An equal start: longitudinal evidence to support children’s healthy development

Using longitudinal evidence to support children’s healthy development and give them an equal start in life is the subject of our editor Yvonne Kelly’s keynote address at the Growing up in Ireland Annual Conference in Dublin today.

Her talk discusses findings from the most recent of the British ‘birth ‘ cohort studies – the Millennium Cohort Study that have so far informed policy development. They include work by researchers at the ESRC Centre for Lifecourse Studies where Yvonne is based on alcohol consumption during pregnancy, breastfeeding and the introduction of solid foods, the physical punishment of children , childhood obesity, reading to children in the early years, and sleep patterns throughout childhood.

She will also share work with the potential to inform future policy challenges such as young people’s drinking, social media use and mental health.

Ahead of her talk, she said:

“It is well established that what happens in the early years of life has long-lasting consequences for health and social success across the lifespan. Stark social inequalities in children’s health and development exist and emerge early in life. It is therefore crucial to identify potential tipping points and opportunities for intervention   during childhood with the potential to affect change and improve life chances.”

 

 

Don’t let the kids get jet-lag: why regular bedtimes are key to a happy healthy childhood

The very best of sleep medicine and research is being presented at the World Sleep Congress in Prague this week. Among that research are findings from work by Child of our Time Editor, Professor Yvonne Kelly and colleagues at the ESRC International Centre for Lifecourse Studies. They have been trying to find out what it is about sleep that matters most when it comes to giving children the best possible start in life. Here Yvonne explains what they have found to date and why regular bedtimes are key to a healthy happy childhood.

What happens in the early years has profound implications for what happens later on in life. Thousands of research papers, many of them using the wonderful rich data in the British Birth Cohort studies, have documented the enduring impacts of the way we live our lives as children on how we fare later on. Children who get a poor start in life are much more likely to experience poor outcomes as adults, whether that’s to do with poor health or their ability to enjoy work and family life later on.

So what has all that got to do with getting enough sleep as a toddler you might ask? Well our research shows it is one of a number of important factors related to getting children off to the best possible start in life and here’s why.

Recommended sleep

The National Sleep Foundation recommends that toddlers should get around 11 to 14 hours sleep every day. For 3-5 year-olds, the recommendation is 10-13 hours and it suggests 9-11 hours for children once they’re at primary school. But is it all about the number of hours sleep children get, or is there more to it than that? Those are the questions we have been addressing in our research into children’s sleep and how it ties in with how they get on at home and at school across the first decade of their life.

Digging into one of those studies mentioned earlier, the Millennium Cohort Study, which has followed the lives of some 20,000 children since the turn of the century, we found that it’s not just the number of hours a child sleeps that matters, but also having consistent or regular bedtimes.

First we looked at the relationship between regular and irregular bedtimes and how the children got on in a range of cognitive tests. The results were striking. Children with irregular bedtimes had lower scores on maths, reading and spatial awareness tests.

Parents who took part in the MCS were asked whether their children went to bed at a regular time on weekdays. Those who answered “always” or “usually” were put in the regular bedtime group, while those who answered “sometimes” or “never” were put in the irregular bedtime group.

Interestingly, the time that children went to bed had little or no effect on their basic number skills, and ability to work with shapes. But having no set bedtime often led to lower scores, with effects particularly pronounced at age three and the greatest dip in test results seen in girls who had no set bedtime throughout their early life.

The key to understanding all this is circadian rhythms. If I travel from London to New York, when I get to there I’m likely to be slightly ragged because jet lag is not only going to harm my cognitive abilities, but also my appetite and emotions. That’s for me, an adult. If I bring one of my children with me and I want them to do well at a maths test having just jumped across time zones, they will struggle even more than I will. The body is an instrument, and a child’s is especially prone to getting out of tune.

The same thing happens when children go to bed at 8 p.m. one night, 10 p.m. the next and 7 p.m. another — we sometimes call this a “social jet lag effect.” Without ever getting on a plane, a child’s bodily systems get shuffled through time zones and their circadian rhythms and hormonal systems take a hit as a result.

Bedtimes and behaviour

Having established the importance of sleep to a child’s intellectual development, we turned our attention to the relationship between regular bedtimes and their behaviour.

At age 7, according to parents and teachers, children in the MCS who had irregular bedtimes were considerably more likely to have behaviour problems than their peers who had a regular bedtime. In addition, the longer a child had been able to go to bed at different times each night, the worse his or her behaviour problems were. In other words the problems accumulated through childhood.

