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Fuel and Food Poverty in the UK must be addressed before the energy price hike this Spring

By e.schaessens, on 18 January 2022

Written by Rebecca Barlow-Noone, a student on the MSc Population Health programme.

During the pandemic, inequalities in the UK have been brought into sharp relief with a rapid rise in food and fuel poverty, which I documented last year and have seen first-hand as a volunteer for Lambeth Foodbanks. Yet with fuel price caps set to skyrocket in the coming months and no plans to protect those on low incomes, it is likely to push even more people below the poverty line, forcing many to decide whether to ‘heat or eat’.

Foodbanks during the pandemic

Compared to 5 years ago, Trussell Trust food bank demand has increased 128%. Between April 2020 and March 2021, 2.5 million emergency food parcels were delivered in the UK by the Trussell Trust, representing a 33% increase from the previous pre-pandemic year. Furthermore, in December 2020, high levels of child food poverty in London led to additional food parcel distributions by UNICEF. This is despite the £20 per week Universal Credit (UC) uplift introduced in March 2020 in response to the pandemic.

The effect of Universal Credit cuts, energy price hikes, and inflation

As winter approached in late 2021, people on UC saw the tightest squeeze yet. The benefits uplift was cut, leaving recipients £1,040 per year worse off; prepayment energy tariffs saw the highest price increase of £153 to £1309 per year, which is used more by those on low incomes than high incomes; and inflation hit a 10-year high. While a taper rate of UC was implemented shortly after the uplift was cut, this only benefitted claimants who were already in work, and did not apply to people receiving legacy benefits.

I am deeply concerned how rising fuel costs this April will affect those already feeling the effects of the cut and price cap increase. When speaking to clients, I often hear how hard it is to make ends meet. I hear from parents forgoing meals for the sake of their children, and elderly clients unable to pay the higher energy bills through the winter. This is only set to get worse, with Age UK estimating that fuel poverty in the elderly may reach over 150,000 without financial protection this spring. It is unacceptable for people to be treated so poorly in a wealthy society such as the UK, at a time when they need the most support.

As costs of living increase for all, now is the time to increase support for those whose incomes at current UC rates do not allow for basic standards of living. Foodbanks across the UK represent an important lifeline, but this cannot be considered the norm and should not be relied upon by Government. The current rise in food bank reliance and the impending rise in fuel costs demands scrutiny into the social policies that are failing to adequately support those in need, to ensure those at most risk are protected from the increasing fuel price cap.

Health and social care access for people experiencing homelessness and lessons for primary care

By guest blogger, on 3 November 2021

This blog is written by Caroline Shulman and Megan Armstrong. Caroline has worked as a GP for people experiencing homelessness in primary care and as a clinical lead in a hospital homeless team. Caroline is principal investigator (PI) on a range of projects on palliative care, frailty and homelessness. Megan was the senior research fellow on this project and currently is the Programme Manager of PD-Care and the PI of exploring self-management in those experiencing low socioeconomic deprivation. 

Though everyone’s circumstances are different, to support people experiencing homelessness, it helps to understand some of the underlying causes of homelessness. Systemic factors such as austerity, increase in poverty and inequality, regressive changes to welfare systems, increased job insecurity with more zero hours contracts, lack of affordable housing and a hostile environment for migrants have contributed to significant increases over the last decade. However, in addition, there are individual vulnerabilities that increase the likelihood of becoming homeless. It is estimated 90% of people who are homeless have experienced adverse childhood experiences with 54% experiencing four or more (1). Adverse childhood experiences include abuse (emotional, physical, sexual or neglect) and household dysfunction such as living with domestic violence, or with a family member who has an addiction, is suicidal, mentally ill or in prison. Lack of having needs met and being soothed as a child impacts on cognitive, emotional, and social development and unresolved trauma is associated with an overdevelopment of the emotional and reactive parts of the brain (2).

People experiencing homelessness have some of the worst health outcomes of any group in society with the average age of death being in their early 50s  (see here). They have a much higher rate of most long terms conditions, including heart disease, respiratory disease than even populations in the most deprived sectors of society. Conditions usually found in older populations, such as cognitive impairment, incontinence, poor mobility, and frailty are highly prevalent at a young age in this population. Many people, with a history of sleeping on the streets in London, end up on homeless hostels. Homeless hostels are staffed by support workers who have no training in health or social care. In one hostel (for adults aged 35+), where residents average age was 55, frailty scores were equivalent to a population of people in their late 80s. All had multimorbidity with the average number of conditions per person being seven. Older age conditions such as cognitive impairment, falls and poor mobility were highly prevalent, though only 9% had any form of social services package of care (3).

