Risk of childhood injury: predictors of mothers' perceptions

Background and objectives: Safety education often targets parental risk perception. Predictors of risk perception, however, are not well known, thus limiting the feasibility of effective safety education. Accordingly, in this study, a range of predictors of maternal risk perception were examined. Methods: A random sample of 870 mothers in northern Sweden was included in the study. Three different questionnaires, with scenarios of a burn injury, a bicycle injury in the home environment, and a bicycle injury in traffic, were completed by the subjects. Multiple linear regression models tested the possible influence of causal attributions, normative beliefs, and sociodemographic and behaviour-related variables on mothers' risk perception. Results: Only 14-23% of the variance in mothers' risk perception could be explained by the multivariate models. Causal attribution to the child was found to be the most important predictor of maternal risk perception. Conclusion: Present theoretical models give few clues about how to design educational models that might influence risk perception. To make safety education more effective, other modifiable factors that influence parental safety behaviour, such as subjective norms and self-efficacy, might be better targets.

Shared physical custody after family split-up: implications for health and well-being in Swedish schoolchildren

AIM

In Sweden, shared physical custody following a parental separation has emerged as means for children to keep close relationships with both parents. Previous studies show that children benefit from regular contact with both parents, who share responsibility for their social, emotional and economic welfare. In this study, we investigate any associations between family arrangements, that is, two-parent, single and shared physical custody families and child health outcomes and whether this association was modified by parent-child communication.

METHODS

Data on 11- to 15-year-old children from the 2005/2006 and 2009/2010 Swedish Health Behaviour in School-aged Children survey were analysed using multivariate logistic regression.

RESULTS

Children in shared physical custody were more likely than children in two-parent families to report multiple health complaints (OR 1.26) and low well-being (OR 1.71). When variables of parent-child communication were entered in the model, the initial differences remained between children living in shared physical custody and those living in two-parent families.

CONCLUSION

Children in shared physical custody and single-parent families are more at risk of negative outcomes compared with children in two-parent families. This association was not modified by parent-child communication in children in shared custody families, indicating that the communication equals that in two-parent family children.

Health outcomes among Swedish children: the role of social capital in the family, school and neighbourhood

AIM

The aim of the study was to explore the extent to which Swedish children's perceptions of social capital in the family, school and neighbourhood predicted health complaints and well-being.

METHODS

The study used data from the Swedish Health Behaviour in School-aged Children survey. The sample consisted of 3926 children aged 11-15 years. Correlations and hierarchical multiple linear regression were performed.

RESULTS

Higher degrees of family, school and neighbourhood social capital corresponded to lower levels of health complaints and higher levels of well-being. Social capital in these three spheres had a cumulative effect on children's health and well-being.

CONCLUSIONS

Social capital in the family, school and neighbourhood matters for children's health and well-being and the contributions from each context seem to be additive. Besides the family context, investments for improving child health should primarily be in the school, focusing on social relations and on creating safe and cohesive school environments. Neighbourhood social capital is also of importance and so must be taken into consideration when planning child health promotion interventions.

Perceptions of community trust and safety - consequences for children's well-being in rural and urban contexts

AIM

To explore the associations between subjective well-being and perceptions of community trust and safety amongst children in rural and urban areas.

METHODS

The study used self-reported data from the 2001/2002 Swedish cross-national WHO study Health Behaviour in School-aged Children. The sample consisted of 3852 children aged 11-15 years, living in different residential areas. Bivariate analyses and multivariate logistic regression were performed.

RESULTS

The results indicated that a greater proportion of children in urban areas perceived low community trust and safety, compared with children in rural areas. Further, the multivariate analysis revealed that perceived community trust and safety significantly impacts upon children's subjective well-being in both rural and urban contexts.

CONCLUSION

Children's perceptions of trust and safety have different magnitudes in urban and rural areas. The associations of perceptions of community trust and safety for children's subjective well-being are relevant in both urban and rural areas. As perceptions of low trust and safety in the community seem to be related to low subjective well-being, efforts to encourage community trust and safety should be included amongst the key priorities in community health promotion.

