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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.”

 

 

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.

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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

 

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.

 

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Sugar-coating the childhood obesity problem

Child obesity figures appear to be on the rise again, causing much concern after earlier signs they had levelled off.  The proportion of  10- and 11-year-olds who were obese in 2015-16 was 19.8 percent, up 0.7 percent on the year before. There was a rise of 0.2 percent among four- and five-year-olds. The announcement comes as researchers at the ESRC International Centre for Lifecourse Studies at UCL have been looking in detail at how and when children become overweight. The team has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents. Yvonne Kelly explains the research findings, and considers their implications for the Government’s recent strategy for tackling the childhood obesity epidemic.

The Government’s much-awaited and much-debated childhood obesity strategy was published in August. In the end, it was less comprehensive than had been anticipated, less draconian too. It focuses on two things – reducing sugar consumption and increasing physical activity. But will it be effective in reversing this worrying obesity trend among our children?

It’s fair to say we don’t fully understand what things influence whether, when and why a child might become overweight. Research to date has shown three distinct weight pathways for children: a healthy BMI throughout childhood; becoming overweight during childhood and being overweight/obese throughout childhood.

Previous research has also shown that the child’s mother’s weight, smoking in pregnancy, mental health and other social and economic factors have some link to childhood obesity. But the evidence is far from complete and, where a child’s own mental health is concerned, it’s not at all clear which way the association works.

To try to get a clearer picture of all these things, our research looked at the BMI paths of the participants in the Millennium Cohort Study, which has tracked the lives of nearly 20,000 children born between 2000-2002. We used data collected at birth, 9 months, age 3, 5, 7 and 11.

Once we had established who was on which BMI path, we were able to look at what factors were at play in their lives and to see whether a tendency to overweight and obesity was an indication that a child would go on to face mental health difficulties in early adolescence or start smoking and drinking.

Four pathways to obesity

The BMI data for the 17,000 children we were able to look at for our study showed four distinct groups of children. More than 80 per cent of them stayed on an average non-overweight path throughout their childhood – we call it the ‘stable’ path. There was a small group (0.6 percent) of children who were obese at age 3 but were then in the stable group by age 7. We call them the the ‘decreasing’ group. There was a ‘moderate increasing group’ (13.1 percent) where children were not overweight at age 3 but whose BMIs increased throughout childhood into the overweight (but not obese) range. Finally we had a ‘high increasing’ group of children (2.5 percent) who were obese at age 3 and whose BMIs continued to increase.

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Girls were 30 percent more likely to be in the ‘moderate increasing’ group than boys and were half as likely to be on the ‘decreasing’ path. Indian, Pakistani and Black African children were up to two times more likely to be on the ‘moderate increasing’ path whilst Pakistani, Black Caribbean and Black African children were up to three times more likely to belong to the ‘high increasing’ group.

The wealthiest children were least likely to be in the ‘moderate increasing’ BMI group and children of mums who smoked during pregnancy were up to two times as likely to belong to increasing BMI groups. Children with overweight mums were most likely to be on the moderate and high increasing paths.

Children on the moderate and high increasing paths were less likely to have regular family routines – they were more likely to skip breakfast or have non-regular bedtime schedules. Interestingly, however, no strong links emerged with some of the things more readily linked with childhood obesity such as sugary drinks and snacks, watching TV and lack of physical activity such as sports, the main focus of the newly published childhood obesity strategy.

Overweight factors

So it seems quite a large range of factors influence the likelihood of a child becoming overweight or obese over the first decade of their life. On top of this, being overweight or obese would also seem to point to a less happy and fulfilling early adolescence and a tendency to explore risky behaviours like smoking and drinking.

Although our research did not show a clear link with sugary drinks and snacks, there are nevertheless some compelling arguments for reducing the sugar intake of our children. These are not only related to problems of obesity, but to wider issues including the major issue of tooth decay and associated emergency hospital admissions. There is also increasing evidence of the ‘addictive’ nature of sugar with research suggesting that it stimulates a sort of ‘reward path’ in certain centres of the brain meaning that the more we have the more we want. It has been shown that people who reduce their sugar intake tend to crave it less.

Where sugar taxes have been introduced in other countries (Mexico, France, Denmark, South Africa amongst others), the intervention has been shown to help reduce the consumption of sugary drinks. As yet, there is no evidence that it helps reduce BMI and tackle obesity, but it’s argued it will take time for us to see an effect on whole populations.

