Community-level social capital, parental psychological distress, and child physical abuse: a multilevel mediation analysis

Years of education mediate the association between adverse childhood experiences and unintended pregnancy: A population-based study in Japan

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with unintended pregnancies, including mistimed pregnancies (MP) and unwanted pregnancies (UWP). However, it remains unknown which cluster of ACEs (i.e., child maltreatment/household dysfunction and deprivation/threat) are associated with MP/UWP and whether years of education mediate these associations.

OBJECTIVE

To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years.

PARTICIPANTS AND SETTING

A retrospective cohort study among 7652 postpartum women in Chiba, Japan.

METHODS

MP/UWP was defined by emotional responses to confirming pregnancy. Multinomial logistic regression analyses with multiple imputed datasets estimated the relative risk ratio (RRR) of MP/UWP by cumulative scores and each cluster of ACEs. Causal mediation analysis assessed the indirect effects of years of education.

RESULTS

Women with 4 or more ACEs were at a 2.4 times higher risk of MP (95 % confidence interval (CI): 1.6-3.8) and a 5.0 times higher risk of UWP (95 % CI: 3.1-8.2). Among ACE clusters, having 3 or more household dysfunction showed the strongest association with MP (RRR: 1.91, 95 % CI: 1.23-2.95), and having 3 or more deprivation showed the strongest association with UWP (RRR: 3.69, 95 % CI: 2.00-6.83). Education years mediated 16 % and 11 % of the association between total ACEs and MP/UWP, respectively, with a similar trend observed in each cluster.

CONCLUSIONS

Not only ACEs score but also each cluster of ACEs was associated with MP and UWP. The mediating effects of years of education were modest.

Association between the number of convenience stores and caries status in permanent teeth among elementary school children: results from the A-CHILD population-based longitudinal cohort study

Background

In Japan, people have rich access to 24-h convenience stores where they can buy sweets, juice and fluoride hygiene products, among others. However, the association between the number of convenience stores in a neighbourhood and caries in elementary school children status has not been studied. This study aimed to investigate this particular association.

Methods

Data were derived from a population-based longitudinal cohort study (A-CHILD study) of elementary school children from first-grade to fourth-grade in Adachi City, Tokyo. Caregivers were asked to complete a questionnaire in 2015, 2016, and 2018. A total of 3,136 caregivers provided a valid response. We analysed the association using multilevel Poisson regression.

Results

The mean number of caries among children in school districts with low, middle, and high number of convenience stores was 0.31 (SD: 0.81), 0.21 (SD: 0.69), and 0.16 (SD: 0.58). After covariate adjustment, children in the school districts with high and middle number of convenience stores had 44% (mean ratio 0.56, 95% CI: 0.31, 0.998) and 31% (mean ratio 0.69, 95% CI: 0.42, 1.13) fewer caries in their permanent teeth, respectively, than children in the school districts with low number of convenience stores. We also found dose-response relationship (p for trend: 0.042).

Conclusion

Higher number of convenience stores in a school district was associated with fewer caries in permanent teeth among elementary school children. Further study elucidating the mechanism on this protective association is warranted.

Number of Siblings and Social Capital Among Parents Rearing Schoolchildren: Results From the A-CHILD Study

BACKGROUND

Having siblings may foster sociality; however, little is known about whether sibling number determines social capital, the resources obtained through social networks. We examined the association between sibling number and social capital among Japanese parents rearing schoolchildren.

METHODS

We used cross-sectional data from the 2018 and 2019 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, targeting all primary and junior high school students and their parents in Adachi, Tokyo, Japan (n = 8,082). Individual-level social capital was evaluated by assessing caregivers' social cohesion, social support, and group affiliation. All analyses were adjusted for age and sex.

RESULTS

An inverse U-shaped association was found between sibling number and social capital. Adults who grew up with one or two, but not three or more siblings had greater social support (coefficient = 0.23; 95% confidence interval [CI], 0.06-0.40 and coefficient = 0.46; 95% CI, 0.29-0.64, respectively) than those who grew up as an only child, after covariate adjustment. Adults who grew up with two or three, but not one or four or more siblings had greater group affiliation (coefficient = 0.09; 95% CI, 0.03-0.16 and coefficient = 0.09; 95% CI, 0.01-0.18, respectively) than those who grew up as an only child, after covariate adjustment. Sibling number was not associated with social cohesion.

