Projects - CHAD Research

Healthy Communities and Place

Positive health effects on the natural outdoor environment in typical populations of different regions in Europe (PHENOTYPE)

There is evidence that contact with natural environments is beneficial to human health and wellbeing, but the mechanisms are not well understood. PHENOTYPE was a four-year European-funded, multi-country project intended to provide a better understanding of the potential mechanisms, and better integration of human health needs into land use planning and green space management.

PHENOTYPE investigated the underlying mechanisms in different population groups using a range of research methods. The project further examined the effects of different characteristics of the natural outdoor environment, and address the implications for land-use planning and green space management.

Find out more information here: http://www.phenotype.eu/en

Healthy Urban Planning

The way we perceive and interact with the surrounding built and natural environment has a profound impact on our health. From exposure to air pollution to access to local greenspace, our behaviour, quality of life and ultimately our life expectancy can be influenced by our surroundings.

In collaboration with Stoke-on-Trent City Council, CHAD had tried to apply findings from the latest research to inform the Joint Local Plan for Stoke-on-Trent and Newcastle-under-Lyme. This work involved conducting research into the area of health and planning in order to:

Listen and explore the challenges experienced by planners
Provide evidence for the inclusion of health in planning decisions
Incorporate a health perspective into the Local Plan and other policies
Act as a planning specialist and consultant throughout the development management process

Applying these into both practice and local policy, CHAD is helping to ensure that our research has a positive impact on our surrounding environment. This project is also helping to shape national policy by providing guidance to Public Health England on the National Planning Policy Guidance and to develop a Healthy Urban Planning Indicator.

This work has been recognised by the Town and County Planning Association and featured in their latest publication on ’reuniting health and planning’

International Physical activity and Environment Network (IPEN)

CHAD researchers are involved in the International Physical Activity Network (IPEN) study. Funded by NIH’s National Cancer Institute, this 15-country study allowed further collection on environmental determinants of physical activity and health in Stoke-on-Trent, which began with a previous MRC-funded project. Collection of survey and GIS data in the UK and other countries using a common approach will enable pooled analyses to examine how specific environmental attributes are related to physical activity using data from a range of diverse environments.

Find out more information here: http://www.ipenproject.org

Associated Publications

Restoration in mental health after visiting urban green spaces, who is most affected? Comparison between good/poor mental health in four European cities
Alessia Grigoletto, Stefania Toselli, Wilma Zijlema, Sandra Marquez, Margarita Triguero-Mas, Christopher Gidlow, Regina Grazuleviciene, Magdalena Van de Berg, Hanneke Kruize, Jolanda Maas, Mark J. Nieuwenhuijsen, Restoration in mental health after visiting urban green spaces, who is most affected? Comparison between good/poor mental health in four European cities, Environmental Research, 2023, 115397, ISSN 0013-9351, https://doi.org/10.1016/j.envres.2023.115397.

Access to parks and physical activity: An eight country comparison
Schipperijn, J., Cerin, E., Adams, M. A., Reis, R., Smith, G., Cain, K., Christiansen, Lars B, van Dyck, Delfien, Gidlow, Christopher, Frank, Lawrence D, Mitáš, Josef, Pratt, Michael, Salvo, Deborah, Schofield, Grant, Sallis, James F. (2017). Access to parks and physical activity: An eight country comparison. Urban Forestry & Urban Greening, 27(Supplement C), 253–263. doi: 10.1016/j.ufug.2017.08.010

Psycho-physiological responses of repeated exposure to natural and urban environments
Marc V. Jones, Christopher J. Gidlow, Gemma Hurst, Daniel Masterson, Graham Smith, Naomi Ellis, David Clark-Carter, Mika P. Tarvainen, Elizabeth C. Braithwaite, Mark Nieuwenhuijsen, Psycho-physiological responses of repeated exposure to natural and urban environments, Landscape and Urban Planning, Volume 209, 2021, 104061, ISSN 0169-2046, doi: 10.1016/j.landurbplan.2021.104061

