The Asymmetric Effects of the Transitions Into and out of Bullying Victimization on Depressive Symptoms: The Protective Role of Parental Education

PURPOSE

This study aims to examine the association between bullying victimization and depressive symptoms among youth from multicultural families in Korea, while distinguishing between the effects of entering and exiting bullying victimization. This study also investigates whether parental education moderates this association.

METHODS

Using data from the Multicultural Adolescent Panel Survey, a nationally representative sample of children from multicultural families in Korea, this study employed novel asymmetric fixed-effects models that separately assess the effects of entering and exiting bullying victimization. Interaction models were conducted to consider the moderating roles of maternal and paternal college attainment.

RESULTS

Conventional fixed-effects models showed that bullying victimization is significantly associated with an increase in depressive symptoms (b = 0.261). Asymmetric fixed-effects models suggest that the magnitude of the entry effect (b = 0.299) was significantly larger than that of the exit effect (b = -0.237). Furthermore, maternal college education amplified the mental health benefits of exiting from bullying victimization but did not buffer the harmful effects of entering bullying victimization. Gender-stratified analyses indicate that this protective effect of maternal college education was only significant for girls. Paternal college education, on the other hand, did not moderate either the entry or exit effects of bullying victimization.

DISCUSSION

The study's findings on the asymmetric effects of bullying victimization on depressive symptoms emphasize the importance of providing follow-up care and mental health support for multicultural family youth who have experienced bullying, with particular attention to those with a history of victimization.

Influence of parental education on the intelligence quotient profiles and socially adaptive behavior of school-age children with autism spectrum disorder in eastern China

Intelligence quotient (IQ) and adaptive behavior are the influencing factors of autism spectrum disorder (ASD) in children entering mainstream schools. This study explored the association between parental education level, IQ, and adaptive behavior in ASD groups. A total of 257 school-age ASD children were enrolled in our study from January 2017 to June 2021. Their parents completed a standard demographic form, including age at autism diagnosis, gender, school placement, and parents' educational background. The Chinese version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) was completed by a certified assessor for each enrolled child. Parents were interviewed on adaptive behavior using the Chinese version of the Adaptive Behavior Assessment System, Second Edition (ABAS-II). The average IQ of school-age ASD children was 76.88 (standard deviation (SD)=22.62) and boys had higher IQ levels than girls. The IQ was positively correlated with age. The General Adaptive Composite (GAC) score was 82.47 (SD=15.86) and adaptive behavior did not increase with age. ASD children who attended mainstream schools had better adaptive behavior profiles than other children. The mother's education level showed a significant correlation with the IQ and adaptive behavior of autistic children, while the father's education level did not. Consequently, better training and support for parents may help autistic children enter mainstream schools, with adaptive training being the most urgently required skill for parents.

Inequalities in Resources for Preschool-Age Children by Parental Education: Evidence from Six Advanced Industrialized Countries

This paper provides new evidence on inequalities in resources for children age 3-4 by parental education using harmonized data from six advanced industrialized countries-United States, United Kingdom, France, Germany, Netherlands, and Japan-that represent different social welfare regime types. We analyze inequalities in two types of resources for young children-family income, and center-based child care-applying two alternative measures of parental education-highest parental education, and maternal education. We hypothesize that inequalities in resources by parental education will be less pronounced in countries where social policies are designed to be more equalizing. The results provide partial support for this hypothesis: the influence of parental education on resources for children does vary by the social policy context, although not in all cases. We also find that the measurement of parental education matters: income disparities are smaller under a maternal-only definition whereas child care disparities are larger. Moreover, the degree of divergence between the two sets of estimates differs across countries. We provide some of the first systematic evidence about how resources for young children vary depending on parents' education and the extent to which such inequalities are buffered by social policies. We find that while early inequalities are a fact of life in all six countries, the extent of those inequalities varies considerably. Moreover, the results suggest that social policy plays a role in moderating the influence of parental education on resources for children.

Effectiveness of the positive discipline program applied to parents of preschool children: A randomized-controlled trial

BACKGROUND

Although the Positive Discipline Program is used extensively internationally, there are very few evidence-based studies on it. This study aims to examine the experimental results of the Positive Discipline Program.

METHOD

This randomized-controlled study had the following types of groups: intervention, active control, and non-contact control. The study sample consisted of 72 parents with children aged between 3 and 6 years. The intervention group participated in an eight-session online Positive Discipline Program, the active control group participated in an eight-session online free interaction program, and the non-contact control group received no intervention.

RESULTS

Parents in the intervention group demonstrated an increase in cooperation with their children after the training and during the follow-up period. In the intervention group, parents' oppressive and authoritarian attitudes decreased after the training and during the follow-up period; spouses' democratic attitudes increased after the training and their overprotective attitudes decreased in the follow-up period. Parent-child communication and unhindered listening increased in the intervention and active control groups. The problem-solving skills of the intervention group increased after the training and during the follow-up period, and sensitivity increased in the follow-up period.

CONCLUSION

As one of the few experimental studies implementing the Positive Discipline Program, this study revealed the strengths of the program as well as culture-specific aspects that need to be improved. Further, this program was effective in improving parents' relationships with their children, attitudes, and problem-solving skills, and it provided evidence for the program's positive contributions to raising a child.

IMPLICATIONS FOR PRACTICE

The Positive Discipline Program can guide parents in solving the developmental and school-related problems of preschool children as well as school and adolescence children.

The effect of poverty on the relationship between household education levels and obesity in U.S. children and adolescents: an observational study

Background

Although ample evidence has shown the link between childhood obesity and socioeconomic status including family income and household education levels, the mediating role of poverty in the association between household education levels and childhood obesity is unclear. This study aimed to quantify the extent to which family poverty levels contribute to the association between household education levels and obesity among US children and adolescents.

Methods

This cohort study used the nationally representative data of 21,754 US children and adolescents aged 6-17 years (National Health and Nutrition Examination Survey 1999-2018). We applied mediation analysis of the association between household education levels (less than high school, high school, and college or above) and obesity mediated through poverty (≤138% vs. >138% federal poverty level), adjusting for demographic characteristics of household head and their offspring. Obesity was defined as age- and sex-specific body mass index in the 95th percentile or greater using the 2000 Centers for Disease Control and Prevention growth charts.

Findings

Among 21,754 children and adolescents (weighted N = 43,544,684; mean age, 11.6 years; female, 49%), 9720 (weighted percentage, 33.0%) were classified as living in poverty and 4671 (weighted percentage, 19.1%) met the criteria for obesity. Low household education level (less than high school) showed increased risks of poverty (adjusted relative risk [95% CI], 5.82 [4.90-6.91]) and obesity (adjusted relative risk [95% CI], 1.94 [1.68-2.25]) compared to high household education level (college or above). We also quantified that poverty mediated 18.9% of the association between household education levels and obesity among children and adolescents. The mediation effect was consistently observed across age, gender, and race/ethnicity.

Interpretation

Poverty mediated the association between the low educational status of household heads and their offspring's obesity. Our findings highlight the importance of reducing obesity risk among the low-income population to minimize the burden of intergenerational health disparities due to socioeconomic status.

Funding

Japan Society for the Promotion of Sciences (22K17392).

Effects of the Nurturing Parenting Program Nurturing Skills for Families on child safety and permanency

BACKGROUND

Many child welfare agencies use the Nurturing Parenting Program Nurturing Skills for Families (NPP) program to strengthen parenting skills. NPP includes a flexible sequence of lessons that are tailored to meet each family's needs.

OBJECTIVE

This study estimated the effects of NPP on child safety and permanency outcomes using a quasi-experimental design.

