What’s a night out without a takeaway?

Ingrained & intertwined risky drinking & eating habits

Posted by Stephanie Scott, Senior Lecturer in Criminology & Sociology, Teesside University

A recent Fuse blog post reflected on the ways in which alcohol and food come together in the lives of young adults (Cassey Muir and Alice Graye ‘the booze, the binge and the bulge’). For example, some young adults may eat a takeaway after a night of drinking and a fry-up the next day, some may choose not to eat prior to drinking and some may drink alcohol alongside a meal. Such reflections are based on findings from the recently completed FOrwaRD project, a study that I have had heavy involvement in as a project applicant and lead researcher.

Yet, whilst the reflections of those on the cusp of adulthood are extremely important, one of the key messages from this project and an abundance of public health research evidence is that behaviours such as risky drinking and associated eating patterns become ingrained and intertwined in our lives long before we turn 18. In other words, health behaviours cluster in adolescence and track to adulthood. Think back. How long have you associated a beer with a curry or white wine with fish or, more bluntly, that going for a takeaway at the end of a night of heavy drinking is the norm? And, are these messages instilled in us during adolescence or perhaps even earlier in childhood? We also know that an unhealthy approach towards food and alcohol is more likely for some young people than others, particularly for alcohol, where we have seen a steady decline in the overall percentages of those who drink alcohol juxtaposed against those who do drink doing so at extremely high levels.

My point here is that, not only do eating and drinking behaviours interact, but the influences on these behaviours, such as parents, peers, marketing, urban space, also overlap, and overlap from an early age. Frankly, we eat and drink certain products for pleasure, for popularity or to socialise. One way in which to tackle a growth in obesogenic and alcohol-related harm is to explore overlapping and distinct influences on these behaviours at the point in which they accelerate i.e. late childhood / early adolescence and use this knowledge in the design of interventions which link rather than separate out such behaviours.

With this in mind, we set out (using Fuse pump prime funding) to identify and synthesise qualitative research evidence into common underlying factors which influence alcohol use and unhealthy eating behaviours amongst young people aged 10–17. This involved bringing together two separate bodies of literature to enable analysis and comparison across two associated fields of study. Thus, our synthesis involves the interpretation of individual studies by identification of second-order constructs (interpretations offered by the original researchers) and third-order constructs (development of new interpretations beyond those offered in individual studies) by way of the development of a ‘model structure’ of shared influences upon both unhealthy eating behaviours and alcohol use amongst young people aged 10–17.

Of the 63 studies included in the review, 27 studies focused on alcohol whereas 36 focused on eating behaviours. Initial analysis of the data identified 16 themes, 14 of which demonstrate shared or overlapping influences on young people’s alcohol use and eating behaviours. For example, we found that both alcohol and food were used by adolescents to overcome personal problems such as to relieve stress, to push away negative feelings or emotions and in some cases to replace human interaction: “…it’s a way like any other to forget or to let off steam, it depends on the person.” (Petrilli et al., 2014).

Whilst these findings are at an exceptionally early stage, one thing is clear – there remains very little research linking young people’s eating behaviours and alcohol use together. Hopefully, emerging publications from this review and the FOrwaRD project will help to lead this change.

With thanks to the core project team Louisa Ells, Emma Giles, Frances Hillier-Brown and Wafa Elamin.


Reference:

1. Enrico Petrilli, Franca Beccaria, Franco Prina & Sara Rolando (2014) Images of alcohol among Italian adolescents. Understanding their point of view, Drugs: Education, Prevention and Policy, 21:3, 211-220, DOI: 10.3109/09687637.2013.875128

Safe negotiation of neighbourhoods should be non-negotiable

Posted by Lesley Haley, AskFuse Research Associate, Teesside University

It’s World Sight Day today. This annual event highlights a range of issues surrounding visual impairment, and the day is linked to the World Health Organisation’s Global Action Plan on sight health. Today is also ‘bin collection day’ where I live, when wheelie bins and recycling boxes migrate from their backyards and gardens to clutter our pavements. It’s a weekly event that occurs in every village, town and city. It’s also a weekly hazard to be negotiated and endured by thousands of our neighbours. Especially those with visual impairment.

