Open Access Open Badges Study protocol

Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study

Rebecca A Hill1*, Sinead Brophy1, Huw Brunt2, Mel Storey1, Non E Thomas3, Catherine A Thornton4, Stephen Palmer5, Frank Dunstan5, Shantini Paranjothy5, Roderick McClure6, Sarah E Rodgers1 and Ronan A Lyons1

Author affiliations

1 School of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK

2 National Public Health Service for Wales, Temple of Peace and Health, Cathays Park, Cardiff, UK CF10 3NW

3 Centre for Child Research, Swansea University, Singleton Park, Swansea, SA2 8PP, UK

4 Institute of Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK

5 Department of Primary Care and Public Health, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

6 Accident Research Centre, Monash University, Victoria, 3800, Australia

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Citation and License

BMC Public Health 2010, 10:150  doi:10.1186/1471-2458-10-150

Published: 23 March 2010



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.


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.