PARTICIPANTS AND SETTING

This study included 1102 children in Arizona whose families were referred to NPP between 2018 and 2020 (treatment group) and 6845 children in Arizona whose families were referred to other in-home family preservation services during the same period (comparison group).

METHODS

Outcomes were based on child welfare administrative data. The study estimated (1) the effects of being referred to NPP (regardless of a family's level of participation) and (2) the effects of completing NPP. Baseline equivalence was established for each analysis. Impacts were calculated by comparing regression-adjusted differences between the study groups.

RESULTS

The study found no evidence of impacts of being referred to NPP. However, children whose families completed NPP were less likely to experience an investigation (ES = -0.28; p = 0.03) or substantiated investigation (ES = -0.66; p = 0.03) 4 months after the service referral, and less likely to experience a removal 16 months later (ES = -0.70; p = 0.00).

CONCLUSIONS

NPP had favorable effects on child welfare outcomes when families completed the program. Additional research is necessary to understand the supports that enable families to complete NPP and the specific components that are particularly effective.

The influence of immigrant background and parental education on overweight and obesity in 8-year-old children in Norway

BACKGROUND

Little is known about the prevalence of overweight/obesity and socio-economic position (SEP) in children with immigrant background in Scandinavia. The purpose of this study is to examine the prevalence of overweight/obesity by immigrant background among children in Norway and to explore the role of SEP in explaining differences in weight status.

METHODS

Anthropometric data from 8,858 children (age 8.3 years) from the population-based Norwegian Childhood Growth Study were used. Information about immigrant background, country of origin, and parental education (used as an indicator of SEP) were provided by Statistics Norway. For children with immigrant background, regional background was determined based on country of origin. Prevalence ratios (PR) were estimated for overweight/obesity and weight-to-height-ratio (WHtR) ≥ 0.5 by immigration and regional background, using generalized estimating equation log-binominal models adjusting for sex, age, survey year (model 1), residential area, population density (model 2) and parental education (model 3).

RESULTS

Children with immigrant background had a higher prevalence of overweight/obesity and WHtR ≥ 0.5 than non-immigrant background children. Adjusted for parental education, children with an immigrant background from Southern and Eastern Europe, Asia except South-Asia, and Africa had a higher prevalence of overweight/obesity [PR: 1.37 (95% confidence interval (CI): 1.10-1.72), 1.28 (1.05-1.57), 1.47 (1.13-1.91), respectively] than children with a non-immigrant background. Children originating from Asia except South-Asia had a higher prevalence of WHtR ≥ 0.5 (PR: 1.64, CI: 1.25-2.15) compared to non-immigrant background children. The adjustment for parental education did not substantially change the results.

CONCLUSION

Children with immigrant background had higher prevalence of overweight/obesity than non-immigrant background children. The difference varied according to region of origin but not substantially according to parental education. There is a need for culturally acceptable preventative measures targeting the parents of immigrant background children.

How is parental education associated with infant and young child feeding in Bangladesh? a systematic literature review

BACKGROUND

Education is expected to bring about positive behavioral changes which could lead to improved health behaviors. Parental education is a primary determinant of child health and development. However, some evidence showed inverse associations between high parental education and recommended infant and young child feeding (IYCF) in Bangladesh. How the association of parental education differs with specific IYCF components has not been reviewed. Therefore, the role of parental education on optimal IYCF practices in Bangladesh appears to be inconclusive. The objective of this review is to summarize how parental education is associated with IYCF practices in Bangladesh.

METHOD

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Google Scholar. Record searching, study selection, and data extraction was performed using Endnote online and Covidence tool, respectively. The Newcastle-Ottawa scale was used for quality assessment of the included studies.

RESULTS

Out of 414 initial hits, 34 studies were included for this review. Of the included studies, 32 were cross-sectional, one was a randomized controlled trial, and one was a retrospective cohort. Most of the studies (n = 24) were nationally representative whereas 10 studies had populations from district and sub-district level. Included studies considered different IYCF-related indicators, including breastfeeding (n = 22), complementary feeding (n = 8), both breastfeeding and complementary feeding (n = 2), both breastfeeding and bottle feeding (n = 1), and pre-lacteal feeding (n = 1). Parental education was found to be positively associated with complementary feeding practices. However, the role of parental education on breastfeeding, in general, was ambiguous. High parental education was associated with bottle-feeding practices and no initiation of colostrum.

CONCLUSION

Public health interventions need to focus not only on non- and/or low-educated parents regarding complementary feeding but also on educated mothers for initiation of colostrum and proper breastfeeding practices.

TRIAL REGISTRATION

This systematic review is registered to PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) with registration ID: CRD42022355465.

The Long Arm of childhood hypothesis and systematic low-grade inflammation: Evidence from parental education of older European adults

Childhood SES has been extensively studied as a predictor for health outcomes in adulthood, though the direct mechanisms remain unclear. The Long Arm of Childhood Model hypothesizes that this process is a chain of events, moderated by numerous factors such as family economic status and environment, health behaviors, as well as biological processes. We expand on this model with objective measures of health in older age, namely C-reactive protein (CRP), as chronic low grade inflammation, which has been found to be connected to both childhood SES as well as a number of cardiovascular diseases in adulthood. Using life history data from SHARE, as well as a novel dried blood spot dataset, we explore the protective role of parent education on the blood level of C-reactive protein in adulthood. Estimating a stepwise linear regression model, we find evidence that years of parental education are negatively associated with CRP in adulthood, with a one-year increase in mother's (father's) years of education decreasing adult CRP by 1.8% (1.1%). Using a modified Sobel test, we measure both the direct and indirect effects, estimating the extent in which later-life mediators significantly alter the relationship between parental education and CRP. While father's education is completely mediated by individual factors such as respondent's education, employment, and health behavior - we observe a lasting association from mother's education, suggesting a direct link between mother's education and CRP in adulthood.

Factors related to the development of executive functions: A cumulative dopamine genetic score and environmental factors predict performance of kindergarten children in a go/nogo task

BACKGROUND

This study aimed at investigating the interaction between genetic and environmental factors in predicting executive function in children aged four to six years.

METHODS

Response inhibition as index of EF was assessed in 197 children using a go/nogo task. A cumulative dopamine (DA) genetic score was calculated, indexing predisposition of low DA activity. Dimensions of parenting behavior and parental education were assessed.

RESULTS

Parental education was positively related to accuracy in nogo trials. An interaction between the cumulative genetic score and the parenting dimension Responsiveness predicted go RT indicating that children with a high cumulative genetic score and high parental responsiveness exhibited a careful response mode.

CONCLUSION

The development of EF in kindergarten children is related to parental education as well as to an interaction between the molecular-genetics of the DA system and parenting behavior.

Determinants of academic achievement: How parents and teachers influence high school students' performance

This study explores the contribution of various drivers of attainment in secondary education in Portugal. We propose a model explaining the influence of students, teachers, and parents' traits on high school achievement, measured by the self-reported Math and Portuguese final grades of 220 students. Using PLS-SEM, we show that previous achievement predicts current achievement in both subjects; however, noteworthy differences were found. Portuguese grades are significantly better for students whose parents have post-secondary education and communicate higher expectations about their offspring's school careers. At the same time, Math achievement is influenced by students' perception of teachers' involvement but not by parents' expectations or education. Previous retention and receiving educational allowance impair Math achievement, but not Portuguese. Results and implications are discussed.

