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.

This project aims to understand the long-term effects of antidepressant use in the adult population.
There is currently a gap in the literature regarding the longitudinal effects of pharmaceutical
interventions for depression, so there is not great clinical understanding of the impact of
antidepressants on health outcomes long-term. For example, some longitudinal studies suggest that
the symptoms of depression improve overall after long term antidepressant use, but this is reported
in tandem with adverse psychological and physical health outcomes like weight gain, sexual
dysfunction, and emotional numbness (Dehar et al. 2016). In the psychiatric literature, there is an
impoverished understanding of depression causality, with multiple competing hypotheses
suggesting genetic, psychological, neurochemical, and neurostructural correlates of the illness. This
suggests that depression as an overarching umbrella term could include multiple phenotypes, that if
captured, could explain different illness trajectories and predict differential health outcomes after
pharmaceutical intervention.

The long-term effects of antidepressant use on a wide range of health outcomes should be explored
to ascertain whether they are an optimal intervention for people who present with mild to
moderate depression and anxiety.

Entrepreneurship is with good reason viewed as a driver of economic growth, employment creation, and social mobility: in 2018, there were 5.7 million small-medium enterprises in the UK, accounting for 99.9% of all businesses, 60% of employment and 52% of the gross value added in the UK private sector. Of these, 96% were micro-businesses with less than 10 employees (Business Statistics, Standard Note, SN/EP/6152, House of Commons Library, December 2018). In fact, policymakers advocate support to entrepreneurship as a way forward for socioeconomic development at regional and national level, therefore helping these firms to form is key to UK prosperity. Government support for entrepreneurs often takes a macro perspective of intervention through subsidies and infrastructure. There is, however, increasing recognition in the entrepreneurship field that the decision to become an entrepreneur and start new ventures is strongly embedded in the close and personal space surrounding an individual, starting from their family relationships. It is well known that self-employment and business ownership choices are highly persistent across generations: entrepreneurial parents tend to have entrepreneurial children. We know much less, however, about the underlying mechanisms that transmit and shape those choices. This is what our project will address. We will examine the ways in which entrepreneurial parents affect their children’s entrepreneurial preferences and behaviours directly – through being role models and providing advice – and indirectly – through shaping attitudes to risk and uncertainty, and exposing the stresses and wellbeing impacts inherent in starting a business. Our findings will identify new ways in which policy can encourage and nurture entrepreneurialism.

Environmental and genetic factors both play a role in shaping individual variation. Characteristics that increase an individual’s chance of survival and reproduction are more likely to be passed onto the next generation. This process is known as natural selection and it is reflected at the genetic level. Negative selection is a form of natural selection whereby rare genetic factors with harmful effect on survival and reproduction are removed from populations. Recent studies have found evidence of negative selection acting on complex traits such as body mass index (BMI), blood pressure and height.

This project will explore how natural selection influences molecular traits. Metabolites are intermediates or end products of biological processes and they are linked to numerous diseases. Gaining a better understanding of how metabolites are related to survival and reproduction will enable researchers to prioritise specific research avenues. This prioritisation may improve human health.

As more people live to old age, dementia is on the rise, but there is currently no effective treatment. This comes at enormous personal, societal and economic cost. I and others have previously shown that a decrease in heart function is associated with early cognitive impairment, however the underlying cause is not clear. It is possible that poor heart function may lead to poor blood flow in the brain, which may be the link. Another possible link between the heart and the brain runs in the opposite direction. Instead of heart problems leading to brain problems, it could be that lower cognitive function as a child leads to heart problems later in life. I will investigate the direction of the heart-brain association in 30yr olds from the ALSPAC cohort, that have had data collected since birth, including genetic, cognitive and heart measures. I will collect new detailed data on the heart and the brain during rest and during exercise. The results of this study are important as dementia is a public health priority. The clinical implications of reduced cognition among people with impaired heart function are considerable. By understanding the underlying mechanisms, we can reduce the burden of both of these conditions.

It is well known that September-born children perform better on school tests than August-borns, most likely because they are "older in the year". This project aims to explore the importance of gene-environment interplay within this context. More specifically, it will investigate whether this September-effect, or the effect of being "old in the academic year", varies with an individual's genetic predisposition, as proxied by a polygenic score for cognitive ability, for educational attainment, and for 'non-cognitive' skills. We will examine the effects on cognitive outcomes such as academic achievement, as well as on non-cognitive skills, such as the children's "strength and difficulties".