Growing up in rural community--children's experiences of social capital from perspectives of wellbeing

INTRODUCTION

People are influenced by the neighborhood in which they live. The neighborhood may be particularly important for children's wellbeing because of the constraints it imposes on their patterns of daily activities. Furthermore, the neighborhood is a central context for social development, being a place where children form networks and learn social skills and values. The aim of this study was to describe how social capital in the neighborhood is perceived by children living in rural areas, and to reveal what this adds to their sense of wellbeing.

METHODS

The study had a descriptive research design with a qualitative approach. Seven single-sex focus group interviews were conducted with children the in 6th grade (aged 11-12 years). Data were analyzed using deductive content analysis.

RESULTS

The children perceived a lack of social capital due to environmental and social constraints in their everyday lives. However, their wellbeing was enhanced by strong cohesion in the neighborhood. In addition, settings such as the school, the natural environment, and sporting associations were highly valued and emerged as crucial factors for enhancing the children's wellbeing. The spatial isolation that characterizes rural areas created a special context of social network structures, cohesion and trust, but was also a breeding ground for exclusion and social control. The stories revealed paradoxical feelings of living in a good and safe area that simultaneously felt isolated and restricted.

CONCLUSIONS

From a rural perspective, this study reveals the complexity of the children's perceptions of their social environment, and the ways in which these perceptions have both positive and negative effects on wellbeing. The results highlight how important it is for health professionals in rural areas to consider the complex influence of bonding social capital on children's wellbeing, and to be aware that it can promote exclusion as well as cohesion.

School demands and subjective health complaints among Swedish schoolchildren: a multilevel study

OBJECTIVES

As children spend a great deal of their time in school, the climate in the classroom can constitute a resource, but also a risk factor in the development of the pupils' health. The aim of the present study was to determine the extent to which demands in the classroom are associated with subjective health complaints in Swedish schoolchildren.

METHODS

Data from the 2001/2002 and 2005/2006 Swedish cross-national Health Behaviour in School-aged Children (HBSC) survey were analysed using a multilevel logistic regression technique.

RESULTS

The study demonstrated a substantial variation between school classes in pupils' subjective health complaints. In school classes with high demands, the odds of having subjective health complaints was about 50% higher than in school classes with low demands. Further, the results indicated that these effects were mediated by sex so as to girls being more affected by high levels of demands in the school class.

CONCLUSIONS

The findings are important since they point at the crucial role that teachers play in creating a favourable school climate. Therefore interventions aiming at supporting teachers to set realistic demands and expectations are one way to improve the school climate. Such interventions should also make clear the need to take into consideration the fact that the school class effect was mediated by sex, i.e. girls being more vulnerable to high level of school class demands.

Obesity prevalence in a cohort of women in early pregnancy from a neighbourhood perspective

BACKGROUND

The evidence of an association between neighbourhood deprivation and overweight is established for different populations. However no previous studies on neighbourhood variations in obesity in pregnant women were found. In this study we aimed to determine whether obesity during early pregnancy varied by neighbourhood economic status.

METHODS

A register based study on 94,323 primiparous pregnant women in 586 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress obesity prevalence on socioeconomic individual-level variables and the neighbourhood economic status. Five hundred and eighty-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001, were included. The majority of neighbourhoods had a population of 4 00010 000 inhabitants.

RESULTS

Seven per cent of the variation in obesity prevalence was at the neighbourhood level and the odds of being obese were almost doubled in poor areas.

CONCLUSION

Our findings supports a community approach in the prevention of obesity in general and thus also in pregnant women.

Are there differences in birth weight between neighbourhoods in a Nordic welfare state?

Background

The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country.

Methods

A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992–2001. The majority of neighbourhoods had a population of 4 000–10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study.

Results

Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors.

Conclusion

Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.

The neighbourhood they live in: does it matter to women's smoking habits during pregnancy?

Socioeconomic factors in the neighbourhood are associated with smoking habits in various populations. We studied a 10-year cohort to determine whether women's smoking behaviour during pregnancy can similarly be determined by neighbourhood economic and ethnic factors. The cohort included 127,074 primiparous pregnant women in 592 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress pregnancy smoking on socioeconomic individual-level variables and neighbourhood characteristics. Seven percent of the variation in pregnancy smoking was at the neighbourhood level and the odds of smoking during pregnancy were doubled in poorer areas. Health education and smoking cessation interventions should be directed at maternity care units in deprived neighbourhoods.

