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Popay J, Halliday E, Mead R, Townsend A, Akhter N, Bambra C, Barr B, Anderson de Cuevas R, Daras K, Egan M, Gravenhorst K, Janke K, Kasim AS, McGowan V, Ponsford R, Reynolds J, Whitehead M. Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation. PUBLIC HEALTH RESEARCH 2023; 11:1-147. [PMID: 37929801 DOI: 10.3310/grma6711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap. Intervention Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods. Objective To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative. Study design, data sources and outcome variables This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction. Results At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M. Main limitations COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas. Conclusions Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emma Halliday
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Anne Townsend
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nasima Akhter
- Department of Anthropology, Durham University, Durham, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | | | - Konstantinos Daras
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Katja Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Janke
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Victoria McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruth Ponsford
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Reynolds
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
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Cavallaro FL, Cannings-John R, Lugg-Widger F, Gilbert R, Kennedy E, Kendall S, Robling M, Harron KL. Lessons learned from using linked administrative data to evaluate the Family Nurse Partnership in England and Scotland. Int J Popul Data Sci 2023; 8:2113. [PMID: 37670953 PMCID: PMC10476150 DOI: 10.23889/ijpds.v8i1.2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Introduction "Big data" - including linked administrative data - can be exploited to evaluate interventions for maternal and child health, providing time- and cost-effective alternatives to randomised controlled trials. However, using these data to evaluate population-level interventions can be challenging. Objectives We aimed to inform future evaluations of complex interventions by describing sources of bias, lessons learned, and suggestions for improvements, based on two observational studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP) in England and Scotland. Methods We first considered how different sources of potential bias within the administrative data could affect results of the evaluations. We explored how each study design addressed these sources of bias using maternal confounders captured in the data. We then determined what additional information could be captured at each step of the complex intervention to enable analysts to minimise bias and maximise comparability between intervention and usual care groups, so that any observed differences can be attributed to the intervention. Results Lessons learned include the need for i) detailed data on intervention activity (dates/geography) and usual care; ii) improved information on data linkage quality to accurately characterise control groups; iii) more efficient provision of linked data to ensure timeliness of results; iv) better measurement of confounding characteristics affecting who is eligible, approached and enrolled. Conclusions Linked administrative data are a valuable resource for evaluations of the FNP national programme and other complex population-level interventions. However, information on local programme delivery and usual care are required to account for biases that characterise those who receive the intervention, and to inform understanding of mechanisms of effect. National, ongoing, robust evaluations of complex public health evaluations would be more achievable if programme implementation was integrated with improved national and local data collection, and robust quasi-experimental designs.
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Affiliation(s)
- Francesca L. Cavallaro
- UCL Great Ormond Street Institute of Child Health, London, UK
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fiona Lugg-Widger
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eilis Kennedy
- Children, Young Adults and Families Directorate, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Michael Robling
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Katie L. Harron
- UCL Great Ormond Street Institute of Child Health, London, UK
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Johnson MI, Woodall J. A healthy settings approach to addressing painogenic environments: New perspectives from health promotion. FRONTIERS IN PAIN RESEARCH 2022; 3:1000170. [PMID: 36238350 PMCID: PMC9551298 DOI: 10.3389/fpain.2022.1000170] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Structural approaches to promoting health focus on policies and practices affecting health at the community level and concentrate on systems and forces of society, including distribution of power, that foster disadvantage and diminish health and well-being. In this paper we advocate consideration of structural approaches to explore macro level influences on the burden of persistent pain on society. We argue that health promotion is an appropriate discipline to ameliorate painogenic environments and that a "settings approach" offers a crucial vehicle to do this. We encourage consideration of socio-ecological frameworks to explore factors affecting human development at individual, interpersonal, organizational, societal, and environmental levels because persistent pain is multifaceted and complex and unlikely to be understood from a single level of analysis. We acknowledge criticisms that the structural approach may appear unachievable due to its heavy reliance on inter-sectoral collaboration. We argue that a settings approach may offer solutions because it straddles "practical" and cross-sectorial forces impacting on the health of people. A healthy settings approach invests in social systems where health is not the primary remit and utilises synergistic action between settings to promote greater health gains. We offer the example of obesogenic environments being a useful concept to develop strategies to tackle childhood obesity in school-settings, community-settings, shops, and sports clubs; and that this settings approach has been more effective than one organisation tackling the issue in isolation. We argue that a settings approach should prove useful for understanding painogenic environments and tackling the burden of persistent pain.
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Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - James Woodall
- Centre for Health Promotion Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
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Focus on Fathers: Exploring the parenting experiences of fathers using a large population-level sample. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Bywater T, Berry V, Blower S, Bursnall M, Cox E, Mason-Jones A, McGilloway S, McKendrick K, Mitchell S, Pickett K, Richardson G, Solaiman K, Teare MD, Walker S, Whittaker K. A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/bcfv2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.
Objectives
To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.
Design
A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).
Setting
The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.
Participants
A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.
Intervention
Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].
Main outcome measures
Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.
Results
The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.
Limitations
The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.
Conclusions
The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.
Future work
The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.
Trial registration
This trial is registered as ISRCTN11079129.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | | | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | | | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, Ireland
| | | | - Siobhan Mitchell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | - M Dawn Teare
- Sheffield Clinical Trials Research Unit, Sheffield, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
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Burgemeister FC, Crawford SB, Hackworth NJ, Hokke S, Nicholson JM. Place-based approaches to improve health and development outcomes in young children: A scoping review. PLoS One 2021; 16:e0261643. [PMID: 34941941 PMCID: PMC8700019 DOI: 10.1371/journal.pone.0261643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
This scoping review examines the strength of evidence for the effectiveness of public policy-led place-based initiatives designed to improve outcomes for disadvantaged children, their families and the communities in which they live. Study designs and methods for evaluating such place-based initiatives were assessed, along with the contexts in which initiatives were implemented and evaluated. Thirty-two reports relating to 12 initiatives were included. Eleven initiatives used a quasi-experimental evaluation to assess impact, although there were considerable design variations within this. The remaining initiative used a pre- and post- evaluation design. Place-based initiatives by definition aim to improve multiple and interrelated outcomes. We examined initiatives to determine what outcomes were measured and coded them within the five domains of pregnancy and birth, child, parent, family and community. Across the 83 outcomes reported in the 11 studies with a comparison group, 30 (36.4%) demonstrated a positive outcome, and all but one initiative demonstrated a positive outcome in at least one outcome measure. Of the six studies that examined outcomes more than once post baseline, 10 from 38 outcomes (26.3%) demonstrated positive sustained results. Many initiatives were affected by external factors such as policy and funding changes, with unknown impact on their effectiveness. Despite the growth of place-based initiatives to improve outcomes for disadvantaged children, the evidence for their effectiveness remains inconclusive.
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Affiliation(s)
| | | | - Naomi J. Hackworth
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Parenting Research Centre, East Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Jan M. Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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Hornburg CB, Borriello GA, Kung M, Lin J, Litkowski E, Cosso J, Ellis A, King Y, Zippert E, Cabrera NJ, Davis-Kean P, Eason SH, Hart SA, Iruka IU, LeFevre JA, Simms V, Susperreguy MI, Cahoon A, Chan WWL, Cheung SK, Coppola M, De Smedt B, Elliott L, Estévez-Pérez N, Gallagher-Mitchell T, Gardner-Neblett N, Gilmore C, Leyva D, Maloney EA, Manolitsis G, Melzi G, Mutaf-Yıldız B, Nelson G, Niklas F, Pan Y, Ramani GB, Skwarchuk SL, Sonnenschein S, Purpura DJ. Next Directions in Measurement of the Home Mathematics Environment: An International and Interdisciplinary Perspective. JOURNAL OF NUMERICAL COGNITION 2021; 7:195-220. [PMID: 34778511 PMCID: PMC8589301 DOI: 10.5964/jnc.6143] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article synthesizes findings from an international virtual conference, funded by the National Science Foundation (NSF), focused on the home mathematics environment (HME). In light of inconsistencies and gaps in research investigating relations between the HME and children's outcomes, the purpose of the conference was to discuss actionable steps and considerations for future work. The conference was composed of international researchers with a wide range of expertise and backgrounds. Presentations and discussions during the conference centered broadly on the need to better operationalize and measure the HME as a construct - focusing on issues related to child, family, and community factors, country and cultural factors, and the cognitive and affective characteristics of caregivers and children. Results of the conference and a subsequent writing workshop include a synthesis of core questions and key considerations for the field of research on the HME. Findings highlight the need for the field at large to use multi-method measurement approaches to capture nuances in the HME, and to do so with increased international and interdisciplinary collaboration, open science practices, and communication among scholars.
