Social and emotional outcomes of Australian children from Indigenous and culturally and linguistically diverse backgrounds

Objectives: 1) profile the living environments and 2) examine the social and emotional outcomes of Australian children from Indigenous and cultural and linguistically diverse (CALD) backgrounds at school entry. Method: Secondary analysis of cross‐sectional data collected in Wave 1 of the Longitudinal Study of Australian Children (n=4,735). Child mental‐health outcomes were measured using parent report of the Strengths and Difficulties Questionnaire (SDQ). Results: Significant differences in family and neighbourhood characteristics, including parental income, maternal education, maternal parenting quality and neighbourhood safety, were found in children of Indigenous and CALD backgrounds compared to the reference group of Australian‐born, English‐speaking children. After controlling for family and neighbourhood characteristics, significant differences in parent‐reported SDQ total difficulties were found for Indigenous children. Significant differences in emotional difficulties and peer problems subscales were found for children with overseas‐born mothers regardless of English proficiency. Conclusions: Children from Indigenous and CALD backgrounds experience poorer mental health outcomes at school entry than their Australian‐born English‐speaking peers. They are also more likely to be exposed to risk factors for poor child mental‐health outcomes within their family and neighbourhood environments.     

Discrepancy between expected and actual child support payments: predicting the health and health-related quality of life of children living in low-income, single-parent families

Objective Although the amount and frequency of child support payments received by single parents are often erratic and fluctuate, no study to date has quantitatively explored how the discrepancy between expected and actual payments relates to child health. This study aims to examine whether the discrepancy between expected and actual child support payments predicts a range of child health outcomes, including global health, health‐related quality of life, involvement in activities and parental psychological distress. Methods This study used results from the Longitudinal Study of Australian Children, which included a sample of parents of children aged 4–5 years (n = 4983). The questionnaire was completed by the parent who spent the most time with the child and knew the child best. From the 4983 families, 332 low‐income single parents reliant on welfare with a formal or informal child support order in place were identified. Results After controlling for income, the discrepancy between expected and actual child support predicted school functioning, conduct problems, total mental health problems and involvement in activities. Discrepancy between expected and actual child support payments did not predict the remaining health‐related quality of life domains, mental health domains, global child health or parental psychosocial distress. Conclusion This was the first study to examine how the discrepancy between expected and actual child support payments relates to child health, providing important data on the effectiveness of the child support system for children's well‐being. These findings highlight the potential impact of the discrepancy on school functioning, conduct problems, total mental health problems and involvement in activities.     

Exploring physical activity engagement and barriers for asylum seekers in Australia coping with prolonged uncertainty and no right to work

This paper explores the engagement in physical activity as a potential coping strategy for asylum seekers living in the Australian community without the right to work and with prolonged uncertainty, and benefits or barriers to undertaking such activity. Semi‐structured in‐depth interviews were held with 29 asylum seekers who had arrived to Australia by boat and were living in the community in the cities of Perth, Sydney or Melbourne in July–October 2013 after their release from immigration detention. The ratio of the numbers of men and women interviewed (23 men and 6 women) was comparable to the ratio of men and women who came by boat to Australia seeking asylum in 2012–2013. Nine participants reported that they participated in physical activity as a coping strategy. Seven other participants were so worried about their future and their families that they did not have the mental or physical energy to engage in physical activity. A further six wanted to participate in physical activity but faced a number of barriers to doing so. The seven remaining participants were either not asked about their physical activity engagement because they focused their discussion on other challenges or did not elaborate on why they were not engaging in physical activity. The findings suggest that physical activity, coupled with other coping strategies, are important for some asylum seekers in trying to manage the distress of being denied the right to work and living with prolonged uncertainty. In addition, these findings highlight the critical barrier that government policy plays in disabling engagement in physical activity, which further compounds social exclusion. This includes the lack of welfare support provided, which hinders people's financial ability to access activities and support in the community.     

