School food research and teenage diets mean sleepless nights and a mountain to climb

Posted by Kelly Rose, Graduate Tutor/PhD researcher at Teesside University

In the spirit of the commencement of the New Year, I thought it the perfect timing to write a second Fuse blog post reflecting on my first year of PhD study. Also, driven by my waking at 2am, Monday of the first week back in a cold sweat, realising I am more baffled than ever!

In my first blog post, I described myself as feeling at the bottom of a mountain…

Now a year and a half in, I can report some relief at successfully passing my annual review, confirmation that I have the capability. This is definite progress, and a sure sign of having climbed at least a little higher towards the summit. A few days ago I also celebrated my 44th birthday, and I suppose the coinciding of a new decade brought a significantly reflective mood (in the most positive sense). This past year has tested me in so many ways that I had never expected. If you want to know yourself at a deeper level, I think a PhD certainly would be the recommendation. I started this journey with the attitude (that I was always telling my students and children) that anyone can do anything they set their mind to. This mantra has definitely helped in times of significant self-doubt.

Progress update

So far, I have completed a systematic review, had a paper of the political timeline of food policy published in the Nutrition Bulletin, shared my research in a conference, and was boosted by an article I contributed to the conversation.com being shared in the Independent online.

What have I learned?

I left secondary school teaching in July 2018 with a strong sense that more was needed to improve adolescent nutrition. Today, with more of a grasp on the research, I am even more incredulous as to why more is not being done by policymakers.

The evidence is clear, teenagers have the poorest diets of any other age group in the UK. The Lancet commission stated we can reap huge benefits from improved health policies, focusing on the global adolescent population, after all they are our future parents and workforce. As I found in the political timeline research and systematic review, there are many examples of good practice with regards to implementing and evaluation of school food standards, whole school policy and health interventions. But still no priority being placed on consistent evaluation and of policing school food provision in England.

Waking up at 2am questions

• Why is our school food provision failing to improve adolescent nutrition?
• Why does the Childhood obesity strategy (part 2) make the assumption that all schools in England are following the national school food standards when there is no evidence that most schools are? #pizzaandcookies. 
• Why the inertia and lack of prioritising teen diets, when the evidence points to the impacts of diet on mental health and school performance? 

Of course, it’s just not that easy, because, this is a multilevel issue, and the problem is much more complex than just implementing a policy or three. There are significant barriers to challenge, as we see the commercial determinants to health as a major part (defined as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health” (Kickbusch et al 2016)).

One of the factors I want to focus in on over the next two years, is the social aspect of teen diets. It is becoming more and more an accepted ‘norm’ that teenagers have a poor diet, and food choice is a major factor in fitting in with peers, with healthy food choices often ridiculed. A low risk perception of unhealthful food choice seems to be a barrier in improving the health of the next generation. I wonder how we can flip this influence.

With all the reflecting done, I am ready to move forward into 2020. This year the plan is to see my systematic review published, to plan and conduct research in building a picture of experiences, views and what is happening in a range of schools in the North East. And with this public declaration I aim to keep momentum and to contribute to the body of research moving forward.

Keep believing and achieving.


Image:
"Junk fast Food illustrations infographics editorial" by Svajune Garnyte is licensed under CC BY-NC 4.0

Now that's what I call blogging 2019

Posted by Mark Welford, Fuse Communications Officer, Teesside University

Happy New Year – can I still say that or have we reached peak-greet when this obligatory salutation is no longer required in email, phone, or awkward fleeting corridor exchange?

This time of year is all about numbers: the 12 days of Christmas, the pounds you’ve gained (lbs) or lost (£), counting steps, units, the 31 days of Dry January, Veganuary, or the point at which you can grant yourself a run free day.

It therefore seems fitting that the Fuse blog has a countdown of its own.  Last year was a fine vintage for blog posts but you may not have had the opportunity to read all 40 of them.  To save you time we have had a look back and created a Top 5 Chart of the ‘bestsellers’.