Primiparas with or without oxytocin augmentation: a prospective descriptive study

AIMS

The aim of this study was to determine during which phase of delivery augmentation is started when used and to establish any correlation that might exist between the oxytocin infusion and the evaluations by primiparas themselves of their labour pain, strength of contractions and fatigue. In addition, we wanted to determine any differences in duration between labour with and labour without augmentation. We finally wanted to measure the incidence of instrumental deliveries, perineal trauma and neonatal outcome among the augmented vs. the non-augmented groups.

BACKGROUND

The most commonly diagnosed complication in primiparas is ineffective contractions or protracted labour, otherwise known as dystocia, which literally means arrested or prolonged labour. Different treatments have been tried during the active phase of labour as well as the second stage of labour. The most common treatment today is amniotomy, often used in combination with an intravenous oxytocin infusion.

MATERIALS AND METHODS

The study was conducted at the hospital in Ostersund in central Sweden from August 1998 to September 1999. Consecutive primiparas giving birth at full-term were selected to the study. The inclusion criteria were an uncomplicated pregnancy and a spontaneous single delivery with head presentation. The total number of participants was 164.

RESULTS

The results showed that 50 of 164 primiparas needed no augmentation, while 88 were augmented during the active phase and 26 during the second stage of labour. The duration of the active phase [median (md) 4 hours 45 minutes, 6 hours 49 minutes and 6 hours 20 minutes respectively for the different groups, P = 0.03], the time between full dilation of the cervix and the start of the second stage (md 20 minutes, 30 minutes and 60 minutes respectively, P = 0.012) and the duration of the second stage of labour (md 40 minutes, 44 minutes and 60 minutes respectively, P = 0.04) were significantly longer in the augmented groups. Operative deliveries, too, were more frequent in the augmented groups. There was a significantly higher rate of perineotomies in the group augmented during the second stage of labour. There were, however, no differences in Apgar score <7 at 1 minute. pH in the umbilical cord and the base deficit were higher in the group which were augmented during the second stage of labour (P = 0.02 and P = 0.06 respectively). Women describing their impression of the experience as a whole generally gave it a high rating, but women who were augmented during the second stage of labour gave the experience a significantly lower score (P = 0.01).

CONCLUSION

Augmentation is used in unusually prolonged deliveries. We did not find that augmentation involved a higher frequency of perineal trauma, although it was correlated with a higher frequency of operative deliveries. There was no correlation between the oxytocin infusion and the primiparas' descriptions of the strength of contractions, pain and fatigue, although greater use of epidurals was observed in women with augmented labour. The number of nulliparas in this study was too small to analyse the incidence of ruptures in the sphincter or draw conclusions about differences between the groups with regard to Apgar scores or metabolic acidosis.

RELEVANCE TO CLINICAL PRACTICE

In clinical practice, good routines concerning oxytocin augmentation are crucial. Interventions as oxytocin augmentation seem to cause harm to mother and child. To evaluate interventions continuously in obstetric care is therefore important.

The significance of neighbourhood context to child and adolescent health and well-being: a systematic review of multilevel studies

Growing up in a poor neighbourhood has negative effects on children and adolescents. In the literature it has been concluded that the risk of low birth weight, childhood injury and abuse, and teenage pregnancy or criminality double in poor areas. However, the validity of such studies has been questioned, as they have been associated with ecological or individualistic fallacies. Studies using multilevel technique might thus contribute important knowledge in this field. The present review clarifies the importance of neighbourhood contextual factors in child and adolescent health outcomes, through considering only studies using multilevel technique. Keyword searching of the Medline, ERIC, PsycInfo, Sociological Abstracts, and Social Citation Index databases was performed. Original studies using multilevel technique to examine the effect of neighbourhood characteristics on child and adolescent health outcomes, and focusing on populations in high-income countries were included. Neighbourhood socioeconomic status and social climate were shown to have small to moderate effects on child health outcomes, i.e. birth weight, injuries, behavioural problems, and child maltreatment. On average, 10% of variation in health outcomes was explained by neighbourhood determinants, after controlling for important individual and family variables. This review demonstrates that interventions in underprivileged neighbourhoods can reduce health risks to children, especially in families that lack resources. An analysis of methodological fallacies indicates that observed effects and effect sizes can be underestimated, and that interventions may well have greater impact than this review was able to establish.