It’s not an obvious connection - World Sight Day and ‘bin day’. And frankly it was a connection that didn’t occur to me either, until I went to the ‘Negotiating Neighbourhoods’ event earlier this year, run by Fuse, the Royal National Institute for the Blind (RNIB), and the Sight Service. The event examined getting around our neighbourhoods, and gave feedback on Newcastle City Council/RNIB’s Newcastle Street Charter. The Charter describes the barriers faced by people with sight loss or mobility issues, and the actions and commitments needed and agreed to reduce these barriers (Newcastle City Council 2017). At the event, policy makers, researchers and people who are experts by experience shared their opinions and insights into safely getting around the built environment of our streets, local neighbourhoods and public spaces. This included feedback on the proliferation of street furniture such as advertising boards, lamp posts, bollards, street signs, bushes, cars parked on pavements, and wheelie bins (Newcastle City Council 2017).

Sight loss affected more than two million people in the UK in 2015, with one in five people aged over 75 living with some form of sight loss, including macular degeneration (RNIB 2018c). So for a significant number of our neighbours with mobility or sight issues, street ‘clutter’ is an increasingly frustrating and problematic issue.

It’s a public health issue too. Street furniture is impacting the health and wellbeing of people with mobility or sight loss issues. The built environment, and the street furniture cluttering it, “is restricting physical activity participation for people with sight loss” (Phoenix et al, 2015, p.127). Sight loss is associated with reduced physical activity, and the adverse social, economic and psychological effects of sight loss are being more widely recognised, including loneliness and isolation (Sim and Mackie 2015). Even the Design Council (2017) reported that ‘hostile’ public spaces could increase people’s risk of disease as it contributed to sedentary lifestyles and social isolation.

Can the humble wheelie bin really be classed as ‘hostile’? The experts by experience at the ‘Negotiating Neighbourhoods’ event have bitter experiences to prove it. Research in public health would also back them up. In 2015, 95 per cent of blind and partially sighted people reported that, in the previous three months, they had collided with a street obstacle, and a third said they had injured themselves while walking around their local area (RNIB 2015a). Many participants in the research carried out by Phoenix et al (2015) talked about injuries and also damage to their self-esteem when outdoors, because of a poorly designed built environment. Street ‘clutter’ is literally having a big impact on our neighbours as they try to navigate our streets.

At the ‘Negotiating Neighbourhoods’ event, the audience was asked “What changes could make the situation better?” Well, from a personal perspective, I have tried to stop parking my car on the pavement, have changed where I place my wheelie bin on ‘bin day’, and have tried to write (this) my first ever blog to raise awareness of the issue.

So what are your thoughts? Could you make one small change in your neighbourhood to make everybody’s everyday journeys just a little bit safer?

Surely, on World Sight day in 2018, being able to safely negotiate our neighbourhoods, should not be negotiable?

#WorldSightDay


References:

Design Council (2017) Creating Health Places Available at: https://www.designcouncil.org.uk/what-we-do/built-environment/creating-healthy-places (Accessed: 23.08.2018).

Newcastle City Council (2017) Newcastle Street Charter. Newcastle: Newcastle City Council. Available at: https://www.newcastle.gov.uk/sites/default/files/wwwfileroot/your-council-and-democracy/equality-diversity-and-citizenship/newcastle_street_charter_final.pdf (Accessed on: 23.08.2018)

Phoenix, C. Griffin, M. Smith, B. (2015) ‘Physical activity among older people with sight loss: a qualitative research study to inform policy and practice environment,’ Public Health 129 (2) pp. 124-130

Royal National Institute of Blind People (RNIB) (2015a): Daily assault course of street obstacles and dangerous crossings injuring blind people. Available at: http://www.rnib.org.uk/daily-assault-course-street-obstacles-and-dangerous-crossings-injuring-blind-people. (Accessed 26.04.2018)

Royal National Institute of Blind People (2018c) Key information and statistics on sight loss in the UK. Available at: https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics (Accessed: 01.06.2018).

