Parenting and health in mid-childhood: a longitudinal study

BACKGROUND: Parenting and parent-child relationships influence children's emotional and social development and evidence exists that they may be life-course determinants of health. This study tests the hypothesis that adverse parenting in the early years predicts poor health in mid-childhood. METHODS: A prospective study using data from the Avon Longitudinal Study of Parents and Children cohort. Health data on over 8000 children (60% of those recruited) were available for analysis at 6.9 and 7.7 years. Exposures: self-reported maternal hostility, resentment and hitting/shouting in early childhood. Outcomes: maternal report of child's health in general and number of health problems when the child was 6.9 and 7.7 years, adjusting for socioeconomic factors. RESULTS: Sub-optimal parenting, as measured here, was observed among 62, 80 and 83% of families for hostility, resentment and hitting/shouting, respectively. Resentment was more common among older mothers in owner-occupied housing. Resentment and hostility predicted health at both ages independently of socioeconomic circumstances. 'Hitting/shouting' was weakly predictive of number of health problems. A greater proportion of variance was explained by parenting variables than by socio-economic variables. CONCLUSIONS: Parenting and parent-child relationships in the early years predict health in mid-childhood in a way consistent with a causal role. If further studies replicate this finding, policies to improve parenting could be expected to have a modest beneficial impact on health as well as emotional and social development. As some aspects of sub-optimal parenting show reverse social class distribution, initiatives targeted at those living in social deprivation may not achieve the optimum impact on health.     

Parenting,Race, and Socioeconomic Status: Links to School Readiness

This study examined the link between socioeconomic status (SES) and school readiness, testing whether parenting (maternal sensitivity and negative behavior/intrusiveness) and financial stress mediated this association and if race moderated these paths. Participants included 164 mother‐child dyads from African American and European American families. Findings supported moderated mediation hypotheses: maternal sensitivity mediated the link between SES and school readiness for European Americans only; maternal negative/intrusive behaviors mediated the link between SES and school readiness for both European Americans and African Americans. These results indicate that the meaning and effects of parenting behaviors can vary by racial groups, and findings obtained for European American families cannot be assumed to apply to ethnic minority families as well. Among the implications of these findings is that programs aimed at increasing school readiness and closing the achievement gap need to be mindful of the cultural context in which children are raised.     

Factors influencing parenting in early childhood: a prospective longitudinal study focusing on change

Background Parenting influences child outcomes but does not occur in a vacuum. It is influenced by socio‐economic resources, parental health, and child characteristics. Our aim was to investigate the relative importance of these influences by exploring the relationship between changing parental health and socio‐economic circumstances and changes in parenting. Methods Data collected from the Avon Longitudinal Study of Parents and Children were used to develop an eight‐item parenting measure at 8 and 33 months. The measure covered warmth, support, rejection, and control and proved valid and reliable. Regression analysis examined changes in financial circumstance, housing tenure, marital status, social support, maternal health and depression, and their influence on parenting score. The final model controlled for maternal age, education, and baseline depression. Results Most mothers reported warm, supportive parenting at both times. Maternal depression was the only variable for which both positive and negative change was associated with changes in parenting score. Less depression was associated with better parenting scores and more depression with worse parenting scores. Improvements in social support and maternal general health were both associated with improved parenting scores, but for neither of these variables was deterioration associated with deterioration in parenting scores. Worsening financial circumstances predicted deterioration in parenting score, but improvements were not predictive of improvements in parenting. Conclusions Programmes aiming to improve parental health and social support are likely to return greater dividends with regard to improving parenting than programmes that aim to reduce family poverty.     

Early childhood health,reproduction of economic inequalities and the persistence of health and mortality differentials

The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities.     