One reason for the young age of death of people experiencing homelessness is the barriers they often face in accessing health and social care. Our study aimed to explore these barriers and potential facilitators from the perspectives of hostel residents and staff (4). We interviewed 18 homeless hostel managers/support staff and 15 people experiencing homelessness from six homeless hostels in London and Kent.

We found there were service barriers to health and social care access due to:

Stigma of both the residents and the hostel staff (often reporting not being believed):

“We have got one of the local GPs around here, they will not accept our residents unless a keyworker is with them, and they have to attend all appointments with them and register with them. They won’t accept them on their own.” Support worker

Lack of communication and information sharing from services with the hostel:

“I was that upset and annoyed that she’s [social worker] not speaking to anyone else that I’m working with [in the hostel]. I said, “It’s not keeping you up to date.” I speak to you once every three weeks, you don’t know what’s happening. So I could be going through a really difficult time and you’re not aware of it….” Resident

A lack of trust from the residents and a struggle to build relationships beyond the hostel staff:

“I’m still finding I’m having to learn to trust people. I don’t always trust people now, and my confidence is not brilliant. Once I know someone [this is different]…., but I’m not very good coming forward at the beginning.” Resident

Incorrect assumptions around capacity and the role of the hostel:

“I think because a lot of people presume because it’s [the hostel] a 24-hour manned project, they’ve got staff. They [external services] don’t really realise that our job isn’t to be carers…It’s not always practical to see everybody every single day. What people see from the outside is 24-hour staff” Support worker

The impact of lack of health and social care support led to staff going beyond their job role, continuous support needed by the residents, and burnout:

“We also have to go and collect people’s medications. We don’t have to but we’re doing that as well and liaising with GPs to put [medication] in dosette boxes and things like that.” Hostel staff

Overall, the hostel staff and residents had a great, trusting relationship. However, due to the lack of external service support, this can become a huge responsibility for the hostel staff. The quote below highlights the trust in the hostel staff.

“I think she [hostel staff member] cares about me. I’ve never actually asked her, does she care? The staff here are alright, I like them. I like the staff here. I ain’t got a bad word to say about them.”

An example of the causes of burnout for hostel staff include the trauma when a resident dies:

“When he was standing along the walls and he was saying, “I’m feeling pain,” and he just slid into the floor. It was during the night, early morning so there were only two staff. Staff were running up and down. It was quite a traumatic experience.”

See our recent paper and blog on palliative care for people experiencing homelessness.

What does this mean for primary care?

  • Everyone needs to be able to register with a GP. Groundswell have developed ‘My Right to Healthcare’ cards that can be posted for free.
  • Training is available for reception staff including a short 6 minute video: resources here
  • Primary Care Networks should consider having an inequalities lead to explore local solutions. They could also undertake a self-assessment to support improved engagement with inclusion health groups (see here).
  • Services should be person-centred, and trauma informed so that people feel safe, welcome, listened to and understood. Here is a video on trauma informed communication skills and an overview of training available here.
  • Services need to recognise the importance of developing trust and trusting relationships, as these are at the heart of healing and recovery. Ideally with the continuity of care with the same provider.
  • Services should  proactively support people with literacy, language, and cognition difficulties.
  • Primary care services should consider how they can take care to people with the highest need to enable trust to be developed. For example, enhanced services undertaking in-reach into hostels can be highly successful in increasing engagement. Reaching out to frontline staff in homeless services, who often feel stigmatised, can be a first step in acknowledging the support they are providing and explore how they can be better supported.

It is our duty to find and care for those in our community who are excluded and marginalised and advocate for their needs. We need to embed inclusive care and assertive advocacy as core to our work.

References

  1. Liu, M., Luong, L., Lachaud, J., Edalati, H., Reeves, A., & Hwang, S. W. (2021). Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis. The Lancet Public Health.
  2. Bennet, M.S. (2017), ‘Connecting Paradigms: A Trauma-Informed & Neurobiological Framework for Motivational Interviewing Implementation’, Bennett Innovation Group, Denver.
  3. Rogans-Watson, R., Shulman, C., Lewer, D., Armstrong, M., & Hudson, B. (2020). Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing, Care and Support.
  4. Armstrong, M., Shulman, C., Hudson, B., Stone, P., & Hewett, N. (2021). Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels. BMJ open11(10), e053185.

