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van Zwieten A, Teixeira-Pinto A, Lah S, Nassar N, Craig JC, Wong G. Life-Course Approaches to Socioeconomic Inequities in Educational Outcomes Across Childhood and Adolescence: An Update. Acad Pediatr 2024:S1876-2859(24)00117-7. [PMID: 38561060 DOI: 10.1016/j.acap.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Anita van Zwieten
- Sydney School of Public Health (A van Zwieten, A Teixeira-Pinto, and G Wong), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research (A van Zwieten, A Teixeira-Pinto, and G Wong), The Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Armando Teixeira-Pinto
- Sydney School of Public Health (A van Zwieten, A Teixeira-Pinto, and G Wong), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research (A van Zwieten, A Teixeira-Pinto, and G Wong), The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Suncica Lah
- School of Psychology (S Lah), University of Sydney, Sydney, NSW, Australia; Australian Research Council Centre of Excellence for Cognition and Its Disorders (ARC CCD) (S Lah), Macquarie University, Sydney, NSW, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research (N Nassar), Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health (JC Craig), Flinders University, Adelaide, SA, Australia
| | - Germaine Wong
- Sydney School of Public Health (A van Zwieten, A Teixeira-Pinto, and G Wong), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research (A van Zwieten, A Teixeira-Pinto, and G Wong), The Children's Hospital at Westmead, Westmead, NSW, Australia; Department of Renal Medicine (G Wong), Westmead Hospital, Westmead, NSW, Australia
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Goldfeld S, Downes M, Gray S, Pham C, Guo S, O'Connor E, Redmond G, Azpitarte F, Badland H, Woolfenden S, Williams K, Priest N, O'Connor M, Moreno-Betancur M. Household income supplements in early childhood to reduce inequities in children's development. Soc Sci Med 2024; 340:116430. [PMID: 38048739 DOI: 10.1016/j.socscimed.2023.116430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/03/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health. METHODS Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0-1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4-5 years, and an intermediate outcome, parental mental health (poor versus good) at 2-3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0-1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated. RESULTS A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864). CONCLUSIONS Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
| | - Marnie Downes
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah Gray
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Cindy Pham
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Gerry Redmond
- College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Francisco Azpitarte
- School of Social Sciences, Loughborough University, Loughborough, United Kingdom
| | - Hannah Badland
- Social and Global Studies Centre, RMIT University, Melbourne, Australia
| | - Sue Woolfenden
- Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Australia; Discipline of Pediatrics, University of New South Wales, Sydney, Australia
| | - Katrina Williams
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Naomi Priest
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Social Research & Methods, The Australian National University, Canberra, Australia
| | - Meredith O'Connor
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Melbourne Children's LifeCourse Initiative, Murdoch Children's Research Institute, Melbourne, Australia; Faculty of Education, University of Melbourne, Melbourne, Australia
| | - Margarita Moreno-Betancur
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Dickerson J, Bridges S, Willan K, Kelly B, Moss RH, Lister J, Netkitsing C, Atkinson AL, Bird PK, Uphoff EP, Mason D, Newsham A, Waiblinger D, Razaq R, Ahern S, Bryant M, Blower SL, Pickett KE, McEachan RM, Wright J. Born in Bradford's Better Start (BiBBS) interventional birth cohort study: Interim cohort profile. Wellcome Open Res 2023; 7:244. [PMID: 37830108 PMCID: PMC10565418 DOI: 10.12688/wellcomeopenres.18394.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
Background: The Born in Bradford's Better Start (BiBBS) interventional birth cohort study was designed as an innovative cohort platform for efficient evaluation of early life interventions delivered through the Better Start Bradford programme. There are a growing number of interventional cohorts being implemented internationally. This paper provides an interim analysis of BiBBS in order to share learning about the feasibility and value of this method. Methods: Recruitment began in January 2016 and will complete in December 2023 with a target sample of 5,000 pregnancies. An interim analysis was completed for all pregnancies recruited between January 2016 and November 2019 with an expected due date between 1 st April 2016 and 8 th March 2020. Descriptive statistics were completed on the data. Results: Of 4,823 eligible pregnancies, 2,626 (54%) pregnancies were recruited, resulting in 2,392 mothers and 2,501 children. The sample are representative of the pregnant population (61% Pakistani heritage; 12% White British; 8% other South Asian and 6% Central and Eastern European ethnicity). The majority of participants (84%) live in the lowest decile of the Index of Multiple Deprivation, and many live in vulnerable circumstances. A high proportion (85%) of BiBBS families have engaged in one or more of the Better Start Bradford interventions. Levels of participation varied by the characteristics of the interventions, such as the requirement for active participation and the length of commitment to a programme. Conclusions: We have demonstrated the feasibility of recruiting an interventional cohort that includes seldom heard families from ethnic minority and deprived backgrounds. The high level of uptake of interventions is encouraging for the goal of evaluating the process and outcomes of multiple early life interventions using the innovative interventional cohort approach. BiBBS covers a period before, during and after the coronavirus disease 2019 (COVID-19) pandemic which adds scientific value to the cohort.