Australian Middle Eastern parents’ perceptions and practices of children's weight‐related behaviours: Talking with Parents’ Study

The home environment is associated with obesity‐related behaviours among children, and research in Australia has shown that some of these behaviours are more prevalent among children from particular cultural backgrounds including Middle Eastern. This study presents findings from face‐to‐face, semi‐structured interviews conducted in April 2013 with a convenience sample of Middle Eastern parents of primary school‐age children at an Islamic private school in Sydney, Australia. The interviews explored parental perceptions and practices regarding state government health messages addressing children's eating, physical activity and screen time. The purpose of the study was to investigate whether the content of these generic public health messages is relevant and acceptable to Middle Eastern parents of young children, and to identify any enablers and barriers to adopting these healthy practices at home. Thematic analysis identified predominant themes. In total, 21 interviews were conducted (reference children: 12 boys/9 girls, aged 5–12 years). The content of current health messages regarding children's weight‐related behaviours was familiar to respondents, and accepted as relevant for guiding their parenting practices. Parents perceived that they typically encouraged healthy behaviours, although they also reported making regular exemptions, in response to various circumstances. Overall, the perceptions and reported practices of the parents were consistent with other studies with Australian parents. There were no apparent culturally specific barriers or enablers to children's weight‐related behaviours. There is however scope for health promoters to provide more precise information on health recommendations, health risks and benefits, and to provide more specific ideas for ways in which parents can act on these health messages within the home and family environment, to encourage and support healthy behaviours in their children.     

Physically active families – de‐bunking the myth? A qualitative study of family participation in physical activity

Background The benefits of physical activity for reducing obesity and related chronic diseases are well known. The need for more family‐based interventions to increase physical activity is frequently cited in the literature; however, little is known about if and how families are physically active together, and what factors might influence family‐based participation in regular physical activity. This study examined the types of activities (physical and sedentary) engaged in as a family and explored parents' perceptions of the importance, frequency, nature and barriers to family physical activity. Methods Semi‐structured telephone interviews were conducted with 30 parents (26 female, four male) of 10‐ to 11‐year‐old schoolchildren who attended either low, middle or high socio‐economic status schools in Bristol, UK. Interviews were transcribed verbatim, anonymized and analysed using conventional content analysis. Results The majority of parents rated family engagement in physical activity as important, and identified benefits such as increased parent–child communication, spending time together, enjoyment, enhanced mental health, weight control and physical fitness. Despite these benefits most parents reported their families did little or no physical activity together as a family unit during the week, and any activities performed together were usually sedentary in nature. They reported increased family physical activity on the weekends but rarely including the full family unit simultaneously. Parents in two‐parent households commonly paired off with one or more children because of complexities of schedules. Commonly reported barriers were busy lifestyles, diverse ages and interests of children and adults, bad weather, and lack of access to facilities, transportation and money to support activities. Conclusions Family‐based interventions might be more effective if they are designed to accommodate the complex demands and needs of two‐parent and single‐parent families and provide affordable, diverse activities appealing to a wide range of interests.     

‘It's very hard to find what to put in the kid's lunch’: What Perth parents think about food for school lunch boxes

Aim: To describe the factors affecting school food selection by parents of young children attending low socioeconomic schools in Perth and recommend the features of resources parents need to make healthier choices. Methods: Nine focus groups of parents of young children attending low socioeconomic status schools in Perth were conducted where parents were asked about the food their children ate at school and their opinions of school food resources. Results: Focus group discussion centred on the themes of the challenge of being a good parent by providing healthy lunch box food; making compromises in what their children eat at school and the barriers to healthy eating in the school environment. Parents were concerned about what their children were eating at school but the barriers of convenience, child preference, cost and food safety prevented them from including healthier food in the lunch box. The amount of time allowed for eating and lack of refrigeration were school‐based barriers that impacted on the type and amount of food selected. Parents liked colourful, practical school food resources with recipes and nutrition information aimed at children. Conclusions: Parents want help with selecting lunch box food/drinks that are nutritious, convenient, inexpensive and appealing for children to eat. Schools need to be supported to introduce healthy eating programs and should review the time given for young children to eat at school. Dietitians need to consider the home food environment and what motivates parents to make food choices for their children.     