Starting a PhD in the wake of COVID-19: a survival guide for new students

By guest blogger, on 13 September 2021

Claire Grant, first year PhD student at University College London’s Institute of Epidemiology and Health Care, provides tips for starting doctoral studies in unusual times.  

I found out that I’d been awarded an Economic and Social Research Council (ESRC) studentship to complete a PhD in Epidemiology and Public Health in March 2020. In the following months, the situation in the UK and around the world unfolded into what we now describe as “unprecedented” times, and the world has since changed. Completing a PhD in any time is known to be an overwhelming, challenging and sometimes stressful experience – but there are some unique challenges in the wake of COVID-19.

This blog post offers an insight into my personal experience of starting a PhD at UCL in 2020, with the aim of sharing some tips for navigating the specific challenges of home working and remote learning. It goes without saying that this list is by no means exhaustive, and that each student will face unique challenges and opportunities as they embark on their studies. This is simply a reflection of my past year and a message of hope to new starters.

1) Ask questions

Starting anything new can be daunting. Understanding how things work, making sense of departmental norms and university culture is difficult, especially when you are working from home. My advice is to ask questions from the start.

The reality is, there are many questions you will not know the answer to and a lot of these can be easily answered by friendly and knowledgeable staff/students at the university. Knowing who to ask for what will become clearer the more communication you have. Asking peers, supervisors and departmental staff for ‘best contacts’ to deal with concerns will help orientate you and your position in the university.

2) Create a good home working environment

If you are working from home, you will need the appropriate equipment and environment to do so. Funding bodies and even departmental funds might be able to support you to buy the software, equipment, and resources you need to work. I assumed that being a student meant that I wouldn’t be entitled to support – but this was not the case (see point 1 – ask questions).

From the beginning, try to create a working environment that is separate from your home life. This can be challenging, especially if you’re living in a place with limited space. If possible, try to work in a separate room to where you sleep, and if this is not possible, set-up a separate working station within the ro om. As tempting as it is to sit in bed all day, the environment you create to work in will impact on your motivation more than you might think.

That said, I will admit that in an effort to create my ‘ideal working from home environment’ earlier this year, I purchased a cheap computer desk from Facebook marketplace. The questionable instructions (see pictures) and my lack of craftsmanship mean that the unassembled planks of wood are still lying in my kitchen.

3) Network

A PhD is a solo venture, but nobody can complete it alone. In the absence of happen-chance meetings on campus, it is important to remember to opt-in to networking opportunities. Sign up to mailing lists on topics and methods that interest you. Email peers in your cohort and arrange Zoom coffee breaks. Download Twitter and follow accounts that relate to your work. Attend departmental seminars, and if you’re feeling brave, even ask questions! The more virtual rooms you enter – the more people and opportunities you will be exposed to.

Networking doesn’t just have to be PhD related. The Department of Epidemiology and Public Health did a great job at organising informal catch-up sessions for students over the past year, and the conversations were mainly structured around Netflix recommendations and lockdown recipes. The Students’ Union at UCL also have a wide range of clubs and societies for postgraduate students to get involved with. Building a social network of likeminded people with similar interests will help you find your place.

4) Set boundaries

               Your working day

Structure a day that suits your project and working style. Nobody is productive all day, yet we can feel guilty for taking breaks, particularly when working from home. I’ve learnt that a long lunchtime walk listening to a podcast (usually the Guardian’s Today in Focus) makes me feel brighter and more ready for the afternoon than if I eat lunch slumped over my laptop. If you’re required to do a lot of reading on your computer – make an active effort to schedule time away from your screen throughout the day. Your eyes and mind will thank you for the rest.

Being online makes us more accessible than ever. This is exciting as we can attend more events, seminars, and trainings than ever before. However, be realistic and thoughtful about how much you can do. For example, don’t try to complete other work tasks while attending online seminars or training. You wouldn’t do that in person. Allow yourself the same time and energy you would offline. This is much easier said than done.

