Frank Kee

• Queen's University Belfast

Objectives: An aggregated interventional N-of-1 or single-case design was used to assess the impact of a befriending intervention on a) health-related quality of life (HR-QoL), and b) the association between loneliness on HR-QoL among older adults. Methods: Participants were n = 33 new users of the service, aged 60 +. Outcomes were measured at 13 t...

Importance Offering pregnant women financial rewards to stop smoking is associated with a more than 2-fold increase in smoking cessation and is cost-effective; however, it is possible that the association is the result of gaming of the outcome measure (eg, not smoking for 24 hours before outcome measurement using a carbon monoxide breath test). Bir...

IntroductionThe UK Longitudinal Linkage Collaboration (UK LLC) is the national Trusted Research Environment (TRE) for the UK's longitudinal research community, supporting the UK's unparalleled collection of Longitudinal Population Studies (LPS). Initially set up as a COVID-19 research resource, UK LLC is now a generic database for any research for...

Objective To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes. Methods Three-group randomized trial including 585 men with obesity comparing daily automated behav...

Good nutrition during the postpartum period, which is also the inter-pregnancy period for many women, has short and long-term health benefits for the mother and her offspring ⁽¹⁾ . Gaining a better understanding of mothers’ dietary patterns at the postpartum stage will help shape appropriate strategies to encourage the adoption of a healthy and mor...

Men living with multiple long-term conditions and obesity are under-represented in behavioural weight management trials. Within an effective text messaging and financial incentives trial, our aim was to explore retention, secondary mental health and wellbeing outcomes, and experiences of men with multiple long-term conditions. Methods Mixed method...

Objective: Weight management interventions can affect mental health. Mental health can affect engagement with weight loss interventions or services. This study explored mental health and wellbeing outcomes, retention and participant experiences of mental health within the Game of Stones trial. Methods: Mixed methods process evaluation within a 3-gr...

Objectives To compare the difference in percentage weight change at 24 months following a 12-month text messaging with financial incentive intervention compared to a waiting list control group, and to compare the text messaging alone group to the control group. Design Assessor-blinded three-arm randomised clinical trial. Setting Three disadvantaged...

Introduction Maintaining cognitive health in later life is a global priority. Encouraging individuals to make health behaviour changes, such as regular physical activity, and providing supportive urban environments can help maintain cognitive health, thereby preventing or delaying the progress of dementia and cognitive decline. However, the mechani...

Background: Up to 20% of patients presenting with an acute coronary heart disease (CHD) event do not report any traditional modifiable cardiovascular risk factors (CVRFs) on admission. However, major predictors of CHD events in the absence of CVRFs are still unknown. Aims: To establish whether increased concentrations of emerging circulating biomar...

The Northern Ireland COhort for the Longitudinal study of Ageing (NICOLA) is Northern Ireland’s largest national population cohort collecting longitudinal data from a representative sample of older people. NICOLA’s Wave 1 includes 8,283 participants aged over 50 years, additionally recruiting 195 household partners living at the same address as pri...

Background Exercise referral schemes (ERS) are an effective strategy for increasing physical activity (PA) in older adults. Behavioural self-management strategies (SMS) may augment the maintenance of PA and associated benefits in this population, resulting in preservation of the functional capacity and prevention of disability over the long-term....

Purpose Epigenetic modifications including DNA methylation (DNAm) are proposed mechanisms by which social or environmental exposures may influence health and behaviours as we age. The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) DNAm cohort, established in 2013, is one of several worldwide, nationally representative prospec...

Background In 2016, large-scale 20 miles per hour speed limits were introduced in the United Kingdom cities of Edinburgh and Belfast. This paper investigates the role that scientific evidence played in the policy decisions to implement lower speed limits in the two cities. Methods Using a qualitative case study design, we undertook content analysi...

BACKGROUND Objective To examine birth weight change caused by adding financial rewards for smoking cessation compared to no rewards for pregnant women. To estimate the average expected birth weight change for those who quit because of rewards. METHODS This study updates a previous systematic review and refocuses the outcome from smoking cessation...