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Affiliation(s)
| | | | | | - Joyce Lin
- California State University, Fullerton
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8
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Hope S, Pearce A, Cortina-Borja M, Chittleborough C, Barlow J, Law C. Modelling the potential for parenting skills interventions to reduce inequalities and population prevalence of children's mental health problems: Evidence from the Millennium Cohort Study. SSM Popul Health 2021; 14:100817. [PMID: 34169135 PMCID: PMC8209401 DOI: 10.1016/j.ssmph.2021.100817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 12/03/2022] Open
Abstract
Parenting programmes can improve parenting quality and, in turn, children's mental health. If scaled-up, they have the potential to reduce population inequalities and prevalence in child mental health problems (MHP). However, this cannot be investigated with trials. Using data from the UK Millennium Cohort Study (18,000 children born 2000-2002), we simulated population impact of scale-up of seven parenting programmes. Predicted probabilities of child MHP (Strengths and Difficulties Questionnaire) by household income quintile (Risk ratios [RRs] and differences [RDs], 95% confidence intervals [CI]) were estimated from logistic marginal structural models, adjusting for parenting quality scores (Child-Parent Relationship Scale at 3 years) and confounders. The impact of scaling-up parenting programmes was simulated by re-estimating predicted probabilities of child MHP after increasing parenting scores according to intervention intensity, targeting mechanisms and programme uptake levels. Analyses included data from 14,399 children, with survey weights and multiple imputation addressing sampling design, attrition and item missingness. Prevalence of child MHP at 5 years was 11.3% (11.4% unadjusted), with relative and absolute income inequalities (RR = 4.8[95%CI:3.6-5.9]; RD = 15.8%[13.4-18.2]). In simulations, universal, non-intensive parenting programmes reduced prevalence (9.4%) and absolute inequalities (RR = 5.0[95%CI:3.8-6.2]; RD = 13.6%[11.5-15.7]). Intensive programmes, targeting a range of potential risk criteria (e.g. receipt of means-tested benefits), reduced inequalities (RR = 4.0[95%CI:3.0-4.9]; RD = 12.4%[10.3-14.6] and, to a lesser extent, prevalence (10.3%). By simulating implementation of parenting programmes, we show that universal non-intensive and targeted intensive approaches have the potential to reduce child MHP at population level, and to reduce but not eliminate inequalities, with important implications for future policy and practice.
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Affiliation(s)
- Steven Hope
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Catherine Law
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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9
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Impact of child development at primary school entry on adolescent health-protocol for a participatory systematic review. Syst Rev 2021; 10:142. [PMID: 33962672 PMCID: PMC8105931 DOI: 10.1186/s13643-021-01694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing child health inequalities is a global health priority and evidence suggests that optimal development of knowledge, skills and attributes in early childhood could reduce health risks across the life course. Despite a strong policy rhetoric on giving children the 'best start in life', socioeconomic inequalities in children's development when they start school persist. So too do inequalities in child and adolescent health. These in turn influence health inequalities in adulthood. Understanding how developmental processes affect health in the context of socioeconomic factors as children age could inform a holistic policy approach to health and development from childhood through to adolescence. However, the relationship between child development and early adolescent health consequences is poorly understood. Therefore the aim of this review is to summarise evidence on the associations between child development at primary school starting age (3-7 years) and subsequent health in adolescence (8-15 years) and the factors that mediate or moderate this relationship. METHOD A participatory systematic review method will be used. The search strategy will include; searches of electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) from November 1990 onwards, grey literature, reference searches and discussions with stakeholders. Articles will be screened using inclusion and exclusion criteria at title and abstract level, and at full article level. Observational, intervention and review studies reporting a measure of child development at the age of starting school and health outcomes in early adolescence, from a member country of the Organisation for Economic Co-operation and Development, will be included. The primary outcome will be health and wellbeing outcomes (such as weight, mental health, socio-emotional behaviour, dietary habits). Secondary outcomes will include educational outcomes. Studies will be assessed for quality using appropriate tools. A conceptual model, produced with stakeholders at the outset of the study, will act as a framework for extracting and analysing evidence. The model will be refined through analysis of the included literature. Narrative synthesis will be used to generate findings and produce a diagram of the relationship between child development and adolescent health. DISCUSSION The review will elucidate how children's development at the age of starting school is related to subsequent health outcomes in contexts of socioeconomic inequality. This will inform ways to intervene to improve health and reduce health inequality in adolescents. The findings will generate knowledge of cross-sector relevance for health and education and promote inter-sectoral coherence in addressing health inequalities throughout childhood. PROTOCOL REGISTRATION This systematic review protocol has been registered with PROSPERO CRD42020210011 .
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Raouna A, Malcolm R, Ibrahim R, MacBeth A. Promoting sensitive parenting in 'at-risk' mothers and fathers: A UK outcome study of Mellow Babies, a group-based early intervention program for parents and their babies. PLoS One 2021; 16:e0245226. [PMID: 33534841 PMCID: PMC7857589 DOI: 10.1371/journal.pone.0245226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the effectiveness of Mellow Babies (MB) in the UK. MB is a 14-week early parenting intervention program that is delivered in groups and is targeted at 'at-risk' parents (both mothers and fathers) and their babies up to 18 months old. METHOD The study used a pragmatic pre-post intervention design. Outcomes were parental mental health, parenting confidence, quality of life, socio-emotional development of children, and perceived parent-child relationship. Fifteen groups representing n = 91 parent-baby dyads were recruited across the UK between 2017-2018. The sample consisted of 10 Mellow Mums groups (70 mother-baby dyads) and 5 Mellow Dads groups (21 father-baby dyads). Intention-to-treat and 'completer' analyses were performed. RESULTS Findings suggest short-term positive outcomes for parents attending MB. Completion of the program was associated with significant improvements in anxiety and overall wellbeing, parenting confidence, and perceived closeness of the parent-child relationship. The significance of these improvements, except for parenting confidence, was maintained in the intention-to-treat analysis. MB engaged and retained a high proportion of parents who could be considered 'at-risk' and benefitted fathers and mothers attending the intervention equally. CONCLUSIONS This is the first prospective study to explore MB participation for both mothers and fathers and to indicate engagement and potential benefits specifically for 'at-risk' parents. Findings further demonstrate the effectiveness of MB as an early intervention program for parents experiencing psychosocial difficulties. Replication by studies using a contrast or control group also incorporating follow-up data would further improve the evidence base for MB.
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Affiliation(s)
- Aigli Raouna
- Mellow Parenting, Glasgow, United Kingdom
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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11
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Black M, Barnes A, Baxter S, Beynon C, Clowes M, Dallat M, Davies AR, Furber A, Goyder E, Jeffery C, Kritsotakis EI, Strong M. Learning across the UK: a review of public health systems and policy approaches to early child development since political devolution. J Public Health (Oxf) 2020; 42:224-238. [PMID: 30799501 PMCID: PMC7251421 DOI: 10.1093/pubmed/fdz012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/20/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Giving children the best start in life is critical for their future health and wellbeing. Political devolution in the UK provides a natural experiment to explore how public health systems contribute to children's early developmental outcomes across four countries. METHOD A systematic literature review and input from a stakeholder group was used to develop a public health systems framework. This framework then informed analysis of public health policy approaches to early child development. RESULTS A total of 118 studies met the inclusion criteria. All national policies championed a 'prevention approach' to early child development. Political factors shaped divergence, with variation in national conceptualizations of child development ('preparing for life' versus 'preparing for school') and pre-school provision ('universal entitlement' or 'earned benefit'). Poverty and resourcing were identified as key system factors that influenced outcomes. Scotland and Wales have enacted distinctive legislation focusing on wider determinants. However, this is limited by the extent of devolved powers. CONCLUSION The systems framework clarifies policy complexity relating to early child development. The divergence of child development policies in the four countries and, particularly, the explicit recognition in Scottish and Welsh policy of wider determinants, creates scope for this topic to be a tracer area to compare UK public health systems longer term.
