UNIVERSITY OF OXFORD

DEPARTMENT OF PUBLIC HEALTH

British Heart Foundation Health Promotion Research Group

ANNUAL REPORT

2006

Old Road Campus, Headington, Oxford OX3 7LF General Enquiries: 01865-289245, Fax 01865-289260

http://www.dphpc.ox.ac.uk/bhfhprg

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Contents 1. Background 1.1 Aims 3 1.2 Location and funding 3 1.3 Staff 3 1.4 Advisory committee 4 2. Report of work carried out 2006 5

2.1 Theme 1. Primary prevention of cardiovascular disease 5 2.2 Theme 2. Burden of cardiovascular disease 9 2.3 Theme 3. Influencing public health policy 10

3. Plans for the future 11

3.1 Theme 1. Primary prevention of cardiovascular disease 11 3.2 Theme 2. Burden of cardiovascular disease 13 3.3 Theme 3. Influencing public health policy 14

4. References 14 Appendix 1 Group publications and papers in press 16 Appendix 2 Membership of outside organisations 18 Appendix 3 Summary of projects 20

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1. Background

1.1 Aims The Group aims:

1. To carry out research which contributes to the development of effective methods for health promotion and in particular for the primary prevention of cardiovascular disease.

2. To carry out research which contributes to a better understanding of the burden of disease and in particular of cardiovascular disease

3. To influence health promotion policy and practice The work of the Group therefore has three themes:

1. The primary prevention of cardiovascular disease 2. The burden of cardiovascular disease 3. Influencing health promotion policy

1.2 Location and funding The Group is one of several research groups and units within the Department of Public Health of the University of Oxford. The current Head of Department is Professor Harold Jaffe. The Group is core funded by the British Heart Foundation (BHF). The Group also receives project funding from the BHF and other health-related charities, from government departments and agencies and from the National Health Service. The Group does not seek or accept sponsorship from food manufacturers and retailers, or from pharmaceutical, alcohol or tobacco companies.

1.3 Staff Members of staff during this year were:

Mike Rayner MA, DPhil, FFPH (Director) Steven Allender BSc, PhD (Senior Researcher) Carukshi Arambepola MBBS, MSc, MD (Researcher) Anna Boxer BTh, MSc (Research/Admin Assistant) Gill Cowburn BSc, RD, RPHNutr (Senior Researcher)

Charlie Foster BA (Ed), MSc, PhD (Senior Researcher)

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Anne Matthews Cert Ed, BA, Ed D (Researcher) Viv Peto BA (Researcher) Pete Scarborough BA (Researcher)

The Group has one associated doctoral student:

Anu Devi BA, MSc

The Group also has three honorary research associates: Nick Cavill BA, MPH Harry Rutter MA, MB, Bchir, MSc, MFPH

Lynn Stockley BSc, MSc, RPHNutr

1.4 Advisory committee An Advisory Committee with representation from the BHF, the University of Oxford, Department of Public Health and with other experts in the field of health promotion research, advises the Group on its strategy. The members of the Advisory Committee are currently:

Professor Harold Jaffe, MA, MD (Professor of Public Health, Head of Department of Public Health, University of Oxford) (Chair) Professor Peter Weissberg, MD, FMedSci (Medical Director, British Heart Foundation) Professor Margaret Thorogood, PhD, FFPH (Professor of Epidemiology, University of Warwick) Professor Martin White, MB, ChB, MSc, FFPH (Professor of Public Health, School of Population and Health Sciences, University of Newcastle upon Tyne)

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2. Report of work carried out 2006 The Group’s publications this year are given in Appendix 1. Table 1 in Appendix 3 summarises the projects that the Group has been involved in this year.

2.1. Theme 1 Primary prevention of cardiovascular disease The Group aims to carry out research that contributes to the development of effective methods for health promotion. To this end it carries out studies related to the various stages in the development of health promotion interventions including: problem definition, solution generation, innovation testing and intervention demonstration1. The Group is principally concerned with interventions in the area of diet and physical activity and primarily interested in interventions which seek to change the environmental determinants of behaviour. 2.1.1 Diet and nutrition In the area of diet and nutrition the Group focuses on the marketing of foods – particularly to children - and on food labelling. This year its work has been principally concerned with the development of nutrient profiling - a tool that can be used for a variety of purposes including the regulation of food advertising and food labelling (Projects 1.1 and 1.2) - and with the monitoring of developments in the area of food marketed to children - particularly vending of foods in secondary schools (Projects 1.5-8). There is currently a vigorous debate in the UK and internationally about the effects of food marketing on children’s diets. A significant milestone in this debate was the publication, in 2003, of a systematic review of the literature on the relationship between food marketing and children’s diets commissioned by the Food Standards Agency2. Professor Gerard Hastings – then at the University of Strathclyde - led the team which carried out the review. Mike Rayner (MR) was the member of the team responsible for advising on the methods for review. The conclusion of the review, that there is sufficient evidence to show that food promotion has an effect on children, particularly their food preferences, purchase behaviour (including ‘pester power’) and consumption, has become generally accepted – even amongst some sections of the food and advertising industry. The debate about the marketing of food to children also led to the European Commission part funding the European Heart Network (EHN) to carry out an investigation into food marketing to children in 20 European countries and an analysis of the policy implications (Project 1.3). The Group was the ‘academic partner’ for this project and Anne Matthews (AM), Mike Rayner and Gill Cowburn (GC) were responsible for the first phase of the work – a survey of the existing information about the nature and extent of food marketing to children and measures taken to counter the adverse consequences. The report of the first phase was published in April 20053.