Socio-Economic Inequalities in Health, Habits and Self-Care During Pregnancy in Spain

Socioeconomic disadvantage can be harmful for mother’s health and can influence child’s health long term. The aim of this study is to analyse social inequalities between pregnant women from four INMA (INfancia y Medio Ambiente) cohorts. The analysis included 2,607 pregnant women recruited between 2004 and 2008 from four INMA cohorts. Data on maternal characteristics were collected through two questionnaires completed in the first and third trimester of pregnancy. The relationship between socioeconomic status (SES) and maternal health, dietary intake, lifestyle habits and self-care related variables was modelled using logistic regression analysis. 33.5 % of women had a university level of education and 47 % had high occupational class. Women with higher SES reported healthier habits, fewer complications during pregnancy, better weight gain control and attended more prenatal appointments than women with lower SES. The risk of sedentary behaviour and passive smoking was higher among women with a lower level of education (OR = 1.7, 95 % CI 1.3–2.2 and OR = 1.6, 95 % CI 1.2–2.3, respectively) and with less skilled occupations (OR = 1.7, 95 % CI 1.4–2.0 and OR = 1.2, 95 % CI 1.0–1.5, respectively). Although both SES indicators—occupation and education—act as social determinants of diet, occupation was a more powerful determinant than education. For other lifestyle and self-caring variables, education was a more powerful predictor than occupation. Social inequalities were observed in health, habits and self-care during pregnancy. Proper care during pregnancy requires the control of common clinical variables and the knowledge of socioeconomic conditions of the pregnant women.     

Intergenerational health disparities: socioeconomic status, women's health conditions, and child behavior problems

OBJECTIVE: Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior. METHODS: Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined. RESULTS: Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health. CONCLUSIONS: Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children.     

南京市城区学龄前儿童母亲育儿压力影响因素分析

目的 调查南京市城区3~6岁幼儿母亲的育儿压力并分析相关的影响因素,为指导母亲科学育儿提供依据。方法 采用简式育儿压力问卷(Parenting Stress Index-short Form,PSI-SF)和自编基本情况调查表、育儿环境调查表、母亲工作情况调查表对随机抽取的400名南京市城区的3~6岁幼儿及其母亲进行调查并比较分析。结果 在调查的母儿生理因素、家庭育儿环境、母亲文化程度及母亲工作状况相关因素中,母亲健康状况、母亲流产史、家庭住房面积、养育方法、母亲文化程度、母亲职业(企业单位与事业及机关单位)、母亲工作量增减及母亲收入增减与母亲育儿压力差异有统计学相关(P均<0.05)。结论 学龄前儿童母亲的育儿压力受多方面因素影响。     

The independent impact of household- and neighborhood-based social determinants on early childhood caries: a cross-sectional study of inner-city children

This study examined the relationship between early childhood caries (ECC) and measures of socioeconomic status as environmental determinants of oral health inequalities. Dental caries and quality of oral hygiene were reported on 384 young inner-city children (24-35 months) by clinical examination. Early childhood caries was diagnosed in 18.5% of children. Ethnicity (P < 0.001) and neighborhood (P < 0.001) were the social variables significantly predictive of ECC in a logistic regression model. Living in a deprived neighborhood and the mother being of East European descent were the social variables with strongest association with ECC. These variables can be considered adequate criteria to identify groups at risk within the overall population.     

A study of Korean working mothers with infants: implications for research and social policy

The purpose of this study was to examine a broad range of variables that predict maternal self-efficacy with a sample of 92 Korean working mothers whose infants are cared for at non-maternal child care settings. In addition, differences between mothers of infants on welfare roll and their socioeconomic status (SES) counterparts (not on welfare) were investigated in the study variables of interest. Several important results were obtained. A unique variance in the maternal self-efficacy scores was found in both the individual's demographic variables (explained by maternal age and maternal education) and psychological state (explained by the mothers' perceived parenting stress). Also, significant differences were detected between the two subgroups by SES (on welfare versus not on welfare). The mothers living in poverty tended to report that they perceived more confidence in parenting than the mothers with higher SES. The mothers in poverty were more likely to be satisfied with their child's substitute care (non-maternal child care) than their SES counterparts. Implications for research and social policy were discussed.     

Social inequalities in health: are there gender differences?