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Affiliation(s)
- Michelle Black
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Amy Barnes
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Susan Baxter
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Claire Beynon
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK
| | - Mark Clowes
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Mary Dallat
- Public Health Agency Northern Ireland, Linenhall Street Unit, 12-22 Linenhall Street, Belfast BT2 8BS, UK
| | - Alisha R Davies
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Andrew Furber
- Public Health England (Yorkshire and the Humber), Blenheim House, Duncombe Street, Leeds LS1 4PL, UK
| | - Elizabeth Goyder
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Catherine Jeffery
- NHS Borders, Borders General Hospital, Melrose, Roxburghshire TD69BS, UK
| | - Evangelos I Kritsotakis
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Mark Strong
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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Choo J, Yang HM, Jae SY, Kim HJ, You J, Lee J. Effects of the Healthy Children, Healthy Families, Healthy Communities Program for Obesity Prevention among Vulnerable Children: A Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082895. [PMID: 32331366 PMCID: PMC7215792 DOI: 10.3390/ijerph17082895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
Background: We aimed to examine whether the Healthy Children, Healthy Families, and Healthy Communities Program, consisting of multi-level strategies for obesity prevention tailoring the context of socioeconomically vulnerable children based on an ecological perspective, would be effective on improving their healthy lifestyle behaviors and obesity status. Methods: Participants were 104 children (and 59 parents) enrolled in public welfare systems in Seoul, South Korea. Based on a cluster-randomized controlled trial (no. ISRCTN11347525), eight centers were randomly assigned to intervention (four centers, 49 children, 27 parents) versus control groups (four centers, 55 children, 32 parents). Multi-level interventions of child-, parent-, and center-level strategies were conducted for 12 weeks. Children’s healthy lifestyle behaviors and obesity status were assessed as daily recommended levels and body mass index ≥85th percentile, respectively. Parents’ parenting behaviors were measured by the Family Nutrition and Physical Activity scale. Results: Compared to the control group, the intervention group showed significant improvements in total composite scores of healthy-lifestyle behaviors—including 60-min of moderate physical activity—but not in obesity status among children. Moreover, the intervention group showed significant improvements in parenting behaviors among parents. Conclusion: The multi-level strategies for obesity prevention based on an ecological perspective may be effective for promoting healthy lifestyles among socioeconomically vulnerable children.
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Affiliation(s)
- Jina Choo
- Department of Community Health Nursing, College of Nursing, Korea University, Seoul 02841, Korea; (H.-M.Y.); (H.-J.K.); (J.Y.)
- Correspondence: ; Tel.: +82-2-3290-4925
| | - Hwa-Mi Yang
- Department of Community Health Nursing, College of Nursing, Korea University, Seoul 02841, Korea; (H.-M.Y.); (H.-J.K.); (J.Y.)
| | - Sae-Young Jae
- Department of Sport Science, University of Seoul, Seoul 02504, Korea;
| | - Hye-Jin Kim
- Department of Community Health Nursing, College of Nursing, Korea University, Seoul 02841, Korea; (H.-M.Y.); (H.-J.K.); (J.Y.)
| | - Jihyun You
- Department of Community Health Nursing, College of Nursing, Korea University, Seoul 02841, Korea; (H.-M.Y.); (H.-J.K.); (J.Y.)
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul 02841, Korea;
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Wolpert M, Humphrey N, Deighton J, Patalay P, Fugard AJ, Fonagy P, Belsky J, Vostanis P. An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr44-1.117-138] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Gardner F, Leijten P, Harris V, Mann J, Hutchings J, Beecham J, Bonin EM, Berry V, McGilloway S, Gaspar M, João Seabra-Santos M, Orobio de Castro B, Menting A, Williams M, Axberg U, Morch WT, Scott S, Landau S. Equity effects of parenting interventions for child conduct problems: a pan-European individual participant data meta-analysis. Lancet Psychiatry 2019; 6:518-527. [PMID: 31072801 DOI: 10.1016/s2215-0366(19)30162-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood conduct problems are a costly public health problem and are five times more common in socially disadvantaged groups than they are in advantaged groups. Untreated, conduct problems have a poor prognosis, with increasing gaps between socioeconomic groups, and high rates of subsequent criminality. Incredible Years is a high quality parenting programme for reducing conduct problems and is widely disseminated in Europe. Many trials have shown Incredible Years to be effective but the potential effects of parenting interventions on social inequality are unknown. Some behavioural interventions (eg, smoking cessation programmes), although beneficial overall, can widen inequality gaps. Because single trials and aggregate-level meta-analyses are ill equipped for examining differential intervention (moderator) effects, we pooled individual-level trial data to assess the effects of Incredible Years on social equity. METHODS We did a systematic review and individual participant data meta-analysis by searching CINAHL, Embase, Global Health, Medline, and PsycINFO, for studies published from inception to March 15, 2019. We also searched the Incredible Years website library and consulted with experts, including the European Incredible Years mentors' network. We included data from all completed randomised trials of the Incredible Years parenting intervention in Europe that included children aged 1-12 years, including unpublished trials, without restriction on publication year or outcome measures. We included prevention (selective or universal) and treatment or indicated prevention trials (for children diagnosed or above the clinical cutoff for conduct problems). We excluded trials or conditions within trials that were not randomised, included additional non-parenting material (eg, child-focused interventions), or were abbreviated, non-standard versions of the usual Incredible Years intervention of 12-14 weekly sessions. We requested individual participant data from the study authors. The primary outcome was child conduct problems, assessed using the Eyberg Child Behavior Inventory Intensity (ECBI-I) scale. Moderators were analysed using multilevel modelling with multiple imputation. FINDINGS Of 15 European trials of Incredible Years parenting programmes (n=1696 children), individual participant data were unavailable for one trial and one trial did not assess the primary outcome. Children were aged 2-10 years (median 5·1), 492 (30%) of 1651 children were from an ethnic minority and 931 (58%) of 1614 were from low-income families. Families who received the Incredible Years intervention reported an overall reduction in child conduct problems (13·5 points on the ECBI-I scale, 95% CI 10·9-16·1). There were no differential effects by family disadvantage (indicated by poverty, lone parenthood, teenage parenthood, household joblessness, or low education), or ethnic minority status. INTERPRETATION We found no evidence for differential effects by social disadvantage, suggesting that Incredible Years is unlikely to widen socioeconomic inequalities in conduct problems. Furthermore, the programme might be an important tool for reducing social disparities and improving poor long-term outcomes in disadvantaged families because follow-up studies indicate that benefits persist. Clinicians and commissioners can be reassured that the programme is similarly effective for families from different backgrounds. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Frances Gardner
- Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Patty Leijten
- Social Policy and Intervention, University of Oxford, Oxford, UK; University of Amsterdam, Amsterdam, Netherlands
| | - Victoria Harris
- Department of Biostatistics, King's College London, London, UK
| | - Joanna Mann
- Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Vashti Berry
- Institute for Health Services Research, University of Exeter, Exeter, UK
| | | | - Maria Gaspar
- Psicologia e Ciências da Educação, University of Coimbra, Coimbra, Portugal
| | | | | | - Ankie Menting
- Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Ulf Axberg
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Stephen Scott
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics, King's College London, London, UK
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Vogel C, Abbott G, Ntani G, Barker M, Cooper C, Moon G, Ball K, Baird J. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act 2019; 16:12. [PMID: 30700323 PMCID: PMC6354411 DOI: 10.1186/s12966-019-0772-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children. METHODS Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling. RESULTS Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]). CONCLUSIONS This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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Horn SR, Roos LE, Beauchamp KG, Flannery JE, Fisher PA. Polyvictimization and externalizing symptoms in foster care children: The moderating role of executive function. J Trauma Dissociation 2018; 19:307-324. [PMID: 29547079 PMCID: PMC6774668 DOI: 10.1080/15299732.2018.1441353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Prior research has identified the role of childhood maltreatment in externalizing problems and executive function (EF) deficits, but minimal work has been done to characterize the effects of co-occurring maltreatment types, defined as polyvictimization. Here, we sought to characterize the association between polyvictimization and externalizing problems in a sample of foster care children aged 3-4 years (N = 84) and examine how EF may mediate or moderate that relationship. A moderation model was supported in that only polyvictimized children with EF scores 1.62 or more standard deviations below the mean were at heightened risk for clinically severe externalizing problems, while no association between polyvictimization and externalizing problems were observed for children who scored at the mean or above on the EF measure. Findings highlight that EF may serve as a resilience factor indicating that individual differences in polyvictimized children's EF skills help to predict variability in externalizing problems. Future research on designing and optimizing intervention programs that target EF skills may mitigate the development of maladaptive outcomes for polyvictimized children.
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Affiliation(s)
- Sarah R Horn
- a Department of Psychology , University of Oregon , Eugene , OR , USA
| | - Leslie E Roos
- a Department of Psychology , University of Oregon , Eugene , OR , USA
| | | | | | - Philip A Fisher
- a Department of Psychology , University of Oregon , Eugene , OR , USA
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Barlow J, Beake S, Bick D, Bryson C, Day L, Gilby N, Glover V, Knibbs S, Leyland A, Lindsay G, Mathers S, McKenna K, Petrou S, Purdon S, Sylva K, Summerbell CD, Tudor F, Wheeler A, Woolgar V. Initial protocol for a national evaluation of an area-based intervention programme (A Better Start) on early-life outcomes: a longitudinal cohort study with comparison (control) cohort samples. BMJ Open 2017; 7:e015086. [PMID: 28851771 PMCID: PMC5724149 DOI: 10.1136/bmjopen-2016-015086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pregnancy and the first few years of a child's life are important windows of opportunity in which to equalise life chances. A Better Start (ABS) is an area-based intervention being delivered in five areas of socioeconomic disadvantage across England. This protocol describes an evaluation of the impact and cost-effectiveness of ABS. METHODS AND ANALYSIS The evaluation of ABS comprises a mixed-methods design including impact, cost-effectiveness and process components. It involves a cohort study in the 5 ABS areas and 15 matched comparison sites (n=2885), beginning in pregnancy in 2017 and ending in 2024 when the child is age 7, with a separate cross-sectional baseline survey in 2016/2017. Process data will include a profiling of the structure and services being provided in the five ABS sites at baseline and yearly thereafter, and data regarding the participating families and the services that they receive. Eligible participants will include pregnant women living within the designated sites, with recruitment beginning at 16 weeks of pregnancy. Data collection will involve interviewer-administered and self-completion surveys at eight time points. Primary outcomes include nutrition, socioemotional development, speech, language and learning. Data analysis will include the use of propensity score techniques to construct matched programme and comparison groups, and a range of statistical techniques to calculate the difference in differences between the intervention and comparison groups. The economic evaluation will involve a within-cohort study economic evaluation to compare individual-level costs and outcomes, and a decision analytic cost-effectiveness model to estimate the expected incremental cost per unit change in primary outcomes for ABS in comparison to usual care. ETHICS AND DISSEMINATION Ethical approval to conduct the study has been obtained. The learning and dissemination workstream involves working within and across the sites to generate learning via communities of practice and a range of learning and dissemination events.
