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A Life Course Approach to Understand Clustering of Behavioural Risk Factors for NCDs in United Kingdom

Project Description

Non communicable diseases (NCDs) namely, cardiovascular diseases (CVDs), cancers, chronic respiratory diseases, diabetes and oral diseases are the leading causes of death and disability globally and impose a significant threat to human health and development. These diseases are responsible for 35 million deaths (60% of all deaths globally) each year. NCDs have also been found to increasingly affect the poorer, vulnerable and disadvantaged sections of the society, thus widening the already existing inequalities in health outcomes across the entire spectrum of socioeconomic hierarchy. People who are relatively poor get sicker sooner and die earlier than people from wealthier sections of society. NCDs are often detected late, when people require extensive, as well as expensive hospital care causing great loss to national income and pushing people further into poverty.

Children growing up in disadvantaged circumstances are more likely to be exposed to many of the behavioural risk factors for NCDs, including tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Almost 80% of the CVDs and Diabetes and one third of cancers could be prevented by eliminating these shared risk factors. Controlling solitary risk factors has been found to significantly reduce the burden of multiple chronic diseases. These modifiable lifestyle risk factors also tend to ‘cluster’ among themselves, increasing the probability that an individual is dealing with multiple health risk factors at a given time. It is very important to focus on clustering because the co-existence of multiple health compromising behaviours is associated with increased risk of chronic diseases and the combination of these health behaviours have been found to have a more detrimental effect than individual behaviour effects. A number of studies from the UK and worldwide have looked at how various risk taking behaviour cluster but very few of them have assessed the patterns or combination of behaviours among adolescents. None of the studies have looked at the effect of upstream determinants (such as childhood socio-economic conditions, life satisfaction, peer relationships, stress and family support) on clustering of health related behaviours of adolescents.

This PhD studentship will focus on longitudinal analysis of the Millennium Cohort Study, making use of the 17 year old data sweep expected soon:
• To assess the distribution of four major behavioural risk factors (diet, physical inactivity, tobacco use and alcohol) in adolescents.
• To assess the count of clustering and identify the patterns of clustering of these behavioural risk factors in adolescents at different points along their life course.
• To identify the role of socio-demographic (standard of living, education level, sex) and psychosocial factors in the clustering of behavioural risk factors and associated inequalities.
Through the collaborative networks of the project supervisors, the prospective student will have the opportunity to explore harmonised analyses in other birth cohorts, such as Growing up in Ireland and the Danish National Birth Cohort. The proposed PhD studentship is strategic and holds importance for generating robust evidence and for guiding policies to control NCDs in UK. It is necessary to explore clustering of lifestyle related health risk behaviours for a number of reasons. Firstly, understanding the prevalence, distribution and frequency of clustering among young adults will inform health promotion planning efforts across multiple dimensions of UK health systems. Secondly, increased understanding of pattern, determinants and associated inequalities in clustering of risk behaviours may support efforts to reduce incidence of chronic diseases, better management of existing chronic diseases and improve overall health outcomes. Thirdly, the socio-demographic analysis of clustering of health risk behaviours over the life course would provide additional insights on challenges and opportunities that exist to improve health of the young adults.

Application is by CV and Cover Letter. The Cover Letter must detail your interest in the studentship, related experience and training and suitability for the position. Applications to be sent to Dr Manu Mathur at

Funding Notes

Funded by the Institute of Population Health Sciences, University of Liverpool. Funding includes 15000 GBP stipend and Home/ EU Fees. Funding also covers institute bench fees of 1000 GBP.


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4. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Geneva, World Health Organization; 2008.
5. Raitakari OT, Leino M, Räikkönen K, Porkka KVK, Taimela S, Räsänen L, et al. Clustering of Risk Habits in Young Adults. American Journal of Epidemiology. 1995;142(1):36-43.
6. Ebrahim S, Montaner D, Lawlor DA. Clustering of risk factors and social class in childhood and adulthood in British women's heart and health study: cross sectional analysis. BMJ. 2004;328(7444):861.
7. Meng L, Maskarinec G, Lee J, Kolonel LN. Lifestyle Factors and Chronic Diseases: Application of a Composite Risk Index. Preventive Medicine. 1999; 29(4): 296-304
8. Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet. 1997;349(9063):1436-42.

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