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A new project (Euro Heart – funded by the European Commission - building on this work - is due to start in July 2007. This project will again be led by the EHN (though this time in conjunction with the European Society of Cardiology) and again the Group is the academic partner. The project will look at all policies and actions on CVD prevention across Europe – not just those concerned with food marketing to children (Project 1.4). Although food advertising to children is a currently an issue of concern there is surprisingly little documented information about its nature and extent particularly in the areas of non-broadcast advertising – magazines, comics, websites, etc. Gill Cowburn and Anna Boxer (AB) have been examining the nature of the link between food marketing in top-selling magazines aimed at children and young people (which are regulated) and non-paid for internet food marketing (which is currently unregulated) to establish whether consideration should be given to tightening controls in this area (Project 1.9). The debate about the marketing of food to children in the UK has led to a growing consensus for the need to take action on the promotion of ‘unhealthy’ food to children. This means that there needs to be an agreed definition of ‘unhealthy’. In 2003 Mike Rayner and Peter Scarborough (PS) began to develop a definition of an ‘unhealthy’ food and presented their results at a seminar organised by the National Consumer Council in 20044. This work was based on earlier work of Mike Rayner and collaborators to develop Guideline Daily Amounts for nutrients such as fat, saturated fat and sodium – now shown voluntarily on many food packets - and definitions of ‘high’, ‘medium’ and ‘low’ in such nutrients - now used for front of pack nutrition signposting schemes5. This led to the Group (Mike Rayner, Peter Scarborough and Lynn Stockley (LS) Research Associate with the Group) being commissioned by the Food Standards Agency (FSA) to develop compositional criteria (nutrient profiles) for ‘unhealthy’ food in relation to the marketing of food to children (Project 1.1). The final report of this work was published in December 20056. During 2006 Ofcom – the broadcast regulator in the UK – considered whether to use the model that the Group had developed for the FSA. In November 2006 Ofcom announced that they would do so. The Group’s work on nutrient profiling is continuing (Project 1.2). This year the Group (MR, PS and AB) completed its analysis of the results of a FSA funded survey of nutritionists’ perceptions of how foods should be categorised with which to test different nutrient profiling models. The results of this work has now been published in Public Health Nutrition. The Group (Mike Rayner, Peter Scarborough and Carukshi Arambepola (CA)) has also been investigating ways in which nutrient profiling models can be validated using the results of food consumption surveys. One paper reporting the results of this work is in press in Public Health Nutrition. Building on its earlier research into health promotion initiatives based in schools, and involving its current work on nutrient profiling, the Group now has a series of projects with a focus on foods sold through vending machines in schools. In 2003 Anne Matthews carried out the evaluation of the Department of Health’s Healthy Vending Project for their Food in Schools Programme – the results of which were incorporated into a Healthy Schools Toolkit7 and in 2004 the Group took on a

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doctoral student (Anu Devi (AD)) whose thesis will be on ‘Promoting healthy eating though vending in secondary schools’ (Projects 1.7 and 1.8). In the summer of 2005 the Group (AM and AD) carried out a survey of vending in Oxfordshire secondary schools and the results of this survey were published on the Group’s website8. The survey was repeated in the summer of 2006 (Project 1.5). This work has led to the Group being commissioned by the School Food Trust to carry out a survey of vending in secondary schools in the whole of England (Project 1.6). The field work for the survey will be carried out in February/March 2007 and the survey will be repeated in February/March 2008. 2.1.2 Physical activity The Group’s research in the area of physical activity has continued to develop. As with its research into diet and nutrition the Group’s research into physical activity is focused on assessing the environmental determinants of health-related behaviour and on population-based preventive interventions which focus on those determinants. Its research in this area is of three types: research synthesis, development of measures and ecological studies. In 2002 a successful application for BHF project funding enabled Charlie Foster (CF) to initiate the Group’s work on the environmental determinants of physical activity. The project involved an analysis of the relationship between the local environment and self reported physical activity using the EPIC-Norfolk cohort data and geographical information systems (GIS) technology (Project 1.10). One paper reporting the results of this project has been published and two papers are in preparation. In research into the relationship between health and the environment there is a lack of validated measures of environmental variables. Therefore the Group (CF with others) have, this year, been working on a project - funded by the Commission for Architecture and the Built Environment (CABE) - to develop a validated measure of the quality of public space in relation to physical activity (Project 1.27). One paper has been published on this issue and two others are in preparation. Meanwhile the Group continues to be involved in the evaluation of health promotion interventions to promote physical activity. Charlie Foster is one the authors of a systematic review of interventions to promote physical activity in adults – carried out to Cochrane Collaboration standards9. This year the review has been updated and will be re-published in the summer of 2007 (Project 1.31). Charlie Foster has also been a joint investigator with the Medical Research Council Unit, Glasgow and the University of Strathclyde in a systematic review of the effectiveness of interventions to promote walking. The paper reporting the results of this review has been submitted for publication in the British Medical Journal (Project 1.30). In recognition of the Group’s expertise in research into the promotion of physical activity, the Group, in 2003, became the hub of the Health Development Agency (HDA) Evidence and Guidance Collaborating Centre for Physical Activity. Its partner in this venture was