One really important piece of good news was that we found that those negative effects appeared to be reversible, so children who changed from not having to having regular bedtimes showed improvements in their behaviour. There seems to be a clear message here that it’s never too late to help children back onto a positive path and a small change could make a big difference to how well they get on. Of course, the reverse was also true so the behaviour of children with a regular bedtime who switched to an irregular one, worsened.

Bedtimes and obesity

In a follow up study, which looked at the impact of routines including bedtimes on obesity, we reported that children with irregular bedtimes were more likely to be overweight and have lower self-esteem and satisfaction with their bodies.

In fact, of all the routines we studied, an inconsistent bedtime was most strongly associated with the risk of obesity, supporting other recent findings which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

So we have a body of robust evidence now that shows very clearly that regular bedtimes really matter when it comes to a child’s health and development over that important first decade of their life.

Providing that evidence in the form of advice to parents and all those caring for young children alongside recommended hours of sleep could make a real difference, helping protect our children from ‘social jet-lag’ and getting them off to a flying start instead.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Why reading is key to giving our kids a great start in life

A growing body of research is pointing to how important and valuable reading is in giving children the best possible start in life, not just for academic success but more broadly including for a child’s mental health and happiness.

In this special episode of the Child of our Time Podcast, Professor Yvonne Kelly is joined by Jonathan Douglas, CEO of the National Literacy Trust and researcher Christina Clark, also from the  Trust. They discuss important new evidence about the benefits of reading for individual children and in addressing social inequalities.

Useful links

Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army

 

Why mental health is not your average problem

There have been numerous reports in recent months of a growing crisis in children and young people’s mental health. From increased suicide attempts and incidents of self-harm to reports of a complete lack of appropriate services, it’s said that young people are facing unprecedented social pressures and that society’s response has been inadequate. When it comes to trends over time in the mental wellbeing of young people, the evidence to date is conflicting. Meanwhile, new research by Andy Ross and colleagues at the ESRC International Centre for Lifecourse Studies at UCL shows that the way we look at those trends may be masking an important story that could help those trying to tackle the problem to identify those most at risk of serious mental health problems.

There are few more high profile health issues at the moment than the mental health crisis among young people. The younger Royals may have helped raise public awareness about the need for more open conversations, but they agree the job is far from done. From a policy perspective, there are pledges of mental health legislation reform in the Queen’s Speech promises from Teresa May that her Government will “ensure that mental health is prioritised in the NHS in England”. But a recent report from NHS Providers says the government’s commitment to parity of esteem between mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline.

Having a full and clear grasp of the scale of the problem and how young people’s mental wellbeing is changing over time will be key to any policies that may be developed to tackle it.

One of the main problems facing those trying to better understand the extent of the problem and whether the situation is getting better or worse, is that the evidence presented to date has been somewhat conflicting and, in some cases, doesn’t give the whole picture.

Some research has shown young people’s mental health deteriorating in the nineties and then stabilising and slightly improving in the early 2000s, whilst other work has evidenced a steady decline. Findings have also been different depending on whether it is teachers, parents or the young person themselves who are asked to report the symptoms.

Trends over time

We wanted to see whether we could add to and improve on the available evidence and show a more nuanced picture of mental health problems among young people by looking at trends over time, not just in respect of average levels of mental health, but also across the spectrum in levels of mental health. In simple terms, we were looking to see whether there were increases in the number of young people with unusually low levels of mental distress at the same time as increases in the numbers of those with very high levels of distress over an 18-year period.

Making use of information collected between 1991-2008 from more than 6,000 young people who took part in the British Household Panel Survey, we looked closely at their self-reported psychological distress. Once a year, young people between the ages of 16-24, were asked whether and how often, for example, they had experienced the loss of sleep through worry, a loss of confidence, felt constantly under strain, unhappy or depressed. They were also asked about positive symptoms such as their ability to concentrate and face up to their problems.

All this information was then combined to create an overall psychological distress score on a scale of 0-36, with high scores indicating high levels of psychological distress.

When we looked at the average psychological distress scores for young women in the study, we saw a small but significant increase over the 18-year period, indicating that, for this group, the situation worsened – in other words, their mental health deteriorated.

No increase was detected in the average scores for young men, which could be interpreted as a sign that levels of mental health among this group remained fairly stable.