Sim F, and Mackie, P (2015) ‘Sight – the most critical sense for public health?’ Public Health. 129 (2) pp. 89–90. Available at: http://dx.doi.org/10.1016/j.puhe.2015.01.009. (Accessed: 22/08/2018)

World Health Organisation (2009) Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2009-2013. Available at: https://www.iapb.org/resources/who-action-plan-for-the-prevention-of-avoidable-blindness-and-visual-impairment-2009-2013/ (Accessed: 23.8.2018)

Starting out and getting ahead in obesity research

Guest post by Enzo Di Battista, Research Dietitian at Aneurin Bevan University Health Board

In the lead up to the UK Congress of Obesity (#UKCO2018), I attended an Early Career Research Workshop in the beautiful grounds of Newcastle University.

Dr Maria Bryant chaired the event in which we had three talks with some interactive elements.  Here I share a few reflections and tips from the workshop.

Grant application and interview success

Professor Judith Rankin kicked off with ‘Skills to enhance the success of (fellowship) interviews’. The talk was split into three main sections – completing a fellowship application, what to do prior to the interview and what to do during the interview.

On listening to Professor Rankin’s advice on completing a grant application for research, I noted ‘5 tips’:

1. Start early on the application – you should take about a year to draft, critique, draft, critique, and draft and critique (you get the idea).
2. Ensure you have a good supervisory team around you for advice and support.
3. Speak with additional experts in research methods. This might be a statistician or an experienced qualitative/mixed-methods researcher.
4. Contact senior people in the obesity field. Most are friendly people willing to take a look at draft applications, if given plenty of time to do so.
5. Liaise with your local clinical trials unit for advice (England), (Scotland), (Wales). 

Getting the application shortlisted is just the first step however, you have to convince funders of your credibility to give you the money. The post-doc fellowship interview is all about YOU, your vision for the research project (not a supervisors) and your commitment to a research career. To ensure you’re ready for interview, Judith stressed the importance of mock interviews. To demonstrate, Dr Bryant stepped up to role play with Judith and we had video interview examples.

To increase the likelihood of success at interview, a panel expects that you have: 

1. Enthusiasm for your project.
2. Designed an achievable project.
3. An understanding of the questions you are trying to address.
4. An understanding of the experimental approaches you plan to use. 

Influencing health-care policy

Dr Barbara McGowan was next to take to the floor for the second talk titled ‘Conducting research with an aim to influence health-care policy’.  She talked us through her career development, from working in the city as an analyst to becoming a medical doctor and research lead. Her story left the impression that her early work had given her an 'edge', improving her data interpretation skills and had benefited her research career path.

The main take-home for me was the clinical research Barbara was undertaking in pharmacotherapy (therapy using pharmaceutical drugs) for obesity. I summarised it in this tweet at the time:

Medications for obesity - findings of Liragultide & Semaglutide: Wt-loss of 8-12% at 1below -3 years.

Research to influence health care policy by Dr Barbara McGowan

Early Career Research Network for #UKCO2018 pic.twitter.com/KBDeFfPJ32

— Dr Enzo Di Battista (@EnzoRD_PhD) 5 September 2018

Semaglutide isn’t licenced in the UK but Barbara feels it will be in the next year or so.

Evaluating public health interventions

Upon returning from a comfort break we settled down to listen to Professor Ashley Adamson, Director of Fuse, talk about‘Evaluating public health interventions’. Ashley highlighted “The value of collaboration” and taking time to develop networks across sectors (industry, public sector, third sector, local government) to establish and maintain public health interventions.

Ashley asked us to form groups and consider how we would implement and evaluate a breakfast club initiative in primary schools. It was a useful exercise to consider what skills (e.g. project management, capacity/network building) and processes (ethics and legalities of working with school children/participant group) were needed for public health interventions and evaluation.

My favourite slide from the talk was entitled ‘An ideal evaluation’ which, as you can see from the picture below has 5 key points, with full references (BRILLIANT!).

