Tag Archives: Equality

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Do sexual minority teenagers have greater health risks?

People who identify as gay or bisexual have long been known to be more likely than others to be at risk from behaviour which can affect their health, such as drug-taking, drinking and not doing enough exercise. But how does this affect today’s teenagers? In an era of greater social liberalism might these differences be disappearing? Professor Yvonne Kelly and Dr Cara Booker discuss new research which sheds light on the issue.

Numerous studies have shown people from sexual minorities tend to suffer disproportionately from a range of health issues, yet until now there has been a paucity of up-to-date, comprehensive evidence about the level of risk faced by this group in the UK. A recent report by the Equalities and Human Rights Commission called for more research.

Two studies have been able to shed new light on the issue. Evidence from Understanding Society, the UK Household Longitudinal Study, examines its impact on adults and suggests problems still persist despite recent social change. And research based on the Millennium Cohort Study (MCS), which has followed almost 12,000 children since their birth between 2000 and 2002, has presented an ideal opportunity to look at the health outcomes of young people while they are still growing up. 

Sexual minority adolescents

MCS is a birth cohort study which has followed up children born in the UK just after the Millennium, and it has followed up its participants at nine months, 3, 5, 7, 11 and 14 years. So using this last sweep, it was possible to look at whether sexual minority adolescents experienced more adverse outcomes than their heterosexual peers. 

Between January 2015, and April 2016, 9885 adolescents in the MCS provided a response about their sexual attraction. Six per cent identified themselves as experiencing same-sex or bisexual attraction. Of these, the large majority were female – particularly among those who said they were bisexual.

Among the 629 respondents in this group, 50 (29 female and 21 male) reported same-sex attraction only and 576 (451 female and 125 male) reported bisexual attraction – this was not the case in the samples taken for Understanding Society, where the gender split was more even.

This may be because there is a lot of fluidity in sexual orientation at younger ages – so girls who say they are bisexual at this age may not say so in the future. But the rates of young people who identify as non-heterosexual have increased over time and so we may expect more young people to be bisexual or non-heterosexual in the MCS sample, who are younger than those in the Understanding Society study.

In order to assess mental health, MCS respondents were asked if they had self-harmed in the past year; how they rated their self-esteem and their subjective wellbeing, and about their general life satisfaction. They were asked if they experienced depressive symptoms, and if they felt they were bullied or victimised. They were also asked if they had been involved in anti-social behaviour such as stealing or violence, how close they felt to their parents, whether they smoked, drank or took illegal drugs, and whether they had had unprotected sex. Their levels of physical activity and diet were also assessed.

Range of problems

The findings suggested sexual minority adolescents were more likely to suffer from a range of problems including high depressive symptoms, self-harm, lower life satisfaction, lower self-esteem and all forms of bullying and victimisation. Young people from sexual minorities also had higher odds of being less physically active, of perceiving themselves as overweight and of having dieted to lose weight. And they were more likely to suffer from more than one of these issues than their heterosexual peers were. 

However, they were no more likely to engage in violence using a weapon, regular smoking, regular cannabis use, regular drinking, or other drug use. Sexual minority adolescents did not have increased odds of engaging in sexual activity or of engaging in risky sexual behaviour, and there was no difference between sexual minority adolescents and heterosexual adolescents regarding whether they had close friendships.

It has been suggested in the past that disparities may occur because sexual minorities experience stress factors such as bullying as well as facing the stress of navigating their identity. Their experience of prejudice and possible absence of support from family and others may be linked to mental distress, and this may lead to potentially risky behaviours such as substance misuse. However, activities such as drinking, smoking, drugs and sex are also part of normal adolescent development – so we would not want to suggest they’re always a major problem.

The teenage years are a time for experimenting and pushing boundaries, something discussed in an earlier Child of our Time blog on sexual behaviour.

Sexual minorities in adulthood

All this has implications for lifelong health and social outcomes. Recent research led by Dr Cara Booker used Understanding Society data from over 40,000 individuals aged 16 and over to explore the health inequalities of sexual minority UK adults. 

Unlike the MCS study, this research included respondents who identified as ‘other’ and those who preferred not to say. And a distinction was drawn between those who identified as gay and those who identified as bisexual. Participants were asked about their physical and mental functioning, minor psychological distress, self-rated health, substance use and disability. 

Overall, heterosexual respondents had the best health while bisexual respondents had the worst. Gay and lesbian respondents reported poorer health than heterosexuals, specifically with regard to mental functioning, distress and illness. 