At every time point, scores for women were worse than they were for men and this gap increased over time.

A story of polarisation

When we drilled deeper into the scores, however, the story changed a little. For young women there was a very clear and consistent increase in high and very high scores, following the overall increase in average scores mentioned above. The prevalence of those with high scores (17 and higher) increased from 12.8 per cent in 1991 to 18.8 per cent in 2008, and the prevalence of those with very high scores (20 and higher) from 6.6 per cent to 11.9 per cent. At the same time, however, there was also a small increase in the prevalence of those with scores much lower than average (5 and lower) from 10.6 per cent to 13.0 per cent.

It seems that when we move beyond looking only at average mental health scores over time, we identify two very different yet concurrent pictures of young women’s mental health. An increase in the number of young women presenting very poor levels of psychological distress, whilst at the same time an increase in young women with far better levels of mental health than average. In other words, over time, the mental wellbeing of young women appears to have become polarised.

Previously, our findings suggested that levels of mental health among young men had remained stable. However, when we look at both low and high scores over time, we find a very clear and consistent increase in low and very low scores, suggesting an overall improvement in levels of mental health among young men.

The prevalence of those with low and very low scores increased from 8.1 per cent to 15.6 per cent and from 2.1 per cent to 5.9 per cent respectively. At the other end of the scale however, whilst there was an increase in prevalence of those with high and very high scores, this increase was too small for us to consider it statistically significant[1]. Nevertheless, by considering trends at both ends of the spectrum we identified an improvement in young men’s mental health, which was otherwise ‘hidden’ when we only looked at average scores over time.

Although our study did not delve deeply into the backgrounds and circumstances of the young people with low and high scores, we did look at income levels to see if increasing levels of inequality might explain what we were seeing. It doesn’t appear to.

What we did find was evidence to support earlier research, which suggests that girls might feel increased pressure to achieve academically, which could contribute to increased levels of psychological distress.

Doing it for themselves

We are yet to explore causes for these trends, however one area that remains significantly under researched is the idea that we are becoming a more individualistic society, in which there are increased expectations placed on young people and an emphasis on them “doing it for themselves”. This includes increased pressure to take responsibility not just for one’s successes, but also for one’s failures, previously thought of as misfortunes, such as unemployment, illness and addiction. It is easy to imagine how the personalising of one’s failings could contribute to a young person’s poor mental health, or how they might develop a fear of failure even.

On the other hand, taking more responsibility for their own destiny could be empowering when things go well, boosting their self-esteem and confidence.

Evidence of polarising trends in young women’s mental health could be the first step in linking time trends to the sort of cultural and societal individualization that is being increasingly talked about amongst those concerned with the health and wellbeing of the UK’s young people.

For young women, continuing gender inequalities (some legislative, some cultural), which serve to frustrate women’s dreams of self-realisation, might also help to explain the differences in poor levels of mental health in particular that we see between them and young men.

By 2020, the NHS has promised that 70,000 more young people will be able to access services for their mental health problems. Robust evidence on trends and how the story of young people’s mental health is changing over time will be key to ensuring those services are provided effectively and efficiently.

Time trends in mental well-being: the polarisation of young people’s psychological distress is research by Andy Ross, Amanda Sacker and Yvonne Kelly and is published in the Journal of Social Psychiatry and Psychiatric Epidemiology

Photo credit: Allan Bergman

Screen use at seven: overweight at 11. Why it’s time to say no to a TV in the bedroom for children

Since the launch of the Childhood Obesity Strategy in 2016, there has been much attention focused on the so-called ‘Sugar Tax’. The March 2017 Budget saw confirmation that sugary soft drinks would be taxed in an attempt to combat rising levels of obesity. This is an important move that has been met with widespread approval from public health professionals. Still, obesity is hugely complex and there are many other things at play in addition to the sugary drinks and snacks that children may consume. Researchers at UCL have been looking in detail at different factors associated with obesity and, in a recent paper, find that children who have a television in their bedroom have higher BMI and more body fat than those who do not. Lead researcher, Anja Heilmann, explains the research and why saying no to a TV in the bedroom could be another important strategy in combatting childhood obesity.

As our TV screens have got flatter, our children have got fatter. There is no getting away from it! Screen-based activities play a central role in our children’s lives. At a very young age, they have unparalleled access to television screens, computers, game consoles and a host of mobile devices. Among 5 to 11 year-olds, TV is still the most consumed medium, with gaming coming second.

