Understanding the dimensions of socioeconomic status that influence toddlers' health: unique impact of lack of money for basic needs in Quebec's birth cohort

The Moderating Role of Maternal Education and Employment on Child Health in Pakistan

BACKGROUND

Pakistan has challenges in fulfilling its universal responsibilities of providing better health facilities to everyone. The Sustainable Development Goals (SDGs) aim to reduce maternal and infant mortality rates. Despite declines in mother and child death, the total mortality ratio has marginally increased. However, neonatal death has not decreased significantly. Family planning is important for controlling population growth and improving child as well as maternal health. Pakistan's government has unceasingly tried to enhance the provision of contraceptive facilities, but still, an unmet need for family planning (UMNFP) exists in our country. Women are said to have UMNFP if they want to limit or space childbearing, but they are not using contraception methods for any reason. The study aimed to explore the effect of the UMNFP and to investigate the moderating role of a mother's education and employment status on a child's health.

METHODS

We analyzed the data of 2,244 women in this study. To investigate the study objectives, we utilized the secondary dataset of the Pakistan Demographic and Health Survey (PDHS) 2017-18 (publicly available on the website of the National Institute of Population Studies) and applied binary logistic regression using SPSS 24.

RESULTS

Results suggest a positive effect of a woman's age (25 to 39 years), maternal education (higher), father's education (higher), family's wealth status (richest), mass media exposure, and adequate birth spacing (at least for 33 months) on a child's health. On the other hand, there is an indirect association between maternal employment, unmet need for family planning, and a child's health. The moderating role of maternal education and employment on the relationship between household wealth status and a child's health is positive.

CONCLUSIONS

We conclude that the strong predictors of child health are UMNFP, maternal education, and employment. The link between the met need for family planning and the child's health is positive. The moderating effect of maternal education and household wealth status on a child's health is progressive. Similarly, the interaction effect of a mother's employment and household wealth status on a child's health is positive. Finally, we concluded that the link between the health of the child and household wealth status is much more diverse and positive when the mother is highly educated and currently employed.

Somatotypological features of men of working age – natives of the North

Anthropometry is known as the basic method for the body physical status assessment.

The aim. The study examined anthropometric and somatometric indices in the working age men and investigated physical development variables specific for the region in terms of being used for early diagnosing obesity-related risks for non-infectious diseases.

Materials and methods. One hundred and twenty-three male subjects aged 32–40 participated in the survey (mean age was 35.2 ± 0.2 years). Subjective main physical

development parameters were analyzed.

Results. Participants’ average body length variables were seen to be significantly higher than those in other Russia’s regions and some other countries. The similar tendency was observed for subjective body mass, chest circumference, and body mass index variables with disharmonic somatotype and hypersthenic type of body constitution revealed in examined working age men in comparison with younger male subjects. Musculoskeletal mass loss and fat accumulation indicate the development tendency of sarcopenia in men of working age. Excessive body weight prevalence in 32–40-year-old men was 47 %, and 17 % of the examinees were diagnosed with 1st degree obesity.

Conclusion. The survey identified the modern population of male northerners as having negative tendencies in their somatometric picture, which involves disharmonic somatotype, sarcopenia, excessive body weight, and 1st degree obesity and results in significant risks for non-infectious inflammation and cardiovascular diseases at the studied age.

Predictors of Child's Health in Pakistan and the Moderating Role of Birth Spacing

There is a consensus that better health should be viewed both as a means and an end to achieve development. The level of development should be judged by the health status of the population and the fair distribution of health services across the people. Many determinants affect a child’s health. This study aimed to explore a child’s health predictors and the moderating role of birth spacing on the association between mother’s health care services utilization (MHCSU) and a child’s health. In this study, we used the dataset of Pakistan Demographic and Health Survey 2017-18 to explore the predictors of child health and the moderating role of birth spacing through binary logistic regression, using SPSS version 20. The results showed an association of mother’s age (35 to 49 years), her education (at least secondary), health care services (more accessible), father’s education (at least secondary), their wealth status (high), and exposure to mass media to improved child health. However, the effect of a mother’s employment status (employed) on her child’s health is significant and negative. The coefficient of moderation term indicated that the moderating role of birth spacing on the association between MHCSU and a child’s health is positive. We conclude that birth spacing is a strong predictor for improving a child’s health. The association between MHCSU and child’s health is more distinct and positive when the birth spacing is at least 33 months.

Occupying 'in-hospitable' spaces: Parental/primary-caregiver perceptions of the impact of repeated hospitalisation in children under two years of age

The experience of having a child hospitalised is stressful and disrupts families in myriad ways; however, the experiences of parents/caregivers who encounter repeated admissions of a child with acute lower respiratory infections are under-researched. This project aims to explore these experiences, from a qualitative perspective, using the philosophical tenets of reflective lifeworld research. The research included 14 face-to-face interviews with parents, grandparents, or primary caregivers, of children who, whilst under two years of age, were admitted to hospital multiple times with a lower respiratory infection diagnosis. Many of the participants were from Māori or Samoan ethnic backgrounds. The findings of this single site study revealed that these parents/caregivers' experiences were characterised by feelings of powerlessness, offering descriptions of hospitals as harsh and difficult places to reside, they are 'in-hospitable'. The findings suggest that repeated hospitalisations created a cycle of stressful experiences that impacted both familial relationships and interactions with society. This study draws attention to this previously obscured population group, and calls health care practitioners and policy advisors to engage differently over issues involving families in similar positions.

