Determinants of Adolescent, Now Young Adults, Social Well-being and Health: Longitudinal Follow-up
Condition: Cardiovascular Risk Factor
Study type: Observational

Summary: 
      Black and ethnic minority groups living in the UK experience high rates of chronic diseases
      such as diabetes, hypertension and heart disease, general morbidity and poor mental health.
      The cause of these excess rates is unknown but obesity, smoking, diet and deprivation are
      important contributing factors. There is also global evidence of the association of these
      diseases in adulthood with health and deprivation in early life and childhood. Persisting
      social deprivation over the lifecourse is disproportionately borne by some ethnic minorities
      (Harding and Balarajan 2001) but the impact on the health of their children is virtually
      unknown. Least is known about the health of Black Caribbean young people. It is important to
      examine risk factor differences by social predictors within the ethnic minority groups as
      well as between them. The DASH Study started as a school-based cohort study of adolescents
      from the main ethnic groups (White British, Black Caribbean, Black African, Indian, Pakistani
      and Bangladeshi) in 10 London boroughs. Wave 1 took place in 2002/03 (MREC Ref:
      MREC/2/10/12), when participants were aged 11-13 years (school years 7 and 8). Wave 2 took
      place in 2005/06 (MREC Ref: 05/MRE10/43) when they were 14-16 years (school years 9 and 10).
      Wave 3 took place in 2010/2011, when participants were aged 19-21 years and involved a postal
      follow-up complemented by telephone interview and on-line questionnaires. The current
      proposal is for a feasibility study, using a small sample of the DASH cohort, to inform the
      design of the next full face-to-face follow-up. DASH will be the first large scale UK
      longitudinal cohort of ethnic minority youths with both social and biological measures from
      childhood to early adulthood. It will allow detailed examination of ethnic differences in the
      social patterning of biological mechanisms and pre-clinical disease in young adulthood.
    

Detailed description: 
      Background:

      Black and ethnic minority groups living in the UK experience high rates of chronic diseases
      such as diabetes, hypertension and heart disease, general morbidity and poor mental health.
      The cause of these excess rates is unknown but obesity, smoking, diet and deprivation are
      important contributing factors. There is also global evidence of the association of these
      diseases in adulthood with health and deprivation in early life and childhood. Persisting
      social deprivation over the lifecourse is disproportionately borne by some ethnic minorities
      (Harding and Balarajan 2001) but the impact on the health of their children is virtually
      unknown. Least is known about the health of Black Caribbean young people. It is important to
      examine risk factor differences by social predictors within the ethnic minority groups as
      well as between them. The DASH Study started as a school-based cohort study of adolescents
      from the main ethnic groups (White British, Black Caribbean, Black African, Indian, Pakistani
      and Bangladeshi) in 10 London boroughs. Wave 1 took place in 2002/03 (MREC Ref:
      MREC/2/10/12), when participants were aged 11-13 years (school years 7 and 8). Wave 2 took
      place in 2005/06 (MREC Ref: 05/MRE10/43) when they were 14-16 years (school years 9 and 10).
      Wave 3 took place in 2010/2011, when participants were aged 19-21 years and involved a postal
      follow-up complemented by telephone interview and on-line questionnaires. The current
      proposal is for a feasibility study, using a small sample of the DASH cohort, to inform the
      design of the next full face-to-face follow-up. DASH will be the first large scale UK
      longitudinal cohort of ethnic minority youths with both social and biological measures from
      childhood to early adulthood. It will allow detailed examination of ethnic differences in the
      social patterning of biological mechanisms and pre-clinical disease in young adulthood.

      Aims:

      (i) To conduct a feasibility study to establish the best methods for data collection,
      including the collection of physical and biological measurements, for subsequent face to face
      follow-up of the entire cohort.

      (ii) To generate a proposal for subsequent follow-up of the entire cohort for submission to
      MRC, dependent on the findings of the postal and telephone surveys and proposed feasibility
      study.

      Objectives:

      I. What are the advantages and disadvantages of conducting the study in the two settings - GP
      surgeries and homes?

        1. Do participants' response rates vary by setting?

        2. What are the challenges faced by the nurses in clinics and home visits?

        3. Will the quality of data collected (e.g. extent of missing data) vary by setting?

        4. Will the delivery of blood samples to the laboratory be reasonably straight forward in
           each setting? II. What percentage of participants will agree to undertake bio-marker
           measures? III. Are mental health measures for this age group, typically used with White
           European populations, culturally appropriate? IV. How will DASH participants' view
           feedback on their medical results (e.g. blood pressure, weight, blood lipids)? V. Were
           participants satisfied with the different components of the survey process - contact,
           consent, data collection? VI. What is the estimated length of time and the resources
           required for subsequent full follow-up of DASH study members?

