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NPRI case studies

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Alcohol marketing and young people

(Professor Gerard Hastings, University of Stirling: January 2006 – December 2009)

This project aimed to examine the relationship between alcohol marketing and alcohol consumption in the young; specifically, whether advertising encourages drinking in young teenagers (13 to 15 years old). The research also included a systematic review of studies of alcohol marketing.

The NPRI project contributed to a body of evidence that teenagers are influenced by marketing and as a result drink more, from a younger age. The research showed covert associations between alcohol and social and sexual success, as well as with attractive lifestyles.

These findings contributed to the House of Lords Health Select Committee on Alcohol Harms and were cited in 'Health First' - the independent alcohol strategy for the UK published in March 2013. While recognising that the influence of the NPRI project was partly due to Professor Hasting’s extensive work over a number of decades, there was clear evidence that the NPRI project itself contributed to alcohol policy and strategy development.

Further information is available from Professor Gerard Hastings.

Professor Gerard Hastings
Email: gerard.hastings@stir.ac.uk

The effect of Tabex (cytisine) on attempts to stop smoking (RCT)

(Professor Robert West, University College London:  February 2006 – February 2011)

Professor West conducted a trial to see if a very low-cost smoking prevention therapy called cytisine (marketed as Tabex) could be effective in helping people stop smoking. Smoking cessation medicines in developed countries such as the UK are quite expensive and the market is dominated by (relatively) new products developed by large businesses. Tabex has been used in Eastern Europe for the past 40 years but had not been adopted elsewhere because of insufficient evidence on its effectiveness. The trial showed that Tabex is a highly effective means of supporting smoking cessation, with participants more than trebling the chances of users quitting compared to those taking a placebo. 

This study has led to renewed interest in the drug and in 2014 a study on Tabex’s effectiveness in comparison with nicotine-replacement therapy (NRT) was conducted by researchers in Auckland, New Zealand. This study showed that it was more effective than nicotine replacement therapy (presently the most widely used smoking cessation therapy). 
Moves are now under way to license the drug in Europe, the US and many other countries globally, which would make affordable cessation treatments accessible to smokers in most countries of the world. 

Testing the feasibility of nicotine assisted reduction to stop in pharmacies: the RedPharm Study

(Professor Paul Aveyard, University of Birmingham: January 2010 – July 2013)

Researchers from the University of Birmingham carried out a feasibility study to examine whether community pharmacists could be trained to deliver nicotine-assisted reduction to stop (NARS) interventions to people to cut down on smoking. The NPRI study showed that promoting this in routine practice was not well received by pharmacists and not many patients took up the offer of support and medication. As the Principal Investigator was a member of NICE Tobacco Harm Reduction guideline group he was able to dissuade the group from issuing guidance that would have encouraged pharmacists to provide smoking reduction services. The study showed how a ‘negative’ result can be policy relevant.

During the study, some people did reduce their smoking. Furthermore, there was evidence that a schedule to help people reduce smoking was more effective than simply trying to reduce smoking without a schedule. This was subsequently cited by the NICE review. The Principal Investigator has refined the measures used as part of the NPRI-funded research and made them available on a website for download. 

Profiles of physical activity in older adults

(Professor Ken Fox, Bristol University: November 2006 – February 2009)

We previously knew very little about the patterns of physical activity in older people. This research combined expertise in human geography, neighbourhood sociology, health psychology and exercise physiology to document physical activity patterns and the environmental and social determinants of physical activity in urban dwelling older people.

In a sample of 125 males (mean age 77.5 yrs) and 115 females (mean age 78.6 yrs), physical activity levels were very low and only three participants met UK recommendations of sustained bouts of activity for at least 10 minutes. Lower levels of physical activity were found in areas of higher deprivation, correlating with poor physical function, higher body mass index, and lower frequency of journeys away from the home.

Observations from the project have been used to inform a practical guide for developing interventions for physical activity in older people and this had been published on the Age Action Alliance website. These were the first guidelines worldwide on physical activity specifically for older adults. Professor Fox also co-authored a chapter in the Chief Medical Officers’ (CMO) report on physical activity, based on these results.