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Affiliation(s)
- Josie Dickerson
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Sally Bridges
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Kathryn Willan
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Brian Kelly
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Rachael H. Moss
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Jennie Lister
- Health Sciences, University of York, York, YO10 5DD, UK
| | - Chandani Netkitsing
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
- Health Sciences, University of York, York, YO10 5DD, UK
| | - Amy L. Atkinson
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Philippa K. Bird
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Dan Mason
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Alex Newsham
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Dagmar Waiblinger
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Rifat Razaq
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Sara Ahern
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Maria Bryant
- Health Sciences, University of York, York, YO10 5DD, UK
- Hull York Medical School, University of York, York, YO10 5DD, UK
| | | | | | - Rosemary M. McEachan
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - John Wright
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
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Dickerson J, Bridges S, Willan K, Kelly B, Moss RH, Lister J, Netkitsing C, Atkinson AL, Bird PK, Uphoff EP, Mason D, Newsham A, Waiblinger D, Razaq R, Ahern S, Bryant M, Blower SL, Pickett KE, McEachan RM, Wright J. Born in Bradford's Better Start (BiBBS) interventional birth cohort study: Interim cohort profile. Wellcome Open Res 2023; 7:244. [PMID: 37830108 PMCID: PMC10565418 DOI: 10.12688/wellcomeopenres.18394.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 06/08/2024] Open
Abstract
Background: The Born in Bradford's Better Start (BiBBS) interventional birth cohort study was designed as an innovative cohort platform for efficient evaluation of early life interventions delivered through the Better Start Bradford programme. There are a growing number of interventional cohorts being implemented internationally. This paper provides an interim analysis of BiBBS in order to share learning about the feasibility and value of this method. Methods: Recruitment began in January 2016 and will complete in December 2023 with a target sample of 5,000 pregnancies. An interim analysis was completed for all pregnancies recruited between January 2016 and November 2019 with an expected due date between 1 st April 2016 and 8 th March 2020. Descriptive statistics were completed on the data. Results: Of 4,823 eligible pregnancies, 2,626 (54%) pregnancies were recruited, resulting in 2,392 mothers and 2,501 children. The sample are representative of the pregnant population (61% Pakistani heritage; 12% White British; 8% other South Asian and 6% Central and Eastern European ethnicity). The majority of participants (84%) live in the lowest decile of the Index of Multiple Deprivation, and many live in vulnerable circumstances. A high proportion (85%) of BiBBS families have engaged in one or more of the Better Start Bradford interventions. Levels of participation varied by the characteristics of the interventions, such as the requirement for active participation and the length of commitment to a programme. Conclusions: We have demonstrated the feasibility of recruiting an interventional cohort that includes seldom heard families from ethnic minority and deprived backgrounds. The high level of uptake of interventions is encouraging for the goal of evaluating the process and outcomes of multiple early life interventions using the innovative interventional cohort approach. BiBBS covers a period before, during and after the coronavirus disease 2019 (COVID-19) pandemic which adds scientific value to the cohort.