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Affiliation(s)
- Jane Barlow
- Department of Social Policy, University of Oxford, Oxford, UK
| | - Sarah Beake
- Florence Nightingale of School of Nursing and Midwifery, Kings College London, London, UK
| | - Debra Bick
- Florence Nightingale of School of Nursing and Midwifery, Kings College London, London, UK
| | | | - Laurie Day
- Policy and Research Unit, Ecorys, Birmingham, UK
| | | | - Vivette Glover
- Department of Surgery and Cancer, Institute for Reproductive and Developmental Biology, Imperial College, London, UK
| | - Sarah Knibbs
- Social Research Institute, Ipsos MORI, London, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Geoff Lindsay
- Department of Education, University of Warwick, Coventry, UK
| | - Sandra Mathers
- Department of Education, University of Oxford, Oxford, UK
| | | | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kathy Sylva
- Department of Education, University of Oxford, Oxford, UK
| | | | - Fiona Tudor
- Social Research Institute, Ipsos MORI, London, UK
| | - Amy Wheeler
- Social Research Institute, Ipsos MORI, London, UK
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Barker M, Baird J, Tinati T, Vogel C, Strömmer S, Rose T, Begum R, Jarman M, Davies J, Thompson S, Taylor L, Inskip H, Cooper C, Nutbeam D, Lawrence W. Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change. Healthcare (Basel) 2017; 5:E17. [PMID: 28335519 PMCID: PMC5371923 DOI: 10.3390/healthcare5010017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/03/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health.
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Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Tannaze Tinati
- NIHR Dissemination Centre, University of Southampton, Alpha House, Enterprise Road, Southampton SO16 7NS, UK.
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Rufia Begum
- Formerly of NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Megan Jarman
- Li Ka Shing Centre for Health Research Innovation, Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, AB T7X 5A1, Canada.
| | - Jenny Davies
- Formerly of Southampton City Council Public Health Team, Southampton City Council, Civic Centre, Southampton SO14 7LY, UK.
| | - Sue Thompson
- Commissioner, Integrated Commissioning Unit, Southampton City Council, Civic Centre, Southampton SO14 7LY, UK.
| | - Liz Taylor
- Former Senior Commissioning Manager for NHS Southampton, NHS Southampton HQ, Oakley Road, Millbrook, Southampton SO16 4GX, UK.
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Don Nutbeam
- Sydney Medical School, Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
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Chor E. Multigenerational Head Start Participation: An Unexpected Marker of Progress. Child Dev 2016; 89:264-279. [PMID: 27868191 DOI: 10.1111/cdev.12673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One-quarter of the Head Start population has a mother who participated in the program as a child. This study uses experimental Head Start Impact Study (HSIS) data on 3- and 4-year-olds (N = 2,849) to describe multigenerational Head Start families and their program experiences. In sharp contrast to full-sample HSIS findings, Head Start has large, positive impacts on cognitive and socioemotional development through third grade among the children of former participant mothers, including improved mathematics skills and reductions in withdrawn and aggressive behavior. Evidence suggests that differences in program impacts between single- and multigenerational Head Start families are driven largely by differences in family resources and home learning environments.
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Intervention with Adolescent Mother–Child Dyads and Cognitive Development in Early Childhood: a Meta-Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 18:116-130. [DOI: 10.1007/s11121-016-0731-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Whittaker A, Williams N, Chandler A, Cunningham-Burley S, McGorm K, Mathews G. The burden of care: a focus group study of healthcare practitioners in Scotland talking about parental drug misuse. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e72-e80. [PMID: 25939770 DOI: 10.1111/hsc.12249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Abstract
Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug-dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug-using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the 'burden of care' that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug-using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this 'hard-to-engage' population; and concern over 'dwindling' resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug-dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug-using mothers and fathers, especially those who are not involved in the child protection system.
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Affiliation(s)
- Anne Whittaker
- Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
| | | | - Amy Chandler
- Centre for Research on Families and Relationships, University of Edinburgh, Edinburgh, UK
| | | | - Kelly McGorm
- Division of Women Youth and Children Community Health Programs, ACT Health, Canberra, Australian Capital Territory, Australia
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Simmonds G, Tinati T, Barker M, Bishop FL. Measuring young women’s self-efficacy for healthy eating: Initial development and validation of a new questionnaire. J Health Psychol 2016; 21:2503-2513. [DOI: 10.1177/1359105315580464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Healthy eating in women of childbearing age is critical to the health of future generations. Interventions that increase women’s dietary self-efficacy may be particularly effective at improving healthy eating. However, no validated tool exists to measure self-efficacy for healthy eating in this specific population. We therefore designed a new questionnaire (the 8-Item Self-Efficacy for Healthy Diet Scale) using a think-aloud study and expert panel consultation. We then pilot-tested the 8-Item Self-Efficacy for Healthy Diet Scale in an interviewer-administered survey of 94 women recruited primarily from community settings. The 8-Item Self-Efficacy for Healthy Diet Scale is an 8-item measure of self-efficacy for healthy eating with promising psychometric properties including internal consistency, convergent, criterion and divergent validity.
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Welsh J, Strazdins L, Ford L, Friel S, O'Rourke K, Carbone S, Carlon L. Promoting equity in the mental wellbeing of children and young people: a scoping review. Health Promot Int 2016; 30 Suppl 2:ii36-76. [PMID: 26420811 DOI: 10.1093/heapro/dav053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is increasing emphasis on wellbeing as a target for mental health promotion, especially during the formative period of childhood. Despite growing research on the importance of mental wellbeing, there is little information on how to effectively promote it or how to promote it equitably. This article presents a scoping review of interventions which seek to promote mental wellbeing and reduce inequities in children and young people living in high income countries. We used Fair Foundations: The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socioeconomic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family health-related factors. We identified more than 1000 interventions which aimed to prevent or treat childhood mental illness, but there were far fewer that aimed to promote children's or young people's mental wellbeing. The interventions we studied were either universal or specifically targeted children from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate factors, although we also identified a handful of interventions that sought to address children's access to services and their educational and neighbourhood environments. However, we found encouraging evidence that interventions in family and educational settings were successful in building children's strengths and supporting positive parenting, universally and within disadvantaged groups. Such positive programme evaluations signal the potential for using a proportionate universalism approach that emphasizes equity in the promotion of mental wellbeing.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Laura Ford
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Sharon Friel
- Regulatory Institutions Network (RegNet), Australian National University, Canberra, ACT 2601, Australia
| | - Kerryn O'Rourke
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Stephen Carbone
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Leanne Carlon
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
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Take your mind off it: Coping style, serotonin transporter linked polymorphic region genotype (5-HTTLPR), and children's internalizing and externalizing problems. Dev Psychopathol 2016; 27:1129-43. [PMID: 26439066 DOI: 10.1017/s0954579415000723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals with the short variant of the serotonin transporter linked polymorphic region gene are more susceptible than individuals homozygous for the long allele to the effects of stressful life events on risk for internalizing and externalizing problems. We tested whether individual differences in coping style explained this increased risk for problem behavior among youth who were at both genetic and environmental risk. Participants included 279 children, ages 8-11, from the Children's Experiences and Development Study. Caregivers and teachers reported on children's internalizing and externalizing symptoms, and caregivers and children on children's exposure to harsh parenting and parental warmth in middle childhood, and traumatic events. Children reported how frequently they used various coping strategies. Results revealed that short/short homozygotes had higher levels of internalizing problems compared with long allele carriers and that short allele carriers had higher levels of externalizing problems compared with long/long homozygotes under conditions of high cumulative risk. Moreover, among children who were homozygous for the short allele, those who had more cumulative risk indicators less frequently used distraction coping strategies, which partly explained why they had higher levels of internalizing problems. Coping strategies did not significantly mediate Gene × Environment effects on externalizing symptoms.
