RESEARCH

(10) "Perceptions and practices of UK general practitioners towards youth vaping: a questionnaire-based study," with Najafi, E., Wasan, D., Baker, Y., Peters, K., Vasooja, D., Warnapala, M. BJGP open (2025).  https://doi.org/10.3399/BJGPO.2025.0080

E-cigarette use among adolescents and young adults is a growing public health concern. General practitioners (GPs) play a critical role in addressing health behaviours, yet there’s limited research on their perceptions and practices towards vaping in young people. This study aims to explore current perceptions and practices amongst GPs concerning vaping in young people. A quantitative approach was employed through an online, self-administered questionnaire. Respondents included both trainee and qualified GPs from across the UK. The questionnaire consisted of Likert-scale and free-text questions, covering screening, counselling, and demographic information. Participants were recruited through newsletters and social media, with 284 responses collected from March to August 2024. Data was analysed using descriptive statistics. The Kruskal-Wallis test was used to assess for significant differences based on respondents’ region of work or level of experience. General practitioners rarely inquire about e-cigarette use (23.9%), despite 85.6% believing it’s important to do so. Lack of time, relevance to the presenting complaint, and method for quantifying and documentation were cited as significant causes. Only 27.5% of GPs provide advice to e-cigarette users, likely due to low rates of confidence (12.3%). A lack of time, understanding of health effects, training, and availability of referral services were cited as causes. There were no significant variations in responses based on respondents' location or level of experience. GPs recognise the importance of youth vaping but face barriers to screening and counselling, indicating the need for change in guidelines and policy.

(9) "UKFood Combined Dataset: Statistical Matching of the Living Costs and Food Survey with the National Diet and Nutrition Survey, 2018-2019. [Data Collection], with Franco Sassi. Office for National Statistics (2025). http://doi.org/10.5255/UKDA-SN-9369-1

(8) "Are Food Taxes for Healthy Eating Acceptable? A Survey of Public Attitudes in the United Kingdom", with Franco Sassi & Hannah Brinsden. BMJ Public Health (2025). https://doi.org/10.1136/bmjph-2024-001731

Appropriately designed food taxes can improve diet quality and health. Fiscal levers are used in several countries to combat the rise in obesity and diet-related diseases. This study aims to investigate public attitudes, knowledge, and policy preferences regarding food taxes for promoting healthy eating in the UK. A survey was administered through YouGov Plc to a nationally representative sample of 2,125 adults, gathering information on: acceptability and support for different types of food taxes, awareness and knowledge of existing taxes, and preferences for the characteristics of possible new taxes. Overall, 48% of respondents support higher taxes on unhealthy foods, rising to 72% if taxes made healthy foods more affordable. Respondents with high socio-economic status and those living in London showed the highest support. Respondents had limited awareness of existing food and beverage taxes, and prioritised discretionary items such as cakes and crisps for possible increased taxation. The survey shows a high level of support for taxing unhealthy foods, as well as concern for the affordability of healthy foods. A carefully designed holistic approach to food taxation can be part of a wider public health strategy and can be favourably met by the general population in the UK.

Media coverage: News Medical, Mirage News, MyScience, Medicalxpress, Imperial News

(7) "Austerity and Waiting Times:  Evidence on reproductive health care delays among young millennials in deprived areas", with Bruce Hollingsworth & Eugenio Zucchelli. Public Health (2025) , 242, 111-116. https://doi.org/10.1016/j.puhe.2025.02.027

This paper examines the effect of the Great Recession and subsequent austerity policies on healthcare use and waiting times among millennials in England. We focus on access to emergency and outpatient hospital care using rich administrative data from the Health Episode Statistics linked to Next Steps, a longitudinal survey including a cohort of individuals born in 1990. Results from interrupted time-series suggest that the number of appointments for outpatient hospital care increased after the Great Recession, with heterogenous effects depending on levels of area deprivation and treatment speciality. However, visits to emergency departments appear to have decreased due to austerity policies alongside only negligible increases in waiting times for treatment, especially in the most deprived areas. These findings indicate that while macroeconomic shocks and austerity policies might have increased the use of hospital care among millennials living in the most deprived areas, waiting times do not appear to be greatly affected.

(6) "Socioeconomic Deprivation, Health and Healthcare Utilisation among Millennials", with Bruce Hollingsworth & Eugenio Zucchelli. Social Science & Medicine (2024), 351, 116961. https://doi.org/10.1016/j.socscimed.2024.116961 

This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents’ health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle.

