To celebrate the 2018 NIHR I am Research campaign, the NIHR School for Public Health (SPHR) has asked members of the School’s community to share their experiences of working in public health research.
What are your main research interests?
I am a behavioural scientist broadly interested in the integration of population and individual approaches to behaviour change within complex systems. I co-lead a programme of Cancer Research UK funded research to evaluate digital behaviour change interventions and manage the monthly population surveys, the ‘Smoking and Alcohol Toolkit Studies’. The majority of my published work has been on smoking cessation, including real-world monitoring and evaluation of e-cigarettes, harm reduction activity, and national tobacco policies and events. The NIHR School for Public Health Research provided funding and helped connect us with experts to expand our research to include alcohol.
I co-authored the second edition of Theory of Addiction and the ABC of Behaviour Change Theories, and I am a Senior Editor at the journal Addiction and an Editor of the Cochrane Tobacco Addiction Group.
Can you tell me about your work with the NIHR School for Public Health Research?
A major piece of work was the highly collaborative Alcohol Toolkit Study (ATS). The ATS is a monthly household survey of adults in England collecting data on alcohol consumption. The ATS provides insight into population-wide influences on alcohol consumption and related behaviour. ATS data has been used extensively, for example, in assessing the relationship between smoking cessation and alcohol, the evaluation of the short-term effect of revised drinking guidelines on related awareness and knowledge and comparing brief interventions on alcohol and smoking.
Key insights about alcohol use in England from the Alcohol Toolkit Study include:
- Less than 10% of those who drink excessively and visit their GP report having received advice on their alcohol consumption (for smoking it is 50%)
- January is associated with increased attempts to cut down but there is little evidence of reduced consumption
- Publication of revised lower risk drinking guidelines can improve drinkers’ knowledge of these guidelines within all socio-demographic groups
Together with Professor Susan Michie and Professor Robert West, I supervised the PhD work of Claire Garnett and David Crane on the development of a smartphone app and an evaluation to assess if it helped people reduce their alcohol consumption.
What impact has this research had?
The ATS was welcomed by Public Health England who supported a related NIHR funded project to evaluate the long-term impact of the new drinking guidelines on alcohol use. The Department of Health and Social Care commissioned Sheffield Alcohol Research Group to use ATS data to estimate amenability to specialist alcohol treatment in England. The team have hosted alcohol events attended by practitioners, public and policymakers. We have a popular policymaker and public-facing website and mailing list, which is updated monthly with the latest trends in key alcohol indicators (www.alcoholinengland.info).
The new national Commissioning for Quality and Innovation (CQUIN) scheme represents a major public health policy initiative. The scheme will incentivise widespread alcohol brief advice in secondary care from 2018. We are planning to extend the Alcohol Toolkit Study to evaluate whether there is an increase in the number of people reporting an attempt to cut down triggered by a health worker following the introduction of these new incentivised targets, including an assessment of the extent to which any effect is distributed equally across different social groups. This research should help steer whether the new policy continues to receive investment. The stakes are high because successful delivery could produce savings of approximately £27 per patient receiving advice through reductions in alcohol-related hospital admissions.
What made you decide to have a career in public health research?
I am a psychologist by training and wanted to apply behavioural science to improving the health of the public, and understanding and improving inequalities. It matters to me that science should be in the service of human fairness and well-being.
What has been the highlight of your research career?
Our work on e-cigarettes because of the policy and public impact. I worked with the Science Media Centre to disseminate our findings at press conferences and took part in live interviews. I was also invited to present at international conferences, to the UK regulatory authorities for medicines and the Science and Technology Select Committee, and co-authored a briefing to the UK All-Party Parliamentary Pharmacy Group.
What advice would you give to someone considering a career in public health research?
I would recommend it. A career in public health research can be rewarding and stimulating, and make a difference to peoples’ lives. As far as is possible, following the principles of open science should improve the quality of your science and its impact. Selecting a topic about which you are passionate and curious is crucial. You should be adept at – or prepared to learn how to – work collaboratively, manage relationships and network; it is a career that demands interdisciplinary working and engagement with the public and policymakers. Finally, remember to keep learning and to keep challenging and updating your beliefs as new evidence accumulates.