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Nitsch E, Hannon G, Rickard E, Houghton S, Sharry J. Positive parenting: a randomised controlled trial evaluation of the Parents Plus Adolescent Programme in schools. Child Adolesc Psychiatry Ment Health 2015; 9:43. [PMID: 26306098 PMCID: PMC4547424 DOI: 10.1186/s13034-015-0077-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/13/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the Parents Plus Adolescents Programme (PPAP)-a parent training course specifically targeting parents of young adolescents (aged 11-16 years)-when delivered as a preventative programme in community school settings. METHODS A sample of 126 parents (mean age of children = 12.34 years; range = 10-16 years) were randomly assigned to either a treatment (PPAP; n = 82) or a waiting-list control condition (WC; n = 44). Analyses are based on a study-completer sample post-treatment (n = 109 parents: PPAP n = 70; WC n = 39) and sample at 6 month follow up (n = 42 parents). RESULTS Both post-treatment (between groups) and 6-month follow-up comparisons of study completers (within PPAP group) revealed significant positive effects of the parenting intervention with respect to adolescent behaviour problems and parenting stress. The post treatment comparisons demonstrated large effect sizes on global measures of child difficulties (partial eta squared = 0.15) and self-reported parent stress (partial eta squared = 0.22); there was a moderate effect size on the self-reported parent satisfaction (partial eta squared = 0.13). CONCLUSIONS This study provides preliminary evidence that PPAP may be an effective model of parent-training implemented in a community-based setting. The strengths and limitations of the study are discussed.
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Affiliation(s)
| | - Geraldine Hannon
- />Parents Plus Charity, ℅ Mater Hospital, 15 St Vincent Street North, Dublin 7, Ireland
| | - Eóin Rickard
- />Parents Plus Charity, ℅ Mater Hospital, 15 St Vincent Street North, Dublin 7, Ireland
| | | | - John Sharry
- />Parents Plus Charity, ℅ Mater Hospital, 15 St Vincent Street North, Dublin 7, Ireland
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Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner‐Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev 2015; 2015:CD009905. [PMID: 26075988 PMCID: PMC10656573 DOI: 10.1002/14651858.cd009905.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. OBJECTIVES To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. SEARCH METHODS We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). SELECTION CRITERIA Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each study. MAIN RESULTS Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. AUTHORS' CONCLUSIONS Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.
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Affiliation(s)
- Laurie M Anderson
- University of WashingtonDepartment of Epidemiology, School of Public HealthP.O. Box 357236SeattleWAUSA98195‐7236
| | - Kathryn L Adeney
- Washington State Institute for Public PolicyEpidemiology and Public Health110 Fifth Avenue SE, Suite 214SeattleWAUSA98504
| | - Carolynne Shinn
- New Hampshire Department of Health and Human ServicesNew Hampshire Division of Public Health ServicesConcordNew HampshireUSA03301‐3852
| | - Sarah Safranek
- University of WashingtonHealth Sciences Library1959 NE Pacific StreetSeattleWAUSA98195‐7155
| | - Joyce Buckner‐Brown
- Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion, Division of Community Health, Research Surveillance & Evaluation Branch4770 Buford Hwy NE, Mailstop K81AtlantaGeorgiaUSA30341
| | - L Kendall Krause
- Bill & Melinda Gates FoundationEpidemiology and Surveillance DivisionSeattleWAUSA
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Woolfenden S, Williams K, Eapen V, Mensah F, Hayen A, Siddiqi A, Kemp L. Developmental vulnerability--don't investigate without a model in mind. Child Care Health Dev 2015; 41:337-45. [PMID: 25088700 DOI: 10.1111/cch.12181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
Abstract
Children who are developmentally vulnerable are at risk of a difficult start to school, and ongoing educational challenges which may adversely impact on long term health outcomes. Clinicians, researchers and service providers need a thorough understanding of both risk and protective factors and their complex interplay to understand their impact on early childhood development, in order to plan effective and comprehensive prevention and interventions strategies. In this opinion piece we recommend that investigation of developmental vulnerability should only proceed if underpinned by both a theoretical model through which the interaction between risk and protective factors may be investigated, and analytical models that are appropriate to assess these impacts.
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Affiliation(s)
- S Woolfenden
- Sydney Children's Hospital Network, Sydney, NSW, Australia
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Jaffee SR, McFarquhar T, Stevens S, Ouellet-Morin I, Melhuish E, Belsky J. Interactive effects of early and recent exposure to stressful contexts on cortisol reactivity in middle childhood. J Child Psychol Psychiatry 2015; 56:138-46. [PMID: 24986671 PMCID: PMC4338758 DOI: 10.1111/jcpp.12287] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Given mixed findings as to whether stressful experiences and relationships are associated with increases or decreases in children's cortisol reactivity, we tested whether a child's developmental history of risk exposure explained variation in cortisol reactivity to an experimentally induced task. We also tested whether the relationship between cortisol reactivity and children's internalizing and externalizing problems varied as a function of their developmental history of stressful experiences and relationships. METHOD Participants included 400 children (M = 9.99 years, SD = 0.74 years) from the Children's Experiences and Development Study. Early risk exposure was measured by children's experiences of harsh, nonresponsive parenting at 3 years. Recent risk exposure was measured by children's exposure to traumatic events in the past year. Children's cortisol reactivity was measured in response to a social provocation task and parents and teachers described children's internalizing and externalizing problems. RESULTS The effect of recent exposure to traumatic events was partially dependent upon a child's early experiences of harsh, nonresponsive parenting: the more traumatic events children had recently experienced, the greater their cortisol reactivity if they had experienced lower (but not higher) levels of harsh, nonresponsive parenting at age 3. The lowest levels of cortisol reactivity were observed among children who had experienced the most traumatic events in the past year and higher (vs. lower) levels of harsh, nonresponsive parenting in early childhood. Among youth who experienced harsh, nonresponsive parent-child relationships in early childhood and later traumatic events, lower levels of cortisol reactivity were associated with higher levels of internalizing and externalizing problems. CONCLUSIONS Hypothalamic-pituitary-adrenal (HPA) axis reactivity to psychological stressors and the relationship between HPA axis reactivity and children's internalizing and externalizing problems vary as a function of a child's developmental history of exposure to stressful relationships and experiences.
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Affiliation(s)
- Sara R Jaffee
- Department of Psychology, University of PennsylvaniaPhiladelphia, PA, USA,Social, Genetic, and Developmental Psychiatry Centre, King's College LondonLondon, UK
| | - Tara McFarquhar
- Psychology and Language Sciences, University College LondonLondon, UK,Anna Freud CentreLondon, UK
| | - Suzanne Stevens
- Department of Psychological Medicine, University of AucklandAuckland, New Zealand
| | - Isabelle Ouellet-Morin
- School of Criminology, Université de MontréalMontreal, QC, Canada,Mental Health Institute of Montréal Research CenterMontreal, QC, Canada,Research Group on Child MaladjustmentMontreal, QC, Canada
| | - Edward Melhuish
- The Department of Psychological Sciences, Birkbeck, University of LondonLondon, UK,Department of Education, University of OxfordOxford, UK,Department of Psychology, University of WollongongWollongong, NSW, Australia
| | - Jay Belsky
- Department of Human Ecology, University of CaliforniaDavis, CA, USA
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Sellers R, Maughan B, Pickles A, Thapar A, Collishaw S. Trends in parent- and teacher-rated emotional, conduct and ADHD problems and their impact in prepubertal children in Great Britain: 1999-2008. J Child Psychol Psychiatry 2015; 56:49-57. [PMID: 24953088 DOI: 10.1111/jcpp.12273] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence from Western countries indicates marked increases in diagnosis and treatment of childhood psychiatric disorders in recent years. These could reflect changes in prevalence of mental health problems, changes in their impact or increased clinical recognition and help-seeking. Epidemiological cross-cohort comparisons are required to test possible changes in prevalence, but are lacking for pre-adolescent children in Great Britain. METHODS Parent and teacher Strength and Difficulties Questionnaire (SDQ) ratings were used to compare rates of emotional, conduct and hyperactivity problems in 7-year-old children across three nationally representative British samples assessed in 1999 (n = 1033), 2004 (n = 648) and 2008 (n = 13,857). The SDQ impact supplement was used to assess associated distress, social, and educational impairment. Stratified analyses examined trends by gender and socio-economic group. RESULTS There was a decline in mean problem scores and a fall in the percentages scoring in the 'abnormal' range for all symptom types across the period of study. This decline was observed for all demographic groups, for parent and teacher reports, and was more marked for boys than girls. Both parent- and teacher-rated impact scores differed across the three cohorts for boys. Teacher-rated impact scores differed across cohorts for girls. CONCLUSIONS The first decade of the 21st Century saw a reduction in perceived levels of emotional and behaviour problems in pre-adolescent children in Great Britain. The threshold at which mental health problems have an impact on children's distress and classroom learning has changed over time. Continued monitoring of child mental health remains a priority.