Media coverage: Mirage News, HealthMediciNet, Imperial News, NIHR SPHR blog, CLS blog, IB knowledge

(5) "Parental nonemployment in childhood and children's health later in life". Economics and Human Biology (2023), Vol:49, Pages 1-23. doi: 10.1016/j.ehb.2023.101241 

While the effects of joblessness on the health of the non-employed are well-documented, its long-term spillover consequences on the health of their relatives, especially children, remain poorly understood. This research explores the long-term associations of parental nonemployment spells experienced during early, mid and late childhood on children’s mental and physical health. The analysis exploits data drawn from the British Household Panel Survey (BHPS) and the UK Household Longitudinal Study (UKHLS), linking detailed parental socioeconomic information with their children between the years 1993 and 2013. This paper employs a Correlated Random Effects (CRE) probit model that allows accounting for unobserved heterogeneity as well as a non-linear Generalized Estimating Equations (GEE) random effects estimator accounting in addition for the dependency structure of the data. Results indicate that experiencing parental nonemployment during early and late childhood has a negative association on the children’s likelihood of suffering from long-standing illnesses later in life, while experiencing parental nonemployment during middle childhood negatively affects the young adult’s mental health. Moreover, experiencing parental nonemployment during late childhood increases the probability of both reporting poor or fair self-assessed health and the likelihood of consuming prescribed medicines in early adulthood. However, there seems to be a considerable effect heterogeneity by family socioeconomic status, parents’ gender, and frequencies of parental nonemployment spells. Current adulthood circumstances, such as level of educational attainment, job situation and household demographics, are used to explore the potential mechanisms affecting results. These findings may help policymakers shape appropriate responses to mitigate the psychological and physical burden derived from parental nonemployment, especially among already disadvantaged households. 

Media coverage: IB knowledge; NIHR SPHR blog

(4) "Impact of new guidance on survival for 22-week births in England and Wales: A population-based cohort", with Lucy K Smith, Emily van Blankenstein, Grenville Fox, Sarah E Seaton, Stavros Petrou, Cheryl Battersby. BMJ Medicine (2023). doi: 10.1136/bmjmed-2023-000579 

Survival estimates inform national recommendations for the provision of survival-focused care of babies born at 22 weeks gestation. However, cautious interpretation is necessary due to different approaches to care and biased population denominators e.g. live births. We explored the impact of changes in national recommendations from an extremely selective approach to a more widespread recommendation of survival-focused care in England and Wales using robust denominators. Using population-based cohort data we present rates of survival-focused care provision and outcomes in 2018-2019 and 2020-2021 for babies alive at the onset of labour. There were 1001 babies alive at the onset of labour at 22+0-22+6 weeks. For these babies, survival-focused care increased three-fold from 11% to 38% (2018-2019: 59/524; 2020-2021: 183/477); admissions to neonatal units increased four-fold (7%(39/524) to 28%(134/477)) and survival to discharge from neonatal care increased three-fold (2.5%(13/524) to 8.2%(39/477)). More babies of lower birthweight and early gestational age received survival-focused care in 2020-2021. A change in national guidance has led to a three-fold increase in babies born at 22 weeks receiving survival-focused care. Survival has remained low at 2 in 10 for those receiving survival-focused care and 3 in 10 for those admitted to neonatal care. Increased care provision has the potential to provide time to gather more information on a baby’s prognosis through their response to treatment, and to offer a palliative approach if severe life-limiting complications develop. However, greater understanding of the consequences of this approach for babies, families and healthcare professionals is needed.

Media coverage: The Guardian; The Times; Medicalxpress; iNews; myScience; ICL Newsletter; BAPM blog; NIHR blog, Nada es Gratis and others

(3) "Coping with COVID-19: The role of hospital care structures and capacity expansion in five countries", with Czypionka T., Reiss M., Hagen T., Löblová O., Murauskienė L., Or Z., Vrangbæk K.  Health Economics, Policy and Law (2023), 1-18. doi: 10.1017/S1744133122000275 

This article examines the responses of five different health systems in the first wave of the Covid-19 pandemic: Denmark, Germany, Israel, Spain, and Sweden. The aim is to understand to what extent these crisis responses were resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralized hospital care structures, more sophisticated concepts for providing specialized services, and greater integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralized governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen healthcare system resilience in pandemic situations and beyond.

(2) "The effect of changes in cost sharing on the consumption of prescription and over-the-counter medicines in Catalonia". Martínez-Jiménez, Mario; García-Gómez, Pilar; Puig-Junoy, Jaume. International Journal Environmental Research & Public Health (2021). 18, no. 5: 2562. doi: 10.3390/ijerph18052562

Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population—co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners—from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits—from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume. 

(1) "Effects of macroeconomic fluctuations on mental health and psychotropic medicine consumption". Martínez-Jiménez, M., Vall Castelló, J. International Journal of Health Economics and Management (2020). 20, p. 277–297. 21 p. doi: 10.1007/s10754-020-09281-3

Our aim in this paper is to understand the impact of macroeconomic fluctuations on mental health and psychotropic medicine consumption. In order to do that we exploit differences in the fluctuations of business cycle conditions across regional units in Catalonia. Our findings suggest that, in general, economic fluctuations at the local level had no significant effect on the consumption of psychotropic medicines. However, we show that a deterioration in local labour market conditions is associated with a reduction in the consumption of anxiolytics medicines. We also report an increase in the consumption of anxiolytics in regions with a softer deterioration in the economic situation. Although we report mild improvements in both mental and physical health for some sub-groups of the population, we also find significant reductions on the probability of sleeping 6h or more. Thus, these elements point towards potential negative effects of local labour market conditions on health in the medium/long term. 