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the British Heart Foundation National Centre for Physical Activity and Health, Loughborough University (Projects 1.12-15). When the HDA became incorporated within the National Institute for Health and Clinical Excellence (NICE) the centre became the NICE Public Health Collaborating Centre: Physical Activity. The Centre is co-ordinated by Nick Cavill (NC) (Research Associate with the Group). In 2005 the Collaborating Centre completed systematic reviews of the effectiveness of brief interventions in primary care; pedometers; exercise referral schemes; and community-based exercise programmes for walking and cycling (Projects 1.16-19). These reviews were published by NICE in April 2006 together with guidance for commissioners of health services and public health professionals on using such approaches. The Collaborating Centre’s reviews in 2006 have focused on environmental determinants of physical activity building on a review to assess the evidence for the effectiveness of interventions to promote physical activity in adults which involve changing environmental determinants undertaken as part of the work commissioned by the HDA (Project 1.14). This was published in 2006. This year the Collaborating Centre has completed five systematic reviews under this theme examining the effectiveness of specific environmental intervention involving: transport; urban planning and design; the natural environment; environmental and other policies and building design (Projects 1.20-25). The Collaborating Centre has now completed approximately ten reviews for the HDA and NICE both to time and within budget. As a result NICE has already commissioned further reviews - the work on which will start in Spring 2007. The focus of these reviews will be on interventions to promote physical activity in children and young adults. The Group has continued to build its capacity for research into the determinants of physical activity and various studies in this regard have all produced papers. A review of the reasons why both children and adults do and do not participate in sport and physical activity (carried out by Charlie Foster, Steve Allender (SA), Gill Cowburn and Nick Cavill) has now led to a paper in Health Education Research (Project 1.26) and an assessment of the social patterning of physical activity using data from the Health Survey for England (SA, CF and AB) has led to a paper being submitted to the Journal of Physical Activity and Health (Project 1.28). Collaborations with other research groups are also proving successful and leading to publications. In conjunction with the universities of Bristol and East Anglia, Charlie Foster has been examining the relationship between access to sports facilities and deprivation and this has led to a paper which has been submitted to the American Journal of Preventive Medicine (Project 1.28).

2.2 Theme 2: Burden of cardiovascular disease

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The main project under this theme is the Coronary heart disease statistics project funded by the BHF (Steve Allender, Peter Scarborough and Viv Peto) (Project 2.1). The project has continued to produce high quality publications. The 2006 edition of the main compendium Coronary heart disease statistics was published in June and was launched in Edinburgh. Steve Allender attended the launch on behalf of the Group. This year’s supplement - Diet, physical activity and obesity - was published in November. Both html and pdf versions of the compendia, fact sheets and supplements are published on the Web at www.heartstats.org. All the data are also available as individual tables and figures. www.heartstats.org is currently visited by over 1,000 people per month. One aim of the Coronary heart disease statistics project is to map services for prevention, treatment and rehabilitation. In collaboration with Professor Bob Lewin, University of York, the Group (SA) has continued to carry out an investigation to assess the provision of cardiac rehabilitation in the UK in relation to potential need and a paper has been submitted to the British Journal of General Practice (Project 2.3). One way of measuring the burden of disease is in terms of its financial costs. In the past few years the Group has developed its links with the Health Economics Research Centre (HERC) in the Department of Public Health of Oxford University. The Group (MR), in collaboration with HERC, has updated its analysis of the costs of CHD to the UK and this year a paper describing these costs was published in Heart. With part funding from the European Heart Network and with support from the Group (MR) HERC has also carried out an analysis of the economic burden of CVD in Europe (Project 2.2). A summary of the results of this project was published in the European cardiovascular disease statistics supplement, published in 2005, but a paper with greater detail was published in the European Heart Journal this year. The extent to which the burden of CVD and other chronic diseases can be attributed to health-related behaviour is controversial but of considerable interest to policy makers. Accordingly in 2004/5 the Group (MR and PS) carried out an analysis of the extent to which ill-health can be attributed to poor diets in the UK. A paper reporting the results of this analysis was published last year10. This year this work has been extended by the Group (SA, PS, CF and MR) to a similar analysis of the extent to which ill-health can be attributed to low levels of physical activity in the UK (Project 2.6). A paper reporting the results of this analysis is currently in press in the Journal of Epidemiology and Community Health. A third paper written by the Group (SA and MR) on the burden of ill health attributable to overweight and obesity has been submitted to Obesity Reviews (Project 2.7). Pete Scarborough’s work on his DPhil project continues. The provisional title for his thesis is ‘Environmental and behavioural determinants of geographic variation in coronary heart disease.’ (Project 2.4).

2.3 Theme 3. Influencing public health policy

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The Group has continued to have an advocacy role to ensure that its research is closely related to, and has an impact upon, both national and international health promotion policy. To this end the Group works: At a national level primarily through:

1. Involvement with non-governmental organisations concerned with nutrition, physical activity and obesity including the British Heart Foundation, the National Heart Forum (MR and CF) and Sustain: the alliance for better food and farming (MR). In particular Mike Rayner chairs Sustain’s Children’s Food Working Party aimed at improving the provision of food to children, restricting the marketing of unhealthy food to children, and improving the education of children about food.

