Monday 21 September 2015

Shielding against the impact of the dementia time bomb

Guest post by Mark Parkinson, Postgraduate Researcher, Department of Public Health & Wellbeing, Northumbria University

Today (September 21) marks the anniversary of World Alzheimer’s Day which aims to raise public awareness about this most common form of dementia.

Dementia represents one of the main causes of disability in later life. Current estimates indicate that someone is diagnosed with the disease every 68 seconds. Alzheimer’s affects 44 million people globally with this figure predicted to triple over the next 35 years - a phenomenon aptly named 'The Dementia Time Bomb'. Advances in health mean many more people are surviving life-threatening diseases such as cancer, but susceptible to life limiting diseases such as dementia.

By 2030 more than 20 million people in the UK will be aged 60 or over. For people familiar with dementia it is one of the diseases most feared as they approach 60 years of age, a fear justified given the increased prevalence of the disease once we reach this milestone, a fear heightened by the fact that it is irreversible and terminal.

The impact of all this truly hit home during a recent conversation with my mother. Renowned for her ability to trounce all-comers at Scrabble, she struggled to recall the word ‘padlock’ prompting her to quip, with mock seriousness, that perhaps she was succumbing to the disease. My mother’s perception of Alzheimer’s still follows a traditional and mistaken one that Alzheimer’s disease is a typical and therefore ‘normal’ part of ageing. She is not alone: it is estimated that around 60% of people worldwide also incorrectly believe this, while 40% of people mistakenly think it is not fatal. I on the other hand stopped dead in my tracks. The sudden realisation that my mother’s uncharacteristic memory block might genuinely be a precursor to the more serious cerebral ‘padlocks’ associated with dementia. As a researcher involved in dementia I was only too well aware that Stage 2 of the disease is generally represented by very mild cognitive decline, including deficits to semantic memory that can include a sudden inability to recall everyday words. Much worse though was my knowledge that the later stage of Alzheimer’s can be marked by far more severe symptoms as part of a terminal degenerative process that can endure for 15 long years. A key question ran through my mind at this point: who would care for my mother if she did develop dementia?

In the vast majority of cases it is a family member who will elect to take on this role. One in eight of the UK adult population already provides such an unpaid but invaluable service. However, a central problem with our continued reliance on unpaid care is that, in general, family carers of people with dementia experience greater health inequalities due to the chronic stress commonly associated with long-term caregiving. This threatens carers' health whilst also undermining their ability to continue to provide care. A key question therefore is, ‘who will care for the carers?’ This question was the springboard for the research project I am presently engaged in which seeks to investigate, ‘What works to support family carers of people with dementia?’ While myriad resources exist that might potentially be made available, what is noticeably absent is any agreed ‘gold standard’ of support that might be put into place, tailored according to the different stages of Alzheimer’s. Unlocking this particular dementia challenge will not prevent the ‘time bomb,’ but it can offer families a much needed protective shield if and when that time does come. The need to raise awareness of dementia and the challenges associated with it has never been more urgent - the disease lies on all our doorsteps. 

Mark is currently engaged in a project concerned with several key questions related to Alzheimer’s disease: (i) which factors remain crucial to resilience-building for family carers of people with dementia (PWD) in order to maintain and sustain informal caregiving and which hinder it (ii) how can tailored support best be targeted to address the needs of specific carers? (iii) how can the inherent health inequalities faced by family carers of PWD be reduced? 

UK Dementia Awareness Week 2015 took place 17-23 May. If you wish to find out more about Alzheimer's please visit the Alzheimer's Society website.

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Tuesday 15 September 2015

Savour the flavour! Expanding young people's experience of food & eating

Posted by Duika Burges Watson, Fuse staff member and Lecturer in Evaluation and Policy Interventions in Centre for Public Policy & Health, Durham University

Food and drink that is high in fat, sugar and salt (HFSS) is disproportionately marketed and promoted to children and young people in the UK. Public health practitioners have long cried that excessive consumption of HFSS foods is detrimental to health but, overall, the health statistics show that globally, people are consuming more HFSS foods and have less healthy diets[1]. So, is there another way?