Mediterranean diet, physical activity, and family characteristics associated with cognitive performance in Italian primary school children: analysis of the I-MOVE project

Working memory (WM) is a multicomponent system that supports cognitive functioning. It has been linked to a wide variety of outcomes including academic success and general well-being. The present study examined the relations between adherence to the Mediterranean diet (MD) and WM among Italian children, adjusting for important parent characteristics and children's lifestyle habits. Data for this study was obtained from 106 children attending primary school in Imola (Italy) who were part of the I-MOVE study emphasizing school-based physical activity. Children's adherence to the MD was calculated using the KIDMED index (KI) based on the ZOOM-8 questionnaire. Physical activity (PA) levels were assessed using an actigraph accelerometer and WM using the backward digit span test. Univariate regression was used to select significant child-level and family measures associated with WM, which were then tested in a single multivariate regression model. Older age is positively associated with higher WM (β = 0.36; 95% CI 0.25, 0.47). Dietary adherence (KI) (β = 0.07; 95% CI 0.01, 0.14) and engagement in organized PA outside school hours (β = 0.58; 95% CI 0.09, 1.10) are positively related to WM. Among the family measures, father's education was positively associated with WM for high school education and for university vs. middle school or lower, respectively.

CONCLUSION

Adherence to the MD was associated with better WM capacity in primary school children. These findings can be used to guide policymakers in designing health promotion programs and instituting policies emphasizing healthy nutrition to improve physical health and boost cognitive functioning.

WHAT IS KNOWN

• The development of working memory involves the entire childhood with a rapid spurt between 2 and 8 years of age. • Working memory plays a critical role in children's learning and academic performance and underlies higher-order cognitive abilities.

WHAT IS NEW

• Adherence to the Mediterranean Diet was associated with higher working memory capacity in primary school children. • Health promotion interventions based on PA and sound nutrition involving children benefit not only physical and mental health, but also cognitive health.

Effectiveness of parental education about pain in the neonatal period on knowledge, attitudes, and practices: A systematic review and meta-analysis

Background

Despite the availability of effective, safe, and feasible pain management strategies, infant pain remains undertreated. Parents can play a key role in advocating for or delivering pain management strategies if they are educated. To date, a quantitative synthesis of the effectiveness of parental education about pain management in the neonatal period has not been performed.

Objective

To systematically review the effectiveness of parental education during the neonatal period on pain management in infancy.

Methods

MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) and non-randomized trials (NRTs) that evaluated parental education with respect to pain management during the neonatal period in any setting from inception to February 2021. Screening of article titles and abstracts and data extraction were performed in duplicate. The risk of bias was assessed using the Cochrane Risk Bias Tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions for RCTs and NRTs, respectively. As per the GRADE methodology, critically important and important outcomes were identified. Critically important outcomes included utilization of pain management strategies and infant pain. Important outcomes included parental knowledge about pain mitigation strategies, parental attitudes, compliance with painful procedures, procedure outcomes, and safety. Data were combined and presented as relative risk (RR) or mean or standardized mean difference (MD or SMD) with 95% confidence interval (CI).

Results

Of the six studies eligible for inclusion, four studies were RCTs and two studies were NRTs. Written information and/or video were used to deliver parental education during the neonatal period in hospital settings in all studies. Four studies (two RCTs and two NRTs) reported on critically important outcomes. The risk of bias was low for the two RCTs and moderate to serious for the two NRTs. Utilization of pain management strategies was assessed for heel lance in the first 48 hours of life in two studies and for vaccine injection at 2 to 6 months of life in two studies. Higher utilization rate for pain management strategies was reported in the pain education group in three studies (RR 1.15, 95% CI 1.04, 1.26; N=2712). There was no difference in the mean number of pain management strategies used in one NRT tracking utilization tracking utilization as continuous data (MD 0.20, 95% CI -0.01, 0.41; N=178). Parent-reported infant pain scores were lower in the pain education group in one RCT (MD -0.16, 95% CI -0.27, -0.06; N=1615). The quality of evidence for the outcome of utilization of pain management strategies was very low while for the outcome of infant pain the quality of evidence was moderate. Five studies (3 RCTs and 2 NRTs) reported on important outcomes. The risk of bias was low for two RCTs and high for one RCT and moderate to serious for the two NRTs. Parental knowledge about pain management strategies (SMD 0.54, 95% CI 0.26, 0.82), parental confidence in their ability to manage pain (SMD 0.24, 95% CI 0.14, 0.34), parental satisfaction with education (MD 1.18, 95% CI 0.84, 1.52) and parental satisfaction with pain management (RR 1.05. 95% CI 1.01, 1.08) were increased in the pain education group. None of the included studies reported on procedural outcomes. No adverse events with the pain education nor the use of pain management interventions were reported in one study.

Conclusions

Parental education in the neonatal period was effective in increasing utilization of pain management strategies during painful procedures. Reduction of pain in infants is based on one study of moderate quality. Furthermore, parental education increased parental knowledge about pain management strategies, confidence in their ability to manage infant pain, and satisfaction with the education and pain management. Parental pain education should be incorporated into postnatal care.

Socioeconomic resources are associated with distributed alterations of the brain's intrinsic functional architecture in youth

Little is known about how exposure to limited socioeconomic resources (SER) in childhood gets "under the skin" to shape brain development, especially using rigorous whole-brain multivariate methods in large, adequately powered samples. The present study examined resting state functional connectivity patterns from 5821 youth in the Adolescent Brain Cognitive Development (ABCD) study, employing multivariate methods across three levels: whole-brain, network-wise, and connection-wise. Across all three levels, SER was associated with widespread alterations across the connectome. However, critically, we found that parental education was the primary driver of neural associations with SER. These parental education associations with the developing connectome exhibited notable concentrations in somatosensory and subcortical regions, and they were partially accounted for by home enrichment activities, child's cognitive abilities, and child's grades, indicating interwoven links between parental education, child stimulation, and child cognitive performance. These results add a new data-driven, multivariate perspective on links between household SER and the child's developing functional connectome.

The Validity and Reliability of Retrospective Measures of Childhood Socioeconomic Status in the Health and Retirement Study: Evidence From the 1940 U.S. Census

OBJECTIVES

Retrospective measures of childhood socioeconomic status (SES) in cohort studies of aging that first observe people late in life-such as the Health and Retirement Study (HRS)-are widely used. However, their measurement validity and reliability are unknown. We assess the reliability and validity of the HRS's retrospective measures of parental education and childhood family finances.

METHODS

We use records for 6,343 HRS sample members who were children in 1940 that have been linked to records from the complete-count 1940 U.S. Census. We assess interrater reliability by comparing (a) retrospective reports of childhood SES collected from sample members in the 1992-2018 HRS to (b) prospective measures of parallel concepts collected from HRS sample members' parents in the 1940 Census. We assess predictive validity by comparing the results of analyses that model later-life outcomes as a function of childhood SES as measured both prospectively and retrospectively.

RESULTS

Interrater reliabilities of retrospective measures of parental education are high; however, the same is not true of the retrospective measure of childhood family finances. Both retrospective and prospective measures of childhood SES are predictive of later-life outcomes, and with similar strengths and directions of associations for most outcomes.

DISCUSSION

Researchers who rely on retrospective indicators of childhood SES from the HRS should be aware of their measurement properties. They are measured with error, and that error modestly attenuates estimates of their associations with later-life outcomes. However, prospective and retrospective measures of childhood SES have similar predictive validity. These findings should reassure researchers who rely on retrospective measures of childhood SES in the HRS and similarly designed surveys.

