Since 2006 English Local Authorities (LA) have had discretionary powers to implement a type of landlord licensing scheme, Selective Licensing (SL), in the private rental sector. The scheme is intended to improve housing standards in areas marked by antisocial behaviour, poor housing conditions, low housing demand, and high levels of migration, deprivation, and crime. Yet up to 2019, only 15% of LA had adopted SL. We examine temporal, socio-economic, and geographical factors associated with SL adoption between 2006 and 2019, focusing on: (A) overall temporal trends in adoption, (B) socio-economic factors in adoption on their own; and in relation to (C) regional diffusion processes. To examine these factors, we applied cumulative adoption rate, logit, and spatial autoregressive logit (SAL) models considering 1st and 2nd order LA neighbours. The influence of socio-economic factors was studied using multiple variables and by coding the LA with the Census 2011 LA classification. The adoption curve showed that the policy has only been adopted at a slow rate. The adoption rate did however increase slightly at the point when the justifiable reasons for implementing SL were expanded. The logit and SAL models showed that higher proportions of the population receiving Income Support was a powerful determinant, while spatial spillovers were not statistically significant. The same was true in SAL with Census classification exposure showing stronger associations with larger urban areas than with spatial spillovers. We note that SL is absent from large parts of Mid- and South-England, so even without evidence of regional diffusion on a local scale it may still exist on a larger scale. We conclude that SL adoption has been slow, regionally patchy, and more correlated with socio-economic factors than with regional diffusion processes. Resource and staffing constraints as well as internal organisational/political and policy-related factors are likely barriers to adoption. More qualitative evidence is needed from local areas including from those that never adopted SL.

The ‘Homes for Ukraine’ (H4U) and Ukrainian Family visa schemes facilitated forcibly displaced Ukrainian nationals to enter England from March 2022. Despite accommodation provision implied in the H4U scheme name, barriers in accessing long-term housing have been a prominent stressor for many arrivals. Some have found themselves in insecure housing upon transitioning out of initial placements. Drawing on repeat interviews with 19 forcibly displaced Ukrainian women in England, this qualitative paper draws on Strong Structuration Theory to explore pathways into and through insecure housing, the perceived impact of housing insecurity on well-being, and coping responses to this problem. Conditions in insecure housing, as well as uncertainty over length of tenure and future housing options were perceived as contributing to poor mental health. Participants coped with insecure housing by becoming more assertive in claiming visa-granted housing-related rights, establishing and drawing on support systems, focusing on the positive aspects of life in England, or in some cases, leaving England to secure housing elsewhere.

In October 2019, South Korea’s Ministry of Health and Welfare issued a national advisory urging the public to refrain from using liquid-type/ electronic cigarettes (e-cigarettes) due to international concerns over vaping-related lung injuries. This study evaluates changes in e-cigarette use trends using nationally representative repeated cross-sectional survey data. We conducted an interrupted time-series (ITS) analysis using age-standardized prevalence data on current use of cigarettes, e-cigarettes (2013–2023), and heated tobacco products (HTPs, 2019–2023) from the Korea National Health and Nutrition Examination Survey. ITS regression models with Newey–West standard errors assessed pre-intervention trends, immediate level changes, and post-intervention trend differences. Subgroup analyses were performed by gender, age, region, and income. We also conducted sensitivity analyses using ± 1-year intervention timings and presented counterfactual projections. E-cigarette use had been increasing before 2019 (+ 0.43

Goods and services consumed in the night-time economy (NTE) are associated with adverse health outcomes. These outcomes are more prevalent in areas with greater deprivation and among minoritized population subgroups. This study was aimed at exploring the views of local authority stakeholders on the harms and health inequalities in the NTE. We focused on inequalities from alcohol and gambling, their relationship with the NTE and how different forms of power might underpin the inequalities generated. We interviewed 17 local authority and third sector stakeholders from two case study areas (Swindon and Derby) who had a professional remit for the night-time economy. Data were analyzed using framework analysis using McCartney’s Sources of Power as a guiding framework for the analytical narrative. Participants highlighted the cumulative impact of years of economic decline in the NTE and resultant tension between local authorities’ public health and economic priorities. For instance, the economic benefits of alcohol licenses were felt to be prioritized over potential adverse health outcomes. Collaboration and the adoption of a whole-system approach were suggested as ways of reducing harms in the town centers and improving users’ perceived safety. However, frustration was expressed at the lack of flexibility in how funds could be spent and the need to give local authorities more power to allocate funds according to the area’s unique challenges. Stakeholders identified that different population sub-groups had varying experiences in using the NTE in their local authorities and consequently had different requirements for what the NTE should ideally offer. Participants highlighted a need for future NTE spaces to accommodate all members of the different communities it serves. This is one of the few qualitative studies that explores the wider contextual factors that underpin persistent inequalities in harms associated with unhealthy commodities. Our findings can be used to help policymakers inform their decision-making process to address these harms and inequalities.

