Mark Bellis

• D.Sc.
• Managing Director at Liverpool John Moores University

Background: ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England. Methods: A nationally representati...

Rock and pop fame is associated with risk taking, substance use and premature mortality. We examine relationships between fame and premature mortality and test how such relationships vary with type of performer (eg, solo or band member) and nationality and whether cause of death is linked with prefame (adverse childhood) experiences. A retrospectiv...

Background: Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective...

Background Adverse childhood experiences (ACEs) increase individuals’ risks of poor health across the life course. For children that suffer household-based ACEs, experiences in other settings such as schools have the potential to exacerbate or mitigate risks of poor health. However, few studies have examined such effects. This study aimed to examin...

Background Evidence indicates that neurodivergent (ND) populations may be more at risk of experiencing adverse childhood experiences (ACEs), compared to neurotypical (NT) populations. However, this evidence has typically not examined a comprehensive set of ACEs and has only included ND individuals on the basis that they have a diagnosis. Very littl...

Background Adverse childhood experiences (ACEs) are associated with negative health and wellbeing outcomes. Ensuring young people receive timely and appropriate support after experiencing ACEs could improve these outcomes. Objective This study aimed to explore what works to support young people living with ACEs; what support do they receive, and wh...

Objective The UK Government increasingly emphasises a comprehensive, multi-agency approach to tackling crime. This pilot study explores the feasibility of integrating police data with routine health data to develop a holistic understanding of the predictors of domestic abuse (DA). ApproachThe study encompasses three work-packages a) coding the narr...

Exposure to adverse childhood experiences (ACEs) is recognised globally as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing within schools and educational settings, as well as the demand for supportive services to address needs. However, there is a lack of clear evidence for effective interventi...

Background A major factor associated with individuals’ adoption of public health advice, or engagement with health, social and other services, is level of trust in information sources and service providers. Individuals exposed to child maltreatment and other ACEs often have poorer health outcomes across the life course and consequently, may benefit...

Background Exposure to child maltreatment is a risk factor for offending. Exposure to adverse childhood experiences (ACEs; child maltreatment and other chronic stressors) is linked to violence involvement and serious offending. Despite an intergenerational transmission of offending behaviour from parent to child, the intergenerational continuity of...

Background A billion children are estimated to suffer violence each year. To support country efforts to end violence against children, WHO and partners developed INSPIRE - a technical package including seven evidence-based strategies to prevent and respond to violence against children. Whilst many of these strategies focus on individual and interpe...

Introduction Trust in health and other systems can affect uptake of public health advice and engagement with health services. Individuals who had adverse childhood experiences (ACEs) are more likely to experience ill health at earlier ages. Ensuring their engagement with health and other services is important in improving their life course prospect...

Objectives Adverse childhood experiences (ACEs) can affect individuals’ resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. Design National cross-sectional face-to-face s...

Objective: Climate change is recognised as the biggest threat to global health of the 21st century and impacts on health and wellbeing through a range of factors. Due to this, the need to take action in order to protect population health and wellbeing is becoming ever more urgent. Methods: In 2019, Public Health Wales carried out a comprehensive mi...

Violence has immediate and long-term repercussions for the health of individuals and communities. Recent increases in the understanding of public health approaches to violence prevention have focused on the policies and practices of government, health, and other public sector agencies. However, the roles of commercial bodies in fostering and preven...

This article seeks to understand the experiences of bystanders to domestic violence and abuse (DVA) during the COVID-19 pandemic in Wales. Globally, professionals voiced concern over the COVID-19 restrictions exacerbating conditions for DVA to occur. Yet evidence suggests this also increased opportunities for bystanders to become aware of DVA and t...

Background Nightlife environments are high risk settings for sexual violence and bystander intervention programmes are being developed in response. However, more research is needed to understand nightlife-related sexual violence, and factors that influence bystander interventions. This study examined nightlife patron’s experiences of sexual violenc...

The Crime and Disorder Act (1998) requires the police, local authorities, NHS, and other organisations to share intelligence and collectively work to reduce violent crime. This paper aimed to explore opinions on linking police data with other agency data. Interviews were undertaken with individuals from police forces in Wales, UK. Barriers to shari...

