Attachment theory explains social, relationship and personality development across the lifespan (Bowlby 1969) and has been shown to provide a psychological framework for understanding mental ill health (Mikulincer & Shaver, 2007). The basic postulation is that very early childhood social interactions with primary caregivers are internalised to create and maintain conscious and unconscious mental representations of the self and others. These form the basis of ‘attachment styles’, which have an impact on close relationships and ability to regulate emotions. There is extensive evidence that attachment style is a predictor of coping strategies, adjustment in response to stressors and therefore a vulnerability to mental health problems (see Mikulincer & Shaver 2012 for a review). Research has widely demonstrated an association between secure attachment style and well-being and positive mental health, whilst both insecure attachment styles (anxious and avoidant) have been associated with poor relationship quality, psychological vulnerability and maladjustment, and mental health difficulties (e.g. Sroufe et al., 1999; Hankin et al., 2005; Mikulincer & Shaver 2007; Groh 2016; Spruit 2019). However, the direction of causality is less well established as most studies rely on cross-sectional design and measure attachment style as a discrete variable at a single point in adulthood.

By using a large prospective birth cohort, we will be able to (a) investigate the prospective relationship and (b) use latent variable modelling of repeated measures of attachment to create a more robust and detailed measure of attachment style. This will aid more nuanced explanations of how and when insecure attachment style may lead to mental ill health, such that the association can be interrogated to identify possible intervention targets.

This proposal has implications for healthcare provision and public health policies around childhood and parental interventions to support research to address the growing number of mental health difficulties in later adolescence.

Risk towards poor mental health is impacted by a number of biological, psychological, and social factors that work together throughout the lifespan and across generations. A large body of research supports the influence of the prenatal environment on children’s developmental and mental health outcomes. For example, prenatal depression has been linked to later risk of depression in children, and prenatal depression, prenatal anxiety, and stressful life events during pregnancy have all been associated with risk of anxiety disorders in children. There is also growing interest in understanding the potential biological causes that may drive these relationships. In particular, inflammation has been suggested as a potential factor that may influence these associations, due to its role in the onset of depression and other mental and physical health disorders. However, few studies to date have examined the role of inflammation in relationships between prenatal maternal stress and child and adolescent mental health outcomes, calling for continued research in this area.

In addition, although the relationships between prenatal stress and child and adolescent mental health outcomes are well-established, children continue to be exposed to a number of influences, both positive and negative, after birth. For example, research suggests that the relationships between prenatal stress and child outcomes may differ depending on how mothers are able to cope with the stress they experience, including their degree of partner and social support, and availability of psychological resources including higher self-esteem and self-efficacy. Furthermore, a growing number of studies suggest that parenting behaviours may play an important role in these associations. For example, children exposed to parental warmth and positive relationships with their mothers and fathers may be buffered to the impacts of early adversity; conversely, children exposed to maltreatment or harsh parenting may exhibit increased vulnerability. Considering how both maternal coping resources and parenting further increase or reduce the risk towards chronic inflammation and later mental health outcomes in children exposed to prenatal stress, however, is an area that requires further investigation. In addition, the influence of many coping resources and parenting behaviours on later inflammation is an understudied area.

Children with asthma are more likely to suffer from attention deficit hyperactivity disorder (ADHD), but we do not understand why; it may be because the two conditions are influenced by similar risk factors early in life or by similar genes which affect lung and brain development. We will investigate this in ALSPAC. Gaining a better understanding of the causes of these common childhood conditions could ultimately lead to ways to prevent them.

The work is an effort to collect serological data on past infection status within the population based cohorts of the UK – in particular a set of cohorts which have been selected to report on 4 important axes of variation – ethnicity, age, socio-economic status and geography. The key thing for us is that we are able to move swiftly to capture the signature of infection and that we are able to exercise the cohorts (and all they bring re. retrospective data and new sample and data collection capacity) whilst being complementary to the efforts of existing studies – importantly REACT 2 and UKBB. We have been focusing on LFT and talking to those testing and developing kits. We have been pursuing the Orient gene kit as a strong option here – given performance, testing and our aim to use this as an epidemiological tool rather than an individually relevant test solution. Paul Elliott has been extremely generous with time and details re. the REACT 2 study and we are now proceeding with Orient gene as a viable option (home-based lateral flow antibody testing). We have been able to work with Peter Diggle (Lancaster) to develop the structure of our sampling frame across the 6 cohorts and now are primed to get approval locally (a process already started re. the PPI around these tests) in order to deliver kits to participants.

Stark inequalities in health already exist in the UK, with people from lower socioeconomic backgrounds suffering from greater levels of ill health across multiple domains. The covid-19 pandemic potentially threatens to worsen these health inequalities. The ‘lockdown’ changed people’s behaviour radically, but the socioeconomic differences in these experiences are not well understood. Some groups of society may have increased health-promoting behaviours – for example, engaging in more physical activity and preparing more food within the home. Other groups may have experienced adverse changes in health-related behaviours – for example, smoking more or consuming more alcohol in response to the stress and anxiety induced by the pandemic. It is possible these differences are socioeconomically patterned, and could therefore worsen pre-existing inequalities. Another key factor likely to influence patterns of behaviour change during the pandemic is household/family structure. For example, parents with children and individuals shielding or living with a household member who was shielding may have been less able to engage with health-promoting behaviours.