So without further ado, here’s our chart toppers:

5. The provocatively titled Can cancer ever be a good thing? in which Fiona Menger (@slt_fi) revisits the writing of 'cancer columnist' John Diamond while working on a head-and-neck cancer research study with a focus on a phenomenon called post-traumatic growth.

Page views: 585.  Posted: 31 May 2019 

4. In What old crisp packets dig up Duika Burges Watson (@debedub) gets hands on to unpack the mystery of the humble crisp.  What is their continued value as ‘food’ and can we still enjoy them as a cultural icon without creating so much waste and damaging our health?

Page views: 640.  Posted: 22 February 2019

Still from the animation

3. Why do some women continue to smoke when they are pregnant?  Sue Jones (@Susan_E_Jones) shares research findings on overcoming barriers to implementing NICE guidance on supporting pregnant women to quit smoking.  The blog includes a short animation which was developed based on the findings.

Page views: 663.  Posted: 10 May 2019

2. If at first you don’t succeed, try, try, try & try again...  Suzanne Moffatt (@SuzanneMoffatt) reflects on 58 months of knock backs in her efforts to secure ‘the big grant’ because multiple failures before success is often untold and sometimes persistence pays off.

Page views: 686.  Posted: 15 February 2019

Courtesy of Children's Future Food Inquiry via twitter

1. "It’s time to act!  It’s time this country gave every child the right to food!"  Pamela Graham (@PamLGraham) begins her blog post with this powerful statement from Corey (pictured right), a 15-year-old Young Food Ambassador who sat on a stage in Westminster and bravely told an audience about her experiences of food insecurity.  With more than double the views of its nearest competitor, Young people taking a stand for their #Right2Food takes the crown as most popular blog post in 2019.

Page views: 1474.  Posted: 03 May 2019

So there you have it, the top five Fuse blog posts from 2019. Can we can do any better in 2020? If you fancy giving it a go, please find out what we are looking for and how to take part here.

P.s. perhaps we need to look more closely at what's going on in February and May!?


Image:

1.  'Now That's What I Call Music! 1989' by brett jordan via Flickr. Attribution 2.0 Generic (CC BY 2.0): https://www.flickr.com/photos/x1brett/45056607035/

Happy New Year from everyone at Fuse

We would like to wish all our readers and contributors a very Happy New Year - why not make a resolution to blog in 2020 and send us your posts?

Image (adapted with thanks):
The original uploader was Rsabbatini at English Wikipedia. [CC BY 4.0], via Wikimedia Commons.

Scaling the mini Matterhorn - risk and adventure with a disability

Posted by Llinos Jehu, Research Associate with AskFuse, Teesside University

Llinos introducing the blog and speaking about her experience of epilepsy

Happy ‘International Day of Persons with Disabilities’! That day set aside by the United Nations to ‘promote the rights and well-being of persons with disabilities in all spheres of society’.

There’s a lot to be happy about. When I was diagnosed with epilepsy in the 1970’s, the world was a very different place. I got used to being treated as a fire and safety hazard (so not allowed into some buildings or events), a risk (so refused insurance), and a liability (excluded from school trips ‘just in case’). Given all the gloom and doom, it’s amazing that I turned out to be such a boringly average sort of person, never knowingly causing anything to spontaneously combust.

Roseberry Topping has been compared to the Matterhorn in the Swiss-Italian Alps

And generally I am happy living as someone with epilepsy, identifying as a disabled person. But then I attend something like the launch of the NIHR Applied Research Collaboration (ARC) in North East & North Cumbria, and get told that I’m going to die 10 years before everyone else. OK, they didn’t actually say that, they didn’t necessarily mean me. But people living with a disability or long term condition are at risk of premature mortality, and that risk isn’t always linked with their condition. For me, good epilepsy management is dependent on taking medication like clockwork. Seizures don’t stop me from taking my medication, but having to remember to order a repeat prescription just might: not more than 10 working days before I run out, but not less than 8 working days as it takes time to process. Good epilepsy management requires a good standard of physical and mental health: managing the weight-gain that the medication can cause, managing stress and anxiety, getting a good night’s sleep. Most people want to achieve some of the things on that list. Epilepsy doesn’t stop me from travelling with my job or going out to see friends; that’s caused by poor public transport. Unless I actually drop down with a seizure (and there’s no reason that I should), epilepsy won’t stop me from doing a 16 mile hike across the Moors. Barriers are more likely to be caused by people asking me, ‘Are you sure you should? Is it safe? Is it wise?’.