There were no differences in either mental or physical health between lesbian and gay respondents once socio-demographic characteristics were controlled for, and there were also some indicators on which bisexuals did not differ from other groups.

Those who were ‘other’ or preferred not to say were similar to each other and generally experienced fewer health inequalities than gay and lesbian respondents, but still had poorer health than heterosexuals. This suggests that health promotion interventions are needed for these individuals, who might not participate in interventions targeted toward known sexual minority groups. 

Range of disparities

In conclusion, these two pieces of research suggest that a range of disparities based on sexual attraction are visible as early as 14 years of age, and are likely to persist through adult life.

These results highlight the need for further prevention efforts and intervention at the school, community, and policy level to ensure that sexual minority adolescents do not face lifelong negative social, economic, and health outcomes.

Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents.

Schools provide an ideal infrastructure to implement effective public health change and social policies. In light of this, a new UK curriculum that teaches students about gender and relationship diversity has been developed, but the guidance around its implementation currently lacks clarity. Therefore, at the policy level, clearer guidelines for schools are needed. 

Better support for families could help, too, to alleviate tensions between parents and sexual minority adolescents. This needs further investigation. 

In conclusion, despite high-profile UK policies such as the legalisation of same sex marriage in 2013 and the introduction of sexual orientation as a protected characteristic during the lifetime of the young people in this study, the evidence presented here indicates that large inequalities in social and health outcomes still exist for sexual minority adolescents growing up in the 21st century.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study, by Rebekah Amos, Eric Julian Manalastas, Ross White, Henny Bos and Praveetha Patalay, was published in Lancet Child Adolescent Health 2020; 4: 36–45 https://doi.org/10.1016/ S2352-4642(19)30339-6

Sexual orientation health inequality: Evidence from Understanding Society, the United Kingdom Household Longitudinal Study, by Cara L Booker, Gerulf Rieger and Jennifer B Unger, was published in Preventive Medicine 101, 2017, 126-132.

Author affiliations: 

Professor Yvonne Kelly, ESRC International Centre for Lifecourse Studies, Institute of Epidemiology and Health Care, University College, London

Dr Cara L Booker, Institute for Social and Economic Research, University of Essex.

Off the scales: time to act on childhood obesity

By 2050, it is said that obesity could cost the NHS almost £10 billion a year, with the full economic cost rising from around £27 billion today to £50 billion by then. Today, the Centre for Social Justice (CSJ) publishes its report, Off the scales: time to act on childhood obesity. It calls on the Government to put prevention, health, inequality and cross-departmental collaboration at the heart of its efforts to tackle childhood obesity, drawing particular attention to the need to address the question of why poorer children are at ever greater risk of being obese. It’s a question researchers at the ESRC International Centre for Lifecourse Studies at UCL, including our editor Yvonne Kelly, have been among the first to address.

There have been numerous major studies on childhood obesity over the past 10 years, many of which have shown the links with poverty. But our research looks specifically at why children from disadvantaged families are significantly more likely to be obese than their better off peers.

To examine this as robustly and rigorously as we could, we used data from the Millennium Cohort Study (MCS) which has tracked the lives of nearly 20,000 children from across the UK since the turn of the century. Using a range of measurements taken when the children were aged 5 and 11 together with detailed information about their backgrounds and family circumstances, we were able to demonstrate just how key poverty was in respect of their obesity.

At age 5, poor children were almost twice as likely to be obese compared with their better off peers. By the age of 11, the gap had nearly tripled.

Knowing as we do that obese children are less likely than their peers to grow into economically successful adults and that obesity is clearly linked with a range of chronic diseases, it’s reasonable to say that for these children, the future is far from bright. From a policy perspective it is also clear that unless the gap between rich and poor children can be closed the chances of reducing the overall obesity trend, as the Government states it is committed to doing, are pretty slim.

How is poverty linked to obesity?

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

To examine this question of whether a parent’s own lifestyle might have a role, 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 a mother was herself overweight or obese and assess children’s physical behaviour, such as how often they exercised, played and how many hours they spent watching TV or playing on a computer, and the time that they went to bed. We looked at whether the child skipped breakfast, how much fruit they ate and how often they had sweet drinks.

A lot of these factors were relevant. A mother’s behaviour when her child was very young was certainly important. Markers of an ‘unhealthy’ lifestyle here could mean as much as a 20 per cent additional risk of obesity for a child.

