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Changing the environment to improve population health: a framework for considering exposure in natural experimental studies.

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cam.issuedOnline2016-04-07
dc.contributor.authorHumphreys, David K
dc.contributor.authorPanter, Jenna
dc.contributor.authorSahlqvist, Shannon
dc.contributor.authorGoodman, Anna
dc.contributor.authorOgilvie, David
dc.contributor.orcidGoodman, Anna [0000-0001-9995-6659]
dc.date.accessioned2018-10-10T05:16:31Z
dc.date.available2018-10-10T05:16:31Z
dc.date.issued2016-09
dc.description.abstractThere is renewed optimism regarding the use of natural experimental studies to generate evidence as to the effectiveness of population health interventions. Natural experimental studies capitalise on environmental and policy events that alter exposure to certain social, economic or environmental factors that influence health. Natural experimental studies can be useful for examining the impact of changes to 'upstream' determinants, which may not be amenable to controlled experiments. However, while natural experiments provide opportunities to generate evidence, they often present certain conceptual and methodological obstacles. Population health interventions that alter the physical or social environment are usually administered broadly across populations and communities. The breadth of these interventions means that variation in exposure, uptake and impact may be complex. Yet many evaluations of natural experiments focus narrowly on identifying suitable 'exposed' and 'unexposed' populations for comparison. In this paper, we discuss conceptual and analytical issues relating to defining and measuring exposure to interventions in this context, including how recent advances in technology may enable researchers to better understand the nature of population exposure to changes in the built environment. We argue that when it is unclear whether populations are exposed to an intervention, it may be advantageous to supplement traditional impact assessments with observational approaches that investigate differing levels of exposure. We suggest that an improved understanding of changes in exposure will assist the investigation of the impact of complex natural experiments in population health.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.30710
dc.identifier.eissn1470-2738
dc.identifier.issn0143-005X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/283342
dc.languageeng
dc.language.isoeng
dc.publisherBMJ
dc.publisher.urlhttp://dx.doi.org/10.1136/jech-2015-206381
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectEnvironmental epidemiology
dc.subjectNeighborhood/place
dc.subjectOutcome Research Evaluation
dc.subjectPUBLIC HEALTH
dc.subjectRESEARCH METHODS
dc.subjectHealth Promotion
dc.subjectHumans
dc.subjectPopulation Health
dc.subjectResearch Design
dc.subjectSocial Environment
dc.titleChanging the environment to improve population health: a framework for considering exposure in natural experimental studies.
dc.typeArticle
dcterms.dateAccepted2016-03-18
prism.endingPage946
prism.issueIdentifier9
prism.publicationDate2016
prism.publicationNameJ Epidemiol Community Health
prism.startingPage941
prism.volume70
pubs.funder-project-idnull (unknown)
pubs.funder-project-idMedical Research Council (MC_UU_12015/6)
pubs.funder-project-idMedical Research Council (MR/K023187/1)
pubs.funder-project-idEconomic and Social Research Council (ES/G007462/1)
pubs.funder-project-idTCC (None)
pubs.funder-project-idWellcome Trust (087636/Z/08/Z)
pubs.funder-project-idEngineering and Physical Sciences Research Council (EP/G00059X/1)
pubs.funder-project-idNETSCC (None)
pubs.funder-project-idMedical Research Council (MC_UP_1001/1)
rioxxterms.licenseref.startdate2016-09
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1136/jech-2015-206381

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