Your personal life

Set boundaries with ‘PhD life’ and ‘regular life’ as you would any other job. Your research will be more important to you than it is to most people, and it might feel all consuming. It’s also likely that you’ve chosen a topic of particular interest to you, making it difficult to switch off. There’s always more work to do, more papers to read and more ideas to talk through. It can feel as though you should be doing something all the time. At the beginning, I found this difficult to manage.

I also found it strange not having the same sense of completing a task as I did when I submitted course work in previous taught courses. At undergraduate level, I remember the feeling of relief after sitting exams, knowing I’d be enjoying some well-deserved time off before being informed of a definitive result – ‘pass’ or ‘fail’. From my experience, this is not the case in a PhD. Feedback from supervisors usually leads to more work. Good project management will account for the much-needed breaks in this academic marathon. When you do take time off, try to detach completely. Let your supervisors know you won’t be available, turn off email notifications on your phone and wait until you return to reply to messages.

Importantly, life continues as you study. Make sure to carve out room for friends and family. Make time for hobbies and interests. A PhD is only one part of your identity.

5) Trust your abilities

You are probably already doing better than you’re giving yourself credit for. It takes time to get used to this new way of working and the beginning of such a mammoth task can feel daunting. Remember that every project is different, so try not to spend time comparing your progress to your peers. Your supervisors will help guide you and there are various UCL check-ins along the way to make sure you’re on track (such as Thesis Committee reviews).

One of the most common anxieties among new doctoral students is ‘imposter syndrome’ – the overwhelming feeling that you’re a fraud. Take note: you have started on a training programme and that is merited on the basis that you have the abilities required to succeed. Trust the process and know that everyone else is probably thinking the same about themselves.

6) Be flexible with your project

Due to COVID-19 restrictions, your project might have to be adapted or changed completely. You are not alone if this is the case. Over the past year many students have faced dilemmas with methodologies and research topics that are not easily modifiable to the world of online learning. Be open to potential alternatives and listen to the experiences of others in your field. There are many learnings from the past year which will be useful to consider when thinking of alternative approaches to your research.

7) Be kind

To yourself, to your peers, and to staff.

Students and staff at UCL have worked tirelessly to adapt to new ways of learning over the past 18-months. It has been a tough time for everyone, and we have all been impacted in some way. Try to acknowledge this and be compassionate to yourself and others. Remember that staff are also facing some of the same challenges as students and will appreciate your understanding.


Enjoy the journey & best of luck with your studies!

Being out at work

By e.schaessens, on 24 April 2020

An interview with Dr Julia Bailey by Sandra Medina and Angela Gichane (before the Covid-19 crisis)

Thank you for doing this interview with us.  Can you tell us about your job?

I am a sexual health doctor in South East London, and senior researcher in the eHealth Unit at UCL. I teach medical students, NHS staff and researchers, and am also a Graduate tutor and co-chair of the Equality Action Group.

What is your experience of being out at work?

I came out in 1987, when I was a medical student – 33 years ago! I’ve always been open about my sexuality (lesbian), but it doesn’t feel particularly relevant at work. I’ve never felt that that my sexuality was an issue working in primary care and in sexual health: these specialities tend to attract open-minded people, and I know of quite a few LGBQ (lesbian, gay, bisexual, queer) colleagues. Trans and Intersex people are less visible in academia and the NHS – we have a lot further to go in helping trans and intersex people feel seen, safe, welcome and included.

I haven’t experienced overt discrimination at work, but my sexuality has shaped (and limited) my choices. For example, I live in London to be part of the queer community, rather than risk feeling alienated in a small, conservative community.

Is visibility important?

A very important role model for me in my teens was the conductor of the Brighton Youth Orchestra (David Gray), who was a fantastically inspiring musician who was gay. His sexuality was well known, and there was no fuss about it (40 years ago).

At medical school there weren’t any visibly out members of staff, and no out students either – I found my community outside the medical school. I bumped into someone years later who told me that I had been an important role model for her at medical school, which was lovely to hear. As Dr Ronx (the queer, Black, androgynous A&E doctor) says, ‘You cannot be what you do not see’, and I think being visibly out is important.

How can tutors can support LGBTQIA* students?

It is really important that students can trust tutors, and that students feel able to talk about life beyond their studies (if they want to). I don’t proactively ask students about their personal lives, but I do tell them that I’m happy to discuss anything that affects their learning or wellbeing.