In March 2022, the Government of the United Kingdom (UK) introduced two visa schemes enabling persons forcibly displaced from Ukraine to temporarily reside in the UK: the Ukrainian Family Scheme and the Ukraine Sponsorship Scheme (commonly called 'Homes for Ukraine'). This paper explores experiences of women forcibly displaced from Ukraine living in England under both schemes, highlighting how they perceive their mental health and well-being to have been shaped by their experiences living with hosts. We conducted 55 interviews, of which 39 were women forcibly displaced from Ukraine, 11 were stakeholders, and 5 were forcibly displaced stakeholders. Stakeholders were persons working at local authorities or other levels of government, volunteers at migration-focused charities, medical practitioners or academics, or translators working within essential services. Interviewees with Homes for Ukraine visa holders revealed a range in host support, spanning paid-for furnished separate housing to households characterised by exploitation and abuse. Many voiced gratitude for supportive hosts yet felt underlying anxiety due to constant impression management and avoiding being an imposition. Accounts by those with Family Scheme visas indicate pervasive overcrowding and a lack of support to secure follow-on accommodation. This lack of security contributed to high degrees of stress as participants attempted to negotiate access to housing support to which they were legally entitled via their visa status. To best support the mental health of forcibly displaced persons in the UK, future homestay initiatives should ensure parity between schemes, sufficient safeguarding and oversight for guests, and improved resources to support host readiness.

Partnerships with commercial actors have been proposed as a policy approach to create healthier food environments. We conducted a systematic review to assess their effectiveness for improving food environments and population health at state, national, or international levels. We searched in 14 databases and two websites for real-world evaluations published between 2010 and 2020. Study quality was appraised using a modified Newcastle-Ottawa Scale. Data were synthesized narratively by outcome (human, food environment, policy content, and implementation progress), considering their effect direction. Seventeen studies reporting on seven PPPs in four countries were included. Most studies (n = 14) involved food reformulation, especially salt reduction. Three focused on specific settings (the eating out-of-home sector, schools, and convenience stores). There was mixed evidence that partnerships make people buy fewer calories or more school meals (n = 3 studies) or reduce product sodium content (n = 6). Some positive effects were described in one uncontrolled study each for decreasing trans-fatty acid intake and for making healthier options more available in school cafeterias, but these studies had important limitations. Five document analyses highlighted shortcomings in the partnerships, including their limited scope, failure to add value to ongoing actions, varying participation levels, and lack of implementation, monitoring, and reporting. Alternative policy approaches should be considered. This systematic review is registered on PROSPERO as CRD42020170963.

Background:Evidence suggests that controls on the physical and temporal availability of alcohol can reduce alcohol-related harms. Public health teams in England and Scotland have in recent years been given a statutory role in licensing systems through which premises are granted permits to sell alcohol. The Exploring the Impact of alcohol premises Licensing in England and Scotland study examined public health team efforts to engage in alcohol licensing from 2012 to 2019. Objective:We aimed to describe the range of public health team practice in engaging with alcohol licensing across England and Scotland, with a particular focus on unusual or innovative practices. Methods:Two sets of interviews were conducted with 20 public health teams in England and Scotland who were actively engaged in alcohol premises licensing. Firstly, representatives of each public health team with experience of licensing activity took part in structured face-to-face or telephone interviews (n = 41) and provided documentation to identify how and when their team engaged with alcohol premises licensing. Secondly, members of public health teams took part in in-depth one-to-one interviews (n = 28) which focused on individual roles and responsibilities. Relevant public health team activity was analysed quantitatively within 19 activities in 6 categories using the 'Public Health engagement In Alcohol Licensing' measure, as well as qualitatively using NVivo (QSR International, Melbourne, Australia). Innovative practices were identified using the highest Public Health engagement In Alcohol Licensing scores for specific activity types across single or multiple 6-month periods. Findings:Within each of the six activity categories, a range of practices were observed. More unusual practices included having a dedicated post to work full-time on alcohol licensing; developing a standardised reviewer tool allowing the team to respond to applications and provide the most relevant evidence in a consistent and systematic way; committing to additional scrutiny of occasional licences or temporary event notices; maintaining a detailed database recording applications made, whether the public health team decided to object and the outcome of the licensing board's decision; engaging with applicants prior to them submitting an application; visiting proposed/current licensed premises to gather bespoke data; leading the writing of local licensing policy; and working closely with licensing standards officers. Conclusions:Across six categories of public health team activity relating to the local alcohol premises licensing system, public health team practices varied, and some public health teams stood out as engaging in more innovative or intensive activities. The identified examples will be of value in informing public health team practice in what remains a relatively new area of work for many, despite limitations in the system. The inclusion of examples from both England and Scotland and from many public health teams will facilitate cross-fertilisation of ideas and practice across public health teams. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

