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What makes an ideal Patient and Public involvement (PPI) panel?

By Andreas Opitz, on 5 September 2019

Authors: Aradhna Kaushal, John Isitt, Christian von Wagner, Douglas Lewins and Stephen Duffy

The Policy Research Unit (PRU) in Cancer Awareness, Screening and Early Diagnosis recently set up a Research Advisory Panel to ensure that its research programme is relevant to and reflects the perspectives of patients and the public. In May, we ran a co-creation workshop designed to help the research advisory panel and PRU staff to build relationships with each other, to share ideas and experiences, to understand different perspectives, and to discover and prioritise discoveries together. The culmination of the workshop was the creation of a manifesto for the development of the Research Advisory Panel.

What did we do?

On the 31st of May we ran a co-creation workshop bringing together newly appointed patient and public members, with academics and administrators – to co-create the Research Advisory Panel’s (RAP) purpose, structure and culture to answer the challenge:

“What would the ideal Research Advisory Panel look like? What should it be responsible for? What’s the best way to involve PPI members effectively with academics and administrators? And how should it be organised?”

Co-creation in healthcare research, sometimes referred to as co-production, is “an approach in which researchers, practitioners and the public work together, sharing power and responsibility from the start to the end of the project, including the generation of knowledge” (NIHR, 2018). This approach is important in healthcare research as those affected by research are in an ideal position to contribute to the design and delivery of research through their unique experiences and knowledge.

The group was made up of nine patient and public involvement (PPI) members, four academic staff from the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis (PRU), the administrator who supports the PRU, and the PRU’s director. Everyone participated equally in the workshop to co-create what an ideal Research Advisory Panel for the PRU would be like and how best to support and integrate PPI members.

What did we find?

In the first half of the workshop, recognising the differences in experience and diversity of the group, attention was given to create relationships, safety, permission and tools for sharing our personal experiences of PPI – the good, the bad and the ugly – and identified a range of attributes and obstacles to PPI in research. We discussed the importance of developing good relationships between PPI members, researchers and clinicians, and creating a positive environment for us to work together.

“As a new PPI member, you’re thrust into the midst of academics, physicians, etc and expected to make conversation over coffee. This can be a big obstacle for some people. They can be totally phased by the social demands.”

“Researchers tend to operate in cliques outside the meeting. [We] need to identify training for researchers to approach us as well as us approaching them.”

“If it really is about being a tick box, now I walk away. I’m not going to be complicit with that kind of game play. If I’m in the room, then accept me being in the room. You might not like everything that I say and that’s allowed, but please don’t have me here as a hologram.”

We then worked in small groups to create the future, writing manifestos for the ideal RAP in terms of purpose, culture and structure, which we presented back to the workshop. The main proposals are summarised below.

What happens next?

The insights from this workshop will be used to guide the future working relationships of the research advisory panel of the PRU. We are currently adopting the manifesto into our current terms of reference and way of working. We also have exciting plans ahead setting up a training and development plan for PPI members and virtual space where they can keep in touch with each other.

For anyone interested in running a similar workshop, please contact Partners in Creation.

How to podcast

By Andreas Opitz, on 30 July 2019

With the help of a Researcher-Led Initiative award, PhD students Fran Harkness and Jo Blodgett, and Research Fellow Aradhna Kaushal organised a day of podcast training for early career researchers to learn how to beam their findings straight into the ears of the general public. Here they explain what a podcast is and how you can get started making your own.

Why podcast?

Do you want to learn how to share your research discoveries beyond academic community (and pay-) walls? It would be unusual for a non-academic to read a journal, and as researchers, it’s not possible control how findings make headlines. But 6 million people in the UK listen to a podcast every week. And with people almost entirely listening to episodes as a lone activity- often on their phones whilst driving or travelling- the podcast has their full attention. Podcasts such as ‘All in the Mind’, ‘The Infinite Monkey Cage’, and our own Institute’s ‘The Lifecourse Podcast’ are easy to access (freely available online), and able to build a relationship with audiences through regular episodes. They disseminate new research in an informal style, often by chatting about new research with a fellow host, or interviewing academics.

Researcher-led initiative

We knew we wanted to make a podcast, but we didn’t know how. That’s where the Researcher-Led Initiative awards came in. We successfully applied for £1000 from the UCL Organisational Development to invite an experienced podcast trainer, Chris Garrington, and fellow academic and journalist Jen Allan to teach us everything we needed to make our own episodes.

Along with 13 other early career researchers, we learnt about the practical aspects of making a podcast such as how to conduct an interview, choosing recording equipment, incorporating jingles, editing audio files and disseminating podcasts online. We practiced recording and editing our recordings. It was such a buzz hearing our voices “introducing” our own podcast after the jingle. Of course 10, 000 more practice hours are needed before any Poddies are won but it was much easier than we thought it would be.

Recording a podcast series

We learnt that before you make your podcast, it’s important to consider the ideal format for the topic. For example, will a monologue or interview work best? Is the role of the presenter to ask questions on behalf of the audience or to offer their own opinions and thoughts? We also considered how many episodes are feasible to make, how often and how long should they be. Who are the audience and what kind of tone and style will appeal to them?

We experimented with sound quality between recording straight onto our laptops or enhancing it with different microphones, and received sage advice such as not to record in a coffee shop and to record some background sound separately when on you are on location in case you need to loop it in behind new recordings back in your studio (ahem bedroom). Jen then gave us a session of how to get the information you need from your interviewees, including to learn to soundlessly agree with them so to not cut them off (as qualitative researchers probably already know), and how to get around difficult questions.

What kit do you need?

You don’t need highly specialised equipment to make a podcast. An investment in a good microphone will ensure the quality of the audio recording. You may also consider different types of microphones (such as lapel microphones or hand-held) for different needs. You can also record interviews via Skype or Zoom using an Ecamm Call Recorder. Once you have your audio file, you can edit this using freely available software such as GarageBand (Mac) or Audacity (Windows). When you are ready to share your podcast with the world, you can share this using a podcast hosting website such as Libsyn: A podcast host simplifies and automates both the RSS feed and file hosting and delivery to your subscribers. But a good host does more than that by providing useful stats, tutorials, and support.