Independent associations between residential neighbourhood and school characteristics and adolescent mental health in the Netherlands

This study examined associations between characteristics of the residential neighbourhood and the school and adolescent mental health, including the moderating role of family socioeconomic status (SES) and family support. Nationally representative Dutch data from adolescents aged 12–16 (N = 6422) were analysed through cross-classified multilevel models. Findings showed that school characteristics are more strongly linked to adolescent mental health than residential neighbourhood characteristics. More specifically, higher levels of school SES were associated with more hyperactivity-inattention problems, while higher levels of school social disorder were related to more conduct problems and more peer relationship problems. Further, higher levels of school SES were associated with more emotional symptoms only for adolescents with a relatively low family SES. Higher levels of neighbourhood SES were associated with fewer peer relationship problems. Overall, there was little evidence for the moderating role of family SES or family support.     

Physical activity of young people in the Torres Strait and Northern Peninsula Region: an exploratory study

Objective: The present study explored the practices of, and perceived barriers to, physical activity of young people living in remote communities in the Torres Strait and Northern Peninsula Area of Far North Queensland. Design and setting: A cross‐sectional survey exploring physical activity practices of children attending primary and secondary schools in two communities in the Torres Strait, Far North Queensland. Participants: A total of 367 primary and secondary school‐aged children (aged 9–16 years). Main outcome measures: Only 50% of the children reported being active for more than 30 min a day and approximately 25% of both primary and high school children surveyed were ‘pretty much active only at week‐ends’. The major barriers cited to being active were related to the climate, lack of equipment and child‐specific activities and low self‐perception of ability. Conclusions: A large proportion of school students in the Torres Strait and Northern Peninsula Area reported low levels of physical activity. The main barriers cited to being active suggest that structural and family‐based strategies are required to help young people, especially girls, to engage in more physical activity. There is also a need for skills and confidence‐building activities delivered in a non‐competitive environment for those who feel that they lack the necessary skills to participate fully.     

Stepping Stones to Resiliency following a community‐based two‐generation Canadian preschool programme

Early intervention programmes are designed to address complex inequities for Canadian families living with low income, affecting social relationships, well‐being and mental health. However, there is limited understanding of resiliency and change in families living with low income over time. We conducted a mixed methods study with recent immigrant, other Canadian‐born, and Aboriginal families living with low income, who attended a two‐generation preschool programme (CUPS One World) between 2002 and 2008. The aim of this study was to develop an understanding of the processes of change. We included 134 children and their caregivers living with low income, and experiencing mental health problems, addiction or social isolation. Children's receptive language, a proxy for school readiness, was measured at programme intake, exit, and age 10 years using the Peabody Picture Vocabulary Test 3rd Edition (PPVT‐III). In Phase I (quantitative), we identified children with receptive language scores in the top and bottom 25th percentile, informing participant selection for Phase II. In Phase II (qualitative), we engaged in constructivist grounded theory to explore experiences of 14 biological mothers, after their children (n = 25) reached age 10 years. Interviews were conducted between June and September 2015. The core category, Stepping Stones to Resiliency, encompassed Perceptions of Family, Moving Forward, Achieving Goals, and Completely Different. Perceptions of Family influenced families’ capabilities to move across the Stepping Stones to Resiliency. Stepping Stones to Resiliency provides a lens from which to view others in their daily challenges to break free of painful intergenerational cycles. It is a reminder of our struggle, our shared humanness, and that movement towards resiliency is more difficult for some than others. Our findings challenge traditional episodic, biomedical treatment paradigms for low‐income families also experiencing intergenerational cycles of mental health problems, addictions, social isolation, and family violence.     

Promoting healthy diet and exercise patterns amongst primary school children: a qualitative investigation of parental perspectives

Parents represent a potentially powerful intermediary in behaviour change strategies aimed at improving the lifestyle behaviours of young children. However, to fulfil this role, parents need to have the necessary knowledge and motivation to assimilate dietary guidelines. This study aimed to assess these psychosocial constructs, and subsequent parental receptiveness to nutrition education, through investigation of the barriers and benefits perceived by parents to the provision of a healthy diet and adequate exercise for their children. A qualitative methodology was employed and 41 parents took part in seven focus groups separated by socio‐economic status (SES). Across the groups, a combination of reported external barriers and unconscious internal barriers, stemming from high optimistic bias, low perceived control and unrealistic health expectations, were observed. SES differences were suggested in restrictive feeding practices, the responsibility attributed to the school and in the level and format of desired nutrition education. Overall a demand for interventions focusing on behavioural techniques rather than fact transmission was uncovered, in particular the promotion of parental self‐awareness to reduce negative influences within the family food environment. Providing realistic definitions of appropriate behaviour and empowering parents to tackle children's weight issues were indicated as important targets for future education programmes.     