The Relation Between Household Food Insecurity and Children's Height in Canada and the United States: A Scoping Review

Household food insecurity is a determinant of health and marker of material deprivation. Although research has shown that food insecurity is associated with numerous adverse health, developmental and nutritional outcomes among children in high-income countries, little is known about its impact on children's height, an important marker of nutritional status and physical development. We reviewed evidence on the relation between experience-based measures of food insecurity and the height of children aged 0-18 y in Canada and the United States. The search, conducted in Embase, Medline, CINAHL, ProQuest, Web of Science, and EconLit from the inception of the databases to October 2017, identified 811 records that were screened for relevance. A total of 8 peer-reviewed studies, 2 from Canada and 6 from the United States, met the inclusion criteria and were summarized. Five studies found no association between food insecurity and children's height. One study found that having taller children in the household predicted more severe food insecurity, whereas 2 studies found that more severe experiences of food insecurity were associated with shorter height among children from ethnic minority populations. These results suggest that household food insecurity may not be associated with height inequalities among children in Canada and the United States, except perhaps in certain high-risk populations. However, the few studies identified for review provide insufficient evidence to determine whether food insecurity is or is not associated with children's height in these countries. Given the importance of optimal linear growth for current and future well-being, it is critical to understand how different modifiable environmental circumstances relate to children's height to help establish priorities for intervention. Families with children are disproportionately affected by food insecurity, and more research explicitly designed to examine the association between household food insecurity and children's height in high-income countries is needed.

Effects on developmental outcomes after cesarean birth versus vaginal birth in Chinese children aged 1-59 months: a cross-sectional community-based survey

OBJECTIVE

It is controversial whether the mode of delivery is associated with developmental outcome, and little was known about growth and development of cesarean children in poor rural areas in China. We aim to measure the development of both cesarean and vaginal-delivered children by Ages and Stages Questionnaires (ASQ) and explore the association between mode of delivery and developmental outcome in poor rural areas in China.

METHODS

Data were collected from a cross-sectional community-based survey, which recruited 1,755 vaginal delivered and cesarean children ages 1 to 59 months in eight counties of China. Caregivers of those children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination andquestionnaires on socio-demographic and neonatal characteristics were conducted. Multivariate logistic regressions were used to measure the association between developmental delay and mode of delivery as well as each socio-demographic factor, respectively, after adjusting other socio-demographic characteristics.

RESULTS

The prevalence of suspected overall developmental delay was 23.4% in the cesarean group, compared with 21.3% in the vaginal delivered group, yet without statistical difference (p < 0.05). Developmental delay was also not significantly different between cesarean and vaginal delivered group in five ASQ domains of communication (7.7% vs. 7.8%, p = 0.949), fine motor (7.0% vs. 6.1%, p = 0.538), gross motor (8.5% vs. 6.4%, p = 0.154), problem solving (7.2% vs. 6.7%, p = 0.722) and personal social (8.0% vs. 7.9%, p = 0.960).

CONCLUSIONS

Our findings suggest that cesarean delivery does not increase or decrease the risk of suspected developmental in children delay as compared with vaginal delivery.

Assessment of risk factors for developmental delays among children in a rural community of North India: A cross-sectional study

BACKGROUND

Initial formative years in every children's life are critical for their optimal development, as these frame the foundation of future well-being. With a varied prevalence of developmental delays (DDs) in the world and most of the studies representing the hospital-based data. The present study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged 2 months to 6 years in the rural area of North India.

METHODS

This was a cross-sectional study in which a multistage random sampling technique was used. From 30 Anganwadi centers, 450 children aged 2 months-6 years were taken in the study. Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family Welfare, India, was used for developmental screening. Binary logistic regression analysis was done to identify the predictors for DDs (domain wise).

RESULTS

Seventy-three (16.2%) children were found to have DDs and 60 (13.3%) children had the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%) children who had delay in speech and language area. About 17/190 (8.9%) children had social delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational age (adjusted odds ratio [AOR] - 13.30), complications during delivery (AOR - 25.79), meconium aspiration (AOR - 12.81), and child never breastfed (AOR - 8.34) were strong predictors for the delay in different domains of developmental milestones.

CONCLUSION

Socio-economic, ante-natal, natal and post-natal factors should be considered for prompt identification and initiation of intervention for DDs.

RECOMMENDATION

There is a need for increasing awareness and knowledge of parents regarding the achievement of developmental milestones according to the age. A multipronged approach to the holistic treatment of developmentally delayed children for early intervention is required.

