HBI2.7 - Avoidable cost of alcohol project

Swedish data were used to estimate the avoidable costs associated with cessation of alcohol use. Meta-analyses were conducted where sufficient epidemiological data were available to estimate the reversibility of all alcohol-related diseases. These were later employed in calculating the avoidable healthcare and associated QALY losses of alcohol consumption in Sweden. The estimates considered impacts on different groups, for example by age and gender. In addition an alternative method has been used to estimate the avoidable cost of liver cirrhosis.

Outcome and Translation

Identifying avoidable cost is important in order to prioritise between different social concerns and to accurately rank alcohol policies based on their cost-effectiveness. For some diseases, the lag time from drinking cessation to reduced mortality and morbidity was shown to be lengthy. However, the reviews identified areas where limited data suggested more research is required to improve the robustness of results. There were also issues related to heterogeneity in the population characteristics of current drinkers, abstainers and former drinkers which need to be accounted for.

The results have been used in the Sheffield Alcohol Policy Model and have informed an application to the Swedish Research Council for a programme grant to model the effects of interventions.

HERU researchers involved in this research project: Anne Ludbrook

External Collaborators: U-G Gerdtham, CH Lyttkens, J Jarl (Lund University); P Lundborg (Vrije Universiteit Amsterdam); and D Petrie (University of Dundee)

Publications

Jarl, J., Gerdtham, U.-G., Ludbrook, A. and Petrie, D. (2010) 'On measurement of avoidable and unavoidable cost of alcohol: an application of method for estimating costs due to prior consumption', International Journal of Environmental Research and Public Health, 7(7), 2881-2895.

HBI2.8 - Be-Wel: the impact of a body weight and physical activity intervention on adults at risk of developing colorectal adenomas

For interventions that require individual behaviour change to be successful, it is particularly important to consider the costs and benefits from the perspective of individual participants and their families. These were explored in the context of the CCA and in more depth in the post-intervention interviews. CCA also allows for a very flexible presentation of results in contexts where more than one outcome is of interest.

Outcome and Translation

The intervention produced a significant weight loss for the intervention group. The intervention costs were relatively high as it was delivered in participants’ own homes but this reduced the burden on them. Longer-term outcomes will require further follow up.

HERU researchers involved in this research project: Anne Ludbrook, Lynda McKenzie and Patrícia Norwood

External Collaborators: A Anderson, J Belch, F Daly, R Steele, S Treweek (University of Dundee); M Stead (University of Stirling); A Kirk (University of Strathclyde); J Wardle (University College London); and J Thomson (NHS Tayside)

Publications

Craigie, A.M., Caswell, S., Paterson, C., Treweek, S., Belch, J.J.F., Daly, F., Rodger, J., Thompson, J., Kirk, A., Ludbrook, A., Stead, M., Wardle, J., Steele, R.J.C. and Anderson, A.S. (2011) 'Study protocol for BeWEL: the impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas' [protocol], BMC Public Health, 11.

Stead, M., Caswell, S., Craigie, A.M., Eadie, D., Anderson, A.S. and The BeWEL Team (2012) 'Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study', Preventive Medicine,54(1), 97-103.[Ludbrook, A., member of BeWEL Team].

Anderson, A. S., Craigie, A. M., Caswell, S., Treweek, S., Stead, M., Macleod, M., Daly, F., Belch, J., Rodger, J., Kirk, A., Ludbrook, A., Rauchhaus, P., Norwood, P., Thompson, J., Wardle, J. and Steele, R. J. C. (2014) 'The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial', BMJ, 348, g1823

Anderson, A. S., Caswell, S., Macleod, M., Craigie, A. M., Stead, M., Steele, R. J. and the BeWELTeam, (Ludbrook, A. and Norwood, P. are on the BeWEL Team) (2015) 'Awareness of lifestyle and colorectal cancer risk: findings from the BeWEL study', Biomed Research International, 2015, Article ID: 871613.

HBI2.16 - BIBS: Benefits of Incentives for Breastfeeding and Smoking cessation. A platform study for a trial

Research objectives:

  1. To determine the evidence for the effectiveness of incentive interventions delivered within or outside the NHS, to (a) individuals, families or (b) organisations that aim to increase and sustain smoking cessation and breastfeeding during pregnancy.

  2. To determine the acceptability and feasibility of a shortlist of promising incentive strategies and potential harms or adverse consequences.

  3. To develop an incentive taxonomy.
  4. To design a feasible trial.

There were three key stages to the research:

Stage 1. Evidence synthesis to meet the knowledge gap on the use of incentives in this underdeveloped field and to integrate evidence on two behaviours; smoking in pregnancy and breastfeeding. It aimed to assess incentives at an individual recipient level as well as at provider and organisational levels.

Stage 2. Primary qualitative research and web surveys to assess the acceptability and feasibility of a shortlist of candidate incentives.

Stage 3. A discrete choice experiment (DCE) to inform the design of a trial.

Outcome and Translation

The research identified a range of potential interventions using different forms of incentives, to individuals or organisations, to encourage healthy behaviours. The feasibility and acceptability of promising interventions was assessed and the effect of different levels of incentive was assessed through the DCE. 

The DCE identified the level of incentive required to increase the likelihood of quitting smoking. This will be used to inform intervention studies, including trials.

Further details on this project are available at the NIHR site project page.

HERU researchers involved in this research project: Anne Ludbrook, Shelley Farrar and Deokhee Yi

External Collaborators: P Hoddinott (University of Stirling); M Campbell (HSRU, University of Aberdeen); L Bauld (UK Centre for Tobacco Control Studies); F Sniehotta (Newcastle University); F Dykes (University of Central Lancashire) and D Tappin (University of Glasgow)

Publications

Hoddinott, P., Morgan, H., MacLennan, G., Sewel, K., Thomson, G., Bauld, L., Yi, D., Ludbrook, A. and Campbell, M. K. (2014) 'Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public', BMJ Open, 4(7), e005524.

Morgan, H., Hoddinott, P., Thomson, G., Crossland, N., Farrar, S., Yi, D., Hislop, J., Moran, V. H., MacLennan, G., Dombrowski, S. U., Rothnie, K., Stewart, F., Bauld, L., Ludbrook, A., Dykes, F., Sniehotta, F. F., Tappin, D. and Campbell, M. (2015) 'Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design', Health Technology Assessment, 19(30).

Farrar, S., Yi, D., Morgan, H., Ludbrook, A. and Hoddinott, P. (2016) Financial incentives to support smoking cessation in pregnant women – size matters', HERU Policy Brief, May 2016University of Aberdeen.

Presentations

Morgan, H., Hislop, J., Rothnie, K., Stewart, F., Hoddinott, P. and Farrar, S. (2012) 'Incentives for smoking in pregnancy: are they the way forward?', Health Challenge Wales, Cardiff, June 2012.

Hoddinott, P., Hislop, J., Morgan, H., Stewart, F., Rothnie, K., Bauld, L., Thomson, G. and Farrar, S. (2012) 'BIBS: Benefits of Incentives for Breastfeeding and smoking cessation: a platform study for a trial', Public Health Agency, Belfast, November 2012.

Hoddinott, P., Hislop, J., Morgan, H., Stewart, F., Farrar, S., Rothnie, K., Bauld, L. and Thomson, G. (2012) 'A mixed methods evidence synthesis of incentive interventions for smoking cessation in pregnancy', Faculty of Public Health Scotland, Crieff, November 2012.

Hoddinott, P., Hislop, J., Morgan, H., Stewart, F., Farrar, S., Rothnie, K., Bauld, L. and Thomson, G. (2012) 'A mixed methods evidence synthesis [poster]', Royal Society of Medicine. Public Health Science: a National Conference Dedicated to New Research in Public Health. London, November 2012.

Morgan, H., Hoddinott, P., Hislop, J., Stewart, F., Rothnie, K., Bauld, L., Thomson, G. and Farrar, S. (2012) 'More questions than answers: the role of incentives around childbirth', Faculty of Public Health Scotland, Crieff, November 2012.

Hoddinott, P., Morgan, H., Thomson, G., Crossland, N., Craig, L., Britten, J., Farrar, S., Newlands, R., Kiezebrink, K. and Coyle, J. (2013), 'Intervention vignettes as a qualitative tool to refine complex intervention design', 2nd Clinical Trials Methodology Conference, EICC, Edinburgh, 18-19 November 2013.