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Affiliation(s)
- Josie Dickerson
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Sally Bridges
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Kathryn Willan
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Brian Kelly
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Rachael H. Moss
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Jennie Lister
- Health Sciences, University of York, York, YO10 5DD, UK
| | - Chandani Netkitsing
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
- Health Sciences, University of York, York, YO10 5DD, UK
| | - Amy L. Atkinson
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Philippa K. Bird
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Dan Mason
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Alex Newsham
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Dagmar Waiblinger
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Rifat Razaq
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Sara Ahern
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - Maria Bryant
- Health Sciences, University of York, York, YO10 5DD, UK
- Hull York Medical School, University of York, York, YO10 5DD, UK
| | | | | | - Rosemary M. McEachan
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
| | - John Wright
- Born in Bradford, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, BD9 6RJ, UK
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A Review on Early Intervention Systems. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2023; 10:147-153. [PMID: 36845328 PMCID: PMC9937857 DOI: 10.1007/s40474-023-00274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/20/2023]
Abstract
Purpose of Review Early intervention programs have been shown to increase the overall socio-emotional and physical wellbeing of children in early childhood and educational settings. The goal of this narrative review is to explore recent literature that describes implementation of these systems and highlights innovative practices in the early childhood intervention sector. Recent Findings Twenty-three articles were included, and we identified three themes in this review. The literature addressed concepts of innovative techniques in relation to childhood disability interventions; policy practices that promote child, family, and practitioner wellbeing; and attention to the importance of trauma-informed care in education for children and families who face the impacts of social marginalization such as racism and colonization. Summary Notable shifts in the current early intervention paradigms are approaches to understanding disability informed by intersectional and critical theories, as well as systems level thinking that goes beyond focusing on individual intervention by influencing policy to advance innovative practice in the sector.
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Bywater T, Berry V, Blower S, Bursnall M, Cox E, Mason-Jones A, McGilloway S, McKendrick K, Mitchell S, Pickett K, Richardson G, Solaiman K, Teare MD, Walker S, Whittaker K. A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/bcfv2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.
Objectives
To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.
Design
A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).
Setting
The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.
Participants
A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.
Intervention
Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].
Main outcome measures
Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.
Results
The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.
Limitations
The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.
Conclusions
The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.
Future work
The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.
Trial registration
This trial is registered as ISRCTN11079129.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | | | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | | | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, Ireland
| | | | - Siobhan Mitchell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | - M Dawn Teare
- Sheffield Clinical Trials Research Unit, Sheffield, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
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Inequities in Children's Reading Skills: The Role of Home Reading and Preschool Attendance. Acad Pediatr 2021; 21:1046-1054. [PMID: 33933683 DOI: 10.1016/j.acap.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children. METHODS We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0-1 year) on children's reading skills (8-9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2-5 years) and preschool attendance (4-5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. RESULTS Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%-24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%-22.7%) higher risk of poor reading outcomes in absolute terms. CONCLUSION There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.
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Childhood disadvantage, neurocognitive development and neuropsychiatric disorders: Evidence of mechanisms. Curr Opin Psychiatry 2021; 34:306-323. [PMID: 33587493 PMCID: PMC9458466 DOI: 10.1097/yco.0000000000000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children living in socioeconomically disadvantaged households have excess risks of neurodevelopmental and neuropsychiatric problems. The purpose of this review is to synthesize evidence for mechanisms that may contribute to these excess risks. RECENT FINDINGS The majority of the 60 studies included in our review focused on children's neurocognitive development and behavioural problems. About half conducted mediation analyses of factors in the family and neighbourhood environments, including access to resources (e.g. cognitive inputs within the home environment) and exposure to stressors (e.g. negative parenting practices), as well as neurobiological embedding of childhood disadvantage. In addition, many studies conducted moderation analyses of factors that were hypothesized to interact with (i.e. exacerbate or mitigate) the harmful effects of childhood disadvantage. SUMMARY Many of the factors that contribute to the excess risk of neurodevelopmental and neuropsychiatric problems among children in disadvantaged households are potentially modifiable (e.g. cognitively stimulating materials, parental language input, cultural resources, parental stress and psychopathology, negative parenting, neighbourhood violence). If their causality is ultimately established, they could be targets for the prevention and reduction of disparities. The continued search for mechanisms should not detract from work to reduce and hopefully eliminate children's exposure to disadvantage.
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Molloy C, Moore T, O'Connor M, Villanueva K, West S, Goldfeld S. A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood. Acad Pediatr 2021; 21:236-243. [PMID: 33359515 DOI: 10.1016/j.acap.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.