CONCLUSION

Growing up with one to three siblings was associated with higher social capital in adulthood than being an only child. Having siblings may provide an opportunity to foster social capital.

Association between skipping breakfast and prediabetes among adolescence in Japan: Results from A-CHILD study

OBJECTIVE

Adolescents with prediabetes are at high risk of developing type 2 diabetes in later life. It is necessary to identify risk factors for prediabetes in adolescents. This study aimed to examine the association between skipping breakfast and prediabetes among adolescents in Japan.

STUDY DESIGN

We used the population-based cross-sectional data of eighth grade in junior high school students from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study conducted in Adachi City, Tokyo, Japan, in 2016, 2018, and 2020. Skipping breakfast was assessed using self-reported questionnaires (N=1510). Prediabetes was defined as hemoglobin A1c (HbA1c) levels of 5.6-6.4%. The association between skipping breakfast and prediabetes was evaluated using multivariate logistic regression analysis. Stratified analysis was also performed using BMI, 1 SD or more, or less than 1SD, as overweight was defined as 1SD or more.

RESULTS

Students who skipped breakfast were 16.4% (n=248). The prevalence of prediabetes was 3.8% (n=58). Skipping breakfast exhibited a significant association with prediabetes (OR:1.95, 95% CI: 1.03 to 3.69) after adjusting for sex, annual household income, family history of diabetes mellitus, BMI, and survey year. Stratified analysis showed stronger association among students with overweight (BMI ≥1SD) (OR=4.31, 95% CI 1.06-17.58), while non-sigificant among students without overweight (BMI<1SD) (OR=1.62, 95% CI 0.76-3.47).

CONCLUSIONS

Skipping breakfast in Japanese adolescents, especially those with overweight, was associated with prediabetes. The promotion of avoiding skipping breakfast may help to prevent prediabetes.

Association between Community Social Capital and Access to Dental Check-Ups among Elementary School Children in Japan

The association between parental social capital and a child's access to dental check-ups has been reported, but few studies have focused on dental check-ups. The present study investigated the association between parental social capital and access to dental check-ups among first-grade elementary school children (6-7 years old) in Japan. We analyzed cross-sectional data of first-grade elementary school children (6-7 years old) in Adachi City, Tokyo, Japan. Community social capital (the total score of social trust, cohesion, mutual aid) and child's dental check-ups (dental check-ups for purposes other than treatment at least once a year) were assessed by questionnaire surveys for parents of the first graders from all 69 elementary schools in 2017 (n = 5260; response rate: 81.6%) and 2019 (n = 5130; response rate: 78.8%). Multilevel Poisson regression analysis, adjusted for children's age in months, gender, mother's educational attainment, mother's employment status, having siblings, living with grandparents, and the density of dental clinics in the school district, was applied. Of the 7936 respondents included in the analysis, 82.7% of children received dental check-ups at least once a year. Individual-level social capital was positively associated with children's dental check-up utilization (prevalence ratio, PR = 0.935 per one interquartile range, IQR; 95% confidence interval, CI: 0.877, 0.996). Community-level social capital was not significantly associated with children's dental check-up utilization (PR = 0.934 per one IQR; 95% CI: 0.865, 1.008). Promoting individual-level social capital, but not community-level social capital, may improve dental check-ups among elementary school children in Japan.

Association of Paternal Workplace and Community Social Capital With Paternal Postnatal Depression and Anxiety: A Prospective Study

OBJECTIVE

The aim of this study is to examine the association between workplace and community social capital and fathers' postpartum depression and anxiety at 3 months after delivery in Japan.

METHODS

Fathers who had babies delivered in two obstetric clinics in Tokyo, Japan were recruited to take part in the study (response rate = 76.2%). Participants completed questionnaires measuring workplace and community social capital, depression, and anxiety at 1 week and a follow-up at 3 months post-delivery (N = 398). Multiple linear regression analyses were performed with multiple imputation for missing data (at most, N = 60, 15.1%).

RESULTS

Community social capital was inversely associated with both depressive symptoms (β = -0.21, 95%CI = -0.33 to -0.08) and anxiety (β = -0.38, 95%CI = -0.66 to -0.11) at 3 months, after adjusting for covariates. No association was found between workplace social capital and depressive symptoms and anxiety.

