While the detrimental impact of alcohol use is well understood, in England and Australia, many adolescents consume, purchase, or are provided alcohol. In the short term, alcohol is linked to increased risk of injury and fatalities; in the long term it is associated with increased risk of cancers and diseases. Adolescent alcohol use is of particular concern as it is associated with poor mental health, brain damage, and increased risk of dependence in adulthood. Despite strong evidence that reducing the supply of alcohol in the built environment can be used to prevent or reduce consumption at a population level, in England and Australia, the prevalence of environments where alcohol is readily available is increasing yearly, often in low socio-economic urban areas.
The number of alcohol outlets in the built environment is one indicator of supply and availability. For adults, evidence consistently demonstrates an association between the number of outlets in a given area and alcohol-related behaviour. The evidence of increased availability on the health and well-being of adolescents is less clear and under examined. Most research is cross-sectional and USA-focused. The proposed project will address this important evidence gap. Our team will undertake a comprehensive longitudinal cross-national analysis of the links between alcohol availability and child and adolescent alcohol uptake with consumption, health and well-being over the adolescent and young adult years. It will use, high quality longitudinal studies of English and Australian participants followed over 17years (2002 to 2018) to examine links between changes in alcohol availability and alcohol-related behaviour and health from the school years (10-17 years) into early adulthood (27-31 years).
English data will be drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC) and Australian data will be drawn from the International Youth Development study (IYDS). Data will be merged with retail outlet data. Changes in the density of outlets in a participant’s local area and its link with the age of initiation and consumption will be examined. Limitations of previous study designs will be addressed by employing novel cross-lagged panel analysis techniques, which mimic an RCT and can be used to develop causal evidence with longitudinal data. Multi-level growth, elasticity, and latent class modelling will be used to investigate issues neglected in the international literature relating to development and policy. The core research questions will be: Does density exposure at early ages have a sustained effect on child and adolescent behaviour? How does density exposure affect the severity and breadth of alcohol-related problems of young people? Are there maximum and minimum availability levels associated with adolescent alcohol-related behaviour and health? Cross-national comparisons will be made and socioeconomic sub-group analyses will be undertaken. An economic evaluation of the impact of adolescent consumption on health and services will be completed. To assist with translation and impact an analysis of policy and legal barriers and facilitators associated with opening or opposing of new alcohol outlets will also be undertaken.
The hypotheses guiding this research proposal are:
1. Exposure to higher density of alcohol sales outlets will predict an earlier age of uptake (initiation of use) of alcohol by adolescents (10-17 years of age) and increases the risk and rate of progressing to greater alcohol use across adolescence and early adulthood.
2. Over time, changes in alcohol sales outlets will be associated with changes in the extent to which adolescents report illegally purchasing alcohol, and changes in the extent to which they report parents supply alcohol to them.
3. Increased costs (health and broader societal), lower productivity and poorer health (including mental health) are expected in adolescents who are exposed to higher alcohol outlet densities.

Here we propose to investigate whether - and how - religious or spiritual belief /behaviour influences health (and vice versa).
The ALSPAC parents have answered data about their religiosity on several occasions. In combination with the information - both self reported and measures in clinic in both parents and their offspring - we will be able to answer questions such as: (a) is religious or spiritual belief and/or attendance (RBA) of adults associated with health benefits or disadvantages in the short or long-term? (b) Does the RBA of one or both parents influence the health of their offspring? (c) Are there differences in risky behaviours between participants reporting different RBA that may explain our findings.