Disadvantaged families

It is hard to predict how much impact the voluntary rather than mandatory reduction in sugar content of drinks and snacks agreed in the strategy will have. As for the sugar tax that will be introduced in two years’ time, there remain concerns that disadvantaged families more likely to purchase and consume sugary goods than their better off counterparts will be hardest hit. Policy makers will need to think hard about how any negative consequences of this might be counteracted.

Our research shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar. Those influences are at play in families even before our children are born.

Helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines would seem to be key, together with targeted support for the ethnic and social groups identified as being most at risk.

Further information and resources

BMI development and early adolescent psychosocial well-being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery, and Amanda Sacker. The work, published in Pediatrics, is funded by the Economic and Social Research Council.

Media coverage

Photo credit: Kim Stromstad

Why poorer children are at greater risk of obesity

Obesity may be the biggest public health crisis facing the UK today. Levels have risen more than three fold since 1980. Being obese makes you vulnerable to a range of health risks. Being an overweight child makes it more likely you will become an obese adult. And you are much more likely to be an overweight child, if you come from a poor family. If current trends continue, half the population of Britain could be obese by 2050. Early intervention is the most effective way to break this cycle. And that requires a better understanding of why children become overweight. A new study by a team at the ESRC funded International Centre for Lifecourse Studies in Society and Health at UCL and LSE makes clear the scale of the problem and points to some crucial factors likely to lead less-well-off children to gain excess weight, as co-author Professor Yvonne Kelly explains.

A link between poverty and childhood obesity has been found in many developed countries. Intuitively, it seems likely this link is the result of poorer parents not being able to afford healthier food, like fruit, or outings involving exercise for their children. It could also be that those parents know less about healthy lifestyles and that they themselves eat less healthily and exercise less. But intuition is an insufficient basis for the scale of intervention required. This study is the first attempt to examine and compare in detail why children in poorer families are more likely to be overweight.

Our data comes from the Millennium Cohort Study (MCS). This tracks nearly 20,000 families from across the UK. We used measurements made when the children were aged 5 (when just entering primary school) and 11 (the point at which they leave primary school and are on the cusp of adolescence). We used standard definitions for ‘obese’ and ‘overweight’.

‘Stark’ link between poverty and obesity

The first thing we found was that the link between relative poverty and childhood obesity is stark. At age 5, poor children were almost twice as likely to be obese compared with their better off peers (6.6% of children from families in the poorest fifth of the sample were obese while the figure for the richest fifth is just 3.5%). By the age of 11, the gap has widened- nearly tripling (7.9% of the poorest fifth are obese; for the best-off, the figure is 2.9%).

Given that obesity is linked to the development of numerous chronic diseases and that there is evidence overweight and obese children are less likely to grow into economically and socially successful adults, this is a significant burden to be borne by the children of the less-well-off. And unless we can weaken the link our chances of reversing the overall obesity trend are much reduced.

Potential causes of that link

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to identify some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To measure the degree to which the mother followed a healthy life-style we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which the mother was herself overweight or obese. To assess the impact of physical behaviour, we compared the frequency of sport or exercise, active play with a parent, hours spent watching TV or playing on a computer, journeys by bike and the time that children went to bed. We compared dietary habits via data on whether the child skipped breakfast and on fruit and sweet drink consumption.

Multiple factors

What we found was that a lot of these factors were relevant. Maternal behaviour in early childhood was certainly important. Markers of ‘unhealthy’ lifestyle here could mean as much as a 20% additional risk of obesity for a child. Measures of physical activity and diet were also relevant at both 5 and 11 years of age, as were early bedtimes and fewer hours in front of the TV or games console. Skipping breakfast and eating more fruit were factors at 5 but less significant at 11. Doing sport more frequently played a more important and protective role at age 11 than at age 5.

Further examination of the differences between the children aged 5 and aged 11 revealed that poorer children aged 5 were much more likely to gain excess weight up to age 11 than richer children. The earlier certain lifestyle factors can be challenged, therefore, the greater the chance of positive impact.

Multiple responses

Assuming that income inequality is not going to disappear, we can only tackle ‘inherited’ obesity via the lifestyle choices that tend to go with lower incomes. Early intervention with mothers clearly has huge potential. And evidence from our work suggests that this should start before birth or even conception. It is clear, too, that campaigns to encourage family physical activity and healthier diets would help.

The Government is already trying to persuade families to eat more healthily and take more exercise. But these efforts are widely targeted and their effectiveness only broadly assessed. Our analysis has already suggested better targeting. More research should be undertaken to narrow the aim and increase effectiveness still further.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health.

Photo credit: Playing on the computer,  John Watson