* LGBTQIA – lesbian, gay, bisexual, trans, queer, intersex, asexual/aromantic

Many people are quite confused about gender, sexuality, pronouns…. can you give us a summary?

Ah yes – I’ve written an e-learning module on this, and I train GP registrars and sexual health clinic staff. There is a lot of confusion, and concepts and language are changing over time …

Gender

In most societies worldwide people are seen as either ‘male’ or ‘female’ (i.e. binary categories).  These categories are decided (assigned) at birth, usually on the basis of genital appearance. A proportion of the population are intersex – i.e. their genetics, genitals and/or hormones are more complex than neat binary ‘male’ or ‘female’ categories.

Whilst sex and sex variation (male, female, intersex) are defined by genetics, gender identity is someone’s internal sense of gender (e.g. masculine, feminine, intersex, non-binary). Gender expression is the way that gender is expressed to others (e.g. through clothes, the body, behaviour…). Cis gender means that a person’s gender identity is the same as the gender they were assigned at birth (e.g. someone who was assumed to be female at birth, and who identifies as a woman). The terms Assigned Male at Birth (AMAB) and Assigned Female at Birth (AFAB) acknowledge someone’s gender history.

Non-binary or genderqueer people are those whose gender identity does not align with either ‘male’ or ‘female’, and who do not subscribe to conventional gender distinctions. Non-binary and genderqueer identities may be static or fluid. Some people may include aspects of ‘male’ and ‘female’ into their identities, others may reject binary gender categories entirely. Non-binary and genderqueer people may or may not look androgynous (not looking typically masculine or feminine).

Transgender or trans is a term for people who have a gender identity or gender expression that differs from their assigned gender. For example this could be someone who was assumed to be female at birth whose gender identity is male.

Pronouns (such as he, she, they) are very important in affirming someone’s gender identity.

Non-binary people may choose the pronoun ‘they’ as a gender neutral pronoun which is neither male nor female.  There are other gender neutral pronouns (e.g. ze, sie, hir, co, per, ey), and terminology concerning gender identity is evolving. It is important not to just guess or assume someone’s gender identity and pronouns.

Gender is distinct from sexuality. For example, ‘gay’, ‘lesbian’ or ‘bisexual’ are sexualities (sexual orientations), i.e. expressions of sexual attraction.  Gay men are typically attracted to male sexual partners; lesbians to female sexual partners; bisexual people are attracted to people of the same or different genders to them. LGBTQIA stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual/Aromantic.  There are many, many other ways of expressing sexuality.

What would help trans and non-binary people feel welcome and included?

Getting people’s gender correct is really important, and it makes a huge difference to be asked rather than just guessing gender and pronouns (he, she, they) from someone’s appearance. This is especially important for trans and non-binary people, for whom mis-gendering can be relentless and horribly undermining.

My pronoun is ‘she’, but I also feel non-binary/genderqueer – I find it liberating to move away from the assumptions and expectations that go with being either male or female. It grates to be identified as a lady: e.g. “Good evening ladies and gentlemen…”. ‘Lady’ does not describe me, and it feels irrelevant and distracting – what does my gender have to do with being in a lecture, meeting, restaurant etc.? I feel that the assumptions and expectations of ‘men’ and ‘women’ can be profoundly harmful and limiting, and we should all be free to express ourselves however we like. We’re a long way from that vision, and expression can be especially hard for people who are marginalised in more than one way (e.g. trans women of colour). We have a lot of work to do to ensure that trans, non-binary and intersex people feel safe to be themselves at work.

As tutors and colleagues, we can demonstrate inclusive attitudes to gender and sexuality by displaying LGB, trans, non-binary and intersex stickers, badges or lanyards, and including logos and our own pronouns in email signatures for example.

For email footers:

Out@UCL logo which acknowledges people of colour and trans people:

How can we create a more inclusive workplace?

I think that social events are a good idea, to help people get to know each other. We need to check whether there barriers to being involved:

  • Equality. can everyone afford to come?
  • Diversity: is the invitation genuinely open to everyone?
  • Inclusion: are there factors that will exclude some people, such as alcohol, caring responsibilities, noise levels, access…..

‘Core competence’ in gender and sexuality is important, so that all staff are familiar with issues that LGBTQIA staff and students may face. It’s important to avoid assumptions, and check people’s preferences in terms of gender, pronouns, and confidentiality for example.