Speaking to Steph Kilinc about her research on the experiences of people living with adult-onset epilepsy

So what would make me happy, and possibly live a bit longer? Good, accessible, affordable public transport for starters. And a text from my pharmacist to say that my meds are ready to collect – after all, they know I’m a responsible person who takes them as instructed. They also know I’m not the sort of person who will stock-pile meds to sell on the internet or feed to my goldfish! The text wouldn’t just make sure I had the meds to take, it would make an enormous contribution to reducing levels of stress and anxiety. It would make me feel that I was viewed as an adult with a range of competing demands on my attention, rather than an old child with nothing else to think about.

Phil and Llinos on how technology helps them to navigate both walks and public transport

What already makes me happy is that I’ve had a life filled with friends who’ve supported and encouraged me. They’ve helped to keep the stress and anxiety levels down, to get the good night’s sleep, to manage the risks and have the adventures. There’s still lots to be unhappy about. Sometimes I’m really, really angry. Hate crime targetting disabled people, increasing levels of inequality: sometimes there can seem little to celebrate. But for this year’s event I’ve walked up Roseberry Topping on a glorious day, accompanied by two great friends: Phil Jeffries who’s a very experienced walker and happens to be partially sighted, and Steph Kilinc, a member of Teesside University’s Behaviour, Health and Resilience Research Group who happens to be a somewhat less experienced walker. We’ve compared Steph’s research findings with our own experiences of living with a disability. Phil’s shown how technology can help someone with a visual impairment to read maps (actually how to interpret maps, he was good at orienteering before his sight loss and there’s only so much technology can achieve). Together we’ve managed to navigate the public transport system and arrived at the same place and at the same time. I’m not stressed, I’m not anxious, I’ll take my meds and have a good night’s sleep. I’ll leave being angry until tomorrow, when I might follow up on those ARC presentations and find out what’s to be done to address that premature mortality risk.

References:

• Stephanie Kılınç a,. The experience of living with adult-onset epilepsy, Kilinc S, van Wersch A, Campbell C, Guy A, Epilepsy & Behvious 73 (2017) 189-196

• Thomas R & Barnes M, 2010, Life expectancy for people with disabilities NEUROREHABILITATION Volume: 27 Issue: 2 Pages: 201-209

• Epilepsy Action: https://www.epilepsy.org.uk

• Epilepsy Research UK: https://www.epilepsyresearch.org.uk/

• NHS: https://www.nhs.uk/news/neurology/people-with-epilepsy-have-higher-risk-of-early-death/

Bridging the research industry 'Valley of Death'

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

I was recently invited to attend a meeting in the British Library of the Bloomsbury SET. Not a group of subversive English writers, intellectuals, philosophers and artists but an Advisory Council for an innovative collaboration between four partner Colleges of the University of London. Namely, the Royal Veterinary College; London School of Hygiene and Tropical Medicine; School of Oriental and African Studies; and the London School of Economics and Political Sciences.

Death Valley, Eastern California

The partnership is funded by Research England and aims to bridge the ‘Valley of Death’: supporting research projects that get stuck between university and the market place. It does this by creating a knowledge exchange platform between the four Colleges that accelerates the delivery of innovative scientific and technical solutions in the field of infectious disease and antimicrobial resistance.

Pronouncing pathogen emergence, zoonotic disease and antimicrobial whatsit was hard enough, let alone my hope of making a meaningful contribution. I thought I would feel completely out of place as a public health researcher and the only social scientist in the room, but to my surprise I quickly discovered that the collaboration faces very similar challenges to Fuse.