Thanks to Chris and Jen, we somehow finished the day with a mini episode and many big plans for the future! Watch this space.

I wanna hold your hand: helping young people prepare for happy healthy relationships

By Andreas Opitz, on 11 July 2019

The teenage years are a time for experimenting and for pushing boundaries – particularly when it comes to intimate relationships. Such experimentation is a natural part of growing up. But there are potential risks, too – particularly if these early experiences aren’t positive ones. A new study from Professor Yvonne Kelly from UCL’s Department of Epidemiology and Public  Health  and colleagues, investigates what kinds of intimate behaviour 14 year-olds engage in, and asks how this insight can help to ensure  young people are well prepared for healthy and happy adult relationships.

We know teenagers experiment with intimacy, often moving ‘up’ the scale from hand-holding or kissing to more explicitly sexual activity. But we also know teenage pregnancy numbers have been dropping in recent years. And our new study suggests that fewer young teenagers are actually having sexual intercourse than some might previously have thought.

We’ve all seen the headlines – studies have shown us (links) that 30 per cent of those born in the 1980s and 1990s had sex before the age of 16, and that among those born in the early 1990s a little under one in five had done so by age 15. But our new evidence, based on 14 year-olds born during or just after the year 2000, paints a rather different picture of this latest generation of teenagers.

Our research used data from the Millennium Cohort Study, the most comprehensive survey of adolescent health and development in the UK. It follows children born between September 2000 and January 2002 and has collected information on them at nine months and subsequently at age  three, five, seven, 11, and  14 years. We used information from the most recently available data, when the study’s participants were 14 years old, and were able to look closely at the lives of 11,000 of them.

Intimate activities

Participants were asked about a range of ‘light’, ‘moderate’ and ‘heavy’ intimate activities. Handholding, kissing and cuddling were classed as ‘light,’ touching and fondling under clothes as ‘moderate’ and oral sex or sexual intercourse as ‘heavy.’

As might have been expected, more than half – 58 per cent – had engaged in kissing, cuddling or hand-holding, while 7.5 per cent, or one in 13, had experienced touching or fondling. But in contrast to other studies, (though our sample was younger than those mentioned above) we found only a very small proportion – 3.2 per cent or fewer than one in 30 – had been involved in ‘heavy’ activities in the year before they were interviewed for the study.

And most parents can take comfort from the fact that if their children aren’t participating in other risky activities such as drinking or smoking, they probably aren’t having sex either – there was clear evidence of links between heavier sexual activity and these factors.

We also found those who were most likely to confide worries in a friend rather than a parent, those whose parents didn’t always know where they were and those who stayed out late were more likely than others were to be engaged in heavier forms of sexual activity. Other potential links were found to drug-taking and as well as to symptoms of depression.

Our findings suggest young people who push boundaries may push several at once – that those who drink, smoke or stay out late, for instance, are more likely to engage in early sexual activity.

So, initiatives which aim to minimise risk and promote wellbeing are crucial – and they need to look at intimate activities, health behaviours and social relationships in relation to one another.

A key point is that if young people can learn about intimacy in a positive way at an early stage, then those good experiences can build foundations which will help them throughout their lives.

Most importantly young people need to know how to ensure their intimate experiences are mutually wanted, protected, and pleasurable. The concept of “sexual competence” – used to refer to sexual experiences characterised by autonomy, an equal willingness of partners, being ‘ready’ and (when relevant) protected by contraceptives – is important at all ages, as are close and open relationships with parents.

Better understanding of this interplay between personal relationships and behaviours are key to better support for young people. The right intervention at the right time can ensure a teenager’s intimate life is set on a positive course.

Partnered intimate activities in early adolescence – findings from the UK Millennium Cohort Study, by Yvonne Kelly. Afshin Zilanawala , Clare Tanton, Ruth Lewis and Catherine H Mercer,is published in the Journal of Adolescent Health.

*Afshin Zilanawala is based at the Research Department of Epidemiology and Public Health, University College London, and Oregon State University, United States.

Clare Tanton is based at London School of Hygiene & Tropical Medicine.

Ruth Lewis is based at the University of Glasgow.

Catherine H Merceris based at University College London.

This blog article is courtesy of the Child of our Time blog, which is a blog about the health and happiness of children living in the UK. led by the ESRC International Centre for Lifecourse Studies, University College London,

Inclusion Health: Co-producing a research and advocacy agenda

By Andreas Opitz, on 12 June 2019

Picture Credit: Ibrar Dar

Picture Credit: Ibrar Dar

Authors: Chantal Edge, Dr Binta Sultan, Serena Luchenski, Dr Al Story

There’s no avoiding the fact that health is getting worse for people who are at the extreme edges of society.  The number of people sleeping rough has almost doubled nationally.  Deaths among homeless people and people who use drugs are increasing, and we are putting more people in prison.   This is driven by social and political forces.  Over the last decade, austerity has led to record numbers of working families living in poverty and major increases in child poverty. Housing is unaffordable to millions, foodbanks have proliferated, children’s and youth centres have seen systematic disinvestment, and access to legal aid has been greatly reduced.  At the same time, funding is decreasing for services which reduce the harms of extreme social exclusion, such as addiction treatment, needle exchange and hostels.

So what should we, as a multidisciplinary research and advocacy group, be doing to stem the tide of inequity? How can we stop people from becoming socially excluded, improve services for people who are, and ultimately help people escape exclusion? The team at our newly launched UCL Collaborative Centre for Inclusion Health has reached out to experts with lived experience of exclusion, policy makers, voluntary sector, health and social care workers and academics to frame our research and advocacy priorities for the next five years.

So what is Inclusion Health?