We need to avoid assuming heterosexuality, and avoid the gender binary – for example, ask say “Good afternoon everyone” instead of ‘Good afternoon ladies and gentlemen’. You can’t guess someone’s gender or sexuality by appearance, and there are far more LGBTQIA people than widely assumed.

Thank you, do you have anything more to add?

Thank you Angela and Sandra, it has been really interesting talking to you. It has reminded me how important these issues are!

Sources of support for LGBTQIA staff and students

Taking the me out of social media

By guest blogger, on 9 October 2019

Emma Walker, second year BBSRC-ESRC funded Centre for Doctoral Training in Biosocial Research PhD student at University College London’s Institute for Epidemiology and Health Care, describes how getting involved with research on social media helped her to reflect on her own usage. 

It’s 00.23 and I should be in bed. I’ve got lots on tomorrow but I’ve spent the last 45 minutes scrolling. Scrolling through the profiles of Instagram “life style coaches”, yogis, models; each collection of photos perfectly curated to appeal to my desire for millennial aesthetic.

Everything feels so much better than anything I have. And actually, in the world of Instagram, I know that everything is much better than what I have. Number of followers or number of likes on each post has conveniently quantified this for me.

The next evening, as part of my public health PhD work, I’m reading Professor Yvonne Kelly’s paper laying out the effects of social media use on the mental health of girls. I diligently make notes “.. greater social media use related to online harassment, poor sleep, low self-esteem and poor body image .. ” “..girls affected more than boys..” and pause periodically to check my phone.

All my friends are at the pub having a great time, another friend just put up a post where she looks amazing, it already has 50 likes. I get to the methods section of the paper “how many times in the last 2 weeks have you felt miserable or unhappy; found it hard to think properly or concentrate; felt lonely; thought you could never be as good as other kids…”.

Then the penny drops. Why do I think I’m immune? I’m like the lifelong smoker who’s confused by their cancer diagnosis: “I never thought it would happen to me.” The idea starts to filter in: I don’t need this in my life. In fact, I need this to not be a part of my life.

The next day I deactivate my Instagram account. That day I meet a friend for coffee in a hipster café and don’t take a picture of my coffee. That night I get to sleep by 11pm. The next day I work more productively than I’ve worked in weeks.

An opportunity to get involved comes up: the National Literacy Trust are really interested in Yvonne’s work and are keen to put together an event for young people. A great group of undergraduates and I devise a series of activities to find out what young people think about the research.

The first section would involve 4 zones at the front of the Renaissance Learning centre room for Strongly Disagree, Disagree, Agree and Strongly Disagree we put a series of statements on the board and ask the pupils to move to a zone and explain why. We include statements on a range of topics including cyber bullying, sleep deprivation, self-esteem and body image and parents and social media.

On the day, the 50 enthusiastic 11-14 year olds from 3 schools across London jostle about, keen to share their opinions and to hear one another’s. I’m amazed at the diversity of ideas, overall willingness to get involved and the mental health literacy of many of the students.

Some responses are predictable; the boys happy to appear less concerned about body image, many keen to state in front of their teachers that social media does not in any way disrupt their studies. Some are surprising; only a handful of pupils had been on social media before arriving at the event that day (a significantly lower proportion than the adults running it!) Other responses are hard to read; were the gaggle of girls laughing at the very idea of social media posts making you feel left out, honest or desperate to seem not to care?

A clear feeling was the young people’s frustration at their parents use of phones and social media. Many expressed irritation at the rules their parents have established – no phones at the table, in bedrooms, after 8pm – that they, themselves constantly break.

One boy described having to ask the same question 3 times before his dad will look up from his phone. The idea that our event should be run for parents was cheered.

Next we presented them with the evidence base for the possible impact of social media and mental health then asked them to make public health campaign like posters with top tips that could go up in their schools. We were presented with a beautiful collection of posters with thoughtful advice, carefully put together information, clever slogans and eye catching drawings. Audio recordings from the day gave further insights from the young who readily offered tips and advice for younger children.

Overall, I think the event was a success. My main impression was that these young people are actually very well equipped to protect themselves from the potential mental health impact of social media. That in fact it may be people in their 20s, who have grown up in the full glare of social media and its pressures, who are at the greatest risk.

It was a real privilege being able to discuss this topic with young people and the message that stood out the most from them is the opportunity parents have to make a difference by practicing what they preach.  Chances are they’ll benefit from switching off!