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Affiliation(s)
- Carly Molloy
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Tim Moore
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Meredith O'Connor
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Karen Villanueva
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Centre for Urban Research, RMIT University (K Villanueva), Melbourne, Victoria, Australia
| | - Sue West
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia.
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O'Connor M, Romaniuk H, Gray S, Daraganova G. Do risk factors for adolescent internalising difficulties differ depending on childhood internalising experiences? Soc Psychiatry Psychiatr Epidemiol 2021; 56:183-192. [PMID: 32785754 DOI: 10.1007/s00127-020-01931-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to examine the continuity of internalising difficulties from childhood to adolescence, and determine if the influence of established risk factors on adolescent mental health differed depending on childhood internalising experiences. METHODS Data were used from the Kindergarten cohort of the Longitudinal Study of Australian Children (LSAC, N = 4983, est. 2004). Internalising difficulties were measured via parent report on the Strengths and Difficulties Questionnaire (SDQ) at each wave from 4-5 to 14-15 years of age, and defined as symptoms in the borderline or abnormal range (≥ 4). Logistic generalised estimating equations were used to characterise associations between childhood internalising problems (4-9 years) and previously identified risk factors with adolescent internalising difficulties at three time points (10-11, 12-13 and 14-15 years). RESULTS The risk of internalising problems was elevated at each adolescent age for those who previously experienced internalising symptoms in childhood compared to those who did not (10-11 years: OR 3.67, 95% CI 3.01-4.47, 12-13 years: OR 2.84, 95% CI 2.32-3.46, and 14-15 years: OR 2.33, 95% CI 1.90-2.87). Other known risk factors were found to be associated with adolescent internalising problems as expected. We found no statistical evidence that these associations differed for adolescents who previously experienced internalising symptoms in childhood. CONCLUSION Findings of this study confirm the continuity of childhood mental health problems and the role of individual and family characteristics in the aetiology of adolescent internalising difficulties. The same risk factors appear relevant to target for adolescents who first experienced internalising symptoms in childhood.
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Affiliation(s)
- Meredith O'Connor
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
| | - Helena Romaniuk
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Sarah Gray
- Murdoch Children's Research Institute, Melbourne, Australia
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Short K, Eadie P, Kemp L. Influential factor combinations leading to language outcomes following a home visiting intervention: A qualitative comparative analysis (QCA). INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:936-954. [PMID: 33051961 DOI: 10.1111/1460-6984.12573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children who experience adversity are more vulnerable to language difficulties. Early interventions beginning antenatally, such as home visiting, are provided to help prevent these problems. To improve the precision of early interventions, the impact of combinations of risk and protective factors over time must be explored and understood. There is, however, limited research investigating how such factors interact with intervention to change language outcomes over time. AIM To explore the different paths that lead to Good and Poor language in a cohort of children experiencing adversity whose mothers received an optimal dose of the Maternal Early Childhood Sustained Home visiting (MECSH) intervention over 2.5 years. METHODS & PROCEDURES A total of 24 low socioeconomic status (SES) mothers experiencing adversity and their children who received more than half the scheduled dose of the MECSH intervention were followed over time: from before birth to school entry. Data were extracted from surveys and direct measurement over the study course. Child language outcome at school entry and the influence of seven key child, maternal and environmental factors, which have been shown in previous research to result in Good and Poor language outcomes, were explored through qualitative comparative analysis (QCA). QCA is a qualitative analytical technique that provides a deeper understanding of factor combinations influencing language development. OUTCOMES & RESULTS Multiple paths to Good (six paths) and Poor language (seven paths) were found. Paths with mostly protective factors resulted in Good language, except when maternal antenatal distress was present. Paths with two or more influential risks usually resulted in Poor language outcomes. When children experiencing adversity received the MECSH home visiting intervention, there was no one risk or protective factor necessary for Good or Poor language outcomes; however, there were clear patterns of factor combinations. CONCLUSIONS & IMPLICATIONS Mothers' antenatal psychological resources were a flag for future language concerns which can be used to improve the precision of the MECSH intervention. They were highly influential to their children's Good and Poor language outcomes by 5 years, when over time they were combined with characteristics such as early childhood education, poor maternal responsivity and/or the number of children in the home. Knowledge of early conditions associated with later Poor language can help clinicians identify and respond in preventative and promoting ways to improve language skills. What this paper adds What is already known on the subject Children experiencing adversity are more vulnerable to language difficulties. Both risk for language difficulties and protection against them in this group are via a complex combination of factors. It is unknown how intervention works with these complex factors to result in Good and Poor language outcomes. What this paper adds to existing knowledge There are multiple paths to both Good and Poor language outcomes for children experiencing adversity. Mothers' psychological resources antenatally in combination with other key factors were particularly influential to Good and Poor language outcomes. What are the clinical implications of this work? In this study, maternal antenatal distress together with poor maternal responsivity were present in children's paths to Poor language outcomes at school entry. An extra focus on responsivity is required in antenatally distressed mothers of children experiencing adversity in early interventions. Children of mothers with good psychological resources antenatally who received home visiting intervention had Good language outcomes at 5 years when combined with 3 years or more of early childhood education and if there were one to two children in the home. Knowledge of these influences on language development can improve the precision of home visiting interventions and help clinicians tailor their visits to individual families' needs.