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project
Wilma L. Zijlema,Ione Avila-Palencia,Margarita Triguero-Mas,Christopher Gidlow,Jolanda Maas,Hanneke Kruize,Sandra Andrusaityte,Regina Grazuleviciene,Mark J. Nieuwenhuijsen. Environment International, doi: 10.1016/j.envint.2018.10.002

Development of the natural environment scoring tool (NEST)
Gidlow et al. Development of the natural environment scoring tool (NEST). Urban Forestry & Urban Greening, 2018, 29: p322-333 doi: 10.1016/j.ufug.2017.12.007

Living Close to Natural Outdoor Environments in Four European Cities: Adults’ Contact with the Environments and Physical Activity
Triguero-Mas, Margarita, Donaire-Gonzalez, David, Seto, Edmund, Valentín, Antònia, Smith, Graham, Martínez, David, Carrasco-Turigas, Glòria, Masterson, Daniel, van den Berg, Magdalena, Ambròs, Albert , Martínez-Íñiguez, Tania, Dedele, Audrius, Hurst, Gemma, Ellis, Naomi, Grazulevicius, Tomas, Voorsmit, Martin, Cirach, Marta , Cirac-Claveras, Judith, Swart, Wim, Clasquin, Eddy, Maas, Jolanda, Wendel-Vos, Wanda, Jerrett, Michael, Gražulevičienė, Regina, Kruize, Hanneke, Gidlow, Christopher J, Nieuwenhuijsen, Mark J. Living Close to Natural Outdoor Environments in Four European Cities: Adults’ Contact with the Environments and Physical Activity. Int J Environ Res Public Health. 2017;14. PMID: 28974010 | doi: 10.3390/ijerph14101162

Natural outdoor environments and mental health: Stress as a possible mechanism
Triguero-Mas M, Donaire-Gonzalez D, Seto E, Valentín A, Martínez D, Smith G, Hurst, Gemma Carrasco-Turigas, Glòria Masterson, Daniel, van den Berg, Magdalena, Ambròs, Albert, Martínez-Íñiguez, Tania ,Dedele, Audrius, Ellis, Naomi, Grazulevicius, Tomas, Voorsmit, Martin, Cirach, Marta, Cirac-Claveras, Judith, Swart, Wim, Clasquin, Eddy, Ruijsbroek, Annemarie, Maas, Jolanda, Jerret, Michael, Gražulevičienė, Regina, Kruize, Hanneke, Gidlow, Christopher J, Nieuwenhuijsen, Mark J. Natural outdoor environments and mental health: Stress as a possible mechanism. Environ Res. 2017;159:629–38. doi: 10.1016/j.envres.2017.08.048

Does the Health Impact of Exposure to Neighbourhood Green Space Differ between Population Groups? An Explorative Study in Four European Cities
Ruijsbroek A, Droomers M, Kruize H, van Kempen E, Gidlow CJ, Hurst G, Andrusaityte S, Nieuwenhuijsen MJ, Maas J, Hardyns W, Stronks K, Groenewegen PP: Does the Health Impact of Exposure to Neighbourhood Green Space Differ between Population Groups? An Explorative Study in Four European Cities. Int J Environ Res Public Health. 2017, 14. PMID: 28594390 | doi: 10.3390/ijerph14060618

Characterisation of the natural environment: quantitative indicators across Europe
Smith G, Cirach M, Swart W, Dėdelė A, Gidlow C, van Kempen E, Kruize H, Gražulevičienė R, Nieuwenhuijsen MJ: Characterisation of the natural environment: quantitative indicators across Europe. Int J Health Geogr 2017, 16:16. PMCID: PMC5406880 | doi: 10.1186/s12942-017-0090-z

Neighbourhood green space, social environment and mental health: an examination in four European cities
Ruijsbroek A, Mohnen SM, Droomers M, Kruize H, Gidlow C, Gražulevičiene R, Andrusaityte S, Maas J, Nieuwenhuijsen MJ, Triguero-Mas M, Masterson D, Ellis N, van Kempen E, Hardyns W, Stronks K, Groenewegen PP: Neighbourhood green space, social environment and mental health: an examination in four European cities. Int J Public Health 2017:1–11. doi: 10.1007/s00038-017-0963-8