Is there a "school effect" on pupil outcomes? A review of multilevel studies

STUDY OBJECTIVE

The school environment is of importance for child outcomes. Multilevel analyses can separate determinants operating at an individual level from those operating at a contextual level. This paper aims to systematically review multilevel studies of school contextual effects on pupil outcomes.

DESIGN

Key word searching of five databases yielded 17 cross sectional or longitudinal studies meeting the inclusion criteria. Results are summarised with reference to type of school contextual determinant.

MAIN RESULTS

Four main school effects on pupil outcomes were identified. Having a health policy or antismoking policy, a good school climate, high average socioeconomic status, and urban location had a positive effect on pupil outcomes. Outcomes under study were smoking habits, wellbeing, problem behaviour, and school achievement.

CONCLUSIONS

Despite the different pupil outcomes and the variety of determinants used in the included papers, a school effect was evident. However, to improve our understanding of school effects, presentations of results from multilevel studies need to be standardised. Intraclass correlation and explained between school variance give relevant information on factors in the school environment influencing pupil outcomes, and should be included in all multilevel studies. Inclusion of pupil level predictors in the multilevel models should be based on theoretical considerations of how schools and communities are interconnected and how pupils and their families are influenced by school contextual factors.

Association between childhood community safety interventions and hospital injury records: a multilevel study

STUDY OBJECTIVE

To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome.

DESIGN

A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression.

SETTING

Twenty five municipalities in Stockholm County in Sweden were studied.

PARTICIPANTS

Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years.

MAIN RESULTS

Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children.

CONCLUSIONS

This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.

Risk of childhood injury: predictors of mothers' perceptions

BACKGROUND AND OBJECTIVES

Safety education often targets parental risk perception. Predictors of risk perception, however, are not well known, thus limiting the feasibility of effective safety education. Accordingly, in this study, a range of predictors of maternal risk perception were examined.

METHODS

A random sample of 870 mothers in northern Sweden was included in the study. Three different questionnaires, with scenarios of a burn injury, a bicycle injury in the home environment, and a bicycle injury in traffic, were completed by the subjects. Multiple linear regression models tested the possible influence of causal attributions, normative beliefs, and sociodemographic and behaviour-related variables on mothers' risk perception.

RESULTS

Only 14-23% of the variance in mothers' risk perception could be explained by the multivariate models. Causal attribution to the child was found to be the most important predictor of maternal risk perception.

CONCLUSION

Present theoretical models give few clues about how to design educational models that might influence risk perception. To make safety education more effective, other modifiable factors that influence parental safety behaviour, such as subjective norms and self-efficacy, might be better targets.

Education of staff--a key factor for a safe environment in day care

In order to create a safe environment in day-care settings, an understanding of factors within the organization of day care, factors which influence safety, is essential. Day-care directors in 83 daycare centres completed a mail-in survey that contained questions about professional experience, the day-care centre's organization of child safety measures and a battery of questions designed to evaluate the directors' perceptions and beliefs about child safety. The day-care directors also carried out a safety inspection at their centre. The results were analysed using the multivariate logistic regression technique. The existence of a continuing plan for continued staff education in child safety was shown to be the strongest predictor of few safety hazards in day-care centres. The day-care directors' perceptions and beliefs about injury prevention were of less importance. This study indicates that in order to promote safety in day-care settings, an on-going plan for continued staff education in child safety should be a matter of routine. The introduction of such a plan should be the concern of the individual day-care directors, policy-makers and managers at the local and national level, and health professionals working in this field.

Perceived social norms as crucial determinants of mother's injury-preventive behaviour

In order to design injury-preventive programmes aimed at parents, an understanding of injury-preventive behaviour is essential. Questionnaires were obtained from 870 mothers of 3, 4 and 9-year-olds. The perceived social norm and other determinants for injury-preventive behaviour were analysed using three multivariate logistic regression models. The final logistic models classified 73.2-82.7% of respondents correctly. Perceived norms of relatives and friends were found to be the most important determinants of mothers' injury-preventive behaviour. Injury-preventive behaviour could neither be explained by mother's perception of injury risks, nor by the perceived norms of professionals within child health care and schools. This study indicates that in order to design injury-prevention programmes, an understanding of social norms is crucial.