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Reproduction of original in: Public Archives of Canada. Library. ; Mode of access: Internet.

ABSTRACT
ObjectivesAlcohol, tobacco and cannabis can cross the placenta, and could have long-lasting effects on the brain of the developing foetus. We examine whether exposure to these substances is associated with educational attainment in adolescence (Key Stage 4 [KS4], aged 16yrs), and consider whether any associations are due to an intrauterine causal mechanism.
ApproachWe use two main approaches: (1) a comparison of the risks associated with maternal substance use during pregnancy with the risks associated with paternal substance use at the same time, and (2) Mendelian Randomisation (MR). The population-based sample are from the Avon Longitudinal Study of Parents and Children. Educational attainment at KS4 was determined through linkage to the National Pupil Database: capped score of eight best subjects (converted to percentage). Mothers and their partners reported use of substances during the mother's pregnancy via questionnaire. In observational complete-case analysis (n=6018), multilevel (child level 1, school level 2) linear models were used to examine the association between maternal and paternal substance use and KS4 attainment adjusted for potential confounders. In MR analysis, genetic markers associated with maternal alcohol (rs1229984) and tobacco (rs1051730) use were used to estimate the unconfounded effect of the exposures.
ResultsMaternal substance use in pregnancy was common (72% reported any alcohol, 22% any tobacco, and 2% any cannabis) and socially patterned (tobacco associated with deprivation, moderate alcohol and light cannabis with higher maternal education). In adjusted observational analyses, children of mothers who smoked had lower KS4 percentage scores (β -2.7, 95% CI -3.7 to -1.7) but a similar association was observed for paternal smoking (β -3.0, -3.8 to -2.2). Compared to children of non-drinkers in first trimester, children whose mothers drank ≥7 units per week had lower KS4 scores (β -4.6, -7.9 to -1.4), but children of lighter drinkers did not. The MR analyses were under-powered but provisional results suggest no association between maternal smoking and KS4 score, but that small amounts of alcohol could have a detrimental effect. Neither maternal nor paternal cannabis use was associated with educational attainment in observational analyses, but few mothers in our sample used cannabis regularly in pregnancy.
ConclusionsThe negative association in observational analysis between maternal smoking in pregnancy and child KS4 attainment is likely due to residual confounding rather than an intrauterine mechanism. Conversely, residual confounding may be masking a negative association between lower levels of alcohol drinking and KS4 attainment in observational analysis.

Explaining Criminal Careers presents a simple quantitative theory of crime, conviction and reconviction, the assumptions of the theory are derived directly from a detailed analysis of cohort samples drawn from the "UK Home Office" Offenders Index (OI). Mathematical models based on the theory, together with population trends, are used to make: exact quantitative predictions of features of criminal careers; aggregate crime levels; the prison population; and to explain the age-crime curve, alternative explanations are shown not to be supported by the data. Previous research is reviewed, clearly identifying the foundations of the current work. Using graphical techniques to identify mathematical regularities in the data, recidivism (risk) and frequency (rate) of conviction are analysed and modelled. These models are brought together to identify three categories of offender: high-risk / high-rate, high-risk / low-rate and low-risk / low-rate. The theory is shown to rest on just 6 basic assumptions. Within this theoretical framework the seriousness of offending, specialisation or versatility in offence types and the psychological characteristics of offenders are all explored suggesting that the most serious offenders are a random sample from the risk/rate categories but that those with custody later in their careers are predominantly high-risk/high-rate. In general offenders are shown to be versatile rather than specialist and can be categorised using psychological profiles. The policy implications are drawn out highlighting the importance of conviction in desistance from crime and the absence of any additional deterrence effect of imprisonment. The use of the theory in evaluation of interventions is demonstrated.

