title: Dispelling the nice or naughty myth: retrospective observational study of Santa Claus.
abstract: OBJECTIVE
  To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Paediatric wards in England, Northern Ireland, Scotland, and Wales.
  
  
  METHODS
  186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015.
  
  
  METHODS
  Presence or absence of Santa Claus on the paediatric ward during Christmas 2015. This was correlated with rates of absenteeism from primary school, conviction rates in young people (aged 10-17 years), distance from hospital to North Pole (closest city or town to the hospital in kilometres, as the reindeer flies), and contextual socioeconomic deprivation (index of multiple deprivation).
  
  
  RESULTS
  Santa Claus visited most of the paediatric wards in all four countries: 89% in England, 100% in Northern Ireland, 93% in Scotland, and 92% in Wales. The odds of him not visiting, however, were significantly higher for paediatric wards in areas of higher socioeconomic deprivation in England (odds ratio 1.31 (95% confidence interval 1.04 to 1.71) in England, 1.23 (1.00 to 1.54) in the UK). In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole.
  
  
  CONCLUSIONS
  The results of this study dispel the traditional belief that Santa Claus rewards children based on how nice or naughty they have been in the previous year. Santa Claus is less likely to visit children in hospitals in the most deprived areas. Potential solutions include a review of Santa's contract or employment of local Santas in poorly represented regions.
authors.affiliation: Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston 02115, MA, USA john.park@mail.harvard.edu.
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.affiliation: University College London Medical School, Royal Free Hospital, London, UK.
authors.forename: Ben G T
authors.initials: BG
authors.lastname: Coumbe
authors.affiliation: University of Edinburgh Medical School, Edinburgh, UK john.park@mail.harvard.edu.
authors.forename: Esther H G
authors.initials: EH
authors.lastname: Park
authors.affiliation: Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK.
authors.forename: George
authors.initials: G
authors.lastname: Tse
authors.affiliation: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston. MA, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston. MA, USA.
authors.forename: Jarvis T
authors.initials: JT
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D004739:England; D005495:Folklore; D006693:Holidays / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009660:Northern Ireland; D010372:Pediatrics; D012189:Retrospective Studies; D012606:Scotland; D012959:Socioeconomic Factors; D014852:Wales