John William Frank

University of Edinburgh | UoE · Centre for Population Health Sciences Usher Institute

Objectives This study investigated sustainability and multimorbidity alongside barriers to employment including health and policy to demonstrate intersectional impact on return-to-work success within a UK welfare-to-work programme. Design Cohort study design: The study calculated the proportion of time spent employed after experiencing a job start...

Objectives Children of women who use substances are difficult to research at a population-level using traditional research methods due to the complexity of their lives. Resultingly, we have little robust evidence on their outcomes. This study developed an administrative data cohort of children exposed to opioids and explored health outcomes. Method...

Background As a novel global health pandemic, Coronavirus Disease-2019 (COVID-2019) has posed various challenges to frontline healthcare providers (FHCPs). This study explored the social and psychological challenges of COVID-19 to the FHCPs at Mbarara Regional Referral Hospital, southwestern Uganda. Methods This was a cross-sectional study with a...

For two decades, the international scholarly publishing community has been embroiled in a divisive debate about the best model for funding the dissemination of scientific research. Some may assume that this debate has been thoroughly resolved in favour of the Open Access (OA) model of scientific publishing. Recent commentaries reveal a less settled...

Objectives Scotland has the lowest life expectancy in Western Europe and significant health inequalities. A national review of public health in 2015 found that there was a lack of coherent action across organisational boundaries, inhibiting progress. This paper describes a rapid (four-month) systematic approach to prioritisation of Scotland's publi...

Objective To analyse the Growing Up in Scotland cohort for predictors of obesity at age 12, present at school entry (age 5–6). Methods The initial model included literature-based risk factors likely to be routinely collected in high-income countries (HICs), as well as “Adverse/Protective Childhood Experiences (ACEs/PCEs)”. Missing data were handle...

The ongoing obesity pandemic threatens the health of hundreds of millions globally. However, to date, no country has had much success in limiting its growth, let alone reversing it. This commentary demonstrates the relevance to the obesity pandemic of the public health conceptual framework of epidemiologist Geoffrey Rose, first published as "Sick I...

This paper argues that the public health conceptual framework of epidemiologist Geoffrey Rose, first published as “Sick Individuals and Sick Populations” in 1985, provides a useful way to critically analyze prevention and control options for modern non-communicable diseases (NCD) and their forerunner, obesity, a pandemic now engulfing Lower-and-Mid...

Background Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using co...

The COVID-19 pandemic has highlighted the fundamental role public health has in protecting populations and mitigating the impact of major threats to global health. We suggest that the COVID-19 pandemic response has raised important issues about the effectiveness and equity implications of current public health practice. We argue that we need to lea...

We are delighted by the spirited, scholarly and well-argued commentaries; we concur with much of what the commentators have said and have incorporated some of their thoughts and ideas into our response. Along with the commentaries, our response incorporates some ideas generated by others and the evolution of our own thinking to reiterate and sup...

Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hos...

Objectives To develop a Critical Appraisal tool for non-computational-specialist public health professionals to assess the quality and relevance of modelling studies about Test and Trace (and Protect – TTP) programmes’ impact on COVID-19 transmission. Study Design Decision-making tool development. Methods Using Tugwell et al.’s Health Care Effect...

New fifth generation (5G) telecommunications systems, now being rolled out globally, have become the subject of a fierce controversy. Some health protection agencies and their scientific advisory committees have concluded that there is no conclusive scientific evidence of harm. Several recent reviews by independent scientists, however, suggest that...

We assess the extent and quality of High-Income Countries’ (HIC) practices in monitoring Socioeconomic Inequalities in Health (SIH) through routine data collection/collation and analysis systems. Official websites of government authorities of eligible countries were examined for any reports containing data on SIH, which were assessed for quality fr...

Background Governments and health policymakers are now looking for strategies to lift the COVID-19 lockdown, while reducing risk to the public. Methods We propose the population attributable risk (PAR) as an established epidemiological tool that could support decision-making through quickly estimating the main benefits and costs of various exit st...

Twelve years have now passed since the influential WHO Report on the Social Determinants of Health (SDoH) in 2008. A group of senior international public health scholars and decision-makers met in Italy in mid-2019 to review the legacy of the SDoH conceptual framework and its adequacy for the many challenges facing our field as we enter the 2020s....

Background: National health surveys linked to vital statistics and health care information provide a growing source of individual-level population health data. Pooling linked surveys across jurisdictions would create comprehensive datasets that are larger than most existing cohort studies, and that have a unique international and population perspe...

Background This study aimed to characterize trends in absolute and relative socioeconomic inequalities in adult premature mortality between 1992 and 2017, in the context of declining population-wide mortality rates. We conducted a population-based cohort study of all adult premature deaths in Ontario, Canada using provincial vital statistics data l...

Objective To examine the association between high maternal weight status and complications during pregnancy and delivery. Setting Scotland. Participants Data from 132 899 first-time singleton deliveries in Scotland between 2008 and 2015 were used. Women with overweight and obesity were compared with women with normal weight. Associations between...