Association of adverse childhood experiences (ACEs) with obesity and underweight in children

PURPOSE

The aim of the study was to test the hypothesis that adverse childhood experiences (ACEs) are related to both obesity and underweight from childhood, and that the association of ACEs with weight abnormalities is modulated by type of ACEs, sex and socioeconomic status (SES) indices.

METHODS

The relations between ACEs (0 vs ≥ 1), ACE accumulation and ACE type with weight status and z scores BMI were assessed in 503 children aged 6-12 years from Poznan, Poland. The effects of interaction of ACEs with sex and SES on z scores BMI were included in the analyses.

RESULTS

ACEs were significantly related to both obesity and underweight, in unadjusted analysis, and when sex and SES indices, such as size of place of residence, people per room in household, and parental education were controlled. The relation of ACEs with z scores BMI was modulated by ACE type, parental subjective assessment of economic situation of a family and parental education. ACE accumulation was not related to an increase of obesity or underweight rate, or z scores BMI.

CONCLUSION

The study implicates the need for both obesity and underweight prevention in individuals with adverse experiences as early as in childhood.

LEVEL OF EVIDENCE

III: evidence obtained from well-designed cohort study.

Risk factors for child stunting in Bangladesh: an analysis using MICS 2019 data

Background

Malnutrition is considered a major public health challenge and is associated with a range of health issues, including childhood stunting. Stunting is a reliable and well-recognized indicator of chronic childhood malnutrition. The objective of this study is to determine the risk factors associated with stunting among 17,490 children below five years of age in Bangladesh.

Methods

Correlates of child stunting were examined using data generated by a cross-sectional cluster survey conducted in Bangladesh in 2019. The data includes a total of 17,490 children (aged < 5 years) from 64,400 households. Multiple logistic regressions were used to determine the risk factors associated with child stunting and severe stunting.

Results

The prevalence of stunting and severe stunting for children was 25.96% and 7.97%, respectively. Children aged 24 to < 36 months [Odds Ratio (OR) = 2.65, 95% CI: 2.30, 3.05] and aged 36 to < 48 months [OR = 2.33, 95% CI: 2.02, 2.69] had more risk of stunting compared to the children aged < 6 months. Children from Sylhet division had the greatest risk of stunting of all the eight divisions [OR = 1.26, 95% CI: 1.09, 1.46]. Children of secondary complete or higher educated mothers were less likely to develop stunting [OR = 0.66, 95% CI: 0.56, 0.79] compared with children of mothers having no education at all. Similarly, children of secondary complete or higher educated father [OR = 0.74, 95% CI: 0.63, 0.87] were found to have lower risk of stunting compared with children whose father hadn’t any education. Substantially lower risk of stunting was observed among children whose mother and father both completed secondary education or above [OR = 0.59, 95% CI: 0.52, 0.69]. Children from the richest households [OR = 0.49, 95% CI: 0.41, 0.58] had 51% lower odds of stunting compared to children from the poorest households.

Conclusions

After controlling for socioeconomic and demographic factors, parental education and household position in the wealth index were found to be the most important determinants of child stunting in Bangladesh.

The influence of maternal and paternal education on birth outcomes: an analysis of the Ottawa and Kingston (OaK) birth cohort

BACKGROUND

Education is considered one of the most robust determinants of health. However, it is unclear whether maternal education and paternal education have differential impacts on perinatal health outcomes. We assess maternal and paternal education differences and their association with adverse birth outcomes in a large birth cohort from Ontario, Canada.

METHODS

The OaK Birth Cohort recruited patients from Ontario, Canada, between October 2002 and April 2009. We recruited mothers were recruited between 12 and 20 weeks' gestation and collected both mother and infant data. The final sample size of the cohort was 8,085 participants. We use logistic regression to model the probability of preterm birth (less than 34 and 37 weeks' gestation), small-for-gestational-age (SGA), or stillbirth as a function of maternal and paternal educational attainment. We adjust for household-level income, maternal and paternal race and ethnicity, and compare the strength of the association between maternal and paternal education on outcomes using Wald tests.

RESULTS

7,928 mother-father-offspring triads were available for the current analysis. 75% of mothers and fathers had college or university level education, and 8.7% of mothers experienced preterm delivery. Compared to mothers with college or university education, mothers with a high school education had an odds ratio of 1.37 (95% CI: 1.01-1.87) for SGA. Paternal education was not associated with infant outcomes. Comparing the odds ratios for maternal education and paternal education showed a stronger association than paternal education at the high school level for SGA birth (difference in odds ratio: 1.95, 95% CI: 1.13-3.36, p = .016) among women at least 25 years old.

CONCLUSION

Maternal education was associated with SGA, and this effect was more robust than paternal education, but both associations were weaker than previously reported.

Hospital training and preparedness of parents and carers in paediatric tracheostomy care: A mixed methods study

INTRODUCTION

Within the UK, the majority of paediatric tracheostomy care is delivered by parents and carers at home. To facilitate this, extensive in-hospital training is delivered by a variety of health care professionals. Our goal was to assess carer perceptions of this process and highlight areas in which we can further improve our service and the training for other hospital providers of paediatric tracheostomy care.

METHODS

A mixed method approach was adopted. In Phase I, qualitative data from five semi-structured interviews with carers of children with a tracheostomy were thematically analysed and subsequently used to develop a questionnaire. In Phase II, the piloted questionnaire was distributed via telephone, email or post to all eligible caregivers who had been tracheostomy trained at GOSH in the last three years (n = 92). Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics respectively.

RESULTS

Thirty-five completed questionnaires were received (38% response rate). Overall participants were highly satisfied with the training provided (mean score 8.42 on a scale of 1 (lowest) to 10 (highest)). Carer identified areas requiring improvement were caregiver education pre-tracheostomy; emergency and complication training; supervision and training post hospital discharge; training schedule; emotional support; and support from community healthcare teams. These findings led to multiple subsequent interventions to further improve the carer training programme including training videos, psychology provision on request and increased community training.

CONCLUSION

Although the evaluation of the service revealed high participant satisfaction in home carer training overall, in-depth analysis of caregivers' experiences indicated common themes in the tracheostomy training service where further support would be beneficial. A carer-centred rather than health professional focus on training needs will allow future attention to be directed to areas of need identified by carers themselves as important to improve the tracheostomy training programme.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

BACKGROUND

Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown.

METHODS

The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income.

RESULTS

An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care.

CONCLUSIONS

The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.

Interactions between parental and personal socioeconomic resources and self-rated health: Adjudicating between the resource substitution and resource multiplication theories

A small body of research has documented intriguing findings, mostly from the United States but also from Europe, which suggest that the positive health effects of socioeconomic resources in adulthood may be conditioned by socioeconomic circumstances in childhood. There are two competing theories in this literature. The first contends that socioeconomic resources have a stronger effect on adult health for people from disadvantaged backgrounds because socioeconomic resources in adulthood substitute or compensate for a paucity of health-related resources earlier in life. The second contends that socioeconomic resources have a stronger effect on adult health for people from advantaged backgrounds because socioeconomic resources in adulthood compound or multiply the health effects of socioeconomic resources earlier in life. We used survey data from the 2012 Longitudinal and International Study of Adults linked to current and historical income data from the Canada Revenue Agency to investigate interactions between parental and personal socioeconomic resources - education and income, treated separately - as predictors of self-rated health in a sample of Canadians aged 25 to 50. Consistent with the resource multiplication theory, we found that the presumed benefits of personal family income for self-rated health were stronger for women from wealthier backgrounds than for women from poorer backgrounds. We found no evidence to support either theory among men. Overall, none of the interactions involving the education of parents or their adult children reached statistical significance. Our results are indicative of the importance of distinguishing between education and income for adults and their parents when adjudicating between these two theories.

Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus

This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.

Time trends in HPV vaccination according to country background: a nationwide register-based study among girls in Norway

Background

Since the human papillomavirus (HPV) vaccine was introduced in Norway in 2009, the vaccine uptake has increased. Whether this increase is similar regardless of the girls’ country background is unknown. We examined changes in HPV vaccine uptake from 2009 to 2014 and studied the impact of parental education and income on HPV vaccine uptake according to country background.

Methods

Girls in the first six birth cohorts (1997–2002) eligible for HPV vaccination were identified through the National Registry. Information on HPV vaccination, country background and socioeconomic factors was extracted from the Norwegian Immunisation Registry and Statistics Norway. Risk differences (RDs) and confidence intervals (CIs) were estimated with linear binomial regression. A total of 177,387 girls were included in the study.

Results

The HPV vaccine uptake increased from 72.5% in 2009 to 87.3% in 2014. The uptake increased for girls in all country background categories. Highest vaccine uptake was observed in girls with East−/South-East Asian background, 88.9% versus 82.5% in the total population. Vaccine uptake decreased slightly with increasing parental education, RD = − 1.6% (95% CI: − 2.3% to − 0.8%) for highest compared with lowest education level. In contrast, the uptake increased with increasing household income, RD = 4.9% (95% CI, 4.3 to 5.5%) for highest compared with lowest quintile. Parental education had largest impact in girls with Asian background, RD = − 8.1% (95% CI − 10.5% to − 5.6%) for higher vs lower education. The largest impact of household income was observed in girls with background from Middle East/Africa, RD for a 200,000 NOK increase in income was 2.1% (95% CI 1.2 to 3.0%).

Conclusions

The HPV vaccine uptake differed with country background but increased over time in all country background categories. Moreover, the impact of education and income on vaccine uptake differed with country background.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10877-8.

A quantitative study of test anxiety and its influencing factors among medical and dental students

Objective

The study was conducted to assess test anxiety and its influencing factors on medical and dental students.

Methods

A cross-sectional study was conducted among students from three private and public medical and dental colleges in the Punjab province of Pakistan. The survey included statements about the demographic profile of the study participants and used the Test Anxiety Inventory (TAI) by Spielberger.

Results

The study included 680 students with a mean age of 20.93 ± 1.76 years. About half the sample (51.8%) scored high on test anxiety (TAI score > 45), and the mean TAI score was slightly higher for the dental (47.75 ± 11.45) than medical students (46.42 ± 12.79). Female students had a significantly higher mean TAI score (48.45 ± 12.79) than male students (41.85 ± 8.91; p < 0.001). The students from private colleges had a significantly greater test anxiety score (50.15 ± 13.23) than students from public colleges (42.88 ± 9.7; p < 0.001). Students whose parents were graduates from a college or university perceived significantly increased test anxiety than those of parents with no/school education (p < 0.001). A female gender (adjusted odds ratio (AOR) 2.10, 95% CI:1.37, 3.22), being a private college student (AOR 2.88, 95% CI:1.90, 4.38), and having a mother with a college or university education (AOR 2.05, 95% CI: 1.25, 3.35) were significantly associated with high on test anxiety.

Conclusion

In our study cohort, test anxiety was common among medical and dental students. A female gender, being a student from a private college, and having a mother with a high education were significantly associated with high test anxiety. The study findings may guide the development of programs that can reduce students’ test anxiety and potentially improve their education.

Influence of internal and external factors on early language skills: A cross-linguistic study

Cross-linguistic studies can provide information about general and language specific features of language development, but relatively few such studies are available in literature. The main aim of the present study was to investigate, from a cross-linguistic perspective, the roles of the internal factor of gender and external factors of birth order and parental education level on the development of language in 2-year-old children. We examined 351 children growing up in three European language contexts: Croatian (N = 104), Estonian (N = 141) and Finnish (N = 106). Information on lexical skills and word combination ability was collected using the short form of the MacArthur-Bates Communicative Development Inventories and the influence of background factors on these aspects of language development was investigated. No significant differences were found in lexical skills or word combination ability among the three language groups. These aspects of language development varied significantly with gender, but not with external factors. Our findings suggest that internal factors may influence early language development more than external factors.

Household and schooling rather than diet offset the adverse associations of height with school competence and emotional disturbance among Taiwanese girls

OBJECTIVE

Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed.

DESIGN

The 2001-2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed.

SETTING

The 2001-2002 NAHSIT for elementary schoolchildren.

PARTICIPANTS

Totally, 2274 schoolchildren aged 6-13 years.

RESULTS

Compared to normal height (-2< height for age z-score (HAZ) <2), shorter girls (HAZ ≤ -2) had a lower OSC (8·87 v. 10·5, P < 0·05) and taller girls (HAZ ≥ 2) had a better OSC (12·3 v. 10·5, P < 0·001). Maternal education and household income each contributed more than 5 % of OSC variance. OSC and HAZ among girls were positively associated and emotional disturbance negatively associated. Shortness-associated lower OSC underwent remediation with advancing school grade. Stature and OSC were not evidently related in boys.

CONCLUSIONS

Shorter stature can compromise OSC among school girls. The major determinants in shorter girls are less household income and limited parental education.

Cognitive decline and impairment in schizophrenia spectrum disorders reconsidered

BACKGROUND

This study applied an algorithm developed to identify schizophrenia spectrum disorder patients with probable decrements between estimated premorbid and current cognitive ability (Keefe et al., 2005). Cognitive trajectories and associated functional status were examined in patients and control participants.

METHODS

Patients with schizophrenia or schizoaffective disorder (n = 139) and control participants (n = 63) completed measures of verbal and working memory, processing speed, verbal fluency, reading ability and non-verbal reasoning. A predicted cognitive composite score was generated using control participants' parental education and reading scores, consistent with methods in Keefe et al. (2005), and compared to current performance. Three performance trajectory profiles were identified: decrement, stable, and increment. Functionality and clinical status were assessed with the Multidimensional Scale of Independent Functioning (MSIF) and the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Approximately 60% (n = 83) of patients demonstrated a decrement trajectory, 16% (n = 22) demonstrated an increment trajectory, and 24% (n = 34) demonstrated a stable trajectory. Patients with decrement profiles were significantly more symptomatic (negative) and functionally impaired (MSIF) than those with increment profiles. Patients with increment and normal-range performance profiles remained functionally deficient relative to controls.

CONCLUSIONS

Schizophrenia and schizoaffective patients meeting psychometric criteria for cognitive decline relative to estimated premorbid levels are common in the outpatient population but may occur less frequently than earlier estimates suggest. Minorities with stable and improved performance profiles also exist, show clinical and functional advantage relative to more typical patients, but underperform healthy controls.

Risk Factors for Overweight and Obesity in Children Attending the First Year of Primary Schools in Modena, Italy

Over the last four decades, childhood overweight/obesity has dramatically increased, becoming a significant public health concern. The main aims of this study were to investigate the prevalence of overweight/obesity among first-year primary schools children in Modena and to identify the associated risk factors. Data were collected on the socio-demographic characteristics of family and weight, height, dietary habits and sedentary behaviours of the children, and on the parents' perception of their child's weight status, through an anonymous questionnaire administered to parents. The questionnaires were delivered by 660 out of 890 (74.2%) families, and after excluding those without anthropometric data, 588 children were included in the study. The prevalence of overweight/obesity among the children was 25.2%, significantly lower in children born to parents with a high education, and higher among children born to foreign parents and overweight/obese mothers. The multivariable analysis showed that the children most likely to become overweight/obese were those who skipped breakfast (OR 2.3, 95%CI 1.3-4.2) and/or mid-morning snacks (OR 3.2, 95%CI 1.5-6.5). Breakfast consumption was positively associated with higher parental education levels, whereas skipping mid-morning snacks is more frequent among children born to foreign parents and overweight/obese mothers. Moreover, 84.7% of the parents of overweight/obese children underestimated their child's weight status. One in four 6-7 year-old children is already overweight or obese. Childhood overweight/obesity is significantly associated with unhealthy lifestyles and family lifestyle. It is therefore essential to implement public health intervention programs aimed at both parents and children, in order to promote healthy lifestyles in early childhood.