Purpose: Befriending interventions are unlikely to reduce loneliness, but they may provide social support which buffers the negative impact of loneliness on health outcomes of older adults. An interventional N-of-1 design was used to assess the impact of a befriending intervention on health-related quality of life (HR-QoL) among older adults, and w...

Introduction Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to S...

Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individua...

Introduction The reproductive years can increase women’s weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women during this life stage is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to...

Norm-based accounts of social behavior in economics typically reflect tradeoffs between maximization of own consumption utility and conformity to social norms. Theories of norm-following tend to assume that there exists a single, stable, commonly known injunctive social norm for a given choice setting and that each person has a stable propensity to...

Background: Aimed to compare the prevalence, characteristics, and associated mortality risk of frailty in Northern Ireland (NI) and the Republic of Ireland (ROI). Methods: Secondary analysis of the first wave of two nationally representative cohorts, the Northern Ireland Cohort for the Longitudinal Study of Ageing or NICOLA study (N = 8504) and...

Background: The proportion of the population aged 65 years or older is increasing. Typically, physical activity and health decline with age, which is why action to promote active ageing is a major public health priority, particularly due to health inequalities in older adults. The aim of this study is to assess the effectiveness and cost-effectiven...

Befriending services are often delivered to older adults with a view to improving social connectedness, but they may also lead to improved health. The objective of the current study was to explore potential mechanisms through which befriending services might impact the health of older adults. Data were collected from 13 befriendee-befriender dyads...

Introduction The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) study is the largest study of ageing in Northern Ireland (NI). The Harmonised Cognitive Assessment Protocol (HCAP) is a substudy of NICOLA designed to assess cognitive impairment and dementia in individuals aged 65 and over. The NICOLA-HCAP substudy is funded by...

Background and Aims Recent investigations have suggested an interdependence of lipoprotein(a) [Lp(a)]-related risk for cardiovascular disease with background inflammatory burden. The aim the present analysis was to investigate whether high-sensitive C-reactive protein (hsCRP) modulates the association between Lp(a) and coronary heart disease (CHD)...

Background Using rewards may be an effective method to positively influence children’s eating behaviour but evidence to date is limited, particularly in older children. The cashless canteen systems in schools provides a unique opportunity to implement a food-based reward scheme but intervention development work and feasibility testing is needed. Th...

Introduction The reproductive years can increase women’s weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women at this time is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to support di...

Aims: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period. Methods: The study sample comprised 553818 individuals from 49 cohorts in 11 European countries (baseline...

Background LDL-cholesterol (LDL-C), quantified by conventional methods, also includes the choles-terol attributable to Lipoprotein (a) (Lp(a)-C) due to their overlapping densities. The clinical relevance of this is still poorly investigated, since current attempts to estimate a true LDL-C (i.e. a LDL-C without its Lp(a)-C content, so called LDL-C-L...

The MECHANISMS study investigates how social norms for adolescent smoking and vaping are transmitted through school friendship networks, and is the first study to use behavioral economics methodology to assess smoking-related social norms. Here, we investigate the effects of selection homophily (the tendency to form friendships with similar peers)...

Aims/hypothesis To determine the extent to which diabetic retinopathy severity stage may be classified using machine learning (ML) and commonly used clinical measures of visual function together with age and sex. Methods We measured the visual function of 1901 eyes from 1032 participants in the Northern Ireland Sensory Ageing Study, deriving 12 va...

Background Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex intervent...

Background Five modifiable risk factors are associated with cardiovascular disease (CVD) and all-cause mortality. The regional and sex-specific prevalence of these modifiable risk factors and their impact on CVD and all-cause mortality have not been evaluated using individual-level data. Methods The Global Cardiovascular Risk Consortium harmonized...