Importance Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk beh...

Exposure to adverse childhood experiences (ACEs) is increasingly recognised as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing in schools and educational settings, as well as demand for supportive services to deal with needs. However, there is a lack of clear evidence for effective intervention...

Background Adverse childhood experiences (ACEs) can impact mental and physical health, leaving people with less resilience to health challenges across the life-course. This study examines whether individuals’ levels and changes in levels of mental health, physical health and sleep quality reported across the first year of the COVID-19 pandemic are...

Adverse childhood experiences (ACEs) encompass various adversities, e.g., physical and/or emotional abuse. Understanding the effects of different ACE types on various health outcomes can guide targeted prevention and intervention. We estimated the association between three categories of ACEs in isolation and when they co-occurred. Specifically, the...

Background: Exposure to domestic abuse can lead to long-term negative impacts on the victim's physical and psychological wellbeing. The 1998 Crime and Disorder Act requires agencies to collaborate on crime reduction strategies, including data sharing. Although data sharing is feasible for individuals, rarely are whole-agency data linked. This stud...

Background: Unemployment has adverse consequences for families and can put children at risk of harm. This study presents a systematic review and meta-analysis of global evidence on associations between parental unemployment and adverse childhood experiences (ACEs). Methods: Systematic literature searches across four databases identified cross-se...

Objectives Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms. Desi...

Brexit, COVID-19 and climate change pose challenges of national and global importance. They continue to have impacts across the economy, society, health, and the environment, all of which are determinants of health and well-being. Between 2018 and 2021, Public Health Wales undertook three Health Impact Assessments (HIA) in relation to the impact of...

Unintentional injury is a significant cause of disease burden and death. There are known inequalities in the experience of unintentional injuries; however, to date only a limited body of re-search has explored the relationship between exposure to adverse childhood experiences (ACEs) and unintentional injury. Using a cross-sectional sample of the ad...

Background Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. Aim This study examined the impact of COVID-19 response measures on changes in violence against women and chil...

Aims Alcohol service to intoxicated patrons is common across nightlife settings and preventing such sales is a key priority globally. In England and Wales, three multi-component programmes have been implemented including: 1) community mobilisation, responsible beverage server (RBS) training and routine law enforcement; 2) community mobilisation and...

Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the star...

Population health and wellbeing is both a result, as well as a driver, of economic development and prosperity on global, European, national and sub-national (local) levels. Wales, one of the four United Kingdom (UK) nations, has shown a long-term commitment to sustainable development and achieving prosperity for all, providing a good example of bot...

Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for ‘Health in All Policies’ (HiAP). A valuable tool to support this is the health impact assessment. This study aims to support pub...

Child physical punishment is harmful to children and, as such, is being prohibited by a growing number of countries, including Wales. Parents' own childhood histories may affect their risks of using child physical punishment. We conducted a national cross-sectional survey of Welsh adults and measured relationships between the number of adverse chil...

Background Forty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in...

Background Social distancing measures have been effective in mitigating the spread of COVID-19; however, they have imposed a significant burden on population mental health and well-being. This study aimed to identify factors associated with loneliness during the COVID-19 pandemic, and to describe the relationship between loneliness and the risk of...

Background Workplace physical activity interventions have shown positive outcomes for employee health, productivity and absenteeism (1,2). However, the majority prescribe the duration and/or type of activity to be undertaken. In response to strong public opinion that employers should do more to improve the health of their workforce, Public Health W...

Introduction Making the case for investing in preventative public health by illustrating not only the health impact but the social, economic and environmental value of Public Health Institutes is imperative. This is captured by the concept of Social Value, which when measured, demonstrates the combined intersectoral value of public health. There is...

This comprehensive Mental Wellbeing Impact Assessment (MWIA) has been carried out by the Wales Health Impact Assessment Support Unit to identify the impacts of the COVID-19 pandemic, and associated policy responses, on the mental wellbeing of young people aged 10-24 in Wales.

Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. D...

This comprehensive Mental Wellbeing Impact Assessment (MWIA) has been carried out by the Wales Health Impact Assessment Support Unit to identify the impacts of the COVID-19 pandemic, and associated policy responses, on the mental wellbeing of young people aged 10-24 in Wales.

Background Interpersonal violence has devastating implications for individuals, families, and communities across the globe, placing a significant burden on health, justice, and social welfare systems. Smartphone technology may provide a platform for violence prevention interventions. However, evidence on the availability and user experience of smar...

Introduction Alcohol service to intoxicated patrons is common across nightlife settings and preventing such sales is a key priority globally. In England and Wales, three multi-component programmes have been implemented including: (1) community mobilisation, responsible beverage server (RBS) training and routine law enforcement; (2) community mobili...

Background In response to successive COVID-19 restrictions in Wales, the Welsh ACE Support Hub launched the #TimeToBeKind campaign in March 2021. The campaign used a short film broadcast on national television and promoted on social media to encourage behaviour change for kindness. We evaluated the #TimeToBeKind campaign film to identify whether wa...

Background Estimates show that only half of adults in Wales meet the UK recommend guidelines for physical activity. In 2015, the financial burden of physical inactivity to the Welsh NHS was estimated to be £35 million. Workplace interventions promoting physical activity can result in positive outcomes for employee health, wellbeing, productivity, j...

Background Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child a...

Background Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children...

This report aims to highlight the major positive and negative health impacts of spatial planning policies during the COVID-19 pandemic on the population of Wales, learn from these, any positive interventions and co-benefits in order to shape a healthier future environment for all. It is aimed at a wide range of stakeholders including planning, en...

Objectives Adverse childhood experiences (ACEs) can affect life-course health and well-being, including risk-taking behaviour and trust. This study explored associations between ACEs and trust in health information on COVID-19, attitudes towards and compliance with COVID-19 restrictions and vaccine hesitancy. Design National cross-sectional teleph...

Issue Public health Institutes (PHIs) need to build on traditional approaches to capture and measure their value and impact. As we transfer into the COVID-19 recovery phase, it is important to maximise the value of the health impact but also the social, economic and environmental impact of PHIs. Exploration is required to understand how the social...

Background The coronavirus (COVID-19) pandemic has highlighted that individuals with behavioural risk factors commonly associated with non-communicable diseases (NCDs), such as smoking, harmful alcohol use, obesity, and physical inactivity, are more likely to experience severe symptoms from COVID-19. These risk factors have been shown to increase t...

Background Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries. Methods In this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Cri...

The SARS-COV-02 pandemic has globally resulted in a number of policies and interventions to address and reduce the transmission of the disease throughout the population. Mitigation measures have ranged from ‘Staying at Home' or ‘Lockdowns' to social distancing policies and requirements to work from home when you can. Whilst there are a number of pa...

Introduction The unemployment rate following the COVID-19 pandemic in Wales is increasing and there is a positive link between unemployment and longstanding illnesses. This study aimed to project the percentage of adults with longstanding illnesses and chronic health conditions following COVID-19 associated with the economic consequences. Methods...

The report provides a strategic overview of the cumulative and interconnected health and well-being impacts of Brexit, COVID-19 pandemic and climate change in Wales and the ‘triple challenge’ that this poses for the population. It identifies the key social determinants and population groups affected by this Triple Challenge and provides some key...

This research explores the experiences and behaviours of bystanders to domestic abuse during the COVID-19 pandemic, to help inform policy and bystander intervention training programmes in light of the changes to daily lives brought about by COVID-19 restrictions. This study, delivered in partnership with the University of Exeter, and funded by Pub...

Background: Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children...

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is...

Background Adverse childhood experiences (ACEs) are negatively associated with a range of child health outcomes. In this study, we explored associations between five individual ACEs and child mental health diagnoses or symptoms. ACEs included living with someone who had an alcohol-related problem, common mental health disorder or serious mental ill...