Parental Education and Children's Sleep Disturbance: Minorities' Diminished Returns

BACKGROUND AND AIMS

While increased parental education reduces children's sleep problems, less is known about racial variation in such protection. According to Minorities' Diminished Returns (MDRs) theory, economic resources such as parental education show weaker health effects for minority groups such as Blacks and Latinos than non-Latino Whites, which is due to racism and social stratification. In this study, we investigated the association between parental education and children's sleep problems, as a proxy of sleep problems, by race.

METHODS

This cross-sectional study included 11718 American children aged 9-10. All participants were recruited to the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education, a five-level nominal variable. The dependent variable - sleep problems, was a continuous variable. Race/ethnicity was the effect modifier. Age, sex, and marital status were the covariates. Mixed-effects regression models were used for data analysis.

RESULTS

Parental education was associated with children's sleep problems. However, there was a weaker inverse association seen in non-Latino Black and Latino families compared to non-Latino White families. This was documented by a significant statistical interaction between race and ethnicity and parental education on children's sleep problems.

CONCLUSION

Diminished protective effect of parental education on children's sleep problems for non- Latino Black and Latino families compared to non-Latino White families is similar to the MDRs in other domains. Worse than expected sleep may contribute to higher-than-expected health risks of middle-class Black and Latino children.

Effects of Parental Education on Screen Time, Sleep Disturbances, and Psychosocial Adaptation Among Asian Preschoolers: A Randomized Controlled Study

PURPOSE

A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers.

DESIGN AND METHODS

A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention.

RESULTS

After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p < .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation.

CONCLUSIONS

Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers.

PRACTICE IMPLICATIONS

Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.

Measuring commissioners' willingness-to-pay for community based childhood obesity prevention programmes using a discrete choice experiment

Background

In the UK, rates of childhood obesity remain high. Community based programmes for child obesity prevention are available to be commissioned by local authorities. However, there is a lack of evidence regarding how programmes are commissioned and which attributes of programmes are valued most by commissioners. The aim of this study was to determine the factors that decision-makers prioritise when commissioning programmes that target childhood obesity prevention.

Methods

An online discrete choice experiment (DCE) was used to survey commissioners and decision makers in the UK to assess their willingness-to-pay for childhood obesity programmes.

Results

A total of 64 commissioners and other decision makers completed the DCE. The impact of programmes on behavioural outcomes was prioritised, with participants willing to pay an extra £16,600/year if average daily fruit and vegetable intake increased for each child by one additional portion. Participants also prioritised programmes that had greater number of parents fully completing them, and were willing to pay an extra £4810/year for every additional parent completing a programme. The number of parents enrolling in a programme (holding the number completing fixed) and hours of staff time required did not significantly influence choices.

Conclusions

Emphasis on high programme completion rates and success increasing children’s fruit and vegetable intake has potential to increase commissioning of community based obesity prevention programmes.

Socioeconomic Status in Infancy and the Developing Brain: Functional Connectivity of the Hippocampus and Amygdala

The development of the hippocampus and amygdala is particularly sensitive to environmental factors, including socioeconomic status (SES). Studies that have investigated associations between SES and brain development markers have rarely focused on connectivity. Accordingly, this longitudinal study examined whether SES in infancy (parental education and income-to-needs ratio) predicts the functional connectivity of the hippocampus and amygdala in late childhood, and in turn whether functional connectivity is associated with child socioemotional adjustment in a middle-class sample. SES indices were measured when children (n = 28) were 7 months old. When children were 10 years of age, they underwent a resting-state functional magnetic resonance imaging exam, and their school teachers completed a questionnaire assessing child socioemotional adjustment. Whole-brain regression analyses, including left and right hippocampi and amygdalae as seeds and SES indices as predictors, revealed that higher parental education predicted stronger functional connectivity between the left and right hippocampi and the right amygdala with the dorsal anterior cingulate cortex, and between the left amygdala and bilateral angular gyrus, after accounting for child age and sex. In turn, the connectivity of these regions was associated with higher child prosocial behavior. These findings contribute to the emerging literature suggesting that SES is associated with variability in the neural substrates of social abilities in children.

Patient Education Programs in Pediatric Atopic Dermatitis: A Systematic Review of Randomized Controlled Trials and Meta-Analysis

INTRODUCTION

Patient education is crucial for improving disease outcomes in atopic dermatitis (AD). This review aims to summarize evidence about the effectiveness of educational programs for parents of pediatric AD patients.

METHODS

PubMed and Embase (inception to Feb 2020) were searched and randomized controlled trials (RCTs) in English were included. Risk of bias was assessed using Cochrane risk of bias tools and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Pooled standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for the disease severity instrument (Scoring of Atopic Dermatitis, SCORAD) and quality of life (QoL) instruments using the random-effects model.

RESULTS

A total of 13 RCTs were included in the systematic review. The meta-analysis of SCORAD contained seven studies with a total of 1853 patients. The reduction in disease severity (SCORAD) was larger in the treatment group (SMD = - 8.22, 95% CI = - 11.29, - 5.15; P < 0.001; I2  =  78.6%). Subgroup analyses revealed that the association was modified by the frequency of sessions (P for Cochran Q  <  0.01) and the duration of follow-up (P for Cochran Q   <  0.01). No significant effect-modification was observed for disease severity and borderline significance was observed for session delivery (individual vs group session). The pooled effect sizes for QoL measures including Dermatitis Family Index (SMD = - 0.65, 95% CI = - 1.49, 0.18), Children's Dermatology Life Quality Index (SMD = - 1.61, 95% CI = - 3.76, 0.55; I2= 89.0%) and Infants' Dermatology Quality of Life Index (SMD = 0.30, 95% CI = - 1.04, 1.63; I2= 63.1%) were not significant.

CONCLUSIONS

Structured patient education is beneficial and should be implemented for the management of AD patients. However, an optimal delivery mode needs to be determined.

Design, development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention

BACKGROUND

The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging.

OBJECTIVE

To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother.

METHODS

First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers.

RESULTS

Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers.

CONCLUSION

Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.

Reconsidering the 'meritocratic power of a college degree'

Previous research has shown that the intergenerational transmission of advantage disappears once individuals obtain a bachelor's degree. This is known as the equalization thesis: the 'meritocratic power' of a college degree. This paper revisits the question of origin-destination association among college graduates. We improve on earlier studies by using three large sample (40,000+) of the National Survey of College Graduates, consisting of birth cohorts between 1938 and 1985. Contrary to the equalization thesis, we find that parental education and parental income are associated with substantially higher post-college incomes. An individual's own attainment only partially mediates the association through the type of college attended, but not through attaining an advanced degree. The consistency of the origin-destination estimates across three decades supports a reproduction thesis of mobility.

