Professor Theresa Marteau, Director of the Behaviour and Health Research Unit (BHRU) and member of Cambridge Institute of Public Health, has been appointed a Dame Commander of the Order of the British Empire for her services to public health in this year’s Queen’s Birthday Honours.
Her research focuses on behaviour change to prevent inactivity, smoking, and the excessive consumption of food and alcohol. By developing and evaluating effective ways of changing these four behaviours, she and her team at BHRU seek to prevent non-communicable diseases, including many cancers, cardiovascular disease and diabetes, and ultimately improve population health and reduce health inequalities.
To recognise her achievement and celebrate the Institute’s first Dame we interviewed Professor Marteau. The below Q&A shines a spotlight on her work:
Q: How does it feel to receive a damehood for your services to public health?
A: This is a huge honour. It is wonderful to have recognition for the contribution that behavioural science can make to improving the health of the population. I am also proud to be a role model to more junior women scientists.
Q: How did you first become interested in your areas of study?
A: My interest in behaviour and in particular the gap between what we believe drives our behaviour and what actually does, stems from my first degree during which I learned about the social psychologists who worked after the second world war to understand “man’s inhumanity to man.” The work of Milgram and others brilliantly highlighted that situations often exert a far greater impact on our behaviour than our values—an observation that informs much of my research today. For about 15 years, though, my focus on behaviour was less on situations and more on risk communication and perception. This work focused on the question of whether being given a personalised risk of developing diabetes, cancer or other potentially preventable diseases based on genetic tests might prompt a change in behaviour to reduce those risks. The results from this and other work using different biological markers of disease shows that while personalised risk information may alter a person’s perception of risk and sometimes intention to change behaviour, taking the evidence as a whole, personalised risk information does not change behaviour.
Formulating the reasons for these intriguing findings shifted my research away from information-based interventions aimed at motivating individuals to resist environments that readily cue unhealthy behaviour, towards less conscious routes to behaviour change involving redesigning environments to more readily cue healthier behaviour.
These cues include the design of cigarette packets, tableware and drinking glasses. The impact of some of these cues on our behaviour can be large and most often operate outside conscious awareness. For example, from the results of our systematic review of 61 experimental studies, we estimate that removing larger sized portions, packages and tableware would reduce the daily energy intake in UK adults by up to 16 per cent (279 calories).
The Herculean global research challenge now is to systematically describe the characteristics of the many overlapping environments in which we live and that shape our behaviour – for good and ill – often without our awareness – including physical, digital, economic, and social ones.
Q: How are you using cutting edge methods in your public health research?
A: In our systematic reviews, we are using text mining to manage the workload generated by searches that, by the nature of the literatures and interventions we are focused on, generate a huge number of records. This automated technology assists in prioritising retrieved study records for manual screening.
We also use a range of other methods in our research including laboratory and field studies. We use laboratory-based studies for two purposes: first, developing interventions prior to testing them in field settings to estimate their effect sizes; and, second, to understand the mechanisms by which interventions have their effects, so we can optimise them. Our recent studies of wine glass size and consumption illustrate the synergies between laboratory and field studies. We first conducted an online lab-based study in which people judged the volumes of wine contained in different sized glasses. Larger glasses were perceived to contain less, given the same actual portion. We hypothesised that this increases drinking speed and overall consumption. We tested this in a field study conducted in a bar. We did indeed find that serving wine in larger glasses increased sales, our measure of consumption, by just over 9%. We are now designing laboratory studies to assess the mechanisms that underlie this effect with a view to selecting glasses for future field studies to reduce consumption.
Q: What are you currently working on?
A: Our current research includes several field studies which pose an extraordinary array of challenges both in their design and execution. We are using a stepped wedge design to assess the impact on sales of calories of several interventions in 18 worksite cafeterias. These interventions include altering the availability of less and more healthy foods, and reducing portion sizes. While stepped wedge designs are efficient for attempting to infer causality using a relatively small set of sites they pose challenges of interpretation, particularly when using endpoints for which there is little knowledge of their natural variation over time. We have just started a pilot study for an even more challenging field study to be conducted in people’s homes assessing the impact on wine consumption from smaller (37.5cl) and larger (75cl) bottles of wine. This involves overcoming such challenges as the need to have a license to sell alcohol, recruiting households willing to receive wine in either size bottle and to have their consumption monitored.
Much of this research is pioneering in the sense that few others have attempted to estimate effect sizes of the types of interventions we are focused on in real life settings. We are committed to generating evidence that is reproducible, using the Open Science Framework to pre-register our studies which includes having available all the details of their design and execution. I don’t doubt that in the coming few years these designs and their execution will become far more efficient and the studies far more common place as we work towards the global goal of realising environments that more readily enable healthier behaviour. In this way, we can look forward to avoiding up to 40% of cancers and 75% of diabetes and cardiovasular disease – a huge prize that spurs us all on.
Read this case study to find out how Professor Marteau’s work is impacting the national debate on obesity