Hoddinott, P., Morgan, H., MacLennan, G., Sewel, K., Thomson, G., Bauld, L., Yi, D., Ludbrook, A. and Campbell, M. K. (2014) 'Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding', Scottish School of Primary Care (SSPC), Cumbernauld, 29-30 April 2014.

Hoddinott, P., Morgan, H., MacLennan, G., Sewel, K., Thomson, G., Bauld, L., Yi, D., Ludbrook, A. and Campbell, M. K. (2014) 'Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding', 13th International Congress of Behavioral Medicine, Groningen, Netherlands, 20-23 August 2014.

Hoddinott, P., Morgan, H., MacLennan, G., Sewel, K., Thomson, G., Bauld, L., Yi, D., Ludbrook, A. and Campbell, M. (2014) 'Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding', Society for Research on Nicotine and Tobacco (SRNT) Europe Annual Meeting, Santiago de Compostela, Spain, 18-20 September 2014.

Hoddinott, P., Morgan, H., Thomson, G., Crossland, N., Farrar, S., Yi, D., Hislop, J., Hall Moran, V., MacLennan, G., Dombrowski, S. U., Rothnie, K., Stewart, F., Bauld, L., Ludbrook, A., Dykes, F., Sniehotta, F. F., Tappin, D. and Campbell, M. (2014) 'The 'push me-pull you' of financial incentives and health inequalities: a mixed methods study investigating smoking cessation in pregnancy and breastfeeding [Poster]', Public Health Science: a National Conference Dedicated to New Research in UK Public Health, Glasgow, 19-22 November 2014.

Morgan, H. on behalf of the BIBS Study Team (Ludbrook, A. and Farrar, S. are members of the BIBS Study Team) (2015) 'Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design' [Poster], 3rd Annual Healthcare Improvement Scotland Research Symposium: Bringing Evidence Together, The Merchants' Hall, Edinburgh, 26 March 2015.

Hoddinott, P. on behalf of the BIBS Study Team (Ludbrook, A. and Farrar, S. are members of the BIBS Study Team) (2015) 'Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design' [Poster], Researching Complex Interventions in Health: the State of the Art, Rougemont Hotel, Exeter, 14-15 October 2015.

HBI2.3 - Economic appraisal of the choice and targeting of lifestyle interventions to prevent disease in deprived populations

The likelihood that conditions such as heart disease, cancers, diabetes and strokes will occur can be affected by the lifestyles that we adopt – such as smoking, over-eating, not taking enough exercise, etc. This study provides information for policy makers, the NHS and individuals about which interventions to change unhealthy behaviours are effective, as well as cost-effective. Such information will assist in making decisions about how best to use the limited resources available to improve the health of the nation. The consequences (in terms of ill health and costs) of different types of lifestyle are affected by an individual’s personal circumstances and the environment in which they live. It is these factors that either promote or provide barriers to an individual changing their behaviour.

The main research questions addressed were: the contribution of different lifestyle factors to ill health and mortality that might be prevented; how this preventable ill health varies between different areas and different social groups who differ in the amount of deprivation they suffer; and the relative costs and benefits of alternative ways of changing behaviour and their impacts on health inequalities.

Outcome and Translation

A novel approach was developed to addressing the role of lifestyles and life circumstances in preventable diseases using econometric analysis of linked survey and hospitalisation data and the results were integrated into an economic evaluation framework. This study developed information for policy makers, the NHS and individuals about which interventions to change unhealthy behaviours are effective, as well as cost-effective, and how these might be targeted to reduce health inequalities.

HERU researchers involved in this research project: Anne Ludbrook, Dami Olajide, Barbara Eberth and Luke Vale

External collaborators: P Boyle, (University of St. Andrews); D Stockton, (ISD) and P Craig (Scottish Government Health Directorates)

Publications

Eberth, B. and Smith, M.D. (2010) 'Modelling the participation decision and duration of sporting activity in Scotland', Economic Modelling, 27(4), 822-834.

Eberth, B. and Smith, M.D. (2010) 'Modelling the participation decision and duration of sporting activity in Scotland', HERU Briefing Paper, November 2010, University of Aberdeen.

Eberth, B., Olajide, D., Craig, P. and Ludbrook, A. (2014) 'Smoking-related disease risk, area deprivation and health behaviours', Journal of Public Health, 36(1), 72-80.

Presentations

Eberth, B. and Smith, MD. (2008) ‘Modelling sporting activity in Scotland’, Health Econometrics Workshop, Milan, Italy, December 2008.

Eberth, B. and Smith, MD. (2009) ‘Modelling the participation decision and the time spent on sporting activity in Scotland’, Scottish Economic Society Annual Conference, Perth, April 2009.

Olajide, D., Ludbrook, A., and Smith, M. (2010) ‘Will quitting smoking and taking up a sport improve your diet? Investigating spillover effects of health behaviour interventions’, UK Society for Behavioural Medicine (NPRI), Leeds, December 2010.

Ludbrook, A. (2011) ‘Economic appraisal of the choice and targeting of lifestyle interventions to prevent disease in deprived populations’, Chief Scientist Office Workshop, Measuring, Understanding and Tackling Health Inequalities: New Insights from Scottish Research, Edinburgh, February 2011.

Olajide, D. and Eberth, B. (2011) ‘Modelling time to incidence of smoking related diseases: a sample selection approach using linked hospitalisation data’, Scottish Economic Society Conference, Perth, April 2011.

Olajide, D. and Eberth, B. (2011) ‘Modelling time to incidence of smoking related diseases: a sample selection approach using linked hospitalisation data’, Scottish Health Informatics Programme Conference, Exploiting Existing Data for Health Research, St Andrews, September 2011.

Eberth, B., Olajide, D. and Ludbrook, A. (2011) ‘Smoking related disease risk and lifestyle behaviours,’ Faculty of Public Health Conference, Aviemore, November 2011.

Olajide, D., Ludbrook, A. and Eberth, B. (2011) ‘Patterns of drinking behaviour and incidence of diseases amongst Scottish adults’, Faculty of Public Health Conference, Aviemore, November 2011.

Ludbrook, A., Smith, MD., Vale, L., Craig, P., Stockton, D., Popham, F., Olajide, D., Eberth, B. and Yi, D. (2011) ‘Economic appraisal of the choice and targeting of lifestyle interventions to prevent disease in deprived populations’, UK Society for Behavioural Medicine / NPRI, Stirling, December 2011.

Ludbrook, A. (2012) ‘Health behaviours and health inequalities: what should be targeted?’, Institute of Health & Society Seminar, Newcastle, May 2012.

Olajide, D, Ludbrook, A. and Eberth B. (2012) ‘Analysis of multiple risky behaviours and associated disease outcomes using Scottish linked hospitalisation data’, NHESG, Kuopio, Finland, August 2012.

Olajide, D. and Ludbrook, A. (2012) ‘Patterns of multiple health behaviours and associated disease outcomes amongst Scottish adults: a latent class regression approach’, Faculty of Public Health Conference, Crieff, November 2012.

Yi, D., Vale, L., Ludbrook, A. and Olajide, D. (2012) ‘Cost effectiveness analysis of smoking intervention programmes in Scotland: impact of health behaviour and deprivation’, [Poster] UK Society for Behavioural Medicine Conference, Manchester, December 2012.

Olajide, D. and Ludbrook, A. (2013) ‘Modelling risk of smoking related disease linked to deprivation: comparison of two linked data sets’, ScottisH Informatics Programme (SHIP) International Conference: Exploiting Existing Data for Health Research, St Andrews, August 2013.

HBI2.1 - An economic evaluation of obesity prevention for UK adults

ARCHIVED


The prevalence of obesity has been rising continuously in the UK with a major impact on mortality, morbidity and well-being. Achieving and maintaining a lower weight significantly reduces the risk of developing many diseases, especially diabetes, coronary heart disease (CHD) and some cancers. The investigation of the acceptability, effectiveness and cost-effectiveness of alternative preventive interventions is necessary for the design and targeting of evidence-based policy.

The study was based on six interlinked work packages: (i) systematic reviews of interventions’ effectiveness and prognostic outcomes of obesity; (ii) qualitative research investigating the causes and possible preventative remedies for obesity-related conditions from the perspective of the public, healthcare practitioners and policy makers; (iii) a discrete choice experiment (DCE) to estimate preferences for alternative lifestyle interventions; (iv) and (v) used econometric techniques to estimate the effectiveness and costs of lifestyle changes and (vi), informed by previous packages, the cost-effectiveness of alternative interventions was assessed.

