Son preference and the increasing availability of prenatal sex selection procedures since the 1980s have shaped reproductive practices and contributed to an estimated 100 million missing girls in Asia. Son preference motivated family-making decisions have also been evidenced among Asian communities in the UK, the USA, and Canada, and is of considerable concern for the communities involved, women's groups, the health sector, policy makers and society at large. The overarching aim of this proposal is to evaluate gender preferences through reproductive decision-making and practice among Asian communities in the UK and gain a contextual understanding of the dynamic factors at play that will inform an ethically founded and gender justice policy framework and interventions aiming to address son preference and potential practices of selective reproduction. The project speaks to demands for research on policy development with regard to son preference and its potential translation into sex-selection in the UK, Europe and Asia (see for instance Serious Crime Act 2015, section 84 (UK); resolution 1829 of the Council of Europe; the interagency statement 'Preventing gender-biased sex selection' of the OHCHR, UNFPA, UNICEF, UN Women and WHO). To coherently tackle the multifaceted aspects of the topic, the project brings together expertise on reproduction, family dynamics, son preference and its manifestations that will enable qualitative and quantitative approaches relevant for informed policy. Using available demographic data from various sources,, we will analyse quantitatively gender-based childbearing practices (e.g. the stopping rule), sex ratio at birth (SRB), trends and intergenerational changes, providing novel and robust evidence of demographic manifestations of son preference, and also clarifying potential evidence of prenatal sex-selection (PSS) in recent years in the UK. Son-preference, though rooted in traditional patriarchy is changing in character. While the quantitative work will bring novel insights into reproductive practices in relation to son-preference, an extensive qualitative analysis will interrogate inter-generational family dynamics within the Asian communities of contextualised practices of gender preferences and factors of changes in son preference and related patriarchal ideologies. An in-depth understanding of the interdependencies between factors underpinning gender preferences provides a rare opportunity to contribute to theories of gender inequality. This work will investigate the pervasiveness of the gendered social order and shifting patriarchal cultures within Asian communities and also the dynamic interrelation of differently gendered social systems. This will help understanding the intersection of class, age and race/ethnicity qualify gender embeddedness within the changing social fabric of contemporary British society, inform the potential diversity of complex gendered experiences including how this is challenging (or not) the very idea of gender norms. The proposed work will also provide a rich case study to advance transnational theories. Outcomes are likely to support informed policy interventions aimed at normative, cultural and behavioural changes. We will conduct an ethical analysis within a gender justice framework combined with a policy framing analysis, to also inform best practice of potential interventions and support communication. Throughout, a variety of stakeholders (academics, medical professionals, women's groups/NGOs, policy makers) will be engaged in this multi-disciplinary project, including the Department of Health (partner), to provide the best evidence-based knowledge on son preference and related childbearing practices, which is of direct relevance to the women concerned, their family, community-based women's organisations, the medical sector, and of importance to inform policies promoting gender equality in the UK and beyond.

There are a number of factors about the UK military which could put them at a greater risk of physical health problems and mortality than the general population. There are very high levels of alcohol use and drinking is an accepted part of military culture. In addition, military personnel are more likely to experience stressful events than the general population, particularly during deployment. Many of these stressful events have previously been found to be associated with mental health problems. The King's Centre for Military Health Research (KCMHR) cohort study was set up to look at a representative sample of UK military personnel, and collected data on mental health, alcohol use and deployment experiences. The study found that 13% of the military are abusing alcohol at a level which is hazardous to their health and overall, levels of alcohol use are much higher than the general population at all ages. Research findings from the general population have shown that both alcohol use and mental health problems are associated with poorer physical health outcomes. Therefore, it is predicted that current and future healthcare use for physical conditions will be high in the UK military population. Identifying the future healthcare needs of military personnel and veterans is a current priority for the UK government. However, the current datasets that are available to look at use of healthcare services (and the reasons why) do not identify whether or not an individual is in the military. The proposed study will be able to identify military personnel in existing NHS datasets for England, Wales and Scotland that include secondary healthcare records, by linking to the KCMHR cohort data. In NHS hospitals, data is recorded each time someone is admitted to hospital as an inpatient, or has an outpatient visit or visits an accident and emergency department. The reason for the hospital visit is coded using an existing international classification of disease and health related problems (ICD-10). This data is collated from all hospitals and is called Hospital Episode Statistics (HES) in England. In this study, English, Scottish and Welsh data will be linked with the KCMHR cohort study, providing information on approximately 10,000 military personnel. This will offer a unique opportunity to study the health of UK military personnel and will provide data on the health problems for which they most commonly seek help. We will be able to identify whether physical health conditions or accidents and injuries are most common. A further aim for the study will be to look at whether we can predict if an individual is likely to be admitted to, or visit hospital, for a physical health condition or an accident or injury, by using the information from the KCMHR cohort about how much alcohol they drink and whether they have a mental health problem. We will also be able to look at the costs to the NHS resulting from high levels of alcohol use and mental health problems within the military. It is a high social, health and political priority to identify the future health care needs of the UK military (serving and ex serving), so that the NHS commissioning board have the data they need in order to plan specialised commissioning of health care services. It is also very important to find out more information about the links between alcohol use, mental health problems and physical ill-health in military personnel. This is so we can identify which military personnel are most at risk of having poorer physical health in the future and also so that there is evidence that existing policies regarding the use of alcohol within military settings may need to be changed.

