No / More than 1 billion people live in societies where consanguineous marriages are common. When children are born to consanguineous unions, there is an increased probability of the expression of single-gene disorders with a recessive mode of inheritance. There are presumptive social benefits of consanguineous marriages reported in the literature. METHODS: The UK's Born in Bradford birth cohort study recruited 12 453 women at 26-28 weeks' gestation between 2007 and 2010. In all, 11 396 completed a questionnaire, including questions about their relationship to their baby's father. We compared Pakistani and Other ethnic groups in consanguineous relationships and Pakistani, Other and White British groups not in consanguineous relationships, calculating percentages and age-adjusted prevalence ratios (95% confidence intervals). RESULTS: In the Pakistani group, 59.3% of women (n = 3038) were blood relatives of their baby's father. Consanguinity was uncommon in the Other ethnic group (7.3%, n = 127) and rare (n = 5) in the White British group. Compared with non-consanguineous counterparts, mothers in consanguineous relationships were socially and economically disadvantaged (e.g. never employed, less likely to have higher education). The Pakistani consanguineous group's social, economic and health lifestyle circumstances were equivalent to, in some cases better than, women in non-consanguineous relationships (e.g. up-to-date in paying bills, or in disagreeing that they wished for more warmth in their marital relationship). The consanguineous relationship group had less separation/divorce. Rates of cigarette smoking during pregnancy were lower in mothers in consanguineous relationships. CONCLUSION: Debate about consanguinity should balance the potential protective effect of consanguineous relationships with established genetic risk of congenital anomaly in children.

No / Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community. Methods: We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13 776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors. Findings: Of 11 396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10 000 livebirths, compared with a national rate of 165·90 per 10 000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56–2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin—1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67–2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14–3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38–0·75), irrespective of ethnic origin. Interpretation: Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making. Funding: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme.

No / The present study aimed to explore previously unreported ethnic differences in infant feeding practices during the introduction of solid foods, accounting for maternal and birth factors, and to determine whether these feeding patterns are associated with BMI at 3 years of age. An observational study using Poisson regression was carried out to investigate the relationship between ethnicity and infant feeding practices and linear regression was used to investigate the relationship between feeding practices and BMI at 3 years of age in a subsample of 1327 infants in Bradford. It was found that compared with White British mothers, mothers of Other ethnicities were less likely to replace breast milk with formula milk before introducing solid foods (adjusted relative risk (RR) – Pakistani: 0·76 (95 % CI 0·64, 0·91), Other South Asian: 0·58 (95 % CI 0·39, 0·86), and Other ethnicities: 0·50 (95 % CI 0·34, 0·73)). Pakistani and Other South Asian mothers were less likely to introduce solid foods early ( < 17 weeks) (adjusted RR – Pakistani: 0·92 (95 % CI 0·87, 0·96) and Other South Asian: 0·87 (95 % CI 0·81, 0·93)). Other South Asian mothers and mothers of Other ethnicities were more likely to continue breast-feeding after introducing solid foods (adjusted RR – 1·72 (95 % CI 1·29, 2·29) and 2·12 (95 % CI 1·60, 2·81), respectively). Pakistani and Other South Asian infants were more likely to be fed sweetened foods (adjusted RR – 1·18 (95 % CI 1·13, 1·23) and 1·19 (95 % CI 1·10, 1·28), respectively) and Pakistani infants were more likely to consume sweetened drinks (adjusted RR 1·72 (95 % CI 1·15, 2·57)). No association between infant feeding practices and BMI at 3 years was observed. Although ethnic differences in infant feeding practices were found, there was no association with BMI at 3 years of age. Interventions targeting infant feeding practices need to consider ethnicity to identify which populations are failing to follow recommendations.

Yes / Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK’s Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26–28 weeks’ gestation at the Bradford Royal Infirmary (2007–2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (<37 weeks’ gestation) and SGA (<10th customised centile). Results After adjustment for socio-demographic and medical factors, financial strain was associated with a 45 % increase in PTB (OR 1.45: 95 % CI 1.06–1.98). Contrary to expectation, maternal distress in Pakistani women was negatively associated with SGA (OR 0.65: CI 0.48–0.88). Obesity in White British women was protective for PTB (OR 0.67: CI 0.45–0.98). Previously recognized risk factors, such as smoking in pregnancy and hypertension, were confirmed. Conclusions This study confirms known risk factors for PTB and SGA, along with a new variable of interest, financial strain. It also reveals a difference in the risk factors between ethnicities. In order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required