Association between parental hospital-treated somatic illnesses in childhood and later mental disorders among offspring up to early adulthood: An explorative study in the 1987 Finnish Birth Cohort

Aims: Earlier studies on the associations between parental somatic illnesses and children’s psychological wellbeing have focused on the most common somatic illnesses or on specific groups of illnesses. In this study, we aimed to systematically examine whether parental somatic illnesses, diagnosed during an offspring’s childhood, are associated with later mental disorders of the offspring and, if so, identify which parental somatic illnesses in particular increase the likelihood for later mental disorders among the offspring. Methods: The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year. Children have been followed over time through to the year 2012 using official registers maintained by the Finnish authorities. Parental diagnoses of specialised hospital inpatient care were identified from the Hospital Discharge Register after children’s birth and followed up until the end of 1995. Children’s psychiatric diagnoses from specialised hospital care were identified from the same register for the periods 1996/1998–2012. Logistic regression analyses were used to calculate sex-specific odds ratios for associations of mental disorders with maternal and paternal somatic illnesses using parental death, education, social assistance and psychiatric inpatient care as covariates. Results: Parental somatic illnesses during an offspring’s childhood seem to increase the risk for later mental disorders. Several previously unreported somatic parental illnesses were found to be significantly associated with offspring’s later mental health. Conclusions: Parental somatic illnesses should be considered as a significant adverse childhood life event, calling for preventive actions and child-centred support in adult healthcare.

Prevalence of suspected developmental delays in early infancy: results from a regional population-based longitudinal study

Background

Prevalence estimates on suspected developmental delays (SDD) in young infants are scarce and a necessary first step for planning an early intervention. We investigated the prevalence of SDD at 4, 6 and 12 months, in addition to associations of SDD with gender, prematurity and maternal education.

Methods

This study is based on a Norwegian longitudinal sample of 1555 infants and their parents attending well-baby clinics for regular health check-ups. Moreover, parents completed the Norwegian translation of the Ages and Stages Questionnaires (ASQ) prior to the check-up, with a corrected gestational age being used to determine the time of administration for preterm infants. Scores ≤ the established cut-offs in one or more of the five development areas: communication, gross motor, fine motor, problem solving and personal-social, which defined SDD for an infant were reported. Chi-square tests were performed for associations between the selected factors and SDD.

Results

According to established Norwegian cut-off points, the overall prevalence of SDD in one or more areas was 7.0 % (10.3 % US cut-off) at 4 months, 5.7 % (12.3 % US cut-off) at 6 months and 6.1 % (10.3 % US cut-off) at 12 months. The highest prevalence of SDD was in the gross motor area at all three time points. A gestational age of < 37 weeks revealed a significant association with the communication SDD at 4 months, and with the fine motor and personal social SDD at 6 months. Gender was significantly associated with the fine motor and problem solving SDD at 4 months and personal- social SDD at 6 months: as more boys than girls were delayed. No significant associations were found between maternal education and the five developmental areas of the ASQ.

Conclusion

Our findings indicate prevalence rates of SDD between 5.7 and 7.0 % in Norwegian infants between 4 and 12 months of age based on the Norwegian ASQ cut-off points (10.3–12.3 %, US cut-off points). During the first year of life, delay is most frequent within the gross motor area. Special attention should be paid to infants born prematurely, as well as to boys. Separate norms for boys and girls should be considered for the ASQ.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0528-z) contains supplementary material, which is available to authorized users.

Parental socioeconomic status, childhood asthma and medication use--a population-based study

Background

Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children.

Methods

This register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression.

Results

Compared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09–1.31 for diagnosis and HR 1.17, 95% CI 1.08–1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77–0.92 for diagnosis, and HR 0.80, 95% CI 0.74–0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61–2.65) and outpatient (HR 1.32, 95% CI 1.18–1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates.

Conclusions

Our findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied.

Socioeconomic and sociodemographic factors associated with asthma related outcomes in early childhood: the Generation R Study

Rationale

Few studies have analyzed the association of socioeconomic and sociodemographic factors with asthma related outcomes in early childhood, including Fraction of exhaled Nitric Oxide (FeNO) and airway resistance (Rint). We examined the association of socioeconomic and sociodemographic factors with wheezing, asthma, FeNO and Rint at age 6 years. Additionally, the role of potential mediating factors was studied.

Methods

The study included 6717 children participating in The Generation R Study, a prospective population-based cohort study. Data on socioeconomic and sociodemographic factors, wheezing and asthma were obtained by questionnaires. FeNO and Rint were measured at the research center. Statistical analyses were performed using logistic and linear regression models.