Chef Sam Storey applies blue colouring to a teacher's tongue
We decided to test an idea with a group of 14 year 9 students from Whitley Bay (a seaside town on the North East coast) to see how they would respond to a workshop exploring the science and gastronomy of ‘taste’ and ‘flavour’. The idea came from work in the NIHR/RfPB funded project, ‘Resources for Living: Exploring the potential of progressive cuisine for survivors of head and neck cancer’. In the course of doing this research we’ve expanded our own understanding of what is ‘good’ to eat. The multi-disciplinary team includes a research chef, Sam Storey, and with him we’ve been playing with food and flavour to try to improve cancer survivor’s experience of food and eating. We used teaching resources available from the Institute of Food Research[2] alongside ‘food play’ ideas developed in our project.

Our workshop involved students from Whitley Bay High School who were participating in a local Enquiry Based Learning (EBL) event. All 300 year 9 students were involved in one of 24 projects – a three day activity in the local community. Our group of 14 spent their three days exploring the senses; this involved a food play workshop, building a raised sensory bed in the local community garden, and talking with the chef and users of New Prospects, a centre for people with learning difficulties, about their experience of food and the senses.

In our two-hour food play workshop we demonstrated how taste and flavour are not the same thing. Salt, sugar and, some scientists now say, fat as well, are largely experienced through taste – that is, via receptors on the tongue and around the mouth; but flavour refers to a much broader ‘multi-modal’ experience[3] of food that includes the very powerful element of aroma. We know that we have around 350 different types of odour receptor that stimulate thousands of flavour experiences. Chewing a flavoursome sweet whilst holding their noses, the students could experience sweetness, but it was not until they let the nose go mid chew that they could identify the flavour of strawberry, blueberry, lime etc. We explored more about aroma on a tour of the Whitley Bay Station Master’s Community Wildlife Garden – rubbing herbs and other edibles to release the volatile compounds and experience numerous delicious smells.

There were many elements to our playful explorations of multi-modal flavour perception. In one experiment we gave the students three coloured jellies and asked them to tell us what the flavours were – red, green, and yellow. Uniformly they responded with colour recognition flavours – red was raspberry, green: lime, and yellow: lemon. When we ‘revealed’ that in fact, all the jellies were identical other than the colour – all flavoured with lemon – they were astonished.

If you think about the experience of food in a contemporary UK supermarket, the only ‘smell’ that really stands out is that of baking bread. Students noted that supermarket shopping while on summer holidays abroad was different – French or Italian supermarkets had more diverse smells. Could critical food awareness challenge their taste for HFSS foodstuffs and make them notice the over-use of piped bread smells? In the school evaluation of the EBL project, our senses workshop rated the highest of all programmes. Students highly valued the experience, which suggests that more could be done. Could flavour appreciation workshops change how young people eat?

Coming up: Flavour masterclass: with Dr Rachel Edwards Stuart, part of the Wolfson Research Institute's Special Interest Group on Culinary Innovation, Senses and Health Seminar Series. St Cuthbert’s Society, Durham - Monday 5 October 12-1pm.

Thursday 10 September 2015

Energy drinks: Don't believe the hype

Guest post by Shelina Visram, Lecturer in the Centre for Public Policy and Health, Durham University

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).

Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

  • If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
  • Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
  • Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
  • Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
  • The strong influence of the marketing activities of energy drink companies should not be underestimated.
  • Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
  • There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.
There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)

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Tuesday 8 September 2015

Translating local action to national policy

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

North West England (NWE) has some of the worst health statistics in the country calling for transformative and challenging approaches by its local public health community. Merseyside-based social enterprise, the Health Equalities Group (HEG) including heart health charity Heart of Mersey has worked with and supported NWE’s Directors of Public Health since 2003.

Obesity and maintaining a healthy weight present huge problems both now and in the future. Balancing the need for a population-based prevention approach whilst government policy focuses on targeting individuals with expensive weight management programmes is particularly difficult. At the same time individual stigmatisation is both unhelpful and particularly damaging. Somehow we have to work towards changing cultures so that junk food is less easily available, that healthier food is the popular choice and walking and cycling are positively encouraged.