BackgroundPolicing in the UK is increasingly taking a public health approach to tackling crime. Birth cohort studies are potentially well-placed to provide evidence on the most important risk and preventative factors. Linking official police records to cohort data offers considerable potential for future research, but data privacy concerns mean achieving such linkage is challenging. As a pilot, the Ministry of Justice provided ALSPAC with an anonymous extract (cannot be linked to study data) detailing consenting participants' criminal convictions and cautions held within the Police National Computer (PNC).
Main AimTo use anonymised PNC data to inform the potential for future research using ALSPAC and individual-level linked crime data.
MethodsWe examine criminality (type, when and where committed) in the cohort participants who were sent for linkage to the PNC in 2013 when they were aged approximately 21 years (n=7358). We consider the representativeness of these participants by comparing their self-reported crime-related behaviours during adolescence to those of participants who did not consent to linkage (n=7604). Finally, we consider these self-reported measures by present-day crime linkage consent status.
ResultsOf those sent for PNC linkage, 885 were linked to a criminal record(s) comprising 2635 convictions and 1365 cautions. A third related to serious crimes, and >90% were committed in Avon and Somerset constabulary. Those sent for linkage self-reported fewer criminal behaviours than those not sent for linkage. Regarding present-day consent status, those who have explicitly opted-in generally self-report fewer criminal behaviours and have less missing data than those who have not responded to the consent campaign.
ConclusionIf future linkage to individual police records was only achieved for explicit consenters, this would under-estimate criminality in the cohort. The geographical clustering of the crimes means local police records, which are more detailed than those of the PNC, could also be used.

Historical records and the research databases of completed studies have the potential either to establish new research studies or to inform follow-up studies assessing long-term health and social outcomes. Yet, such records are at risk of destruction resulting from misconceptions about data protection legislation and research ethics. The recent destruction of the Windrush disembarkation cards, which potentially could have formed the basis of a retrospective cohort study, illustrates this risk. As organisations across Europe transition to the EU General Data Protection Regulation (GDPR), this risk is being amplified due to uncertainty as to how to comply with complex new rules, and the requirement under GDPR that data owners catalogue their data and set data retention and destruction rules. The combination of these factors suggests there is a new meaningful risk that scientifically important historical records will be destroyed, despite the fact that GDPR provides a clear legal basis to hold historical records and to repurpose them for research for the public good. This letter describes this risk; details the legal basis enabling the retention and repurposing of these data; makes recommendations as to how to alleviate this risk; and finally encourages the research and research-active clinical community to contact their 'Data Protection Officers' to promote safe-keeping of historical records.

Canada's June 28th, 2004, federal election was an exciting and, in several respects a surprising contest. One major surprise was the election campaign itself. Rather than being the predictable, boring event many commentators had anticipated, the campaign was a closely fought battle between a longtime governing party and a new opposition party that had been formed only six months before the election was called. A second surprise, at least for some observers, was turnout, with participation in a national election falling to the lowest level in Canadian history. A third, potentially very significant, surprise was the success of the separatist Bloc Québécois, accompanied by a resurgence of support for Quebec sovereignty. After the election, the future of Canada's national party system, indeed, the future of Canadian democracy, appeared more problematic than had been the case only a few months earlier.

ObjectiveTo use longitudinal birth cohort data linked to police records to examine whether the relationship between adverse childhood experiences (ACEs) and police-recorded serious violence depends on the type, timing or duration of ACEs.
MethodsThe sample are 5070 participants (born 1991-1992) from the Avon Longitudinal Study of Parents and Children who allowed linkage to Avon and Somerset (A&S) local police data, lived in A&S from age 16-24 years, and had exposure and confounder data. The binary outcome (no, yes) is having a police record for a serious violence (SV) offence from age 16-24. ACEs were parent-reported from birth to age 11 and include measures of parental physical and emotional abuse. Logistic regression was used to examine associations between the timing of different ACEs and SV, adjusted for child sex, ethnicity, and family socioeconomic position.
Results6% of the participants had experienced physical abuse, 17% emotional abuse, and 121 individuals (2.4%) had at least one SV record. In adjusted models, there was evidence of an association between physical (OR 1.90, 95% 1.08-3.35) but not emotional (0.96, 0.60-1.54) abuse and risk of SV. Results suggest that those who experienced physical abuse in both early (<4 years) and later (4-11 years) childhood, or later childhood only, might have been at greater risk of SV than those who experienced it only during early childhood, although numbers were small and confidence intervals were consequently wide.
ConclusionResults to date suggest that associations with SV differ between ACE types, and that timing may be important. In our presentation, we will also present findings for other ACEs.

