School of Medicine, Swansea University, Singleton Park, Swansea, UK.
BMC Public Health. 2010 Mar 23;10:150. doi: 10.1186/1471-2458-10-150.
Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health.
METHODS/DESIGN: EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes.
The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes.
健康是多种因素共同作用的结果。例如，住房条件差、教育程度低、医疗保健机会减少等因素相互交织，都会导致健康状况恶化。当人们对自己的环境几乎无法施加影响时，试图改变个人行为的政策收效甚微。但是，进行结构性环境变革并了解各种因素的相互作用方式，有可能在不依赖个人资源的情况下促进健康选择。“健康生活环境”（EHL）项目旨在研究妊娠和产后环境对健康的影响，并研究如何进行结构性变革以优化健康结果。基线评估将集中于出生结局以及母婴健康。
方法/设计：EHL 是一项纵向出生队列研究。我们计划在 2010 年 4 月至 2013 年 3 月期间招募 1000 名孕妇。我们将研究妊娠环境（孕产妇健康）和产后环境（住房和邻里条件）对这些妇女所生婴儿后续健康结果的影响。数据收集将从参与者怀孕约 20 周开始。参与者将完成一份问卷、进行人体测量、佩戴加速度计、记录饮食日记，并在其家中进行环境测量。还将要求他们同意在分娩后抽取脐带血样本。这些数据将与常规收集的电子数据（例如从全科医生诊所、医院就诊、儿童健康和发育记录中获取的健康记录）相结合。之后，将每年对参与者进行随访，以了解后续暴露和儿童健康结果。
EHL 的基线评估将提供有关妊娠和产后环境对出生结局以及母婴健康影响的信息。研究结果可用于为针对结构性和环境因素的复杂干预措施提供信息，以减少不良健康状况。队列的长期随访将侧重于环境暴露与随后发生不良健康结果（包括肥胖和糖尿病）之间的关系。