At the same time, childhood obesity is not just a national, but a global health worry. In 2014/15 a third of 11 year-old children in England were overweight and a fifth were obese.

Research has repeatedly reported a link between TV viewing and obesity, but although some has hinted at the idea that a television in a child’s bedroom might exacerbate the problem, the evidence here has been rather contradictory. Other plausible pathways could include eating unhealthy snacks whilst watching TV, exposure to food advertising and insufficient and poor quality sleep.

Using information from the Millennium Cohort Study (MCS), which has followed the lives of more than 18,000 children born around the turn of the century, we had the opportunity to see whether having a TV in their bedroom when they were age 7 was, in any way, linked with a child being overweight when they were 11 years old. In other words, we wanted to get to grips with whether there were implications over a child’s lifetime of their screen use and if so, what those implications were.

Useful information

Using trained interviewers, the MCS collects a wide range of useful information including the independently measured height, weight and body fat of a child. These provided us with a set of obesity-related measurements: weight, Body Mass Index (BMI) and Fat Mass Index (FMI), a powerful set of measures for overweight and obesity.

When the children were age seven, parents were asked if their son or daughter had a TV in their bedroom, how many hours they spent watching TV or DVDs and how much time they spent playing on a computer.

 At age 7, more than half of the 12,556 boys and girls we looked at in our research had a TV in their room and it was these children who were more likely to be overweight when they turned 11 when we compared them with those without a TV. They were also more likely to have higher BMI and FMI. In total, a quarter of the boys and nearly a third of the girls were overweight at age 11 and the links between having a TV in the bedroom and overweight were stronger for the girls.

Another strength of the research is that we controlled for the child’s BMI at age 3 and maternal BMI, that way adjusting for genetic factors, as well as food environment in the family. We also adjusted for family income and mother’s education – both of which are important as overweight/obesity is socially patterned, as is TV use.

Interestingly, there was no link between overweight and the time a child, whether they were a boy or a girl, spent playing on a computer.

Clear link

So, given the size of our sample and the robustness of the methods employed here, we can say with considerable confidence that there is a clear link between having a TV in the bedroom as a young child and being overweight a few years down the line. For girls, this represents a 30 per cent increase in the risk of being overweight at 11 compared with their peers who do not have one. For boys the risk increases by around 20 per cent.

Another interesting point to note is that the size of this risk or effect is about the same as that of other things shown to be linked with obesity, such as not being breastfed and being physically inactive.

Nevertheless, policy makers looking to create and implement strategies to reduce obesity should certainly consider building access to television screens in children’s bedrooms into their thinking. Specific initiatives focused on young girls could also be important.

Meanwhile, for parents who may consider it a good idea for a young child to have their own TV in their bedroom or feel under pressure to provide one, the message is quite clear: resist the idea and you may be doing even more to set your child on a healthier path into their teenage years and beyond.

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study is research by Anja Heilmann, Patrick Rouxel, Emla Fitzsimons, Yvonne Kelly, and Richard Watt and is published in the International Journal of Obesity.

A risky problem: what can keep young people away from alcohol and cigarettes?

Smoking and drinking among very young people has been declining in recent years, but it’s not all good news. There is still a lot of public health concern around the numbers of older children who are consuming alcohol and cigarettes, as these are the young people most likely to come to harm as a result of drinking too much. Their risky behaviours are also likely to persist and intensify into adulthood. So what factors might prevent a young person from smoking and drinking in the first place? New research published in BMC Public Health shows that levels of happiness among children and awareness of the risks may be key to success. Lead author on the research, Noriko Cable, explains more. 

According to Public Health England (PHE), alcohol is now the leading risk factor for ill-health, early mortality and disability among those aged 15 to 49 in England. It wants to “prevent and reduce” the harms caused by alcohol. It also has ambitions to create “a tobacco-free generation” by 2025.

The most recent figures from the Survey of Smoking, Drinking and Drug Use Among Young People in England show that around 90,000 children aged between 11 and 15 are regular smokers and 240,000 have drunk alcohol in the past week. These figures are the lowest they have been since the survey began in 1982.

However, recent research published in BMC Public Health by colleagues at UCL, shows that around one in seven 11 year-olds is drinking alcohol and that having peers who consume alcohol makes them four times more likely to drink that their peers who don’t. We also know that smokers start young, two thirds of them before the age of 18.