For example, the project is trying to pool their commercialisation expertise across the Colleges and create a ‘single open door’ for government agencies, big pharmaceutical companies, small and medium sized enterprises, and overseas partners particularly in Africa. So, similar to our AskFuse service but with industry. In spite of their best efforts to engage researchers from the different Colleges, the project leads found that not all academics are keen to engage in partnership working outside their immediate area of expertise and that interdisciplinary partnerships, particularly with social sciences and humanities colleagues, proved challenging, as they speak a different language and have different cultures for sourcing funding.

It also proved challenging to develop trusting relationships with industry partners: academics don’t know how to find these partners and engage them in their projects, while industry partners allege that academics are ignorant of innovate technologies that have been developed in-house. This is akin to public health researchers not being aware of different types of knowledge that are being used in local government. It takes time to develop these relationships and exchange knowledge within them, for which the three-year grant funding is not long enough to show full results.

While the partnership is keen to engage with social scientists about the social aspects of the commercialisation process (e.g. work with local non-governmental organisations on engaging communities and identifying cultural and societal perceptions around vaccine use and human health), Research England is more interested in the commercialisation of ‘hard’ intellectual property through licensing or spin-out. Hence, the key performance indicators are all skewed towards these outputs. In other words, the incentive structure set by the funder is not encouraging the very thing that the partnership is trying to achieve. This sounds very similar to the lack of incentives and career opportunities within universities for engaging in knowledge exchange in public health.

Group photo (me, furthest right)

During the meeting, the need for creating an infrastructure within the Bloomsbury SET that can facilitate conversations between academics across the Colleges and broker relationships with industry partners was acknowledged by the Advisory Council members. Dedicated funding to develop collaborative proposals between industry partners and academic researchers that address this need was suggested as a useful knowledge transfer mechanism. Similar to the Public Health Practice Evaluation Scheme (PHPES) operated within the NIHR School for Public Health Research.

In summary, even if you don’t have any expertise in a particular scientific field (and can’t even pronounce their topics), chances are that you have more in common and face similar struggles when moving research findings outside academic institutions, whether that involves industry or policy and practice partners. The Colleges study transmittable diseases from animals to humans but to have impact with their research equal attention is needed to the transmission of knowledge from one human sector/ academic discipline to another.

A tale of two families: diabetes and rugby

Posted by Ruth Boocock, Senior Lecturer in Dietetics, Teesside University

The rain is coming in sideways, the mud is three inches and counting, a Sunday afternoon somewhere in the North of England. My rugby family. Amongst the rain, probably beneath four or five bodies, my seventeen year old daughter is having fun.

A whistle goes and a rain sodden, mud covered monstrosity jogs towards her family on the touch line. An upper arm extended, a mobile phone waved at a discreetly protected sensor and a blood glucose level read. Sometimes it’s an insulin pen to compensate for the adrenaline, other times a sports drink to refuel, such is the trial and error process of educating herself on what management routines work for training and matches. Blood glucose responses to physical activity for this recently diagnosed teenager with type 1 diabetes are highly variable based on activity type and timing and require different adjustments (Colberg et al, 2016)1. There are looks of course. Some parents are confused but a hurried whisper and the confusion is quickly replaced by respect. No mess, no fuss, just ordinary life. There are more important and more exciting things to do. Opponents to fell, tries to be scored. Rugby here, really has no barriers. A progressive, modern, attractive, dynamic and inclusive sport played by all (World Rugby, 2017-2025 vision)2.

Today is World Diabetes Day and the theme for 2019 is ‘The Family and Diabetes’. The aim, to raise awareness of the impact that diabetes has on the family and support network of those affected, as well as promoting the role of family in the management, care, prevention and education of diabetes.