2. Membership of government committees such as the Public Health Interventions Advisory Committee of the National Institute for Health and Clinical Excellence (NICE) (MR), the Department of Health’s Food and Drink Advertising and Promotion Forum (MR), the National Alliance for Physical Activity (CF). Both Mike Rayner and Charlie Foster have contributed towards evidence reviews for the Foresight Programme of the Office of Science and Technology to support its project on Tackling Obesities: Future Choices.

At an international level primarily through:

3. Involvement with the European Heart Network (as Chair of its Nutrition Expert Group (MR)) and with its activities in relation to diet (MR, GC, AM) and physical activity (CF). In particular Mike Rayner currently represents the EHN on the European Union Platform on Diet, Physical Activity and Health.

For a list of affiliations to outside organisations see Appendix 2.

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3.1 Plans for the future Table 2 in Appendix 3 summarises the project that the Group proposes to carry out

3.1 Theme 1. Primary prevention of cardiovascular disease The Group proposes to continue to develop its work under this theme focusing on the modification of environmental determinants of diet and physical activity. To this end the Group will continue to work on the promotion of healthy eating (led by Mike Rayner) and the promotion of physical activity (led by Charlie Foster) but will also seek to develop projects with a focus on both. In developing its work under this theme the Group proposes to build on its strong track record of systematic reviews and will draw on expertise in systematic review methodology more widely available with the Department of Public Health of the University of Oxford. It also proposes to build on its increasing expertise in secondary analysis of existing datasets (c.f. Projects 1.1, 1.2 and 1.10). But the Group will also aim to continue to develop further primary research projects relating to the various stages in the development of health promotion interventions including: problem definition, solution generation, innovation testing and intervention demonstration as previously. Projects as previously will be funded through a mixture of charitable and government funding. 3.1.1 Diet and nutrition In the area of diet and nutrition the Group will continue to focus on marketing of food - particularly to children. It has become increasingly clear that in relation to the marketing of foods to children there needs to be more research into effective interventions. Currently various initiatives are proposed or about to be implemented that would restrict the marketing of ‘unhealthy’ foods to children and/or improve the marketing of ‘healthy’ foods. The Group is in a good position (working with others) to evaluate these initiatives. The Group is already carrying out research to investigate some of the effects of a proposed ban on the sale of certain foods from vending machines in secondary schools. It proposes to extend this work to looking at the effects on pupils’ behaviour and diets (Project 1.c). The Group also proposes to investigate and monitor the nature and extent of commercial activities in both primary and secondary schools in relation to food advertising and nutrition education since changes in the rules governing these commercial activities are likely (Projects 1.a and 1b).

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In relation to the labelling of foods there are various new initiatives which the Group is in a good position to help evaluate. In particular the FSA has recently issued recommendations on front of pack ‘nutritional signposting’11 but it remains to be seen what effect these recommendations will have. Regardless of the precise way the practice (and regulation of) food marketing and labelling may develop, the Group’s recent success in developing nutrient profiling to provide definitions of ‘healthy’ and ‘unhealthy’ foods is beginning to form the basis to a programme of further projects which could help to inform future initiatives in relation to the marketing and labelling of foods. In particular the Group propose to focus on improving the ways of testing different nutrient profile models. The aims of the Group’s programme of research into population based approaches to the promotion of healthy eating will therefore be:

1. To continue to develop logical and transparently derived definitions of terms commonly applied to foods such as ‘healthy’, ‘unhealthy’, ‘healthier’, ‘less healthy’, ‘high fat’, ‘low fat’, etc.

2. To assess the effect of changes to food marketing practices on diet-related behaviour (e.g. in the light of government or industry initiatives)

This research will involve systematic review of the existing literature, secondary analysis of existing data sets – in particular the results of the National Diet and Nutrition Survey and similar surveys, and evaluative studies involving a variety of methods. 3.1.2 Physical activity In investigating population based approaches to the promotion of physical activity, the Group will focus on approaches that involve modifying the environmental determinants of risk rather than on advice and/or treatment in relation to those risks. There are even fewer research groups concerned with the promotion of physical activity than of healthier eating and the identification of the determinants of physical activity is at an even earlier stage. Therefore the Group will continue to build on its work in identifying the environmental determinants of physical activity. The aim of the Group’s programme of research into environmental determinants of physical activity will be:

1. To review the nature of the relationship between aspects of the environment and different types of physical activities for different population groups including adults and children.

2. To develop measures of different aspects of the environment that can be used in future studies of the relationship between the environment and physical activity.

3. To examine the perceived and actual use of resources such as green space, swimming pools, sport centres and the relation between these variables and objectively assessed physical activity.

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4. To assess the effect of changes to the environment on physical activity in well conducted process and outcome evaluation studies (e.g. large scale new town developments).

5. To identify which aspects of the environment could be harnessed in helping the sedentary to change and the active to maintain their physical activity behaviour.

This research will involve systematic review of the literature, the analysis of data from cross sectional and prospective studies examining environmental determinants of physical activity such as the Bristol Quality of Life Survey (Project 1.h) and in the long term evaluations of interventions. In the area of physical activity the Group will continue to work closely with the BHF National Centre for Physical Activity, Loughborough University. The Group is already working closely with the BHF National Centre on projects in connection with the NICE Public Health Collaborating Centre for Physical Activity (Projects 1.20-25 and 1e). For Collaborating Centre projects the Group has responsibility for leading the work (CF), co-ordinating the centre (Nick Cavill) and for reviewing the evidence (CF) and the BHF National Centre for gathering knowledge of best practice from practitioners and feeding back evidence and guidance to such practitioners.

