Funded projects

The recent Marmot Review of Health Inequalities (Marmot 2010) has the creation of healthy and sustainable places and communities, the creation of fair employment and good work for all and the enabling of children and young people to maximise their capabilities and opportunities as key policy objectives to improve health and reduce health inequalities. This project will investigate how urban regeneration programmes impact on health and psychological wellbeing, and its wider determinants, by comparing changes in families in an area undergoing regeneration with those in comparison areas with no comparable regeneration.

In this study, regeneration activities in Stratford, London Borough of Newham, will act as the main intervention being evaluated, primarily the construction of the Olympic Park and Stratford City developments during late 2011 and early 2012. These developments are a major investment in regeneration and will cover an area of 7000 acres in the London Borough of Newham. They include provision for a total of 2.9 million sq. Ft. retail and leisure space, 1.3 million sq. Ft. hotel space, a 6.6 million sq. Ft. commercial district, 16,400 new homes and 180,000 sq. Ft. of new and refurbished community spaces. Physical regeneration will comprise of 'sustainable' transport networks (rail and active travel corridors); educational and housing infrastructure; new civic space, parks and green areas; improving the connectivity and accessibility of 'fringe' communities to the Olympic Park and development of shopping, business and community facilities. Comparison areas are Tower Hamlets, Hackney and Barking & Dagenham, similar in terms of deprivation level and socio-demographics, where no comparable regeneration is taking place.

The purpose of the proposed project is to answer the following primary research question

1. What is the impact of urban regeneration on the social determinants of health (employment), health behaviours (physical activity) and health outcomes (mental health and wellbeing) of adolescents and their parents?

Underpinning this objective are the following secondary research questions:

2. What are the wider socio-environmental and health impacts of urban regeneration in terms of benefit status, educational attainment, social cohesion/capital, diet, smoking, alcohol use and obesity?

3. How are socio-economic and health impacts distributed by age, sex, ethnicity and education?

4. What are the effects on health and health behaviours of specific components of the regeneration programme?

5. Are socio-economic and health impacts sustained over time?

We will answer these questions by undertaking a longitudinal quasi-experimental questinnaire survey comparing changes in health over time in the intervention (regeneration) area with those in a comparison area, and an integrated in-depth longitudinal qualitative study of family experiences of physical and social regeneration in the intervention (regeneration) area.

Participants will be surveyed pre-regeneration and again at 6 and 18 months post-regeneration in both intervention and comparison areas. The qualitative study will investigate attitudes to, and experiences of, regeneration over the same period and will allow us to ways in which the outcomes of regeneration are experienced and utilised in health promoting and health damaging ways. Full ethical approval will be obtained.

The intervention will be successful if improvements in health and health inequalities in the regeneration area are greater than in comparison areas. The team has substantial experience in evaluating complex social interventions, survey design, qualitative research and the social determinants of health and wellbeing. This, combined with expertise in geography, psychology, evaluation, public health and statistics, make us well-placed to undertake this project.

The proposal costs less than 0.03% of the total cost of the regeneration programme and there are no current plans to evaluate these the effects of the regeneration programme on public health representing a cost-effective opportunity for policy learning.

Design: Two elements.

1. Controlled longitudinalquasi-experimental study comparing impacts on young people and their parents in regeneration andnon-regeneration areas. Comprises a school-based survey of adolescents with parent data collected through interviews. Parents of children will be recruited through schools.

2. Nested longitudinal qualitative study will explore families' experiences of regeneration and its impacts on wellbeing in order to unpack the ways in which regeneration leads to impacts on health and the social determinants of health.

Setting: Newham (intervention site) and Tower Hamlets, Hackney and Barking & Dagenham (comparison sites) in east London.

Target Population: Adolescents aged 11-13 (school years 7 & 8) and their parents.

Intervention: Urban regeneration programme in Newham (Olympic Park & Stratford City). Comprises a comprehensive redevelopment
of public and active transport infrastructure (rail, cycle paths, walking routes), new civic space, parks, green areas and major Olympic sporting facilities as well as provision of new housing, retail, business and community facilities and aesthetic improvements, economic development and employment.

Measurement of outcomes, duration of follow-up: Primary outcomes: pre-post change in adolescent & parent mental health andwellbeing (self-esteem, psychological problems, satisfaction), physical activity (adults: moderate and intensive physical activity, sedentray behaviour; adolescents: general physical activity and sedentary behaviour), household SES (employment status). Secondary outcomes: pre-post change in benefit status (adults), social capital/cohesion, smoking, alcohol use, diet and obesity (BMI).

Duration of follow-up: 6 months & 18 months post-regeneration.

Sample Size: 1. Questionnaire survey: Achieved sample at final follow-up of 1766 pupils from 24 schools (74 per school) and 1766 parents. Data will be collected in 6 secondary schools in Newham, and 18 secondary schools from Tower Hamlets, Hackney and Barking & Dagenham and the households of parents residing in these areas. This gives 80% power with 95% significance to detect 8% change in primary outcomes with an assumed ICC of 0.02. 2.Qualitative study: Semi-structured interviews and focus groups with a purposive, diverse sample of c20 families reflecting the diversity of the baseline sample at 6 & 18 months post-regeneration.

Planned analyses: 1. Questionnaire survey: Questionnaire data will be double-punched and cleaned. Main analyses: (i) demographic, socio-economic and environmental correlates of physical activity and mental wellbeing using multi-level regression models accounting for the clustered nature of our sample; (ii) investigation of whether accessibility to health promoting environmental resources from either home or school is related to specific health behaviours; (iii) longitudinal analysis to assess the effect of regeneration on primary outcomes (employment, physical activity and mental wellbeing) through investigating pre-post changes in individual outcomes between baseline (wave 1) and follow-up (wave 2) - outcomes will be assessed at wave 3 to investigate whether changes have been sustained; (iv) analysis of effects on health inequalities using stratified analysis to assess social patterning of impacts on outcomes; (v) analysis of individual changes in objective and subjective accessibility to environmental resources over time and relationships with individual changes in outcomes controlling for demographic and socio-economic factors. 2. Qualitative study: Qualitative interview data will be recorded, transcribed, coded and subject to thematic analysis using framework methodology (Ritchie et al 1994) and adopting a theory generating grounded theory approach (Strauss, Corbin 1998)

Project timetable and recruitment rate: Total duration: 60 months. Survey Baseline (Jan-June 2011); wave 2: 6 month post-intervention follow-up (Jan-June 2013 ); wave 3 18 month post-intervention follow-up (Jan-June 2014). We have previously conducted a cohort study (RELACHS) of adolescent health in East London schools with an 84% response at baseline, 75% at first follow-up and 56% at final follow-up compared to baseline. Qualitative study: data collection in tandem with 6 & 18 month post-intervention follow-up of survey.

£1,999,748