The Northern Health Futures (NortHFutures) hub aims to create a world-leading healthcare technology (health-tech) development ecosystem. This will address unmet health needs and inequalities by supporting: inclusive digital skills training and sharing; research, innovation and entrepreneurship, enabled by digital design. Based in the North East and North Cumbria (NENC), with national and global reach, NortHFutures will support underserved communities, as it is known that national disparity of investment in NENC negatively impacts population health and wellbeing, and that a 'levelling up' of investment is needed to stimulate socio-economic and cultural growth for all, to encourage living and ageing well. NortHFutures builds upon the joined-up NENC approach to people-powered digital health innovation, as our regional Integrated Care Board (ICB) uniquely involves local authorities, communities, and citizens. Academic team members have a research track record that is stakeholder-involved and civic- and community-engaged. They are world-leading on understanding (i) health inequalities from medical, social, and design perspectives, and (ii) the opportunities for enrichment and enablement related to ageing well, connecting rural and urban populations, and pioneering applications of data science. In the pilot phase, we draw on this specialist expertise to address evidenced unmet health needs in NENC, (which have national and global importance): children and young people's health and nutrition; mental health and wellbeing; development of digital surgical pathways (for monitoring patient journeys beyond the hospital); living well with multiple long-term conditions. We combine the strengths and resources of 6 universities (Newcastle, Cumbria, Durham, Northumbria, Sunderland and Teesside), bringing regional investment in NIHR services, facilities and Applied Research Collaborations, plus National Innovation Centres for Ageing (NICA), Data (NICD) and Rural Enterprise (NICRE), National Horizons Centre (NHC), EPSRC Digital Economy programmes in data and digital citizens, and Health Data Research UK, the UK's national institute for health data science. NortHFutures supports new planned Centres, including Northumbria's Centre for Health & Social Equity and Cumbria's new campus and medical school. These University offers combine with an extensive partner network, including: ICB-NENC, 7 NHS Trusts, NHS Business Services Authority, Department of Health and Social Care, Health Education England; VCSE organisations delivering community-based services; industry partners - from SMEs to global tech giants; civic bodies such as Local and Combined Authorities; existing health research networks (e.g. AHSN-NENC, Newcastle Health Innovation Partnership); and innovation accelerators (e.g. Innovation SuperNetwork). Through an integrated, regional approach uniting this consortium for the first time, NortHFutures ambitiously aims to establish global leadership in Digital Health. To deliver this we will develop a supportive community infrastructure. We will co-design a digital brokerage service to connect and amplify partners' work, to offer and consume expertise, services and facilities (supporting acceleration of health-tech companies at differing tech-readiness levels). We will pioneer a Live Digital Health Databank, to explore, and train for, advanced healthcare data analytics, combining live data flows with care records (e.g. Great North Care Record). This will support personalised health diagnostics and interventions, giving our hub a unique value proposition to companies wishing to explore advanced data technologies. We will invest in Extended Reality pilots, to open up possibilities for clinical practice and service delivery. Our approaches will embed Responsible Research and Innovation (RRI), and Patient and Public Engagement (PPIE) throughout, to deliver health-tech that supports care beyond the hospital and is co-designed with end-users.