Results

At age 6 years, 9% (456/5084) of the children had wheezing symptoms and 7% (328/4953) had asthma. Children from parents with financial difficulties had an increased risk of wheezing (adjusted Odds Ratio (aOR) = 1.63, 95% Confidence Interval (CI):1.18–2.24). Parental low education, paternal unemployment and child's male sex were associated with asthma, independent of other socioeconomic or sociodemographic factors (aOR = 1.63, 95% CI:1.24–2.15, aOR = 1.85, 95% CI:1.11–3.09, aOR = 1.58, 95% CI:1.24–2.01, respectively). No socioeconomic or gender differences in FeNO were found. The risks of wheezing, asthma, FeNO and Rint measurements differed between ethnic groups (p<0.05). Associations between paternal unemployment, child's sex, ethnicity and asthma related outcomes remained largely unexplained.

Conclusions

This study showed differences between the socioeconomic and sociodemographic correlates of wheezing and asthma compared to the correlates of FeNO and Rint at age 6 years. Several socioeconomic and sociodemographic factors were independently associated with wheezing and asthma. Child's ethnicity was the only factor independently associated with FeNO. We encourage further studies on underlying pathways and public health intervention programs, focusing on reducing socioeconomic or sociodemographic inequalities in asthma.

Low income/socio-economic status in early childhood and physical health in later childhood/adolescence: a systematic review

To systematically review the literature on the relationship between early childhood low income/socioeconomic status (SES) and physical health in later childhood/adolescence, to identify gaps in the literature and to suggest new avenues for research. A systematic search of electronic databases from their start date to November 2011 was conducted to identify prospective longitudinal studies in industrialized countries with a measure of low income/SES in the first 5 years of life and physical health outcomes in later childhood or adolescence. STROBE criteria were used to assess study quality. Risk estimates were expressed as odds ratios with 95 % confidence intervals where possible. Heterogeneity of studies precluded meta-analysis. Nine studies fulfilled the inclusion criteria. Significant associations of early childhood low income/SES with activity-limiting illness, parent-reported poor health status, acute and recurrent infections, increasing BMI percentile and hospitalization were reported. Results for parent-reported asthma were less consistent: there was a significant association with low income/SES in early childhood in 2 studies but null findings in 3 others. This systematic review of the association of early childhood low income/SES with physical health status in later childhood and adolescence shows that, in contrast to the extensive literature on the impact of poor childhood social circumstances on adult health, the evidence base is limited. The literature points to some associations of early low income/SES with later poor health status, but many key research questions remain unanswered. Implications for further research are considered.

Is the onset of disabling chronic conditions in later childhood associated with exposure to social disadvantage in earlier childhood? A prospective cohort study using the ONS Longitudinal Study for England and Wales

BACKGROUND

The aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, particularly the association with socio-economic status (SES). Very few studies have used longitudinal datasets to examine whether exposure to social disadvantage in early childhood increases the risk of developing chronic conditions in later childhood. Here we examine this association, and its temporal ordering, with onset of all-cause disabling chronic later childhood in children reported as free from disability in early childhood.

METHODS

The study comprised a prospective cohort study, using data from the Office for National Statistics Longitudinal Study (ONSLS) for England and Wales. The study sample included 52,839 children with complete data born between 1981-1991 with no disabling chronic condition/s in 1991. Index cases were children with disability recorded in 2001. Comparison cases were children with no recorded disability in 1991. A socio-economic disadvantage index (SDI) was constructed from data on social class, housing tenure and car/van access. Associations were explored with logistic regression modelling controlling sequentially for potentially confounding factors; age, gender, ethnicity and lone parenthood.

RESULTS

By 2001, 2049 (4%) had at least one disability. Socio-economic disadvantage, age, gender and lone parenthood but not ethnicity were significantly associated with onset of disabling chronic conditions. The SDI showed a finely graded association with onset of disabling chronic conditions in the index group (most disadvantaged OR 2·11 [CI 1·76 to 2·53]; disadvantaged in two domains OR 1·45 [CI 1·20 to 1·75]; disadvantaged in one domain OR 1·14 [CI 0·93 to 1·39] that was unaffected by age, gender and ethnicity and slightly attenuated by lone parenthood.

CONCLUSION

To our knowledge, this is the first study to identify socio-economic disadvantage in earlier childhood as a predisposing factor for onset of all-cause disabling chronic conditions in later childhood. Temporal ordering and gradation of the response indicate socio-economic disadvantage may play a causal role. This suggests that targeting preventative efforts to reduce socio-economic disadvantage in early childhood is likely to be an important public health strategy to decease health inequalities in later childhood and early adulthood.

Association between Household Income and Asthma Symptoms among Elementary School Children in Seoul

OBJECTIVES

This study examined the association between socioeconomic factors and asthma symptoms.

METHODS

A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms.

RESULTS

The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors (p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81).

CONCLUSIONS

It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.

Children of low socioeconomic status show accelerated linear growth in early childhood; results from the Generation R Study

OBJECTIVES

People of low socioeconomic status are shorter than those of high socioeconomic status. The first two years of life being critical for height development, we hypothesized that a low socioeconomic status is associated with a slower linear growth in early childhood. We studied maternal educational level (high, mid-high, mid-low, and low) as a measure of socioeconomic status and its association with repeatedly measured height in children aged 0-2 years, and also examined to what extent known determinants of postnatal growth contribute to this association.