Free School Breakfast Initiative: Data augmentation and analysis 

(Professor Laurence Moore, Cardiff University: May 2009 – May 2011)

This NPRI award supported a secondary analysis of data that had been generated by a trial of primary school free breakfast provision commissioned by the Welsh Government. 

The NPRI-supported analysis showed that universal school breakfast provision may reduce health inequalities because the trial led to an increase in healthy eating and reduction in breakfast skipping among children from lower socio-economic status groups in particular.  This has influenced on-going national policy discussions, with the work being drawn to the attention of Ministers as an exemplar of research evidence informing practice.  It has been widely cited in evidence seminars, often with senior policy officials, as well as researchers and practitioners.

The influence of incentives on children’s consumption of vegetables

(Dr Lucy Cooke, University College of London: September 2008 – November 2011)

On average, children consume too much saturated fat and sugars and only half the quantity of fruit and vegetables recommended for good health. Parents employ various strategies to encourage their children to ‘eat their greens’, but the research evidence suggests that many are ineffective and some counter-productive. This study investigated the impact of incentives on liking and consumption of vegetables in 4-6 year-old children in a school setting and also when carried out by parents in the home. The study (now called ‘Tiny Tastes’) provided independent evidence to support the use of repeated taste exposure together with small non-food rewards to increase vegetable acceptance in children.

Tiny Tastes has been influential in providing independent evidence to support and endorse a common practice adopted in the Department of Health’s Start4Life Campaign. The researchers have worked hard to disseminate the study outcome.  It is now widely known and used by many parents. 

Smartphone: promoting weight loss and improved health using mobile phone technology

(Professor Janet Cade, University of Leeds)

The objectives of this study were to develop a mobile smartphone package to support weight loss.

The smartphone app (My Meal Mate) was the first free app to contain a large UK-based food database. When tested in a small trial against other products (a website and paper diary), for self-monitoring of food intake, the app was used two to three times more often than the other products (which were only used about once a week).

The results found that over the six months of the study, those using the app lost more weight. The app has also proved to be one of the most effective methods for tracking food intake and calories to support weight loss and was the first such app to be hosted on the NHS Choices website, where it is frequently downloaded (the apps had received between 10,000 and 50,000 downloads as at May 2014). The app has also been cited in NICE guidance. [Please note the NHS Choices website no longer refers to the app directly.]

Environmental determinants of physical activity and obesity in adolescents 

(Professor  Ashley Cooper, Bristol University) 

The project developed an objective way to measure the spatial location of physical activity by combining accelerometer data with that from personal GPS receivers to see where children go to be physically active.

The main purpose of the study was to explore changes in physical activity across the primary/secondary school transition and to identify factors potentially influencing the decline in physical activity through adolescence. No overall difference in physical activity was seen in children measured in primary school and one year later in secondary school. However, among children with longer distances to travel to and from school, physical activity declined markedly in those who changed from walking to motorised travel and increased in those who continued to walk. The study outcomes were published in the journal Medicine and Science in Sport and Exercise.

Early origins of obesity: developing strategies for intervention   

(Professor  Ashley Adamson, Newcastle University: April 2006 – July 2008)

This project sought to determine the early origins of obesity in 619 children that were between six and eight years old at the time of the research. A quarter of the children were overweight or obese, as were half of their mothers. Only 7% of the children were meeting recommended physical activity targets and they also ate (on average) 1.7 portions of fruit and vegetables per day (3.3 portions less than UK recommendations). Parents overestimated how active their children were and thought that the scale of the problem of childhood obesity was ‘overhyped’. In addition to some highly-cited scientific papers, the project also had significant coverage in the media and was cited in the Health Survey for England 2008 ‘Physical activity and fitness’ and the National Obesity Observatory report ‘Physical activity surveillance in England: what is measured and where are the gaps?’ (both published in 2009).