The social and genetic inheritance of educational attainment: Genes, parental education, and educational expansion

Recently, several genome-wide association studies of educational attainment have found education-related genetic variants and enabled the integration of human inheritance into social research. This study incorporates the newest education polygenic score (Lee et al., 2018) into sociological research, and tests three gene-environment interaction hypotheses on status attainment. Using the Health and Retirement Study (N = 7599), I report three findings. First, a standard deviation increase in the education polygenic score is associated with a 58% increase in the likelihood of advancing to the next level of education, while a standard deviation increase in parental education results in a 53% increase. Second, supporting the Saunders hypothesis, the genetic effect becomes 11% smaller when parental education is one standard deviation higher, indicating that highly educated parents are more able to preserve their family's elite status in the next generation. Finally, the genetic effect is slightly greater for the younger cohort (1942-59) than the older cohort (1920-41). The findings strengthen the existing literature on the social influences in helping children achieve their innate talents.

Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association's intricacy

Worldwide, under-five mortality (U5M) rate is highest in sub-Saharan Africa (SSA). There exists a gap in knowledge on the pathway through which Parental Educational Homogamy (PEH) influences U5M in SSA. In this study, we tested the research hypothesis' PEH is not associated with under-five children's survival probability in SSA. Demographic and health survey datasets for 21 SSA countries were analyzed. Cross-sectional design and multi-stage cluster sampling technique were used for sample selection in each of the countries under investigation. The dependent variable was the survival status of a newborn to age 59 months while the main independent variable was PEH generated from information on wife's and husband's level of education. Data were analyzed using Chi-square test, Cox-proportional hazard model and Brass-adjusted model (α=0.05). Under-five mortality rate ranges from 56/1,000 live born in South Africa to 190/1,000 live born in Sierra-Leone. Across countries, U5M rate was higher among the children of parents with at most primary education than that of parents who had at least secondary education. This pattern of U5M rate was also observed for children of parents where husbands were more educated than their wives. Maternal age at birth, sex of the child, toilet facility, type of cooking fuel, tetanus injection during pregnancy, and birth weight were significantly associated with U5M in 14, 11, 8, 7, 11, 14 and 20 countries respectively. A significant relationship was established between PEH and U5M in 11 of the 21 studied countries but was identified as a predictor of U5M in Congo Democratic Republic, Gambia and Zimbabwe. Parental educational homogamy exhibits a pattern of relationship with U5M in SSA. Ensuring that individuals particularly women have at least secondary education before childbearing will facilitate an U5M reduction in SSA.

Parental education, health literacy and children's adult body height

Human anthropometric traits, while significantly determined by genetic factors, are also affected by an individual's early life environment. An adult's body height is a valid indicator of their living conditions in childhood. Parental education has been shown to be one of the key covariates of individuals' health and height, both in childhood and adulthood. Parental functional literacy has been demonstrated to be another important determinant of child health, but this has largely been overlooked in studies on height. The objective of this study was to analyse the associations between parents' education, their functional literacy and their children's adult body height. The study used data for 39,240 individuals from the 2016 wave of the nationally representative Life in Transition Survey (LITS) conducted in 34 countries in Southern and Eastern Europe, the Middle East and Central Asia. Using linear and Poisson models, regression adjustment treatment estimators and multilevel mixed-effects linear regressions, the study analysed the links between mother's and father's educational attainment, parental functional literacy, measured by the number of books in the childhood home, and children's adult height. The models also included other individual and contextual covariates of height. The results demonstrated that mother's educational attainment and parental functional literacy have independent associations with children's adult body height. Sufficient literacy skills of the parent may have a positive effect on children's growth even if parental education is low. These associations remained significant across time. The study also provides evidence of a widening of the height gap for men born in the period just before and after systemic transition in post-socialist societies, which may suggest an increase in social differences in early living standards.

Supporting caregivers of children born prematurely in the development of language: A scoping review

Background

Infants born prematurely can display impairments that negatively impact the early years of their development. Compared to their peers born at term, preterm children have higher risks of cerebral palsy, sensory deficits, learning disabilities, cognitive and language deficits, as well as difficulties related to attention and behaviour. Following discharge, parents of preterm children are often supported through neonatal follow-up programs or by community health care practitioners. Through assessment and consultation, professionals foster parental resilience by teaching them about their child's development. Research shows a large volume of literature on improving outcomes for preterm infants, but less attention has been given to the impact and potential importance of education of parents regarding the care they provide from the home.

Objective

A scoping review was completed to determine the best practices for early intervention in premature children regarding the development of language skills during the preschool years.

Methods

The review followed the guidelines for the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

Results

Four general themes emerged from the review and included the importance of providing (1) parental training in the care of an infant born prematurely during neonatal intensive care unit stay; (2) education on the development of language and the importance of parental responsiveness; (3) provision of activities to support child language learning; and (4) overall and ongoing monitoring and support by qualified health professionals.

Conclusions

The conclusions drawn will provide guidance to health care professionals regarding the education of parents on best practices for stimulating language development in their child.

Conceptual skills and verbal abilities were better in children aged six to seven years who were from more highly educated families and attended sports clubs

AIM

We explored the cognitive abilities, health behaviour and cardiorespiratory fitness of preschool Estonian children aged 6-7 and any association with parental education, attending sports clubs and gender.

METHODS

Data were obtained from 256 children recruited from 13 randomly chosen kindergartens in Tartu, Estonia. Cognitive abilities were assessed using the modified Boehm Test of Basic Concepts - Third Edition. Objective physical activity (PA) intensity and sedentary levels were measured over seven days by accelerometry. To assess cardiorespiratory fitness, we used the 20-m shuttle run from the PREFIT test battery. Parents reported their educational attainment, together with their child's sports club attendance, sleep duration and screen time.

RESULTS

Children from more highly educated families had significantly better test results for conceptual skills, verbal abilities and cardiorespiratory fitness. PA levels, cardiorespiratory fitness and perception and conceptual skills test results were better in children who attended sports clubs. Higher cardiorespiratory fitness level, shorter screen time and sleep duration were associated with better conceptual skills.

CONCLUSION

Conceptual skills and verbal abilities were better in the children of more highly educated families and if they attended sports clubs. Children's cognitive abilities may benefit from better cardiorespiratory fitness, reduced sedentary activity and less screen time.

A Growing Social Divide in Body Mass Index, Strength, and Fitness of Swedish Male Conscripts

PURPOSE

The aim of the study was to monitor trends in socioeconomic inequalities in body mass index (BMI), cardiorespiratory fitness (CRF), and muscular strength over several decades in a population of Swedish males aged 18-19 years.

METHODS

The cohort consists of 1.5 million young men attending military conscript examinations from late 1968 to 2005. Parental education was used as a marker for socioeconomic conditions in the conscripts' families of origin. Changing gradient in BMI, CRF, and muscular strength in sons of parents with higher and lower educational attainment was evaluated during four periods covering 36 years.

RESULTS

Over the course of the obesity epidemic, BMI remained higher in conscripts with lesser (vs. higher) parental education. Moreover, the absolute difference in obesity prevalence between groups showed a continuous increase, from .6% to 3.9%, indicating growing inequalities. Regarding fitness, lower CRF was consistently associated with less parental education, but with no clear secular trend in the magnitude of the difference. Finally, social differences in muscular strength changed in direction, from lower strength among conscripts with higher parental education in the initial observation period to lower strength associated with lower parental education in the final decade studied.

CONCLUSIONS

Among Swedish conscripts entering adulthood, social gradients in BMI and obesity widened continuously between 1968 and 2005. An apparent reversal of the earlier gradient in muscular strength in young men may be related to societal trends in occupational and leisure-time physical activity over the observation period. This cohort is being continually monitored through national registries for obesity-related comorbidities in later life.