“Inclusion Health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations.” (Luchenski 2017, The Lancet)

Put simply, Inclusion Health is about understanding the forces that cause and perpetuate social exclusion so we can prevent it and bring vulnerable and under-served people in our society ‘out of the cold’. People who are homeless, drug users, prisoners, or sex workers suffer from poorer health outcomes than people in the general population and are far more likely to die early.  Research at UCL found that women from these socially excluded groups were 12 times more likely to die than other women of the same age, and men eight times more likely. People who are socially excluded are more likely to be murdered or commit suicide and more likely to die from accidents, overdoses, infectious diseases, cancers, liver disease, heart problems and respiratory diseases. Social exclusion damages health, destroys lives and fractures communities. Dedicated research and advocacy to highlight the harms of exclusion and remedy the causes is urgently needed.

What is the new UCL Collaborative Centre for Inclusion Health?

The UCL Collaborative Centre for Inclusion Health (CCIH) was set up by a multidisciplinary team of researchers, experts with lived experience and frontline professionals who are dedicated to reducing health inequity. The Centre already has a broad range of research projects underway, measuring the health harms of exclusion and developing and testing interventions to improve the health of excluded groups. At the heart of all these projects are partnerships with people who have lived experience of exclusion (‘experts by experience’) and professionals from across the public and voluntary sector.

Co-producing the Inclusion Health agenda

Picture Credit: Ibrar Dar

Picture Credit: Ibrar Dar

On 3rd June 2019, the Centre held a launch event to bring together a wide range of experts to shape the agenda and co-produce research and advocacy priorities for the next five years.  Over 100 representatives from the voluntary sector, policy, academia, healthcare and a wide range of experts by experience worked together to tackle three key areas – preventing exclusion, improving services for those who are excluded and escaping exclusion.  Through a series of presentations, workshops, democratic voting and ‘dream-boarding’ we collected and collated information on where we need to start.

Consultation and analysis is on-going but emerging priorities include:

  • Tackling the upstream determinants of exclusion – political determinants, poverty and traumatic childhoods
  • Addressing societal and professional ignorance, indifference and stigma that can further deepen and perpetuate exclusion
  • Making services more accessible and integrated to stop people falling through the cracks
  • Ensuring that experts by experience are at the heart of health research, service development and decision making
  • Creating better routes out for people to escape exclusion

This event was run in partnership with the UCL Centre for Co-Production in Health Research and made possible by funding from UCL Grand Challenges.

Next steps

Over the coming months we’ll be disseminating our findings from the day. We will use this evidence to inform and influence research and advocacy priorities for funders, and ensure that our current and future research projects tackle the priorities that have been set.

There is a legal duty in England on politicians and policy makers to better integrate services and tackle health inequalities. People forced to the margins of our society suffer from humiliating disadvantage, preventable disease and premature death. Their lives, cut short, indicate that there is something toxic in our society. Evidence to inform better policy, practice and advocacy is urgently needed.

Picture Credit: Ibrar Dar

Picture Credit: Ibrar Dar

Chantal Edge is an NIHR Clinical Doctoral Research Fellow and Specialty Registrar in Public Health, researching the use of telemedicine for hospital appointments in prison. Dr Binta Sultan is an NIHR Doctoral Research Fellow and a Consultant in HIV and Sexual Health, her research centres on improving hepatitis C linkage to care in people who experience homelessness using novel technologies. Serena Luchenski is an NIHR Clinical Doctoral Research Fellow, a Consultant in Public Health and Chair of the UCL Collaborative Centre for Inclusion Health; her research is on developing a public health preventative approach to hospital care for people experiencing homelessness. Dr Al Story leads the Find&Treat Outreach Service based at UCLH and is Co-Director of the UCL Collaborative Centre for Inclusion Health.

Picture-credit-Binta-Sultan

Picture-credit-Binta-Sultan

If you’re interested in learning more about Inclusion Health we run a short course on Homeless and Inclusion Health at UCL. This can also be taken as an optional MSc module on the MSc Population Health or any UCL MSc programme. It has no pre-requisites and we welcome interested participants from any sector. You can find more information here.

If you are interested in becoming involved in Inclusion Health research please contact us at ccihcore@live.ucl.ac.uk outlining your area of interest.

Accessing GP appointments- a disaster waiting to happen or hope on the horizon?

By Andreas Opitz, on 17 May 2019

In this post Ruth Abrams and Sophie Park reflect on the current pressures facing GPs and NHS today.

In a recent expose called ‘GPs: Why Can’t I Get an Appointment?’, a Panorama documentary, which aired on BBC1 on Wednesday 8th May, emphasised the current limits of and pressures on the NHS system. The programme featured interviews with overworked GPs and allied healthcare professionals, painting a rather bleak picture. Practices are merging and closing at an ever increasing rate. Patient loads increase as patient lists are subsumed. Patient multi-morbidities have increased the need for chronic conditions to be monitored with regular GP appointments. Yet on average patients wait a minimum of two weeks for a routine appointment. Early retirement and a limited flow of trainees into General Practice also contribute to the strain, making practice sustainability difficult to envisage. Inevitably, pressure and frustration are being felt amongst both patient groups and the primary care workforce.

Whilst those researching, working in and experiencing primary care within the UK will already be familiar with these factors, what has become a pressing concern since the 2015 publication of the BMA’s, National survey of GPs: The future of General Practice, is patient safety. At present only the most urgent of cases are seen quickly in General Practice. Yet still an unsafe number of patients are seen by any one GP in a day. This high demand placed upon GPs makes for little time to reflect on cases.

Enter- the release of the new GP contract and the NHS long term plan which intend to employ a multi-disciplinary army of healthcare professionals. Within this new way of working, workloads will be shared amongst staff, with greater efforts being made for both integration and collaboration. A typical GP’s day will begin to look very different. Micro-teams will have time to discuss patient cases, a GP’s time can once again be focused on the professional tasks only they can undertake and overall there begins to be a healthier outlook to teamwork.

Some promote this utopian vision of General Practice working unquestioningly. Pots of money, such as those made available through the Prime Minister’s Fund, have encouraged new ways of working with very limited evidence base. Yet one aspect seemingly unaddressed within the new plans is the disparity across patient access and levels of deprivation within the UK. In a recent report by the Health Foundation, GPs working in higher deprived areas see more patients compared to their counterparts. These are areas where recruitment of this new workforce will inevitably be harder. This raises questions about how best to incentivise recruitment so that patient access to care remains equal for all.