The relationship between natural outdoor environments and cognitive functioning and its mediators
Zijlema WL, Triguero-Mas M, Smith G, Cirach M, Martinez D, Dadvand P, Gascon M, Jones M, Gidlow C, Hurst G, Masterson D, Ellis N, van den Berg M, Maas J, van Kamp I, van den Hazel P, Kruize H, Nieuwenhuijsen MJ, Julvez. The relationship between natural outdoor environments and cognitive functioning and its mediators. Environ Res. 2017, 27;155:268-275. doi: 10.1016/j.envres.2017.02.017

The effect of randomised exposure to different types of natural outdoor environments compared to exposure to an urban environment on people with indications of psychological distress in Catalonia
Triguero-Mas M, Gidlow CJ, Martínez D, de Bont J, Carrasco-Turigas G, Martínez-Íñiguez T, et al. The effect of randomised exposure to different types of natural outdoor environments compared to exposure to an urban environment on people with indications of psychological distress in Catalonia. PLoS One; 2017, 1;12(3):e0172200. doi: 10.1371/journal.pone.0172200.s014

Research note: Natural environments and prescribing in England. Landscape and Urban Planning
Gidlow, C.J., Smith, G., Martinez, D., Wilson, R., Trinder, P., Gražulevičienė, R. and Nieuwenhuijsen, M.J. Research note: Natural environments and prescribing in England. Landscape and Urban Planning. 2016. doi: 10.1016/j.landurbplan.2016.02.002

Natural environments and chronic stress measured by hair cortisol
Gidlow, C.J., Randall, J., Gillman, J., Smith, G.R. and Jones, M.V. Natural environments and chronic stress measured by hair cortisol. Landscape and Urban Planning, 2016, 148, pp.61-67. doi: 10.1016/j.landurbplan.2015.12.009

Visiting green space is associated with mental health and vitality: A cross-sectional study in four European cities
van den Berg, M., van Poppel, M., van Kamp, I., Andrusaityte, S., Balseviciene, B., Cirach, M., Danileviciute, A., Ellis, N., Hurst, G., Masterson, D. and Smith, G., Triguero-Mas M , Uzdanaviciute I , Wit Pd , Mechelen Wv , Gidlow C , Grazuleviciene R , Nieuwenhuijsen MJ , Kruize H , Maas J.. Visiting green space is associated with mental health and vitality: A cross-sectional study in four European cities. Health & Place. 2016, 38:8-15. doi: 10.1016/j.healthplace.2016.01.003

Where to put your best foot forward: Psycho-physiological responses to walking in natural and urban environments
Gidlow, C.J., Jones, M. V., Hurst, G., Masterson, D., Clark-Carter, D., Tarvainen, M. P., Smith, G. & Nieuwenhuijsen, M. Where to put your best foot forward: Psycho-physiological responses to walking in natural and urban environments. Journal of Environmental Psychology, 2015, 45:22-29. doi: 10.1016/j.jenvp.2015.11.003

The association between green space and depressive symptoms in pregnant women: moderating roles of socio-economic status and physical activity
McEachan, R, Prady, S.L., Smith, G., Fairley, L., Cabieses, B., Gidlow, C., Wright, J., Dadvand, P., van Gent, D., Nieuwenhuijsen, MJ. The association between green space and depressive symptoms in pregnant women: moderating roles of socio-economic status and physical activity. Journal of Epidemiology and Community Health. doi: 10.1136/jech-2015-205954

The Effect of Park and Urban Environments on Coronary Artery Disease Patients: A Randomized Trial
Grazuleviciene, R., Vencloviene, J., Kubilius, R., Grizas, V., Dedele, A., Grazulevicius, T., Ceponiene, I., Tamuleviciute-Prasciene, E., Nieuwenhuijsen, M.J., Jones, M. and Gidlow, C. The Effect of Park and Urban Environments on Coronary Artery Disease Patients: A Randomized Trial. BioMed Research International, 2015, 403012, 9, 2015. doi: 10.1155/2015/403012