On the rugby pitch my personal and professional life comes into sharp focus. I have spent the last twenty years as a dietitian sharing the journeys of people with diabetes. From the familiar insulin dose adjustment which offers greater freedom to eat and exercise while minimising glycaemic excursions (changes in blood glucose levels), to the battle of weight management and diabetes polypharmacy (the use of multiple medications). Weight loss for those with type 2 diabetes unlocking a future without diabetes or at least the ability to rationalise the use of diabetes medications.

Willowy wings take to the pitch alongside broader hardier oaks. At its best they complement each other wonderfully. From helping to prevent and manage medical conditions to reducing the risk of type 2 diabetes, the benefits of sport and activity on a person’s physical wellbeing are huge. But only 63% of adults are physically active for the recommended 150 minutes weekly, with figures lower still for children (Department of Health and Social Care, 2019; Sport England, 2019)3,4.

Rugby helps to maintain or improve aerobic capacity (the ability of the heart and lungs to get oxygen to the muscles), strength and balance and bone health and contributes to meeting the physical activity guidelines. Other benefits to exercise include reduced stress and improved self-esteem. Rugby reminds these girls that nobody’s self-worth comes from how they look or the perfect make-up or beautiful hair or high fashion clothes of online celebrities. There is a wonderful freedom here but also a challenge. Obesity. There is a fine line between giving girls and women confidence in their bodies and shape while also encouraging those patterns of healthy eating that will allow them to play at their best and get the most out of their training and their life. We do not always get the balance right. Push come to shove however they are out there two-to-three-times a week, come rain or shine working incredibly hard, growing as team mates and women, and reducing their risk of developing type 2 diabetes by 30-40%. That has to be an excellent beginning.

On the pitch there is just the team, on the side lines the wider rugby family. Sometimes also the diabetes family. Nicknames abound. Banter flows. Yet there are no labels. There are no diabetics, no 'fat girls', just a team and its friendships, its victories and losses, its celebrations and of course, lots and lots of mud.


Ruth’s current doctoral studies seek to identify barriers and enablers to the implementation of diabetes remission strategies for adults with type 2 diabetes recently diagnosed within general practice in one of the most deprived local authority districts in England.


References:

1. Colberg et al. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care; 39(11): 2065-2079. https://doi.org/10.2337/dc16-1728
2. Accelerating the global development of women in rugby 2017-25. https://www.world.rugby/womens-rugby/development-plan?lang=en 
3. Department of Health and Social Care (2019). UK Chief Medical Officers' Physical Activity Guidelines. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report
4. Sport England (2019). Active Lives Adult Survey: May 18/19 report. https://www.sportengland.org/media/14239/active-lives-adult-may-18-19-report.pdf

Images:

1. 'Logo for the World Diabetes Day' by International Diabetes Foundation via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:World_Diabetes_Day_logo.svg
2. Published by: West Park Leeds Girls Rugby ‘Meet your #innerwarrior’ event, with thanks to Kurt Nutchey

Can Scottish inventiveness curb the nation’s alcohol habit?

Posted by John Mooney, Senior Lecturer in Public Health, University of Sunderland

 Churchill is defeated by a Temperance movement MP - Dundee election result in 1922

“Of all the nations of this earth, perhaps only the ancient Greeks surpass the Scots in their contribution to mankind…” 

Sir Winston Churchill

This often cited sentence from the great orator’s canon of memorable expressions, frequently (in social media posts at least), is accompanied by a story of the number of times in a normal day ‘the typical Englishman’ is obliged to thank his Northern cousins for gifts bestowed:

From the spreading of ‘Dundee marmalade’ in the morning to his whisky night-cap it is easy to lose count of those almost innumerable causes for daily gratitude. In these days of Prophet Greta, perhaps the less said about ‘TarMacAdam’ and the internal combustion engine the better… but in our defence there is always Kirkpatrick MacMillan’s bicycle to offset that carbon footprint!