Public-private partnerships (PPPs) between commercial actors and governments or other non-commercial organizations are widely encouraged as a way of achieving a range of policy objectives, including the creation of healthier food environments, despite the evidence of their limited effectiveness at doing so. The aims of this qualitative study were to critically interrogate the role and legitimacy of food industry actors as partners in policies to improve the food environment, and to explore related underlying issues that impede the design and implementation of effective policies. Qualitative interviews with 16 academics from 6 countries with expertise on population food policy, including public-private partnerships, to improve the food environment were conducted from January to March 2020. A manual thematic analysis of the data was employed, and theoretical lenses relevant to the commercial determinants of health were applied. Key themes constructed from the data have been conceptualized as 'fault lines', metaphorically used here to indicate underlying issues or factors that cause systemic problems or impede success of public health goals. The reported fault lines are categorized as (i) uninterrogated assumptions that partnership working is effective; (ii) the role of exclusive social networks; (iii) the voluntary nature of partnerships; (iv) data ownership; (v) control of narratives; and (vi) the centrality of political ideology. This paper calls for a systematic and critical interrogation of the mechanisms and extent of commercial actors' involvement in making decisions about healthy diets for the population.

Place matters for understanding patterns of gambling harm as shown by the spatial clustering of both ‘vulnerable’ people and gambling outlets. Harms are experienced at a community level (and never restricted to individuals) and are spread unequally across communities of place. Following the liberalisation of gambling laws in the UK in the 1990s, gambling outlets and advertising have proliferated in many economically disadvantaged places, with the gambling industries in some cases appearing to target these areas. Despite growing recognition of place-based inequalities in the harms caused by gambling, there have been limited efforts to understand gambling as a spatial practice that reflects and produces inequalities in health. This paper presents a synthesis of theories and explanations in the social science and public health literature about the unequal harms from gambling experienced by people in different places. We draw on a socio-material approach in our synthesis to show how different assemblages of gambling products, venues, marketing materials and collective histories form in different localities to influence different gambling practices with varying consequences for health. The synthesis foregrounds how different levels of power and influence in the production, regulation and experience of space across communities shape i) the meanings of gambling as a social practice and ii) the collective resources of communities to protect themselves from gambling harms. The analysis thus points to socio-material spaces as sites for interventions to reduce inequalities in harm.

There has been increasing pressure to implement policies for promoting healthy food environments worldwide. We conducted an evidence map to critically explore the breadth and nature of primary research from 2010-2020 that evaluated the effectiveness, cost-effectiveness, development, and implementation of mandatory and voluntary food environment policies. Fourteen databases and 2 websites were searched for "real-world" evaluations of international, national, and state level policies promoting healthy food environments. We documented the policy and evaluation characteristics, including the World Cancer Research Fund International NOURISHING framework's policy categories and 10 equity characteristics using the PROGRESS-Plus framework. Data were synthesized using descriptive statistics and visuals. We screened 27,958 records, of which 482 were included. Although these covered 70 countries, 81% of publications focused on only 12 countries (United States, United Kingdom, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand, and South Africa). Studies from these countries employed more robust quantitative methods and included most of the evaluations of policy development, implementation, and cost-effectiveness. Few publications reported on Africa (n = 12), Central and South Asia (n = 5), and the Middle East (n = 6) regions. Few also assessed public-private partnerships (PPPs, n = 31, 6%) compared to voluntary approaches by the private sector (n = 96, 20%), the public sector (n = 90, 19%), and mandatory approaches (n = 288, 60%). Most evaluations of PPPs reported on the same 2 partnerships. Only 50% of publications assessing policy effectiveness compared outcomes between population groups stratified by an equity characteristic, and this proportion has decreased over time. There are striking inequities in the origin, scope, and design of these studies, suggesting that research capacity and funding lies in the hands of a few expert teams worldwide. The small number of studies on PPPs questions the evidence base underlying the international push for PPPs to promote health. Policy evaluations should consider impacts on equity more consistently. This study was registered at PROSPERO as CRD42020170963.

