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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.

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.

High-income countries face enormous challenges in adapting to the pressures of an ageing population. Key among these is the increase in demand for health and social care, which will require an increase in the size and productivity of the workforce in those sectors. Policies to date have struggled to achieve this. This research aims to inform policy by (i) providing causal evidence on the impact of managers on the productivity of nursing teams in hospitals, and (ii) documenting the impact of pay and alternative job opportunities on the ability of the social care sector to attract and retain skilled workers, and exploring the implications for care recipients. One key challenge is finding a way to cleanly identify whether staffing changes have had a causal impact on patients in hospitals or care homes, because those staffing changes can themselves be a response to changes in the number or mix of patients. Another is the difficulty in objectively measuring the 'productivity' or output of health and social care staff, given the absence of a profit or revenue measure. Past research in this area has been further hampered by data limitations. This work will overcome these issues through innovative use of administrative data - including bespoke data not previously made available to researchers - and credible strategies to identify causal effects, informed by discussions with experienced nursing professionals. The first strand of the research will exploit a new, bespoke dataset linking electronic staff roster data to electronic patient records for a large NHS Trust in England. Using methods at the forefront of the econometric literature, it will exploit movements of senior nurse managers across hospital wards to identify the distribution of manager quality in a nursing setting. It will address the following questions: how important are hospital ward managers in determining the productivity of their nursing teams? Through which channels do 'good' managers have an impact? To what extent does variation in the quality of these managers explain variation in patient outcomes across different wards and hospitals? And could a better allocation of managers to wards improve patient outcomes? The second strand will use administrative payroll data covering more than 750,000 workers in the adult social care workforce in England. The social care sector, known internationally as the long-term care sector, is labour-intensive and increasingly economically important. Using a broad range of measures of the outside pay and job opportunities for those workers, the research will address the following questions: what impact do local labour market conditions have on retention and turnover? In particular, what happens when the outside option for care workers changes? What are the implications for the health outcomes of patients in care homes? And why isn't pay in the social care sector more responsive to these local conditions? The outputs of this project will be high-quality peer-reviewed evidence that directly informs clinical practitioners and UK health and social care policy. The research will build upon and benefit from excellent links with experienced nursing professionals, who will help focus the work on relevant clinical outcomes and aid with interpretation of results. We will present work in progress and findings to a wide range of audiences, including academics, policymakers, practitioners and the general public, to enable a broad range of users to benefit from the research.

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.