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Affiliation(s)
- Kate Short
- School of Public Health and Community Medicine (SPHCM), University of New South Wales, Sydney, NSW, Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
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Wake M, Hu YJ, Warren H, Danchin M, Fahey M, Orsini F, Pacilli M, Perrett KP, Saffery R, Davidson A. Integrating trials into a whole-population cohort of children and parents: statement of intent (trials) for the Generation Victoria (GenV) cohort. BMC Med Res Methodol 2020; 20:238. [PMID: 32972373 PMCID: PMC7512047 DOI: 10.1186/s12874-020-01111-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Very large cohorts that span an entire population raise new prospects for the conduct of multiple trials that speed up advances in prevention or treatment while reducing participant, financial and regulatory burden. However, a review of literature reveals no blueprint to guide this systematically in practice. This Statement of Intent proposes how diverse trials may be integrated within or alongside Generation Victoria (GenV), a whole-of-state Australian birth cohort in planning, and delineates potential processes and opportunities. Methods Parents of all newborns (estimated 160,000) in the state of Victoria, Australia, will be approached for two full years from 2021. The cohort design comprises four elements: (1) consent soon after birth to follow the child and parent/s until study end or withdrawal; retrospective and prospective (2) linkage to clinical and administrative datasets and (3) banking of universal and clinical biosamples; and (4) GenV-collected biosamples and data. GenV-collected data will focus on overarching outcome and phenotypic measures using low-burden, universal-capable electronic interfaces, with funding-dependent face-to-face assessments tailored to universal settings during the early childhood, school and/or adult years. Results For population or registry-type trials within GenV, GenV will provide all outcomes data and consent via traditional, waiver, or Trials Within Cohorts models. Trials alongside GenV consent their own participants born within the GenV window; GenV may help identify potential participants via opt-in or opt-out expression of interest. Data sharing enriches trials with outcomes, prior data, and/or access to linked data contingent on custodian’s agreements, and supports modeling of causal effects to the population and between-trials comparisons of costs, benefits and utility. Data access will operate under the Findability, Accessibility, Interoperability, and Reusability (FAIR) and Care and Five Safes Principles. We consider governance, ethical and shared trial oversight, and expectations that trials will adhere to the best practice of the day. Conclusions Children and younger adults can access fewer trials than older adults. Integrating trials into mega-cohorts should improve health and well-being by generating faster, larger-scale evidence on a longer and/or broader horizon than previously possible. GenV will explore the limits and details of this approach over the coming years.
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Affiliation(s)
- Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Yanhong Jessika Hu
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Hayley Warren
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Michael Fahey
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.,Monash Children's Hospital, Clayton, VIC, 3168, Australia
| | - Francesca Orsini
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.,Monash Children's Hospital, Clayton, VIC, 3168, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Andrew Davidson
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
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Goldfeld S. The potential of proportionate universal health services. Acta Paediatr 2020; 109:1700-1702. [PMID: 32394543 DOI: 10.1111/apa.15279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health Royal Children's Hospital Parkville Vic. Australia
- Population Health Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Paediatrics University of Melbourne Parkville Vic. Australia
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