“The people make it fun,the activities we do just make sure we turn up on time.” Factors influencing older adults’ participation in community‐based group programmes in Perth,Western Australia

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people.     

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes—A review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self‐management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer‐reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant‐related barriers to self‐management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant‐related issues, and whether they are perceived as barriers to T2DM self‐management. Identifying self‐management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM.     

The Australian Government's ‘Social Inclusion Agenda’: the intersection between public health and social policy

Social exclusion and social inclusion have been popular policy themes in the UK and Europe, and made more modest appearances in countries such as Canada and New Zealand, for over a decade. In 2007, the Australian Government became the latest country in this trend of structuring social policy around issues of exclusion, launching its ‘Social Inclusion Agenda’ (SIA). The SIA aims to increase social and economic participation through a reorientation of social services and increased attention to issues of equity. At the same time, there has been international consensus on the importance of the social determinants of health (such as education, income and gender) for individuals and populations. The SIA has the potential to make a substantive contribution to the social determinants of health and hence the health and wellbeing of the population. However, much will depend on the extent to which international discourses of inclusion, exclusion, structural inequality and third way politics are taken up, adapted or discarded in the Australian context. At this formative stage of the SIA's development, the public health community is in a unique position to contribute to the development and direction of the SIA to secure the potential health gains it offers. This article outlines the formulation of social inclusion policy in Australia, and discusses the potential promises and pitfalls of a social inclusion approach. Our examination of the Australian experience of social inclusion policy provides an opportunity to reflect on the relationship between social inclusion and health internationally.     

Changing children's diets: developing methods and messages

With an increasing prevalence of childhood overweight and obesity within the UK ( Chinn & Rona, 2001 ) and the emergence of type II diabetes as a childhood condition ( Kaufman, 2002 ), primary school children represent an important target group for health promotion. However, the increasing social and financial freedom enjoyed by this population is unlikely to be matched by an increase in their food control, cognitive abilities or the perceived need required to facilitate healthy behaviours, especially food choice. Thus, indirect attempts at behavioural modification are needed, with parents indicated as potentially powerful education intermediaries. This presentation will summarize the key findings of a 3‐year research project which aimed to investigate the current motivators and reinforcers for behaviour change within the families of primary school children in the UK. Three separate studies, utilizing both qualitative and quantitative methodologies, were undertaken with a total of 253 parents of primary school children, recruited from locations within the south east and the north west of the UK. Using focus groups and a questionnaire developed to assess the key constructs of the Theory of Planned Behaviour ( Ajzen, 1988 ), the barriers and benefits perceived by parents to be associated with the provision of a healthy diet were identified and quantified. These results were used to inform the development of a parental education programme, which was subsequently pilot tested and evaluated in order to highlight the practical implications for intervention delivery within this population. Results indicated a general rejection by parents of traditional nutritional messages and sources in favour of a more concrete but flexible approach with a short‐term health focus delivered by neutral agencies. Although healthy eating was viewed positively, parents tended to set themselves unrealistic targets and to have suboptimal nutritional knowledge and an inadequate awareness of their own influence as a model for their child's behaviour. Negative approaches to food control were frequently observed along with practical barriers to education uptake. Results would suggest that behavioural techniques should be promoted in preference to simple fact acquisition and novel, possibly ‘virtual’ approaches to parent–educator contact are worthy of further investigation. Differences in parental attitudes and behaviour were observed between families of different socio‐economic status (SES). Parents also appeared to reinforce inappropriate gender stereotypes in relationship to food and exercise behaviour. Social support was shown to positively impact on parental intention to provide a healthy diet. Although tailored nutrition education programmes are required which promote behavioural techniques via SES sensitive approaches, this research has confirmed the overarching role of environmental support. By nurturing family and community cohesiveness, the potential for long‐term behavioural change and health improvements in primary school‐aged population may be realized.     