CONCLUSION

Paternal community social capital, but not workplace social capital, was shown to be a preventive factor for paternal depression and anxiety up to 3 months post-delivery. To prevent paternal mental health problems during the postpartum period, an intervention to promote paternal community, rather than workplace, social capital may be warranted.

The Pathways Linking to Sleep Habits among Children and Adolescents: A Complete Survey at Setagaya-ku, Tokyo

It has been noted that Japanese children sleep the least in the world, and this has become a major social issue. This study examined the pathways linked to sleep habits (SH) among children and adolescents. A questionnaire-based survey was conducted in March 2019 on children and their parents at all 63 public elementary and 29 public junior high schools in Setagaya-ku, Tokyo. For the analysis, 22,385 pairs of children-parent responses (valid response rate: 68.8%) with no missing data were used. This survey collected data on SH, physical activity (PA), screen time (ST) for the child, and lifestyle and neighborhood social capital (NSC) for the parents. Moreover, the pathways linking 'NSC' → 'parental lifestyle' → 'child's PA/ST' →'child's SH' were examined through structural equation modeling. The results indicated that children's SH were affected by their PA and ST and influenced by the lifestyle of their parents and the NSC that surrounds them. Thus, we concluded that it is necessary to provide direct interventions and take additional measures with regard to parent lifestyle and their NSC to solve persistent sleep problems in children.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government

Background

Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors.

Methods

Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0.

Results

In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03).

Conclusions

It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

The association of community and individual parental social capital with behavior problems among children in Japan: results from A-CHILD longitudinal study

PURPOSE

The purpose of this study was to determine the association of individual-level and community-level parental social capital with childhood behavior problems using population-based longitudinal data in Japan.

METHODS

We analyzed data from a population-based longitudinal survey study which followed first-grade elementary school children (6-7 years old) in Adachi City, Tokyo, Japan. At baseline, the parents of first-grade students from all 69 elementary schools in Adachi City were asked to respond to a questionnaire assessing behavior problems and prosocial behavior (using the Strengths and Difficulties Questionnaire) and parental social capital in the community (N = 5494). Data on follow-up questionnaires on behavior problems were collected when children were second grade. Among both surveys, 3656 parents returned valid responses. The association between individual-level and community-level parental social capital and children's behavior problems were analyzed using multilevel analyses adjusting for covariates.

RESULTS

Community-level social capital was positively associated with prosocial behaviors, but not for total difficulties, after adjustment for covariates (coefficient = 0.19, 95% CI 0.03 to 0.36). Individual-level parental social capital was also positively associated with prosocial behaviors (coefficient = 0.27, 95% CI 0.12 to 0.41) and negatively associated with total difficulties (coefficient = - 0.54, 95% CI - 0.89 to - 0.19).

CONCLUSIONS

This study showed that greater community-level social capital can benefit children with increased prosocial behaviors. Individual-level parental social capital can be protective of youth by increasing prosocial behaviors and reducing difficult behaviors. Boosting both community and individual social capital can be a promising means to enhance children's well-being.

Poor parenting behaviours and dental caries experience in 6- To 7-year-old children

OBJECTIVES

The association between poor parenting and dental caries in children remains unclear. We investigated the association of poor parenting with dental caries and oral health behaviour among children aged 6-7 years in Japan.

METHODS

Two waves of repeated cross-sectional surveys on children and their caregivers in Adachi City, Tokyo, were analysed. Questionnaires on parenting behaviour and the child's oral health behaviour were distributed through schools and completed by 8499 caregivers (response rate = 80.8%). The number of decayed or filled primary teeth (dft) at school dental health check-ups was linked to the survey data (N for complete case analysis = 6309). Factor analysis was performed to identify types of poor parenting: poor involvement, child abuse and lack of supervision of a child's health behaviours. The association between factor scores (z-score), the number of dft and oral health behaviour (not brushing teeth twice a day, not controlling snack eating habits and drinking juice every day) was evaluated by Poisson's regressions adjusted for covariates, including caregiver's socioeconomic status.