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Affiliation(s)
- Ruth Sellers
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Taylor N, Lawton R, Moore S, Craig J, Slater B, Cracknell A, Wright J, Mohammed MA. Collaborating with front-line healthcare professionals: the clinical and cost effectiveness of a theory based approach to the implementation of a national guideline. BMC Health Serv Res 2014; 14:648. [PMID: 25528580 PMCID: PMC4301624 DOI: 10.1186/s12913-014-0648-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals - but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes. METHODS The TDFI approach was used in a pre-post study in three NHS hospitals with a fourth acting as a control (with usual care and no TDFI). The target behavior identified for change was to increase the use of pH testing as the first line method for checking the position of a nasogastric tube. Repeat audits were undertaken in each hospital following intervention implementation. We used Zou's modified Poisson regression approach with robust standard errors to estimate risk ratios for the use of pH testing. The projected return on investment (ROI) was also calculated. RESULTS Following intervention implementation, the use of pH first line increased significantly across intervention hospitals [risk ratio (95% CI) ranged from 3.1 (1.14 to8.43) p < .05, to 8.14 (3.06 to21.67) p < .001] compared to the control hospital, which remained unchanged [risk ratio (CI) = .77 (.47-1.26) p = .296]. The estimated savings and costs in the first year were £2.56 million and £1.41 respectively, giving an ROI of 82%, and this was projected to increase to 270% over five years. CONCLUSION The TDFI approach improved the uptake of a patient safety guideline across three hospitals. The TDFI approach is clinically and cost effective in comparison to the usual practice.
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Affiliation(s)
- Natalie Taylor
- Centre for Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, UK.
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Sally Moore
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Joyce Craig
- York Health Economics Consortium Limited, Level 2, Market Square, University of York, York, YO10 5NH, England.
| | - Beverley Slater
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Alison Cracknell
- Leeds Teaching Hospital NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Mohammed A Mohammed
- School of Healthcare Studies, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK.
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Multilevel evaluation of 'China Healthy Lifestyles for All', a nationwide initiative to promote lower intakes of salt and edible oil. Prev Med 2014; 67:210-5. [PMID: 25088409 DOI: 10.1016/j.ypmed.2014.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the impact of 'China Healthy Lifestyle for All' on levels of knowledge, taste and intentions to modify future consumption of salt and edible oil. METHODS Between May and August 2012, a face-to-face survey carried out in all 31 provinces, autonomous regions, and municipalities in mainland China, achieved a 98.1% response. Intention-To-Treat analysis via multilevel logistic regression was used to examine differences in outcomes between 31,396 non-institutionalised individuals aged > 18 years from 31 'intervention' (i.e. participating) and 26 'control' (i.e. non-participating) counties respectively. RESULTS Adjusting for socioeconomic confounders, participants in 'intervention' counties were more likely to know the limit of salt (Odds Ratio 3.14, 95% Confidence Interval (95% CI) 1.98, 4.96) and oil consumption (3.67, 95% CI 2.31, 5.82), and were more intent to modify their consumption (salt 1.98, 95% CI 1.41, 2.76; oil OR 1.99, 95% CI 1.41, 2.81) and to report a change in taste (salt 1.90, 95% CI 1.31, 2.75; oil 2.07, 95% CI 1.38, 3.10). 'Intervention' effects were consistent regardless of income or education, but women and older participants benefited disproportionately. Outcomes were 2.8 and 4.7 times more likely among those with better recall. CONCLUSION Place-based health promotion interventions have an important role to play in addressing non-communicable disease in China.
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Kelaher M, Sabanovic H, La Brooy C, Lock M, Lusher D, Brown L. Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia. Soc Sci Med 2014; 123:278-86. [PMID: 25103343 DOI: 10.1016/j.socscimed.2014.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/19/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
Abstract
There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity.
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Affiliation(s)
- Margaret Kelaher
- Centre for Health Policy Programs and Economics, School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia.
| | - Hana Sabanovic
- Centre for Health Policy Programs and Economics, School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia.
| | - Camille La Brooy
- Centre for Health Policy Programs and Economics, School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia.
| | - Mark Lock
- The Wollotuka Institute, Birabahn Building, The University of Newcastle, University Drive, Callaghan 2308, New South Wales, Australia.
| | - Dean Lusher
- Faculty of Life and Social Sciences, Swinburne University of Technology, Mail H31, PO Box 218, Hawthorn, Victoria 3122, Australia.
| | - Larry Brown
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, 6th Floor, New York, NY 10032, United States.
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Barr B, Bambra C, Whitehead M. The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study. BMJ 2014; 348:g3231. [PMID: 24865459 PMCID: PMC4035504 DOI: 10.1136/bmj.g3231] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England compared with more affluent areas led to a reduction in geographical inequalities in mortality amenable to healthcare. DESIGN Longitudinal ecological study. SETTING 324 lower tier local authorities in England, classified by their baseline level of deprivation. INTERVENTION Differential trends in NHS funds allocated to local areas resulting from the NHS resource allocation policy in England between 2001 and 2011. MAIN OUTCOME MEASURE Trends in mortality from causes considered amenable to healthcare in local authority areas in England. Using multivariate regression, we estimated the reduction in mortality that was associated with the allocation of additional NHS resources in these areas. RESULTS Between 2001 and 2011 the increase in NHS resources to deprived areas accounted for a reduction in the gap between deprived and affluent areas in male mortality amenable to healthcare of 35 deaths per 100,000 population (95% confidence interval 27 to 42) and female mortality of 16 deaths per 100,000 (10 to 21). This explained 85% of the total reduction of absolute inequality in mortality amenable to healthcare during this time. Each additional £10 m of resources allocated to deprived areas was associated with a reduction in 4 deaths in males per 100,000 (3.1 to 4.9) and 1.8 deaths in females per 100,000 (1.1 to 2.4). The association between absolute increases in NHS resources and improvements in mortality amenable to healthcare in more affluent areas was not significant. CONCLUSION Between 2001 and 2011, the NHS health inequalities policy of increasing the proportion of resources allocated to deprived areas compared with more affluent areas was associated with a reduction in absolute health inequalities from causes amenable to healthcare. Dropping this policy may widen inequalities.
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Affiliation(s)
- Ben Barr
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
| | - Clare Bambra
- Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
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Miller EB, Farkas G, Vandell DL, Duncan GJ. Do the effects of head start vary by parental preacademic stimulation? Child Dev 2014; 85:1385-400. [PMID: 24597729 DOI: 10.1111/cdev.12233] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Data from the Head Start Impact Study (N = 3,185, age = 3-4 years) were used to determine whether 1 year of Head Start differentially benefited children from homes with high, middle, and low levels of parental preacademic stimulation on three academic outcome domains-early math, early literacy, and receptive vocabulary. Results from residualized growth models showed positive impacts of random assignment to Head Start on all three outcomes, and positive associations between parental preacademic stimulation and academic performance. Two moderated effects were also found. Head start boosted early math skills the most for children receiving low parental preacademic stimulation. Effects of Head Start on early literacy skills were largest for children receiving moderate levels of parental preacademic stimulation. Implications for Head Start are discussed.
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Page A, Morrell S, Hobbs C, Carter G, Dudley M, Duflou J, Taylor R. Suicide in young adults: psychiatric and socio-economic factors from a case-control study. BMC Psychiatry 2014; 14:68. [PMID: 24597482 PMCID: PMC3975730 DOI: 10.1186/1471-244x-14-68] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. This study compared the relative contributions of psychiatric disorder and socio-economic disadvantage associated with suicide in terms of relative and attributable risk in young adults. METHOD A population-based case-control study of young adults (18-34 years) compared cases of suicide (n = 84) with randomly selected controls (n = 250) from population catchments in New South Wales (Australia), with exposure information collected from key informant interviews (for both cases and controls). The relative and attributable risk of suicide associated with ICD-10 defined substance use, affective, and anxiety disorder was compared with educational achievement and household income, adjusting for key confounders. Prevalence of exposures from the control group was used to estimate population attributable fractions (PAF). RESULTS Strong associations were evident between mental disorders and suicide for both males and females (ORs 3.1 to 18.7). The strongest association was for anxiety disorders (both males and females), followed by affective disorders and substance use disorders. Associations for socio-economic status were smaller in magnitude than for mental disorders for both males and females (ORs 1.1 to 4.8 for lower compared to high SES groups). The combined PAF% for all mental disorders (48% for males and 52% for females) was similar in magnitude to socio-economic status (46% for males and 58% for females). CONCLUSION Socio-economic status had a similar magnitude of population attributable risk for suicide as mental disorders. Public health interventions to reduce suicide should incorporate socio-economic disadvantage in addition to mental illness as a potential target for intervention.