Before closing the workshop, Maria asked for everyone’s opinions on the afternoon and what they would like from future events. On reflection, I felt that maintaining such a high calibre of speakers was key to the quality of the workshop – so that needs to be consistent. Perhaps in future, it would be interesting to hear about emerging subjects within the obesity field and to invite someone who has recently completed a PhD or Post-doc fellowship to share their personal experiences.

If you have any thoughts on what makes for an excellent Early Career Research Workshop please feel free to post a comment below and I can feed it back to the UKCO2019 organising committee. Many thanks!

Cancer and the simple pleasure of a good cuppa

Posted by Duika Burges Watson, Lecturer, Institute of Health and Society, Newcastle University

Thousands of people will today enjoy catching up over cake and a cuppa for the World's Biggest Coffee Morning, Macmillan Cancer Support's biggest fundraising event. But what if after cancer that cuppa and cake don’t taste right?

“When I had been through the treatment and was supposedly ‘cured’, I had hoped a cup of tea would do what it had always done and give me pleasure. But it didn’t, the tea had a textural product in it so I could swallow it. It wasn’t tea anymore, I felt miserable with it”

So said one of the head and neck cancer survivors who participated in our NIHR Research for Patient Benefit (RfPB) funded study, ‘Resources for Living’. Living beyond the life-saving treatment for cancer, all participants in our study had on-going difficulties with food and eating. It’s not the same for everyone, some people return to normal eating, but for those that live long-term with ‘altered eating’ and the unique difficulties they have, it can be miserable.

Since we formed the Altered Eating Research Network at Newcastle University following the end of the study, we’ve come to appreciate just how widespread the problem is of altered eating. Far from limited to cancer survivorship, we have a long list (and one that grows with each successive public engagement event) of conditions and experiences that may result in altered eating. We define ‘altered eating’ as a changed state of any combination of physical, emotional and social interactions with food and eating that has a negative impact on health and wellbeing. It’s a deliberately broad definition that we’ve found useful in charting a new approach to addressing it.

And on public engagement. We are very lucky to have Sam Storey, BBC Food and Farming ‘cook of the year’ finalist, 2018, as one of our team members. His passion for food notwithstanding, Sam has a unique empathy for those that have lost enjoyment in food and a remarkable skill at finding ways to bring that pleasure back. If there was a headline for our research and events it would be that ‘pleasure matters’. With increasing evidence[1] from the neurological sciences, and the advent of a research focus on ‘hedonia’(pleasure) and eudaimonia (satisfaction) in human wellbeing (e.g. the Journal of Happiness Studies) it appears there is a very real reason for the importance of pleasure to wellbeing. Combined with the feedback we get from events and research, we are ploughing ahead with a whole range of ideas of how we can help those that experience a loss of pleasure and find eating a burden.

Over the summer we ran two very successful events in collaboration with the Whitley Bay Film Festival. Two chocolate themed events - a ‘smell-along’ experience of the Spanish movie Like Water for Chocolate, and an ‘eat-along’ experience of Chocolat. They were for general audiences, but at each we introduced the films with information about the research we are doing with Altered Eating. Both events were sell-outs and great successes. You can read a blog about one person’s experience of the first event here. But as with the other events we’ve held in the last year or so (flavour masterclasses for example) we invariably discover something new, meet someone who is affected and distressed by altered eating difficulties.

Cook Sam Storey and Dr Duika Burges Watson: raining chocolate for the film festival

Our first serving during Chocolat was the most delicious hot chocolate timed perfectly to coincide with the moment Vianne Rocher (Juliette Binoche), an expert chocolatier, opens her shop in a conservative and austere rural French village. At 24 minutes in she serves hot chocolate, prepared with a ‘special kind of chilli pepper’, to the disbelieving Armande (Judi Dench), her elderly, eccentric landlady. With the first sniff and taste, Armande is emotionally transformed from bitterness to joy. For most of the movie-goers, the hot chocolate Sam had prepared was indeed a joyful experience. However, in presenting it to one person they told me “no thank you, I don’t like chocolate”. At first, I was perplexed, why pay for a chocolate eat along film if you don’t like chocolate? But then, in our research we’ve experienced this before, participants who didn’t want to participate in ‘eating’ at food play events (or not at first anyway). A reminder that food is more than about eating and that the commensal experience of being together with others matters too.