RESULTS

Poor involvement and lack of supervision of a child's health behaviours were positively associated with dft (mean ratio, MR [95% confidence interval, CI] =1.05 [1.03, 1.07] and 1.18 [1.16, 1.21], respectively) and unhealthy oral health behaviours. Child abuse was not associated with dft (MR = 0.99 [0.96, 1.01]) but was associated with all three unhealthy oral health behaviours (prevalence ratio, PR [95% CI] were 1.11 [1.06, 1.16], 1.11 [1.06, 1.16] and 1.06 [1.00, 1.11] for not brushing teeth, not controlling snack eating and drinking juice, respectively).

CONCLUSIONS

Poor involvement and lack of supervision of a child's health behaviours were associated with dental caries, and any type of poor parenting was associated with poor oral health behaviour among children.

Neighbourhood collective efficacy and protective effects on child maltreatment: A systematic literature review

Research within the community-based child protection approach has used the neighbourhood collective efficacy theory of social disorganisation to focus on investigating the social conditions and processes that facilitate residents' ability to intervene or protect children from parental maltreatment. However, much of the research into the protective effects of neighbourhood collective efficacy on child maltreatment has yielded mixed results. In a review of empirical studies published between 2008 and 2019, we investigated the sources of these mixed findings and the pathways through which neighbourhood collective efficacy could protect children from parental maltreatment. Following the PRISMA guidelines for systematic literature reviews yielded 21 empirical research articles on the subject that were critically examined in line with the theoretical underpinning and research questions. Evidence suggests both direct and sequential pathways in which increased social cohesion and informal social control (ISC) protect against parents' maltreatment behaviours. Higher levels of neighbourhood social cohesion were found to be a potential primary preventive strategy against risk factors for maltreatment. The use of ISC measures from the traditional collective efficacy scale account for the mixed findings and limited research on the direct and indirect forms of ISC. Moreover, the transactional processes posited by collective efficacy theory that link neighbourhood social cohesion to ISC have yet to be examined and confirmed with respect to child maltreatment. Studies addressing these theoretical and methodological gaps are encouraged, in particular, studies examining ISC dimensions using item measures of specific residents' actions within child maltreatment behaviours. The results provide implications for community-based child protection practice, in terms of promoting cultural norms and values that foster social cohesion and facilitate ISC interventions within neighbourhoods.

The impact of public assistance on child mental health in Japan: results from A-CHILD study

Public assistance is one option for providing a safety net to protect the health of children, but assistance may also generate feelings of shame that impact self-esteem. This study aims to elucidate the impact of public assistance on child mental health. We used cross-sectional data on 6920 first graders from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. We found children living in relative poverty had more behavioral problems, low resilience, and were likely to refuse to go to school. After propensity-score matching among low-income households, the likelihood of children refusing to go to school was larger in the families receiving assistance as compared to non-recipients (OR 4.00, 95% CI 0.85-18.84) although there were no significant differences between recipients and non-recipients in low-income households. Our study produced insufficient evidence to indicate that social assistance is associated with child mental health, resilience, or school refusal.

The Association between Parental Involvement Behavior and Self-Esteem among Adolescents Living in Poverty: Results from the K-CHILD Study

It is not yet known why some adolescents living in poverty show high self-esteem, while others do not. Parental involvement may be an important determinant to promote self-esteem among adolescents living in poverty. The aim of this study is to explore better parenting involvement behavior to promote self-esteem among adolescents living in poverty. Participants included fifth-, eighth-, and 11th-grade students living in Koichi prefecture, Japan. The participants were part of the Kochi Child Health Impact of Living Difficulty (K-CHILD) study, in 2016 (n = 10,784). Participants completed a questionnaire with questions about socioeconomic status and 14 parental involvement behaviors, including 9 specific kinds of parental interactions with their child (e.g., talking about school life), and 5 elements related to parental care for their child's physical health (e.g., access to health care). The numbers of parental involvement behaviors, parental interactions with their child, and parental care for their child's physical health were treated as continuous and quartile, to see the association. Overall, the study showed that the larger the number of parental involvement behaviors, the higher the self-esteem score of their off-spring (p < 0.01) among both adolescents living in poverty and not living in poverty, in which interaction between poverty and parental involvement behaviors was not significant. Both parental interaction with their child and parental care for their child's physical health were associated with higher self-esteem, in which parental interaction with their child had a larger effect than parental care for their child's physical health. To empower adolescents in poverty, caregivers need to provide both parental interaction with the child and parental care for the child's physical health.