Early life adversities, such as child maltreatment, are all too common in the UK. Research to date suggests that such adversities can have long-term effects on health. For instance, adversities experienced in childhood and even during pregnancy may alter the way the body deals with stress throughout life. This can result in an increased risk of diseases such as heart disease, depression and type 2 diabetes. It is therefore important to investigate how early life adversities might be linked to poorer health to better inform the development of interventions. Previous research into the health effects of early life adversities has been limited in a number of ways. Firstly, many studies have added up the number of adversities a child has experienced to create a score indicating 'total stress'. Unfortunately many children who experience one adversity are also more likely to experience another. The approach of tallying adversities does not help us to understand how adversities might affect health and what we can do about this. We also don't know whether experiencing adversities at certain ages (e.g. during pregnancy) has a greater effect on health than when experienced at other points in early life. There is also little evidence on whether associations between early life adversities and health are different for boys and girls. Also different types of early life adversity are likely to have different associations with health. The aim of this project is to develop a more valid measure of early life adversity and investigate how it is related to health at different points of life. This new measure will take account of the way in which children who experience one adversity are more likely to experience another. This measure will then be applied to look at associations with health. The research will focus on mental health from childhood onwards, as well as biological markers of stress from childhood and into adulthood. The research will use three of the UK's world-renowned longitudinal studies: the Millennium Cohort Study (MCS), Avon Longitudinal Study of Parents and Children (ALSPAC), and National Child Development Study (NCDS). These are all large studies with >15,000 participants. Each study has followed the same group of people over time. ALSPAC will be used to assess associations between early life adversities in relation to biological markers of stress from childhood into adolescence. The MCS will be used to assess whether children who experience early life adversities are more likely to have mental health problems across childhood and into adolescence. Finally, the NCDS will be used to test associations between early life adversities and both biological markers of stress in middle-age and mental health across adulthood. The proposed project will be undertaken at the Department of Epidemiology and Public Health at UCL under the mentorship of Prof. Yvonne Kelly, with support from a network of experts in social statistics, biology and sociology in the International Centre for Life Course Studies in Society and Health. Non-academic partners will be involved from the beginning of the research process. These partners include Barnardo's, the Association of Young People's Health and the Department of Health, who will be able to feed the findings of the research into their work with vulnerable families. Outputs from the project will include at least six academic papers, presentations at six conferences, a briefing note for non-academic audiences, an end of project policy seminar for academics and non-academics, and contributions to blogs and Twitter. The project also has a strong training element to enable the principal investigator to make the transition to independent researcher. In summary, this project has the potential to advance research in the field of early life adversities and health. It will be the first to provide evidence on how early life adversities increase the risk of poor health.

Cigarette smoking and harmful use of alcohol are major preventable causes of early death, disease, accidents and injury in the UK. Although the health effects of smoking have been widely recognised for decades, active and passive smoking still kill over 100,000 people and cause over 160,000 new cases of illness in children each year. Half of the 10 million smokers in the UK today will be killed by their smoking unless they stop. In contrast to smoking, alcohol consumption in the UK has increased markedly in the last thirty years. Ten million people in the UK now drink alcohol to harmful levels, and alcohol causes over 15,000 deaths, 1 million hospital admissions, and accidents and violence that together cost our society more than £20 billion each year. Like the effects of smoking, these harms affect the poorest in society most. Also like tobacco, alcohol consumption is driven by very powerful multinational industries with substantial political influence. It is therefore essential to find better ways to prevent smoking and harmful use of alcohol, now and in the future, and to prevent commercial interests from undermining these actions. Much has been learnt from the successes of reducing smoking prevalence, and many successful tobacco strategies can be applied to prevent alcohol harm. However, alcohol strategies must also take account of the fact that while smoking is dangerous at all levels, low levels of alcohol consumption do not have equivalent health harms to tobacco. So while tobacco policy can be pursued with the aim of eradicating smoking from society, alcohol policy has to aim to prevent consumption to levels that cause significant harm to the user, or to others. This proposal aims to address these problems by bringing together leading tobacco and alcohol researchers to build on success in tobacco research over the past five years by creating a new research centre, the UK Centre for Tobacco and Alcohol Studies (UKCTAS), to study new ways to prevent tobacco and alcohol-related harm, and promote their implementation. Since 2008 we have applied this approach in smoking prevention through the existing UK Centre for Tobacco Control Studies (UKCTCS), and achieved significant impacts on tobacco policy and practice (see www.ukctcs.org). We now propose to continue our tobacco work and to establish a major new focus on alcohol, by incorporating leading international alcohol researchers into the new Centre. Our work will aim to: 1. Understand and identify preventable reasons why people smoke or use alcohol to a harmful degree, and improve understanding of the health impacts of these behaviours 2. Understand and develop better population measures to to reduce smoking and harmful use of alcohol 3. Develop and implement better individual health interventions to prevent smoking and harmful use of alcohol 4. Develop and apply harm reduction strategies for those otherwise likely to continue to smoke or sustain harm from alcohol 5. Understand the tactics of the industry to encourage tobacco and alcohol consumption and thus undermine health policy and practice 6. Use the outcomes of our research to work, with other professional and public groups and individuals, to improve UK and international action to prevent smoking and harm from alcohol We will also aim to further develop our training and development of academic, policymaker and practitioner capacity for tobacco and alcohol work in the future, and to establish UKCTAS as a self sustaining Centre by the end of the five-year funding period. The main benefits of the Centre will be the achievement of sustained reductions in harms to individuals and society from tobacco and alcohol use.