METHODS

This study was based on data from 2972 mothers with a Dutch ethnicity, and their children participating in The Generation R Study, a population-based cohort study in Rotterdam, The Netherlands (participation rate 61%). All children were born between April 2002 and January 2006. Height was measured at 2 months (mid-90% range 1.0-3.9), 6 months (mid-90% range 5.6-11.4), 14 months (mid-90% range 13.7-17.9) and 25 months of age (mid-90% range 23.6-29.6).

RESULTS

At 2 months, children in the lowest educational subgroup were shorter than those in the highest (difference: -0.87 cm; 95% CI: -1.16, -0.58). Between 1 and 18 months, they grew faster than their counterparts. By 14 months, children in the lowest educational subgroup were taller than those in the highest (difference at 14 months: 0.40 cm; 95% CI: 0.08,0.72). Adjustment for other determinants of postnatal growth did not explain the taller height. On the contrary, the differences became even larger (difference at 14 months: 0.61 cm; 95% CI: 0.26,0.95; and at 25 months: 1.00 cm; 95% CI: 0.57,1.43)

CONCLUSIONS

Compared with children of high socioeconomic status, those of low socioeconomic status show an accelerated linear growth until the 18th month of life, leading to an overcompensation of their initial height deficit. The long-term consequences of these findings remain unclear and require further study.

Child asthma and change in elevated depressive symptoms among mothers of children of a birth cohort from Quebec

The authors examined the association between maternal reports of child asthma attacks since birth and occurrence of elevated maternal depressive symptoms at seventeen months postpartum in the present study. The modifying role of poverty in this association was also examined. Data from n = 1,696 mother-child dyads from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1998, were used. Maternal depressive symptoms were measured with an abridged and validated twelve-item version of the Center for Epidemiologic Studies Depression Scale. Maternal reports of child asthma attacks since birth in relation to the occurrence of maternal depressive symptoms at 17 months postpartum and the potential modifying role of poverty were tested using multiple logistic regression models. When mothers reported child asthma attacks, those without elevated depressive symptoms at 5 months postpartum had lower odds of elevated depressive symptoms one year later (OR = 0.2, 95% CI: 0.1-0.7). Poverty was associated with increased odds of elevated maternal depressive symptoms (OR = 2.4, 95% CI: 1.5-3.9), without interacting with child asthma. Through this study, the authors suggest that in mothers without elevated symptoms at 5 months, reported child asthma attacks since birth did not contribute one year later to new occurrence of depressive symptoms.

Maternal mental health and childrearing context in the development of children at 6, 18 and 36 months: a Taiwan birth cohort pilot study

BACKGROUND

This study investigated a possible pathway of the childrearing context and maternal mental health at 6 months, and how these factors influence children's development at 6, 18 and 36 months.

METHODS

Using random sampling, 2048 children and mothers were selected. The mother's health status was evaluated using the Taiwanese version of the 36-Item Short Form Health Survey (SF-36), and infant development was assessed using the high reliable Taiwan birth cohort study instrument. All data were collected using parental self-report, and were analysed using multiple linear regression analysis and further pathway using structural equation modelling.

RESULTS

This study showed that 12 factors effected children's development at 6 months, and some dissipated with growth. Of these, maternal education had an enduring effect on different domains of child development, and this effect intensified as the child grew older. Children who grew up in a family with more siblings would show a delay in language development at 6 months; they have a delay in motor and social development at 18 and 36 months. Additionally, maternal mental health effected the children's fine motor development at 6 months. However, this effect disappeared at 18 months, and influenced children's social development at 36 months.

CONCLUSIONS

This study demonstrated that the development of children at as young as 6 months is affected by various factors. These factors may dissipate, continue to influence child development up to 3 years of age, turn from being disadvantageous to beneficial, or affect different domains of child development. Also, parental self-report instrument might be has its limitation and could be contributed by several confounding factors. Thus, continuous longitudinal follow-up on changes in maternal conditions, family factors, and environmental factors is vital to understand how these early infantile factors affect each other and influence the developmental trajectories of children into early childhood.

Deliberation to enhance awareness of and prioritize socioeconomic interventions for health

Health disparities are, to a large extent, the result of socio-economic factors that cannot be entirely mitigated through the health care system. While an array of social services are thought to be necessary to address the social determinants of health, budget constraints, particularly in difficult economic times, limit the availability of such services. It is therefore necessary to prioritize interventions through some fair process. While it might be appropriate to engage in public deliberation to set priorities, doing so requires that the public accept such a deliberative process and appreciate the social determinants of health. We therefore analyzed the results of a study in which groups deliberated to prioritize socio-economic interventions to examine whether these two requirements can possibly be met and to explore the basis for their priorities. A total of 431 residents of Washington, D.C. with incomes under 200% of the federal poverty threshold participated in 43 groups to engage in a hypothetical exercise to prioritize interventions designed to ameliorate the social determinants of health within the constraints of a limited budget. Findings from pre- and post-exercise questionnaires demonstrate that the priority setting exercise was perceived as a fair deliberative process, and that following the deliberation, participants became more likely to agree that a broad number of determinants contribute to their health. Qualitative analysis of the group discussions indicate that participants prioritized interventions that would provide for basic necessities and improve community conditions, while at the same time addressing more macro-structural factors such as homelessness and unemployment. We conclude that engaging small groups in deliberation about ways to address the social determinants of health can both change participant attitudes and yield informed priorities that might guide public policy aimed at most affordably reducing health disparities.