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Affiliation(s)
- Andrew Page
- School of Science and Health, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia.
| | - Stephen Morrell
- School of Public Health and Community Medicine, University of New South Wales, Samuels Building, Botany Street, Randwick, NSW 2052, Australia
| | - Coletta Hobbs
- Sydney School of Public Health, University of Sydney, Edward Ford Building, Camperdown, NSW 2006, Australia
| | - Greg Carter
- Centre for Translational Neuroscience and Mental Health (CTNMH), University of Newcastle, Locked Bag 7, Hunter Region Mail Centre, Newcastle, New South Wales NSW 2310, Australia,Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle Hospital, Locked Bag 7, Hunter Region Mail Centre, Newcastle, New South Wales NSW 2310, Australia
| | - Michael Dudley
- School of Psychiatry, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick NSW 2031, Australia
| | - Johan Duflou
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia,Department of Forensic Medicine, New South Wales Health Pathology, PO Box 90, Glebe, NSW 2037, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Samuels Building, Botany Street, Randwick, NSW 2052, Australia
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Maharaj V, Rahman F, Adamson L. Tackling child health inequalities due to deprivation: using health equity audit to improve and monitor access to a community paediatric service. Child Care Health Dev 2014; 40:223-30. [PMID: 23121388 DOI: 10.1111/cch.12011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deprived children constitute a large population with high levels of ill health, and difficulty with access to healthcare contributes to their poor health outcomes. There is debate on how best to engage deprived families and the literature on differential access to paediatric care based on deprivation is limited. AIMS To demonstrate that community paediatrics can contribute to reduction of health inequalities by providing services that are accessible to and preferentially used by children whose health is likely to be affected by deprivation. To provide a template for others to improve and monitor equity in their services. METHOD Long-term service reconfiguration and health equity audit. We used routinely collected activity data and the Indices of Multiple Deprivation to construct equity profiles of the children using our service, and compared these with the profile of the population aged 0-16 years in the geographical area covered by the service. RESULTS The new patient contact rate for the most deprived children in the population was more than three times that of the least deprived [odds ratio (OR) 3.29, 95% confidence interval (CI) 2.76-3.93]. Deprived children were more than twice as likely to require multi-agency meetings as part of their medical care (OR 2.28, 95% CI 1.94-2.69). Seventy per cent (3693/5312) of our total contacts were with children in the two most deprived quintiles. There was a marked socio-economic gradient in all types of contact. CONCLUSIONS The model of care used by our community paediatric service successfully engages deprived families, thereby reducing health inequalities due to poor access. Key features are multi-agency working, removing barriers to access, raising staff awareness and use of health equity audit. Our findings provide support for tackling health inequalities via health services that are available to all, but capable of responding proportionately according to level of need, a model recently described as proportionate universalism.
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Affiliation(s)
- V Maharaj
- Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK
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Page A, Lewis G, Kidger J, Heron J, Chittleborough C, Evans J, Gunnell D. Parental socio-economic position during childhood as a determinant of self-harm in adolescence. Soc Psychiatry Psychiatr Epidemiol 2014; 49:193-203. [PMID: 23744444 DOI: 10.1007/s00127-013-0722-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence. METHODS This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991-1992 to age 16-18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods. RESULTS Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income. CONCLUSIONS Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.
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Affiliation(s)
- Andrew Page
- Discipline of Epidemiology and Biostatistics, School of Population Health, University of Queensland, Herston Road, Herston, QLD, 4006, Australia,
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Feng X, Astell-Burt T. Neighborhood socioeconomic circumstances and the co-occurrence of unhealthy lifestyles: evidence from 206,457 Australians in the 45 and up study. PLoS One 2013; 8:e72643. [PMID: 23977335 PMCID: PMC3744491 DOI: 10.1371/journal.pone.0072643] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on the co-occurrence of unhealthy lifestyles has tended to focus mainly upon the demographic and socioeconomic characteristics of individuals. This study investigated the relevance of neighborhood socioeconomic circumstance for multiple unhealthy lifestyles. METHOD An unhealthy lifestyle index was constructed for 206,457 participants in the 45 and Up Study (2006-2009) by summing binary responses on smoking, alcohol, physical activity and five diet-related variables. Higher scores indicated the co-occurrence of unhealthy lifestyles. Association with self-rated health, quality of life; and risk of psychological distress was investigated using multilevel logistic regression. Association between the unhealthy lifestyle index with neighborhood characteristics (local affluence and geographic remoteness) were assessed using multilevel linear regression, adjusting for individual-level characteristics. RESULTS Nearly 50% of the sample reported 3 or 4 unhealthy lifestyles. Only 1.5% reported zero unhealthy lifestyles and 0.2% had all eight. Compared to people who scored zero, those who scored 8 (the 'unhealthiest' group) were 7 times more likely to rate their health as poor (95%CI 3.6, 13.7), 5 times more likely to report poor quality of life (95%CI 2.6, 10.1), and had a 2.6 times greater risk of psychological distress (95%CI 1.8, 3.7). Higher scores among men decreased with age, whereas a parabolic distribution was observed among women. Neighborhood affluence was independently associated with lower scores on the unhealthy lifestyle index. People on high incomes scored higher on the unhealthy lifestyle index if they were in poorer neighborhoods, while those on low incomes had fewer unhealthy lifestyles if living in more affluent areas. INTERPRETATION Residents of deprived neighborhoods tend to report more unhealthy lifestyles than their peers in affluent areas, regardless of their individual demographic and socioeconomic characteristics. Future research should investigate the trade-offs of population-level versus geographically targeted multiple lifestyle interventions.
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Affiliation(s)
- Xiaoqi Feng
- Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia.
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Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. Int J Nurs Stud 2013; 50:587-92. [PMID: 23159157 DOI: 10.1016/j.ijnurstu.2012.09.010] [Citation(s) in RCA: 961] [Impact Index Per Article: 87.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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Phillips G, Renton A, Moore DG, Bottomley C, Schmidt E, Lais S, Yu G, Wall M, Tobi P, Frostick C, Clow A, Lock K, Petticrew M, Hayes R. The Well London program--a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results. Trials 2012; 13:105. [PMID: 22769971 PMCID: PMC3441284 DOI: 10.1186/1745-6215-13-105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/14/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here. METHODS The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. RESULTS There were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. CONCLUSIONS Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.
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Affiliation(s)
- Gemma Phillips
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Adrian Renton
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Derek G Moore
- Institute for Research on Child Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Christian Bottomley
- Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Elena Schmidt
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Shahana Lais
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Ge Yu
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Martin Wall
- The Centre for Social and Health Outcomes Research and Evaluation, Level 7, 90 Symonds Street, Auckland, New Zealand
| | - Patrick Tobi
- Institute for Health and Human Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Caroline Frostick
- Institute for Research on Child Development, University of East London, Water Lane, E15 4LZ, London, UK
| | - Angela Clow
- Department of Psychology, University of Westminster, 309 Regent Street, London, W1B 2UW, UK
| | - Karen Lock
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Richard Hayes
- Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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Tinati T, Lawrence W, Ntani G, Black C, Cradock S, Jarman M, Pease A, Begum R, Inskip H, Cooper C, Baird J, Barker M. Implementation of new Healthy Conversation Skills to support lifestyle changes - what helps and what hinders? Experiences of Sure Start Children's Centre staff. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:430-437. [PMID: 22452549 PMCID: PMC3679516 DOI: 10.1111/j.1365-2524.2012.01063.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Effective communication is necessary for good relationships between healthcare practitioners and clients. This study examined barriers and facilitators to implementing new communication skills. One hundred and ten Sure Start Children's Centre staff attended one of 13 follow-up workshops in Southampton, UK between May 2009 and February 2011 to reflect on the use of new skills following a training course in communication, reflection and problem-solving. Barriers and facilitators were assessed with an adapted Problematic Experiences of Therapy scale (PETS). Staff reported frequency of skill use, and described what made it more difficult or easier to use the skills. Complete data were available for 101 trainees. The PETS indicated that staff had confidence in using the skills, but felt that there were practical barriers to using them, such as lack of time. Skills were used less often when staff perceived parents not to be engaging with them (Spearman's correlation r(s) = -0.42, P < 0.001), when staff felt less confident to use the skills (r(s) = -0.37, P < 0.001) and when there were more practical barriers (r(s) = -0.37, P < 0.001). In support of findings from the PETS, content analysis of free text responses suggested that the main barrier was a perceived lack of time to implement new skills. Facilitators included seeing the benefits of using the skills, finding opportunities and having good relationships with parents. Understanding the range of barriers and facilitators to implementation is essential when developing training to facilitate ongoing support and sustain skill use. Special attention should be given to exploring trainees' perceptions of time, to be able to address this significant barrier to skill implementation. Staff training requires a multi-faceted approach to address the range of perceived barriers.