As many as one in six teenagers have self-harmed at some point, and self-harm is the strongest known risk factor for suicide. Eating disorders are also common, affecting over one-in-twenty adolescent girls. Both self-harm and eating disorders are linked to early death.
Up to half of those with an eating disorder also self-harm. However, we know little about why these mental health conditions often occur together.
One reason might be that some risk factors for eating disorders and self-harm are the same. One characteristic, seen in both conditions, is difficulty managing emotions. However, we do not know whether individuals with an eating disorder find managing emotions difficult because they have an eating disorder, or whether difficulty managing emotions is one of the reasons they develop an eating disorder. Similar gaps in our knowledge exist in relation to people who engage in self-harm; we do not know for certain whether difficulties managing emotions occur before self-harming behaviour starts. One study in adolescents in China suggests difficulty in managing emotions leads to later self-harm, however, little else is known about this area. It is also likely that a number of other factors link difficulties in managing emotions with later self-harm and eating disorders. These factors include difficulties in understanding social situations, difficulties in reading facial expressions, and the experience of being bullied.
To enhance our understanding about the development of self-harm and eating disorders, we have assembled a team of outstanding scientists from two universities.
We will conduct an analysis of existing data from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC is a study of over 13,000 children born in and around Bristol in 1991-1992 and followed up since birth with regular questionnaires and clinics. Very few studies have such a large number of people, with such detailed questions collected over time. We will use ALSPAC data to study whether early childhood difficulties in managing emotions is associated with later self-harm and eating disorders. We will also use it to investigate whether ability to understand social situations, to recognise emotions, or the experience of being bullied, are involved in the relationship between difficulties in managing emotions and later self-harm and eating disorders

Obstructive lung diseases are a common cause of disease and disability throughout life.

According to WHO estimates, 65 million people have moderate to severe chronic obstructive pulmonary disease (COPD). More than 3 million people died of COPD in 2005, which corresponds to 5% of all deaths globally.

In 2002 that COPD was the fifth leading cause of death. Total deaths from COPD are projected to increase by more than 30% in the next 10 years unless urgent action is taken to reduce the underlying risk factors, especially tobacco use. Estimates show that COPD becomes in 2030 the third leading cause of death worldwide.

The aim of this research project is to understand factors during childhood that influence the development of peak lung function in early adulthood. We will measure the lung function of around 5,000 young adults who have been intensively studied since before birth as part of a longitudinal birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Lung function increases with physical growth through childhood, reaching a peak in early adulthood. Following this peak, there is a gradual loss of lung function throughout the rest of life. Therefore, failure to attain maximal lung function during childhood could lead to early onset of respiratory illnesses in adult life. This study will build on previous measurements of lung function in the ALSPAC cohort linked to a wealth of data on early lifestyle and environment to try to find out what factors are associated with slow acquisition of lung function during childhood and low peak lung function in early adulthood.

Parental depression is related to internalising as well as externalizing problems, including attention problems, in childhood. These behaviours are heritable, so this association may be due to the transmission of genes from parents to children. However, as parents also provide part of the environment to their children, it is difficult to disentangle the role of nature versus nature in the intergenerational transmission of these behaviours.

One way to investigate the extent to which parental environmental influences exert an effect on offspring behaviour is by looking at the impact of the parental genome. M-GCTA (maternal-effects genome-wide complex trait analysis) estimates the extent to which SNPs in the maternal or paternal genome contribute to variance in offspring behaviour.

Additionally, recent investigations have made use of polygenic scores constructed using non-transmitted DNA from parents to offspring to report associations between parenting and offspring behaviours traits. These studies show that the part of the parental genotype that children do not inherit nonetheless predicts childhood behavior, indicating an effect of genetic nurture. The methodology has not been applied to investigate parental influences on offspring behavioural problems thus far. The aim of this project is to use transmitted and non-transmitted polygenic scores to clarify parental genetic and genetically-mediated environmental influences on offspring internalizing, externalizing and attentional problems. Furthermore, we aim to investigate whether the genetic nurture effect on offspring internalizing, externalizing and attention problems is exacerbated in children of depressed parents.