Family poverty over the early life course and recurrent adolescent and young adult anxiety and depression: a longitudinal study

OBJECTIVES

We determined whether exposure to family poverty over a child's early life course predicts adolescent and young adult anxiety and depression.

METHODS

We used a birth cohort study of a sample of women in Brisbane, Australia, who were recruited in early pregnancy and whose children were followed up on at ages 14 and 21 years. Some 2609 mothers and adolescents provided usable data at the 14- and 21-year follow-ups.

RESULTS

After adjustment for poverty at other phases, poverty at the 14-year follow-up was the strongest predictor of adolescent and young adult anxiety and depression. The more frequently the child was exposed to poverty, the greater was the risk of that individual being anxious and depressed at both the 14- and 21-year follow-ups.

CONCLUSIONS

Family poverty predicts higher rates of adolescent and young adult anxiety and depression. Increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression. Repeated experiences of poverty over a child's early life course are associated with increased levels of poor mental health.

Poverty and chronic illness in early childhood: a comparison between the United kingdom and Quebec

OBJECTIVES

Our goal was to examine the association between poverty, in the first and fourth years of life and cumulatively in the first and fourth years of life, and the health of children in the fourth year of life in the UK Millennium Cohort Study and in the Quebec Longitudinal Study of Child Development (QLSCD).

METHODS

Data from the UK Millennium Cohort Study of 14 556 children and from the QLSCD of 1950 children were analyzed. Comparable measures of poverty were households in receipt of the safety-net benefit: income support in the United Kingdom and social welfare in Quebec. Three parent-reported health indicators were examined: asthma attack, long-standing illness, and limiting long-standing illness by the fourth year of life. Associations were explored with logistic regression modeling controlling for child characteristics and maternal education.

RESULTS

Poverty only in the first year of life significantly increased the risk of asthma attacks and limiting long-standing illness in the fourth year of life among UK children; trends were in the expected direction in the QLSCD but did not reach statistical significance. Poverty in the fourth year of life only significantly increased the risk of all 3 outcomes for UK children but not for Quebec children. For children experiencing poverty in both the first and fourth years of life, the risks for all 3 outcomes also increased in the United Kingdom, whereas only the risk of limiting long-standing illness increased in Quebec. Adjustment for confounding had little effect on the increased risks associated with poverty.

CONCLUSIONS

These findings suggest that experience of poverty at various times in early childhood increases the risk of asthma attacks and chronic illness in the fourth year of life; however, they also indicate that poverty at different stages of the early childhood life course may have different effects on chronic illness in different country settings.

Child developmental screening instrument from six to thirty-six months in Taiwan birth cohort study

BACKGROUND

A reliable and valid assessing tool to detect the problem before the child becomes deviant is very important.

AIM

This study aimed to further test the reliability and validity of developmental screening instrument for follow-up of thirty-six months children in Taiwan. Also, the stability and changes in the development of children from six to thirty-six months were investigated.

METHODS

A total of 1751 infants were administered the six-month scale, which included levels of Gross and Fine Motor, Language/Communication, and Social ability. At eighteen months, 1267 infants were followed up, and at thirty-six months, 1630 infants were followed up.

RESULTS

Item analysis showed the thirty-six months scale had a Cronbach's alpha of 0.793. By confirmatory factor analysis, the correlations of the four dimensions in this scale were within the range of 0.38 to 0.61. Structural equation modeling showed that the six month scale could directly predict the eighteen months scale, and the gross motor, language, and social dimensions in the thirty-six months scale. The eighteen-month scale was also predictive of the thirty-six months scale. The six, eighteen and thirty-six-month scales all had acceptable reliability and validity, including content, construct and predictive validity. Additionally, the language development at six months was predictive of the language and social development at thirty-six months. The predictive model showed there were correlations between each dimensions at different ages.

CONCLUSIONS

This study is the pilot of a large and scientifically robust longitudinal first national birth cohort study in Taiwan, and the findings should provide useful reference for future studies.

The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis

BACKGROUND

Disparities in child health outcomes persist despite advances in medical technology and increased global wealth. The social determinants of health approach is useful in explaining the disparities in health. Our objective in this paper is four-fold: (1) to test whether the income relationship (and the related income gradient) is the same across different child health outcomes; (2) to test whether the association between income and child health outcomes persists after controlling for other traditional socioeconomic characteristics of children and their family (education and employment status); (3) to test the role of other potentially mediating variables, namely parental mental health, number of children, and family structure; and (4) to test the interaction between income and education.