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Affiliation(s)
- Tannaze Tinati
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, UK.
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Jarman M, Lawrence W, Ntani G, Tinati T, Pease A, Black C, Baird J, Barker M. Low levels of food involvement and negative affect reduce the quality of diet in women of lower educational attainment. J Hum Nutr Diet 2012; 25:444-52. [PMID: 22515167 DOI: 10.1111/j.1365-277x.2012.01250.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women of lower educational attainment tend to have poorer quality diets and lower food involvement (an indicator of the priority given to food) than women of higher educational attainment. The present study reports a study of the role of food involvement in the relationship between educational attainment and quality of diet in young women. METHODS The first phase uses six focus group discussions (n = 28) to explore the function of food involvement in shaping the food choices of women of lower and higher educational attainment with young children. The second phase is a survey that examines the relationship between educational attainment and quality of diet in women, and explores the role of mediating factors identified by the focus group discussions. RESULTS The focus groups suggested that lower food involvement in women of lower educational attainment might be associated with negative affect (i.e. an observable expression of negative emotion), and that this might mean that they did not place a high priority on eating a good quality diet. In support of this hypothesis, the survey of 1010 UK women found that 14% of the effect of educational attainment on food involvement was mediated through the woman's affect (P ≤ 0.001), and that 9% of the effect of educational attainment on quality of diet was mediated through food involvement (P ≤ 0.001). CONCLUSIONS Women who leave school with fewer qualifications may have poorer quality diets than women with more qualifications because they tend to have a lower level of food involvement, partly attributed to a more negative affect. Interventions to improve women's mood may benefit their quality of diet.
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Affiliation(s)
- M Jarman
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
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Tunstall H, Cabieses B, Shaw R. The characteristics of mobile families with young children in England and the impact of their moves on neighbourhood inequalities in maternal and child health. Health Place 2012; 18:657-70. [PMID: 22361636 DOI: 10.1016/j.healthplace.2011.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 11/10/2011] [Accepted: 11/27/2011] [Indexed: 11/18/2022]
Abstract
This study compares the health and socio-demographic characteristics of residentially mobile families with young children in England to families that do not move and assesses the impact of their moves upon inequalities in health between neighbourhoods. The analysis uses data from the first two waves of the Millennium Cohort Study describing 9022 cohort members, born in 2000-2002, and their families. A third of the families moved between the waves of the survey when the children were aged nine months and three years. Mobile families moved disproportionately toward less deprived areas but had disadvantaged socio-economic characteristics and poor outcomes for infant's birth weight and accidents and mother's self-rated health, limiting longstanding illness and mental health. Health outcomes were worst among the minority moving to more deprived neighbourhoods. Families' moves moderately increased health inequalities between neighbourhoods with high and low deprivation.
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Affiliation(s)
- Helena Tunstall
- University of York, Department of Health Sciences, York YO10 5DD, UK.
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Cowley S. Home visitors and child health in England: advances and challenges. Rev Esc Enferm USP 2011; 45 Spec No 2:1810-6. [PMID: 22569677 DOI: 10.1590/s0080-62342011000800030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 11/29/2011] [Indexed: 11/22/2022] Open
Abstract
There is increasing interest in the early years as a focus for reducing health inequalities as well as one that is important for the children themselves. This paper describes the introduction in England of Sure Start Local Programmes, which included home visiting within a community development approach, and an intensive home visiting programme, the Nurse-Family partnership, for disadvantaged teenage mothers. It reflects on changes and challenges in service provision to mothers and their pre-school children in England, explaining that a long tradition of home visiting was, paradoxically, reduced as attention focused on the newer initiatives. This is now being addressed, with attention to a range of evidence based programmes and a specific focus on heath visitor provision.
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Neighborhood characteristics and mental health: the relevance for mothers of infants in deprived English neighborhoods. Soc Psychiatry Psychiatr Epidemiol 2011; 46:1243-9. [PMID: 20924554 DOI: 10.1007/s00127-010-0298-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 09/24/2010] [Indexed: 12/28/2022]
Abstract
PURPOSE Neighborhood features have been linked with adult mental-health problems, particularly depression. A recent comprehensive review indicated structural neighborhood features derived from data sources such as the census may be less important predictors of mental health problems than social processes but that most studies lack multiple neighborhood measures. The aim of the study is to investigate relations between multiple neighborhood factors (observations, interviewer ratings, UK Census data) and maternal mental-health problems. METHODS 14,700 mothers with 9-month-old infants living in 195 deprived neighborhoods in England were interviewed, neighborhoods were observed and census data on employment, ethnic background and housing tenancy utilized. RESULTS Lower (interviewer-rated) neighborhood quality and lower neighborhood prosperity predicted more mother-reported mental-health problems net of family-level predictors. Contrary to expectations detailed observations did not contribute additionally. CONCLUSIONS Neighborhood conditions, though not as important as family factors and maternal characteristics, are sufficiently important to consider when planning mental health services; they can be assessed at relatively low cost by census data or professionals' ratings.
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Lawrence W, Keyte J, Tinati T, Haslam C, Baird J, Margetts B, Swift J, Cooper C, Barker M. A mixed-methods investigation to explore how women living in disadvantaged areas might be supported to improve their diets. J Health Psychol 2011; 17:785-98. [PMID: 22044913 DOI: 10.1177/1359105311425271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mixed-methods explored the potential for using Sure Start Children's Centres (SSCCs) to deliver an intervention to improve the diets of disadvantaged women and their children. In an 'expert' discussion, SSCC staff described gaining women's trust, meeting needs and bringing about change as key to engaging women successfully. Structured observations in SSCCs showed they host activities in an environment conducive to building relationships and meeting women's needs. However, staff often missed opportunities to support women to make dietary changes. These data suggest that an intervention to help staff make the most of these opportunities would have the best chance of success.
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Yiannakoulias N. Spatial aberration vs. geographical substance: Representing place in public health surveillance. Health Place 2011; 17:1242-8. [DOI: 10.1016/j.healthplace.2011.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/21/2011] [Accepted: 07/21/2011] [Indexed: 11/17/2022]
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Wade C, Llewellyn G, Matthews J. Modeling contextual influences on parents with intellectual disability and their children. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2011; 116:419-437. [PMID: 22126657 DOI: 10.1352/1944-7558-116.6.419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many parents with intellectual disability experience living conditions associated with risk for children and parents. This study used structural equation modeling to test a theoretical model of the relationships among parent, child, family, and contextual variables in 120 Australian families where a parent had an intellectual disability. Findings revealed that parenting practices had a direct effect on children's well being, that social support was associated with children's well being through the mediator of parenting practices, and that access to social support had a direct influence on parenting practices. Implications of the findings for research, intervention, and policy are explored, with the goal of promoting optimal well being for children who are raised by parents with intellectual disability.
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Bradley RH, McKelvey LM, Whiteside-Mansell L. Does the Quality of Stimulation and Support in the Home Environment Moderate the Effect of Early Education Programs? Child Dev 2011; 82:2110-22. [DOI: 10.1111/j.1467-8624.2011.01659.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brownell MD, Chartier M, Au W, Schultz J. Program for expectant and new mothers: a population-based study of participation. BMC Public Health 2011; 11:691. [PMID: 21896195 PMCID: PMC3178495 DOI: 10.1186/1471-2458-11-691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/06/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Manitoba Healthy Baby Program is aimed at promoting pre- and perinatal health and includes two components: 1) prenatal income supplement; 2) community support programs. The goal of this research was to determine the uptake of these components by target groups. METHODS Data on participation in each of the two program components were linked to data on all hospital births in Manitoba between 2004/05 through 2007/08. Descriptive analyses of participation by maternal characteristics were produced. Logistic regression analyses were conducted to identify factors associated with participation in the two programs. Separate regressions were run for two groups of women giving birth during the study period: 1) total population; 2) those receiving provincial income assistance during the prenatal period. RESULTS Almost 30% of women giving birth in Manitoba received the Healthy Baby prenatal income supplement, whereas only 12.6% participated in any community support programs. Over one quarter (26.4%) of pregnant women on income assistance did not apply for and receive the prenatal income supplement, despite all being eligible for it. Furthermore, 77.8% of women on income assistance did not participate in community support programs. Factors associated with both receipt of the prenatal benefit and participation in community support programs included lower SES, receipt of income assistance, obtaining adequate prenatal care, having completed high school and having depressive symptoms. Having more previous births was associated with higher odds of receiving the prenatal benefit, but lower odds of attending community support programs. Being married was associated with lower odds of receiving the prenatal benefit but higher odds of participating in community support programs. CONCLUSIONS Although uptake of the Healthy Baby program in Manitoba is greater for women in groups at risk for poorer perinatal outcomes, a substantial number of women eligible for this program are not receiving it; efforts to reach these women should be enhanced.
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Affiliation(s)
- Marni D Brownell
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Wendy Au
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Jennifer Schultz
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
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