Patrick Tobi | Middlesex University (original) (raw)
Papers by Patrick Tobi
International Health, Sep 28, 2021
Background: Cataract is a major cause of visual impairment globally, affecting 15.2 million peopl... more Background: Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods: Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results: Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Conclusions: Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
Summary objective To investigate the effect of scaling up antiretroviral treatment (ART) on the w... more Summary objective To investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects. methods Exploratory interviews with health managers and senior clinical staff were used to identify locally relevant work environment indicators. A self-reported Likert scale questionnaire was adminis-tered to a randomly selected cohort of 269 health professionals at health facilities in KwaZulu Natal and Western Cape provinces of South Africa that included ART delivery sites. The cohort was disaggregated into ART and non-ART groups and differences between the two compared with Fisher’s exact test and the non-parametric Mann–Whitney U-test. results The ART sub-cohort reported: (i) a lighter workload (P = 0.013), (ii) higher level of staffing (P = 0.010), (iii) lower sickness absence (P = 0.032), (iv) higher overall job satisfaction (P ...
Sexually Transmitted Infections, 2013
Poster presentations Methodology A total of 721 IDUs (551 male, 170 female) enrolled in SHALOM we... more Poster presentations Methodology A total of 721 IDUs (551 male, 170 female) enrolled in SHALOM were interviewed by peer educators in early 2012 as part of programme risk assessments during routine outreach. Bivariate and multivariate analyses were conducted to compare the male and female clients. Results Female IDUs engaged in much higher risk behaviour than male IDUs, injecting over twice the rate of men (20.7 vs. 10.0 times per week, p < 0.001). Sexual activity was higher among women-a mean of 18 sex acts per week compared to less than one per week among men (p < 0.001). Women were significantly more likely to be poly-drug users and regularly drink alcohol. Women were significantly less educated, less likely to have a regular sexual partner and more likely to be widowed or divorced. They were more likely to be working full-time (mostly as sex workers). Linear regression analysis for female IDUs (n = 169, R2 = 0.46) showed that older age, more sex acts per week and poly-drug use were significantly associated with greater injecting frequency. Linear regression analysis for male IDUs (n = 386, R2 = 0.21) showed that older age and heroin use were significantly associated with greater injecting frequency. Conclusion Female IDUs have increased risk of HIV compared to their male counterparts due to more frequent injecting (associated with higher income from sex work), sex (mostly paid) and alcohol use. Such high risks require targeted interventions to meet the specific needs of female IDUs.
Journal of Epidemiology & Community Health, 2012
Conclusion Clinically significant BMI changes, similar to those achieved under research condition... more Conclusion Clinically significant BMI changes, similar to those achieved under research conditions, may be replicable in service delivery settings for children of all socio-demographic groups analysed. However, at the population level, scaled up programmes may work better for some groups than others. Public health implications of these results for health inequalities will be discussed.
Journal of Global Health, 2021
Background Preventing visual impairment due to avoidable causes has been a long-standing global p... more Background Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task shifting strategies. Methods Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n = 13), traditional ophthalmic staff (n = 17) and other stakeholders from the districts (n = 6), training institution staff (n = 4) and MOH headquarters (n = 2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a document review. Results In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone. Conclusions Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment.
Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement... more Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods
is available at the end of the articleLondon adult population and the national Health Survey for ... more is available at the end of the articleLondon adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions: Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.
This article discusses the methods and findings of a study to estimate the unit costs of a progra... more This article discusses the methods and findings of a study to estimate the unit costs of a programme to promote health and wellbeing in deprived neighbourhoods of London. In view of the policy emphasis on primary prevention of ill health and promotion of wellbeing, it is as important to understand the costs and outcomes of public health initiatives as those of health and social care services. Investigating the costs of public health initiatives, however, can present challenges.