Positive health effects of the natural outdoor environment in typical populations in different regions in Europe (PHENOTYPE): a study programme protocol
Nieuwenhuijsen MJ, Kruize H, Gidlow C, et al. Positive health effects of the natural outdoor environment in typical populations in different regions in Europe (PHENOTYPE): a study programme protocol. BMJ Open. April 1, 2014 2014;4(4). doi: 10.1136/bmjopen-2014-004951

Inequality, green spaces, and pregnant women: roles of ethnicity and individual and neighbourhood socioeconomic status
Dadvand, P., Wright, J., Martinez, D., Basagaña, X., McEachan, R.R., Cirach, M., Gidlow, C.J., de Hoogh, K., Gražulevičienė, R. and Nieuwenhuijsen, M.J . Inequality, green spaces, and pregnant women: roles of ethnicity and individual and neighbourhood socioeconomic status. Environment international 2014, 71:101-108. doi: 10.1016/j.envint.2014.06.010

The association between natural outdoor environments and common somatic symptoms
Watson, C., Nieuwenhuijsen, M. J., Triguero-Mas, M., Cirach, M., Maas, J., Gidlow, C., … Zijlema, W. L. (2020). The association between natural outdoor environments and common somatic symptoms. Health & Place, 64, 102381. https://doi.org/https://doi.org/10.1016/j.healthplace.2020.102381

Understanding correlates of neighborhood aesthetic ratings: A European-based Four City comparison
Zijlema WL, Triguero-Mas M, Cirach M, Gidlow C, Kruize H, Grazuleviciene R, Nieuwenhuijsen M, Litt J. Understanding correlates of neighborhood aesthetic ratings: A European-based Four City comparison. Urban Forestry & Urban Greening, 2020. 47:126523. doi: https://doi.org/10.1016/j.ufug.2019.126523

Exploring mechanisms underlying the relationship between the natural outdoor environment and health and well-being – Results from the PHENOTYPE project
Kruize, H., van Kamp, I., van den Berg, M., van Kempen, E., Wendel-Vos, W., Ruijsbroek, A., Swart, W., Maas, J., Gidlow, C., Smith, G., Ellis, N., Hurst, G., Masterson, D., Triguero-Mas, M., Cirach, M., Gražulevičienė, R., van den Hazel, P., Nieuwenhuijsen, M., 2019. Exploring mechanisms underlying the relationship between the natural outdoor environment and health and well-being – Results from the PHENOTYPE project. Environment International, 2020, 134: 105173. https://doi.org/10.1016/j.envint.2019.105173

Momentary mood response to natural outdoor environments in four European cities
Kondo, M.C., Triguero-Mas, M., Donaire-Gonzalez, D., Seto, E., Valentín, A., Hurst, G., Carrasco-Turigas, G., Masterson, D., Ambròs, A., Ellis, N., Swart, W., Davis, N., Maas, J., Jerrett, M., Gidlow, C.J., Nieuwenhuijsen, M.J., 2019. Momentary mood response to natural outdoor environments in four European cities. Environment International, 2020. 134: 105237. https://doi.org/10.1016/j.envint.2019.105237

Health Across the Life Course

RIsk COmmunication in NHS Health Check (RICO)

Qualitative video-stimulated recall study to explore cardiovascular disease risk communication in NHS Health checks using QRISK2 10-year risk and JBS3 lifetime risk calculators: NIHR Health Technology Assessment, 2017-2019.

NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. The RICO study uses novel qualitative methods and quantitative process evaluation to explore practitioner and patient CVD risk perceptions when using two different CVD risk calculators, the associated advice or treatment offered by the practitioner, and patients’ responses.

Find out more information here:

HEalth Check TRial (HECTR)
Randomised Controlled Trial of uptake in NHS Health Checks for CVD risk: Public Health England, Stoke-on-Trent city Council, Staffordshire County Council, 2015-2017.

Three-arm randomised controlled trial comparing uptake when patients were invited by generic invitation letters, letters that were personally tailored to individual patients CVD risk, or by telephone. Data from over 4600 patient from 9 general practices in Stoke-on-Trent/Staffordshire showed that the telephone was the most effective and cost-effective method, with the CVD risk-tailored letters offering only modest improvements (vs. generic letters).