Urban regeneration of urban green and blue spaces (UGBS) is assumed to benefit residents’ mental wellbeing. However, the mechanistic pathways linking UGBS to wellbeing before vs. after regeneration remain unclear. This study assessed the mediating roles of subjective perceptions of the environment and instoration indicators (social capital and phys...

The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alco...

Patient-centred trial design and delivery; improves recruitment and retention; increases participant satisfaction; encourages participation by a more representative cohort; and allows researchers to better meet participants’ needs. Research in this area mostly focusses on narrow facets of trial participation. We aimed to systematically identify the...

Previous research has illustrated the role of urban green and blue spaces in improving the economic, social, environmental, and health-related outcomes of urban populations. The Connswater Community Greenway is presented as a case study to assess the social value of an urban regeneration project. Using real-world data from two time points (2012 and...

Introduction At the start of the COVID-19 pandemic there was an urgent need to identify individuals at highest risk of severe outcomes, such as hospitalisation and death following infection. The QCOVID risk prediction algorithms emerged as key tools in facilitating this which were further developed during the second wave of the COVID-19 pandemic to...

Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review...

Background: Given that the majority of the worlds population live in cities, it is essential to global health efforts that we design them in ways that both reduce non-communicable diseases (NCDs) risk and that facilitate adoption and maintenance of healthy lifestyles. Current approaches tend to focus on the relationship between urban design-related...

Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic d...

Aim: To investigate whether there is an association between subgingival microbial diversity and reduced respiratory function. Materials and methods: A group of dentate 58-72-year-old men in Northern Ireland had a comprehensive periodontal examination including subgingival plaque sampling. DNA was extracted from plaque samples and the V1-V3 regio...

Background The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) is a prospective, longitudinal study of a representative cohort of older adults living in Northern Ireland, United Kingdom. Its aim is to explore the social, behavioural, economic and biological factors of ageing and how these factors change as people age. The stud...

Prospective population-based studies investigating associations between reactive symptoms following SARS-CoV-2 vaccination and serologic responses to vaccination are lacking. We therefore conducted a study in 9003 adults from the UK general population receiving SARS-CoV-2 vaccines as part of the national vaccination programme. Titres of combined Ig...

We know little about how smoking prevention interventions might leverage social network structures to enhance protective social norms. In this study we combined statistical and network science methods to explore how social networks influence social norms related to adolescent smoking in school-specific settings in Northern Ireland and Colombia. Pup...

Time preference is a measure used to ascertain the level of which individuals prefer smaller, immediate rewards over larger, delayed rewards. We explored how an individual’s time preference associates with their epigenetic profile. Time preferences were ascertained by asking participants of the Northern Ireland COhort for the Longitudinal study of...

Peer support interventions for dietary change may offer cost-effective alternatives to interventions led by health professionals. This process evaluation of a trial to encourage the adoption and maintenance of a Mediterranean diet in a Northern European population at high CVD risk (TEAM-MED) aimed to investigate the feasibility of implementing a gr...

Introduction: The Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia. Methods: This quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with th...

Aim Designing financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand a...

Background: The imposition of restrictions on social mixing early in the COVID-19 pandemic was followed by a reduction in asthma exacerbations in multiple settings internationally. Temporal trends in social mixing, incident acute respiratory infections (ARI) and asthma exacerbations following relaxation of COVID-19 restrictions have not yet been d...

Background Evidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation. Methods An observational, re...

Background Patient-centred trial design and delivery; improves recruitment and retention, with a direct impact on increased cost and time efficiency of research; increases participant satisfaction; encourages participation by a more representative patient group; allows research teams to better meet participants’ psychosocial needs; and ensures outc...

Background Patient-centred trial designs improve research quality and efficiency, ultimately allowing safe drugs to reach clinic more quickly. Our qualitative work suggests quantifying 6 key trial attributes could define priorities for patient-centred CF trials: type of medicine, trial design (placebo v open label), washout, stipend, location of vi...

Background Befriending services are commonly deployed in the support of older people living alone, but lack an established evidence base, particularly in relation to their association with health outcomes. Methods To explore the potentially therapeutic impact of befriending on Health-Related Quality-of-Life (HR-QoL) and cognitive function, we used...