Parent scaffolding of young children’s use of touch screen tablets

ABSTRACT

Parents play a key role in supporting young children’s interactions with tablets (e.g. iPads). Little is known about the types of scaffolding parents provide during tablet activities and how these relate to child age, SES, and home use. Fifty-five parent–child dyads (M child age?=?3.49 years) were videoed as they played on an iPad. All parent utterances were coded into three types of scaffolding behaviours (cognitive, affective, technical scaffolding; CATs). Home tablet use and family demographics were reported via a parent questionnaire. Parents used CATs strategies to support their children’s learning. Parents most frequently used cognitive scaffolding and least frequently technical scaffolding. SES was not related to the number of tablets at home. The negative association found between technical scaffolding and child age suggests that younger children require more scaffolding by parents. Coaching parents in using scaffolding strategies during joint-tablet activities has the potential to support early learning.     

An exploratory study of parents' approaches to health promotion in families of adolescents with physical disabilities

Background The life expectancy of children with physical disabilities now extends into adulthood and has been accompanied by the transfer of rehabilitation services from institutions to the home. Thus, families must increasingly partner with health service providers to promote their child's health and prevent the development of secondary conditions that may contribute to heart disease, stroke, respiratory diseases, low endurance and emotional difficulties. Aim To investigate within a family context the health promotion efforts of parents on behalf of a child with a physical disability. Method The Long Interview Method was used to interview 15 families (11 two‐parent and 4 single‐parent) having a child 11–16 years of age with a physical disability including cerebral palsy (7), spina bifida (3), muscular dystrophy (3) and other conditions (2). Results Parents' health promotion efforts were characterized by three main themes. First, parents emphasized traditional lifestyle health behaviours including nutrition, physical activity, tobacco, alcohol and drug use, and personal hygiene. Second, parents tried to foster their adolescent's social life and friendships. They expressed particular concern about how, and if, their child would develop a sense of purpose and have a productive future. Third, parents invested a great deal of effort into observing daily routines, making arrangements for their child's social inclusion and supporting their child in a way that balanced independence with safety and energy conservation. Conclusions Parents recognize that their child with a physical disability faces greater obstacles, and work hard at health promotion. Healthcare workers need to work with parents to: (1) provide information about specific lifestyle health behaviours including nutrition, physical activity and sexuality; (2) advocate for resources to foster social inclusion; and (3) discuss family strategies that balance parental involvement with their child's need for independence and energy conservation for daily activities.     

Parent Recruitment and Retention in a Universal Prevention Program for Child Behavior and Emotional Problems: Barriers to Research and Program Participation

Despite the potential of parent training as a prevention and behavioral family intervention strategy, there are a number of important issues related to implementation (e.g., recruitment and retention of families). This paper presents recruitment and retention data from families enrolling in a randomized controlled universal prevention trial for child behavior problems conducted in Germany. The recruitment rate averaged 31% (general project participation), with families of lower socioeconomic status (SES) participating at a lower rate. Project-declining families most often reported intrusion of privacy as their primary concern. In contrast, once parents were enrolled in the project, participation among those randomized to the parent training group averaged 77% (program/intervention participation); non-participation was mostly due to logistical issues. Parents accepting the offer of parent training were more likely to report child behavior problems than did declining parents. Although parents from more disadvantaged areas had a lower overall level of participation in the project once recruited, parents with children having higher levels of behavior problems indeed were more likely to participate in the intervention. Different recruitment methods may be required to engage high-risk families from socioeconomically disadvantaged areas to further improve community-level impact on child mental health.     

School-Based Mental Health Prevention Activities for Homeless and At-Risk Youth

Children who are homeless or who live in poverty face increased exposure to risk factors. Participating in mental health prevention activities may serve as a buffer against stress for these children. Schools are an optimal setting for providing prevention services. In this paper, we describe the implementation of and results from the Empowerment Zone (EZ) project, which involved providing mental health and health prevention services to children during small group and classroom activities. The EZ Project was incorporated into character education activities for a summer school program designed to improve reading and math skills for at risk elementary school age youth. The character education program is a key component in the Baltimore City schools where character traits, such as honesty, are taught through small group and classroom activities. Teachers were trained to implement mental health prevention activities; they also reported on the quality and utility of the program, after watching activities implemented by clinicians in their classrooms. Parents also had opportunities to participate in classes, which focused on teaching discipline techniques and discussing ways to improve parent-child relationships and foster children's socioemotional development. Results were positive, supporting project activities. Future empirical research evaluating the effectiveness of mental health prevention programs delivered in schools is needed.