So we wanted to examine more closely the sorts of things that might drive young people away from cigarettes and alcohol. In this way we hope to arm policy makers, health practitioners and those working directly with or caring for children and young people with information that can help with the development of clear policies and interventions.

Protective role

We focused on three factors thought to play a protective role in preventing young people from starting to smoke and drink. These were: their awareness of the harms, their well-being or happiness and how supportive their networks of friends and family were.

Information came from Understanding Society, a large UK survey, which, in addition to collecting a wide range of social and economic information from everyone in the household aged 16 and over, has a special self-completion questionnaire for 10-15 year olds. Our sample contained 1,729 boys and girls.

We examined answers at two time points (approximately a year apart) to questions about their smoking and drinking. With these two sets of information, we were able to see whether they had started but then stopped smoking or drinking, whether they were persistent users of cigarettes and alcohol, whether they had started between the first and second surveys (initiation) or whether they had not smoked or drunk alcohol at either point.

The children were also asked about how happy they were with different aspects of their lives, including how they were getting on at school, how they felt about their appearance, family and friends and life in general.

On a scale of 1-4, the children were asked to rate how risky they thought different levels of smoking and drinking were. They were also asked how many supportive friends they had; friends they could confide in.

Harm awareness and happiness

Nearly 70 per cent of the study participants described themselves as persistent non-users of alcohol and cigarettes, and around 13 per cent categorized themselves as persistent users. Persistent non-users scored highest on harm awareness and happiness tests compared to the other groups.

About 8 per cent of the study group labelled themselves as ex-users and about 13 per cent had started using alcohol or cigarettes between the first and second time they completed the survey. Young people aged 10 to 12 were more likely to be in the persistent non-use group, whereas participants aged 13 and above were more likely to be in the persistent user and initiation groups.

We were surprised that while, for most young people, knowledge of the potential and actual harms of alcohol and smoking was linked with them never drinking or smoking, for some it seemed to be associated with them starting to drink or smoke. It is possible that positive expectations from drinking alcohol or smoking cigarettes may, in some way, have overridden their awareness of what harm they could do.

The happier the young person was, and more aware of the harms of alcohol and cigarettes, the more likely they were never to drink or smoke. Having supportive friends to confide in did not play a role in preventing adolescents from using alcohol or cigarettes.

Promoting happiness and harms

So it seems that promoting young people’s happiness and well-being and making them aware of the harms of smoking and drinking may be key to keeping them away from alcohol and cigarettes. In terms of possible timings for information and interventions, another takeaway from the study might be that working with children between the ages of 10 and 12, before they start trying cigarettes and alcohol, could be important.

Because the information used in this study is self-reported, we need to interpret the findings with caution, but they do suggest that making adolescents aware of alcohol and smoking related harm can be helpful in preventing them from engaging in risky health behaviors.

Colleagues at the Centre are now getting to grips with the new age 14 data from the Millennium Cohort Study and, in collaboration with Mentor, a charity working on the ground in schools to tackle alcohol and drug abuse, are hoping to develop our growing body of evidence in this area that will help formulate policies and activities to make some of Public Health England’s ambitions around smoking and alcohol a reality.

Further information

What could keep young people away from alcohol and cigarettes? Findings from the UK Household Longitudinal Study is research by Noriko Cable, Maria Francisca Roman Mella and Yvonne Kelly and is published in BMC Public Health.

 

Tackling the childhood obesity epidemic: Can regular bedtimes help?

Nearly one in five 10 and 11-year-olds in England is obese, according to NHS figures. With childhood obesity posing not just a nationwide, but a worldwide health threat, public health researchers around the globe are striving to establish which aspects of a young child’s life might set them on a path to being obese later on. Associate Professor Sarah Anderson from The Ohio State University College of Public Health and colleagues from University College London outline the first research to try to disentangle the role of children’s routines and behaviour at age 3 on obesity at age 11 and show that bedtime routines and learning to manage emotions really do matter.

The UK’s Chief Medical Officer Professor Dame Sally Davies has warned that the health of millions of children is in jeopardy and is concerned that being overweight is becoming the norm. She fears half the population could be obese by 2050 at a cost of billions of pounds to the health service and wider economy.

The latest statistics highlight a stark contrast between the wealthiest and poorest families, with childhood obesity rates in the most deprived areas more than double those in the most affluent areas.