The background section of the abstract and introduction section of the main text have been revise... more The background section of the abstract and introduction section of the main text have been revised to clarify the objective of the paper i.e. to investigate the factors acting at the later (maintenance) stage of exercise behaviour change. p4. It would be useful to provide the reader a reference for the definition of ERS. A reference has been added (ref no 1). p5. The reviewer is not certain that "mixed methods evaluation" is understandable? Please clarify "mixed". This has been clarified with the following insertion in the text: '…..which used a combination of qualitative and quantitative approaches to analyse participants exercise behaviour, experiences and barriers to participation in the scheme. …'. The authors' evaluation report to which the statement refers has also been formally referenced (ref no 12): p5. Where do 58% and 45% come from? The data is taken from the authors' evaluation report which is now included as an additional reference (ref no. 12): p6. How the 1089 participants were registered? How were they recruited? Participants were referred by their general practitioners to the exercise scheme. This is mentioned in the 'Setting' section (p5) and the text has been amended to clarify this. Text in the 'Participants' section has also been revised to make clear that participants' details were obtained from the scheme's database.
International Health, 2021
Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people... more Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery,...
European Journal of Public Health, 2014
Perspectives in Public Health, 2017
Full bibliographic details must be given when referring to, or quoting from full items including ... more Full bibliographic details must be given when referring to, or quoting from full items including the author's name, the title of the work, publication details where relevant (place, publisher, date), pagination, and for theses or dissertations the awarding institution, the degree type awarded, and the date of the award.
International Health, 2021
Background Evidence indicates that school-based vision screening by trained teachers is an effect... more Background Evidence indicates that school-based vision screening by trained teachers is an effective way of identifying and addressing potential vision problems in schoolchildren. However, inconsistencies have been reported in both the testing methods and accuracy of the screeners. This study assessed the prevalence of refractive errors and accuracy of screening by teachers in Grand Kru County, Liberia. Methods We conducted a retrospective analysis of data from four schools where, in February 2019, children were screened for refractive errors by trained teachers and then re-examined by ophthalmic technicians. One row of five optotypes of the Snellen 6/9 (0.2 logMar) scale (tumbling E chart) was used at a distance of 3 m. The prevalence of visual impairment and associations with sex, age and school were explored. Sensitivity, specificity and predictive values were calculated. Results Data were available for 823 of 1095 eligible children with a mean age of 13.7 y (range 5–18) and male...
Primary Health Care Research & Development
Aim To examine assumptions about public–private partnership (PPP) activities and their role in im... more Aim To examine assumptions about public–private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. Background PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. Methods A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Results Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable inve...
Primary Health Care Research & Development
Aim To compare the characteristics of mental health and physical health participants attending an... more Aim To compare the characteristics of mental health and physical health participants attending an exercise referral scheme (ERS) and investigate associations with their adherence to exercise. Background While people referred to an ERS with a mental health diagnosis have similar initial rates of uptake as physical health participants, they are more likely to drop out. Comparisons of the groups to understand their differences and how these might impact on their adherence have been limited by the typically low numbers of mental health referrals in many schemes. Methods Retrospective analysis of a participant cohort. Data were extracted on all participants enrolled over a 12- month period (n = 701) and included measurements at baseline, mid-point (13 weeks) and end of programme (20-26 weeks). Differences were explored between the mental health (n=141) and physical health (n=560) subcohorts, and between adherers and non-adherers in each group. Binomial logistic regression estimated the e...
European journal of sport science, Jan 11, 2017
Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary ... more Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary behaviour. The aim of this study was to examine associations between individual and neighbourhood-level characteristics in 40 deprived neighbourhoods in London, UK. A cross-sectional design was utilised with baseline data from the Well London Cluster Randomised Controlled Trial in 40 deprived neighbourhoods in London. Multilevel linear regression was used to examine associations between individual characteristics (measured by household survey), neighbourhood characteristics (neighbourhood audit, GIS and routinely available datasets) and sedentary behaviour (sitting time). Individual-level positive mental well-being and health behaviours were associated with sedentary time. Individual-level social networks were associated with decreased sedentary time in men and increased sedentary time in women. Neighbourhood-level measures of social networks and perceived neighbourhood quality were asso...