But chocolate is a little unique in terms of eating pleasures. As Professor Barry Smith, a member of the AE Network and expert in the sensory and hedonic elements of food notes, chocolate is for most, a hugely pleasurable experience that is both about flavour and texture, “the pleasure of anticipation and the reward in eating it match up. The aroma and the taste are the same. And that matters because there are two sorts of pleasure ivolved. When you start eating it, turn it around in your mouth to get the melting quality which strokes the tongue. Receptors in the tongue then respond to this stroking and it's a different feeling from touch. That's why we love a velvety wine or double cream - it's the feeling on our tongues”.

Ah yes, no wonder the tea didn’t ‘taste’ right.


Reference:

1. Kringelbach, M.L., 2015. The pleasure of food: underlying brain mechanisms of eating and other pleasures. Flavour, 4(1), p.20.

Collaborating, meandering and consolidating to identify research priorities on welfare advice and health

Posted by Natalie Forster, Senior Research Assistant and Monique Lhussier, Associate Professor in Public Health and Wellbeing, Northumbria University and Fuse

As the judges of the Man Booker prize for fiction whittle down their long list and decide on the shortlist of books in the running for best novel of the year, we’ve been making a few (more research focused) lists of our own.

Setting aside our individual research plans and ambitions to focus on welfare and health

Funded by the NIHR School for Public Health Research, we are currently working collaboratively (from across Fuse, University College London, The University of Sheffield, and London School of Hygiene and Tropical Medicine) to set the future research agenda in the area of welfare advice and health. Working across this number of institutions, we have managed to set aside our individual research plans and ambitions and combine our expertise in a series of workshops to focus on the issues of welfare and health. Colleagues from the welfare advice sector have agreed to join us and are keeping the discussions grounded in the realities of practice, over the course of four workshops (this blog marks our half way point).

The first workshop saw us (tentatively at first) present our research to each other; with both our detailed topics and methodologies varying significantly, as one might expect. Deciding which research questions to pursue is a daunting task. Shortlisting questions was a delicate juggling act of managing our respective interests and expertise, while keeping practice perspective up front and centre, to ensure the usefulness of our future findings. This process also opened up fundamental discussions about the role of welfare advice in society, and how this should be studied.

One key area of debate concerns whether we should study the health impact of welfare advice, welfare itself, and/or systems of welfare provision in their broadest sense. At present, the UK boasts a welfare system that, in its complexity and inaccessibility, needs the intervention of advice services for users to access their entitlements. As researchers, should we therefore focus our attention on this hostile welfare environment, thought to perpetuate or deepen health inequalities, as opposed to advice services themselves? For example, a research emphasis on the health outcomes of advice might have been interesting but could play into wider failings to make benefits accessible if the advice-health relationship is proved any less than definitive. The group also considered whether advice services should be studied as an intervention or in terms of their function within society.

Further discussions centred around which outcomes, and particular user groups to focus on, and whether to study universal or means tested benefits, continuously swerving between the pragmatic and the theoretical, the national and the local. These fruitful meanderings were captured in a long list of possible research questions which we then worked to weigh up against agreed criteria. The result? A consolidated and (slightly!) shortened list of research questions, focused on five priority areas:

1. Are there inequalities in the impact and reach of advice services across social groups? How/ does advice delivery mode matter?
2. What are the individual and system level impacts of the de-implementation of advice services?
3. What are the impacts of changes to welfare provision on children, inter-generationally and throughout the life course? 
4. How do experiences of social welfare vary by social group, geographically and across generations? How do different identities combine to influence how social welfare is understood? 
5. What is the impact of the rise in precarious employment and low wages on advice seeking and provision?

So quite a research agenda to fulfil! Throughout the remainder of the project, we’ll be engaging with advice sector representatives and recipients of advice to hear their views on the directions research in the area should take before developing concrete plans for how we could actually carry out this research. After that it’s time to commit pen to paper and draft those grant applications!