Obese and overweight children living in poor families were more likely to have mothers who did not breastfeed or breastfed for a shorter duration, who introduced solid foods early in infancy, who smoked during pregnancy, and who were overweight or obese. The poorest children were also more likely to spend more time watching TV and using a PC (and so have greater exposure to food and drink advertising), experience later and more irregular bedtimes, do less sports and be more physically inactive, engage less in active play with their parent, live in an area without a playground, and not have breakfast every day.

5-year-olds from poorer families were also much more likely to gain excess weight up to age 11 than richer children, leading us to conclude that the earlier certain risk factors can be challenged and the appropriate support provided for the least well off families, the greater the chance of positive impact on the risk of obesity and in a reduction in inequality.

Pathways to obesity

More recently we have identified four BMI trajectories for children. The good news is that 80 per cent of them are on a stable path where, on average, from when they’re born through to age 11, they are not overweight.

There is a small group of children who are obese at age 3 but then join the stable group by age 7. We call them the ‘decreasing’ group. There is a ‘moderate increasing group’ (13.1 per cent) where children are not overweight at age 3 but whose BMIs increase throughout childhood into the overweight (but not obese) range. Finally we have a ‘high increasing’ group of children (2.5 per cent) who are obese at age 3 and whose BMI continues to increase.

From an inequality perspective, what’s most striking here is that the wealthiest children are least likely to be in the ‘moderate increasing’ BMI group whilst the poorest children are more than twice as likely to be on the high increasing path.

Today’s CSJ report agrees with our analysis that early intervention is key and, in line with it, proposes three key early years intervention opportunities to ensure children get the healthiest start possible before they reach primary school age.

The report acknowledges that the Government is already trying to persuade families to eat more healthily and take more exercise. But it has joined a body of voices critical of the Childhood Obesity Plan, which, it believes, “fails to put reducing inequality as a goal … despite acknowledging that the childhood obesity burden falls hardest on the poorest children.”

Certainly our body of evidence indicates that policy makers need to acknowledge and address inequality as a root cause of obesity. Doing something about the structural factors in people’s lives is what is needed rather than ‘tinkering around the edges’ of the problem.

Today the CSJ asks why there are disproportionately high levels of obesity, particularly childhood obesity, in our most deprived communities. Our research has gone some way to answering that question, and makes it clear that there is no simple one-stop shop solution.

Obesity is caused by a combination of environmental, biological, cultural and psychological factors, where one factor does not dominate and yet our obsessional search for the ‘one thing’ that can tackle obesity continues. If the Government is going to reduce obesity rates, it will indeed, need to introduce multiple bold measures in tandem across the entire ecosystem and recognise that success may only be measurable after a few years.

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

BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery and Amanda Sacker and is published in Pediatrics

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.

Useful links

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.

Be prepared: the mental health benefits of scouting and guiding

Being a scout or a guide when we are young might be a good experience for us in all sorts of ways, but can those positive effects be long lasting though our lives and if so, how? Research using the 1958 Birth Cohort shows a strong link between being a scout or a guide when young and better mental health later in life. Professor Richard Mitchell from the University of Glasgow talks to the Child of our Time Podcast about the research, what he and colleagues from Edinburgh found and what he thinks it tells us.

Photo credit: One-and-Other Girl Guides UK

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.

Putting a SPRING in the step of mums-to-be

Making sure that mums-to-be are in the best possible health is key to ensuring their baby gets the best possible start in life. But what sorts of things can help them achieve that? In this episode of the Child of our Time Podcast, Professor Hazel Inskip from the MRC Lifecourse Epidemiology Unit at the University of Southampton, talks about an ongoing trial making use of healthy conversations and Vitamin D supplements to try to improve the diet of just pregnant women.

Photo credit: Pregnant, Frank de Kleine

Better start for children

Giving children the best possible start in life is the topic of a keynote talk today by our editor Yvonne Kelly.

Yvonne will be presenting a range of new evidence from the ESRC International Centre for Lifecourse Studies  to politicians, business leaders, and other professionals and key decision makers at an event discussing how Gothenburg can be made an equal and socially sustainable city.

Yvonne will talk about the factors which are most closely linked with a child’s health and well-being and present findings on children’s verbal skills, behaviour, bedtimes, reading and obesity. She will make the case that signs of social inequalities are evident early in a child’s life and that it is important to intervene early to tackle those inequalities.