Objectives An evaluation of a short animated film on adverse childhood experiences (ACEs) to explore attitudes and sentiment towards the film including, for a subsample of professionals, associations between attitudes and personal experience of ACEs. Design Mixed-method exploratory design. Setting Professionals and the general public. Participan...

Background Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decision...

Background Adverse childhood experiences (ACEs) can affect health and well-being across the life course. Resilience is an individual characteristic that is known to help negate the effect of adversities and potentially transform toxic stress into tolerable stress. Having access to a trusted adult during childhood is critical to helping children bui...

Introduction: Population health concerns have been raised about negative impacts from overuse of digital technologies. We examine patterns of online activity predictive of Digital Overuse and Addictive Traits (DOAT). We explore associations between DOAT and mental well-being and analyse how both relate to self-reported changes in self-esteem, perce...

Interpersonal violence is a serious threat to the attainment of the Sustainable Development Goals (SDGs). A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study us...

Over the past three years, a partnership of the four Welsh police forces, Barnardo’s Cymru, Her Majesty’s Prison and Probation Service and Public Health Wales has worked together to bring about substantive change in the culture and operation of policing and criminal justice in Wales. Consistent with the wider legislative and policy context national...

Background Preventing sexual violence in nightlife environments is a pervasive issue across many countries. This study explored the associated impact of a nightlife worker sexual violence awareness raising/bystander training programme (STOP-SV) on trainees’ sexual violence myth acceptance and readiness and confidence to intervene. Methods : Pre- a...

The Wales Health Impact Assessment Support Unit, WHO Collaborating Centre on Investment for Health and Wellbeing Directorate has published ‘A COVID-19 pandemic world and beyond: The health impact of home and agile working in Wales ’. Home working has emerged as having a significant impact for many in the population as a result of the measures imple...

The Wales Health Impact Assessment Support Unit, WHO Collaborating Centre on Investment for Health and Wellbeing Directorate has published ‘A COVID-19 pandemic world and beyond: The health impact of home and agile working in Wales ’. Home working has emerged as having a significant impact for many in the population as a result of the measures imple...

Background Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals’ health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global researc...

Objectives: Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years. Study design: The study design used in the study is a population-based electronic cohor...

Objectives To examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients. Design Cross-sectional observational study using anonymised data from electronic health records for 763 patients. Setting Four general practices in northwest England and Nor...

This is the expanded original rapid response letter in relation to the Triple Challenge that the UK faces in Brexit, Covid-19 and Climate Change.

The Main Findings report provides a comprehensive appraisal of the potential health and well-being impacts of the Staying at Home and Social Distancing Policy (commonly referred to as ‘Lockdown’) on the population of Wales in the short, medium and long term. It was carried out rapidly in real-time and draws upon learning from international evidence...

The Main Findings report provides a comprehensive appraisal of the potential health and well-being impacts of the Staying at Home and Social Distancing Policy (commonly referred to as ‘Lockdown’) on the population of Wales in the short, medium and long term. It was carried out rapidly in real-time and draws upon learning from international evidence...

The Supporting Information report contains the methodology, literature review and supporting technical documents

Background: Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few st...

Experts from across the globe have warned of the adverse consequences of COVID-19 lockdown and physical distancing restrictions on violence in the home, with the United Nations describing it as a shadow pandemic. This social innovation narra-tive explores how a public health approach to violence prevention is implemented in Wales during the COVID-1...

Objective To estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales. Design The study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted lif...

Escaping the impact of a traumatic childhood is often aided by support, direction and hope from a trusted individual – sometimes acting alone, often as part of a broader service. This book collects together stories of such pioneering individuals. Known as ACE interrupters, these are people who have helped prevent ACEs, reduced their impact on child...

Background: Making the case for investing in public health by illustrating the social, economic and environmental value of public health interventions is imperative. Economic methodologies to help capture the social value of public health interventions such as Social Return on Investment (SROI) and Social Cost-Benefit Analysis (SCBA) have been dev...

Background For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective To explore public acceptance of public health statements and examine differences in acceptability across socio‐demographics, health behaviours (physical activity, diet, binge drinking and...

Abstract Background Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 y...