Self-harm in young people is a major problem. As many as 1-in-6 teenagers have self-harmed, but we know little about what happens to them as they get older. We also know little about how much self-harm thoughts and behaviours (SHTB) change from day-to-day, and what factors help to predict this. This project will look at predictors and patterns of SHTB both over long periods of time (from adolescence to adulthood) and over short periods of time (over days/weeks).
Although selfharm is very common in young people, most do not seek help. This makes it difficult to provide support. In this study, I will find out whether young people who self-harm are either (1) not visiting a GP or (2) visiting a GP for other reasons and not telling them about their self-harm. I will also look for factors that will help GPs to better identify young people who have self-harmed.

Sarcopenia is defined as the age-related loss of muscle mass and function, occurring in 5-13% of individuals at 60 years of age, leading to increases in premature mortality, functional decline, falls and hospitalisations.

Age-related declines in muscle function are three times greater than those which occur in muscle mass, as changes such as motor unit loss lead to reduced muscle quality. Therefore it is crucial to assess muscle function, mass and quality in order to fully understand the determinants and consequences of sarcopenia.

Studies of sarcopenia to date have focused on identifying factors influencing decline, whereas less well known are the factors which determine peak muscle function. A similar concept of ‘peak bone mass’ is well established in the osteoporosis field, through which several key early-life determinants of bone mass have been identified. Strong relationships exist between muscle and bone, and around a third of individuals with sarcopenia also have osteoporosis. As a result, early-life influences on bone mass accrual may also involve effects on muscle function.

This project will examine whether early-life factors found to influence peak bone mass acquisition, also affect the attainment of peak muscle function. Furthermore, we aim to identify novel factors that contribute to peak muscle function. To do this, we propose to invite attendees to the ALSPAC@30 clinic to undergo a mid-calf peripheral quantitative computed tomography (pQCT) scan, from which muscle mass and density will be derived. We will also use jumping mechanography, a quick, highly-repeatable, sensitive method of assessing muscle function.

Adverse built, social and physical environments are associated with worse mental health outcomes which first emerge in adolescence, offering potentially modifiable population-level targets for prevention. While early detection has become the cornerstone of UK and Australian youth mental health provision, which has led to improved downstream clinical and social outcomes for young people, primary prevention remains an elusive goal, resulting in lifelong physical and mental health disparities which affect whole communities. Hitherto, most studies of the environment and mental health have considered selected indicators from a single domain (built, social or physical), making unobserved and residual confounding major obstacles to causal inference and primary prevention. Methods to characterise the way in which the exposome affects mental health and well-being are now required.

We will address this in two phases.

First, by linking large, geocoded epidemiological and clinical data from ALSPAC with a comprehensive set of built, social and physical environmental exposures via the ALSPAC-PEARL/ALGAE linkage, we will identify the pathways through which these factors affect various mental health outcomes. We will also consider how physical health and activity in childhood may mediate the relationship with later mental health, and vice versa. Environmental data will be linked from multimodal sources available in PEARL/ALGAE and via integration of other available environmental data to characterise the built (building quality, indoor air quality, density, land use, overcrowding, transportation links), social (population density, social isolation and cohesion, inequality, deprivation, ethnic diversity, homelessness, crime) and physical (air, light & noise pollution; accessibility to and quality of green or blue spaces, walkability) environment.

Second, we will develop a simulation platform (SAPPHIRE) to evaluate putative intervention strategies in the built environment to prevent selected adverse mental health outcomes and physical health comorbidities. We will develop a simulation approach based on the ALSPAC sample and the wider population of the Bristol region. We will synthesise theoretical and empirical evidence to build this platform via a hybrid Dynamics/Agent-Based Modelling approach, consistent with capturing the interplay between geospatial, household and individual factors which affect mental health. SAPPHIRE will be open-source, so that decision makers can readily adapt, deploy and test prevention strategies in different contexts based on parameter values representing their local circumstances. This has the potential to unlock primary or secondary prevention strategies in the built environment, which would otherwise be prohibitively expensive, time-consuming or impossible to deploy in the wild.