title: Does involvement in a cohort study improve health and affect health inequalities? A natural experiment.
abstract: Evidence suggests that the process of taking part in health research can improve participants' health, independent of any intended intervention. However, no research has yet explored whether these effects differ across socioeconomic groups. If the effect of mere participation in health research also has a social gradient this could increase health inequalities and bias research results. This study used the Born in Bradford family cohort (BIB) to explore whether simply taking part in BIB had improved participants' health and, if so, whether this effect was mediated by socioeconomic status.
  
  
  
  Survey data on self-reported health behaviours were collected between 2007 and 2010 as part of BIB. These were augmented by clinical data on birth weight. Pregnant women on their second pregnancy, joining BIB for the first time formed the control group. Their health was compared to women on their second pregnancy who had both pregnancies within the study, who formed the exposed group. In order to limit the inherent bias in a non-randomised study, propensity score analysis was used, matching on age, ethnicity, education and date of questionnaire. The results were then compared according to mothers' education.
  
  
  
  Of six outcomes tested, only alcohol consumption showed a statistically significant reduction with exposure to BIB (OR: 0.35, 95% CIs 0.13, 0.92). Although effect estimates were larger for women with higher education compared to lower education, these effects were not statistically significant.
  
  
  
  Despite one significant finding, these results overall are insufficient to conclude that simply taking part in BIB affected participants' health. We recommend that socioeconomic status is considered in future studies testing effects of research participation, and that randomised studies with larger sample sizes are conducted.
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK. annie.quick@neweconomics.org.
authors.forename: Annie
authors.identifier: 0000-0001-9224-7331
authors.initials: A
authors.lastname: Quick
authors.affiliation: Mental Health and Addiction Research Group (MHARG), Hull York Medical School and Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Jan R
authors.initials: JR
authors.lastname: Böhnke
authors.affiliation: Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Pickett
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015987:Effect Modifier, Epidemiologic; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D011247:Pregnancy; D057216:Propensity Score; D012923:Social Class; D011795:Surveys and Questionnaires
keywords: Born in Bradford; Hawthorne effect; Health inequalities; Mere measurement