Graham Moon | University of Southampton (original) (raw)

Papers by Graham Moon

... based studies and the evaluation of multilevel inﬂuences on health outcomes Graham Moon, SV S... more ... based studies and the evaluation of multilevel inﬂuences on health outcomes Graham Moon, SV Subramanian, Kelvyn Jones, Craig ... deprivation and disability, education, skills and training deprivation, barriers to housing and services, living environment deprivation and crime). ...

![Research paper thumbnail of Consumed with worry: `unsafe' alcohol consumption and self-reported problem drinking in England](https://attachments.academia-assets.com/110190243/thumbnails/1.jpg)

Health Education Research, Oct 1, 2000

cludes, however, that the two measures are broadly similar in their relationship to social and st... more cludes, however, that the two measures are broadly similar in their relationship to social and structural variables. Tenure provides an Using data from the 1994 Health Survey for England, logistic multivariate multilevel model-exception to this conclusion and indicates a continuing need to take account of housing ling techniques are used to investigate the simultaneous effect of individual demographic circumstances in developing an understanding of drinking behaviour. characteristics and socio-structural factors on self-reported problem drinking as revealed by Institute for the Geography of Health, Department of types of people who are likely to consume unsafe

Social Science & Medicine, Apr 1, 2000

Health-related behaviours are of central importance to health promotion and to the promotion of e... more Health-related behaviours are of central importance to health promotion and to the promotion of enhanced population health. In the UK, localised knowledge of the quantitative dimensions of health-related behaviours is traditionally attained by conducting a costly sample survey. Such surveys seldom generate reliable data at scales more local than that of the health authority, they also need to be repeated regularly. This paper outlines an alternative framework for generating statistics on small-area health related behaviours using routinely available data from the annual Health Survey for England N 17,000 and the decennial Population Census. Using a multilevel modelling approach nesting individuals within postcode sectors within health authorities, and focusing on the prevalence of smoking and`problem' drinking, the paper comprises four sections: a consideration of the modelling strategy, a comparison of the smoking and drinking models, an outline of the estimation strategy, and the presentation and discussion of ward-level estimates of smoking and drinking behaviour for England. The paper concludes that the method is better at estimating smoking than drinking but that it oers a feasible, cheap and more informative alternative to the survey approach to the generation of information on smoking and drinking behaviour.

Oxford University Press eBooks, May 8, 2003

Social Science & Medicine, Apr 1, 2019

Small area health data are not always available on a consistent and robust routine basis across n... more Small area health data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data or the use of proxy measures. Geodemographic indicators are widely marketed as a potential proxy for many health indicators. This paper tests the extent to which the inclusion of geodemographic indicators in small area estimation methodology can enhance small area estimates of limiting long-term illness (LLTI). The paper contributes to international debates on small area estimation methodologies in health research and the relevance of geodemographic indicators to the identification of health care needs. We employ a multilevel methodology to estimate small area LLTI prevalence in England, Scotland and Wales. The estimates were created with a standard geographicallybased model and with a cross-classified model of individuals nested separately in both spatial groupings and nonspatial geodemographic clusters. LLTI prevalence was estimated as a function of age, sex and deprivation. Estimates from the cross-classified model additionally incorporated residuals relating to the geodemographic classification. Both sets of estimates were compared against direct estimates from the 2011 Census. Geodemographic clusters remain relevant to understanding LLTI even after controlling for age, sex and deprivation. Incorporating a geodemographic indicator significantly improves concordance between the small area estimates and the Census. Small area estimates are however consistently below the equivalent Census measures, with the LLTI prevalence in urban areas characterised as 'blue collar' and 'struggling families' being markedly lower. We conclude that the inclusion of a geodemographic indicator in small area estimation can improve estimate quality and enhance understanding of health inequalities. We recommend the inclusion of geodemographic indicators in public releases of survey data to facilitate better small area estimation but caution against assumptions that geodemographic indicators can, on their own, provide a proxy measure of health status.

Health Services and Delivery Research, 2020

Background Community treatment orders are widely used in England. It is unclear whether their use... more Background Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes. Objectives To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs. Design Secondary analysis using multilevel statistical modelling. Setting England, including 61 NHS mental health provider trusts. Participants A total of 69,832 patients eligible to be subject to a community treatment order. Main outcome measures Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality. Data sources The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England. Results There was signifi...

Journal of Evaluation in Clinical Practice, 2019

Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

BMJ open, Jan 18, 2018

Supervised community treatment (SCT) for people with serious mental disorders has become accepted... more Supervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data. Four years of data from the Mental Health Services Dataset (MHSDS) will be an...

The British Journal of Psychiatry, 2018

SummaryConventional approaches to evidence that prioritise randomised controlled trials appear in... more SummaryConventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.Declaration of interestAll authors had financial support from the National Institute for Health Research Health Services and Delivery Research Programme while completing this work. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, the Medical Research Council, Central Commissioning Facility, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, the Health Services and Delivery Research Programme or the Dep...