Some studies suggest that socio-economic status (SES) inequalities in health are smaller in women than men, but the evidence is inconsistent as to whether this applies across various health measures and life stages. The first aim of this paper was to establish whether the magnitude of social inequality in health differs for men and women during early adulthood, specifically in respect to self rated health, limiting long-standing illness, psychological distress, respiratory symptoms, asthma/wheezing, height and obesity; second, to determine whether explanations for socioeconomic inequality in poor self rated health differ for men and women. Analyses are based on longitudinal data from the British 1958 birth cohort study using information from birth to age 33. When gender differences in inequalities were examined using social class, no significant differences emerged across the seven health measures examined at ages 23 and 33. SES inequalities based on education, however, showed greater inequality among men at age 33 for limiting long-standing illness and respiratory symptoms, but greater inequality among women for poor rated health at age 23 and psychological distress at age 33. Hence, gender differences in the magnitude of health inequality were inconsistent across age and health measures. An analysis of the contribution of explanatory factors to social class differences in self-rated health suggested that causes of inequality were similar for men and women. However, some discrepancies emerged, notably in the greater contribution of job insecurity to class differences for men and in the greater contribution of age at first child for women. The magnitude and explanations for gender differences in SES health inequalities are likely to vary according to life stage and health measure.     

Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health

OBJECTIVE: Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention. METHODS: Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c) racial/ethnic disparities in the health indicators "adjusting" for different SES measures. RESULTS: Education-income correlations were moderate and varied by race/ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator. CONCLUSIONS: Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome- and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.     

An Examination of Parenting Capacity Variables and Child Adjustment Outcomes Across Socioeconomic Level in Pediatric Cancer

The objective of this article is to investigate how parenting capacities and child outcomes vary across different indexes of socioeconomic status (SES; e.g., composite vs. single dimension) in a sample of families of children with pediatric cancer. Parents provided demographic information for the Hollingshead Index of Social Position, the Parent Protection Scale (PPS), the Child Vulnerability Scale (CVS), the Parenting Stress Index/Short Form (PSI/SF), and the Behavior Assessment System for Children–Second Edition, Parent Rating Scale. Only the PPS differed by composite social status on the Hollingshead Index. Both the PPS and the PSI/SF varied as a function of lower parent education and family income, whereas the CVS was impacted only by lower parent education level. Child externalizing and internalizing problems were influenced only by lower family income. Results highlight the variability in parent and child adjustment outcomes based on the manner in which SES is measured in families of children with cancer.     

Childhood social and economic well-being and health in older age

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants' mean age was 67 years; 57% were women. By race/ethnicity, 76% were White, 14% were Black, and 8% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95% CI: 1.21, 1.47) and Black (AOR = 1.37, 95% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.     

The generational transmission of socioeconomic inequalities in child cognitive development and emotional health

Socioeconomic inequalities in the health of adults have been largely attributed to lifestyle inequalities. The cognitive development (CD) and emotional health (EH) of the child provides a basis for many of the health-related behaviours which are observed in adulthood. There has been relatively little attention paid to the way CD and EH are transmitted in the foetal and childhood periods, even though these provide a foundation for subsequent socioeconomic inequalities in adult health. The Mater-University of Queensland Study of Pregnancy (MUSP) is a large, prospective, pre-birth cohort study which enrolled 8556 pregnant women at their first clinic visit over the period 1981-1983. These mothers (and their children) have been followed up at intervals until 14 years after the birth. The socioeconomic status of the child was measured using maternal age, family income, and marital status and the grandfathers' occupational status. Measures of child CD and child EH were obtained at 5 and 14 years of age. Child smoking at 14 years of age was also determined. Family income was related to all measures of child CD and EH and smoking, independently of all other indicators of the socioeconomic status of the child. In addition, the grandfathers' occupational status was independently related to child CD (at 5 and 14 years of age). Children from socioeconomically disadvantaged families (previous generations' socioeconomic status as well as current socioeconomic status) begin their lives with a poorer platform of health and a reduced capacity to benefit from the economic and social advances experienced by the rest of society.     

