1. Born in Bradford John Wright YCCSA Seminar

2. Growing up in Bradford High infant mortality High rates of disability High rates of asthma Impending diabetes epidemic Childhood obesity Social change

3. Cohort Studies N O N – R A N D O M I Z E D DiseaseNo DiseaseDiseaseNo Disease Defined Population ExposedNon-exposed

4. De Stavola et al 2006 AJE

6. SOCIO-ECONOMIC Deprivation Social capital Education GENETIC Consanguinity MOTHER ETHNICITY LIFESTYLE Nutrition/diet Smoking Alcohol ENVIRONMENT Air pollution Chemical exposures Water MEDICAL Depression/anxiety Diabetes Hypertension Infections Obesity BIOLOGICAL Nutritional biomarkers Metabolic biomarkers Vitamin D EXPOSURES OUTCOMES Birth weight Anthropometry Pre-eclampsia/diabetes Congenital anomalies Kidney volume Growth Obesity/Overweight Anthropometry Immune function Growth Obesity/Overweight Allergy Well-being Education attainment CHD Diabetes Hypertension Obesity LIFE COURSE BIRTH INFANT ETHNICITY LIFESTYLE Breastfeeding Diet Physical activity Infant feeding/weaning Infant care practices ENVIRONMENT Housing Recreation facilities Shops MEDICAL Hospital/GP attendance Infections SOCIO-ECONOMIC GENETIC BIOLOGICAL CHILD ETHNICITY LIFESTYLE Diet Physical activity Screen viewing ENVIRONMENT Housing Recreation facilities Green spaces MEDICAL SOCIO-CULTURAL ADULT ETHNICITY LIFESTYLE ENVIRONMENT MEDICAL SOCIO-CULTURAL

7. Data collected Demographic/socio-economic Family history Lifestyle factors – smoking/drugs/alcohol Diet Well being – GHQ 28 Social Capital Clinical: antenatal and medical histories; drugs; BP; weight; U/S scans. Blood: routine; GTT; insulin; DNA extraction

11. BiB Biobank BiB Database

16. Country of birth UK born Pakistani women Pakistani women born in Pakistani who moved to the UK aged 5 or under Pakistani women born in Pakistani who moved to the UK aged over 5

17. Women’s employment status

18. Mental health 42.3%53.7% 29.4% 37.7%

19. Sleep-sharing by ethnicity

20. Smoking and alcohol Smoking ReferenceComparison Mean Difference grams95% C.I.p-value Non-smoker Decreasing or quitting throughout-80-129 to -31<0.01 Continuing smoking throughout-240-324 to -156<0.01 Alcohol ReferenceComparison Mean Difference grams95% C.I.p-value Non-drinker Decreasing or stopping drinking throughout19-32 to 710.46 Continuing drinking throughout-7-75 to 620.85

21. Exposures of interest Polycyclic hydrocarbons Heterocyclic amines Acrylamides Nitrosamines Mycotoxins (Deoxynivalenol) Organochlorins (PCBs, dioxin) DNA reactive aldehydes Alcohols

22. n=238 n=216 n=244 n=189 n=217 Acrylamide adducts (AA-Hb, pmol/g Hb), glycidamide adducts (GA-Hb) and birth weight (grams) by country Birth weight AA-Hb GA-Hb

23. DBPs – spatial and temporal variation in the study area Little spatial variation in TTHM concentrations in the Bradford region (Fig. 1) Clear pattern of seasonal variation – TTHM concentrations peak in late summer (Fig.2) Fig. 1 Modelled TTHM averaged over 2006-2008 for 8 WSZs Fig.2 Modelled TTHM over 2006-2008 for each WSZ

24. Monitoring Nitrogen Oxides Three 2-weekly monitoring periods (summer, winter and intermediate) during 2009 40 NO x sites (using Ogawa badge) at Traffic, Urban Background and Rural Background sites Keighley Bingley Bradford

25. ESCAPE NO 2 predictions

26. Cyrrillic

28. Growth faltering v WHO 2006

29. Vitamin D status and ethnic origin

30. Seroprevalence of herpes virus infection Seroprevalence (%) nCMVEBVVZV White, UK born350 48.693.794.8 Asian, UK born300 89.394.395.0 Asian, S. Asia born299 98.392.689.6 p<0.0001p=0.64p=0.003

31. Atopy 14 schools 155 children tested Mean age at test: 5.3 years (range 4.6 – 6.2) 42 children, 27% atopic (95% CI 20 – 35) Based on 2mm weal size: 52 children, 34% atopic (95% CI 26 – 42)

32. First 125 BradCAS cases: Consanguinity ConsanguinityBiB cohort (%) BradCAS recruits (%) No6753 (70.4) 68 (58.8) Yes2843 (29.6) 57 (45.2) Total9596125 In the BradCAS cohort there is an excess of births which are the product of a consanguineous union. Consanguinity overallOR1.98 (95% CI 1.4-2.8)

33. Impact of BiB Structure Process Outcome Awareness raising Capacity building NHS infrastructure Communities of practice Better measurement General practice profiles Congenital anomalies register Evidence base Diabetes detection

34. Promoting healthier lifestyles? Has being part of the Born in Bradford project made you more aware of the health of you and your child? 71% Has being part of Born in Bradford encouraged you to adopt a healthier life style? 61%