There is also a certain feel that these plans are being done to, rather than with GPs. We need only reflect back a few short years to the junior doctor protests to recall that in order for patient safety to happen, workforce perspectives must be accounted for. In order for the NHS to remain as successful as it has been and for the principles of Astana declaration to be realised, GP engagement rather than negation needs to remain central to all future planning activities.

Unequal access to care and a disruption to professional identities present major issues. But doing nothing is no longer an option. At a time when the NHS is so often synonymous with the words crisis and strain rather than success, a Utopian vision for both staff and patients may be both timely and necessary. Reifying this however, becomes a different matter all together.

Retirement: good or bad for your heart?

By Andreas Opitz, on 16 May 2019

Is retirement good for your heart, or bad for it? The question is an important one because cardio-vascular disease (CVD) is the biggest cause of death globally and costs health services a huge amount of money.

Some studies have shown retired people have a higher risk of being diagnosed with CVD than those who are still working. But until now the evidence has been unclear.

We set out to review evidence from across the world, so that we could help to build a more accurate picture of whether, and how, retirement might affect our cardio-vascular health. As CVD is linked to our lifestyle, diet and other behaviour, there are lots of ways in which changes that take place in retirement might have an effect – both negative or positive.

Longitudinal studies

We looked for longitudinal studies that could help answer our questions, and found 82 which measured risk factors for CVD and 14 which looked at actual incidence of CVD. The second set of 14 papers provided the answer to our first question – does retirement affect our cardio-vascular health?

The answer revealed a major difference between the USA and Europe. Studies conducted in the US showed no significant effect, good or bad, on retirees’ cardio-vascular health. In Europe, meanwhile – with the exception of France – studies consistently showed a link between retirement and an increase in CVD.

Data from the British Regional Heart Study, for instance, showed that healthy men who retired before the age of 60 were more likely than others to die from circulatory disease within five and a half years. Fatal and non-fatal CVD was also more common among retirees in Denmark, Greece, Italy and the Netherlands.

Why might this be? Could there be cultural or lifestyle differences between Europe and the US which might cause this difference? We took a systematic look at the risk factors.

Weight gain

First, we looked at weight gain. If Americans were less likely to put on weight after retirement compared to Europeans, that might help to explain the difference. But when we looked at this, we found that body mass index (BMI) actually increased after retirement in the USA – and also Japan -but did not change in England, Denmark, France, Germany, Switzerland or Korea. While those who do physically demanding jobs are likely to put on weight after they retire, most people aren’t.

Could it be that retired people generally do less exercise – another risk factor – in Europe? The studies suggest that’s not the reason. While many retirees did more physical activities, they also spent more time sitting still – so the effect was a balanced one. For instance, a retiree might play more golf, but also watch more television.

Do retired people perhaps smoke more, we asked? Again, there were contradictory results but 12 out of 14 studies either showed no effect or showed retirement led to people smoking less.

Perhaps retired people in Europe drink more, then? Again, this couldn’t be identified as the reason. Studies in Australia, the UK, Japan and the USA suggested there was no association between retirement and alcohol consumption.

Diet is another possible cause of CVD, but again, there was no clear pattern of between retirement and diet emerged from reviewed studies.

No benefits

So the picture isn’t straightforward, and we don’t have answers as to why retirement might put Europeans at risk but not Americans. What we can say, though, is that none of the studies we looked at found any beneficial effects of retirement on CVD.

Apart from a decrease in smoking, there wasn’t evidence of any general ‘relief’ effect of retirement on people’s cardio-vascular health – so the supposition that working could be bad for our health and therefore retirement better for it doesn’t necessarily hold true.

However, studies that showed retirement brought negative health effects should be interpreted with caution. Many assessed the health effects of retirement by comparing retired people with employed people – and we know people who stay in the labour market are generally healthier than retirees. We do know people who have CVD, diabetes or hypertension are more likely to retire.

What our review has done is to reveal the complex nature of the underlying mechanism through which retirement might impact on the risk factors for CVD. Different people react differently to retirement, depending on their life experiences and the cultural and policy environments in which they live. So there isn’t one global solution to any of this – each country needs to plan its citizens’ retirement according to their individual needs.

The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studiesby Baowen Xue, Jenny Head and Anne McMunn, is published by The Gerontologist.

This blog article is courtesy of the Work Life blog, which is a blog about the relationship between work and  health and well-being of people, whether they are preparing for  working life, managing their work / life balance or preparing for retirement and life beyond retirement. Led by the ESRC International Centre for Lifecourse Studies, University College London,

By Andreas Opitz, on 24 April 2019

Where you live in your 20s affects when you retire – here’s how

File 20190417 139116 1aozy2a.jpg?ixlib=rb 1.1
Where you decide to live will impact your career. Shutterstock.

Emily Murray, UCL

Across the globe, people are living longer. Many countries – including the UK – have responded by raising the age of retirement. By 2028, UK citizens will need to be 67 years old to receive their state pension, and further increases have been recommended by both government and independent reviews.

But there’s one major issue with this: most employees in the UK already stop working before the current state pension age of 65. For some, early retirement can be a positive life change which means they can afford to stop working. But for others, early retirement is a result of poor health or unemployment, which can eat into savings and widen inequalities among older people.

Previous studies have shown that in areas where there are more unemployed people, older people are also more likely to leave the workforce. In the past, researchers thought this was because older workers are more likely to be made redundant and have a harder time finding another job when they are unemployed.


Read more: Where people live influences whether they stop working before pension age


But our new research shows that the link between local unemployment and retirement age actually depends on where people live as young adults. Specifically, people in their 20s who live in areas where there are fewer jobs are more likely to be unemployed and in poor health at mid-life – and these are two significant causes of early retirement.

A lifelong study

My colleagues and I at the Research on Extended Working Lives (RenEWL) consortium set out to understand this phenomenon using data from the 1946 British birth cohort study – a representative sample of all British people born in one week in March 1946 across England, Scotland and Wales.