Association of Existence of Third Places and Role Model on Suicide Risk Among Adolescent in Japan: Results From A-CHILD Study

Objective: Low self-esteem among adolescents can be considered a risk factor for suicidal behavior in adolescents. Thus, the purpose of this study is to investigate the association between the existence of a third place and role model on self-esteem among adolescents in Japan, where low self-esteem is prevalent among adolescents. Methods: We analyzed data from the 2016 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, in which a school-based questionnaire was conducted among children in grades 4, 6, and 8 living in Adachi City, Tokyo (N = 1,609). Children self-rated their own levels of self-esteem. Low self-esteem was defined as lower 10 percentile group. The existence of a third place was defined as a place where children spent time after school other than the home or school campus, and role model was defined as having someone, other than a parent, who they looked up to, and these concepts were assessed via questionnaire. Results: Adolescents without a third place and role model accounted for 10.5 and 6.1%, respectively. We found that children who lacked a third place also showed a significant association with low self-esteem (OR: 1.75, 95% confidence interval (CI): 1.09-2.81), and those who lacked a role model were 3.34 times more likely to have lower self-esteem (95% CI: 1.98-5.62). Conclusion: The existence of a third place and a role model may be important to prevent low self-esteem among adolescents in Japan.

Pathway of the Association Between Child Poverty and Low Self-Esteem: Results From a Population-Based Study of Adolescents in Japan

Child poverty leads to various negative consequences, including low self-esteem, which is a risk factor for mental illness, suicide, or poor academic achievement. However, little is known about why child poverty leads to low self-esteem. We aimed to elucidate the association of child poverty and low self-esteem based on the ecological model, which includes family-level, school-level, and community-level factors. Data were obtained from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016, and participants included 1,652 children in fourth grade (534 pairs), sixth grade (530 pairs), and eighth grade (588 pairs) living in Adachi City, Tokyo, Japan. A questionnaire survey was implemented to assess child poverty, parental mental health, parental involvement with children, parental social capital by caregivers, and self-esteem and school social capital by children. The structural equation model was applied to elucidate the association between child poverty and low self-esteem, using family-level (parental mental health and parental involvement with children), school-level (school social capital), and community-level (parental social capital) factors. Child poverty was associated with low self-esteem. Child poverty leads to poor parental involvement, which can be indirectly associated with poor parental mental health and poor parental social capital, and poor parental involvement was directly or indirectly associated with low self-esteem through poor school social capital. To mitigate the impact of child poverty on low self-esteem, comprehensive health policies targeting family-level (parental mental health and parental involvement with children), school-level (school social capital), and community-level (parental social capital) factors may be effective.

Association between social capital and second dose of measles vaccination in Japan: Results from the A-CHILD study

BACKGROUND AND OBJECTIVES

Measles vaccination is important to prevent outbreak, and social capital can be an important preventive factor. However, there have been very few studies that investigated the association between social capital and measles vaccination, especially the second dose, which is more likely to be suboptimal. This study aimed to investigate the association between social capital and second dose of measles vaccine.

METHODS

Data were derived from a population-based study of first-grade elementary school children (6-7 years old) in Adachi City, Tokyo. Caregivers were asked to complete a questionnaire, and 4291 of them provided a valid response (response rate: 80.1%). Among these 4291 valid responses, 69 responses were excluded since variables for social capital measures were missing, which resulted in analytic sample size of 4222. We analyzed the association between measles vaccination and social capital including social ties, social trust and mutual aid by multilevel logistic regression analysis with a random intercept model.

RESULTS

About 8.9% of the children did not receive a second dose of measles-containing vaccines. After covariates adjustments, increase of one-standard-deviation of poor individual-level social ties showed 11% lower odds of receiving measles-containing vaccines (OR: 0.89, 95% CI: 0.80-0.99). By contrast, no significant association between community-level social ties and measles vaccination was found. Regarding social trust, no significant association between individual-level social trust and measles vaccination was found. However, increase of one-standard-deviation of poor community-level social trust showed 11% lower odds of receiving measles-containing vaccines (OR: 0.89, 95% CI: 0.79-0.998). There was no association between mutual aid and measles vaccination.

CONCLUSION

Social ties and social trust were associated with second dose of measles vaccination. Fostering social capital may be effective in raising the low rate of second dose of measles vaccine.