Outcome and Translation

The systematic reviews showed that diet and exercise interventions providing support to individuals with BMI ≤ 35kg/m2 would lead to an average weight loss of more than 2kg persisting for at least for two years. Diet and exercise and/or behaviour therapy demonstrated significant reduction in hypertension and improvement in the risk of metabolic syndrome and diabetes compared with no treatment control. The qualitative research identified that stakeholders had different views of where responsibility lay – individuals focused on their own actions while health professionals and policy makers viewed obesity as a socio-ecologically-determined problem. Findings from these two work packages informed the DCE which found that there was a general preference for maintaining current lifestyles, together with a sensitivity to costs which suggests financial incentives could be used to help maximise up-take of healthy lifestyle interventions. Econometric analysis was used to inform the economic evaluation model. This model is now being used in early modelling of potential obesity prevention and treatment interventions to inform the design of new empirical evaluation studies.

HERU researchers involved in this research project: Dami Olajide, Anne Ludbrook, Mandy Ryan, and Deokhee Yi.

External collaborators: M Sutton (University of Manchester); L Aucott, E van Teiljingen, F Douglas, J Greener, L Vale (Population Health, University of Aberdeen); A Goode, A Scott (University of Melbourne) and K Mavromaras (University of Adelaide)

Publications

Brown, T., Avenell, A., Edmunds, E., Moore, H., Whittaker, V., Avery, L., Summerbell, C. for the PROGRESS group (Ryan, M. and Vale, L. members of this group) (2009) 'Systematic review of long-term lifestyle interventions to prevent obesity in adults', Obesity Reviews, 10 (6), 627-638.

Aucott, L., Gray, D., Rothnie, H., Thapa, M., Waweru, C. for the PROGRESS group (Ryan, M. and Vale, L. are members of this group), (2011) 'Effects of lifestyle interventions and long-term weight loss on lipid outcomes – a systematic review', Obesity Reviews, 12(5), e412-e425.

Olajide, D. and Ludbrook, A. (2012) 'Diet, risk of obesity and socioeconomic circumstances of individuals in the UK: a seemingly unrelated approach', Nordic Journal of Health Economics, 1(2), 99-118.

Ryan, M., Yi, D., Avenell, A., Douglas, F., Aucott, L., van Teijlingen, E. and Vale, L. (2015) 'Gaining pounds by losing pounds: preferences for lifestyle interventions to reduce obesity', Health Economics, Policy, and Law, 10(2), 161-182.

Olajide, D. and Ludbrook, A. (2014) 'Effects of income, education and occupation status on diet and risk of obesity', HERU Briefing Paper, December 2014, University of Aberdeen.

Ryan, M., Yi, D., Avenell, A., Douglas, F., Aucott, L., Van Teijlingen, E. and Vale, L. (2015) 'Gaining pounds by losing pounds: research finds financial incentives could help reduce obesity', HERU Policy Brief, March 2015, University of Aberdeen.

Presentations

Vale, L. (2006) ‘Economic evaluation of obesity prevention’, National Prevention Research Initiative, Medical Research Council, London, February 2006.

Vale, L. (2006) ‘Economic evaluation of obesity prevention’, Obesity Research Group, University of Aberdeen, Aberdeen, February 2006.

Ludbrook, A. (2006) ‘What really works?’ Childhood Obesity Conference, Edinburgh, December 2006.

Ludbrook, A. (2007) ‘Obesity: treatable condition or lifestyle choice?’ Northern Ireland Health Economics Group, Belfast, October 2007.

Goode, A.J., Mavromaras, K.G. and Smith, MD. (2008)Intergenerational transmission and healthy eating behaviour’, Scottish Economic Society Annual Conference, Perth, April 2008.

Olajide, D. and Smith, MD. (2009) ‘Obesity-related disease incidence modelling using hospitalisation records: correcting for sample selection bias’, Scottish Economic Society Annual Conference, Perth, April 2009.

Olajide, D. and Ludbrook, A. (2010) ‘A multilevel analysis of the influence of households on sedentary behaviour among children in Scotland’, European Conference on Health Economics (ECHE), Helsinki, Finland, July 2010.

Ryan, M., Yi D., Avenell, A., Douglas, F., Aucott, L., van Teijlingen, E. and Vale, L. (2010) ‘Understanding preferences for lifestyle interventions to reduce obesity: should we pay people to live well?’ UK Society for Behavioural Medicine 6th Annual Scientific Meeting, University of Leeds, December 2010.

Ryan M. (2012) ‘Using Discrete Choice Experiments to understand preferences for lifestyle interventions: should we pay people to live well? Invited Plenary presentation’, British Psychological Society, Division of Health Psychology Annual Conference, University of Glasgow, February 2012.

Ryan M. (2012) ‘Discrete Choice Experiments in health economics: an application to lifestyle interventions’, Seminar, Community Health Sciences, Centre of Health Economics Research, University of Southern Denmark, Denmark, April 2012.

Ryan M. (2012) ‘Discrete choice experiments in health economics: an application to lifestyle interventions’, Seminar, Community Health Sciences, University of Calgary, Canada, April 2012.

Olajide, D., Ludbrook, A. and Vale L. (2012) ‘Variations in costs of hospital admissions for obesity-related diseases: a mixed effects mixed distribution approach’, European Conference on Health Economics, Zurich, July 2012.

Pol, M. van der, Ludbrook A. and Ryan M. (2012) ‘Incentives in health promotion: taxing people for unhealthy behaviours or paying people for healthy behaviours?’ British Science Festival, Aberdeen, September 2012.

Vale, L., Yi, D. on behalf of the PROGRESS Group (Ludbrook, A. and Ryan, M. are members of group) (2014) 'Ib for £: an economic evaluation of obesity prevention for UK adults', Health Economics and Health Technology Assessment (HEHTA) Seminar, Glasgow University, Glasgow, 30 October 2014.

Ryan, M. (2016) 'Gaining pounds by losing pounds: preferences for lifestyle interventions to reduce obesity', Scottish Economic Society Annual Conference, Perth, 20 April 2016.

Vale, L., Yi, D., Lee, K. W. on behalf of the PROGRESS Group (Ludbrook, A. and Ryan, M. are members of group) (2016) 'Ib for £: an economic evaluation of obesity prevention for UK adults', Institute of Applied Health Research, Birmingham University, Birmingham, England, October 2016.

HBI1.5 - Engaging with Older People to develop and deliver Interventions for the self-management of Chronic pain (EOPIC)

Taking a multi-disciplinary approach that emphasised the interconnections between chronic pain, physical and emotional functioning, material resources and social aspects of the everyday lives of older adults, the project comprised five phases of research:

  1. Investigation of the attitudes and approaches adopted by general practitioners, primary care teams, pain clinics and older adults towards pain management in older age;
  2. Assessment of the acceptability, effectiveness and cost-effectiveness of self-management strategies;
  3. Measurement of the economic consequences of pain in later life;
  4. Development of working prototypes of new, innovative materials (e.g. written and audiovisual, including web-based resources) that help older adults to live with pain in the community; and
  5. Exploration of effective and cost-effective ways to disseminate and deliver newly developed materials.

Outcome and Translation

The programme of work enhanced the evidence base on the beliefs, attitudes and economic consequences of pain in older populations, to allow improved service provision.

HERU researchers involved in this research project: Paul McNamee and Dwayne Boyers

External collaborators: B Smith (University of Dundee); A Clarke, D Jones (University of Northumbria); P Schofield (University of Greenwich); D Martin (University of Teesside )

Publications

Schofield, P., Clarke, A., Jones, D., Martin, D., McNamee, P. and Smith, B. (2011) 'Chronic pain in later life: a review of current issues and challenges', Aging Health, 7(4), 551-556.

Clarke, A., Anthony, G., Gray, D., Jones, D., McNamee, P., Schofield, P., Smith, B.H. and Martin, D. (2012) '"I feel so stupid because I can't give a proper answer ..." How older adults describe chronic pain: a qualitative study', BMC Geriatrics, 12.

Boyers, D., McNamee, P., Clarke, A., Jones, D., Martin, D., Schofield, P. and Smith, B. H. (2013) 'Cost-effectiveness of self-management methods for the treatment of chronic pain in an aging adult population: a systematic review of the literature', Clinical Journal of Pain, 29(4), 366-375.