METHODS

This population-based cross-sectional study used data from the 2003 US National Survey of Children's Health involving 102,353 children aged 0 to 17 years. Using multivariate logistic regression models, the association between household income, education, employment status, parental mental health, number of children, family structure and the following child health outcomes were examined: presence or absence of asthma, headaches/migraine, ear infections, respiratory allergy, food/digestive allergy, or skin allergy.

RESULTS

While the associations of some determinants were found to be consistent across different health outcomes, the association of other determinants such as household income depended on the specific outcome. Controlling for other factors, a gradient association persisted between household income and a child having asthma, migraine/severe headaches, or ear infections with children more likely to have the illness if their family is closer to the federal poverty level. Potentially mediating variables, namely parental mental health, number of children, and family structure had consistent associations across health outcomes.

CONCLUSION

There appears to be evidence of an income gradient for certain child health outcomes, even after controlling for other traditional measures of socioeconomic status. Our study also found evidence of an association between certain child health outcomes and potential mediating factors.

Twin-singleton influence on infant development: a national birth cohort study

BACKGROUND

While studying the development of twins, gestational age and birthweight were suggested as two of the major mediators to be considered. In addition, maternal age, maternal education, parental income and assisted reproductive technologies (ART) also should be considered as moderators. Thus the purpose of this study was to investigate the mediators and moderators of twin and singleton development.

METHODS

Being a national birth cohort study, 21 648 infants were randomly selected and developmental measures were assessed at 6 and 18 months post partum. Children's development at 6 and 18 months were measured using the high reliable Taiwan Birth Cohort Study instrument, which measures children's development in four domains of gross motor, fine motor, language and social development. Additionally, maternal sociodemographics including maternal age, maternal education and parental income; children's characteristics including gender, birthweight, gestational age, single or multiple births, ART or natural conception information were also collected. These data were analysed using a three-step multiple linear regression analysis and further validated using structural equation modelling.

RESULTS

Parental sociodemographics, children characteristics and being twin all had effect on children's development. Additionally, ART and twin were mediators between maternal age and children's development. Mothers aged over 40 were more likely to choose ART, thus increases their likelihood of having twins. Additionally, mothers aged over 40 were more likely to give birth to premature or low-birthweight babies, regardless if they were twin or not. Twins had a higher prevalence of prematurity or low birthweight, which also affected their development in all four domains at 6 and 18 months. Thus prematurity and low birthweight were mediating factors between twin and children's development; with these two mediating factors controlled, there were no difference between twin and singleton development.

CONCLUSIONS

The conceptual construct of structural equation modelling showed these factors interacted and influenced children's development through multiple pathways. Medical intervention may facilitate children's development through prenatal growth and premature care.

Interventions for educating children who are at risk of asthma-related emergency department attendance

BACKGROUND

Asthma is the most common chronic childhood illness and is a leading cause for paediatric admission to hospital. Asthma management for children results in substantial costs. There is evidence to suggest that hospital admissions could be reduced with effective education for parents and children about asthma and its management.

OBJECTIVES

To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

SEARCH STRATEGY

We searched the Cochrane Airways Group Trials Register, including the MEDLINE, EMBASE and CINAHL databases, and reference lists of trials and review articles (last search May 2008).

SELECTION CRITERIA

We included randomised controlled trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We pooled dichotomous data with a fixed-effect risk ratio. We used a random-effects risk ratio for sensitivity analysis of heterogenous data.

MAIN RESULTS

A total of 38 studies involving 7843 children were included. Following educational intervention delivered to children, their parents or both, there was a significantly reduced risk of subsequent emergency department visits (RR 0.73, 95% CI 0.65 to 0.81, N = 3008) and hospital admissions (RR 0.79, 95% CI 0.69 to 0.92, N = 4019) compared with control. There were also fewer unscheduled doctor visits (RR 0.68, 95% CI 0.57 to 0.81, N = 1009). Very few data were available for other outcomes (FEV1, PEF, rescue medication use, quality of life or symptoms) and there was no statistically significant difference between education and control.

AUTHORS' CONCLUSIONS

Asthma education aimed at children and their carers who present to the emergency department for acute exacerbations can result in lower risk of future emergency department presentation and hospital admission. There remains uncertainty as to the long-term effect of education on other markers of asthma morbidity such as quality of life, symptoms and lung function. It remains unclear as to what type, duration and intensity of educational packages are the most effective in reducing acute care utilisation.

Medical, social, and economic factors associated with health-related quality of life in Canadian children with hydrocephalus

OBJECTIVE

To study the factors associated with health-related quality of life (HRQL) in Canadian children with hydrocephalus, using a comprehensive model of determinants of child health, including socioeconomic factors.