Objective: To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. Design: Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phas...

Purpose: To report prevalence and risk factor associations for age-related macular degeneration (AMD) and AMD features from multimodal retinal grading in a multidisciplinary longitudinal population-based study of aging in Northern Ireland. Study design: Population-based longitudinal cohort study. Methods: Retinal imaging at the Norther Ireland...

Background: Emerging infectious diseases (EIDs) arise and affect society in complex ways. We conducted a scoping review to explore how systems-oriented methods have been used to prevent and control EIDs. Methods: We used the Joanna Briggs Institute framework for scoping reviews in this study. We included peer-reviewed articles about health care sys...

Background Lipoprotein(a) (Lp(a)) represents a unique proatherogenic lipoprotein with potent pro-thrombotic and pro-inflammatory properties. Recent studies demonstrated that Lp(a)-associated risk for cardiovascular disease (CVD) was significantly increased only in individuals with a high inflammatory burden (i.e. hsCRP levels >2 mg/L). However, the...

Introduction Cardiovascular biomarkers may reflect different aspects of cardiovascular disease, including myocardial tissue damage (high-sensitive cardiac troponin [hs-cTn]), hemodynamic stress (N-terminal prohormone of brain natriuretic peptide [NT-proBNP)), or inflammation (high-sensitivity C-reactive protein [hs-CRP]). Purpose To determine the...

Background Recent evidence highlights the epidemiological value of blood DNA methylation (DNAm) as surrogate biomarker for exposure to risk factors for non-communicable diseases (NCD). DNAm surrogate of exposures predicts diseases and longevity better than self-reported or measured exposures in many cases. Consequently, disease prediction models ba...

Background: Little is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations. Methods: This prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-Co...

Antibody responses to SARS-CoV-2 vaccines vary for reasons that remain poorly understood. A range of sociodemographic, behavioural, clinical, pharmacologic and nutritional factors could explain these differences. To investigate this hypothesis, we tested for presence of combined IgG, IgA and IgM (IgGAM) anti-Spike antibodies before and after 2 dose...

Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the r...

Little is known about the personality and cognitive traits that shape adolescents’ sensitivity to social norms. Further, few studies have harnessed novel empirical tools to elicit sensitivity to social norms among adolescent populations. This paper examines the association between sensitivity to norms and various personality and cognitive traits us...

Introduction Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the CO...

Background Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play. Objectives The main objective was to evaluate and understand t...

Objective: To examine effectiveness, cost-effectiveness, generalizability and acceptability of financial incentives for smoking cessation during pregnancy ‘bolted-on’ to variously organised UK SSSs. This paper reports effectiveness. Design: A prospective pragmatic, multi-centre, parallel group, single-blinded, individually randomised controlled sup...

Background Historically, high levels of morbidity and mortality have been associated with cardiovascular disease in the Northern Ireland population. Previously reported associations between single nucleotide polymorphisms (SNPs) and cardiovascular disease within other populations have not always been consistent. Objective To investigate associatio...

Background In 2016, large scale 20mph speed limits were implemented in the cities of Edinburgh (Scotland) and Belfast (Northern Ireland). The fact that both cities succeeded in implementing 20mph speed limit interventions is important. They illustrate the processes of transport and public health policy change. This paper describes how 20mph speed l...

Background Obesity increases the risk of type 2 diabetes, heart disease, stroke, mobility problems and some cancers, and its prevalence is rising. Men engage less than women in existing weight loss interventions. Game of Stones builds on a successful feasibility study and aims to find out if automated text messages with or without endowment incenti...

Purpose To assess differences in rod-mediated dark adaptation (RMDA) between different grades of age-related macular degeneration (AMD) severity using an Optical Coherence Tomography (OCT)-based criterion compared to the Beckman Colour Fundus Photography-based (CFP) classification. To assess association between subretinal drusenoid deposit (SDD) pr...