Background with rationale Children born to opioid-dependent mothers are at a developmental disadvantage from pre-birth. They are additionally affected by the mother’s compromised ability to recognise and respond to the infant’s cues. Development is often compounded by environmental factors. Research to date has primarily focused on early infancy an...

Several countries have increased their legal minimum age for work in line with international conventions on child labor. We evaluated the effect of increasing the legal minimum age for work on school attendance in 3 low- and middle-income countries using difference-in-differences analyses. Increasing the legal minimum age for work increased school...

Objectives To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks. Methods Using Growing Up in Scotland birth cohort data (N = 2816), an inv...

Background and objectives Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine the prevalence of ACEs at age 8 in a recent prospective birth cohort and...

Objective To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I–II. Design Pragmatic randomised clin...

Objectives To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstr...

There is increasing interest amongst researchers and policy makers in identifying the effect of public health interventions on health inequalities by socioeconomic status (SES). This issue is typically addressed in evaluation studies through subgroup analyses, where researchers test whether the effect of an intervention differs according to the soc...

Objectives To investigate the role of individual factors (including age, health and personal circumstances) and external factors associated with clients having a job start while engaging with the Work Programme and variations by benefit type. Setting The UK Government’s main return to work initiative (The Work Programme) in Scotland. Design Piece...

Addressing social determinants of health (SDoH) has been acknowledged as an essential objective for the promotion of both population health and health equity. Extant literature has identified seven potential areas of investment to address SDoH: investments in sexual and reproductive health and family planning, early learning and child care, educati...

It is assumed that long-established research findings and internationally accepted evidence should, and will, be translated into policy and practice. Knowledge about what prevents harm and promotes health has, in fact, guided and resulted in numerous beneficial public health actions. However, such is not always the case. The authors examine three n...

This article presents a critical commentary of specific organizational models and practices for bridging 'the gap' between public health research and policy and practice. The authors draw on personal experiences of such models in addition to the wider knowledge translation and exchange literature to reflect on their strengths and weaknesses as impl...

There has been a substantial amount of debate around the role of parental risk aversity in children's health and wellbeing, with results suggesting that, whilst in the short-term, parents may ensure their children's safety, in the longer-term, children's psychological well-being may be compromised, and a lack of activity may result in a range of ot...

Background Child marriage harms girls’ health and hinders progress toward development goals. Randomized studies have shown that providing financial incentives for girls’ education can effectively delay marriage, but larger-scale interventions are needed in light of slow progress toward curbing the practice. Many sub-Saharan African countries elimin...

The percentage of women born during the pre-policy period between 1970 and 1987 who experienced each outcome and estimates of the average annual percentage-point change in each outcome over the same time period. (DOCX)

Introduction By 2020 people aged 50 years and over will make up almost half of the adult population in the UK. Policy aims to enable more people to work for longer however there is a dramatic drop in labour participation after age 50. Our aim was to investigate the impact of age, and health on return to work (RTW) in welfare benefit claimants engag...

Objective: To examine changes in minimum wage associated with changes in women's weight status. Design: Longitudinal study of legislated minimum wage levels (per month, purchasing power parity-adjusted, 2011 constant US dollar values) linked to anthropometric and sociodemographic data from multiple Demographic and Health Surveys (2000-2014). Sep...

Purpose Our objective was to develop a clinical prediction model to identify workers with sustainable employment following an episode of work-related low back pain (LBP). Methods We used data from a cohort study of injured workers with incident LBP claims in the USA to predict employment patterns 1 and 6 months following a workers' compensation cla...

Background The purpose of this situation analysis was to explore the views of health and non-health professionals working with women of childbearing age on current and future delivery of preconception care in one National Health Service (NHS) Board area in Scotland. Methods The situation analysis was undertaken using a mixed methods approach. Six...

We offer a UK-based commentary on the recent "Perspective" published in IJHPM by Thakkar and Sullivan. We are sympathetic to the authors' call for increased funding for health service and policy research (HSPR). However, we point out that increasing that investment - in any of the three countries they compare: Canada, the United States and the Unit...

Objectives To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden. Design Comparative cross-sectional study. Setting Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south...

Objectives Returning to employment after a period on welfare benefits is particularly challenging for people aged over-50 and those with health conditions. We explore the unemployment-to-employment transitions made by clients engaging with the Work Programme (WP); the UK Government’s main return to work (RTW) initiative. It supports two main groups...

Background: This study examines whether young never smokers in Scotland, UK, who have tried an e-cigarette are more likely than those who have not, to try a cigarette during the following year. Methods: Prospective cohort survey conducted in four high schools in Scotland, UK during February/March 2015 (n=3807) with follow-up 1 year later. All pu...

Applied prevention research centres (APRCs) are important parts of public health efforts to prevent chronic disease and promote healthy living. How to measure their practical impacts upon society remains poorly understood. This study aimed to identify indicators considered by a diverse set of stakeholders to be most important for capturing the prac...

Background Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning. Our objective was to analyse contemporary sex differences over a 20-year period. Methods We ana...

Background Adiposity rebound is considered critical to the development of overweight and obesity. The purpose of this study was to investigate how growth has changed in comparison to the UK 1990 BMI growth reference curves between the ages 4–8 years and identify any marked deviations in growth. We also examined potential maternal and child risk/pro...