3.2 Theme 2. Burden of cardiovascular disease Assessing the burden of CVD is complementary to assessing the effectiveness of population-based approaches to its prevention. Only through an understanding of the extent and distribution of the burden, and to what factors the burden can be attributed, can there be a proper evaluation of the extent to which population-based approaches to its prevention would be cost effective. Work under this theme will therefore underpin and inform work under Theme 1. The major project under Theme 2 will be the Coronary heart disease statistics project (Project 2.1) with the production of its associated publications and the maintenance and development of the www.heartstats.org website. The project is led by Steve Allender In accepting the Group’s proposal for further funding (September 2005-August 2008) the BHF agreed that the project should have a more academic role and should involve more primary research. A programme of research is being developed which builds on previous burden of disease work and makes use of the large data sets accessed within the Coronary heart disease statistics project. Through collaboration with other researchers in the UK and abroad projects are planned which investigate; temporal trends in CHD mortality in the 20th century (Project 2c); changes in inequalities in morbidity and mortality; and deprivation and CHD morality at a small area level. Further work is planned which investigates the social and geographic patterning of CHD risk factors including nutrition, physical activity and obesity.

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A particular focus under Theme 2 has, in the past, been the assessment of the burden of CVD in terms of its economic costs. This work has been carried out in collaboration with the Health Economics Research Centre of the Department of Public Health of the University of Oxford. It is proposed that the Group should build on its success and develop further projects in this area. Peter Scarborough will continue work on a part-time DPhil studying the relationship between area-level and individual-level risk factors for CHD in England. The project will investigate the variation of CHD mortality and morbidity rates around England, and estimate the relative strength of area-level influences such as deprivation, climate and pollution as compared to established lifestyle risk factors such as smoking, poor diet, physical inactivity and binge drinking. The analysis will have an ecological cross-sectional design, with all wards in England as the units of analysis. Recently developed synthetic estimates of the prevalence of lifestyle risk factors at local authority level will be used in the analysis. It is expected that the DPhil thesis will be completed in 2010.

3.3 Theme 3: Influencing health promotion policy The Group will continue to have an advocacy role (working closely with the BHF’s Policy Team) to ensure that its research is closely related to, and has an impact upon, both national and international health promotion policy. To this end the Group will also continue to work with the National Heart Forum, Sustain: the alliance for better food and farming, and the European Heart Network.

4. References 1 Nutbeam D. Evaluating health promotion – progress, problems and solutions. Health Promotion International, 1998; 13: 27-44. 2 Hastings G, Stead M, McDermott L, Forsyth A, MacKintosh AM, Rayner M, Godfrey C, Caraher M, Angus K. Review of research on the effects of food promotion to children. Food Standards Agency: London, 2003. 3 Matthews A, Cowburn G, Rayner M, Longfield J, Powell C. The marketing of unhealthy food to children in Europe. European Heart Network: Brussels, 2005. 4 O’Neil M. Traffic lights for food? National Consumer Council: London, 2004. 5 Rayner M, Scarborough P, Williams C. The origin of Guideline Daily Amounts and the Food Standards Agency’s guidance on what counts as ‘a lot’ and ‘a little’. Public Health Nutrition, 2004; 7 (4): 549-556. 6 Rayner M, Scarborough P, Boxer A, Stockley L. Nutrient profiles: Development of final model. Food Standards Agency: London, 2005. 7 Department of Health. Healthy Schools Toolkit DH: London, 2004.

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8 Matthews A, Devi A, Rayner M. Survey of vending in Oxfordshire secondary schools. British Heart Foundation Health Promotion Research Group: Oxford, 2005. 9 Hillsdon M, Thorogood M, Foster C. Intervention for physical activity (Cochrane Review) In: The Cochrane Library, Issue 1, 2005. Update Software: Oxford, 2005. 10 Rayner M, Scarborough P. The burden of food-related ill health in the UK. Journal of Epidemiology and Community Health, 2005; 59: 1054-1057. 11 Food Standards Agency. Board agrees principles for front of pack labelling Food Standards Agency: London, 2006. http://www.food.gov.uk/news/newsarchive/2006/mar/signpostnewsmarch

Appendix 1. Group publications and papers in press In press: Allender S, Foster C, Boxer A. Occupational and non-occupational physical activity and the social determinants of physical activity: Results from the Health Survey for England. Journal of Physical Activity and Health, in press. Allender S, Foster C, Scarborough P, Rayner M. The burden of physical activity related ill health in the UK. Journal of Epidemiology and Community Health, in press. Cavill N, Foster C, Martin BW, Oja P. Evidence-based approaches to physical activity promotion and policy development in Europe: contrasting case studies. Promotion and Education, in press. Cowburn G, Boxer A. Magazines for children and young people and the links to internet food marketing: a review of the extent and type of food advertising. Public Health Nutrition, in press. Dawson J, Hillsdon M, Boller I, Foster C. Percieved barriers to walking in the neighbourhood environment and change in physical activity levels over 12 months. British Journal of Sports Medicine, in press. Dawson J, Hillsdon M, Boller I, Foster C. Pperceived barriers to walking in the neighbourhood environment: a survey of middle aged and older adults attending walking schemes. Journal of Aging and Physical Activity, in press. Foster C, Hillsdon M, Cavill N, Bull F, Buxton K, Crombie H. Interventions that use the environment to promote physical activity. National Institute of Health & Clinical Excellence: London, in press. Hillsdon M, Panter J, Foster C, Jones A. Equitable access to exercise facilities. American Journal of Preventive Medicine, in press. Matthews A. Children and obesity: a pan-European project examining the role of food marketing. European Journal of Public Health, in press. Mytton O, Gray A, Rayner M, Rutter H. Could targeted food taxes improve health? Journal of Epidemiology and Community Health, in press. Rayner M. Social Marketing, Obesity Reviews, in press. Scarborough P, Rayner M, Stockley , Black A. Nutrition professionals’ perception of the ‘healthiness’ of individual foods, Public Health Nutrition, in press. Scarborough P, Boxer A, Rayner M, Stockley L. Testing nutrient profile models using data from a survey of nutrition professionals, Public Health Nutrition, in press.