Health & place, 2018

An increasing number of countries across the world are planning for the eradication of the tobacc... more An increasing number of countries across the world are planning for the eradication of the tobacco epidemic. The actions necessary to realise this ambition have been termed the tobacco endgame. The focus of this paper is on the intersection between the tobacco endgame with place, a neglected theme in recent academic and policy debates. We begin with an overview of the key themes in the literature on endgame strategies before detailing the international landscape of engame initiatives, paying particular attention to the opportunities and challenges of endgame strategies in low and middle income countries. Finally, we critically assess the current endgame debates and suggest a novel agenda for integrating geographical perspectives into research on the endgame that provides enhanced understanding of the challenges associated with this important global health vision.

BMJ Open, 2017

ObjectivesThis study aims to address, for the first time, the challenges of constructing small ar... more ObjectivesThis study aims to address, for the first time, the challenges of constructing small area estimates of health status using linked national surveys. The study also seeks to assess the concordance of these small area estimates with data from national censuses.SettingPopulation level health status in England, Scotland and Wales.ParticipantsA linked integrated dataset of 23 374 survey respondents (16+ years) from the 2011 waves of the Health Survey for England (n=8603), the Scottish Health Survey (n=7537) and the Welsh Health Survey (n=7234).Primary and secondary outcome measuresPopulation prevalence of poorer self-rated health and limiting long-term illness. A multilevel small area estimation modelling approach was used to estimate prevalence of these outcomes for middle super output areas in England and Wales and intermediate zones in Scotland. The estimates were then compared with matched measures from the contemporaneous 2011 UK Census.ResultsThere was a strong positive as...

A review of family planning services provided by the Portsmouth and South-East Hampshire Health A... more A review of family planning services provided by the Portsmouth and South-East Hampshire Health Authority in 1988 concluded that more needed to be known about why people used the services and who attended which clinic. In order to address this need, therefore, a survey was conducted on November 8, 1992 among 7 of the most heavily used health authority family planning clinics (FPC) and 7 general practitioner (GP) practices which offer contraceptive services. The GP practices were located close to FPCs. 3 additional GPs were added, of which 2 were not in the health authority area, and 1 was a branch. The survey instrument, which was developed by a select steering group is presented in its entirety. A 96% response rate was achieved. Results showed a median age of 24 years among clinic attendees and an age range of 16-47 years. FPCs tended to have younger clients. There were no differences between GPs and FPCs in the number of miscarriages experienced. FPCs had a large proportion of single (40%), never-married women, while GPs had primarily married or cohabiting women patients. 94% of the GP group reported that the GP practice was their usual location for contraceptive services, while 83% in the FPC group reported the FPC as their usual location. GP use may reflect habit and clinics may attract a more mobile population or referrals. The question pertaining to the usual source of FP advice and information elicited ambiguous responses. Of the data tabulated by age, it appears that 14-16 year old were more likely to choose another FPC, whereas women in other age groups were likely to seek advice from a GP. The reasons for attending a FPC were to be able to consult a woman doctor and to obtain contraceptive supplies. Personal attention from one's own doctor was the reason given for attendance at GP groups. Both facilities reported that oral contraceptives were the most common method used. FPC tended to prescribe alternatives, particularly to young acceptors who were more likely to use oral contraceptives with a barrier method. Contraceptive knowledge is obtained wherever women normally go for advice. Both types of facilities have a continuing and complementary role.

Social Science Research, 2016

This paper examines the secondary data requirements for multilevel small area synthetic estimatio... more This paper examines the secondary data requirements for multilevel small area synthetic estimation (ML-SASE). This research method uses secondary survey data sets as source data for statistical models. The parameters of these models are used to generate data for small areas. The paper assesses the impact of knowing the geographical location of survey respondents on the accuracy of estimates, moving beyond debating the generic merits of geocoded social survey datasets to examine quantitatively the hypothesis that knowing the approximate location of respondents can improve the accuracy of the resultant estimates. Four sets of synthetic estimates are generated to predict expected levels of limiting long term illnesses using different levels of knowledge about respondent location. The estimates were compared to comprehensive census data on limiting long term illness (LLTI). Estimates based on fully geocoded data were more accurate than estimates based on data that did not include geocodes.

Population Health Metrics, 2015

Background: Complete and accurate data on maternal smoking prevalence during pregnancy are not av... more Background: Complete and accurate data on maternal smoking prevalence during pregnancy are not available at a local geographical scale in England. We employ a synthetic estimation approach to predict the expected prevalence of smoking during pregnancy and smoking at delivery by Primary Care Trust (PCT). Methods: Multilevel logistic regression models were used with data from the 2010 Infant Feeding Survey and 2011 Census to predict the probability of mothers (a) smoking at any point during pregnancy and (b) smoking at delivery, according to age, deprivation, and the ethnic profile of the home area. These probabilities were applied to demographic information on mothers giving birth from 2010/11 Hospital Episode Statistics data to produce expected counts, and prevalence figures, of smokers by PCT, with Bayesian 95 % credible intervals. The expected prevalence of smoking at delivery by PCT was compared with midwife-collected Smoking at the Time of Delivery (SATOD) data using a Bland-Altman plot. Results: The expected prevalence of smoking during pregnancy by PCT ranged from 8.1 % (95 % CI 5.6-1.0) to 31.6 % (27.5-34.8). The expected prevalence of smoking at delivery ranged from 2.5 % (1.4-4.0) to 17.1 % (13.7-20.4). Figures for expected smoking prevalence at delivery showed some agreement with SATOD, though SATOD data were generally higher than the synthetic estimates (mean difference 2.99 %). Conclusions: It is possible to derive good estimates of expected smoking prevalence during pregnancy for small areas, potentially at much lower cost than conducting large surveys. Such data may be useful to help plan and commission smoking cessation services and monitor their effectiveness.