Race- and sex-specific associations of parental education with insulin resistance in middle-aged participants: the CARDIA study

Low childhood socioeconomic status (SES) has been linked with insulin resistance (HOMA-IR) in adulthood. Our aim was to examine if maternal and paternal education, as indicators of childhood SES, equally contributed to increased HOMA-IR in later life. Of 5,115 adults from the Coronary Artery Disease Risk Development in Young Adults (CARDIA) Study aged 18-30 years in 1985-1986, data on 1,370 females and 1,060 males with baseline and 20 year follow-up data were used to estimate associations of maternal and paternal education with HOMA-IR, adjusting for personal education, BMI, lipids, blood pressure, and lifestyle factors. Parental education was determined as high with ≥ 12 years of schooling and classified as both high, only mother high, only father high, both low education. Distinct combinations of maternal and paternal education were associated with HOMA-IR across race and sex groups. Lowest year 20 HOMA-IR in European American (EA) females occurred when both parents were better educated, but was highest when only the father had better education. HOMA-IR was lowest in African American (AA) participants when the mother was better educated but the father had less education, but was highest when both parents were better educated. Parental education was unrelated to HOMA-IR in EA males. Associations of parental education with HOMA-IR are seen in AA females, AA males, and EA females but not in EA males. The distinct combinations of parental education and their associations with HOMA-IR especially in AA participants need to be addressed in further research on health disparities.     

Does class matter? SES and psychosocial health among Hungarian adolescents

Previous research finds a significant relationship between socioeconomic inequalities and health status: individuals with lower income, education, and occupational prestige have and report more health problems. Interestingly, this relationship is not consistent across the life cycle: health differences among adolescents across socioeconomic groups are not as clearly defined. Using data (n = 1,039) on adolescents from southern Hungary, we examine the role of socioeconomic differences in predicting psychosocial health. We argue that this investigation is of particular importance in a post-communist system where the general perception of SES is undergoing significant transformation. Findings show that classical' SES (socioeconomic status) indicators (manual/nonmanual occupational status) were not significant predictors of psychosocial health in this sample of Hungarian adolescents. While parents' employment status as a 'objective' SES indicator had limited effect, SES self-assessment, as a subjective SES variable, proved to be a strong predictor of adolescents' psychosocial health. We discuss the implications of these findings for the broader SES-health literature with specific attention paid to the impact these relationships may have for adolescent and young adult development in a post-communist country like Hungary.     

Socioeconomic inequalities in lipid and glucose metabolism in early childhood in a population-based cohort: the ABCD-Study

ABSTRACT: BACKGROUND: Socioeconomic inequalities in cardiovascular disease are pervasive, yet much remains to be understood about how they originate. The objective of this study was to explore the relations of socioeconomic status to lipid and glucose metabolism as indicators of cardiovascular health in 5-6 year olds. Additionally to explore the explanatory role of maternal factors, birth outcome, and child factors. METHODS: In 1308 5-6 year old ethnic Dutch children from the ABCD cohort study, lipids (cholesterol, LDL, HDL, triglycerides), glucose and C-peptide were measured after an overnight-fast. RESULTS: There were no differences in cholesterol, HDL, LDL, and triglycerides between socioeconomic groups, as indicated by maternal education and income adequacy. However, children of low educated mothers had on average a higher glucose (beta = 0.15; 95% confidence interval (CI) 0.03 - 0.27), logC-peptide (beta = 0.07; 95% CI 0.04 - 0.09), and calculated insulin resistance (HOMA-IR) (beta = 0.15; 95% CI 0.08 - 0.22) compared to children of high educated mothers. Only childhood BMI partly explained these differences (models controlled for age, height, and sex). CONCLUSIONS: The socioeconomic gradient in cardiovascular risk factors seems to emerge in early childhood. In absence of underlying mechanisms these empirical findings are relevant for public health care and further explanatory research.     

Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review

Socioeconomic inequalities in health are an important topic in social sciences and public health research. However, little is known about socioeconomic disparities and mental health problems in childhood and adolescence. This study systematically reviews publications on the relationships between various commonly used indicators of socioeconomic status (SES) and mental health outcomes for children and adolescents aged four to 18 years. Studies published in English or German between 1990 and 2011 were included if they reported at least one marker of socioeconomic status (an index or indicators, e.g., household income, poverty, parental education, parental occupation status, or family affluence) and identified mental health problems using validated instruments. In total, 55 published studies met the inclusion criteria, and 52 studies indicated an inverse relationship between socioeconomic status and mental health problems in children and adolescents. Socioeconomically disadvantaged children and adolescents were two to three times more likely to develop mental health problems. Low socioeconomic status that persisted over time was strongly related to higher rates of mental health problems. A decrease in socioeconomic status was associated with increasing mental health problems. The strength of the correlation varied with age and with different indicators of socioeconomic status, whereas heterogeneous findings were reported for gender and types of mental health problems. The included studies indicated that the theoretical approaches of social causation and classical selection are not mutually exclusive across generations and specific mental health problems; these processes create a cycle of deprivation and mental health problems. The review draws attention to the diversity of measures used to evaluate socioeconomic status, which might have influenced the comparability of international epidemiological studies. Furthermore, the review highlights the need for individual-level early childhood interventions as well as a reduction in socioeconomic inequalities at a societal level to improve mental health in childhood and adolescence.     

Socioeconomic status and health: do gradients differ within childhood and adolescence?

Socioeconomic status (SES) gradients may not be static across the lifespan, but instead may vary in strength across different life stages. This study examined the periods in childhood when SES and health relationships emerge and are strongest among US children. Data came from the National Health Interview Survey, 1994, a cross sectional, nationally representative sample of 33,911 US children ages 0-18. Parents were asked about family SES and child health status. Global health measures included overall ratings of child health, activity and school limitations. Acute conditions included childhood injuries and respiratory illnesses. For all global child health measures, lower family SES was associated with poorer child health in a gradient fashion (P < .001); these differences did not vary across age. For specific conditions, interaction effects of SES with age were found (P < .05). Interaction effects revealed that for injury and acute respiratory illness, expected SES gradients (lower SES with poorer outcomes) were evident during adolescence. In contrast, respiratory illness had a reverse SES gradient in early childhood. In sum, for global child health measures, associations of lower SES with poorer health throughout childhood suggest that factors that do not change with age (e.g., health care quality) may best explain overall health status. However, for acute conditions, the relationship between low SES and poor child health appears most consistently during adolescence. This suggests that normal development-related changes during adolescence, such as increasing peer group affiliation, may help explain these gradients. These patterns are important to understand for optimally timing interventions to reduce SES disparities in US children's health.     

Socioeconomic inequalities in under-five mortality in rural Bangladesh: evidence from seven national surveys spreading over 20 years

Background

Socioeconomic inequality in health and mortality remains a disturbing reality across nations including Bangladesh. Inequality drew renewed attention globally. Bangladesh though made impressive progress in health, it makes an interesting case for learning. This paper examined the trends and changing pattern of socioeconomic inequalities in under-five mortality in rural Bangladesh. It also examined whether mother’s education had any effect in reducing socioeconomic inequalities.

Methods

Data from rural samples of seven Bangladesh Demographic Health Surveys, carried out so far, were used. Children born alive during 5 years preceding the surveys were included in the analysis. Univariate, bivariate and multivariate analyses were carried out.

Results

Under-five mortality rate steadily declined over the years from 128/1000 in 1994 to 48 in 2014. Females had 8% lower mortality rates than males. Children of mothers with no schooling had 1.88 times higher mortality than those whose mother had six or more years of schooling. Similarly, children from low asset category households had on an average 1.17 times higher mortality rate than those from high asset category households. Inequality by mother’s education disappeared in the recent years, and inequality by household socioeconomic condition persisted all through. The pattern of inequality by sex, mother’s education, and household socioeconomic status was not changed statistically significantly over the years, and mothers’ education did not reduce socioeconomic inequalities.

Discussion

The reduction in mortality was consistent with changes in the proximate determinants of child survival in the country. Proximate determinants included maternal factors, environmental contamination, nutrient deficiency, personal illness control, and injury. Health and population programmes have been effective in increasing immunization coverage, use of ORS for managing diarrhoeal diseases, and increasing contraceptive use. Development activities on the other hand raised the literacy, especially among females, demand for modern health services, and reduction of poverty. However, socioeconomic inequality still exists in both under-five mortality and proximate determinants of child survival.

Conclusions

The socioeconomic inequality in under-five mortality is showing resistance against further reduction. An assessment of the adequacy of the existing programmes taking the proximate determinants of child survival into consideration will be useful for further improvement.