Background. Local government is important for health equity because local policies often affect place‐based health, health equity, and their wider social determinants of health. In England, local governments must produce Joint Health and Wellbeing (JH&W) Strategies, outlining local strategies for health improvement. These strategies have been produced concurrently with budget cuts to local governments that are associated with adverse health and mortality outcomes. Using a novel approach, we assessed whether English local governments’ strategies for place‐based health and equity help explain why some disadvantaged areas have better mortality trends than others. Methods. We sampled “Joint Health and Wellbeing” (JH&W) Strategies for 20 disadvantaged localities covering the years 2013–2017. We sampled areas to include some with larger and some with smaller budget cuts. We developed a qualitative appraisal process for scoring the extent to which JH&W strategies focused on (i) place‐based social determinants of health and (ii) health equity. Using qualitative comparative analysis, we assessed whether mortality trends might be explained by JH&W scores or wider contextual factors such as budget cuts, population age, and disadvantage. Results. JH&W strategies on place‐based social determinants of health and equity were often underdeveloped. Only a minority of strategies were highly rated (i.e., scoring >2 out of 3) for addressing social inequalities of health (n = 6), and even fewer scored highly for place‐based social determinants of health (n = 3). Our qualitative comparative analysis found that external and contextual factors (e.g., budget cuts and disadvantages) offer more plausible explanations than JH&W strategies for place variations in life expectancy trends. Conclusion. Budget cuts and other contextual factors better explain mortality trends than JH&W strategies. This raises concerns about what such strategies can realistically achieve in the face of structural disadvantage and national policies that restrict local spending.

Some places have better than expected health trends despite being disadvantaged in other ways. Thematic analysis of qualitative data from stakeholders (N = 25) in two case studies of disadvantaged local authorities the North West and South East of England assessed explanations for the localities' apparent health resilience. Participants identified ways of working that might contribute to improved life expectancy, such as partnering with third sector, targeting and outcome driven action. Stakeholders were reluctant to assume credit for better-than-expected health outcomes. External factors such as population change, national politics and finances were considered crucial. Local public health stakeholders regard their work as important but unlikely to cause place-centred health resilience.

Health outcomes are influenced by social and environmental determinants of health. As places where people work, live, meet and consume, high street retail environments are influential in shaping health. In recent decades, high streets have been in decline, prompting policies to revitalise retail environments and support local businesses, particularly in European and North American countries. The aim of this scoping review was to systematically map evidence on retail environment interventions, to gain a deeper understanding of the current evidence base assessing their possible health and wellbeing impacts. The objectives were to identify different types of interventions and the outcomes they address; and the mechanism through which interventions are theorised to influence health and equity. Peer-reviewed studies were identified through academic databases (MEDLINE, Embase, EconLit, Web of Science and Social Policy and Practice) using relevant search terms. Additional (grey) literature was identified using citation scanning and online searches. Studies were eligible if they evaluated interventions with a significant focus on supporting the retail environment, reported on at least one health and wellbeing outcome and were written in English. Relevant data were extracted and presented descriptively. An interpretive approach was taken to analyse theories of change. The searches identified 53 peer-reviewed studies and nine grey literature reports. Interventions were categorised as follows: area-based initiatives, business improvement districts, business incentives, and demand-side incentives. Studies predominantly evaluated impacts on social and environmental determinants of health. Some studies measured impacts on self-rated (mental) health, physical activity and food consumption and purchasing. Studies reported evidence of both improved and worsening outcomes. Theories of change were often under-specified and reductionist, lacking a clear understanding of the complex systems in which interventions take place. Future interventions could benefit from more comprehensive theories of change that meaningfully integrate economic, and health and wellbeing outcomes. This requires intersectoral collaboration.

Background Greater availability of alcohol is associated with higher consumption and harms. The legal systems, by which premises are licensed to sell alcohol in England and Scotland, differ in several ways. The ‘Exploring the impact of alcohol licensing in England and Scotland’ study measured public health team activity regarding alcohol licensing from 2012 to 2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken. Objectives To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences. Methods Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish public health teams selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n = 66) and their rationale for the approaches taken (n = 28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found. Findings Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish public health teams in 2012–3 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point. (3) Renewals of statements of licensing policy were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organisational structures in Scotland, with public health stakeholders spread across several organisations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English public health teams felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish public health teams felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, public health teams there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally, Scottish public health teams involved the public more in licensing process, partly because of statutory licensing forums there. Conclusions The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by public health teams and how temporary increases in availability are handled in the two licensing systems. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Reseacrh programme as award number 15/129/11.