Public Health Intelligence, 2016
International Health, Sep 28, 2021
Background: Cataract is a major cause of visual impairment globally, affecting 15.2 million peopl... more Background: Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods: Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results: Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Conclusions: Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
Summary objective To investigate the effect of scaling up antiretroviral treatment (ART) on the w... more Summary objective To investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects. methods Exploratory interviews with health managers and senior clinical staff were used to identify locally relevant work environment indicators. A self-reported Likert scale questionnaire was adminis-tered to a randomly selected cohort of 269 health professionals at health facilities in KwaZulu Natal and Western Cape provinces of South Africa that included ART delivery sites. The cohort was disaggregated into ART and non-ART groups and differences between the two compared with Fisher’s exact test and the non-parametric Mann–Whitney U-test. results The ART sub-cohort reported: (i) a lighter workload (P = 0.013), (ii) higher level of staffing (P = 0.010), (iii) lower sickness absence (P = 0.032), (iv) higher overall job satisfaction (P ...
Sexually Transmitted Infections, 2013
Poster presentations Methodology A total of 721 IDUs (551 male, 170 female) enrolled in SHALOM we... more Poster presentations Methodology A total of 721 IDUs (551 male, 170 female) enrolled in SHALOM were interviewed by peer educators in early 2012 as part of programme risk assessments during routine outreach. Bivariate and multivariate analyses were conducted to compare the male and female clients. Results Female IDUs engaged in much higher risk behaviour than male IDUs, injecting over twice the rate of men (20.7 vs. 10.0 times per week, p < 0.001). Sexual activity was higher among women-a mean of 18 sex acts per week compared to less than one per week among men (p < 0.001). Women were significantly more likely to be poly-drug users and regularly drink alcohol. Women were significantly less educated, less likely to have a regular sexual partner and more likely to be widowed or divorced. They were more likely to be working full-time (mostly as sex workers). Linear regression analysis for female IDUs (n = 169, R2 = 0.46) showed that older age, more sex acts per week and poly-drug use were significantly associated with greater injecting frequency. Linear regression analysis for male IDUs (n = 386, R2 = 0.21) showed that older age and heroin use were significantly associated with greater injecting frequency. Conclusion Female IDUs have increased risk of HIV compared to their male counterparts due to more frequent injecting (associated with higher income from sex work), sex (mostly paid) and alcohol use. Such high risks require targeted interventions to meet the specific needs of female IDUs.
Journal of Epidemiology & Community Health, 2012
Conclusion Clinically significant BMI changes, similar to those achieved under research condition... more Conclusion Clinically significant BMI changes, similar to those achieved under research conditions, may be replicable in service delivery settings for children of all socio-demographic groups analysed. However, at the population level, scaled up programmes may work better for some groups than others. Public health implications of these results for health inequalities will be discussed.
Journal of Global Health, 2021
Background Preventing visual impairment due to avoidable causes has been a long-standing global p... more Background Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task shifting strategies. Methods Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n = 13), traditional ophthalmic staff (n = 17) and other stakeholders from the districts (n = 6), training institution staff (n = 4) and MOH headquarters (n = 2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a document review. Results In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone. Conclusions Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment.
Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement... more Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods
is available at the end of the articleLondon adult population and the national Health Survey for ... more is available at the end of the articleLondon adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions: Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.
This article discusses the methods and findings of a study to estimate the unit costs of a progra... more This article discusses the methods and findings of a study to estimate the unit costs of a programme to promote health and wellbeing in deprived neighbourhoods of London. In view of the policy emphasis on primary prevention of ill health and promotion of wellbeing, it is as important to understand the costs and outcomes of public health initiatives as those of health and social care services. Investigating the costs of public health initiatives, however, can present challenges.