There were 2,526 cohort members, who told us whether they had retired from their main occupation or were still in work. First, we explored where they had lived in childhood (at age four), young adulthood (age 26) and mid-life (age 53). Then, for all three ages, we looked at census data to find out how many working-age people in their local authority were unemployed at the time.

History matters. Shutterstock.

By the age of 68, more than 80% of the people in the cohort had retired, with the average age of retirement being around 59 years. As seen in previous studies, those who lived in areas with higher levels of unemployment at mid-life, also tended to retire earlier. For each 5% increase in local unemployment, people retired on average roughly 1.5 years earlier.

Long-term effects

But when we started to delve into where cohort members had lived earlier in their lives – as well as considering their health, employment and education history – we realised just how strongly unemployment levels in the local area during early adulthood continued to affect people throughout their lives.

If a cohort member lived in a local authority where there was more unemployment than average as a child, it was also likely that they would live somewhere similar as an adult. And those who lived in areas with higher than average unemployment rates as young adults then went on to have poorer health and were more likely to be unemployed at mid-life – compared with those who lived in areas with lower unemployment rates.

Researchers have found that health and employment status strongly predict what age people retire. We found this as well, with cohort members who were unemployed at mid-life retiring on average about five years earlier than those who were working full time at the same age.

What’s more, we found that the link between where people live in their mid-life and their retirement age can actually be traced right back to where they lived in their 20s. So the experiences people had when they were younger had a long term impact on their health and employment status at mid-life.

For example, someone who had moved in their early 20s to Guildford, where there was high employment, was more likely to still be in work when they reached mid-life, than someone who had lived in their 20s in Glasgow – where unemployment was high – regardless of where either lived later in life (although it is likely both will have lived in the same or equivalent employment area in their 50s).

Our findings imply that people should think carefully about how where they live⁠ ⁠might affect⁠ ⁠t⁠h⁠e⁠i⁠r⁠ ⁠c⁠a⁠r⁠e⁠e⁠r⁠.⁠ ⁠P⁠e⁠o⁠p⁠l⁠e⁠ ⁠seem to k⁠n⁠o⁠w⁠ ⁠t⁠h⁠a⁠t⁠ ⁠i⁠t⁠’⁠s⁠ ⁠e⁠a⁠s⁠i⁠e⁠r⁠ ⁠t⁠o⁠ ⁠g⁠e⁠t⁠ ⁠a⁠ ⁠j⁠o⁠b⁠ ⁠i⁠n⁠ ⁠a⁠r⁠e⁠a⁠s⁠ ⁠where there are more jobs available – indeed, graduates tend to migrate into urban centres with more employment opportunities. ⁠O⁠u⁠r⁠ ⁠r⁠e⁠s⁠e⁠a⁠r⁠c⁠h⁠ ⁠s⁠h⁠o⁠w⁠s⁠ ⁠t⁠h⁠a⁠t⁠ ⁠t⁠h⁠e⁠s⁠e⁠ ⁠e⁠a⁠r⁠l⁠y⁠ ⁠c⁠a⁠r⁠e⁠e⁠r⁠ ⁠d⁠e⁠c⁠i⁠s⁠i⁠o⁠n⁠s⁠ ⁠c⁠a⁠n⁠ ⁠h⁠a⁠v⁠e⁠ ⁠c⁠o⁠n⁠s⁠e⁠q⁠u⁠e⁠n⁠c⁠e⁠s⁠ ⁠i⁠n⁠t⁠o⁠ ⁠p⁠e⁠o⁠p⁠l⁠e⁠’⁠s⁠ ⁠r⁠e⁠t⁠i⁠r⁠e⁠m⁠e⁠n⁠t⁠ ⁠y⁠e⁠a⁠r⁠s⁠.

If the government wants to encourage people to stay in work longer, it should give older workers the support they need to stay in work and in good health. It could also help them maintain their employment, even when they’re not in the best of health – for example by adapting workplaces for older workers, or encouraging flexible working. By improving job opportunities for young people living in places with high unemployment, it could help people to keep working for

Where you live in your 20s affects when you retire – here’s how

File 20190417 139116 1aozy2a.jpg?ixlib=rb 1.1
Where you decide to live will impact your career. Shutterstock.

Emily Murray, UCL

Across the globe, people are living longer. Many countries – including the UK – have responded by raising the age of retirement. By 2028, UK citizens will need to be 67 years old to receive their state pension, and further increases have been recommended by both government and independent reviews.

But there’s one major issue with this: most employees in the UK already stop working before the current state pension age of 65. For some, early retirement can be a positive life change which means they can afford to stop working. But for others, early retirement is a result of poor health or unemployment, which can eat into savings and widen inequalities among older people.

Previous studies have shown that in areas where there are more unemployed people, older people are also more likely to leave the workforce. In the past, researchers thought this was because older workers are more likely to be made redundant and have a harder time finding another job when they are unemployed.


Read more: Where people live influences whether they stop working before pension age


But our new research shows that the link between local unemployment and retirement age actually depends on where people live as young adults. Specifically, people in their 20s who live in areas where there are fewer jobs are more likely to be unemployed and in poor health at mid-life – and these are two significant causes of early retirement.

A lifelong study

My colleagues and I at the Research on Extended Working Lives (RenEWL) consortium set out to understand this phenomenon using data from the 1946 British birth cohort study – a representative sample of all British people born in one week in March 1946 across England, Scotland and Wales.

There were 2,526 cohort members, who told us whether they had retired from their main occupation or were still in work. First, we explored where they had lived in childhood (at age four), young adulthood (age 26) and mid-life (age 53). Then, for all three ages, we looked at census data to find out how many working-age people in their local authority were unemployed at the time.

History matters. Shutterstock.

By the age of 68, more than 80% of the people in the cohort had retired, with the average age of retirement being around 59 years. As seen in previous studies, those who lived in areas with higher levels of unemployment at mid-life, also tended to retire earlier. For each 5% increase in local unemployment, people retired on average roughly 1.5 years earlier.