Yes / Objectives Congenital anomaly (CA) are a leading cause of disease, death and disability for children throughout the world. Many have complex and varying healthcare needs which are not well understood. Our aim was to analyse the healthcare needs of children with CA and examine how that healthcare is delivered. Design Secondary analysis of observational data from the Born in Bradford study, a large prospective birth cohort, linked to primary care data and hospital episode statistics. Negative binomial regression with 95% CIs was performed to predict healthcare use. The authors conducted a subanalysis on referrals to specialists using paper medical records for a sample of 400 children. Setting Primary, secondary and tertiary healthcare services in a large city in the north of England. Participants All children recruited to the birth cohort between March 2007 and December 2011. A total of 706 children with CA and 10 768 without CA were included in the analyses. Primary and secondary outcome measures Healthcare use for children with and without CA aged 0 to <5 years was the primary outcome measure after adjustment for confounders. Results Primary care consultations, use of hospital services and referrals to specialists were higher for children with CA than those without. Children in economically deprived neighbourhoods were more likely to be admitted to hospital than consult primary care. Children with CA had a higher use of hospital services (β 1.48, 95% CI 1.36 to 1.59) than primary care consultations (β 0.24, 95% CI 1.18 to 0.30). Children with higher educated mothers were less likely to consult primary care and hospital services. Conclusions Hospital services are most in demand for children with CA, but also for children who were economically deprived whether they had a CA or not. The complex nature of CA in children requires multidisciplinary management and strengthened coordination between primary and secondary care. / research by a PhD candidate supported by a Bradford University studentship, in conjunction with the White Rose Consortium, and the National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Yorkshire and Humber programme 'Healthy Children Healthy Families Theme', IS-CLA-0113-10020.

Yes / To investigate factors associated with movement behaviours among White British (WB) and South Asian (SA) children aged 6-8 years during school terms and holidays. Cross-sectional. Three primary schools from the Bradford area, UK. One hundred and sixty WB and SA children aged 6-8 years. Sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry during summer, winter and spring and during school terms and school holidays. Data were analysed using multivariate mixed-effects multilevel modelling with robust SEs. Factors of interest were ethnicity, holiday/term, sex, socioeconomic status (SES), weight status, weekend/weekday and season. One hundred and eight children (67.5%) provided 1157 valid days of data. Fifty-nine per cent of children were WB (n=64) and 41% (n=44) were SA. Boys spent more time in MVPA (11 min/day, p=0.013) compared with girls and SA children spent more time in SB (39 min, p=0.017) compared with WB children in adjusted models. Children living in higher SES areas were more sedentary (43 min, p=0.006) than children living in low SES areas. Children were more active during summer (15 min MVPA, p<0.001; 27 LPA, p<0.001) and spring (15 min MVPA, p=0.005; 38 min LPA, p<0.001) and less sedentary (−42 min and −53 min, p<0.001) compared with winter. Less time (8 min, p=0.012) was spent in LPA during school terms compared with school holidays. Children spent more time in MVPA (5 min, p=0.036) during weekend compared with weekdays. Overweight and obese children spent more time in LPA (21 min, p=0.021) than normal-weight children. The results of our study suggest that significant child level factors associated with movement behaviours are ethnicity, sex, weight-status and area SES. Significant temporal factors are weekends, school holidays and seasonality. Interventions to support health enhancing movement behaviours may need to be tailored around these factors.

Yes / In this report we focus on refugee and asylum seekers views on receiving, understanding and improving messages about public health advice. Refugees and asylum seekers as a group have incomplete access to television and WIFI or data to access the information they need in they way they prefer. Refugees and asylum seekers have constructive suggestions on how to improve key messages so they can be better understood. There is an ongoing risk to refugee and asylum seeker health, and population health if people are unable to receive official messages in a way that is relevant to them. / University of Bradford, NHS England

Yes / British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner-city areas of Bradford. Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women-only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. / UKPRP. Grant Number: MR/S037527/1 NIHR. Grant Number: NIHR200166

Yes / British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda. Methods: A two‐step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n= 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n= 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system. Results: Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well‐being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population. Conclusion: Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population. Patient or Public Contribution: Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into are search agenda. / NIHR, Grant/Award Number: NIHR200166;UKPRP, Grant/Award Number:MR/S037527/1

This thesis explores the dynamics of narrative production and contestation within individuals’ stories and the collective stories of the communities in which they live. The research is focused on trying to understand the relationship between public stories constructed about place and community, and the stories told by the inhabitants of those places. A case study in the city of Bradford provides a focus for inquiry. A qualitative research design is utilised, combining theory with primary data collection and analysis. A narrative analysis of national, academic and local stories about Bradford is used to disaggregate collective narratives of the city and explore the relationship between popular, political and academic discourses. It provides a context for the analysis of in-depth interviews with a range of inhabitants from a selected geographic area within Bradford, centred on how their individual stories relate to the identified collective stories of Bradford. Analysis of the fieldwork data shows that individuals are often engaged in complex negotiations of public discourse in ways that may reinforce and contest existing stories, but also complement them with parallel stories that neither reinforce nor contest but construct a different narrative. It reveals and reflects on apparent contradictions within everyday storytelling, for example, how nostalgia can be displayed about harsh times of socio-economic decline, or how attitudes to change over time can be variably positive and negative depending both on the speakers’ positioning of themselves and of the interviewer, and the speakers’ purpose in the interaction.