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Scarborough P, Rayner M, Stockley L. Developing nutrient profile models: a systematic approach. Public Health Nutrition, in press. 2006: Allender S, Peto V, Scarborough P, Boxer A, Rayner M. Coronary heart disease statistics. British Heart Foundation: London. 2006.

Allender S, Peto V, Scarborough P, Boxer A, Rayner M. Diet, physical activity and obesity statistics. British Heart Foundation: London. 2006.

Allender S, Cowburn G, Foster C. Understanding participation in sport and physical activity among children and adults: a review of qualitative studies. Health Education Research, 2006; 21: 826-835. Foster C, Hillsdon M, Cavill N, Bull F, Buxton K, Crombie H. Four commonly used methods to increase physical activity. National Institute of Health & Clinical Excellence: London, 2006. Gildow C, Johnston L, Crone D, Morris C, Smith A, Foster C, James D. Socio-demographic patterning of referral, uptake and attendance in Physical Activity Referral Schemes. Journal of Public Health, 2006; 6: e-print.

Hillsdon M, Panter J, Foster C, Jones A. The relationship between access and quality of urban green space with population physical activity. Public Health, 2006; 12: 1127-1132.

Jones A, Bentham G, Foster C, Hillsdon M, Panter J. Evidence Review on Obesogenic Environments. Foresight Directorate, Office of Science and Technology: London. 2006.

Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. European Heart Journal, 2006; 27: 1610–1619.

Luengo-Fernandez R, Leal J, Gray A, Petersen S, Rayner M. The cost of cardiovascular disease in the UK. Heart, 2006; 92: 1384-1389.

Rayner M, Scarborough P, Allender S. Values underlying the National Service Framework for coronary heart disease in England: a discourse analysis. Journal of Health Services Research & Policy, 2006; 11: 67–73.

Rayner M. Social marketing. Bulletin of the Food Ethics Council, 2006; 1 (2):

Rayner M. Is advertising any good? Bulletin of the Food Ethics Council, 2006; 1 (4): 5.

Appendix 2. Membership of outside organisations Mike Rayner Department of Health, Food and Drink Advertising and Promotion Forum (Sustain Representative, 2005 - ) Department of Health, Food and Drink Advertising and Promotion Forum (Chair, Sponsorship Working Party, 2005 - ) National Institute for Health and Clinical Excellence, Public Health Interventions Advisory Committee (Member, 2005 - ) National Heart Forum Executive Committee (Member, 1996 - ) Sustain (formerly the National Food Alliance) Management Committee (Member, 1994 - , Vice-Chair, 2004 - ) Sustain Children’s Food Working Party (formerly Food Labelling and Marketing, then Children’s Food Bill Working Party (Chair, 1995 - ) Joint Health Claims Initiative Council (Sustain Representative, 1999 - and Treasurer, 1999 - 2004) Co-operative Retail Responsible Retailing Advisory Panel (Member 2004 - ) European Union Platform on Diet, Physical Activity and Health (formerly European Commission Obesity Platform) (European Heart Network Representative, 2004 - ) European Union Platform on Diet, Physical Activity and Health. Monitoring Working Package (European Heart Network Representative, 2004 -) European Heart Network Nutrition Expert Group (Chair, 1996 - ) European Heart Network Children, Obesity and Associated Chronic Diseases Project Steering Committee (Member, 2004 - 2006) Steven Allender International Advisory Group for the School Meals Project (Member, 2006 - ) Children and Social Capital Research Group (Member, 2006 - ) International Society for Behavioural Nutrition and Physical Activity (Member, 2006 - ) Society for Social Medicine (Member, 2004 - ) European Public Health Association (Member, 2004 - ) Public Health Association of Australia and New Zealand (Member, 2002 - ) Australian Council of Health Physical, Education and Recreation (Member, 2002 -) Oxfordshire Health Services Research Committee (Member, 2004 - )

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Gill Cowburn Nutrition Society (Member, 1993 - ) British Dietetic Association (Member, 1986 - ) Charlie Foster National Institute for Health and Clinical Excellence. Irritable Bowel Syndrome Clinical Guidelines Development Group (Member, 2006 - ) National Heart Forum (Associate Member, 2005 - ) British Association of Sport and Exercise Sciences (Member, 1998 - ) American College of Sports Medicine (Member, 1994 - ) Viv Peto Society for Social Medicine (Member, 1992 - )

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Appendix 3

Table 1. Summary of the British Heart Foundation Health Promotion Groups projects in 2006 Project No.