The NWE Directors of Public Health asked HEG to develop a collaborative approach to healthy weight in 2012 and the Food Active campaign was eventually launched in November 2013. It calls for policies to:
  • Control the marketing of junk food to children and young people
  • Place a duty on sugar sweetened beverages
  • Enforce 20mph speed limits in urban areas (lower traffic speeds make cycling, walking and play safer)
In the same way Liverpool and the NWE played an important role in the development of smoke free policies, Food Active hopes to bring local pressure to bear on government in calling for a more upstream approach to addressing obesity.

We began by building the evidence base around attitudes towards sugary drinks and modeling the effects a tax on such drinks may have on consumption. This in turn can be compared with the prevalence and cost of type 2 diabetes, and bariatric surgery etc. As data show teenagers are the highest consumers of sugary and ‘energy’ drinks, we established a media-friendly campaign called ‘Give Up Loving Pop’ to raise the debate and heighten the pressure for action. In the same way that regional tobacco control organisations have worked closely with national charities such as Action on Smoking and Health (ASH), Food Active has developed relationships with the Children’s Food Campaign and Action on Sugar.

In 2014, learning from ASH and the excellent work of local government on the Local Authority Declaration on Tobacco Control, Food Active started to develop a similar declaration on healthy weight. A regional meeting followed by workshops with three North West authorities showed that such a declaration could:
  • Raise with elected representatives and the public that local authorities have a role to play in addressing obesity
  • Help to show a wide range of policies (such as transport, planning and leisure) all have a part to play in promoting healthy weight
A Local Authority Declaration on Healthy Weight is more complex than its tobacco control equivalent and it is being developed in two parts; the first with some generic commitments (such as agreeing that obesity and overweight are a priority), the second more locally focused and aligning with local policies and priorities (for example Local Transport Plans).

As previously, the North West’s health needs will help to make the call for more concerted and resourced national action.

Robin will be speaking about the Food Active campaign tomorrow (9 September) at the CPPH Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices 

Robin Ireland

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Thursday 3 September 2015

Getting our hands greasy: The joys of researching food and drink sold near secondary schools

Guest post by Wendy Wills, Sociologist of Food and Public Health, University of Hertfordshire

Next Wednesday (9 September) I will be at Durham University to present and discuss the findings from a study which colleagues and I conducted that focused on exploring the reasons that young teenagers at secondary school buy food and drink outside school.

It was a busy project, with just two weeks at each of our seven selected case study schools to run an online survey in classes of 13-15 year olds, as well as asking them to take part in a written exercise and focus groups. We also conducted interviews with the young people, as well as the head teachers, school kitchen supervisors and local retailers. Over 600 young people took part. I had two brilliant early career researchers working full time collecting data in Scotland (the work was funded by the Food Standards Agency north of the border) plus some part time help from colleagues.

I love conducting fieldwork – there is nothing quite like getting your hands dirty (or greasy in this case but more on that later) during data collection and no better way to fully get to the heart of your research questions than being ‘in the field’ with your team. I particularly enjoy research with young people as they are often very happy to tell you exactly what they think and indeed, they are often pleased to be asked about matters that they are often not consulted about – such as the food and drink they have access to.
So, being in Scotland and racing from classroom to chip shop to follow young people (with their consent of course!) as they decide where to go on a particular day to buy their lunch was something of an adventure.

The young people had us salivating over their lunchtime purchases, though not for any health-related reason! For the most part it was the complete opposite. Part of our plan was to purchase the same edibles as the young people we accompanied so that we could weigh and record each item (to later conduct a nutritional analysis of the unpackaged food and drink they bought). We often had bags full of (extremely cheap) deep fried ‘chicken balls’ with luminous orange sweet and sour sauce from takeaway shops; warm sausage rolls with the grease oozing through their paper bags from bakeries and bottles of bright green, blue or orange ‘energy drinks’ from corner shops that sometimes had questionable hygiene and/or felt a little intimidating.
'Chicken balls'
As all this action happened over lunchtime you can imagine the team were often hungry by the time we left each school and so we sometimes resorted to trying some of the rapidly cooling food and drink that filled the boot of our car. The worst thing I tried was the battered and deep fried pizza slice – words cannot really describe it – the hard and tasteless pizza base, the smear of tomato paste, the greasy battered coating.

The fieldwork did not only provide us with greasy hands but also an appetite for supporting effective policies and interventions that promote healthy eating to secondary school pupils.