Our focus so far has been on issues to do with the design and manufacture of cigarettes, with successful initiatives on low-tar cigarettes, additives, and technologies with the potential to reduce the delivery of known smoke toxins. Early detection of cancer or pre-cancerous changes is an important factor in reducing cancer mortality, but its effectiveness depends upon high levels of public participation in cancer screening. As part of the Flexiscope Trial , a randomised controlled trial of flexible sigmoidoscopy for the prevention of bowel cancer in 400,000 adults, we are studying the processes whereby individuals decide to participate in screening. Data from the first two screening centres have given insights into the factors which influence attendance, and these have been tested experimentally in a trial of modified screening information to increase uptake. We are also examining the psychological impact of the screening programme, to establish the extent of any adverse psychological effects of participation and investigate possible markers of vulnerability to screening-related anxiety.
Adolescence is a time when many health compromising behaviours show an increase.
Young people often begin smoking, start selecting a poorer diet and cease regular physical activity during the teenage years. Understanding the factors associated with development of change in health behaviours during this formative period is the focus of a new cohort study to follow adolescents from age 11 to 15. Measures of smoking behaviour, diet and physical activity are being taken annually in about 5000 children, over a period of rapid change and development, in which behaviours with important implications for long-term health are being established. In addition to assessing health beliefs and attitudes and family and social influences, we shall be taking specimens to permit analysis of possible genetic determinants of both smoking behaviour and dietary preferences. Several of our studies include elements designed to investigate the socio-economic variations in health behaviours.