Title People Involved

Funder Funding allocated*

Dates Status Main achievements and publications

Theme 1. Evaluating health promotion: nutrition Project 1.1 The development and testing of

nutrient profiles for regulating the promotion of foods to children

MR, PS, AB with L Stockley, A Black

Food Standards Agency

£96,768 2004-2006 Completed Reports published by FSA in October 2004, September 2005, December 2005, three papers in press in Public Health Nutrition

Project 1.2 Further work on nutrient profiling

MR, PS, AB, CA

BHF core 2005- Ongoing Paper submitted to Public Health Nutrition, two papers in preparation

Project 1.3 Analysis of food promotion to children across Europe (Children, Obesity and Associated Avoidable Chronic Diseases Project, Phase 1)

AM, GC with European Heart Network and others

European Commission, BHF core

£11,688 2004-2006 Completed Report published by EHN in May 2005, paper in press in European Journal of Public Health*

Project 1.4 Mapping and analysis of national plans, policies and measures impacting on cardiovascular health promotion and cardiovascular disease prevention across Europe (Euro Heart)

GC with European Heart Network and others

European Commission BHF core

tbc 2007-2010 Funding confirmed

Project will start in July 2007

Project 1.5 Survey of vending in Oxfordshire secondary schools

AM, AD, AB BHF core 2004- Ongoing Survey carried out in 2005 and 2006, report of survey in 2005 published by BHF HPRG,

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paper in preparation Project 1.6 Survey of vending in English

secondary schools GC, AM, AB, School Food Trust £27,979 2006-2008 Ongoing Survey to be carried out in

2006 and 2007, 2006 survey in progress.

Project 1.7 Systematic review of the effectiveness of interventions involving vending machines in schools in promoting healthier eating

AD (DPhil project) 2004- Ongoing Studies collected., quality appraisal of studies in progress

Project 1.8 Qualitative study of the perceived costs and benefits of vending machines in Oxfordshire secondary schools

AD (DPhil project) 2004- Ongoing Data analysis in progress

Project 1.9 Survey of food advertising in magazines for children and young people

GC, AB BHF core 2005-2006 Completed One paper in press in Public Health Nutrition

Theme 1. Evaluating health promotion: physical activity Project 1.10

Examination of the relationship between the local environment and self reported physical activity using the EPIC-Norfolk cohort data and geographical information systems (GIS) technology (Environment and Physical Activity Study)

CF with M Hillsdon, N Wareham P Wilkinson, M Thorogood

BHF £74,893 2003-2005 Completed Paper published in Public Health*

Project 1.11

NICE (formerly HDA) Public Health Collaborating Centre for Physical Activity

CF, NC with L Almond, F Bull, A Hill, H Rutter

HDA/NICE 2004 - Ongoing

Project 1.12

Evidence briefing CF, NC with M Hillsdon

HDA £22,000 2004-2005 Completed Published by HDA in 2005

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Project 1.13

Effective action briefing CF, NC with K Buxton

£52,400 2004-2005 Completed Published by NICE in April 2006

Project 1.14

Evidence review CF, NC £16,000 2004-2006 Completed Published by NICE in April 2006

Project 1.15

Information services CF, NC with K Buxton

£20,000 2004-2005 Completed

Project 1.16

Review of brief interventions in primary care

CF, NC with S Bannerjee

2005-2006 Completed

Published by NICE in April 2006

Project 1.17

Review of pedometers F Bull, CF 2005-2006 Completed Published by NICE in April 2006

Project 1.18

Review of exercise referral schemes

K Buxton, CF 2005-2006 Completed Published by NICE in April 2006

Project 1.19

Review of community based walking and cycling programmes

CF, NC

NICE £58,500

2005-2006 Completed Published by NICE in April 2006

Project 1.20

Physical activity and the environment: Public health programme scope development

CF, NC with F Bull

NICE £25,000 2005-2006 Completed To be published by NICE in January 2006

Project 1.21

Review of physical activity and environment: Transport

CF, NC with A Davies

2006 Completed Review completed, NICE will send out for consultation in April 2007

Project 1.22

Review of physical activity and environment: Urban planning and design

F Bull, CF 2006 Completed Review completed, NICE will send out for consultation in April 2007

Project 1.23

Review of physical activity and environment: Natural environment

K Buxton, CF 2006 Completed Review completed, NICE will send out for consultation in April 2007

Project 1.24

Review of physical activity and environment: Policy

CF, NC 2006-2007 Ongoing Review underway, NICE will send out for consultation in April 2007

Project 1.25

Review of physical activity and environment: Building design

F Bull, CF

NICE

£210,000

2006-2007 Ongoing Review underway, NICE will send out for consultation in April 2007

Project Understanding participation in CF, NC, GC, Sport England £20, 754 2004-2005 Completed Report submitted, paper

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1.26 sport and physical activity amongst children and adults

SA published in Health Education Research*

Project 1.27

Assessing the relationship between the quality of urban green space and physical activity

CF with M Hillsdon, A Jones

Commission for Architecture and the Built Environment

£78,774 2005 Completed Paper published in Public Health*

Project 1.28

Assessing the social patterning of physical activity

SA, CF, AB BHF core 2006 Completed Paper submitted to the Journal of Physical Activity and Health

Project 1.29

Understanding the relationship between deprivation and access to physical activity facilities across England