      Outcome measures:

      These will be examined by setting (home visit, GP surgery) using a mixture of quantitative
      and qualitative methods and are as follows:

      I. Percentage response rates - overall, per item/physical measure; II. Percentage consistency
      of answers to questionnaire items; III. Percentage physical measures within expected range
      e.g. spirometric measures; IV. Mean length of time for interview; V. Mean length of time for
      taking physical/biological measures; VI. Qualitative appraisal of cultural appropriateness of
      mental health measures and of respondents' satisfaction with survey processes.

      Sample At the recent telephone survey, respondents were asked if they would be willing to
      take part in a small feasibility study to prepare for a later full face to face follow-up.
      Almost all agreed and of those, a sample of 300 (40-50 in each of the main ethnic groups-
      White British, Black Caribbean, Black African, Pakistani, Bangladeshi, Indian) will be
      invited to complete a questionnaire, and have physical and physiological measures taken.
      Interviews will be conducted in respondents' own homes or GP surgeries dependent on the
      preference of the respondent. As this is a feasibility study, the sample size has been chosen
      pragmatically to give a reasonable spread, with equal gender representation across the 10
      London boroughs that the whole sample was in at wave 2.

      Specially trained nurses will conduct the survey in homes or General Practitioners'
      surgeries, supervised by a nurse manager in the General Practice Research Framework. Nurses
      will be attached either to the General Research Practice Framework or the Primary Care
      Research Network.

      Main Questionnaire The content reflects mainly questions that were asked in previous waves
      (general health; health behaviours; psychological well-being; SEC; social support; and
      relationship with parents). New items include parenthood; age appropriate mental health
      measures; own education, economic activity and occupation; job strain; caring; 'romantic'
      relationships; positive and negative emotions; views on their parents being invited to
      participate in DASH in order to examine generational influences. The investigators will
      explore two methods of delivery of the questionnaires - self complete questionnaires done
      prior to visit and computer assisted interviews. If the questionnaire is not completed by the
      time of the interview, respondents will be asked if they would like to complete a computer
      assisted interview. Completion of the questionnaire is expected to take about 40 minutes.

      Physical/physiological measures As in waves 1/and 2, height, weight, arm, waist and hip
      circumference, lung function, blood pressure will be measured.

      New measures include:

      (i)Hand to foot bio-impedance (ii) Bio-markers - HbA1c, total cholesterol, HDL-cholesterol
      (iii) Dietary assessment - 24 hour recall interviews Qualitative assessment - focus groups
      and semi-structured interviews. For the new mental health/cognitive measures, the
      investigators will conduct focus group vignette assessment, based on explanatory model and
      illness perception theories. This will be carried out in a small sub-sample (6 participants
      per ethnic group and allowing for 2 gender-specific groups; n=48). Analysis of these data
      will focus on narratives about the signs and symptoms of different aspects of mental health
      in the different ethnic groups. These data will provide valuable insights about the
      appropriateness of measures, usually validated with European populations, for ethnic minority
      groups.

      A research scientist will conduct semi-structured interviews with respondents to obtain
      feedback on the process of follow-up - what worked well, how best to improve the process,
      what was un/acceptable etc. The investigators will also enquire about the usefulness of
      feedback of results. A similar evaluation will take place with the nurses with the aim of
      identifying best practice in clinics and homes.

      Data analysis Descriptive statistics will be used to look at the general distributions and
      quality of the data collected. Outcomes measured as rates will be examined by data collection
      setting (GP surgeries vs. home visits), ethnic group and socio-demographic characteristics
      using standard comparisons technique such as Chi-square test or logistic regression. Mean
      length of time and any continuous outcomes will be compared using linear regression. In
      addition, although the sample size of each ethnic group is small, the total sample will allow
      analyses of the potential social patterning of biological mechanisms in a diverse sample in
      young adulthood.
    

Intervention name(s): No intervention
Intervention type(s): Other
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        School children, aged 11-13 years, representing the main UK ethnic groups (White-European,
        Black African, Black Caribbean, Indian, Pakistani/Bangladeshi, Other, mainly mixed race).
      
Keywords: Ethnicity; adolescents; cohort; longitudinal; health inequalities