The background section of the abstract and introduction section of the main text have been revise... more The background section of the abstract and introduction section of the main text have been revised to clarify the objective of the paper i.e. to investigate the factors acting at the later (maintenance) stage of exercise behaviour change. p4. It would be useful to provide the reader a reference for the definition of ERS. A reference has been added (ref no 1). p5. The reviewer is not certain that "mixed methods evaluation" is understandable? Please clarify "mixed". This has been clarified with the following insertion in the text: '…..which used a combination of qualitative and quantitative approaches to analyse participants exercise behaviour, experiences and barriers to participation in the scheme. …'. The authors' evaluation report to which the statement refers has also been formally referenced (ref no 12): p5. Where do 58% and 45% come from? The data is taken from the authors' evaluation report which is now included as an additional reference (ref no. 12): p6. How the 1089 participants were registered? How were they recruited? Participants were referred by their general practitioners to the exercise scheme. This is mentioned in the 'Setting' section (p5) and the text has been amended to clarify this. Text in the 'Participants' section has also been revised to make clear that participants' details were obtained from the scheme's database.
International Health, 2021
Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people... more Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery,...
European Journal of Public Health, 2014
Perspectives in Public Health, 2017
Full bibliographic details must be given when referring to, or quoting from full items including ... more Full bibliographic details must be given when referring to, or quoting from full items including the author's name, the title of the work, publication details where relevant (place, publisher, date), pagination, and for theses or dissertations the awarding institution, the degree type awarded, and the date of the award.
International Health, 2021
Background Evidence indicates that school-based vision screening by trained teachers is an effect... more Background Evidence indicates that school-based vision screening by trained teachers is an effective way of identifying and addressing potential vision problems in schoolchildren. However, inconsistencies have been reported in both the testing methods and accuracy of the screeners. This study assessed the prevalence of refractive errors and accuracy of screening by teachers in Grand Kru County, Liberia. Methods We conducted a retrospective analysis of data from four schools where, in February 2019, children were screened for refractive errors by trained teachers and then re-examined by ophthalmic technicians. One row of five optotypes of the Snellen 6/9 (0.2 logMar) scale (tumbling E chart) was used at a distance of 3 m. The prevalence of visual impairment and associations with sex, age and school were explored. Sensitivity, specificity and predictive values were calculated. Results Data were available for 823 of 1095 eligible children with a mean age of 13.7 y (range 5–18) and male...
Primary Health Care Research & Development
Aim To examine assumptions about public–private partnership (PPP) activities and their role in im... more Aim To examine assumptions about public–private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. Background PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. Methods A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Results Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable inve...
Primary Health Care Research & Development
Aim To compare the characteristics of mental health and physical health participants attending an... more Aim To compare the characteristics of mental health and physical health participants attending an exercise referral scheme (ERS) and investigate associations with their adherence to exercise. Background While people referred to an ERS with a mental health diagnosis have similar initial rates of uptake as physical health participants, they are more likely to drop out. Comparisons of the groups to understand their differences and how these might impact on their adherence have been limited by the typically low numbers of mental health referrals in many schemes. Methods Retrospective analysis of a participant cohort. Data were extracted on all participants enrolled over a 12- month period (n = 701) and included measurements at baseline, mid-point (13 weeks) and end of programme (20-26 weeks). Differences were explored between the mental health (n=141) and physical health (n=560) subcohorts, and between adherers and non-adherers in each group. Binomial logistic regression estimated the e...
European journal of sport science, Jan 11, 2017
Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary ... more Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary behaviour. The aim of this study was to examine associations between individual and neighbourhood-level characteristics in 40 deprived neighbourhoods in London, UK. A cross-sectional design was utilised with baseline data from the Well London Cluster Randomised Controlled Trial in 40 deprived neighbourhoods in London. Multilevel linear regression was used to examine associations between individual characteristics (measured by household survey), neighbourhood characteristics (neighbourhood audit, GIS and routinely available datasets) and sedentary behaviour (sitting time). Individual-level positive mental well-being and health behaviours were associated with sedentary time. Individual-level social networks were associated with decreased sedentary time in men and increased sedentary time in women. Neighbourhood-level measures of social networks and perceived neighbourhood quality were asso...
Public Health Intelligence, 2016