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ObjectivesMental wellbeing can deteriorate throughout adolescence; females and children from low-income families more likely to experience mental health conditions. Views of greenspace from home positively impact cognition, but links with wellbeing has not been explored in children. We linked environment and survey data for 14 year olds in Wales, UK.
ApproachOur cross-sectional study examined the relationship between views of greenspace and wellbeing for >1000 children aged 14 years living in Wales between 2015-2016. We linked data on views of greenspace from the home location with individual-level wellbeing and socio-demographic data in the SAIL Databank; a secure research environment. Our health outcome was derived from self-reported wellbeing measures in the Millennium Cohort Study. Views of greenspace were derived from LiDAR data and quantified on a continuous scale (0-1). We used Generalised Additive Models to investigate associations between views of greenspace and wellbeing; adjusting for factors such as parent wellbeing and deprivation.
ResultsHomes in coastal areas had larger views of greenspace than non-coastal residences. Individuals living in the most deprived areas had smaller views of greenspace (mean = 0.03) than least deprived (mean = 0.12). Overall, individuals living in detached homes had the greatest views of greenspace (0.4) and flats had the poorest views of greenspace (mean = 0.02). We will report our final regression analyses at the conference investigating the association between views of greenspace and adolescent wellbeing. Our models will be fully adjusted and sub-analyses will be stratified by gender and urban/rural status. We will also report findings on whether deprivation mediates for any relationships.
ConclusionOur study is the first to link objectively measured views of greenspace with wellbeing data for a national cohort. Our results can be used to develop interventions to support good wellbeing in adolescents. Further longitudinal research is required to investigate the causal pathways between views of greenspace and adolescent wellbeing.

Acknowledgement We thank the SAIL databank for assisting in the statistical disclosure process. Declarations and Funding Data is collected routinely and access to this was granted via the SAIL databank. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication. The data sets generated and analysed during the current study are available in the SAIL databank repository, https://saildatabank.com/. This work was supported by funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK to the ELAStiC Project (ESL015471/1) and Public Health Wales. The views expressed are those of the authors and should not be assumed to be of the funding body. The research was also supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. The funders had no role in designing the study, data collection, analysis, or interpretation, or in writing the report; MAB's role in the design, analysis, and writing was independent of the funding from Public Health Wales. SP, SL and MAB had the original idea for this study. SP, AE, RA, EL and RD designed the study and developed the analysis plan. AJ provided advice on the mental health codes used in this analysis. AB extracted the data and prepared data sets for analysis. EM, AE and RA analysed the data. EM and RA wrote the first draft of the paper. All authors were involved in interpreting the findings, revising drafts and agreeing the final version. ; Peer reviewed ; Publisher PDF

ObjectivesResearch on bi-directional associations between self-reported caregiver mental health and child development is mixed. Through linkage of a cohort study and primary care data, we examine whether maternal mental health diagnoses, treatment and symptoms are bi-directionally associated with child development, namely emotional and conduct problems, hyperactivity and peer problems.
ApproachWe accessed 14 years of data by linking the Millennium Cohort Study (in Wales) to anonymised individual-level population-scale health and administrative data within the Secure Anonymised Information Linkage (SAIL) Databank. We identified maternal mental health problems using John et al's (2016) existing algorithm for anxiety and depression diagnoses, symptoms and treatment. We measured child development using parent-reports of the Strengths and Difficulties questionnaire. Outcomes were tested when the child was 3, 5, 7, 11 and 14 years of age. We used Bayesian Structural Equation Modelling, specifically Random-Intercept Cross-Lagged Panel Models, to analyse within and between-person associations.
ResultsWe found that mother's mental health was strongly associated over time, as were children's development difficulties. Cross-lagged associations from mother to child were weakly positively associated at age 3 to 5 for child total scores, and at age 11 to 14 for child emotional problems. In contrast, child development associations with maternal mental health were significant from age 7 to 11 for total scores, emotional and peer problems, but weakly associated at age 3 to 5, and 11 to 14 for conduct problems. Hyperactivity had few associations. Few associations at the same-time point were found, but emotional problems at age 11 and 14 were positively associated, as were hyperactivity at age 14, and peer problems at age 11. Between-person effects were consistently strongly associated.
ConclusionWe find mixed evidence for bi-directional associations, but strong between-person associations. Overall development and emotional problem models showed more bi-directional relationships; child development was positively associated with mother's mental health event at age 7 for all models except hyperactivity, conduct problems were weakly associated at age 5 and 11.