Long-term effects

But when we started to delve into where cohort members had lived earlier in their lives – as well as considering their health, employment and education history – we realised just how strongly unemployment levels in the local area during early adulthood continued to affect people throughout their lives.

If a cohort member lived in a local authority where there was more unemployment than average as a child, it was also likely that they would live somewhere similar as an adult. And those who lived in areas with higher than average unemployment rates as young adults then went on to have poorer health and were more likely to be unemployed at mid-life – compared with those who lived in areas with lower unemployment rates.

Researchers have found that health and employment status strongly predict what age people retire. We found this as well, with cohort members who were unemployed at mid-life retiring on average about five years earlier than those who were working full time at the same age.

What’s more, we found that the link between where people live in their mid-life and their retirement age can actually be traced right back to where they lived in their 20s. So the experiences people had when they were younger had a long term impact on their health and employment status at mid-life.

For example, someone who had moved in their early 20s to Guildford, where there was high employment, was more likely to still be in work when they reached mid-life, than someone who had lived in their 20s in Glasgow – where unemployment was high – regardless of where either lived later in life (although it is likely both will have lived in the same or equivalent employment area in their 50s).

Our findings imply that people should think carefully about how where they live⁠ ⁠might affect⁠ ⁠t⁠h⁠e⁠i⁠r⁠ ⁠c⁠a⁠r⁠e⁠e⁠r⁠.⁠ ⁠P⁠e⁠o⁠p⁠l⁠e⁠ ⁠seem to k⁠n⁠o⁠w⁠ ⁠t⁠h⁠a⁠t⁠ ⁠i⁠t⁠’⁠s⁠ ⁠e⁠a⁠s⁠i⁠e⁠r⁠ ⁠t⁠o⁠ ⁠g⁠e⁠t⁠ ⁠a⁠ ⁠j⁠o⁠b⁠ ⁠i⁠n⁠ ⁠a⁠r⁠e⁠a⁠s⁠ ⁠where there are more jobs available – indeed, graduates tend to migrate into urban centres with more employment opportunities. ⁠O⁠u⁠r⁠ ⁠r⁠e⁠s⁠e⁠a⁠r⁠c⁠h⁠ ⁠s⁠h⁠o⁠w⁠s⁠ ⁠t⁠h⁠a⁠t⁠ ⁠t⁠h⁠e⁠s⁠e⁠ ⁠e⁠a⁠r⁠l⁠y⁠ ⁠c⁠a⁠r⁠e⁠e⁠r⁠ ⁠d⁠e⁠c⁠i⁠s⁠i⁠o⁠n⁠s⁠ ⁠c⁠a⁠n⁠ ⁠h⁠a⁠v⁠e⁠ ⁠c⁠o⁠n⁠s⁠e⁠q⁠u⁠e⁠n⁠c⁠e⁠s⁠ ⁠i⁠n⁠t⁠o⁠ ⁠p⁠e⁠o⁠p⁠l⁠e⁠’⁠s⁠ ⁠r⁠e⁠t⁠i⁠r⁠e⁠m⁠e⁠n⁠t⁠ ⁠y⁠e⁠a⁠r⁠s⁠.

If the government wants to encourage people to stay in work longer, it should give older workers the support they need to stay in work and in good health. It could also help them maintain their employment, even when they’re not in the best of health – for example by adapting workplaces for older workers, or encouraging flexible working. By improving job opportunities for young people living in places with high unemployment, it could help people to keep working for longer.The Conversation

Emily Murray, Senior Research Fellow, Department of Epidemiology & Public Health, UCL

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Emily Murray, Senior Research Fellow, Department of Epidemiology & Public Health, UCL

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Anti-social working hours: Are they making women depressed?

By Andreas Opitz, on 12 March 2019

The rise of globalisation and the 24/7 economy are fuelling demands for people to work long hours and weekends.  But what’s the evidence about how these ways of working link with depression? Gill Weston and colleagues from the International Centre for Lifecourse Studies in Society and Health at UCL and Queen Mary University of London found such working conditions are linked to poorer mental health in women.

Across the globe, the effects of overwork are becoming apparent.  In eastern Asian countries the risk of death due to overwork has increased.  In the UK, work-related stress accounts for millions of lost working days every year.

Within the EU, a significant proportion of people have to work unsociable hours – with nearly a quarter working most Saturdays and a third working at least one Sunday a month.  But despite this, there isn’t much clear evidence about the links between work patterns and mental health.

Some studies have found a connection between unsociable work patterns and depression.  But many of the studies only focused on men, some only looked at specific types of worker or workplaces and few took account of work conditions such as whether workers had any control over how fast they worked.

To address these gaps, we set out to look for links between long or irregular hours and depression using a large nationally representative sample of working men and women in the UK.  We particularly wanted to look at whether there were differences between men and women because research has shown that work is organised, experienced and rewarded differently for men and women, and because men and women react differently to overwork and time pressure.

We used data from Understanding Society, which surveys people living in 40,000 households across the UK.  In particular we focused on information about working hours, weekend working and working conditions collected from 11,215 working men and 12,188 working women between 2010 and 2012.  They had completed a questionnaire designed to study levels of psychological distress.

Who works the most?

We found men tended to work longer hours in paid work than women, and having children affected men’s and women’s work patterns in different ways: while mothers tended to work fewer hours than women without children, fathers tended to work more hours than men without children.

Two thirds of all men worked weekends, compared with half of all women.  Those who worked all or most weekends were more likely to be in low skilled work and to be less satisfied with their job and their earnings than those who only worked Monday to Friday or some weekends

Which workers have the most depressive symptoms?

Women, in general, are more likely to be depressed than men, and this was no different in our study.

Independent of their working patterns, we also found that workers with the most depressive symptoms were older, smokers, on lower incomes, in physically demanding jobs, and who were dissatisfied at work.

Are long and irregular hours linked to depression?

Taking these findings and other factors into account, when we looked at the mental health effects of work patterns on men and on women, the results were striking: while there was little or no difference in depressive symptoms between men who worked long hours and those who did not, this was not the case for women.

Those women who worked 55 hours or more per week had a higher risk of depression than women working a standard 35-40 hour week.

