaviour change (COM-B) was used to analyse the qualitative data.ResultsInterviews revealed many barriers in the DCD pathway related to capability (confusing terminology, inconsistent knowledge, inappropriate referrals), opportunity (resource constraints, DCD being considered low priority, and disconnected services), and motivation (overlapping job roles, a desire to consider those with difficulties not eligible for a diagnosis). No facilitators were consistently identified across interviews.ConclusionFamilies face multiple barriers to obtaining a diagnosis for their child through existing clinical pathways for assessment and support. These findings are unlikely to be unique to Bradford, due to international research highlighting these issues via parental interviews. These findings therefore may reflect challenges both nationally and internationally within DCD pathways. There is an urgent need for: (i) clear communication across different services (with consistency in terminology), and (ii) a more collaborative and integrated approach to assessment, diagnosis, and support in order to help these children thrive.

There is a Special Educational Needs and Disabilities (SEND) crisis, with complex diagnostic pathways contributing to access inequities, intervention delays, and increasing paediatric service demand. We explored whether routine data collection processes could be repurposed for earlier ‘vulnerability’ detection and the development of scalable, practitioner-facing need identification tools. The Early Years Foundation Stage Profile (EYFSP) was selected as a canonical example of data recording for administrative purposes potentially containing rich information on neurodevelopmental status. This conceptual and design paper introduces the scientific rationale, development process, and implementation architecture underpinning the Electronic Developmental Support Passport (EDSP). We developed the EDSP as a classroom-based system using adaptive, observation-based assessment to identify developmental needs and generate tailored support strategies. Here, we outline the theoretical foundations, development process, and design principles of the EDSP, alongside its broader implications for data-informed needs-led systems of support. The EDSP proved the principle that routine data recording processes can be used for longitudinal developmental tracking and actionable neurodevelopmental support. The EDSP infrastructure enables standardised documentation of need and creates opportunities for integration with health and social care data systems. The EDSP has the potential to improve early identification, support children waiting for assessment, and support targeted referrals.

Strategic behavior in sensorimotor adaptation tasks is typically described as either a gradual error-minimization process or as a process of learning through trial and error. The former predicts a gradual monotonic reduction in error, until some asymptote, while the latter predicts behavioral exploration to discover an efficacious solution. Another explanation is that a sufficiently rich understanding of the task culminates in an “Aha!” moment and that this richer understanding naturally entails a new strategy. This predicts some period of perseveration in baseline behavior, followed by an abrupt shift to a new strategic solution. To avoid obfuscation caused by the motor system, we first investigated these hypotheses in a strategy-only aiming game, where participants aim and fire a cannon at targets. Most participants exhibited a period of baseline perseveration followed by a single-trial shift to a distinct strategy. This strategy typically appears to produce the correct compensatory magnitude for a noisily estimated perturbation, as well as substantial variability in compensatory sign. We then applied the same analyses to reaching data from a visuomotor rotation task that inhibited implicit adaptation through delaying feedback presentation. Similarly, we found that participants typically perseverated in reaching toward the target before suddenly switching, in a single trial, to good performance in compensatory magnitude. We fit our generative “Aha!” model to 1,337 participants across several datasets and show that it faithfully captures these phenomena. Our findings highlight the need to update existing models to account for the abrupt, insight-driven shifts that characterize individual human responses to sensorimotor perturbations.

CLINICAL RELEVANCE:Vision plays an important role in the normal motor development of children. Increased understanding of this relationship is important for providing appropriate advice in a clinical setting. BACKGROUND:Growing evidence indicates that vision anomalies are associated with reduced motor performance in children. This study investigated whether feedback loop noise, induced by common vision anomalies, adversely affects sensorimotor processing in children aged 7 to 16. METHODS:Sensorimotor function was measured in 409 children aged 7-8, 10-11, and 15-16 years as part of an annual school vision programme. The vision programme included assessment of visual acuity, binocular vision and refraction. Aiming and steering sensorimotor performance were measured using a validated tool that utilised a stylus on a tablet computer. Analysis of covariance models tested whether visual function (binocular near visual acuity, amplitude of accommodation, near point of convergence) and refractive error, along with age, contributed to the variance in aiming and steering performance. RESULTS:Sensorimotor performance showed considerable variation within each age group. The simplest models that captured aiming variance included age and refractive error (R2 = 0.42, F[3, 402] = 99.04, p < 0.001), whilst age and accommodative function contributed towards steering variance (R2 = 0.22, F[3, 400] = 38.72, p < 0.001). CONCLUSION:Hyperopic refractive errors and reduced accommodative function affect the ability to perform sensorimotor transformations, negatively impacting age-expected manual control skill levels. Longitudinal research is needed to test whether correcting hyperopia can: (i) improve the development of sensorimotor processing; (ii) produce beneficial changes in motor skill abilities.