Symposium on "parental education" at the ICCH17

This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium “parental education” at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2018.

How do energy balance-related behaviors cluster in adolescents?

OBJECTIVES

To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level.

METHODS

Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5 years old) from Maringá/Brazil (BRACAH Study; n = 682) and ten European cities (HELENA Study; n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods.

RESULTS

Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster.

CONCLUSIONS

Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.

Parental education and family income affect birthweight, early longitudinal growth and body mass index development differently

AIM

This study investigated the effects of two parental socio-economic characteristics, education and income, on growth and risk of obesity in children from birth to 8 years of age.

METHODS

Longitudinal growth data and national register-based information on socio-economic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height was compared in groups dichotomised by parental education and income.

RESULTS

Low parental education was associated with a higher BMI from 4 years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birthweight, but did not independently predict BMI development. At 8 years of age, children from less educated families had a three times higher risk of obesity, independent of parental income. Children whose parents had fewer years of education but high income had significantly higher height than all other children.

CONCLUSION

Parental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children.

Socioeconomic gaps in science achievement

BACKGROUND

In contrast to the extensive research on socioeconomic gaps in reading and math achievement, little attention has been given to socioeconomic disparities in science skills, particularly during the early years of schooling. This emphasis on later years may be problematic because large socioeconomic disparities emerge in the early years, thus it is crucial to document the size of disparities in science achievement and begin unpacking the range of factors that contribute to these disparities. Additionally, it is crucial to know which components of socioeconomic status are more strongly linked to children's science skills so that resources can be more effectively targeted to address disparities. Using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (N = 9250), this study examines disparities in science achievement across elementary and middle school related to parental income and parental education separating their effects from each other and from a range of confounding factors. Additionally, it considers whether characteristics of children, families, and schools are pathways through which socioeconomic disparities emerge.

RESULTS

Results show moderate gaps in science achievement related to both household income and parental education. The primary pathways through which parental education and family income influenced science achievement was through mathematics and reading achievement. For parental education gaps, smaller indirect effects also operated through access to informal science learning opportunities both inside and outside of the home environment.

CONCLUSION

First, this study highlights the importance of considering the contributions of multiple measures of socioeconomic status, instead of a composite. Second, it shows that socioeconomic disparities in science achievement emerge early and that programs and policies aimed at addressing these gaps may need to target children during the early elementary and preschool years. Third, our findings suggest that elementary instructional approaches that simultaneously address science instruction with reading and/or mathematics instruction will likely be especially important for improving overall science outcomes.

Eight-year outcome of implementation of abusive head trauma prevention

Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.

Education, school type and screen time were associated with overweight and obesity in 2930 adolescents

AIM

This cross-sectional study analysed the influence of socio-economic factors on screen time, overweight and obesity.

METHODS

We asked adolescents aged 10, 14 and 17 from 10 school types in urban and rural regions in Upper Austria to complete questionnaires from December 2012 to February 2013. Their parents were also asked to complete questionnaires.

RESULTS

The questionnaires were completed by 2930 adolescents and 2209 parents. Total weekend screen time was significantly associated with a higher body mass index (BMI) in 10-year-old boys (p < 0.005) and 10-year-old girls (p = 0.002), and there were significant associations between higher BMI and television time and longer weekend video game use in subjects aged 10 and 14. Higher education levels were associated with shorter daily video game use and longer computer use. Males (p < 0.0001) and adolescents from immigrant families (p < 0.0001) reported longer screen times at all ages. Lower parental education and higher parental BMI correlated significantly with longer screen time and BMI in the youngest age group.

CONCLUSION

The greatest weight problems were in younger adolescents, despite shorter screen times, and boys and adolescents from immigrant families reported the longest screen times. Prevention strategies need to start early.

Gender differences and the role of parental education, school types and migration on the body mass index of 2930 Austrian school children : A cross-sectional study

BACKGROUND

Austria faces increasing numbers of childhood overweight and obesity. Despite increasing numbers of studies, associations between parental body mass index (BMI) and education and the school type on overweight/obesity in students have not been reported. The objective of this study was to evaluate the influence of these parameters on the genesis of overweight/obesity in a large cohort representative of youth in Upper Austrian.

METHODS

A cross-sectional analysis of data from 2930 children and adolescents aged 10, 14 or 17 years from 11 different state school types was conducted. Students and their parents completed a questionnaire and heights and weights were measured.

RESULTS

Of the students 16.9% fulfilled the criteria for overweight and 5.6% for obesity, with the highest rates in the 10-year-olds (19.6% and 5.8%, respectively). While no gender differences were present in the youngest age group, the body mass index (BMI) during adolescence remained higher in boys but decreased significantly in girls. Male gender remained a risk factor through all calculations. Boys were overrepresented in schools with lower education levels and more often had BMIs ≥ 85th and ≥95th percentile. Higher parental education levels and lower parental BMIs were associated with lower BMIs of their offspring. Migration was an additional association factor for BMIs ≥ 85th percentile.

CONCLUSION

Low parental education levels, higher parental BMIs and migration background were associated with overweight and obesity in 10-year-olds. In adolescence, male gender and higher parental BMIs remained risk factors.

Interaction between Parental Education and Twin Correlations for Cognitive Ability in a Norwegian Conscript Sample

We examine a sample of Norwegian twin conscripts for evidence of an interaction between parental education and the heritability of general cognitive ability (GA). Ability scores were obtained on 1706 pairs of twins who were conscripted into the Norwegian Armed Forces between 1931and 1960. Education scores were available for mothers and fathers; the majority of the parents had less than a high school education. GA scores were heteroscadistic with respect to mid-parent education, with reduced variability at higher levels of education. Both MZ and DZ twin correlations for GA were linearly and negatively related to mid-parent education, DZ twins substantially more so. When the model was extended to an ACE model consisting of standardized positive ACE variance components, the modification appeared to disappear. Further analysis revealed that this occurred because the steep decline of DZ twin correlations with increasing mid-parent education resulted in a violation of the classical twin model for much of the parameter space. Other phenomena that might result in large declines in DZ twin correlations are considered, along with implications for other studies of socioeconomic interactions with the heritability of GA in European samples.

Pathways of Intergenerational Transmission of Advantages during Adolescence: Social Background, Cognitive Ability, and Educational Attainment

Educational attainment in adolescence is of paramount importance for attaining higher education and for shaping subsequent life chances. Sociological accounts focus on the role of differences in socioeconomic resources in intergenerational reproduction of educational inequalities. These often disregard the intergenerational transmission of cognitive ability and the importance of children's cognitive ability to educational attainment. Psychological perspectives stress the importance of cognitive ability for educational attainment but underemphasize potentially different roles of specific socioeconomic resources in shaping educational outcomes, as well as individual differences in cognitive ability. By integrating two strands of research, a clearer picture of the pathways linking the family of origin, cognitive ability, and early educational outcomes can be reached. Using the population-based TwinLife study in Germany, we investigated multidimensional pathways linking parental socioeconomic position to their children's cognitive ability and academic track attendance in the secondary school. The sample included twins (N = 4008), respectively ages 11 and 17, and siblings (N = 801). We observed strong genetic influences on cognitive ability, whereas shared environmental influences were much more important for academic tracking. In multilevel analyses, separate dimensions of socioeconomic resources influenced child cognitive ability, controlling parental cognitive ability. Controlling adolescent cognitive ability and parental cognitive ability, parental socioeconomic resources also directly affected track attendance. This indicated that it is crucial to investigate the intertwined influences on educational outcomes in adolescence of both cognitive ability and the characteristics of the family of origin.