Objectives
• To compare self-reported and police-recorded serious violence using data from a longitudinal UK birth cohort linked to local (Avon and Somerset Constabulary) police records
• To assess the risk of police-recorded serious violence according to study participation status across the lifecourse
ApproachWe linked data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to local police records on charges, cautions and other out of court disposals. We compared the risk of self-reported serious violence at 8 time points from 15 to 25 years to police-recorded serious violence at these ages. We then compared the risk of police-recorded serious violence among those actively participating in ALSPAC to those not participating at various time points from pregnancy onwards. We used logistic regression to examine whether differences in risk could be explained by socio-demographic and family characteristics associated with ALSPAC participation.
ResultsThe sample included 12,662 participants who had received fair processing materials and had not opted out of linkage to police records. They linked to a total of 6,283 offences, of which 933 were classified as serious violence (involving a total of 530 individuals). Self-reported serious violence in the past year was particularly high at 15 years (23.5%); at other ages it ranged from 3.7% (22 years) to 8.7% (20 years). Police-recorded serious violence was lower at all ages, peaking at 1.0% at 17 and 18 years. The risk of police-recorded serious violence was higher among those not participating in ALSPAC than among active participants, particularly during adolescence and early adulthood. This difference was only partially explained by socio-demographic and other factors.
ConclusionA key advantage of linkage to police records is it enables outcomes to be measured irrespective of study participation status as relying only on active participants leads to bias. Combining self-reported and police-recorded outcomes allows us to derive measures of offending that take account of the biases inherent in each.

ABSTRACT
Objectives"Clearly, details about an individual's mental health, for example, are generally much more 'sensitive' than whether they have a broken leg."
UK Information Commissioners Office
There is a perceived wisdom – based on issues such as social taboos, religious sensitivities, or financial implications linked to health status – that some health data is more sensitive than others. This distinction is present in many of the regulatory interpretations of privacy law (e.g. the UK Information Commissioners Office interpretation of the EU Data Directive, illustrated above), and is factored into the thinking of ethics and other regulatory decision-making committees. However, these particularly 'sensitive' data are defined at a regulatory level in broad terms (e.g. mental health), yet need implementing by researchers in precise terms. In 2013 our longitudinal research study was given approval by the UK Secretary of State for Health to access identifiable patient health records with the exception of those relating to mental health, sexual health or termination of pregnancy. Our objective therefore was to develop a generalisable informatics approach which enabled us to filter out sensitive records at the point of extraction.
ApproachWe developed a methodology based on the Cochrane systematic review approach: firstly using internationally recognised definitions of health concepts and reference texts (e.g. British National Formulary drug manual) we identified keywords associated with sensitive health events (including symptom and diagnostic terms, drug and appliance codes, community and secondary care references); secondly, through data-mining code terminologies – using both code terms and information embedded within the structure of the schema itself - we identified code values relating to these terms; thirdly we minimised our results through filtering out spurious results via manual review; finally, the resulting code lists were then crossed-referenced with other terminologies to ensure interoperability.
ResultsWe produced separate definitions of mental health and sexual health events initially using Read codes. Using NHS cross-reference tables we were able to translate Read observation and diagnostic codes to the SNOMED CT vocabulary, but were unable to translate Read drug codes into the SNOMED/DM+D vocabulary.
ConclusionWe have demonstrated a systematic and partially interoperable approach to defining 'sensitive' health information. However, any such exercise is likely to include decisions which will be open to interpretation and open to change over time. As such, the application of this technique should be embedded within an appropriate governance framework which can accommodate misclassification while minimising potential patient harm.