Schofield, P., Smith, B. H., Martin, D., Jones, D., Clarke, A., McNamee, P., Marsh, R., Morrison, M., Morrison, R., Fowler, S., Anthony, G. and Stewart, C. (2014) 'Systematically searching for and assessing the literature for self-management of chronic pain: a lay users' perspective', BMC Geriatrics, 14(1), 86.

Clarke, A., Martin, D., Jones, D., Schofield, P., Anthony, G., McNamee, P., Gray, D. and Smith, B.H. (2014) ' "I try and smile, I try and be cheery, I try not to be pushy. I try to say 'I'm here for help' but I leave feeling... worried": a qualitative study of perceptions of interactions with health professionals by community-based older adults with chronic pain', PLoS One, 9(9), e105450.

McNamee, P. and Mendolia, S. (2014) 'The effect of chronic pain on life satisfaction: evidence from Australian data', Social Science & Medicine, 121c, 65-73.

Geneen, L. J., Martin, D. J., Adams, N., Clarke, C., Dunbar, M., Jones, D., McNamee, P., Schofield, P. and Smith, B. H. (2015) 'Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis', Systematic Reviews, 4, 132.

Presentations

Boyers, D. EOPIC project team (Smith, B., Schofield, P., Gray, D., Clarke, A., McNamee, P., Martin, D., Jones, D. and Roche, P.) (2010) 'EOPIC: Engaging with older people and their carers to develop interventions for the self-management of chronic pain' [Poster], Life Long Health and Well Being Research Retreat, Newcastle, October 2010.

Boyers, D. (on behalf of the EOPIC project team - Smith, B., Schofield, P., Gray, D., Clarke, A., McNamee, P., Martin, D., Jones, D. and Roche, P.) (2010) 'Self-management interventions for older adults with chronic pain: a systematic review of the cost-effectiveness literature', Life Long Health and Well Being Research Retreat, Newcastle, October 2010.

Boyers, D., McNamee, P., Schofield, P., Martin, D., Jones, D., Clarke, A. and Smith, B. (2011) 'Cost-effectiveness of self-management of chronic pain in older adults: a systematic review', Life-Long Health & Well-Being Conference, University of Newcastle, November 2011.

McNamee, P. (2012) 'Economic consequences of chronic pain in older age', Monash University, Melbourne, May 2012.

Clarke, A., Jones, D., Martin, D., McNamee, P., Schofield, P. and Smith, B. (2012) 'Engaging with older people and their carers to develop interventions for the self-management of chronic pain', Life-Long Health & Well-Being Conference, University of Edinburgh, December 2012.

Ma, A., Skatun, D., McNamee, P., Clarke, A., Jones, D., Martin, D., Schofield, P. and Smith, BH. (2013) 'The labour market outcomes of chronic pain', Scottish Pain Research Community (SPaRC) Annual Scientific Meeting, West Park Conference Centre, Dundee, March 2013.

McNamee, P. (2013) 'Chronic pain in older age and compensating income variation: how important are psycho-social factors', ARC Centre of Excellence in Population Ageing Research (CEPAR) International Conference, University of New South Wales, Sydney, Australia, July 2013.

McNamee, P. and Mendolia, S. (2014) 'The effect of chronic pain on life satisfaction: evidence from Australia', Health Economists' Study Group, Sheffield, 8-10 January 2014.

HBI2.6 - An evaluation to assess the effectiveness of "Quit 4 U", a smoking cessation service in Dundee combining financial incentives and behavioural support

The uptake of smoking cessation services by smokers living in relatively deprived areas tends to be low. NHS Tayside has introduced a new scheme (quit4u) in which participants are paid a financial incentive if verified as smoke-free. This study assessed the effectiveness and cost-effectiveness of supplementing standard smoking cessation services with financial incentives using the ISD minimum dataset on smoking cessation services. The results showed that quit rates were higher for quit4u compared to standard smoking cessation services. Quit4u was also shown to be a cost-effective use of NHS resources.

Outcome and Translation

Smoking remains a major public health concern. Devising (cost)-effective smoking cessation interventions is challenging, especially in relatively deprived areas. This study showed that quit4u was cost-effective. It should be considered whether similar schemes should be provided in other areas in Scotland thereby reducing smoking and its negative health effects in deprived areas throughout Scotland in a cost-effective manner.

HERU researchers involved in this research project: Marjon van der Pol and Anne Ludbrook

External Collaborators: C Martin, R Armstrong (Scottish Centre for Social Research) and A Amos (University of Edinburgh)

Publications

Ormston, R., McConville, S., Pol, M. van der, Ludbrook, A. and Amos, A. (2012) Evaluation of quit4.Report to NHS Health Scotland, NHS Health Scotland.

Ormston, R., Pol, M. van der, Ludbrook, A., McConville, S. and Amos, A. (2015) 'quit4u: the effectiveness of combining behavioural support, pharmacotherapy and financial incentives to support smoking cessation', Health Education Research, 30(1), 121-133.

Presentations

Pol, M. van der and Ludbrook, A. (2010) ‘Quantitative analysis, implementation and evaluation: the learning to date’, Joint Seminar between NHS Tayside, NHS Health Scotland and the Scottish Centre for Social Research, Dundee, June 2010.

Amos A, Pol, M. van der (2010) ‘Lessons from quit4u: combining support, pharmacotherapy and financial incentives to support smoking cessation’, UK National Smoking Cessation Conference, Birmingham, June 2012.

Ludbrook, A. Pol, M. van der, Ormston, R. and Amos, A. (2012) ‘Innovation in smoking cessation: the impact of quit4u on take up and smoking quit rates in a deprived area’, Annual Public Health Conference, Crieff, November 2012.

Ormston, R., Amos, A., Ludbrook, A., McConville, S. and Pol, M. van der (2012) ’Getting the ‘whole package’ right: learning from the quit4u smoking cessation scheme’, Annual Public Health Conference, Crieff, November 2012.

HBI1.2 - ICDC: Improving the efficient and equitable care of patients with chronic medical conditions: interdisciplinary chronic disease collaboration

Obesity, smoking, physical inactivity and an ageing population have contributed to an epidemic of high blood pressure, diabetes, kidney disease and vascular disease. These chronic conditions, which often occur together, are major causes of death and disability. Effective treatments exist but many patients do not adhere to the prescribed treatment and/or their lifestyle choices reduce the effectiveness of the treatments.

A survey of 1849 patients with one or more chronic diseases living in Western Canada was conducted in 2012. The survey focused on various aspects of healthcare delivery, financial barriers, geographic barriers and use of information technology as they relate to the care and management of patients with chronic disease.

The economics component of this study investigated the correlation between individuals’ time preference and risk attitude, and adherence to advice on health behaviours. The results showed that time and risk preferences play a role in adherence to some but not all health behaviours.

Outcome and Translation

The research identified several potentially modifiable barriers that, if addressed through health policy, could further optimise care of individuals with chronic disease.

HERU researchers involved in this research project: Marjon van der Pol

External Collaborators: B Hemmelgarn, BJ Manns, NR Campbell, KM King, L McLaren, K McLaughlin (University of Calgary); MA Tonelli, S Bowen, A Timothy, TA Caulfield, JA Johnson, SW Klarenbach, FA McAlister, RC Plotnikoff, RT Tsuyuki (University of Alberta); D Gordon (University of Alberta Hospital);  RZ Lewanczuk, P Sargious, S Viner (Alberta Health Services); D Huserau (Canadian Agency for Drugs & Technologies in Health); C Sanmartin (Statistics Canada); SE Straus (University of Toronto) and MW Rosenberg (Queen's University).

Publications

Pol, M. van der, Hennessy, D. and Manns, B. (2017) 'The role of time and risk preferences in adherence to physician advice on health behavior change', European Journal of Health Economics, 18(3), 373-386.

Presentations

Pol, M van der, Hennessey, D. (2013) ‘The role of time and risk preferences in adherence to physician advice on lifestyle behaviour change’, Nordic Health Economists’ Study Group (NHESG), Oslo, August 2013.

HBI2.12 - InegSante: Tackling inequalities in health and access to health care in African and Middle-Eastern countries: challenges of measurement and explanation

The INEGSANTE research project was directly related to themes 4 (Catastrophe, risks, vulnerabilities) and 1 (Demographic dynamics and future of societies in developing countries) of the call for proposals ‘les Suds Aujourd’hui II’. It aimed at improving the scientific debate about equity in healthcare expenditures and in access to healthcare in developing countries in three related ways:

  • Providing decomposition and microsimulation techniques that are appropriate for disentangling the respective roles of individual behaviours and preferences and of characteristics of healthcare delivery systems and financing schemes in the analysis of equity.