Objectives Supporting people back into employment after a period on welfare benefits is an important policy goal in many countries but difficult to achieve for people aged over 50 and those out of work for health reasons. The study’s objective was to establish a cohort of clients engaging with the UK Government’s return to work (RTW) initiative, th...

Preventive medical interventions and non-medicalised public health programmes that promise health benefits in the future, from actions taken now, carry a strong ethical requirement of 'first, do no harm' or primum non nocere. New preventive advice and interventions are being promoted on a daily basis. Disease Prevention: A Critical Toolkit provides...

Chapter 2 employs the historical example of Goldberger’s investigations of the major epidemic of pellagra in the southern USA in the early years of the twentieth century, to introduce the ‘hierarchy of preventive interventions.’ Subsequently, four worked examples are provided of recent preventive medical or community programme interventions that we...

In this chapter, the authors use the historical case-study of John Snow’s investigations into the London cholera epidemics, about 160 years ago, to introduce a widely-used epidemiological study design—the cohort study—for quantifying the strength of association between a putatively causal exposure and an adverse health outcome. This historical exam...

So far, the authors have tried to lay out the principles of evaluating evidence for both the causation of diseases and their prevention. The authors have so far focused in this book mainly on studies purporting to show that preventive interventions improve health on average, i.e. improve the probability of future good health and/or longer life for...

There is a huge number of research papers published each year, and it is difficult to decide which are most useful and reliable, even if one can find those that relate to a specific research question of interest. This chapter provides guidance on finding the sources, and types of information that are most useful and reliable in the area of preventi...

In this chapter, the authors look at how causation and prevention, discussed in Chapter 3 largely in terms of the health of individuals, have parallel, but rather different implications when applied to entire communities or populations. A useful starting point is the ‘slow, non-infectious’ pandemic of obesity. The underlying drivers of this pandemi...

In Chapter 2, the example of a widely-used screening test for prostate cancer (PSA) was used to illustrate one of the most profound turnarounds in medical thinking about prevention in recent decades. This was spurred on by the first-ever publication of a controlled trial of a cancer screening test, which demonstrated strong evidence that the test d...

In this chapter, the authors examine a specific kind of preventive advice—what (and what not) to eat and drink to stay healthy. While it is tempting to critique the vast majority of this advice purely on the basis that it comes from sources not formally trained in nutritional science or epidemiology, the authors have restricted their discussion to...

This chapter builds on the earlier discussions of causation, including the seminal ideas of Geoffrey Rose (Chapter 5), risk factor detection for chronic disease (Chapter 7), and cancer screening (Chapter 8). In this chapter, the authors look critically at the most high-profile approach to prevention to arise in the last few decades—genetic testing...

Objectives: Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for...

Background There has been a rapid increase in the retail availability of e-cigarettes in the UK and elsewhere. It is known that exposure to cigarette point-of-sale (POS) displays influences smoking behaviour and intentions in young people. However, there is as yet no evidence regarding the relationship between e-cigarette POS display exposure and e...

Statistical and biological methods are available to probe why the prevalence of obesity has risen more in some countries than in others, says John Frank.

Objectives: To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. Methods: A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24-49 y) from the...

Adverse anthropometric outcomes, monthly minimum wage and level of development in the study sample of adult women, by country. (PDF)

Differences by SES in the proportion of overweight and obese women in each low-income country. Panel A. Highest education level. Panel B. Occupation status. Panel C. Geographic location. (PDF)

Differences by SES in the proportion of overweight and obese women in each middle-income country. Panel A. Highest education level. Panel B. Occupation status. Panel C. Geographic location. (PDF)

Association of minimum wage with obesity in adult women in overall and stratified two-level random intercept models. (PDF)

Association of monthly minimum wage with overweight and obesity in adult women using pooled data with interaction terms. (PDF)

Association of monthly minimum wage with obesity in adult women using pooled data with interaction terms. (PDF)

Introduction: As further restrictions have been placed on tobacco advertising and promotions, point of sale (PoS) displays of cigarettes in shops have become an increasingly important source of young people's exposure to tobacco products. This study explored the relationship between PoS displays of cigarettes and brand awareness among secondary sc...

Objective To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents. Design Cross-sectional observational study. Setting High schools in Scotland. Participants Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 commu...

Introduction: Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how...

A report for the Early to Mid-Working Life Working Group of the Scottish Collaboration for Public Health Research and Policy (SCPHRP). Edinburgh 2011

Background: The Scottish Government's 'Route-Map Action Plan' for obesity prevention sets out 62 potential intervention policies across all stages of the life course. We used the ANGELO Framework (Analysis Grid for Environments Linked to Obesity) to assess the appropriateness and likely impact of the balance of measures being proposed. Methods:...

While widespread lip service is given in the UK to the social determinants of health (SDoH), there are few published comparisons of how the UK's devolved jurisdictions 'stack up', in terms of implementing SDoH-based policies and programmes, to improve health equity over the life-course. Based on recent SDoH publications, seven key societal-level in...