ABSTRACT
ObjectivesRates of common mental disorders may be increasing among children and adolescents, though evidence of this is mixed. Symptom questionnaires in population surveys may overestimate clinical disease. Conversely, lower participation of individuals with mental disorders may lead to underestimates in surveys. Clinical databases may have greater population coverage and contain information of more obvious clinical validity; however, several factors, including the help-seeking behaviour of individuals and the recording practices of clinicians, may influence burden-of-disease estimates based on these databases. The aim of the current investigation was to compare case definitions of common mental disorders (CMD) using linked electronic primary care data to definitions derived from self-reported data obtained in an observational study.
ApproachWe studied 1,562 adolescents who had completed the Revised Clinical Interview Schedule (CIS-R) in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17-18 years and had linkage established to their electronic primary care records for at least 6 months after the time they completed the CIS-R. We used lists of Read codes corresponding to diagnoses, symptoms and treatment to create twelve definitions of CMD and also of depression alone. We calculated sensitivities and specificities of these, using CIS-R case definitions as the reference standard. All analyses were carried in Stata 13.0.
ResultsSensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD. For both depression and CMD, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of cases.
ConclusionsMost individuals meeting case definitions for CMD based on information in clinical records also met CMD case definitions based on symptoms reported in a contemporaneous survey. Conversely, many individuals identified as CMD cases based on reported symptoms had no evidence of CMD in their clinical records. A small number of individuals with CMD recorded in their clinical records had not reported symptoms of this in the survey. Overall, these data suggest that clinical databases are likely to yield underestimates of the burden of CMD in the population. Clinical records appear to yield highly valid diagnoses of common mental disorders which may be useful for studying risk factors and outcomes of these conditions. The greatest epidemiological value is likely to be obtained when the combination of information from both survey and clinical records is possible.

ABSTRACT
BackgroundElectronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants' views about data linkage and inform approaches to information. This paper focusses on issues of consent.
MethodsDigitally recorded interviews were conducted with 55 participants aged 17-19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach.
ResultsParticipant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with 'opt-in' consent through which participants are 'asked' if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent.
ConclusionsFindings from this study question the validity of 'informed consent' as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process.

ABSTRACT
ObjectivesIn the UK, some children undertake National Cycle Proficiency Scheme [NCPS]/Bikeability training in primary school. It aims to promote cycling and safe cycling behaviours but there has been little scientific evaluation of its effectiveness. We aimed to examine the impact of cycle training on cycle-related behaviours and accidents in adolescence using self-report and hospital episode statistics (HES) data.
ApproachThe sample (n=5415) were participants in the Avon Longitudinal Study of Parents and Children who reported whether or not they had received NCPS training. Self-reported outcomes at 14 and 16 years included: cycling to school, ownership of cycle helmet, use of cycle helmet and high-visibility clothing on last cycle, and involvement in a cycle accident. Hospital admittance due to a cycle accident from 11-16 years was also included for a subsample (n=2222) who have been linked to HES. The association between cycle training and each of the outcomes was analysed using multilevel logistic regression (individual level 1, school level 2 [pseudo-ID of school attended obtained from linkage to National Pupil Database]), adjusted for a range of potential confounders.
ResultsApproximately 40% had received NCPS training. At 14 and 16 years, trained children were more likely to cycle to school (at 16 years: adjusted OR 1.56, 95% CI 1.20-2.02) and to own a helmet (16 years: 2.03, 1.72-2.41) than those who had not attended a course. They were also more likely to have worn a helmet on their last cycle at age 14 (1.26, 1.07-1.49), and to have worn high-visibility clothing at age 16 (1.70, 1.22-2.39). Training was not associated with self-reported involvement in a cycle accident, and only six participants with HES data had been admitted to hospital due to a cycle accident. Irrespective of training, results indicate very low use of high-visibility clothing (5%), very few girls cycling to school (<2%), and less than half of helmet owners wearing one on their last cycle. Ownership and use of helmets was particularly low in children from lower socio-economic position families.
ConclusionCycle training for children can have benefits that persist into adolescence. However, the low use of cycle helmets and high-visibility clothing indicate the further potential for interventions to encourage safe cycling behaviours in young people. Our hospital admissions outcome only captures individuals who sustained serious injuries; more minor cycle injuries would have been treated in A&E but a lack of detail in admission codes precludes analysis of such data.