Data from the Office for National Statistics demonstrate that between 23rd March and 5th April 2020, 27% of the UK workforce were furloughed due to the COVID-19 lockdown. Many others lost jobs, or had working hours and income reduced. The adverse financial and employment consequences of the covid-19 lockdown are concentrated in already vulnerable groups of society – they are more likely to be experienced by people in insecure or low-paid jobs. The young adults in ALSPAC are in the age groups most likely to have been affected by furlough, job losses, and loss of pay or hours (https://www.resolutionfoundation.org/publications/young-workers-in-the-c...). Detailed pre-pandemic data from the ALSPAC cohort offers the opportunity to better understand which groups of society were more likely to be impacted financially by the lockdown. We will explore whether SEP, adverse childhood experiences, pre-existing mental health problems, obesity, smoking, alcohol use, shielding or living with a household member who was shielding, and family structure are associated with greater likelihood of adverse financial changes during covid-19, and hence whether the lockdown is likely to exacerbate health challenges for these groups.

Public health messages about what constitutes a healthy diet have been promoted by the UK government since the early 1990s. These messages have been based on developing knowledge about foods and eating patterns that result in better health. The ways in which these messages actually influence the diet of the population and the effect on the risk of diseases such as heart disease have not been studied over the long-term. We plan to use data on diet collected from mothers in ALSPAC to see how their diet changes over time in parallel with changes in public messages about nutrition, and whether any changes have reduced their risk of heart disease. This will help policymakers to develop guidance for maximum impact on women's health.

Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are neurodevelopmental conditions affecting ~10% of people. Young people with ASD and ADHD experience substantial adversity (e.g. bullying, maltreatment) which is linked with poor adult outcomes. However, some people may show resilience, demonstrating adaptive outcomes, for example positive wellbeing, despite this adversity.
I will explore resilience in ASD and ADHD, from childhood to young adulthood. I will conduct a qualitative study to determine what adaptive outcomes look like to young people with ASD/ADHD. Then, using data from two large studies that follow young people over time, I will investigate factors linked with adaptive outcomes in ASD and ADHD. Using innovative statistical analyses, I will test the roles of child characteristics, the family and social environment, and genetics.
The findings will inform future interventions to reduce adversity and boost resilience amongst young people with neurodevelopmental conditions.

Adolescence is a critical stage of life for the formation of both physical and mental health. Health behaviours and health status developed in adolescence often endure into adulthood and influence life expectancy. Health-risk behaviours such as excessive alcohol consumption and physical inactivity are not only linked with mental health, but are also two major contributors (globally) to disease in adulthood such as cancer, diabetes and cardiovascular disease. Adolescence is a time when physical activity levels decline, alcohol consumption increases and mental health states can deteriorate. However, conversely, research shows links between higher physical activity levels and higher levels of alcohol consumption (although largely this has been derived from non UK-based University/College populations). Advice given by a former UK Chief Medical Officer is that children should not drink at all before the age of 18 but certainly not before the age of 15. Excessive alcohol consumption can result in unwanted consequences (particularly in adolescence) such as being a perpetrator or victim of violence or other criminal activity, or unprotected (or regretted) sexual activity. Alcohol has been strongly linked to suicide in adolescence (the number one cause of preventable death); as well as more generally impacting or impeding healthy brain development. Other factors (which contribute to or cause inequalities in health outcomes) also should be considered when looking at health behaviours in adolescence e.g. socioeconomic status (SES), educational attainment, gender and psychosocial health. Those with a lower SES (SES - being typically derived from household income and education levels) tend to fare worse in health outcomes. Despite higher levels of physical activity being associated with higher SES in adolescence (as is a higher level of alcohol consumption), it appears that higher educational attainment (also correlated with higher SES) reduces the occurrence or frequency of binge-drinking. While those from lower SES backgrounds are more likely to experience greater harms from alcohol consumption. Gender contributes significantly to health inequalities, disadvantaging girls. In early adolescence, girls are more likely to be diagnosed with an anxiety or depressive disorder, more likely to have lower levels of physical activity and are more likely to be at risk of alcohol-related harm than their male equivalents. Mental health is becoming one of the biggest issues we face globally and has been strongly linked to physical activity/inactivity. Those that undertake regular physical activity are less likely to be depressed, but conversely are more likely to consume alcohol at higher levels (and in particular binge-drink). This research will seek to untangle the links between risk of alcohol-related harm and levels of physical activity at ages 13.5, 15.5 and 17.5 using data in the ‘Children of the 90’s cohort’ from the Avon Longitudinal Study of Parents and Children (ALSPAC). The research will determine associations or patterns at each time-point (age in years) and also make comparisons of changes over time. The individual-level analysis (longitudinal) will also utilise data for 24.5 year olds to compare with 17.5 year olds The following factors will be used as a means of explaining findings at each time-point, individually, and collectively: SES, educational attainment, gender and psychosocial health. The aim is to create new knowledge on the associations and patterns between physical activity and alcohol consumption levels across early to late adolescence in a UK population. Findings will inform further UK-based research on this topic.

In research projects focussed on children and families, information about children is often gathered via a single parent, often the child's mother or female caregiver. For many such studies, there are valid scientific reasons why involvement of the child's father or male caregiver is also important. For cohort studies, which follow families over time, early recruitment and ongoing engagement of fathers can be particularly important. However, recruiting and engaging fathers to such studies can be challenging, especially if fathers and mothers do not live together. As a result fathers are widely under-represented in such research. A scoping review of recruitment and engagement methods suggests that involving fathers may require a different approach to that used for mothers. This study seeks to review how fathers are recruited and engaged in the ALSPAC G2 cohort, to propose tailored recommendations to improve recruitment and engagement and test the feasibility and acceptability of the revised, tailored approach with participants and research staff. The general learning from this process is expected to be relevant to many similar research projects.