Find out more information here: https://doi.org/10.1186/ISRCTN15840751

Evaluation of the Supporting a Smokefree Pregnancy Scheme

The Supporting a Smokefree Pregnancy Scheme (SaSFPS) in Stoke (co-ordinated by Stoke-on-Trent City Council) is an innovative intervention aimed at increasing smoking cessation in pregnancy. It aims to improve the health of pregnant women and to reduce the risks to their unborn children by increasing the number of pregnant women who stop smoking. Within this, specific goals are:

To support pregnant smokers to set a quit date and achieve a Carbon Monoxide (CO) validated 4 week quit (<10ppm)
To provide enhanced support to those women who have set a quit date and achieved a 4-week quit, within the scheme, to remain smoke-free throughout the pregnancy and for 12 weeks post-partum.

Information on smoking is routinely collected from pregnant women and nationally measured at time of delivery (SATOD). Stoke-on-Trent’s SATOD rates are above England’s average. There is a commitment to improving these rates, given the adverse effects that smoking is known to have on the outcomes of pregnancy which include increasing the overall risk of infant mortality by an estimated 40%, increasing the risk of miscarriage, premature birth, stillbirth, placental abnormalities, low birth-weight and sudden unexpected death in infancy (e.g., Dietz et al, 2010; Royal College of Physicians, 2010). Therefore, attempts to improve understanding about effective Schemes to help pregnant women to stop smoking are required.

CHAD is carrying out a mixed methods evaluation of the scheme, using programme data and primary qualitative data collection with clients and staff to explore their views and experiences of the scheme as well as its impact on quit rates.

References

Dietz, P.M., England, L.J., Shapiro-Mendoza, C.K., Tong, V.T., Farr, S.L., Callaghan, W.M. (2010). Infant morbidity and mortality attributable to prenatal smoking. Am J Prev Med. 39(1):45-52. doi: 10.1016/j.amepre.2010.03.009.

Royal College of Physicians. (2010). Passive smoking and children. A report by the Tobacco Advisory Group. London: Royal College of Physicians.

Associated Publications

The Impact and Perception of England’s Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study
Riley V, Gidlow C, Fedorowicz S, Lagord C, Thompson K, Woolner J, Taylor R, Clark J, Lloyd-Harris A. The Impact and Perception of England’s Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study. JMIR Cardio 2023;7:e39097. URL: https://cardio.jmir.org/2023/1/e39097 doi: https://doi.org/10.2196/39097

Cardiovascular disease risk communication in NHS health checks: video-stimulated recall interviews with practitioners
Gidlow CJ, Ellis NJ, Riley VA, Cowap L, Grogan S, Cottrell E, Grogan S, Chambers R, Calvert S, and Clark-Carter D. Cardiovascular disease risk communication in NHS health checks: video-stimulated recall interviews with practitioners. BJGP Open, 2021; BJGPO.2021.0049. doi: https://doi.org/10.3399/BJGPO.2021.0049

A qualitative exploration of two risk calculators using video-recorded NHS health check consultations
Riley, V.A., Ellis, N.J., Cowap, L., Grogan, S., et al. (2020). A qualitative exploration of two risk calculators using video-recorded NHS health check consultations. BMC Fam Pr, 21:250. doi: https://doi.org/10.1186/s12875-020-01315-6

Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators
Gidlow, C.J., Ellis, N.J., Cowap, L., Riley, V.A., et al. (2020). Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open; 10:e037790. doi: https://doi.org/10.1136/bmjopen-2020-037790

A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study
Gidlow CJ, Ellis NJ, Cowap L, et al. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC Fam. Pract. 2020. 20(11). https://doi.org/10.1186/s12875-018-0897-0

Understanding implementation and uptake in the National Health Service Health Check Programme
Riley VA, Gidlow C, Ellis NJ. Understanding implementation and uptake in the National Health Service Health Check Programme. Public Health. 2018;159:63–6. doi: 10.1016/j.puhe.2018.01.024

A qualitative investigation of non-response in NHS Health Checks
Ellis NJ, Gidlow CJ, Cowap L, Randall J, Iqbal Z, Kumar J. A qualitative investigation of non-response in NHS Health Checks. BMC Archives of Public Health 2015, 73(1):14. doi: 10.1186/s13690-015-0064-1