The COVID-19 pandemic has placed a spotlight on existing and enduring health inequalities experienced by different ethnic groups. There has been a longstanding call to generate and improve the use of ethnicity data available across different data sources, in order to improve our understanding of health risks, behaviours and outcomes.
We used multiple anonymised individual-level population-scale data sources available within the Secure Anonymised Information Linkage (SAIL) Databank to develop a harmonised ethnicity spine for the population of Wales. We documented ethnicity information in multiple longitudinal records from January 2000 onwards. Data sources included: health and social care, birth and mortality records, national census records, specialist clinical audits and registers, surveys and other routine electronic data. To enable multi-source harmonisation, we explored the ethnicity categorisation as well as temporal changes in recording and classifications by obtaining distribution of records for population, which informed our harmonisation algorithm for standardisation of ethnicity records.
We used over 20-data sources on ~5-million individuals, spanning varying time-periods starting from January 2000 upto a maximum of 22-years. We harmonised available recorded ethnicity values into standardised ethnic classification groups within a national ethnicity-spine. Furthermore, we investigated the impact of different harmonisation methods, including composite, latest date of recording, modal and weighted modal results. With the main focus of the methodological development being in response to the COVID-19 pandemic, when linked to the ~3.1 million individuals alive and resident in Wales from January 2020, we generated harmonised ethnic groups towards ~95% completeness in data coverage for the whole population of Wales. The predominant ethnic group in Wales observed was White, accounting for 89% of the population when using the latest date of recording method.
This research highlights challenges in using longitudinal ethnicity data across different sources. Further work is needed to understand the basis on which individuals / organisations record ethnicity overtime. We recommend improvements recognising differences between ethnicity and other social constructs (e.g. ancestry, nationality, country of origin) are better documented / understood.

Background Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. Methods E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. Results In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a 'fad', which had begun to run its course. Conclusions This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.

Funding: This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (HDRUK2020.146). EAVE II is funded by the Medical Research Council (MC_PC_19075) and supported by the Scottish Government. This work is supported by BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004). BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. ConCOV is supported by the Medical Research Council (MR/V028367/1); Health Data Research UK (HDR-9006) which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council (grant ES/S007393/1). ; Introduction : The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received their first vaccine dose and over 44 million people have received their second vaccine dose across the UK. We aim to assess the uptake rates, effectiveness, and safety of all currently approved COVID-19 vaccines in the UK. Methods and analysis : We will use prospective cohort study designs to assess vaccine uptake, effectiveness and safety against clinical outcomes and deaths. Test-negative case–control study design will be used to assess vaccine effectiveness (VE) against laboratory confirmed SARS-CoV-2 infection. Self-controlled case series and retrospective cohort study designs will be carried out to assess vaccine safety against mild-to-moderate and severe adverse events, respectively. Individual-level pseudonymised data from primary care, secondary care, laboratory test and death records will be linked and analysed in secure research environments in each UK nation. Univariate and multivariate logistic regression models will be carried out to estimate vaccine uptake levels in relation to various population characteristics. VE estimates against laboratory confirmed SARS-CoV-2 infection will be generated using a generalised additive logistic model. Time-dependent Cox models will be used to estimate the VE against clinical outcomes and deaths. The safety of the vaccines will be assessed using logistic regression models with an offset for the length of the risk period. Where possible, data will be meta-analysed across the UK nations. Ethics and dissemination : We obtained approvals from the National Research Ethics Service Committee, Southeast Scotland 02 (12/SS/0201), the Secure Anonymised Information Linkage independent Information Governance Review Panel project number 0911. Concerning English data, University of Oxford is compliant with the General Data Protection Regulation and the National Health Service (NHS) Digital Data Security and Protection Policy. This is an approved study (Integrated Research Application ID 301740, Health Research Authority (HRA) Research Ethics Committee 21/HRA/2786). The Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub meets NHS Digital's Data Security and Protection Toolkit requirements. In Northern Ireland, the project was approved by the Honest Broker Governance Board, project number 0064. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journals. ; Publisher PDF ; Peer reviewed