BACKGROUND:Traffic-related air pollution is a risk factor for lung disease and early mortality. Clean air zones are public health policy interventions used to reduce traffic-related air pollution in urban areas, but evidence of their health benefits is limited. We describe a natural experiment study evaluating the impact of the Ultra Low Emission Zone (ULEZ) in London, UK. The primary aim was to assess the impact of the ULEZ on children's lung function growth trajectories, by comparing forced expiratory volume in 1 s (FEV1) measurements over 5 years between children in London and Luton, UK. METHODS:The Children's Health in London and Luton (CHILL) study is a prospective, two-arm, parallel cohort study. We recruited children aged 6-9 years from primary schools in central London (the original area of the ULEZ implementation) and Luton (a comparator site with no clean air zone). Children were excluded if they had symptoms of lung disease (excluding asthma) or learning or physical disabilities preventing them from giving informed assent. Lung function was measured by spirometry at annual school visits at baseline (before ULEZ implementation) and over the following 4 years. Annual residential exposures to nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters of less than 10 μm (PM10) and less than 2·5 μm (PM2·5) were estimated at each child's home address at 20 m2 resolution using a validated dispersion modelling system. The primary outcome was the annual rate of lung function growth, measured as post-bronchodilator FEV1 over the 5-year study period. We assessed growth trajectories against individualised residential exposure to NO2, PM10, and PM2·5. We used mixed-effects linear regression to compare lung function growth between London and Luton and to examine associations between air pollution exposures and lung growth. FINDINGS:Of 122 schools approached, 84 (69%) agreed to participate (44 schools in London; 40 schools in Luton). Of 9419 children invited, we recruited 3414 children (1664 in London and 1750 in Luton) between June 5, 2018, and April 4, 2019, before ULEZ implementation. 3209 (94·0%) of 3414 children were included in the FEV1 analysis (1557 children in London, 1652 children in Luton). Children were similar across the two sites in terms of age, height, and weight, with a higher proportion of girls in London (867 [56%] of 1557) than in Luton (809 [49%] of 1652). Baseline adjusted FEV1 was lower in London than Luton (difference -38 mL, 95% CI -58 to -18; p=0·0002). At baseline, children's modelled annual exposures to NO2, the pollutant most reflective of exhaust emissions, were 18·95 μg/m3 (95% CI 18·51 to 19·38; p<0·0001) higher in London than in Luton. Over the follow-up period, children's FEV1 growth increased by 10 mL/year (95% CI 5 to 15; p=0·0002) more in London than in Luton (233 mL/year vs 223 mL/year), with modelled residential exposures to NO2 decreasing faster in London than in Luton (decreases of -3·77 μg/m3 per year in London vs -1·77 μg/m3 per year in Luton; p<0·0001). After 4 years, mean FEV1 reached parity across sites: 2283 mL (2207 to 2354) in London; 2282 mL (2185 to 2376) in Luton. The proportion of children with clinically impaired lung function fell from 184 (14%) of 1280 children to 51 (9%) of 585 children in London, and from 126 (9%) of 1339 children to 41 (7%) of 606 children in Luton. INTERPRETATION:Introduction of the London ULEZ was associated with improved lung function growth trajectories in children in London compared with children in Luton, suggesting that previous deficits in lung development were restored. This evidence supports wider implementation of clean air zones as a public health intervention. FUNDING:National Institute for Health and Care Research and Natural Environment Research Council UK Research and Innovation.

The impact of student-level risk factors on not in education, employment or training (NEET) rates (e.g. low attainment, absenteeism and socio-economic disadvantage) are well-documented. However, there is limited research on how school characteristics influence NEET rates, despite recognition that inclusive school environments can have a positive effect on education outcomes. In this work, we hypothesized that proxy measures of 'inclusivity' would affect sustained post-16 engagement, and we tested this hypothesis using 3 years of administrative data for secondary schools in England while controlling for known student and school local area risks. Our results indicate that schools with lower suspension rates, higher student progress ('Progress 8') and onsite post-16 provision had lower rates of students becoming NEET. Single-sex and faith schools also exhibited reduced NEET rates. These results suggest school culture and inclusivity play an important role in shaping student trajectories. The proportion of 16-17 year olds in England who become NEET has remained stubbornly high for more than a decade, putting these individuals at risk of long-term adverse outcomes. Our results suggest that policies promoting inclusive school environments, supportive disciplinary practices and clear post-16 pathways may help increase sustained engagement in education and training.

Background Multimorbidity of internalising and cardiometabolic conditions (ICM-MM) is the most common combination of mental and physical health conditions in older age. Few studies have examined the likelihood that individuals with adverse childhood experiences (ACEs) such as abuse or neglect will develop ICM-MM in mid to late adulthood, or gender disparities. Methods UK Biobank participants (n = 157,184, mean age 55.94, SD= 7.74; 68186 males and 88998 females) reported on ACEs as well as sociodemographic and lifestyle factors. Diagnoses of internalising conditions (depression and anxiety) and cardiometabolic conditions (hypertension, obesity, type 2 diabetes, dyslipidaemia and chronic kidney disease) were obtained through linked electronic healthcare records. Logistic regression models tested associations between ACEs and internalising conditions, cardiometabolic conditions and ICM-MM, accounting for gender differences and sociodemographic and lifestyle factors. Results ACEs were associated with all individual and multimorbid presentations. Stronger associations were found with internalising conditions (OR 1.84) and ICM-MM (OR range 1.73-2.15) than cardiometabolic conditions (OR range 1.08-1.44). Females were more likely to report most ACEs, but health risks following ACEs were similar for both genders. The associations remained when accounting for sociodemographic and lifestyle factors, including gender, age, socioeconomic status, ethnicity, diet, alcohol intake, smoking status and physical activity levels. Conclusions This is the first study to report associations between ACEs and the most common type of physical and mental health multimorbidity in mid to late adulthood. The results highlight the importance of early ACE intervention and trauma-informed healthcare. ### Competing Interest Statement Michael J. Owen reports grants from Akrivia Health and Takeda Pharmaceuticals outside the submitted work. ### Funding Statement This work was funded by a PhD studentship to LKB from Health and Care Research Wales (MvdB; PH, MJO, FR, MMW; HS 22 04) and the Tackling Multimorbidity at Scale Strategic Priorities Fund programme (MvdB, PH, MJO, MMW, RP; MR/W014416/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at https://www.ukbiobank.ac.uk/use-our-data/