CF with M Hillsdon, A Jones

BHF core 2006 Completed Paper submitted to American Journal of Preventive Medicine

Project 1.30

Systematic review of walking interventions

D Ogilvie, CF Scottish Physical activity research collaboration centre (SPARColl) funded by Scottish Executive BHF core

Expenses 2005 - Ongoing Paper at final review stage with the British Medical Journal*

Project 1.31

Update of systematic review of intervention for physical activity promotion for Cochrane Collaboration

CF with M Hillsdon, M Thorogood

BHF core 2006 Completed Revised review submitted to Cochrane Collaboration

Theme 2. Assessing the burden of cardiovascular disease Project 2.1 Coronary heart disease

statistics SA, VP, PS, AB

BHF £368,727

2005-2008 Ongoing 2006 edition of statistics compendium published in June 2006, Diet, physical activity and obesity supplement to published November 2006, 2007 edition of statistics compendium in preparation

Project 2.2 Assessing the economic cost of cardiovascular disease in Europe

MR with S Petersen, A Gray and

European Heart Network BHF Project 2.1,

£10,000 2004-2006 Completed Summary findings published in European CVD supplement, paper published in European

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others Heart Journal, paper in press in Heart

Project 2.3 Mapping the provision of cardiac rehabilitation in England

SA with B Lewin, H Bethall

BHF Project 2.1 2003- Ongoing Paper submitted to British Journal of General Practice

Project 2.4 Development of synthetic estimates of CHD risk factors in local authorities

PS BHF Project 2.1 (DPhil project)

2005- Ongoing Literature review completed, and draft of chapter prepared, analysis plans prepared, data collection in process

Project 2.5 Development of indicators of cardiovascular morbidity (Cardiovascular indicators surveillance set in Europe – EUROCISS (II))

SA with Instituto Superiore Di Sanita, Italy, and others.

European Commission BHF Project 2.1

Expenses

2004-2007 Ongoing Report in preparation

Project 2.6 Estimating the burden of physical inactivity-related ill health

SA, CF, PS, MR

BHF core and BHF Project 2.1

2006 Completed Paper in press in Journal of Epidemiology and Community Health.

Project 2.7 Estimating the burden of overweight and obesity related ill health

SA, MR BHF core and BHF Project 2.1

2006- Ongoing Paper in press in Obesity Reviews

Project 2.8 Study of urbanisation and its relation to obesity in a developing country

CA, SA BHF core 2006 Ongoing Paper in preparation

Project 2.9 Assessing the pattern of mortality over the 20th century in England and Wales

SA, PS with S Capewell

BHF project 2.1 2006- Ongoing Data collected, analysis plan in preparation

MR: Mike Rayner; SA: Steve Allender; CA: Carukshi Arambepola; AB: Anna Boxer; GC: Gill Cowburn; AD: Anu Devi; CF: Charlie Foster; AM: Anne Matthews; VP: Viv Peto; PS: Peter Scarborough; NC: Nick Cavill; * total project funding, amounts given in brackets are for projects where group member not the principal investigator.

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Table 2. Summary of the British Heart Foundation Health Promotion Group’s proposed projects: Project No.

Title People Involved

Proposed start date

Status

Theme 1a. Evaluating health promotion: nutrition 1.a Food related commercial

materials in the primary school curriculum

GC Short proposal drafted

1.b Food, schools and the commercialization of childhood

MR, GC, AM Full proposal drafted

1.c The effect of the School Food Trust’s vending standards on English secondary school pupils’ behaviour and diets.

AM Short proposal drafted

Theme 1b. Evaluating health promotion: physical activity

1.d Natural Environment Research Council - Environment and Human Health

M Hillsdon with CF, S MacIntyre, A Jones

January 2007

Proposal successful – funded by the Welcome Foundation

1.e Extension of NICE Collaborating Centre for evidence and physical activity: Interventions and Programme guidance development

CF, NC, F Bull

April 2007 Third wave of reviews (adults) First wave of reviews (children)

1.f Validation of CABE green space measure

CF, A Jones, J Panter

Short proposal in preparation

1.g Systematic review of qualitative studies examining the relationship between the environment and physical activity

CF, SA, GC Short proposal in preparation

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1.h Analysis of Bristol Quality of Life Survey data set

M Hillsdon with CF, A Jones

Short proposal in preparation

Theme 2. Assessing the burden of cardiovascular disease 2.a The validity of CHD risk scores

for the UK: a validation study using record linkage from the 1994 Health Survey for England and the 1994 Scottish Health Survey.

SA, PS with P Primatesta

Short proposal drafted, full proposal in preparation

2.b Trends in the decline of cardiovascular disease in England

PS, SA, MR with M Goldacre

October 2007

Short proposal drafted, full proposal submitted to MRC

2.c The emergence of obesogenic environments, economic transition and human development in Sri Lanka

CA, SA Short proposal drafted, full proposal in preparation

2.d Changes in the life course and its effects on chronic disease

SA Short proposal in preparation

MR: Mike Rayner; SA: Steve Allender; CA: Carukshi Arambepola AB: Anna Boxer; GC: Gill Cowburn; AD: Anu Devi; CF: Charlie Foster; AM: Anne Matthews; VP: Viv Peto; PS: Peter Scarborough; NC: Nick Cavill; * total project funding, amounts given in brackets are for projects where group member not the principal investigator.