Food environments are important determinants of healthy diets among young people. This study explored young people's perspectives on their food environment, their recommendations to policymakers and views on youth engagement in policy processes. There is limited research on young people's perspectives on their involvement in developing food environment policies. Youth engagement in policymaking processes can lead to greater policy integrity and inclusivity. Four focus group discussions were conducted with 39 young people (12-21 years) from a town in North West England and a metropolitan area in the English Midlands. Participants were recruited through youth organizations. Data were analysed using inductive thematic analysis. Young people reported concerns about the density of fast food outlets in their local area, the unaffordability of healthier food, and fast food advertisement. These issues were not believed to be prioritized in local and national policymaking. Accordingly, policy recommendations were mainly for structural food environment policies, including restrictions on fast food outlet density and incentives for menu reformulation. Young people did not feel involved in local decisions about the food environment. They expressed a need for more meaningful engagement beyond consultation. Young people have repeatedly shown to have a deep understanding of the social, commercial and political factors that influence diet and health. It is essential that policymakers aiming to improve young people's diets take their unique views and concerns into account to create effective policies that resonate with young people.

Abstract Background Improving the public’s understanding of how regional and socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. This is particularly so for young people. Our study sought to explore young people’s lived experiences and understandings of health inequalities. Methods We carried out focus group discussions (n = 18) with 42 young people, aged 13–21, recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focus group discussions designed to explore their (i) perceptions of factors impacting their health in their local area, (ii) understandings of health inequalities and (iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n = 15). However, with one group in the North East, we carried out discussions face-to-face (n = 3). Data were analysed thematically and we used NVivo-12 software to facilitate data management. Results Young people from all groups demonstrated an awareness of a North-South divide in England, UK. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people’s health and wellbeing, such as linking poverty and employment precarity to chronic stress. Young people did not believe these inequalities were inevitable. They described the Conservative government as prioritising the South and thus perpetuating inequalities through uneven investment. Conclusions Our study affords important insights into young people’s perceptions of how wider determinants can help explain the North-South health divide in England. It demonstrates young people’s contextualised understandings of the interplay between spatial, social and health inequalities. Our findings support calls for pro-equity policies to address the structural causes of regional divides in health. Further research, engaging young people in deliberative policy analysis, could build on this work.

Background:Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. Objectives:This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Data sources:Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Methods:Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. Results:A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches. Conclusion:From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. Limitations:This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Future work:Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. Study registration:This study is registered as PROSPERO CRD42020170963. Funding:This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

Objective: In the United Kingdom, some public health teams (PHTs) routinely engage with local alcohol premises licensing systems, through which licenses to sell alcohol are granted. We aimed to categorize PHT efforts and to develop and apply a measure of their efforts over time. Method: Preliminary categories of PHT activity were developed based on prior literature and were used to guide data collection with PHTs in 39 local government areas (27 in England; in Scotland), sampled purposively. Relevant activity from April 2012 to March 2019 was identified through structured interviews (N = 62), documentation analysis, and follow-up checks, and a grading system was developed. The measure was refined based on expert consultation and used to grade relevant PHT activity for the 39 areas in 6-month periods. Results: The Public Health engagement In Alcohol Licensing (PHIAL) Measure includes 19 activities in six categories: (a) staffing; (b) review-ing license applications; (c) responding to license applications; (d) data usage; (e) influencing licensing stakeholders or policy; and (f) public involvement. PHIAL scores for each area demonstrate fluctuation in type and level of activity between and within areas over time. Participating PHTs in Scotland were more active on average, particularly on senior leadership, policy development, and working with the public. In Eng-land, activity to influence license applications before decision was more common, and a clear increase in activity is apparent from 2014 onward. Conclusions: The novel PHIAL Measure successfully assessed diverse and fluctuating PHT engagement in alcohol licensing systems over time and will have practice, policy, and research applications. (J. Stud. Alcohol Drugs, 84, 318-329, 2023)

Background:Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap.Intervention:Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods.Objective:To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative.Study design, data sources and outcome variables:This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction.Results:At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M.Main limitations:COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas.Conclusions:Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change.Funding:This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.