It’s no accident of course that pride of place be afforded in the above account to Scotland’s national drink of distilled and malted barley – renowned the World over for its unparalleled quality and distinctive dalliance on the palate. Scotland’s broader relationship with alcohol however, has not traditionally been a reputation to which one might raise a glass and is perhaps better summed up by the lovable and tragic Rab C Nesbit (right). The real tragedy of course being the excessive and abiding toll of alcohol related illness and premature death for which Scotland is infamous and also near the top of the World league table, for all the wrong reasons...

And yet, the nation’s pioneering spirit (of the non-liquid variety!) and very inventiveness in the face of a challenge may yet serve up another exemplar for others to follow. In May 2018 Scotland became the first country in the World to introduce legislation that set a minimum floor price for a unit of alcohol (MUP). While other fiscal mechanisms have been tried and tested for tackling cheap alcohol, MUP has consistently shown the greatest promise in modelling studies, since it cannot be “absorbed” by the retailer [1].

Sure enough, the first evaluation of the population level impact of MUP has found the policy to be associated with reduced alcohol purchasing. In line with model predictions, the reductions were largest for those households purchasing the most alcohol and for those drinks with the cheapest alcohol content [2, 3]. The very modest impacts on household budgets and the effect of reducing alcohol purchasing / consumption the most for those at greatest risk of harm also in line with predictions [4], helps counter any serious criticisms that the policy represents a regressive measure by unfairly targeting the economically disadvantaged. In the words of the Glaswegian novelist Val McDermid, on BBC Television’s Question Time in 2017: “There is nothing regressive about preventing people in Scotland’s poorest communities drinking themselves to death with cheap alcohol”.

Returning to the bigger picture, Scotland’s appetite for policy innovation to tackle alcohol harms is by no means restricted to minimum pricing. Rather, MUP is seen as only one component of a ‘whole system’ approach to tackling this most intractable and culturally embedded of public health problems. Bringing drink driving levels into line with the lower threshold in place across the rest of the EU [5] and incorporating health outcomes as a long overdue legitimate alcohol licensing objective [6], being two potential ingredients in the mix…

The Scottish ‘double edged’ relationship with alcohol can be best summed up by another snippet of Churchillian wisdom, a man who by all accounts was not unaccustomed to enjoying a ‘brandy before breakfast’:

"Whisky has killed more men then bullets, but most men would rather be full of whisky then bullets." 

Sir Winston Churchill

Perhaps the pragmatic recognition of a population’s natural affinity for a risky behaviour responsible for such a significant health burden is the first step towards realising that only meaningful restrictions in access mediated through price and availability, as well as legislative sanctions, might yet constitute the best defence against our worst excesses. Most Scots, myself included, know only too well of the devastating impact alcohol can exert on friends, families and communities. Maybe that is why we are most responsive to the remedies!


References:

1. Meier PS, Holmes J, Angus C, Ally AK, Meng Y, Brennan A: Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study. PLoS Med 2016, 13(2):e1001963-e1001963.
2. Mooney JD, Carlin E: Minimum unit pricing for alcohol in Scotland. BMJ 2019, 366:l5603.
3. O’Donnell A, Anderson P, Jané-Llopis E, Manthey J, Kaner E, Rehm J: Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18. BMJ 2019, 366:l5274.
4. Holmes J, Meng Y, Meier PS, Brennan A, Angus C, Campbell-Burton A, Guo Y, Hill-McManus D, Purshouse RC: Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: A modelling study. The Lancet 2014, 383(9929):1655-1664.
5. Haghpanahan H, Lewsey J, Mackay DF, McIntosh E, Pell J, Jones A, Fitzgerald N, Robinson M: An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment. Lancet 2019, 393(10169):321-329.
6. Mooney JD, Sattar Z, de Vocht F, M Smolar M, Nicholls J, Ling J: Assessing the feasibility of using health information in alcohol licensing decisions: a case study of seven English local authorities. In: Lancet Public Health Science: 2016; Cardiff: The Lancet; 2016: 78.

Image:

1. Election result in Dundee in the 1920s when Churchill was defeated by a Temperance movement MP. With thanks to Eric Carlin, Director of the Scottish Health Action on Alcohol Problems (SHAAP).