Tobacco Control, 2009

To identify the impact of a smoking cessation programme on area-based social and ethnic inequalit... more To identify the impact of a smoking cessation programme on area-based social and ethnic inequalities in smoking rates through social and ethnic differences in enrolment and quitting. Analysis of records of 11 325 patients who enrolled in an innovative smoking cessation programme in Christchurch, New Zealand between 2001 and 2006. We compare enrolment, follow-up, quitting and impact on population smoking rates in the most and least deprived neighbourhoods and the neighbourhoods with the lowest and highest proportions of Māori. Enrolment as a proportion of the population was higher from the most deprived areas but as a proportion of neighbourhood smokers, it was lower. Enrolees from the least deprived quintile were 40% more likely to quit than those from the most deprived quintile. Smoking rates were 2.84 (2.75 to 2.93) times higher in the most deprived neighbourhoods. If the programme had not been available we estimate that this differential would have reduced to 2.81 (2.72 to 2.90). In neighbourhoods with the highest proportion of Māori, smoking rates were 2.33 (2.26 to 2.41) times higher and we estimate that without the programme smoking rates would be 2.30 (2.23 to 2.37) times higher. Although enrolees were drawn from a wide variety of backgrounds, those most likely to quit tended to reside in affluent areas or areas with a low proportion of Māori. There was no evidence that this smoking cessation programme increased or decreased inequalities within the Christchurch population. For smoking cessation programmes to have an impact on health inequalities more effort is required in targeting hard-to-reach groups and in encouraging them to quit.

Nicotine & Tobacco Research, 2011

General practice is a recommended setting for the delivery of smoking cessation programs. Little ... more General practice is a recommended setting for the delivery of smoking cessation programs. Little is known about the types of practice that achieve higher cessation rates. To address this gap in knowledge, we assessed the impact of general practice characteristics on the outcomes of a large scale smoking cessation intervention delivered in general practice settings. A cross-sectional study was undertaken of 7,778 participants enrolled on a structured cessation program comprising repeated brief interventions in one-to-one sessions and nicotine replacement therapy in Christchurch New Zealand, 2001-2007. We employed a logistic multilevel analysis of respondents nested in general practices with cessation at 6 months as the outcome measure. After taking into account relevant individual-level predictors (age, sex, smoking intensity) and area-level surrogates for individual predictors (socioeconomic status and access to tobacco retail outlets), there remained significant variation in quit rates between practices. This variation reduced when practice characteristics were included. Practices with a majority of male doctors and practices with fewer male patients were associated with better quit rates. Practices with large numbers of doctors were less effective in achieving cessation with heavy smokers. The effectiveness of smoking cessation programs can be influenced significantly by practice characteristics. To increase quit rates, more attention should be paid to the institutional setting of smoking cessation programs. Assessments of the effectiveness of cessation programs should give appropriate recognition to the fact that some practices may find higher quit rates more difficult to achieve.

Journal of Epidemiology & Community Health, 2009

To investigate whether neighbourhood measures of geographical accessibility to outlets selling to... more To investigate whether neighbourhood measures of geographical accessibility to outlets selling tobacco (supermarkets, convenience stores and petrol stations) are associated with individual smoking behaviour in New Zealand. Methods: Using Geographical Information Systems, travel times from the population-weighted centroid of each neighbourhood to the closest outlet selling tobacco were calculated for all 38,350 neighbourhoods across New Zealand. These measures were appended to the 2002/03 New Zealand Health Survey; a national survey of 12,529 adults. Two-level logistic regression models were fitted to examine the effects of neighbourhood locational access upon individual smoking behaviour after controlling for potential individual-and neighbourhood-level confounding factors, including deprivation and urban/rural status. Results: After controlling for individual-level demographic and socioeconomic variables, individuals living in the quartiles of neighbourhoods with the best access to supermarkets (OR 1.23, 95% CI 1.06-1.42) and convenience stores (OR 1.19, 95% CI 1.03-1.38) had a higher odds of smoking compared to individuals in the worst access quartiles. However, the association between neighbourhood accessibility to supermarkets and convenience stores was not apparent once other neighbourhood-level variables (deprivation and rurality) were included. Conclusions: At the national level, there is little evidence to suggest that after adjustment for neighbourhood deprivation better locational access to tobacco retail provision in New Zealand is associated with individual-level smoking behaviour.

Health Soc Care Community, 2001

Urban Policy in Britain, 1994