  • Re-examining the relationship between income and healthcare inequalities, notably with an attempt to operationalise in this field Sen’s concepts of ‘adaptive preferences and capability deprivation’ and through measuring ex post re-ranking effects of healthcare expenditures on income distribution.

  • Performing econometric analysis applying, for the first time, these approaches to national household surveys including detailed data on healthcare expenditures and consumption in a large sample of 12 African and Middle Eastern low-income (Burkina-Faso, Senegal, Zambia), lower middle-income (Cameroon, Côte d’Ivoire, Egypt, Jordan, Morocco, Palestine, Tunisia) and upper middle-income (Lebanon, South Africa) countries.

HERU researchers involved in this research project: Ramses Abul Naga

External collaborators: Abu-Zaineh, M., Moatti, J.P., Arrighi, Y., Ventelou, B., Woode, M.E. (Marseille); Boutayeb, A. (University Mohammed Premier, Morocco); Mataria, A. (World Health Organization, Regional Office for the Eastern Mediterranean).

Publications

Abu-Zaineh, M. and Abul Naga, R.H. (2013) 'Wealth, health, and the measurement of multidimensional inequality: evidence from the Middle East and North Africa', in Rosa Dias, P. & O'Donnell, O. (eds.) Health & Inequality, Research on Economic Inequality, Volume 21, Emerald Group Publishing, 421-439.

HBI1.6 - Investigating the Glasgow effect

The ‘Scottish Effect’ (and more recently, the ‘Glasgow Effect’) are terms that have been coined in recent years to describe the levels of poor health experienced in Scotland (and, particularly, Glasgow) in comparison to other parts of the UK over and above those explained by greater socio-economic deprivation. The causes of this ‘effect’ are unknown. The aim of the project was to carry out a population survey in three UK cities (Glasgow, Liverpool and Manchester) to gather new data on three potential explanations for Glasgow’s relatively poorer health profile. The three hypotheses were:

  1. that individual values in Glasgow are different from those in Liverpool and Manchester (e.g. Glaswegians have a different psychological outlook to others, in terms of their aspirations or ‘time preferences’ (and related levels of, and attitudes to, risk taking));

  2. that there are lower levels of social capital in Glasgow; or that Glasgow’s poor health derives from particular Thatcherite policies of the late 1970s/1980s (the ‘political attack’ hypothesis).

The results showed that there are differences in some aspects of social capital (trust and reciprocity, and social participation) between Glasgow and the two English cities. However, it appears less plausible that Glasgow’s population suffers from a lower sense of coherence, from the effects of different childhood experiences, or that the population is more associated with other particular ‘values’ that might have adverse impacts on health, such as psychological outlook, hedonism and future orientation (‘time preferences’) (although there is some evidence that Glasgow’s population may be more risk-seeking).

Outcome and Translation

It is crucial to understand what factors are associated with the poorer levels of health in Glasgow (after controlling for deprivation) so that effective policies can be formulated to address health inequalities.

HERU researchers involved in this research project: Marjon van der Pol and Ewan Gray

External Collaborators: D Walsh, R McLaughin RC Tannahill (Glasgow Centre for Population Health); G McCartney (NHS Health Scotland) and P Hanlon (University of Glasgow)

Publications

Walsh, D., McCartney, G., McCullough, S., Pol, M.van der., Buchanan, D. and Jones, R. (2013) Exploring potential reasons for Glasgow's 'excess' mortality: results of a three-city survey of Glasgow, Liverpool and Manchester, Glasgow: Glasgow Centre for Population Health.

Walsh, D., McCartney, G., McCullough, S., Pol, M. van der, Buchanan, D. and Jones, R. (2015) 'Comparing levels of social capital in three northern post-industrial UK cities', Public Health,129(6), 629-638.

Walsh, D., McCartney, G., McCullough, S., Pol, M. van der, Buchanan, D. and Jones, R. (2015) 'Always looking on the bright side of life? Exploring optimism and health in three UK post-industrial urban settings', Journal of Public Health, 37(3), 389-397.

Pol, M. van der, Walsh, D. and McCartney, G. (2015) 'Comparing time and risk preferences across three post-industrial UK cities', Social Science and Medicine, 140(September), 54-61.

Presentations

Walsh, W., McCartney, G., McCullough, S., Jones, R. and Pol, M. van der (2012) 'What explains different health outcomes in identically deprived post-industrial UK cities?', Population Health: Methods and Challenges Conference, Birmingham, April 2012.

Pol, M. van der (2013) 'Can preference heterogeneity partly explain the Glasgow effect?', Glasgow Health Economics Seminar Series (GhESS), Glasgow, January 2013.

Pol, M. van der (2013) 'Can preference heterogeneity partly explain the Glasgow effect? Time and risk preferences and health behaviour.', School of Health and Related Research (ScHARR) Seminar Series, University of Sheffield, March 2013.

Pol, M. van der and Walsh, D. (2013) 'Can preference heterogeneity partly explain the Glasgow effect?', Health Economists' Study Group, University of Warwick, 26-28 June

Pol, M. van der (2014) 'Geographical preference heterogeneity: a plausible hypothesis for higher levels of mortality in Glasgow?', Institute of Health Economics and Management (IEMS) Seminars in Health and Labor Economics, University of Lausanne, 29 October 2014.

Pol, M. van der (2015) 'Investigating the Glasgow effect on health', Behavioural Science Seminar, Behavioural Science Centre, University of Stirling, 14 October 2015.

HBI2.2 - Local evaluation of Keep Well in Aberdeen City Community Health Partnership

The research involved qualitative and quantitative methods. Interviews were held with key informants to elicit information about resource use, staffing, activities not covered by routine data sources, and referral patterns, to support the analysis of costs and effects of delivery options, as well as identifying features of good practice and potential barriers to change within practices. A second aspect of the qualitative research was eliciting the views of practice patients. Quantitative data from practices was analysed to compare patterns of activity before/after Keep Well to detect changes (if any) affecting the Keep Well population and the rest of the practice.

Outcome and Translation

The results of this evaluation informed decision making about the future role and funding of Keep Well.

HERU researchers involved in this research project: Anne Ludbrook

External collaborators: F Douglas (Population Health, University of Aberdeen)

Publications

Ludbrook, A. and Douglas, F. (2011) Local evaluation of Keep Well in Aberdeen Community Health Partnership. NHS Grampian Final Report, NHS Grampian.

Presentations

Ludbrook, A., Douglas F., Leighton Beck, L. and Ross Archer D. (2011) ‘What works well with Keep Well? Initial providers' perspectives on anticipatory care’, Faculty of Public Health Conference, Aviemore, November 2011

HBI1.3 - MRC Early Career Fellowship: The intergenerational transfer of eating habits, physical activity, behaviour and body composition: evidence from the UK

This Postdoctoral Fellowship allowed for the development of peer-reviewed papers from PhD research, in three areas: spousal correlations in BMI, labour supply and BMI, and the economic determinants of physical activity behaviour.

Further research was conducted on the intergenerational transfer of BMI and lifestyle characteristics using the Panel Study of Income Dynamics and the National Child Development Survey. The research looked at how to disentangle the family effects from the neighbourhood effects. The analysis controlled for time-invariant individual and family effects as well as neighbourhood characteristics.

Outcome and Translation

This project improved our understanding of the determinants of the obesity epidemic and potential policy interventions.

HERU researchers involved in this research project: Heather Brown

Publications

Brown, H., Hole, A.R. and Roberts, J. (2010) 'Going the same 'weigh': spousal correlations in obesity in the UK', Sheffield Economic Research Paper Series (SERP 2010012).

Brown, H. and Roberts, J. (2011) 'Exercising choice: the economic determinants of physical activity behaviour of an employed population', Social Science & Medicine, 73(3), 383-390.

Brown, H. (2011) 'Marriage, BMI, and wages: a double selection approach', Scottish Journal of Political Economy, 58(3), 347-377.

Brown, H. and Roberts, J. (2012) 'Exploring the factors contributing to sibling correlations in BMI: study using the panel study of income dynamics', Obesity, 20(5), 978-984.