Method of invitation and geographical proximity as predictors of NHS Health Check uptake
Gidlow C, Ellis N, Randall J, Cowap L, Smith G, Iqbal Z, and Kumar J. Method of invitation and geographical proximity as predictors of NHS Health Check uptake. Journal of Public Health 2015, 37(2):195-201. doi: 10.1093/pubmed/fdu092

Opportunistic community-based health checks
Gidlow CJ, Ellis NJ. Opportunistic community-based health checks. Public Health. 2014;128(6):582-584. doi: 10.1016/j.puhe.2014.03.007

Feeding Infants with Down’s Syndrome: A Qualitative study or mothers’ experiences
Cartwright, A & Boath, E. (2018) Feeding Infants with Down’s Syndrome: A Qualitative study or mothers’ experiences. Journal of Neonatal Nursing, 24, 134-141. doi: 10.1016/j.jnn.2018.03.001

Antidepressants for preventing postnatal depression
Molyneaux E, Telesia LA, Henshaw C, Boath E, Bradley E, Howard LM. Antidepressants for preventing postnatal depression. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD004363. doi: 10.1002/14651858.CD004363.pub3

Peer support workers’ experiences of supporting women with postnatal depression: a constant comparative exploration
Carter, R. Cust, F & Boath, E (2018) Peer support workers’ experiences of supporting women with postnatal depression: a constant comparative exploration. Journal of Infant and Reproductive Psychology, 36 (2): doi: 10.1080/02646838.2017.1416336

Health Inclusion

Evaluation of a pilot project: ‘Asking about ACEs’ (Adverse Childhood Experiences)

This study is an evaluation of the pilot project ‘Asking about ACEs’ which is being trialled in two organisations in Stoke-on-Trent. The services involved are Arch and Youth Offending. It is a 6 month pilot and is being co-ordinated by Stoke-on-Trent City Council and evaluated by CHAD. We were successful in securing funding for the evaluation from Staffordshire Police and Crime Commissioner.

Adverse Childhood Experiences (ACEs) are a complex set of childhood experiences before the age of 18 that can include: sexual abuse, emotional abuse by a parent/caregiver, physical abuse by a parent/caregiver, emotional neglect by a parent/caregiver, physical neglect by a parent/caregiver, drugs/alcohol abuse in the household, having witnessed abuse in the household, a loved one in prison, loss or abandonment of/by a parent/caregiver, and mental illness in the household (McGee et al, 2015). Existing evidence has found that increasing ACEs are strongly related to adverse behavioural, health and social outcomes including, for example, involvement in violence, early unplanned pregnancy, incarceration, unemployment and problems with drug use and drug addiction (e.g., Felitti et al, 1998; Bellis et al, 2013).

Routine Enquiry about Adversity in Childhood (REACh) is the process of systematically asking individuals about adverse childhood experiences during routine assessments (McGee et al, 2015). The ‘Asking about ACEs’ pilot follows the same principle. Ultimately, the goal of this pilot is to enable individuals to move forward, changing focus from ‘what’s wrong with me’ to ‘what happened to me’, supporting people to break the cycle of risky behaviours/coping mechanisms and reduce demand for repeat interventions.

CHAD is conducting a mixed methods evaluation of the pilot. There are three main elements to this evaluation:

Conduct secondary analyses of service data
Collect qualitative data from clients to explore impact, experiences and delivery of the pilot
Collect qualitative data from service providers to explore views about implementation, delivery and impact of the pilot.

We anticipate completing this piece of work by the end of 2019.

References

Bellis, M.A., Lowey, H., Leckenby, N., Hughes, K. & Harrison, D. (2013). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36(1): 81‐91. doi:10.1093/pubmed/fdt038.

Felitti, M.D, Anda, R.F., Nordenberg, M.D, Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4): 245‐58.

McGee, C., Hughes, K., Quigg, Z., Bellis, M., Larkin, W. & Lowey, H. (2015) A Scoping Study of the Implementation of Routine Enquiry about Childhood Adversity (REACh): Blackburn with Darwen. Liverpool: Centre for Public Health, Liverpool John Moores University.