STUDY DESIGN

A cross-sectional study was performed between November 2005 and November 2006 at 3 Canadian pediatric hospitals. Parents of children with hydrocephalus age 5 to 18 years completed the Hydrocephalus Outcome Questionnaire (HOQ) and the Health Utilities Index Mark 3 (HUI-3).

RESULTS

A consecutive sample of 340 subjects participated from a total of 366 eligible children (mean age, 11.6 +/- 3.6 years; mean time from the diagnosis of hydrocephalus, 10.0 +/- 4.6 years). Adjusted multivariate linear regression models demonstrated that the most important determinants of poorer HRQL included lower family income, lower parental education, worse family functioning, seizures, myelomeningocele, and prolonged treatment for cerebrospinal fluid shunt obstruction.

CONCLUSIONS

Despite a national universal health care system, socioeconomic disparities remain important as determinants of HRQL. Given the absence of a parallel private health care system in Canada, this suggests that the impact of socioeconomic factors is related to issues other than access to care.

Poverty and cumulative hospitalization in infancy and early childhood in the Quebec birth cohort: a puzzling pattern of association

OBJECTIVE

We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty-hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years.

METHOD

Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization.

RESULTS

At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04-1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73-1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66-1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99-1.60).

CONCLUSION

Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.

Duration of poverty and child health in the Quebec Longitudinal Study of Child Development: longitudinal analysis of a birth cohort

OBJECTIVES

The objective of this study was to examine the relationship between duration of poverty and the health of preschool children in the Quebec Longitudinal Study of Child Development birth cohort.

METHODS

Data from the Quebec Longitudinal Study of Child Development for 1950 children who were followed annually up to age 3 years were analyzed. Poverty was defined as having an income below the low-income cutoff from Statistics Canada. Five health indicators were examined: asthma attacks, infections, growth delay, a cumulative health-problems index, and maternal perception of the child's health. The association between duration of poverty and child health was explored with logistic regression modeling controlling for child and mother characteristics, including the mother's level of education, social support, and physical violence.

RESULTS

In this birth cohort, 13.7% (268) 3-year-old children from the Quebec Longitudinal Study of Child Development experienced intermittent poverty since birth (1-2 episodes), and another 14.4% (280) experienced chronic poverty (3-4 episodes). Children from families with chronic poverty had more frequent asthma attacks and had a higher cumulative health-problems index score, whereas children with intermittent poverty were more often perceived to be in less than very good health by their mothers. These associations remained statistically significant when controlling for child and mother characteristics. No association was observed between duration of poverty and infections or growth delay.

CONCLUSIONS

Chronic poverty affects a large number of children and has negative consequences for preschool children's health, although universal health care is available. The effects of chronic poverty may vary according to different health indicators and the age of the child.

A validation study of the Norwegian version of the Ages and Stages Questionnaires

AIM

To explore the construct validity of the ASQ in relation to premature birth; maternal age, completeness of the family and level of education; and the child's gender.

METHODS

Norwegian mothers' evaluations of 1172 children who completed age appropriate ASQs twice were statistically analysed by means of univariate and multivariate methods.

RESULTS

The developmental level of girls is on average higher than that of boys at both assessments and there is a substantial increase between follow-up assessments in all ASQ scores except for gross motor skills. The mother's level of education; whether the child was born prematurely or at full-term; and the interaction between the child's gender and his/her mother's level of education are important factors relating to the child's developmental status in both assessments.

CONCLUSION

The results that were derived by means of the Ages and Stages Questionnaires concerning the impact of maternal socio-demographical factors, the child's gender, and premature birth upon early childhood development largely confirm the findings in the literature supporting the construct validity of the ASQ. The ASQ was found to be an effective diagnostic tool of developmental delay and/or disturbances. The development of gender dependent norms is recommended.

Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework

BACKGROUND

Maternal smoking and low socioeconomic status are known to be associated with each other and with longstanding respiratory problems in childhood but their interrelation has received little attention. In this paper, the interrelations is studied using a conceptual hierarchical framework among children aged 0-11 years in a representative sample of British households with children.

METHOD

With data from the family and children study, this paper tested a conceptual hierarchical framework, in which maternal education acting through lone parenthood would influence material hardship and all three would have effects on maternal smoking increasing the risk of children's longstanding respiratory problems.

RESULTS

Among children 0-2, maternal education and material hardship had indirect effects on respiratory problems mediated through more proximal variables. After adjustment for maternal education, the effect of lone parenthood was partially mediated through material hardship and maternal smoking. Adjustment for socioeconomic status variables attentuated but did not eliminate the effect of maternal smoking (odds ratio=2.04, 95% confidence interval=1.30, 3.20). Among children 3-11, the effect of maternal education was partially mediated through proximal variables. Lone parenthood and material hardship had indirect effects only. Adjustment for confounding eliminated the effect of maternal smoking (odds ratio=1.06, 95% confidence interval=0.88, 1.26).

CONCLUSIONS

Reducing childhood longstanding respiratory problems will require attention to background socioeconomic status factors in addition to maternal smoking.