Brown, H. and Pol, M. van der. (2014) 'The role of time preferences in the intergenerational transfer of smoking', Health Economics, 23(12), 1493-1501.

Presentations

Brown, H. (2010) ‘Marriage, BMI, and wages: a double selection approach’, Scottish Economic Society Conference, Perth, April 2010.

Brown H. and Roberts J. (2010) ‘Born to be wide: examining maternal and adolescent correlations in BMI’, European Conference on Health Economics, Helsinki, July 2010.

Brown H. and Roberts J. (2010) ‘Going the same way? Spousal correlation in obesity’, European Conference on Health Economics, Helsinki, July 2010.

Brown, H. (2010) ‘He ain't heavy he's my brother: examining sibling correlations in BMI’, Michigan University, September 2010.

Brown, H. (2010) ‘The role of lifestyle characteristics in influencing correlations in BMI for two cohorts of siblings’, PSID Conference on Health and SES, USA, September 2010.

Brown, H. (2010) ‘He ain't heavy he's my brother: examining sibling correlations in BMI’, University of Leeds, November 2010.

Brown, H. and Pol, M. van der. (2011) ‘Intergenerational transfer of health: the role of time and risk preferences’, Health Economists’ Study Group (HESG), York, January 2011.

Brown, H. (2011) ‘Born to be wide: examining maternal and adolescent correlations in BMI’, HERU Workshop on Obesity, Aberdeen, May 2011.

Brown, H. (2011) ‘Examining the pathways contributing to the intergenerational transmission of smoking’, Understanding Society/BHPS Conference, Essex, June 2011.

Brown, H. and Pol, M. van der. (2011) ‘Intergenerational transfer of health: the role of time and risk preferences’, iHEA, Toronto, July 2011.

HBI1.1 - PhD: Economic analysis of dietary and physical activity behaviours: consequences for obesity interventions (MRC Capacity Building PhD)

Diet and physical activity are two of the five key risk factors being addressed to improve health in the UK. The evidence base relating to the effectiveness and cost-effectiveness of public health interventions designed to influence such behaviours is weak. In other lifestyle behaviours, such as smoking and alcohol use, empirical models of behaviour based on secondary data have been developed. Studies have considered models of single-lifestyle behaviours with varying concentration on the roles of prices, information, regulation and peers. With respect to diet and physical activity there has been less research. This thesis has examined individuals’ combined diet and physical activity behaviours and the factors influencing those behaviours, including social status and deprivation. The effect of diet and physical activity on obesity, measured by BMI, has been examined using a range of data sources and modelling approaches, and policy implications have been identified.

Outcome and Translation

This PhD project improved understanding of the economic factors that affect diet and physical activity choices to inform the development of policy interventions. Simultaneous estimation of diet and physical activity suggested that low activity-uptake was associated with significantly higher BMI in overweight and obese individuals regardless of diet quality. Whilst there was evidence that diet quality is important for individual body weight, physical activity had a major influence on BMI, especially in the upper quantiles of the BMI distribution, i.e. amongst those with the most excess weight. This was found even for levels of physical activity below recommended levels, suggesting that any physical activity has a benefit for overweight and obese individuals. This finding may be useful in developing future information and advice.

PhD student: Frauke Becker

Supervisors: Anne Ludbrook and Barbara Eberth (HERU)

Publications

Becker, F. (2012) 'Economic dietary analysis and physical activity behaviours in relation to obesity', PhD Thesis, HERU, University of Aberdeen.

Presentations

Becker, F. (2009) ‘Patterns in dietary and physical activity behaviour in Scotland consequences for obesity intervention’, Annual Public Health Conference, Peebles, November 2009.

Becker, F., Ludbrook, A. and Eberth, B. (2010) 'Determinants of diet and physical activity - empirical evidence from the Scottish Health Survey', European Conference on Health Economics, Helsinki, July 2010.

Becker, F. (2011) 'Determinants of diet and physical activity - empirical evidence from the Scottish Health Survey', University of Aberdeen PhD Symposium, Aberdeen, February 2011

Becker, F. (2011) 'Diet and physical therapy - simultaneous determinants of BMI', HERU Workshop on Obesity, Aberdeen, May 2011.

Becker, F. and Eberth, B. (2012) 'Decomposition of changes in BMI distributions using quantile regression: empirical evidence from the HILDA survey', Nordic Health Economists' Study Group (NHESG), Kuopio, Finland, August 2012.

HBI2.14 - PhD: An economic perspective of the social determinants of health and health inequalities in Malawi

The project, implemented as a PhD study, was organised as follows. The first chapter of the thesis outlined the research questions, rationale and background to the study. Chapter 2 examined two research hypotheses. Focusing on the effect of household and mother’s education, it tested whether a socio-economic gradient in child malnutrition exists, focusing on stunting and under-weight in children aged below 5 years using a linear regression model. This chapter also tested whether the socio-economic determinants of child malnutrition have similar effects across the stunting and under-weight distributions using a quantile regression framework. Chapter 3 examined whether a socio-economic gradient in infant mortality exists. Using count regression models, chapter 4 examined whether a socio-economic gradient in healthcare utilisation exists, focussing on outpatient visits for children aged 5 years and below in Malawi. Chapter 5 revisited the hypothesis of the existence of a socio-economic gradient in child malnutrition addressed by decomposing the socio-economic inequalities in child stunting and under-weight.

The results show evidence of a socio-economic gradient in child health in Malawi. The thesis also finds a positive and significant effect of wealth and a negative effect of mother’s education on infant mortality. Furthermore, the findings show no significant effect of wealth but a positive effect of mother’s education on outpatient utilisation.

Additionally, the thesis finds significant and substantial effects of child-, household- and community-level factors on child health and outpatient care. Policy-wise, the results point to an urgent need for clearly specifying the distributional goals for the Malawi health sector in the next health sector strategic plan.

Outcome and Translation

This research is of interest as its findings will substantially inform the development of policies aimed at tackling inequalities and which are based on a secure evidence base linking socio-economic factors to health, thus indicating where resources should be applied most effectively.

PhD student: Dominic Nkhoma

Supervisors: Ramses Abul Naga and Barbara Eberth (HERU)

Publications

Nkhoma, D. (2014) 'An economic perspective of the determinants of and inequalities in child health and health care in Malawi', PhD Thesis, HERU, University of Aberdeen.

Presentations

Nkhoma, D. (2011) 'Social determinants of child mortality in Malawi', Presented at the Health Econometrics Working Group, HERU, Aberdeen, November 2011.

Nkhoma, D. (2011) 'Determinants of child malnutrition in Malawi: a family perspective', Presented at the HERU Internal Seminar Series, Aberdeen, December 2011.

Nkhoma, D. (2013) 'Measuring and explaining inequality and change in inequality, in infant mortality in Malawi', Presented at the Health Econometrics Working Group, HERU, Aberdeen, February 2013.

HBI1.4 - PhD: Time preference for future health events

A novel choice task called the portfolio choice was developed and piloted in a student sample. This differed from previous time preference elicitation tasks in two aspects of question framing: the use of multiple choice within a set (portfolio choice) and outcomes described as sequences rather than single occurrences. The effect of time preferences on smoking behaviour was estimated in general population cross-sectional data. The analysis includes several explanatory variables potentially correlated with time preferences and health behaviours. These include demographic and socio-economic status measures and four psychological measures of traits found to be associated with health behaviours (self-efficacy, sense of coherence, life orientation and risk attitude). The role of time preferences in obesity was investigated using a Household Survey Panel data set. This approach utilised variations in time preference and BMI over time to allow estimation of the effect of time preferences unbiased by all time-invariant omitted variables.

Outcome and translation

Increasing our understanding of individuals’ time preference for health is critical for devising appropriate interventions to address health behaviours and will inform discounting practices in economic evaluation of health interventions. The research addressed several of the remaining key questions.

PhD student: Ewan Gray

Supervisors: Marjon van der Pol (HERU); Euan Phimister (Department of Economics, University of Aberdeen).

Publications

Gray, E. (2012) 'Time preference for future health events', PhD Thesis, HERU, University of Aberdeen.

Presentations

Gray, E. (2010) 'Time preferences for future health events', University of Aberdeen PhD Symposium, Aberdeen, June 2010.

Gray, E. and Pol, M. van der. (2011) 'A novel method of eliciting social time preferences for health', Health Economists' Study Group (HESG), York, Jauary 2011.