Similarly, weekend working showed differences for men and women.  Compared to workers who only worked on weekdays, men who worked weekends also had a greater number of depressive symptoms, but only if they had little control at work or were dissatisfied with work.  Whereas for women,  regardless of their control or satisfaction, working most or all weekends was linked to more depressive symptoms.

Why might women suffer more than men while working these antisocial hours?

There might be a number of reasons why women might be more affected than men:

  • Women who work long hours are in a minority – just four per cent of them in our sample worked 55 hours or more per week. This may place them under additional pressure.
  • Women working longer hours tend to be in male-dominated occupations, and this may also contribute to stress.
  • Women working weekends tend to be concentrated in low-paid service sector jobs, which have been linked to higher levels of depression.
  • Many women face the additional burden of doing a larger share of domestic labour than men, leading to extensive total work hours, added time pressures or overwhelming responsibilities.

What should be done about these risks?

Our findings should encourage employers and policy-makers to think about how to reduce the burdens and increase support for women who work long or irregular hours – without restricting their ability to work when they wish to.  More sympathetic working practices could bring benefits both for workers and for employers – of both sexes.

Long work hours, weekend working and depressive symptoms in men and women: Findings from a UK population-based study by Gill Weston, Afshin Zilanawala, Elizabeth Webb, Livia Carvalho, and Anne McMunn is published in the  Journal of Epidemiology and Community Health, which is published by the BMJ.

E-cigarettes – a tool to reduce inequalities in smoking?

By Andreas Opitz, on 19 February 2019

Since their arrival in the UK in 2010/11, electronic cigarettes (e-cigarettes or vapes) have rapidly become the most popular aid to help people quit smoking. With evidence continuing to grow showing that vaping 1) poses a small fraction of the risks of smoking and 2) improves smoking quit success, Public Health England have restated that smokers who are struggling to quit should ‘try switching to an e-cigarette’ along with seeking help by trained specialists. But what does this mean for existing inequalities in smoking?

Following a steady decline over the past decade, 15% of the population in England are estimated to currently smoke. However, smoking rates fall along a social gradient, with one in four people from disadvantaged socio-economic groups smoking, compared with one in ten from more affluent groups. This means that a disproportionate number of the ~78,000 deaths and the ~485,000 hospital admissions caused by smoking in England each year fall upon the disadvantaged.

Given their popularity (used by >30% of smokers making a quit attempt) and generally lower cost compared with cigarettes, e-cigarettes have potential to help reduce inequalities in smoking cessation. However, a concern during the early period in which e-cigarettes first arrived on the UK market was that they were more popular with better off smokers. If the devices boost quit success, which appears to be the case, then these differences in use across the social gradient could potentially lead to disadvantaged smokers being left behind, thus worsening the existing inequalities.

Keeping up with change

Since their creation in 2003 by a Chinese pharmacist Hon Lik, e-cigarettes have continued to evolve with novel designs and more effective nicotine delivery systems being rolled out each year. The Smoking Toolkit Study (STS), set up by the Tobacco and Alcohol Research Group at UCL to monitor population trends in smoking in England, is one way that researchers and policy makers can keep up with this ever-changing landscape of e-cigarette use and assess whether they promote or detract from reducing smoking rates.

Using STS data from 2014 to 2017, our recent research published in the journal Addiction was the first of kind to look at the use of e-cigarettes by different socio-economic groups at the population level. Our study analysed data from over 81,000 adults in England, including 16,000 past-year smokers, 5,300 smokers making a quit attempt and 13,500 long-term ex-smokers. E-cigarette use in each group was assessed using participant social grade (based on occupation) or housing status as key indicators of socio-economic position.

Narrowing differences among smokers

Our analysis indicated that in the three years from 2014 to 2016, disadvantaged smokers were around half as likely to use e-cigarettes. However, by 2017 this difference was no longer evident. Similarly, there were no differences in e-cigarette use by smokers making a quit attempt. Should this absence of difference between socioeconomic groups remain going forward then it is unlikely that the use of e-cigarettes among smokers and quit attempters will have a persistent impact on inequalities. However, it will be important to investigate whether there are socio-economic differences in the success of quit attempts with e-cigarettes, something which researchers in our group have been looking into.

Greater e-cigarette use among disadvantaged ex-smokers

Our research also showed a different pattern among smokers who had been quit for over a year, with disadvantaged ex-smokers more than twice as likely to use an e-cigarette. This could have important implications, and really depends on whether e-cigarettes prevent ex-smokers from relapsing back into smoking tobacco. If that were true (unfortunately there isn’t much research on this yet) then e-cigarette use would protect more disadvantaged smokers from slipping back into smoking and act to reduce inequalities; an equity-positive effect.

The wider picture

Inequalities in smoking are driven by a complex and nuanced system acting at the population, community and individual level. Reducing disparity requires action at all levels such as tobacco taxes, public health media and education campaigns and individual specialist support that targets the neurobiological and motivational components of nicotine addiction that dependent smokers struggle with. E-cigarettes are not a magic wand for quitting smoking. Rather, given their popularity and similar effectiveness to other forms of nicotine replacement therapy, they are part of a toolbox of interventions that are contributing to the continuing decline in smoking in the UK. If they are available, affordable and able to deliver nicotine effectively without the loss of social identity that some smokers subscribe to, e-cigarettes may also help redress the persistent inequalities in smoking.

Loren Kock (@loren_kock.) is a Cancer Research UK funded PhD student in Epidemiology and Public health, working within the UCL Tobacco and Alcohol Research Group. His research focusses on how e-cigarettes and other smoking cessation interventions impact on socio-economic inequalities in smoking cessation.

Teenage depression: The potential pitfalls of too much social media use

By Andreas Opitz, on 14 January 2019

A new mobile phone will be in the pockets of many teenagers as they head back to school in the coming days. The period between Xmas and New Year will have been spent signing up for social media apps where they can chat, share photos and videos with friends, all part of the excitement of owning a new device. But how many of these young people and their parents are aware of the potential pitfalls of spending too much time on social media sites?  And what can parents, teachers and young people themselves do to maximize the benefits of life online whilst minimising those pitfalls? It’s a question that Yvonne Kelly, Director of the ESRC International Centre for Life course Studies at UCL and colleagues have been asking as part of a major programme of research on social media use and young people’s wellbeing.