As for me, it’s now been 6 months since I deleted Instagram and whilst it hasn’t been plain sailing – I have got this itch for the buzz of an influx of likes –  for the time being I’m happy and I would wholeheartedly recommend it!

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

By guest blogger, 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,

Do you not feel clever enough? Some advice to existing and new PhD students about Impostor Syndrome.

By guest blogger, on 4 October 2018

This blog post is written by Alexis Karamanos, who is a very active and engaged PhD student within UCL’s Institute of Epidemiology and Health Care (Research Department of Epidemiology and Public Health). A big thank you to Alex for providing this piece which I’m sure many staff and students will find useful.

Doing a PhD is rewarding, but at times challenging. During my PhD, there are times when I feel I should not be there. While I was indeed struggling to get some results, other very clever students in the IEHC were doing an amazing job; they were publishing to international journals, they were writing and talking to the media about their work, and they were also attending great conferences in the UK and abroad. It was then that I started feeling an outsider in academia; that I maybe sneaked my way in and I was/am about to be found out anytime soon. This is impostor syndrome and (believe it or not) it is very common among PhD students. Paradoxically, impostor syndrome is that intrusive idea that your success is due to mere luck and not your talent or qualifications. Evidence shows that about 70% of people experience it, according to the Journal of Behavioral Science https://www.tci-thaijo.org/index.php/IJBS/article/view/521 . So far, there is no single explanation as to why impostor syndrome occurs. Some experts believe that it has to do with personality traits like anxiety or neuroticism, while others focus on family and behavioural determinants.

Working day-in day-out towards an ultimate goal; a completion of a PhD in this case was never meant to be an easy task. Many people describe PhD time as an emotional ‘’roller coaster‘’ (https://core.ac.uk/download/pdf/11233054.pdf) with many ups and downs along the way, but for some people like me, it looks to be more than that. During one of the first panel meetings with my PhD supervisors, one of them explained to me that ‘’doing a PhD would render me an expert in my topic’’.  While that is true to a certain extent, living up to such an expectation (if taken literally and really did take it literally) can be very difficult. However, the good news is that impostor feelings can be managed to enable you to work to the best of your ability.

One of the first steps to start dealing with impostor feelings is to acknowledge that you have impostor thoughts and put them into perspective. Remind yourself than an impostor thought is just a thought, and not the reality.

Consider your PhD as just a beginners qualification. A PhD is the time during which you develop basic research skills, which you can further develop along the course of your professional career (academic or not). Never say never! Probably in the future you can become a prominent expert in your field, but this certainly takes much more effort and time than a three or four year long PhD.

Something that my PhD topic and experience has taught me so far is that my/your ability is not fixed, but something that can be developed and improved over time with effort and most importantly, patience. What I am always trying to remind myself of is the Socratic paradox; according to which the Greek philosopher Socrates responded to an oracle posed by Pythia, the oracle of Delphi ‘’Socrates is the wisest’’ that ‘’The only thing I know is that I know nothing’’. Truly liberating!

One thing that you can also try is to reframe your thoughts. One way to do so is to learn how to respond to challenges by learning how to value constructive criticism; that it is not a sign of academic incompetence to ask ‘’stupid’’ questions, to ask for help even for something that is considered ‘’easy’’ by others, or remembering that the more you practice a skill, the better you will get at it.

Last but not least, it can be helpful to share your feelings with trusted friends, your partner, mentors or your supervisors. When in doubt, our thoughts may be tricking us to believe in something which may not be true. Therefore, being open about your impostor thoughts may allow other people to critically assess your thoughts together and possibly de-dramatise them. People who have more experience can reassure you that what you’re feeling is normal, and knowing others have been in your position can make it seem less frightening. Nevertheless, if you think that by doing so will not make any difference, it will be wise to seek professional help. UCL’s Students Psychological and Counselling Services  are doing a great job in helping students with challenging feelings such as those related to impostor syndrome, either by providing a number of one to one sessions with a therapist or by providing specialized courses on how to overcome PhD perfectionist thoughts (I have been to one of those great courses and they really do help a lot).

To conclude, if you have impostor thoughts, it is important to remember that most people experience moments of doubt, and that is completely normal and not something to feel bad about it. The main goal should not be for you to not have impostor related moments, but not an impostor life. No matter how much effort and time it takes, the impostor syndrome can effectively be managed and overcome.