Gray, E. (2011) 'The influence of time preference on the onset of obesity: evidence from a general population longitudinal survey in the Netherlands', HERU workshop on obesity, Aberdeen, May 2011.

Gray, E. (2011) 'The influence of time preferences on the onset of obesity: evidence from a general population', Faculty of Public Health conference, Aviemore, November 2011.

Gray, E. (2012) 'The influence of time preferences on the onset of obesity: evidence from a general population longitudinal survey', College des Economistes de la Sante (CES) / Health Economists' Study Group (HESG), Marseille, January 2012.

HBI2.13 - ROMEO: Systematic reviews and integrated report on the quantitative and qualitative evidence base for the management of obesity in men

Simultaneous systematic reviews of the literature on evidence-based management strategies for treating and engaging men in obesity services, by integrating the quantitative, qualitative and health economic evidence base were undertaken. Interventions included in the reviews included lifestyle interventions (diet and physical activity) and drug treatment (Orlistat).

Outcome and Translation

Based on all the literature reviewed, the study concluded that weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content.

No studies set out to determine the cost-effectiveness of treatment exclusively for men. However five studies reported results for subgroups of men. Interventions were grouped into lifestyle interventions (three studies) and Orlistat (two studies). The retrieved studies showed promising evidence of cost-effectiveness, especially when interventions were targeted at high-risk groups, such as those with impaired glucose tolerance. There appears to be some sex-specific elements to cost-effectiveness, although there were no clear trends or indications of what may be contributing to this. 

The economic evidence was highly uncertain, and limited by variable methodological quality of the included studies. Future studies are required to demonstrate the cost-effectiveness of interventions specifically targeted towards weight loss for men.

A best practice guide was produced by Public Health England and the Men's Health Forum based on the research findings of the RoMEO project.

Wilkins, D. (2014) How to....make weight-loss services work for men, London: Men's Health Forum.

HERU researchers involved in this research project: Dwayne Boyers (HERU)

External Collaborators: A Avenell, (HSRU, University of Aberdeen); F Douglas (Population Health, University of Aberdeen) and P Hoddinott (University of Stirling)

Publications

Robertson, C., Archibald, D., Avenell, A., Douglas, F., Hoddinott, P., Van Teijlingen, E., Boyers, D., Stewart, F., Boachie, C., Fioratou, E., Wilkins, D., Street, T., Carroll, P. and Fowler, C. (2013) Systematic reviews and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Report submitted to NIHR HTA Programme.

Robertson, C., Archibald, D., Avenell, A., Douglas, F., Hoddinott, P., Van Teijlingen, E., Boyers, D., Stewart, F., Boachie, C., Fioratou, E., Wilkins, D., Street, T. and Carrol, P. and Fowler, C. (2014) 'Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men', Health Technology Assessment, 18(35).

Stewart, F., Fraser, C., Robertson, C., Avenell, A., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2014) 'Are men difficult to find?: Identifying male-specific studies in MEDLINE and Embase', Systematic Reviews, 3(1), 78.

Boyers, D., Avenell, A., Stewart, F., Robertson, C., Archibald, D., Douglas, F., Hoddinott, P. and van Teijlingen, E. (2015) 'A systematic review of the cost-effectiveness of non-surgical obesity interventions in men', Obesity Research & Clinical Practice, 9(4), 310-327.

Robertson, C., Avenell, A., Boachie, C., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2015) 'Should weight loss and maintenance programmes be designed differently for men? A systematic review of long-term randomised controlled trials presenting data for men and women: the ROMEO project', Obesity Research & Clinical Practice, 10(1), 70-84.

Robertson, C., Avenell, A., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2017) 'Clinical effectiveness of weight loss and weight maintenance interventions for men: a systematic review of men-only randomized controlled trials (The ROMEO Project)', American Journal of Men's Health, 11(4), 1096-1123.

Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E., Stewart, F., Robertson, C., Boyers, D. and Avenell, A. (2015) 'A qualitative evidence synthesis on the management of male obesity', BMJ Open, 5(10), e008372.

Avenell, A., Robertson, C., Stewart, F., Boyers, D., Douglas, F., Archibald, D., van Teijlingen, E., Hoddinott, P. and Boachie, C. (2016) 'Sex can affect participation, engagement, and adherence in trials' (letter), BMJ, 355, i6754.

Presentations

Boyers, D., Stewart, F. and Avenell, A. (2013) 'Evaluating the cost-effectiveness of new interventions in the management and treatment of obesity: lessons for good practice evaluations from the ROMEO project', [poster] European Conference on Obesity (ECO), Liverpool, May 2013.

Robertson, C. F., Archibald, D., Avenell, A., Douglas, F., Hoddinott, P., Van Teijlingen, E., Boyers, D., Stewart, F., Boachie, C. and Fioratou, E. (2013) 'Using a combined realist and socio-ecological approach to integrating quantitative and qualitative systematic review evidence in a health technology assessment setting', 21st Cochrane Colloquium, Quebec, 19-23 September 2013.

Archibald, D. , Douglas, F., Hoddinott, P., Van Teijlingen, E., Robertson, C. F., Stewart, F., Boyers, D. and Avenell, A. (2013) 'A mixed-method evidence synthesis on the management of male obesity: the ROMEO (Review Of MEn and Obesity) project', Scottish Faculty of Public Health Conference, Dunblane, 7-8 November 2013.

Boyers, D., Avenell, A., Stewart, F., Robertson, C., Archibald, D., Douglas, F., Hoddinott, P. and van Teijlingen, E. (2014) 'Evaluating the cost-effectiveness of interventions for the management and treatment of obesity in men – results from the ROMEO study' [poster], Men's Health and Wellbeing: Critical Insights Conference, Leeds, 7-8 July 2014.

Robertson, C., Avenell, A., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E., Boyers, D. and the ROMEO Project Group (2014) 'Should weight loss programmes be designed differently for men? A systematic review of long-term weight loss randomised controlled trials: the Romeo project' [poster], Men's Health and Wellbeing: Critical Insights Conference, Leeds, 7-8 July 2014.

Hoddinott, P., Archibald, D., Robertson, C., Stewart, F., Boyers, D., Douglas, F., van Teijlingen, E. and Avenell, A. (2014) 'Obesity in men: evidence synthesis findings and their implications for primary care. The ROMEO (Review of Men and Obesity) Project', Society for Academic Primary Care, Edinburgh, 9-12 July 2014.

Boyers, D., Avenell, A., Stewart, F., Robertson, C., Archibald, D., Douglas, F., Hoddinott, P. and van Teijlingen, E. (2014) 'A systematic review of the cost-effectiveness of non-surgical obesity interventions in men' [poster], Association for the Study of Obesity, UK Congress on Obesity, Birmingham, 16-17 September 2014.

Robertson, C., Avenell, A., Boachie, C., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2014) 'Should weight loss programmes be designed differently for men and women? The ROMEO (Review of Men and Obesity) project', Association for the Study of Obesity, UK Congress on Obesity, Birmingham, 16-17 September 2014.

Robertson, C., Avenell, A., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2014) 'A systematic review of long-term weight management randomised controlled trials for obese men: the ROMEO project [poster]', Association for the Study of Obesity, UK Congress on Obesity, Birmingham, 16-17 September 2014.

Robertson, C., Avenell, A., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E. and Boyers, D. (2014) 'A systematic review of weight loss interventions for obese men in the UK: the ROMEO project' [poster], Association for the Study of Obesity, UK Congress on Obesity, Birmingham, 16-17 September 2014.

HBI2.10 - Scoping study of the economic impact on the alcohol industry of pricing and non-price policies to regulate the affordability and availability of alcohol in Scotland

A logic model was developed to identify where the impact of different policies was likely to be and the supply chains for the alcohol industry were mapped. A review of potential data sources was carried out, including consultation with industry sources. Four study options were explored in detail and an assessment was made of the likely outputs of each study in relation to the evaluation objectives and the risks associated with each option.

Outcome and Translation

The results were reported to NHS Health Scotland and informed their decision making in relation to commissioning further research.

HERU researchers involved in this research project: Anne Ludbrook

External collaborators: D Petrie (University of Melbourme).

Publications

Petrie, D., Ludbrook, A., Gobey, M., Dewhurst, J., Montagna, C. and Molana, H. (2010) Scoping study of the economic impact on the alcohol industry of pricing and non-price policies to regulate the affordability and availability of alcohol in Scotland. Final Report to NHS Health Scotland, NHS Health Scotland.