Today they publish key new research, which provides much-needed new evidence on the links between heavy social media use and depression in teenagers. The research shines light on the underlying processes that could be at work and that might explain the link between the two. Here, Yvonne explains how their research might help policymakers, educators, parents and young people themselves better understand and prevent the potential pitfalls of living too much of their life on social media platforms.

2018 has seen a growing chorus of voices including those of the former and current Health Secretaries, Jeremy Hunt and Matt Hancock calling for a thorough investigation of the links between social media use and the growing numbers of young people struggling with mental health issues. Indeed Matt Hancock issued “an urgent warning” on the potential dangers of social media on children’s mental health, stating that the threat of social media on mental health is similar to that of sugar on physical health.

The Chief Medical Officer, Dame Sally Davies has been tasked by the Government with leading that investigation and with coming up with evidence based recommendations around what constitutes safe social media use and what changes need to be made and by whom to make that a reality. The Royal College of Paediatrics and Child Health (RCPCH) recently issued the first ever guidance on managing children’s screen time, calling for further research particularly into social media.

In recent months, we and others have submitted written and oral evidence to two Parliamentary inquiries in this area and had discussions with the Royal Society for Public Health which is campaigning actively  to get us all thinking harder about our social media use.

We’ve talked about our early research  showing that 10 year-old girls who used social media sites for chatting had more social and emotional problems at age 15 than their peers who used them less or not at all. Those problems continued to get worse as they got older.

Our new research published in The Lancet’s EClinical Medicine draws stronger links between heavy social media use and depressive symptoms in girls and boys at the age of 14.  We look at the possible ways in which social media use might linked to depressive symptoms. We consider 4 potential pathways – through young people’s sleep patterns, their experiences of online harassment, body image and self-esteem. It is the first research to look at all of these potential pathways at the same time.

Our data for this research came from the Millennium Cohort Study, which has followed the lives of some 19,000 children born at the turn of the century. This piece of research, looked at the social media use and mental health of nearly 11,000 of the study’s participants.

Social media use

In line with our earlier research, we saw that girls were heavier users of social media than boys with two fifths of them using it for more than 3 hours per day (compared with one fifth of boys). Girls were a lot less likely NOT to use social media at all (4 per cent girls and 10 per cent boys).

Examining the underlying processes that might be linked with social media use and depression, we saw a number of really striking findings including:

  • 40 per cent of girls and 25 per cent of boys had experience of online harassment or cyberbullying
  • 78 per cent of girls and 68 per cent of boys were unhappy with their body/weight and 15 percent girls and 12 per cent of boys were unhappy with their appearance
  • 13 per cent of girls and 9 per cent of boys had low self-esteem
  • 13 per cent of girls and 11 per cent of boys reported getting fewer than 7 hours sleep per night and 40 per cent of girls and 28 per cent of boys said their sleep was often disrupted

Girls, it seems from these findings, are struggling more with these aspects of their lives than boys – in some cases considerably more. When we turned our attention to the signs of depression exhibited by our participants, we could see that here too girls fared worse with scores on average twice as high as those of boys.

The link between social media use and depressive symptoms was stronger for girls compared with boys. For girls, greater daily hours of social media use corresponded to a stepwise increase in depressive symptoms and the percent with clinically relevant symptoms. For boys, higher depressive symptom scores were seen among those reporting 3 or more hours of daily social media use.

There was a clear link between social media use and all the pathways we investigated – more time spent on social media related to having poorer sleep, more experiences of on-line harassment, unhappiness with the way they look and low self esteem. In turn, these things were directly related to having depressive symptoms.

A closer look at the pathways was also revealing. The most important routes from social media use to depressive symptoms were shown to be via poor sleep and online harassment.

Social media use linked directly to having poor sleep which in turn was related directly to having more depressive symptoms. The role of online harassment was more complex, with multiple pathways through poor sleep, self-esteem and body image, all of which linked directly to depressive symptoms.

Potential pitfalls and key routes

Our findings add weight to the growing evidence base on the potential pitfalls associated with lengthy time spent engaging on social media. In particular they point to poor sleep and online harrassment as being key routes between social media use and depression.

These findings are highly relevant to current policy development on guidelines for the safe use of social media and calls on industry to more tightly regulate hours of social media use for young people. They add weight to the Screen Time Guidance issued by the RCPCH today, particularly the suggestion to set and agree child appropriate time limits on screen use.

When it comes to social media use specifically, our research indicates that the a similar approach could be useful. Clinical, educational and family settings are all potential points of contact where young people could be encouraged and supported to reflect not only on their social media use, but also other aspects of their lives including on-line experiences and their sleep patterns.

At home, families may want to reflect on when and where it’s ok to be on social media and agree limits for time spent online. Curfews for use and the overnight removal of mobile devices from bedrooms might also be something to consider. School seems an obvious setting for children and young people to learn how to navigate online life appropriately and safely and for interventions aimed at promoting self-esteem. Clearly a large proportion of young people experience dissatisfaction with the way they look and how they feel about their bodies and perhaps a broader societal shift away from the perpetuation of what are often highly distorted images of idealised beauty could help shift these types of negative perceptions.

As we head into 2019, millions of young people will be getting their first experiences of life online using the devices they got for Xmas. They will rapidly become expert at downloading apps, posting photos and interacting with their peers. With the gift there was no instruction manual to help them understand and navigate some of the pitfalls our research outlines. We hope our work brings, at least, some guidance for all those keen to ensure these children continue to thrive and do well, so that they enjoy the benefits that new digital technology brings whilst staying safe and happy.

Social media use and adolescent mental health: Findings from the Millennium Cohort Study is research by Yvonne Kelly, Afshin Zilanawala, Cara Booker and Amanda Sacker and is published in The Lancet’s EClinicalMedicine journal.