"Temporary Employment, Fertility and Health at Birth", with Judit Vall Castello

We investigate the effect of temporary employment on fertility behaviour and perinatal health. The research question is based on the hypothesis that fixed-term contracts and their inherent employment instability imply a worse career path that may have spillover impacts on subsequent fertility and perinatal outcomes. To tackle endogeneity concerns, we use the 1984 labour market reform as a natural experiment; this reform led to an extensive liberalisation in the regulation of the fixed-term contract in Spain. We thus compare fertility decision-making and perinatal outcomes using the father´s occupational status between low- and high-skilled ones before and after the 1984 reform. This is so because we expect the reform to have less effect on skilled fathers. Our data comes from the years 1980-2017 of the Childbirth Statistics Bulletin provided by the Spanish National Statistics Office (INE). We apply a cohort regression discontinuity difference-indifference strategy (RDD-DiD) to identify the reform’s within-cohort effects, where the treatment and the control differ only in the father’s professional status and month of birth. We find that the fixed-term contract regulation reduces the mean number of childbirths, and decreases the birth rates for low-skilled fathers. Also, for low-skilled fathers compared to their skilled counterparts, the reform leads to a reduction in the mean of birth weight and gestational age, as well as, increases the risk of preterm birth for their first child. This pattern helps to shed light on the trends of fertility rates and perinatal outcomes in Spain.

"Health, Retirement and Economics Shocks", with Bruce Hollingsworth & Eugenio Zucchelli

• • Health, Econometrics and Data Group (HEDG) Working Papers 21/11, HEDG, c/o Department of Economics, University of York. 

  • IZA DP No. 14574 Health, Retirement and Economic Shocks.

We explore the effects of retirement on both physical and mental ill-health and whether these change in the presence of economic shocks. We employ inverse probability weighting regression adjustment to examine the mechanisms influencing the relationship between retirement and health and a difference-in-differences approach combined with matching to investigate whether the health effects of retirement are affected by the Great Recession. We estimate these models on data drawn from the English Longitudinal Study of Ageing (ELSA) and find that retirement leads to a deterioration in both mental and physical health, however there seems to be considerable effect heterogeneity by gender and occupational status. Our findings also suggest that retiring shortly after the Great Recession appears to improve mental and physical health, although only among individuals working in the most affected regions. Overall, our results indicate that the health effects of retirement might be influenced by the presence of economic shocks.

"Food Taxes and their Redistribution Effects on Nutrient Quality", with Franco Sassi

Taxation of food high in fat, sugar, and salt content aims to reduce obesity and non-communicable diseases by disincentivising consumption. This paper examines the relationship between nutrient-related food quality, prices and taxes in the United Kingdom. We define food quality using the Nutrient Profiling Model (NPM), which scores foods based on nutrient composition, identifying food products high in fat, salt, and sugar (HFSS). Our analysis relies on the ONS Living Costs and Food Survey and Family Food, which contains information on food purchases by type of food, nutrient content and socioeconomic characteristics covering about 5,000 households in the 2018/19 fiscal year. Results show a positive relationship between food prices and poorer nutrient quality in the UK, while foods with a high content of fat, sugar and salt are taxed at zero rates, other healthy foods are taxed at the standard rate (20%). Using two-way fixed effects and logit models, we show that, on average, households with children and low-income households purchase more HFSS foods compared to least deprived/childless households. We also find that households with children are more likely to intake more of their calories, sugars and fat from HFSS foods compared to childless households. A tax reform should be considered to reduce the consumption of unhealthy food and improve population health while reducing the cost burden on low-income families. 

• Early Life Conditions and Child’s Cognitive Development. (with Edith Aguirre)

The prevalence of neurodevelopmental disabilities, including autism spectrum disorder and ADHD, has risen significantly in the past decade. This study examines the impact of early-life factors, such as infant health at birth and breastfeeding, on adaptive behaviour development by age three in the United Kingdom. Neurodevelopmental disabilities are often diagnosed using adaptive behaviour scales, which assess communication, physical skills, and social-emotional development. Using data from 4,811 children in the UK Household Longitudinal Study (2011–2023), we analyse the role of infant health at birth, breastfeeding practices and parental and household characteristics. Employing a set of robust empirical methodologies, we find that breastfed children exhibit stronger adaptive behaviour by age three. In contrast, children with poor perinatal health show slower development. These adverse effects are particularly pronounced among boys and children from non-white British maternal backgrounds. Socioeconomic status plays a key role in shaping these developmental outcomes. Our findings underscore the importance of early-life interventions to support cognitive development, especially for vulnerable populations. Addressing disparities in early childhood conditions could help mitigate long-term developmental challenges. 

• The Long-Run Educational Shadow of Neonatal Care Admission at Birth. (with Orla Doyle)