HBI2.9 - Screening and brief interventions for alcohol misuse delivered in the community pharmacy setting: a pilot study

The economic component of this study focussed on the identification of cost and resource issues that will be important in developing a full trial. The main factors are delivery costs in the pharmacy and the opportunity cost of pharmacist time. A value of information analysis was conducted to assess the potential value of conducting a full trial.

Outcome and Translation

Alcohol brief interventions have been shown to be cost-effective in other settings but have not been evaluated in pharmacy. Opportunistic delivery in this setting has the potential to reach a different population compared with delivery in healthcare settings.

HERU researchers involved in this research project: Anne Ludbrook

External collaborators: M Watson (Other Applied Health Sciences, University of Aberdeen) and D Stewart (Robert Gordon University)

Publications

Ludbrook, A. Screening and brief interventions for alcohol misuse delivered in the community pharmacy setting: a pilot study. Final report to Chief Scientist Office. March 2011.

Presentations

Fitzgerald, N., Stewart, D., Jaffray, M., Inch, J., Duncan, E., Afolabi, E. and Ludbrook, A. (2011) 'A pilot study of alcohol screening and brief interventions in community pharmacies', International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) Meeting, Boston, MA, USA, September 2011.

HBI2.4 - Smarter choices, smarter places programme

In August 2008 the Scottish Government announced a programme of ‘Sustainable Travel Demonstration Communities’ to showcase ways of saving people money, improving their health, building stronger communities and improving the environment. This project evaluated those impacts. The health economics component focused on changes in physical activity directly or indirectly associated with the programme and the impact of these on health. A difference-in-difference analysis was carried out on survey data and demonstrated that the SCSP programme had an effect on physical activity.

Outcome and Translation

The project results demonstrated effects of the programme on active travel and physical activity. Transport Scotland provided further funding to local authorities to build on the success of the SCSP Programme.

HERU researchers involved in this research project: Anne Ludbrook, Shelley Farrar and Patricia Norwood

External researchers: J Anable, D Haldane, J Nelson (School of Geosciences, University of Aberdeen) and J Parker (Integrated Transport Planning Ltd)

Publications

Derek Halden Consultancy, University of Aberdeen and Integrated Transport Planning (2013) Going Smarter: Final Report. Report for Transport Scotland. March 2013.

Norwood, P., Eberth, B., Farrar, S., Anable, J. and Ludbrook, A. (2014) 'Active travel intervention and physical activity behaviour: an evaluation', Social Science & Medicine, 113, 50-58.

Presentations

Norwood, P., Eberth, B., Farrar, S., Anable, G. and Ludbrook, A. (2013) 'Active travel intervention and physical activity behaviour: an evaluation', Scottish Faculty of Public Health Conference, Dunblane, 7-8 November 2013.

HBI1.7 - Socio-economic inequalities in health and behaviour: application of novel approaches to identify health inequalities in Scotland and England to inform policy

Reducing health inequalities is a major focus of the Scottish Government. Understanding the mechanisms that generate health inequalities requires an in-depth understanding of the underlying determinants. Health behaviours and their associated socio-economic inequalities were viewed here as health inequality determinants. The project aimed to understand how and to what extent health behaviours and income-related inequalities (IRIs) in health behaviours are a mediating factor in health inequalities.

The main factors contributing to IRIs were income itself, employment status, particularly economic inactivity, and no educational qualifications. However, health behaviours as health and health behaviour determinants were also found to make significant contributions to health and health behaviour inequalities. We further found that changes in IRIs are largely driven by changes in the responsiveness of health and health behaviours to indicators of socio-economic status rather than changes in the IRI in these indicators.

Outcome and Translation

The relative scale of the impact of health determinants on health and health behaviours, compared with the effect of inequalities in the health determinants, suggests that, in the short term, reducing the impact of disadvantage on health and health behaviours has more effect on IRIs than changes in the underlying distribution of income, economic activity and education. This implies that health improvement interventions which reduce the impact of disadvantage on health have the potential to reduce IRIs in health more effectively, in the short term, than interventions which seek to reduce IRIs in education and economic circumstances, which would be longer-term and implemented largely outwith the NHS.

HERU researchers involved in this research project: Anne Ludbrook, Rodolfo Hernández and Barbara Eberth

External collaborators: U-G Gerdtham (Lund University)

Publications

Eberth, B., Ludbrook, A., Hernández, R. and Gertham, U-G. (2014) Socio-economic inequalities in health and behaviour: application of novel approaches to identify health inequalities in Scotland and England to inform policy. Final report, Edinburgh: Scottish Government Chief Scientist Office.

Eberth, B., Ludbrook, A., Gerdtham, U.-G. and Hernández, R. (2014) Socioeconomic inequalities in health and behaviour: application of novel approaches to identify health inequality in Scotland and England to inform policy. CSO Focus on Research, Edinburgh: Chief Scientist Office.

Eberth, B., Ludbrook, A., Hernández, R. and Gerdtham, U.-G. (2014) Identifying underlying causes of health inequality to inform policy, HERU Briefing Paper, University of Aberdeen, September 2014.

Presentations

Eberth, B. (2011) 'Novel approaches to identifying determinants of health inequality and effective policy responses', Chief Scientist Office workshop on: measuring, understanding and tackling health inequalities: new insights from Scottish research., Edinburgh, 21st February 2011.

Eberth, B. (2013) 'An Evaluation of Health Inequalities in Scotland Using repeated Cross-Sectional Survey Data', Scottish Faculty of Public Health Conference, Dunblane, Scotland, November 2013.

Eberth, B. (2014) 'Health behaviours and health inequalities in Scotland', Scottish Institute for Research in Economics (SIRE) Policy Forum on Health Inequalities, Edinburgh, 19 June 2014.

Eberth, B. and Ludbrook, A. (2015) 'Socioeconomic inequalities in health and behaviour: application of novel approaches to identify health inequality in Scotland and England to inform policy', HERU Policy Workshop, Edinburgh, January 2015.

HBI2.15 - Study to analyse and evaluate health, social and environmental impact of a possible EU intervention on the protection of workers' health from risks related to exposure environmental tobacco smoke

Previous work on the health and economic impacts of ETS was updated and the most recent evidence identified. Consideration was given to a range of options from full ban on smoking in public places to lesser restrictions.

Outcome and Translation

The research was incorporated into a report to the European Union Directorate-General for Employment, Social Affairs and Inclusion. This report is intended for use by the Commission in its engagement with social partners.

HERU researchers involved in this research project: Anne Ludbrook

HBI2.5 - Weigh Well: MRC IES Platform Grant: scoping and feasibility preparation for an RCT on post partum weight loss

This project was a pre-trial feasibility study of a weight loss intervention. The economic component informed questions relating to the scale and significance of the difference in costs and benefits between intervention and control groups, including health service costs and benefits, other social costs and benefits, and costs and benefits to the women and their families. Alternative data collection methods were evaluated to establish which costs and benefits should be collected in a full trial and allow power calculations to be carried out for the economic analysis. Some pre-trial modelling was carried out.

Outcome and Translation

The results from this study helped to design better interventions with post-partum women and develop methods for data collection which will have wide application for public health interventions. The study showed that the intervention was potentially effective but identified issues of recruitment and retention as important areas to address in a full RCT.

HERU researchers involved in this research project: Anne Ludbrook, Lynda McKenzie

External collaborators: A Anderson, R Barbour, AF Kirk, G Mires, A Symon, S Treweek, B Williams (University of Dundee); R Fraser (University of Sheffield) and JM Thompson (NHS Dundee)

Publications

Craigie, A. M., Barbour, R. S., Anderson, A. S. and the WeighWell Team (Ludbrook, A. is a member of the WeighWell team (2010) 'How can we help women lose weight after child birth? Formative findings from the WeighWell weight management study', (Abstract from Summer Meeting, 28 June - 1st July, 2010)', Proceedings of the Nutrition Society, 69(OCE6), E429.

Craigie, A. M., Barbour, R. S., Anderson, A. S. and the WeighWell team (Ludbrook, A. is a. member of the WeighWell team) (2011) 'Findings from the WeighWell feasibility study of post-partum weight loff: challenges for a randomised controlled trial', (Abstract from Scottish Section Meeting, 5-6 April, 2011), Proceedings of the Nutrition Society, 70(OCE1), E15.