Despite the publication in August 2016 of the Government’s long-awaited childhood obesity strategy, charities and health organisations remain highly critical, describing it as a watered-down effort that puts business interests ahead of those of public health. Even the recent introduction of the so-called ‘sugar-tax’ on soft drinks has been met with scepticism in some quarters.

To help inform public health strategies going forward, our researchers looked at the bedtime, mealtime and tv/video routines of very young children and their emotional and behavioural development to see if, at this early stage, it is possible to identify those most at risk of becoming obese.

The study includes information on nearly 11,000 children collected through the UK Millennium Cohort Study (MCS). When the children were three, their parents reported whether children always, usually, sometimes, or never or almost never had a regular bedtime and mealtime, and the amount of television and video they watched each day.

They were also asked a series of questions about the child’s behaviour during the previous six months. Questions were about how children cope with emotions and their persistence and independence in play, including how easily the child became frustrated and whether they sought help from adults when faced with a difficult task. This was to get an idea of how well the child was able to ‘self-regulate’ their behaviour in these areas.

Regular routines

Children with regular bed and mealtimes and who watched less television were better able to control their emotions than their peers with less regular and consistent routines.

At 11-years-old, 6.2 per cent (682) of the children in the MCS were obese, with obesity more common in lower income and less educated families.

Of the routines we studied, inconsistent bedtime was most strongly associated with the risk of obesity, supporting recent findings by our UCL colleagues which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11, stressing the importance of adequate sleep for preventing childhood obesity.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

Regular bedtimes and obesity

Surprisingly, toddlers with irregular meal times had a lower risk of obesity at age 11. Once other routines were factored in, television viewing was not related to obesity, although it is important to note that computer use was not taken into account, and the media environment for young children today is different than it was when children in MCS were young.

There was also a clear link between lower levels of emotional self-control in early childhood and obesity later on. Children with poor emotion regulation at age 3 were over 50 per cent more likely to be obese when studied at age 11.

Children’s level of persistence and independence was not linked to later obesity, however, and it is possible that this could be explained by the relative immaturity of the parts of the brain responsible for a child’s cognitive compared with their emotional development at this young age.

Strongest risk

Our study is the first to look at the relationship between a child’s routines, their ability to regulate their emotions and behaviour and how these factors work together to predict obesity.

The two strongest risk factors for obesity were irregular bedtime and a poor ability to control emotions and these were completely independent of each other. In other words, the link between bedtimes and obesity could not be explained away by a child’s inability to regulate their emotions.

There is a need to look more closely at the timing and regularity of children’s mealtimes and how they impact obesity later on, as we think there may be a lot more factors at play than we have considered here. We also need to better understand how the development of emotional and cognitive self-regulation interacts with metabolic, behavioural and social pathways to obesity.

However, our study supports previous research showing that children’s emotional regulation develops within a family context which includes routines.

One message from our study is crystal clear. To be effective, obesity strategies must target early childhood, and must find a way to support parents, especially those from the most deprived areas, to introduce and maintain consistent bedtimes and other home routines, as well as help children regulate emotions and respond to stress.

Another key message is that one size does not fit all. There is a lot going on in children’s lives that is important for their health and development. Saying that, it would seem that getting our children to bed at the same time every night could be a simple, cost-effective tool in the tool-kit to get them off to a good start and maybe in the larger battle against obesity.

Self-regulation and household routines at age three and obesity at age 11: Longitudinal analysis of the Millennium Cohort Study is research by Sarah Anderson from The Ohio State University College of Public Health; Amanda Sacker and Yvonne Kelly from University College London and Robert Whitaker of Temple University, Philadelphia.

Reducing harm from alcohol consumption

Child of our Time editor Yvonne Kelly has shared her latest research findings on very young drinkers with policy makers, senior health professionals and third sector groups.

Yvonne was  part of a high profile panel presenting research and taking questions from MPs and others with an interest in the creation of a strategy to reduce harm from alcohol consumption.

The event, organised by The All-Party Parliamentary Health Group and CLOSER (the UK Longitudinal Studies Consortium), comes as a recent report from Public Health England stated that among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.

It has also been acknowledged that the harmful effects of heavy alcohol consumption go well beyond the implications for public health, presenting both serious economic and social challenges: current estimates of the annual cost to society of alcohol consumption range from 1.3% to 2.7% of annual GDP. In addition, around half of all violent incidents involving adults are alcohol-related.

Photo credit: Jes 

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