What has social media got to do with your mental health?

Niamh McDade, Senior Policy and Communications Executive at the Royal Society for Public Health

There is no denying that social media has revolutionised the way we communicate and share information. Social media has become a space in which we form and build relationships, shape self-identity, express ourselves, and learn about the world around us – so it’s really no surprise that social media is intrinsically linked to mental health!

Social media has huge potential to support good mental health and wellbeing and indeed, in many ways it does. Our Status of Mind report published in May 2017, examined the positive and negative effects of social media on young people’s health and after surveying 1,479 14-24 year olds, we revealed many benefits of social networking. It can provide young people who may be suffering from mental health issues an opportunity to read, watch or listen to, and understand, the health experiences of others – relating them back to their own reality.

We also found nearly seven in 10 teens reported receiving support on social media during tough or challenging times via ‘groups’ or ‘pages’ which allow users to surround themselves with like-minded people and share their thoughts or concerns. Adding to this, social media can act as an effective platform for accurate and positive self-expression, and a place to share creative content and express interests and passions with others.

All in all, it seems great, right? And you are probably asking why a public health organisation would be running a campaign asking users to go Scroll Free this September!

Whilst there are a range of benefits, for many of us, our relationship with social media has become a little complicated. This is understandable in an online world where we are faced with a constant influx of images and videos, unrealistic beauty standards and an endless stream of apparently blissful, happy relationships. Our research has shown social media to contribute to anxiety and depression, poor sleep, negative body image, cyberbulling and FoMO (fear of missing out) – characterised by the need to be constantly connected with what other people are doing, so as not to miss out.

Scroll Free September offers a unique opportunity to take a break from all personal social media accounts for 30 days during September. A good relationship is one of balance, and Scroll Free September is here to help you gain that with social media both on and offline. By going Scroll Free for a month, you’ll have a chance to reflect on your social media use – what you missed, what you didn’t, and what you got to do and enjoy instead!

The idea is that by taking notice of and learning which elements of social media make you feel good and which make you feel bad, participating in Scroll Free September could help you build a healthier, more balanced relationship with social media in the future – a relationship where your use is conscious and mindful, and where you are the one in control.

We know that going cold turkey on social media may seem a bit much of an ask for some, so before you start tweeting your excuses, there are a range of different options to make your participation that bit easier including:

1. The Cold Turkey

Give up all personal social media for 30 days. Looking for #inspo? Emma Stone, Jenifer Lawrence, Elton John and Simon Cowell are all scroll free.

2. The Night Owl

If going cold turkey sounds a bit much, you can choose to take a break from social media at evenings after 6pm.

 

 

3. The Social Butterfly

Why not try taking a break from social media at all social events - talk to your friends, listen to the music, eat your burger without worrying about the insta post – #connect.

4. The Sleeping Dog

Find yourself going to bed at a reasonable time with the best intentions, then spending hours scrolling through your social media accounts? Is the first thing you do in the morning check your newsfeed? Give up social media in the bedroom and improve your sleep.

5. The Busy Bee

Secretly scrolling your way through the working day? Give up social media in school, work or university and maximise your productivity.

Whichever plan you choose is up to you, but the more you disconnect with social media, the more you might get from it. You can still use it for work and of course, still use your device for other purposes. Our hope is that by the end of the month you will be able to reflect back on what you missed, what you didn’t, and use that knowledge to build a healthier relationship with social media which will last into the future.

Why not join almost 5,000 others across the world who have already signed-up. Who knows what you could get up to with all that free time spent Scroll Free!

Take the plunge and sign-up at www.scrollfreeseptember.org

Wishing you the best of luck!

Blogiday

The blog is on holiday over August but we still need your 500-700 word blog posts so that we can start September in style.

Please email them to Mark Welford (m.welford@tees.ac.uk).

Here's how to take part and why you should blog.

Image: "'Gone fishing'" by Stephen McCowage via Flickr.com, copyright © 2015: https://www.flickr.com/photos/130768092@N05/16139476647